Equine emergency and ICU Flashcards
Differences between teflon and polyurethane catheter
PU is less thrombogenic so can stay in for longer; up to a week or more even if over the wire
Teflon = max 24 hours; more memory and more thrombogenic
What is an over the wire catheter
Where a wire is placed into the veil and then whole catheter and giving set is threaded over the wilre; then pull wire out
This causes the least trauma to the tip of the catheter so is the least thrombogenic
What type of surgery has higher risk of thrombophlebitis; so may choose over the wire catheters for this
Colic
Why might we placed superglue between the catheter and giving set screw
If these come apart, air could get sucked in and cause an air embolus which can be fatal
What should we do to maintian a catheter
Palpate for heat/swelling
Flush every 4-6 hours with hep saline + before and after medications
Can pul back to feel resistance
Ultrasound scanning
+ must check that the giving set and catheter remain tightly attached
What are signs of air embolus
Dullness, pyrexia, neuro signs, death
What is. apotential sequelae of thrombophlebitis from catheter
Septic process somewhere else e.g bacterial endocaditis
Why must we never use the other jugular once one has been affected by thrombophlebitis
If this one also gets affected; bilateral thrombophlebitis can stop venous drainage from head causign asphyxiation and death
What vein could we put a catheter in if there is thrombophlebitis of one jugular
Lateral thoracic
Cephalic (foal)
How to deal with thrombophlebitis from catheter
Remove it and place pressure on vein for 5 mins
Culture the tip
NSAIDs
Anti-coagulants if not already on them
Only give antimicrobials if persistently pyrexic
When must we take care with interpreting plasma lactate; what about creatintne as markers of dehydratino
Lactate; with liver disease
Creatinine; with kidney disese
What must we remember with handling of samples for lactate measurement
Place in heparin tube
MEasure within 5 mins !
What would be described as a mild, moderate or severe % dehydration
Mild = 5-8%
Moderate = 8-10
Severe = 10-12% dehydration
What things could lead to loss of water frmo the circulatio n
Lack of fluid intake
Bowel hypersecretion in colitis
Fluid loss to reflux
Diarrhoea
Signs of haemorrhagic shoc
Marked hypovolaemia meands tachycardia and tachypnoea
Male MMs
Long CRT
Sweating
Depression, weakness
Lactate conc increases
Only small volume of concentrated urine since poor renal perfusino; see pre-renal azotaemia
4 main mechanisms of shock
Hypovolaemic
Cardiogenic
Obstructive
Distributive/vasodilatory
What do we see on U/S with haemoabdomen
Hyperechoic smokey swirls in abdominal effusion
What should we remember to do if we see elevated creatinine in a dull, vaguely unwell horse
Check for internal haemorrhage
What is permissive hypotensive fluid resuscitation
When we consciously underperfuse patients with uncontrolled haemorrhage in haemorrhagic shock
- Due to risk of aggressive fluid therapy popping off an unstable clot
What should we use/avoid in uncontrolled haemorrhage and shock
Avoid alpha2 sedation because it causes a transient hypertensive phase wich could pop off the clot
Use tranexamic acid as a clot stabiliser
Avoid aggressive fluid therapy
What % of blood volume loss can horses tolerate wihtout showing signs
15%
(up to 30% if ver slow onset so can compensate)
What do we use to decide if a patient needs a transfusion
Clinical parameters rather than PCV/PP
What individuals would we want as a blood donor
Geldings (since females who have had a foal may have alloantibodies)
Not TBs (since these more likely to have Aa or Qa blood type which can get transufsion reactions)
WHat blood volume can we take from a donor
20% blood volume
- Volume is 8% of BW
- So multiple BW by 0.016
what is key in the set up for giving blood
Giving set must have an in line filter
What clot stabiliser is good to use in internal haemorrhage case
Tranexamic acid
What shoud we suspect if there is a lack of response of a seemlingly uncomplicated hypovolaemia to the calculated fluid replacement volumes
There may be distributive shock going on at same time due to endotoxaemia
What things can lead to distributive shock
Anything where gut wall compromised because this contains lots of free endotoxin
Septic conditions e.g endometritis
Signs of distributive/hypovolaemic shock
Tachycardia/tachypnoea
Weak peripheral pulses
Pyrexis
Discoloured MMs due to congetsion
INCREASED CRT
Decreased borygmi (blood preferntially shunted away from guts_
Sweating
What is maintenance fluid rate in horse
2-3ml/kg/hr
What fluid might we use in a hyperkalaemic pateitn
0.9% saline (because Hartmann’s contains K+ so ocntraindicated)
e.g in renal failure, bladder rupture in neonate
How much/how fast to give fluids n shock
Go for 10-20L bolus then reassess clinical parameters
What fluid do we use in shock resuscitation
Hartmann’s because it is only thing that comes in 5L bags and need to give 10-20L bolus
–> Can supplement with KCl to make it isotonic
When can we give enteral rather than IV fluids
In mild uncomplicated hypovolaemia
NOT in moderate/severe shock as the intestines will not be well perfused enough to absorb this
Start 1L/hr; can increase to 2L/hr if well tolerated
How can we prevent laminitis in endotoxaemia case
Cryotherapy of distal limbs
Biosponge
NSAIDs
Deep bed of shavings
Solar support
(could do lidocaine but expensive)
What is the definition of hyperlipaemia
Triglycerides >5.6mmol/L
How much does 1L of hyperimmune plasma increase foal IgG by
2g/L
How much hyperimmune plasma do foals with FPT need
Those with 0-4g/L already nmay need 2L
Those with 2-4 may just need 1
Must recheck later because a septic foal will use these up rapidly
What might we need to give a foal that is starting to show a reaction to plasma transfusion
Dexamethasone +/- adrenaline
