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429 Cards in this Set
- Front
- Back
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In an animal receiving fluid therapy, the IV catheter site should be assessed every: |
2 hours |
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What are the 5 vital signs that need to be monitored in an emergency patient? |
RR, HR, Temperature, BP, Pain score |
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List the 5 characteristics of a good “ready area”. |
Where crash cart lives, good lighting, near oxygen source, centrally located, near OR |
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What does ABCDE stand for? |
-Airway = patent? Noisy breathing? -Breathing/ Bleeding = Yes/ No, dyspnea, ect - Circulation = MM/CRT, pulse quality and rate, extremity temperature - Disability = LOC, response to environment, Ambulatory or recumbent - External = open fracture, proposed eye, extreme pain |
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Define Stuporous |
Reacts only to noxious stimuli |
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Define Obtunded |
Reacts appropriately to stimuli but at a much lower level or slower pace |
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How are body fluid compartments broken up in percentages? |
intracellular (ICF)= 40% - in the cells. extracellular (ECF)= 20% interstitial (ISF) = 15% - all tissue that is not blood vessel or cells intravascular (IVF)= 5% -in blood vessels |
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What lab tests should be done in conjunction with PE to asses dehydration and blood volume? |
PCV/TP. stick BUN. USG |
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What will a USG result be for a dehydrated pt with normal renal function? |
elevated |
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What is the formula for replacement fluid rate? |
hydration deficit + maintenance + ongoing losses= replacement fluid rate |
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What is the maintenance rate? |
60mls/kg/day |
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How do you find hydration deficit? |
wt (kg) x %dehydrated x 1000 |
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normal urinary output for a patient. |
1-2 mls/kg/hr |
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Describe the methods used to monitor the effectiveness of fluid therapy. |
HR and pulse quality- RR, depth, auscultation, any signs of coughing- MM color and moisture/CRT- Skin turgor (feels gelatinous with fluid overload) and eye position- LOC- level of consciousness |
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Identify patient’s that would benefit from a central line over a peripheral catheter. |
animal in diabetic ketoacidosis they need central catheter for multi blood draws. |
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Explain what central venous pressure monitors in a patient and the 2 indications for this monitoring tool. |
- Estimates BP within right atrium and Indicator of blood volume- INDICATIONS: 1. Monitoring efficacy of fluid therapy 2. Monitoring patients at risk of volume overload |
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What is a normal CVP? |
Normal 0-10 cm H20. - Reading over 10cm H20 can indicate fluid overload or reading 2-4 cm H20 over previous measurement. |
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How long does it take SubQ fluids to absorb? |
6-8 hours |
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What is the amount you should administer fluids subQ? |
10mls/kg/site, isotonic fluid |
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1lb BW = ? mls |
500mls of fluid gain or lost |
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When given IV, what percentage of crystalloid will move into interstitial and intracellular space within 30-60 minutes |
~75% |
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Examples of balanced electrolyte isotonic crystalloid solution |
examples: LRS, Normosol R, Plasmalyte A |
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Which type of fluid is electrolyte, pH, and osmolality most like serum? |
isotonic crystalloid balanced electrolyte solution |
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What is an example an unbalanced electrolyte isotonic crystalloid solution? |
Ex: 0.9% NaCl |
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What are some examples of hypotonic solutions? |
examples of HYPOTONIC: plasmalyte M, 0.45% NaCl, 5% Dextrose in water (D5W) |
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What are examples of hypertonic solutions? |
Examples: 3 and 7.5% NaCl |
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What type of fluids are considered "maintenance" fluids? |
Hypotonic solutions |
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What are some examples of colloids? |
Examples: dextrans gelatins hydroxyethyl starches (HES) hetastarch/ vetstarch |
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In what animals can eye position and skin turgor be misleading for gauging dehydration? |
chronically emaciated animals, hyperthyroid or kidney dz cats, young and old animals- lack elasticity, obese animals- no excess skin to tent |
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What is the pathophysiology of shock. |
Decreased blood flow = Decreased oxygen delivery to tissues |
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Describe the 4 types of shock and give an example of each. |
cardiogenic- heart disease. Distributive- sepsis. Obstructive- heart worm disease. hypovolemic- hemorrhage. |
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Explain how the body compensates when a decrease in cardiac output and blood pressure are sensed. |
Baroreceptors in heart and vasculature sense decreases in cardiac output and blood pressure which results in the activation of adrenal gland (to release epinephrine/norepinephrine/cortisol) and Renin Angiotensin aldosterone system (sodium and water) |
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what is first stage of shock? |
compensatory |
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What stage of shock is a patient who is tachypnic, tachycardic, normal temp, normal CRT with pale MM, and normal to slightly decreased BP? |
compensatory |
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What is the second stage of shock? |
Decompensated |
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A 30kg dog was HBC 30 minutes ago. Primary survey reveals: pale MM with a CRT of 3 sec. HR 160bpm, RR- 45bpm, weak femoral pulses with absent dorsal metatarsal pulses. Initial PCV 55% TS 4.0g/dL. What stage of shock is this pt in? |
early decompenstory |
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What does a low TS tell us and what kind of fluid will patient need to help correct it? |
Low Albumin levels. Will need colloids to maintain colloid oncotic pressure. FFP, plasma or Albumin transfusion. |
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What opioids & opiates can be safely used in critically ill patients in shock? |
Buprenex (mild to moderate pain, mostly in cats), Hydromorphone (mild to severe pain, mostly in dogs), Fentanyl (moderate to severe pain, mostly in dogs), oxymorphone (moderate to severe pain, in dogs and cats) |
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What are 3 key clinical signs that a cat is in shock? |
Bradycardia, hypothermia, hypotension |
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What is the purpose of a lactate concentration test. |
evaluates tissue perfusion. HIGH LACTATE = POOR PERFUSION |
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What is a common for blood glucose for a patient in shock? |
hypoglycemia |
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Explain what the goal of shock treatment is. |
- improve perfusion so tissues receive oxygen |
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Calculate an initial shock dose of an isotonic crystalloid to give to a cat or a dog. |
DOG- 90mls/kg. CAT- 55mls/kg |
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How does treatment for carcinogenic shock differ? |
CARDIOGENIC SHOCK IS DIFFERENT BC THERE IS NOT FLUID BOLUSES, THEY NEED OXYGEN AND NO STRESS. |
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Identify a sympathomimetic and explain when they are commonly used in shock patients. |
Dopamine. Dobutamine. Indications:Patient is unresponsive to vigorous fluid therapy. Improve myocardial contractility and BP with minimal vasoconstriction |
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INITIAL SHOCK DOSES WITH ISOTONIC CRYSTALLOID for Dog |
1/4 to 1/3 of 90mls/kg (ESTIMATED BLOOD VOLUME) |
