Emergency Medicine and Shock Overview

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Questions and Answers

Which condition is a potential etiology of shock due to lack of oxygen transport?

Hypovolemia (correct)

Hypervolemia

Anemia

Dehydration

Which clinical sign indicates decreased cardiac output?

Weak pulse (correct)

Strong pulse

Normal pulse

Rapid pulse

What color of mucous membranes reflects severe cardiovascular compromise?

Gray or cyanotic (correct)

Bright pink

Brick red

Pale

Which type of shock is commonly associated with brick red mucous membranes?

Septic shock Signup and view all the answers

Which of the following is NOT an etiology listed for shock?

Hemorrhage Signup and view all the answers

Which clinical sign indicates hypothermia in shock presentations?

Cold extremities Signup and view all the answers

What does depressed mentation suggest in a clinical setting?

Lack of oxygen transport Signup and view all the answers

Which condition reflects arterial hypoxemia?

Gray or cyanotic mucous membranes Signup and view all the answers

What is the correct initial approach when monitoring fluid therapy outcomes?

Urine output measurement can help assess hydration status. Signup and view all the answers

Which factor is most critical to prevent overloading the heart during fluid therapy?

Tracking central venous pressure diligently. Signup and view all the answers

In which situation may fluid administration need to be altered despite the standard protocol?

When the animal exhibits oliguria. Signup and view all the answers

What is the significance of a sudden increase in central venous pressure (CVP)?

Fluid administration rate may need to decrease. Signup and view all the answers

Which of the following is NOT a clinical sign of overhydration?

Decreased body weight. Signup and view all the answers

Why is it essential to distribute fluid infusion evenly throughout the day?

It minimizes the risk of fluid overload and overhydration. Signup and view all the answers

How often should electrolyte and acid-base status be determined during fluid therapy?

Every 12 to 24 hours. Signup and view all the answers

What does a gain or loss of 1 kg in body weight indicate regarding fluid therapy?

A change of 1000 mL body water. Signup and view all the answers

Which method is advised for accessing the urinary bladder during a tracheostomy?

Incise the sternohyoideus muscle while directing the needle toward the urinary bladder Signup and view all the answers

What is a critical contraindication for performing abdominocentesis?

Severe coagulopathy Signup and view all the answers

When performing thoracocentesis, which locations are recommended for needle insertion based on the presence of fluid?

Ventral in the 3rd to 7th intercostal spaces Signup and view all the answers

How should the tracheostomy tube fit during insertion?

Loosely to allow for swelling Signup and view all the answers

What is the optimal position for a patient undergoing abdominocentesis?

Standing or in sternal recumbency Signup and view all the answers

What should be done with the needle during the insertion phase of an abdominocentesis?

Advance with slight negative pressure until a pop is felt Signup and view all the answers

In the event of a pneumothorax, where should the site for thoracocentesis be located?

Dorsal in the 5th to 9th intercostal spaces Signup and view all the answers

Which important precaution should be taken while suturing the skin edges after inserting a tracheostomy tube?

Suture loosely to accommodate swelling Signup and view all the answers

What is the primary objectives of broad spectrum antibiotics in septic shock?

To provide rapid and effective infection control Signup and view all the answers

Which fluid should be used for maintenance in an animal requiring plasma volume expansion?

5% dextrose for maintenance Signup and view all the answers

What is the appropriate action to take if an animal is not hydrated during volume resuscitation?

Use 0.7% NaCl in combination with hetastarch Signup and view all the answers

In cardiopulmonary resuscitation for dogs weighing less than 5 kg, which technique is recommended to provide closed chest compression?

Utilizing the thumb and first two forefingers Signup and view all the answers

What should be established first in basic life support during an emergency?

An airway using an endotracheal tube Signup and view all the answers

When administering blood or plasma, what condition requires fresh or stored blood transfusion?

Very low hematocrit and total protein levels Signup and view all the answers

What is the recommended ventilation frequency during chest compressions in CPR?

Once every 15 compressions Signup and view all the answers

In phase 1 of cardiopulmonary resuscitation, what is crucial for ensuring adequate airflow?

Establishment of an airway Signup and view all the answers

What should be monitored to ensure a good prognosis in heat-related conditions?

Rapid recovery of corneal reflexes Signup and view all the answers

During blood transfusion, which step is critical before proceeding?

Crossmatching for compatibility Signup and view all the answers

What is the consequence of continuing cooling measures if body temperature is below 104° F?

Risk of hypothermia development Signup and view all the answers

In cases of severe heatstroke, what type of fluid therapy is recommended?

Combination of crystalloids and colloids Signup and view all the answers

What type of allergic reaction does anaphylaxis represent?

Type I hypersensitivity Signup and view all the answers

What is the result of the interaction between antigen and IgE on mast cells during anaphylaxis?

