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Emergency Board Review Triage A airway patent adequate FiO2 arterial bleeding pressure B Breathing characterize pattern inspiratory expiratory paradoxical C Circulation D Disability neurologic musculoskeletal E Evaluate abdominal urinary general Triage Secondary Survey A airway C Cardiovascular circulatory R Respiratory A Abdomen S Spine H Head eyes ears and neck too Triage Secondary Survey P Pelvis rectal L Limbs including tail A Arteries N Nerves including cranial nerves reflexes pain sensation Quick Blood Gas 6 Questions 1 Is the patient hypoxemic PaO2 2 Is the patient hypo or hyperventilating PaCO2 3 Is there an acid base abnormality 4 What it is the primary abnormality Metabolic or respiratory 5 Is it simple simple with compensation or mixed 6 Why does it exist how do you fix it Quick facts for acid base Rules of 4 pH 7 4 o4 PaCO2 40 4 HCO3 24 2 PaO2 4 5 x FiO2 You can not compensate to normal pH Quick facts for acid base Most common cause of respiratory alkalosis in emergency is pain or fever induced hyperventilation Most common cause of respiratory acidosis is hypoventilation from anesthetics upper airway obstruction severe parenchymal disease or neurologic disease Quick facts for acid base Most common cause of metabolic acidosis in emergency is lactic acidosis shock ketosis other unmeasured anions ethylene glycol or hypochloridemia differentiate with anion gap Most common cause of metabolic alkalosis is vomiting Small Animal Toxicology Basic steps Eliminate further absorbtion Bathe or vacuum Emesis Hydrogen peroxide 3 1 2 ml kg can repeat once in 10 min Dishwashing liquid 1 8 with water and give 10 ml kg once Small Animal Toxicology Eliminate absorbtion emesis Apomorphine dogs 03mg kg IV 04 mg kg IM 08 mg kg SC or 3 mg kg conjunctival Xylazine cats 44mg kg IM Syrup of Ipecac potential cardiotoxicity muscle weakness hemorrhagic diarrhea Small Animal Toxicology Eliminate absorbtion Gastric lavage light sedation maybe 20 ml kg of tepid water repeated until clear Activated charcoal 1 4 g kg with 1g 50 ml water if not premixed not good with heavy metal Cathartic often with activated charcoal Small Animal Toxicology Eliminate absorbed toxin Diuresis for some Ion trapping Definitive antidote or competitive inhibitor depends on toxin Supportive care Small Animal Toxicology Acetaminophen Clinical signs Methemoglobinemia dark blood dyspnea facial and front limb swelling cats typical or dogs with very high dose Hepatic necrosis 24 48 hours later vomiting abdominal pain anorexia cats and dogs Small Animal Toxicology Acetaminophen Treatment basic principles plus N acetylcysteine IV or PO 140 mg kg first then 70 mg kg QID for 6 doses Ascorbic acid for methemoglobin Cimetidine Supportive Small Animal Toxicology Methylxanthines chocolate caffeine theophylline Clinical signs vomiting hyperactivity restlessness tachycardia tachypnea ataxia convulsions cardiac arrhytmia death Small Animal Toxicology Treatment Arrhythmia lidocaine ventricular or esmolol SVT Tremors seizures diazepam phenobarbital or pentobarbital induction Renal excretion and can reabsorb in urinary bladder Small Animal Toxicology Lead Clinical signs Gi anorexia vomiting pain diarrhea Neuro seizures hysteria ataxia blindness tremors Hemolytic anemia very high nRBC beyond expected for anemia Small Animal Toxicology Lead Diagnosis High nRBC basophilic stippling with mild anemia and other signs Radiographs Blood levels 0 6ppm or liver post mortem Small Animal Toxicology Lead Treatment Chelation calcium EDTA Penicallimine Succimer Repeat lead levels after treatment to determine if more is needed Supportive care Small Animal Toxicology Cholinesterase inhibitors organophosphates and carbamates Clinical signs depends if muscarinic or nicatinic Nicotinic striated muscle stiffness fasciculation tremor weakness paralysis Muscarinic smooth muscle SLUD bradycardia Small Animal Toxicology Ch Inhibitors Treatment Atropine 1 2 mg kg 1 4 IV SC can be repeated glycopyrrolate not effective b c does not cross blood brain barrier 2 PAM in addition to atropine in organophosphate may reverse binding to Achesterase Midazolam and diphenhydramine for nicotinic Small Animal Toxicology Pyrethrins Clinical signs Hypersalivation vomiting diarrhea ataxia hyperexcitability fasciculation depression disorientation seizures dyspnea Small Animal Toxicology Pyrethrin Treatment Diazepam for seizures Phenobarbitol for continued seizures Methacarbamol for muscle tremors Small Animal Toxicology Zinc Clinical signs Depression vomiting diarrhea hemolytic anemia renal failure Diagnosis Radiographs hemolytic anemia Zinc levls in serum urine or tissue Small Animal Toxicology Treatment Supportive care Remove source Chelation with calcium EDTA or penicallimine Small Animal Toxicology Ivermectin Clinical signs Mydriasis apparent blindness aggresion bradycardia cyanosis dyspnea seizures coma death Treatment NO BENZODIAZIPINE Physostigmine Supportive Small Animal Toxicology Ethylene glycol Clinical signs 1st 12 hours vomiting intoxicated stuporous ataxic comatose PU PD 2nd 12 24 hours may be normal may have tachycardia or signs of pulmonary disease 3rd 24 hours or 12 24 in cats renal failure Small Animal Toxicology E G Diagnosis Crucial to diagnosis as soon as possible therapies do not work after 4 6 hours in cat or 812 hours in dog Ethylene glycol test false positives Clinical signs plus high osmolar gap or acidosis with high anion gap Calcium oxalate crystalluria occ Early as 3 hours in cat or 6 hours in dog often later Small Animal Toxicology E G Treatment Aggressive fluids Competitive inhibition of alcohol dehydrogenase Ethanol 7 IV 4 mehtylpyrazole better for dogs high dose in cats early Hemo or peritoneal dialysis Small Animal Toxicology Rodenticide Clinical signs Generally act via Vitamin K antagonism Affects factors II VII IX X Clinical signs noted 2 7 days later Small Animal Toxicology Treatment Vit K1 Amount and duration depend on type Warfarin and 1st generation coumarin 2 5mg kg SC over 4 6 places initially then 12 5 mg kg PO for 7 days Bromadiolone or brodifacoum 5 mg kg SC then 2 5 mg kg for 2 3 weeks Diphacinone or chlorphacinone 5 mg kg SC then 2 5 5mg kg for 4 weeks Small Animal Toxicology Lily Clinical signs renal toxicity in cats Basic principles and diuresis Treatment within 6 hours potential to prevent All parts poisonous Small Animal Toxicology Oleander Similar to digitalis GI or cardiac arrhythmia All parts toxic 30 40 leaves can kill adult horse

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