Emergency medicine Flashcards
An animal presenting with an English “H” or Spanish “J” airway sound is indicative of which type of obstruction?
Laryngeal or tracheal
What does the absence of the menace reflex indicate in rabbits and rodents?
Not necessarily anything, often absent in normal animals
If you are bitten by a ferret during exam, this is the best way to get them to release:
Hold them under a running faucet
What is the most common zoonotic risk associated with chinchillas?
Giardia
What condition can result after handling an aggressive/stressed rat that causes recurrent fever, vomiting, muscle ache and enlarged lymph nodes 6-10 days after handling?
Rat bite fever - caused by Streptobacillus moniliformis and/or Spirillum minus
What can occur when gerbils and mice are picked up too caudally?
Tail slip
How is tail slip in gerbils and mice treated?
Amputation at the level where the skin ends
What virus carried by rats, mice, and Syrian hamsters can result in mild symptoms that can progress to meningitis, especially in prenatal and immunocompromised people?
Lymphocytic choriomeningitis virus
What two factors does oxygen delivery to tissues depend on?
Arterial oxygen content and cardiac output
Why is the oxygen-hemoglobin dissociation curve shifted to the right in ECMs relative to larger mammals?
They have higher oxygen consumption per gram of tissue (so diffusion gradient must be higher)
What direction should a tube be advanced for nasotracheal intubation?
Ventrally and medially into the ventral nasal meatus
List 3 contraindications for nasotracheal intubation:
- UR disease
- Edema of the nasal passages
- Narrowing of the nasal passages (s/a from apical elongation from the teeth)
A guinea pig housed with a rabbit is presenting with anorexia, oculonasal discharge, dyspnea, and other LRT signs. What are two most possible etiologic agents that may be causing the clinical signs?
Bordetella bronchiseptica or Streptococcus pneumoniae
What non-respiratory disease should be considered in prairie dogs with respiratory distress?
Pseudo-odontoma causing obstructive respiratory disease
Sedation with this agent will decrease hematocrit 15 minutes after induction in ferrets, so is not ideal to use prior to blood collection for transfusion.
Isoflurane
List 3 sites that are suitable for IO placement in most ECMs:
Proximal humerus, tibia and femur
Urethral catheters in guinea pig males should be placed where?
In the external urethral opening dorsal of the glans, avoiding the ventral intromittent sac
What is the normal PCV of ferrets?
45-65%
If rodenticide toxicity is suspected, what medication can be administered?
Vitamin K
If acetaminophen toxicity is suspected in ferrets, what medication can be administered?
N-acetylcysteine
If NSAID toxicity is suspected in ferrets, what medication can be administered?
Misoprostol
Why are ferrets more prone to heat stress?
They don’t have sweat glands and can’t tolerate temps above 86* >~10 minutes
Ingestion of ibuprofen in ferrets will result in what clinical signs?
GI - Anorexia, vomiting, diarrhea, melena
Neuro - tremors, ataxia, depression coma
Renal - Anuria or oliguria
What course of action should be taken with a ferret with ibuprofen ingestion 1 hr ago?
- Induce emesis/gastric lavage and charcoal
- IV fluids
- Sucralfate, Misoprostol, Metoclopramide +/- anticonvulsants to treat GI ulcerations, renal failure, hepatic/CNS effects
A recently vaccinated 1 yr old ferret presenting with a 106* fever, pain, anorexia and muscle wasting is likely suffering from what disease?
Disseminated idiopathic myositis
If a jill presents with dystocia, after ensuring kits are positioned appropriately, what should be administered to induce labor?
Prostaglandin F2 alpha, then oxytocin if labor is not induced within 3 hours. C-section if no kits w/in 8 hours
Name the 4 stages of wound healing in order:
- Inflammatory phase
- Debridement phase
- Repair phase
- Maturation phase
How do neutrophils contribute to wound debridement and prevention of infections?
They phagocytose bacteria and cellular debris. They release enzymes and growth factors that facilitate the breakdown of necrotic material and stimulate monocytes to turn to macrophages
What do macrophages do in a wound during the debridement stage?
They help remove necrotic tissue, bacteria and foreign material. They secrete chemotactic/growth factors that recruit mesenchymal cells, stimulate angiogenesis and modulate matrix formation leading to granulation tissue formation
What cells migrate into wound along fibrin strands to deposit collagen, elastin and proteoglycans during the repair phase?
Fibroblasts
Following fibrin deposition, what is released from endothelial cells of new capillaries that invade the wound bed and clears the path for granulation tissue?
Plasminogen activator
What role does granulation tissue play in wound healing?
Provides a surface for epithelium to migrate across and helps with wound contraction
When does the maturation phase of wound healing occur?
2.5-3 weeks after the initial injury
What are factors that can affect wound healing?
- Infections/inflammation from foreign debris
- Seroma formation
- Excessive use of antiseptics in/around wounds
- Impaired blood supply
- Type of injury/instrument used (ie scissors vs. scalpel)
- Condition/age of patient
- Concurrent illness
- Stress/pain causing endogenous steroid release or iatrogenic steroids
- Radiation/chemotherapy
Scrubbing of wounds and flushing antiseptic agents into wounds is discouraged because:
It damages tissue and potentially promotes infection; Antiseptics can have cytotoxic effects that may delay wound healing
For wound lavage, which antiseptic is preferred and why?
