Cardiac & Respiratory
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| show | Airway, Cardiovascular, Respiratory, Abdomen, Spine, Head, Pelvis, Limbs, Arteries/Veins, Nerves
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| What is "A CRASH PLAN" used for | show 🗑
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| What is the first question you should ask yourself about "Airway?" | show 🗑
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| show | Administer supplemental oxygen by mask, O2 cage, etc
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| show | Is the breathing noisy (snoring or squeaking); is there abdominal effort to inspiration, expiration, or both; Upon auscultation do you hear crackles or wheezes; and are the respirations just fast but lungs are clear (pain, anxiety, trauma, fever, etc)
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| What is the normal range for the respiration rate? | show 🗑
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| If respirations are labored, lung sounds are absent or increased, or animal is cyanotic or tachypneic then this is considered what? | show 🗑
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| If the animal is attempting to breath and unable what should be the first three attempted steps? | show 🗑
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| show | The vet must perform an emergency tracheostomy
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| show | Evaluate Mucus Membranes and Assess CRT
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| show | anemia, shock, pain, or poor circulation
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| show | cyanosis which can occur with impaired respiration & Tylenol toxicity
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| Brown or "muddy" mucus membranes indicate what? | show 🗑
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| Yellow mucus membranes indicate what? | show 🗑
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| show | shock (at the beginning), heatstroke, and some toxins
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| show | Provides a crude indication of hydration status and peripheral perfusion (circulation)
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| Capillary refill times that are rapid < 1 sec (almost immediately refill) indicate what? | show 🗑
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| show | dehydration, hypovolemia (low blood volume), hypothermia, pain, shock
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| show | Palpate the femoral pulse and metatarsal pulse, this will tell you roughly how well the animal is perfusing
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| show | early shock, pain
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| What is something important that you should always check with pulses? | show 🗑
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| show | decompensating shock, pneumothorax
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| show | Ausculted heart beat does not match palpated pulses
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| What should you do if the pulse is absent and there is no auscultable heart beat? | show 🗑
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| show | A thromboembolic disease (blood clot- saddle thrombus in cats; they’re usually really painful/stressed and the pulse-less leg is cold)
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| show | hypovolemia, pain, hypoxemia, hyperthermia, sepsis, anemia, stress
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| show | Bradycardia
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| show | It can be seen in serious conditions like head trauma, Addison’s crisis, etc.
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| show | Pulse Quality, Heart Rate, and Temperature
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| Active cooling needs to be done to bring down temps if they are above what? | show 🗑
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| show | Multi-organ failure
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| show | Less than 94 (<94)
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| Temps < 82 can result in what? | show 🗑
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| show | blood pressure and perfusion
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| show | After you have assessed the "A" and "C" of "A CRASH PLAN".
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| Is it ok to draw blood and place an IVC before any sort of estimate has been presented to the owner? | show 🗑
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| The R is Respiratory so if we've already checked Airway what do we need to do? | show 🗑
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| When evaluating the "effort" with airway what are some things you should be looking at/for? | show 🗑
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| show | 1:2, meaning a patient exhales for twice as long as it inhales when breathing normally
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| show | Is it distended or discolored?
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| What is the first step of S in "A CRASH PLAN"? | show 🗑
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| How do you palpate the spine? | show 🗑
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| What is the second step of S in "A CRASH PLAN"? | show 🗑
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| What is the third step of S in "A CRASH PLAN"? | show 🗑
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| show | TOES. Evaluate toe-pinch for animal’s recognition of deep pain sensation and assess for crossed-extensor reflexes; use a hemostat
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| show | Schiff-Sherrington syndrome
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| show | severe SC damage
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| Loss of anal or bladder tone can indicate what? | show 🗑
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| show | The head includes evaluation of eyes, ears, nose, mouth, and face
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| When evaluating the eyes it's important to note Anisocoria (uneven pupil size), pupillary light reflexes; depressed or absent menace, palpebral, corneal, or nasal reflexes as these can indicate what? | show 🗑
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| show | Scleral vessels may be ruptured from head trauma, choking, or extreme stress
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| Why is it important to check the ears of trauma patients? | show 🗑
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| show | Check for bleeding or any deviation
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| What should you check with the mouth of a trauma patient? | show 🗑
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| show | Check for any drooping of the facial muscles; palpate the skull for pain and possible fractures (gently- the brain’s under there!)
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| What should you do to assess the pelvis? | show 🗑
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| Bruising is usually present in the inguinal and caudal abdominal regions when what is true? | show 🗑
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| show | From the muscle trauma sustained when the dog/cat was thrown/shaken by the other dog or car- over manipulation of the pelvis and limbs may cause pain in general
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| Why should you always check the toenails and footpads closely? | show 🗑
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| How should you treat injured foot pads and toenails? | show 🗑
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| show | Most of it has been checked already, BUT the patient's status is always changing and should be reassessed at various points
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| show | Laterally
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| show | Sternally
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| A jugular pulse when laying sternal can indicate what? | show 🗑
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| If the patient is stable a central line or jugular catheter can be place to measure what? | show 🗑
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| show | Head tilt, nystagmus, strabismus, unresponsive pupils, and LOC
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| show | A: Alert
V: responds to voice or visual stimuli
P: responds to painful stimuli only
U: coma, unresponsive
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| Once the animal has been brought to your hospital what do you need to determine? | show 🗑
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| show | Continue to monitor the animal while paperwork, payment, etc is getting taken care of
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| What does it mean when an animal is "In patient"? | show 🗑
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| show | Animals that present with a cause and treated then sent home; acute gastritis, minor lacerations, torn toe nails, non-anaphylactic bee stings, vaccine reaction, limping, etc.
