Podcast
Questions and Answers
Which condition is a potential etiology of shock due to lack of oxygen transport?
Which condition is a potential etiology of shock due to lack of oxygen transport?
Which clinical sign indicates decreased cardiac output?
Which clinical sign indicates decreased cardiac output?
What color of mucous membranes reflects severe cardiovascular compromise?
What color of mucous membranes reflects severe cardiovascular compromise?
Which type of shock is commonly associated with brick red mucous membranes?
Which type of shock is commonly associated with brick red mucous membranes?
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Which of the following is NOT an etiology listed for shock?
Which of the following is NOT an etiology listed for shock?
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Which clinical sign indicates hypothermia in shock presentations?
Which clinical sign indicates hypothermia in shock presentations?
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What does depressed mentation suggest in a clinical setting?
What does depressed mentation suggest in a clinical setting?
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Which condition reflects arterial hypoxemia?
Which condition reflects arterial hypoxemia?
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What is the correct initial approach when monitoring fluid therapy outcomes?
What is the correct initial approach when monitoring fluid therapy outcomes?
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Which factor is most critical to prevent overloading the heart during fluid therapy?
Which factor is most critical to prevent overloading the heart during fluid therapy?
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In which situation may fluid administration need to be altered despite the standard protocol?
In which situation may fluid administration need to be altered despite the standard protocol?
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What is the significance of a sudden increase in central venous pressure (CVP)?
What is the significance of a sudden increase in central venous pressure (CVP)?
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Which of the following is NOT a clinical sign of overhydration?
Which of the following is NOT a clinical sign of overhydration?
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Why is it essential to distribute fluid infusion evenly throughout the day?
Why is it essential to distribute fluid infusion evenly throughout the day?
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How often should electrolyte and acid-base status be determined during fluid therapy?
How often should electrolyte and acid-base status be determined during fluid therapy?
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What does a gain or loss of 1 kg in body weight indicate regarding fluid therapy?
What does a gain or loss of 1 kg in body weight indicate regarding fluid therapy?
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Which method is advised for accessing the urinary bladder during a tracheostomy?
Which method is advised for accessing the urinary bladder during a tracheostomy?
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What is a critical contraindication for performing abdominocentesis?
What is a critical contraindication for performing abdominocentesis?
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When performing thoracocentesis, which locations are recommended for needle insertion based on the presence of fluid?
When performing thoracocentesis, which locations are recommended for needle insertion based on the presence of fluid?
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How should the tracheostomy tube fit during insertion?
How should the tracheostomy tube fit during insertion?
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What is the optimal position for a patient undergoing abdominocentesis?
What is the optimal position for a patient undergoing abdominocentesis?
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What should be done with the needle during the insertion phase of an abdominocentesis?
What should be done with the needle during the insertion phase of an abdominocentesis?
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In the event of a pneumothorax, where should the site for thoracocentesis be located?
In the event of a pneumothorax, where should the site for thoracocentesis be located?
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Which important precaution should be taken while suturing the skin edges after inserting a tracheostomy tube?
Which important precaution should be taken while suturing the skin edges after inserting a tracheostomy tube?
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What is the primary objectives of broad spectrum antibiotics in septic shock?
What is the primary objectives of broad spectrum antibiotics in septic shock?
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Which fluid should be used for maintenance in an animal requiring plasma volume expansion?
Which fluid should be used for maintenance in an animal requiring plasma volume expansion?
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What is the appropriate action to take if an animal is not hydrated during volume resuscitation?
What is the appropriate action to take if an animal is not hydrated during volume resuscitation?
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In cardiopulmonary resuscitation for dogs weighing less than 5 kg, which technique is recommended to provide closed chest compression?
In cardiopulmonary resuscitation for dogs weighing less than 5 kg, which technique is recommended to provide closed chest compression?
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What should be established first in basic life support during an emergency?
What should be established first in basic life support during an emergency?
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When administering blood or plasma, what condition requires fresh or stored blood transfusion?
When administering blood or plasma, what condition requires fresh or stored blood transfusion?
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What is the recommended ventilation frequency during chest compressions in CPR?
What is the recommended ventilation frequency during chest compressions in CPR?
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In phase 1 of cardiopulmonary resuscitation, what is crucial for ensuring adequate airflow?
In phase 1 of cardiopulmonary resuscitation, what is crucial for ensuring adequate airflow?
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What should be monitored to ensure a good prognosis in heat-related conditions?
What should be monitored to ensure a good prognosis in heat-related conditions?
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During blood transfusion, which step is critical before proceeding?
During blood transfusion, which step is critical before proceeding?
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What is the consequence of continuing cooling measures if body temperature is below 104° F?
What is the consequence of continuing cooling measures if body temperature is below 104° F?
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In cases of severe heatstroke, what type of fluid therapy is recommended?
In cases of severe heatstroke, what type of fluid therapy is recommended?
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What type of allergic reaction does anaphylaxis represent?
What type of allergic reaction does anaphylaxis represent?
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What is the result of the interaction between antigen and IgE on mast cells during anaphylaxis?
What is the result of the interaction between antigen and IgE on mast cells during anaphylaxis?
