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ER Procedures #4

QuestionAnswer
What are the ABCs of Emergencies? Airway, Breathing, Cardiac
What is the most important step of CPCR? Venous access
At what rate are we breathing for the animal? 1 breath every 3-5 seconds
How does CPCR start once the animal has been brought back? Vet auscultating the heart and lungs and directing staff
If you don't have anything to do or don't know what to do what should/can you do? Document!
What are 2 huge components of successful CPCR? Documentation and Roleplay
Why is roleplay important? Because it makes it a body memory
what is the most important part of treating shock? Getting O2 to the tissues
If you're using your anesthetic machine for positive pressure ventilation what should you do? flush the system and make sure you're not going over 20mmH20
What is it important to remember about dosing in regards to trach tube administration? You double it
Why do you double the dose when administered via trach tube? because some of it will be lost in the tube and the upper portions of the airway
How does epinephrine help with blood pressure? It creates arterial constriction which results in increased diastolic pressures which results in augmented coronary and cerebral blood flow?
What should you do after you administer a drug via trach tube? give a sigh/breath or blow into the tube
Why is atropine given during emergencies? It prevents bradycardia
How does atropine prevent bradycardia? It inhibits the vagus nerve thereby inhibiting normal vagal tone.
Does atropine increase heart rate? No, often we will see an increase in the HR after administration however the drug is not causing the HR to increase it is simply inhibiting the vagus nerve
What is dopamine used for during CPCR? For supporting blood pressure and enhancing kidney blood flow in dogs
What is dobutamine used for during CPCR? For promoting forward flow of blood. It is the preferred drug in cardiogenic shock
What organ system is most affected by blood pressure? Kidneys
Can epinephrine or atropine restart the heart? No
What is doxapram used for during CPCR? To stimulate respiration if you have spontaneous breathing that is not being effective, NOT a substitute for mechanical breathing
What is important to remember about doxapram in regards to CPCR? It increases respiratory rate and volume it will not actually increase oxygen saturation in arterial blood
When is doxapram used most often? for resuscitation of neonates after a c-section
What do you need to keep in mind about administering Dobutamine during CPCR? That the ranges of dosing for these drugs is very wide and the mount to be given can vary depending on the animal and the monitoring parameters
When is Atropine contraindicated as a CPCR drug? In patients with a tachycardia or ventricular tachycardia. BE CERTAIN the patient is actually bradycardic
What are glucocorticoids used for during CPCR? They're used as an anti-inflammatory, they also stabilize membranes, improve microcirculation & cardiac output, and they improve metabolism by increasing O2 uptake so lactic acid levels fall
Which steroids are commonly used during CPCR? Dex SP, Solu-Delta-Cortef
What is the approximate dose for Dex SP in a CPCR situation? Canine = 0.2mg/kg/IV Feline = 5mg/kg/IV
What is the approximate dose for Solu-Delta-Cortef in a CPCR situation? Canine = 5.5/mg/kg/IV to 11mg/kg/IV There is no dosage for trauma with felines, but for respiratory such as asthma in the acute state the dosing is 1-3mg/IV or IM
What is the most commonly seen emergency in veterinary medicine? GI tract emergencies
What are the 5 primary functions of the intestinal tract? Motility, secretions, digestion, absorption, barrier function
When triaging a GI emergency, what questions should be asked? When was the last time the animal was acting normal?eating?potty?Has the animal been exposed to any toxins/are any other animals or people in the house showing similar symptoms?Does the animal have a history of eating things it ought not eat?trash?
What is the most common cause of vomiting in young animals? Foreign bodies
What items are typically removed for the GI tract of animals? socks, undies, pantyhose, corn cobs/ peach pits, rocks, tampons, toys, bones, sewing needles (cats)
What are the signs of esophageal foreign bodies? Dysphagia/gulping, excessive salivation, repeated swallowing motions, apparent regurgitation after eating/drinking
How is a esophageal foreign body diagnosed? may be palpable, radiographs, +/- endoscopy, esophagitis, angioedema
How are esophageal foreign bodies treated? cervical radiographs, treat perfusion deficits as this patient will need GA to remove the object endoscopiclly +/- feeding tube post obstruction, gastroprotectant agents
name one gastro-protectant agent sucralfate
Why does healing of the esophagus take a long time? esophagus has very little vasculature
Compressions should be done at what a rate? 80-100 compressions per minute (2-3 per second)
What are you listening or when auscultating the heart? Heart murmurs, gallop, arrhythmias, and muffled sounds
What is an ECG/EKG? electrocardiogram, measures the electrical activity of the heart
What is an echocardiogram (Echo)? An ultrasound of the heart which helps to look for masses, evaluates valves and their function, thickness, motion and chamber size
What is Syncope? fainting
What is glucose come in and what is it dosed out to? Comes in 50% and dosed out to 5% or 2.5%
How is glucose administered? Injected intravenously or transmucosally
When is glucose added to fluid therapy? If the blood glucose level is below 80mg/dL
When is bicarbonate added to fluid therapy? If the metabolic acidosis is severe
When administering bicarbonate what do you need to do? administer slowly over 20 minutes and have an ECG monitor on as you are giving the drug.
