Emergency Medicine and Critical Care
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Emergency Medicine IntroductionEmergency patients present special challenges because their underlying disease processes can cause immediate life-threatening problems that require rapid and aggressive intervention. In addition, the full extent of the animal’s illness, injuries, or toxicity may not be evident for some time after initial presentation. Problems can arise from an acute illness, toxicity, or injury; from a chronic illness that has decompensated; or from an unexpected complication of a concurrent illness. The status of all postoperative patients should be considered critical until life-threatening anesthetic or surgical complications are excluded. The golden rule of emergency medicine is to treat the most life-threatening problems first. When a patient is then stable, it should be closely monitored for progression or resolution of disease and possible complications.
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Evaluation and Initial Treatment of Small Animal Emergency PatientsTriage is the art of assigning priority to emergency patients and their problems based on rapid assessment of historical and physical parameters (). Several historical or observed problems warrant transfer of the animal to the treatment area regardless of physical findings, and they are listed below; all members of the veterinary medical staff should be able to recognize these common presenting complaints so that rapid (STAT) evaluation by a veterinarian can occur; these conditions may either require rapid intervention or can potentially lead to rapid decompensation:
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Specific Diagnostics and TherapyDiagnostic and therapeutic efforts in emergency situations are directed by the nature and severity of the trauma. Blunt trauma is commonly associated with thoracic and abdominal bleeding, organ rupture, fractures, and neurologic injuries. Penetrating trauma is typically localized to the path of the penetrating object, which is rarely a straight line. Falling from a height causes long bone and facial bone fractures as well as thoracic and abdominal injuries. A dog bitten by a larger dog can have deep-penetrating bite wounds, spinal injuries, major cervical, abdominal, and thoracic trauma (even without penetrating wounds), and tracheal rupture from the shearing forces sustained during thrashing motions. Resuscitation of the airway, breathing, and circulation; control of hemorrhage; and pain relief are followed by a careful evaluation of the nervous system, thorax, abdomen, integument, ocular, and musculoskeletal systems.
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Fluid TherapyCardiac function, intravascular volume, and vascular tone, integrity, and patency are critical to normal circulation. An abnormality in one or more of these components of circulation leads to stimulation of the sympathetic nervous system, which results in compensatory changes to maintain perfusion. The hemodynamic and cellular changes that develop as a result of these abnormalities are called shock. As shock progresses, oxygen and substrate delivery to the tissues becomes insufficient to meet energy requirements for cellular maintenance and repair. If shock progresses and cellular energy demands cannot be met, the ensuing organ failure leads to death. Early recognition of the type and stage of shock is vital to establishing a successful fluid therapy plan; timely intervention with appropriate therapy will prevent or decrease organ injury and/or death.
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Monitoring the Critically Ill Small AnimalAnticipation, not reaction, is the key to successful management of critically ill animals. Animals must be effectively treated and actively monitored to detect or prevent organ compromise before organ failure occurs. This often requires aggressive and repeated fluid resuscitation, close patient monitoring, and support throughout the course of definitive therapy.
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Monitoring the Critically Ill Small Animal Using The Rule of 20
- Fluid Balance
- Oncotic Pull/Albumin
- Glucose
- Electrolytes
- Acid-Base Balance
- Oxygenation and Ventilation
- Neurologic Status
- Blood Pressure
- Heart Rate, Rhythm, and Contractility
- Temperature
- Coagulation
- Red Blood Cell and Hemoglobin Concentration
- Renal Function
- Infection Identification/Prevention and Treatment and Immune Status
- GI Motility and Mucosal Integrity
- Drug Dosages and Metabolism
- Nutrition
- Pain Control
- Wound Care and Bandages
- Veterinary Nursing Care and Tender, Loving Care
- For More Information
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Monitoring the Critically Ill Small Animal Using The Rule of 20
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Ophthalmic EmergenciesOphthalmic emergencies require rapid diagnosis and appropriate and often aggressive therapy for maintenance of vision. It is critical to assess the patient's potential for vision by performing a menace response, dazzle reflex, and direct and consensual pupillary light reflexes (PLRs). A consensual PLR (from the affected to nonaffected eye) is particularly useful when the ocular media is opaque and thus prevents assessment of a direct PLR.
- Ophthalmic Emergencies in Small Animals
- Proptosis in Small Animals
- Eyelid Lacerations in Small Animals
- Corneal Foreign Bodies in Small Animals
- Penetrating Intraocular Injuries in Small Animals
- Corneal Lacerations in Small Animals
- Deep Stromal Corneal Ulcers, Descemetocele, and Iris Prolapse in Small Animals
- Glaucoma in Small Animals
- Anterior Lens Luxation in Small Animals
- Anterior Uveitis in Small Animals
- Acute Vision Loss in Small Animals
- Sudden Acquired Retinal Degeneration Syndrome (SARDS) in Small Animals
- Retinal Detachment in Small Animals
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Wound ManagementWound healing is the restoration of the normal anatomic continuity to a disrupted area of tissue. An understanding of the normal process of wound healing is essential to make sound decisions in the management of wounds. Correctly using the principles of wound management helps avoid premature wound closure and its potential complications.
- Wound Management in Small Animals
- General Principles of Wound Healing in Small Animals
- Initial Wound Management in Small Animals
- Drains in Wound Management of Small Animals
- Negative Pressure Wound Therapy in Small Animals
- Wound Bandages and Dressings for Small Animals
- Surgical Techniques in Wound Management in Small Animals
- Factors that Interfere with Wound Healing in Small Animals
- Management of Specific Wounds in Small Animals
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Equine Emergency MedicineEquine emergencies can be challenging for veterinary practitioners and emotionally charged for owners. There is also the inherent possibility of injury to the owner and veterinarian because of the sheer size of the animal and the “fight or flight” reflexes of an injured horse. Problems can be reduced by educating owners about emergency preparedness and first aid procedures. The most common types of equine emergencies are abdominal pain (colic), trauma, lacerations, and acutely ill foals.
- Equine Emergency Medicine
- Equine Emergency Procedures
- Equine Trauma and First Aid
- Other Common Equine Emergencies
- Neonatal Intensive Care and Emergencies in Foals