Increased histamine release Signup and view all the answers

Why is it recommended to avoid using dogs that are positive for DEA-1 and DEA-7 antigens as blood donors?

To reduce the risk of hemolytic reactions Signup and view all the answers

When is the administration of fresh or frozen plasma indicated?

If DIC is present Signup and view all the answers

What is the recommended method for monitoring urine output in animals with oliguria or polyuria?

Measure urine output regularly instead of only after fluid administration. Signup and view all the answers

What indicates successful rehydration based on changes in PCV and plasma protein levels?

Both PCV and plasma protein should decrease. Signup and view all the answers

How should fluid therapy be adjusted if there is a sudden increase in central venous pressure (CVP)?

Immediately decrease the rate of fluid administration. Signup and view all the answers

Which of the following clinical signs would suggest overhydration in a patient?

Diminished urine output coupled with increased body weight. Signup and view all the answers

What is the primary treatment for increasing heart rate and blood pressure in a severe shock situation?

Epinephrine Signup and view all the answers

When administering IV fluids, why is it advisable to distribute fluids evenly throughout the day?

To minimize the likelihood of fluid overload complications. Signup and view all the answers

What does a gain or loss of 1 kg in body weight signify in terms of body water changes?

Represents an increase or decrease of 500 mL of body water. Signup and view all the answers

Which drug should not be administered to patients with a third-degree atrioventricular block?

Epinephrine Signup and view all the answers

Which monitoring parameter is crucial to assess electrolyte and acid-base status during fluid therapy?

Conducting tests every 12 to 24 hours. Signup and view all the answers

In the case of cardiac arrhythmias, which medication is recommended for long-term therapy?

Sotalol Signup and view all the answers

What does clinical monitoring involve when assessing signs of overhydration?

Monitoring for body weight increases and respiratory complications. Signup and view all the answers

When managing blood pressure, what should be done if the pulse is weak or not palpable?

Increase blood pressure immediately Signup and view all the answers

What condition necessitates the replacement of red blood cells if the hematocrit is below 20%?

Hemorrhage Signup and view all the answers

Which treatment option is not typically recommended until 10 to 15 minutes after cardiac arrest?

Sodium bicarbonate Signup and view all the answers

Which of the following is an appropriate response in treating bradyarrhythmias if the patient is hypoxemic?

Large doses of epinephrine Signup and view all the answers

What should be done prior to blood transfusion to reduce the risk of reaction?

Give corticosteroids Signup and view all the answers

What is the initial intervention for a patient in septic shock requiring airway support?

Establish an airway and administer oxygen Signup and view all the answers

Which fluid is advised for volume expansion when an animal is not hydrated?

0.7% NaCl with hetastarch Signup and view all the answers

In the context of basic life support, what should follow after establishing an airway?

Provide ventilation support Signup and view all the answers

What is the appropriate technique for closed chest compression in dogs over 5 kg?

Use the heel of hands to compress the thorax Signup and view all the answers

What fluid therapy condition indicates the need for fresh or stored blood transfusion?

Very low hematocrit and total protein Signup and view all the answers

What is the recommended frequency of ventilation during chest compressions in CPR?

Once for every 15 compressions Signup and view all the answers

What should be done with blood or plasma before administering it to a patient?

Type and crossmatch before transfusion Signup and view all the answers

What should be monitored to assess the effectiveness of fluid therapy?

Body weight and urine output Signup and view all the answers

What is the defining characteristic of hypertonic dehydration?

Loss of water exceeding the loss of electrolytes Signup and view all the answers

Which of the following best describes hypotonic dehydration?

Low serum sodium concentration in the presence of dehydration Signup and view all the answers

What percentage of body weight does extracellular water typically represent in adults?

20% Signup and view all the answers

What is a critical threshold for detectable dehydration in terms of body weight loss?

5% Signup and view all the answers

Which electrolyte disturbance is indicated when correcting metabolic acidosis?

Hyperkalemia Signup and view all the answers

What factor is considered critical when evaluating a history of dehydration?

Recent episodes of urination and diarrhea Signup and view all the answers

What percentage of total body water is represented by intracellular water in adults?

40% Signup and view all the answers

What indicates an acute life-threatening dehydration condition?

Loss of more than 12% body weight Signup and view all the answers

Which condition should prevent the placement of a nasogastric tube?

Presence of severe coagulopathy Signup and view all the answers

What is the first step to ensure proper nasogastric tube placement?

Measure the catheter to the last rib Signup and view all the answers

What should be done immediately after arterial sampling to prevent excessive bleeding?

Place firm pressure for 3 to 5 minutes Signup and view all the answers

Which is an appropriate action during a tracheostomy procedure?

Clip and prepare the skin over the larynx Signup and view all the answers

In which situation should rapid intravenous anesthesia be administered?

Prior to skin incision for tracheostomy Signup and view all the answers

What is a contraindication for performing arterial sampling?

