CORD-19_Custom_license_subset  

CORD-19:dc97e1de3b69da13f534f15afdcedbf48064c69d JSONTXT 8 Projects

Annnotations TAB TSV DIC JSON TextAE

Id Subject Object Predicate Lexical cue
T1 2-10 Sentence denotes Abstract
T2 13-15 Sentence denotes 1.
T3 16-41 Sentence denotes Is there a patent airway?
T4 42-145 Sentence denotes If airway noises are present or the animal is stuporous, gently and carefully extend the head and neck.
T5 146-177 Sentence denotes If possible, extend the tongue.
T6 178-223 Sentence denotes Wipe mucus, blood, or vomitus from the mouth.
T7 224-281 Sentence denotes In unconscious animals, maintain head and neck stability.
T8 282-284 Sentence denotes 2.
T9 285-313 Sentence denotes Look for signs of breathing.
T10 314-407 Sentence denotes If there is no evidence of breathing or the gum color is blue, begin mouth-to-nose breathing.
T11 408-525 Sentence denotes Encircle the muzzle area with your hands to pinch down on the gums, and blow into the nose 15 to 20 times per minute.
T12 526-528 Sentence denotes 3.
T13 529-567 Sentence denotes Is there evidence of cardiac function?
T14 568-649 Sentence denotes Check for a palpable pulse on the hind legs or for an apex beat over the sternum.
T15 650-759 Sentence denotes If no signs of cardiac function are found, begin external cardiac compressions at 80 to 120 times per minute.
T16 760-762 Sentence denotes 4.
T17 763-787 Sentence denotes Is there any hemorrhage?
T18 788-895 Sentence denotes Use a clean cloth, towel, paper towel, or disposable diaper or feminine hygiene product to cover the wound.
T19 896-966 Sentence denotes Apply firm pressure to slow hemorrhage and prevent further blood loss.
T20 967-1030 Sentence denotes Do not use a tourniquet, because this can cause further damage.
T21 1031-1145 Sentence denotes Apply pressure, and as blood seeps through the first layer of bandage material, place a second layer over the top.
T22 1146-1148 Sentence denotes 5.
T23 1149-1175 Sentence denotes Cover any external wounds.
T24 1176-1297 Sentence denotes Use a clean bandage material soaked in warm water, and transport the animal to the nearest veterinary emergency facility.
T25 1298-1363 Sentence denotes Address penetrating wounds to the abdomen and thorax immediately.
T26 1364-1366 Sentence denotes 6.
T27 1367-1407 Sentence denotes Are there any obvious fractures present?
T28 1408-1495 Sentence denotes Immobilize fractures with homemade splints made of newspaper, broom handles, or sticks.
T29 1496-1559 Sentence denotes Muzzle the awake animal before attempting to place any splints.
T30 1560-1708 Sentence denotes If a splint cannot be attached safely, place the animal on a towel or blanket and transport the animal to the nearest veterinary emergency facility.
T31 1709-1733 Sentence denotes Is the animal breathing?
T32 1734-1930 Sentence denotes If the animal is not breathing, immediately intubate the animal and start artificial ventilations with a supplemental oxygen source (see Cardiac Arrest and Cardiopulmonary Cerebral Resuscitation).
T33 1931-2001 Sentence denotes If the animal is breathing, what are the respiratory rate and pattern?
T34 2002-2058 Sentence denotes Is the respiratory rate normal, increased, or decreased?
T35 2059-2176 Sentence denotes Is the respiratory pattern normal, or is the breathing rapid and shallow, or slow and deep with inspiratory distress?
T36 2177-2308 Sentence denotes Are the respiratory noises normal, or is there a high-pitched stridor on inspiration characteristic of an upper airway obstruction?
T37 2309-2402 Sentence denotes Does the animal have its head extended and elbows abducted away from the body with orthopnea?
T38 2403-2471 Sentence denotes Do the commissures of the mouth move with inhalation and exhalation?
T39 2472-2550 Sentence denotes Is there evidence of expiratory distress with an abdominal push on exhalation?
T40 2551-2579 Sentence denotes Note the lateral chest wall.
T41 2580-2712 Sentence denotes Do the ribs move out and in with inhalation and exhalation, or is there paradoxical chest 1 P = Pelvis Perform a rectal examination.
T42 2713-2749 Sentence denotes Palpate for fractures or hemorrhage.
T43 2750-2788 Sentence denotes Examine the perineal and rectal areas.
T44 2789-2820 Sentence denotes Examine the external genitalia.
T45 2821-2865 Sentence denotes Examine the pectoral and pelvic extremities.
T46 2866-2913 Sentence denotes Are there any obvious open or closed fractures?
T47 2914-2987 Sentence denotes Quickly splint the limbs to prevent further damage and help control pain.
T48 2988-3027 Sentence denotes Examine the skin, muscles, and tendons.
T49 3028-3071 Sentence denotes Palpate the peripheral arteries for pulses.
T50 3072-3171 Sentence denotes Use a Doppler piezoelectric crystal to aid in finding a pulse if thromboembolic disease is present.
T51 3172-3197 Sentence denotes Measure the patient's BP.
T52 3198-3264 Sentence denotes From afar, note the level of consciousness, behavior, and posture.
T53 3265-3308 Sentence denotes Note respiratory rate, pattern, and effort.
T54 3309-3374 Sentence denotes Is the patient conscious, or is the patient obtunded or comatose?
T55 3375-3456 Sentence denotes Are the pupils symmetric and responsive to light, or is there anisocoria present?
T56 3457-3664 Sentence denotes Does the patient display any abnormal postures such as Schiff-Sherrington posture (extended rigid forelimbs, flaccid paralysis of the hindlimbs) that may signify severe spinal shock or a severed spinal cord?
T57 3665-3756 Sentence denotes Examine the peripheral nerves for motor and sensory input and output to the limbs and tail.
T58 3757-3936 Sentence denotes ancillary diagnostic evaluation hemodynAmiC TeChniques Perform electrocardiography, direct or indirect BP monitoring, and pulse oximetry in any critically ill traumatized patient.
T59 3937-4156 Sentence denotes imAging TeChniques Obtain radiographs of the thorax and abdomen in any animal that has sustained a traumatic injury once the patient's condition is more stable and the animal can tolerate positioning for the procedures.
T60 4157-4296 Sentence denotes Survey radiographs may reveal pneumothorax, pulmonary contusions, diaphragmatic hernia, pleural or abdominal effusion, or pneumoperitoneum.
T61 4297-4501 Sentence denotes Focused assessments of the abdomen and thorax after trauma (AFAST and TFAST) have been described to evaluate the abdomen for fluid and to evaluate the thorax for fluid, free air, and pericardial effusion.
T62 4502-4931 Sentence denotes During these examinations, ultrasound is used to evaluate four quadrants of the abdomen: (1) the diaphragm or hepatic view, on ventral midline just caudal to the sternum, (2) the spleno-renal view in the left lateral quadrant, (3) the cysto-colic view on ventral midline over the urinary bladder, and (4) the hepato-renal view on right lateral, the most dependent area of the abdomen with the patient in right lateral recumbency.
T63 4932-5262 Sentence denotes For evaluation of the thorax, the patient is positioned in lateral recumbency and the ultrasound probe is directed in a horizontal plane at the dorsal aspect of the ninth intercostal space, in the transverse and longitudinal planes caudal to the point of the elbow, over the heart to evaluate for pericardial and pleural effusion.
T64 5263-5367 Sentence denotes The examinations take only small amounts of time and can reveal whether ongoing fluid loss is occurring.
T65 5368-5468 Sentence denotes As with other ultrasonographic techniques, AFAST and TFAST results are sometimes operator-dependent.
T66 5469-5593 Sentence denotes Abdominocentesis (abdominal paracentesis) refers to puncture into the peritoneal cavity for the purpose of fluid collection.
T67 5594-5750 Sentence denotes Abdominal paracentesis is a somewhat sensitive technique for fluid collection as long as more than 6 mL/kg of fluid are present within the abdominal cavity.
T68 5751-5867 Sentence denotes In the event that you suspect peritonitis and have a negative tap with abdominal paracentesis, DPL can be performed.
T69 5868-5925 Sentence denotes To perform abdominal paracentesis, follow this procedure:
T70 5926-5928 Sentence denotes 1.
T71 5929-6037 Sentence denotes Place the patient in left lateral recumbency and clip a 4-to 6-inch square with the umbilicus in the center.
T72 6038-6040 Sentence denotes 2.
T73 6041-6110 Sentence denotes Aseptically scrub the clipped area with antimicrobial scrub solution.
T74 6111-6113 Sentence denotes 3.
T75 6114-6328 Sentence denotes Wearing gloves, insert a 22-or 20-gauge needle or over-the-needle catheter in four quadrants: cranial and to the right, cranial and to the left, caudal and to the right, and caudal and to the left of the umbilicus.
T76 6329-6452 Sentence denotes As you insert the needle or catheter, gently twist the needle to push any abdominal organs away from the tip of the needle.
T77 6453-6608 Sentence denotes Local anesthesia typically is not required for this procedure, although a light sedative or analgesic may be necessary if severe abdominal pain is present.
T78 6609-6679 Sentence denotes In some cases, fluid will flow freely from one or more of the needles.
T79 6680-6781 Sentence denotes If not, gently aspirate with a 3-to 6-mL syringe or aspirate with the patient in a standing position.
T80 6782-6892 Sentence denotes Avoid changing positions with needles in place because iatrogenic puncture of intraabdominal organs may occur.
T81 6893-6895 Sentence denotes 4.
T82 6896-7023 Sentence denotes Save any fluid collected in sterile red-and lavender-topped tubes for cytologic and biochemical analyses and bacterial culture.
T83 7024-7086 Sentence denotes Monitor hemorrhagic fluid carefully for the presence of clots.
T84 7087-7163 Sentence denotes Normally, hemorrhagic effusions rapidly become defibrinated and do not clot.
T85 7164-7316 Sentence denotes Clot formation can occur in the presence of ongoing active hemorrhage or may be caused by the iatrogenic puncture of organs such as the spleen or liver.
T86 7317-7377 Sentence denotes If abdominal paracentesis is negative, DPL can be performed.
T87 7378-7517 Sentence denotes Although peritoneal dialysis kits are commercially available, they are fairly expensive and often impractical for the general practitioner.
T88 7518-7556 Sentence denotes To perform DPL, follow this procedure:
T89 7557-7559 Sentence denotes 1.
T90 7560-7631 Sentence denotes Clip and aseptically scrub the ventral abdomen as described previously.
T91 7632-7634 Sentence denotes 2.
T92 7635-7728 Sentence denotes Wearing sterile gloves, cut multiple side ports in a 16-or 18-gauge over-the-needle catheter.
T93 7729-7898 Sentence denotes Use care to not cut more than 50% of the circumference of the catheter, or else the catheter will become weakened and potentially can break off in the patient's abdomen.
T94 7899-7901 Sentence denotes 3.
T95 7902-8036 Sentence denotes Insert the catheter into the peritoneal cavity caudal and to the right of the umbilicus, directing the catheter dorsally and caudally.
T96 8037-8054 Sentence denotes 1 cotton filling.
T97 8055-8235 Sentence denotes The sponges can be left dry if the wound has minimal exudate but should be moistened with sterile 0.9% saline or lactated Ringer's solution if the wound has high-viscosity exudate.
T98 8236-8328 Sentence denotes Topical ointments may be applied (silver sulfadiazine, chlorhexidine ointment) if necessary.
T99 8329-8539 Sentence denotes The intermediate layer should be thick absorbent wrapping material, covered by an outer layer of porous tape such as Elastikon (Johnson & Johnson Medical, Arlington, Texas), or Vetrap (3M, St Paul, Minnesota) .
T100 8540-8655 Sentence denotes Change the bandages at least once daily or more frequently if strike-through of exudate occurs through the bandage.
T101 8656-8745 Sentence denotes To place a wet-to-dry bandage over a wound, first place the contact layer over the wound.
T102 8746-8831 Sentence denotes Next, apply strips of adhesive tape to the patient's paw on either side, if possible.
T103 8832-8939 Sentence denotes The strips (stirrups) will be used to hold the bandage in place and prevent it from slipping down the limb.
T104 8940-8991 Sentence denotes Wrap the intermediate layer over the contact layer.
T105 8992-9101 Sentence denotes Turn the adhesive strips around so that the adhesive layer can be secured to the intermediary layer in place.
T106 9102-9154 Sentence denotes Wrap the final, or tertiary, layer over the bandage.
T107 9155-9219 Sentence denotes The function of a wet-to-dry bandage is to help debride a wound.
T108 9220-9297 Sentence denotes The moistened gauze dries and is pulled off the wound at each bandage change.
T109 9298-9377 Sentence denotes Dry necrotic tissue and debris that adhere to the gauze are pulled off with it.
T110 9378-9497 Sentence denotes In addition, the moistened material dilutes the wound exudate and enhances its absorption into the gauze contact layer.
T111 9498-9649 Sentence denotes If large amounts of exudate come from the wound, the contact layer and intermediate layer absorb the exudate, wicking the material away from the wound.
T112 9650-9765 Sentence denotes Finally, delivery of medications into the wound can occur to promote the development of healthy granulation tissue.
T113 9766-9926 Sentence denotes oPen Wound in rePAir sTAge oF heAling Early Repair During the early stage of repair, granulation tissue, some exudate, and minor epithelialization are observed.
T114 9927-10195 Sentence denotes Place a nonadherent bandage with some antibacterial properties (petroleum-or nitrofurazone-impregnated gauze) or absorbent material (foam sponge, hydrogel, or hydrocolloid dressing) in direct contact with the wound to minimize disruption of the granulation tissue bed.
T115 10196-10299 Sentence denotes Next, place an absorbent intermediate layer, followed by a porous outer layer, as previously described.
T116 10300-10427 Sentence denotes Granulation tissue can grow through gauze mesh or adhere to foam sponges and can be ripped away at the time of bandage removal.
T117 10428-10494 Sentence denotes Hemorrhage and disruption of the granulation tissue bed can occur.
T118 10495-10606 Sentence denotes Later in the repair process, granulation tissue can exude sanguineous drainage and have some epithelialization.
T119 10607-10646 Sentence denotes A late nonadherent bandage is required.
T120 10647-10759 Sentence denotes The contact layer should be some form of nonadherent dressing, foam sponge, hydrogel, or hydrocolloid substance.
T121 10760-10859 Sentence denotes The intermediate layer and outer layers should be absorbent material and porous tape, respectively.
T122 10860-10942 Sentence denotes With nonadherent dressings, wounds with viscous exudates may not be absorbed well.
T123 10943-11040 Sentence denotes This may be advantageous and enhance epithelialization, provided that complications do not occur.
T124 11041-11171 Sentence denotes Infection, exuberant granulation tissue, or adherence of absorbent materials to the wound may occur and delay the healing process.
T125 11172-11295 Sentence denotes Moist healing is a newer concept of wound management in which wound exudates are allowed to stay in contact with the wound.
T126 11296-11441 Sentence denotes In the absence of infection a moist wound heals faster and has enzymatic activity as a result of macrophage and polymorphonuclear cell breakdown.
T127 11442-11511 Sentence denotes Enzymatic degradation or "autolytic debridement" of the wound occurs.
T128 11512-11644 Sentence denotes Moist wounds tend to promote neutrophil and macrophage chemotaxis and bacterial phagocytosis better than use of wet-to-dry bandages.
T129 11645-11861 Sentence denotes A potential complication and disadvantage of moist healing, however, is the development of bacterial colonization, folliculitis, and trauma to wound edges that can occur because of the continuously moist environment.
T130 11862-11990 Sentence denotes 1 Use surfactant-type solutions (Constant-Clens, Kendall, Mansfield, Massachusetts) for initial wound cleansing and debridement.
T131 11991-12100 Sentence denotes Use occlusive dressings for rapid enzymatic debridement with bactericidal properties to aid in wound healing.
T132 12101-12247 Sentence denotes Bandage wet necrotic wounds with a dressing premoistened with hypertonic saline (Curasalt [Kendall] , 20% saline) to clean and debride the wounds.
T133 12248-12348 Sentence denotes Hypertonic saline functions to desiccate necrotic tissue and bacteria to debride the infected wound.
T134 12349-12419 Sentence denotes Remove and replace the hypertonic saline bandage every 24 to 48 hours.
T135 12420-12582 Sentence denotes Next, place gauze impregnated with antibacterial agents (Kerlix AMD [Kendall] ) over the wound in the bandage layer to act as a barrier to bacterial colonization.
T136 12583-12818 Sentence denotes If the wound is initially dry or has minimal exudate and is not obviously contaminated or infected, place amorphous gels of water, glycerin, and a polymer (Curafil [Kendall] ) over the wound to promote moisture and proteolytic healing.
T137 12819-12897 Sentence denotes Discontinue moisture gels such as Curafil once the dry wound has become moist.
T138 12898-13009 Sentence denotes Finally, the final stage of moist healing helps to promote the development of a healthy granulation tissue bed.
T139 13010-13145 Sentence denotes Use calcium alginate dressings (Curasorb or Curasorb Zn with zinc [Kendall] ) in noninfected wounds with a moderate amount of drainage.
T140 13146-13236 Sentence denotes Alginate gels promote rapid development of a granulation tissue bed and epithelialization.
T141 13237-13335 Sentence denotes Foam dressings also can be applied to exudative wounds after a healthy granulation bed has formed.
T142 13336-13390 Sentence denotes Change foam dressings at least once every 4 to 7 days.
T143 13391-13513 Sentence denotes The use of granulated sugar has become popular in recent years to treat open wounds that are contaminated and/or infected.
T144 13514-13624 Sentence denotes Sugar possesses antibacterial properties and helps promote wound healing and development of a granulation bed.
T145 13625-13834 Sentence denotes Sugar bandages are an excellent choice for shearing or degloving injuries, burns, and decubital ulcers, particularly ones that are infected with Pseudomonas species, Escherichia coli, or streptococcal species.
T146 13835-14003 Sentence denotes The placement of a sugar bandage is similar to that of a wet-to-dry bandage, in that first the wound must be thoroughly lavaged with either tap water or sterile saline.
T147 14004-14046 Sentence denotes Next, devitalized tissue must be debrided.
T148 14047-14138 Sentence denotes Next, pour a thick layer (approximately 1 cm thick) of granulated sugar over the wound bed.
T149 14139-14232 Sentence denotes Next, wrap the wound with sterile gauze squares, cotton bandage material, and an outer layer.
T150 14233-14375 Sentence denotes Change the wound dressing at least once to twice daily initially, then once daily to every other day as the granulation bed becomes healthier.
T151 14376-14473 Sentence denotes The sugar can be eliminated from the bandaging process once a healthy granulation bed is present.
T152 14474-14801 Sentence denotes For closed wounds without any drainage, such as a laceration that has been repaired surgically, a simple bandage with a nonadherent contact layer (e.g., Telfa pad [Kendall] ), an intermediate layer of absorbent material, and an outer porous layer (Elastikon, Vetrap) can be placed to prevent wound contamination during healing.
T153 14802-14879 Sentence denotes The nonadherent pad will not stick to the wound and cause patient discomfort.
T154 14880-15012 Sentence denotes Because there usually is minimal drainage from the wound, the function of the intermediate layer is more protective than absorptive.
T155 15013-15090 Sentence denotes Any small amount will be absorbed into the intermediate layer of the bandage.
T156 15091-15255 Sentence denotes It is important with any bandage to place the tape strips or "stirrups" on the patient's limb and then overlap in the bandage, to prevent the bandage from slipping.
T157 15256-15412 Sentence denotes Place the intermediate and tertiary layers loosely around the limb, starting distally and working proximally, with some overlap with each consecutive layer.
T158 15413-15497 Sentence denotes This method prevents excessive pressure and potential impairment of venous drainage.
T159 15498-15680 Sentence denotes Leave the toenails of the third and fourth digits exposed, whenever possible, to allow daily examination of the bandage to determine whether the bandage is impairing venous drainage.
T160 15681-15799 Sentence denotes If the bandage is too tight and constricting or impeding vascular flow, the toes will become swollen and spread apart.
T161 15800-15956 Sentence denotes When placed and maintained properly (e.g., the bandage does not get wet), there usually are relatively few complications observed with this type of bandage.
T162 15957-16063 Sentence denotes In some cases it is necessary to cover a wound in which a Penrose drain has been placed to allow drainage.
T163 16064-16164 Sentence denotes In many cases there is a considerable amount of drainage from the drain and underlying soft tissues.
T164 16165-16428 Sentence denotes The function of the bandage is to help obliterate dead space created by the wound itself, absorb the fluid that drains from the wound and that will contaminate the environment, and prevent external wicking of material from the external environment into the wound.
T165 16429-16603 Sentence denotes When the bandage is removed, the clinician can examine the amount and type of material that has drained from the wound in order to determine when the drain should be removed.
T166 16604-16839 Sentence denotes When a bandage is placed over a draining wound, the contact layer should be a commercially available nonadherent dressing and several layers of absorbent wide-mesh gauze placed directly over the drain at the distal end of the incision.
T167 16840-16965 Sentence denotes Overlay the layers of gauze with a thick layer of absorbent intermediate dressing to absorb fluid that drains from the wound.
T168 16966-17233 Sentence denotes If the gauze and intermediate layers are not thick or absorbent enough, there is a potential for the drainage fluid to reach the outer layer of the bandage and provide a source of wicking of bacteria from the external environment into the wound, leading to infection.
T169 17234-17389 Sentence denotes Minor Hemorrhage Some wounds such as lacerations have minor bleeding or hemorrhage that require an immediate bandage until definitive care can be provided.
T170 17390-17611 Sentence denotes To create a pressure bandage, place a nonadherent dressing immediately in contact with the wound, followed by a thick layer of absorbent material, topped by a layer of elastic bandage material such as Elastikon or Vetrap.
T171 17612-17816 Sentence denotes Unlike the bandage for a closed wound, the top tertiary outer layer should be wrapped with some tension and even pressure around the limb, starting from the distal extremity (toes) and working proximally.
T172 17817-17910 Sentence denotes The pressure bandage serves to control hemorrhage but should not be left on for long periods.
T173 17911-18030 Sentence denotes Pressure bandages that have been left on for too long can impair nerve function and lead to tissue necrosis and slough.
T174 18031-18140 Sentence denotes Therefore pressure bandages should be used in the hospital only, so that the patient can be observed closely.
T175 18141-18265 Sentence denotes If hemorrhage through the bandage occurs, place another bandage over the first until the wound can be repaired definitively.
T176 18266-18379 Sentence denotes Removal of the first bandage will only disrupt any clot that has formed and cause additional hemorrhage to occur.
T177 18380-18524 Sentence denotes Fractures require immediate immobilization to prevent additional patient discomfort and further trauma to the soft tissues of the affected limb.
T178 18525-18621 Sentence denotes As with all bandages, a contact layer, an intermediate layer, and an outer layer should be used.
T179 18622-18691 Sentence denotes Place the contact layer in accordance with any type of wound present.
T180 18692-18803 Sentence denotes The intermediate layer should be thick absorbent material, followed by a top layer of elastic bandage material.
T181 18804-19223 Sentence denotes An example is to place a Telfa pad over a wound in an open distal radius-ulna fracture, followed by a thick layer of cotton gauze cast padding, followed by an elastic layer of Kling (Johnson & Johnson Medical, Arlington, Texas) , pulling each layer tightly over the previous layer with some overlap until the resultant bandage can be "thumped" with the clinician's thumb and forefinger and sound like a ripe watermelon.
T182 19224-19348 Sentence denotes The bandage should be smooth with consecutive layers of even pressure on the limb, starting distally and working proximally.
T183 19349-19530 Sentence denotes Leave the toenails of the third and fourth digits exposed to allow monitoring for impaired venous drainage that would suggest that the bandage is too tight and needs to be replaced.
T184 19531-19650 Sentence denotes Finally, place a top layer of Vetrap or Elastikon over the intermediary layer to protect it from becoming contaminated.
T185 19651-19787 Sentence denotes If the bandage is used with a compound or open fracture, drainage may be impaired and actually lead to enhanced risk of wound infection.
T186 19788-19971 Sentence denotes Bandages placed for initial fracture immobilization are temporary until definitive fracture repair can be performed once the patient's cardiovascular and respiratory status is stable.
T187 19972-20067 Sentence denotes An external pin splint is required when fractures or luxations are associated with open wounds.
T188 20068-20206 Sentence denotes In some cases it may be difficult to bandage under the bars of the pin splint in such a way that the bandage is in contact with the wound.
T189 20207-20308 Sentence denotes To create padding around the pins, fit foam rubber sponges to lie securely under and around the pins.
T190 20309-20510 Sentence denotes Place bandages around the external fixator apparatus in layers to decrease contamination of the wound from the external environment and to absorb fluid that drains from the wound (Figures 1-4 to 1-6) .
T191 20511-20677 Sentence denotes A cup splint is indicated when bandaging pad wounds to decrease pressure on the footpad and prevent spreading of the footpads when the dog or cat places the paw down.
T192 20678-20757 Sentence denotes If the toes spread, spreading of the footpad can delay or impair wound healing.
T193 20758-20930 Sentence denotes The splint functions to place the paw in a more vertical direction so that the patient bears weight on the toe tips and not directly on the pads during the healing process.
T194 20931-20998 Sentence denotes Rights were not granted to include this figure in electronic media.
T195 20999-21039 Sentence denotes Please refer to the printed publication.
T196 21040-21121 Sentence denotes To create a cup or clamshell splint, follow this procedure (Figures 1-7 to 1-11):
T197 21122-21124 Sentence denotes 1.
T198 21125-21183 Sentence denotes Place a nonadherent contact layer directly over the wound.
T199 21184-21186 Sentence denotes 2.
T200 21187-21326 Sentence denotes Place stirrups of tape in contact with the skin of the dog, to be placed over the intermediate layer and prevent the bandage from slipping.
T201 21327-21329 Sentence denotes 3.
T202 21330-21460 Sentence denotes Place a fairly thick layer of absorbent intermediate bandage material over the contact layer such that the bandage is well padded.
T203 21461-21526 Sentence denotes Pull the tape stirrups and secure them to the intermediate layer.
T204 21527-21529 Sentence denotes 4.
T205 21530-21762 Sentence denotes Place a length of cast material that has been rolled to the appropriate length, such that the cast material is cupped around the patient's paw, and lies adjacent to the caudal aspect of the limb to the level of the carpus or tarsus.
T206 21763-21897 Sentence denotes In the case of a clamshell splint, place a layer of cast material on the cranial and caudal aspect of the paw and conform it in place.
T207 21898-21900 Sentence denotes 5.
T208 21901-22010 Sentence denotes Take the length of cast padding and soak it in warm water after it has been rolled to the appropriate length.
T209 22011-22163 Sentence denotes Wring out the pad, and secure and conform it to the caudal (or cranial and caudal, in the case of a clamshell splint) aspect of the distal limb and paw.
T210 22164-22166 Sentence denotes 6.
T211 22167-22246 Sentence denotes Secure the cast material in place with a layer of elastic cotton gauze (Kling).
T212 22247-22249 Sentence denotes 7.
T213 22250-22319 Sentence denotes Secure the bandage in place with a snug layer of Elastikon or Vetrap.
T214 22320-22478 Sentence denotes Short or long splints made of cast material can be incorporated into a soft padded bandage to provide extra support of a limb above and below a fracture site.
T215 22479-22696 Sentence denotes For a caudal or lateral splint to be effective, it must be incorporated for at least one joint above any fracture site to prevent a fulcrum effect and further disruption or damage to underlying soft tissue structures.
T216 22697-22823 Sentence denotes A short lateral or caudal splint is used for fractures and luxations of the distal metacarpus, metatarsus, carpus, and tarsus.
T217 22824-22889 Sentence denotes To place a short lateral or caudal splint, follow this procedure:
T218 22890-22892 Sentence denotes 1.
T219 22893-22982 Sentence denotes Secure a contact layer as determined by the presence or absence of any wound in the area.
T220 22983-22985 Sentence denotes 2.
T221 22986-23133 Sentence denotes Place tape stirrups on the distal extremity, to be secured later to the intermediate bandage layer and to prevent slipping of the bandage distally.
T222 23134-23136 Sentence denotes 3.
T223 23137-23243 Sentence denotes Place layers of roll cotton from the toes to the level of the mid tibia and fibula or mid radius and ulna.
T224 23244-23367 Sentence denotes Place the layers with even tension, with some overlap of each consecutive layer, moving distally to proximally on the limb.
T225 23368-23370 Sentence denotes 4.
T226 23371-23556 Sentence denotes Secure the short caudal or lateral splint and conform it to the distal extremity to the level of the toes and proximally to the level of the mid tibia and fibula or mid radius and ulna.
T227 23557-23559 Sentence denotes 5.
T228 23560-23659 Sentence denotes Secure the lateral or caudal splint to the limb with another outer layer of elastic cotton (Kling).
T229 23660-23662 Sentence denotes 6.
T230 23663-23752 Sentence denotes Cover the entire bandage, and splint with an outer tertiary layer of Vetrap or Elastikon.
T231 23753-23868 Sentence denotes Make sure that the toenails of the third and fourth digits remain visible to allow daily evaluation of circulation.
T232 23869-23975 Sentence denotes Long lateral or caudal splints are used to immobilize fractures of the tibia or fibula and radius or ulna.
T233 23976-24140 Sentence denotes The splints are fashioned as directed for short splints but extend proximally to the level of the axilla and inguinal regions to immobilize above the fracture site.
T234 24141-24256 Sentence denotes A spica splint is used to immobilize the humerus and elbow and shoulder joints in the case of luxation or fracture.
T235 24257-24304 Sentence denotes To place a spica splint, follow this procedure:
T236 24305-24307 Sentence denotes 1.
