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57 Cards in this Set

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  • Back
Cell Adhesion Molecules, Leukocyte Trafficking, and Strategies to Reduce Leukocyte Infiltration 2001
What mediates the initial slowing of leukocytes on the vascular endothelium

a. Selectins (after vasodilation, intravascular hydrostatic pressure reduces neutrophil flow through the vessel and allows for additional selecting-selectin receptor binding)
What allows the leukocytes to adhere to the endothelium

a. B2 integrins that are activated by leukocyte exposure to cytokines and Proinflammatory mediators
What are the intercellular adhesion molecules for endothelial cells

a. ICAM-1 (intercellular adhesion molecule 1)
What allows leukocytes to extravasate into tissues through the tight junctions of the endothelial cells

a. Platelet and endothelial cell adhesion molecule -1 (PECAM-1)
What allows perivascular migration through the extracellular matrix

a. B1 integrins
Which breed of dog have impaired expression of B2 integrins by leukocytes therefore making transmigration of leukocytes difficult

a. Irish setters-> similar to leukocyte adhesion deficiency in humans. Predisposed to mucosal infections
What are the three main types of selectins and what are they comprised of

a. L, E, and P selectins and they are heavily glycosylated membrane proteins
i. L-selectin is for leukocytes and allows adhesion to the endothelial cells
ii. P-selectin is a platelet selectin and is mobilized from storage granules to the cell surface after activation by LPS, TNFalpha, IL-1, oxygen radicals, histamine, thrombin, and interferon gamma and is necessary for leukocyte adhesion
iii. E-selectin is an endothelial leukocyte adhesion molecule that is synthesized and expressed on endothelial cells, induced by IL-1 and TNFalpha
What are integrins

a. Required for firm leukocyte-endothelial cell adherence
What substances are known to allow the conformational change in L-selecting that activates it

a. C5a and leukotriene B4
What do integrins require

a. Divalent cations for adherence to their ligands
Where is the alpha4Beta7 integrin expressed in high concentration by a subset of lymphocytes

a. Gut associated lymphoid tissue
ICAM-1 expression increases after activation by what cytokines

a. IL-8, IL-1, TNFgamma and alpha, PAF and LSP
How do NSAIDS affect adhesion molecule expression

a. Inhibit the formation of cyclooxygenase or lipooxygenase which are responsible for prostaglandin and leukotriene formation and therefore reduce stimuli for adhesion molecule expression
How do glucocorticoids affect adhesion molecule formation

a. Reduced production of prostaglandins and leukotrienes by inhibition of phospholipase A2 which decreases leukocyte trafficking by reduction of chemotactic factors and limitation of leukocyte and endothelial cell activation. Coritsol and dexamethasone reduce L-selectin expression
What are the proposed means of reducing cell adhesion molecule expression

a. Inhibition of IL-1 and TNFalpha
b. Use of IL-10 and IL-34 to inhibit TNFalpha
c. Antibodies to selectins and ICAM-1
Hemoglobin Solutions and Tissue Oxygenation 2003
How soluble is oxygen in plasma

a. Poorly soluble, if there was no Hb, cardiac output would need to increase to more than 40 times to maintain oxygen delivery above critical value
What is the structure of hemoglobin

a. Tetramer that consists of 2 alpha and 2 beta polypeptide chains
b. Each polypeptide chain contains a heme group with a central iron molecule to bind oxygen
What determines the affinity of Hb for oxygen

a. Partial pressure of oxygen , partial pressure of carbon dioxide, pH, body temperature, intraerythrocyte concentration f 2.3 DPG, and the chemical structure of Hb
The heme iron must be in what state to bind oxygen

a. Ferrous or reduced state, Fe+2 (Fe+3 is a oxidized form and cannot bind oxygen)
What compound allows iron to stay in the appropriate state so that it can bind to oxygen

a. Nicotinamide adenine dinucleotide-methemoglobin reductase
What happens to Hb if it is released free in the plasma (intravascular hemolysis)