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how much blood can be collected from a donor at one time. |
DOG: 19 mls/kg CAT: 11 mls/kg |
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how often a donor can safely donate blood. |
every 6-8 weeks |
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What Is the most common additive solution used? |
CPDA |
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Describe the difference between a closed-blood collection system and an open-blood collection system and identify which one is best for component preparation. |
Closed is sterile. Allows from collection, processing, and storage without exposure. Best system to use for component preparation.Semi closed/ open is high risk for contamination . 60ml syringe, 19 g butterfly catheter & 3 way stopcock. Only used with drawing fresh whole blood from one patient and immediately giving to another. More common in cats |
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Describe how the amount of blood collected is measured during blood donation. |
Gram scale. 1g= 1ml |
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Define leukoreduction and explain the purpose |
Act of utilizing a filter to remove WBCs from collected blood.May reduce transfusion reactionsVery expensive and not done often. |
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Describe what storage lesions are and when they are typically seen. |
Multiple changes to RBCs that may be seen 1 - 2 weeks post collection.Leads to major organ dysfunction. |
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What is DEA? |
dog erythrocyte antigen (DEA). |
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What is most antigenic blood type in dog? |
DEA1 + |
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In cats what is most fatal transfusion type? |
Type B cat getting type A blood |
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Major crossmatch |
= RECIPIENT'S plasma + DONOR'S RBCs |
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Minor crossmatch |
=RECIPIENTS RBCs + DONORS plasma |
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What is formula for calculating how much whole blood a patient should receive? |
WB volume to be administered =RECIPIENT BV X (PCV DESIRED - PCV RECIPIENT) / PCV OF DONOR BV DOG 90MLS/KG CAT 55 MLS/KG |
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dentify how many milliliters 1 unit of blood equals in a dog and a cat. |
1 unit in dog = 450ml. 1 unit in cat = 56ml |
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What is the recommended transfusion rate and over what period of time it is recommended to administer a transfusion. |
FIRST 10-15 MINUTES GO SLOWLY (0.25-1ML/KG) if tolerated 3-5ml/kg. Ideally should be administered as fast as will tolerate and should take no longer than 4 hours. Max rate is 22 ml/kg/hr |
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What is most common clinical sign for transfusion reaction? |
Fever - Most commonly seen within 2 hours |
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What type of hypersensitivity to a transfusion results in urticaria (hives), pruritis, vomiting, diarrhea? |
Allergic- Type I |
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What type of hypersensitivity to a transfusion results in antibodies binding to antigens on RBCs causing hemolysis and leading to depression, recumbency, urination, defecation, salivation, |
Hemolytic- Type II |
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What is TRALI? What type of reaction is it? (immunologic or non immunologic) |
Transfusion-related acute lung injury (TRALI)- immunologic transfusion reaction. |
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What are clinical signs of TRALI? |
Acute onset of dyspnea and hypoxia with diffuse pulmonary infiltrates without signs of volume overload |
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What is TRIM? What type of reaction is it? (immunologic or non immunologic) |
Transfusion-related immunomodulation (TRIM) - immunologic transfusion reaction. Type III hypersensitivity reaction occurring weeks after transfusion |
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What happens with TRIM and what are clinical signs? |
Immunosuppression that results in immune complexes deposited in lymph nodes, joints, kidneys, vessel walls, and RBCsClinical signs include fever, erythema, edema, urticaria, lymph node enlargement, joint swelling |
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Name 3 examples of non immunologic transfusion reactions, |
TACO- transfusion associated circulatory overload, sepsis, improperly collected or stored blood |
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What is TACO? |
transfusion associated circulatory overload |
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Define Autotransfusion |
Act of removing blood from a patient and administering back into the patient’s circulation |
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Define Xenotransfusion |
Act of transfusing blood from a member of one species to a member of a different species |
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A patient presents with damage to a major vessel, requiring plasma coagulation factors to form a stable clot in a process called _____ hemostasis. |
secondary |
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Define fibrinolysis |
Clot dissolves after vascular wall repair (days) |
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Ecchymosis |
large areas of bleeding on skin |
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clinical signs of a hemostatic disorder |
Petechiation (on mucous membrane), Ecchymosis- large areas of bleeding on skin, Epistaxis, Hematuria |
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tests used to diagnose disorders of primary hemostasis |
Platelet estimate - Quantity. Buccal mucosal bleeding time (BMBT) - Fx |
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tests used to diagnose disorders of secondary hemostasis. |
Activated partial thromboplastin time (aPTT), Prothrombin time (PT), Proteins induced by Vitamin K antagonism (PIVKA), Activated clotting time (ACT) |
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Is Thrombocytopenia primary or secondary disorder? |
primary |
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Is Thrombopathia primary or secondary disorder? |
primary |
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Is von Willebrand’s Disease (vWD) primary or secondary disorder? |
primary |
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What is the most common hereditary bleeding defect in dog? |
von Willebrand’s Disease (vWD) |
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A dog is experiencing an excessive amount of unexplained bleeding after her spay. Which of the following conditions is this dog most likely to have? A. vWD B. Hemophilia A C. Hemophilia B |
A. vWD |
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Define thrombocytopenia and identify the 2 categories of causes. |
Low platelet count. Increased destruction (immune mediated or drugs) and Increased consumption (DIC) |
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what tests confirms that a patient has a thrombocytopenia. |
Platelet estimate and BMBT |
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Define thrombopathia. |
Thrombopathia- platelet function defect |
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Describe the pathophysiology of von Wildebrand’s Disease. |
VWF is a protein that promotes platelet clumping. Results in platelet function defect so platelet numbers look norma |
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What breed is vWD is most commonly identified in. |
doberman |
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What is Mucosal surface bleeding and hemorrhage after surgery or trauma a clinical sign of? |
vWD |
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What test is used to screen a dog for vWD? |
BMBT, vWF |
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What is most appropriate use for FFP? |
to treat coagulation factor deficiencies |
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What is preferred routine treatment for patients with thrombocytopenia and thrombopathia? |
FWB |
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How soon after initial RBC storage can storage lesions begin to reduce RBC efficacy and put the pt at risk for multiple organ dysfunction? |
7 days |
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A patient receiving a blood transfusion begins to experience urticaria and pruritus 30 minutes after transfusion is started. This animal is most likely experiencing: |
a type 1 hypersensitivity |
