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89 Cards in this Set
- Front
- Back
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What is the most widely used treatment in veterinary medicine? What is the first line?
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Fluid Therapy
Crystalloides |
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When is it appropriate to give fluids?
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Dehydration, hypovolemic and non-cardiogenic shock, correction of electrolyte imbalances, restore acid/base balance, during surgery, when giving CRI's, as a mainstay for treatment of renal insufficiency or failure, pancreatitis, GI disease with vominting, addisonian crisis, sepsis, DKA.
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What is IV fluid choice based on?
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patients hemodynamic status, serum electrolyte measurements, acid-base balance, and suspected or confirmed underlying disease.
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What are Crystalloids?
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crystalloid solutions consist of predominantly water, with sodium chloride or glucose as primary component. Mainstay of Fluid therapy.
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What are the different types of Crystalloids?
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1. Hypotonic - osmolality is less than serum. Goes to intracellular space. Maintenance fluid with high risk fluid retention.
2. Isotonic - osmolality closest to serum. Good for maintainance and shock therapy. -0.9% NaCl -Lactated Ringer Normosol R 3. Hypertonic - greater osmolality than the extracellular fluid. used in very small boluses to increase vascular pressure by drawing fluid. Used for animals in shock. -7% NaCl |
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What are colloids?
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refers to a solution that has an osmolality greater than the extracellular space. This solution does not pass through the vascular membrane. Remains intravascular to assist with oncotic pressure.
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Two common Colloids?
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1. Hetastarch - high molecular weight, stays within the vascular space for 12-48 hours.
2. Dextran - lower molecular weight, but has a larger variation of molecules. Shorter duration within the vascular space but has greater oncotic pull to the vascular space. |
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Name two natural colloids
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1. Plasma - ideal colloid to increase oncotic pressure and assist with hypoproteinemia
2. Packed red blood cells - contain RBC's only. This is given to animals who have significant RBC anemia and decreased oxygen carrying capacity. |
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What are Maintenance fluids?
What is the general calculation number? |
represent the amount of fluid necessary for a normally hydrated animal that is NPO.
2-3 mL/kg/hr |
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What are Replacement Fluids? What is the calculation formula?
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represent the amount of fluid needed to replace losses. In order to calculate this you need to know the percent dehydration.
Bw (kg) X % dehydration X 1000 = # of mL's Add this volume to maintenance to get the amount infused over 24 hour period. |
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What percent is Mild Dehydration and what are the C.S?
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5% - dehydration, tacky mucous membranes, slightly slow skin turgor.
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What percent is Moderate Dehydration and what are the C.S?
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8% - slow skin turgor, tacky and pale mucous membranes, tachycardia, weak pulses, animal may be depressed.
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What percent is Severe Dehydration and what are the C.S?
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10% - previous signs plus skin loses elasticity, eyes are sunken, signs of hypovolemic shock are present
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Hypernatremia
-What? -What happens? -Clinical Signs? -Treatment |
-When sodium concentration is greater than 155 mmol/L
-when sodium concentration exceed 170 mmol/L, intracellular dehydration results, and since brain cells are particularly sensitive to dehydration, neurological signs are observed. -lethargy and weakness in early stages if mild. Untreated you will see seizures, coma, and death, extreme neurologic. -hypernatremic animals should be given 0.9% NaCl. Patients should be frequently monitored and reassessed. |
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Hyponatremia
-what -what happens? -Treatment |
-Sodium concentration less than 145 mmol/L
-When sodium is lost, body reacts by decreasing ADH release, causing urine to become more dilute and thereby returning plasma osmolality to normal. If there is significant volume depletion with this then the down-reg of ADH is overridden and ADH secretion is enhanced. -best choice -> Norm R and then when the sodium starts to rise, switch to 0.9% NaCl - correct slowly!!! |
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Causes of Hyponatremia
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1) Addisons - aldosterone deficiency, allows sodium loss, volume depletion, ADH release and thirst resulting in hyponatremia
2) Renal Failure - vomiting causes loss of both sodium and water, polyuria enhances volume depletion and ADH release is stimulated. |
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Hyperkalemia
-What? -Seen with? -C.S. |
-Translocation of potassium out of cells can cause mild to moderate hyperkalemia.
