😱Triage & Shock😱
What are the two goals of triage?
these are the four patient classifications of triage
what are to treat the sickest first and maximize available resources
immediate/unstable; emergent; urgent; non-emergent/stable (ordered in way seen)
This is the difference between osmolality vs toncity
osmolality- fluid electrolyte composition compared to plasma
tonicity-total effect electrolytes have on water movement from ECF =isotonic, hypotonic, hyperonic
These three components are required for DKA
2) symptoms of complicated pt vs uncomplicated
3) risk factors
4) clin path
1) hyperglycemia, increased ketones, and metabolic acidosis
(the ketones are acidic and effect capacity is overwhelmed. Urine becomes acidic, electrolyte and water losses to dehydration hypovolemia and hypotension)
2)complicated: vomiting, anorexia, dehydration, dull. these animals are sick and need immed care.
uncomplicated: PU/PD, wt. loss, polyphagia, persistent hyperglycemia + glucosuria, ketonuria. still eating, drinking, maintaining hydration, no vomiting, other signs
3) something to put over edge some type of concurrent dx: acute pancreatitis, UTI, hyperadrenocorticism. cat: hepatic lipidosis, CKD
4) hyperglycemia, glucosuria, ketonuria, non-regenerative anemia, neutrophilia, a bunch of causes have pseudohyponatermia secondary to hyperglycemia, increased K, and p decrease
These are the signs of pt in respiratory distress
Air hunger, increased work/ effort of breathing, chest tightness.
dog laying there, not making eye contact, just focused on breathing, orthopneic position
These are the most common causes of cardiopulmonary arrest (CPA) in dogs and cats
Reversible arrest (the five H's and T's)
hypothermia/hyperthermia, hypoxemia, hypovolemia, hyperkalemia, hypoglycemia, H+ (acidosis), Tachy/brady arrhythmias, tension pneumothorax, thromboembolic disease, tamponade (pericardial effusion), toxins
Once a triage exam is performed this exam is done
and after it these are performed
then this exam is done
primary survey
2) emergency (pointy of care diagnostics), initiate emergency treatment, perform life-saving interventions
3) secondary survey, complete remainder of exam, non-emergent evaluations
This is the most common type of fluid loss in dogs and cats and commonly seen with these dxs
while this is commonly seen with diabetes insipidus, excessive panting and water restriction. and is a loss of free water
isotonic fluid loss; gi and renal dx.
both water and na are equally lost from ECF compartment. if becomes severe enough can result in intravascular fluid loss (hypovolemia).
2) hypotonic fluid loss. clincally see hypernatremia and hyperosmolality
addisons common signalment? breeds?
2) presenting compliant and history? specifically stable vs Addisonian crisis
3) on blood work?
70% females, median age 4 years
Porturguese water dogs, standard poodles
2) stable: vague non, specific signs. ex v/d, anorexia, lethargy, gi signs mild. pu/pd. crisis-similar to stable. waxing and waning. GI signs more severe, collapse, tremors/weakness. Key is bradycardia in dog with other signs of hypovolemic shock.
3) lack of stress leukogram, azotemia (elevated bun/creatine), hyperkalemia, hyponatremia. (in shock would expect stress leukogram). Sometimes can see also hypoglycemia
For respiratory evaluation this is critical because?
staged pt. evaluation, bc hypoxic animals can quickly decompensate despite minimal handling or restraint
this is the difference between basic life support and advanced life support
basic life support: compressions (Restores blood flow) and breathing (ventilation and oxygenation). Known as CAB. chest compressions-lock elbows, 100-120 min, 2 min cycle. venitlation-intubate in lateral recumbany-6-8 breaths per min, peak pressure of 20-25 cm h20, avoid hyperventilation/hypo,
advanced life support DEF. drugs and defibrillation, electrolytes, and fluid therapy (if indicated).