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Why is it recommended to avoid using dogs that are positive for DEA-1 and DEA-7 antigens as blood donors?
Why is it recommended to avoid using dogs that are positive for DEA-1 and DEA-7 antigens as blood donors?
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When is the administration of fresh or frozen plasma indicated?
When is the administration of fresh or frozen plasma indicated?
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What is the recommended method for monitoring urine output in animals with oliguria or polyuria?
What is the recommended method for monitoring urine output in animals with oliguria or polyuria?
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What indicates successful rehydration based on changes in PCV and plasma protein levels?
What indicates successful rehydration based on changes in PCV and plasma protein levels?
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How should fluid therapy be adjusted if there is a sudden increase in central venous pressure (CVP)?
How should fluid therapy be adjusted if there is a sudden increase in central venous pressure (CVP)?
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Which of the following clinical signs would suggest overhydration in a patient?
Which of the following clinical signs would suggest overhydration in a patient?
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What is the primary treatment for increasing heart rate and blood pressure in a severe shock situation?
What is the primary treatment for increasing heart rate and blood pressure in a severe shock situation?
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When administering IV fluids, why is it advisable to distribute fluids evenly throughout the day?
When administering IV fluids, why is it advisable to distribute fluids evenly throughout the day?
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What does a gain or loss of 1 kg in body weight signify in terms of body water changes?
What does a gain or loss of 1 kg in body weight signify in terms of body water changes?
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Which drug should not be administered to patients with a third-degree atrioventricular block?
Which drug should not be administered to patients with a third-degree atrioventricular block?
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Which monitoring parameter is crucial to assess electrolyte and acid-base status during fluid therapy?
Which monitoring parameter is crucial to assess electrolyte and acid-base status during fluid therapy?
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In the case of cardiac arrhythmias, which medication is recommended for long-term therapy?
In the case of cardiac arrhythmias, which medication is recommended for long-term therapy?
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What does clinical monitoring involve when assessing signs of overhydration?
What does clinical monitoring involve when assessing signs of overhydration?
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When managing blood pressure, what should be done if the pulse is weak or not palpable?
When managing blood pressure, what should be done if the pulse is weak or not palpable?
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What condition necessitates the replacement of red blood cells if the hematocrit is below 20%?
What condition necessitates the replacement of red blood cells if the hematocrit is below 20%?
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Which treatment option is not typically recommended until 10 to 15 minutes after cardiac arrest?
Which treatment option is not typically recommended until 10 to 15 minutes after cardiac arrest?
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Which of the following is an appropriate response in treating bradyarrhythmias if the patient is hypoxemic?
Which of the following is an appropriate response in treating bradyarrhythmias if the patient is hypoxemic?
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What should be done prior to blood transfusion to reduce the risk of reaction?
What should be done prior to blood transfusion to reduce the risk of reaction?
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What is the initial intervention for a patient in septic shock requiring airway support?
What is the initial intervention for a patient in septic shock requiring airway support?
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Which fluid is advised for volume expansion when an animal is not hydrated?
Which fluid is advised for volume expansion when an animal is not hydrated?
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In the context of basic life support, what should follow after establishing an airway?
In the context of basic life support, what should follow after establishing an airway?
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What is the appropriate technique for closed chest compression in dogs over 5 kg?
What is the appropriate technique for closed chest compression in dogs over 5 kg?
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What fluid therapy condition indicates the need for fresh or stored blood transfusion?
What fluid therapy condition indicates the need for fresh or stored blood transfusion?
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What is the recommended frequency of ventilation during chest compressions in CPR?
What is the recommended frequency of ventilation during chest compressions in CPR?
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What should be done with blood or plasma before administering it to a patient?
What should be done with blood or plasma before administering it to a patient?
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What should be monitored to assess the effectiveness of fluid therapy?
What should be monitored to assess the effectiveness of fluid therapy?
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What is the defining characteristic of hypertonic dehydration?
What is the defining characteristic of hypertonic dehydration?
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Which of the following best describes hypotonic dehydration?
Which of the following best describes hypotonic dehydration?
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What percentage of body weight does extracellular water typically represent in adults?
What percentage of body weight does extracellular water typically represent in adults?
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What is a critical threshold for detectable dehydration in terms of body weight loss?
What is a critical threshold for detectable dehydration in terms of body weight loss?
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Which electrolyte disturbance is indicated when correcting metabolic acidosis?
Which electrolyte disturbance is indicated when correcting metabolic acidosis?
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What factor is considered critical when evaluating a history of dehydration?
What factor is considered critical when evaluating a history of dehydration?
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What percentage of total body water is represented by intracellular water in adults?
What percentage of total body water is represented by intracellular water in adults?
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What indicates an acute life-threatening dehydration condition?
What indicates an acute life-threatening dehydration condition?
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Which condition should prevent the placement of a nasogastric tube?
Which condition should prevent the placement of a nasogastric tube?
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What is the first step to ensure proper nasogastric tube placement?
What is the first step to ensure proper nasogastric tube placement?
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What should be done immediately after arterial sampling to prevent excessive bleeding?