-seen with metabolic acidosis as a result of excess hydrogen ions being buffered in cells and potassium being exchanged to maintain electroneutrality. -EKG abnormalities (Bradycardia), abdominal pain, diarrhea, and flaccid paralysis of the limbs |
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Causes of Hyperkalemia
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urethral obstruction, rupture of the urinary bladder or ureters, oliguric or anuric renal failure, hypoadrenocorticism
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How do you treat Moderate Hyperkalemia (6-8 mmol/L)
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IV administration of potassium-free fluids and elimination of the factors causing the hyperkalemia.
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How do you treat sever hyperkalemia, and what three things are included?
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1) IV Calcium Gluconate - calcium antagonizes the cardiac effects of hyperkalemia without altering the plasma concentration of potassium. (Protects Heart)
2) IV Dextrose - administration will cause potassium to be shifted back into the cells due to increased insulin secretion 3) Regular Insulin - co-administered as an IV Bolus with dextrose (Drives K+ back into cells) |
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Hypokalemia
-what? -Causes? -Clinical Signs? -Treatment? |
regulation of potassium involves a balance between intake, excretion, and distribution within the body. Most potassium is removed by the kidneys
-result from inadequate intake, increased excretion through polyuria or diarrhea, vomitting, chronic renal failure. -may be subtle or have obvious muscle weakness. may manifest as ventroflexion of the neck or a stiff stilted gait. Muscle weakness is usually seen when potassium levels fall below 2.0 Meq/L -Animals that are anorectic or vomiting and those with moderate to severe hypokalemia require IV supplementation. |
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What happens if you oversupplement?
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Causes Fatal Cardiac Bradycardia
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Hydration status can be evaluated by a number of parameters?
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skin turgor, CRT, MM (color and moisture), pulse strength, alertness
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Clinical Signs of Fluid Overload
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Serous nasal discharge, subcutaneous edema, increased urine output with normal kidneys, ascites, restlessness, chemosis, exophthalmos, coughing increased respiratory rate, vomiting, crackles
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How do you determine potassium replacement
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1) multiply weight by the maxiumum replacement
2) size of the bag in mL divided by the rate the fluid is running at 3)multiply the two answers together. If that number is larger than the recommended amount from the chart then its safe. |
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How do you calculate dextrose supplementation?
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Percentage X the size of the bag divided by the percent of sugar (50%)
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What is shock? Categorized as what?
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syndrome characterized by severe deterioration in clinical signs such as mental state, MM color, CRT, heart rate and pulse quality.
Hypovolemic, obstructive, cardiogenic, or distributive |
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Four types of Shock? Which one is different?
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1) Hypovolemic
2) Obstructive 3) Cardiogenic 4)Distributive: a)septic b)anaphylactic c)neurogenic |
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Explain Hypovolemic Shock
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occurs when loss of circulating blood volume causes a severe decrease in tissue perfusion. Always caused by hemorrhage or sever dehydration.
example: HBC due to blood loss. |
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Explain Obstructive Shock
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physical obstruction in the circulatory system.
example: pericardial effusion, or heartworm disease |
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Explain cardiogenic shock
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results from failure of pump function of the heart. Pump failure may be caused by hypertrophic or dilative cardiomyopathy, valvular insufficiency or stenosis, or arrhythmias.
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Explain Distributive shock
What causes it? |
relative hypovolemia due to vasodilation and or increased vascular permeability with pooling of blood in the peripheral vasculature or loss of fluid into the extracascular space.
sepsis, anaphylaxis, central nervous system injuries. |
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Explain the types of Distributive Shock
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a) septic shock - serious, abnormal condition that occurs when an overwhelming infection leads to low blood pressure and low blood flow.
b) Anaphylactic shock - tissues in different parts of the body release histamine and other substances. c)Neurogenic shock - results from the disruptive of autonomic nervous system control over vasoconstriction |
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What is the common type of shock seen in small animal medicine?
