Emergency Medicine Vet Tech, review

What does the MCV signal in blood work?

Indicates the average RBC volume

Can be altered by agglutination or hemolysis

Total protein volumes are estimated on which value?

Total solids (TS)

Total solids (TS)

Is a good predictor of protein concentration

(plasma proteins influenced by TS)

Normal K9 PCV

37% - 55%

Lower in puppies

Higher in greyhounds

Normal Cat PCV

30% - 45%

Lower in kittens

Total solids K9 normal

5.4 - 7.5 g/dl

Total solids Cat normal

5.7 - 7.6 g/dl

Anemia is defined as

A PCV measurement below the reference range

Caused by

Dehydration

Splenic contractions (Mostly in k9’s)

Normal WBC for K9

6k-17k cells / microliter of blood

Normal WBC for cats

5500 - 19k cells / microliter of blood

Normal platelet for k9’s

160k - 430k cells / microliter of blood

Normal platelet for cats

300k - 800k cells / microliter of blood

Hyperkalemia causes

Urethral obstruction

acute renal failure

hypoadrenocorticism (addison’s dz)

Azotemia is associated with

kidney failure

Urine production of cat and dog

1-2 ml/kg/hr

Urine specific gravity for cats and dogs

1.30-1.35 g/dl

In blood gas analysis, arterial samples give info about …

Oxygenation

In Venus sample this give info about …

acid-base status & ventilation

What does elevated lactate lvls mean?

a diverse group of serious underlying conditions

How is lactate “cleared?”

By the liver

converting it back to glucose

OR

oxidizing the molecule to CO2 & H20

What is systolic pressure?

Pressure against arteries, generated by ventricular contraction

What is diastolic pressure?

minimum pressure maintained between contractions

What is mean arterial pressure?

Average pressure during the cardiac cycle

What is Hypoxemia

Partial pressure of O2 in arterial blood less than 80 mm Hg

Severe = less than 60 mm Hg

What 4 major organ systems should you focus on in an emergency p+?

Respiratory

Cardiovascular

Neurological (Nervous system)

Renal systems

System that certifies emergency & critical care hospitals

The Veterinary & Critical Care Society (VECCS)

What is the goal of triage?

To ensure the most critical patients are assessed 1st

To ensure life-threatening conditions are tx 1st

In a telephone triage, what is written down?

Callers name

Phone #

Pet signalment

Situation (like what happened)

How long should a hospital triage take?

2-5 min

In a life-threatening situation, how do you take triage?

At the same time you are assisting/giving life-saving tx

What does the ABCDE mean?

Airway

Breathing

Circulation

Disability

External assessment

Triage color system: Red

Pt w/ life-threatening condition

Immediate stabilization needed

(Cardiac arrest Or Resp.distress)

Triage color system: Orange

Emergency pt

Tx needed within the next 10 min

(Shock, GDV, dyspnea, toxic ingestion, severe pain)

Triage color system: Yellow

pt w/ urgent condition

recieve care in less than 60 min. Checked up on multiple times to check if condition has worsened or not

(Mild dehydration, moderate blood loss, Seizure history)

Triage color system: Green

Pt. remains in waiting room. Owner is instructed to notify receptionist if patient has worsened.

Should recieve care around 120 min

(Non-hemorragic v+, D+, Moderate wound size/pain)

Triage color system: Blue

Pt is stable/non-urgent. Seen when DVM is available.

Should be seen in around 4hrs

(mild cough, lameness, skin dz, mild pain)

What can happen when a pt is not stabilized fast enough?

PH lvls become unstable

Acid-base lvls become unstable

Rep.distress/arrest can occur

Death

Before administrating sedation for your pt, what should you examine first before you do?

Rule out primary heart diseases and airway obstructions

Stridor

Noisy breathing, high-pitched sound

Locations:

Larynx

Trachea

Stridor

Noisy breathing, low-pitched sound

Locations:

Nostrils

Esophagus

What are Cheyne-Stokes?

escalating hyperventilation, followed by decremental hyperventilation, and finally apnea, which repeats in cycles.

What causes Cheyne-Stokes?

Congestive heart failure

Kidney problems

Severe neurologic issues

What is Kussmaul breathing?

Regular, deep breaths w/out pause

What causes Kussmaul breathing?

Severe acidotic disorders

What is paradoxical breathing?

Inspiration: Chest contracts

Expiratiion: Chest expands

What is dyspnea?

Labored breathing

What can cause dyspnea in labored inspiration?

Upper airway disorders (above thoracic inlet)

FB

Collapsed trachea

Laryngeal paralysis

Tracheal collapse

Nasopharyngeal disorders (Masses. Polyps more in cats)

Brachycephalic occlusive syndrome

Severe head trauma (fx’s/swelling/hemorrhages)

What can cause dyspnea in labored expiration?

obstructive dz (distal to thoracic inlet)

Feline asthma

What can cause dyspnea in labored inspiration & expiration?

Combo of upper & lower airway dz’s

fixed airway obstruction

parenchymal disorders

Pneumonia (infectious, aspiration)

Contusions

Pulmonary edema

Neoplasia

What can cause Hypernea? (Deep breath)

Airway obstruction

Narrowing airways

What can cause Hypopnea? (shallow breath)

Pleural effusion

Pneumothorax

Diaphragmatic rupture/paralysis

What can harsh lung sounds indicate?

