EDUCATION

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EDUCATION

• Education is what survives after what has been
  learned has been forgotten.
• - B.F. Skinner

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Anaphylaxis/Allergic reactions

• Rare, life-threatening reactions to something
  injected or ingested
• Untreated, it results in shock, resp/cardiac
  failure, and death
• IgE Antibodies to allergen bind to mast cells on
  subsequent exposure, the Ag-Ab reaction causes
  massive release of histamine and other
  inflammatory mediators
• Histamine ? vasodilation ? ?BP
• Initiating factors
• Insects
• Vaccines
• Antibiotics
• Certain hormones
• Other medications
• Foods

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Anaphylaxis/Allergic reactions

• Signs
• Sudden onset of vom/diarrhea
• Shock
• Gums are pale
• Limbs are cold
• HR rapid, weak
• Face scratching (early sign)
• Respiratory distress
• Collapse
• Seizures
• Coma
• Death

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Anaphylaxis/Allergic reactions

• Rx (this is an extreme emergency)
• Eliminate cause
• Epinephrine
• H1 antihistamines (Diphenhydramine)
• IV fluids
• Corticosteroids
• Oxygen
• Prevention
• There is no way to predict what will bring on
• an anaphylactic reaction the first time
• Always inform vet if animal has had previous
• reaction to vaccine
• Owners should have an epi-pen with them at all
  times

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Heat Stroke (Hyperthermia)

• Requires immediate treatment
• Dogs do not cool as well as humans (dont sweat)
• Causes
• Left in hot car
• Water deprivation
• Obesity/older
• Chained without shade in hot weather
• Muzzled under a hot dryer
• Short-nosed breed (esp Pug, Bulldog)/heavy coat
• Heart/Resp disease or any condition that impairs
  breathing or ability to cool body
• Lack of acclimatization/exercise

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Heat Stroke

• Signs
• Rapid, frantic, noisy breathing
• Tongue/mm bright red, thick saliva
• Vomiting/diarrheamay be bloody
• Rectal temp gt105
• Unsteady/stagger
• Coma/death

Prevention
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Heat Stroke

• Complications
• Multi-system organ failure
• Denatures proteins
• Hypotension
• Lactic acidosis
• Decreased oxygen delivery
• Electrolyte abnormalities gt cerebral edema and
  death
• Coagulopathies gt DIC
• If survives the first 24 hrs, prognosis is more
  favorable

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Heat Stroke

• TREATMENT Mild cases move dog to a/c building or
  car
• Temp gt104º, immerged in cool water, hose down
• Temp gt106º, cool water enema (cool to 103º)
• Temp gt109 leads to multiple organ failure
• STOP COOLING EFFORTS AT 103º
• IV fluids
• Corticosteroids

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Emergency Drugs in Cats
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Emergency Drugs in Dogs
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Pain Management

• Misconceptions about animal pain
• Animals do not experience pain
• Pain doesnt really affect how animal responds to
  treatment
• Signs of pain are too subjective to be assessed
• Pain is good because it limits activity
• Analgesia interferes with accurate assessment of
  treatment
• Pain management not major concern in LA (except
  horses)
• Pain shows weakness/fragility (Lab vs Collie)
• Fresh ideas about animal pain
• Analgesia increases chance of recovery in
  critically ill
• Pain associated with diagnostic test should be
  minimized
• Morally correct thing to do

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Pain Management

• Signs
• Vocalization
• ?HR
• ?RR
• Restlessness, abnormal posturing, unwilling to
  move
• ? Body temperature
• ?BP
• Inappetence
• Aggression
• Facial expression, trembling
• Depression, insomnia

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Pain Management

• Sequelae to untreated pain
• Neuroendocrine responses
• Excessive release of pit, adr, panc hormones
• Cause immunosuppression and disturbances of
  growth, development, and healing
• Cardiovascular compromise
• ?BP, HR, intracranial pressure
• Coagulopathies
• ?platelet reactivity, DIC
• Long-term recumbency
• Decubital ulcers
• Poor appetite/nutrition
• Hypoproteinemia?slow healing

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Pain Management

• Pain Relief
• Nonpharmacologic interventions (differentiate
  pain vs stress)
• Give relief from
• Boredom, Thirst, Anxiety, Need to
  urinate/defecate
• Clean bedding/padding
• Reduce light/sound
• Stroking pet, calming speech
• Owner visits ()
• Minimize painful events (reduce , improve skills
  in injections, blood draw

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Pain Management

• Questions the Vet Tech must continually ask (you
  are in charge of pain meds)
• Is patient at acceptable comfort level
• Are there any contraindications to giving pain
  meds
• What is the appropriate (safe, effective) med for
  this patient

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Pain Management

• Drug Options
• Nonsteroidal Antiinflammatory Drugs (NSAIDs)
• Most widely used
• Extremely effective for acute pain
• Most effective when used preemptively (before
  tissue injury)
• Usually not adequate to manage surgical pain
• COX-2 NSAIDs do not cause damage to stomach
  lining
• Opioids
• Most commonly used in critically injured animals
• Rapid onset of action effective safe
• 4 types of receptors
• µ analgesia, sedation, and resp depression
• ? analgesia and sedation
• S depression, excitement, anxiety
• ?
• Side effects
• Vomiting, constipation, excitement, bradycardia,
  panting
• Metabolized by liver excreted by kidneys
• Use caution with hepatic, renal disease

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Pain Management

• Opioids
• Morphine sulfate
• Used for max analgesia/sedation
• Inexpensive
• Side-effects systemic hypotension, vomiting
• Cats particularly sensitive
• Oxymorphone
• 10x potency of morphine
• Much more expensive less resp depression and GI
  stimulation
• Side-effects depression, sensory
  hypersensitivity
• Hydromorphone
• Similar effects of Oxymorphone
• More widely available, less expensive than
  Oxymorphone

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Pain Management

• Opioids
• Fentanyl citrate
• Extremely potent
• Rapid onset, short duration when administered IM
  or IV
• Transdermal patch
• 3-day duration
• Shave hair, apply to the skin
• Butorphanol Tartrate
• ? agonist µ antagonist
• Analgesic effect questionable (gt1 h) good
  sedative (2 h)
• More expensive than morphine
• Less vomiting, resp. depression
• Buprenorphine
• Partial mu agonist
• 30x potency of morphine longer duration
• good absorption via buccal mucosa

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Pain Management

• Opioids
• Antagonists
• Naloxone HCl
• Reversal occurs within 1-2 min
• Can be used to reverse anesthesia (Inovar-Vet)