Clin Med - FT Intro

pbhati17's version from 2017-03-03 01:27

Fluid Therapy Considerations

What % dehydration is mild dehydration? What are the CS associated w/ mild dehydration?5-7% dehydrated, there will be a mild skin tent & mild tacky MM
What #% dehydration is moderate dehydration? What are the CS associated w/ moderate dehydration?8-10% is moderate. The animal will be depressed, have tacky MM & a CRT >2 sec
What #% dehydration is severe dehydration? What are the CS associated w/ severe dehydration?>10% dehydrated, the extremities will be cool, there will be poor perfusion & a CRT of >3-4 sec
**** 1 L of fluid is how many kilograms????1L = 1Kg!!!
*****What is the maintenance dose for dogs & cats?? *KNOW THE UNITS40-60mL/Kg/day (CATS USE LOWER END)
*****What is the maintenance dose for horses? *KNOW THE UNITS50mL/Kg/day
If a 10kg dog is 5% dehydrated, how much fluid does she need?10kg x 0.05 = 0.5 L (its L bc 1L= 1kg)
If a 10kg dog needs a maintenance dose, how much fluid will she need?10kg x 60mL/kg/day (must know this rate) = 600mL = 0.6L
A shock dose is how much compared to body weight? How much is it compared to blood volume? What is the actual dose, in ml/kg?A shock dose is 8-9% of the body weight (think about a PTx that is 8% dehydrated) & it is essentially 1 blood volume. The dose is 80-90ml/kg (CATS ARE MUCH LESS THO)
Explain giving a shock DOSE vs a BOLUS. which is prolly a better idea? Describe your bolus delivery method.A DOSE is giving the whole amount. A BOLUS is that you give it a quarter of the dose at a time. So, for bolus delivery, give a 1/4 of the dose as a bolus, then recheck recheck recheck! If they are still hypovolemic, give another 1/4 dose as a bolus, recheck & recheck & continue this method until the CS improve!
What are crystalloids? What are some examples (4)?They are basic electrolyte solutions which work as buffers. Examples incld LRS, saline, plasmalyte & hypertonic saline
What are colloids? What are some examples of artificial (2) & natural (1) colloids?Colloid fluids have large, osmotically active particles which remain in the vasculature & affect starling's forces. Artificial colloids are hetastarch & oxyglobin. A natural colloid would be any type of blood product
Crystalloid replacement fluids → if given IV, how rapidly do they move from the vasculature to the interstitium? How much of the total amount given stays in the vasculature, versus moves to the interstitium? (What does this lead to?)The movement from the vasculature to the interstitium is quite rapid, taking about 30 min. It will equilibrate w/ 25% of the volume staying in the vasculature & 75% moving into the interstitium. This will result in brief volume expansion & it maintains electrolyte balance

