Blocked Cat

Question 1

Survival rate to discharge is >___%

Answer 1

90

But most owners elect PTS because recurrence rate is 10-40% and it can happen at any time

Question 2

________ % of cases are idiopathic

Answer 2

50%

Other causes are uroliths and urethral plugs(minerals,cells,mucous like protein)

Question 3

UTI is a common cause of UO . T/F

Answer 3

F

Uncommon cause ; older cats >10 yr at increased risk

Question 4

Systemic signs are seen when UO is >___hrs

Answer 4

24

Question 5

Death can occur within ______ hours of UO

Answer 5

48 hr

Question 6

Moderate bradycardia would be ______ to ______ bpm

Answer 6

100-140

<100 is considered as severe bradycardia

Question 7

Bradycardia is in indication of ↑ K. T/F

Answer 7

T

• But absence of bradycardia does not r/o ↑ K
• There is not direct correlation between both

Question 8

Normal HR does not r/o ↑ K . T/F

Answer 8

T

Question 9

Pain medications chosen by author?

Answer 9

• opioids like buprenorphine or methadone

- epidural (can be done later once pet is under anesthesia)

Question 10

Which route does author chose for pain medications?

Answer 10

IV if dehydrated

Otherwise IV or IM

Question 11

Which medication does author use for sedation?

Answer 11

In some cases opioid given for analgesia is sufficient

But author prefers Midazolam/diazepam

Question 12

What does of midazolam/diazepam does author prefer?

Answer 12

0.1-0.2 mg/kg

Sometimes even upto 0.3 mg/kg

Route is IV

Question 13

Which sedative drug does author avoid?

Answer 13

alpha 2 agonist

As they cause vasoconstriction and ↓ HR and also block release of endogenous insulin for ~ 2 hrs

Question 14

1 step for stabilization as per author is ________

Answer 14

IV catheter

Can get some blood for BG analysis while putting IV catheter

Question 15

IV cather → next step?

Answer 15

Pain relief +/- sedation

Question 16

Pain reflief +/- sedation → next step?

Answer 16

Collect blood For

• Chemistry
• electrolytes
• BG
• CBC (not as important as others)

Question 17

Blood collection → next step?

Answer 17

IV fluid bolus

• LRS or hartmanns
• 10 ml/kg bolus (i.e. 1/6th of shock dose)

Question 18

IV fluids → next step?

Answer 18

ECG

Question 19

K levels > ____ mEq/L can significantly increase anesthetic risks

Answer 19

7.5 (at or above this level, K starts to have bad effects on heart)

Normal levels are 3.5 -5.1 mEq/L

Question 20

What does author do when K levels are > 7 as far as relieving obstruction is concerned?

Answer 20

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

Question 21

Steps in case of hyperkalemia?

Answer 21

-Relieve obstruction
-IV fluid bolus
-Glucose bolus
+/- Calcium gluconate 10%

Question 22

calcium gluconate 10% dose?

Answer 22

0.5-1.5 ml/kg slow IV

• Does not reduce K
• Effects last ~ 20-30 min

Question 23

how is calcium gluconate 10% useful in hospital settings?

Answer 23

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

Question 24

Temporarily relieving obstruction is usually done hours before GA and putting indwelling catheter.

T/F

Answer 24

T

Question 25

Benefits of temporarily relieving obstruction?

Answer 25

• 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

Question 26

When would author do everything in one go i.e. getting pet under IM/IV anesthesia directly?

Answer 26

If pet is aggressive

Question 27

1st step in case of temporarily relieving obstruction?

Answer 27

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

Question 28

What flush solution do you need ?

Answer 28

Couple of 20 ml syringes (0.9% NS)
Can mix 1:1 with sterile lubricant

Can also add lidocaine <1 mg/kg

Question 29

What catheter to use for unblocking?

Answer 29

• 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

Question 30

Which recumbency to use?

Answer 30

Lateral can be done in case of sedation ; In case of GA, dorsal recumbency with back legs and tail moved forward

Question 31

Exteriorizing tip of penis is important before unblocking . T /F

Answer 31

T

Question 32

What to do once the tip is in ?

Answer 32

Hold the prepuce and move it towards the tail side and caudally

Question 33

What does author do after relieving obstruction with 22 G catheter?

Answer 33

Use tom cat catheter and use 50 ml syringe to empty out bladder

Question 34

What length of tom cat catheter does author recommend?

Answer 34

15 cm is best

But 12-15 cm works