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What of the following is a disorder of secondary hemostasis? -vWD -DIC -IMHA -IMT |
DIC |
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Which of the following diseases is most likely to lead to a non regenerative anemia? -IMHA -acute blood loss -chronic kidney dz -IMT |
chronic kidney dz |
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A 6lb cat was transfused 1 unit of blood. how much blood did it receive? |
56 mls |
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Which of the following is a non immunologic reaction? -sepsis -TRALI -acute hemolytic reaction -TRIM |
sepsis |
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A dog with vWD is scheduled for surgery. Which agent is ideal for controlling severe bleeding during the procedure? |
Cryoprecipitate |
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What is the initial phase of DIC? |
super activation of tissue factor |
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Healthy animals can tolerate a ____ percentage loss of blood volume? |
20 |
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What is max time a blood transfusion should take? |
4 hours |
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Which of the following is used to detect primary hemostatic disorder in a pt? -BMBT -ACT -PTT -PT |
BMBT |
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Identify what coagulation factor is deficient in a patient with Hemophilia A |
Factor VIII deficiency |
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Identify what coagulation factor is deficient in a patient with Hemophilia B |
Factor IX deficiency |
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Identify the species and gender of animal that will exhibit clinical signs of Hemophilia. |
Dog- male |
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What is an example of an acquired coagulopathy that causes Factor activation defects? |
rodenticide toxicity |
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What is an example of an acquired coagulopathy that causes Dysfunctional synthesis? |
severe hepatic dz |
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What is an example of an acquired coagulopathy that causes factor consumption? |
DIC |
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What is an example of an acquired coagulopathy that causes Dilutional coagulopathy? |
High volume fluid resuscitation. Massive transfusion |
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Name 5 pts at risk for DIC |
Neoplasia, GDV, IMHA, heartworm disease, heat stroke, sepsis, anaphylaxis, shock, pancreatitis, liver failure, pyometra, vWD, Rodenticide toxicity, etc |
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What may be seen in patients with non overt DIC |
may see evidence of thrombosis |
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What is the treatment for a patient with non overt DIC? |
Heparin |
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What is the treatment for a pt with overt DIC? |
Blood components. Choice depends on symptoms (FFP, Cryo or FWB) |
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Identify the first step that must be taken in evaluating a patient with confirmed anemia. |
RETICULOCYTE COUNT. Young, anucleate RBCs. |
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What type of anemia is usually seen with RBC loss? |
Typically see a REGENERATIVE anemia |
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What type of anemia is usually seen with RBC destruction? |
Typically see a REGENERATIVE anemia |
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What type of anemia is usually seen with Reduced or ineffective erythropoiesis? |
Non regenerative |
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Signs of shock develop at ____% BV reduction |
60-70 |
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Name examples of reasons for chronic blood loss. |
GI ulcerations or lesions, parasites, neoplasia |
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What is Extravascular hemolysis? |
Phagocytosis by macrophages in spleen, liver, bone marrow, and lymph nodes |
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What are some common causes of extravascular hemolysis? |
IMHA, inherited RBC defect, Toxin ingestion, infection |
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What is IMMUNE-MEDIATED HEMOLYTIC ANEMIA (IMHA) |
Autoantibodies produced against healthy RBCs resulting in hemolysis |
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How can a patient get IMHA? |
Either idiopathic as primary disease or as a secondary dz from a immune response directed at foreign antigen. |
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What is Evans syndrome? |
IMHA and IMT can occur concurrently |
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A dog comes in with tachycardia, pale- icteric MM, and "port wine colored" urine, what is the most likely wrong? |
IMHA |
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In a blood smear, what would you most likely see with IMHA? |
spherocytes, polychromasia |
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On a CBC/ chemistry panel, what findings would point to IMHA? |
decreased RBC, decreased PCV, increased bilirubin |
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What does a saline agglutination test diagnose? |
IMHA |
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What does a Coombs test diagnose? |
IMHA |
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Identify the class of drugs that are most commonly used to treat a patient with IMHA. |
Steroids , +/- immunosuppressive drugs |
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Explain the 2 most common complications that are seen in a patient with IMHA. |
DIC and pulmonary thromboembolism |
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If a patient was at risk for pulmonary thromboembolisms, what clinical signs would you look for? |
dyspnea, respiratory distress |
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What is most common form of non regenerative anemia? |
anemia of chronic disease |
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Identify best blood component that can be used to treat an anemic patient. |
PRBCs. Better option for those patients that do not need blood volume expansion. Ex. IMHA or chronic anemia |
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Define decontamination. |
Removal of any toxin and prevention or reduction of absorption |
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Emesis is most effective ____ hours post ingestion. |
2 |
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the percentage of stomach contents that generally come back up with emesis induction is |
40-60% |
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A dog came in who recently ingested his owners adderol should emesis be initiated? |
no
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An animal ingested a Caustic substance, should emesis be induced? |
no |
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An animal ingested Petroleum distillates and hydrocarbons (gas, propane, butane), should emesis be induced? |
no |
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Name 3 reasons pt should not have emesis induced. |
Patient is already vomiting, Patient has had recent abdominal surgery, Patient has megaesophagus, Patients with altered level of consciousness, Seizures, Dyspneic patients, Lacking swallow reflex |
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How long should you flush eyes with saline or tap water? |
20-30 minutes |
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What direction should you rinse eyes? |
medial to lateral |
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What should you use to bath animal with topical contamination? |
dishwashing detergent |
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A dog came in who ingested bleach, what is the best way to treat? |
dilution. Water or milk. 2-6ml/kg |
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What are three drug options for inducing emesis and which one is best for cats? |
apomorphine, xylazine (cats), hydrogen peroxide 3% |
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What is the dose of hydrogen peroxide 3%? |
1 tablespoon per 20lbs. Can repeat in 10 minutes if needed |
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What is the best technique used for a toxin ingested when emesis is contraindicated? |
gastric lavage |
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Gastric lavage is best performed _____ hours after ingestion. |
<4 |
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What are 2 times when AC should be used. |