T237 24308-24356 Sentence denotes Place a contact layer if any wounds are present.
T238 24357-24359 Sentence denotes 2.
T239 24360-24480 Sentence denotes Apply tape stirrups to the distal limb to attach to the intermediate layer and prevent slipping of the bandage distally.
T240 24481-24483 Sentence denotes 3.
T241 24484-24602 Sentence denotes Place layers of conforming cotton gauze circumferentially and overlapping, moving up the limb from distal to proximal.
T242 24603-24605 Sentence denotes 4.
T243 24606-24697 Sentence denotes Incorporate the leg bandage into a layer of cotton bandage that is secured over the thorax.
T244 24698-24700 Sentence denotes 5.
T245 24701-24787 Sentence denotes Secure the cotton in place with a layer of snug elastic cotton material such as Kling.
T246 24788-24858 Sentence denotes Make sure that the bandage is not so tight that breathing is impaired.
T247 24859-24861 Sentence denotes 6.
T248 24862-25065 Sentence denotes Place splint material on the lateral aspect of the limb, extending the material from the level of the toes proximally over the entire limb and extending proximally to over the scapula and dorsal midline.
T249 25066-25070 Sentence denotes 1 7.
T250 25071-25204 Sentence denotes After rolling the splint to an appropriate length and width, moisten the splint material in warm water to allow it to set and harden.
T251 25205-25207 Sentence denotes 8.
T252 25208-25281 Sentence denotes Replace the splint and conform it to the bandage over the patient's body.
T253 25282-25284 Sentence denotes 9.
T254 25285-25347 Sentence denotes Secure the splint in place with another layer of cotton Kling.
T255 25348-25352 Sentence denotes 10 .
T256 25353-25456 Sentence denotes Wrap the entire bandage in place with a layer of tertiary bandage material such as Elastikon or Vetrap.
T257 25457-25483 Sentence denotes Mathews KA, Binnington AG:
T258 25484-25547 Sentence denotes Wound management using sugar, Compend Contin Educ Pract Vet 24:
T259 25548-25560 Sentence denotes 41-50, 2002.
T260 25561-25583 Sentence denotes Piermattei DL, Flo GL:
T261 25584-25708 Sentence denotes Brinker, Piermattei, and Flo's handbook of small animal orthopedics and fracture management, ed 4, St Louis, 2006, Elsevier.
T262 25709-25732 Sentence denotes Blood comPonent theraPy
T263 25733-25891 Sentence denotes Blood component therapy involves the separation of blood into its cellular and fluid components and infusing the components specific for each patient's needs.
T264 25892-26104 Sentence denotes Blood component therapy is the mainstay of initial and ongoing management of hematologic emergencies and can provide support of the critically ill patient until the underlying disease process has been controlled.
T265 26105-26369 Sentence denotes The separation of blood into red blood cells (RBC), plasma, cryoprecipitate, and platelet-rich products allows for more specific replacement of the animal's deficit(s), decreases the risks of transfusion reactions, and allows for more efficient use of donor blood.
T266 26370-26493 Sentence denotes Box 1-4 lists indications for transfusion of RBCs, platelet-rich plasma, fresh frozen or fresh plasma, and cryoprecipitate.
T267 26494-26631 Sentence denotes Cell membrane receptors on the surface of RBCs serve the purpose of self-recognition versus non-self-recognition during states of health.
T268 26632-26780 Sentence denotes The presence or absence of various glycoprotein and glycolipid moieties on the RBC surface helps to define blood groups or "types" within a species.
T269 26781-26892 Sentence denotes In dogs, six major cell surface dog erythrocyte antigens (DEAs, 1.1, 1.2, 3, 4, 5, and 7) have been identified.
T270 26893-27011 Sentence denotes Dogs that are negative for DEAs 1.1, 1.2, and 7 but Box 1-4 aPProach to Blood comPonent theraPy red Blood Cell suPPorT
T271 27012-27115 Sentence denotes • Packed cell volume that drops rapidly to less than 20% in the dog and less than 12% to 15% in the cat
T272 27116-27196 Sentence denotes • Acute loss of more than 30% of blood volume (30 mL/kg in dog, 20 mL/kg in cat)
T273 27197-27302 Sentence denotes • Clinical signs of lethargy, collapse, hypotension, tachycardia, tachypnea (acute or chronic blood loss)
T274 27303-27375 Sentence denotes • Ongoing hemorrhage • Poor response to crystalloid and colloid infusion
T275 27376-27565 Sentence denotes • Life-threatening hemorrhage caused by thrombocytopenia or thrombocytopathia • Surgical intervention necessary in a patient with severe thrombocytopenia or thrombocytopathia PlAsmA suPPorT
T276 27566-27825 Sentence denotes • Life-threatening hemorrhage with decreased coagulation factor activity • Severe inflammation (pancreatitis, systemic inflammatory response syndrome) • Replenish antithrombin (disseminated intravascular coagulation, protein-losing enteropathy or nephropathy)
T277 27826-28077 Sentence denotes • Surgery necessary in a patient with decreased coagulation factor activity • Severe hypoproteinemia-to partially replenish albumin, globulin, and clotting factors 1 positive for DEA 1.4 are known as "universal donors" and have DEA 1.1-negative blood.
T278 28078-28170 Sentence denotes DEAs 1.1 and 1.2 are the most immunogenic RBC antigens known in canine transfusion medicine.
T279 28171-28328 Sentence denotes Transfusion of DEA 1.1-or 1.2-positive blood to a DEA 1.1-and 1.2-negative dog can result in immediate hemolysis or a delayed-type hypersensitivity reaction.
T280 28329-28528 Sentence denotes In addition, viability of DEA 1.1-and 1.2-positive cells in a DEA 1.1-and 1.2-negative recipient is shortlived, ultimately defeating the long-term goal of increasing oxygen delivery in the recipient.
T281 28529-28690 Sentence denotes As with dogs, feline blood groups are defined by specific carbohydrate moieties attached to lipids (glycolipids) and proteins (glycoproteins) on the RBC surface.
T282 28691-28753 Sentence denotes Three blood types (A, B, and AB) have been identified in cats.
T283 28754-28799 Sentence denotes Type A is the most common blood type in cats.
T284 28800-28968 Sentence denotes Type B is relatively uncommon and occurs in Abyssinian, Persian, Devon Rex, and British Shorthair cats but can be found in domestic shorthair and longhair cats as well.
T285 28969-29040 Sentence denotes Type A is completely dominant over type B by simple mendelian genetics.
T286 29041-29233 Sentence denotes Type AB is a rare blood type that has been identified infrequently in domestic shorthair cats; Birman, Abyssinian, Somali, British Shorthair, and Scottish Fold cats; and Norwegian Forest Cats.
T287 29234-29324 Sentence denotes Unlike dogs, cats possess naturally occurring antibodies against other feline blood types.
T288 29325-29609 Sentence denotes The presence of naturally occurring autoantibodies is of paramount importance, necessitating blood typing with or without crossmatch before any feline transfusion, because hemolytic transfusion reactions potentially can be fatal, even with no prior sensitization or blood transfusion.
T289 29610-29718 Sentence denotes Type B cats possess large quantities of anti-A antibodies, primarily of the immunoglobulin M (IgM) subclass.
T290 29719-29883 Sentence denotes Type A blood infused into a type B cat will be destroyed within minutes to hours, and as little as 1 mL of incompatible blood can cause a life-threatening reaction.
T291 29884-29961 Sentence denotes Type A cats typically possess weak anti-B antibodies of IgG and IgM subtypes.
T292 29962-30136 Sentence denotes Transfusion of type B blood into a type A cat will result in milder clinical signs of reaction and a markedly decreased survival half-life of the infused RBCs to just 2 days.
T293 30137-30354 Sentence denotes Because type AB cats possess both moieties on the cell surface, they lack naturally occurring alloantibodies; transfusion of type A blood into a type AB cat can be performed safely if a type AB donor is not available.
T294 30355-30448 Sentence denotes The life span of an RBC from a type-specific transfusion into a cat is approximately 33 days.
T295 30449-30670 Sentence denotes Each clinic must weigh the cost-benefit ratio, the need for blood products, and the overall quantity of blood products in the practice when deciding which option works best for the staff, the clientele, and patient needs.
T296 30671-30812 Sentence denotes Busy hospitals requiring large quantities of blood products at regular intervals may elect to keep an in-house colony of donor dogs and cats.
T297 30813-30986 Sentence denotes Maintenance of a closed donor colony may be impractical because of the economics of feeding and housing the animals and using cage space that can be used for other patients.
T298 30987-31212 Sentence denotes In addition, care of the animals-including frequent health examinations, blood testing (complete blood count, biochemistry panels, heartworm tests), and daily care-are labor intensive for veterinarian and support staff alike.
T299 31213-31281 Sentence denotes Other options include using staff-or client-owned animals as donors.
T300 31282-31393 Sentence denotes This practice eliminates the expense of housing donors within the clinic and the labor required for daily care.
T301 31394-31505 Sentence denotes Donor animals can be used as needed or can have scheduled collections to replenish the stock of blood products.
T302 31506-31682 Sentence denotes The final option, which may be more practical for clinics with an infrequent need for blood products, is to purchase blood components from a commercial blood bank (Table 1-1) .
T303 31683-31865 Sentence denotes Blood donors should receive annual physical examinations and general health screenings, including a complete blood count, serum biochemistry panel, and occult heartworm antigen test.
T304 31866-32019 Sentence denotes Canine donors also should be screened initially for Lyme disease, Babesia, Rocky Mountain spotted fever (Rickettsia rickettsii), Ehrlichia, and Brucella.
T305 32020-32158 Sentence denotes The prevalence of Babesia species in the racing Greyhound industry in Florida, Arizona, and Colorado is high (estimated to be 30% to 50%).
T306 32159-32321 Sentence denotes Dogs ideally should weigh more than 50 lb (27 kg), be 1 to 8 years of age, have a packed cell volume (PCV) of at least 40%, and have never received a transfusion.
T307 32322-32418 Sentence denotes A healthy donor safely can donate 10 to 20 mL/kg of whole blood every 3 to 4 weeks if necessary.
T308 32419-32538 Sentence denotes Feline blood donors ideally should weigh more than 8 lb, be 1 to 8 years of age, and have never received a transfusion.
T309 32539-32604 Sentence denotes In addition, donor cats should be screened for feline 1 obtained.
T310 32605-32795 Sentence denotes The blood can be transfused immediately or placed into a small sterile collection bag that contains 0.14 mL of citrate phosphate dextrose adenine anticoagulant per milliliter of whole blood.
T311 32796-32891 Sentence denotes No more than 11 to 15 mL/kg should be obtained at any given time from a feline donor (Box 1-5).
T312 32892-32994 Sentence denotes There are many indications for administering transfusions of whole blood and component blood products.
T313 32995-33069 Sentence denotes Take a stepwise approach for every patient that may require a transfusion.
T314 33070-33146 Sentence denotes If a patient is at risk for blood loss or is anemic, consider a transfusion.
T315 33147-33245 Sentence denotes Make a decision regarding the type of transfusion therapy appropriate for each particular patient.
T316 33246-33330 Sentence denotes Once a decision has been made about which components need to be Minor crossmatch* 2.
T317 33331-33460 Sentence denotes Obtain a crossmatch segment from blood bank refrigerator for each donor to be crossmatched, or use an EDTA tube of donor's blood.
T318 33461-33498 Sentence denotes Make sure tubes are labeled properly.
T319 33499-33501 Sentence denotes 3.
T320 33502-33565 Sentence denotes Collect 2 mL of blood from recipient and place in an EDTA tube.
T321 33566-33597 Sentence denotes Centrifuge blood for 5 minutes.
T322 33598-33600 Sentence denotes 4.
T323 33601-33633 Sentence denotes Extract blood from donor tubing.
T324 33634-33665 Sentence denotes Centrifuge blood for 5 minutes.
T325 33666-33745 Sentence denotes Use a separate pipette for each transfer because cross-contamination can occur.
T326 33746-33748 Sentence denotes 5.
T327 33749-33848 Sentence denotes Pipette plasma off of donor and recipient cells and place in tubes labeled DP and RP, respectively.
T328 33849-33851 Sentence denotes 6.
T329 33852-33936 Sentence denotes Place 125 mcL of donor and recipient cells in tubes labeled DR and RR, respectively.
T330 33937-33939 Sentence denotes 7.
T331 33940-34066 Sentence denotes Add 2.5 mL 0.9% sodium chloride solution from wash bottle to each red blood cell tube, using some force to cause cells to mix.
T332 34067-34069 Sentence denotes 8.
T333 34070-34110 Sentence denotes Centrifuge RBC suspension for 2 minutes.
T334 34111-34113 Sentence denotes 9.
T335 34114-34196 Sentence denotes Discard supernatant and resuspend RBCs with 0.9% sodium chloride from wash bottle.
T336 34197-34200 Sentence denotes 10.
T337 34201-34250 Sentence denotes Repeat steps 8 and 9 for a total of three washes.
T338 34251-34254 Sentence denotes 11.
T339 34255-34379 Sentence denotes Place two drops of donor RBC suspension and two drops of recipient plasma in tube labeled Ma (this is the major crossmatch).
T340 34380-34383 Sentence denotes 12.
T341 34384-34508 Sentence denotes Place two drops of donor plasma and two drops of recipient RBC suspension in tube labeled Mi (this is the minor crossmatch).
T342 34509-34512 Sentence denotes 13.
T343 34513-34755 Sentence denotes Prepare control tubes by placing two drops of donor plasma with two drops of donor RBC suspension (this is the donor control); and place two drops of recipient plasma with two drops of recipient RBC suspension (this is the recipient control).
T344 34756-34759 Sentence denotes 14.
T345 34760-34851 Sentence denotes Incubate major and minor crossmatches and control tubes at room temperature for 15 minutes.
T346 34852-34855 Sentence denotes 15.
T347 34856-34890 Sentence denotes Centrifuge all tubes for 1 minute.
T348 34891-34894 Sentence denotes 16.
T349 34895-34936 Sentence denotes Read tubes using an agglutination viewer.
T350 34937-34940 Sentence denotes 17.
T351 34941-34982 Sentence denotes Check for agglutination and/or hemolysis.
T352 34983-34986 Sentence denotes 18.
T353 34987-35040 Sentence denotes Score agglutination with the following scoring scale:
T354 35041-35071 Sentence denotes 4+ One solid clump of cells 3+
T355 35072-35104 Sentence denotes Several large clumps of cells 2+
T356 35105-35160 Sentence denotes Medium-sized clumps of cells with a clear background 1+
T357 35161-35324 Sentence denotes Hemolysis, no clumping of cells NEG Negative for hemolysis; negative for clumping of red blood cells *Indicates that this must be done for each donor being tested.
T358 35325-35384 Sentence denotes EDTA, Ethylenediaminetetraacetic acid; RBC, red blood cell.
T359 35385-35436 Sentence denotes 1 administered, calculate a volume to be delivered.
T360 35437-35589 Sentence denotes Exercise caution when administering larger volumes to small patients or those with cardiac insufficiency, because volume overload potentially can occur.
T361 35590-35722 Sentence denotes If RBC products are to be administered, at minimum a blood typing procedure should be performed before type-specific blood is given.
T362 35723-35898 Sentence denotes The gold standard is to perform a crossmatch for each unit administered to decrease the risk of a transfusion reaction or sensitization of the patient to foreign RBC antigens.
T363 35899-36081 Sentence denotes In patients with severe hemorrhage when there is not enough time even for performing a blood typing procedure, universal blood (DEA 1.1-, 1.2-, and 1.7-negative) can be administered.
T364 36082-36218 Sentence denotes A common misconception is that administration of whole blood or packed RBCs should occur when patient PCV decreases to a certain number.
T365 36219-36285 Sentence denotes In fact, no absolute "transfusion trigger" number actually exists.
T366 36286-36452 Sentence denotes Administer a transfusion whenever a patient demonstrates clinical signs of anemia, including lethargy, anorexia, weakness, tachycardia, and/or tachypnea (Table 1 -3).
T367 36453-36645 Sentence denotes Indications for fresh whole blood transfusion include disorders of hemostasis and coagulopathies including disseminated intravascular coagulation (DIC), von Willebrand disease, and hemophilia.
T368 36646-36772 Sentence denotes Fresh whole blood and platelet-rich plasma also can be administered in cases of severe thrombocytopenia and thrombocytopathia.
T369 36773-36852 Sentence denotes Stored whole blood and packed RBCs can be administered in patients with anemia.
T370 36853-37005 Sentence denotes If PCV drops to below 10% or if rapid hemorrhage causes the PCV to drop below 20% in the dog or below 12% to 15% in the cat, a transfusion is advocated.
T371 37006-37014 Sentence denotes Consider
T372 37015-37929 Sentence denotes Fresh whole blood Coagulopathy with active hemorrhage (DIC, thrombocytopenia; massive acute hemorrhage; no stored blood available) Stored whole blood Massive acute or ongoing hemorrhage; hypovolemic shock caused by hemorrhage that is unresponsive to conventional crystalloid and colloid fluid therapy; unavailability of equipment required to prepare blood components Packed red blood cells Nonregenerative anemia, immune-mediated hemolytic anemia, correction of anemia before surgery, acute or chronic blood loss Fresh frozen plasma Factor depletion associated with active hemorrhage (congenital-von Willebrand factor, hemophilia A, hemophilia B; acquired-vitamin K antagonist, rodenticide intoxication, DIC); acute or chronic hypoproteinemia (burns, wound exudates, body cavity effusion; hepatic, renal, or gastrointestinal loss); colostrum replacement in neonates Frozen plasma (contains stable clotting factors)
T373 37930-38368 Sentence denotes Acute plasma or protein loss; chronic hypoproteinemia; colostrum replacement in neonates; hemophilia B and selected clotting factor deficiencies Platelet-rich plasma* Thrombocytopenia with active hemorrhage (immunemediated thrombocytopenia, DIC); platelet function abnormality (congenital-thrombasthenia in Bassett Hounds; acquired-NSAIDs, other drugs) Cryoprecipitate (concentration of factor VIII, von Willebrand factor, and fibrinogen)
T374 38369-38809 Sentence denotes Congenital factor deficiencies (routine or before surgery): hemophilia A, hemophilia B, von Willebrand disease, hypofibrinogenemia; acquired factor deficiencies DIC, Disseminated intravascular coagulation; NSAIDS, nonsteroidal antiinflammatory drugs. *Must be purchased because logistically one cannot obtain enough blood simultaneously to provide a significant amount of platelets; platelets infused have a very short (<2 hours) half-life.
T375 38810-39118 Sentence denotes fresh frozen plasma or cryoprecipitate administration in cases of coagulopathy, including von Willebrand disease, rodenticide intoxication with depletion of activated vitamin K-dependent coagulation factors, and hemophilia or in cases of severe hypoproteinemia with albumin concentrations less than 2.0 g/dL.
T376 39119-39264 Sentence denotes Frozen plasma also will suffice in cases of severe hypoproteinemia, warfarin-like compound intoxication, and factor IX deficiency (hemophilia B).
T377 39265-39524 Sentence denotes When considering the type of blood component product required for transfusion, one should answer a number of questions to decrease the risk of a transfusion reaction and to decrease the risk for rejection or destruction of the component that has been infused.
T378 39525-39581 Sentence denotes First, knowledge of a patient's blood type is essential.
T379 39582-39643 Sentence denotes Whenever possible, type-specific RBCs should be administered.
T380 39644-39856 Sentence denotes If an animal has received prior transfusion(s), the risk of a transfusion reaction or rejection is increased because of the development of antibodies directed against glycoprotein moieties on the surface of RBCs.
T381 39857-40039 Sentence denotes If a prior transfusion has taken place, the patient's blood (RBCs and plasma) must be crossmatched with the donor blood (RBCs and plasma) to make sure that no incompatibility exists.
T382 40040-40351 Sentence denotes In dogs, if neither a blood typing nor a crossmatch procedure is available or if the emergent situation requires that a transfusion be administered before blood typing or crossmatch can be performed, blood from a universal donor (e.g., DEA 1.1-, 1.2-, and 1.7-negative) should be administered whenever possible.
T383 40352-40530 Sentence denotes Because there is no universal donor in the cat and because cats possess naturally occurring alloantibodies, all cat blood should be typed and crossmatched before any transfusion.
T384 40531-40598 Sentence denotes Table 1 -4 indicates blood component dose and administration rates.
T385 40599-40691 Sentence denotes Blood products should be warmed slowly to 37° C before they are administered to the patient.
T386 40692-40832 Sentence denotes Blood warmer units are available for use in veterinary medicine to facilitate rapid transfusion without decreasing patient body temperature.
T387 40833-40945 Sentence denotes RBC and plasma products should be administered in a blood administration set containing a 170-μm in-line filter.
T388 40946-41060 Sentence denotes Smaller in-line filters (20 μm) also can be used in cases in which extremely small volumes are to be administered.
T389 41061-41215 Sentence denotes Blood products should be administered over a period of 4 hours, whenever possible, according to guidelines set by the American Association of Blood Banks.
T390 41216-41437 Sentence denotes The volume of blood components required to achieve a specific increment in the patient's PCV depends largely on whether whole blood or packed RBCs are transfused and whether there is ongoing hemorrhage or RBC destruction.
T391 41438-41625 Sentence denotes Because the PCV of packed RBCs is unusually high (80% for Greyhound blood), a smaller total volume than with whole blood is required to achieve a comparable increase in the patient's PCV.
T392 41626-41747 Sentence denotes In general, 10 mL of packed RBCs per kilogram or 20 mL of whole blood per kilogram will raise the recipient's PCV by 10%.
T393 41748-41833 Sentence denotes The "Rule of Ones" states that 1 mL per 1 lb of whole blood will raise the PCV by 1%.
T394 41834-41994 Sentence denotes If the patient's PCV does not raise by the amount anticipated by the foregoing calculation(s), causes of ongoing hemorrhage or destruction should be considered.
T395 41995-42100 Sentence denotes The goal of red blood component therapy is to raise the PCV to 25% to 30% in dogs and 15% to 20% in cats.
T396 42101-42255 Sentence denotes If an animal is hypovolemic and whole blood is administered, the fluid is redistributed into the extravascular compartment within 24 hours of transfusion.
T397 42256-42418 Sentence denotes This will result in a secondary rise in the PCV 24 hours after the transfusion in addition to the initial rise 1 to 2 hours after the RBC transfusion is complete.
T398 42419-42489 Sentence denotes The volume of plasma transfused depends largely on the patient's need.
T399 42490-42597 Sentence denotes In general, plasma transfusion should not exceed 22 mL/kg during a 24-hour period for normovolemic animals.
T400 42598-42718 Sentence denotes Thaw plasma at room temperature, or place it in a Ziploc freezer bag and run 1 under cool (not warm) water until thawed.
T401 42719-42924 Sentence denotes Then administer the plasma through a blood administration set that contains an in-line blood filter or through a standard drip-type administration set with a detachable in-line blood administration filter.
T402 42925-43017 Sentence denotes The average rate of plasma infusion in a normovolemic patient should not exceed 22 mL/kg/hr.
T403 43018-43100 Sentence denotes In acute need situations, plasma can be delivered at rates up to 5 to 6 mL/kg/min.
T404 43101-43223 Sentence denotes For patients with cardiac insufficiency or other circulatory problems, plasma infusion rates should not exceed 5 mL/kg/hr.
T405 43224-43421 Sentence denotes Plasma or other blood products should not be mixed with or used in the same infusion line as calcium-containing fluids, including lactated Ringer's solution, calcium chloride, or calcium gluconate.
T406 43422-43493 Sentence denotes The safest fluid to mix with any blood product is 0.9% sodium chloride.
T407 43494-43666 Sentence denotes Administer fresh frozen plasma, frozen plasma, and cryoprecipitate at a volume of 10 mL/kg until bleeding is controlled or the source of ongoing albumin loss is eliminated.
T408 43667-43812 Sentence denotes The goal of plasma transfusion therapy is to raise the albumin to a minimum of 2.0 g/dL or until bleeding stops as in the case of coagulopathies.
T409 43813-44061 Sentence denotes Monitor the patient to ensure that bleeding has stopped, coagulation profiles (ACT, APTT, and PT) have normalized, hypovolemia has stabilized, and/or total protein is normalizing, which are indications for discontinuing ongoing transfusion therapy.
T410 44062-44127 Sentence denotes Critically ill patients (e.g., cardiac failure or renal failure):
T411 44128-44367 Sentence denotes 3-4 mL/kg/hr Fresh frozen plasma 10 mL/kg body mass (repeat in 2-3 days or in 3-5 days or until bleeding stops); monitor ACT, APTT, and PT before and 1 hr after transfusion 4-10 mL/min or use rates for whole blood (infuse within 4-6 hours)
T412 44368-44392 Sentence denotes Cryoprecipitate General:
T413 44393-44449 Sentence denotes 1 unit/10 kg/12 hr or until bleeding stops Hemophilia A:
T414 44450-44618 Sentence denotes 12-20 units factor VIII/kg; 1 unit of cryoprecipitate contains approximately 125 units of factor VIII 4-10 mL/min or use rates for whole blood (infuse within 4-6 hours)
T415 44619-44932 Sentence denotes Platelet-rich plasma 1 unit/10 kg (1 unit of platelet-rich plasma will increase platelet count 1 hour after transfusion by 10,000/µL) 2 mL of plasma per minute Check platelet count before and 1 hour after transfusion ACT, Activated clotting time; APTT, activated partial thromboplastin time; PT, prothrombin time.
T416 44933-45087 Sentence denotes Use of Cryoprecipitate Plasma cryoprecipitate can be purchased or manufactured through the partial thawing and then centrifugation of fresh frozen plasma.
T417 45088-45274 Sentence denotes Cryoprecipitate contains concentrated quantities of vWF, factor VIII, and fibrinogen and is indicated in severe forms of von Willebrand disease and hemophilia A (factor VIII deficiency).
T418 45275-45339 Sentence denotes Platelet-rich plasma must be purchased from a commercial source.
T419 45340-45402 Sentence denotes One unit of fresh whole blood contains 2000 to 5000 platelets.
T420 45403-45540 Sentence denotes The viability of the platelets contained in the fresh whole blood is short-lived, just 1 to 2 hours after transfusion into the recipient.
T421 45541-45748 Sentence denotes Because platelet-rich plasma is difficult to obtain, animals with severe thrombocytopenia or thrombocytopathia should be treated with immunomodulating therapies and the administration of fresh frozen plasma.
T422 45749-45845 Sentence denotes In dogs, blood and plasma transfusions can be administered intravenously (IV) or intraosseously.
T423 45846-45938 Sentence denotes The cephalic, lateral saphenous, medial saphenous, and jugular veins are used most commonly.
T424 45939-46041 Sentence denotes Fill the recipient set so that the blood in the drip chamber covers the filter (normal 170-μm filter).
T425 46042-46125 Sentence denotes With small amounts of blood (50 mL) or critically ill patients, use a 40-μm filter.
T426 46126-46192 Sentence denotes Avoid latex filters for plasma and cryoprecipitate administration.
T427 46193-46292 Sentence denotes Blood can be administered at variable rates, but the routine figure of 4 to 5 mL/min often is used.
T428 46293-46348 Sentence denotes Normovolemic animals can receive blood at 22 mL/kg/day.
T429 46349-46423 Sentence denotes Dogs in heart failure should receive infusions at no more than 4 mL/kg/hr.
T430 46424-46450 Sentence denotes Volume is given as needed.
T431 46451-46569 Sentence denotes To calculate the approximate volume of blood needed to raise hematocrit levels, use the following formula for the dog:
T432 46570-46661 Sentence denotes Surgical emergencies and shock may require several times this volume within a short period.
T433 46662-46817 Sentence denotes If more than 25% of the patient's blood volume is lost, supplementation with colloids, crystalloids, and blood products is indicated for fluid replacement.
T434 46818-46915 Sentence denotes One volume of whole blood achieves the same increase in plasma as two to three volumes of plasma.
T435 46916-47109 Sentence denotes If the patient's blood type is unknown and DEA 1.1-negative whole blood is not available, any dog blood can be administered to a dog in acute need if the dog has never had a transfusion before.
T436 47110-47235 Sentence denotes If mismatched blood is given, the patient will become sensitized, and after 5 days, destruction of the donor RBCs will begin.
T437 47236-47380 Sentence denotes In addition, any subsequent mismatched transfusions may cause an immediate reaction (usually mild) and rapid destruction of the transfused RBCs.
T438 47381-47548 Sentence denotes The clinical signs of a transfusion reaction typically are seen only when DEA 1.1 blood is administered to a DEA 1.1-negative recipient that was sensitized previously.
T439 47549-47671 Sentence denotes Incompatible blood transfusions to breeding females can result in isoimmunization and in hemolytic disease in the puppies.
T440 47672-47870 Sentence denotes The DEA 1.1-negative bitch that receives a transfusion with DEA 1.1-positive blood and that produces a litter from a DEA 1.1-positive stud can potentially have puppies with neonatal isoerythrolysis.
T441 47871-47991 Sentence denotes Cats with severe acute anemia in need of a blood transfusion are typically extremely depressed, lethargic, and anorexic.
T442 47992-48104 Sentence denotes The stress of restraint and handling can push these critically ill patients over the edge and cause them to die.
T443 48105-48175 Sentence denotes Extreme gentleness and care are mandatory in restraint 1 and handling.
T444 48176-48239 Sentence denotes The critically ill cat should be cradled in a towel or blanket.
T445 48240-48428 Sentence denotes Supplemental flowby or mask oxygen should be administered, whenever possible, although it may not be clinically helpful until oxygen-carrying capacity is replenished with infusion of RBCs.
