Emergencies in Vet Med

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Emergencies in Vet Med

• Small Animal Nutrition and Nursing

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Emergency Evaluation Procedure

• Things to remember during an emergency
• DONT PANIC
• Any animal will bite if in pain or frightened
• Only muzzle if no breathing concerns
• Handle injured areas as little as possible
• Minimize stress

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Common Terms used in emergency situations

• Tachycardia increased heart rate
• Bradycardia decreased heart rate
• Pulmonary edema build up of fluid in the lungs
  (both sides)
• Pleural effusion Free fluid in the chest cavity
  (can be one sided)

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Common Terms used in emergency situations

• Ambulatory ability to walk
• Pneumothorax Free air in the chest cavity
• Hypoxia Diminished availability of oxygen to the
  body tissues
• Petechiae Red spots on the gums (clotting
  disorder)

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4 Organ Systems to focus on

1. Respiratory
2. Cardiovascular
3. Central Nervous System
4. Renal System

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Emergency Evaluation Procedure

• Triage is a rapid classification of the emergency
  by how life threatening or urgent the situation
  is.
• Triage should take less than 5 minutes
• Triage Priority List
• Respiratory no oxygen, no life
• Cardiac Arrest no heart rate
• Arterial Hemorrhage spurting or pumping bright
  red frank blood
• Shock
• Thoracic wound DEEP, into chest wall
• Seizure constant not cluster
• Poison ingestion
• Fractures

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Emergency Evaluation Procedure

• What needs to be assessed within the first few
  seconds
• CRT slow shock or dehydration. Fast
  increased blood pressure
• MM white shock. Blue lack of oxygen. Pale
  anemia
• HR Tachycardia? Bradycardia? No heart rate?
• RR Dyspnea? No breathing? Rapid and shallow
  (agonal breaths) signs of cardiac arrest
• Pulse quality Thready? Matching heart rate?
• Pupils dialated? Matching size?

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Emergency Evaluation Procedure

• Triage also includes collecting a patient history
  while examining
• Primary Problem why are they here today, what
  has changed or happened
• Duration how long has this been going on?
• Frequency is it continual? Every few hours?
  Every few weeks?
• Current Therapy Has the animal been treated for
  this before? Currently on any medications?

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Emergency Evaluation Procedure

• Baseline information that should be obtained
  quickly These values can weight until animal is
  stable.
• PCV Anemia? Increased white cell count?
  Dehydration?
• TPP dehydration?
• Urine S.G. Kidneys functioning?
• WT For future drug calculations? Monitor if
  gaining weight as on fluids?

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Stabilization

• All patients should be stabilized
• IV catheter placed
• Maintain body temp
• Provide/ensure airway
• These procedures can generally be done without
  the direct supervision of a DVM

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Respiratory Arrest

• Usually leads to cardiac arrest
• Causes
• Shock
• Overdose of anesthetics
• Structural disorders of the chest wall or
  diaphragm
• HBC or any other blow to the body
• Gun shot
• Oral or tracheal foreign bodies
• Severe head injuries
• The brain is not functioning properly to tell the
  body to keep breathing
• Disorders of the pulmonary tissue/lining
• Pneumonia
• Edema

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Respiratory Arrest

• Treatment
• Stop anesthesia
• Turn off gas and leave on and maybe even increase
  oxygen level
• Respiratory Stimulants
• Dopram
• Clear area of any obstructions
• Visual exam
• Suction might be used
• Intubate if not already
• Artificial respirations
• Bag the animal with oxygen hooked up to the mask
• Remove fluid or air from the chest cavity
• Probably done by the doctor
• Using a butterfly catheter try to draw out any
  fluid or air that might be causing the problem

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Respiratory Arrest

• Manual Artificial respiration (if no
  endotracheal tube available)
• Open mouth, extend tongue, check for obstructions
• Close mouth with tongue extended
• Place kimwipe over nose

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Respiratory Arrest

• Manual Artificial respiration cont
• Inhale and place your mouth over the nose
• Use fingers to seal lips around the mouth
• Exhale into nose 20 times per minute (cautious
  not to over inflate chest)

