Blocked Cat Flashcards
Survival rate to discharge is >___%
90
But most owners elect PTS because recurrence rate is 10-40% and it can happen at any time
________ % of cases are idiopathic
50%
Other causes are uroliths and urethral plugs(minerals,cells,mucous like protein)
UTI is a common cause of UO . T/F
F
Uncommon cause ; older cats >10 yr at increased risk
Systemic signs are seen when UO is >___hrs
24
Death can occur within ______ hours of UO
48 hr
Moderate bradycardia would be ______ to ______ bpm
100-140
<100 is considered as severe bradycardia
Bradycardia is in indication of ↑ K. T/F
T
- But absence of bradycardia does not r/o ↑ K
- There is not direct correlation between both
Normal HR does not r/o ↑ K . T/F
T
Pain medications chosen by author?
- opioids like buprenorphine or methadone
- epidural (can be done later once pet is under anesthesia)
Which route does author chose for pain medications?
IV if dehydrated
Otherwise IV or IM
Which medication does author use for sedation?
In some cases opioid given for analgesia is sufficient
But author prefers Midazolam/diazepam
What does of midazolam/diazepam does author prefer?
0.1-0.2 mg/kg
Sometimes even upto 0.3 mg/kg
Route is IV
Which sedative drug does author avoid?
alpha 2 agonist
As they cause vasoconstriction and ↓ HR and also block release of endogenous insulin for ~ 2 hrs
1 step for stabilization as per author is ________
IV catheter
Can get some blood for BG analysis while putting IV catheter
IV cather → next step?
Pain relief +/- sedation
Pain reflief +/- sedation → next step?
Collect blood For
- Chemistry
- electrolytes
- BG
- CBC (not as important as others)
Blood collection → next step?
IV fluid bolus
- LRS or hartmanns
- 10 ml/kg bolus (i.e. 1/6th of shock dose)
IV fluids → next step?
ECG
K levels > ____ mEq/L can significantly increase anesthetic risks
7.5 (at or above this level, K starts to have bad effects on heart)
Normal levels are 3.5 -5.1 mEq/L
What does author do when K levels are > 7 as far as relieving obstruction is concerned?
Author will temporarily relieve obstruction under effect of pain meds +/- sedatives discussed before and once pet is more stable then proceed with GA and putting indwelling catheter
Steps in case of hyperkalemia?
-Relieve obstruction
-IV fluid bolus
-Glucose bolus
+/- Calcium gluconate 10%
calcium gluconate 10% dose?
0.5-1.5 ml/kg slow IV
- Does not reduce K
- Effects last ~ 20-30 min
how is calcium gluconate 10% useful in hospital settings?
Buy you 20-30 min to lightly sedate pet to temporarily relieve obstruction and put IV catheter
then once pet is more stable and hydrated, GA can be given to put indwelling IV Catheter
Temporarily relieving obstruction is usually done hours before GA and putting indwelling catheter.
T/F
T
Benefits of temporarily relieving obstruction?
- Immediate relief to pet and ↓ in their stress level
- provide sample for UA
- Give time to discuss long term plans with owners
- allows you not to rush the pet to anesthesia
When would author do everything in one go i.e. getting pet under IM/IV anesthesia directly?
If pet is aggressive
1st step in case of temporarily relieving obstruction?
ASSESS THE TIP OF PENIS
Sometimes a crystal/mucous plug is all that is blocking
If not the case, then clip around penis, prep and sterile drape → proceed with unblocking in a sterile way if possible
What flush solution do you need ?
Couple of 20 ml syringes (0.9% NS)
Can mix 1:1 with sterile lubricant
Can also add lidocaine <1 mg/kg
What catheter to use for unblocking?
- 22 g IV catheter with stylet removed
- 3.5 Fr Tom cat catheter 14 cm - open end or close end
Author uses 22 g IV catheter first and then transition to tom cat catheter was obstruction relieved especially at the tip
Which recumbency to use?
Lateral can be done in case of sedation ; In case of GA, dorsal recumbency with back legs and tail moved forward
Exteriorizing tip of penis is important before unblocking . T /F
T
What to do once the tip is in ?
Hold the prepuce and move it towards the tail side and caudally
What does author do after relieving obstruction with 22 G catheter?
Use tom cat catheter and use 50 ml syringe to empty out bladder
What length of tom cat catheter does author recommend?
15 cm is best
But 12-15 cm works