IV acess: IM, IT, IO.
drugs: reversal-nalaxone, flumazenil, atipamezole. vasopressors: epinephrine, vasopressin, parasympatholytic: atropine, antiarrhytmics: amiodarone, lidocaine, mg,
common electylote derrangements: high K, ionized hypocalcemia, low glucose
defib-if in ventricular fibrillation. one full cycle of chest comprresion before defib
This is defined as critical decrease in DO2 compared to oxygen consumption VO2 in tissues.
and is secondary to?
shock
poor perfusion or unevenly distributed blood flow in relative to oxygen consumption. inadequate cellular energy production
puppies and kittens maintenance rate is different how? and what is the most common cause of death for them?
require higher maintenance rate, hypovolemia most common cause of death
hypoglycemia with Addison's?
Bolus of 50% dextrose, and dilute bit or CRI.
These are the emergency resp diagnostics and procedures
Bed side tests: blood gas, TFAST, pulse ox,
advanced imaging: thoracic rads, thoracic CT scan, only performed after pt is stabl-ish
emergency procedures: therapeutic thoracocentesis for pleural space dx
indications for epinephrine
atripine
sodium bicarb
vasoconstriction, most common cpr drug. get blood flood out of peripheral vessels and to vital organs
atropine-increase hr at level of SA node. used when asystole, pulseless electrical activity (PEA) and high vagal tone.
bicarb severe acidemia
These are the components of the perfusion triangle
heart, vasculature and blood
These are 3 components of fluid therapy plan
Maintenace, replacement/rehydration, ongoing losses
What electrolyte abnormalities are expected with Addison's dx and how are they tx?
Sodium and potassium are effected. (low salt, high k) -see this on BW, see k effects on ECG,
TX-FLUIDS. sp. isotonic crystalloid bolus and give it fast and recheck after each.
is pt hypovolemic hyponatremic pt give same na conc. if normovolemic hyponatremic do not mess with na
for hyperkalemia-calcium gluconate, regular insulin, (terbutaline is third line)
These are ways to give oxygen and therapeutics
procedures: oxygen response trial (give oxygen and recheck) .non-invasive oxygen delivery-flow by oxygen, tight fitting face mask, oxygen cage. Invasive oxygen delivery: nasal or nasopharyngeal prongs/catheter, intubation & mechanical ventilation, high flow nasal oxygen.
other therapies: anxiolytics, sedatives, specific drug therapy for underlying dx
monitoring devices used in cpr
most key ones are ECG and ETCO2
These are the two broad classifications of shock and the subcategories under them
circulatory (hypovolemic, cardiogenic, distributive, obstructive)
non-circulatory (metabolic, hypoxemic)
fluid overload is defined by? and may result in...
5-10% increase in body wt. postive fluid balance.
may result in: acid/base disturbances, electrolyte abnormalities, interstitial edema and cavitary effusion, organ dysfunction/failure, delayed healing (surgical site dehiscence)
TX for DKA
1) Key is fluids. then also electrolyte supplementation, and insulin.
fluids-hypovolemia give isotonic crystalloid then reassess. Euvolemic but dehydrated give IV fluid therapy/rehydration will aid in managing hyperglycemia.
electrolytes-give but and don't exceed.
insulin therapy-manage ketones. start after giving fluids. make sure electrolytes fixed by insulin will cause rapid electrolyte intracellular shifts. Regular insulin therapy-CRI, glucose shouldn't drop more than 100mg/dl per hour. when drops stop giving insulin. also give dextrose to decrease ketones
respiratory localization difference?
lower vs upper airway.
lower airway is going to be in the lungs use a stethoscope to hear ex penumonia, interstial lung dx. pleural space dx.
Vs upper ariway can hear it without. inspiratory dyspnea, external audible noise, wheeze etc.
can also ex pleural space dx also see inspiratory dyspnea nad reduced lung sounds on auscultation
this is how to determine when return of spontaneous circulation ROSC has occured
earliest indictor of ROSC is abrupt increase in ETCO2. (low etco2 <10-15 mmhg) associate with reduced chance of ROSC
spontaneous cardiac rhythm is typically first to return. spontaneous resp can take hours or longer.
gold standard-to mechanically venitlate post ROSC