Usually follows emesis. Too much time has passed to induce emesis |
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What are routes for apomorphine? |
Routes include: IV, SQ, IM, or putting a tablet in conjunctiva. IV best. |
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What are routes for xylazine? |
IM and subQ |
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T/F: Bleach, ethanol, xylitol, ethylene glycol do not bind to AC |
T |
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What is a cathartic? |
Used in conjunction with activated charcoal to increase GI motility and shorten absorption time |
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Toxiban with sorbitol is an example of what? |
Cathartic |
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Explain the method of action of Activated Charcoal and why it may need to be administered more than one time |
AC inhibits GI absorption of substances by attracting it and pulling it away from surface so that the animal can eliminate it through GI track. Because some drugs are recirculated via enterohepatic circulation and get secreted through bile ducts into the GI tract |
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What are two common drug toxicities that will cause enterohepatic circulation? |
NSAIDS and aceteminaphin |
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What is one side effect of cathartics? |
diarrhea |
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What routes can sorbitol be given? |
enterally only |
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What routes can toxiban be given? |
enterally or as enema |
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When intravenous lipid therapy is indicated for decontamination. |
For fat soluble toxins. (permethrins, ivermectin, local anesthetics (bupivacaine can cause fatal arrhythmias), some antidepressants) |
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What is an example of a fat soluble toxin? |
permethrins, ivermectin, local anesthetics bupivacaine can cause fatal arrhythmias, some antidepressants |
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Where is METHYLXANTHINES found? |
caffeine, chocolate |
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Where is XYLITOL found? |
artificial sweetener |
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What products contain permethrins/pyrethroids? |
pet dips, sprays, shampoos, dusts |
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What organ system is affected with consumption of lillies, raisins, grapes, or currants? |
acute renal failure |
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What happens in the body with consumption of onions, garlic, or chives? |
CAUSES OXIDATIVE INJURY TO RBCS RESULTING IN HEINZ BODY FORMATION AND HEMOLYTIC ANEMIA OCCURS. |
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What happens in the body with consumption of methylxanthine? |
Stimulate heart and respiratory muscles and cause minor diuresis, GI SIGNS- VERY ANXIOUS |
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What happens in the body with consumption of xylitol? |
Results in secretion of insulin causing hypoglycemia, Can result in hepatic necrosis and death in high doses |
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What organ system is affected by permethrin, pyrethroids, or organophosphates ingestion? |
nervous system |
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What is SLUD? |
“SLUD”- SALIVATION, LACRIMATION, URINATION, DEFICATION |
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What toxin causes SLUD? |
Organophosphates |
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What body system does ivermectin affect? |
Neuro |
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What is the saying to remember breed sensitivities for the MDR1 mutation? |
"White feet don't treat" |
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What are 2 antidotes for organophosphate? |
2-PAM (PRALIDOXIME CHLORIDE)
atropine |
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What is the antidote for acetaminophen? |
N-Acetylcysteine |
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What is the antidote for lead, zinc? |
CaNa2EDTA |
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What is the antidote for cholecalciferol? |
Calcitonin |
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What is the antidote for Ethylene glycol? |
Ethanol 4-Methylpyrazole (4-MP) |
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What is the antidote for benzodiazepines? |
flumazenil |
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What is the antidote for Anticoagulation rodenticides? |
Vitamin K1 |
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What is the antidote for opioids? |
Naloxone |
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What is the antidote for xylazine and amitraz? |
Yohimbine & atipamazole |
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What are N-acetylcysteine or S-adenosylmethionine (SAME) used for? |
liver protetants and antioxidants |
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How long does apomorphine take to cause emesis? |
10-20 minutes. |
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what species is apomorphine controversial for production of emesis? |
cats |
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how fast does xylaxine work to cause emesis? |
within minutes, if its going to work |
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what emetic is best in cats? |
xylaxine |
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Most common tests to dx a pt with cardiac dz |
ECG hx & physical chest rads electrocardiogram- only definitive US BP echocardiogram |
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Explain what type of shock patients in CHF are experiencing. |
cardiogenic |
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What are the associated emergencies with heart worm dz? |
caval syndrome, right sided heart failure, pulmonary hypertension |
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what signalment of dog is dilated cardiomyopathy common? |
large breed dog |
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Explain what 4 factors determine systolic function/ cardiac output. |
1. preload, 2. Afterload, 3. Contractility, 4. Heart rate |
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what heart condition produces a continuous murmur through systole and diastole? |
PDA |
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Explain what 3 factors determine stroke volume. |
1. preload, 2. Afterload, 3. Contractility |
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Describe proper handling of a patient in heart failure, including the best position to keep them in. What meds can be used to help? |
Provide calm quiet environment, stress free, “do an x-ray let them relax, take blood let them relax.”Let them sit sternally and limit restraintCant handle stress- sedatives are good (butorphanol- IM) Sedatives- butorphanol. Morphine- helps with congestion, opens up. Acepromazine- can drop BP. |
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Identify the common drug therapies used in the emergency treatment of congestive heart failure and explain the rationale for use. |
Positive inotropic drugs (PIMOBENDAN- Helps contractility) diuretics (works great! FUROSEMIDE) vasodialators- (ace inhibitors, Amlodipine/Hydralazine, nitroglycerine) |
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Identify the most important parameters to monitor after administration of a diuretic |
Urine production, after 15 minutes |
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Identify the most important parameter to monitor in a patient receiving vasodilator therapy and how often this parameter should be checked. |
Check BP every 10 minutes to make sure it doesnt drop |
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What are three common emergencies caused by CHF? |
pulmonary edema, pleural effusion, severe ascites |
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what do positive inotropic drugs do? |
improve contractility and cardiac output in pt's who have low output failure in addition to CHF attributable to diastolic dysfunction. |
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_________'s ability to decrease pulmonary venous pressure rapidly makes it one of the most effective emergency treatments for life threatening pulmonary edema caused by CHF. |
furosemide |
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What drugs are used to decrease regurgitant fraction and decrease after load (systemic vascular resistance) in heart failure treatment? examples. |
arterial dilators- amlodipine & hydralazine |
