Exam 2 - Small Animal

Order triage emergencies from most critical to least critical?

Respiratory compromise, cardiovascular compromise, neurological compromise, other (infectious, unsightly, painful, etc)

ABCs approach from initial assessment?

Airway, breathing, circulation, disability/neuro, external assesment

• TPR, weight afterwards

What should be done to check a patient’s airway?

• Assess airway

• Stertor, stridor, effort, phase

• Are they moving air?

• Oxygen is never wrong

SPO2 less than or equal to 90% =

severe hypoxemia

Perfusion parameters to check for shock

MM color, CRT, pulse quality, HR, extremity temp

Shock is…

a physical exam diagnosis

Low BP =

shock

What are some things you can do/check for with circulation?

• Stop external hemorrhage

• Oxygen if needed

• Place IVC

• Fluids

• ECG

• BP

What are the “Big 4” for state bloodwork?

• PCV/TP

• BG

• Lactate

What should be assessed when looking at disability/neuro during triage?

• Assess level of consciousness

• Ability to walk

• Ability to move limbs/pain response

• Seizures

What are some things that should be ready for triage?

• IVC supplies

• Oxygen administration

• Gurneys

• CPR area/crash cart

• BP supplies

• Warming devices

• Monitors

• Quick diagnostics

Initial estimate form

• Quick explanation

• Rough estimate

• CPR code

What should be included in a quick history and when should a thorough history be performed?

Quick history

• Presenting complaint

• When last normal/progression?

• What’s been done/given already?

• Previous health issues?

• Medications/allergies?

Thorough history

• after stabilization

• <5 minutes

Imaging should…

wait until stable enough

What should be part of the secondary assessment for triage?

• Repeat physical exam

• Evaluation of full bloodwork results

• Imaging interpretation

• Reassess ABCs

A repeated physical exam for triage should look for:

• Recurrence of shock (perfusion parameters)

• Respiratory

• Neuro status

• Pain/anxiety

• Clean, dry, good nursing care

• Maintenance of lines, tubes, catheters

• Bandaging/splints

• Urine output/hydration status/fluids

What kind of imaging can be done very quickly during an emergency?

TFAST/AFAST ultrasound

Hyperkalemia

high potassium levels in the blood

What are some common types of feeding tubes?

• NE (Nasoesophageal)

• NG (Nasogastric)

• Esophagostomy

• Gastrostomy tube

• Jejunostomy tube

What are some ways to confirm placement of a NE/NG tube?

• Radiographs are the gold standard

• Attach a syringe and aspirate (You want negative pressure!, if not you’re in the lungs)

• Inject a small amount of air into tube and listen to stomach (should hear the air)

• Inject small amount of saline (if the patient coughs, you’re in the lungs)

Features of NE/NG tubes

• stays in place for short/moderate amount of time

• Inexpensive

• No specialized equipment

• Bolus or CRI feedings

• In-hopsital use ONLY

• Nurses typically place

• No anesthesia needed (may use local block)

What are some considerations for NE/NG tubes

• Must verify positioning

• Patients can remove the tube

• Can be uncomfortable

• Tubes are small

• Liquid diets ONLY

• MUST wear e-collar

What are some contraindications for NE/NG tubes?

• Epistaxis

• Nasopharyngeal disease

• Esophageal disease

• Maxillofacial trauma

• Coagulopathies

Placement of NE/NG tubes

• Drop proparacaine into nose and possibly eyes

• Measure NE: 7th to 9th intercostal space NG: Caudal border of 13th rib

• Mark tube at desired length with sharpie

• Place stay suture on side of nose

• Lube the tube with lidocaine jelly

• Aim ventrally and medially

• Gently advance tube to desired location (STOP IF YOU HIT RESISTANCE)

• Can check for swallowing

• Confirm placement

• Secure in place with finger-trap

Esophagostomy tube

• Short to long-term use

• Placed by vet under general anesthesia

• Used in patients with maxillofacial trauma

• Liquid or slurry diets

• Can give meds through tube

• Avoid in patients with

  • Esophageal disease, coagulopathies

• Patients can go home with tube in place

• Complication:

  • infection, clogging, falling out

Gastrostomy tube

• Long-term use

• Placed by vet under general anesthesia

• Bypasses oral cavity, pharynx, and esophagus

• Tolerated by patients well

• Must remain in place for at least 2-3 weeks

  • Seal needs to form between stomach and tube

  • Sepsis likely if pulled before then

• Can be maintained for months

Jejunostomy tube

• Long-term use

• Placed by vet under general anesthesia

• Like a G-tube, but also bypasses the stomach

• Liquid diet ONLY

• Typically used in patients with proximal GI disease (pancreatitis)

• Must remain in place for at least 7 days

Thoracostomy tube (chest tube)

• Can be placed by nurses under direct DVM supervision

• Indications:

  • Pneumothorax

  • Pleural effusion

• Complications:

  • Latrogenic pneumothorax

  • Infection

  • Trauma to thoracic organs

• Supplies

  • Mila kit

  • Clippers and scrub

  • sterile gloves

Tracheostomy tube

• Placed by vet under general anesthesia

• Indications:

  • Upper airway disease

  • Upper airway obstruction

    • Trauma, neoplasia, laryngeal paralysis, swelling

• Complications:

  • Infection

  • Obstruction of tube

  • Requires diligent patient management

Nasal oxygen

• Provides supplemental oxygen

• Procedure like NE/NG tubes

  • Measure from tip of nose to medial canthus of eye

• Must have e-collar on

• Different types

• Connect to a bubbler with moisturized air

  • Oxygen is dry - can cause irritation

• % O2 depends on # of tubes

  • 1 delivers 30%

  • 2 delivers 40%

What are some reasons for why we give “fluids”?

