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EDUCATION. “Education is what survives after what has been learned has been forgotten.” - B.F. Skinner. Anaphylaxis/Allergic reactions. Rare, life-threatening reactions to something injected or ingested Untreated, it results in shock, resp/cardiac failure, and death - PowerPoint PPT PresentationTRANSCRIPT
EDUCATION“Education is what survives after what has been learned has been
forgotten.”- B.F. Skinner
Rare, life-threatening reactions to something injected or ingestedUntreated, it results in shock, resp/cardiac failure, and deathIgE 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
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
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
Anaphylaxis/Allergic reactions
Requires immediate treatmentDogs do not cool as well as humans (don’t 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
Heat Stroke (Hyperthermia)
• Signs– Rapid, frantic, noisy breathing– Tongue/mm bright red, thick saliva– Vomiting/diarrhea—may be bloody– Rectal temp >105°– Unsteady/stagger– Coma/death
Heat Stroke
Prevention
• Complications– Multi-system organ failure– Denatures proteins– Hypotension– Lactic acidosis– Decreased oxygen delivery– Electrolyte abnormalities => cerebral edema and
death– Coagulopathies => DIC– If survives the first 24 hrs, prognosis is more favorable
Heat Stroke
• TREATMENT Mild cases: move dog to a/c building or car– Temp >104º, immerged in cool water, hose down– Temp >106º, cool water enema (cool to 103º)– Temp >109° leads to multiple organ failureSTOP COOLING EFFORTS AT 103º– IV fluids– Corticosteroids
Heat Stroke
Emergency Drugs in Cats
Emergency Drugs in Dogs
• Misconceptions about animal pain– Animals do not experience pain– Pain doesn’t 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
Pain Management
• Signs– Vocalization– ↑HR– ↑RR– Restlessness, abnormal posturing, unwilling to move– ↑ Body temperature– ↑BP– Inappetence– Aggression– Facial expression, trembling– Depression, insomnia
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
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]
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
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– Κ: analgesia and sedation – Σ: depression, excitement, anxiety– Δ
• Side effects– Vomiting, constipation, excitement, bradycardia, panting
• Metabolized by liver; excreted by kidneys– Use caution with hepatic, renal disease
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
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• Κ agonist; μ antagonist• Analgesic effect questionable (>1 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
Pain Management
• Opioids– Antagonists• Naloxone HCl
– Reversal occurs within 1-2 min– Can be used to reverse anesthesia (Inovar-Vet)
Pain Management