Patient Management and Decontamination Flashcards
Witnessed Exposure Questions
What is the substance?
How much?
How long ago?
First priority with any patient?
STABILIZE
No Witnessed Exposure Questions
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?
Other important history questions
Where does the pet live?
What do they have access to?
Is there a magic antidote?
very rarely
If there isn’t a magic antidote, what is the goal with toxicities?
decontamination
Solution to Pollution is __________
Dilution
What sorts of stuff can cause ocular irritation/corrosion?
superglue, medicated shampoos, wrong eye med, or even an ear med, plus many more
What would you flush eyes with, and how, for how long?
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
Why should you never use Visine or “get the red out” products?
they contain alpha-2s which cause sedation, and the animal may lick it!
What else might you do after an ocular exposure and why?
Fluorescein staining after flushing to check for a corneal ulcer (treatable)
Goal of dermal decontamination?
prevent percutaneous absorption
What can you use to remove toxins from the surface of the skin or fur?
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
Keratolytic shampoos
made to get rid of grease in the coat
What products shouldn’t you use on dermal exposures?
gentle shampoos (they won’t do anything), automatic dishwasher detergents
The answer to sticky is ______
oil
What should you NEVER use on birds?
Mineral oil!
only use food based oils as needed because birds will preen their feathers
Oral Dilution
used to make compounds less irritating
Examples of Products for Oral Dilution
milk of magnesia, Maalox, Mylanta, milk, water; can even use fruit flavored yogurt, or water-laden veggies
be sure to avoid salicylates (aspirin compounds)
Compounds that will cause Oral Irritation
caustic substances (typically a cleaning product) and petroleum distillates
emetics
substances that induce vomiting to remove stomach contents
Most animals only vomit ____% of their stomach contents
40-75%
How soon after ingestion should an emetic be used?
within 30-90 minutes, ideally
Contraindications to Inducing Vomiting
caustic or petroleum distillates (can cause hydrocarbon aspiration), or if the species can’t vomit
Are emetics most effective on an empty or full stomach?
full (or at least with something in it)
Species that Can’t Vomit
rodents, rabbits, horses, ruminants, avians, reptiles
Caution with using too much hydrogen peroxide?
can cause hemorrhagic gastritis
Apomorphine
centrally acting emetic (acts on dopamine receptors) that can cause CNS depression (can reverse with naloxone)
How to get a cat to vomit?
alpha-2 agonists (because that is the kind of receptors their emetic center has), spin in the office chair
Gastric Lavage
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
Crop Lavage
for birbs, place endotracheal tube under anesthesia and flush with saline and aspirate repeatedly
Activated Charcoal
adsorbent binds most organic compounds (large, nonpolar best) and facilitates excretion in the feces; available in multiple formulations
Why is activated charcoal so effective??
SURFACE AREA - 1g has surface area size of football field
When should you NOT give activated charcoal?
-compromised airway
-seizures/coma
-caustic materials
-petroleum distillates
-fertilizers or brutal alcohols (nitrates, ethanol, etc)
How can activated charcoal cause hypernatremia?
ingredients like sorbitol, glycerol, and PEG are osmotically active, so they draw free water into the GI tract resulting in relative hypernatremia
Treatments for Hypernatremia from Activated Charcoal
low sodium fluids and warm water enemas
cathartics
substance to decrease GI transit time to enhance elimination of substances (intentionally cause diarrhea, so nothing can be released and reabsorbed)
Classes of Cathartics
- Bulk
- Osmotic
- Saline
Contraindications to Cathartics?
if the animal already has diarrhea, or is dehydrated
Why wouldn’t you give a bird an enema?
you do not want to push fecal material into the cloaca/repro tract
Do fluids flush out toxins?
not really, they are given to support the cardiovascular system
Saline Cathartics
stimulate GI motility
Osmotic Cathartics
pulls free water into the GI tract (ex: 70% sorbitol)
Bulk Cathartics
essentially make stool bigger to increase rate of peristalsis to decrease transit time (ex: high fiber like pumpkin, bread)
