Indepth Unit 6 - Triage

Emergency Preparedness

  • In emergency situations, animals are treated based on the severity of their condition, not their order of arrival.

  • Triage involves evaluating and prioritizing patients, with the most critical cases being seen first.

    • Example: An unconscious dog hit by a car receives higher priority than a limping dog.

  • A crash cart contains all necessary supplies and medications for common emergencies.

    • Its location should be known to all staff.

    • Supplies must be organized and clearly labeled.

    • Regular inventory checks are essential, at least monthly and after each use.

  • Some animals may require supplemental oxygen.

  • Crash cart contents include:

    • Endotracheal tubes (various sizes)

    • Gloves

    • Tape

    • Gauze

    • Scissors

    • IV catheters

    • Fluids

    • Urinary catheters

    • Monitors

    • Bandage material

    • Ambu-bag (for lung inflation)

    • Stethoscope

    • Syringes and needles

    • Blood tubes and other laboratory supplies

  • Veterinary technicians perform emergency procedures like CPR, catheter placement, and drug administration.

Commonly Used Emergency Drugs

  • Emergency drugs are available in tablet, injectable, and inhaled forms.

  • Inhaled drugs generally act faster than injectable drugs, which are faster than tablets.

    • Tablets require breakdown and absorption before taking effect.

Specific Drug Categories and Examples

  • Antihistamines: Treat allergic reactions (e.g., red, itchy skin).

    • Examples: diphenhydramine, hydroxyzine

  • Anticholinergics: Increase heart rate and counteract organophosphate overdose effects (drooling, vomiting, diarrhea).

    • Example: atropine

    • Organophosphate toxicity can occur from over-the-counter flea medications.

    • Side effects: dry mouth, constipation

  • Beta-2-adrenergic agonists: Stimulate heart rate and increase blood pressure in life-threatening emergencies.

    • Example: epinephrine

    • Albuterol: Opens airways to improve breathing.

      • Available in tablets, syrup, and inhalation form.

      • Side effects: rapid heart rate, high blood pressure

  • Methylxanthines: Dilate airways and mildly stimulate the heart.

    • Examples: aminophylline, theophylline (used for asthma, bronchitis, collapsing trachea)

    • Side effects: hyperexcitability, muscle tremors

  • Corticosteroids: Treat shock and inflammation.

    • Examples: prednisolone, dexamethasone

    • Low doses relieve inflammation.

    • High doses suppress the immune system (used for autoimmune disorders and preventing organ rejection).

    • Side effects: increased appetite and water consumption (leading to increased urination).

    • Caution: Do not use with NSAIDs due to increased risk of gastrointestinal ulcers.

  • Doxapram: Respiratory stimulant used in neonates after difficult births or cesarean sections.

    • Administered by injection or as a drop under the tongue.

Cardiovascular Drugs

  • Affect the heart and blood vessels.

  • Some drugs speed up the heart, while others slow it down.

  • Inotropes: Increase the strength of the heartbeat, making it more efficient.

    • Epinephrine has an immediate effect on heart rate and strength of contraction during cardiac resuscitation.

    • Dopamine and dobutamine are administered as constant rate infusions (CRI) to improve blood delivery (perfusion) to vital organs.

    • Digoxin slows the heart rate, allowing more time to fill (beneficial for weak hearts).

      • Narrow safety range; high levels can cause loss of appetite, vomiting, and diarrhea.

  • Vasodilators: Dilate (open) blood vessels, reducing the heart's workload.

    • Examples: hydralazine, nitroglycerin, nitroprusside

    • Side effects: excessively low blood pressure with rapid heart rate, lethargy, vomiting, and diarrhea.

  • Antiarrhythmics: Address abnormal heart rhythms (bradycardia or tachycardia).

    • Procainamide and lidocaine slow a tachycardic heart.

    • Beta-blockers (atenolol, propranolol) reduce blood pressure and heart rate.

      • Beta-blockers have opposite effects to beta-agonists like epinephrine.

  • Diuretics: Promote fluid loss to treat excessive fluid accumulation.

    • Increase urine flow to remove fluid.

    • Furosemide: used for heart disease.

    • Mannitol: treats cerebral edema due to head trauma.

    • Potential side effects: dehydration and electrolyte abnormalities.