Pneumonia

Neoplasia

Pulmonary contusions

Example of a cardiogenic parenchymal disorder

R-sided heart failure

Example of a non-cardiogenic parenchymal disorder

Fluid overload

Stangulation

Electrocution

Adaptation of dyspnea: Orthopnea

Stand or sit sternal

Lift head and extended neck

Abduct elbows

MM color: Muddy/gray

Poor tissue perfusion

Hypoxia

MM color: Brick red

Septic shock

CO2 poisoning

MM color: Yellow

Hepatic (liver) disfunction

Hemolysis

biliary obstruction

MM color: Brown

Acetaminophen toxicity (Tylenol)

MM color: Petechia/ecchymoses

Primary coagulation disorder

CRT: <1sec Conditions

Fever

distrubutive shock

heat stroke

compensatory stage of hypovolemic shock

Polycythemia

systemic inflammatory response syndrome (SIRS)

Arterial pulse Quality: Bounding/snappy

Increased pulse pressure

sepsis

compensatory shock

patent ductus arteriosus

Lvl of conciousness (LOC) : Obtunded

Inattentive or drowsy

Responds to environmental stimuli

Lvl of conciousness (LOC) : Stuporous

unresponsive to environmental stimuli

Responds to painful stimuli

Bleeding: Arterial

Bright red blood

rapid

pulsating spurts

Bleeding: Venous

Dark red blood

Oozing

What does “A CRASH PLAN” mean?

Airway & breathing

Cardiovascular

Respiratory

Abdomen (Wounds, bruises, pain)

Spine (Wounds, bruises, pain, palpate spin)

Head & EENT (Ears, eyes, nose, throat) (Nose, face, skull, teeth, eyes, jaw, ears, tongue)

Pelvis (Ilial wings, ischium, greater trochanter, rectum, genitals)

Legs (movements, feelings, joints, skin)

Arteries & veins (pulses, jugular fillings)

Nerves (LOC, peripheral nerves)

How much does a CPR cycle last?

2 min

How often does a CPR rotation occur?

every 2 min

What is the cardiac pump theory?

Ventricles compressed between sternum & Spine = dorsal recumbency

ventricles compressed between the ribs = lat recumbency

What is the thoracic pump theory?

chest compressions increase overall intrathoracic pressure

blood from thorac vessels go to venous circulation

What is a benefit of abdominal compressions?

Decreases abdominal trauma

When giving CPR, what is the common position the animal in placed in?

Lat recumbency

CPR hand placement: Barrel-chested dogs

(English bulldog/pugs)

hands directly over the heart

Lateral or dorsal recumbency

CPR hand placement: Keel chested dogs

(greyhound/doberman pincher)

Hands directly over the heart

CPR hand placement: cats & small dogs

circumferential compressions

For CPR, how many compressions is normal / min?

100-200

What type of compression is more effective? Direct or internal?

Internal

But has more risks

What drugs can be given IV & IO?

Atropine

Epinephrine

Lidocaine

Sodium bicarb

Naloxone

Vasopressin (high doses)

Which drugs can be given IT?
(intra-tracheal)

(NAVEL)

Naloxone

Atropine

Vasopressin

Epinephrine

Lidocaine

When you cannot give medicine or tx through IV, what route can you give it? And at what higher doses?

Via ET

2x the dosage

(Epinephrine = 10x)

(dilute with sterile water/saline)

What route is considered the "last resort?” & NOT reccomended.

IC (Intra cardiac)

Defibrillator: Monophasic

Unidirectional current flows

One electrode to the other

Dose: 4-6 J/kg

Defibrillator: Biphasic

Current: starts from one direction, reverses, flows in other direction

Recommended

Dose: 2-4 J/kg

Defibrillator: Mechanical

Striking the patient with the heel of your hand over the heart

ONLY IF ELECTRICAL DEFIB NOT AVAILABLE

Normal CO2 for cats and dogs?

35-45 mm Hg

Serious abnormalities seen w/ patients post-cardiac care?

Anoxic brain injury

postischemic cardiac dysfunction

reperfusion injury

SpO2 lvl’s for cat & dog?

94% - 98%

(100% is good too)

What is the mean arterial pressure maintenance range?

80 & 120 mm Hg

What does a PaO2 (partial pressure of O2 in arterial blood) less than 60 mm Hg mean?

Patient needs O2 supplementation

OR

Mechanical ventilation

What does a PaCO2 (partial pressure of CO2 in arterial blood) greater than 60 mm Hg mean?

Patient needs mechanical ventilation

Oxygenation status: SpO2 reading

Pro: less invasive

Con: Can be less accurate

Can be falsely elevated/decreased

Needs a pulse ox

What does an SpO2 reading of 92% indicate?

Hypoxia

CO2 status: Capnography

Pro: non-invasive

Monitors Co2 partial pressure & ETCO2

What can hypercapnia indicate?

Decreased ventilation

What can hyporcapnia indicate?

Hyperventilation

Pain

Hypoxia

What does poor tissue perfusion result in?

More O2 being demanded from the body

O2 supply can’t keep up

Why is anerobic metabolism bad?

Results in the buildup of lactic acid

Turns to lactic acidosis