Advanced medical care unit 3

What are the main goals of fluid therapy?

Treat shock, replace fluid losses, deliver medications, and support homeostasis

What percentage of an adult patient's body weight is total body water (TBW)?

About 60%

What percentage of body weight is intracellular fluid?

About 40%

What percentage of body weight is extracellular fluid?

About 20%

What is interstitial fluid?

Fluid that bathes cells and tissues

What percentage of body weight is interstitial fluid?

About 15%

What is plasma?

The liquid portion of blood

What percentage of body weight is plasma?

About 5%

What is transcellular fluid?

Specialized fluid found in spaces such as joints, the GI tract, and body cavities

What is the normal daily fluid loss through urination?

Approximately 15 mL/kg/day

What is the normal daily fluid loss through defecation?

Approximately 15 mL/kg/day

What is the normal daily fluid loss through respiration?

Approximately 5-10 mL/kg/day

What are examples of abnormal fluid loss?

Vomiting, diarrhea, polyuria, hemorrhage, and burns

What is third spacing?

Fluid remains in the body but is in the wrong compartment

What is an example of third spacing?

Ascites

What hormone helps the body conserve water?

Antidiuretic hormone (ADH)

What can happen when fluid-loss compensation fails?

Organ perfusion decreases, potentially causing shock

What are the goals of fluid therapy for shock?

Restore intravascular volume, correct perfusion deficits, and improve cardiac output

What is dehydration?

Loss of fluid from the interstitial and intracellular compartments

What level of dehydration is considered severe?

Greater than 10%

What must the veterinary team determine before replacing fluids?

Which compartment lost fluid, what type was lost, how much is needed, and how to replace it

What do hypertonic fluids do?

They draw fluid into the vasculature

What do isotonic fluids do?

They maintain balance

What do hypotonic fluids do?

They move fluid towards cells and tissues

What are crystalloids?

Fluids containing small particles that can move between body-fluid compartments

What are colloids?

Fluids containing large particles that remain primarily in the intravascular compartment

What is albumin's main function?

Maintaining plasma oncotic pressure and helping prevent fluid from leaking out of vessels

What are examples of natural colloids?

Whole blood, plasma, and albumin products

What are examples of synthetic colloids?

Dextrans, gelatins, and hydroxyethyl starches

When should synthetic colloids generally be avoided?

When the patient responds to crystalloids or has preexisting azotemia

What should be monitored during fluid therapy?

Body weight, urine production, blood pressure, perfusion, and physical examination findings

What are signs of fluid overload?

Edema, coughing, increased respiratory rate, weight gain, and serous nasal discharge

What should be done if respiratory signs suggest fluid overload?

Obtain chest radiographs

Why should emergency protocols be prepared in advance?

There is not enough time to prepare once an emergency occurs

How many people are typically needed to handle an emergency?

About three to five people

Who usually leads the emergency team?

The veterinarian

Why should emergency team members have assigned roles?

To make treatment faster and more organized

What should be recorded during an emergency?

Procedures performed, medications given, and patient responses

What are the characteristics of a good emergency care area?

It should be accessible, clean, and well-stocked

What essential equipment should an emergency area contain?

IV supplies, fluids, monitoring equipment, oxygen, suction, and a crash cart

What should a crash cart contain?

Emergency medications, syringes, needles, laryngoscopes, endotracheal tubes, and an Ambu bag

When should crash-cart supplies be checked?

Before each shift

How often should crash-cart supplies be checked for expiration and proper function?

At least monthly

What receptors does epinephrine stimulate?

Alpha-1 and beta-adrenergic receptors

What is the effect of alpha-1 stimulation by epinephrine?

Peripheral vasoconstriction

How does epinephrine help during CPR?

It increases aortic diastolic pressure and improves coronary and cerebral blood flow

What are the positive inotropic and chronotropic effects of epinephrine?

Increased force of contraction and increased heart rate

What is triage?

Prioritizing patients according to the urgency of their conditions

What is the purpose of the primary survey?

To identify and treat immediately life-threatening problems

What does ABC stand for in emergency assessment?