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t/F: venodilation can reduce congestion but will not improve cardiac output |
t |
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What is one example of a venodilating drug |
nitroglycerin |
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What are drugs that block the enzyme that converts angiotensin I to angiotensin II? |
Angiotensis converting enzyme inhibitor (ACE) |
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Why aren't ACE inhibitors used in emergency CHF situations? |
they don't take effect quickly enough |
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What is the main disadvantage of arterial dilators? |
drops BP |
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What are the most commonly used vasodilators? |
ACE inhibitors (not used in emergencies) |
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__________ increased contractility w/o a significant increase in heart rate or vascular resistance, which makes it a good choice for treating heart failure pt with mitral regurgitation or myocardial failure. |
dobutamine |
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_________ is a useful in heart failure pts in situations where poor contractility is associated with hypotension. |
Dobutamine |
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|
Name to sympathomimetic drugs |
dobutamine and dopamine |
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An orally administered positive inotrope that is commonly used in CHF due to mitral valve dz or dilated cardiomyopathy is ________ |
pimobendan |
|
|
What do positive inotrope drugs do? |
increase stroke volume by increasing contractility thereby improving cardiac output and BP. |
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Explain the proper way to administer cardiac medications and what should be monitored during administration. |
Give slowly, monitor ECG |
|
|
Define orthopnea. |
a posture with feet spread apart, the elbows abducted, and the head and neck extended. “AIR HUNGRY” POSTURE |
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Improved cardiac output after vasodilation therapy should be monitored for what |
improved perfusion: warming of extremities, decreased blood lactate levels, increased venous O2 tension. |
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in addition to increase contractility, what else should you monitor for after giving a positive inotrope? |
vasoconstriction, vasodilation, increased HR, or arrhythmias. |
|
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What should be considered first when an animal experiences syncope, weakness, or collapse? |
cardiac arrhythmias |
|
|
Identify emergencies in which cardiac arrhythmias are commonly seen |
Trauma Splenic tumors GDV Canine dilated cardiomyopathy Urethral obstruction in cats Heat induced illness Feline cardiomyopathies |
|
|
Identify what diagnostic tool is the gold standard for diagnosing cardiac arrhythmias. |
ECG |
|
|
what is a Holter system is used for. |
It is an ambulatory ECG machine that continuously monitors the ECG over a 24 hour period. Use it a lot in patients that are collapsing but when they come in their ECG is normal. |
|
|
T/F: prolonged tachycardia can damage the heart, even when BP and cardiac output are adequate. |
T |
|
|
How does hyperkalemia affect an ECG |
"tented T waves". low or absent P waves, prolonged QRS, and increased T waves. most commonly Bradycardia |
|
|
tall and skinny QRS complexes indicate |
originating from atria (supraventricul) |
|
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short and wide QRS complexes indicate |
originating from ventricle (ventricular) |
|
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What are some causes of VPCs |
pain, hypoxia, hypoperfusion from shock |
|
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Identify what 2 electrolyte abnormalities can cause dysrhythmias. |
hyperkalemia , hypomagnesium |
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|
Identify the most common emergency in which we see hyperkalemia |
blocked tom |
|
|
Identify the treatment of choice for ventricular fibrillation. |
Defibrillation |
|
|
Identify commonly used drugs to treat ventricular arrhythmias in dogs and in cats. |
Lidocaine/ procainamide most commonly used in dogs. Lidocaine and beta blockers (esmolol/ propranolol) are more commonly used in cats |
|
|
Identify commonly used drugs to treat atrial fibrillation. |
Calcium channel blockers (diltiazam) CRI. slow the heart rate |
|
|
Identify commonly used drugs to treat supraventricular tachycardia. |
Beta blocking drugs (esmolol or propanolol) or calcium channel blockers (diltiazam) |
|
|
Identify commonly used drugs to treat bradyarrhythmias. |
anticholinergics- atropine, glycopyrrolate |
|
|
what is the best long-term therapy option for symptomatic patients with bradyarrhthymias. |
PACE MAKER implantation |
|
|
what is caval syndrome. |
A compliction of heart worm disease where there are a large number of worms in the right atrium and entwine themselves in the tricuspid valve and cause acute and severe tricuspid regurg. Also cause hemoglobinuria. CBC may indicate liver/kidney dysfunction and signs of DIC. |
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What is Pericardial effusion and explain when the term cardiac tamponade is used. |
Fluid build up around the heart in the pericardial sac. When fluid accumulates slowly the pericardium stretches and can compensate for increeeased pressure in the heart. You will see signs of right sided heart failure. Cardiac tamponade is when it builds up quickly and no time exists to compensate. You will see signs of shock. |
|
|
what are the 2 most common causes of pericardial effusion |
neoplasia & PERICARDITIS |
|
|
What are the 2 most common cause of cardiac tamponade |
trauma, atrial tears and in some cases right atrial hemangiosarcoma |
|
|
Identify the etiology of feline aortic thromboembolism. |
Devastating complication of myocardial dz |
|
|
Describe clinical signs commonly associated with FATE. |
posterior paresis, paralysis, pain/vocalizing, urinary/fecal incontinence, affected limbs will be cold and cyanotic with no pulses. Heart will have murmur, gallop or arrhythmia. |
|
|
What are 6 treatment goals for FATE |
Stabilize preexisting heart dz, administer analgesics for pain, administer heparin to prevent the growth of the clot, consider using tissue plasminogen activator, surgery or catheter to remove clot, prevent and treat the injuries caused by ischemic necrosis, use clopidogrel to prevent formation of clots in the future. |
|
|
what 3 pieces of information an arterial blood gas analysis will tell us about a patient. |
Acid-base status Oxygenation Animal’s ability to ventilate |
|
|
what piece of information cannot be determined if a venous sample is collected for a blood gas analysis. |
OXYGENATION |
|
|
what 2 vessels is an arterial blood sample is usually obtained from. |
dorsal pedal artery or femoral artery. |
|
|
Explain the proper way to handle an arterial blood sample once it is obtained. |
Analyze immediately. 15 minute window at room temperature. One hour window if place in ice bath |
|
|
Define FiO2 and how this relates to properly analyzing a blood gas sample. |
fraction of inspired oxygen (FIO2). It is also important to know this information for interpretation of the blood gas values |
|
|
define pyrexic |
febrile |
|
|
Describe what 2 organ systems regulate acid-base balance. |
Lungs & kidneys |
|
|
define pH of blood |
- Measure of acidity or alkalinity of blood, Measures amount of hydrogen ions in the blood |
|
|
PaO2 |
Partial pressure of oxygen in blood. Indicates how well blood is being oxygenated |
|
|
SaO2 |
Arterial hemoglobin saturation Equivalent to Pulse Ox |
|
|
PaCO2 |
Partial pressure of carbon dioxide in circulating blood Indicator of how well patient is ventilating |
|
|
HCO3 |
Bicarbonate ion = levels controlled by kidneys Major buffer in body = Alkaline Considered metabolic component of blood gas |
|
|
What factor evaluates the metabolic system? 1. SaO2 2. HCO3 3. PaO2 4. PaCO2 |
2. HCO3 |
|
|
What factors evaluate the respiratory system? 1. SaO2 2. PaCO2 3. PaO2 4. all |
all |
|
|
when examining blood gases, if PaCo2 is high, a form of ______________ exists. |
respiratory acidosis |
|
|
What is one reason a pt would have a high PaCO2? |
hypoventilation |
|
|
What Is a normal PaO2 value? |
90 -100mmHg breathing room air |
|
|
one therapy that all patients in respiratory distress benefit from. |
oxygen |
|
|
which method of oxygen supplementation is best for prolonged therapy. |
Naso-oxygen catheter. Measurement is from nose to lateral canthus of eye. 100ml/kg/min to reach 40% FiO2 |
|
|
oxygen flow rate of a patient receiving oxygen through a naso-oxygen catheter to achieve 40% FiO2. |
