resuscitation in small animals - Maravet

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Heat Stroke 51 meglumine is contraindicated. These drugs act on the hypothalamic set point and may contribute to iatrogenic hypothermia. They also may worsen gastrointestinal ulceration and ischemic damage to the kidneys. Corticosteroid use is unproven, although its use for specific complications such as cerebral edema may be warranted. 14. What complications should be anticipated in animals with heat stroke? Core temperatures at or above 43°C (109°F) may result in irreparable organ damage. Oxidative phosphorylation is uncoupled, cellular membrane function is impaired, and enzymes are denatured. Kidney damage is common because of direct thermal injury to the renal tubular epithelium, decreased renal flow, and hypotension and thrombosis associated with DIC. Clinically, BUN and creatinine levels are increased, and renal tubular casts are seen in the urine. Oliguria and anuria may develop. Hypotension and thermal injury also affect the gastrointestinal tract, causing gastric and intestinal ulceration. Disruption of the normal mucosal barrier may lead to bacteremia and sepsis. Liver damage, as evidenced by increased levels of AST, ALT and serum bilirubin, may result from thermal injury or prolonged splanchnic hypotension. Disseminated intravascular coagulation is a common complication of heat stroke. Endothelial cell damage occurs causing elevated endothelin, circulating intercellular adhesion molecule-I, and von Willebrand factor-antigen. Heat can also cause widespread cell necrosis leading to inactivation and consumption of platelets and coagulation factors. Thrombocytopenia, increased fibrin degradation products, and prolonged prothrombin and partial thromboplastin times also are seen. Nerve tissue is susceptible to thermal injury. With direct effects of the heat on endothelium, thermal injury may cause brain hemorrhage and edema as well as thrombosis and infarction of cerebral tissue. Prolonged exposure to high temperatures leads to neuron death and permanent brain damage. 15. How long after successful cooling can the above complications be a problem? Clinical signs related to the above complications may develop 3-5 days after apparent recovery. Changes in mental status, oliguria, vomiting, bloody diarrhea, icterus, dyspnea, and petechiation should alert the clinician to the possibility of significant complications. Continuous monitoring well past resolution of the hyperthermia is mandatory. 16. How should complications be managed? Acute renal failure should be aggressively treated with intravenous fluids to restore hydration and to improve glomerular filtration rate. Central venous pressure and urine output should be followed regularly in all patients with heat stroke. Ifoliguric renal failure is present, intravenous furosemide and a constant-rate infusion of dopamine may be given to improve urine output. Patients with signs of liver failure or gastrointestinal damage should receive supportive care to maintain fluid and electrolyte balance. Because of the risk of bacterial translocation across damaged tissues, broad-spectrum, nonnephrotoxic antibiotics should be started. Fresh frozen plasma should be used to replace clotting factors in patients with DIC. Subcutaneous injections of heparin may be indicated to prevent microvascular thrombosis associated with DIC. Seizures are initially treated with intravenous diazepam. Coma or other signs of cerebral edema may be managed with intravenous dexamethasone. 17. Discuss ways to prevent heat stroke. Heat stroke is most likely to occur when animals are confined in a hot environment. Owners should be educated about the risks of keeping animals in cars or under the sun without adequate shade or water. Animals with preexisting airway problems or obesity should be exercised carefully, preferably not during the hottest times of the day. When possible, underlying problems such as laryngeal paralysis and obesity should be corrected.
52 Heat Stroke BIBLIOGRAPHY I. Bouchama A, Hammami M, Haq A, Jackson J: Evidence for endothelial cell activation/injury in heatstroke. Crit Care Med 24: 1173-1178, 1996. 2. Drobatz KJ: Heat-induced illness in dogs. Proceedings of the Fourth International Veterinary Emergency and Critical Care Symposium. 1994, pp 361-364. 3. Drobatz KJ, Macintire DK: Heat-induced illness in dogs: 42 cases (1976-1993). J Vet Med Assoc 209: 1894-1899, 1996. 4. Hardy RM: Fluid and electrolyte disorders: Hypernatremia. Vet Clin North Am 19:231-240, 1989. 5. Holloway SA: Heatstroke in dogs. Comp Contin Educ Pract Vet 14:1598-1604, 1992. 6. Lee-Parritz DE, Pavletic MM: Physical and chemical injuries: Heatstroke, hypothermia, bums, and frostbite. In Murtaugh RJ (ed): Veterinary Emergency and Critical Care Medicine. S1. Louis, Mosby, 1992, pp 194-196. 7. Ruslander D: Heat stroke. In Kirk RW (ed): Kirk's Current Veterinary Therapy, vol XI. Philadelphia, W.B. Saunders, 1992, pp 143-146.