If you are using a crystalloid for volume re-expansion, how much should you give?If using for volume re-expansion should use 3-4X the amount you calculate
Take a look at table 3.6 on slide 9.I don't think we need to memorize it but it's worth a glance
What are colloids most helpful in doing?Useful for volume resuscitation & hypoproteinemic PTx
Synthetic colloid, aka? Which 2 ways can you give this? What bad side effect may be present w/ this? How expensive is it?Hetastarch! You can give as bolus or in a maintenance dose. There may or may not be prolonged bleeding times w/ high doses of hetastarch. It is less expensive than the other colloids
What is oxyglobin? How long is good for? How available/expensive is it?It is a Polymerized bovine Hb product. It has a long shelf life, but may be difficult to find & is more expensive than hetastarch
What are some blood products which can be used as a natural colloid? What are the downsides to using these blood products?Whole blood, FFP (fresh frozen plasma), pRBCs (packed red blood cells), platelet concentrate. The downsides to using these are that there might be transfusion rxns, you might need to do typing/cross matching, the FFP would need time to thaw & these products are more expensive than hetastarch (about on par for price w/ oxyglobin)
If you are going to give HYPERtonic saline, what is the RULE OF THUMB?For every 1 L of Hypertonic Saline replace w/ 10L of crystalloid (this is a RATIO)
Why do you need to give crystalloids if you give colloids?Bc you're robbing Peter to pay Paul - you need to give crystalloids bc colloid is stealing water from interstitium & you will need to replace that again at some point
How much NaCl is in a hypertonic saline? What is this solution used for....what is it not used for? Explain why it works the way it does. Explain how it affects the blood volume (#s)7% NaCl. This czs an immediate expansion of the vascular space, so it is for RESUSCITATION. It is NOT A MAINTENANCE FLUID! It works bc it creates a hypertonic ECF, which means the ICF redistributes to the ECF (blood) where it is needed. This hypertonicity leads to an expansion of fluid 2-3xs larger than the amount given....however, this means the interstitium is now dehydrated so you will NEED to give regular crystalloid after use of this.
Give 2 examples of combinations of crystalloids & colloids commonly used(1) Saline + hetastarch
(2) Hypertonic Saline & Colloid boluses plus LRS
Oral/enteral route of admin of fluids → which basic method should you not overlook?Free choice water! They are probably thirsty-let them drink!
Oral/enteral route of admin of fluids → nasogastric intubation is most often used in who & why?In horses, bc it stimulates the gastro-colic reflex (one of a number of physiological reflexes controlling the motility, or peristalsis, of the gastrointestinal tract. It involves an ↑ in motility of the colon in response to stretch in the stomach & byproducts of digestion in the small intestine. Thus, this reflex is responsible for the urge to defecate following a meal. The small intestine also shows a similar motility response. The gastrocolic reflex helps make room for more food)
Oral/enteral route of admin of fluids → when is an oral/enteral route of admin CONTRAINDICATED? (1 specific to horses, 2 in general)(1) Contraindicated if nasogastric reflux in horses (put the tube in & stuff starts coming up out of it)
(2) Dont do if any PTx has a GI obstruction
(3) Contraindicated if ANY PTx is moderate to severely dehydrated
Why would you not want to use an oral/enteral route of admin in a PTx who is MODERATELY to SEVERELY dehydrated?Bc at these levels of dehydration, perfusion to the gut (& skin, so SQ is also contraindicated in this case) is very ↓, which means that a lot of the fluid wont be absorbed by virtue of less blood being around to absorb it
WHO & WHEN do you do Subcutaneous Route of Administration of fluids? (When don't you?) WHICH fluid do you use & HOW MUCH?ONLY IN SMALL ANIMALS w/ MILD DEHYDRATION! (Moderate to severe dehydration, or hypovolemia, means there is less perfusion to the skin so it wont be absorbed well). You will want to choose an ISOTONIC fluid (I'm sure hypertonic would burn & prolly cz other problems) & you will do 10ml/kg/site
How much fluid can you give SQ?10ml/kg/site (on pic on slide, shows 4 sites on back of cat, 1 above each shoulder & 1 above each hip)
Which delivery method of fluids is the Most appropriate choice for moderate to severe dehydration & resuscitation?IV!!
What are the main IV sites for IV fluids? What should you monitor when you are giving IV fluids?Jugular, Cephalic, Saphenous veins. Monitor CS & electrolyte levels!
IV fluid therapy → What is the next best option if you cannot get a vein??INTRAOSSEUS! (Blood is made in BM...So if you put fluids into BM, it will come out directly into the blood)
What is the #1 factor of choosing a catheter if you care about the volume you can give during a specific time? Talk about some specifics about thisRADIUS/DIAMETER! Radius of catheter determines the volume you can give. Specifically, Poiseuille’s Law says Laminar flow along a tube is proportional to the 4th power of the pipe’s radius... so volume is dependent on radius^4
In general, what size catheter do you wanna pick? For resuscitation, what size catheter would you want to pick?In general, you want to see the smallest necessary catheter for the job at hand. However, if you are doing Resuscitation, GO BIG!!!
Explain the difference btwn when you'd use a "over the needle" catheter, versus a "over the wire" catheterThe over the needle catheter is used in short term situations. Over the wire catheters are used long term, bc they are soft & non-thrombogenic & allow you single or multiple lumens (see slide 16 for pic of over the wire catheterization & a multiple lumen catheter)
How can you keep a catheter from moving? Why would you want to monitor daily for? You should flush the catheter frequently....w/ what?You can bandage OR suture a catheter in place. You'd want to monitor daily for inflammation and/or thrombophlebitis. Flush frequently w/ Heparinized Saline
If a PTx is dehydrated & has Elevated PCV/TP/Creatinine, what will happen to these values in response to fluid therapy?The values will ↓
A hypovolemic PTx will be tachycardic. How does the HR respond to fluid therapy?↓ hr
What is the resp rate in a hypovolemic PTx & how does fluid therapy change this?They’ll be Tachypneic while hypovolemic & fluid therapy will ↓ this back to normal