WHY does bicarbonate have to be administered slowly over 20 minutes and have an ECG monitor on during administration? Because it can induce metabolic alkalosis and several other problems if given too fast so you need to know the base deficit (how acidotic the animal is - NO Guessing!) You can basically throw them from one end to the other
Can bicarbonate be given down a trach tube? HELL NO
Why can't bicarbonate be given down a trach tube? Because it is a detergent and will disrupt the natural surfactant on the alveoli causing them to collapse (it breaks up the mucus)
Regardless of the outcome what should happen after CPCR? De-brief, double check CPCR record or transfer doses/orders to one, stock crash cart, check drugs for expiration/low/empty, check ET tube cuffs, make copies of CPCR record
What is it important to remember about de-breifing? Discuss how things went and how things could have gone better It's not the time to put each other down. If this is something you're not comfortable doing as a group, ask the doctor in private what could have been done better and overall how the CPCR went?
What are analgesics/opioids used for during CPCR? Used in cardiogenic shock for vasodilation
What can analgesics/opioids cause in a patient who is in cardiogenic shock? they can lower the respirations and cause hypotension
How are diuretics used during CPCR? They're used to pull fluid out of the body, helpful with pulmonary edema and overhydration.
What will diuretics also cause in a patient that we should be aware of? It increases thirst and urine output
What are two examples of diuretics used in a CPCR situation? Lasix (furosimide) and Mannitol (osmotic diuretic)
What are GI Protectants used for in a CPCR situation? protect the GI tract to help prevent GI ulcers and sloughing of the mucosa after septic shock due to shunting of the blood as it occurs in bloody vomit or diarrhea.
What are two examples of GI Protectants? Sucralfate and famotidine
What sounds would you be listening to when auscultating the lungs? crackles, wheezing, muffled for pulmonary edema
What is the first drug we would most likely give a Congestive Heart Failure patient? furosemide - diuretic
What is another name for Feline thromboembolism? Saddle thrombus
What are the presenting symptoms of Congestive Heart Failure? tachypnea, harsh lung sounds, inspiratory crackles that progress to crackles/wheezes throughout, distinguishable heart murmur
What are the treatments that all cardio patients receive upon arrival at the ER? O2, IVC, Drugs if indicated by DVM, Possibly, pericardiocentisis, Possibly, Thoracocentisis (BE PREPARED
What is a sinus arrhythmia? due to underlying condition, heart rate increases with respirations
What is an atrial tachycardia arrhythmia atrial flutter - severe underlying structural heart disease. atriums are "fluttering" and moving quicker than the ventricular motion
What is atrial fibrillation arrhythmia? it's where the atriums contract out of sync with the ventricle. a serious symptom of underlying heart disease, don't usually go back to a normal rhythm
What arrhythmia is common post surgery & post GDV? Ventricular fibrilation
What is ventricular tachycardia arrhythmias? where the Ventricle contracts at an irregular rate compared to the atriums
What is vomiting/ the active expulsion of GI contents often preceded by excessive swallowing/salivation, +/- abdominal pain
What should you ask owners of vomiting animals? is the vomiting projectile? Non-productive (dry heaves)?volume, color, consistency, frequency? when does it occur/ after eating/drinking? is there blood in it? does it look like coffee grounds/
What is the most common cause of vomiting? acute gastritis
Diarrhea is rarely life threatening, however it can be an emergency situation. How would you determine if an animals diarrhea constitutes an emergency? is it profuse? bloody? or has it continued over a period of time?
What questions should you ask the owners of an animal with diarrhea? How frequently is it occurring? how much @ 1 time? straining or projectile? any blood seen (dark/frank or bright/fresh)? melena (black/tarry)? odor? metallic? decomposing?
What is hemorrhagic gastroenteritis? acute disease that occurs in dogs, progressive, animals decline quickly. moderate to severe dehydration and even hypovolemic shock may occur
How is Hemorrhagic gastroenteritis diagnosed? Lab tests: CBC,PCV,Parvo snap tests
What will the PCV of an HGE patient indicate? the PCV will be 70%or higher, at that % the blood will be very thick due to dehydration of the patient
How is HGE treated? aggressive fluid therapy to replace loss from v/d, pain control, anti-emetics, NPO 24-48 hr. followed by a strict bland diet, maintain hygiene, apply a7d or aquaphor to patients bottom to soothe soreness from diarrhea
What is considered the mother of all emergencies?? Gastric dilatation volvulus (GDV)
GDV is often referred to as bloat, why? because it is characterized by the malposition of the stomach when it fills with gas and rotates within the abdominal cavity
What is the cause of GDV? Cause is unknown
What might predispose a dog to GDV? deep chested dogs are predisposed (while it is most often thought of with large breed dogs, small dogs with deep chests can also be affected)
What is being compromised in GDV that requires surgical intervention? return blood flow! blood vessels connect the stomach and spleen, as the stomach rotates the spleen rotates as well thus compressing the vena cava and decreasing venous return to the heart and portal vein.
