Emergency and Critical Cases

Question 1

•Two cats present simultaneously

–One has a urethral obstruction of unknown duration; HR=60; T=37.5C; RR=8BPM; CRT 2-3 secs; MM – pink but dry; severe mental depression; PCV=50%; TS=80g/L

–Other cat is anaemic; HR=240BPM; T=40C; RR=36; CRT=1-2 secs; MM – pink, moist; Mentally alert; PCV=10%; TS=65g/L

1. How would you prioritise these animals?
2. What is your immediate management of the most critical cat?
3. As you work on the most critical patient, what instructions would you give to begin treating the other cat?

Answer 1

1. Prioritise blocked cat as is bradycardic and dehydrated

Second cat is probably just struggling to deal with its anaemia e.g. M Haemofelis. This second cat wont die before top cat – needs blood transfusion

2. DO NOT ANAESTHETISE YET

Needs fluids and ECG. Find out how bad potassium is. Low RR and HR – pending arrest.Catheterise blocked cat and pain relief or cystocentesis – don’t want to stress atm though. Ready to die so do not give drugs (apart from diazepam).

3. Haematology to ascertain type of anaemia and place in oxygen tent, physical exam to locate blood loss ascertain, set up US machine and have a look if in shock shock rate fluids. Need blood in the future.

Question 2

–Haematology to ascertain type of anaemia and place in oxygen tent, physical exam to locate blood loss ascertain, set up US machine and have a look if in shock shock rate fluids.

1. After triage assessment, how would you prioritise these two dogs
2. What is the immediate management of the most critical patient
3. What first aid would you provide to the waiting animal

Answer 2

1. Vomiting dog first need to ascertain cause of vomiting and high HR, T, RR, increased CRT and MM grey. Less CRS stable. It is in decompensated dog. Whereas # case is compensated shock.
2. ABCN – ensure okay. Can give Oxygen. IV, ive analgesia and then think about radiography.
3. Splint and opiods (assess mentation before opiod) and full ABCDN

Stabilise the limb – less uncomfortable.

Abx a good option (broad spec with anaerobic cover).

(Robert jones – will depend how proximal as can actually make it swing more)

Question 3

•An owner calls about their cat that has been hit by a car. The cat is in sternal recumbency and has blood around the head. It is in obvious respiratory distress

1. What are your recommendations for transport?
2. What parameters should be monitored during transport?
3. How do you prepare the hospital and staff prior to presentation?

Answer 3

1. Transport on rigid transport medium, keep warm and minimise movement and stress and get to vets ASAP, apply pressure to blood loss if significant and possible, move on horizontal plane holding shoulders and pelvis simultaneously
2. Check RR, mentation (conscious and breathing), any signs of external bleeding
3. Set up anaesthetic machine, draw up drugs, set up US machine, set up CPR station, turn O2 on and check, have staff ready and waiting.

Question 4

•Define basic and advanced life support

Answer 4

Basic: chest compressions and ventilation one full cycle 2 mins.

Advanced: initiated monitoring, IV access, ECG and dependent on ECG findings appropriate drugs for VF (defib, precordial thump) VT (lidocaine/adrenaline) and then asystole (adrenaline). Cant ECG with chest compressions. If intubated capnography – above 200mlmg you probably have some to the brain. If the pupils blow – you haven’t got much chance.

Question 5

•List priorities for basic life support

Answer 5

Airway (intubate), breathing, circulation and neurological assessment

Question 6

•list priorities for advanced life support

Answer 6

Obtaining vascular access, Capnography, PLR, ECG monitoring

Question 7

•Chest compression during closed chest CPR promotes blood flow by what two methods

Answer 7

Thoracic recoil: Remember you are trying to increase intrathoracic pressure and not compress the ventricle of the heart

This method compresses the whole thorax and hopefully sucks blood into caudal vena cava and generating a stroke volume.

The thoracic pump will not be effective in animals with severe hypovolaemia, or incompetent tricuspid valves

Question 8

•How can you measure success of resuscitative attempts?

Answer 8

During compression a synchronous femoral pulse can be palpated vice versa not synchronous suggest animal is starting to make its own stroke volume again is also good. Colour of mucous membrane improves Eye position changes (central à ventromedial) Pupil changes size. ECG changes. Palpebral, corneal, gag reflex may be noticed. Breathing or chest movements (twitches) resume. Lacrimation. Animal regains consciousness . Capnograph.

Question 9

•Ventilations and chest compressions are not producing adequate perfusion. What else can you do? Open chest CPR is not an option

Answer 9

Precordial thump or defib depending on ECG reading, or other drug protocols suitable to ECG reading, for cardiopulmonary arrest give adrenaline, performed alternate abdo compressions to push more blood to heart and binding back legs to increase thoracic blood volume.

Adrenaline – low dose a good place to start. Keep giving

No need to give atropine – probably not vagally stimulated

Tie the legs

Pulse the abdo

Over 10KG – widest part – thoracic pump

Under 10kg or V shaped dog – ventrally over the heart relying on the cardiac pump

Question 10

1. When can you start feeding? How would it differ if this was a jejunostomy tube? How can you feel if feed being tolerated?
2. What type of diet best fed intitially and why?

Answer 10

1. 24 hours later to get a fibrin seal. Leave J tube longer. Food is tolerated; if you remove 50% of what you put in the previous food you may need to re think
2. Type – One that goes down tube and meets calorie requirement. E.g. critical care

Question 11

cat been anorexic for a week. How fast before full caloric intake?

Answer 11

–3- 4 days go steady

Question 12

What are the primary metabolic complication associated with re-feeding anorexic patient? (2)

Answer 12

–HypoK, HypoP