Chlorhexidine 0.05% (over povidone-iodine 1%) because it least affects the healing process and has higher bactericidal activity and long residual effects
What three techniques can be used for wound debridement?
Surgical, enzymatic (trypsin and Castor oil) and mechanical (adherent bandages, calcium alginate)
How long can demarcation of viable tissue take to determine?
24 hours to 5 days
When is primary closure utilized?
With clean wounds less than 6 hrs old that can be closed w/out tension or dead space
If a wound is older than 8 hours but has minimal contamination or trauma present and has not reached the granulation phase, what type of closure can be utilized?
Delayed primary closure
When and how is secondary closure performed?
When wounds do not close by second intent; granulation tissue is removed and fresh skin margins are created and the wound is closed following apposition of skin edges
What are potential disadvantages of second intent wound closure?
Scarring and/or incomplete healing, especially in high movement/tension areas
What type of bandages could be utilized for an exudate-producing wound that is not clean?
Wet-to-dry or dry-to-dry bandages
What is the most common cause for blood transfusion besides acute trauma in: a. intact female rabbit, b. intact female ferret, c. ferret with GI signs
a. uterine pathology
b. hyperestrogenism causing pancytopenia
c. Helicobacter-associated gastric ulcers
List 3 indications for blood transfusions.
An increased need for albumin, coagulation factors and/or red blood cells
When should hypertonic crystalloids be avoided?
In dehydrated patients as they already have a volume-depleted extravascular fluid component
What is often the first clinical sign of dehydration in hindgut fermenters?
Decreased fecal production and gastrointestinal hypomotility
What is happening when a rabbit receiving a transfusion shows signs of DIC, bronchospasm and vascular collapse? How is this treated?
An acute hemolytic transfusion reaction due to a donor-recipient mismatch. Transfusion should be stopped and corticosteroids, fluids and bronchodilators should be administered
If ferret or rabbit blood is not available, what can be used for a xenotransfusion as a last resort?
Feline red blood cells
(But jepm 2024 study says NOT to do this with ferrets)
How should a patient in severe hypovolemic shock be approached?
Bolus hypertonic saline, then colloids. Follow with isotonic crystalloids and bolus of colloids until systolic BP >90 mmHg; Continue crystalloids. Rewarm concurrently
If overhydration is suspected, how should it be treated?
Discontinue IV/IO fluid therapy, provide supplemental oxygen and admin diuretics IV
What sedatives should be avoided in critical patients?
Alpha 2 agonists because they reduce cardiac output and tissue perfusion
What method of induction should be avoided in critically ill exotics and why?
Inhalant induction; leads to physical struggle and prolonged period of apnea, hypoxemia, hypercapnia, and bradycardia
The following are clinical signs of what type of coagulation issue?
- Reduced or absent tissue perfusion
- Necrotic extremities
- Absent pulses
- Regional pain / loss of nociception
Thrombosis
Disorders of primary hemostasis cause ____ , while secondary hemostatic disorders cause _____ .
Petechial or mucosal hemorrhage; Hematomas and large body cavity bleeds
What 3 tests should a patient presenting with anemia and abnormal bruising have performed?
- CBC w/sequential platelet assessment
- Biochemistry
- Coagulation factors if species appropriate
What are potential causes of thrombocytopenia in ECM?
- Hyperestrogenemia in ferrets
- Benzimidazole administration
- Neoplasia/chemo agents
- Infectious agents (Eimeria, Histoplasmosis
- DIC
- Venomous snake bites
How does Vitamin C deficiency cause hemorrhage?
Abnormal collagen synthesis caused ultrastructural changes to blood vessel walls
While DIC is difficult to diagnose in ECM, what is indicative of overt DIC?
Severe thrombocytopenia with prolonged clotting times and elevated fibrin-related markers (d-dimer)
What type of cells does RHD target and what does it cause?
Hepatocytes, phagocytic and endothelial cells
Hepatocellular necrosis, DIC, and death
What species does not need to be cross matched for the first transfusion as they do not have blood types?
Ferrets
What are the acute effects of fluid overload?
Interstitial or pulmonary edema, body cavity effusions, especially when accompanied by body weight increases of 5-10%
What is the best way to assess hydration level in ECM patients?
Measure changes in body weight and measure weight of all fluid outputs
What 2 monitoring tools most effectively assess quality and patient response to CPR?
ETCO2 and ECG
What is the best first initial step in veterinary CPR?
Chest compressions (per ER book establish airway… so idk)
What are the 6 H’s of reversible etiologies for cardiopulmonary arrest?
- Hypovolemia/hemorrhage
- Hypoxia
- Hydrogen ions (acidosis)
- Hyper- or hypo-electrolytes
- Hypoglycemia
- Hypo- or hyperthermia
What are the 5 T’s of reversible etiologies for cardiopulmonary arrest?