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Cardiac Arrest

• CAUTION! Irreversible damage if longer than 4
  minutes.
• Causes
• Respiratory arrest
• Once breathing stops, the heart stops 60-90
  seconds later
• Hypoxia (o2 cut from tissues) is the cause, not
  the actual respiratory arrest
• Overdose of antibiotics
• To high of an IV dose given
• Animal got into meds at home
• Shock
• Toxemia (toxins in the blood stream)
• Embolism
• Clot lodges in the lung

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Cardiac Arrest

• Causes cont..
• Electrical shock
• Puppies or kittens chewing on electrical cord
• Severe head/chest trauma
• HBC
• Hypothermia
• Cardiac disease

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Cardiac Arrest

• Warning signs before cardiac arrest
• Changes in ECG
• Cyanosis
• Rapid shallow respirations/agonal breaths
• Increased HR with irregular pulse
• Femoral pulse different than heart rate
• Dark blood
• Fixed and dialated pupils

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Cardiac Arrest

• Treatment
• Discontinue anesthesia
• Keep intubated and increase oxygen
• May have to bag animal
• Check airway
• Make sure that the endotracheal tube is still in
  and that the cuff is inflated
• Make sure that there is not excess fluid in the
  mouth
• Check that tongue is not rolled back into mouth
• Provide adequate ventilation
• Bag with oxygen
• Artificial/manual ventilation
• CPR

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Cardiopulmonary Resuscitation
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ABC

• The first step is to establish a patent Airway
• 1.Pull tongue out of mouth bring head in line
  w/neck ( straight)
• 2.Close mouth place your mouth over nostrils
  give 2 breaths
• 3.If they dont go in, visually inspect the
  airway remove any foreign objects
• 4.If breaths still unsuccessful, proceed to
  Heimlich Maneuver

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Heimlich Maneuver

• 1.Turn animal upside down w/ back against your
  chest
• 2.Place fist just below the ribcage while
  hugging the patient
• 3.Give 5 sharp thrusts with both arms
• 4.Check to see if object is visible remove
• 5.Give 2 rescue breaths
• 6.If they dont go in- repeat step 1

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• Breathing
• 1.Pull tongue out of mouth align head neck
• 2.Breathe at 12 breaths per minute ( 1 every 5
  seconds)
• 3.Watch chest to observe it rise- do not over
  inflate!
• 4.If breaths dont go in return to A- Airway

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• Circulation
• 1. Check for major points of bleeding
• 2. Check pulse ( in groin)
• 3. Place animal onits right side
• 4. Lock hands together place where left elbow
  touches ribcage
• 5. For cats small dogs use 1 hand in a
  squeezing motion
• 6. Compress chest 15 times followed by 2 rescue
  breaths

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• CPR (2 person or one person)
• Place animal in lateral position on RIGHT side
• Clench hand together and place on chest wall
  behind heart
• Compress 60-100 times per minute (one person)
• Respirations 20-40 per minute (other person)

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Massive Hemorrhage

• Pressure bandage (Arterial/Venous/Capillary)
• Use sterile gauze
• Keep pressure on the site until bleeding stops
• Check bleeding by gauging amount of blood in
  bandage, add more gauze if necessary
• When bleeding has stopped, add more gauze to make
  a bandage around the healthy tissue
• Pressure Points (Arterial)
• These are anatomical areas where it is possible
  to press an artery against the bone or tissue to
  stop the flow of blood.
• Clamping with forceps (Arterial/venous)
• Grab vessel only, not the skin or muscle around
  vessel
• Tourniquet
• Least desirable, used only in life and death
  situations
• Use on tail or extremities
• Use a flat strip rubber or cloth
• Tighten enough to stop blood flow
• Apply above the point between wound and the heart
• When blood flow has decreased try to replace with
  a pressure bandage
• NEVER COVER A TOURNIQUET
• Leave on for 20 minutes then slowly release to re
  oxygenate the tissue
• If tourniquet is released to quickly animal can
  go into shock.