100 ml/kg/min |
|
|
where is the best position and location to place an IV catheter in a respiratory distress patient. |
Hind limb, Standing |
|
|
Define thoracocentesis and explain the purpose. |
Removal of air or fluid from pleural cavity |
|
|
What area will you prep for a thoracocentesis and what position will the animal be for fluid vs. air? |
Aseptically prep 7th-9th IC spaces Needle inserted dorsally for air and ventrally for fluid Air – Standing, sternal, or lateral Fluid – Standing or sternal |
|
|
supplies needed to perform a thoracocentesis. |
18 or 20 g butterfly or otn catheter, clippers, scrub, 3 way stop cock |
|
|
when might a thoracic drain may be placed. |
If thoracocentesis must be performed more than 2 times within a few hours of presentation Tension pneumothorax is present Continuous re-effusion is anticipated Penetrating chest injury has occurred |
|
|
What should you consider when placing dyspnic patients in cages? |
they easily become hyperthermic |
|
|
what 2 conditions are nebulization and coupage is indicated. |
Aspiration pneumonia. Smoke inhalation |
|
|
common breathing irregularities of a patient with an upper airway emergency. |
altered breathing pattern Inspiratory dyspnea Stertor Stridor |
|
|
Name 3 upper airway emergencies. |
Laryngeal or tracheal trauma Obstruction Laryngeal paralysis Brachycephalic airway syndrome |
|
|
Name 3 lower airway emergencies. |
Pulmonary edema Pulmonary contusions smoke inhalation feline asthma pneumonia |
|
|
define Pneumonia |
Inflammation of lung tissue secondary to bacteria, fungus, virus, irritants |
|
|
auscultation characteristics of a patient with lower airway disease. |
pulmonary crackles and wheezes |
|
|
What is the most common disease that causes pulmonary edema |
CHF |
|
|
why are pulse oximetry and blood gas readings not accurate when a patient presents with smoke inhalation is tested? |
Carbon monoxide molecules, even in a small amount, can attach to the patient's hemoglobin replacing oxygen molecules. A pulse oximeter cannot distinguish the differences and the reading will show the total saturation level of oxygen and carbon monoxide. |
|
|
Describe the breathing pattern of a patient with pleural space disease. |
Labored breathing with abdominal contraction “dysynchronous” |
|
|
auscultation characteristics of a patient with pleural space disease. |
Muffled heart and lung sounds |
|
|
Name 2 pleural space diseases |
Pneumothorax – Tension pneumo is life-threatening Pleural effusion- Ex: Pyothorax, Chylothorax, Hemothorax, |
|
|
What are three different types of pleural effusion. |
Pyothorax, Chylothorax, Hemothorax, |
|
|
how should a patient with flail chest should be positioned and why. |
Position pt flail side down to decrease movement of flail segment |
|
|
Define the term “Acute Abdomen”. |
Sudden abdominal pain or signs of GI upset of unidentified cause. May or may not be caused by GI disease |
|
|
cyanosis is usually not evident until the o2 saturation is below: |
60% |
|
|
a fellow cat tech is triaging a pt and notes the MMs look brown in color. What might be the cause? |
Methomoglobinemia |
|
|
What procedure used to stabilize a pt with cardiac tamponade? |
pericardiocentesis |
|
|
why are Axillary or auricular temperatures are preferred method if bradycardic or hypotensive. |
RECTAL THERMOMETERS MAY INDUCE VAGALLY MEDIATED ARREST IN SEVERELY BRADYCARDIC OR HYPOTENSIVE PTS. |
|
|
What is Diagnostic peritoneal lavage |
stick two needles in abdomen, flushing fluid in and pulling fluid out. Performed if peritonitis is suspected, abdominocentesis is negative, and no ultrasound |
|
|
what are perimeters that differentiate hypovolemia from dehydration? |
dehydrated: sunken eyes, skin turgor, mm color moisture hypovolemia: pulse quality, poor perfusion, extremity temp, mentation |
|
|
What is a H2 receptor antagonist help? |
ulcer prophylaxis - Pepcid |
|
|
Identify patients that a nasogastric tube is indicated: |
Aerophagia Bloating tendencies Frequent vomiting Gastric motility disorders Megaesophagus Risk for silent regurgitation and aspiration Need enteral nutrition |
|
|
In what direction do you feed a NG tube? |
ventrally and medially |
|
|
Why should enteral nutrition be started ASAP with GI disease? |
Shown to be more effective than drugs at preventing ulcers in critical patients Preserves normal GI function allowing quicker return to normal enteral nutrition |
|
|
What are 3 risk factors for GDV? |
breed, genetics, fast eating and raised food bowls |
|
|
pathophysiology of GDV and identify vessels and organs that have compromised circulation. |
Distension and rotation of the stomacH, Distension compresses VENA CAVA, and compromises gastric and splenic circulation, Rotation blocks PORTAL VEIN affecting blood flow to liver, pancreas, SI, and stomach, Results in reduced CO, BP, and tissue perfusion |
|
|
what are common signs of GDV |
Acute onset, NONPRODUCTIVE VOMITING OR RETCHING (MAY OR MAY NOT BE PRESENT) , Restless, uncomfortable, distended abdomen, ingestion of unleavened bread |
|
|
How do you measure for orogastric intubation? |
to the last rib |
|
|
what is a common arrhythmias seen in post-operative GDV patients. |
Arrhythmias - VPCs and V-tach |
|
|
Define Peritonitis and explain the etiology. |
Inflammation of the thin tissue that lines the inner wall of the abdomen and covers most of the abdominal organs Etiology:Rupture or perforation of a hollow viscus |
|
|
define Stranguria- |
straining to urinate
|
|
|
what are 3 consequences of untreated urinary tract obstruction? |
hyperkalemia (bradycardia) hypovolemic shock acute kidney injury uroabdomen |
|
|
Where does the urinary obstruction most commonly occur in dog? |
urethra (just proximal to os penis) |
|
|
how is a urinary tract obstruction dx? |
-IMAGING-ECG-UrinalysiS |
|
|
proper radiographic technique/positioning to use when assessing for uroliths in the bladder and urethra. |
YOU NEED TO GET THE URETHRA IN THE XRAY. ALMOST LIKE A PELVIC XRAY RATHER THAN ABDOMINAL. |
|
|
how do you Correct hyperkalemia? |
10% Calcium gluconate – Slow and monitor ECG, IV regular insulin + dextrose: |
|
|
How do you Correct metabolic acidosis- |
Sodium bicarbonate |
|
|
most common location for urinary tract obstruction to occur in cat |
sigmoid flexure |
|
|
What method can be done in the dog but not the cat when trying to pass a urinary catheter? |
Urohydropropulsion may be done if cannot easily pass catheter in dogs |
|
|
How often should you clean the urinary catheter? |
Catheter care 3x daily Wipe lines with dilute chlorhex solution start at penis and move down line |
|
|
How long should a urinary catheter be in? |
12-48 hours |
|
|
T/F: post-obstructive diuresis Begins 7 days post obstruction in 50% of cats and lasts 1-2 days |
F- It Begins 1-2 days post obstruction in 50% of patients and lasts 1-2 days |
|
|
clinical signs of Dystocia. |
1. No signs of labor 24HRS after dam’s temperature drops or progesterone decrease 2. No puppy is produced after 30-60 minutes of hard labor 3. Crying, biting, or injuring the vulva area 4. Hemorrhagic, odorous, mucopurulent vaginal discharge 5. Resting for >4 HOURS between fetuses 6. Presence of fetus or fetal membranes in vulva for 15 MINUTES 7. Weak or absent contractions for >2 HOURS |
|
|
3 treatment options for Dystocia |
manual manipulation medical intervention surgery |
|
|
anesthetic considerations for the Dam during a C-Section |
At risk for ASPIRATION Decreased MAC (KEEP THEM LOW ON INHALANT) At risk for hypotension and hypoxia in dorsal recumbency |
|
|
What is the induction drugs of choice for C sections? |
isoflurane and propofol |
|
|
A bacterial infection of the uterus is ________ |
pyometra |
|
|
_____ is the most common cause of bacterial infection of the uterus |
E. coli |
|
|
A middle aged cat comes in with PU/PD, vomiting, abdominal enlargement and vaginal discharge, what is most likely wrong? |
pyometra |
|
|
In what stage of estrous does pyometra occur? |
diestrus |
|
|
What causes the PU/PD in pyometra? |
release of endotoxin from E.coli interferes with Na and Cl absorption and blocks action of ADH. |
|
|
Open vs closed pyometra is indicated by the ____ |
cervix |
|
|
The biggest difference in clinical signs for open vs. closed pyometra is _____________ |
vaginal discharge with open pyometra |
|
|
What is the treatment of choice for pyometra |
ovariohysterectomy |
|
|
hypocalcemia in a post partum patient is termed __________ |
eclampsia |
|
|
A small toy breed dog comes in 3 weeks postpartum with a little of 8. She has a stiff gait, salivation, muscle rigidity and is panting and whining. What is wrong and what will you do for this dog? |
She has eclampsia. Administer IV 10% calcium gluconate slowly over 20-30 minutes while on ECG. Send them home with oral calcium and vitamin D. |
