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Equine Surgery and Medicine 2 > Intensive Care of Colic Horses > Flashcards

Intensive Care of Colic Horses Flashcards

1
Q

Therapeutic goal

A

Treatment of primary disease

Treat the already developed compllications and prevent any further

Supportive therapy of individual body systems

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2
Q

Principles

A

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
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3
Q

Basic equipment in ICU

A

Fluid admin

ECG

Centrifuge

Refractometer

Glucose and lactate meter

Urinalysis strips

Microscope

US- with Doppler

O2 tank and regulator

Isolation units (biosecurity)

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4
Q

Intermediate level equiment of ICU

A

Blood gas and electrolyte analyser

CBC analyser

Coag profile testing

Direct and indirect BP

IV fluid pumps

Sling and hoists

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5
Q

Advanced equipment for ICU

A

Pulse oximeter

Mechanical vent

Colloid osmometer

Capnograph

Continuous ECG

Syringe infusion pumps

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6
Q

What are the basic procedures

A

Monitoring: phys parameters, imaging and lab tests

Fluids: crystalloids, colloids, plasma, blood

Analgesia

Sedation

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7
Q

Emergency drugs

A

NSAIDS

  • Flunixin meglumine
  • Phenylbut
  • Suxibuzone
  • Ketoprofen, meloxicam, metamizole

Opiods: morph and but

Ketamine (CRI): conc infusion at low dose

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8
Q

Emergency drugs: sedatives

A

Alpha 2: detomidine, xylazine and romifidine

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9
Q

Dobutamine

A

GA of bad colic- when BP is low because +inotrop

IV

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10
Q

Doxapram

A

Resp stim

IV or topical under tongue

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11
Q

Epi

A

Anaphylaxis: IV, IM, SC or intrthecal

Asystole: IV

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12
Q

Glycopyrrolate

A

BronchoD or bradycard: IV, IM, SC

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13
Q

Lidocaine

A

Postop after SI surgeries

SI ileus: loading dose then in CRI

Arrhythmia: bolus then CRI

*bad colic can cause arrhythmia

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14
Q

Definition of shock

A

Insufficient blood flow to the tissues, as a result of circ problems

  1. blood loss internally or externally
  2. plasma loss: transudation or exudation
  3. loss of fluids and electrolytes: colic or races
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15
Q

What are the stages of shock

A

Compensated

Decompensated

Irreversible

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16
Q

Compensated stage of shock

A

Vital organs maintained

incr BP

Activation of compensatory mechanisms

17
Q

Decompensated stage of shock

A

The comp mechanisms are unable to deliver sufficient O2 to the tissues

Microvasc tissue perfusion is disturbed

Cell function decreasing

18
Q

Irreversible stage of shock

A

Severe organ dysfunction

MODS, MOFS

19
Q

Consequences of hypovol shock

A

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

20
Q

Distributive shock

A

Abnormal peroph blood distrib

  1. vasogenic or neurogenic: acute trauma or anaphylaxis
  2. Septic/toxic: neonatal foals septicaemia, endotox

leads to SIRS!!!!

21
Q

Endotoxaemic cause of distributive shock

A

Ileus

Acute colitis

Prox enteritis

Peritonitis

Pleuritis

Pneumonia

*the first 3 show colic signs

22
Q

Clinical signs of shock

A

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

23
Q

Clinical signs of shock: blood parameters

A

The ones that INCREASE!:

  1. Ht
  2. TPP
  3. Albumin
  4. Lactate
  5. Creatinine and urea

++ leucopenia and neutropenia

24
Q

Treatment of shock

A

Restore CIRC

Treat the cause

Treat the metabolic disorders

25
Q

Vascular access: catheters

A

Polyethylene and polypropylene: highly thrombogenic

Teflon: less thrombogenic

**Polyurethane: much less thrombogenic

Silastic: the least

26
Q

Fluid therapy: crystalloids: LRS

A

matches physio ion conc!!

27
Q

Fluid therapy: crystalloids: ringers soln

A

Higher Na and Cl

28
Q

Fluid therapy: crystalloids: physio saline

A

for hyponatraemia! when Na<125mmol/L

29
Q

Fluid therapy: crystalloids Hypertonic saline

A

This is 7-7.5% NaCl

Max dose: 4ml/kg

Used when rapid decrease of PCV!! should be followed by isotonic e.g LRS

30
Q

Fluid therapy: crystalloids: Hypotonic NaCl soln

A

this is 0.45% soln

Only for maint!!

Should not be used for rapid fluid expansion- will cause haemolysis

31
Q

Fluid therapy: Plasma expanders

A

Use when TPP is very low: <40g/L and cannot be measured by a refractometer or osmometer

  1. Dextrans=macromolecules, therefore can cause allergic reaction and have a short half lief
  2. Hydroxyethyl starch (HES): keeps oncotic P higher for longer, prolongs clotting times, longer half life. Max dose: 10ml/kg of 6% soln
32
Q

Fluid therapy Equine plasma

A

Cheap if in house but v expensive if it has to be purchased

Long half life

Risk of infectious diseases

Allergic reactions/incompatibilities

33
Q

Fluid therapy: whole blood

A

For hematopoietic diseases

When Ht is<15% or in hypixaemia

Incompatibility: Qa and Aa antigens

Inf diseases

34
Q

Oral fluid therapy

A

Via NG tube

Only for mild deficits, horse can tolerate well when there is no reflux or obstruction

For every 21L of water:

  1. 10g NaCl
  2. 15g NaHCO3
  3. 75g KCl
  4. 60g K2HPO4

Ca should be given separately because it ppts!!

35
Q

NG tubing

A

is NB at the beginning of colic

Gastric decompression especially for acute gastric dilation or reflux

36
Q

Caecal trocarisation

A

R paralumbar fossa

Release of gas

To give AB’s

Complications: peritonitis and abscesses

37
Q

Transrectal trocarisation of the large colon

A

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

38
Q
A

Equine Surgery and Medicine 2 (15 decks)

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