The hospitalised Horse & Critical Care Flashcards
(77 cards)
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
2
Q
What common conditions for hospitalisation?
A
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
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
5
Q
What CV procedures can be done in hospital?
A
- Electrocardiogram
- Electrocardiography
6
Q
What respiratory procedures done in hospital?
A
- Endoscopy
- Tracheal aspirate
- BAL
- Pleurocentesis
- Thoracic US
- Emergency tracheostomy
- Intranasal oxygen admin
7
Q
Catheterisation in hospital?
A
JUGULAR
8
Q
What two types of catheters?
A
Teflon (Angiocath) / Polyurethrane (Mila) and silicone
9
Q
Describe Teflon cath?
A
10
Q
DESCRIBE POLYURETHRANE (MILA) CATHETER?
A
11
Q
What type of cath do you need?
A
12
Q
Catheter size?
A
- wide bore = inc infusion rate
- Av 14-16 gauge
Hypovolaemic -> 12 gauge
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
14
Q
Catheter Complications to do with Placement?
A
- Haaematoma formation
- Accidental carotid puncture
- Catheter tip extravascular
- Catheter embolism
15
Q
catheter Complications - Indwelling?
A
- Occlusion of catheter
- TJhrombus
- Thrombophlebitis
- Septic thrombophlebitis
- Air embolism
16
Q
Common horse complications?
A
- GI issues
- Unexplained fever
- Hyperlipaemia
- Jugular vein thrombophlebitis
- Unwilingness to drink & inappetance
17
Q
Why do we see GIT issues?
A
-Inc susceptibility to: colic, D+, Gastric ulcers
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)
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
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
21
Q
Diarrhoea ?
A
Close monitroting for early recognition -> abnormal clinical parameters precede the diarrhoea (Temp, CVS, F consistency)
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
23
Q
When to isolate a D+ case?
A
- Pyrexic
- Systemic signs
- Suspicious of infection
- Profuse watery D+ +/_ foul smell
24
Q
What approach to a Diarrhoea case?
A
- History
- Bloods
- Faecal samples - Salmonella & C.difficile toxin
- Abdo US
25
How to Treat D+ ?.
(Symptomatically)
- Restore + maintain circulating blood vol -> IVFT
- Control systemic inflammation - analgesia +/- anti-endotox therapy
- Antimicrobial therapy??
- Nutritional support
26
How do we get Thrombophlebitis complication?
- Indwelling atheters or venipuncture sites
- Risk factor: endotox
- Septic or non septic
27
Clinical appearance fo thrombophlebitis?
- Heat, pain swelling
- No drainage at affected site
- Pyrexia
- Peripheral venous distention
28
What to do about investigation of thrombophlebitis?
- US - identify presence of thrombus and patency -> cavitatory area of dec echogeniticity within thrombus suggest septic
- Culture & sensitivity of catheter tip
29
What complications from thrombophlebitis
vegetative endocarditis
30
TX for Thrombophlebitis?
- 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
31
What else might we give for thrombophlebitis?
-Topical anti-inflamamtories: DMSO
- Anti-thrombotic: aspirin every other day
32
Prevention of Thrombophlebitis
- 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
WHy do horses appear unwilling t drin & eat?
- Unfamiliar environemnt and feed
- Pain
- Systemi affects: infection, fever, depressed mentation
34
What should you identify when horse not EATING/drinking?
Are they UNABLE to? or unwilling?
35
Fussy horses - what to do?
- 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
How to investigate inappetance?
- Investigate hyperlipaemia & hyperlipidaemia
- Ensure adequate pain control
- Anorexia is part of the acute phase response to infection
- Asssociated with pyrexia
37
Cause of hyperlipaemia?
inadequate food intake (negative energy balance) excacerbated
38
WHo gets more affected by Hyperlipaemia ?
Donkeys & ponies
39
Why do we get hyperlipaemia?
- 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
CLS of hyperlipaemia?
Nonspecific - depression, anorexia, weakness, ataxia, seizures, signs of liver or other organ failure
41
Diagnosis Hyperlipâemia?