Severe coagulopathy Signup and view all the answers

What is an important consideration when verifying the placement of a nasogastric tube?

Conduct a radiographic assessment Signup and view all the answers

Which site is commonly used for arterial sampling in the lower limb?

Femoral artery in the inguinal region Signup and view all the answers

Which etiology of shock is characterized by a deficiency in oxygen transport due to a reduced volume of blood?

Hypovolemia Signup and view all the answers

What clinical sign is indicative of shock when observing the color of mucous membranes?

Gray or cyanotic color Signup and view all the answers

Which of the following clinical signs can reflect hypovolemia during a shock presentation?

Weak pulse Signup and view all the answers

Which of the following can be a clinical presentation indicating shock due to sepsis?

Brick red mucous membranes Signup and view all the answers

Which of the following correctly identifies a state associated with poor oxygen transport in the context of shock?

Hypoxia Signup and view all the answers

Among the listed clinical signs, which one is least likely to directly correlate with shock?

Loud heart sounds Signup and view all the answers

In cases of shock, which of the following abnormalities could contribute to the overall condition due to cardiovascular system issues?

Tachycardia Signup and view all the answers

Which of the following best describes a significant clinical sign of decreased oxygen transport due to hypovolemia?

Pallor in extremities Signup and view all the answers

What is the expected effect on skin turgor in cases of severe dehydration?

It takes longer to return to normal as dehydration worsens. Signup and view all the answers

Which of the following solutions should NOT be used for maintenance due to high sodium content?

0.9% sodium chloride Signup and view all the answers

Which parameter typically indicates an increase in dehydration?

Increased total plasma protein Signup and view all the answers

What primary characteristic defines sensible fluid losses in animals?

They are measured and can be quantified. Signup and view all the answers

What indicates that urine specific gravity should increase in a dehydrated animal?

The kidneys are healthy and concentrating urine. Signup and view all the answers

How is the volume of fluid required to correct dehydration typically calculated?

Weight in kg multiplied by the percentage of dehydration. Signup and view all the answers

Which factors cause dehydration in animals?

Decreased thirst and food intake. Signup and view all the answers

Which component is high in intracellular fluid compared to extracellular fluid?

Potassium Signup and view all the answers

What is the primary purpose of administering broad spectrum antibiotics in septic shock?

To cover a wide range of potential bacterial pathogens Signup and view all the answers

In which scenario should fresh or stored blood transfusion be administered?

When hematocrit is very low Signup and view all the answers

What is the recommended first action in basic life support for emergency situations?

Establish an airway as soon as possible Signup and view all the answers

How should maintenance fluids be adjusted in a dehydrated animal requiring plasma volume expansion?

Combination of 0.9% NaCl or lactated Ringer’s solution can be used Signup and view all the answers

What is the primary method to correct metabolic acidosis in a patient?

Sodium bicarbonate administration Signup and view all the answers

What should be monitored when defining success in intervention for heat-related conditions?

Vital signs and changes in urine output Signup and view all the answers

Which condition is most likely to follow aggressive fluid therapy?

Hypokalemia Signup and view all the answers

During cardiopulmonary resuscitation, what is the recommended method for ventilation in relation to chest compressions?

Ventilate once for every 15 chest compressions Signup and view all the answers

What is the correct approach if epinephrine and closed chest compression fail after 5 minutes?

Perform open-chest cardiac massage Signup and view all the answers

What is the appropriate immediate action if severe coagulopathy is suspected before arterial sampling for blood gas analysis?

Wait for coagulopathy to resolve before proceeding. Signup and view all the answers

For eventual reduction in mortality, when should cooling measures be initiated?

Immediately during transport to the hospital Signup and view all the answers

Which technique is specifically recommended for closed chest compression on dogs weighing less than 5 kg?

Compress the thorax with the thumb and first two forefingers Signup and view all the answers

Which step should be taken to verify the placement of a nasogastric tube?

Use radiographs to confirm placement. Signup and view all the answers

Which of the following treatments is NOT indicated early in the treatment of septic shock?

Corticosteroid therapy Signup and view all the answers

What is the appropriate primary treatment for managing heart rate and blood pressure in severe shock conditions?

Combination therapy including fluids and vasopressors Signup and view all the answers

What medication is advised to prevent reperfusion injury during treatment?

Calcium entry blockers Signup and view all the answers

In which scenario should a nasogastric tube NOT be placed?

The patient shows signs of respiratory distress. Signup and view all the answers

What is a contraindication for corticosteroid therapy in shock management?

Septic shock Signup and view all the answers

What is a proper technique to secure a nasogastric tube after placement?

Suture the tube to the nostril. Signup and view all the answers

What treatment should be administered to manage severe pulmonary edema effectively?

Diuretics like furosemide Signup and view all the answers

What is the correct method for performing a tracheostomy in an emergency?