What should be done immediately after arterial sampling to prevent excessive bleeding?
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Which is an appropriate action during a tracheostomy procedure?
Which is an appropriate action during a tracheostomy procedure?
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In which situation should rapid intravenous anesthesia be administered?
In which situation should rapid intravenous anesthesia be administered?
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What is a contraindication for performing arterial sampling?
What is a contraindication for performing arterial sampling?
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What is an important consideration when verifying the placement of a nasogastric tube?
What is an important consideration when verifying the placement of a nasogastric tube?
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Which site is commonly used for arterial sampling in the lower limb?
Which site is commonly used for arterial sampling in the lower limb?
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Which etiology of shock is characterized by a deficiency in oxygen transport due to a reduced volume of blood?
Which etiology of shock is characterized by a deficiency in oxygen transport due to a reduced volume of blood?
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What clinical sign is indicative of shock when observing the color of mucous membranes?
What clinical sign is indicative of shock when observing the color of mucous membranes?
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Which of the following clinical signs can reflect hypovolemia during a shock presentation?
Which of the following clinical signs can reflect hypovolemia during a shock presentation?
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Which of the following can be a clinical presentation indicating shock due to sepsis?
Which of the following can be a clinical presentation indicating shock due to sepsis?
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Which of the following correctly identifies a state associated with poor oxygen transport in the context of shock?
Which of the following correctly identifies a state associated with poor oxygen transport in the context of shock?
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Among the listed clinical signs, which one is least likely to directly correlate with shock?
Among the listed clinical signs, which one is least likely to directly correlate with shock?
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In cases of shock, which of the following abnormalities could contribute to the overall condition due to cardiovascular system issues?
In cases of shock, which of the following abnormalities could contribute to the overall condition due to cardiovascular system issues?
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Which of the following best describes a significant clinical sign of decreased oxygen transport due to hypovolemia?
Which of the following best describes a significant clinical sign of decreased oxygen transport due to hypovolemia?
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What is the expected effect on skin turgor in cases of severe dehydration?
What is the expected effect on skin turgor in cases of severe dehydration?
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Which of the following solutions should NOT be used for maintenance due to high sodium content?
Which of the following solutions should NOT be used for maintenance due to high sodium content?
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Which parameter typically indicates an increase in dehydration?
Which parameter typically indicates an increase in dehydration?
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What primary characteristic defines sensible fluid losses in animals?
What primary characteristic defines sensible fluid losses in animals?
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What indicates that urine specific gravity should increase in a dehydrated animal?
What indicates that urine specific gravity should increase in a dehydrated animal?
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How is the volume of fluid required to correct dehydration typically calculated?
How is the volume of fluid required to correct dehydration typically calculated?
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Which factors cause dehydration in animals?
Which factors cause dehydration in animals?
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Which component is high in intracellular fluid compared to extracellular fluid?
Which component is high in intracellular fluid compared to extracellular fluid?
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What is the primary purpose of administering broad spectrum antibiotics in septic shock?
What is the primary purpose of administering broad spectrum antibiotics in septic shock?
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In which scenario should fresh or stored blood transfusion be administered?
In which scenario should fresh or stored blood transfusion be administered?
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What is the recommended first action in basic life support for emergency situations?
What is the recommended first action in basic life support for emergency situations?
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How should maintenance fluids be adjusted in a dehydrated animal requiring plasma volume expansion?
How should maintenance fluids be adjusted in a dehydrated animal requiring plasma volume expansion?
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What is the primary method to correct metabolic acidosis in a patient?
What is the primary method to correct metabolic acidosis in a patient?
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What should be monitored when defining success in intervention for heat-related conditions?
What should be monitored when defining success in intervention for heat-related conditions?
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Which condition is most likely to follow aggressive fluid therapy?
Which condition is most likely to follow aggressive fluid therapy?
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During cardiopulmonary resuscitation, what is the recommended method for ventilation in relation to chest compressions?
During cardiopulmonary resuscitation, what is the recommended method for ventilation in relation to chest compressions?
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What is the correct approach if epinephrine and closed chest compression fail after 5 minutes?
What is the correct approach if epinephrine and closed chest compression fail after 5 minutes?
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What is the appropriate immediate action if severe coagulopathy is suspected before arterial sampling for blood gas analysis?
What is the appropriate immediate action if severe coagulopathy is suspected before arterial sampling for blood gas analysis?
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For eventual reduction in mortality, when should cooling measures be initiated?
For eventual reduction in mortality, when should cooling measures be initiated?
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Which technique is specifically recommended for closed chest compression on dogs weighing less than 5 kg?
Which technique is specifically recommended for closed chest compression on dogs weighing less than 5 kg?
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Which step should be taken to verify the placement of a nasogastric tube?
Which step should be taken to verify the placement of a nasogastric tube?
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Which of the following treatments is NOT indicated early in the treatment of septic shock?
Which of the following treatments is NOT indicated early in the treatment of septic shock?
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What is the appropriate primary treatment for managing heart rate and blood pressure in severe shock conditions?
What is the appropriate primary treatment for managing heart rate and blood pressure in severe shock conditions?