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Shock

• A complicated syndrome with multiple causes
• Ultimately will lead up to drop in BP, causing
  insufficient perfusion of blood to the tissues.
• Circulatory failure

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Shock

• General Signs
• Pale or white MM
• Increased CRT
• Tachycardia with decreased heart sounds
• Tachypnea
• Decrease of consciousness
• Decrease of temperature
• Cool extremities

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Shock

• Types of Shock
• Hypovolemic shock Decreased blood volume
• Anaphylactic shock Allergic reaction to
  something
• Cardiogenic shock The heart is unable to pump
  blood with sufficient pressure to maintain normal
  blood pressure
• Septic shock occurs when an overwhelming
  
• infection leads to low blood pressure and low
  blood flow.
• Septic shock occurs most often in the very old
  and the very young

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Hypovolemic shock

• Causes
• Hemorrhage
• Severe dehydration

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Hypovolemic shock

• Signs
• History of trauma
• Blood loss
• Tachycardia
• Weak pulse
• Pale or white MM
• Prolonged CRT
• Cold extremities

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Hypovolemic shock

• Treatment
• Replace lost volume 1-2 IV catheters will be
  placed ASAP, the doctor will probably order an
  open line to get into animal as quickly as
  possible.
• Crystalloids are usually fluid of choice.
• It is helpful if you have warmed fluids.
• Use the largest catheter you can get into the
  animal. Dog 20-22 gauge (giant breed 18 gauge)
  Cat 20-22 gauge

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Allergic Reactions

• Causes
• Vaccine reaction
• Insect bite
• Food allergy

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Severe facial edema
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Allergic Reaction

• Signs Occur within seconds to minutes after
  exposure to the allergen
• Airway swells up
• Restlessness
• Diarrhea
• Vomiting
• Hives and angioedema (hives on the lips, eyelids,
  throat, and/or tongue) often occur

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Allergic Reaction

• Treatment
• Epinephrine
• Steroids
• Antihistamines

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Cardiogenic shock

• Causes
• Hypertrophic or congestive heart disease An
  excessive thickening of the heart muscle
• Cardiomyopathy Acondition in which the muscle
  of the heart is abnormal
• Cardiac tamponade ,severe arrythmias occurs
  when the heart is squeezed by fluid that collects
  inside the sac (pericardium) that surrounds it.

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Cardiogenic shock

• Signs
• Weakness
• Increased heart rate
• Increased respiratory rate
• Weak thready pulse

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Cardiogenic shock

• Treatment
• Restore heart function
• Pericardiocentesis may be needed.
• A procedure used to drain fluid out of the sac
  surrounding the heart.
• This is done by inserting a needle through the
  chest and into the sac.

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Septic shock

• Causes
• Any bacterial organism can cause septic shock.
• Fungi and (rarely) viruses may also cause this
  condition.

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Septic shock

• Signs
• Decreased urine output from kidney failure may be
  one symptom.
• High or very low temperature
• Cool, pale extremities
• Restlessness
• Rapid heart rate
• Low blood pressure, especially when standing

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Septic shock

• Treatment
• Provide oxygen, and relieve respiratory distress
  (if present)
• Administer intravenous fluids to restore blood
  volume
• Treat underlying infections with antibiotics
• Support any poorly functioning organs

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General Treatment of shock

• IV fluids
• Oxygen
• Keep animal warm or cool
• Antibiotics
• Nutrition
• Follow DVM orders

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Patient Monitoring

• Blood Pressure
• PCV
• Urine output
• ECG
• Pulse ox

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Thoracic Wounds

• Pneumothorax Free air in the chest
• Pressure from the air in the chest cavity makes
  breathing difficult
• Treatment
• Major Aspirate Air
• Mild Rest the animal with supportive care
• Hemothorax Blood in the chest cavity
• Treatment
• Aspirate the blood
• Supportive care

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Thoracic Wounds

• Closed Rib Fractures
• Destroys normal function of the chest wall
• Treatment
• Strict cage rest
• DO NOT bandage chest
• Surgery (only if you have 2 broken ribs broken in
  2 places)
• Diaphragmatic Hernia
• A tear in the diaphragm
• Allows abdominal contents into the chest
• Treatment
• Chronic may not notice
• Acute Dyspnea
• Surgery to repair diaphragm

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General Treatment of thoracic problems

• Maintain airway
• Treat any shock
• Oxygen
• Raise front half of patient
• Avoid stress (x-rays)
• Good side up (good lung up)

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Coma or loss of consciousness

• Caution Always check on unconscious animal for
  head or neck injuries before moving.
• Causes
• CNS disease
• Trauma to head
• Severe shock

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Levels of consciousness/unconsciousness

