Small Animal - Emergency Critical Care

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Triage is sorting patients according to their need for medical care
1 survey is performed ASAP to check for life threatening conditions
2 survey is a full PE later on and includes diagnostics, monitoring and therapeutics
What is the difference between triage, primary survey and secondary survey?
Airway
Breathing
Circulation
Disability

This is used for the primary survey
What does ABCD stand for?
asses airway patency and provide O2 therapy if needed
What should you consider under A of primary survey?
Is your patient apneic? > ventilate

If not apneic, assess RR, auscultate the thorax and check for any visible trauma
What should you consider under B of primary survey?
Check all perfusion parameters: CRT, MM, HR, PR + quality, temp of extremes vs core
What should you consider under C of primary survey?
Level of consciousness + CNS status, pain, toxin exposure
What should you consider under D of primary survey?
Level 1 - immediate
An animal presents with apnea, active seizures or imminent CPA. What triage level is it?
Level 2 - very urgent, requires immediate evaluation
An animal presents with acute abdominal pain, shock, dyspnoea or suspected poisoning. What triage level is it?
Level 3 - urgent. Needs immediate visual + evaluation within 15 minutes and an exam in under 2 hrs
An animal presents with trauma without shock, respiratory distress or V+ and D+. What triage level is it?
Level 4 - standard. Needs visual + evaluation w/i 60 mins, and an exam w/i 3 hrs
An animal presents with minor trauma, abscess, anorexia or lethargy. What triage level is it?
Level 5 - non-urgent. Needs evaluation + exam w/i 4 hours
An animal presents with lameness, skin dz or cough w/o resp distress. What triage level is it?
RR, resp effort, thoracic auscultation, MM colour
What four parameters do you use to evaluate respiratory distress in patients?
N 15-40
ABN >50
What is the normal and an abnormal RR for a dog?
N 15-30
ABN > 50
What is the normal and an abnormal RR for a cat?
upper airway +/- pleural space dz
Increased respiratory effort on inspiration indicates
lower airway or parenchymal dz
Increased respiratory effort on expiration indicates
parenchymal, lower airway or pleural space dz
Increased respiratory effort on inspiration and expiration indicates
laryngeal or caudal upper airway dz (extrathoracic trachea)
Stridor, a high pitched sound on inspiration, indicates
Upper airway dz - nasal passage or nasopharynx
Stertor, a low pitch snore on INS or EXP indicates
Respiratory distress
What does open mouth breathing in cats indicate?
parenchymal dz
Crackles heard on thoracic auscultation indicate
pleural space dz
Muffled sounds heard on thoracic auscultation indicate
hypoxaemia
An SPO2 of 90-95% and PaO2 of 60-80mmHg indicates
normal!
An SPO2 of >95% and PaO2 of >80mmHg indicates
serious hypoxaemia
An SPO2 of <90% and PaO2 of 6<00mmHg indicates
life-threatening hypoxaemia
An SPO2 of <75% and PaO2 of <40mmHg indictaes
F/OBS, laryngeal paralysis
Name 2 causes of upper airway dz
asthma, bronchoconstriction
Name 2 causes of lower airway dz
pneumonia, pulmonary oedema
Name 2 causes of parenchymal dz
pneumothorax, pleural effusion/mass
Name 2 causes of pleural space dz
Pulse oximetry (SpO2)
Arterial BG (PaO2, PaCO2)
Venous BG (PvCO2)
Thoracic RG
Thoracic US
Thoracocentesis
What are 6 tests you can use to Dx the cause of respiratory distress?
flow-by
mask
hood/tent
nasal
cage
intubation
What are 6 methods of providing oxygen to an animal?
Mask, hood/tent, nasal, intubation
Which oxygen systems provide high FiO2?
severe hypoxaemia PaO2 <60mmHg
severe hypoventilation PCO2 >60mmHg
eexcess resp effort - at risk of ventilatory arrest
In which 3 cases should IPPV be used?
Shock
What term describes the body's response to inadequate cellular energy production?
Decreased DO2 (delivery rate of oxygen)
hypovolaemia due to IV volume loss, vasodilation, failure of pump and decreased CO2 are associated with what parameter change?
Cardiogenic shock, may be caused by DCM, HCM, tamponade, anaesthetics
Which type of shock has low CO (forward flow), but is not due to hypovolaemia?
Hypovolaemic shock
Which type of shock is caused by low IV volume e.g. from fluid loss (V/D/PU), HM+ or maldistribution?
Vasodilatory shock, involves systemic vasodilation, mitochondrial dysfnx and myocardial depression
Which type of shock can be caused by SIRS, sepsis or anaphylaxis?
Cardiogenic or Hypovolaemic