T446 48429-48513 Sentence denotes Blood can be administered by way of the cephalic, medial saphenous, or jugular vein.
T447 48514-48598 Sentence denotes Intramedullary infusion is also possible, if vascular access cannot be accomplished.
T448 48599-48709 Sentence denotes The average 2-to 4-kg cat can accept 40 to 60 mL of whole blood injected IV over a period of 30 to 60 minutes.
T449 48710-48766 Sentence denotes Administer filtered blood at a rate of 5 to 10 mL/kg/hr.
T450 48767-48867 Sentence denotes The following formula can be used to estimate the volume of blood required for transfusion in a cat:
T451 48868-48985 Sentence denotes Anticoagulated blood volume (mL) PCV desired PCV of recipient Body mass (kg) 70 PCV of donor in anticoagulant − = × ×
T1 48986-49100 Sentence denotes The exact overall incidence and clinical significance of transfusion reactions in veterinary medicine are unknown.
T2 49101-49207 Sentence denotes Several studies have been performed that document the incidence of transfusion reactions in dogs and cats.
T3 49208-49302 Sentence denotes Overall, the incidence of transfusion reactions in dogs and cats is 2.5% and 2%, respectively.
T4 49303-49443 Sentence denotes Transfusion reactions can be immune-mediated and non-immune-mediated and can happen immediately or can be delayed until after a transfusion.
T5 49444-49598 Sentence denotes Acute reactions usually occur within minutes to hours of the onset of the transfusion but may occur up to 48 hours after the transfusion has been stopped.
T6 49599-49714 Sentence denotes Acute immunologic reactions include hemolysis and acute hypersensitivity including RBCs, platelets, and leukocytes.
T7 49715-49831 Sentence denotes Signs of a delayed immunologic reaction include hemolysis, purpura, immunosuppression, and neonatal isoerythrolysis.
T8 49832-50126 Sentence denotes Acute nonimmunologic reactions include donor cell hemolysis before onset of transfusion, circulatory volume overload, bacterial contamination, citrate toxicity with clinical signs of hypocalcemia, coagulopathies, hyperammonemia, hypothermia, air embolism, acidosis, and pulmonary microembolism.
T9 50127-50242 Sentence denotes Delayed nonimmunologic reactions include the transmission and development of infectious diseases and hemosiderosis.
T10 50243-50451 Sentence denotes Clinical signs of a transfusion reaction typically depend on the amount of blood transfused, the type and amount of antibody involved in the reaction, and whether the recipient has had previous sensitization.
T11 50452-50632 Sentence denotes Monitoring the patient carefully during the transfusion period is essential for recognizing early signs of a transfusion reaction, including those that may become life-threatening.
T12 50633-50745 Sentence denotes A general guideline for patient monitoring is first to start the transfusion slowly during the first 15 minutes.
T13 50746-50908 Sentence denotes Monitor temperature, pulse, and respiration every 15 minutes for the first hour, 1 hour after the end of the transfusion, and every 12 hours minimally thereafter.
T14 50909-51040 Sentence denotes Also obtain a PCV immediately before the transfusion, 1 hour after the transfusion has been stopped, and every 12 hours thereafter.
T15 51041-51160 Sentence denotes Monitor coagulation parameters such as ACT and platelet count at least daily in patients requiring transfusion therapy.
T16 51161-51310 Sentence denotes The most common documented clinical signs of a transfusion reaction include pyrexia, urticaria, salivation or ptyalism, nausea, chills, and vomiting.
T17 51311-51457 Sentence denotes Other clinical signs of a transfusion reaction may include tachycardia, tremors, collapse, dyspnea, weakness, hypotension, collapse, and seizures.
T18 51458-51630 Sentence denotes Severe intravascular hemolytic reactions may occur within minutes of the start of the transfusion, causing hemoglobinemia, hemoglobinuria, DIC, and clinical signs of shock.
T19 51631-51743 Sentence denotes Extravascular hemolytic reactions typically occur later and will result in hyperbilirubinemia and bilirubinuria.
T20 51744-51988 Sentence denotes Pretreatment of patients to help decrease the risk of a transfusion reaction remains controversial, and in most cases pretreatment with glucocorticoids and antihistamines is ineffective at preventing intravascular hemolysis and other reactions.
T21 51989-52191 Sentence denotes The most important component of preventing a transfusion reaction is to screen each recipient carefully and process the donor component therapy carefully before the administration of any blood products.
T22 52192-52252 Sentence denotes Treatment of a transfusion reaction depends on its severity.
T23 52253-52340 Sentence denotes In all cases, stop the transfusion immediately when clinical signs of a reaction occur.
T24 52341-52470 Sentence denotes In most cases discontinuation of the transfusion and administration of drugs to stop the hypersensitivity reaction will be suffi-
T25 52471-52723 Sentence denotes Central venous pressure refers to the hydrostatic pressure in the anterior vena cava and is influenced by vascular fluid volume, vascular tone, function of the right side of the heart, and changes in intrathoracic pressure during the respiratory cycle.
T26 52724-52907 Sentence denotes The CVP is not a true measure of blood volume but is used to gauge fluid therapy as a method of determining how effectively the heart can pump the fluid that is being delivered to it.
T27 52908-53012 Sentence denotes Thus the CVP reflects the interaction of the vascular fluid volume, vascular tone, and cardiac function.
T28 53013-53217 Sentence denotes Measure CVP in any patient with acute circulatory failure, large-volume fluid diuresis (e.g., because of a toxin or oliguric or anuric renal failure), fluid in-and-out monitoring, and cardiac dysfunction.
T29 53218-53376 Sentence denotes The placement of central venous catheters and thus CVP measurements is contraindicated in patients with known coagulopathies including hypercoagulable states.
T30 53377-53470 Sentence denotes To perform CVP monitoring, place a central venous catheter in the right or left jugular vein.
T31 53471-53608 Sentence denotes In cats and small dogs, however, a long catheter placed in the lateral or medial saphenous vein can be used for trends in CVP monitoring.
T32 53609-53786 Sentence denotes First, assemble the equipment necessary for jugular catheter (see Vascular Access Techniques for how to place a jugular or saphenous long catheter) and CVP monitoring (Box 1-7).
T33 53787-53983 Sentence denotes After placing the jugular catheter, take a lateral thoracic radiograph to ensure that the tip of the catheter sits just outside the right atrium for proper CVP measurements (see Figure 1 -13 on p.
T34 53984-53988 Sentence denotes 57).
T35 53989-54057 Sentence denotes To establish an intravenous catheter for CVP, follow this procedure:
T36 54058-54060 Sentence denotes 1.
T37 54061-54251 Sentence denotes Assemble the CVP setup such that the male end of a length of sterile intravenous catheter extension tubing is inserted into the T port of the jugular or medial or lateral saphenous catheter.
T38 54252-54381 Sentence denotes Make sure to flush the length of tubing with sterile saline before connecting it to the patient to avoid iatrogenic air embolism.
T39 54382-54386 Sentence denotes 1 2.
T40 54387-54481 Sentence denotes Next, insert the male end of a three-way stopcock into the female end of the extension tubing.
T41 54482-54484 Sentence denotes 3.
T42 54485-54706 Sentence denotes Attach a 20-mL syringe filled with heparinized sterile 0.9% saline to one of the female ports of the three-way stopcock and either a manometer or a second length of intravenous extension tubing attached to a metric ruler.
T43 54707-54709 Sentence denotes 4.
T44 54710-54759 Sentence denotes Lay the patient in lateral or sternal recumbency.
T45 54760-54762 Sentence denotes 5.
T46 54763-54833 Sentence denotes Turn the stopcock OFF to the manometer or ruler and ON to the patient.
T47 54834-54921 Sentence denotes Infuse a small amount of heparinized saline through the catheter to flush the catheter.
T48 54922-54924 Sentence denotes 6.
T49 54925-54992 Sentence denotes Next, turn the stopcock OFF to the patient and ON to the manometer.
T50 54993-55091 Sentence denotes Gently flush the manometer or length of extension tubing with heparinized saline from the syringe.
T51 55092-55228 Sentence denotes Use care not to agitate the fluid and create air bubbles within the line or manometer, which will artifactually change the CVP measured.
T52 55229-55231 Sentence denotes 7.
T53 55232-55435 Sentence denotes Next, lower the 0 cm point on the manometer or ruler to the level of the patient's manubrium (if the patient is in lateral recumbency) or the point of the elbow (if the patient is in sternal recumbency).
T54 55436-55438 Sentence denotes 8.
T55 55439-55559 Sentence denotes Turn the stopcock OFF to the syringe, and allow the fluid column to equilibrate with the patient's intravascular volume.
T56 55560-55734 Sentence denotes Once the fluid column stops falling and the level rises and falls with the patient's heartbeat, measure the number adjacent to the bottom of the meniscus of the fluid column.
T57 55735-55793 Sentence denotes This is the CVP in centimeters of water (see Figure 1 -4).
T58 55794-55796 Sentence denotes 9.
T59 55797-55964 Sentence denotes Repeat the measurement several times with the patient in the same position to make sure that none of the values has been increased or decreased artifactually in error.
T60 55965-56072 Sentence denotes Alternately, attach the central catheter to a pressure transducer and perform electronic monitoring of CVP.
T61 56073-56115 Sentence denotes There is no absolute value for normal CVP.
T62 56116-56176 Sentence denotes The normal CVP for small animal patients is 0 to 5 cm H 2 O.
T63 56177-56258 Sentence denotes Values less than 0 cm H 2 O are associated with absolute or relative hypovolemia.
T64 56259-56395 Sentence denotes Values of 5 to 10 cm H 2 O represent borderline hypervolemia, and values greater than 10 cm H 2 O suggest intravascular volume overload.
T65 56396-56521 Sentence denotes Values greater than 15 cm H 2 O may be correlated with congestive heart failure (CHF) and the development of pulmonary edema.
T66 56522-56612 Sentence denotes In individual patients, the trend in change in CVP is more important than absolute values.
T67 56613-56801 Sentence denotes As a rule of thumb, when using CVP measurements to gauge fluid therapy and avoid vascular and pulmonary overload, the CVP should not increase by more than 5 cm H 2 O in any 24-hour period.
T68 56802-56927 Sentence denotes If an abrupt increase in CVP is found, repeat the measurement to make sure that the elevated value was not obtained in error.
T69 56928-57055 Sentence denotes If the value truly has increased dramatically, temporarily discontinue fluid therapy and consider administration of a diuretic.
T70 57057-57208 Sentence denotes • Two lengths of intravenous extension tubing • Three-way stopcock • Heparinized 0.9% saline solution • 20-mL syringe • Manometer or ruler (centimeter)
T71 57209-57360 Sentence denotes The diagnosis of intracellular fluid deficit is difficult and is based more on the presence of hypernatremia or hyperosmolality than on clinical signs.
T72 57361-57517 Sentence denotes An intracellular fluid deficit is expected when free water loss from insensible losses and vomiting, diarrhea, or urine is not matched by free water intake.
T73 57518-57778 Sentence denotes Consideration of the location of the patient's fluid deficit, the degree and type of acid-base and electrolyte disorders, and the presence of any ongoing fluid losses should dictate and help guide each patient's individualized fluid therapy plan ( Table 1-5) .
T74 57779-57831 Sentence denotes Normal pH in dogs and cats ranges from 7.30 to 7.45.
T75 57832-58079 Sentence denotes The three major mechanisms that maintain blood pH within a normal physiologic range include buffering systems, respiratory mechanisms that alter carbon dioxide, and renal (metabolic) mechanisms that retain or excrete hydrogen and bicarbonate ions.
T76 58080-58253 Sentence denotes The metabolic contribution to acid-base balance can be estimated by measuring total carbon dioxide and pH or by calculating the bicarbonate or base deficit or excess values.
T77 58254-58366 Sentence denotes Hydrogen and bicarbonate ions have an important influence on normal structure and function of cellular proteins.
T78 58367-58498 Sentence denotes Treat acidemia if the bicarbonate is less than 12 mEq/L, if the pH is less than 7.2, or if the base deficit is less than −10 mEq/L.
T79 58499-58605 Sentence denotes Normal bicarbonate concentration is 18 to 26 mEq/L in dogs and 17 to 23 mEq/L in cats (Boxes 1-8 and 1-9).
T80 58606-58717 Sentence denotes The respiratory system further contributes to acid-base status by changes in the elimination of carbon dioxide.
T81 58718-58794 Sentence denotes Hyperventilation decreases the blood Pco 2 and causes respiratory alkalosis.
T82 58795-58869 Sentence denotes Hypoventilation increases the blood Pco 2 and causes respiratory acidosis.
T83 58870-58945 Sentence denotes Depending on the altitude, the Pco 2 in dogs can range from 32 to 44 mm Hg.
T84 58946-58990 Sentence denotes In cats, the normal value is 28 to 32 mm Hg.
T85 58991-59065 Sentence denotes Venous Pco 2 values are 33 to 50 mm Hg in dogs and 33 to 45 mm Hg in cats.
T86 59066-59154 Sentence denotes Use a systematic approach whenever attempting to interpret a patient's acid-base status.
T87 59155-59262 Sentence denotes Ideally, obtain an arterial blood sample so that you can monitor the patient's oxygenation and ventilation.
T88 59263-59331 Sentence denotes Once an arterial blood sample has been obtained, follow these steps:
T89 59332-59334 Sentence denotes 1.
T90 59335-59437 Sentence denotes Determine whether the blood sample is arterial or venous by looking at the oxygen saturation (Sao 2 ).
T91 59438-59575 Sentence denotes The Sao 2 should be greater than 90% if the sample is truly arterial, although it can be as low as 80% if a patient has severe hypoxemia.
T92 59576-59578 Sentence denotes 2.
T93 59579-59605 Sentence denotes Consider the patient's pH.
T94 59606-59684 Sentence denotes If the pH is outside of the normal range, an acid-base disturbance is present.
T95 59685-59774 Sentence denotes If the pH is within the normal range, an acid-base disturbance may or may not be present.
T96 59775-59817 Sentence denotes If the pH is low, the patient is acidotic.
T97 59818-59862 Sentence denotes If the pH is high, the patient is alkalotic.
T98 59863-60299 Sentence denotes History of vomiting and diarrhea, no visible clinical signs of deficit 4% Dry mucous membranes, mild skin tenting 5% Increased skin tenting, dry mucous membranes, mild tachycardia, normal pulse* 7% Increased skin tenting, dry mucous membranes, tachycardia, weak pulse pressure 10% Increased skin tenting, dry corneas, dry mucous membranes, elevated or decreased heart rate, poor pulse quality, altered level of consciousness* 12% *Note:
T99 60300-60526 Sentence denotes These measures are largely subjective because patients with severe weight loss and loss of subcutaneous fat and very young and very old animals may have increased skin tenting or sunken eyes even in the absence of dehydration.
T100 60527-60529 Sentence denotes 3.
T101 60530-60571 Sentence denotes Next, look at the base excess or deficit.
T102 60572-60652 Sentence denotes If the base excess is increased, the patient has higher than normal bicarbonate.
T103 60653-60786 Sentence denotes If there is a base deficit, the patient may have a low bicarbonate or increase in unmeasured anions (e.g., lactic acid or ketoacids).
T104 60787-60789 Sentence denotes 4.
T105 60790-60820 Sentence denotes Next, look at the bicarbonate.
T106 60821-60909 Sentence denotes If the pH is low and the bicarbonate level is low, the patient has a metabolic acidosis.
T107 60910-61005 Sentence denotes If the pH is high and the bicarbonate level is elevated, the patient has a metabolic alkalosis.
T108 61006-61067 Sentence denotes Vomiting of stomach contents Diuretic therapy Posthypercapnia
T109 61068-61723 Sentence denotes Oral administration of sodium bicarbonate or other organic anions (e.g., lactate, citrate, gluconate, and acetate) Oral administration of cation exchange resin with nonabsorbable alkali (e.g., phosphorus binder) *Patients with diabetic ketoacidosis may have some component of hyperchloremic metabolic acidosis along with increased anion gap acidosis. † The metabolic acidosis early in renal failure may be hyperchloremic and later may convert to typical increased anion gap acidosis. ‡ Patients with hypoadrenocorticism typically have hypochloremia because of impaired water excretion, absence of aldosterone, impaired renal function, and lactic acidosis.
T110 61724-61778 Sentence denotes These factors prevent manifestation of hyperchloremia.
T111 61779-61979 Sentence denotes Ethylene glycol intoxication Salicylate intoxication Other rare intoxications (e.g., paraldehyde or methanol) Diabetic ketoacidosis* Uremic acidosis † Lactic acidosis normAl Anion gAP (hyPerChloremiC)
T112 61980-62290 Sentence denotes Carbonic anhydrase inhibitors (e.g., aceta zolamide) Ammonium chloride Cationic amino acids (e.g., lysine, arginine, and histidine) Posthypocapnic metabolic acidosis Dilutional acidosis (e.g., rapid administration of 0.9% saline) Hypoadrenocorticism ‡ Box 1-9 differential diagnoses for metaBolic acidosis 1 5.
T113 62291-62317 Sentence denotes Next, look at the Paco 2 .
T114 62318-62410 Sentence denotes If the patient's pH is low and the Paco 2 is elevated, the patient has respiratory acidosis.
T115 62411-62500 Sentence denotes If the patient's pH is high and the Paco 2 is low, the patient has respiratory alkalosis.
T116 62501-62503 Sentence denotes 6.
T117 62504-62584 Sentence denotes Finally, if you are interested in the patient's oxygenation, look at the Pao 2 .
T118 62585-62623 Sentence denotes Normal Pao 2 is greater than 80 mm Hg.
T119 62624-62626 Sentence denotes 7.
T120 62627-62769 Sentence denotes Next, you must determine whether the disorders present are primary disorders or an expected compensation for disorders in the opposing system.
T121 62770-62901 Sentence denotes For example, is the patient retaining bicarbonate (metabolic alkalosis) because of carbon dioxide retention (respiratory acidosis)?
T122 62902-63002 Sentence denotes Use the chart in Table 1 -6 to evaluate whether the appropriate degree of compensation is occurring.
T123 63003-63100 Sentence denotes If the adaptive response falls within the expected range, a simple acid-base disorder is present.
T124 63101-63196 Sentence denotes If the response falls outside the expected range, a mixed acid-base disorder is likely present.
T125 63197-63199 Sentence denotes 8.
T126 63200-63337 Sentence denotes Finally, you must determine whether the patient's acid-base disturbance is compatible with the history and physical examination findings.
T127 63338-63519 Sentence denotes If the acid-base disturbance does not fit with the patient's history and physical examination abnormalities, question the results of the blood gas analyses and possibly repeat them.
T128 63520-63622 Sentence denotes The most desirable method of assessing the acid-base status of an animal is with a blood gas analyzer.
T129 63623-63726 Sentence denotes Arterial samples are preferred over venous samples, with heparin used as an anticoagulant (Table 1-7) .
T130 63727-64289 Sentence denotes Metabolic acidosis ↓ − 3 HCO 0.7 mm Hg decrement in Pco 2 for each 1 mEq/L decrement in Metabolic alkalosis ↑ − 3 HCO 0.7 mm Hg increment in Pco 2 for each 1 mEq/L increment in Acute respiratory acidosis ↑ Pco 2 1.5 mEq/L increment in for each 10 mm Hg increment in Pco 2 Chronic respiratory acidosis ↑ Pco 2 3.5 mEq/L increment in for each 10 mm Hg increment in Pco 2 Acute respiratory alkalosis ↓ Pco 2 2.5 mEq/L decrement in for each 10 mm Hg decrement in Pco 2 Chronic respiratory alkalosis ↓ Pco 2 5.5 mEq/L decrement in for each 10 mm Hg decrement in Pco 2
T131 64291-64371 Sentence denotes Potassium Potassium primarily is located in the intracellular fluid compartment.
T132 64372-64541 Sentence denotes Serum potassium is regulated by the actions of the sodium-potassium-adenosine triphosphatase pump on cellular membranes, including those of the renal tubular epithelium.
T133 64542-64757 Sentence denotes Inorganic metabolic acidosis artifactually can raise serum potassium levels because of redistribution of extracellular potassium in exchange for intracellular hydrogen ion movement in an attempt to correct serum pH.
T134 64758-64906 Sentence denotes Potassium is one of the major players in the maintenance of resting membrane potentials of excitable tissue, including neurons and cardiac myocytes.
T135 64907-64974 Sentence denotes Changes in serum potassium can affect cardiac conduction adversely.
T136 64975-65119 Sentence denotes Hyperkalemia lowers the resting membrane potential and makes cardiac cells, particularly those of the atria, more susceptible to depolarization.
T137 65120-65296 Sentence denotes Characteristic signs of severe hyperkalemia that can be observed on an ECG rhythm strip include an absence of P waves, widened QRS complexes, and tall tented or spiked T waves.
T138 65297-65425 Sentence denotes Further increases in serum potassium can be associated with bradycardia, ventricular fibrillation, and cardiac asystole (death).
T139 65426-65814 Sentence denotes Treatment of hyperkalemia consists of administration of insulin (0.25 to 0.5 units/kg, intravenous regular insulin) and dextrose (1 g dextrose per unit of insulin administered, followed by 2.5% dextrose IV via constant rate infusion (CRI) to prevent hypoglycemia), calcium (2 to 10 mL of 10% calcium gluconate administered IV slowly to effect), or sodium bicarbonate (1 mEq/kg IV slowly).
T140 65815-65982 Sentence denotes Insulin plus dextrose and bicarbonate therapy help drive the potassium intracellularly, whereas calcium antagonizes the effect of hyperkalemia on the myocardial cells.
T141 65983-66185 Sentence denotes All of the treatments work within minutes, although the effects are relatively short-lived (20 minutes to 1 hour) unless the cause of the hyperkalemia is identified and treated appropriately (Box 1-10).
T142 66186-66318 Sentence denotes Dilution of serum potassium also results from restoring intravascular fluid volume and correcting metabolic acidosis, in most cases.
T143 66319-66423 Sentence denotes Treatment with a fluid that does not contain potassium (preferably 0.9% sodium chloride) is recommended.
T144 66424-66518 Sentence denotes Hypokalemia elevates the resting membrane potential and results in cellular hyperpolarization.
T145 66519-66662 Sentence denotes Hypokalemia may be associated with ventricular dysrhythmias, but the ECG changes are not as characteristic as those observed with hyperkalemia.
T146 66663-66845 Sentence denotes Causes of hypokalemia include renal losses, anorexia, gastrointestinal loss (vomiting, diarrhea), intravenous fluid diuresis, loop diuretics, and postobstructive diuresis (Box 1-11).
T147 66846-67025 Sentence denotes If the serum potassium concentration is known, potassium supplementation in the form of potassium chloride or potassium phosphate can be added to the patient's intravenous fluids.
T148 67026-67103 Sentence denotes Correct serum potassium levels less than 3.0 mEq/L or greater than 6.0 mEq/L.
T149 67104-67165 Sentence denotes Potassium rates should not exceed 0.5 mEq/kg/hr (Table 1-8) .
T150 67166-67288 Sentence denotes Metabolic acidosis from bicarbonate depletion often corrects itself with volume restoration in most small animal patients.
T151 67289-67394 Sentence denotes Patients with moderate to severe metabolic acidosis may benefit from bicarbonate supplementation therapy.
T152 67395-67554 Sentence denotes The metabolic contribution to acid-base balance is identified by measuring the total carbon dioxide concentration or calculating the bicarbonate concentration.
T153 67555-67863 Sentence denotes If these measurements are not available, the degree of expected metabolic acidosis can be estimated subjectively by the severity of underlying disease that often contributes to metabolic acidosis: hypovolemic or traumatic shock, septic shock, diabetic ketoacidosis (DKA), or oliguric or anuric renal failure.
T154 67864-68005 Sentence denotes If the metabolic acidosis is estimated to be mild, moderate, or severe, add sodium bicarbonate at 1, 3, and 5 mEq/kg body mass, respectively.
T155 68006-68096 Sentence denotes Bicarbonate concentration also can be artifactually decreased in patients with severe DKA.
T156 68097-68286 Sentence denotes Patients with DKA may not require bicarbonate administration once volume replacement has been accomplished and perfusion has been restored, and the ketoacids are metabolized to bicarbonate.
T157 68287-68421 Sentence denotes If the bicarbonate measurement of base deficit is known, the following formula can be used as a gauge for bicarbonate supplementation:
T158 68422-68635 Sentence denotes Base deficit 0.3 Body mass (kg) mEq Bicarbonate to administer × = = 1 Osmolality Osmolality is measured by freezing point depression or a vapor pressure osmometer, or it may be calculated by the following formula:
T159 68636-68682 Sentence denotes mOsm / kg 2[(Na ) (K )] BUN / 2.8 Glucose / 18
T160 68683-68805 Sentence denotes where sodium and potassium are measured in milliequivalents, and BUN and glucose are measured in milligrams per deciliter.
T161 68806-68907 Sentence denotes Osmolalities less than 260 mOsm/kg or greater than 360 mOsm/kg are serious enough to warrant therapy.
T162 68908-68992 Sentence denotes The difference between the measured Box 1-10 differential diagnoses for hyPerkalemia
T163 68993-69166 Sentence denotes Unlikely to cause hyperkalemia in presence of normal renal function unless iatrogenic (e.g., continuous infusion of potassium-containing fluids at an excessively rapid rate)
T164 69167-69686 Sentence denotes Acute mineral acidosis (e.g., hydrochloric acid or ammonium chloride) Insulin deficiency (e.g., diabetic ketoacidosis) Acute tumor lysis syndrome Reperfusion of extremities after aortic thromboembolism in cats with cardiomyopathy Hyperkalemic periodic paralysis (one case report in a pit bull) Mild hyperkalemia after exercise in dogs with induced hypothyroidism Infusion of lysine or arginine in total parenteral nutrition solutions drugs Nonspecific β-blockers (e.g., propranolol)* Cardiac glycosides (e.g., digoxin)*
T165 69687-70366 Sentence denotes Urethral obstruction Ruptured bladder Anuric or oliguric renal failure Hypoadrenocorticism Selected gastrointestinal disease (e.g., trichuriasis, salmonellosis, or perforated duodenal ulcer) Late pregnancy in Greyhound dogs (mechanism unknown, but affected dogs had gastrointestinal fluid loss) Chylothorax with repeated pleural fluid drainage Hyporeninemic hypoaldosteronism † drugs Angiotensin-converting enzyme inhibitors (e.g., enalapril)* Angiotensin receptor blockers (e.g., losartan)* Cyclosporine and tacrolimus* Potassium-sparing diuretics (e.g., spironolactone, amiloride, and triamterene)* Nonsteroidal antiinflammatory drugs* Heparin* Trimethoprim* From DiBartola SP:
T166 70367-70692 Sentence denotes Fluid, electrolyte, and acid-base disorders in small animal practice, St Louis, 2005, Elsevier. *Likely to cause hyperkalemia only in conjunction with other contributing factors (e.g., other drugs, decreased renal function, or concurrent administration of potassium supplements). † Not well documented in veterinary medicine.
T167 70693-70785 Sentence denotes 1 osmolality and the calculated osmolality (the osmolal gap) should be less than 10 mOsm/kg.
T168 70786-70912 Sentence denotes If the osmolal gap is greater than 20 mOsm/kg, consider the presence of unmeasured anions such as ethylene glycol metabolites.
T169 70913-71075 Sentence denotes The volume of extracellular fluid is determined by the total body sodium content, whereas the osmolality and sodium concentration are determined by water balance.
T170 71076-71260 Sentence denotes Serum sodium concentration is an indication of the amount of sodium relative to water in the extracellular fluid and provides no direct information about the total body sodium content.
T171 71261-71394 Sentence denotes Patients with hyponatremia or hypernatremia may have decreased, normal, or increased total body sodium content (Boxes 1-12 and 1-13).
T172 71395-71557 Sentence denotes An increased serum sodium concentration implies hyperosmolality, whereas a decrease in serum sodium concentration usually, but not always, implies hypoosmolality.
T173 71558-71775 Sentence denotes The severity of clinical signs of hypernatremia and hyponatremia is related primarily to the rapidity of the onset of the change rather than to the magnitude of the associated plasma hyperosmolality or hypoosmolality.
T174 71776-71968 Sentence denotes Clinical signs of neurologic disturbances include disorientation, ataxia, and seizures, and coma may occur at serum sodium concentrations less than 120 mEq/L or greater than 170 mEq/L in dogs.
T175 71969-72362 Sentence denotes Therapy for hypernatremia or hyponatremia with fluid containing low or higher concentrations of sodium should proceed with caution, because rapid changes (decreases or increases) in serum sodium and osmolality can cause rapid changes in the intracellular and extracellular fluid flux, leading to intracellular dehydration or edema, even though the serum sodium has not been returned to normal.
T176 72363-72473 Sentence denotes A rule of thumb is to not raise or lower the serum sodium by more than 15 mEq/L during any one 24-hour period.
T177 72474-72562 Sentence denotes Restoration of the serum sodium concentration over a period of 48 to 72 hours is better.
T178 72563-72664 Sentence denotes In almost all circumstances, an animal will correct its sodium balance with simple fluid restoration.
T179 72665-72812 Sentence denotes If severe hypernatremia exists that suggests a free water deficit, however, the free water deficit should be calculated from the following formula:
T180 72813-72977 Sentence denotes Hypernatremia can be corrected slowly with 0.45% sodium chloride plus 2.5% dextrose, 5% dextrose in water, or lactated Ringer's solution (sodium content 130 mEq/L).
T181 72978-73035 Sentence denotes Correct hyponatremia initially with 0.9% sodium chloride.
T182 73036-73097 Sentence denotes Sodium is balanced predominantly by chloride and bicarbonate.