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| show | Vasodilation, so warm them up before administering fluids
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| show | Vasoconstriction
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| What does Manitol do? | show 🗑
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| What does Manitol do in the vial? and what should you do in response? | show 🗑
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| Pulled tail in cats can cause what and why? | show 🗑
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| show | A saddle thrombus
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| True or False You can have a high HR and a low BP | show 🗑
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| show | Central Venous Pressure
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| show | Know your normals, Communicate with Owners, ABCs, and A CRASH PLAN
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| What are the normals you need to know from most to least critical? | show 🗑
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| show | When cellular energy production has fallen to a critically low level and organ function is compromised "systemic hypoprofusion"
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| What does shock mean? | show 🗑
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| How does shock work? | show 🗑
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| show | hyperdynamic phase
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| show | cellular damage and death of cells, at first the body compensates but if we don't intervene the body will get to an irreversible state of shock. It produces insufficient circulation and reduced blood flow through microcirculation
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| show | Hypervolemic, Obstructive, Distributive, Cardiogenic, and Septic Shock
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| show | YES
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| What is Hypervolemic Shock? | show 🗑
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| When we have problems with hypervolemic shock what happens with the heart? | show 🗑
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| Dog seems fine, but you know trauma has happened, what should you do? | show 🗑
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| What is obstructive shock? | show 🗑
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| show | Because something is obstructing and keeping the tissues from getting properly perfused.
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| show | It is a subcategory where ther is relative or functional hypovolemia due to something like vasodilation (blood is still there, but the vessels are all dilated and BP falls suddenly)
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| show | Shock resulting in cardiac failure; the heart is unable to pump blood
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| What is the cause of cardiogenic shock? | show 🗑
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| What causes metabolic shock? | show 🗑
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| What is the primary method of treating shock? | show 🗑
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| show | Hemorrhagic gastroenteritis
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| show | 1. we are anesthetizing them and those agents cause BP to drop and 2. Possible blood loss
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| show | Isotonic
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| show | hypertonic
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| When more particles are outside a membrane than inside this is called what? | show 🗑
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| show | It will move into the membrane as it moves towards an isotonic state
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| show | It will move out of the membrane as it moves towards an isotonic state
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| Breath: Ketoacidic | show 🗑
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| show | smells like amonia
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| Breath: Renal or Kidney disease | show 🗑
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| show | To monitor without monitors and to administer TLC that the doctor doesn't have time for
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| show | Rupture of the bladder, specific gravity
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| When dehydrated, what do an animal's MM feel like? | show 🗑
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| Dehydration: Clinical signs not detectable | show 🗑
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| Dehydration: Slight increase in skin turgor, MM tacky | show 🗑
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| show | 6-8% dehydration
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| show | 10-12% dehydration
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| Dehydration: rominent signs of shock and or death | show 🗑
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| show | When the patient is stable
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| When determining a baseline, what tests should be done? | show 🗑
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| What are some diagnostic indicators of dehydration? | show 🗑
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| show | With high water loss (5-8% dehydration) or severe disorders
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| How should catheters be prepared? | show 🗑
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| show | Every 3 to 7 days, while checking for infection daily
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| When do we administer SQ fluids? | show 🗑
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| show | Hypertonic solutions and those containing 5% or more dextrose
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| show | Vomiting or having other GI problems
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| What type of fluid administration rarely has an effect on hydration in a emergency situation? | show 🗑
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| show | Over the needle and through the needle
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| show | Are the most commonly found in practice and are only good for the short term use. Typical days of use is 3-7 days with proper care.