Incise the skin from the larynx to the thoracic inlet. Signup and view all the answers

What vital precaution should be observed during arterial blood gas sampling?

Apply pressure for 1 minute after sampling. Signup and view all the answers

Which site is recommended for the collection of blood in standing patients?

Dorsal metatarsal artery distal to the tarsus joint. Signup and view all the answers

What approach should be taken if a patient shows signs of vomiting before nasogastric tube insertion?

Avoid the procedure if there is severe vomiting. Signup and view all the answers

What physiological condition describes elevated serum sodium concentration in dehydration?

Hypertonic dehydration Signup and view all the answers

When is dehydration clinically detectable in an individual?

When 5% of body weight in water has been lost Signup and view all the answers

Which of the following indicates hypotonic dehydration?

Low serum sodium concentration Signup and view all the answers

What represents a life-threatening condition in terms of fluid loss?

Acute loss of more than 12% body weight Signup and view all the answers

Which type of dehydration occurs with a loss of isotonic fluid along with intake of hypotonic fluids?

Hypotonic dehydration Signup and view all the answers

What characteristic of hypertonic fluids limits their use in hypovolemic patients?

They can increase the risk of pulmonary edema. Signup and view all the answers

What percentage of total body weight does extracellular water represent in adults?

20% to 25% Signup and view all the answers

Which condition is characterized by a history of decreased water intake or increased fluid loss?

Dehydration Signup and view all the answers

In which condition is phosphorus supplementation usually required?

Significant hypophosphatemia Signup and view all the answers

Which of the following describes the body's total water percentage in adults?

50% to 70% Signup and view all the answers

When serum sodium is low (hyponatremia), what should the fluid composition prioritize?

More salt than water for rapid correction. Signup and view all the answers

Which of the following formulations is most appropriate for maintaining volume expansion in the absence of laboratory data?

Lactated Ringer’s solution Signup and view all the answers

What precaution is recommended when using synthetic colloids in patients with hypoproteinemia?

Monitor heart rate for potential bradycardia as a sign of toxicity. Signup and view all the answers

What is the best approach to fluid selection in patients with elevated serum sodium levels?

Give hypertonic fluids that contain more water than salt. Signup and view all the answers

Which colloid solution is primarily indicated for patients experiencing shock due to low oncotic pressure?

Hetastarch Signup and view all the answers

When should practitioners be cautious with the use of synthetic colloids?

In patients with congestive heart failure Signup and view all the answers

What is the recommended approach when treating a patient with hypernatremia or water deficit?

Opt for a low-sodium fluid such as 0.45% saline in 2.5% dextrose. Signup and view all the answers

What is the maximum recommended infusion rate for potassium supplementation in maintenance fluids?

0.5 mEq/kg/hr Signup and view all the answers

In which circumstance is the SC route of fluid administration deemed inappropriate?

When the patient is in shock Signup and view all the answers

Which condition indicates that sodium bicarbonate should be added to parenteral fluids?

Metabolic acidosis Signup and view all the answers

What is a critical consideration when potassium supplementation is indicated?

Use caution as hyperkalemia can cause death. Signup and view all the answers

What is an appropriate site for SC fluid administration?

The trunk of the animal Signup and view all the answers

What might result from administering fluids containing preservatives in young animals?

Potential toxicity leading to significant health issues Signup and view all the answers

Which method is recommended for intravenous fluid administration in small dogs?

Use the cephalic or lateral saphenous veins. Signup and view all the answers

What role does the packed cell volume (PCV) play in assessing dehydration?

It indicates increased plasma protein levels with dehydration. Signup and view all the answers

Which solution is considered inadequate as a maintenance solution for hydration due to its sodium content?

0.9% sodium chloride Signup and view all the answers

What is the typical insensible water loss in normal animals?

20 mL/kg/day Signup and view all the answers

What physiological change is likely observed as dehydration progresses in terms of skin turgor?

Increased time for skin to return to normal position. Signup and view all the answers

Which of the following factors contributes to dehydration in animals?

Decreased water intake Signup and view all the answers

In a dehydrated animal, what change would one expect in the urine specific gravity?

It would increase if the kidneys are healthy. Signup and view all the answers

What is an early sign of dehydration that can be detected in animals?

Increased heart rate Signup and view all the answers

Which of the following statements about metabolic acidosis and dehydration is true?

It can occur as a result of dehydration. Signup and view all the answers

What is the correct procedure after arterial sampling for blood gas analysis to manage bleeding?

Place firm pressure over the site for 3 to 5 minutes. Signup and view all the answers

In which of the following situations should a nasogastric tube NOT be placed?

Patients with respiratory distress due to brachycephalic syndrome. Signup and view all the answers

Which method is NOT recommended for confirming the placement of a nasogastric tube?

