Ettinger Critical Care 3

Front 1

What on PE in a traumatized animals should make you suspicious of pulmonary contusions?

Back 1

increased bronchovesicular scounds

Front 2

TX for pulmonary contusions

improvement seen

Back 2

judicious fluids

O2

pain relief

improve generally in 24-36 hours

Front 3

What clinical signs are indicative of poor tissue perfusion

Back 3

pale/gray mm

prolonged CRT

rapid HR

weak pulses

Front 4

What is the most common organ system effected by heatstroke

Back 4

acute renal failure

Front 5

Besides ARF, what other body systems/side effects occur with heatstroke

Back 5

DIC (can occur early or late in dz process)

liver dysfunction

cardiac arrythmias

intraparenchymal hemorrhage (seizures)

GI - sloughing

widespread necrosis of muscles - rhabdomyolysis- myoglobin

Front 6

Signs of ____ become more pronounced as the syndrome progresses

Back 6

shock

Front 7

What breeds are at increased risk for splenic torsion

pathogenesis

Back 7

great danes

GSD

unknonwn pathogenesis

Front 8

What particular caution should be taken during SX of splenic torsion

Back 8

do not untwist the spleen

Front 9

With rupture of the biliary system, prior to undergoing surgery, what pre-operative tests should be run and why?

Back 9

coagulation screen

b/c the absence of bile salts in the duodenum and jejunum preculedes absorption of fat and fat soluable vitamines (such as vit K)

Front 10

What elements comprise Virchow's triad

Back 10

hypercoagulable state

vascular stasis

disruption of the vascular endothelium

Front 11

What differentiates acute lung injury vs. acute respiratory distress syndrome

Back 11

based on the severity of hypoxemia

It's based on the ratio of the parital pressure of arterial oxygen to the fraction of insopired oxygen (PaO2:FIO2).

ALI is 200-300

ARDS less than 200

Front 12

What is the progression of ARDS vs. ALI

Back 12

ALl ARDS cases result form prgression of ALI, but not all ALI lead to ARDS

Front 13

What is the hallmarks of ALI/ARDS

Back 13

hypoxemia refractory to increasing amounts of oxygen

Front 14

What urine output defines oligoanuria

Back 14

<0.25 mls/kg/hr

Front 15

What urine output defines nonoliguria

Back 15

0.25-2 ml/kg/hr

Front 16

What urine output defines polyruia

Back 16

greater than 2 mL/kg/hr

Front 17

When can furosemide be given with low urine output?

Back 17

- hydrated animal

- adequate blood pressure (MAP >80)

Front 18

What dose of furosemide can be used for low urine output

Back 18

IV bolus 2.2 mg/kg

should have results in 20-30 min

repeat and double the dose up to 10 mg/kg

Front 19

When during lactation is hypocalcemia most likely

Back 19

second/third week

less likely first and fourth

Front 20

How long after estrus would pyometra deveolpe

Back 20

1-12 weeks

Front 21

What is sepsis

Back 21

patient with infection induced systemic inflammation

Front 22

What is severe sepsis

Back 22

organ dysfunction secondary to sepsis

Front 23

What is septic shock

Back 23

development of hypotension not responsive to IV fluid administration

Front 24

What criteria are seen with systemic inflammatory response syndrome

how many must be present

Back 24

Temperature <100.4 >104

HR >90

RR >20 bpm or PaCO2 <32

WBC >12,000 <4,000 or >10% bands

2 or more must be present

Front 25

If animals have unexplained shock (no HX of PE findings consistent with trauma, blood, fluid loss or cardiac disease) ____ should be suspected as the underlying cause

Back 25

sepsis

Front 26

Goals of TX for sepsis

Back 26

- TX infection

- supportive care - maintain tissue perfusion

- alter the inflammatory cascade

Front 27

What type of bacteria is MC associated with sepsis in dogs and cats

Back 27

gram -

Front 28

What is cardiogenic shock

Back 28

results from failure of adequate forward flow

can result from diastolic, systolic or obstruction of flow

Front 29

Examples of cardiogenic shock

systolic

diastolic

obstructive

Back 29

Systolic:

CHF

Diastolic:

HCM, pericardial tympanade,

Obstructive:

TE dz, tumors, distended organs (GDV)

Front 30

What is hypovolemic shock

Back 30

inadequate delivery of O to tissues and accumulation of byproducts due to insufficient blood volume

Front 31

What is distributive shock

Back 31

the effective circulating volume is inadequate to provide tissue perfusion

inappropriate vasodilation which leads to a relative hypovolemia

Front 32

What is a classic example of distributive shock

Back 32

septic shock

Front 33

What are typical signs for early (compensated shock)

Back 33

increased HR

+/- increased RR

Front 34

What are intermediate stages of shock

Back 34

increased HR

increased RR

decreased mentation

decreased BP

Front 35

If see increased HR, RR decreased mentation with decreased BP and pale MM, increased CRT, and cold extremeties what type of shock might you be dealing with

Back 35

cardiogenic or hypovolemic

Front 36

If see increased HR, RR decreased mentation with decreased BP and red mucous membranes, decreased CRT and normal to increased temperature, what type of shock might you be dealing with

Back 36

distributive shock

Front 37

What are some treatments for shock

Back 37

O reguardless of the type of shock

1/4 of the shock bolus withing 15 min with re-evaulation of HR, MM, CRT, pulse quality)

Front 38

What type of shock would fluid therapy be fatal

Back 38

cardiogenic

Front 39

_______ an acute life-theratening allergic reaction resulting from massive generalized release of _____

Back 39

systemic anaphylasis

mast cell mediators including histamine

Front 40

What is the cellular level of interaction that causes the release of histamine from MC

Back 40

Ag-IgE on the surface of MC that releases histamine

Front 41

Systemic anaphylasxis is this type hypersenstivity reaction

Back 41

Type 1

Front 42

What happens during the infalmmatory response after stimulation of systemic anaphylasis

Back 42

- release of inflammatory mediators is reapid: ganulocyte exocytosis within seconds

- activation of the arachadonic acid cascade in minuets

- cytokin synthesis and secretion in 2-24 hours

Front 43

ANAPHYLACTOID cause reactions by

What does it not requre

Back 43

do not require IgE

directly activating MC to release histamine or

more commonly, activating complement

They do not require previous exposure and sensitization

Front 44

What is the shock organ of the dog?

Back 44

liver

Front 45

What is the shock organ of the cat

Back 45

lungs

Front 46

What are generic TX for anaphylaxis

Back 46

- O2 if respiratory distress

- fluid therapy - shock doses

- epinephrine - inotrophic and chronotropic effects on heart and bronchodilation, decreases systemic inflammatory mediators

- +/- glucocorticoids, antihistamines, aminophilline, and atropine

Front 47

Why should glucocorticoids not be used in place of epinephrine in the emergency situlation?

Back 47

they have little effect on the immediate stages of anaphylaxis

Front 48

What are some clinical signs of anaphylaxis?

Back 48

hypotension

bronchospasm

uticaria

erythema/puritis

arrhythmia

vomiting

diarrhea

Front 49

What signs are seen initally with anaphylaxis? Progresses to

Back 49

excitment

V/D

respirtaory distress

collapse secondary to hypovolemic shock and death within 1 hour if not treated