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What medication is advised to prevent reperfusion injury during treatment?
What medication is advised to prevent reperfusion injury during treatment?
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In which scenario should a nasogastric tube NOT be placed?
In which scenario should a nasogastric tube NOT be placed?
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What is a contraindication for corticosteroid therapy in shock management?
What is a contraindication for corticosteroid therapy in shock management?
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What is a proper technique to secure a nasogastric tube after placement?
What is a proper technique to secure a nasogastric tube after placement?
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What treatment should be administered to manage severe pulmonary edema effectively?
What treatment should be administered to manage severe pulmonary edema effectively?
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What is the correct method for performing a tracheostomy in an emergency?
What is the correct method for performing a tracheostomy in an emergency?
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What vital precaution should be observed during arterial blood gas sampling?
What vital precaution should be observed during arterial blood gas sampling?
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Which site is recommended for the collection of blood in standing patients?
Which site is recommended for the collection of blood in standing patients?
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What approach should be taken if a patient shows signs of vomiting before nasogastric tube insertion?
What approach should be taken if a patient shows signs of vomiting before nasogastric tube insertion?
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What physiological condition describes elevated serum sodium concentration in dehydration?
What physiological condition describes elevated serum sodium concentration in dehydration?
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When is dehydration clinically detectable in an individual?
When is dehydration clinically detectable in an individual?
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Which of the following indicates hypotonic dehydration?
Which of the following indicates hypotonic dehydration?
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What represents a life-threatening condition in terms of fluid loss?
What represents a life-threatening condition in terms of fluid loss?
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Which type of dehydration occurs with a loss of isotonic fluid along with intake of hypotonic fluids?
Which type of dehydration occurs with a loss of isotonic fluid along with intake of hypotonic fluids?
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What characteristic of hypertonic fluids limits their use in hypovolemic patients?
What characteristic of hypertonic fluids limits their use in hypovolemic patients?
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What percentage of total body weight does extracellular water represent in adults?
What percentage of total body weight does extracellular water represent in adults?
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Which condition is characterized by a history of decreased water intake or increased fluid loss?
Which condition is characterized by a history of decreased water intake or increased fluid loss?
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In which condition is phosphorus supplementation usually required?
In which condition is phosphorus supplementation usually required?
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Which of the following describes the body's total water percentage in adults?
Which of the following describes the body's total water percentage in adults?
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When serum sodium is low (hyponatremia), what should the fluid composition prioritize?
When serum sodium is low (hyponatremia), what should the fluid composition prioritize?
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Which of the following formulations is most appropriate for maintaining volume expansion in the absence of laboratory data?
Which of the following formulations is most appropriate for maintaining volume expansion in the absence of laboratory data?
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What precaution is recommended when using synthetic colloids in patients with hypoproteinemia?
What precaution is recommended when using synthetic colloids in patients with hypoproteinemia?
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What is the best approach to fluid selection in patients with elevated serum sodium levels?
What is the best approach to fluid selection in patients with elevated serum sodium levels?
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Which colloid solution is primarily indicated for patients experiencing shock due to low oncotic pressure?
Which colloid solution is primarily indicated for patients experiencing shock due to low oncotic pressure?
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When should practitioners be cautious with the use of synthetic colloids?
When should practitioners be cautious with the use of synthetic colloids?
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What is the recommended approach when treating a patient with hypernatremia or water deficit?
What is the recommended approach when treating a patient with hypernatremia or water deficit?
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What is the maximum recommended infusion rate for potassium supplementation in maintenance fluids?
What is the maximum recommended infusion rate for potassium supplementation in maintenance fluids?
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In which circumstance is the SC route of fluid administration deemed inappropriate?
In which circumstance is the SC route of fluid administration deemed inappropriate?
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Which condition indicates that sodium bicarbonate should be added to parenteral fluids?
Which condition indicates that sodium bicarbonate should be added to parenteral fluids?
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What is a critical consideration when potassium supplementation is indicated?
What is a critical consideration when potassium supplementation is indicated?
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What is an appropriate site for SC fluid administration?
What is an appropriate site for SC fluid administration?
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What might result from administering fluids containing preservatives in young animals?
What might result from administering fluids containing preservatives in young animals?
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Which method is recommended for intravenous fluid administration in small dogs?
Which method is recommended for intravenous fluid administration in small dogs?
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What role does the packed cell volume (PCV) play in assessing dehydration?
What role does the packed cell volume (PCV) play in assessing dehydration?
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Which solution is considered inadequate as a maintenance solution for hydration due to its sodium content?
Which solution is considered inadequate as a maintenance solution for hydration due to its sodium content?
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What is the typical insensible water loss in normal animals?
What is the typical insensible water loss in normal animals?
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What physiological change is likely observed as dehydration progresses in terms of skin turgor?
What physiological change is likely observed as dehydration progresses in terms of skin turgor?
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Which of the following factors contributes to dehydration in animals?
Which of the following factors contributes to dehydration in animals?
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In a dehydrated animal, what change would one expect in the urine specific gravity?
In a dehydrated animal, what change would one expect in the urine specific gravity?
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What is an early sign of dehydration that can be detected in animals?