T183 73098-73190 Sentence denotes The difference between these concentrations, Na + − (Cl − + ) has been called the anion gap.
T184 73191-73230 Sentence denotes The normal anion gap is 12 to 25 mEq/L.
T185 73231-73419 Sentence denotes When the anion gap exceeds 25, consider the possibility of an accumulation of unmeasured anions (e.g., lactate, ketoacids, phosphate, sulfate, ethylene glycol metabolites, and salicylate).
T186 73420-73535 Sentence denotes Abnormalities in the anion gap may be helpful in determining the cause of metabolic acidosis (Boxes 1-14 and 1-15).
T187 73536-73662 Sentence denotes The colloid oncotic pressure of blood is associated primarily with large-molecular-weight colloidal substances in circulation.
T188 73663-73811 Sentence denotes The major player in maintaining intravascular and interstitial oncotic pressure, the water-retaining property of each fluid compartment, is albumin.
T189 73812-73887 Sentence denotes Albumin contributes roughly 80% to the colloidal oncotic pressure of blood.
T190 73888-73953 Sentence denotes The majority of albumin is located within the interstitial space.
T191 73954-74134 Sentence denotes Hypoalbuminemia can result from increased loss in the form of protein-losing enteropathy or nephropathy and wound exudates, or it may result from lack of hepatic albumin synthesis.
T192 74135-74204 Sentence denotes Serum albumin pools are in a constant flux with interstitial albumin.
T193 74205-74392 Sentence denotes Once interstitial albumin pools become depleted from replenishing serum albumin, serum albumin levels can continue to decrease, which can lead to a decrease in colloidal oncotic pressure.
T194 74393-74559 Sentence denotes Serum albumin less than 2.0 g/dL has been associated with inadequate intravascular fluid retention and the development of peripheral edema and third spacing of fluid.
T195 74560-74677 Sentence denotes Oncotic pressure can be restored with the use of artificial or synthetic colloids or natural colloids (see Colloids).
T196 74678-74892 Sentence denotes Maintenance fluid requirements have been extrapolated from the formulas used to calculate a patient's daily metabolic energy requirements because it takes 1 mL of water to metabolize 1 Kcal of energy (Table 1 -9) .
T197 74893-74993 Sentence denotes The patient's daily metabolic water (fluid) requirements can be calculated by the following formula:
T198 74994-75112 Sentence denotes Administration of an isotonic crystalloid fluid for maintenance requirements often can produce iatrogenic hypokalemia.
T199 75113-75281 Sentence denotes In most cases, supplemental potassium must be added to prevent hypokalemia resulting from inappetence, kaliuresis, and supplementation with isotonic crystalloid fluids.
T200 75282-75411 Sentence denotes The most reliable method for determining the degree of fluid deficit is by weighing the animal and calculating acute weight loss.
T201 75412-75574 Sentence denotes Acute weight loss in a patient with volume loss in the form of vomiting, feces, wound exudates, and urine is a result of fluid loss and not loss of muscle or fat.
T202 75575-75674 Sentence denotes Lean body mass normally is not gained or lost rapidly enough to cause major changes in body weight.
T203 75675-75724 Sentence denotes One milliliter of water weighs approximately 1 g.
T204 75725-75820 Sentence denotes This fact allows calculation of the patient's fluid deficit, if ongoing losses can be measured.
T205 75821-75933 Sentence denotes When a patient is first presented, however, the body weight before a fluid deficit has occurred rarely is known.
T206 75934-76135 Sentence denotes Instead, one must rely on subjective measures of dehydration to estimate the patient's percent dehydration and to calculate the volume of fluid required to rehydrate the patient over the next 24 hours.
T207 76136-76195 Sentence denotes To calculate the volume deficit, use the following formula:
T208 76196-76321 Sentence denotes The patient's fluid deficit must be added to the daily maintenance fluid requirements and administered over a 24-hour period.
T209 76322-76496 Sentence denotes Ongoing losses can be determined by measuring urine output, weighing the patient at least two or three times a day, and measuring the volume or weight of vomitus or diarrhea.
T210 76497-76763 Sentence denotes A crystalloid fluid contains crystals of salts with a composition similar to that of the extracellular fluid space and can be used to maintain daily fluid requirements and replace fluid deficits or ongoing fluid losses (Table 1- *30 × Body weight (kg) + 70 = mL/day.
T211 76764-76769 Sentence denotes Note:
T212 76770-76955 Sentence denotes This formula will slightly underestimate the requirements for patients that weigh less than 2 kg and will slightly overestimate the requirements for patients that weigh more than 70 kg.
T213 76956-77053 Sentence denotes 1 also can be treated with isotonic fluids with or without supplemental electrolytes and buffers.
T214 77054-77233 Sentence denotes Depending on the patient's clinical condition, choose the specific isotonic crystalloid fluid to replace and maintain the patient's acid-base and electrolyte status (Table 1-11) .
T215 77234-77427 Sentence denotes Crystalloid fluids are readily available, are relatively inexpensive, and can be administered safely in large volumes to patients with no preexisting cardiac or renal disease or cerebral edema.
T216 77428-77563 Sentence denotes After infusion, approximately 80% of the volume of a crystalloid fluid infused will redistribute to the interstitial fluid compartment.
T217 77564-77680 Sentence denotes Therefore crystalloid fluids alone are ineffective for ongoing intravascular volume depletion when given as a bolus.
T218 77681-77838 Sentence denotes The crystalloid fluid bolus must be followed by a CRI, taking into consideration the patient's daily maintenance fluid requirements and ongoing fluid losses.
T219 77839-77941 Sentence denotes Administration of a large volume of crystalloid fluids can cause dilutional anemia and coagulopathies.
T220 77942-78114 Sentence denotes Obtain the patient's hematocrit before fluid infusion and regularly during the course of fluid therapy, particularly in patients with preexisting anemia or hypoproteinemia.
T221 78115-78290 Sentence denotes A colloid is a large-molecular-weight particle that acts as an effective volume expander by drawing fluid from the interstitial fluid compartment into the intravascular space.
T222 78291-78484 Sentence denotes When administered with a crystalloid, a colloid serves to hold or retain the crystalloid fluid within the vascular space for a longer time than if the crystalloid fluid were administered alone.
T223 78485-78654 Sentence denotes Because of this property, colloids can promote better tissue perfusion at lower infusion volumes and equivalent colloid oncotic pressures and mean BPs than crystalloids.
T224 78655-78786 Sentence denotes Administer the synthetic colloids in incremental boluses of 5 to 10 mL/kg over 5 to 15 minutes during the treatment of hypotension.
T225 78787-78974 Sentence denotes When synthetic colloids are administered for maintenance of colloidal oncotic pressure in hypoalbuminemic or hypoproteinemic patients, the recommended dose is 20 to 30 mL/kg/day as a CRI.
T226 78975-79177 Sentence denotes Because colloids retain fluid in the vascular space, the volume of crystalloid fluid infused (maintenance + deficit + ongoing losses) should be decreased by 25% to 50% to avoid vascular volume overload.
T227 79178-79237 Sentence denotes Two major classes of colloids exist: natural and synthetic.
T228 79238-79327 Sentence denotes Natural colloids (whole blood, packed RBCs, plasma) are discussed elsewhere in this text.
T229 79328-79566 Sentence denotes Concentrated human albumin and canine specific purified concentrated albumin are natural purified colloids that recently have become more popular in the treatment of advanced hypoalbuminemia and hypoproteinemia and will be discussed here.
T230 79567-79654 Sentence denotes Synthetic colloids are starch polymers and include hydroxyethyl starch and pentastarch.
T231 79655-79719 Sentence denotes Concentrated human albumin is available as a 5% or 25% solution.
T232 79720-79848 Sentence denotes The 5% solution has an osmolality similar to that of serum (308 mOsm/L), whereas the 25% solution is hyperoncotic (1500 mOsm/L).
T233 79849-79941 Sentence denotes A 25% albumin solution draws fluid from the interstitial space into the intravascular space.
T234 79942-80060 Sentence denotes Concentrated albumin solutions often are used to restore circulating volume when synthetic colloids are not available.
T235 80061-80282 Sentence denotes Albumin not only is important at maintaining the colloidal oncotic pressure of blood but also serves as a valuable free-radical scavenger and carrier of drugs and hormones necessary for normal tissue function and healing.
T236 80283-80377 Sentence denotes Albumin levels less than 2.0 g/dL have been associated with increased morbidity and mortality.
T237 80378-80568 Sentence denotes Concentrated human albumin solutions can be administered as an effective method of restoring interstitial and serum albumin concentrations in situations of acute and chronic hypoalbuminemia.
T238 80569-80748 Sentence denotes Albumin (25%) is available in 50-and 100-mL vials and is more cost-efficient as an albumin replacement than fresh frozen plasma when procurement and administration are considered.
T239 80749-80855 Sentence denotes Recommended albumin infusion rates are 2 to 5 mL/kg over 4 hours, after pretreatment with diphenhydramine.
T240 80856-81024 Sentence denotes Although concentrated human albumin is structurally similar to canine albumin, closely monitor the patient for signs of allergic reaction during and after the infusion.
T241 81025-81231 Sentence denotes Experimentally, concentrated infusion of human albumin into normoalbuminemic healthy dogs has resulted in the development of antialbumin antibodies, urticaria, fever, and acute anaphylaxis leading to death.
T242 81232-81353 Sentence denotes Extreme reactions, however, have not been reported in clinically hypoalbuminemic patients into which albumin was infused.
T243 81354-81443 Sentence denotes Polyarthritis and urticaria have also been documented within 3 weeks of albumin infusion.
T244 81444-81522 Sentence denotes For these reasons, albumin therapy may be beneficial, but it is not innocuous.
T245 81523-81628 Sentence denotes The perceived benefit must outweigh the potential risk of acute and chronic reactions in canine patients.
T246 81629-81839 Sentence denotes Hydroxyethyl starch solutions contain a large-molecular-weight amylopectin polymer that has molecules with a molecular weight that exceeds 100,000 D and has an average halflife of 24 to 36 hours in circulation.
T247 81840-81953 Sentence denotes Hetastarch can bind with vWF and cause prolongation of the ACT and APTT; however, it does not cause coagulopathy.
T248 81954-82141 Sentence denotes Recommended rates of hetastarch infusion are 5-to 10-mL incremental boluses for the treatment of hypotension and 20 to 30 mL/kg/day as a CRI for maintenance of colloidal oncotic pressure.
T249 82142-82413 Sentence denotes imPlemenTing The Fluid TherAPy PlAn Many are the acceptable ways to administer the fluids prescribed for each patient based on the degree of dehydration, estimation of ongoing losses, ability to tolerate oral fluid, and metabolic, acid-base, and electrolyte derangements.
T250 82414-82515 Sentence denotes Administer the fluids in a manner that is best for the patient and most appropriate for the practice.
T251 82516-82755 Sentence denotes To determine the rate of intravenous fluid infusion, take the total volume of fluids that have been prescribed and divide the total volume by the total number of hours in a day that intravenous fluids can be delivered safely and monitored.
T252 82756-82916 Sentence denotes The safest and most accurate way to deliver intravenous fluids, particularly in extremely small animals or those with CHF, is through an intravenous fluid pump.
T253 82917-83104 Sentence denotes Fluid should not be administered IV if the patient cannot be monitored to make sure that the fluids are being delivered at a safe rate and that the fluid line has not become disconnected.
T254 83105-83254 Sentence denotes Supplement fluids over as many hours as possible to allow the patient as much time as possible to redistribute and fully use the fluids administered.
T255 83255-83396 Sentence denotes Fluids administered too quickly can cause diuresis to occur, such that the majority of the fluids administered will be excreted in the urine.
T256 83397-83557 Sentence denotes If time is limited or if extra time is needed for safe administration of fluids, consider using a combination of IV and subcutaneously (SQ) administered fluids.
T257 83558-83669 Sentence denotes Intravenous is the preferred route of administration of fluids in any patient with dehydration and hypovolemia.
T258 83670-83780 Sentence denotes As intravascular volume depletion occurs, reflex peripheral vasoconstriction occurs to restore core perfusion.
T259 83781-83939 Sentence denotes The subcutaneous tissues are not perfused well, and therefore fluids administered SQ will not be absorbed well into the interstitial and intravascular spaces.
T260 83940-84107 Sentence denotes SQ administered fluids can be absorbed slowly and delivered effectively in the management of mild interstitial dehydration and in the treatment of renal insufficiency.
T261 84108-84254 Sentence denotes SQ administered fluids should never take the place of IV administered fluids in a hypovolemic patient or one with severe interstitial dehydration.
T262 84255-84370 Sentence denotes Intramedullary (intraosseous) infusion works well in small patients in which vascular access cannot be established.
T263 84371-84508 Sentence denotes Shock doses of fluids and other substances, including blood products, can be administered under pressure through an intraosseous cannula.
T264 84509-84644 Sentence denotes Because of the inherent discomfort and risk of osteomyelitis with intraosseous infusion, establish vascular access as soon as possible.
T265 84645-84736 Sentence denotes The safest and most efficient method of intravenous fluid infusion is through a fluid pump.
T266 84737-84828 Sentence denotes In cases in which a fluid pump is unavailable, infusion by gravity feed is the next option.
T267 84829-84962 Sentence denotes Infusion sets from various manufacturers have calibrated drip chambers such that a specific number of drops will equal 1 mL of fluid.
T268 84963-85065 Sentence denotes Fluid rates can be calculated based on the number of drops that fall into the drip chamber per minute:
T269 85066-85237 Sentence denotes Fluid volume to be infused (mL) mL / hour Number of hours available = Many pediatric drip sets deliver 60 drops/mL, such that milliliters per hour equals drops per minute.
T270 85238-85385 Sentence denotes Carefully record fluid orders so that the volume to be administered is recorded as milliliters per hour, milliliters per day, and drops per minute.
T271 85386-85478 Sentence denotes This will allow personnel to detect major discrepancies and calculation errors more readily.
T272 85479-85563 Sentence denotes The volume actually delivered should be recorded in the record by nursing personnel.
T273 85564-85694 Sentence denotes All additives should be listed clearly on the bottle on a piece of adhesive tape or a special label manufactured for this purpose.
T274 85695-85849 Sentence denotes A strip of adhesive tape also can be attached to the bottle and marked appropriately to provide a quick visualization of the estimate of volume delivered.
T275 85851-86070 Sentence denotes Orogastric lavage is indicated for gastric decontamination of most types of toxins, for elimination of food during food bloat, and for gastric decompression during surgery for gastric dilatation-volvulus syndrome (GDV).
T276 86071-86308 Sentence denotes Equipment needed to perform orogastric lavage includes a large-bore flexible orogastric lavage tube, permanent marker or white tape, lubricating jelly, warm water, two large buckets, a roll of 2-inch white tape, and a manual lavage pump.
T277 86309-86361 Sentence denotes To perform orogastric lavage, follow this procedure:
T278 86362-86364 Sentence denotes 1.
T279 86365-86529 Sentence denotes Place all animals under general anesthesia with a cuffed endotracheal tube in place to protect the airway and prevent aspiration of gastric contents into the lungs.
T280 86530-86532 Sentence denotes 2.
T281 86533-86630 Sentence denotes Place a roll of 2-inch white tape into the animal's mouth, and secure the tape around the muzzle.
T282 86631-86707 Sentence denotes You will insert the tube through the hole in the center of the roll of tape.
T283 86708-86710 Sentence denotes 3.
T284 86711-86833 Sentence denotes Next, place the distal end of the tube at the level of the last rib, directly adjacent to the animal's thorax and abdomen.
T285 86834-87019 Sentence denotes Measure the length of the tube from the most distal end to the point where it comes out of the mouth, and label this location on the tube with a permanent marker or piece of white tape.
T286 87020-87022 Sentence denotes 4.
T287 87023-87133 Sentence denotes Lubricate the distal portion of the tube, and gently insert it through the roll of tape in the animal's mouth.
T288 87134-87136 Sentence denotes 5.
T289 87137-87177 Sentence denotes Gently push the tube down the esophagus.
T290 87178-87216 Sentence denotes Palpate the tube within the esophagus.
T291 87217-87293 Sentence denotes Two tubes should be palpable: the orogastric tube and the patient's trachea.
T292 87294-87330 Sentence denotes Push the tube down into the stomach.
T293 87331-87459 Sentence denotes You can verify location by blowing into the proximal end of the tube and simultaneously auscultating the stomach for borborygmi.
T294 87460-87462 Sentence denotes 6.
T295 87463-87546 Sentence denotes Insert the manual pump to the proximal end of the tube, and instill the warm water.
T296 87547-87626 Sentence denotes Alternate instilling water with removal of fluid and gastric debris by gravity.
T297 87627-87692 Sentence denotes Repeat the process until the efflux fluid is clear of any debris.
T298 87693-87695 Sentence denotes 7.
T299 87696-87751 Sentence denotes Save the gastric efflux fluid for toxicologic analyses.
T300 87752-87763 Sentence denotes Hackett TB:
T301 87764-87834 Sentence denotes Emergency approach to intoxications, Clin Tech Small Anim Pract 15 (2)
T302 87836-87933 Sentence denotes Hypoxia, or inadequate tissue oxygenation, is the primary reason for supplemental oxygen therapy.
T303 87934-88137 Sentence denotes Major causes of hypoxia include hypoventilation, ventilation-perfusion mismatch, physiologic or right-to-left cardiac shunt, diffusion impairment, and decreased fraction of inspired oxygen (Table 1-12) .
T304 88138-88258 Sentence denotes Inadequate tissue perfusion caused by low cardiac output or vascular obstruction also can result in circulatory hypoxia.
T305 88259-88360 Sentence denotes Finally, histiocytic hypoxia results from inability of cells to use oxygen that is delivered to them.
T306 88361-88471 Sentence denotes This form of hypoxia can be observed with various toxin ingestions (bromethalin, cyanide) and in septic shock.
T307 88472-88679 Sentence denotes A patient's oxygenation status can be monitored invasively by drawing arterial blood gas samples or noninvasively through pulse oximetry, in most cases (see Acid-Base Physiology and Pulse Oximetry sections).
T308 88680-88730 Sentence denotes Inspired air at sea level has a Po 2 of 150 mm Hg.
T309 88731-88845 Sentence denotes As the air travels through the upper respiratory system to the level of the alveolus, the Po 2 drops to 100 mm Hg.
T310 88846-88910 Sentence denotes Tissue oxygen saturation in a normal healthy animal is 95 mm Hg.
T311 88911-89031 Sentence denotes After oxygen has been delivered to the tissues, the oxygen left in the venous system (Pvo 2 ) is approximately 40 mm Hg.
T312 89032-89142 Sentence denotes Normally, oxygen diffuses across the alveolar capillary membrane and binds reversibly with hemoglobin in RBCs.
T313 89143-89223 Sentence denotes A small amount of oxygen is carried in an unbound diffusible form in the plasma.
T314 89224-89434 Sentence denotes When an animal has an adequate amount of hemoglobin and hemoglobin becomes fully saturated while the animal is breathing room air, supplemental oxygen administration will only increase the Sao 2 a small amount.
T315 89435-89496 Sentence denotes The unbound form of oxygen dissolved in plasma will increase.
T316 89497-89742 Sentence denotes If, however, inadequate hemoglobin saturation is obtained by breathing room air, as in a case of pneumonia or pulmonary edema, for example, breathing a higher fraction of inspired oxygen (Fio 2 ) will improve bound and unbound hemoglobin levels.
T317 89743-89818 Sentence denotes The formula for calculating oxygen content of arterial blood is as follows:
T318 89819-90040 Sentence denotes where Cao 2 is the arterial oxygen content, 1.34 is the amount of oxygen that can be carried by hemoglobin (Hb), Sao 2 is the hemoglobin saturation, and 0.003 × Pao 2 is the amount of oxygen dissolved (unbound) in plasma.
T319 90041-90327 Sentence denotes Dissolved oxygen actually contributes little to the total amount of oxygen carried in the arterial blood, and the majority depends on the amount or availability of hemoglobin and the ability of the body (pH and respiratory status) to saturate the hemoglobin at the level of the alveoli.
T320 90328-90415 Sentence denotes indiCATions For oxygen TherAPy Oxygen therapy is indicated whenever hypoxia is present.
T321 90416-90568 Sentence denotes The underlying cause of the hypoxia also must be identified and treated, for chronic, lifelong oxygen therapy is rarely feasible in veterinary patients.
T322 90569-90707 Sentence denotes If hemoglobin levels are low because of anemia, oxygen supplementation must occur along with RBC transfusions to increase hemoglobin mass.
T323 90708-90896 Sentence denotes Whenever possible, use arterial blood gas analyses or pulse oximetry to gauge a patient's response to oxygen therapy and to determine when an animal can be weaned from supplemental oxygen.
T324 90897-90998 Sentence denotes The goal of oxygen therapy is to increase the amount of oxygen bound to hemoglobin in arterial blood.
T325 90999-91110 Sentence denotes Oxygen supplementation can be by hood, oxygen cage or tent, nasal or nasopharyngeal catheter, or tracheal tube.
T326 91111-91196 Sentence denotes In rare cases, administration of oxygen with mechanical ventilation may be indicated.
T327 91197-91313 Sentence denotes Administration of supplemental oxygen to patients with chronic hypoxia is sometimes necessary but is also dangerous.
T328 91314-91480 Sentence denotes With chronic hypoxia the patient develops a chronic respiratory acidosis (elevated Paco 2 ) and depends almost entirely on the hypoxic ventilatory drive to 1 breathe.
T329 91481-91641 Sentence denotes Administration of supplemental oxygen increases Pao 2 and may inhibit the central respiratory drive, leading to hypoventilation and possibly respiratory arrest.
T330 91642-91740 Sentence denotes Therefore, closely monitor animals with chronic hypoxia that are treated with supplemental oxygen.
T331 91741-91891 Sentence denotes Oxygen hoods can be purchased from commercial sources or can be manufactured in the hospital using a rigid Elizabethan collar, tape, and plastic wrap.
T332 91892-92018 Sentence denotes To make an oxygen hood, place several lengths of plastic wrap over the front of the Elizabethan collar and tape them in place.
T333 92019-92138 Sentence denotes Leave the ventral third of the collar open to allow moisture and heat to dissipate and carbon dioxide to be eliminated.
T334 92139-92294 Sentence denotes Place a length of flexible oxygen tubing under the patient's collar into the front of the hood, and run humidified oxygen at a rate of 50 to 100 mL/kg/min.
T335 92295-92354 Sentence denotes Animals may become overheated with an oxygen hood in place.
T336 92355-92446 Sentence denotes Carefully monitor the patient's temperature so that iatrogenic hyperthermia does not occur.
T337 92447-92542 Sentence denotes Commercially available Plexiglas oxygen cages can be purchased from a variety of manufacturers.
T338 92543-92727 Sentence denotes The best units include a mechanical thermostatically controlled compressor cooling unit, a circulatory fan, nebulizers or humidifiers to moisten the air, and a carbon dioxide absorber.
T339 92728-92919 Sentence denotes Alternately, a pediatric (infant) incubator can be purchased from hospital supply sources, and humidified oxygen can be run into the cage at 2 to 10 L/min (depending on the size of the cage).
T340 92920-93007 Sentence denotes High flow rates may be required to eliminate nitrogen and carbon dioxide from the cage.
T341 93008-93088 Sentence denotes In most cases the Fio 2 inside the cage reaches 40% to 50% using this technique.
T342 93089-93350 Sentence denotes Disadvantages of using an oxygen cage are high consumption or use of oxygen, rapid decrease in the Fio 2 within the cage whenever the cage must be opened for patient treatments, lack of immediate access to the patient, and potential for iatrogenic hyperthermia.
T343 93351-93503 Sentence denotes nAsAl or nAsoPhAryngeAl oxygen One of the most common methods for oxygen supplementation in dogs is the use of nasal or nasopharyngeal oxygen catheters.
T344 93504-93639 Sentence denotes Nasal oxygen catheters tend to be irritating to the nasal mucosa and are not as well tolerated by patients as nasopharyngeal oxygen is.
T345 93640-93642 Sentence denotes 1.
T346 93643-93770 Sentence denotes To place a nasal or nasopharyngeal catheter, obtain a red rubber catheter (8F to 12F, depending on the size of the patient). a.
T347 93771-93905 Sentence denotes For nasal oxygen supplementation, measure the distal tip of the catheter from the medial canthus of the eye to the tip of the nose. b.
T348 93906-94024 Sentence denotes For nasopharyngeal oxygen supplementation, measure the catheter from the ramus of the mandible to the tip of the nose.
T349 94025-94027 Sentence denotes 2.
T350 94028-94096 Sentence denotes Mark the tube length at the tip of the nose with a permanent marker.
T351 94097-94099 Sentence denotes 3.
T352 94100-94207 Sentence denotes Instill topical anesthetic such as proparacaine (0.5%) or lidocaine (2%) into the nostril before placement.
T353 94208-94210 Sentence denotes 4.
T354 94211-94318 Sentence denotes Place a stay suture adjacent to (lateral aspect) the nostril while the topical anesthetic is taking effect.
T355 94319-94321 Sentence denotes 5.
T356 94322-94375 Sentence denotes Lubricate the tip of the tube with sterile lubricant.
T357 94376-94378 Sentence denotes 6.
T358 94379-94492 Sentence denotes Gently insert the tube into the ventral medial aspect of the nostril to the level made with the permanent marker.
T359 94493-94728 Sentence denotes If you are inserting the tube into the nasopharynx, push the nasal meatus dorsally while simultaneously pushing the lateral aspect of the nostril medially to direct the tube into the ventral nasal meatus and avoid the cribriform plate.
T360 94729-94731 Sentence denotes 7.
T361 94732-94896 Sentence denotes Once the tube has been inserted to the appropriate length, hold the tube in place with your fingers adjacent to the nostril, and suture the tube to the stay suture.
T362 94897-95023 Sentence denotes If the tube is removed, you can cut the suture around the tube and leave the stay suture in place for later use, if necessary.
T363 95024-95026 Sentence denotes 8.
T364 95027-95171 Sentence denotes Suture or staple the rest of the tube dorsally over the nose and between the eyes to the top of the head, or laterally along the zygomatic arch.
T365 95172-95176 Sentence denotes 1 9.
T366 95177-95285 Sentence denotes Attach the tube to a length of flexible oxygen tubing, and provide humidified oxygen at 50 to 100 mL/kg/min.
T367 95286-95289 Sentence denotes 10.
T368 95290-95412 Sentence denotes Secure an Elizabethan collar around the patient's head to prevent the patient from scratching at the tube and removing it.
T369 95413-95559 Sentence denotes The Rule of 60s states that if a patient's Pao 2 is less than 60 mm Hg, or if the Paco 2 is 60 mm Hg, mechanical ventilation should be considered.
T370 95560-95663 Sentence denotes For mechanical ventilation, anesthetize the patient and intubate the patient with an endotracheal tube.
T371 95664-95836 Sentence denotes Alternately, a temporary tracheostomy can be performed and the patient can be maintained on a plane of light to heavy sedation and ventilated through the tracheostomy site.
T372 95837-95968 Sentence denotes This method, although technically more invasive initially, allows the patient to be awake despite requiring mechanical ventilation.
T373 95969-96039 Sentence denotes Mechanical ventilation is required in the most critically ill animals.
T374 96040-96127 Sentence denotes If mechanical ventilation is required, 24-hour one-on-one veterinary care is necessary.
T375 96129-96213 Sentence denotes A noninvasive means of determining oxygenation is through the use of pulse oximetry.
T376 96214-96486 Sentence denotes A pulse oximeter uses different wavelengths of light to distinguish characteristic differences in the properties of the different molecules in a fluid or gas mixture-in this case, oxygenated (oxyhemoglobin) and deoxygenated hemoglobin (deoxyhemoglobin) in pulsatile blood.
T377 96487-96524 Sentence denotes The process is termed pulse oximetry.
T378 96525-96638 Sentence denotes Oxyhemoglobin and deoxyhemoglobin are different molecules that absorb and reflect different wavelengths of light.
T379 96639-96766 Sentence denotes Oxyhemoglobin absorbs light in the infrared spectrum, allowing wavelengths of light in the red spectrum to transmit through it.
T380 96767-96916 Sentence denotes Conversely, deoxyhemoglobin absorbs wavelengths of the red spectrum and allows wavelengths in the infrared spectrum to transmit through the molecule.
T381 96917-97027 Sentence denotes The spectrophotometer in the pulse oximeter transmits light in the red (660 nm) and infrared (920 nm) spectra.
T382 97028-97165 Sentence denotes The different wavelengths of light are transmitted across a pulsatile vascular bed and are detected by a photodetector on the other side.
T383 97166-97469 Sentence denotes The photodetector processes the amount of light of varying wavelengths that reaches it, then transmits an electrical current to a processor that calculates the difference in the amount of light originally transmitted and the amount of light of similar wavelength that actually reaches the photodetector.
T384 97470-97794 Sentence denotes The difference in each reflects the amount of light absorbed in the pulsatile blood and can be used to calculate the amount or ratio of oxyhemoglobin to deoxyhemoglobin in circulation, or the functional hemoglobin saturation, by the following formula: where Hbo 2 is oxygenated hemoglobin, and Hb is deoxygenated hemoglobin.
T385 97795-97879 Sentence denotes Four molecules of oxygen reversibly bind to hemoglobin for transport to the tissues.
T386 97880-98018 Sentence denotes Carbon monoxide similarly binds to hemoglobin and forms carboxyhemoglobin, a molecule that is detected similarly to oxygenated hemoglobin.
T387 98019-98110 Sentence denotes Thus Sao 2 as detected by a pulse oximeter is not reliable if carboxyhemoglobin is present.
T388 98111-98211 Sentence denotes In most cases, pulse oximetry or Sao 2 corresponds reliably to the oxyhemoglobin dissociation curve.