• Comatose Complete loss of consciousness with no
  response to stimuli
• Stupor Loss of consciousness reacts to strong
  stimuli (toe pinch)
• Apathetic Partial loss of consciousness reacts
  to stimuli and loud noises
• Common in anesthetic recovery
• Delirious Transitory loss of consciousness
• Patient will react to stimuli followed by a
  resting period

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Treatment of unconsciousness

• Watch closely (vomiting)
• Keep warm
• IV fluids
• Express bladder or place u-cath.
• Turn frequently keep on padded surface to
  prevent sores
• NEVER administer PO medications

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Other emergencies

• Electric shock
• Signs
• Dyspnea
• Burns in mouth
• Pulmonary edema
• Heart arrhythmia 

• Treatment
• Oxygen
• Diuretics
• Steroids

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Other emergencies

• Proptosis More commonly seen in brachycephalic
  breeds (i.e. shi-tzus, pugs, pekineese)
• Prolapse of the eye due to trauma
• Treatment
• Stabilize animal
• Put the eye back in the socket
• Suture 3rd eyelid to upper eylid
• Antibiotics
• Steroids

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Uveitis

• Symptoms
• Pain/discomfort
• Redness
• Inflammation
• Blepharospasm
• Prolapsed nicitans
• Treatment
• Topical atropine
• Topical corticosteroids

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Gastric Dilation Volvulus (GDV)-Bloat

• Bloat describes a stomach which has become
  abnormally enlarged or distended. The stomach is
  filled with gas, food, liquid, or a combination
  thereof.
• Torsion is the abnormal positioning of the
  stomach which is caused by the stomach's rotation
  about its axis, i.e. twisting of the stomach.
• Bloat usually leads to torsion, although torsion
  can occur without bloat.

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• Gastric Dilation Volvulus (GDV)-Bloat
• Causes Unknown
• Predisposition
• Large or giant breeds with deep chests
• Rapid or overeating
• Over consumption of H2O
• Exercise after feeding
• Keeping food too low for larger breeds

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• Gastric Dilation Volvulus (GDV)-Bloat
• Signs
• Lethargy
• Abdominal distention
• Increased and shallow respirations
• Vomiting and/or retching
• Restlessness
• Increased HR/weak pulse
• Shock

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Abdominal Distention
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• Gastric Dilation Volvulus (GDV)-Bloat
• Treatment
• Trocar
• Pass stomach tube
• Treat for shock
• Radiographs
• Surgery (Gastropexy)

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• Prolapse of rectum
• Cause Persistant diarrhea
• Treatment
• Lubricate and replace rectum
• Suture, almost shut
• Feed bland liquid diet

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Burns

• 1st degree
• Sunburn, outer layer of skin
• 2nd degree
• Partial thickness burns
• 3rd degree
• Full thickness burns

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Burns

• 1st degree
• Red, painful and raw
• Treatment Pain relievers
• 2nd degree
• Sub Q edema
• Treatment IV fluids, Pain relievers, Antibiotics
• 3rd degree
• Skin will sluff
• Burns not painful, healing is
• Treatment All of the above skin grafting

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Pneumonia

• Patient may posture abnormally in an attempt to
  facilitate breathing
• Symptoms
• Tachypnea
• Dyspnea
• Increased lung sounds
• Treatment
• Supply O2
• AB therapy
• Supportive care

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Seizure

• Causes include hypoglycemia, inflammatory dz,
  trauma, epilepsy toxicity
• Symptoms
• Pupillary changes
• Hyperthermia
• Hyperdynamic state
• Treatment
• Diazapam
• Propnaolol

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Feline Urethral Obstruction

• Symptoms
• Dysuria Hematuria
• Vocalization
• Painful abdomen
• Distended bladder
• Treatment
• Removal of obstruction
• Fluid Therapy

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Acute Renal Failure

• Symptoms
• Vomiting/diarrhea
• Dehydration
• Treatment
• Fluid Therapy

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GI Obstruction

• Symptoms
• Vomiting/diarrhea
• Abdominal pain
• Dehydration
• Treatment
• Radiographs/ultrasound
• Surgical intervention
• Fluid therapy

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Pancreatitis

• Symptoms
• Vomiting/diarrhea
• Lethargy
• Anorexia
• Painful abdomen
• Treatment
• Fluid Therapy
• AB
• Pain medication