What is an early sign of dehydration that can be detected in animals?
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Which of the following statements about metabolic acidosis and dehydration is true?
Which of the following statements about metabolic acidosis and dehydration is true?
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What is the correct procedure after arterial sampling for blood gas analysis to manage bleeding?
What is the correct procedure after arterial sampling for blood gas analysis to manage bleeding?
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In which of the following situations should a nasogastric tube NOT be placed?
In which of the following situations should a nasogastric tube NOT be placed?
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Which method is NOT recommended for confirming the placement of a nasogastric tube?
Which method is NOT recommended for confirming the placement of a nasogastric tube?
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What action should be taken if a patient is undergoing tracheostomy and severe coagulopathy is present?
What action should be taken if a patient is undergoing tracheostomy and severe coagulopathy is present?
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During emergency arterial sampling, which type of syringe should be utilized?
During emergency arterial sampling, which type of syringe should be utilized?
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What should be done before placing a nasogastric tube in a patient?
What should be done before placing a nasogastric tube in a patient?
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What is the most critical step when preparing for a tracheostomy procedure?
What is the most critical step when preparing for a tracheostomy procedure?
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Which anatomical location is NOT commonly used for arterial blood sampling in emergency settings?
Which anatomical location is NOT commonly used for arterial blood sampling in emergency settings?
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Study Notes
Emergency Medicine
- Emergency care focuses on immediate stabilization and support of vital functions.
- Fluid therapy is crucial for restoring blood volume and tissue perfusion.
- Monitoring fluid administration is vital to prevent overhydration and complications.
- Tracheostomy is a procedure to create an opening in the trachea to secure an airway.
- Abdominocentesis is used to sample abdominal fluid for diagnostic purposes, avoiding blind techniques in cases of large masses or organomegaly.
- Thoracocentesis is used to drain fluid from the chest cavity, avoiding the procedure in cases of chronic effusions due to the risk of fibrosing pleuritis.
Shock
- Shock is a life-threatening condition characterized by inadequate tissue perfusion and oxygen delivery.
- Hypovolemia and hypoxia contribute to shock.
- Sepsis is a significant cause of shock.
-
Clinical signs of shock:
- Depressed mentation
- Weak pulse
- Color changes in mucous membranes (pale, gray/cyanotic, brick red)
- Hypothermia
Cardiopulmonary Resuscitation (CPR)
- CPR consists of basic life support: airway, breathing, and circulation.
- Advanced life support may include medication administration and other interventions.
-
Basic life support:
- Airway: Establish an open airway using methods like endotracheal intubation or tracheotomy.
- Breathing: Use a ventilator or exhaled air to assist breathing.
- Circulation: Perform chest compressions at a rate of 80 to 100 compressions per minute.
Fluid Therapy for Shock
-
Initial therapy:
- Establish an airway if needed.
- Administer oxygen.
- Obtain history and perform a physical examination.
- Place a jugular catheter.
- Collect blood for laboratory analysis.
-
Blood volume:
- Administer 0.9% NaCl or lactated Ringer’s solution for plasma volume expansion.
- In dehydrated animals, 0.7% NaCl (hypertonic saline) can be used in combination with hetastarch.
- Give fresh or frozen plasma for hypoproteinemia.
- Give fresh or stored blood when hematocrit and total protein are very low.
Blood Transfusion
- Whole blood transfusion is used for rapid decrease in PCV.
- Crossmatching is essential to prevent transfusion reactions.
- Compatibility testing is done at three temperatures.
- Major incompatibility: Agglutination or hemolysis in a mix of 100 µL donor cells and 100 µL patient serum.
- Minor incompatibility: Agglutination or hemolysis in a mix of 100 µL patient cells and 100 µL donor serum.
Heatstroke
- Heatstroke is a serious condition caused by excessive body temperature.
-
Clinical signs:
- Hyperthermia
- Panting
- Increased heart rate
- Weakness
- Seizures
- Collapse
-
Management:
- Cool the animal down gradually, avoiding rapid cooling measures.
- Administer fluids as needed.
- Monitor closely for complications such as DIC.
- Administer broad-spectrum antibiotics.
Anaphylaxis
- Anaphylaxis is a life-threatening allergic reaction.
- Antigen-IgE interaction on mast cells leads to histamine release.
-
Clinical signs:
- Respiratory distress
- Vasodilation
- Cardiovascular collapse
-
Treatment:
- Administer epinephrine.
- Provide supportive care.
-
Prevention:
- Identify and avoid triggers.
- Desensitization therapy.
Fluid Therapy
- Fluid therapy is an important treatment for various conditions in animals.
- Fluid therapy can be used for resuscitation from shock, correcting dehydration, hypokalemia, and metabolic acidosis.
- Fluid therapy is also used for correcting other electrolyte disturbances, parenteral nutrition, treatment of anemia, and coagulopathies.
- The distribution of body water and electrolytes is crucial for understanding fluid therapy.
- Total body water accounts for 50% to 70% of body weight in adults.
- Water is distributed in the body as intracellular water (40% of body weight) and extracellular water (20% of body weight).
