6. Other wound therapies:
Vacuum-Assisted Closure (VAC).
Honey and sugar therapy – creates a hypertonic
environment.
Recumbent Patient Care
Prevent decubital ulcers and atelactasis – rotate patient
every 2-4 hours
Urinary bladder and bowel maintenance
Pain control
Airway/ET tube/tracheostomy tube care
Adequate enteral or parenteral nutrition
Proper ocular care
Large Animal
“Proud Flesh” = Exuberant Granulation Tissue - horses
Modified Thomas splint = traction splint – bovine or small
ruminants
7. Pain Management
Preemptive and mutlimodal analgesia.
Signs of pain – physiologic vs behavioral vs dysphoria.
4 main categories of analgesics:
NSAIDs
Local anesthetic
Opioids
α₂-agonists
Adjunct analgesics:
Tranquilizers
NMDA receptor antagonists
Gabapentin
Corticosteriods
Tricylic antidepressants
8. Basic Monitoring of the ER & CC patient
Treat the patient not the numbers!
Initial blood diagnostics
PCV/TP, BG, CBC/Chemistry
Advanced blood diagnostics
Coagulation tests - ACT vs. BMBT vs. PT/aPTT
Lactate
Blood gas analysis – pH, HCO3¯, PaCO2, PaO2
metabolic acidosis vs. metabolic alkalosis; respiratory acidosis
vs. respiratory alkalosis
Other diagnostic tools
BP, SpO2, ETCO2, CVP, ECG, radiographs, ultrasound
9. Basic ECG Interpretation
Most common Lead to view arrhythmias –
Lead II
Electrode placement – right lateral
recumbency; Black/white/red/green/brown
Common paper speed of 50mm/sec or
25mm/sec
Interference = “60-cycle”
ECG waveforms
cardiac conduction system – SA node →→→
Purkinje fibers
P, QRS, & T waves
11. Diagnostic Sampling & Advanced ER techniques
Orogastric intubation
tip of nose to 13th rib
Intrarectal
Enemas vs med admin
Intraosseous
Alternative method for rapid IV-fluid
delivery in neonates and small
animals
Intravenous
Winged, over-the-needle, through-
the- needle, & multilumen
Tracheal care
Intratracheal - ER drugs (NAVEL)
Transtracheal wash
Tracheostomy tube placement &
care
Oxygen therapies
Flow-by/mask, cage, nasal
cannulas, oxyhoods
Thoracic care
Thoracocentesis - btn 7th & 8th
intercostal space
Thoracic drain placement
Abdominal care
Abdominocentesis - diagnostic vs
therapeutic
Gastric trocharization
Intraperitoneal administration - inject
@ level of umbilicus (Rt or Lt of
midline)
Peritoneal lavage
Urine collection/techniques
Voided, manual bladder expression,
cystocentesis, vs. catheterization
(collection vs indwelling)
Normal urine output
Aspirates
Arthrocentesis
Bone marrow
Fine needle
12. Fluid Therapy
Total Body Water (TBW) ~60%
ICF ~30-40% vs. ECF ~16-20%
Crystalloids
Hypertonic – rapid volume expansion (ex. Head injury,
cerebral edema).
Isotonic – replacement fluid (ex. Dehydration,
resusciation, ongoing losses).
Hypotonic – replace free water deficit; treat
hypernatremia.
Colloids – increase oncotic pressure; used in
resuscitation and patient’s with hypoproteinemia.
Natural (O₂-carrying capacity) vs. synthetic
13. Fluid Therapy
Phases of fluid therapy
Resuscitation – restore vascular volume; rapid fluid
bolus (“shock dose”).
Replacement – correct dehydration.
Fluid deficit (L) = % dehydrated (in decimal form) X
weight in kgs.
Maintenance – after dehydration is corrected.
Administering IV fluids.
Gravity-fed systems vs. fluid pumps.
Fluid additives
KCl, Dextrose, Sodium Bicarbonate,
Metoclopramide, Vitamin B-complex
Complications – fluid volume overload;
electrolyte/acid-base imbalances.
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14. Transfusion Medicine
Goal – to promote oxygen delivery to the tissues!
Remember to treat the patient, NOT the numbers!
Blood donors
Specific requirements - dog vs. cat
Canine universal donor = DEA 1.1 negative
Felines and equines – no universal donor known.
Pre-transfusion testing
Blood-typing – based on agglutination reactions.
Canine - >12 DEA group systems identified; no natural-occurring
antibodies.
