smallanimal final spring
Terms
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- primary survey
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60 seconds
Level of conscousness(AVPU=alert, visual acuity, pain level, unconscious)
ABC
Gross exam-initiate life saving procedures if needed
Attach monitors - Vital signs
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HR
Pulse rate, strength
RR
mm color
CRT
Temp
BP
jugular vein distension, fill time - Base line data in emergency/triage
- 2 lead EKG, PCV/TP, BUN, BG, blood smear
- Frequency of monitoring
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continually during crisis
every 10-15 min when stable for at least 30 min
decrease to no less than every 4 hrs for 1st 24 hrs - Length of time for cephalic catheter to stay in
- 3 days
- ACRASHPLAN
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Airway
Circulation-mm CRT pulse temp
Respiratory
Abdomen
Spine
Head
Pelvis
Limbs
Arteries and veins'
Nerves - epiphera
- blood around the eye
- After primary survey
- Vitals, decision for tx
- Puncture wound
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clip and clean, may enlarge for drainage. Flush. If abcessed may place penrose drain.
Abs, hot pack twice daily
comps= abcess, sloughing, systemic infection - Contusion
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Bruise. Painfull
Ice within 2-4 hrs. >12 hrs alternate ice and heat
Look for other injuries
could signal internal injuries, coag problem - Abrasion
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Scrape, oozing fluid, painful at first.
Sedate w/ analgesic. Clip, clean, flush. Place KY in wound. apply Ab. Wrap lightly
Comp=pyoderma - Laceration
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Rip or tear
Ligate vessels if bleeding. Apply pressure, Protect, control infection, pain mgt
Comp= hemmorage - How are breaks describes
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Where on bone- distal or proximal.
Type of fx
Which bone orleg - Open reduction
- Surgical repair of broken limb
- closed reduction
- cast or splint of fx
- reduction of fx
- putting ends in opposition
- Initial tx of fx
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Assess for other damage
control bleeding
stabilize wound
sx if indicated - 1st degree burn
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sunburn- only epidermis.
PAINFUL, red. Heals repidly
cool w/ water - 2nd degree burn
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superficial involving all layers of dermis. Tan crust, reddened skin. Blisters +/- after several hrs.Painful
Abs. +/- pain meds.
Observe for shock, hypovolemia - 3rd degree burn
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full thickness- all layers of dermis. May not be painful. Pearly white w/ charred grey edges. Leathery, firm and depressed. Susceptivle to pseudomonis
IV cath, fluids, ABs, cool packs
If >50% may euth - 4th degree burn
- skin plus SQ fat and muscle
- eschar
- thick crust - scab caused by burning. Requires multiple debridements
- types of burns (not classes)
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heat
chemical
electrical - First aid for burns
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Ice pack, cold H2O,
chemical- PPE- watch for splashing of chemical
electrical-check mouth, may not be able to eat. Watch for heart arryhthmias - ID of poisonous snakes
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triangular head, rattles, raised eyes.
Red and yellow-dangerous fellow. - types of snake venom
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Lyses, necrosis-western diamondback
Neurotoxins- green mohave - snake bite symptoms
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may take hours
puncture wound, severe pain
edeme, petechiae, ecchymosis, sloughing
hypotension, hypovolemic shock
lethargy, tremors, neuro signs, collapse - snake bite treatment
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Keep quiet.
Tx< 30 min inc survival
Constrictor band if peripheral.