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Publisher: HANLEY & BELFUS, INC. Me
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xii Contributors Michael R. Lappin,
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DEDICATION To my residents in emerg
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I. Life-threatening Emergencies Sec
Page 10 and 11: Decision Making in Veterinary Emerg
Page 12: 4 Cardiopulmonary Arrest and Resusc
Page 15 and 16: Cardiopulmonary Arrest and Resuscit
Page 17: Cardiopulmonary Arrest and Resuscit
Page 21 and 22: Cardiopulmonary Arrest and Resuscit
Page 23 and 24: Respiratory Distress 15 6. Blumenth
Page 25 and 26: 16 Respiratory Distress Hyperventil
Page 27 and 28: 18 Respiratory Distress Chest wall.
Page 29 and 30: 20 Respiratory Distress 20. What ar
Page 31 and 32: 4. PATHOPHYSIOLOGY OF CONGESTIVE HE
Page 34 and 35: Pathophysiology of Congestive Heart
Page 36 and 37: Class I Class II Class III Class IV
Page 38 and 39: Shock 29 5. During the course of th
Page 40 and 41: Shock 31 15. Blood flow to which or
Page 43 and 44: 34 Shock administration of general
Page 45 and 46: 36 Shock Often the infusion of a sy
Page 47 and 48: 38 Acute Gastric Dilatation-Volvulu
Page 49 and 50: 40 Acute Gastric Dilatation-Volvulu
Page 52 and 53: Anaphylaxis 43 obstruction, profuse
Page 54 and 55: 44 Hypothermia bronchoconstriction,
Page 56 and 57: 46 Hypothermia 11. What cUnical fin
Page 58 and 59: 48 Heat Stroke across ischemia-dama
Page 60: Heat Stroke 49 of environmental tem
Page 65 and 66: 54 Treatment Priorities in Trauma S
Page 67 and 68: 56 Treatment Priorities in Trauma 1
Page 69 and 70: 58 Arterial Bleeding 9. Should a to
Page 71 and 72: 12. RESPIRATORY EMERGENCIES Elisa M
Page 73 and 74: 62 Respiratory Emergencies 15. Name
Page 75 and 76: 64 Respiratory Emergencies 27. What
Page 77 and 78: Traumatic Myocarditis 65 • Loss o
Page 79 and 80: Traumatic Myocarditis 67 therapy. I
Page 81 and 82: 68 Fluid Selection in Trauma BIBLIO
Page 83: 70 Fluid Selection in Trauma 11. Wh
Page 86 and 87: Fluid Selection in Trauma CONTROVER
Page 88: 74 Blood Transfusions 8. Mandell DC
Page 91 and 92: Blood Transfusions 77 17. Can trans
Page 93 and 94: 78 Brain Injuries II. Purvis 0: Aut
Page 95 and 96: 80 Brain Injuries The Small Animal
Page 97 and 98: 82 Brain Injuries Examination ofthe
Page 99 and 100: 84 Brain Injuries 24. Should mannit
Page 101 and 102: Acute Spinal Cord Injuries BIBLIOGR
Page 103 and 104: Acute Spinal Cord Injuries 87 11. W
Page 105 and 106: Peripheral Nerve Trauma 89 22. What
Page 107 and 108: 90 Peripheral Nerve Trauma o Neurot
Page 109 and 110: 92 NERVE Pudendal SI-S3 Pelvic plex
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94 Extremity Trauma 8. What is a gr
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20. ABDOMINAL INJURIES Wayne E. Win
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98 Abdominal Injuries 11. Which oth
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Pain Management in Emergencies 99 a
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Pain Management in Emergencies 101
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22. DISASTER PREPAREDNESS AND THE V
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Disaster Preparedness and the Veter
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Ill. Common Primary Complaints Sect
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PRIMARY GI DISORDERS Obstructions (
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114 Diarrhea idiopathic vestibular
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116 Diarrhea 9. What are the potent
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Syncope vs. Seizures 117 3. Jergens
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26. ATAXIA Tim Hackett, D.V.M., M.S
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27. ANOREXIA Tim Hackett. D.v.M., M
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Anorexia 123 10. Should anorexia be
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124 Fever BIBLIOGRAPHY I. Barrett R
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126 Stranguria during fever, can be
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Stranguria 127 • Urinary tract in
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Stranguria 129 and cats is transiti
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Obstipation and Constipation 131 11
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132 Obstipation and Constipation Co
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Fractured Tooth Drugs Used for Chro
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Abscesses and Cellulitis 135 and up
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136 Abscesses and Cellulitis 5. How
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Rattlesnake Envenomation 137 11. Wh
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Rattlesnake Envenomation 139 Rattle
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142 Lameness 5. What is the Ortolan
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144 Infectious Disease fluid therap
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Infectious Disease 145 2. How can t
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IV. Ophthalmic Emergencies Section
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Acute Ocular Trauma 149 11. How is
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Acute Ocular Trauma 151 deep stroma
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152 Ocular Hemorrhage removal, trea
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154 Ocular Hemorrhage 7. What cyclo