T389 98212-98292 Sentence denotes Oxygen saturation greater than 90% corresponds to a Pao 2 greater than 60 mm Hg.
T390 98293-98496 Sentence denotes Above this value, large changes in Pao 2 are reflected in relatively small changes in Sao 2 , making pulse oximetry a relatively insensitive method of determining oxygenation status when Pao 2 is normal.
T1 98497-98730 Sentence denotes Because pulse oximetry measures oxygenated versus nonoxygenated hemoglobin in pulsatile blood flow, it is fairly unreliable when severe vasoconstriction, hypothermia, shivering or trembling, or excessive patient movement are present.
T2 98731-98934 Sentence denotes In addition, increased ambient lighting and the presence of methemoglobin or carboxyhemoglobin also can cause artifactual changes in the Sao 2 , and therefore the measurement is not reliable or accurate.
T3 98935-99009 Sentence denotes Most pulse oximeters also display a waveform and the patient's heart rate.
T4 99010-99203 Sentence denotes If the photodetector does not detect a good-quality signal, the waveform will not be normal, and the heart rate displayed on the monitor will not correlate with the patient's actual heart rate.
T5 99204-99302 Sentence denotes The efficiency of ventilation is evaluated using the Paco 2 value on an arterial blood gas sample.
T6 99303-99408 Sentence denotes Alternatively, a noninvasive method to determine end-tidal carbon dioxide is through use of a capnograph.
T7 99409-99508 Sentence denotes The science of capnometry uses a spectrophotometer to measure carbon dioxide levels in exhaled gas.
T8 99509-99582 Sentence denotes The capnometer is placed in the expiratory limb of an anesthetic circuit.
T9 99583-99694 Sentence denotes A sample of exhaled gas is aliquoted from the breath, and an infrared light source is passed across the sample.
T10 99695-99832 Sentence denotes A photodetector on the other side of the sample flow measures the amount or concentration of carbon dioxide in the sample of expired gas.
T11 99833-99895 Sentence denotes The calculated value is displayed as end-tidal carbon dioxide.
T12 99896-99943 Sentence denotes This value also can be displayed as a waveform.
T13 99944-100051 Sentence denotes When placed in graphic form, a waveform known as a capnogram is displayed throughout the ventilatory cycle.
T14 100052-100244 Sentence denotes Normally, at the onset of exhalation the gas exhaled into the expiratory limb of the tubing comes from the upper airway or physiologic dead space and contains relatively little carbon dioxide.
T15 100245-100356 Sentence denotes As exhalation continues, a steep uphill slope occurs as more carbon dioxide is exhaled from the bronchial tree.
T16 100357-100503 Sentence denotes Near the end of exhalation, the capnogram reaches a plateau, which most accurately reflects the carbon dioxide level at the level of the alveolus.
T17 100504-100631 Sentence denotes Because carbon dioxide diffuses across the alveolar basement membrane so rapidly, this reflects arterial carbon dioxide levels.
T18 100632-100724 Sentence denotes If a plateau is not reached and notching of the waveform occurs, check the system for leaks.
T19 100725-100892 Sentence denotes If the baseline waveform does not reach zero, the patient may be rebreathing carbon dioxide or may be tachypneic, causing physiologic positive end-expiratory pressure.
T20 100893-100957 Sentence denotes The Sodasorb in the system should be replaced if it has expired.
T21 100958-101060 Sentence denotes Conversely, low end-tidal carbon dioxide may be associated with a decrease in perfusion or blood flow.
T22 101061-101207 Sentence denotes Decreased perfusion can be associated with low end-tidal carbon dioxide values, particularly during cardiopulmonary cerebral resuscitation (CPCR).
T23 101208-101324 Sentence denotes End-tidal carbon dioxide levels are one of the most accurate predictors of the efficacy of CPCR and patient outcome.
T24 101325-101479 Sentence denotes In addition, the difference between arterial carbon dioxide levels (Paco 2 ) and end-tidal carbon dioxide can be used to calculate dead-space ventilation.
T25 101480-101579 Sentence denotes Increases in the difference also occur with poor lung perfusion and pulmonary diffusion impairment.
T26 101580-101667 Sentence denotes Thoracocentesis refers to the aspiration of fluid or air from within the pleural space.
T27 101668-101800 Sentence denotes Thoracocentesis may be diagnostic to determine whether air or fluid is present and to characterize the nature of the fluid obtained.
T28 101801-101967 Sentence denotes Thoracocentesis also can be therapeutic when large volumes of air or fluid are being removed to allow pulmonary reexpansion and correction of hypoxemia and orthopnea.
T29 101968-102018 Sentence denotes To perform thoracocentesis, follow this procedure:
T30 102019-102021 Sentence denotes 1.
T31 102022-102073 Sentence denotes First, assemble the equipment necessary (Box 1-16).
T32 102074-102076 Sentence denotes 2.
T33 102077-102155 Sentence denotes Next, clip a 10-cm square in the center of the patient's thorax on both sides.
T34 102156-102158 Sentence denotes 3.
T35 102159-102194 Sentence denotes Aseptically scrub the clipped area.
T36 102195-102197 Sentence denotes 4.
T37 102198-102289 Sentence denotes Ideally, thoracocentesis should be performed within the seventh to ninth intercostal space.
T38 102290-102428 Sentence denotes Rather than count rib spaces in an emergent situation, visualize the thoracic cage as a box, and the clipped area as a box within the box.
T39 102429-102601 Sentence denotes You will insert your needle or catheter in the center of the box and then direct the bevel of the needle dorsally or ventrally to penetrate pockets of fluid or air present.
T40 102602-102604 Sentence denotes 5.
T41 102605-102685 Sentence denotes Attach the needle or catheter hub to the length of intravenous extension tubing.
T42 102686-102788 Sentence denotes Attach the female port of the intravenous extension tubing to the male port of the three-way stopcock.
T43 102789-102884 Sentence denotes Attach the male port of the 60-mL syringe to one of the female ports of the three-way stopcock.
T44 102885-102924 Sentence denotes The apparatus is now assembled for use.
T45 102925-102927 Sentence denotes 6.
T46 102928-103041 Sentence denotes Insert the needle through the intercostal space such that the bevel of the needle initially is directed downward.
T47 103042-103044 Sentence denotes 7.
T48 103045-103147 Sentence denotes Next, push down on the hub of the needle such that the needle becomes parallel with the thoracic wall.
T49 103148-103331 Sentence denotes Through movement of the hub of the needle in a clockwise or counterclockwise manner, the bevel of the needle will move within the thoracic cavity to penetrate pockets of air or fluid.
T50 103332-103438 Sentence denotes In general, air is located dorsally and fluid is located more ventrally, although this is not always true.
T51 103439-103441 Sentence denotes 8.
T52 103442-103464 Sentence denotes Aspirate air or fluid.
T53 103465-103577 Sentence denotes Save any fluid obtained for cytologic and biochemical analyses and bacterial culture and susceptibility testing.
T54 103578-103702 Sentence denotes In cases of pneumothorax, if thoracocentesis needs to be repeated more than three times, consider using a thoracostomy tube.
T55 103703-103876 Sentence denotes Place a thoracostomy tube in cases of pneumothorax whenever negative suction cannot be obtained or repeated accumulation of air requires multiple thoracocentesis procedures.
T56 103877-104006 Sentence denotes Thoracostomy tubes also can be placed to drain rapidly accumulating pleural effusion and for the medical management of pyothorax.
T57 104007-104213 Sentence denotes Before attempting thoracostomy tube placement, make sure that all necessary supplies are assembled (Box 1-17; Have an assistant pull the patient's skin cranially and ventrally toward the point of the elbow.
T58 104214-104295 Sentence denotes This will facilitate creating a subcutaneous tunnel around the thoracostomy tube.
T59 104296-104298 Sentence denotes 6.
T60 104299-104439 Sentence denotes Draw up 2 mg of 2% lidocaine per kilogram (1 mg/kg for cats) along with a small amount of sodium bicarbonate to take away some of the sting.
T61 104440-104442 Sentence denotes 7.
T62 104443-104550 Sentence denotes Insert the needle at the dorsal aspect of the tenth intercostal space and to the seventh intercostal space.
T63 104551-104708 Sentence denotes Inject the lidocaine into the seventh intercostal space at the point where the trocarized thoracic drainage catheter will penetrate into the thoracic cavity.
T64 104709-104834 Sentence denotes Slowly infuse the lidocaine as you withdraw the needle to create an anesthetized tunnel through which to insert the catheter.
T65 104835-104837 Sentence denotes 8.
T66 104838-105036 Sentence denotes While the local anesthetic is taking effect, remove the trocar from the catheter and cut the proximal end of the catheter with Mayo scissors to facilitate adaptation with the Christmas tree adapter.
T67 105037-105039 Sentence denotes 9.
T68 105040-105284 Sentence denotes Attach the Christmas tree adapter to the three-way stopcock and the three-way stopcock to a length of intravenous extension tubing and the 60-mL syringe so that the apparatus can be attached immediately to the thoracostomy tube after placement.
T69 105285-105288 Sentence denotes 10.
T70 105289-105409 Sentence denotes Aseptically scrub the lateral thorax a second time and then drape it with sterile huck towels secured with towel clamps.
T71 105410-105413 Sentence denotes 11.
T72 105414-105517 Sentence denotes Wearing sterile gloves, make a small stab incision at the dorsal aspect of the tenth intercostal space.
T73 105518-105521 Sentence denotes 12.
T74 105522-105581 Sentence denotes Insert the trocar back into the thoracostomy drainage tube.
T75 105582-105627 Sentence denotes Insert the trocar and tube into the incision.
T76 105628-105800 Sentence denotes Tunnel the tube cranially for approximately three intercostal spaces while an assistant simultaneously pulls the skin cranially and ventrally toward the point of the elbow.
T77 105801-105804 Sentence denotes 13.
T78 105805-105898 Sentence denotes At the seventh intercostal space, direct the trocar and catheter perpendicular to the thorax.
T79 105899-106020 Sentence denotes Grasp the catheter apparatus at the base adjacent to the thorax to prevent the trocar from going too far into the thorax.
T80 106021-106024 Sentence denotes 14.
T81 106025-106272 Sentence denotes Place the palm of your dominant hand over the end of the trocar, and push the trocar and catheter into the thoracic cavity, throwing your weight into the placement in a swift motion, not by banging the butt of your hand on the end of the stylette.
T82 106273-106414 Sentence denotes For small individuals, standing on a stool or kneeling over the patient on the triage table can create leverage and make this process easier.
T83 106415-106457 Sentence denotes The tube will enter the thorax with a pop.
T84 106458-106461 Sentence denotes 15.
T85 106462-106531 Sentence denotes Gently push the catheter off of the stylette and remove the stylette.
T86 106532-106535 Sentence denotes 16.
T87 106536-106670 Sentence denotes Immediately attach the Christmas tree adapter and have an assistant start to withdraw air or fluid while you secure the tube in place.
T88 106671-106674 Sentence denotes 17.
T89 106675-106772 Sentence denotes First, place a horizontal mattress suture around the tube to cinch the skin securely to the tube.
T90 106773-106836 Sentence denotes Use care to not penetrate the tube with your needle and suture.
T91 106837-106840 Sentence denotes 18.
T92 106841-106917 Sentence denotes Next, place a purse-string suture around the tube at the tube entrance site.
T93 106918-107036 Sentence denotes Leave the ends of the suture long, so that you can create a finger-trap suture to the tube, holding the tube in place.
T94 107037-107040 Sentence denotes 19.
T95 107041-107154 Sentence denotes Place a large square of antimicrobial-impregnated adhesive tape over the tube for further security and sterility.
T96 107155-107158 Sentence denotes 20.
T97 107159-107344 Sentence denotes If antimicrobial adhesive is not available, place a gauze pad 4 × 4 inches square over the tube, and then wrap the tube to the thorax with cotton roll gauze and Elastikon adhesive tape.
T98 107345-107348 Sentence denotes 21.
T99 107349-107448 Sentence denotes Draw the location of the tube on the bandage to prevent cutting it with subsequent bandage changes.
T100 107449-107552 Sentence denotes An alternate technique to use if a trocar thoracic drainage catheter is not available is the following:
T101 107553-107555 Sentence denotes 1.
T102 107556-107638 Sentence denotes Prepare the lateral thorax and infuse local lidocaine anesthetic as listed before.
T103 107639-107641 Sentence denotes 2.
T104 107642-107679 Sentence denotes Make a small stab incision with a No.
T105 107680-107714 Sentence denotes 10 scalpel blade as listed before.
T106 107715-107717 Sentence denotes 3.
T107 107718-107918 Sentence denotes Obtain the appropriately sized red rubber catheter and cut multiple side ports in the distal end of the catheter, taking care to not cut more than 50% of the circumference of the diameter of the tube.
T108 107919-107921 Sentence denotes 4.
T109 107922-108061 Sentence denotes Insert a rigid, long urinary catheter into the red rubber catheter to make the catheter more rigid during insertion into the pleural space.
T110 108062-108064 Sentence denotes 5.
T111 108065-108143 Sentence denotes Grasp the distal end of the catheter(s) in the teeth of large Carmalt forceps.
T112 108144-108150 Sentence denotes Tunnel
T113 108151-108269 Sentence denotes Metzenbaum scissors under the skin to the seventh intercostal space and make a puncture through the intercostal space.
T114 108270-108272 Sentence denotes 6.
T115 108273-108458 Sentence denotes Remove the Metzenbaum scissors, and then tunnel the Carmalt forceps and red rubber tube under the skin to the hole created in the seventh intercostal space with the Metzenbaum scissors.
T116 108459-108461 Sentence denotes 7.
T117 108462-108594 Sentence denotes Insert the tips of the Carmalt forceps and the red rubber catheter through the hole, and then open the teeth of the Carmalt forceps.
T118 108595-108597 Sentence denotes 8.
T119 108598-108661 Sentence denotes Push the red rubber catheter cranially into the pleural cavity.
T120 108662-108664 Sentence denotes 9.
T121 108665-108769 Sentence denotes Remove the Carmalt forceps and the rigid urinary catheter, and immediately attach the suction apparatus.
T122 108770-108827 Sentence denotes Secure the red rubber catheter in place as listed before.
T123 108828-108835 Sentence denotes Hackett
T124 108837-109150 Sentence denotes Placement of a temporary tracheostomy can be lifesaving; it can be used to relieve upper respiratory tract obstruction, to facilitate removal of airway secretions, to decrease dead space ventilation, to provide a route of inhalant anesthesia during maxillofacial surgery, and to facilitate mechanical ventilation.
T125 109151-109349 Sentence denotes In an emergent situation in which asphyxiation is imminent and endotracheal intubation is not possible, any cutting instrument placed into the trachea distal to the point of obstruction can be used.
T126 109350-109452 Sentence denotes To perform a slash tracheostomy, quickly clip the fur and scrub the skin over the third tracheal ring.
T127 109453-109495 Sentence denotes Make a small cut in the trachea with a No.
T128 109496-109563 Sentence denotes 11 scalpel blade, and insert a firm tube, such as a syringe casing.
T129 109564-109815 Sentence denotes Alternately, insertion of a 22-gauge needle attached to intravenous extension tubing and adapted with a 1-mL syringe case to attach to a humidified oxygen source also temporarily can relieve obstruction until a temporary tracheostomy can be performed.
T130 109816-109913 Sentence denotes In less emergent situations, place the patient under general anesthesia and intubate the patient.
T131 109914-110015 Sentence denotes Assemble all the equipment necessary before starting the temporary tracheostomy procedure (Box 1-18).
T132 110016-110065 Sentence denotes To perform a tracheostomy, follow this procedure:
T133 110066-110068 Sentence denotes 1.
T134 110069-110108 Sentence denotes Place the patient in dorsal recumbency.
T135 110109-110111 Sentence denotes 2.
T136 110112-110244 Sentence denotes Clip the ventral cervical region from the level of the ramus of the mandible caudally to the thoracic inlet and dorsally to midline.
T137 110245-110247 Sentence denotes 3.
T138 110248-110350 Sentence denotes Aseptically scrub the clipped area, and then drape with sterile huck towels secured with towel clamps.
T139 110351-110353 Sentence denotes 4.
T140 110354-110465 Sentence denotes Make a 3-cm ventral midline skin incision over the third to sixth tracheal rings, perpendicular to the trachea.
T141 110466-110468 Sentence denotes 5.
T142 110469-110545 Sentence denotes Bluntly dissect through the sternohyoid muscles to the level of the trachea.
T143 110546-110548 Sentence denotes 6.
T144 110549-110641 Sentence denotes Carefully pick up the fascia overlying the trachea and cut it away with Metzenbaum scissors.
T145 110642-110644 Sentence denotes 7.
T146 110645-110710 Sentence denotes Place two stay sutures through or around adjacent tracheal rings.
T147 110711-110713 Sentence denotes 8.
T148 110714-110753 Sentence denotes Incise between trachea rings with a No.
T149 110754-110771 Sentence denotes 11 scalpel blade.
T150 110772-110843 Sentence denotes Take care to not cut more than 50% of the circumference of the trachea.
T151 110844-110846 Sentence denotes 9.
T152 110847-110951 Sentence denotes Using the stay sutures, pull the edges of the tracheal incision apart, and insert the tracheostomy tube.
T153 110952-111047 Sentence denotes The Shiley tube contains an internal obturator to facilitate placement into the tracheal lumen.
T154 111048-111149 Sentence denotes Remove the obturator, and then insert the inner cannula, which can be removed for cleaning as needed.
T155 111150-111153 Sentence denotes 10.
T156 111154-111253 Sentence denotes Once the tube is in place, secure the tube around the neck with a length of sterile umbilical tape.
T157 111254-111338 Sentence denotes Postoperative care of the tracheostomy tube is as important as the procedure itself.
T158 111339-111560 Sentence denotes Because the tracheostomy tube essentially bypasses the protective effects of the upper respiratory system, one of the most important aspects of tracheostomy tube care and maintenance is to maintain sterility at all times.
T159 111561-111675 Sentence denotes Any oxygen source should be humidi- fied with sterile water or saline to prevent drying of the respiratory mucosa.
T160 111676-111793 Sentence denotes If supplemental oxygen is not required, instill 2 to 3 mL of sterile saline every 1 to 2 hours to moisten the mucosa.
T161 111794-111975 Sentence denotes Wearing sterile gloves, remove the internal tube and place it in a sterile bowl filled with sterile hydrogen peroxide, to be cleaned every 4 hours (or more frequently as necessary).
T162 111976-112260 Sentence denotes If a Shiley tube is not available, apply suction to the internal lumen of the tracheostomy tube every 1 to 2 hours (or more frequently as needed) with a sterile 12F red rubber catheter attached to a vacuum pump to remove any mucus or other debris that potentially could plug the tube.
T163 112261-112435 Sentence denotes Unless the patient demonstrates clinical signs of fever or infection, the prophylactic use of antibiotics is discouraged because of the risk of causing a resistant infection.
T164 112436-112570 Sentence denotes After the temporary tracheostomy is no longer necessary, remove the tube and sutures, and leave the wound to heal by second intention.
T165 112571-112670 Sentence denotes Primary closure of the wounds could predispose the patient to subcutaneous emphysema and infection.
T166 112672-112772 Sentence denotes Urohydropulsion is a therapeutic procedure for removal of uroliths from the urethra of the male dog.
T167 112773-112884 Sentence denotes The technique works best if the animal is heavily sedated or is placed under general anesthesia (Figure 1-12) .
T168 112885-112935 Sentence denotes To perform urohydropulsion, follow this procedure:
T169 112936-112938 Sentence denotes 1.
T170 112939-112978 Sentence denotes Place the animal in lateral recumbency.
T171 112979-112981 Sentence denotes 2.
T172 112982-113034 Sentence denotes Clip the fur from the distal portion of the prepuce.
T173 113035-113037 Sentence denotes 3.
T174 113038-113139 Sentence denotes Aseptically scrub the prepuce and flush the prepuce with 12 to 20 mL of antimicrobial flush solution.
T175 113140-113142 Sentence denotes 4.
T176 113143-113218 Sentence denotes Have an assistant who is wearing gloves retract the penis from the prepuce.
T177 113219-113221 Sentence denotes 5.
T178 113222-113330 Sentence denotes While wearing sterile gloves, lubricate the tip of a rigid urinary catheter as for urethral catheterization.
T179 113331-113333 Sentence denotes 6.
T180 113334-113438 Sentence denotes Gently insert the tip of the catheter into the urethra until you meet the resistance of the obstruction.
T181 113439-113441 Sentence denotes 7.
T182 113442-113489 Sentence denotes Pinch the tip of the penis around the catheter.
T183 113490-113492 Sentence denotes 8.
T184 113493-113649 Sentence denotes Have an assistant insert a gloved lubricated finger into the patient's rectum and press ventrally on the floor of the rectum to obstruct the pelvic urethra.
T185 113650-113652 Sentence denotes 9.
T186 113653-113737 Sentence denotes Attach a 60-mL syringe filled with sterile saline into proximal tip of the catheter.
T187 113738-113741 Sentence denotes 10.
T188 113742-113944 Sentence denotes Quickly inject fluid into the catheter and alternate compression and relaxation on the pelvic urethra such that the urethra dilates and suddenly releases the pressure, causing dislodgement of the stone.
T189 113945-114114 Sentence denotes Small stones may be ejected from the tip of the urethra, whereas larger stones may be retropulsed back into the urinary bladder to be removed surgically at a later time.
T190 114115-114136 Sentence denotes Osborne CA, Finco DR:
T191 114137-114215 Sentence denotes Canine and feline nephrology and urology, Baltimore, 1995, Williams & Wilkins.
T192 114216-114613 Sentence denotes The type of catheter that you choose for vascular access depends largely on the size and species of the patient, the fragility of the vessels to be catheterized, the proposed length of time that the catheter will be in place, the type and viscosity of the fluid or drug to be administered, the rate of fluid flow desired, and whether multiple repeated blood samples will be required (Table 1-14) .
T193 114614-114877 Sentence denotes A variety of over-the-needle, through-the-needle, and over-the-wire catheters are available for placement in a variety of vessels, including the jugular, cephalic, accessory cephalic, medial saphenous, lateral saphenous, dorsal pedal artery, and femoral arteries.
T194 114878-114997 Sentence denotes One of the most important aspects of proper catheter placement and maintenance is to maintain cleanliness at all times.
T195 114998-115101 Sentence denotes The patient's urine, feces, saliva, and vomit are common sources of contamination of the catheter site.
T196 115102-115284 Sentence denotes Before placing a peripheral or central catheter in any patient, consider the patient's physical status including the presence of vomiting, diarrhea, excessive urination, or seizures.
T197 115285-115473 Sentence denotes In a patient that has an oral mass and is drooling excessively or a patient that is vomiting, peripheral cephalic catheterization may not be the most appropriate, to prevent contamination.
T198 115474-115617 Sentence denotes Conversely, in a patient with excessive urination or diarrhea, a lateral or medial saphenous catheter is likely to become contaminated quickly.
T199 115618-115818 Sentence denotes Whenever one places or handles a catheter or intravenous infusion line, the person should wash the hands carefully and wear gloves to prevent contamination of the intravenous catheter and fluid lines.
T200 115819-115921 Sentence denotes One of the most common sources of catheter contamination in veterinary hospitals is caretakers' hands.
T201 115922-116023 Sentence denotes In emergent situations, placement of a catheter may be necessary under less than ideal circumstances.
T202 116024-116151 Sentence denotes Remove those catheters as soon as the patient's condition is more stable, and place a second catheter using aseptic techniques.
T203 116152-116386 Sentence denotes In general, once the location of the catheter has been decided, set up all equipment necessary for catheter placement before starting to handle and restrain the patient. lists the equipment needed for most types of catheter placement.
T204 116387-116481 Sentence denotes After setting up all of the supplies needed, clip the fur over the site of catheter placement.
T205 116482-116586 Sentence denotes Make sure to clip all excess fur and long feathers away from the catheter site to prevent contamination.
T206 116587-116812 Sentence denotes For catheter placement in limbs, clip the fur circumferentially around the site of catheter placement to facilitate adherence of the tape to the limb and to facilitate catheter removal with minimal discomfort at a later date.
T207 116813-116910 Sentence denotes Next, aseptically scrub the catheter site with an antimicrobial scrub solution such as Hibiclens.
T208 116911-116956 Sentence denotes The site is now ready for catheter insertion.
T209 116957-117105 Sentence denotes Consider using a central venous catheter whenever multiple repeated blood samples will need to be collected from a patient during the hospital stay.
T210 117106-117358 Sentence denotes Central venous catheters also can be used for CVP measurement, administration of hyperoncotic solutions such as parenteral nutrition, and administration of crystalloid and colloid fluids, anesthesia, and other injectable drugs (Figures 1-13 and 1-14) .
T211 117359-117489 Sentence denotes Through-the-needle or over-the-wire catheters are available from a variety of veterinary and human manufacturers and distributors.
T212 117490-117570 Sentence denotes Over-the-wire central venous catheters can be placed by the Seldinger technique.
T213 117571-117656 Sentence denotes Sterility must be maintained at all times, regardless of the type of catheter placed.
T214 117657-117739 Sentence denotes Central catheters also can be placed via the Seldinger or over-the-wire technique.
T215 117740-117852 Sentence denotes A number of companies manufacture kits that contain the supplies necessary for over-the-wire catheter placement.
T216 117853-117917 Sentence denotes Each kit minimally should contain an over-the-needle catheter to
T217 117919-118144 Sentence denotes place into the vessel, a long wire to insert through the original catheter placed, a vascular dilator to dilate the hole in the vessel created by the first catheter, and a long catheter to place into the vessel over the wire.
T218 118145-118286 Sentence denotes Additional accessories can include a paper drape, sterile gauze, a scalpel blade, local anesthetic, 22-gauge needles, and 3-or 6-mL syringes.
T219 118287-118441 Sentence denotes To place a jugular central venous catheter, place the patient in lateral recumbency and extend the head and neck such that the jugular furrow is straight.
T220 118442-118555 Sentence denotes Clip the fur from the ramus of the mandible caudally to the thoracic inlet and dorsally and ventrally to midline.
T221 118556-118649 Sentence denotes Wipe the clipped area with 4-× 4-inch gauze squares to remove any loose fur and other debris.
T222 118650-118716 Sentence denotes Aseptically scrub the clipped area with an antimicrobial cleanser.
T223 118717-118863 Sentence denotes Wearing sterile gloves, drape the site of catheter placement with sterile drapes, and occlude the jugular vein at the level of the thoracic inlet.
T224 118864-118979 Sentence denotes Pick up the skin over the site of catheter placement, and insert a small bleb of local anesthetic through the skin.
T225 118980-119066 Sentence denotes The local anesthetic should not be injected into the underlying vessel (Figure 1-15) .
T226 119067-119138 Sentence denotes Make a small nick into the skin through the local anesthetic with a No.
T227 119139-119148 Sentence denotes 10 or No.
T228 119149-119166 Sentence denotes 11 scalpel blade.
T229 119167-119218 Sentence denotes Use care to avoid lacerating the underlying vessel.
T230 119219-119331 Sentence denotes Next, occlude the jugular vein as previously described, and insert the over-the-needle catheter into the vessel.
T231 119332-119379 Sentence denotes Watch for a flash of blood in the catheter hub.
T232 119380-119418 Sentence denotes Remove the stylette from the catheter.
T233 119419-119509 Sentence denotes Next, insert the long wire into the catheter and into the vessel (Figures 1-16 and 1-17) .
T234 119510-119599 Sentence denotes The J-wire is curved at its tip to prevent iatrogenic trauma to the vessel and the heart.
T235 119600-119699 Sentence denotes Pull the J-wire back so that the curve straightens out, and then insert the J-wire into the vessel.
T236 119700-119725 Sentence denotes Never let go of the wire.
T237 119726-119827 Sentence denotes Remove the catheter, and place the vascular dilator over the wire and into the vessel (Figure 1-18) .
T238 119828-119933 Sentence denotes Gently twist to place the dilator into the vessel a short distance, creating a larger hole in the vessel.
T239 119934-119993 Sentence denotes The vessel will bleed more after creation of a larger hole.
T240 119994-120069 Sentence denotes Remove the vascular dilator, and leave the wire in place within the vessel.
T241 120070-120140 Sentence denotes Insert the long catheter over the wire into the vessel (Figure 1-19) .
T242 120141-120211 Sentence denotes Push the catheter into the vessel to the catheter hub (Figure 1 -20) .
T243 120212-120275 Sentence denotes Slowly thread the wire through a proximal port in the catheter.
T244 120276-120395 Sentence denotes Once the catheter is in place, remove the wire, and suture the catheter in place to the skin with nonabsorbable suture.
T245 120396-120486 Sentence denotes Gently wrap layers of cotton roll gauze, Kling, and Elastikon or Vetrap over the catheter.
T246 120487-120711 Sentence denotes Secure a male adapter or T port that has been flushed with heparinized saline, and then label the catheter with the size and length of catheter, date of catheter placement, and initials of the person who placed the catheter.
T247 120712-120742 Sentence denotes The catheter is ready for use.
T248 120743-120838 Sentence denotes Monitor the catheter site daily for erythema, drainage, vessel thickening, or pain on infusion.
T249 120839-121030 Sentence denotes If any of these signs occur, or if the patient develops a fever of unknown origin, remove the catheter, culture the catheter tip aseptically, and replace the catheter in a different location.
T250 121031-121125 Sentence denotes As long as the catheter is functional without complications, the catheter can remain in place.
T251 121127-121196 Sentence denotes Place the patient in sternal recumbency as for cephalic venipuncture.
