General Zoo Medicine Flashcards
Describe cardiopulmonary resuscitation in zoo and wild animals.
What is the CPR algorithm?
What are the two types of compressions?
What emergency medications should be used?
What are the two most useful monitoring parameters to determine success?
How is CPR changed for the following taxa?
- Fish
- Herps
- BIrds - what species cannot have ulnar IO catheters?
- Large Mammals
What specific anesthetic complications need to be kept in mind for the following species:
- Felids
- Diving species
- Ruminants?
CPR -
- Cardiac Pump Theory (hand over heart)
– Narrow-chested species in lateral recumbency
– Barrel-chest species in dorsal recumbency
- Thoracic pump theory (hand over widest part of thorax)
– Increase in intrathoracic pressure, secondary blood flow
– Large-chested species in lateral
Emergency Meds
- IV or IO access ASAP
- Anesthetic reversal agents
- Vasopressors
– Increase SVR and maintain blood flow to organs
Epinephrine
- Low-dose epi every other CPR cycle
- High-dose has better ROSC, but poorer survival to discharge - Use if CPR >10 mins
- Consider CRI of epinephrine – increased cerebral perfusion?
Vasopressin
- Can use alongside or in place of epi every other cycle
Vagolytics
- Atropine = parasympatholytic
- No significant benefit seen, but no adverse ones either
- Consider atropine every other cycle, especially if high vagal tone
Anti-arrhythmic meds, Steroids, Electrolytes, Bicarb
- Lido or amiodarone for “shockable” rhythms if don’t respond to defib
- Steroids – NOT recommended
- Hyperkalemia or hypocalcemia warrant tx
- Sodium bicarb – consider for prolonged CPR
Fluids and supp. O2
- IVF ONLY if hypovolemic
- Fluids for euvolemic patient 🡪 increase RA pressure 🡪 decrease perfusion
- FiO2 100% only if hypoxemic
- If normoxemic – oxygen toxicity (reactive species)
Intratracheal Drugs
- NAVEL = Naloxone, Atropine, Vasopressin, Epinephrine, Lidocaine
- For epi, report 2-10x IV dose
- Dilute in sterile water and give via red rubber
Patient Monitoring
* 2 most useful tools = ECG and EtCO2
* Assess ECG after each cycle (keep in mind – PEA)
* EtCO2 – sharp, sudden spike associated with increased CO
* >15mmHg in dogs 🡪 greater ROSC
Taxa-Specific Recommendations
* Fish
– Improve oxygen – oxygenated water over gills in cranial 🡪 caudal direction
– Location of heart – impractical for compressions
* Reptile and Amphibians
– High tolerance for anoxia
– Keep @ POTZ for best drug metabolism
– Snakes and lizards = Cardiac pump compressions, ventilation 2-8 rpm
– Can consider air sac canula for snakes
– Doxapram as potential respiratory stimulant
– Keep amphibian skin moist
* Avian
– Keel – makes cardiac compressions difficult; no diaphragm for thoracic pump
– Keel compressions could increase intracoelomic pressure
– Compressions at 100-120bpm; Ventilation at 40-50 rpm
– Consider air sac canula and IO catheter
– NO ULNAR CATHETERS in Californian condors and pelicans (pneumatic)
* Large Mammals
– Use of compressor’s hands, knees, and body may be needed.
– 80bpm with thoracic pump
* Ventilation 10-20 rpm
Know species-specific anesthetic complications
- Severe hyperkalemia in anesthetized felids
- Diving species – bradycardia, peripheral blood shunting
- Ruminants – regurgitation
Describe transfusions in zoological medicine.
What are the known blood types?
- For dogs?
- Felids?
- Apes?
How is crossmatching performed?
- Major v minor?
What anticoagulants can be used?
What is the theoretical transfusion volume?
What types of transfusion reactions may occur?
Blood types
- DEA 1 in dogs - strong antigenicity (DEA 1+ or DEA1- if presence or absences of RBC surface antigens)
- DEA 1 exists in wild canids, commercial QuickTestDEA1 successfully used in wild canids
- Wild felids have same AB blood groups as domestic cats
- Human ABO blood groups described in apes, New-World, and Old-World monkeys
– Naturally occurring alloantibodies found in primates, same as humans
– Chimps - predominantly group A
– Bonobos - all group A
– Orangutans - A, B, or AB
– Gorillas - blood groups are not similar, human card tests cannot be used
Blood compatibility tests (crossmatch)
- Major: recipient plasma + donor washed RBCs
- Minor: donor plasma + recipient washed RBCs
- Agglutinates or hemolyzes if antibodies present = not compatible
What are the critical hematocrits when considering transfusions in the following taxa:
- Herps
- Birds
- Carnivores
- Herbivores
- Primates
Anticoagulants:
- Most common anticoagulants: citrate-phosphate-dextrose (CPD), citrate-phosphate-dextrose-adenosine-1 (CPDA-1), acid-citrate-dextrose (ACD) (1:7 dilution)
- Emergency situation: heparin 5-10 IU/mL of blood - not recommended for storage
Theoretical transfusion volume:
((Desired Hct - Recipient Hct)/Donor Hct) x 90 x BW x volume in mL, weight in kg
- Can also use Hct and Hg to decide when to end transfusion
- Rate: start slow, wide range of rates reported in literature
Transfusion Reactions
- Most severe: acute immunologic hemolytic reaction due to blood type incompatibility
- Secondary to accelerated destruction of transfused or recipient RBCs, characterized by acute hemolysis
- Circulatory overload from too rapid transfusion rate and/or too large volume (esp with chronic anemia)
- CS: tachycardia, tachypnea, vomiting, hypotension, pyrexia, hemoglobinuria, edema, death
- Antibodies detectable days after 1st transfusion, cross-matching is essential before any further transfusions
