Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
90 Cards in this Set
- Front
- Back
- 3rd side (hint)
|
Hypovolaemia |
Defecit in blood volume which can lead to hypotension and hypo perfusion
Oxygen delivery to tissues and removal of waste products is impaired |
|
|
|
Hypoperfusion
|
Inadequate tissue blood flow that can either be caused by hypovolaemia or reduced cardiac output or dehydration or a combination
|
|
|
|
Dehydration
|
Reduction in the water content of the body but is often used to refer to combined water and solute losses in excess of intake.
|
|
|
|
What causes hypovolaemia
|
Haemorrhage
Fluid loss in excess of intake Loss of plasma volume (transudate or exudate) |
|
|
|
Transudate
|
Ultrafiltrate of plasma that occurs due to an increase in fluid pressure or decrease in colloid pressure
Low protein and specific gravity Low cell count |
|
|
|
Exudate
|
Sweat, blood,blood components released at an external surface
Increased permeability or inflammatory processes can cause tgis |
|
|
|
How is hydration state assessed
|
Mucous membranes
Skin turgor Retraction of the globe |
|
|
|
5% dehydration
|
Undetectable by physical exam
|
|
|
|
5-6%
|
Dry mucous membranes
Subtle loss of skin elasticity |
|
|
|
6-8% dehydration
|
Mild to moderate reduction in skin elasticity
Increased CRT Dry mucous membranes Mild retracted globe |
|
|
|
10-12%
|
Marked reduction in skin elasticity
CRT >2s May show shock Dry mucous membranes Sunken eyes |
|
|
|
Signs of shock
|
Tachycardia
Cool extremities Weak pulses |
|
|
|
12-15% dehydration
|
Severe signs of shock
Crt >3s Severe debilitation |
|
|
|
>15% dehydration
|
Incompatible with life
|
|
|
|
Assessing perfusion
|
Mucous membrane colour
CRT AUC/pulse quality Heart rate and blood pressure |
|
|
|
Normal dog HR
|
60-120
|
|
|
|
Normal cat HR
|
160-200
|
More than double dogs
|
|
|
Differentiating hypovolaemia from hypoperfusion
|
USG and urine output
Body weight Urea Electrolytes CVP Central venous pressure |
|
|
|
Central venous pressure
|
(also known as: right atrial pressure; RAP) describes the pressure of blood in the thoracic vena cava, near the right atrium of the heart. CVP reflects the amount of blood returning to the heart and the ability of the heart to pump the blood into the arterial system
|
Think vena cava
|
|
|
Aims of fluid replacement
|
Restore circulating blood volume
Replace pre-existing blood losses Supply normal maintenance requirements Allow for ongoing losses Decision on the composition of fluid is crucial |
|
|
|
Signs of volume decrease
|
Weak rapid pulse
Pale, tacky mucous membranes Slow CRT Poor skin elasticity Cool extremities Sunken eyes Reduced urine output Small heart radiographically |
|
|
|
Signs of volume overload
|
Coughing due to pulmonary oedema
Increased respiratory rate Oedema Ascites Pleural effusion |
|
|
|
How do we monitor a patient
|
Heart rate decreases
Pulse quality improving Mucous membrane moistness CRT Skin tenting Urine output Central venous pressure PCV/total protein Urea creatinine Blood pressure |
|
|
|
Uses of 0.9% saline
|
Hypochloraemia
Short term gastric vomiting Hyponatraemia Interoperative fluids Hypoadrenocorticism |
|
|
|
What is hartmanns
|
Isotonic
Replacement solution Electrolyte composition Na Cl K Ca Lactate |
|
|
|
When would you use hartmanns
|
Electrolyte losses
Acidosis Intestinal losses Diabetic ketoacidosis Renal failure Intraoperative fluid therapy Liver disease Cerebral oedema |
|
|
|
When is hartmanns not indicates
|
Use in same fluid line as blood products or
Sodium bicarbonate Hypercalcaemia |
|
|
|
What is ringers
|
Like hartmanns but does not contain lactate
|
|
|
|
When is ringers indicated
|
Fluid and electrolyte replacement
Prepyloric vomiting Liver disease Metabolic alkalosis |
|
|
|
When is ringers not indicated
|
Blood products and use of sodium bicarbonate
Hypercalcaemia |
|
|
|
What is 7.2% saline
|
Hypertonic solution that draws fluid rapidly into the inter saucer space
|
|
|
|
Hypertonic saline: dose
|
4ml/kg
|
|
|
|
Effective window for hypertonic saline
|
5-30 minutes
|
|
|
|
What does urine output of <1mg/kg/h indicate
|
Renal perfusion inadequate
|
|
|
|
Use of hypertonic saline
|
Increase in circulating volume in large animals
|
|
|
|
What do you infuse following hypertonic saline
|
Always istonic fluids can be combined with colloids
|
|
|
|
What are maintenance fluids
|
Lowe sodium load that replacement fluids
Addition of des tries or glucose makes them isotonic but catalyst hypotonic |
|
|
|
What are the 2 maintenance fluids
|
5% dextrose
0.18% saline |
|
|
|
Use of 5 % dextrose
|
Rapidly passes out of the vascular space
Not for hypovolaemia but free water losses - sweating or panting |
|
|
|
What is the use of 4% glucose and .18% saline |
Mainly water with small amounts of Na and Cl
If used for maintenance then potassium is required Suitable for treating free water loss |
|
|
|
What are natural colloids |
Contain plasma or albumen, not often readily available-require preparation from blood sources
|
|
|
|
What are colloids |
Retained in circulation for longer than crystalloids unless capillaries leaky
