Intensive Care of Colic Horses Flashcards
Therapeutic goal
Treatment of primary disease
Treat the already developed compllications and prevent any further
Supportive therapy of individual body systems
Principles
Much easier in hospitals! where there is the equipment, experience and continuous supervision
Acute abdomen is most freq
Personnel:
- Emergency and critical care specialist
- Int med specialist
- Anaesth specialist
- Surgeon
- Tenchnicians and nurses
Basic equipment in ICU
Fluid admin
ECG
Centrifuge
Refractometer
Glucose and lactate meter
Urinalysis strips
Microscope
US- with Doppler
O2 tank and regulator
Isolation units (biosecurity)
Intermediate level equiment of ICU
Blood gas and electrolyte analyser
CBC analyser
Coag profile testing
Direct and indirect BP
IV fluid pumps
Sling and hoists
Advanced equipment for ICU
Pulse oximeter
Mechanical vent
Colloid osmometer
Capnograph
Continuous ECG
Syringe infusion pumps
What are the basic procedures
Monitoring: phys parameters, imaging and lab tests
Fluids: crystalloids, colloids, plasma, blood
Analgesia
Sedation
Emergency drugs
NSAIDS
- Flunixin meglumine
- Phenylbut
- Suxibuzone
- Ketoprofen, meloxicam, metamizole
Opiods: morph and but
Ketamine (CRI): conc infusion at low dose
Emergency drugs: sedatives
Alpha 2: detomidine, xylazine and romifidine
Dobutamine
GA of bad colic- when BP is low because +inotrop
IV
Doxapram
Resp stim
IV or topical under tongue
Epi
Anaphylaxis: IV, IM, SC or intrthecal
Asystole: IV
Glycopyrrolate
BronchoD or bradycard: IV, IM, SC
Lidocaine
Postop after SI surgeries
SI ileus: loading dose then in CRI
Arrhythmia: bolus then CRI
*bad colic can cause arrhythmia
Definition of shock
Insufficient blood flow to the tissues, as a result of circ problems
- blood loss internally or externally
- plasma loss: transudation or exudation
- loss of fluids and electrolytes: colic or races
What are the stages of shock
Compensated
Decompensated
Irreversible
Compensated stage of shock
Vital organs maintained
incr BP
Activation of compensatory mechanisms
Decompensated stage of shock
The comp mechanisms are unable to deliver sufficient O2 to the tissues
Microvasc tissue perfusion is disturbed
Cell function decreasing
Irreversible stage of shock
Severe organ dysfunction
MODS, MOFS
Consequences of hypovol shock
Decr IV vol (decr BP)
Hypotonia
Decr CO
VasoC
Contration of spleen- pumps RBC’s into circ- this could incr PCV
Decr intestinal secretion
Organ dysfunction
VasoD on periph in the decomp state
Distributive shock
Abnormal peroph blood distrib
- vasogenic or neurogenic: acute trauma or anaphylaxis
- Septic/toxic: neonatal foals septicaemia, endotox
leads to SIRS!!!!
Endotoxaemic cause of distributive shock
Ileus
Acute colitis
Prox enteritis
Peritonitis
Pleuritis
Pneumonia
*the first 3 show colic signs
Clinical signs of shock
Decr skin turgor
Cold extremities
Variable colour of mm- depends on type of shock e.g toxic=purple rim
CRT delayed
Tachypnoea
Tachycard
Weak pulse
Clinical signs of shock: blood parameters
The ones that INCREASE!:
- Ht
- TPP
- Albumin
- Lactate
- Creatinine and urea
++ leucopenia and neutropenia
Treatment of shock
Restore CIRC
Treat the cause
Treat the metabolic disorders
Vascular access: catheters
Polyethylene and polypropylene: highly thrombogenic
Teflon: less thrombogenic
**Polyurethane: much less thrombogenic
Silastic: the least
Fluid therapy: crystalloids: LRS
matches physio ion conc!!
Fluid therapy: crystalloids: ringers soln
Higher Na and Cl
Fluid therapy: crystalloids: physio saline
for hyponatraemia! when Na<125mmol/L
Fluid therapy: crystalloids Hypertonic saline
This is 7-7.5% NaCl
Max dose: 4ml/kg
Used when rapid decrease of PCV!! should be followed by isotonic e.g LRS
Fluid therapy: crystalloids: Hypotonic NaCl soln
this is 0.45% soln
Only for maint!!
Should not be used for rapid fluid expansion- will cause haemolysis
Fluid therapy: Plasma expanders
Use when TPP is very low: <40g/L and cannot be measured by a refractometer or osmometer
- Dextrans=macromolecules, therefore can cause allergic reaction and have a short half lief
- Hydroxyethyl starch (HES): keeps oncotic P higher for longer, prolongs clotting times, longer half life. Max dose: 10ml/kg of 6% soln
Fluid therapy Equine plasma
Cheap if in house but v expensive if it has to be purchased
Long half life
Risk of infectious diseases
Allergic reactions/incompatibilities
Fluid therapy: whole blood
For hematopoietic diseases
When Ht is<15% or in hypixaemia
Incompatibility: Qa and Aa antigens
Inf diseases
Oral fluid therapy
Via NG tube
Only for mild deficits, horse can tolerate well when there is no reflux or obstruction
For every 21L of water:
- 10g NaCl
- 15g NaHCO3
- 75g KCl
- 60g K2HPO4
Ca should be given separately because it ppts!!
NG tubing
is NB at the beginning of colic
Gastric decompression especially for acute gastric dilation or reflux
Caecal trocarisation
R paralumbar fossa
Release of gas
To give AB’s
Complications: peritonitis and abscesses
Transrectal trocarisation of the large colon
Only when surgery not an option (The large colon is so full of gas that it is impairing breathing)
Puncture of the large colon through the rectum
16-12G (is that meant to be 21?) or stylet of IV catheter
IV giving set
Sedation
Buscopan
Ext P on abd wall
Complications:: bleeding, or tear of the Rectum or large colon