Anti-venin
Prevent shock: benadryl, fluids, pain meds, +/- steroids, IV abs - Snake bite tx in order
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1. IV pain meds
2. fluids
3. locate bite
4. anti-venin
5. IV Abs
6. clip and clean
7. baseline blood - bee stings
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symptoms-nothing--anaphylactic shock
hives, edema
care-benadryl im, O2 if needed
if rx- Epi, steroids, fluid
comp=gagging, trembling-collapse usu w/i 20-30 min - spiders
- black widow, violin/brown recluse- bulls-eye lesion. neuro damage. May need to excise
- hyperthermia
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common- brachycephalic, rabbits
symptoms=panting, salivation, V/D,dry mm, brt red-grey,seizures,coma dehydration.oliguria, anuria
care-ASAP ice packs in towels between legs, on head. when temp 103 stop, rub ice chips on mm, cool IV lines
comp=coma, death, blindness - hypothermia
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from external factors,not anesthesia
symptoms-cold skin, extremitites, mm cold, pale. shivering then sluggish
tx-rewarm slowly in swirling warm water 102-105. warm blankets, circulating hot water pad, hair dryer, warm iv fluids - frostbite
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usu extremities.
symptoms=pale, red, scaly during warming. painful at first, hurts when warming
tx= heat gently- use own body heat with warm towels. no rubbing, Ab ointments
comp=amputation, sloughing - #1 cause of cardiopulmonary arrest
- prescribed drugs or anesthetics
- causes of cardiopulmonary arrest
- seizures, stress w/ pre-existing condition, loss of fluids/tissue,drugs, anesthesia, old age, airway obstruction, kidney or liver disease
- premonitory signs of cardiopulmonary arrest
- dark unoxygenated blood, cyanosis, respiration change in rate and effort, dilated pupils, cold clammy skin, tacky mm, fast uneven HR
- Team approach for cardiopulmonary arrest
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1. Airway mgt
2. Cardo mgt
3. Venous access
4. Monnitoring
5. Drugs
6. Practice drills
7. Evaluation - CPR drugs
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Central venous or IT
Fluids-LRS
Atropine-Inc HR
Epi-vasoconstrictor-Inc BP
Lidocaine-antiarrhythmia-for PVC, ventricular tachycardia
Dopram-respiratory stimulant - chemical defibrillation
- 10% Ca Chloride at 1mEq/Kg/ or 0.2ml/KG
- ABCs of CPR
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Airway
Breathing
Cardiac
Drugs
Ecg
Follow up - Hypovolemic shock
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decreased intravascular volume
causes-blood loss, dehydration, malnourishment, protein losing disease - cardiogenic shock
- decreased cardiac output from pump insufficiency
- vasogenic shock
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bloodflow is poorly distributed
causes-toxicity, anesthetic, organ malfunction, septic shock (pyo) - obstructive shock
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physical obstruction
aneuryism, embolism, tumor - shock stage 1
- 1. compensatory/early= Inc HR, bounding pulse, norm to high BP, mm normal to very pink,CRT<1
- shock stage 2
- decompensatory/middle and late- pale, cold, slow CRT HR slow, BP decreased. edema, kidney and GI at risk. septicemia can occur
- shock stage 3
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terminal/irrevversible
heart failure, severe hypotension, pulmonary edema, abnormal breathing - treatment for shock
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Airway, oxygen
Rapid IV fluids-60-90ml/Kg for stage 2. Crystalloid or colloids
Corticosteroids-Solu Delta or Dex Na Phos
Vasoactive drugs-dobutamine, dopamine
Monitor - anaphylactic shock tx
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shock can be local or systemic
tx for systemic
establish airway, oxygen if needed.
IV LRS
Epi
Corticosteroids-sodium prednisolone succinate IV
Dex Sp IV if only local
Benadryl IV slowly
Recovery within 5-10 minutes is good prognosis - bloat
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distention of the stomach caused by food, secretions, gas w/ possible malpositioned stomach.
dx-retching, abd distention,diff breathing
xray, abd percussion
tx=-basic life support
decompression via gastrocentesis'
passing of stomach tube
sx-gastropexy - info needed for poison control hotline
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name and spelling of poison, type of product
route, amt of exposure
size, species of animal
how long ago - tx for poison
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slow rate of absorption
emesis-hydrogen peroxide-1-2 tsp per 10Kg up to 3 X at 5min intervals.