T252 121197-121305 Sentence denotes Clip the antebrachium circumferentially, and wipe the area clean of any loose fur and debris (Figure 1-21) .
T253 121306-121416 Sentence denotes Aseptically scrub the clipped area, and have an assistant occlude the cephalic vein at the crook of the elbow.
T254 121417-121604 Sentence denotes The person placing the catheter should grasp the distal carpus with the nondominant hand and insert the over-the-needle catheter into the vessel at a 15-to 30-degree angle (Figure 1-22) .
T255 121605-121722 Sentence denotes Watch for a flash of blood in the catheter hub, and then gently push the catheter off of the stylette (Figure 1-23) .
T256 121723-121799 Sentence denotes Have the assistant occlude the vessel over the catheter to prevent backflow.
T257 121800-121852 Sentence denotes Flush the catheter with heparinized saline solution.
T258 121853-121973 Sentence denotes Make sure that the skin and catheter hub are clean and dry to ensure that the tape adheres to the catheter hub and skin.
T259 121974-122067 Sentence denotes Secure a length of 1 ⁄2-inch white tape tightly around the catheter and then around the limb.
T260 122068-122159 Sentence denotes Make sure that the catheter hub does not "spin" in the tape, or the catheter will fall out.
T261 122160-122284 Sentence denotes Next, secure a second length of 1-inch adhesive tape under the catheter and around the limb and catheter hub (Figure 1-24 ).
T262 122285-122345 Sentence denotes This piece of tape helps to stabilize the catheter in place.
T263 122346-122453 Sentence denotes Finally, place a flushed T port or male adapter in the catheter hub and secure to the limb with white tape.
T264 122454-122573 Sentence denotes Make sure that the tape is adhered to the skin securely, but not so tightly as to impede venous outflow (Figure 1-25) .
T265 122574-122697 Sentence denotes The catheter site can be covered with a cotton ball impregnated with antimicrobial ointment and layers of bandage material.
T266 122698-122842 Sentence denotes Label all catheters with the date of placement, the type and gauge of catheter inserted, and the initials of the person who placed the catheter.
T267 122844-122932 Sentence denotes The femoral artery can be catheterized for placement of an indwelling arterial catheter.
T268 122933-123068 Sentence denotes Indwelling arterial catheters can be used for continuous invasive arterial BP monitoring and for procurement of arterial blood samples.
T269 123069-123156 Sentence denotes Place the patient in lateral recumbency, and tape the down leg in an extended position.
T270 123157-123233 Sentence denotes Clip the fur over the femoral artery and aseptically scrub the clipped area.
T271 123234-123356 Sentence denotes Palpate the femoral artery as it courses distally on the medial surface of the femur and anterior to the pectineus muscle.
T272 123357-123467 Sentence denotes Make a small nick incision over the proposed site of catheter placement using the bevel of an 18-gauge needle.
T273 123468-123574 Sentence denotes Place a long overthe-needle catheter through the nick in the skin and direct it toward the palpable pulse.
T274 123575-123711 Sentence denotes Place the tip of the catheter so that the needle tip rests in the subcutaneous tissue between the artery and the palpating index finger.
T275 123712-123842 Sentence denotes Advance the needle steeply at a 30-degree angle to secure the superficial wall of the vessel and then the deep wall of the vessel.
T276 123843-123958 Sentence denotes The spontaneous flow of blood in the catheter hub ensures that the catheter is situated in the lumen of the artery.
T277 123959-124036 Sentence denotes Feed the catheter off of the stylette, and cover the hub with a catheter cap.
T278 124037-124126 Sentence denotes Flush the catheter with sterile heparinized saline solution, and then secure it in place.
T279 124127-124219 Sentence denotes Some persons simply tape the catheter in place with pieces of 1 ⁄2-and 1-inch adhesive tape.
T280 124220-124351 Sentence denotes Others use a "butterfly" piece of tape around the catheter hub and suture or glue the tape to the adjacent skin for added security.
T281 124352-124416 Sentence denotes The dorsal pedal artery commonly is used for catheter placement.
T282 124417-124500 Sentence denotes To place a dorsal pedal arterial catheter, place the patient in lateral recumbency.
T283 124501-124588 Sentence denotes Clip the fur over the dorsal pedal artery, and then aseptically scrub the clipped area.
T284 124589-124788 Sentence denotes Tape the distal limb so that the leg is twisted slightly medially for better exposure of the vessel, or the person placing the arterial catheter can manipulate the limb into the appropriate position.
T285 124789-124859 Sentence denotes Palpate the dorsal pedal pulse as it courses dorsally over the tarsus.
T286 124860-124996 Sentence denotes Place an over-the-needle catheter percutaneously at a 15-to 30-degree angle, threading the tip of the needle carefully toward the pulse.
T287 124997-125165 Sentence denotes Advance the needle in short, blunt movements, and watch the catheter hub closely for a flash of pulsating blood that signifies penetration into the lumen of the artery.
T288 125166-125259 Sentence denotes Then thread the catheter off of the stylette, and cover the catheter hub with a catheter cap.
T289 125260-125445 Sentence denotes Secure the catheter in place with lengths of 1 ⁄2-and 1-inch adhesive tape as with any other intravenous catheter, and then flush it with heparinized saline solution every 2 to 4 hours.
T290 125447-125545 Sentence denotes Any vessel that can be catheterized percutaneously also can be catheterized with surgical cutdown.
T291 125546-125671 Sentence denotes Restrain the patient and clip and aseptically scrub the limb or jugular vein as for a percutaneous catheterization procedure.
T292 125672-125784 Sentence denotes Block the area for catheter placement with a local anesthetic before cutting the skin over the vessel with a No.
T293 125785-125802 Sentence denotes 11 scalpel blade.
T294 125803-125886 Sentence denotes While wearing sterile gloves, pick up the skin and incise the skin over the vessel.
T295 125887-125971 Sentence denotes Direct the sharp edge of the blade upward to avoid lacerating the underlying vessel.
T296 125972-126103 Sentence denotes Using blunt dissection, push the underlying subcutaneous fat and perivascular fascia away from the vessel with a mosquito hemostat.
T297 126104-126157 Sentence denotes Make sure that all tissue is removed from the vessel.
T298 126158-126248 Sentence denotes Using the mosquito hemostat, place two stay sutures of absorbable suture under the vessel.
T299 126249-126368 Sentence denotes Elevate the vessel until it is parallel with the incision, and gently insert the catheter and stylette into the vessel.
T300 126369-126421 Sentence denotes Secure the stay sutures loosely around the catheter.
T301 126422-126566 Sentence denotes Suture the skin over the catheter site with nonabsorbable suture, and then tape and bandage the catheter in place as for percutaneous placement.
T302 126567-126719 Sentence denotes Remove catheters placed surgically as soon as possible and exchange them for a percutaneously placed catheter to prevent infection and thrombophlebitis.
T303 126720-126824 Sentence denotes The most important aspect of catheter maintenance is to maintain cleanliness and sterility at all times.
T304 126825-126927 Sentence denotes An indwelling catheter can remain in place for as long as it is functional and no complications occur.
T305 126928-127060 Sentence denotes Change the bandage whenever it becomes wet or soiled to prevent wicking of bacteria and debris from the environment into the vessel.
T306 127061-127235 Sentence denotes Check the bandages and catheter sites at least once a day for signs of thrombophlebitis: erythema, vessel hardening or ropiness, pain on injection or infusion, and discharge.
T307 127236-127315 Sentence denotes Also closely examine the tissue around and proximal and distal to the catheter.
T308 127316-127430 Sentence denotes Swelling of the paw can signify that the catheter tape and bandage are too tight and are occluding venous outflow.
T309 127431-127593 Sentence denotes Swelling above the catheter site is characteristic of perivascular leakage of fluid and may signify that the catheter is no longer within the lumen of the vessel.
T310 127594-127838 Sentence denotes Remove the catheter if it is no longer functional, if there is pain or resistance on infusion, if there is unexplained fever or leukocytosis, or if there is evidence of cellulitis, thrombophlebitis, or catheter-related bacteremia or septicemia.
T311 127839-127907 Sentence denotes Aseptically culture the tip of the indwelling catheter for bacteria.
T312 127908-128024 Sentence denotes Animals should wear Elizabethan collars or other forms of restraint if they lick or chew at the catheter or bandage.
T313 128025-128222 Sentence denotes Catheter patency may be maintained with constant fluid infusion or by intermittent flushing with heparinized saline (1000 units of unfractionated heparin per 250 to 500 mL of saline) every 6 hours.
T314 128223-128280 Sentence denotes Flush arterial catheters more frequently (every 2 hours).
T315 128281-128347 Sentence denotes Disconnect intravenous connections only when absolutely necessary.
T316 128348-128406 Sentence denotes Wear gloves whenever handling the catheter or connections.
T317 128407-128488 Sentence denotes Label all fluid lines and elevate them off of the floor to prevent contamination.
T318 128489-128546 Sentence denotes Date each fluid line and replace it every 24 to 36 hours.
T319 128547-128812 Sentence denotes If an intravenous catheter cannot be placed because of small patient size, hypovolemia, hypothermia, or severe hypotension, needles can be placed into the marrow cavity of the femur, humerus, and tibia for intraosseous infusion of fluids, drugs, and blood products.
T320 128813-128902 Sentence denotes This technique is particularly useful in small kittens and puppies and in exotic species.
T321 128903-129055 Sentence denotes Contraindications to intraosseous infusion include avian species (which have pneumatic bones), fractures, and sepsis, because osteomyelitis can develop.
T322 129056-129251 Sentence denotes An intraosseous catheter is relatively easy to place and maintain but can cause patient discomfort and so should be changed to an intravenous catheter as soon as vascular access becomes possible.
T323 129252-129367 Sentence denotes To place an intraosseous catheter, clip and aseptically scrub the fur over the proposed site of catheter placement.
T324 129368-129460 Sentence denotes The easiest place for intraosseous placement is in the intertrochanteric fossa of the femur.
T325 129461-129590 Sentence denotes Inject a small amount of a local anesthetic through the skin and into the periosteum where the trocar or needle will be inserted.
T326 129591-129725 Sentence denotes Place the patient in lateral recumbency, and grasp the leg between your fingers, with the stifle braced against the palm of your hand.
T327 129726-129820 Sentence denotes Push the stifle toward the abdomen (medially) to abduct the proximal femur away from the body.
T328 129821-129892 Sentence denotes This will shift the sciatic nerve out of the way of catheter placement.
T329 129893-129976 Sentence denotes Insert the tip of the needle through the skin and into the intertrochanteric fossa.
T330 129977-130100 Sentence denotes Gently push with a simultaneous twisting motion, pushing the needle parallel with the shaft of the femur, toward your palm.
T331 130101-130183 Sentence denotes You may feel a pop or decreased resistance as the needle enters the marrow cavity.
T332 130184-130232 Sentence denotes Gently flush the needle with heparinized saline.
T333 130233-130389 Sentence denotes If the needle is plugged with bone debris, remove the needle and replace it with a fresh needle of the same type and size in the hole that you have created.
T334 130390-130451 Sentence denotes A spinal needle with an internal stylette also can be placed.
T335 130452-130545 Sentence denotes The stylette will prevent the needle from becoming clogged with bone debris during insertion.
T336 130546-130683 Sentence denotes Secure the hub of the needle with a butterfly length of white adhesive tape and then suture it to the skin to keep the catheter in place.
T337 130684-130718 Sentence denotes The catheter is now ready for use.
T338 130719-130814 Sentence denotes The patient should wear an Elizabethan collar to prevent disruption or removal of the catheter.
T339 130815-130952 Sentence denotes The intraosseous catheter can be maintained as any peripheral catheter, with frequent flushing and daily evaluation of the catheter site.
T340 130953-130971 Sentence denotes Beal MW, Hughes D:
T341 130972-131083 Sentence denotes Vascular access: theory and techniques in the small animal emergency patient, Clin Tech Small Anim Pract 15 (2)
T342 131085-131198 Sentence denotes The definition of pain has been debated philosophically over the ages and has changed as knowledge has increased.
T343 131199-131314 Sentence denotes Pain is defined as an unpleasant sensory or emotional experience associated with actual or perceived tissue damage.
T344 131315-131420 Sentence denotes Until recognition of a noxious stimulus occurs in the cerebral cortex, no response or adaptation results.
T345 131421-131601 Sentence denotes Rational management of pain requires an understanding of the underlying mechanisms involved in pain and an appreciation of how analgesic agents interact to disrupt pain mechanisms.
T346 131602-131687 Sentence denotes Multiple factors and causes produce pain in human beings and domestic animal species.
T347 131688-131939 Sentence denotes The causes of pain, psychological and physical, may derive from many different mechanisms within emergency medicine, among them trauma, infectious disease, neglect, environmental stress, surgery, and acute decompensation of chronic medical conditions.
T348 131940-131997 Sentence denotes The two major classes of pain are acute and chronic pain.
T349 131998-132052 Sentence denotes Box 1-20 gives specific categories and causes of pain.
T350 132053-132630 Sentence denotes The pain sensing and response system can be divided into the following categories: nociceptors, which detect and filter the intensity of the noxious stimuli; primary afferent nerves, which transmit impulses to the central nervous system (CNS); ascending tracts, which are part of the dorsal horn and the spinal cord that conveys stimuli to higher centers in the brain; higher centers, which are involved in pain discrimination, some memory, and motor control; and modulating or descending systems, which are a means of 1 processing, memorizing, and modifying incoming impulses.
T351 132631-132946 Sentence denotes Current analgesic therapies may inhibit afferent nociceptive transmission within the brain and spinal cord; directly interrupt neural impulse conduction through the dorsal horn, primary afferent nerves, or dorsal root ganglion; or prevent the nociceptor sensitization that accompanies initial pain and inflammation.
T352 132947-133198 Sentence denotes The physiologic aspects of pain are believed to be produced by the transmission, transduction, and integration of information from initial nerve endings, peripheral neuronal input, and ascending afferent nerves via the thalamus to the cerebral cortex.
T353 133199-133311 Sentence denotes Ascending afferent nerves to the limbic system are believed to be responsible for the emotional aspects of pain.
T354 133312-133381 Sentence denotes There are several classification schemes for different types of pain.
T355 133382-133564 Sentence denotes Acute pain, such as the pain that results from trauma, surgery, or infectious agents, is abrupt in onset, is relatively short in duration, and may be alleviated easily by analgesics.
T356 133565-133695 Sentence denotes In contrast, chronic pain is a long-standing physical disorder or emotional distress that is slow in onset and difficult to treat.
T357 133696-133765 Sentence denotes Both types of pain can be classified further based on site of origin.
T358 133766-133855 Sentence denotes Somatic pain arises from superficial skin, subcutaneous tissue, body wall, or appendages.
T359 133856-133964 Sentence denotes Visceral pain arises from abdominal or thoracic viscera and primarily is associated with serosal irritation.
T360 133965-134036 Sentence denotes Analgesia, then, is the loss of pain without the loss of consciousness.
T361 134037-134208 Sentence denotes This is in contrast to anesthesia, which is the loss of sensation in the whole body or a part of the body with the loss of consciousness or at least depression of the CNS.
T362 134209-134447 Sentence denotes Untreated pain causes immediate changes in the neurohormonal axis, which in turn causes restlessness, agitation, increased heart and respiratory rates, fever, and BP fluctuations, all of which are detrimental to the healing of the animal.
T363 134448-134579 Sentence denotes A catabolic state is created as a result of increased secretion of catabolic hormones and decreased secretion of anabolic hormones.
T364 134580-134695 Sentence denotes The net effect the majority of neurohormonal changes produce is an increase in the secretion of catabolic hormones.
T365 134696-134801 Sentence denotes Hyperglycemia is produced and may persist because of production of glucagon and relative lack of insulin.
T366 134802-134883 Sentence denotes Lipolytic activity is stimulated by cortisol, catecholamines, and growth hormone.
T367 134884-135002 Sentence denotes Cardiorespiratory effects of pain include increased cardiac output, vasoconstriction, hypoxemia, and hyperventilation.
T368 135003-135081 Sentence denotes Protein catabolism is a common occurrence and major concern regarding healing.
T369 135082-135293 Sentence denotes Pain associated with inflammation causes increase in tissue and blood levels of prostaglandins and cytokines, both of which promote protein catabolism indirectly by increasing the energy expenditure of the body.
T370 135294-135466 Sentence denotes Powerful evidence indicates that local anesthetic, sympathetic agonist, and opioid neural blockade may produce a modification of the responses to these physiologic changes.
T371 135467-135669 Sentence denotes Variable reduction in plasma cortisol, growth hormone, antidiuretic hormone, β-endorphin, aldosterone, epinephrine, norepinephrine, and renin is based on the anesthetic technique and the drugs selected.
T372 135670-135906 Sentence denotes Prophylactic administration of analgesics blunts the response before it occurs; analgesics administered after perception of pain are not as effective, and higher doses are generally necessary to achieve an equivalent level of analgesia.
T373 135908-136028 Sentence denotes Effective pain control can be achieved only when the signs of pain can be assessed effectively, reliably, and regularly.
T374 136029-136192 Sentence denotes The experience of pain is unique to each individual, which makes pain assessment difficult, especially in traumatized and patients and those in critical condition.
T375 136193-136397 Sentence denotes Most attempts to assess clinical pain use behavioral observations and interactive variables in addition to assessment of physiologic responses such as heart rate and respiratory rate, BP, and temperature.
T376 136398-136621 Sentence denotes But many factors can influence the processing and outward projection of pain, including altered environments, species differences, within-species variations (age, breed, sex), and the type, severity, and chronicity of pain.
T377 136622-136710 Sentence denotes Within-species differences (age, breed, and sex) further complicate the pain assessment.
T378 136711-136807 Sentence denotes Most notable is that different breeds of dogs act differently when confronted with pain or fear.
T379 136808-137018 Sentence denotes Labrador Retrievers tend to be stoic, whereas Greyhounds and teacup breeds tend to react with a heightened state of arousal around even the simplest of procedures (e.g., subcutaneous injections and nail trims).
T380 137019-137106 Sentence denotes The individual character and temperament of the animal further influences its response.
T381 137107-137209 Sentence denotes Pediatric and neonatal animals seem to have a lower threshold for pain and anxiety than older animals.
T382 137210-137341 Sentence denotes In any species, the duration and type of pain make it more (acute) or less (chronic) likely to be expressed or exhibited outwardly.
T383 137342-137486 Sentence denotes Unfamiliarity with normal behaviors typical of a particular species or breed makes recognition of their pain behaviors and responses impossible.
T384 137487-137566 Sentence denotes The definition and recognition of pain in an individual animal are challenging.
T385 137567-137706 Sentence denotes Because of all the differences discussed, there is no straight line from insult, albeit actual or perceived, to degree of pain experienced.
T386 137707-137787 Sentence denotes Nor is there a formula for treating "X" type of pain with "Y" type of analgesic.
T387 137788-137928 Sentence denotes A goal of analgesia is to treat all animals with analgesic drugs and modalities as preemptively as possible and using a multimodal approach.
T388 137929-138063 Sentence denotes Use analgesic treatment as a tool for diagnosis of pain in the event that recognition of these phenomena is difficult for the patient.
T389 138064-138232 Sentence denotes In other words, with countless drugs and treatment modalities available, analgesic administration should never be withheld from an animal, even if pain is questionable.
T390 138233-138345 Sentence denotes It is important to remember that no behavior or physiologic variable in and of itself is pathognomonic for pain.
T391 138346-138501 Sentence denotes Interactive and unprovoked (noninteractive) behavior assessments and trending of physiologic data are useful to determine the pain in an individual animal.
T392 138502-138532 Sentence denotes This is known as pain scoring.
T393 138533-138679 Sentence denotes Baseline observations, especially observations from someone who has known the animal well, can be helpful to serial behavior and pain assessments.
T394 138680-138865 Sentence denotes Pain scoring systems have been developed and are reviewed elsewhere; the purposes of these systems are to evaluate and to help guide diagnostic and analgesic treatments ( Table 1 -15) .
T395 138866-138979 Sentence denotes Regardless of the scale or method used to assess pain, the caregiver must recognize the limitations of the scale.
T396 138980-139088 Sentence denotes If in doubt regarding whether pain is present or not, analgesic therapy should be used as a diagnostic tool.
T397 139089-139226 Sentence denotes Classic behaviors associated with pain in dogs and cats include abnormal postures, gaits, movements, and behaviors (Boxes 1-21 and 1-22).
T398 139227-139557 Sentence denotes Stoicism is apparent apathy and indifference in the presence of pain and is perhaps the "number one" sign of ineffective pain relief or persistent pain in many animals, because so many display apathy and classically normal physiologic parameters even in the face of severe distress, overt suffering, or blatant trauma and illness.
T399 139558-139669 Sentence denotes The absence of normal behaviors is also a clinical sign of pain, even when abnormal behaviors are not observed.
T400 139670-139832 Sentence denotes Acute pain results in many of the aforementioned behavioral and physiologic signs, but chronic pain in small animals is an entirely different and distinct entity.
T401 139833-139939 Sentence denotes Chronic pain is often present in the absence of obvious tissue pathology and changes in physical demeanor.
T402 139940-140067 Sentence denotes Again, the severity of the pain may not correlate with the severity of any pathologic condition that may or may not be present.
T403 140068-140245 Sentence denotes Chronic pain, especially if insidious in onset (cancer, dental, or degenerative pain), may well go unnoticed in dogs and cats, even by family members or intermittent caregivers.
T404 140246-140482 Sentence denotes Inappetence, lack of activity, panting in a species classically designed to be nose breathers, decreased interest in surroundings, different activity patterns, and abnormal postures are just a few signs of chronic pain in cats and dogs.
T405 140483-140575 Sentence denotes Cats are a species that in particular are exemplary in their abilities to hide chronic pain.
T406 140576-140729 Sentence denotes They will exhibit marked familial withdrawal, finding secluded areas where they may remain for days to weeks when they experience acute and chronic pain.
T407 140730-140928 Sentence denotes When deciding on a pain management protocol for a patient, always perform a thorough physical examination and include a pain score assessment before injury and pain have occurred, whenever possible.
T408 140929-141075 Sentence denotes Form a problem list to guide your choice of anesthesia and t a B l e 1 -1 5 Pain scale 1 No pain 2 Mild pain 3 Moderate pain 4 Severe pain 5
T409 141076-141104 Sentence denotes Excruciating pain analgesia.
T410 141105-141219 Sentence denotes For example, using a nonsteroidal antiinflammatory drug (NSAID) in an animal with renal failure would not be wise.
T411 141220-141364 Sentence denotes Remember to account for current medications that the patient may be taking that may augment or interfere with the analgesic or anesthetic drugs.
T412 141365-141473 Sentence denotes Use multimodal techniques and regional therapy and drugs to target pain at different sites before it occurs.
T413 141474-141609 Sentence denotes Once a strategy has been decided on, frequently reassess the patient and tailor the protocol to meet each patient's response and needs.
T414 141610-141783 Sentence denotes meThods To reduCe PAin Drug therapy (in particular, opioids with or without α 2 -agonists) is a cornerstone for acute pain treatment and surgical preemptive pain prevention.
T415 141784-141997 Sentence denotes However, local anesthetics delivered epidurally, via perineural or plexus injection or intraarticular or trigger point injection, are also effective analgesics for acute and chronic forms of pain and inflammation.
T416 141998-142251 Sentence denotes The NSAIDs that classically have been reserved for treatment of more chronic or persistent pain states now are being used regularly for treatment of acute and perioperative pain once BP, coagulation, and gastrointestinal parameters have been normalized.
T417 142252-142394 Sentence denotes An opioid is any natural or synthetic drug that is derived from the poppy, which interacts with opiate receptors identified on cell membranes.
T418 142395-142559 Sentence denotes The drugs from this class constitute the most effective means of controlling acute, perioperative, and chronic pain in human and veterinary medicine (Table 1 -16) .
T419 142560-142794 Sentence denotes Their physiologic effects result from the interaction with one or more of at least five endogenous opioid receptors (μ, σ, δ, ε, and κ). μ-Receptor agonists are noted for their ability to produce profound analgesia with mild sedation.
T420 142795-142910 Sentence denotes These drugs diminish "windup, " the hyperexcitable state resulting from an afferent volley of nociceptive impulses.
T421 142911-142991 Sentence denotes They elevate the pain threshold and are used preemptively to prevent acute pain.
T422 142992-143062 Sentence denotes As a class, opioids cause CNS depression with their intense analgesia.
T423 143063-143153 Sentence denotes Dose-related respiratory depression reflects diminished response to carbon dioxide levels.
T424 143154-143279 Sentence denotes Cardiac depression is secondary only to bradycardia and is more likely with certain opioids such as morphine and oxymorphone.
T425 143280-143421 Sentence denotes Narcotics produce few if any clinically significant cardiovascular effects in dogs and cats; they are considered cardiac soothing or sparing.
T426 143422-143572 Sentence denotes Because opioids increase intracranial and intraocular pressure, use them more cautiously in patients with severe cranial trauma and or ocular lesions.
T427 143573-143665 Sentence denotes Opioids directly stimulate the chemoreceptor trigger zone and may cause nausea and vomiting.
T428 143666-143812 Sentence denotes Most opioids depress the cough reflex via a central mechanism; this may be helpful in patients recovering from endotracheal intubation irritation.
T429 143813-143944 Sentence denotes A key characteristic of opioids that makes them desirable for use in emergency and critical care situations is their reversibility.
T430 143945-144061 Sentence denotes Antagonists block or reverse the effect of agonists by combining with receptors and producing minimal or no effects.
T431 144062-144437 Sentence denotes Administer all reversal agents, such as naloxone and naltrexone, slowly if given intravenously and to effect. a 2 -AgonisTs As a class of drugs, α 2 -agonists warrant special attention because most members of the group possess potent analgesic power at doses that are capable of causing sedation, CNS depression, cardiovascular depression, and even general anesthetic states.
T432 144438-144585 Sentence denotes Originally developed for antihypertensive use, α 2 -agonists quickly have attained sedative analgesic status in veterinary medicine (Table 1 -17) .
T433 144586-144703 Sentence denotes Like the opioids, α 2 -agonists produce their effects by aggravating α-adrenergic receptors in the CNS and periphery.
T434 144704-144931 Sentence denotes nonsTeroidAl AnTiinFlAmmATory drugs NSAIDs, which classically have been used to treat chronic pain and inflammation, as well as cardiovascular diseases, have taken on a new role in the treatment of perioperative and acute pain.
T435 144932-145124 Sentence denotes Recently developed potent oral and parenteral forms of these drugs have compared favorably with and sometimes superiorly to opioids for treatment of acute inflammation and pain (Table 1 -18) .
T436 145125-145361 Sentence denotes Nonsteroidal drugs can be used alone, but their best use is that of providing synergistic analgesia with different classes of analgesics (narcotics) or modalities (local, regional, and epidural analgesia, physical therapy, acupuncture).
T437 145362-145579 Sentence denotes Most NSAIDS act by inhibition of cyclooxygenase (COX; also known as prostaglandin synthetase), an enzyme that catalyzes the incorporation of molecular oxygen into arachidonic acid to produce mediators of inflammation.
T438 145580-145843 Sentence denotes There are at least a few forms of COX, among them COX-1, the major constitutive enzyme primarily involved in normal physiologic functions, and COX-2, the enzyme responsible for most of the hyperalgesia and pain responses experienced after tissue injury or trauma.
T439 145844-145894 Sentence denotes Some NSAIDS inhibit COX and lipoxygenase activity.
T440 145895-146157 Sentence denotes Most of the currently available oral and parenteral NSAIDS for small t a B l e 1 -1 7 a 2 -agonists used for analgesia and sedation 1 animal medicine and surgery target the COX pathways predominantly, although one (tepoxalin) is thought to inhibit both pathways.
T441 146158-146295 Sentence denotes Inhibition of COX-1 and COX-2 can inhibit the protective effects and impair platelet aggregation and lead to gastrointestinal ulceration.
T442 146296-146386 Sentence denotes There are definite contraindications and relative contraindications for the use of NSAIDs.
T443 146387-146647 Sentence denotes NSAIDs should not be administered to patients with renal or hepatic insufficiency, dehydration, hypotension, or conditions that are associated with low circulating volume (CHF, unregulated anesthesia, shock), or evidence of ulcerative gastrointestinal disease.
T444 146648-146767 Sentence denotes Trauma patients should be stabilized completely regarding vascular volume, tone, and pressure before the use of NSAIDs.
T445 146768-147044 Sentence denotes Patients receiving concurrent administration of other NSAIDs or corticosteroids, or those considered to be cushingoid, should be evaluated carefully for an adequate "washout" period (time of clearance of drug from the system) before use of an NSAID or before switching NSAIDs.
T446 147045-147315 Sentence denotes Patients with coagulopathies, particularly those that are caused by platelet number or function defects or those caused by factor deficiencies, and patients with severe, uncontrolled asthma or other bronchial disease are probably not the patients in which to use NSAIDs.
T447 147316-147522 Sentence denotes Other advice is that NSAIDs not be administered to pregnant patients or to females attempting to become pregnant because COX-2 induction is necessary for ovulation and subsequent implantation of the embryo.
T448 147523-147737 Sentence denotes The administration of NSAIDs should be considered only in the well-hydrated, normotensive dog or cat with normal renal or hepatic function, with no hemostatic abnormalities and no concurrent steroid administration.
T1 147738-147817 Sentence denotes NSAIDs can be used in many settings of acute and chronic pain and inflammation.
T2 147818-148128 Sentence denotes Among these are well-stabilized musculoskeletal trauma and surgical pain, osteoarthritis management, meningitis, mastitis, animal bite and other wound healing, mammary or transitional cell carcinoma, epithelial (dental, oral, urethral) inflammation, ophthalmologic procedures, and dermatologic or otic disease.
