Lower urinary emergencies (Allen) Flashcards
1
Q
Three common emergencies
A
- Blocked cat
- urethral obstruction in a dog
- uroabdomen
2
Q
Common causes
A
- uroliths
- FIC
- urethral stricture
- neoplasia
3
Q
hypothermia, bradycardia
A
probs hyperkalemic too
-spiked P waves on EKG
4
Q
Why do blocked cats die?
A
- hyperkalemia
- hypovolemia
- metabolic acidosis
5
Q
Initial tests blocked cat
A
IV cath
electrolytes
renal values
6
Q
less acidosis with what fluid
A
LRS
7
Q
Cold cats
A
peripheral alpha 2 receptors don’t respond
-BP won’t rise unless warm
8
Q
Signs of trouble
A
- hyperkalemia (> 7.5 - 8 mmol/L)
- dull mentation or recumbency
- hypothermia
- bradycardia
- EKG changes
- bradycardia
- absent p waves
- large T waves
- sine wave appearance - this thing has K of 9 and gonna die
9
Q
drugs that lower K
test question
A
- Insulin
- Sodium bicarb
- Terbutaline
*Calcium gluconate does not change K
10
Q
treating hyperkalemia
A
- fluid, fluid, fluid
- calcium gluconate: 1 ml/kg
- dextrose: 1 ml/kg (dilute 1:3 to avoid raging phlebitis)
- Insulin with dextrose (1 unit with dextrose)
- sodium bicarb (1mcg/kg = 1 ml/kg)
- Terbutaline (0.01 mg/kg) - shifts Na for K
11
Q
hyperkalemia tx
- isotonic crystalloids
- dextrose and insulin
- albuterol or terbutaline
- sodium bicarb
- Establishment of urine output
A
- isotonic crystalloids
- MOA: dilution
- onset: immediate
- complication: volume overload
- dextrose and insulin
- MOA: shifts K intracelularly with glucose
- onset: 20 min
- complication: hypoglycemia
- albuterol or terbutaline
- MOA: stimulates Na, K atpase pump
- onset: 30 min
- complications: tachycardia
- sodium bicarb
- MOA: exchange for H
- onset: 30 min
- complications: paradoxical CNS acidosis
- establishment of urine out
- MOA: excretion
- onset: immediately
- complications: bladder rupture, urethral tear
12
Q
Sedation options
A
- Stable
- ketamine/midazolam/buprenorphine
- not intubated
- Midazolam/buprenorphine/propofol/inhalent
- intubated
- avoid ketamine if murmers
- ketamine/midazolam/buprenorphine
- Sick
- no sedation
- Sacrococcygeal block
- Benzodiazepine/buprenorphine alone
- if more sedation required consider a low dose of opioids or ketamine
13
Q
Unblocking
A
- Open ended tom cat catheter
- extrude penis then pull prepuce over cather to straighten S shape
- If resistance
- flush while passing
- gently twist
- gently apply pressure to bladder while passing and flushing
- empty bladder
- flush while removing cath
- replace with red rubber/slippery sam cath
- suture to skin surrounding prepuce
14
Q
Post unblocking care
A
- Analgesia
- buprenorphine: 0.01-0.02 mg/kg q6-8
- NO NSAIDS
- u cath care q6h
- hourly urine for first few hours
15
Q
Fluids after unblocking
A
- sometime needs lots of fluids
- If no/little urine output then trouble shoot cath
- if ok try fluid bolus 50-100 mls
- Until blodwork returns exceed outs with ins
- May need more than 60ml/hr