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156 Sudden Blindness orders such as
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Sudden Blindness 157 poorly respons
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Uveitis 159 3. Krohne SD, Vestre WA
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160 Uveitis 9. What are the major c
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162 Uveitis 14. What significance c
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Glaucoma 163 2. Bistner S, Shaw D,
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Glaucoma 165 true for plunger loads
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Vision-threatening Corneal Ulcers B
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168 Vision-threatening Corneal Ulce
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v. Respiratory Emergencies Section
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172 Allergic Airway Disease in Cats
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176 Dirofilariasis necessary not on
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Dirofjlariasis 177 through the host
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Dirofilariasis 179 19. How frequent
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45. PULMONARY THROMBOEMBOLISM Elisa
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Pulmonary Thromboembolism 183 17. W
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184 Laryngeal Paralysis 25. What ca
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186 Laryngeal Paralysis • Aryteno
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Near Drowning 187 13. Schachter S,
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Pulmonary Edema 189 16. What monito
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190 Pulmonary Edema 3. Describe the
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192 Pulmonary Edema thereby decreas
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49. HEMOPTYSIS Wayne E. Wingfield,
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50. SMOKE INHALATION AND BURN INJUR
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198 Smoke Inhalation and Burn Injur
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VI. Cardiovascular Emergencies Sect
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202 Mitral Valve Insufficiency Due
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204 Dilated Cardiomyopathy tachyarr
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206 Dilated Cardiomyopathy function
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208 Dilated Cardiomyopathy Digoxin
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210 Dilated Cardiomyopathy Devices
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Cardiac Arrhythmias 211 14. Sisson
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Cardiac Arrhythmias 213 3. Holter m
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Cardiac Arrhythmias 215 2. Frequenc
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Cardiac Pacemakers 217 Electrocardi
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Pericardial Effusion BIBLIOGRAPHY I
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Pericardial Effusion 221 effusion a
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Pericardial Effusion 223 23. What a
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Feline Myocardial Disease 225 felin
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Feline Myocardial Disease 227 prece
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Feline Myocardial Disease 229 befor
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Feline Myocardial Disease 231 diagn
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232 Systemic Arterial Thromboemboli
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234 Systemic Arterial Thromboemboli
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236 Neutropenia, Sepsis, and Thromb
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238 Neutropenia. Sepsis, and Thromb
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Neutropenia, Sepsis, and Thrombocyt
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Coagulation Disorders 243 renal dys
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244 Coagulation Disorders and morta
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61. METABOLIC EMERGENCIES IN PATIEN
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Metabolic Emergencies in Patients w
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• Chlorpropamide • Vincristine
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252 Cancer Treatment-induced Conges
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Chemotherapy-induced Anaphylaxis 25
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Extravasation of Chemotherapeutic D
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260 Extravasation of Chemotherapeut
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Chemotherapy-induced Acute Renal Fa
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Chemotherapy-induced Acute Renal Fa
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Anemia, Thrombocytopenia, and Hypop
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268 Anemia, Thrombocytopenia, and H
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270 Intervertebral Disk Disease 7.
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272 Seizures 5. Fingeroth 1M: Treat
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Seizures 273 8. Give examples of bi
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276 Meningitis and Encephalitis 3.
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278 Meningitis and Encephalitis 15.