Checking for clinical signs of aspiration. Signup and view all the answers

What action should be taken if a patient is undergoing tracheostomy and severe coagulopathy is present?

Delay the procedure until coagulopathy is treated. Signup and view all the answers

During emergency arterial sampling, which type of syringe should be utilized?

A heparinized syringe. Signup and view all the answers

What should be done before placing a nasogastric tube in a patient?

Pre-measure the catheter to the last rib. Signup and view all the answers

What is the most critical step when preparing for a tracheostomy procedure?

Prepare by clipping and cleaning the skin. Signup and view all the answers

Which anatomical location is NOT commonly used for arterial blood sampling in emergency settings?

Radial artery at the wrist. Signup and view all the answers

Study Notes

Emergency Medicine

Emergency care focuses on immediate stabilization and support of vital functions.
Fluid therapy is crucial for restoring blood volume and tissue perfusion.
Monitoring fluid administration is vital to prevent overhydration and complications.
Tracheostomy is a procedure to create an opening in the trachea to secure an airway.
Abdominocentesis is used to sample abdominal fluid for diagnostic purposes, avoiding blind techniques in cases of large masses or organomegaly.
Thoracocentesis is used to drain fluid from the chest cavity, avoiding the procedure in cases of chronic effusions due to the risk of fibrosing pleuritis.

Shock

Shock is a life-threatening condition characterized by inadequate tissue perfusion and oxygen delivery.
Hypovolemia and hypoxia contribute to shock.
Sepsis is a significant cause of shock.
Clinical signs of shock:
- Depressed mentation
- Weak pulse
- Color changes in mucous membranes (pale, gray/cyanotic, brick red)
- Hypothermia

Cardiopulmonary Resuscitation (CPR)

CPR consists of basic life support: airway, breathing, and circulation.
Advanced life support may include medication administration and other interventions.
Basic life support:
- Airway: Establish an open airway using methods like endotracheal intubation or tracheotomy.
- Breathing: Use a ventilator or exhaled air to assist breathing.
- Circulation: Perform chest compressions at a rate of 80 to 100 compressions per minute.

Fluid Therapy for Shock

Initial therapy:
- Establish an airway if needed.
- Administer oxygen.
- Obtain history and perform a physical examination.
- Place a jugular catheter.
- Collect blood for laboratory analysis.
Blood volume:
- Administer 0.9% NaCl or lactated Ringer’s solution for plasma volume expansion.
- In dehydrated animals, 0.7% NaCl (hypertonic saline) can be used in combination with hetastarch.
- Give fresh or frozen plasma for hypoproteinemia.
- Give fresh or stored blood when hematocrit and total protein are very low.

Blood Transfusion

Whole blood transfusion is used for rapid decrease in PCV.
Crossmatching is essential to prevent transfusion reactions.
Compatibility testing is done at three temperatures.
Major incompatibility: Agglutination or hemolysis in a mix of 100 µL donor cells and 100 µL patient serum.
Minor incompatibility: Agglutination or hemolysis in a mix of 100 µL patient cells and 100 µL donor serum.

Heatstroke

Heatstroke is a serious condition caused by excessive body temperature.
Clinical signs:
- Hyperthermia
- Panting
- Increased heart rate
- Weakness
- Seizures
- Collapse
Management:
- Cool the animal down gradually, avoiding rapid cooling measures.
- Administer fluids as needed.
- Monitor closely for complications such as DIC.
- Administer broad-spectrum antibiotics.

Anaphylaxis

Anaphylaxis is a life-threatening allergic reaction.
Antigen-IgE interaction on mast cells leads to histamine release.
Clinical signs:
- Respiratory distress
- Vasodilation
- Cardiovascular collapse
Treatment:
- Administer epinephrine.
- Provide supportive care.
Prevention:
- Identify and avoid triggers.
- Desensitization therapy.

Fluid Therapy

Fluid therapy is an important treatment for various conditions in animals.
Fluid therapy can be used for resuscitation from shock, correcting dehydration, hypokalemia, and metabolic acidosis.
Fluid therapy is also used for correcting other electrolyte disturbances, parenteral nutrition, treatment of anemia, and coagulopathies.
The distribution of body water and electrolytes is crucial for understanding fluid therapy.
Total body water accounts for 50% to 70% of body weight in adults.
Water is distributed in the body as intracellular water (40% of body weight) and extracellular water (20% of body weight).
Extracellular water consists of interstitial fluid (12% to 14% of body weight) and intravascular fluid (6 to 8% of body weight).
Electrolytes are essential for maintaining fluid balance and cellular function.
Dehydration is detectable when approximately 5% of body weight in water has been lost.
An acute loss of more than 12% body weight in water is life-threatening.
History of decreased water intake, vomiting, polyuria, diarrhea, excessive panting or salivation may suggest dehydration.
Clinical signs of dehydration include sunken eyes, dry mucous membranes, decreased skin turgor, and increased heart rate.
Different types of fluids are used in fluid therapy, including crystalloids, colloids, and blood products.
Crystalloids are solutions that contain electrolytes and are used to expand the intravascular volume.
Colloids are solutions that contain large molecules that stay in the intravascular space, providing a more sustained volume expansion.
Blood products are used to replace blood loss and improve oxygen-carrying capacity.
The rate of fluid infusion is adjusted based on the animal's condition and the severity of dehydration.
Fluid therapy is monitored to assess its effectiveness and adjust the treatment plan.
Overhydration is a potential complication of fluid therapy and can lead to various clinical signs, including an increase in body weight, increased urination, pulmonary edema, and vomiting
It is important to monitor the efficacy of fluid therapy by assessing body weight, PCV, plasma protein, central venous pressure, and electrolyte status.

