Patient Management and Decontamination

Question 1

Witnessed Exposure Questions

Answer 1

What is the substance?
How much?
How long ago?

Question 2

First priority with any patient?

Answer 2

STABILIZE

Question 3

No Witnessed Exposure Questions

Answer 3

When were they last normal?
How long have symptoms lasted?
Any initial signs you’re not seeing now?
Other pets? Are they showing any signs?

Question 4

Other important history questions

Answer 4

Where does the pet live?
What do they have access to?

Question 5

Is there a magic antidote?

Answer 5

very rarely

Question 6

If there isn’t a magic antidote, what is the goal with toxicities?

Answer 6

decontamination

Question 7

Solution to Pollution is __________

Answer 7

Dilution

Question 8

What sorts of stuff can cause ocular irritation/corrosion?

Answer 8

superglue, medicated shampoos, wrong eye med, or even an ear med, plus many more

Question 9

What would you flush eyes with, and how, for how long?

Answer 9

Large quantities of neutral solutions (normal saline, tepid tap water, artificial tears) for 20-30 minutes with and eyedropper for smaller patients or a plastic cup for larger, with breaks of course

Question 10

Why should you never use Visine or “get the red out” products?

Answer 10

they contain alpha-2s which cause sedation, and the animal may lick it!

Question 11

What else might you do after an ocular exposure and why?

Answer 11

Fluorescein staining after flushing to check for a corneal ulcer (treatable)

Question 12

Goal of dermal decontamination?

Answer 12

prevent percutaneous absorption

Question 13

What can you use to remove toxins from the surface of the skin or fur?

Answer 13

dishwashing liquid (like Dawn) OR keratolytic shampoo; can use oily substances (olive oil/peanut butter/mayo/mineral oil/vegetable oil) on non-water soluble compounds as well

Question 14

Keratolytic shampoos

Answer 14

made to get rid of grease in the coat

Question 15

What products shouldn’t you use on dermal exposures?

Answer 15

gentle shampoos (they won’t do anything), automatic dishwasher detergents

Question 16

The answer to sticky is ______

Answer 16

oil

Question 17

What should you NEVER use on birds?

Answer 17

Mineral oil!

only use food based oils as needed because birds will preen their feathers

Question 18

Oral Dilution

Answer 18

used to make compounds less irritating

Question 19

Examples of Products for Oral Dilution

Answer 19

milk of magnesia, Maalox, Mylanta, milk, water; can even use fruit flavored yogurt, or water-laden veggies

be sure to avoid salicylates (aspirin compounds)

Question 20

Compounds that will cause Oral Irritation

Answer 20

caustic substances (typically a cleaning product) and petroleum distillates

Question 21

emetics

Answer 21

substances that induce vomiting to remove stomach contents

Question 22

Most animals only vomit ____% of their stomach contents

Answer 22

40-75%

Question 23

How soon after ingestion should an emetic be used?

Answer 23

within 30-90 minutes, ideally

Question 24

Contraindications to Inducing Vomiting

Answer 24

caustic or petroleum distillates (can cause hydrocarbon aspiration), or if the species can’t vomit

Question 25

Are emetics most effective on an empty or full stomach?

Answer 25

full (or at least with something in it)

Question 26

Species that Can't Vomit

Answer 26

rodents, rabbits, horses, ruminants, avians, reptiles

Question 27

Caution with using too much hydrogen peroxide?

Answer 27

can cause hemorrhagic gastritis

Question 28

Apomorphine

Answer 28

centrally acting emetic (acts on dopamine receptors) that can cause CNS depression (can reverse with naloxone)

Question 29

How to get a cat to vomit?

Answer 29

alpha-2 agonists (because that is the kind of receptors their emetic center has), spin in the office chair

Question 30

Gastric Lavage

Answer 30

pet placed under anesthesia to remove recently ingested toxicants by placing stomach tube and adding water and letting gravity drain until it comes out clear

Question 31

Crop Lavage

Answer 31

for birbs, place endotracheal tube under anesthesia and flush with saline and aspirate repeatedly

Question 32

Activated Charcoal

Answer 32

adsorbent binds most organic compounds (large, nonpolar best) and facilitates excretion in the feces; available in multiple formulations

Question 33

Why is activated charcoal so effective??

Answer 33

SURFACE AREA - 1g has surface area size of football field

Question 34

When should you NOT give activated charcoal?

Answer 34

-compromised airway -seizures/coma -caustic materials -petroleum distillates -fertilizers or brutal alcohols (nitrates, ethanol, etc)

Question 35

How can activated charcoal cause hypernatremia?

Answer 35

ingredients like sorbitol, glycerol, and PEG are osmotically active, so they draw free water into the GI tract resulting in relative hypernatremia

Question 36

Treatments for Hypernatremia from Activated Charcoal

Answer 36

low sodium fluids and warm water enemas

Question 37

cathartics

Answer 37

substance to decrease GI transit time to enhance elimination of substances (intentionally cause diarrhea, so nothing can be released and reabsorbed)

Question 38

Classes of Cathartics

Answer 38

1. Bulk 2. Osmotic 3. Saline

Question 39

Contraindications to Cathartics?

Answer 39

if the animal already has diarrhea, or is dehydrated

Question 40

Why wouldn't you give a bird an enema?

Answer 40

you do not want to push fecal material into the cloaca/repro tract

Question 41

Do fluids flush out toxins?

Answer 41

not really, they are given to support the cardiovascular system

Question 42

Saline Cathartics

Answer 42

stimulate GI motility

Question 43

Osmotic Cathartics

Answer 43

pulls free water into the GI tract (ex: 70% sorbitol)

Question 44

Bulk Cathartics

Answer 44

essentially make stool bigger to increase rate of peristalsis to decrease transit time (ex: high fiber like pumpkin, bread)