Natural and synthetic |
|
|
|
What does a urine output of 1-2ml/kg/h indicate |
Normal infusion
|
|
|
|
What does a urine output of >2ml/kg/h indicate |
Overinfusion
|
|
|
|
When is a good time to stop fluids |
Normal vitals
And eating drinking and urinating normally Over infusion signs |
|
|
|
What are the 3 types of fluids |
Crystalloids
Colloids Blood products |
|
|
|
What are crystalloids |
Electrolyte solutions can pass easily out of the vascular space and are used to replace interstitial deficits
|
|
|
|
What are the 3 categories of crystalloids |
Hypertonic
Hypotonic Isotonic |
|
|
|
What are the main types of replacement fluids |
0.9% NaCl
Hartmanns Ringers |
|
|
|
0.9% NaCl
|
Isotonic
Contains NaCl and water |
|
|
|
What are the uses of colloids |
Volume expansion of the intravascular space in hypovolaemia Oncotic support in patients with hypoalbumenaemia |
|
|
|
Wjat does the size of the mollecule change about its properties |
Th larger the mollecule, the longer spent in the intravascular space Smaller molecules are extravasated or excreted, larger are degraded by enzymes or phagocytes |
|
|
|
How can we use colloids to treat hypovolaemia |
5ml/kg given over a period of 10-30 minutes with repetition if required Maximum 20ml/kg per 24h |
|
|
|
What are the synthetic colloids |
Gelatin based molecules Hyroxyethylstarches |
|
|
|
What are the risks of colloid use |
Anaphylaxis Potential for interference with coagulation Overinfusion Interfere with USG or measurement of total solids |
|
|
|
Properties of gelatin based colloids |
Small mollecular size Short dutation Large oncotic pull Minimal effect on clotting Some may have high potassium |
|
|
|
What are the properties of hydroxyethylstarches |
Different mollecular weight modified starches Hetastarch molecule than penta and tetrastarch Duration related to the size Longer term support Hypoalbunaemia |
|
|
|
What is oxyglobin |
Natural colloid derived from bovine haemoglobin Considered blood product Act as a colloid due to the large Hb mollecules No cross matching Stored for 3 years Increases O2 capacity |
|
|
|
What are the blood products |
Whole blood Packed red blood cells FFP Frozen plasma Cryoprecipitate Oxyglobin |
|
|
|
What are the downsides to the use of oxyglobin |
Care with colume overloading in cats Alters mucous membrane colour Interfere with colometric tab essays |
|
|
|
using whole blood |
Good for acute blood loss Raises PCV Anaemia and coagulopathies 28d storage Protein degradation after 12-24h Acute blood loss |
|
|
|
Packed RBC |
Centrifugate of whole blood Increase PCV Resuspend in Nacl Normovolaemic anaemia and whole blood loss Simultaneous use with other fluid |
|
|
|
Fresh frozen plasma |
Clotting factors and plasma proteins Frozen withing 6h of collection 2-3m frozen storage Coagulopathies Low albumen |
|
|
|
Frozen plasma |
Frozen after more than 6h Vitk factors but not V VIII or VWf Rodenticide toxicity |
|
|
|
Cryoprecipitate |
Plasma fraction of blood 20% fibrinogen 50% factor 7 and 30% factors 8c, 13, vWF Inherited disorders -18c for 1 year Increase oxygen carryn capacity |
|
|
|
What is KCl for? |
Hypokalaemia
|
|
|
|
How do we prevent arrythmias with KCl |
Measure potassium levels and never give more than 0.5mm/h Ensure renal and caridac function are good |
|
|
|
What is sodium bicarbonate used for |
Acidaemia |
|
|
|
What precautions do we take when administering sodium bicarbonate |
adequacy of resp function no calcium constantly reassess |
|
|
|
What is the calculation for bicarbonate |
0.3 x Be x weight |
|
|
|
Routes of administration of fluids |
Oral Subcut IV IO IP |
|
|
|
When is oral administration of fluids contraindicated |
Gastrointestinal dysfunction Extreme losses |
|
|
|
When is subcut useful |
Small animals and exotics Home treatment |
|
|
|
What is the issue with subcut fluids |
Limited absorbtion if vasoconstriction |
|
|
|
When is interosseous administration useful |
If peripheral venous access is impossible Rapidly absorbed |
|
|
|
Why do we need to take care with interosseous administration |
Infection or leakage |
|
|
|
Problems with IP administration |
Organ penetration Draw fluid into space if hypertonic |
|
|
|
How do we calculate the amount needed for replacing losses |
Estimate % dehydration Time scale Add maintenance
|
|
|
|
What do most poeple do for adressing losses |
Use a multiple of maintenence requirement |
|
|
|
What do we need when calculating rate |
Maintainence rate + additional losses How many mls per hour -> how many mls per minute -> how many drops per minute/second |
|
|
|
Maintenence rate |
2ml/kg/hr |
|
|
|
how many drops in a ml |
20 |
|
|
|
How do we compensate for blood loss |
estimate animal blood volume estimate blood loss
|
|
|
|
1ml of blood weighs |
1.3g |
|
|
|
Blood volume of dog |
88ml/kg |
|
|
|
Blood volume of cat |
66ml/kg |
|
|
|
Blood volume of horses |
70-90ml/kg |
|
|
|
What should we use with 10% blood loss |
crystalloid |
|
|
|
What should we use with 10-20% blood lost |
collodis |
|
|
|
What should we use with 20% blood loss or more |
product with oxygen carrying capacity |
|