Emergency techniques

Arterial blood gas analysis helps assess oxygenation, ventilation, and acid-base balance.
Common sites for arterial sampling include the femoral artery and dorsal metatarsal artery.
A heparinized syringe is used for arterial sampling.
Firm pressure should be applied to the puncture site for 3 to 5 minutes after blood collection.
Nasogastric tube placement can be used for gastric decompression, administration of medications, and obtaining samples for diagnostic purposes.
Nasogastric tube placement is contraindicated in patients with facial trauma, brachycephalic breeds with respiratory distress, severe coagulopathy, or severe vomiting.
The tube should be premeasured to the last rib and lubricated with local anesthetic.
Placement should be confirmed with radiographs.
Tracheostomy is a surgical procedure that creates an opening in the trachea to facilitate breathing.
Tracheostomy is indicated in cases of airway obstruction or severe respiratory distress.
Severe coagulopathy is a contraindication for tracheostomy.
Broad-spectrum antibiotics are indicated after tracheostomy to prevent infection.
Peritoneal fluid collection can be used for diagnostic purposes and to assess abdominal effusion.
A good site for peritoneal fluid collection in standing patients is caudal to the spleen, slightly to the right of midline.
In left lateral recumbency, fluid collection can be performed caudal to the umbilicus, slightly to the right of midline.

Cardiopulmonary Resuscitation

Cardiopulmonary resuscitation (CPR) is an emergency procedure performed when a patient has stopped breathing and/or the heart has stopped beating.
The goal of CPR is to restore circulation and breathing to the patient.
Phase 1 of CPR involves basic life support, which includes establishing an airway, breathing, and circulation.
Phase 2 of CPR involves advanced life support, which includes drug therapy, fluid therapy, electrocardiography, and treatment of specific conditions.
CPR is performed using a combination of chest compressions, ventilations, and medications.
Drugs used in CPR include epinephrine, lidocaine, sotalol, sodium bicarbonate, and anticholinergics (atropine).
Fluid therapy is essential during CPR to support blood pressure and organ perfusion.
Electrocardiography can be used to monitor cardiac activity and guide CPR interventions.
Understanding the principles and techniques of fluid therapy and cardiopulmonary resuscitation is crucial for providing effective emergency care to animals.

Dehydration

Sodium and chloride are higher in extracellular fluid and lower in intracellular fluid
Potassium, magnesium, and phosphorus are lower in extracellular fluid and higher in intracellular fluid
Water intake should equal water loss in normal animals
Insensible water loss is approximately 20 mL/kg/day
Sensible water losses are between 20 and 40 mL/kg/day in normal animals consuming food
0.45% sodium chloride can make a good maintenance solution but does not contain adequate potassium
Lactated Ringer’s and 0.9% sodium chloride are not good maintenance solutions because they contain too much sodium and chloride.
Dehydration can be caused by decreased water intake (due to decreased thirst and appetite centers in sick animals, decreased food intake)
Physical examination findings associated with dehydration include depression, acute loss of body weight, sunken eyes, decreased skin turgor, dry mucous membranes, tachycardia, diminished capillary refill, and signs of shock
Skin turgor can be assessed by measuring skin elasticity when lifted; in normal animals, the skin should return to its position quickly; as dehydration progresses, the return time increases
Dehydration is as high as 5% to 10% before a loss of skin turgor becomes noticeable
Dehydration can be assessed by packed cell volume (PCV) increasing, total plasma protein increasing and urine specific gravity increasing (if the kidneys are healthy)
Metabolic acidosis is common with dehydration
Dehydration correction should be done by administering volume of fluids equal to weight (kg) multiplied by percentage of dehydration