a. Hb dissociates into alpha beta dimers which bind to haptoglobin and are removed by hepatic macrophages. If haptoglobin is depleted, then renal clearance of dimers predisposes the proximal tubules to damage
How are compounds that are RBC substitute solutions different from blood products

a. Cell-free-Hb based oxygen carriers have a Hb molecule that is not constrained by a cell membrane and is uniformly distributed throughout the plasma. Oxyglobin is minimally antigenic; has a higher P50 (oxygen affinity) and colloid oncotic pressure than human whole blood, and lower viscosity which helps enhance oxygen off-loading . Half life is less than blood but is dose dependent (15-50 hours)
How is bovine Hb different from human Hb

a. Not dependent on 2.3-DPG to unload oxygen
What is the effect of oxyglobin on systemic and pulmonary arterial blood pressure

a. Increases due to vasoconstriction
What are some of the proposed reasons as to why oxyglobin causes vasoscontriction

a. Enhanced sensitivity of alpha-2 adrenoreceptors, release of thromboxane, platelet activating factor, and oxygen free radicals, scavenging of NO
What are some of the therapeutic applications of oxyglobin

a. Reduce fluid requirements, normalize blood pressure, attenuate vascular endothelial dysfunction, improve oxygen transport and delivery, prolong survival in animal models of hypotensive, hypovolemic, and traumatic shock
Cardiopulmonary resuscitation in small animal medicine: An update 2008
When should the decision to resuscitate be made and when should the termination of CPR be made

a. To resuscitate should be made with clients desires and the termination of CPR should be made with information regarding the patient’s disease, prognosis, and the clients desires; most cases of CPR should be ended after 20 minutes
What are predisposing causes for cardiopulmonary arrest

a. Sepsis, cardiac failure, pulmonary disease, neoplasia, coagulopathies, anesthesia, toxicities, Multisystemic trauma, traumatic brain injury, and systemic inflammatory response syndrome
What things may be seen in a patient prior to cardiopulmonary arrest

a. Obtundation, hypothermia, bradycardia, hypotension, dilated/unresponsive pupils, changes to respiratory depth and rate or rhythm, progressing to gasping and finally agonal breaths at death
What things have been shown to improve long-term survival in CPA consistently

a. Manual chest compressions, with manual ventilation and the use of debrillator for treatment of ventricular fibrillation or pulseless ventricular tachycardia
What monitoring tool can be used to ensure proper placement of the endotracheal tube

a. End-tidal carbon dioxide
What things can be utilized to stimulate spontaneous ventilation

a. Manual ventilation with 2 breaths 1-2 seconds in duration with positive pressure ventilation using 100% inspired oxygen; can also use acupuncture at the GV26 point -25 gauge needle inserted into the bone in the nasal pilthrum at the ventral aspect of the nares
What medication should be avoided to stimulate ventilation

a. Doxapram because it decreases cerebral blood flow and increases cerebral oxygen consumption
Delivery of an excessive rate of respirations can cause what

a. Lower coronary perfusion pressure, decreased cardiac preload, decreased cardiac output, decreased right ventricular function, increased intrathoracic pressure, and decreased venous return to the heart
Return of spontaneous circulation is directly related to what

a. Maintenance of sufficiently high myocardial perfusion pressures
External chest compressions when correctly performed with generate systolic pressures in what area and cardiac output of what percentage of prearrest values

a. 60-80 mmHg and cardiac output and between 25-40% prearrest values
Indications for internal cardiac massage include what

a. Penetrating chest wounds, thoracic trauma with rib fractures, pleural space disease, diaphragmatic hernias, pericardial effusion, hemoperitoneum, intraoperative sudden cardiac arrest, failure to achieve adequate circulation after 2-5 minutes of external chest compressions
What are the 4 arrythmias that can cause pulseless cardiac arrest

a. Asystole (most common arrest rhythm in dogs and cats) (debrillation is contraindicated), ventricular tachycardia (debrillation is indicated), ventricular fibrillation (defibrillation is indicated), pulseless electrical activity (no therapy has been shown to be effective)
What are causes of ventricular tachycardia