T3 148129-148280 Sentence denotes Whereas opioids seem to have an immediate analgesic effect when administered, most NSAIDS will take up to 30 minutes for their effect to be recognized.
T4 148281-148431 Sentence denotes Therefore most perioperative or acute NSAID use is part of a balanced pain management scheme, one that uses narcotics and local anesthetic techniques.
T5 148432-148603 Sentence denotes NSAIDs are devoid of many of the side effects of narcotic administration-namely, decreased gastrointestinal motility, altered sensorium, nausea and vomiting, and sedation.
T6 148604-148731 Sentence denotes NSAIDs are also devoid of many of the side effects of steroid administration-namely, suppression of the pituitary adrenal axis.
T7 148732-148793 Sentence denotes The toxic effects of salicylates in cats are well documented.
T8 148794-148924 Sentence denotes Cats are susceptible because of slow clearance and dose-dependent elimination caused by deficient glucuronidation in this species.
T9 148925-149067 Sentence denotes Because of this, the dose and the administration interval of most commonly used NSAIDs need to be altered in order for these drugs to be used.
T10 149068-149308 Sentence denotes Cats that have been given canine doses of NSAIDs (twice daily or even once daily repetitively) may show hyperthermia, hemorrhagic or ulcerative gastritis, kidney and liver injury, hyperthermia, respiratory alkalosis, and metabolic acidosis.
T11 149309-149426 Sentence denotes Acute and chronic toxicities of NSAIDs have been reported in cats, especially after repeat once-daily administration.
T12 149427-149627 Sentence denotes Ketoprofen, flunixin, aspirin, carprofen, and meloxicam have been administered safely to cats, although like most antibiotics and other medications, they are not approved and licensed for use in cats.
T13 149628-149854 Sentence denotes An important note, though, is that administration intervals ranging from 48 to 96 hours have been used, and antithrombotic effects often can be achieved at much lower doses than those required to treat fevers and inflammation.
T14 149855-150013 Sentence denotes I recommend the use of no loading doses, minimum 48-hour administration intervals, and assurance of adequate circulating blood volume, BP, and renal function.
T15 150014-150245 Sentence denotes Because many of the NSAIDs are used off-label in cats, it is imperative that the clinician carefully calculate the dose, modify the administration interval, and communicate this information to the client before dispensing the drug.
T16 150246-150395 Sentence denotes Even drugs that come in liquid form (meloxicam), if administered to cats via box-labeled directions used for dogs, will be given in near toxic doses.
T17 150396-150686 Sentence denotes To worsen the misunderstanding about dosages for cats, drops from manufacturer's bottles often are calibrated drops; when these same liquids are transferred into pharmacy syringes for drop administration, the calibration, of course, is lost, and the animal potentially receives an overdose.
T18 150687-150909 Sentence denotes A more accurate method of dispensing oral NSAIDs for use in cats and administering them is to calculate the dose in milligrams and determine the exact number of milliliters to administer, rather than using the drop method.
T19 150910-151059 Sentence denotes Ketamine classically was considered a dissociative anesthetic, but it also has potent activity as an N-methyl-d-aspartate (NMDA) receptor antagonist.
T20 151060-151176 Sentence denotes This receptor, located in the CNS, mediates windup and central sensitization (a pathway from acute to chronic pain).
T21 151177-151362 Sentence denotes Blockade of this receptor with microdoses of ketamine results in the ability to provide body surface, somatic, and skin analgesia with potentially lower doses of opioids and α-agonists.
T22 151363-151439 Sentence denotes Loading doses of 0.5 to 2 mg/kg are used IV with CRIs of 2 to 20 mcg/kg/min.
T23 151440-151619 Sentence denotes In and of itself, this drug possesses little to no analgesic ability and indeed in high doses alone often can aggravate, sensitize, or excite the animal in subacute or acute pain.
T24 151620-151748 Sentence denotes Amantadine is another NMDA blocker that has been used for its antiviral properties and stabilizing effects in Parkinson disease.
T25 151749-151849 Sentence denotes Amantadine has been used for neuropathic pain in human beings but is available only in an oral form.
T26 151850-151935 Sentence denotes Suggested starting doses for cats and dogs range from 3 to 5 mg/kg orally (PO) daily.
T27 151936-152070 Sentence denotes When the drug is given PO or IV, patients are unlikely to develop behavioral or cardiorespiratory effects with ketamine or amantadine.
T28 152071-152195 Sentence denotes Tramadol is an analgesic that possesses weak opioid μ-agonist activity and norepinephrine and serotonin reuptake inhibition.
T29 152196-152258 Sentence denotes Tramadol is useful for mild to moderate pain in small animals.
T30 152259-152386 Sentence denotes Although the parent compound has very weak opioid activity, the metabolites have excellent binding affinity for the μ receptor.
T31 152387-152525 Sentence denotes Tramadol has been used for perisurgical pain control when given PO in cats and dogs at a dose of 1 to 4 mg/kg PO once to four times daily.
T32 152526-152665 Sentence denotes Regardless of its affinity for the opioid receptors, the true mechanism of action of tramadol in companion animals remains largely unknown.
T33 152666-152729 Sentence denotes Gabapentin is a synthetic analog of γ-aminobutyric acid (GABA).
T34 152730-152864 Sentence denotes Originally introduced as an antiepileptic drug, the mechanism of action of gabapentin remains somewhat unclear in veterinary medicine.
T35 152865-152978 Sentence denotes The drug is among a number of commonly used antiepileptic medications used to treat central pain in human beings.
T36 152979-153085 Sentence denotes The rationale for use is the ability of the drugs to suppress discharge in pathologically altered neurons.
T37 153086-153181 Sentence denotes Gabapentin does this through calcium channel modulation without binding to glutamate receptors.
T38 153182-153291 Sentence denotes Chronic, burning, neuropathic, and lancinating pain in small animals responds well to 1 to 10 mg/kg PO daily.
T39 153292-153397 Sentence denotes Local anesthetic agents are the major class of drugs used as peripheral-acting analgesics (Table 1 -19) .
T40 153398-153499 Sentence denotes Local anesthetics block the transmission of pain impulses at the peripheral nerve nociceptor regions.
T41 153500-153617 Sentence denotes Local anesthetics may be used to block peripheral nerves or inhibit nerve "zones" through use of regional techniques.
T42 153618-153770 Sentence denotes Although all local anesthetics are capable of providing pain relief, agents with a longer duration of action are preferred for pain management purposes.
T43 153771-153897 Sentence denotes Bupivacaine is an example of a longacting local anesthetic drug that is used along with lidocaine for long-acting pain relief.
T44 153898-154014 Sentence denotes A single dose of bupivacaine injected at a local site will provide local anesthesia and analgesia for 6 to 10 hours.
T45 154015-154233 Sentence denotes Lidocaine administered as an intravenous CRI (50 to 75 mcg/kg/min in dogs, 1 to 10 mcg/ kg/min in cats) is effective in the treatment of chronic neuropathic pain and periosteal and peritoneal pain (e.g., pancreatitis).
T46 154234-154370 Sentence denotes Mexiletine, an oral sodium channel blocker, can be used as an alternative to injectable lidocaine for provision of background analgesia.
T47 154371-154497 Sentence denotes Many drugs (Table 1 -20) are used in combination with opioids, α 2 -agonists, and ketamine to provide anxiolysis and sedation.
T48 154498-154717 Sentence denotes Injection of local anesthetic solution into the connective tissue surrounding a particular nerve produces loss of sensation (sensory blockade) and/or paralysis (motor nerve blockade) in the region supplied by the nerve.
T49 154718-154832 Sentence denotes Local anesthetics also may be administered epidurally, intrathoracically, intraperitoneally, and intraarticularly.
T50 154833-154912 Sentence denotes Lidocaine and bupivacaine are the most commonly administered local anesthetics.
T51 154913-154985 Sentence denotes Lidocaine provides for quick, short-acting sensory and motor impairment.
T52 154986-155080 Sentence denotes Bupivacaine provides for later-onset, longer-lasting desensitization without motor impairment.
T53 155081-155230 Sentence denotes Combinations of the two agents diluted with saline are used frequently to provide for quick-onset analgesia that lasts 4 to 6 hours in most patients.
T54 155231-155353 Sentence denotes Adding a narcotic and/or an α 2 agent often maximizes the analgesia and increases the pain-free interval to 8 to 18 hours.
T55 155354-155419 Sentence denotes Epinephrine-free and preservative-free solutions are recommended.
T56 155420-155546 Sentence denotes Precision placement of anesthetic close to nerves, roots, or plexuses is improved with the use of a stimulating nerve locator.
T57 155547-155699 Sentence denotes Cats seem to be more sensitive to the effects of local anesthetics; therefore the lower ends of most dose ranges are used for blockades in this species.
T58 155700-155987 Sentence denotes Unlike most instances of general anesthesia, during which the animal is rendered unconscious and nerve transmission is decreased by virtue of CNS depression, local and regional techniques block the initiation of noxious signals, thereby effectively preventing pain from entering the CNS.
T59 155988-156213 Sentence denotes This is an effective means not only of preventing initial pain but also of reducing the changes that take place in the dorsal horn of the spinal cord, spinothalamic tracts, limbic and reticular activating centers, and cortex.
T60 156214-156309 Sentence denotes Frequently the neurohormonal response that is stimulated in pain and stress is blunted as well.
T61 156310-156476 Sentence denotes Overall, the patient has fewer local and systemic adverse effects of pain, disease processes are minimized, chronic pain states are unlikely, and outcome is improved.
T62 156477-156646 Sentence denotes Regional techniques are best used as part of an analgesic regimen that consists of their continuous administration, narcotics, α-agonists, anxiolytics, and good nursing.
T63 156647-156872 Sentence denotes Lidocaine can be added to sterile lubricant in a one-to-one concentration to provide decreased sensation for urinary catheterization, nasal catheter insertion, minor road burn analgesia, and pyotraumatic dermatitis analgesia.
T64 156873-156949 Sentence denotes Proparacaine is a topical anesthetic useful for corneal or scleral injuries.
T65 156950-157111 Sentence denotes Local anesthetics can be used to infiltrate areas of damage or surgery through use of long-term continuous drainage catheters and small, portable infusion pumps.
T66 157112-157223 Sentence denotes This is an effective means of providing days of analgesia for massive surgical or traumatic soft tissue injury.
T67 157224-157518 Sentence denotes Even without the catheter, incisional or regional soft tissue blocking using a combination of 1 to 2 mg of lidocaine per kilogram and 0.5 to 2 mg of bupivacaine per kilogram diluted with equal volume of saline and 1:9 with sodium bicarbonate is effective for infiltrating large areas of injury.
T68 157519-157736 Sentence denotes Administration of local anesthetic drugs around the infraorbital, maxillary, ophthalmic mental, and alveolar nerves can provide excellent analgesia for dental, orofacial, and ophthalmic trauma and surgical procedures.
T69 157737-157930 Sentence denotes Each nerve may be desensitized by injecting 0.1 to 0.3 mL of a 2% lidocaine hydrochloride solution and 0.1 to 0.3 mL of a 0.5% bupivacaine solution using a 1.2 to 2.5-cm, 22-to 25-gauge needle.
T70 157931-158085 Sentence denotes Precise placement perineurally versus intraneurally (neuroma formation common) is enhanced by using catheters in the foramen versus needle administration.
T71 158086-158180 Sentence denotes Always perform aspiration before administration to rule out intravascular injection of agents.
T72 158181-158326 Sentence denotes inTrAPleurAl BloCkAde Intrapleural blockade is used to provide analgesia for thoracic, lower cervical, cranial abdominal, and diaphragmatic pain.
T73 158327-158522 Sentence denotes After aseptic preparation, place a small through-theneedle (20 to 22-gauge) catheter in the thoracic cavity between the seventh and ninth intercostal space on the midlateral aspect of the thorax.
T74 158523-158783 Sentence denotes Aseptically mix a 0.5-to 1-mg/kg lidocaine and a 0.2 to 0.5-mg/kg bupivacaine dose with volume of saline equal to the volume of bupivacaine, and slowly inject it over a period of 2 to 5 minutes after aspiration to ensure that no intravascular injection occurs.
T75 158784-158893 Sentence denotes Depending on where the lesion is, position the patient to allow the intrapleural infusion to "coat" the area.
T76 158894-159091 Sentence denotes Most effective is positioning the patient in dorsal recumbency for several minutes after the block to make sure local anesthetic occupies the paravertebral gutters and hence the spinal nerve roots.
T77 159092-159175 Sentence denotes The block should be repeated every 3 hours in dogs and every 8 to 12 hours in cats.
T78 159176-159246 Sentence denotes Secure the catheter to the skin surface for repetitive administration.
T79 159247-159413 Sentence denotes Administration of local anesthetic around the brachial plexus provides excellent analgesia for forelimb surgery, particularly distal to the shoulder, and amputations.
T80 159414-159560 Sentence denotes Nerve locatorguided techniques are much more accurate and successful than blind placement of local anesthetic; however, even the latter is useful.
T81 159561-159625 Sentence denotes To administer a brachial plexus blockade, follow this procedure:
T82 159626-159628 Sentence denotes 1.
T83 159629-159701 Sentence denotes Aseptically prepare a small area of skin over the point of the shoulder.
T84 159702-159704 Sentence denotes 2.
T85 159705-159930 Sentence denotes Insert a 22-gauge, 1 1 ⁄2-to 3-inch spinal needle medial to the shoulder joint, axial to the lesser tubercle, and advance it caudally, medial to the body of the scapula, and toward the costochondral junction of the first rib.
T86 159931-160018 Sentence denotes Aspirate first before injection to make sure that intravenous injection does not occur.
T87 160019-160021 Sentence denotes 3.
T88 160022-160180 Sentence denotes Inject one third of the volume of local anesthetic mix, and then slowly withdraw the needle and fan dorsally and ventrally while infusing the remaining fluid.
T89 160181-160183 Sentence denotes 4.
T90 160184-160254 Sentence denotes Local anesthetic doses are similar to those for intrapleural blockade.
T91 160255-160413 Sentence denotes ePidurAl AnesThesiA And AnAlgesiA Epidural analgesia refers to the injection of an opioid, a phencyclidine, an α-agonist, or an NSAID into the epidural space.
T92 160414-160480 Sentence denotes Epidural anesthesia refers to the injection of a local anesthetic.
T93 160481-160531 Sentence denotes In most patients a combination of the two is used.
T94 160532-160720 Sentence denotes Epidural analgesia and anesthesia are used for acute and chronic surgical pain or traumatically induced pain in the pelvis, tail, perineum, hind limbs, abdomen, and thorax ( Table 1 -21) .
T95 160721-160964 Sentence denotes Procedures in which epidural analgesia and anesthesia are useful include forelimb and hindlimb amputation, tail or perineal procedures, cesarean sections, diaphragmatic hernia repair, pancreatitis, peritonitis, and intervertebral disk disease.
T96 160965-161154 Sentence denotes Epidural blocks performed using opioids or bupivacaine will not result in hindlimb paresis or decreased urinary or anal tone (incontinence), unlike lidocaine or mepivacaine epidural blocks.
T97 161155-161279 Sentence denotes Morphine is one of the most useful opioids for administration in the epidural space because of its slow systemic absorption.
T98 161280-161403 Sentence denotes Epidural catheters used for the instillation of drugs through CRI or intermittent injection can be placed in dogs and cats.
T99 161404-161571 Sentence denotes Routinely placed at the lumbosacral junction, these catheters are used with cocktails including preservative-free morphine, bupivacaine, dexmedetomidine, and ketamine.
T100 161572-161743 Sentence denotes Extremely effective for preventing windup pain in the peritoneal cavity or caudal half of the body, the catheters may be maintained if placed aseptically for 7 to 14 days.
T101 161744-161811 Sentence denotes To provide epidural analgesia or anesthesia, follow this procedure:
T102 161812-161814 Sentence denotes 1.
T103 161815-161868 Sentence denotes Position the animal in lateral or sternal recumbency.
T104 161869-161871 Sentence denotes 2.
T105 161872-161925 Sentence denotes Clip and aseptically scrub over the lumbosacral site.
T106 161926-161928 Sentence denotes 3.
T107 161929-162119 Sentence denotes Palpate the craniodorsal-most extent of the wings of the ileum bilaterally and draw an imaginary line through them to envision the spine of L7, located immediately behind the imaginary line.
T108 162120-162122 Sentence denotes 4.
T109 162123-162240 Sentence denotes Advance a 20-to 22-gauge, 1 1 ⁄2-to 3-inch spinal or epidural needle through the skin just caudal to the spine of L7.
T110 162241-162243 Sentence denotes 5.
T111 162244-162320 Sentence denotes The needle will lose resistance as it is introduced into the epidural space.
T112 162321-162436 Sentence denotes Drop saline into the hub of the needle, and the saline will be pulled into the epidural space as the needle enters.
T113 162438-162539 Sentence denotes Discrete intercostal nerve blocks can provide effective analgesia for traumatic or postsurgical pain.
T114 162540-162647 Sentence denotes Identify the area of the injury, and infiltrate three segments on either side of the injury with analgesic.
T115 162648-162709 Sentence denotes To perform an intercostal nerve block, follow this procedure:
T116 162710-162712 Sentence denotes 1.
T117 162713-162787 Sentence denotes Clip and aseptically scrub the dorsal and ventral third of the chest wall.
T118 162788-162790 Sentence denotes 2.
T119 162791-162849 Sentence denotes Palpate the intercostal space as far dorsally as possible.
T120 162850-162852 Sentence denotes 3.
T121 162853-162971 Sentence denotes Use a 25-gauge, 5 ⁄8-inch needle at the caudolateral aspect of the affected rib segments and those cranial and caudal.
T122 162972-162974 Sentence denotes 4.
T123 162975-163245 Sentence denotes Direct the tip of the needle caudally such that the tip of the needle "drops" off of the caudal rib. (This places the needle tip in proximity to the neuromuscular bundle that contains the intercostal nerve that runs in a groove on the caudomedial surface of the rib.) 5.
T124 163246-163295 Sentence denotes Aspirate to confirm that the drug will not go IV.
T125 163296-163298 Sentence denotes 6.
T126 163299-163342 Sentence denotes Inject while slowly withdrawing the needle.
T127 163343-163414 Sentence denotes Inject 0.5 to 1.0 mL at each site, depending on the size of the animal.
T128 163415-163425 Sentence denotes Gaynor JS,
T129 163427-163590 Sentence denotes An acute condition in the abdomen is defined as the sudden onset of abdominal discomfort or pain caused by a variety of conditions involving intraabdominal organs.
T130 163591-163750 Sentence denotes Many animals have the primary complaint of lethargy, anorexia, ptyalism, vomiting, retching, diarrhea, hematochezia, crying out, moaning, or abnormal postures.
T131 163751-163954 Sentence denotes Abnormal postures can include generalized rigidity, walking tenderly or as if "on eggshells, " or a prayer position in which the front limbs are lowered to the ground while the hind end remains standing.
T132 163955-164092 Sentence denotes In some cases it may be difficult initially to distinguish between true abdominal pain or referred pain from intervertebral disk disease.
T133 164093-164310 Sentence denotes Rapid progression and decompensation of the patient's cardiovascular status can lead to stupor, coma, and death in the most extreme cases, making rapid assessment, treatment, and definitive care extremely challenging.
T134 164311-164423 Sentence denotes Often the patient's signalment and history can increase the index of suspicion for a particular disease process.
T135 164424-164556 Sentence denotes A thorough history often is overlooked or postponed in the initial stages of resuscitation of the patient with acute abdominal pain.
T136 164557-164735 Sentence denotes Often, asking the same question in a variety of forms can elicit an answer from the client that may lead to the source of the problem and the reason for the acute abdominal pain.
T137 164736-165245 Sentence denotes Important questions to ask the client include the following: ❏ What is your chief complaint or the reason you brought your animal in for emergency treatment? ❏ When did the signs first start, or when was your animal last normal? ❏ Do you think that the signs have been the same, getting better, or getting worse? ❏ Does your animal have any ongoing or past medical problems? ❏ Have similar signs occurred in the past? ❏ Does your animal have access to any known toxins, or does he or she run loose unattended?
T138 165246-166375 Sentence denotes 1 ❏ Has your animal ingested any garbage, compost, or table scraps recently? ❏ Are there any other animals in your household, and are they acting sick or normal? ❏ Has your animal been vaccinated recently? ❏ Has there been any change in your pet's appetite? ❏ Have you noticed any weight loss or weight gain? ❏ Have you noticed any increase or decrease in water consumption or urination? ❏ Does your animal chew on bones or toys? ❏ Have you noticed any toys, socks, underwear, or other items missing from your household? ❏ Is there a possibility that the animal has sustained any trauma, including being hit by a car or kicked by a larger animal or person? ❏ Have you noticed a change in your pet's defecation habits? ❏ Have you seen any vomiting or diarrhea? ❏ What does the vomitus or diarrhea look like? ❏ Does the vomitus occur in relation to eating? ❏ Is there any blood or mucus in the vomitus or diarrhea? ❏ When was the last time your animal vomited or had diarrhea? ❏ When your animal vomits, does it actively retch with abdominal contractions, or is it more passive like regurgitation? ❏ What is the color of the feces?
T139 166376-166441 Sentence denotes Is it black or red? ❏ Does the vomit smell malodorous like feces?
T140 166442-166569 Sentence denotes As with any other emergency, the clinician must follow the ABCs of therapy, and treat the most life-threatening problems first.
T141 166570-166619 Sentence denotes Perform a perfunctory physical examination first.
T142 166620-166678 Sentence denotes Briefly observe the patient from a distance, and consider:
T143 166679-166711 Sentence denotes Are there any abnormal postures?
T144 166712-166742 Sentence denotes Is there respiratory distress?
T145 166743-166818 Sentence denotes Is the animal ambulatory, and if so, do you observe any gait abnormalities?
T146 166819-166868 Sentence denotes Do you observe any ptyalism or attempts to vomit?
T147 166869-166975 Sentence denotes Auscult the patient's thorax for crackles, which may signify aspiration pneumonia resulting from vomiting.
T148 166976-167091 Sentence denotes Examine the patient's mucous membrane color and capillary refill time, heart rate, heart rhythm, and pulse quality.
T149 167092-167184 Sentence denotes Many patients in pain have tachycardia, which may or may not be accompanied by dysrhythmias.
T150 167185-167362 Sentence denotes If a patient's heart rate is inappropriately bradycardic, consider hyperkalemia, in association with hypoadrenocorticism, whipworm infestation, or urinary obstruction or trauma.
T151 167363-167505 Sentence denotes Evaluate the patient's hydration status by examining skin turgor, mucous membrane dryness, and whether the eyes appear sunken in their orbits.
T152 167506-167675 Sentence denotes Perform a brief neurologic examination, and determine whether the patient is actively having a seizure or whether mental dullness, stupor, coma, or nystagmus is present.
T153 167676-167790 Sentence denotes Posture and spinal reflexes can assist in making a diagnosis of intervertebral disk disease versus abdominal pain.
T154 167791-167875 Sentence denotes Perform a rectal examination to evaluate for the presence of hematochezia or melena.
T155 167876-168004 Sentence denotes Examine the abdomen last, in case inciting a painful stimulus precludes you from evaluating other organ systems more thoroughly.
T156 168005-168105 Sentence denotes Visually inspect the abdomen for the presence of external masses, bruising, or penetrating injuries.
T157 168106-168221 Sentence denotes Reddish discoloration of the periumbilical area often is associated with the presence of intraabdominal hemorrhage.
T158 168222-168342 Sentence denotes It may be necessary to shave the fur to inspect the skin and underlying structures visually for bruising and ecchymoses.
T159 168343-168432 Sentence denotes Auscult the abdomen for the presence or absence of borborygmi to characterize gut sounds.
T160 168433-168553 Sentence denotes Next, perform percussion and ballottement to evaluate for the presence of a gas-distended viscus or peritoneal effusion.
T161 168554-168735 Sentence denotes Finally, perform first superficial and then deep palpation of all quadrants of the abdomen, noting abnormal enlargement or masses and whether focal pain is elicited in any one area.
T162 168736-168875 Sentence denotes Once the physical examination has been performed, implement initial therapy in the form of analgesia, fluid resuscitation, and antibiotics.
T163 168876-169069 Sentence denotes TreATmenT Treatment for any patient with an acute condition in the abdomen and shock is to treat the underlying cause, maintain tissue oxygen delivery, and prevent end-organ damage and failure.
T164 169070-169160 Sentence denotes A more complete description of shock and oxygen delivery is given in the section on shock.
T165 169161-169321 Sentence denotes The administration of analgesic agents to any patient with acute abdominal pain is one of the most important therapies in the initial stages of case management.
T166 169322-169414 Sentence denotes Table 1 -22 lists analgesic drugs for use in the patient with an acute condition in abdomen.
T167 169415-169523 Sentence denotes Table 1 -23 lists analgesic and anxiolytic drugs to avoid in the patient with an acute condition in abdomen.
T168 169524-169640 Sentence denotes Many patients with acute abdominal pain are clinically dehydrated or are in hypovolemic shock because of hemorrhage.
T169 169641-169858 Sentence denotes Careful titration of intravenous crystalloid and colloid fluids including blood products is necessary based on the patient's perfusion parameters including heart rate, capillary refill time, BP, urine output, and PCV.
T170 169859-170017 Sentence denotes Fluid therapy also should be based on the most likely differential diagnoses, with specific fluid types administered according to the primary disease process.
T171 170018-170110 Sentence denotes In dogs, a shock volume of fluids is calculated based on the total blood volume of 90 mL/kg.
T172 170111-170175 Sentence denotes In cats, shock fluid rate is based on plasma volume of 44 mL/kg.
T173 170176-170395 Sentence denotes In most cases any crystalloid fluid can be administered at an initial volume of one fourth of a calculated shock dose and then titrated according to whether the patient's cardiovascular status responds favorably or not.
T174 170396-170631 Sentence denotes In cases of an acute condition in the abdomen from known or suspected hypoadrenocorticism, severe whipworm infestation, or urinary tract obstruction or rupture, 0.9% sodium chloride fluid without added potassium is the fluid of choice.
T175 170632-170832 Sentence denotes When hemorrhage is present, the administration of whole blood or packed RBCs may be indicated if the patient has clinical signs of anemia and shows clinical signs of lethargy, tachypnea, and weakness.
T176 170833-170998 Sentence denotes Fresh frozen plasma is indicated in cases of hemorrhage resulting from vitamin K antagonist rodenticide intoxication or hepatic failure or in cases of suspected DIC.
T177 170999-171096 Sentence denotes A more thorough description of fluid therapy is given in the sections on shock and fluid therapy.
T178 171097-171235 Sentence denotes The empiric use of broad-spectrum antibiotics is warranted in cases of suspected sepsis or peritonitis as a cause of acute abdominal pain.
T179 171236-171449 Sentence denotes Ampicillin sulbactam (22 mg/kg IV q6-8h) and enrofloxacin (10 mg/kg once daily) are the combination treatment of choice to cover t a B l e 1 -2 2 analgesic agents for use in dogs and cats with acute abdominal Pain
T180 171451-171577 Sentence denotes Obtain a urinalysis via cystocentesis whenever possible, except in cases of suspected pyometra or transitional cell carcinoma.
T181 171578-171691 Sentence denotes Azotemia in the presence of nonconcentrated (isosthenuric or hyposthenuric) urine suggests primary renal disease.
T182 171692-171838 Sentence denotes Secondary causes of apparent renal azotemia and lack of concentrating ability also occur in cases of hypoadrenocorticism and gram-negative sepsis.
T183 171839-171938 Sentence denotes Renal tubular casts may be present in cases of acute renal ischemia or toxic insult to the kidneys.
T184 171939-172009 Sentence denotes Bacteriuria and pyuria may be present with infection and inflammation.
T185 172010-172207 Sentence denotes When a urinalysis is obtained via free catch or urethral catheterization, the presence of bacteriuria or pyuria also may be associated with pyometra, vaginitis, or prostatitis or prostatic abscess.
T186 172208-172355 Sentence denotes Serum lactate is a biochemical indicator of decreased organ perfusion, decreased oxygen delivery or extraction, and end-organ anaerobic glycolysis.
T187 172356-172566 Sentence denotes Elevated serum lactate greater than 6 mmol/L has been associated with increased morbidity and need for gastric resection in cases of GDV and increased patient morbidity and mortality in other disease processes.
T188 172567-172859 Sentence denotes A more recent study showed that initial lactate concentrations greater than 9.0 mmol/L or a lactate concentration that does not significantly decrease by 4 mmol/L or 42.5% of initial serum value after fluid resuscitation was associated with an increased risk of complications including death.
T189 172860-172963 Sentence denotes A rising serum lactate level in the face of adequate fluid resuscitation is a negative prognostic sign.
T190 172964-173064 Sentence denotes The serum glucose level can sometimes decrease in animals with sepsis, including septic peritonitis.
T191 173065-173202 Sentence denotes Glucose concentrations of abdominal fluid are significantly lower in animals with septic peritonitis compared with nonseptic peritonitis.
T192 173203-173466 Sentence denotes In animals with septic peritonitis, comparison of abdominal fluid glucose concentrations with peripheral serum concentrations shows that an abdominal glucose concentration 20 mg/dL or more lower than that of peripheral blood is consistent with septic peritonitis.
T193 173467-173596 Sentence denotes Obtain abdominal radiographs as one of the first diagnostic tests when deciding whether to pursue medical or surgical management.
T194 173597-173727 Sentence denotes The presence of GDV, linear foreign body, pneumoperitoneum, pyometra, or splenic torsion warrants immediate surgical intervention.