Auscultate for heart murmur or arrhythmia
A cat presents with obtunded mentation, CRT >2s, pale and white MM, tachycardia, a fair to absent pulse and cool extremities. What two types of chock could this be, and how would you DDx between them?
Vasodilatory
A cat presents with obtunded mentation, a rapid CRT, injected MM, tachycardia, a bounding pulse and warm extremities. What type of shock is this?
Lactate, urine output, PvO2, central venous pressure, BP
What are 4 biomarkers you can use to Dx and monitor shock?
(HINT: BLUP)
fluids
How should you treat cardiogenic shock? (1 word)
isotonic crystalloid
Which fluid type would you recommend for a dog with dehydration and shock?
colloid

renal dz, heart dz, coagulopathy
Which fluid type would you recommend for a dog with a coagulopathy and shock? In which instances should you avoid this fluid type?
Hypertonic saline

Arrhythmia, dehydrated
Which fluid type would you recommend for a dog with head trauma and shock? In which instances should you avoid this fluid type?
With other fluids for anaemia and coagulopathies

For HM+
When should blood products be used to in a patient?
CAT 40-50ml/kg

DOG 80-90ml/kg
What are the shock doses in dogs and cats for isotonic crystalloids?
CAT 5-10ml/kg

DOG 10-20ml/kg
What are the shock doses in dogs and cats for colloids?
CAT 2-3ml/kg

DOG 4-6ml/kg
What are the shock doses in dogs and cats for hypertonic saline?
CAT 5-10ml/kg

DOG 10-20ml/kg

Packed RBC
For HM+: 10-25ml/kg/hr
What are the shock doses in dogs and cats for blood products? (also, HM+ rates)
begin with 1/4 - 1/2 dose, and then give the rest over 5-20mins
How should shock fluids be administered?
Pneumothorax
Pulmonary contusions
Hemothorax
Rib fx/flail chest
Diaphragmatic hernia
Myocardial contusions
What are 6 possible sequalae to thoracic trauma?
DX muffled dorsal lung sounds

TX thoracocentesis +/- thoracostomy tube (if persistent)
How would you Dx and Tx pneumothorax?
DX muffled ventral lung sounds

TX thoracocentesis only if severe dyspnoea > relieve resp distress but don't empty
How would you Dx and Tx hemothorax?
DX inc lung sounds +/- crackles

TX O2 therapy +/- manual PPV
How would you Dx and Tx pulmonary contusions?
Analgesia +/- paradoxical movement - rarely need to bandage or Sx
How would you Tx rib dx/flail chest?
DX muffled lung +/- heart sounds +/- thoracic borborygmy

TX O2 therapy + Sx
How would you Dx and Tx diaphragmatic hernia?
DX may have ventricular arrhythmia

TX anti-arrhythmic = lidocaine
How would you Dx and Tx myocardial contusions
Hemoabdomen
Septic abdomen
Uroabdomen
What are 3 possible sequalae to following abdominal trauma?
supportive therapy w/ blood, isotonic fluids (no bolus, causes HM+) +/- Sx
How would you Tx hemoabdomen?
Sx
How would you treat a septic abdomen?
Sx, but ca prolong catheter use if therapeutic
How would you Tx uroabdomen?
US = peritoneal effusion

RG = free peritoneal gas, effusion, DH, body wall hernia, fx
What might US and RG reveal following abdominal trauma?
PCV TP compare between peripheral and central
Cyto for sepsis
Glucose of effusion vs plasma for sepsis
K + creatinine for uroabdomen
What might abdominocentesis reveal following abdominal trauma (4 things)?
DX serial neuro exams

TX stabilise resp + CV > mannitol or hypetonic saline > O2 therapy > PPV (hyperventilation)
How would you Dx + Tx a traumatic brain injury?
Immobilise > neuro evaluation of pelvic and thoracic limbs > lateral thoracic and abdo RG
How would you deal with spinal trauma or injury?
Stabilise > RG > padded bandage to stabilise > Sx if needed
How would you deal with fractures (general)?
Sterile lube > cover w/ coft padded bandage to prevent contamination > parenteral Ab

Can clip/clean following stabilisation/evaluation
How would you deal with wounds (general)?