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Hypovolemic Shock
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Physical signs that are associated with shock ?
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They are related to compensatory mechanism the body invokes to maintain life
Tachycardia decreased pulse quality Prolonged CRT Pale MM Cool extremities |
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Three Stages of shock
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Stage 1: also called compensated, or nonprogressive) body appropriately comp.
Stage 2: (also called decompensated or progressive) Stage 3: (also called irreversible) |
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Explain Stage 1 of shock
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low blood flow is first detected, Body activates a bunch of systems to restore and maintain perfusion. heart beats faster, blood vessels become slightly smaller in diameter, kidney works to maintain fluid in circulatory system. maximize blood flow to most important organs.
Very few symptoms, and treatment can completely halt any progression |
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Explain Stage 2 of shock
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the methods of stage one start to fail. systems are unable to improve profusion any longer. O2 deprivation in brain cause patient to become confused and disoriented.
With quick and appropriate treatment, this stage of shock can be reversed. |
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Explain stage 3 of shock
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length of time that poor perfusion has existed begins to take a perm. toll on body organs and tissue. heart function continues to spiral downward and kidneys usually shut down completely.
The endpoint is the patients death |
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What is the goal of therapy in the management of hypovolemic shock.
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to restore circulating blood volume and improve oxygen delivery to tissues.
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What are the four main ways to manage hypovolemic shock?
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Control Hemorrhage
Restore Circulating Volume Optimize oxygen delivery sympathomimetics |
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Fluid amounts in shock for dogs and cats and shock maintenance
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Dogs - 20-40 mL/kg IV over 15 minutes, then reassess. Follow with 70-90 mL/kg over 1 hr.
Cats: 10-20 mL/kg over 15 minutes, then reassess. Follow this with 35-50 mL/kg over 1 hour Shock maintenance: Dogs get 10-12 mL/kg/hr and cats get 5-6 mL/kg/hr |
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What do sympathomimetics do?
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increase heart rate, increase heart muscle contraction, and increase vascular tone. drugs are indicated when patient is unresponsive to aggressive fluid therapy. given as a CRI
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Give examples of sympathomimetics and what they do
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Dopamine: low dose will increase heart rate and contractility and high does will cause vasoconstriction
Norepinephrine: potent arterial and venous vasoconstrictor Dobutamine: increases contractility, but has minimal effect on heart rate and peripheral vascular resistance. |
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Pulse Ox
Does what? Normal SpO2? |
measures percent oxygen bound to hemoglobin
norm - greater than 95% less than 93% may need o2 supplementation less than 90% serioiusly hypoxemic |
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What does increase PCV and TS indicate?
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dehydration
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Decrease in PCV and TS mean?
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suggests recent blood loss or fluid administration
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increased TS with a normal PCV indicates what?
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anemia with dehydration
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Commonly measured electrolytes are?
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Na, K, Cl, Mg, ionized calcium
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What does PaCO2 tells what?
PaO2 indicates what? |
PaCO2 = how well the patient is ventilating
PaO2 = how well the patient is oxygenating |
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Explain the conduction system
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heart beats with electrical impulse from the hearts "natural pacemaker" (SA Node) moves through it. starts in right atrium, spreads throughout atria and to atrioventricular (AV) node. From the AV node, impulses travel down a group of specialized fibers (His-purkinje system) to all parts of ventricles. Exact route must be followed for the heart to pump properly.
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What is atrial depolarization?
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firing of the SA node sends electrical impulse through atria which cause atrial depol. creating p waves on ECG and triggering atrial contraction..
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What does the P Wave equal?
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P wave = SA Node fires = atrial depolarization
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How do you get Ventricular depolarization?