Blood sample -opaque discolouration of plasma
Elevated triglyceride <5.65mmol/l= hyperlipidaemia
Elevated triglycerides >5.65mmol/L= hyperlipaemia
42
Therapeutics - Hyperlipaemia?
- 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
What to give horse for hyperL therapeudics?
Glucose dextrose infusion 1-2mg/kg/min of 50% solution
Ponies/ minature -> may also rq tube feeding or parenteral nutrition containing amino acids
44
Monitoring for hyperlipaemia?
Daily monitoring of triG levels in blood until they have returned to normal limits
45
Fever values?
Adult: 37.5-38.5
Foal: 37.2-38.9
46
Common causes of unexplained fever?
- Postop infection
- Peritonitis - after abdo surgery
infection most common cause -> look for clinical signs
less common causes: inflamamtory, immunologic or neoplastic causes
47
Monitoring of fever?
Take TEMP TWICE DAILY
48
What common 'critical care' scenarios?
- COlic - endotox
- Sepsis/ septic shock
- Acute haemorrhage
- Seizure/encephalopathies
- Atypical myopathy
Sick foals
49
rapid assessment of CVS ?
50
Assessing tissue perfusion?
- 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
PCV evaluation?
52
TS/TSP EVAL?
53
Se/Sp of PCV & TS?
BOTH have low Se & Sp - more suitable for serial monitoring
54
Lactate?
normal <1mmol/L
- Produced by anaerobic metabolism - Se indicator of tissue perfusion
Hypovol -> inv lactate prod & dec clearance from liver & kidenys
55
T/F Lactate can also inc in states of sepsis or endotox?
TRUE
56
Prognosis if high lactate?
if persistently high -> poor pg (esp if not decreasing in resp to appropriate therapy)
57
Renal indices as indicators of poor tissue perf?
- Serum Creatinine con (ass with dehydration/hypovol)
- Urine output & USG
inc USG = early indicator of dehyd
dec production = early hypovol
58
Other perfusion indicators?
- Arterial blood pressure
- Arterial blood gas (acidosis?)
- Central venous pressure (indirect est of vol)
59
How to calculate fluid deficit?
Dehydration % x BW(kg) = fluid deficit
60
ROA for fluids?
HYPOVOL: IV
Dehydrated:
- Oral
- Enteral (intragastri)
- IV
61
NG intubation for fluids?
- Intermittent -> 6-8L eveyr 40-60mins bolus (can cause abdo pain)
OR
- Indwelling CRI maw 20ml/kg/hr
62
How to make isotonic fluids for NG tubing?
Add electrolytes -> 4.9g/L Salt
63
hat is NG tubing fluids good for?
Ideal for hydration of GIT contents
Management of impactions of LI
64
IVFT - when?
- Tx of mod to severe hypovol
- Patients with GI dysfunction
65
What IV cath sites?
- Jugular vein
- Cephalic vein
- Lateral thoracic vein
66
Material & Type & Size ?
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
Infusion sets
- Wide borte, coiled fluid lines
(gravitational infusion)
- Small Animal giving sets (suitable foals, use w/infusion pumps)
68
Fluid types ?
- Crystalloids fluids
replacement solutions
hypertopnic solutions
hypotonic solutions
- Colloid fluids
Biologic -> whole blood, plasma, albumin
Synthetic-> hyroxyethylstarch, gelatins, dextrans
69
Crystalloids?
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
crystalloids - Hypertonic?
- 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
IV fluid bolus = shock dose ?
60-80mls/kg
give 1/2 all replacement volume rapidly (20L)
40L bolus takes 2-3 gravity infusion
72
Colloids?
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
'fluid challenge replaement?
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
Maintenance fluid rates?
- Adult -> 2-3 mls/kg/hr
- Neonatal foals -> 4-6mls/kg/hr
75
What might ongoing losses be?
- D+
- Gastric reflux - 3rd space loss
- Sweating
76
How to discontinue fluid therapy?
- Avoid abrupt cessation
- Gradual taper to < maintenance for 12-24 hrs before discontinuation
77
Complications of Fluid Therapy?
- Thrombophlebitis
- ELectorlyte/ acid-base derangement
- Overhydration