When is GDV most commonly seen? in animals who perform extraneous exercise immediately before or after a large meal
What are the clinical signs of GDV? Non-productive retching, abdominal distension, restlessness, as the disease progresses hypovolemic shock sets in and the animal is recumbent
What should we treat for first? Why? Shock sets in rapidly and is very common so always treat for it first! ( IVC,crystalloid/colloid boluses, pain management)
A gas filled stomach puts pressure of the diaphragm causing what? inadequate ventilation ( these animals need oxygen support)
How is GDV diagnosed? lateral radiographs, ( large gas filled stomach, black structure on radiograph)
What can be done to reduce pressure caused by GDV? Gastrocentesis- a trochar placed in the stomach to release pressure OR a gastric decompression- placing an orogastric tube in the stomach to relieve pressure and improve cardiac output
When the abdomen of a GDV patient is auscultated what will it sound like? a resonating sound (almost like a ping)
What would you ask the owner of a GDV patient before taking their animal back to the treatment area? ask for permission to place an IVC, begin oxygen therapy, and take radiographs
What are potential post op complication with GDV? Tissue hypoxia, hyporoteinemia, sepsis, anemia, DIC disseminated intravascular coagulation
with minimal to no complication whew should a post op GDV patient be allowed water/food? water should be offered after 12 hours, if water is well tolerated, small meatball sized portions of a bland diet can be offered about 24 hours post op
What medications may be needed for a post-op GDV patient? Fentanyl, Lidocane CRI, famotidine, sucralfate
What is the pancreas? a gland in the abdominal cavity, serves important functions related to digestion as well as the production of certain hormones ( insulin and glucagon)
How can pain vary with pancreatitis? abdominal pain may be mild to severe, pain maybe be localized to the right upper quadrant of the abdomen on palpation
History of what is typical with canine pancreatitis patients? dietary indiscretions either acute or chronic
What are the clinical signs of pancreatitis in cats? fever, icterus, dehydration, painful abdomen on palpation
What are the clinical signs of pancreatitis in dogs? anorexia, weakness, occasional diarrhea, painful abdomen on palpation
Pancreatitis is thought to be induced by what>? Low protein/high fat diets
While the cause of pancreatitis is unknown it can occur due to what type of events? FB removal, tumor removal, trauma
How is pancreatitis diagnosed? in house snap tests fPl & cPl (may be more sensitive than blood chemistries
What is the treatment for pancreatitis? fluid therapy (both crystalloids and colloid are indicated in most cases) aggressive pain management(cranial abdomen), bland diet if eating, esophagostomy tube if not eating (most common in cats)(water down bland diet to administer via tube)
What nursing care is required for pancreatitis patients? pain control, monitor fevers (possible antibiotic therapy may be needed) IVF- Monitor for pulmonary edema or fluid overload
Why are crystalloids and colloid both indicated in most pancreatitis patients? Animals tend to get hypotensive leading to liver and kidney failure
Why is fluid therapy beneficial for pancreatitis patients? fluid therapy helps flush out extra enzymes so the pancreas can self heal
What is a highly contagious viral infection of puppies that affects the GI tract? Canine parvovirus
How is CPV transmitted? via contact with contaminated feces7-14 days
What is the incubation period for canine parvo virus? 7-14 days
How does canine parvo virus infect cells, infects rapidly dividing cells that exist in bone marrow and the GI tract
While parvo can affects dogs of any age it is most commonly seen in puppies of what age? 6-12 weeks
Signs of parvo virus include the sudden onset of??? Anorexia, vomiting, diarrhea, dehydration, lethargy, painful abdomen, severely affected animals may present with septic shock
How is parvo virus diagnosed? CBC, (neutropenia, resulting in peripheral consumption and also from destruction of the white blood cells within the bone marrow, additional blood work may reveal hypoglycemia, hypoproteinemia, electrolyte imbalances,
in-house snap tests may give false negatives under what conditions? if the disease is in the early stages or the puppy has received a live vaccine within the last 2 weeks
How is parvo treated? intensive veterinary management, hospitalization is essential to correct dehydration & electrolyte imbalances, nutritional therapy/supplements, IVF & meds to control v/d, severe cases may require blood/plasma tranfusions or other intensive protocols
How can parvo be prevented? vaccination, thorough cleaning and disinfecting of the quarters/anything touched by the infected patient
What is the most effective disinfectant for combating parvo virus? household bleach !:32 dilution
What are the 4 ways toxins can enter the body? ingestion, inhalation, injection, topical
What is the goal when treating a toxicity patient? limit toxic absorption & progression of toxicity
When would you induce vomiting in a toxicity patient? 3-4 hr. cut-off (depending on substance, condition of patient etc) inducing vomiting may be successful for up to 8hr in some cases,
When is it contraindicated to induce vomiting? in dyspenic patients, or patients that have ingested corrosive agents or are comatose
Created by: Adeprey4311