a. Repetitive firing from an ectopic focus can occur with hypoxia, pain, ischemia, sepsis, electrolyte changes, trauma, pancreatitis, GDV, primary cardiac disease
What is the definition of defibrillation

a. Termination of ventricular fibrillation for at least 5 seconds after delivery of an electric shock that depolarizes myocardial cells and eliminates ventricular fibrillation. Should not stop chest compressions to set up the defibrillator
Proper defibrillation position and materials include what

a. Only defibrillator paste (conductive paste) and largest electrode paddles placed on opposite sides of the chest with the patient in dorsal recumbency; perform chest compressions for 2 minutes afterwards and then check rhythm and consider 2nd shock at that point but not too early
Medications given intratracheally should be diluted with what

a. 5-10 mls of serile water
What type of fluids should be given to patients undergoing CPR

a. If the patient is hypovolemic, can give rehydration rates but shock doses of fluids should be avoided, euvolemic patients can have bolus therapy of 20 ml/kg for dogs and 10 ml/kg for cats
What fluid type has been shown to improve survival from ventricular fibrillation when compared to isotonotic fluids

a. Hypertonic saline
What is the MOA for epinephrine

a. Alpha-2 agonist causing peripheral arteriolar vasoconstriction, overrides beta-2 agonist actions . Alpha-1 agonist effects can be detrimental to the myocardium by increasing myocardial oxygen demands and causing intramyocardial coronary arteriolar vasoconstriction and enhancing reduction in myocardial perfusion
What are some disadvantages of epinephrine

a. Maximizes cerebral blood flow and aortic diastolic right atrial gradient but is also associated with higher refibrillation rate and lower survival rate
What are the effects of vasopressin

a. Nonadrenergic endogenous pressor that causes peripheral, coronary, and renal vasoconstriction by stimulating V1A receptors in smooth muscle of the vasculature leading to vasoconstriction. Can also cause dilation of cerebral vasculature and less constriction in the coronary and renal blood vessels than in peripheral tissue
What is the MOA for atropine

a. Anticholinergic parasympatholytic that is effective at muscarinic receptors and is effective in the treatment of vagal induced asystole
What is the MOA for Amiodarone

a. Class III antiarrhythmic agent with effects including prolongation of the myocardial cell action potential duration and refractory period by affecting Na, K, and Ca channels. It is also an alpha and beta inhibitor. Medication of choice for refractory ventricular fibrillation after defibrillation
How does Lidocaine compare to the effets of Amiodarone

a. It was shown to have decreased rate of return of spontaneous circulation compared to Amiodarone and increased risk of asystole after defrillation, not recommended for treatment of ventricular fibrillation if defibrillation is planned
When is calcium therapy recommended

a. Treatment of calcium channel blocker toxicity, hyperkalemia, and hypocalcemia.
When is magnesium therapy recommended

a. Treatment of ventricular arrhythmias that are refractory as decreased concentrations of magnesium have been shown to result in increased myocardial excitability
Post resuscitation, what parameters should be monitored

a. Pulse rate, rhythm, character, mental status, ECG, pulse ox, temperature (allowing for permissive hypothermia is fine), lung sounds, mucous membranes, CRT, urine output, electrolytes, blood gasses, PCV, total solids, glucose concentration, serum lactate concentration CVP, neurologic function, patient comfort
What is a disadvantage of dopamine compared to Dobutamine

a. May cause excessive vasoconstriction without increase in cardiac output
What are the effects of norepinephrine

a. Mixed alpha and beta adrenergic receptor agonist and increases cardiac contractility, cardiac oxygen demand, heart rate, stroke volume, as well as vasoconstriction of renal, splanchnic, and pulmonary vasculature
When should the neurologic deficits incurred during resuscitation dissipate

a. Within 24-48 hours, if longer than 48 hours has a poor prognosis (after 24 hours, absent corneal reflex, absent PLR, absent withdrawal, and absent motor response are poor prognostic indicators)
What complications can be seen after CPR

a. Cerebral edema, hypoxemia, reperfusion injury, abnormal hemostasis, acute renal failure, sepsis, MODS, recurrent CPA