Apomorphine-6mg tab/6ml saline- 1ml/10Kg IV
Activated charcoal by gavage or nasogastric tube(If powder make slurry of 1 g activated charcoal in 5-10 ml H2O)
Remove toxin from skin and fur
IV fluids, diuresis(mannitol and furosemide), cathartics(sodium sulfate) to increase excretion - antidotes for poisons
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warfarin-vitamin K
ethylene glycol-ethanol
tylanol-mocomyst - nursing card/supportive care for toxicity, poisoning
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prevent aspiration pneumonia
anticonvulsants
muscle relaxers
treat/prevent shock
keep loud noises down- some poisons and apomorphine cause hypersensitivity - emergency protocol for seizures
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1. control seizures'
2. airway
3 check vitals
4. keep head lowered
5 IV cath
6 specific poison tx
7 treat for shock - aminophylline
- bronchodilator-feline asthma
- dexamethasone
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corticosteroid.
anti-inflammatory
treats shock - digoxin
- CHF-increases force decreases rate
- pharmacology
- the science of dealing with the preparation, use and effects of drugs
- pharmacotherapeutics
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plan of tx which utilizes drugs-
Treatment regimen-Name of drug, route, dose, frequency, duration
Choice made by vet
Vet-client-pet relationship must exist - legend
- rx only
- pharmacokinetics
- sequence of events that occurs from time drug is administered till excretion
- drug absorption
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Determined by:
1.method of cellular transport- passive active or ionization
2. PH and ionization state of the drug
3. absorptive surface of the site
4. blood supply at the site
5. solubility of the drug
6. formulation of the drug
7. condition of GI tract - drug distribution
- process by which drug is carried from site of administration to site of action
- Factors effecting drug distribution
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1. proteins in plasma may bind/store drug
2. certain tissues (fat) store drug
3. tissue barriers-blood/brain
4. disease - biotransformation
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metabolism-bodys ability to transform a drug to a form that can be eliminated
occurs primarily in liver - factors effecting biotransformation
- species, age, nutritional status
- drug excretion
- process by which drug is eliminated- usu kidney
- half-life
- amt of time it takes to reduce amt of drug in body to 1/2
- LD50
- the dose of drug lethal to 50% of animals in trial
- pharmacodynamics
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study by which drugs produce physiological changes in body
1. affinity/attraction
2. efficacy
3.antagonist
4. stimulation, replacement
5.adverse drug reactions - types of topical products
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lotion-usu large area
ointment-small local area
cream-more liquid than oint
powder- for drying
aerosols and sprays - parts of rx label
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date
owner and pet name
name of drug
strength
number, amt
instructions
vets name/hospital name
exp date
warnings
Optional-initials, childproof, other instructions ie shake - not to mix parenteral IV
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acidic with alkaline
vitamins and abs
diff abs
antifungals with anything
steroids and abs
Flush catheter with NaCl between incompatible drugs - Purpose of hormone drugs
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to correct a deficiency
to obtain a desired effect - estrogen
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female hormone produced in the ovaries
to induce abortion
to treat urinary incontinence in spayed females
spayed ferrets-prevent cystic ovaries
IM. oral-DES
adverse-anemia, bone marrow supression - progestins
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similar to progesterone-prolong, maintain repro environment for fetus to plant
Ovaban, Megace-controls estrus, prevent false preg,control male behavior, treat dermatoses
adverse-hyperglycemia, adrenal suppression, endometrial hyperplasia
Depo Medrol-skin, suppress estrus - Androgens
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testosterone=rarely used
treats urinary incontinence in un-neutered male dogs. Increases libido
Inj only - Anabolic steroids
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produced in adrenal
stimulates appetite
cancer support
Winstrol-V - Pituitary hormones
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FSH-stimulates follicle to produce ova
LH-helps thicken endometrium
oxytoxin-expels eggs, fetus - phenobarbital
- can be used in cats
- dilantin
- dogs only-seizure control. draws sodium out of cell
- sodium bromide-
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seizure control
crystal-mix with water, can be toxic - gabapentin-neurontin
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dogs only-anti convulsant
hard on liver,kidney