Anticonvulsants

  • Seizures are caused by abnormal electrical activity in the brain.

  • Anticonvulsant drugs stop seizures.

    • Examples: injectable diazepam, phenobarbital (injectable and tablet form)

    • Diazepam is given IV for rapid seizure control.

    • Phenobarbital tablets are used for long-term seizure control.

    • Both agents have sedative properties.

Antiemetics

  • Prevent and treat vomiting.

    • Maropitant (Cerenia): Treats vomiting and motion sickness.

    • Chlorpromazine: Controls vomiting associated with gastrointestinal inflammation and chemotherapy.

    • Metoclopramide: Normalizes stomach and GI tract contractions, easing passage of material.

Emetics

  • Induce vomiting to treat toxin ingestion, common in dogs, less so in cats.

    • Apomorphine is used in dogs.

    • Xylazine is used in cats.

    • Both can cause sedation.

    • Apomorphine tablet administration in dogs:

      • A tiny piece is placed inside the lower eyelid for rapid absorption.

      • The tablet is removed, and the eye is flushed when vomiting occurs.

  • Activated charcoal can be given after inducing vomiting to prevent further toxin absorption.

Miscellaneous Antidotes

  • Activated charcoal: Absorbs drugs or toxins in the GI tract.

    • Administer orally.

    • Do not give oral medications within three hours of charcoal administration.

    • Avoid giving mineral oil or dairy products concurrently.

    • Administered via stomach tube due to taste.

  • Calcium EDTA: Chelates heavy metals (lead, zinc).

    • Treats lead poisoning or zinc toxicity.

    • Available as calcium disodium versenate injectable (for human use).

    • Distinct from the EDTA used as an anticoagulant in blood collection tubes.

  • Methylene blue: Treats methemoglobinemia or acetaminophen toxicity in dogs.

    • Adverse effects: Heinz body anemia.

    • Do not give to cats.

  • Acetylcysteine: Treats acetaminophen poisoning.

    • Administer orally (bad taste, needs to be hidden in food).

    • Nebulized acetylcysteine helps break up mucus caused by pulmonary diseases or dry eye (KCS), but can cause bronchospasms so monitoring is important.

  • Dimercaprol: Treats toxicity due to arsenic, lead, mercury, copper, zinc, or gold.

  • Pralidoxime chloride (2-PAM): Reverses organophosphate effects.

    • Must be given promptly before organophosphates age.

    • Do not use if the animal is having a carbamate or pyrethrin reaction.

  • Penicillamine: Chelates copper, lead, iron, and mercury.

    • Treats chronic copper toxicosis in dogs or cystine urolithiasis.

  • Sodium thiosulfate: Treats cyanide toxicity in horses and ruminants.

    • Administer intravenously very slowly.

    • Active ingredient in fish tank water dechlorinators.

  • Ethanol (alcohol): Competitively inhibits harmful crystal formation after ethylene glycol (antifreeze) toxicity if given soon after ingestion.

  • Fomepizole: Direct antidote to ethylene toxicity.

    • Administer intravenously (diluted in 0.9% sterile saline) within eight hours of ingestion.

  • Antivenin (antivenom): Treats snake bites from poisonous snakes.

    • Contains antibodies that combine and inactivate venom.

    • Does not reverse existing tissue damage.

    • Expensive.

  • Vitamin K1: Treats rodenticide poisoning causing excessive bleeding.

  • Thiamine HCl: Treats thiamine deficiency.

    • Deficiency in livestock and cats can cause severe neurological signs (e.g., inability to stand).

Reversal Agents

  • Atipamezole HCl: Reverses medetomidine (Domitor—an alpha-2 agonist).

    • Pain may return after reversal if the procedure was painful.

  • Flumazenil: Reverses benzodiazepines.

  • Naloxone HCl: Narcotic antagonist; treats narcotic overdoses.

  • Tolazoline: Reverses alpha-2 agonists like xylazine (Rompun) in horses.

    • Monitor for tachycardia, muscle twitching, or apprehension.

  • Neostigmine: Mimics the parasympathetic nervous system.

    • Treats ivermectin overdoses in cats.

  • Yohimbine HCl: Reverses alpha-2 agonists, especially xylazine (Rompun).