auburn emergency board review

Emergency Board Review

Triage

A- airway (patent, adequate FiO2)- arterial bleeding ( pressure)

B- Breathing (characterize pattern)inspiratory, expiratory,

paradoxical C- Circulation D- Disability (neurologic,

musculoskeletal) E- Evaluate (abdominal, urinary, general)

Triage- Secondary Survey

A- airway C- Cardiovascular/circulatory R- Respiratory A- Abdomen S- Spine H- Head (eyes, ears, and neck too)

Triage- Secondary Survey

P- Pelvis (rectal) L- Limbs (including tail) A- Arteries N- Nerves (including cranial nerves,

reflexes, pain sensation)

Quick Blood Gas- 6 Questions 1. Is the patient hypoxemic? PaO2 2. Is the patient hypo or hyperventilating?

PaCO2 3. Is there an acid-base abnormality? 4. What it is the primary abnormality?

Metabolic or respiratory 5. Is it simple, simple with compensation or

mixed? 6. Why does it exist, how do you fix it?

Quick facts for acid base

Rules of 4 pH- 7.4 +/- .o4 PaCO2- 40 +/-4 HCO3- 24 +/-2 PaO2- 4-5 x FiO2

You can not compensate to normal pH


Most common cause of respiratory alkalosis in emergency is pain or fever induced hyperventilation

Most common cause of respiratory acidosis is hypoventilation from anesthetics, upper airway obstruction, severe parenchymal disease, or neurologic disease


Most common cause of metabolic acidosis in emergency is lactic acidosis (shock), ketosis, other unmeasured anions (ethylene glycol), or hypochloridemia (differentiate with anion gap)

Most common cause of metabolic alkalosis is vomiting

Small Animal Toxicology

Basic steps Eliminate further absorbtion

• Bathe or vacuum• Emesis

Hydrogen peroxide (3%) 1-2 ml/kgcan repeat once in 10 min

Dishwashing liquid 1:8 with water and give 10 ml/kg once


Eliminate absorbtion - emesisApomorphine (dogs) .03mg/kg IV, .04

mg/kg IM, .08 mg/kg SC, or .3 mg/kg conjunctival

Xylazine (cats) .44mg/kg IMSyrup of Ipecac- potential

cardiotoxicity, muscle weakness, hemorrhagic diarrhea


Eliminate absorbtion Gastric lavage- light sedation maybe

• 20 ml/kg of tepid water repeated until clear

Activated charcoal• 1-4 g/kg with 1g/50 ml water (if not

premixed)- not good with heavy metal Cathartic- often with activated

charcoal


Eliminate absorbed toxin Diuresis for some Ion trapping

Definitive antidote or competitive inhibitor- depends on toxin

Supportive care


Acetaminophen Clinical signs

• Methemoglobinemia- dark blood, dyspnea, facial and front limb swelling (cats typical or dogs with very high dose)

• Hepatic necrosis- 24-48 hours later vomiting, abdominal pain, anorexia (cats and dogs)


Acetaminophen Treatment- basic principles plus

• N-acetylcysteine IV or PO (140 mg/kg first then 70 mg/kg QID for 6 doses)

• Ascorbic acid for methemoglobin• Cimetidine• Supportive


Methylxanthines (chocolate, caffeine, theophylline) Clinical signs- vomiting, hyperactivity,

restlessness, tachycardia, tachypnea, ataxia, convulsions, cardiac arrhytmia, death


Treatment• Arrhythmia- lidocaine (ventricular) or

esmolol (SVT)• Tremors/seizures- diazepam,

phenobarbital or pentobarbital induction• Renal excretion and can reabsorb in

urinary bladder


Lead Clinical signs

• Gi- anorexia, vomiting, pain, diarrhea• Neuro- seizures, hysteria, ataxia,

blindness, tremors• Hemolytic anemia (very high nRBC

beyond expected for anemia)


Lead Diagnosis

• High nRBC, basophilic stippling with mild anemia and other signs

• Radiographs• Blood levels (>0.6ppm) or liver post

mortem


Lead Treatment

• Chelation- calcium EDTA, Penicallimine, Succimer

• Repeat lead levels after treatment to determine if more is needed

• Supportive care


Cholinesterase inhibitors (organophosphates and carbamates) Clinical signs- depends if muscarinic

or nicatinic• Nicotinic- striated muscle stiffness,

fasciculation, tremor, weakness, paralysis• Muscarinic- smooth muscle SLUD,

bradycardia


Ch. Inhibitors Treatment

• Atropine (.1-.2 mg/kg, 1/4 IV, ¾ SC) can be repeated, glycopyrrolate not effective b/c does not cross blood brain barrier)

• 2-PAM in addition to atropine in organophosphate, may reverse binding to Achesterase

• Midazolam and diphenhydramine for nicotinic


Pyrethrins Clinical signs

• Hypersalivation, vomiting, diarrhea, ataxia, hyperexcitability, fasciculation, depression, disorientation, seizures, dyspnea


Pyrethrin Treatment

• Diazepam for seizures• Phenobarbitol for continued seizures• Methacarbamol for muscle tremors


Zinc Clinical signs

• Depression, vomiting, diarrhea, hemolytic anemia, renal failure

Diagnosis• Radiographs, hemolytic anemia• Zinc levls in serum, urine, or tissue


Treatment Supportive care Remove source Chelation with calcium EDTA or

penicallimine


Ivermectin Clinical signs

• Mydriasis, apparent blindness, aggresion, bradycardia, cyanosis, dyspnea, seizures, coma, death

Treatment• NO BENZODIAZIPINE• Physostigmine?• Supportive


Ethylene glycol Clinical signs

• 1st 12 hours- vomiting, intoxicated, stuporous, ataxic, comatose, PU/PD

• 2nd 12-24 hours- may be normal, may have tachycardia, or signs of pulmonary disease

• 3rd >24 hours (or 12-24 in cats)- renal failure


E.G. Diagnosis

• Crucial to diagnosis as soon as possible, therapies do not work after 4-6 hours in cat or 8-12 hours in dog

• Ethylene glycol test- false positives• Clinical signs plus high osmolar gap or acidosis

with high anion gap• Calcium oxalate crystalluria (occ. Early as 3 hours

in cat or 6 hours in dog, often later)


E.G. Treatment

• Aggressive fluids• Competitive inhibition of alcohol

dehydrogenase• Ethanol 7% IV• 4-mehtylpyrazole (better for dogs, high dose

in cats early)

• Hemo or peritoneal dialysis


Rodenticide Clinical signs

• Generally act via Vitamin K antagonism• Affects factors II, VII, IX, X• Clinical signs noted 2-7 days later


Treatment Vit K1 Amount and duration depend on type Warfarin and 1st generation coumarin 2.5mg/kg SC over 4-6 places initially then 1-

2.5 mg/kg PO for 7 days Bromadiolone or brodifacoum 5 mg/kg SC then 2.5 mg/kg for 2-3 weeks Diphacinone or chlorphacinone 5 mg/kg SC then 2.5-5mg/kg for 4 weeks


Lily Clinical signs- renal toxicity in cats Basic principles and diuresis Treatment within 6 hours potential to

prevent All parts poisonous


Oleander Similar to digitalis- GI or cardiac

arrhythmia All parts toxic (30-40 leaves can kill

adult horse) Treatment- basic care plus

• Monitor potassium• Possible phenytoin• Possible antidigitalis antibody fragments


Resource for other poisonous plants http://vet.purdue.edu/depts/addl/toxic/

cover1.htm

auburn emergency board review

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