Airway, breathing, and circulation

What is the purpose of a secondary survey?

To identify additional injuries or problems after immediate threats are addressed

Why must life-threatening problems be treated before minor injuries?

They pose the greatest immediate risk to the patient's life

Why should the patient be reassessed frequently during stabilization?

The patient's condition can change rapidly

What does CRT measure?

The time required for color to return to the mucous membranes after blanching

What does pulse quality help assess?

Circulation and perfusion

Why is mucous membrane color evaluated during triage?

It provides information about circulation and oxygenation

What is the first priority when treating a respiratory emergency?

Minimize stress and support breathing

What can be used to support oxygenation during a respiratory emergency?

Supplemental oxygen

Why might sedation be used for a respiratory emergency?

To reduce stress and respiratory effort when appropriate

What is thoracocentesis?

Removing air or fluid from the pleural space with a needle or catheter

When is thoracocentesis indicated?

When pneumothorax or pleural effusion is present

What medication may be used for heart failure with respiratory distress?

Furosemide

What type of medication is furosemide?

A diuretic

What medication may be given by inhaler to cats with asthma?

Albuterol

When should additional diagnostic tests be performed during a respiratory emergency?

After the patient has been stabilized

What should be evaluated during cardiovascular triage?

Mucous membrane color, CRT, pulse quality, heart rate, jugular veins, and heart sounds

What tools are used for cardiovascular monitoring?

ECG and blood pressure monitoring

How can external hemorrhage initially be controlled?

With pressure bandages

When should the source of bleeding be investigated?

Once the patient is stable

How soon may PCV and total solids changes become apparent after hemorrhage?

Changes may not appear for 12-24 hours

What should be addressed first in a trauma patient?

Life-threatening injuries

Why is IV access important in trauma patients?

It allows fluids and medications to be administered

When should analgesia be administered to trauma patients?

Early in the treatment protocol

What injuries should be suspected in trauma patients until ruled out?

Pulmonary contusions and traumatic brain injuries

What supportive measures may be used when brain injury is suspected?

Oxygen and elevation of the head

How often should a trauma patient be reassessed during initial stabilization?

Continuously at first, then every 3-5 minutes until stable

What is gastric dilatation-volvulus (GDV)?

A condition in which the stomach twists around its axis

What is an initial treatment step for GDV?

Establishing a large-bore IV catheter and rapidly administering fluids

How can the stomach be decompressed in GDV?

By trocarization or orogastric intubation

What definitive treatment is required for GDV?

Surgery

In which animals is urethral obstruction commonly seen?

Male cats

What may an obstructed bladder feel like on palpation?

Hard and firm

Why is bloodwork performed in a cat with urethral obstruction?

To evaluate kidney values and related abnormalities

When are fluids started for a urethral obstruction?

After the patient has been catheterized

How long does a urinary catheter typically remain in place for urethral obstruction?

At least two days

What is a general initial treatment principle for toxin exposure?

Decontamination, when appropriate

What is shock?

Inadequate cellular energy production due to altered blood flow or impaired oxygen delivery

Why is shock life-threatening?

It can cause serious complications and death if untreated

What are early signs of shock?

Depression or anxiety, tachycardia, and tachypnea

How may pulse quality change during shock?

It may be normal, decreased, or increased

What are signs of progressing shock?

Severe tachycardia, altered mentation, hypotension, pale mucous membranes, and weak pulses

What may occur during the terminal stage of shock?

Massive vasodilation, severe hypotension, and cardiac arrest

What are the major categories of shock?

Hypovolemic, cardiogenic, distributive, and obstructive

What causes hypovolemic shock?

Inadequate circulating blood volume

What can cause hypovolemic shock?

Hemorrhage or significant fluid loss

What causes cardiogenic shock?

Failure of the heart to pump effectively

What causes distributive shock?

Abnormal distribution of blood flow due to changes in vascular tone

What causes obstructive shock?

Physical obstruction that prevents normal circulation

What is systemic inflammatory response syndrome (SIRS)?

A widespread inflammatory response that can lead to organ dysfunction

What does DIC stand for?

Disseminated intravascular coagulation