|
|
Name 4 conditions that IV calcium gluconate can be used. |
hyperkalemia, dystocia, hypocalcemia, and eclampsia |
|
|
What considerations do you need to remember when giving calcium gluconate? |
give slowly over 20-30 minutes and watch ECG for arrhythmias while administered |
|
|
define Paraphimosis |
Penis unable to retract into prepuce. |
|
|
What is the treatment plan for a dog with paraphimosis? |
Lubricate and replace penis. Sometimes they need sedation or a hyperosmolar solution. E collar. |
|
|
What 5 functions should be assessed in a neurologic emergency? |
Mentation Gait posture cranial nerves postural reactions spinal reflexes |
|
|
Define tonic |
Increased muscle rigidity |
|
|
define clonic |
Rhythmic jerking movements |
|
|
Define atonic |
Flaccid muscles |
|
|
define myoclonic |
Brief twitch of a muscle or muscle group |
|
|
define absence |
Spaced out or staring into space |
|
|
define delirium/dementia |
exaggerated reactions |
|
|
A dog has been seizing for 20+ minutes he is having ______________ |
status epilepticus |
|
|
A client calls and says his dog went unconscious and seized 3 times without regaining consciousness. What type of seizures is his dog having? |
cluster seizures |
|
|
High frequency seizures is when an animal has _______ seizures in _________ minutes |
3-4, 30 minutes or a large amount of seizures in 1 day. |
|
|
A dog having a seizure for 20 minutes put it at risk for what other complications? |
Hyperthermia Dehydration Neurogenic pulmonary edema Cardiovascular compromise Renal injury Neurologic damage Metabolic derangements-Hypoglycemia |
|
|
A pt is rushed into your hospital as a STAT that is currently seizing, what are 3 things you should grab? |
IV supplies Glucose machine diazepam/midazolam |
|
|
If a patient is currently seizing and its blood glucose was low (<40mg/dl) what will you give? |
Dilute 50% Dextrose and give slowly IV |
|
|
If a patient is currently seizing and its blood glucose was normal what will you give? |
Diazepam or Midazolam |
|
|
You check on a pt at your hospital who has been having seizures throughout the night and his temperature is 104F. What will you do and for how long? |
use COOL WET TOWELS, FANS, IV FLUIDS and TEPID WATER BATHS to bring his temp down to 102F. |
|
|
When do you want to start active cooling a patient who is experiencing seizures and when do you stop? |
Active cooling starts >103F and stops <102F |
|
|
What are he clinical signs used to evaluate prognosis in a spinal cord injury in order |
1. Spinal pain 2. Proprioception deficits 3. Paresis/ paralysis 4. Inability to urinate or defecate normally 5. Loss of nociception a. Superficial pain b. Deep pain |
|
|
If you use a hemostat to pinch the toe bone of an animal who was HBC, what does tell you? what is the prognosis? |
He cannot feel deep pain, which is the last pain sense to be lost and is not a good prognosis. |
|
|
A miniature Weiner dog is brought into the clinic with spinal pain, paralysis in its back legs, and normal mentation. What is the most likely cause of this pain? |
IVDD |
|
|
A healthy 2 yo Labrador was playing frisbee with his owner when all of a sudden was exhibiting signs of pain and acute neurologic signs. The owner stated no hx of trauma. What is going on with the dog? |
FIBROCARTILAGENOUS EMBOLISM (FCE) |
|
|
In order to isolate where the spinal cord injury is occurring, vets different factors on a table to test the patient. What are the 4 spinal cord functions for neurolocalization from the table? |
Strength Reflexes Tone Postural reactions |
|
|
A dog was HBC and is at the hospital laying in lateral recumbency. His thoracic limbs are extended with normal to decreased tone in the pelvic limbs what is this posture called and what section of the spinal cord does this indicate is injured? |
Shiff-Sherington posture, T3-L3 |
|
What is this posture? Where is the injury? |
Shiff Sherrington
T3-L3 |
|
|
Define Opisthotonus |
indication of brain herniation and is characterized by head and neck arched backwards in lateral recumbency with hind legs flexed |
|
|
_______ is usually a consequence of progressive increases in intracranial pressure. |
death |
|
|
In regards to dramatic Brian injury what stage do we aim treatment towards? |
Secondary injury. |
|
What is this posture? Where is spinal injury? |
Decerebellate rigidity injury to cerebellum |
|
What is this posture?Where is spinal injury? |
Decerebrate rigidity Results from brain herniation Extension of all four limbs |
|
|
You have a patient who is recumbent in your hospital, list somethings you will do for this patient to prevent decubital ulcers. |
position changes ~2-4hrs, Clean, soft bed, Frequent bathing and thorough drying, Monitor skin |
|
|
How will you prevent muscle spasms, pain and edema in your recumbent patient? |
passive range of motion therapy |
|
|
What are the 2 stages of brain injury? |
Primary Brain Injury = the injury itself. Physical disruption of intracranial structures as a result of traumatic event Secondary Brain Injury = Caused by combination of intracranial and systemic factors that can lead to neuronal cell death . TREATMENT IS AIMED AT SECONDARY. |
|
|
Cerebral perfusion pressure directly dependent on __________ |
MAP (CPP = MAP – ICP) |
|
|
You doctor asks you to give Mannitol to your head trauma patient. Why are you giving it and how do you give it? |
its an osmotic diuretic to decrease ICP. It needs to be warmed prior and given through a filter. |
|
|
To what degree do you elevate the head in a head trauma pt? |
15-30 degrees |
|
|
Oculocephalic reflex (OCR) can only be evaluated when a patient is ___________ |
comatose |
|
|
What is the Oculocephalic reflex (OCR) |
Their eyes do not move when you move the head. The eyes are fixed. |
|
|
What three parameters measures brainstem reflexes? |
Pupil size, PLR, and Oculocephalic reflex |
|
|
If a patient at your hospital who had severe head trauma had normal pupil size upon presentation then mitotic pupils 2 hours later, what does this indicate |
increasing intracranial pressure |
|
|
What are the 3 categories evaluated with the Modified Glascow Coma Scale. |
Motor activity, brainstem reflexes, LOC |
|
|
define Anisocoria |
pupils are diff sizes |
|
|
treatment goals for a patient in head trauma. |
Prevent hypoxia, prevent hypertension, decrease intracranial pressure |
|
|
What are some options when attempting to decrease intracranial pressure. |
MANNITOL, HYPERTONIC SALINE, HEAD ELEVATION, MAINTAIN PaCO2 AT 30-55MMHG. |
|
|
Which of the following is true regarding pericardial effusion? a. furosemide is initially given to rid the body of excess fluid b. tharacocentesis is used to initially stabilize the patient c. the patient may exhibit signs of left sided heart failure. d. neoplasia and pericarditis are common causes |
d. neoplasia and pericarditis are common causes |
|
|
Feline aortic thromboembolism most commonly occurs secondary to: |
hypertrophic cardiomyopathy |
|
|
colloid solutions: a. may decrease platelet function b. are an ideal fluid replacement for dehydration c. diffuse quickly into the interstitial space d. are given in large volumes |
a. may decrease platelet function |
|
|
you are prepping a patient for a thoracocentesis. B/w which intercostal spaces should you prep? |
7-9 |
|
|
Pneumonia is defined as: |
inflammation of the lungs |
|
|
The least stressful method to deliver oxygen to a critical pt being examined by the vet is: |
flow by |
|
|
What type of posture is an animal with orthopnea exhibiting? |
standing or sternal with elbows abducted and neck extended |
|
|
What type of fluid is found in the chest of an animal with chylothorax? |
lymph |
|
|
Which of the following patients would benefit the most from a transfusion with PRBCs? a. a pt with IMHA b. to with a massive hemorrhage c. a patient with rodenticide poisoning d. a patient with DIC |
a. a pt with IMHA |
|
|
Which emergency treatment strategy for CHF will best help to improve cardiac output by decreasing systemic vascular resistance? a. propanolol b. amplodipine c. furosemide dobutamine |
amplodipine |
|
|
Which of the following is a disorder of secondary hemostasis? a. immune mediated hemolytic anemia b. vWD c. Immune mediated thrombocytopenia d. DIC |
DIC |
|
|
The most common 2 sites for intraosseous canalization are: |
Humorous and femur |
|
|
Based on the FiO2 rule, an animal is breathing 40% oxygen should have a PaO2 of: |
200mmHG (5times rule) |
|
|
The most common clinical sign of cardiac arrhythmias is: |
syncope |
|
|
What is the most important thing to monitor in a CHF patient within 15 minutes of administering a diuretic? |
Urinary output |
|
|
The vet is hospitalizing a 13.7# dog who has been vomiting for 3 days. The dog has dry mucous membranes, a prolonged skin tent, and a heart rate of 172bpm. The dog is estimated to have vomited 75mls over the past 2 hours. Calculate the RFR this dog should initially be started at. a. 56 ml/hr b. 72ml/hr c. 34ml/hr d. 76ml/hr |
