VET 242 Midterm Study Guide

Introduction/Triage (pg 3-16)

Essential Crash Cart Items
- ER drugs
- Needles/Syringes
- ET Tubes
- Laryngoscope
- IV Catheters
- Fluid Administration Sets
- Intubation Supplies
- Clippers
- Scrub
- Tape
Conditions Requiring Immediate Evaluation and Care
- Dry Heaving/Non-Productive Vomiting
- Respiratory Issues
- Trauma
- Acute Weakness or Collapse
- Changes in Mentation
- Toxin Exposure
- Snakebite
- Dystocia
- Seizures
ABCDEs of Triage
- Airway
- Assess if the airway is patent.
- Determine if there is an obstruction that needs removal.
- Consider intubation if necessary.
- Breathing
- Check if the patient is breathing.
  - Apneic or agonal breathing requires intubation and positive pressure ventilation.
  - If in respiratory distress, determine the cause:
  - Upper airway obstruction
  - Lower airway disease
  - Pleural space disease
- Interventions include:
  - Oxygen administration
  - Sedation
  - Tracheostomy
  - Positive Pressure Ventilation (PPV)
  - Thoracocentesis
- Circulation
- Assess heart rate, pulse rate and quality:
  - Strong vs weak/thready pulses
  - Check for pulse deficits and murmurs
  - Assess for arrhythmias
- Evaluate mucous membrane (MM), color, moisture, and capillary refill time (CRT).
  - Pale MM indicates anemia or poor perfusion.
  - Cyanosis indicates poor oxygenation.
  - Injected MM indicates inflammatory response.
  - Jaundice indicates hepatic disease or red blood cell (RBC) hemolysis.
  - Petechiae indicates a clotting disorder.
- Interventions:
  - If no heart rate, initiate CPR
  - Control major hemorrhage
  - Conduct fluid resuscitation with venous access
- Disability (Neurologic Compromise)
- Assess mentation:
  - Obtunded
  - Stuporous
  - Comatose
  - Dysphoric
- Examine pupils for size, shape, and pupillary light reflex (PLR).
- Observe postures:
  - Decerebrate
  - Decerebellate
  - Schiff-Sherrington
- Interventions:
  - Administer oxygen
  - Handle patients with neurologic trauma carefully
  - Use anticonvulsants for seizures
- External Exam
- Conduct thorough examination of the abdomen:
  - Check for pain, distension, fluid wave, bruising, and open wounds.
- Assess for orthopedic injuries.
- Look for ocular emergencies.

Hospital Triage

Client Communication
- Keep clients informed about wait times and costs for common scenarios.
- Allow clients to visit patients during treatment.
Care for Hospitalized Patients
- Anticipate treatment times.
- Ensure all necessary supplies for treatments are ready.
General Hospital Care
- Tasks such as laundry and cleaning are important, but patient care takes precedence.
- Strive for efficient management in the emergency room environment.

ER Clinical Pathology (pg 399-415)