- Toxins or tablets
- Tension pneumothorax
- Tamponade (d/t pericardial effusion)
- Thrombosis/thromboembolism
- Trauma
List the 6 factors that make the risk for anesthetic related death in small animals ~10x greater than K9/fel.
- High SA to V ratio and high metabolic rates
- Higher sensitivity to stress
- Limited venous accessibility
- Difficult intubation
- Higher predilection for hidden preop morbidities
- Relative inexperience of vets
At what rate and tidal volume should breaths be administered during CPCR?
10-20 breaths/minute at 10 mL/kg tidal volume (pressure 10-20 mmHg)
If venous access is not achieved during CPCR, what should be done to drugs administered intratracheally to increase the chance of efficacy/absorption?
Double the dose, dilute with sterile saline/water to volume of 2-4 mL, admin 2 PP breaths after drugs administered
What is considered the best indirect indicator of cardiac output and pulmonary blood flow?
ETCO2
What does an ETCO2 of 12-18 mmHG indicate? <10 mmHg? >45 mmHg during CPR?
ROSC;
Incorrect intubation/ineffective CPCR technique or hyperventilation;
Hypoventilation or increased CO2 delivery to lungs after ROSC
What drug(s) should be administered with sinus bradycardia?
Atropine; or glycopyrrolate in rabbits due to atropinesterases in blood
Which is false regarding the goals of effective CPCR?
A. ETCO2 <10 mmHg
B. Normal acid-base status, glucose, and e-lyte levels.
C. Mean (direct) arterial blood pressure >50 mmHg
A. ETCO2 should be >30-40 mmHg with normoxia
What drug resulted in severe, transient neurologic side effects in chinchillas when given at 40 mg/kg?
Tramadol
A patient with severe systemic disease that poses a constant threat to life is in what ASA classification?
Class IV (V is moribund - will not live w/out surgery but high risk of death under anesthesia)
What is the most useful indicator to assess anesthetic depth in small mammals?
Toe pinch/leg withdrawal (righting reflex is 1st to go, can still feel pain; palpebral/corneal lost at dangerously deep level)
Which are appropriate ventilator settings for a small mammal for IPPV during surgery?
A. Tidal: 10-15 mL/kg; RR: 20-40 bpm; Pressure: 15-20 mmHg
B. Tidal 5-10 mL/kg; RR 20-40 bpm; Pressure 5-10 mmHg
C. Tidal 10-15 mL/kg; RR 10-15 bpm; Pressure: 15-20 mmHg
A. Tidal: 10-15 mL/kg; RR: 20-40 bpm; Pressure: 15-20 mmHg
What is the ideal minimum database for most ECM emergencies (when pt size/status allows)?
PCV, TP, BG, blood smear
Which of the following will NOT cause total solids to increase on refractometry?
A. Hyperglycemia
B. Hypercholesterolemia
C. Acute blood loss
C
What does an increased total protein most commonly indicate?
Dehydration
Which is CORRECT regarding POC glucometers in exotic mammals?
A. Veterinary glucometers consistently overestimate, and human glucometers consistently underestimate
B. Veterinary glucometers consistently underestimate, human glucometers consistently overestimate
C. There was no correlation/pattern in regard to veterinary and human glucometers
A - Vet gluc: overestimate; Human gluc: underestimate
Which is true regarding lactate in exotic companion mammals?
A. D-lactate is most commonly measured by POC analyzers
B. In critically ill rabbits, L-lactate values were persistently low compared with rabbits with a good prognosis where lactate values increased
C. POC analyzers showed minimal difference vs lab results
B is correct (A - L lactate measured; C - significant difference - POC good for trends but not for single dx/px value)
What should the cuff width to limb circumference ratio be for measuring BP?
30-40%
Which of the following is NOT a normal finding on ferret ECGs?
A. VPCs
B. A pronounced sinus arrhythmia
C. 1st and 2nd-degree AV block
A. technically high grade 2nd degree AV or 3rd degree block would also be abnormal
Which of the following is TRUE about the fecal occult blood test?
A. Certain foods such as broccoli and lamb can cause false positive results
B. There is no way to prevent false positive results when setting up the test
C. The test is based on detection of activity of peroxidase in leukocytes
A is correct; B - mitigate false + by delaying time to evaluation after smearing; C - detects peroxidases in heme/hemoglobin
Which is correct?
A. If acid-base disturbance is respiratory in origin, pH and PCO2/HCO3- go in the same direction; metabolic goes in opposite
B. If acid-base disturbance is respiratory in origin, pH and PCO2/HCO3- go in the opposite direction; metabolic goes in same
C. A low pH with a low PCO2 indicates a respiratory acidosis
B is correct; (C - low pH and HIGH PCO2 is resp acidosis)
Which pathways does prothrombin time (PT) assess?
Extrinsic (factor VII) and common (f X, V, II or prothrombin)
What does activated partial thromboblastin time (APTT) assess?
Intrinsic (Factor XII, then XI, IX, VIII) and common pathways (X, V, II, fibrinogen)
What is the first treatment that should be administered with CHF (besides oxygen +/- sedation) in ECM?
Furosemide