72 ml/hr |
|
|
When aspirating fluid from a chest tube it is important to: a. wipe the end of the aspiration port with chlorohexidine scrub before and after handling b. continuously monitor the ECG during the entire procedure c. pull back as hard as you can and stop once you achieve negative pressure d. apply gentle pressure and stop once you have achieved negative pressure |
apply gentle pressure and stop once you have achieved negative pressure |
|
|
Which of the following drugs is used to treat ventricular tachycardia: a. amplodipine b. lidocaine c. dobutamine d. enalapril |
lidocaine |
|
|
Which of the following fluid choices would increase oncotic pressure? a. 7% NaCl b. 0.45% NaCl c. Hetastarch d. Lactated Ringers solution |
b. 0.45% NaCl |
|
|
In standard calibration on ECG paper, each vertical 1mm box = |
0.1mV |
|
|
Cardiac output is a product of __________ and ____________ |
heart rate and stroke volume |
|
|
Which is the major buffer in the body and determines the metabolic component of a blood gas? |
HCO3 |
|
|
Normal urine production for cats and dogs is: |
1-2ml/kg/hr |
|
|
What procedure is used to stabilize a patient with cardiac tamponade? |
pericardiocentesis |
|
|
First degree AV block occurs when: |
conduction through the AV node is delayed |
|
|
Which best describes cariogenic shock? |
severe low output failure |
|
|
Which treatment strategy is appropriate in treating brachycephalic airway syndrome? a. keeping patient alert b. slow rewarming c. active cooling d. physical movement |
c. active cooling |
|
|
Which of the following occurs first in oxygen toxicity? a. the animal will start to hyperventilate to rid the body of excess oxygen b. PaO2 will begin to decrease on a blood gas analysis c. radical oxygen molecules will begin to form into nodules in the lungs d. Reactive oxygen species are produced and damage pulmonary epithelium |
d. Reactive oxygen species are produced and damage pulmonary epithelium |
|
|
What is the acid-base imbalance of the patient with these blood gas results? PH=7.063 (7.35-7.45) PaCO2= 106.7 mmHg (35-45) PaO2= 56.3mmHg (90-100) HCO3= 28.4 Meq/L (20-24) |
Respiratory acidosis |
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A 45# dog has presented to the ER after being HBC. the dogs PCV has dropped acutely in the last 2 hours to 25% and the vet has decided to do a blood transfusion. Calculate how much blood the dog will need. The desired PCV is 35% and the donors is 55%. |
335mls |
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In L/min, calculate the oxygen flow rate for a 73# dog that has a nasal oxygen catheter in place. |
3.3L/min (100 ml/kg/min) |
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A 25# corgi Is hospitalized at the clinic. The doc ordered a 2% lidocaine CRI to be given at a rate of 70ug/kg/min. The dog is currently hooked up to a 500ml bag of LRS at 40mls/hr. How much lidocaine do you add to the bag of fluids? |
29.9mls |
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Which of the following is most likely to happen when a patient is hyperventilating: a. PaCO2 will decrease b. PaCO2 will increase c. PaO2 will increase d. PaO2 will decrease |
a. PaCO2 will decrease |
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What way should you position a patient with flail chest on the right side? |
The patient should be positioned with the right side down |
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What is the purpose of nebulizing a patient? |
to thin secretions in the lungs. |
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What is Diabetes ketoacidosis a complication of? |
diabetes mellitus |
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What is happening in the body when an animal is in DKA? |
Without insulin, cells cannot access glucose and undergo starvation. To provide alternative energy source stored body fat is broken down into fatty acids. Fatty acids converted by liver into ketone bodies (ketoacids) (Acetoacetate, Beta-hydroxybutyrate, acetone). Production exceeds elimination and ketosis occurs |
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What are the 3 ketoacids in DKA? |
Acetoacetate, Beta-hydroxybutyrate, acetone |
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A dog comes in with signs of weakness, stupor, anorexia and vomiting and upon PE you notice it is tachypnic and has an acetone smell to his breath. What could this dog have? |
DKA |
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A dog comes in with DKA and blood work and a urinalysis is ran. What would 4 laboratory findings consistent with his dz? |
Hyperglycemia Glucosuria Ketonuria Metabolic acidosis |
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A patient is hospitalized with DKA, what are your 4 treatment goals? |
1. Restore volume and enhance perfusion- IV Isotonic crystaloids (LRS, Noromosol-R) preferred. 2. Insulin therapy to gradually lower BG- CRI of regular insulin 3. Correction of acidosis and electrolyte abnormalities- potassium, magnesium, phosphate supplements if needed. Hypokalemia +/- hypophosphatemia 4. Treat underlying and/or concurrent conditions- antibiotics if needed for other infection (UTI common) |
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What type of catheter will you use in a patient with DKA? Why? |
Central line. Because blood gluclose levels should be checked every 2 hours and to administer insulin CRI |
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What type of insulin is commonly used to treat a patient with DKA. |
regular insulin |
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How would you set up a CRI of regular insulin |
Placed in 250ml bag of 0.9% NaCl. 50mls should be allowed to flow through line to saturate tubing before starting infusion. Insulin damaged by UV light (protective bags or tin foil). Fresh bag must be made every 24hrs. Double lumen central line or second IV catheter |
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Explain how and why blood glucose should be gradually lowered in a patient with DKA. |
Blood glucose should be lowered gradually: 50 – 100 mg/dl/hr Lowering too fast can result in cerebral edema |
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When your DKA patients glucose levels get to _____________ dextrose containing fluids should be supplemented. |
< 200mg/dl a 2.5% or 5% Dextrose is supplemented in fluids until ketosis resolves. Goal is to maintain BG between 200-300 mg/ |
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What are 2 electrolyte imbalances commonly seen in a DKA patient. |
hypokalemia hypophosphatemia |
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Acute onset of Hypoadrenocorticism is called ___________ |
addisonian crisis |
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destruction of the adrenal gland by immune mediated causes is likely the etiology of what? |
hypoadrenocorticism |
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What hormones are deficient in hypoadrenocorticism? |
either aldosterone, cortisol or both |
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A female 4 yo standard poodle presents in hypovolemic shock, with collapse, shaking, seizures, and bradycardia. The ECG shows tented T waves. What could this dogs problem be? |
Addisonian crisis |
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What are the 4 electrolyte abnormalities in a patient with Addison's disease? |
hyperkalemia hyponatremia hypoglycemia azotemia |
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Identify the Na:K ratio that may indicate a patient has Addison’s Disease. |
Na:K ratio < 27:1 |
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You patient is suspected to have Addison's dz, what test would you do to confirm? |
ACTH stimulation test will be low. |
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The most important treatment goal for your patient with Addisonian Crisis is ____________ |
Fluid therapy. Isotonic Crystaloids. |
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what are 3 ways to correct electrolyte imbalances for your addisonian crisis patient with severe hyperkalemia? |
10% Calcium gluconate Regular insulin with IV dextrose Dextrose |
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Patients with ___________ need glucocorticoid and mineralocorticoid replacement, via IV glucocorticoid and once stable DOCP monthly. |
Addison's disease |
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the 2 most life-threatening concerns for a patient experiencing an Addisonian Crisis are? |
Hypotension and hypoperfusion are most life-threatening concerns (hypovolenia and shock) |