- Extracellular water consists of interstitial fluid (12% to 14% of body weight) and intravascular fluid (6 to 8% of body weight).
- Electrolytes are essential for maintaining fluid balance and cellular function.
- Dehydration is detectable when approximately 5% of body weight in water has been lost.
- An acute loss of more than 12% body weight in water is life-threatening.
- History of decreased water intake, vomiting, polyuria, diarrhea, excessive panting or salivation may suggest dehydration.
- Clinical signs of dehydration include sunken eyes, dry mucous membranes, decreased skin turgor, and increased heart rate.
- Different types of fluids are used in fluid therapy, including crystalloids, colloids, and blood products.
- Crystalloids are solutions that contain electrolytes and are used to expand the intravascular volume.
- Colloids are solutions that contain large molecules that stay in the intravascular space, providing a more sustained volume expansion.
- Blood products are used to replace blood loss and improve oxygen-carrying capacity.
- The rate of fluid infusion is adjusted based on the animal's condition and the severity of dehydration.
- Fluid therapy is monitored to assess its effectiveness and adjust the treatment plan.
- Overhydration is a potential complication of fluid therapy and can lead to various clinical signs, including an increase in body weight, increased urination, pulmonary edema, and vomiting
- It is important to monitor the efficacy of fluid therapy by assessing body weight, PCV, plasma protein, central venous pressure, and electrolyte status.
Emergency techniques
- Arterial blood gas analysis helps assess oxygenation, ventilation, and acid-base balance.
- Common sites for arterial sampling include the femoral artery and dorsal metatarsal artery.
- A heparinized syringe is used for arterial sampling.
- Firm pressure should be applied to the puncture site for 3 to 5 minutes after blood collection.
- Nasogastric tube placement can be used for gastric decompression, administration of medications, and obtaining samples for diagnostic purposes.
- Nasogastric tube placement is contraindicated in patients with facial trauma, brachycephalic breeds with respiratory distress, severe coagulopathy, or severe vomiting.
- The tube should be premeasured to the last rib and lubricated with local anesthetic.
- Placement should be confirmed with radiographs.
- Tracheostomy is a surgical procedure that creates an opening in the trachea to facilitate breathing.
- Tracheostomy is indicated in cases of airway obstruction or severe respiratory distress.
- Severe coagulopathy is a contraindication for tracheostomy.
- Broad-spectrum antibiotics are indicated after tracheostomy to prevent infection.
- Peritoneal fluid collection can be used for diagnostic purposes and to assess abdominal effusion.
- A good site for peritoneal fluid collection in standing patients is caudal to the spleen, slightly to the right of midline.
- In left lateral recumbency, fluid collection can be performed caudal to the umbilicus, slightly to the right of midline.
Cardiopulmonary Resuscitation
- Cardiopulmonary resuscitation (CPR) is an emergency procedure performed when a patient has stopped breathing and/or the heart has stopped beating.
- The goal of CPR is to restore circulation and breathing to the patient.
- Phase 1 of CPR involves basic life support, which includes establishing an airway, breathing, and circulation.
- Phase 2 of CPR involves advanced life support, which includes drug therapy, fluid therapy, electrocardiography, and treatment of specific conditions.
- CPR is performed using a combination of chest compressions, ventilations, and medications.
- Drugs used in CPR include epinephrine, lidocaine, sotalol, sodium bicarbonate, and anticholinergics (atropine).
- Fluid therapy is essential during CPR to support blood pressure and organ perfusion.
- Electrocardiography can be used to monitor cardiac activity and guide CPR interventions.
- Understanding the principles and techniques of fluid therapy and cardiopulmonary resuscitation is crucial for providing effective emergency care to animals.
Dehydration
- Sodium and chloride are higher in extracellular fluid and lower in intracellular fluid
- Potassium, magnesium, and phosphorus are lower in extracellular fluid and higher in intracellular fluid
- Water intake should equal water loss in normal animals
- Insensible water loss is approximately 20 mL/kg/day
- Sensible water losses are between 20 and 40 mL/kg/day in normal animals consuming food
- 0.45% sodium chloride can make a good maintenance solution but does not contain adequate potassium
- Lactated Ringer’s and 0.9% sodium chloride are not good maintenance solutions because they contain too much sodium and chloride.
