1Monitoring Equipment

Pulse oximeter

Capnography

Blood gas analysis

2Blood Pressure Monitoring

Indirect Doppler

Oscillometric

Dynamap

Cardell

Direct Arterial catheter

Transducer

Monitor

3Indirect Blood Pressure

Measures systolic pressures Apply occlusion cuff over appendage

Cuff should be 40% of the circumference of leg

Place snugly around leg, tape in place

4Indirect Blood Pressure

Cuff is placed on: Mid foreleg distal to hock

Base of tail

Below the stifle in cats

5Doppler

Seemingly more accurate

Has more clinical uses

6Direct Blood Pressure

Techniques Invasive

More accurate

Requires arterial catheter placement

Requires transducer and mechanical transmitter

Records systolic, diastolic, and mean pressures continuously through series of waveforms

7Ideal Blood Pressure Values

Mean blood pressure ranges from 75-90 mm Hg Systolic blood pressures >175 mm Hg indicates

hypertension

Pulses should be palpable if the mean arterial blood pressure is >60 mm Hg

Systolic values >90 mm Hg and diastolic values >60 mm Hg are required to maintain adequate perfusion of vital organs

8Central Venous Pressure

Crude way to monitor a patient’s cardiac output via a jugular catheter in anterior vena cava

Used as a marker in fluid therapy to assess a patient’s response to treatment

Useful marker in determining perfusion status

9Central Venous Pressure

Normal central venous pressure is 0-5 cm H2O

Values <0 indicate hypovolemia, dehydration, or inadequate fluid therapy

Values or trends >8 or 10 indicate an increase in vascular volume and adequate fluid therapy

Sudden increases in CVP or values >10 may indicate venous congestion, increased thoracic pressure, and volume overload

10Coagulation Status

Helpful in assessing unexplained bleeding

Helpful in detecting DIC

Methods Evaluation of a blood smear

May detect red blood cell morphology changes and provide an estimation of platelet numbers

11Coagulation Status

Methods Buccal mucosal bleeding time (BMBT)

Evaluates platelet function

Can be used as an in-house screening test for von Willebrand’s disease

12Renal System Monitoring

Standard monitoring includes urine-specific gravity before IV fluids (if possible)

Laboratory markers include the BUN, creatinine, phosphorous

13Renal System Monitoring

Urine output should be estimated in all animals and recorded in the medical record Critical cases require close monitoring of urine production

through indwelling urinary catheters or specifically designed cages that allow urine to drain through a grate to be collected

Minimum urine production is 2-4 ml/kg/hr

14Central Nervous System Monitoring Note changes in mentation, level of consciousness, and

respiratory patterns

Changes may be subtle

Acute changes in neurologic status should be reported immediately

15Central Nervous System Monitoring Frequent monitoring of pupillary size and

responsiveness to light

Early signs of increased intracranial pressure include mental dullness, tachypnea, tachycardia, and dilated pupils

Later signs include bradycardia, fixed pinpoint pupils, seizures, coma, and death

Early recognition and intervention are key to the management

16Abdominal Cavity Evaluation Examined initially by palpation

Palpation can detect abdominal distension

Distension possible due to fluid accumulation, organ enlargement, and intestinal gas

17Abdominal Pain

Detected by the presence of discomfort, splinting, or vocalization

Animals with unexplained abdominal pain or distension warrant further investigation and monitoring

18Abdominocentesis

Procedure to confirm the presence of abdominal fluid and to collect samples for fluid analysis

Abdominocentesis is commonly performed to detect active hemorrhage, infection (peritonitis), ascites, uroabdomen, and neoplastic effusions

19Abdominocentesis

If only a small amount of fluid is collected, a four-quadrant tap may be performed in which the four areas of the abdomen centered around the umbilicus are sampled

20Thoracocentesis

May be performed as an emergency diagnostic procedure in animals with severe respiratory distress

Performed with the animal comfortably restrained in sternal recumbency

21Urinary Obstruction

Common emergency

Causes

Urinary stones, tumors, trauma, and/or inflammation

Obstructions can be fatal

Metabolic abnormalities can develop quickly

May develop secondary kidney damage

May even rupture the urinary system and leak urine into the abdomen

22Toxicities

Patient history is crucial What did the animal ingest?

When did the animal ingest it?

Is the animal showing any clinical signs?

Was the ingestion witnessed or suspected?

Are there other animals or children who could also be exposed?

23Toxicities

Manufacturer labels contain important information Advise client to bring label to the veterinary practice with

the pet

Additional information may be obtained from poison control centers

24Toxicities

Treatment Based on the toxin ingested

Inducing vomiting should be cautiously considered

Vomiting contraindicated for ingestion of caustic substances and petroleum products

25Toxicities

Inducing vomiting Apomorphine is a potent emetic agent

Directly stimulates the vomiting centers of the brain to cause vomiting

Used only in dogs

Absorbed across the conjunctival membranes of the eye

Small tablets may be placed in the conjunctival sac until vomiting has occurred

Can be flushed from the conjunctiva to terminate the vomiting episode

26Toxicities

Induction of vomiting in cats Very challenging!

Xylazine (a sedative drug) often used

Household remedies

Hydrogen peroxide and syrup of ipecac

Hydrogen peroxide administered orally will reliably result in vomiting due to bitter taste and gastric irritation