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VMS 4001 > The hospitalised Horse & Critical Care > Flashcards

The hospitalised Horse & Critical Care Flashcards

1
Q

Indications for Hospitalisation

A
  • Diagnose or suspicious of a condition whihc will rq emergency tx or surgery
  • Don’t have facilities and/ or euipment to arry out diagnostis/ tx on yard
  • Nor comfortable perfoming a procedure
  • Client request
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2
Q

What common conditions for hospitalisation?

A
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3
Q

Weight loss investigation t the yard?

A
  • CLinical exam & oral exam
  • Rectal exam
  • Take a blood for haem and biochem
  • Faecal sample for parasitology
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4
Q

What common GI procedures in hospital?

A
  • Rectal exam
  • Abdo US
  • Abdominocentesis
  • NG tube
  • Gastroscopy
  • Rectal mucosal biopsy
  • Oral glucose absorption test
  • Liver biopsy
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5
Q

What CV procedures can be done in hospital?

A
  • Electrocardiogram
  • Electrocardiography
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6
Q

What respiratory procedures done in hospital?

A
  • Endoscopy
  • Tracheal aspirate
  • BAL
  • Pleurocentesis
  • Thoracic US
  • Emergency tracheostomy
  • Intranasal oxygen admin
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7
Q

Catheterisation in hospital?

A

JUGULAR

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8
Q

What two types of catheters?

A

Teflon (Angiocath) / Polyurethrane (Mila) and silicone

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9
Q

Describe Reflon cath?

A
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10
Q

DESCRIBE POLYURETHRANE (MILA) CATHETER?

A
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11
Q

What type of cath do you need?

A
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12
Q

Catheter size?

A
  • wide bore = inc infusion rate
  • Av 14-16 gauge
    Hypovolaemic -> 12 gauge
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13
Q

Describe Catheter Maintenance

A
  • Adequately secured
  • Regularly inspected
  • Flushed with heparinised salien 4 times a dauy - Injection port wiped with spirit or removed prior to injection
  • ALWAYS check for patency before injecting
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14
Q

Catheter Complications to do with Placement?

A
  • Haaematoma formation
  • Accidental carotid puncture
  • Catheter tip extravascular
  • Catheter embolism
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15
Q

catheter Complications - Indwelling?

A
  • Occlusion of catheter
  • TJhrombus
  • Thrombophlebitis
  • Septic thrombophlebitis
  • Air embolism
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16
Q

Common horse complications?

A
  • GI issues
  • Unexplained fever
  • Hyperlipaemia
  • Jugular vein thrombophlebitis
  • Unwilingness to drink & inappetance
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17
Q

Why do we see GIT issues?

A

-Inc susceptibility to: colic, D+, Gastric ulcers

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18
Q

What types of colic do they get as complications ?

A
  • Large colon impactions from stall confirnement
  • Caecal impactions ass with hospitalisation (most at risk throroughbred, ortho surgery, stalls, NSAID)
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19
Q

How to monitor for COLIC?

A
    • Auscultaiton of GI moility - caecal flush RD quadrant
  • Water intake/ faecal output

Further exam if in doubt -> rectal exam

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20
Q

How do we manage colic impactions?

A
  • FLUIDS enteral Ng tube 5-8L Q24h +/_ Mg sulphate or liquid paraffin
  • Analgesic (if showing colic signs)
  • Stop feed , handwalking if allows
  • Monitor closely
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21
Q

Diarrhoea ?

A

Close monitroting for early recognition -> abnormal clinical parameters precede the diarrhoea (Temp, CVS, F consistency)

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22
Q

What ussually causes D+

A

NAsocomial infection - hospital acquired infection BUT may have been incubating prior to admission

Infectious - salmonella and clostridial enterocolitis!

Non-infectious -> AB associated, NSAID ass, feed related

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23
Q

When to isolate a D+ case?

A
  • Pyrexic
  • Systemic signs
  • Suspicious of infection
  • Profuse watery D+ +/_ foul smell
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24
Q

What approach to a Diarrhoea case?

A
  1. History
  2. Bloods
  3. Faecal samples - Salmonella & C.difficile toxin
  4. Abdo US
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25
Q

How to Treat D+ ?.

A

(Symptomatically)
- Restore + maintain circulating blood vol -> IVFT
- Control systemic inflammation - analgesia +/- anti-endotox therapy
- Antimicrobial therapy??
- Nutritional support

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26
Q

How do we get Thrombophlebitis complication?

A
  • Indwelling atheters or venipuncture sites
  • Risk factor: endotox
  • Septic or non septic
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27
Q

Clinical appearance fo thrombophlebitis?

