Emergências e cuidados intensivos em animais de companhia: abordagem ao choque
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2018-01-25
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O choque é uma síndrome muito observada nas unidades de cuidados intensivos e que, frequentemente, culmina em disfunção orgânica e morte. Define-se como a insuficiente produção de energia intracelular, podendo classificar-se em choque circulatório, choque metabólico e choque hipoxémico. O primeiro resulta de uma inadequada perfusão tecidual que tem como consequência a diminuição da disponibilidade de oxigénio para as células e, consoante a sua etiologia, pode subdividir-se em choque hipovolémico, choque cardiogénico, choque distributivo e choque obstrutivo. No que diz respeito à apresentação clínica, esta pode variar consoante a fase em que o animal se encontra, sendo comum encontrar alterações nas mucosas, no tempo de repleção capilar, na frequência cardíaca, na qualidade do pulso e no estado mental. O diagnóstico é feito maioritariamente com base nesta alterações e na história e anamnese. Contudo, outros meios como a gasometria, a pressão venosa central e o lactato podem demonstrar-se muito úteis neste processo. O tratamento deve ter por base a correção do ABC, caraterístico de uma situação de emergência, sendo a fluidoterapia a componente maioritária do mesmo. O prognóstico está dependente da fase em que o choque é identificado e se inicia o tratamento. No entanto, esta síndrome resulta frequentemente em elevado grau de morbilidade e mortalidade. A componente prática desta dissertação, apresenta e discute nove casos clínicos de animais em choque ou com diagnósticos que frequentemente conduzem a esta síndrome. Os dados foram recolhidos no Hospital Veterinário Central, tendo sido acompanhados em contexto de estágio curricular. Relativamente aos casos expostos e discutidos foi possível concluir que a individualidade de cada organismo resulta numa apresentação clínica que nem sempre está de acordo com a bibliografia, o que, por vezes dificulta a classificação do choque e a fase em que ele se encontra. A história clínica e a anamnese são fatores importantes que, por vezes, permitem equilibrar esta dificuldade. A monitorização é essencial ao longo de toda a abordagem clínica, nomeadamente os novos meios que permitem uma melhor avaliação da perfusão tecidual. Apesar de alguns casos de sucesso, e de tratamento adequado, esta síndrome frequentemente culmina em morte.
Shock is a common syndrome in intensive care units that, frequently, culminates in organic dysfunction and death.It is defined as the insufficient intracelular energy production, classifiable as circulatory shock, metabolic shock and hypoxic shock. Circulatory shock results from an inadequate tissue perfusion that consequently causes the diminishing of oxygen availability to cells and, depending on the etiology, can be subdivided in hypovolemic shock, cardiogenic shock, distributive shock and obstructive shock. Concerning clinic presentation, it can vary depending on which stage the animal is at, where is commonly found changes in the* mucous* membranes, capillary refill time, heart rate, pulse quality and mental state. The diagnosis is done mainly based on these alterations and in history and anamnesis. However, other means like gasometry, central venous pressure and the lactate can be very useful in this process. The treatment must have as a basis the ABC correction, exemplar of na emergency situation, were fluidotherapy is the main component. The prognosis depends on the stage in which shock is identified and treatment administered. However, this syndrome frequently results in na elevated degree or morbidity and mortality. The practical component of this work presents and discusses nine clinical cases of animals in shock or with diagnoses that frequently lead to this syndrome. The data was collected at the Hospital Veterinário Central, while being followed in a context of curricular externship. Concerning the presented and discussed cases, it was possible to conclude that the individuality of each organism result in a clinical presentation that not always matches the bibliography, which, at times hinders the classification of the shock and the stage it is encountered. The clinical history and the anamnesis are essential factos that, at times, can reduce this hindrance. Monitoring is essential acros the entire clinical approach, namely new means that allow a better evaluation of tissue perfusion. Despite some success cases, and adequate treatment, this syndrome frequently culminates in death.
Shock is a common syndrome in intensive care units that, frequently, culminates in organic dysfunction and death.It is defined as the insufficient intracelular energy production, classifiable as circulatory shock, metabolic shock and hypoxic shock. Circulatory shock results from an inadequate tissue perfusion that consequently causes the diminishing of oxygen availability to cells and, depending on the etiology, can be subdivided in hypovolemic shock, cardiogenic shock, distributive shock and obstructive shock. Concerning clinic presentation, it can vary depending on which stage the animal is at, where is commonly found changes in the* mucous* membranes, capillary refill time, heart rate, pulse quality and mental state. The diagnosis is done mainly based on these alterations and in history and anamnesis. However, other means like gasometry, central venous pressure and the lactate can be very useful in this process. The treatment must have as a basis the ABC correction, exemplar of na emergency situation, were fluidotherapy is the main component. The prognosis depends on the stage in which shock is identified and treatment administered. However, this syndrome frequently results in na elevated degree or morbidity and mortality. The practical component of this work presents and discusses nine clinical cases of animals in shock or with diagnoses that frequently lead to this syndrome. The data was collected at the Hospital Veterinário Central, while being followed in a context of curricular externship. Concerning the presented and discussed cases, it was possible to conclude that the individuality of each organism result in a clinical presentation that not always matches the bibliography, which, at times hinders the classification of the shock and the stage it is encountered. The clinical history and the anamnesis are essential factos that, at times, can reduce this hindrance. Monitoring is essential acros the entire clinical approach, namely new means that allow a better evaluation of tissue perfusion. Despite some success cases, and adequate treatment, this syndrome frequently culminates in death.
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choque , hipoperfusão , débito cardíaco , resistência vascular sistémica , pressão arterial, , fluidoterapia