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)
Treatment- basic care plus

Monitor potassium
Possible phenytoin
Possible antidigitalis antibody fragments

Small Animal Toxicology

Resource for other poisonous plants
http://vet.purdue.edu/depts/addl/toxic/
cover1.htm