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| show | Are used when fluid therapy and serial blood draws are needed for the long term care of the patient. Typical days of use is up to 14 days
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| show | To maximize the delivery of oxygen to all tissues through different modalities of treatment
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| show | Introduction of air, broken catheter tip, burring the catheter, accidental fluid overload
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| What is the most common type of shock seen? | show 🗑
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| show | loss of blood or fluids, V/D, hemorrhage, or severe dehydration
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| show | State of circulatory collapse that occurs secondary to inflammatory disease over the whole body
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| What are the early signs of Sepsis in dogs? | show 🗑
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| show | They typically hide their symptoms until it is too late
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| What are the later signs of sepsis in dogs | show 🗑
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| What is the one shock that is considered it's "own shock?" | show 🗑
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| show | Good route for small puppies and kittens and others where you cannot access a vein
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| What is an advantage to giving fluids IP? | show 🗑
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| show | Too femur right below knee and must be placed aseptically
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| show | Introduction of air, broken catheter tip, burring the catheter, accidental fluid overload
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| show | 7 days
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| show | 3 days
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| show | Serial blood draws, CVP, or parental nutrition
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| show | 14 days
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| show | Mandible to manubrium, and midline to midline
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| How would you control pain for a central line placement? | show 🗑
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| How should you prepare for a central line placement? | show 🗑
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| show | Remove stylet from catheter and place J guide wire thru the catheter, then remove the catheter through the guide wire
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| show | Once you have the guide wire inserted about 1/2 of its length into the vein, you will then take the vein dilator and place it over the guide wire, thru the skin
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| 3rd step of central line placement | show 🗑
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| show | Take off the cap on the shortest port, (this is the longest lumen that opens at the distal tip of the catheter) and thread the catheter over the wire to place it in the vein
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| show | Let go of it
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| What are some reasons for placing a multi lumen catheter? | show 🗑
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| show | Suspected coagulopathies, complete all lab testing prior to placement
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| show | To ensure the catheter tip is in the cranial aspect of the heart
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| show | IVC placement, preliminary lab tests, fluid therapy, oxygen delivery, invasive or non-invasive, sedation, pain management, ventilation
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| show | Early stages of shock, vasoconstriction and increase heart rate to try and maintain blood pressure and increase cardiac output; leads to hypovolemic shock
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| show | Progressive at first, body will compensate. BUT if not instituted quickly the body will decompensated and it will become irreversible
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| show | It produces the Heart rate and stroke volume CO=HR x SV
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| show | Volume of blood ejected by the ventricles with each heartbeat and has 3 determinants
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| show | Preload, Afterload, and contractility
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| show | Force stretching the ventricles and filling just before contraction (blood volume)
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| show | Resistance at the vasculature that the heart must overcome for blood to leave the heart.
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| What is Contractility? | show 🗑
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| What is happening during Obstructive shock? | show 🗑
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| show | Sepsis, Anaphylaxis, and neurogenic disease
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| What is sepsis? | show 🗑
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| What is Cardiac Tamponade? | show 🗑
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| show | The local inflammatory response gets out of hand and affects tissues in other parts of the body
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| show | The inflammatory cascades all start feeding back on each other and cause more inflammation , causing system wide effects; happens with chemotherapy, febrile, or an abscess gone untreated
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| What are free radicals? | show 🗑
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| show | Sepsis, heat stroke, severe pancreatitis, disseminated cancer, autoimmune disease,
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| Patents with septic shock usually have a history of what? | show 🗑
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| show | Multiple Organ Dysfunction Syndrome
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| show | The systemic response becomes severe and tissue injury causes multiple organ malfunction including endotoxemia
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| What is endotoxemia? | show 🗑
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| What does SIRS stand for? | show 🗑
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| What are some indications of SIRS? | show 🗑
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| show | Compensatory, early decompensatory, late decompensatory
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| show | Starts once the animal has suffered the initial injury; can include slight increase in RR, red or pale mm, tachycardia, bounding pulse
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| What are the signs of Early Decompensatory? | show 🗑
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| show | The terminal stage of all forms of shock, due to severe tissue hypoxia;
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| show | Pale to cyanotic mm w/ undetectable, severe hypotension, hypothermia, absent or weak pulse, bradycardia
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| When do we use oxygen therapy? | show 🗑
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| What are some other things you can be doing to treat shock? | show 🗑
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| show | Shock, blood loss, dehydration, systemic disease, supportive treatment, diuresis
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| show | contain sodium as their osmotic active particle +/- other electrolytes
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| show | LRS, Normosol R, Plasmalyte, NACL 0.9%, 2.5% Dextrose and 0.45& saline
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| show | High molecular weight substances that do not easily cross capillary membranes
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| True or False Crystalloids and Colloids are never given together? | show 🗑
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| What are some examples of Colloids? | show 🗑
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| What is the half life concentration of Pentastarch? | show 🗑
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| What is the half life concentration of Hetastarch? | show 🗑
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| show | False they do so rapidly
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| show | Used to provide free water to replace insensible losses and can provide intercellular carbs in septic patient
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| What are the cons of dextrose containing solutions? | show 🗑
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| show | Distribute evenly in the extracellular space when given IV, but only 25% of the volume will remain in the vascular space after 1 hour
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| show | Normosol R, 0.9% sodium chloride, LRS Plasmalyte
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| What are the pros of Isotonic Crystalloids? | show 🗑
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| show | Rapid redistribution not good for maintenance because of high sodium and chloride content, osmolality and inadequate potassium
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| What are Hypotonic Crystalloids? | show 🗑
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| show | 0.45% NACL with 2.5% Dextrose
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| What are the pros of Hypotonic Crystalloids? | show 🗑
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| What are the cons of Hypotonic Crystalloids? | show 🗑
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| What are Hypertonic solutions? | show 🗑
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| show | 0.7% NACL
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| show | Used for rabid volume expansion, small volumes can increase intravascular space in large dogs
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| show | Effect is transient, often combined with colloids, expensive
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