Electrolyte Concentrations
- Affected by:
- Intake: Drinking, food, IV supplementation
- Excretion/Loss: Loss from the body
- Shifts: Between intracellular and extracellular fluid
Disorders of Electrolytes
- Sodium
- Most significant contributor to plasma osmolality.
- Changes indicate disturbance in body water rather than sodium concentration.
- Hypernatremia (>155 mEq/L): Sodium concentration increases due to loss of free water or solute-poor fluid.
  - Common causes include CKD, diarrhea, pancreatitis, peritonitis, intestinal obstruction, vomiting, diabetes insipidus, lack of water access, heat stroke, and fever.
  - Symptoms: Lethargy, weakness, ataxia, seizures, altered LOC, possible coma and death.
  - Treatment:
  - Gradually decrease sodium level for chronic cases.
  - Replace free water deficit, such as via IV crystalloid fluids.
  - Calculate free water deficit as follows:
    $ext{Free Water Deficit} = \bigg(\frac{ ext{Current Na}^+/140}-1\bigg) imes 0.6 imes ext{weight (kg)}$
  - Monitor sodium concentrations frequently and adjust fluids based on hypernatremia degree.
- Hyponatremia (<140 mEq/L): If free water gain occurs, sodium concentration will be diluted.
  - Causes include decreased plasma volume, hypothalamic disorders, inappropriate ADH release, and renal problems.
  - Symptoms: Minimal unless severe.
  - Treatment involves restoring IV space, correction of hypovolemia with fluids, and raising sodium levels gradually to prevent complications.
- Potassium
- Most significant intracellular cation.
- Hyperkalemia: Caused by increased intake, movement from intracellular to extracellular space (often due to acidosis), and decreased renal excretion.
  - Symptoms: Muscle weakness, changes in EKG (such as bradycardia, asystole).
  - Treatment varies based on severity but may include dextrose infusion, calcium gluconate, or insulin therapy.
- Hypokalemia: Caused by excessive cellular movement, inadequate intake, or urinary losses.
  - Symptoms include skeletal muscle weakness and cardiac arrhythmias.
  - Treatment focuses on potassium replacement and correcting underlying causes.
- Chloride, Calcium, and Acid-Base Balance
- Calcium
- Hypercalcemia: Caused by neoplasia, renal failure, and elevated vitamin D levels. Can result in PU/PD, muscle weakness, bradycardia, and neurologic dysfunction.
  - Treat underlying cause with IV fluids, furosemide, and sometimes corticosteroids.
- Hypocalcemia: Causes include eclampsia and pancreatitis. Symptoms can be minimal but may include EKG abnormalities and muscle tremors. Treatment depends on the ionized calcium level and may involve IV calcium therapy.

Medical Implications

Anion Gap: Used to detect unmeasured anions in blood. Examples include lactate, ketones, and uremic anions.
Acid-Base Evaluation: Understanding the relationship between CO2 (acting as an acid) and HCO3 (acting as a base) to evaluate arterial blood gases.
Blood Gas Analysis: Assessing pH, CO2, HCO3 to evaluate for respiratory and metabolic acidosis/alkalosis.

Venous Access and Fluid Therapy** (pg 35-42, 385-399)

Options for venous access
- Butterfly Catheter: For blood draws and medication administration.
- Over-the-Needle Catheter: Can be used for up to 72 hours.
- Through-the-Needle: Typically used in specific scenarios.
- Seldinger Technique: Ideal for central venous catheterization.
- PICC Line: Long-term access.
- Intraosseous Access: Particularly in neonates or for exotics.
Crystalloids vs Colloids
- Crystalloids: Solutions with small, osmotically active particles.
- Colloids: Solutions containing larger particles exerting oncotic pressure to retain fluids in the vascular space.
Fluid Calculation Examples
- Maintenance fluid rate calculation using the formula:
  $(30 ext{ kg} imes ext{BW}) + 70 = ext{ml/day}$ or the older method of $(60 ext{ ml}/ ext{kg}/ ext{day})$ .
Shock Doses:
- Dogs: 90 ml/kg
- Cats: 45 ml/kg

Shock (pg 17-33)

Definition of Shock: Inadequate cellular energy due to poor tissue perfusion resulting in decreased oxygen delivery.
Categories of Shock:
- Hypovolemic: Loss of intravascular volume.
- Obstructive: Decreased venous return to the heart.
- Distributive: Maldistribution of vascular volume often due to systemic inflammation.
- Cardiogenic: Heart failure affecting output.
Management Strategies per Category:
- Hypovolemic requires crystalloid and colloid therapy for volume restoration.
- Obstructive necessitates treating the obstruction.
- Distributive benefits from supportive fluids and vasopressors.
- Cardiogenic shocks require inotropes and careful fluid management.

Trauma (pg 65-82)

CRASH PLAN: A systematic approach for trauma evaluation.
- Airway, Cardiovascular, Respiratory, Abdomen, Spine, Head, Pelvis, Limbs, Arteries, Nerves.
Initial Treatments:
- Intravenous catheter placement, oxygen therapy, and analgesia, notably with opioids.
Diagnostics: Use of ultrasound, blood work, rapid tests for electrolytes, and EKG as necessary before moving to radiology for assessments like fractures or pneumothorax.
Stabilization Endpoints: Determined by vital signs normalization, adequate respiratory function, and pain management.
Procedures: Understand equipment and techniques for thoracocentesis and when to use abdominocentesis in traumatic cases.
CPR Guidelines and Techniques:
- Chest compression rates: 100-120/min, with ventilations at 10/min. Understand chest compression theories for effective application.