Emergency Techniques

Arterial blood sampling for blood gas analysis should not be performed if a severe coagulopathy is present
Arterial blood samples should be collected using a heparinized syringe
Common arterial sampling sites include the femoral artery in the inguinal region and the dorsal metatarsal artery distal to the tarsus joint
After arterial sampling, place firm pressure over the site for 3 to 5 minutes to stop bleeding
Nasogastric tubes should not be placed in patients with deforming facial trauma, brachycephalic breeds with respiratory distress, if severe coagulopathy is present, or if there is severe vomiting
To place a nasogastric tube, premeasure the catheter to the last rib, and place several drops of local anesthetic into the nostril
Gently insert the tip of the catheter into the nostril and push the catheter up on the nasal philtrum, advancing the tube in a ventral and medial direction into the ventral meatus
Suture the tube to the nostril and use skin staples to attach the tube to the face
Verify the placement of the tube with radiographs
Tracheostomy should not be performed if a severe coagulopathy is present
Use rapid IV anesthesia when performing a tracheostomy
Clip and prepare the skin before performing a tracheostomy
Incise skin from the larynx to the thoracic inlet
Bluntly force the tips of Mayo scissors through the tissue, avoid lacerating the lung parenchyma or coronary arteries
A good site for collecting blood in standing patients is caudal to the spleen, slightly to the right of midline, with the needle pointed towards the urinary bladder
If the patient is in left lateral recumbency, collect blood caudal to the umbilicus, slightly to the right of midline, with the needle pointed towards the urinary bladder

Shock

Shock can be caused by lack of oxygen transport (hypovolemia and hypoxia)
Shock can be caused by cardiovascular system abnormalities
Shock can be caused by sepsis
Shock causes depressed mentation
Shock causes weak pulses indicating decreased cardiac output or peripheral vascular resistance
Shock changes mucous membrane color (pale- anemia, gray or cyanotic- arterial hypoxemia and severe cardiovascular compromise, brick red- septic shock)
Shock causes hypothermia with cold extremities
Broad spectrum antibiotics are indicated in shock, especially in septic shock
Maintenance fluids should contain 5% dextrose

Cardiopulmonary Resuscitation

Phase 1 of cardiopulmonary resuscitation focuses on establishing an airway, breathing, and circulation
Establish an airway as soon as possible during Phase 1 (endotracheal tube, tracheotomy, mouth-to-muzzle)
Use a ventilator or exhaled air during Phase 1, but do not overinflate the lungs
During Phase 1, use closed chest compression, 80-100 compressions/minute
Ventilate once for every 15 chest compressions during Phase 1
If a third person is available, use the palm of the hand to compress the abdomen against the spine for 5-10 seconds 2-3 times/minute during Phase 1
Phase 2 of cardiopulmonary resuscitation focuses on advanced life support like correcting acid-base and electrolyte disturbances, evaluating cardiac function, and restoring heart rhythm.
Epinephrine should be administered for cardiac arrest.
If epinephrine is ineffective, a consistent method of treatment is with electrical defibrillation during Phase 2
Open-chest cardiac massage should be considered if 5 minutes of closed chest compression and epinephrine are ineffective during Phase 2
Phase 3 of cardiopulmonary resuscitation focuses on prolonged life support like adequate oxygenation, gauging, hypnogenesis (sedation, pain control), and intensive care.
Phase 3 includes drug therapy (catecholamines- dopamine, dobutamine)- to increase cardiac output and peripheral perfusion, diuretics- furosemide to treat pulmonary edema, mannitol (if cardiac arrest longer than 3 minutes), calcium entry blockers- diltiazem to prevent reperfusion injury, sedation (diazepam) to avoid pentobarbital, and antibiotics

Heatstroke

Treat heatstroke immediately to reduce mortality
Lower core temperature early by using cool water to wet the patient and providing air movement to enhance evaporation
Do not use cold water or ice water to treat heatstroke