- Dehydration can be caused by decreased water intake (due to decreased thirst and appetite centers in sick animals, decreased food intake)
- Physical examination findings associated with dehydration include depression, acute loss of body weight, sunken eyes, decreased skin turgor, dry mucous membranes, tachycardia, diminished capillary refill, and signs of shock
- Skin turgor can be assessed by measuring skin elasticity when lifted; in normal animals, the skin should return to its position quickly; as dehydration progresses, the return time increases
- Dehydration is as high as 5% to 10% before a loss of skin turgor becomes noticeable
- Dehydration can be assessed by packed cell volume (PCV) increasing, total plasma protein increasing and urine specific gravity increasing (if the kidneys are healthy)
- Metabolic acidosis is common with dehydration
- Dehydration correction should be done by administering volume of fluids equal to weight (kg) multiplied by percentage of dehydration
Emergency Techniques
- Arterial blood sampling for blood gas analysis should not be performed if a severe coagulopathy is present
- Arterial blood samples should be collected using a heparinized syringe
- Common arterial sampling sites include the femoral artery in the inguinal region and the dorsal metatarsal artery distal to the tarsus joint
- After arterial sampling, place firm pressure over the site for 3 to 5 minutes to stop bleeding
- Nasogastric tubes should not be placed in patients with deforming facial trauma, brachycephalic breeds with respiratory distress, if severe coagulopathy is present, or if there is severe vomiting
- To place a nasogastric tube, premeasure the catheter to the last rib, and place several drops of local anesthetic into the nostril
- Gently insert the tip of the catheter into the nostril and push the catheter up on the nasal philtrum, advancing the tube in a ventral and medial direction into the ventral meatus
- Suture the tube to the nostril and use skin staples to attach the tube to the face
- Verify the placement of the tube with radiographs
- Tracheostomy should not be performed if a severe coagulopathy is present
- Use rapid IV anesthesia when performing a tracheostomy
- Clip and prepare the skin before performing a tracheostomy
- Incise skin from the larynx to the thoracic inlet
- Bluntly force the tips of Mayo scissors through the tissue, avoid lacerating the lung parenchyma or coronary arteries
- A good site for collecting blood in standing patients is caudal to the spleen, slightly to the right of midline, with the needle pointed towards the urinary bladder
- If the patient is in left lateral recumbency, collect blood caudal to the umbilicus, slightly to the right of midline, with the needle pointed towards the urinary bladder
Shock
- Shock can be caused by lack of oxygen transport (hypovolemia and hypoxia)
- Shock can be caused by cardiovascular system abnormalities
- Shock can be caused by sepsis
- Shock causes depressed mentation
- Shock causes weak pulses indicating decreased cardiac output or peripheral vascular resistance
- Shock changes mucous membrane color (pale- anemia, gray or cyanotic- arterial hypoxemia and severe cardiovascular compromise, brick red- septic shock)
- Shock causes hypothermia with cold extremities
- Broad spectrum antibiotics are indicated in shock, especially in septic shock
- Maintenance fluids should contain 5% dextrose
Cardiopulmonary Resuscitation
- Phase 1 of cardiopulmonary resuscitation focuses on establishing an airway, breathing, and circulation
- Establish an airway as soon as possible during Phase 1 (endotracheal tube, tracheotomy, mouth-to-muzzle)
- Use a ventilator or exhaled air during Phase 1, but do not overinflate the lungs
- During Phase 1, use closed chest compression, 80-100 compressions/minute
- Ventilate once for every 15 chest compressions during Phase 1
- If a third person is available, use the palm of the hand to compress the abdomen against the spine for 5-10 seconds 2-3 times/minute during Phase 1
- Phase 2 of cardiopulmonary resuscitation focuses on advanced life support like correcting acid-base and electrolyte disturbances, evaluating cardiac function, and restoring heart rhythm.
- Epinephrine should be administered for cardiac arrest.
- If epinephrine is ineffective, a consistent method of treatment is with electrical defibrillation during Phase 2
- Open-chest cardiac massage should be considered if 5 minutes of closed chest compression and epinephrine are ineffective during Phase 2
- Phase 3 of cardiopulmonary resuscitation focuses on prolonged life support like adequate oxygenation, gauging, hypnogenesis (sedation, pain control), and intensive care.
- Phase 3 includes drug therapy (catecholamines- dopamine, dobutamine)- to increase cardiac output and peripheral perfusion, diuretics- furosemide to treat pulmonary edema, mannitol (if cardiac arrest longer than 3 minutes), calcium entry blockers- diltiazem to prevent reperfusion injury, sedation (diazepam) to avoid pentobarbital, and antibiotics
Heatstroke
- Treat heatstroke immediately to reduce mortality
- Lower core temperature early by using cool water to wet the patient and providing air movement to enhance evaporation
- Do not use cold water or ice water to treat heatstroke
Fluid Therapy
- Used to resuscitate from shock, correct dehydration, hypokalemia, and metabolic acidosis
- Can also be used to correct other electrolyte disturbances and for parental nutrition, treatment of anemia and coagulopathies
- Total body water is about 50% to 70% of body weight in adults
- Cats have slightly less body water; young animals and neonates have a higher percentage of body water
- Intracellular water is about 40% of body weight
- Extracellular water is about 20% of body weight
- Interstitial fluid is about 12% to 14% of body weight
- Intravascular fluid is about 6 to 8% of body weight
- Sodium and chloride are high in extracellular fluid and low in intracellular fluid
- Potassium, magnesium, and phosphorus are low in extracellular fluid and high in intracellular fluid
- Water intake should equal water loss in normal animals
- Insensible water loss is about 20 mL/kg/day
- Sensible losses are 20 to 40 mL/kg/day in normal animals consuming food
- A 0.45% sodium chloride solution makes a good maintenance solution but does not contain adequate potassium
- Lactated Ringer's and 0.9% sodium chloride are not good maintenance solutions because they contain too much sodium and chloride
- Dehydration is detectable when approximately 5% of body weight in water has been lost.