Feline – 1 blood group system (AB) with 3 blood types: A – most
common; B – purebreds; AB- rare; have naturally-occurring
alloantibodies.
Crossmatching – compatibility test between potential donor and
recipient’s blood (agglutination reaction = incompatible)
Major –donor’s RBCs & recipient’s plasma
Minor - donor’s plasma & recipient’s RBCs
15. Transfusion Medicine continued
Blood Products
Fresh whole blood (FWB) –up to 8 hrs after collection; provides ALL
blood components; platelet function lost after 24 hrs
pRBCs – increase RBC mass by providing O₂-carrying support
PRP – produced from FWB at SLOW centrifugation
Plasma – from FWB at HIGH centrifugation
FFP – 12 mth shelf-life; contains ALL coagulation factors
FP – FFP not used within 12 mths or thawed and re-frozen
LP – not frozen; shelf-life = 5 days after expiration of whole blood
Note: FP & LP contain no functional platelets or coag factors-V and VIII.
Preparing refrigerated vs frozen blood products
Monitor vital signs & mentation status before starting transfusion
& every 15 minutes for 1st hour, then every ½ hour thereafter.
Transfusion reactions – acute allergic hypersensitivity, acute
hemolytic reaction, nonimmune-mediated reaction, delayed
hemolytic reaction, nonhemolytic immune reaction, TACO
16. Triage
Know your normals!
Telephone triage – never dismiss an owner’s concern.
Lobby triage – introduce yourself; quick assessment;
explain to owner as you go; get brief presenting complaint.
Most critical – respiratory, cardiovascular, neurological,
urogenital, abdominal, musculoskeletal.
ABCs of triage
Be prepared – staff (teamwork) & facility (emergency care
station – ex. mobile crash cart).
Types of shock – hypovolemic, distributive, obstructive,
cardiogenic, septic
Complications – SIRS, DIC, MODS
Reperfusion injury
17. Cardiopulmonary Arrest
Common causes of CPA in dogs & cats
1st = cardiovascular failure (ex. hypovolemia, hemorrhage, anemia)
2nd = respiratory failure
CPR vs CPCR
Basic Life Support - CABC
Chest compressions – 2 minute cycles; cardiac vs thoracic pump
method; 100-120 comp/min
Airway – intubation
Breathing – ventilatory support; ~10 breaths/min
Acupuncture to stimulate breathing – Jen Chung
Circulation- IV access and fluids
Advanced Life Support
ER drug(s) administration – IV, IO, ET-tube, IC
Defibrillation
EtCO₂
Record progress!
Post-cardiac arrest care – respiratory system, GI tract, kidneys,
CNS, blood glucose, medications
23. Toxicological Emergencies
Pesticides
Permithrins/Pyrethrins – more sensitive in cats (neurologic
effects)
Organophosphates – most common/most toxic insecticides;
antodote = atropine
Metaldehydes – snail/slug bait; neurologic effects
Ivermectin – broad-spectrum antiparasitic; sensitive dog breed
– Collies
Ant traps – low risk of toxicosis
Rodenticides
Anticoagulant – 1st generation = Warfarin; 2nd generation =
Brodifacoum; antidote = Vitamin K₁
Bromethalin – affects CNS; no antidote only supportive care
Cholecalciferol – active Vitamin D₃ derivative; affects calcium
24. Toxicological Emergencies
Ethylene Glycol – antidote = 4-MP (fomepizole) or
7% ehtanol (100 proof vodka)
Acetominophen – hepatic and RBC damage
antidote - acetylcysteine
NSAIDS – human and veterinary medications
Primary toxic effects – GI tract
Tx – supportive care and GI protectants
Metals – Zinc (RBC damage); Lead (GI and
nervous system)
Recreational – marijuana and alcohol cause CNS
depression
25. Euthanasia/Grief/Loss/Compassion Fatigue
Euthanasia = Greek for “Good death”
Respect and validate the client’s decision.
Choose your words carefully! (ex. “put to sleep”).
Agent used – overdose of anesthetic (narcotic) = pentobarbital
Routes of administration – IV*, IC, IP, occiptial sinus (birds)
Know what to expect upon euthanasia
Grief loss – complex issues of attachment, loss, and grief
Stages – Denial, bargaining, depression, anger, resolution
Compassion fatigue
Primary cause of “burnout” = frequent performance of
euthanasias
Practice wellness and develop coping mechanisms →→ Support
yourself!
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