A
  • Heat, pain swelling
  • No drainage at affected site
  • Pyrexia
  • Peripheral venous distention
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28
Q

What to do about investigation of thrombophlebitis?

A
  • US - identify presence of thrombus and patency -> cavitatory area of dec echogeniticity within thrombus suggest septic
  • Culture & sensitivity of catheter tip
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29
Q

What complications from thrombophlebitis

A

vegetative endocarditis

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30
Q

TX for Thrombophlebitis?

A
  • REMOVE IVcath
  • Collect cath tip for culture
  • Avoid catheterisation other JV due to risk of bilat JV thrombosis
  • Hot pack site several times / d
  • Systemic AMs if infection suspected
  • NSAID
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31
Q

What else might we give for thrombophlebitis?

A

-Topical anti-inflamamtories: DMSO
- Anti-thrombotic: aspirin every other day

32
Q

Prevention of Thrombophlebitis

A
  • Minimise vein trauma in critical horses
  • Sterility during placement - Use minimally thrombogenic catheters
  • Long cath less complications
  • Risk of patient (hympercoagulable)
  • FLush
  • Cath site clean adn dry
  • Check patency
  • Monitor
33
Q

WHy do horses appear unwilling t drin & eat?

A
  • Unfamiliar environemnt and feed
  • Pain
  • Systemi affects: infection, fever, depressed mentation
34
Q

What should you identify when horse not EATING/drinking?

A

Are they UNABLE to? or unwilling?

35
Q

Fussy horses - what to do?

A
  • Bring in water bucket/water from home
  • Flavour the water - apple juice, electrolyte mix
  • Oral salt to stimulate intake
  • Soak hay and feed to inc fluid intake
  • Place small bore indwelling NG tube feeding tube for ongoing fluid delivery
36
Q

How to investigate inappetance?

A
  • Investigate hyperlipaemia & hyperlipidaemia
  • Ensure adequate pain control
  • Anorexia is part of the acute phase response to infection
  • Asssociated with pyrexia
37
Q

Cause of hyperlipaemia?

A

inadequate food intake (negative energy balance) excacerbated

38
Q

WHo gets more affected by Hyperlipaemia ?

A

Donkeys & ponies

39
Q

Why do we get hyperlipaemia?

A
  • Occurs when the rate of lipolysis from adipose stoe exceeds the rate of removal of triglyceride from the plasma
  • Excessive fat deposition causes organ dysfunction
40
Q

CLS of hyperlipaemia?

A

Nonspecific - depression, anorexia, weakness, ataxia, seizures, signs of liver or other organ failure

41
Q

Diagnosis Hyperlipâemia?

A

Blood sample -opaque discolouration of plasma
Elevated triglyceride <5.65mmol/l= hyperlipidaemia
Elevated triglycerides >5.65mmol/L= hyperlipaemia

42
Q

Therapeutics - Hyperlipaemia?

A
  • Resolution of underlying disease process
  • Establish positive energy balance
  • Reduce stress to limit anxiety and encourage appetite
  • Most patients inappetant - enteral or parenteral nutrition tq
43
Q

What to give horse for hyperL therapeudics?

A

Glucose dextrose infusion 1-2mg/kg/min of 50% solution
Ponies/ minature -> may also rq tube feeding or parenteral nutrition containing amino acids

44
Q

Monitoring for hyperlipaemia?

A

Daily monitoring of triG levels in blood until they have returned to normal limits

45
Q

Fever values?

A

Adult: 37.5-38.5
Foal: 37.2-38.9

46
Q

Common causes of unexplained fever?

A
  • Postop infection
  • Peritonitis - after abdo surgery

infection most common cause -> look for clinical signs

less common causes: inflamamtory, immunologic or neoplastic causes

47
Q

Monitoring of fever?

A

Take TEMP TWICE DAILY

48
Q

What common ‘critical care’ scenarios?

A
  • COlic - endotox
  • Sepsis/ septic shock
  • Acute haemorrhage
  • Seizure/encephalopathies
  • Atypical myopathy

Sick foals

49
Q

rapid assessment of CVS ?

A
50
Q

Assessing tissue perfusion?

A
  • Dehydrattion:
    1. Tachy MM
    2. Prolonged skin tent
    3. Sunken eyes in foals
    4.(tear film)
  • Hypovol
    tachycardia/pnoea
    Weak peripheral pulse
    Reduced jugular fill
    Altered mentation
    Pronolged CRT
    Cold extremities
    Dec urine ouput
51
Q

PCV evaluation?

A
52
Q

TS/TSP EVAL?

A
53
Q

Se/Sp of PCV & TS?

A

BOTH have low Se & Sp - more suitable for serial monitoring

54
Q

Lactate?