Fluid Therapy

Used to resuscitate from shock, correct dehydration, hypokalemia, and metabolic acidosis
Can also be used to correct other electrolyte disturbances and for parental nutrition, treatment of anemia and coagulopathies
Total body water is about 50% to 70% of body weight in adults
Cats have slightly less body water; young animals and neonates have a higher percentage of body water
Intracellular water is about 40% of body weight
Extracellular water is about 20% of body weight
Interstitial fluid is about 12% to 14% of body weight
Intravascular fluid is about 6 to 8% of body weight
Sodium and chloride are high in extracellular fluid and low in intracellular fluid
Potassium, magnesium, and phosphorus are low in extracellular fluid and high in intracellular fluid
Water intake should equal water loss in normal animals
Insensible water loss is about 20 mL/kg/day
Sensible losses are 20 to 40 mL/kg/day in normal animals consuming food
A 0.45% sodium chloride solution makes a good maintenance solution but does not contain adequate potassium
Lactated Ringer's and 0.9% sodium chloride are not good maintenance solutions because they contain too much sodium and chloride
Dehydration is detectable when approximately 5% of body weight in water has been lost.
Acute loss of more than 12% body weight in water is life-threatening
Decreased water intake, vomiting, polyuria, diarrhea, excessive panting or salivation may suggest dehydration
Findings associated with dehydration include depression, acute loss of body weight, sunken eyes, decreased skin turgor, dry mucous membranes, tachycardia, diminished capillary refill, and signs of shock
Skin turgor should return quickly when lifted a short distance
As dehydration progresses, the time required for the skin to return to its normal position increases
Dehydration is as much as 5% to 10% before a loss of skin turgor can be detected
Packed cell volume (PCV) and total plasma protein both increase with dehydration
Urine specific gravity should increase in a dehydrated animal if the kidneys are healthy
Metabolic acidosis is common in dehydration
Volume of fluid needed for correction of dehydration is determined based on the percentage of dehydration and the animal's weight
Monitor heart rate; bradycardia is a sign of toxicity
Only significant hypophosphatemia requires phosphorus supplementation, usually in diabetic ketoacidosis
Avoid oversupplementation
If sodium is normal, use fluids that are normal in sodium and osmolality (lactated Ringer’s, Plasma-Lyte 148, Normosol-R, or 0.9% NaCl)
If serum sodium is elevated, choose a hypotonic solution (5% dextrose in water, 0.45% NaCl in 2.5% dextrose)
If serum sodium is low, fluids should contain more salt. However, hypertonic fluids are usually not used unless hyponatremia is severe
Benzoic acid may be used as a preservative, and can be toxic
Signs of toxicity are neurological
Do not use fluids containing preservatives in cats, puppies, or small dogs

Supplementation of Parenteral Fluids

Potassium is added to fluids if serum potassium concentration is less than 3.5 mEq/L
Potassium supplementation may still be indicated if potassium is between 3.5 and 4.5 mEq/L if ventricular arrhythmias are present
Potassium supplements are added to maintenance fluids, if needed, at a rate of approximately 20 to 30 mEq/L
The rate of infusion of potassium is most important. Do not exceed a rate of 0.5 mEq/kg/hr
Use potassium supplementation with caution as death can result due to hyperkalemia
Sodium bicarbonate is added if alkali replacement is needed
Signs of hypervolemia include increased CVP, increased urination, gelatinous feel to SC tissue, pulmonary edema, vomiting, or diarrhea
Discontinue all IV infusions and give furosemide if hypervolemia occurs

General Guidelines for Fluid Selection

Choose fluids with normal sodium and osmolality for normonatremia
Choose a hypotonic solution for hypernatremia
Choose fluids containing more salt for hyponatremia
Choose a synthetic colloid to administer in conjunction with crystalloid fluids when rapid intravascular expansion is needed or if there is lowered oncotic pressure

Routes of Administration for Parenteral Fluids

Do not use SC route in shock, severe dehydration, hypothermia, or emergency replacement of fluids
Do not give 5% dextrose in water SC with severe dehydration
Choose a site on the trunk for SC administration
Use the IV route for accurate delivery of large amounts of fluids
Use the jugular vein in cats and small dogs, or if serious disease is present
Use a 20- to 22-gauge needle in cats and small dogs, and a 14- to 20-gauge needle in medium to large dogs
Place catheter aseptically, and change every 72 hours

Emergency Techniques

Do not perform arterial sampling if a severe coagulopathy is present
Use a heparinized syringe for arterial sampling
Most common sites for arterial sampling are the femoral artery in the inguinal region, and the dorsal metatarsal artery distal to the tarsus joint
Place firm pressure over the site for 3 to 5 minutes after bleeding
Do not place a nasogastric tube in patients with deforming facial trauma, in brachycephalic breeds with respiratory distress, if severe coagulopathy is present, or if there is severe vomiting
Premeasure the catheter to the last rib for the nasogastric tube
Place several drops of local anesthetic into the nostril and wait several minutes
Place the tip of the catheter in the nostril, and gently push the catheter up on the nasal philtrum, advancing the tube in a ventral and medial direction into the ventral meatus
Suture the tube to the nostril, and use skin staples to attach the tube to the face
Verify placement with radiographs
Do not perform tracheostomy if severe coagulopathy is present
Use rapid IV anesthesia, clip, and prepare the skin for tracheostomy
Incise skin from larynx to the thoracic inlet. Bluntly force the tips of Mayo scissors through the tissue

Abdominal Paracentesis

Do not perform in animals with severe coagulopathy
Perform aseptic technique
A good site for collection in standing patients is caudal to the spleen, slightly to the right of midline, with the needle directed toward the urinary bladder
If in left lateral recumbency, go caudal to the umbilicus, slightly to the right of midline, with the needle directed toward the urinary bladder

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This quiz covers essential concepts in emergency medicine, focusing on critical care practices and the management of shock. Learn about fluid therapy, vital procedures like tracheostomy, and the significance of monitoring in emergency situations. Additionally, explore the causes and clinical signs of shock, an urgent medical condition that requires immediate attention.