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280 Coma 6. When should mannitol be
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282 Acute Progressive Lower Motor N
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Acute Progressive Lower Motor Neuro
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Brain Death BIBLIOGRAPHY I. Barsant
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286 Brain Death the main reason for
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74. HYPOGLYCEMIA Chris McReynolds,
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Acute Pancreatitis 295 Many other n
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Acute Pancreatitis 297 10. Do norma
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Hypoadrenocorticism 299 3. Hill RC,
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300 Hypoadrenocorticism 4. Which ab
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302 Hypoadrenocorticism 15. When sh
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Peritionitis 7. Outline the major c
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Peritionitis 307 creatinine is grea
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Peritionitis 309 closed depending o
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Potassium Abnormalities 311 5. How
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Potassium Abnormalities 313 19. Wha
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314 Magnesium Abnormalities CONTROV
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316 Magnesium Abnormalities 15. Whi
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318 Hypoproteinemia with loop diure
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Hypoproteinemia 3. What is the prim
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Fluid and Electrolyte Therapy 321 1
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Fluid and Electrolyte Therapy 323 1
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Fluid and Electrolyte Therapy CONTR
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328 Acid-Base Disorders 5. List the
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Portosystemic Shunts CONTROVERSY 37
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Portosystemic Shunts 335 enema. Sei
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Hepatic Lipidosis and Acute Hepatit
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338 Hepatic Lipidosis and Acute Hep
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340 Transfusion Trigger 4. Dimski O
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342 Transfusion Trigger 12. What is
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344 Transfusion Trigger BIBLIOGRAPH
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346 Foreign Bodies in the Digestive
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348 Foreign Bodies in the Digestive
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Canine Hemorrhagic Gastroenteritis
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350 Esophageal Disorders 3. Which d
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352 Esophageal Disorders 11. What o
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Canine Parvovirus 353 21. How do yo
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Canine Parvovirus 355 9. What are t
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Canine Parvovirus CONTROVERSIES 18.
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Intussusception 359 fluid-filled lo
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Colitis 361 15. What suture pattern
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362 Colitis 3. What is the typical
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XI. Reproductive Emergencies Sectio
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366 Paraphimosis 12. What are the s
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Paraphimosis 367 4. What factors pr
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368 Eclampsia • Preputial adhesio
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Dystocia • Depressed or obtunded
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Dystocia 373 11. What other ecbolic
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96. ABORTION LoriA. Wise, DYM., M.S
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XII. Urologic Emergencies Section E
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Urinary Tract Infection and Acute P
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380 Urinary Tract Infection and Acu
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382 Urinary Tract Infection and Acu
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384 Acute Renal Failure treatment w
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Acute Renal Failure 385 3. What are
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Acute Renal Failure 387 therapy may
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Acute Renal Failure 389 because of
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Acute Renal Failure 391 28. What fa
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392 Obstructive Feline Lower Urinar
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Peritoneal Dialysis and Hemodialysi
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General Toxicology and Approaches 4
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General Toxicology and Approaches 4
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Ethylene Glycol Intoxication 409 el
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Ethylene Glycol Intoxication 411 7.
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412 Lead Poisoning BIBLIOGRAPHY I.
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414 Organophosphate and Carbamate T
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Organophosphate and Carbamate Toxic
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Anticoagulant Rodenticide Toxicity
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418 Anticoagulant Rodenticide Toxic
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420 Cholecalciferol Toxicity times
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Cholecalciferol Toxicity 421 transi
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422 Toxin-induced Seizures disodium
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424 Bites and Stings 8. Is seizure
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Bites and Stings 425 of the venom s
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Bites and Stings 427 17. What are t
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Nonsteroidal Antiinflammatory Drug
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XIV. Emergency Procedures Section E
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Temporary Tracheostomy 433 of the n
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Temporary Tracheostomy 435 each of
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Thoracic Drainage 437 enough to pro
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Thoracic Drainage Proper placement
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Thoracic Drainage 441 If the leak p
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442 Pericardiocentesis 21. Should I
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444 Pericardiocentesis Intravenous
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446 Emergency Venous Access 8. Mill
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EmergencyVenousAccess 447 around th
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Urethral Catheterization BIBLIOGRAP
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450 Urethral Catheterization rigidi
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452 Urethral Catheterization 3. A s
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454 Urethral Catheterization viscou
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456 Urethral Catheterization Result
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458 Abdominal Paracentesis Needle p
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460 Abdominal Paracentesis protein,
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462 Cerebrospinal Fluid Collection
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Cerebrospinal Fluid Collection and
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118. INVASIVE BLOOD PRESSURE MONITO
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Invasive Blood Pressure Monitoring
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Dopplertechnique Indirect Arterial
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120. MECHANICAL VENTILATION Elizabe
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Initial Ophthalmic Evaluation 477 2
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Initial Ophthalmic Evaluation Ophth
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Appendix I: Emergency Drugs 481 Dru
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484 Appendix I: Emergency Drugs Dru
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ABCs of basic life support, 5 of po
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Arrhythmias, cardiac (cont.) postop
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Cardiovascular disease (cont.) as r
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Diarrhea, 114-117 canine hemorrhagi
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Fluid therapy (cant.) for smoke inh
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Ileus, paralytic, 348 Immersion syn
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Neutropenia, 235-236, 237-240, 353
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Propulcid, 132, 133 Prostaglandin F
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