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impulses travel through the AV node, bundle of His, right and left bundle branches, purkinje fibers, and ventricular muscle cells causing ventricular depol. creating Q, R, and S waves and triggers ventricular contraction.
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How do you get ventricular repolarization?
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T wave is formed when the ventricles return to their resting state.
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Define Systole
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when heart contracts and blood is pumped away
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Define Systolic
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the pressure exerted on the vessels when the left ventricle contracts
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Define Diastole
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when heart relaxes and ventricle fills with blood
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Define Diastolic
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pressure exerted on the vessel when the ventricle is at rest.
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Define Preload
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how much blood is contained in the ventricle just before it contracts.
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Define Afterload
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force that resists the flow of blood leaving the heart
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Define Contractility
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How effectively the heart muscle contracts
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Stroke Volume
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amount of blood pumped with each beat of the heart.
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What three things determine stroke volume?
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Preload, afterload, and contractility
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Define Cardiac Output?
How do you get cardiac output? |
total volume of blood pumped by the heart in one minute
(amount ejected from one ventricle in one minute) stroke volume X Heart Rate = cardiac output |
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What three things are used in diagnosing heart disease?
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Species, size, clinical signs
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Define
Bradycardia Tachycardia |
slow heart rate
fast heart rate |
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Gallop rhythm
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abnormal rhythm where you hear S3 or S4 or both
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Low-Output (Forward Failure)
occurs when? Example? |
occurs when the heart cannot pump enough oxygenated blood to the tissues. Severe low-output failure, especially when accompanied by hypotension, is called cardiogenic shock.
example: Dilated Cardiomyopathy - large heart/balloon like, thin walls cant contract real well. |
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Explain Congestive Heart Failure. Also called what?
Two types? |
Backward Failure
occurs when increased pulmonary or systemic venous pressure cause fluid to accumulate in tissue (edema) or in body cavities (effusion). Categorized as right or left heart failure according to whether systemic or pulmonary pressure is increased by heart disease. |
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Explain right and left heart failure
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Right sided heart failure - Fluid backs up from the right side of the heart into the body causing ascities.
Left sided heart failure, fluid accumulates from the left heart into the lungs. |
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What is the ECG?
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is the making of a graphic record that depicts the electrical activity of the heart muscle over time.
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Clinical indications for performing an ECG?
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1. primary cardiac pathology
2. severe electrolyte or acid-base disturbances 3. hypoadrenocorticism 4. animals that present severely tachycardic or bradycardic 5. trauma 6. ICU setting in Hospital 7. Anything under anesthesia. |
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What are the two things to remember when performing an ECG?
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minimize the movement of a patient
place patient in right lateral recumbency on a non-conductive surface. |
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Hypertrophic Cardiomyopathy (HCM)
-What? -C.S. -Diagnosis -Treatment |
- disease that causes thickening of the heart muscle resulting in poor relaxing and filling ability. AS the hearts pumping chamber becomes thicker, less blood enters the chamber, and less blood is ejected out to the body. middle-aged male cats may be more commonly affected. usually causes left sided heart failure
-some show no sign of illness, especially early in the disease. lethargy, decreased activity level, rapid and or labored breathing and possibly open mouth breathing with excitement or exercise. -radiographs, ECG, echocardiagram -beta-blockers (propranolol), calcium channel blockers (diltiazem), |
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What is a Saddle Thrombus?