• Replace losses/dehydration (vomiting, diarrhea, etc.)

• Daily maintenance for anorectic patients

• BP maintenance under GA

  • 3ml/kg/hr cats, 5ml/kg/hr dogs

• Fix electrolyte/acid base disorders

• IV nutrition

• Blood products (RBCs, plasma)

• Carrier agent for drugs

• Maintain IV access, monitoring (e.g. art lines)

Total body water =

50-70% of body weight in kg (60%)

What are the two big fluid compartments?

Intracellular and extracellular

The Intracellular compartment accounts for how much of the body’s water?

2/3

Intracellular compartment

Fluid inside of the cell

Extracellular compartment

outside of the cell

Extracellular compartment accounts for how much of the body’s water?

1/3

What three compartments that make up the extracellular compartment?

Interstitial fluid, intravascular fluid (plasma) & transcellular fluid (fluid found in cavities)

Osmosis

Water is going to move from a fluid of higher water concentration (low solutes) to a fluid with a lower water concentration (high solutes)

Tonicity

effective osmolality as compared to something else

Osmolarity

amount of solutes within specific fluid volume

Colloids

“big” particles that help hold fluid around them and (theoretically) stay in the IV space

The ability of colloids to help pull fluid around them is called what?

Oncotic pressure or COP (colloid osmotic pressure)

Crystalloids

small particles in aqueous solution

• Variations of salt water

• Isotonic, hypertonic, hypotonic

• Isotonic most commonly used fluid in vet med

Isotonic IV solutions

• same osmolarity as the blood (same concentration of solutes)

• equal transfer of water, not affecting the cell

• it expands extracellular fluid volume (plasma)

Ex. Plasmalyte, Normosol-R, Lactated Ringers, 0.9% NaCl

Hypertonic IV Fluids

• higher osmolarity than the blood (higher concentration of solutes in fluid)

• osmosis will cause water to leave intracellular space (cell shrinks)

• expands extracellular space

• Ex. 3% NaCl, 7.5% NaCl

Hypotonic fluids

• lower osmolarity than blood (lower solute concentration in fluid)

• Osmosis causes water to move from extracellular space to intracellular space (cell swells)

• Dilute extracellular space and replenish inside of cell

• Ex. DSW (5% dextrose in water), 0.45% NaCl, Sterile water

Where do most isotonic crystalloids end up?

In the interstitial space

What are Isotonic fluids used for?

• Rehydration

• Replacement of losses

• IV boluses for shock

Shock

A life-threatening condition that occurs when the body is not getting enough blood flow. This means that the cells and organs are not getting enough oxygen and nutrients to function properly.

FULL shock dose is =

blood volume

What is the full fluid shock dose for a dog and cat?

Dog: 90 ml/kg

Cat: 60 ml/kg

How much of a full shock dose do we usually start with?

¼ of a full dose

How much is a quarter shock bolus for a dog/cat?

• 20-ish ml/kg for a dog

• 15 ml/kg for a cat

Fluid plan

Maintenance + deficit + ongoing losses

List the required gear to enter a small animal barrier kennel/run

Boot covers, gown, exam gloves, mask

List at least four diseases that require barrier nursing

Canine parvovirus, Infectious hepatitis, kennel cough, leptospirosis, feline panleukopenia virus

What is the normal range for blood glucose in a cat and dog?

Canine: 67 - 132 mg/dL

Feline: 75 - 134 mg/dL

What is the normal range for TP for both cats and dogs?

6-7.5 g/dL

What are four locations where IO catheters are typically located?

Tibial tuberosity, Greater tubercle, wing of ilium, trochanteric fossa of the femur

What are common conditions requiring rehabilitation?

• Soft tissue surgery

• Neurologic injuries

• Post-surgical

• Weight loss

• Canine athletes

• Geriatric/hospice

• Critical care

Rehabilitation

• evaluation and treatment of functional problems/impairments (disease or injury)

• Management of a disability towards the treatment of the disease and return to normal function

What are the three types of massages?

Effleurage, Petrissage, Friction

What are some positive benefits of rehabilitation

• Improve recovery time

• Reduce pain and inflammation

• Improve strength and endurance

• Minimize side effects of injury

• Positive mental/social wellbeing

What is included in a physical exam for a rehabilitation evaluation?

• Weight

• TPR

• Temperament

• Musculoskeletal and neurologic assessment

• Gait

• Pain/Lameness scales

• Objective vs subjective

What is included in a musculoskeletal exam?

• Gait analysis (walk, pace, trot)

• Range of motion (Goniometry)

• Posture

• Muscle mass (tone, strength, symmetry, cirumference)

What is included in a neurologic exam?

• Gait analysis (ataxia, paretic vs pelagic)

• Spinal reflexes

• Sensation

• Proprioception

Goniometry

• Measuring flexion and extension of each joint

• Establish a baseline

Paresis

weakness; partial or incomplete loss of voluntary motor function

Plegia

indicates complete loss of voluntary motor function; paralysis