Practical Approach to the Small Animal Emergency Patient

Table of Contents   Part I: Practical approaches for the emergent patient Chapter 1: The triage exam................................................................................ 5 The triage history and presenting complaint The triage physical exam Initial diagnostic and stabilization options Chapter 2: Rational lab work selection and “diagnostic stewardship”..................... 14 Determining the need for testing Speed versus accuracy: Point of care and send out lab work Testing for a purpose: Rule in versus rule out lab testing Chapter 3: Selecting appropriate imaging studies................................................ 22 History and physical exam to justify imaging Limitations and risks of diagnostic imaging Chapter 4 Intravenous Fluid Therapy: Yes, no, how much, how fast........................ 29 Assessing hydration and volume status Creating a fluid therapy plan Fluid therapy for the patient with a heart murmur Chapter 5: Analgesia and sedation.................................................................... 43 Risk/benefit of (in)appropriate sedation and analgesia Cardiopulmonary effects of sedatives and analgesics Building a sedation protocol Sedating the patient with a heart murmur Chapter 6: Use of antibiotics in the emergent patient........................................... 60 Assessing the need for antibiotics A location-based approach to antimicrobial therapy Risk factors for multidrug resistant infections Chapter 7: Decision making for hospital admission.............................................. 74 Benefits of hospitalization Owner goals of care   Part II: Clinical reasoning for common diseases and presentations Chapter 8: Approach to the “down dog”............................................................. 78 Differentiating between cardiovascular, neurologic, and toxicologic disease Chapter 9: Diabetic Emergencies....................................................................... 86 Differentiating diabetes mellitus from stress hyperglycemia Managing the “healthy” diabetic Assessing the “sick” diabetic Evaluating cats on SGLT-2 inhibitors Fluid and insulin therapy for DK/DKA and HHS patients The hypoglycemic diabetic Chapter 10: Trauma...................................................................................... 107 Initial patient assessment and stabilization in trauma Managing traumatic brain injury/craniomaxillofacial trauma and the role for CT Imaging and treatment of thoracic trauma Assessment and management of abdominal trauma and cavitary effusions Fracture and soft tissue injury assessment and stabilization Decision making and prognosis with vertebral fractures Stabilization and management of penetrating thoracic or abdominal wounds Bite wound assessment Chapter 11: Spontaneous hemoabdomen......................................................... 148 Patient assessment and stabilization Utility of imaging Transfusion decision making Surgical timing Likelihood of hemangiosarcoma Perioperative monitoring Chapter 12: Gastric dilatation and volvulus (GDV).............................................. 167 Patient evaluation and stabilization The prognostic role of lactate Surgical timing Perioperative complications Chapter 13: The blocked cat........................................................................... 176 Stabilizing the hyperkalemic UO Urethral rupture and the un-unblockable cat Recurrent urethral obstruction Chapter 14: Approach to vomiting and diarrhea................................................. 192 Surgical versus non-surgical causes and the need for imaging Medical versus surgical management for foreign body obstruction Assessing the inpatient versus outpatient GI distress Chapter 15: Dyspnea..................................................................................... 210 Upper versus lower airway localization Point of care ultrasound in the dyspneic patient Evaluating for congestive heart failure Oxygen therapy and fallback strategies for the dyspneic patient Chapter 16: Neurologic emergencies................................................................ 232 Managing the 1st time seizure Value of advanced imaging in the seizure patient Stabilizing and treating cluster seizures and status epilepticus Approaching the “chronic” seizure patient Vestibular disease Decision making and management for spinal cord disease Chapter 17: Immune mediated hemolytic anemia (IMHA) and thrombocytopenia (ITP) 260 Diagnosis and testing for IMHA/ITP Transfusion decision making in IMHA/ITP Initial immunosuppression for IMHA/ITP Thromboprophylaxis in IMHA Hemorrhage management for ITP Use of adjunctive therapies Chapter 18: Approach to the azotemic pet........................................................ 280 Identifying acute, acute on chronic, and chronic kidney failure Differentiating and managing acute, acute on chronic, and chronic renal failure When to monitor urinary output Managing oligo/anuria Considerations for hemodialysis Chapter 19: Managing the chronic disease patient............................................. 296 Assessing for progression of chronic disease Common medication side effects Medication adjustment options Chapter 20: Toxin ingestion management......................................................... 305 Induction of emesis Decision making for charcoal administration Use of intralipid emulsion Indications for intravenous fluid diuresis Extracorporeal therapy Chapter 21 Client communication and palliative care......................................... 316 Diagnosis and decision making Identifying goals of care Tools to maintain patient comfort and dignity Discussing euthanasia Chapter 22: Cardiac emergencies..................................................................... 322 Initial and fallback treatments for congestive heart failure Diagnosis, treatment, and prognosis for feline arterial thromboembolism (ATE) Arrhythmia identification and management Chapter 23: Reproductive Emergencies............................................................ 349 Dystocia identification Medical and surgical management of dystocia Neonatal resuscitation and postpartum conditions Pyometra management Chapter 24: Cardiopulmonary-Cerebral Resuscitation (CPCR)............................... 361 Reversible causes for cardiac arrest Managing the traumatic cardiac arrest Terminating resuscitative efforts Post resuscitation care