Basic Approaches to Treatment II (19) Flashcards
When should you NOT induce vomiting?
- horse, ruminant, rodent, rabbit reptile bird
- not fully alert and fully conscious
- has significant respiratory compromise
- abnormal pharyngeal reflexes
- is seizuring
- has already vomited multiple times
- has ingested a substance with rapid onset of action
When should you not induce vomiting regarding the upper GI tract?
- caustic/corrosive agents (acids, alkalis)
- ingested toxin is mixed with something that may damage the esophagus (broken glass)
Risks from the toxin must be _____ risks of emesis
outweigh
How long after toxin ingestion does emesis become futile?
- consistency and amount of material in stomach
- caloric density of stomach contents
- fat content of stomach contents
- intragastric pressure
- the toxin is ingested
What is the gastric emptying time for liquids?
15-45 minutes
What is the gastric emptying time for solids?
take longer than liquids, are retained in the stomach until almost liquid
- some non-absorbable solids can remain in stomach for weeks to months
started 30-60 minutes, complete 9-12 hours
Is this a good time to induce emesis?
yes, food is protective and prevents damage from the foreign material
What is the rule of thumb for emesis?
the sooner, the better
<30 post-ingestion is best
T/F: Inducing emesis will allow for the stomach to be completely empties
FALSE - may not remove all of the toxin
What is the major risk for emesis? Which species is it rare in?
aspiration
dogs, cats, ferrets, and pigs
What is the best emetic for home use?
hydrogen peroxide 3%
What is the MOA for hydrogen peroxide?
irritate pharyngeal and gastric mucosa - must be fizzy to work
How long should you wait for hydrogen peroxide to work?
1-2 times if no effect within 10-15 minutes
What should you do when you induce vomiting at home?
- prevent animal from eating the vomit
- have owner collet the vomit and bring it with them
What are some home ingredients you should not use?
What are central acting emetics?
- apomorophine
- xylazine
What is apomorphine?
synthetic derivative of morphine
- stimulates dopaminergic receptors in chemoreceptor trigger zone —> place that triggers the gut for emesis
How do you use apomorphine?
IV administration, single use only, vomit center is depressed following initial CRTZ
produces excitement in cats
What does xylazine do?
activates alpha-2 receptors in chemoreceptor trigger zone
What are apomorphine tablets?
What is the most common way of administering apomorphine?
place tablet or portion of tablet under the eyelid in the conjunctiva sac
What is ropinirole?
- dopamine D2 agonist (dopamine is trigger for emesis)
- formulated as ophthalmic solution
What if emesis is unsafe?
consider gastric lavage
When do you only consider gastric lavage?
- only if cannot safely induce emesis
- only if risks from toxin outweigh risks of lavage
- only if it is safe
When should you NOT form gastric lavage?
- toxin ingested is caustic, corrosive
- toxin ingested is a volatile hydrocarbon
- an increased risk of gastric perforation exists
- if sharp objects are in the stomach
When is gastric lavage indicated over emesis?
- patient has altered mental status
- the patient has respiratory compromise
How is gastric lavage performed across different animals?
small animals: should be performed under general anesthesia, with a cuffed endotracheal tube in place
horse and ruminants: anesthesia and endotracheal tube not required
T/F: Gastric lavage is more effective than emesis
FALSE
What is the major risk of gastric lavage in small animals?
aspiration - check endotracheal tube cuff often
recline patient with head down
How do you perform a rumen lavage?
animal NOT anesthetized
place large tube into rumen, use a garden hose
When should you consider gastronomy or rumenotomy?
- large items or imbedded items in stomach/rumen
- if emesis or lavage not safe or unlikely to be effective
What is whole bowel irrigation? What substance is used?
give large amount via stomach tube
polyethylene glycol
for massive overdoses of sustained release drugs or toxins poorly bound by AC
What are oral chelators?
used more in large animals, form insoluble compounds in the GI tract to decrease absorption