Clinical Signs? Treatment? Recurrence? |
thrombi develop in heart (left atrium), travel to systemic arteries. they lodge in the distal aorta, where they often cause posterior paresis, paralysis and pain.
hind limb paralysis, pain, cold rear legs, no femoral pulses, cats are often "Yowling" on presentation, may have dyspnea and tachypnea. medical management, pain relief (morphine), heparin and or warfarin, TPA, surgical removal of clots 50% will have a recurrence within 9 months. |
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Canine Pericardial Effusion
What? Clinical Signs Diagnosis Treatment |
Fluid can accumulate in the pericardial sac for many reasons. Neoplasia and idiopathic are two of the most common causes of pericardial effusion. Right sidede heart failure.
weakness or collapse, weak pulses and muffled heart sounds. radiographs, ultrasound, echocardiogram fluid load them and then tap them. Fluid is bloody in appearance. Idiopathic - after treatment, 50-60% will not recur. |
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DCM
Dilated Cardiomyopathy What? Affects? Clinical Signs? Treatment? |
disease of the heart muscle which causes the heart to enlarge and not function properly. many factors suggest a genetic cause.
Affects both the left and right sides of the heart with either side being more severely affected. both ventricle and the atria enlarge and ventricle loses its ability. cough, weakness, dyspnea, exercise, intolerance, poor perfusion. |
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Congestive Heart Failure
What? |
Left sided shows as repiratory distress with shortness of breath, and coughing.
Right sided is seen as ascites or fluid build up. Same as in cats. |
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Emergency treatment of heart failure?
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Diuretic therapy - lasix
Oxygen therapy Vasodilators |
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Define Cardiomegaly and one medication
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heart shape is normal but it too large.
Vetmedin - increase contractility and cardiac output. |
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Mitral valve disease in dogs
what? C.S. Diagnosis Treatment |
pathalogical changes occur in valves, and as more damage happens, valve regurgitation leads to dilation of the adjacent atrium and ventricle. A progressively larger volume of blood moves ineffectually back and forth between ventricle and atrium, which diminshes the forward flow to the aorta.
-may have non for years, usually present with cough, exercise intolerance, tachypnea, pulmonary edema -PE findings - murmur; radiographs - will show left heart enlargement; ECG may or may not show something; echocardiogram will give most specific information. usually enalapril if treatment is required. |
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Antiarrhythmics
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1 Diltiazem - calcium channel blocker
2 verapamil - calcium channel blocker 3 Atenolol - beta-blocker 4 propanolol - beta-blocker 5 lidocaine - control PCV and ventricular arrhythmias 6 procainomide - control arrythmias |
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Positive Inotropes
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Digoxin - strengthens contractility of heart muscle
Pimobendan - mixed vasodilator |
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Vasodilators
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Enalapril - ACE Inhibitor
Nitroglycerin - help reduce congestion by dilating veins. |
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Diuretics
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Furosemide - Lasix
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Calculate maintenance and replacement fluids for a 21 lb. Dog that is 8% dehydrated. Answer these questions.
a. what is the maintenance rate? b. what is the total maintenance volume to be given? c. what is the replacement volume? d. At what rate will you set your fluid pump? |
a. 21 lb X 2.2 = 9.5 kg
9.5 kg X 3mL = 28.5 mL/kg b. 28.5 mL/kg X 24 hr = 684 mL's c. 9.5 kg X .08 X 1000mL = 760 d. 684 mL + 760 mL = 1444 mL 1444 mL \ 24 hr = 60 mL/hr |
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Your patient is on fluids. He has a 1 liter bag of Norm R and is getting it @ 50 mL/hr. The bag is spiked to 2.5% with dextrose. The dr wants to increase the dextrose to 5%. How much dextrose do you need to add to the bag?
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(2.5% X 1000mL) / 50% = 50mL
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Gremlin is a MC DSH weighing 7 kg. His serum potassium is 2.9. He has a 500 mL bag of fluids, and his fluid rate is 35 mL/hr.
a. according to the chart, how much KCl should you add to the bag? b. how many mL is this? c. what is his maximum replacement? d. how many hours will his fluid bag last? e. what is his maximum replacement per hour? f. can you safely put the amount indicated on the chart in his fluid bag? |
a. 20 mEq
b. 10mL c. 7 kg X .5 mEq/hr/kg = 3.5 mEq/hr d. 500mL / 35 mL/hr = 14.2 hr e. 14.2 hr X 3.5 mEq/hr = 49.7 mEq f. YES |