A

normal <1mmol/L
- Produced by anaerobic metabolism - Se indicator of tissue perfusion

Hypovol -> inv lactate prod & dec clearance from liver & kidenys

55
Q

T/F Lactate can also inc in states of sepsis or endotox?

A

TRUE

56
Q

Prognosis if high lactate?

A

if persistently high -> poor pg (esp if not decreasing in resp to appropriate therapy)

57
Q

Renal indices as indicators of poor tissue perf?

A
  • Serum Creatinine con (ass with dehydration/hypovol)
  • Urine output & USG
    inc USG = early indicator of dehyd
    dec production = early hypovol
58
Q

Other perfusion indicators?

A
  • Arterial blood pressure
  • Arterial blood gas (acidosis?)
  • Central venous pressure (indirect est of vol)
59
Q

How to calculate fluid deficit?

A

Dehydration % x BW(kg) = fluid deficit

60
Q

ROA for fluids?

A

HYPOVOL: IV

Dehydrated:
- Oral
- Enteral (intragastri)
- IV

61
Q

NG intubation for fluids?

A
  • Intermittent -> 6-8L eveyr 40-60mins bolus (can cause abdo pain)
    OR
  • Indwelling CRI maw 20ml/kg/hr
62
Q

How to make isotonic fluids for NG tubing?

A

Add electrolytes -> 4.9g/L Salt

63
Q

hat is NG tubing fluids good for?

A

Ideal for hydration of GIT contents
Management of impactions of LI

64
Q

IVFT - when?

A
  • Tx of mod to severe hypovol
  • Patients with GI dysfunction
65
Q

What IV cath sites?

A
  • Jugular vein
  • Cephalic vein
  • Lateral thoracic vein
66
Q

Material & Type & Size ?

A

Material:
- teflon, Polyurethrane, Silastic
Type:
- Over-the-needle
- Through-the-needle
-Over-the-wire

Size:
- 10-12 gauge
- 14-16 gauge
- 3-4inch, 5-6 inch

67
Q

Infusion sets

A
  • Wide borte, coiled fluid lines
    (gravitational infusion)
  • Small Animal giving sets (suitable foals, use w/infusion pumps)
68
Q

Fluid types ?

A
  • Crystalloids fluids
    replacement solutions
    hypertopnic solutions
    hypotonic solutions
  • Colloid fluids
    Biologic -> whole blood, plasma, albumin
    Synthetic-> hyroxyethylstarch, gelatins, dextrans
69
Q

Crystalloids?

A

Replacement solutions (isotonic)
- Large volumes needed to replace Iv volume deficit
- Move quickly out of circulation

Commonly available solutions:
-0.9% NaCl
- LActated Ringers solution
- Normasol-R
- Plasmalyte 148

Lactated ringers for rapid volume replacement (lower in Na & Cl compared to Saline)

70
Q

crystalloids - Hypertonic?

A
  • Osmotic effect causes rapid inc in Iv volume, but effect is hsort-lived
  • Rapid restoration of blood vol
  • Max dose 4mls/kg (2L) bolus
  • ALWAYS follow with replacement fluids
    Contraindiated in uncontrolled haemorrhage hyperosmolar states, and neonatal foals
71
Q

IV fluid bolus = shock dose ?

A

60-80mls/kg
give 1/2 all replacement volume rapidly (20L)
40L bolus takes 2-3 gravity infusion

72
Q

Colloids?

A

solution ctonaining high molecular weight molecules
-> natural or synthetic
- remain in vasculature and exert oncotic pressure to reteain fluid in IV space
- Polydisperse solutions -> High av MW -> longer duration iwth reduced oncotic effect vs Low av MW greater oncotic effect, shorter duration

INDICATED IN RAPID RESTORATION OF IV volume

73
Q

‘fluid challenge replaement?

A

10-20mls/kg rapid IV bolus
- FOALS 0.5-1L as bolus then reassess perfusion
- Repeat until signs of hypoperfusion resolve (3-4 times)

74
Q

Maintenance fluid rates?

A
  • Adult -> 2-3 mls/kg/hr
  • Neonatal foals -> 4-6mls/kg/hr
75
Q

What might ongoing losses be?

A
  • D+
  • Gastric reflux - 3rd space loss
  • Sweating
76
Q

How to discontinue fluid therapy?

A
  • Avoid abrupt cessation
  • Gradual taper to < maintenance for 12-24 hrs before discontinuation
77
Q

Complications of Fluid Therapy?

A
  • Thrombophlebitis
  • ELectorlyte/ acid-base derangement
  • Overhydration

VMS 4001 (17 decks)

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