- Acute loss of more than 12% body weight in water is life-threatening
- Decreased water intake, vomiting, polyuria, diarrhea, excessive panting or salivation may suggest dehydration
- Findings associated with dehydration include depression, acute loss of body weight, sunken eyes, decreased skin turgor, dry mucous membranes, tachycardia, diminished capillary refill, and signs of shock
- Skin turgor should return quickly when lifted a short distance
- As dehydration progresses, the time required for the skin to return to its normal position increases
- Dehydration is as much as 5% to 10% before a loss of skin turgor can be detected
- Packed cell volume (PCV) and total plasma protein both increase with dehydration
- Urine specific gravity should increase in a dehydrated animal if the kidneys are healthy
- Metabolic acidosis is common in dehydration
- Volume of fluid needed for correction of dehydration is determined based on the percentage of dehydration and the animal's weight
- Monitor heart rate; bradycardia is a sign of toxicity
- Only significant hypophosphatemia requires phosphorus supplementation, usually in diabetic ketoacidosis
- Avoid oversupplementation
- If sodium is normal, use fluids that are normal in sodium and osmolality (lactated Ringer’s, Plasma-Lyte 148, Normosol-R, or 0.9% NaCl)
- If serum sodium is elevated, choose a hypotonic solution (5% dextrose in water, 0.45% NaCl in 2.5% dextrose)
- If serum sodium is low, fluids should contain more salt. However, hypertonic fluids are usually not used unless hyponatremia is severe
- Benzoic acid may be used as a preservative, and can be toxic
- Signs of toxicity are neurological
- Do not use fluids containing preservatives in cats, puppies, or small dogs
Supplementation of Parenteral Fluids
- Potassium is added to fluids if serum potassium concentration is less than 3.5 mEq/L
- Potassium supplementation may still be indicated if potassium is between 3.5 and 4.5 mEq/L if ventricular arrhythmias are present
- Potassium supplements are added to maintenance fluids, if needed, at a rate of approximately 20 to 30 mEq/L
- The rate of infusion of potassium is most important. Do not exceed a rate of 0.5 mEq/kg/hr
- Use potassium supplementation with caution as death can result due to hyperkalemia
- Sodium bicarbonate is added if alkali replacement is needed
- Signs of hypervolemia include increased CVP, increased urination, gelatinous feel to SC tissue, pulmonary edema, vomiting, or diarrhea
- Discontinue all IV infusions and give furosemide if hypervolemia occurs
General Guidelines for Fluid Selection
- Choose fluids with normal sodium and osmolality for normonatremia
- Choose a hypotonic solution for hypernatremia
- Choose fluids containing more salt for hyponatremia
- Choose a synthetic colloid to administer in conjunction with crystalloid fluids when rapid intravascular expansion is needed or if there is lowered oncotic pressure
Routes of Administration for Parenteral Fluids
- Do not use SC route in shock, severe dehydration, hypothermia, or emergency replacement of fluids
- Do not give 5% dextrose in water SC with severe dehydration
- Choose a site on the trunk for SC administration
- Use the IV route for accurate delivery of large amounts of fluids
- Use the jugular vein in cats and small dogs, or if serious disease is present
- Use a 20- to 22-gauge needle in cats and small dogs, and a 14- to 20-gauge needle in medium to large dogs
- Place catheter aseptically, and change every 72 hours
Emergency Techniques
- Do not perform arterial sampling if a severe coagulopathy is present
- Use a heparinized syringe for arterial sampling
- Most common sites for arterial sampling are the femoral artery in the inguinal region, and the dorsal metatarsal artery distal to the tarsus joint
- Place firm pressure over the site for 3 to 5 minutes after bleeding
- Do not place a nasogastric tube in patients with deforming facial trauma, in brachycephalic breeds with respiratory distress, if severe coagulopathy is present, or if there is severe vomiting
- Premeasure the catheter to the last rib for the nasogastric tube
- Place several drops of local anesthetic into the nostril and wait several minutes
- Place the tip of the catheter in the nostril, and gently push the catheter up on the nasal philtrum, advancing the tube in a ventral and medial direction into the ventral meatus
- Suture the tube to the nostril, and use skin staples to attach the tube to the face
- Verify placement with radiographs
- Do not perform tracheostomy if severe coagulopathy is present
- Use rapid IV anesthesia, clip, and prepare the skin for tracheostomy
- Incise skin from larynx to the thoracic inlet. Bluntly force the tips of Mayo scissors through the tissue
Abdominal Paracentesis
- Do not perform in animals with severe coagulopathy
- Perform aseptic technique
- A good site for collection in standing patients is caudal to the spleen, slightly to the right of midline, with the needle directed toward the urinary bladder
- If in left lateral recumbency, go caudal to the umbilicus, slightly to the right of midline, with the needle directed toward the urinary bladder
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Description
This quiz covers essential concepts in emergency medicine, focusing on critical care practices and the management of shock. Learn about fluid therapy, vital procedures like tracheostomy, and the significance of monitoring in emergency situations. Additionally, explore the causes and clinical signs of shock, an urgent medical condition that requires immediate attention.
