auburn emergency board review
DESCRIPTION
NBE reviewTRANSCRIPT
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
Quick facts for acid base
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
Quick facts for acid base
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
Small Animal Toxicology
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
Small Animal Toxicology
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
Small Animal Toxicology
Eliminate absorbed toxin Diuresis for some Ion trapping
Definitive antidote or competitive inhibitor- depends on toxin
Supportive care
Small Animal Toxicology
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)
Small Animal Toxicology
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
Small Animal Toxicology
Methylxanthines (chocolate, caffeine, theophylline) Clinical signs- vomiting, hyperactivity,
restlessness, tachycardia, tachypnea, ataxia, convulsions, cardiac arrhytmia, death
Small Animal Toxicology
Treatment• Arrhythmia- lidocaine (ventricular) or
esmolol (SVT)• Tremors/seizures- diazepam,
phenobarbital or pentobarbital induction• Renal excretion and can reabsorb in
urinary bladder
Small Animal Toxicology
Lead Clinical signs
• Gi- anorexia, vomiting, pain, diarrhea• Neuro- seizures, hysteria, ataxia,
blindness, tremors• Hemolytic anemia (very high nRBC
beyond expected for anemia)
Small Animal Toxicology
Lead Diagnosis
• High nRBC, basophilic stippling with mild anemia and other signs
• Radiographs• Blood levels (>0.6ppm) or liver post
mortem
Small Animal Toxicology
Lead Treatment
• Chelation- calcium EDTA, Penicallimine, Succimer
• Repeat lead levels after treatment to determine if more is needed
• Supportive care
Small Animal Toxicology
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
Small Animal Toxicology
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
Small Animal Toxicology
Pyrethrins Clinical signs
• Hypersalivation, vomiting, diarrhea, ataxia, hyperexcitability, fasciculation, depression, disorientation, seizures, dyspnea
Small Animal Toxicology
Pyrethrin Treatment
• Diazepam for seizures• Phenobarbitol for continued seizures• Methacarbamol for muscle tremors
Small Animal Toxicology
Zinc Clinical signs
• Depression, vomiting, diarrhea, hemolytic anemia, renal failure
Diagnosis• Radiographs, hemolytic anemia• Zinc levls in serum, urine, or tissue
Small Animal Toxicology
Treatment Supportive care Remove source Chelation with calcium EDTA or
penicallimine
Small Animal Toxicology
Ivermectin Clinical signs
• Mydriasis, apparent blindness, aggresion, bradycardia, cyanosis, dyspnea, seizures, coma, death
Treatment• NO BENZODIAZIPINE• Physostigmine?• Supportive
Small Animal Toxicology
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
Small Animal Toxicology
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)
Small Animal Toxicology
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
Small Animal Toxicology
Rodenticide Clinical signs
• Generally act via Vitamin K antagonism• Affects factors II, VII, IX, X• Clinical signs noted 2-7 days later
Small Animal Toxicology
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
Small Animal Toxicology
Lily Clinical signs- renal toxicity in cats Basic principles and diuresis Treatment within 6 hours potential to
prevent All parts poisonous
Small Animal Toxicology
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