T195 173728-173960 Sentence denotes If a loss of abdominal detail occurs because of peritoneal effusion, perform additional diagnostic tests including abdominal paracentesis (abdominocentesis) and abdominal ultrasound to determine the cause of the peritoneal effusion.
T196 173961-174055 Sentence denotes Abdominal ultrasonography is often useful in place of or in addition to abdominal radiographs.
T197 174056-174131 Sentence denotes The sensitivity of abdominal ultrasonography is largely operator-dependent.
T198 174132-174567 Sentence denotes Indications for immediate surgical intervention include loss of blood flow to an organ, linear bunching or placation of the intestinal tract, intussusception, pancreatic phlegmon or abscess, a fluid-filled uterus suggestive of pyometra, gastrointestinal obstruction, intraluminal gastrointestinal foreign body, dilated bile duct, gallbladder mucocele, or gas within the wall of the stomach or gallbladder (emphysematous cholecystitis).
T199 174568-174722 Sentence denotes The presence of peritoneal fluid alone does not warrant immediate surgical intervention without cytologic and biochemical evaluation of the fluid present.
T200 174723-174788 Sentence denotes See also Abdominal Paracentesis and Diagnostic Peritoneal Lavage.
T201 174789-174900 Sentence denotes Abdominal paracentesis (abdominocentesis) often is the deciding factor in whether to perform immediate surgery.
T202 174901-175051 Sentence denotes Abdominocentesis is a sensitive technique for detecting peritoneal effusion in the presence of more than 6 mL/kg of fluid within the abdominal cavity.
T203 175052-175229 Sentence denotes Abdominal effusion collected should be saved for bacterial culture and evaluated biochemically and cytologically based on your index of suspicion of the primary disease process.
T204 175230-175326 Sentence denotes If creatinine, BUN, or potassium is elevated compared with that of serum, uroabdomen is present.
T205 175327-175427 Sentence denotes Elevated abdominal fluid lipase or amylase compared with serum supports a diagnosis of pancreatitis.
T206 175428-175597 Sentence denotes Elevated lactate compared with serum lactate or an abdominal fluid glucose level less than 50 mg/dL is highly sensitive and specific for bacterial or septic peritonitis.
T207 175598-175698 Sentence denotes The presence of bile pigment or bacteria is supportive of bile and septic peritonitis, respectively.
T208 175699-175868 Sentence denotes Free fibers in abdominal fluid along with clinical signs of abdominal pain strongly support gastrointestinal perforation, and immediate surgical exploration is required.
T209 175869-176011 Sentence denotes In the event of negative abdominocentesis findings when peritoneal effusion or bile or gastrointestinal perforation is suspected, perform DPL.
T210 176012-176112 Sentence denotes Peritoneal dialysis kits are commercially available but are often expensive and impractical (see pp.
T211 176113-176124 Sentence denotes 7 and 488).
T212 176125-176299 Sentence denotes Animals that have acute abdominal pain can be divided into three broad categories, depending on the primary cause of pain and the initial definitive treatment (Table 1 -24) .
T213 176300-176373 Sentence denotes Some diseases warrant a nonsurgical, medical approach to case management.
T214 176374-176443 Sentence denotes Other conditions require immediate surgery after rapid stabilization.
T215 176444-176615 Sentence denotes Other conditions initially can be managed medically until the patient is hemodynamically more stable and then may or may not require surgical intervention at a later time.
T216 176616-176694 Sentence denotes Specific management of each disease entity is listed under its own subheading.
T217 176695-176758 Sentence denotes Box 1-23 lists specific indications for exploratory laparotomy.
T218 176759-177017 Sentence denotes The best means to explore the abdominal cavity accurately and thoroughly is to open the abdomen on midline from the level of the xiphoid process caudally to the pubis for full exposure and then to evaluate all organs in every quadrant in a systematic manner.
T219 177018-177197 Sentence denotes Address specific problems such as gastric or splenic torsion, enteroplication, and foreign body removal, and then copiously lavage the abdomen with warmed sterile saline solution.
T220 177198-177304 Sentence denotes Suction the saline solution thoroughly from the peritoneal cavity so as to not impair macrophage function.
T221 177305-177423 Sentence denotes In cases of septic peritonitis, the abdomen may be left open, or a drain may be placed for further suction and lavage.
T222 177424-177568 Sentence denotes The routine use of antibiotics in irrigation solutions is contraindicated because the antibiotics can irritate the peritoneum and delay healing.
T223 177569-177776 Sentence denotes When the abdominal cavity is left open, secure sterile laparotomy towels and water-impermeable dressings over the abdominal wound with umbilical tape, and then change these daily or as strike-through occurs.
T224 177777-177910 Sentence denotes Open abdomen cases are often effusive and require meticulous evaluation and management of electrolyte imbalances and hypoalbuminemia.
T225 177911-178111 Sentence denotes The abdomen can be closed and/or the abdominal drain removed when the volume of the effusion decreases, when bacteria are no longer present, and when the neutrophils become more healthy in appearance.
T226 178113-178266 Sentence denotes The following are clinical conditions, patient signalment, common history, physical examination, and characteristic findings of various diagnostic tests.
T227 178267-178441 Sentence denotes A blank column next to a condition indicates no specific signalment, history, physical examination, or diagnostic test is characteristic for a particular disease process. (1)
T228 178443-178555 Sentence denotes Anaphylactic shock occurs as an immediate hypersensitivity reaction to a variety of inciting stimuli (Box 1-24).
T229 178556-178651 Sentence denotes In animals, the most naturally occurring anaphylactic reaction results from wasp or bee stings.
T230 178652-178773 Sentence denotes Most other reactions occur as a result of an abnormal sensitivity to items used in making medical diagnoses or treatment.
T231 178774-179458 Sentence denotes Penetrating abdominal injury Presence of bacterial on abdominal fluid Presence of greater than 500 mcL of white blood cells in lavage fluid effluent, particularly if degenerative neutrophils are present Presence of food or plant material in lavage fluid Presence of creatinine, blood urea nitrogen, potassium, or lactate in abdominal fluid greater than that in peripheral blood Presence of glucose in abdominal fluid less than 50 mg/dL or less than in peripheral blood Presence of bilirubin in lavage fluid Pneumoperitoneum on radiographs Continued evidence of peritoneal irritation Box 1-24 inciting allergens that can cause anaPhylactoid reactions, angioneurotic edema, or urticaria
T232 179459-179746 Sentence denotes During an anaphylactic reaction, activation of C5a and the complement system results in vascular smooth muscle dilation and the release of a cascade of inflammatory mediators, including histamine, slow-reacting substance of anaphylaxis, serotonin, heparin, acetylcholine, and bradykinin.
T233 179747-179819 Sentence denotes Clinical signs associated with anaphylaxis differ between dogs and cats.
T234 179820-179942 Sentence denotes In dogs, clinical signs may include restlessness, vomiting, diarrhea, hematochezia, circulatory collapse, coma, and death.
T235 179943-180026 Sentence denotes In cats, clinical signs often are associated with respiratory system abnormalities.
T236 180027-180190 Sentence denotes Clinical signs may include ptyalism, pruritus, vomiting, incoordination, bronchoconstriction, pulmonary edema and hemorrhage, laryngeal edema, collapse, and death.
T237 180191-180296 Sentence denotes The most important steps to remember in any emergency are the ABCs of airway, breathing, and circulation.
T238 180297-180396 Sentence denotes First, establish an airway through endotracheal intubation or emergency tracheostomy, if necessary.
T239 180397-180515 Sentence denotes Concurrently, an assistant should establish vascular or intraosseous access to administer drugs and fluids (Box 1-25).
T240 180516-180596 Sentence denotes Differential diagnoses to consider for anaphylactic shock include the following:
T241 180597-180676 Sentence denotes The patient should be hospitalized until complete resolution of clinical signs.
T242 180677-180886 Sentence denotes After initial stabilization and treatment, it is important to maintain vascular access and continue intravenous fluid therapy until the patient is no longer hypotensive and vomiting and diarrhea have resolved.
T243 180887-181039 Sentence denotes In cases of fulminant pulmonary hemorrhage and edema, administer supplemental oxygen until the patient is no longer hypoxemic or orthopneic on room air.
T244 181040-181203 Sentence denotes Normalize and maintain BP using positive inotropes (dobutamine, 3 to 10 mcg/kg/min CRI) or pressors (dopamine, 3 to 10 mcg/kg/min IV CRI; see discussion of shock).
T245 181204-181402 Sentence denotes If blood-tinged vomitus or diarrhea has been observed, administer antibiotics to decrease the risk of bacterial translocation and sepsis (cefoxitin, 22 mg/kg IV tid; metronidazole, 10 mg/kg IV tid).
T246 181403-181596 Sentence denotes Also consider using gastroprotectant drugs (famotidine, 0.5 to 1.0 mg/kg IV; ranitidine, 0.5 to 2.0 mg/kg PO, IV, IM bid; sucralfate, 0.25 to 1.0 g PO tid; omeprazole, 0.7 to 1.0 mg/kg PO sid).
T247 181597-181696 Sentence denotes A second and less serious form of allergic reaction manifests as angioneurotic edema and urticaria.
T248 181697-181777 Sentence denotes In most cases, clinical signs develop within 20 minutes of an inciting allergen.
T249 181778-181879 Sentence denotes Although this type of reaction causes patient discomfort, it rarely poses a life-threatening problem.
T250 181880-181961 Sentence denotes Most animals have mild to severe swelling of the maxilla and periorbital regions.
T251 181962-182043 Sentence denotes The facial edema also may be accompanied by mild to severe generalized urticaria.
T252 182044-182124 Sentence denotes Some animals may paw at the face, rub at the eyes, or have vomiting or diarrhea.
T253 182125-182379 Sentence denotes The treatment for angioneurotic edema involves suppressing the immune response by administration of short-acting glucocorticoid drugs and blocking the actions of histamine by the synergistic use of histamine-1 (H 1 ) and H 2 receptor blockers (Box 1-26).
T254 182380-182460 Sentence denotes In some cases, the inciting cause is a known recent vaccination or insect sting.
T255 182461-182573 Sentence denotes Many times, however, the inciting cause is not known and is likely an exposure to a stinging insect or arachnid.
T256 182574-182771 Sentence denotes Differential diagnoses for acute facial swelling and/or urticaria include acetaminophen toxicity (cats), anterior caval syndrome, lymphadenitis, vasculitis, hypoalbuminemia, and contact dermatitis.
T257 182772-182947 Sentence denotes mAnAgemenT Observe animals that have demonstrated angioneurotic edema for a minimum of 20 to 30 minutes after injection of the short-acting glucocorticoids and antihistamines.
T258 182948-183042 Sentence denotes Monitor BP to make sure that the patient does not have concurrent anaphylaxis and hypotension.
T259 183043-183157 Sentence denotes After partial or complete resolution of clinical signs, the animal can be discharged to its owner for observation.
T260 183158-183250 Sentence denotes In dogs, mild vomiting or diarrhea may occur within 1 to 2 days after this type of reaction.
T261 183251-183322 Sentence denotes Wherever possible, exposure to the inciting allergen should be avoided.
T262 183324-183583 Sentence denotes Complications observed while a patient is under anesthesia can be divided into two broad categories: (1) those related to equipment malfunction or human error and (2) the patient's physiologic response to the cardiorespiratory effects of the anesthetic drugs.
T263 183584-183752 Sentence denotes Careful observation of the patient and familiarity with anesthetic equipment, drug protocols, and monitoring equipment are necessary for the safest anesthesia to occur.
T264 183753-183874 Sentence denotes Despite this, however, anesthetic-related complications are frequent and need to be recognized and treated appropriately.
T265 183875-183916 Sentence denotes • Administer short-acting glucocorticoid:
T266 183917-184017 Sentence denotes • Dexamethasone sodium phosphate (Dex SP), 0.25 to 1.0 mg/kg IV, SQ, IM • Administer antihistamines:
T267 184018-184163 Sentence denotes • Diphenhydramine, 2 mg/kg IM BID as needed • Famotidine, 0.5 to 1.0 mg/kg IV, SQ, IM IM, Intramuscularly; IV, intravenously; SQ, subcutaneously.
T268 184164-184361 Sentence denotes The resPirATory sysTem Many anesthetic drugs have a dose-dependent depressive effect on the respiratory system and cause a decrease in respiratory rate and tidal volume, leading to hypoventilation.
T269 184362-184465 Sentence denotes Respiratory rate alone is not a reliable indicator of the patient's oxygenation and ventilatory status.
T270 184466-184538 Sentence denotes The respiratory tidal volume can be measured with a Wright respirometer.
T271 184539-184647 Sentence denotes Perform pulse oximetry and capnography as noninvasive measures of the patient's oxygenation and ventilation.
T272 184648-184934 Sentence denotes Ventilation can be impaired as a result of anesthetic drugs, patient position, pneumothorax, pleural effusion (chylothorax, hemothorax, pyothorax), equipment malfunction, rebreathing of carbon dioxide, thoracic wall injury, or alveolar fluid (pulmonary edema, hemorrhage, or pneumonia).
T273 184935-185110 Sentence denotes Problems such as a diaphragmatic hernia, GDV, or gravid uterus can impede diaphragmatic excursions once the patient is placed on its back and can lead to impaired ventilation.
T274 185111-185250 Sentence denotes The work of breathing also may be increased because of increased resistance of the anesthesia circuit and increased dead space ventilation.
T275 185251-185302 Sentence denotes This is particularly important in small toy breeds.
T276 185303-185501 Sentence denotes Clinical signs of inadequate ventilation and respiratory complications include abnormal respiratory pattern, sudden changes in heart rate, cardiac dysrhythmias, cyanosis, and cardiopulmonary arrest.
T277 185502-185595 Sentence denotes End-tidal carbon dioxide, or capnography, gives a graphic display of adequacy of ventilation.
T278 185596-185826 Sentence denotes Rapid decreases in end-tidal carbon dioxide can be caused by disconnection or obstruction of the patient's endotracheal tube or poor perfusion, namely, cardiopulmonary arrest (see Capnometry [End-Tidal Carbon Dioxide Monitoring]).
T279 185827-186204 Sentence denotes Postoperatively, hypoventilation can occur because of the residual effects of the anesthetic drugs, hypothermia, overventilation during intraoperative support, surgical techniques that compromise ventilation (thoracotomy, cervical disk surgery, atlantooccipital stabilization), postoperative bandaging of the abdomen or thorax, ventilatory muscle fatigue, or injury to the CNS.
T280 186205-186266 Sentence denotes Cardiac output is a function of heart rate and stroke volume.
T281 186267-186387 Sentence denotes Factors that influence stroke volume include vascular and cardiac preload, cardiac afterload, and cardiac contractility.
T282 186388-186559 Sentence denotes The patient's cardiac output can be affected adversely by the negative inotropic and chronotropic and vasodilatory effects of anesthetic drugs, all leading to hypotension.
T283 186560-186685 Sentence denotes Bradycardia, tachycardia, cardiac dysrhythmias, and vascular dilation can lead to hypotension and inadequate organ perfusion.
T284 186686-186750 Sentence denotes Table 1 -25 lists the normal heart rate and BP in dogs and cats.
T285 186751-186810 Sentence denotes Bradycardia is defined as a heart rate below normal values.
T286 186811-186855 Sentence denotes Many anesthetic drugs can cause bradycardia.
T287 186856-186999 Sentence denotes Causes of bradycardia include use of narcotics or α 2 -agonist drugs, deep plane of anesthesia, increased vagal tone, hypothermia, and hypoxia.
T288 187001-187094 Sentence denotes Hypotension is defined as physiologically low BP (mean arterial pressure less than 65 mm Hg).
T289 187095-187195 Sentence denotes A mean arterial BP less than 60 mm Hg can result in inadequate tissue perfusion and oxygen delivery.
T290 187196-187247 Sentence denotes The coronary arteries are perfused during diastole.
T291 187248-187410 Sentence denotes Inadequate diastolic BP, less than 40 mm Hg, can cause decreased coronary artery perfusion and myocardial hypoxemia that can predispose the heart to dysrhythmias.
T292 187411-187726 Sentence denotes Causes of perianesthetic hypotension include peripheral vasodilation by anesthetic drugs, bradycardia or tachyarrhythmias, hypothermia, inadequate cardiac preload from vasodilation or hemorrhage, decreased venous return from patient position or surgical manipulation of viscera, and decreased cardiac contractility.
T293 187728-187855 Sentence denotes Cardiac Dysrhythmias ECG monitoring is useful for the early detection of cardiac dysrhythmias during the perianesthetic period.
T294 187856-188032 Sentence denotes Clinical signs of cardiac dysrhythmias include irregular pulse rate or pressure, abnormal or irregular heart sounds, pallor, cyanosis, hypotension, and an abnormal ECG tracing.
T295 188033-188196 Sentence denotes Remember that the single best method of detecting cardiac dysrhythmias is with your fingertips (palpate a pulse or apex heartbeat) and ears (auscultate the heart).
T296 188197-188376 Sentence denotes Confirm the dysrhythmia by auscultating the heart rate and rhythm, identify the P waves and the QRS complexes, and evaluate the relationship between the P waves and QRS complexes.
T297 188377-188453 Sentence denotes Is there a P wave for every QRS complex, and a QRS complex for every P wave?
T298 188454-188561 Sentence denotes During anesthesia, fluid, acid-base, and electrolyte imbalances can predispose the patient to dysrhythmias.
T299 188562-188694 Sentence denotes Sympathetic and parasympathetic stimulation, including during the process of intubation, can predispose the patient to dysrhythmias.
T300 188695-188842 Sentence denotes If the patient's plane of anesthesia is too light, perception of pain can cause catecholamine release, sensitizing the myocardium to ectopic beats.
T301 188843-188978 Sentence denotes Atrioventricular (AV) blockade can be induced with the administration of α 2 -agonist medications, including xylazine and medetomidine.
T302 188979-189052 Sentence denotes Thiobarbiturates (thiopental) can induce ventricular ectopy and bigeminy.
T303 189053-189204 Sentence denotes Although these dysrhythmias may not be harmful in the awake patient, anesthetized patients are at a particular risk of dysrhythmia-induced hypotension.
T304 189205-189277 Sentence denotes Carefully monitor and treat all dysrhythmias (see Cardiac Dysrhythmias).
T305 189278-189346 Sentence denotes Box 1-27 lists steps to take to prevent perianesthetic dysrhythmias.
T306 189347-189476 Sentence denotes Awakening during anesthesia can occur and can be caused by equipment failure and, although no one likes to admit it, human error.
T307 189477-189565 Sentence denotes Table 1 -29 lists causes of arousal during anesthesia and appropriate immediate actions.
T308 189566-189834 Sentence denotes Delayed recovery can be caused by a number of factors, including excessive anesthetic depth, hypothermia, residual action of narcotics or tranquilizers, delayed metabolism of anesthetic drugs, hypoglycemia, hypocalcemia, hemorrhage, and breed or animal predisposition.
T309 189835-189910 Sentence denotes Careful t a B l e 1 -2 8 causes and treatment of Perianesthetic hypotension
T310 189911-189949 Sentence denotes Hypothermia Provide ambient rewarming.
T311 189950-190038 Sentence denotes Hypocalcemia* Administer calcium chloride (10 mg/kg IV) or calcium gluconate (23 mg/kg).
T312 190039-190087 Sentence denotes Decrease vaporizer setting and anesthetic depth.
T313 190088-190126 Sentence denotes Reverse with opioids or α 2 -agonists.
T314 190127-190139 Sentence denotes Vasodilation
T315 190140-190195 Sentence denotes Administer an intravenous crystalloid bolus (10 mL/kg).
T316 190196-190246 Sentence denotes Administer an intravenous colloid bolus (5 mL/kg).
T317 190247-190299 Sentence denotes Administer a pressor (phenylephrine 1-3 mcg/kg/min).
T318 190300-190326 Sentence denotes Decrease anesthetic depth.
T319 190327-190351 Sentence denotes Administer ephedrine (0.
T320 190353-190494 Sentence denotes The presentation of a patient with a bleeding disorder often is a diagnostic challenge for the veterinary practitioner (Boxes 1-28 and 1-29).
T321 190495-190907 Sentence denotes In general, abnormal bleeding can be caused by five major categories: (1) vascular trauma, (2) defective production of hemostatic factors, A clotting disorder should be suspected in any patient with a history of development of spontaneous deep hematomas, unusually prolonged bleeding after traumatic injury, bleeding at multiple sites throughout the body involving multiple organ systems, delayed onset of severe
T322 190908-191000 Sentence denotes • Stabilize acid-base and electrolyte balance before anesthetic induction whenever possible.
T323 191001-191049 Sentence denotes • Rehydrate patient before anesthetic induction.
T324 191050-191116 Sentence denotes • Select anesthetic agents appropriate for the particular patient.
T325 191117-191174 Sentence denotes • Be aware of the effects of the drugs on the myocardium.
T326 191175-191254 Sentence denotes • Ensure adequate anesthetic depth and oxygenation before anesthetic induction.
T327 191255-191302 Sentence denotes • Ensure ventilatory support during anesthesia.
T328 191303-191398 Sentence denotes • Monitor heart rate, rhythm, blood pressure, pulse oximetry, and capnometry during anesthesia.
T329 191399-191462 Sentence denotes • Ensure adequate anesthetic depth before surgical stimulation.
T330 191463-191541 Sentence denotes • Avoid surgical manipulation to the heart or great vessels whenever possible.
T331 191542-191582 Sentence denotes • Avoid changes in perianesthetic depth.
T332 191583-191603 Sentence denotes • Avoid hypothermia.
T333 191604-191714 Sentence denotes 1 hemorrhage after bleeding, and an inability on the practitioner's part to find an organic cause of bleeding.
T334 191715-191920 Sentence denotes The signalment, history, clinical signs, and results of coagulation tests often can aid in making a rapid diagnosis of the primary cause of the disorder and in the selection of appropriate case management.
T335 191921-192601 Sentence denotes When taking a history, ask the following important questions: ❏ What is the nature of the bleeding? ❏ What sites are affected? ❏ How long has the bleeding been going on? ❏ Has your animal had any previous or similar episodes? ❏ Is there any possibility of any toxin exposure? ❏ If so, when and how much did your animal consume? ❏ Is there any possibility of trauma? ❏ Does your animal run loose outdoors unattended? ❏ Have you ever traveled, and if so, where? ❏ Has your animal been on any medications recently or currently? ❏ Has your animal been vaccinated recently? ❏ Have any known relatives of your animal had any bleeding disorders? ❏ Have you seen any other abnormal signs?
T336 192602-192788 Sentence denotes Abnormalities found on physical examination may aid in determining whether the hemorrhage is localized or generalized (e.g., bleeding from a venipuncture site versus bleeding diathesis).
T337 192789-192976 Sentence denotes Note whether the clinical signs are associated with a platelet problem and superficial hemorrhage or whether deep bleeding can be associated with abnormalities of the coagulation cascade.
T338 192977-193205 Sentence denotes Also, make an attempt to identify any concurrent illness that can predispose the patient to a bleeding disorder (e.g., pancreatitis, snakebite, sepsis, immunemediated hemolytic anemia, or severe trauma and crush or burn injury).
T339 193206-193425 Sentence denotes Abnormalities associated with coagulopathies include petechiae and ecchymoses, epistaxis, gingival bleeding, hematuria, hemarthrosis, melena, and hemorrhagic cavity (pleural and peritoneal or retroperitoneal) effusions.
T340 193426-193604 Sentence denotes DIC is a complex syndrome that results from the inappropriate activation of the clotting cascade, leading to disruption of the normal balance between thrombosis and fibrinolysis.
T341 193605-193789 Sentence denotes The formation of diffuse microthrombi with concurrent consumption of platelets and activated clotting factors leads to end-organ thrombosis with various degrees of clinical hemorrhage.
T342 193790-193989 Sentence denotes In animals, DIC always results from some other pathologic process, including various forms of neoplasia, crush and heat-induced injury, sepsis, inflammation, and immune-mediated disorders (Box 1-30).
T343 193990-194194 Sentence denotes The pathophysiologic mechanisms involved in DIC include vascular endothelial damage, activation and consumption of platelets, release of tissue procoagulants, and consumption of endogenous anticoagulants.
T344 194195-194445 Sentence denotes Because DIC always results from some other disease process, diagnosis of DIC is based on a number of criteria when evaluating various coagulation test findings, peripheral blood smears, platelet count, and end products of thrombosis and fibrinolysis.
T345 194446-194519 Sentence denotes There is no one definitive criterion for the diagnosis of DIC (Box 1-31).
T346 194520-194588 Sentence denotes Thrombocytopenia occurs as platelets are consumed during thrombosis.
T347 194589-194728 Sentence denotes It is important to remember that trends in decline in platelet numbers are just as important as thrombocytopenia when making the diagnosis.
T348 194729-194862 Sentence denotes In some cases the platelet count still may be within the normal reference range but has significantly decreased in the last 24 hours.
T349 194863-194936 Sentence denotes Early in DIC the procoagulant cascade dominates, with hypercoagulability.
T350 194937-194992 Sentence denotes ACT, APTT, and PT may be rapid and shorter than normal.
T351 194993-195085 Sentence denotes In most cases, we do not recognize the hypercoagulable state in our critically ill patients.
T352 195086-195200 Sentence denotes Later in DIC, as platelets and activated clotting factors become consumed, the ACT, APTT, and PT become prolonged.
T353 195201-195290 Sentence denotes Antithrombin (AT), a natural anticoagulant, also becomes consumed, and AT levels decline.
T354 195291-195386 Sentence denotes AT levels can be measured at commercial laboratories and in some large veterinary institutions.
T355 195387-195467 Sentence denotes The end products of thrombosis and subsequent fibrinolysis also can be measured.
T356 195468-195555 Sentence denotes Fibrinogen levels may decline, although this test is not sensitive or specific for DIC.
T357 195556-195613 Sentence denotes Fibrin degradation (split) products also become elevated.
T358 195614-195775 Sentence denotes Fibrin degradation products are normally cleared by the liver, and levels of these also become elevated in cases of hepatic failure because of lack of clearance.
T359 195776-195941 Sentence denotes More recently, cage-side D-dimer tests have become available to measure the breakdown product of cross-linked fibrin as a more sensitive and specific monitor of DIC.
T360 195942-196013 Sentence denotes Management of DIC first involves treating the primary underlying cause.
T361 196014-196091 Sentence denotes By the time DIC becomes evident, rapid and aggressive treatment is necessary.
T362 196092-196304 Sentence denotes If you are suspicious of DIC in any patient with a disease known to incite DIC, then ideally, to achieve the best possible prognosis, you should begin treatment before the hemostatic abnormalities start to occur.
T363 196305-196404 Sentence denotes Treatment involves replacement of clotting factors and AT and prevention of further clot formation.
T364 196405-196495 Sentence denotes To replenish clotting factors and AT, administer fresh whole blood or fresh frozen plasma.
T365 196496-196593 Sentence denotes Heparin requires AT as a cofactor to inactivate thrombin and other activated coagulation factors.
T366 196594-196723 Sentence denotes Administer heparin (50 to 100 units/kg SQ q6-8h of unfractionated heparin; or fractionated enoxaparin [Lovenox], 1 mg/kg SQ bid).
T367 196724-196836 Sentence denotes Aspirin (5 mg/kg PO bid in dogs; every third day in cats) also can be administered to prevent platelet adhesion.
T368 196837-196980 Sentence denotes Management of DIC also involves Rule of 20 monitoring and case management to maintain end-organ perfusion and oxygen delivery (see Rule of 20).
T1 196981-197075 Sentence denotes Hemophilia A is a sex-liked recessive trait that is carried by females and manifests in males.
T2 197076-197161 Sentence denotes Female hemophiliacs can result when a hemophiliac male is bred with a carrier female.
T3 197162-197459 Sentence denotes Hemophilia A has been reported in cats and a number of dog breeds, including Miniature Schnauzer, Saint Bernard, Miniature Poodle, Shetland Sheepdog, English and Irish Setters, Labrador Retriever, German Shepherd Dog, Collie, Weimaraner, Greyhound, Chihuahua, English Bulldog, Samoyed, and Vizsla.
T4 197460-197517 Sentence denotes Mild to moderate internal or external bleeding can occur.
T5 197518-197618 Sentence denotes Clinical signs of umbilical cord bleeding can become apparent in some animals shortly after weaning.
T6 197619-197707 Sentence denotes Gingival hemorrhage, hemarthrosis, gastrointestinal hemorrhage, and hematomas may occur.
T7 197708-197796 Sentence denotes Clotting profiles in animals with factor VIII deficiency include prolonged APTT and ACT.
T8 197797-197847 Sentence denotes The PT and buccal mucosa bleeding time are normal.
T9 197848-197952 Sentence denotes Affected animals have low factor VIII activity but normal to high levels of factor VIII-related antigen.
T10 197953-198096 Sentence denotes Carrier females can be detected by low (30% to 60% of normal) factor VIII activity and normal to elevated levels of factor VII-related antigen.
T11 198097-198172 Sentence denotes Von Willebrand disease is a deficiency or defect in von Willebrand protein.
T12 198173-198229 Sentence denotes A number of variants of the disease have been described:
T13 198230-198403 Sentence denotes Von Willebrand disease type 1 is associated with a defect in factor VIIR protein concentration, and von Willebrand disease type 2 is associated with a defect in VIIIR (vWF).
T14 198404-198472 Sentence denotes Type 1 von Willebrand disease is most common in veterinary medicine.
T15 198473-198627 Sentence denotes Von Willebrand disease has been identified in more than 29 breeds of dogs, with an incidence that varies from 10% to 60% depending on the breed of origin.
T16 198628-198792 Sentence denotes Affected breeds include Doberman Pinschers, German Shepherd Dogs, Scottish Terriers, and standard Manchester Terriers, Golden Retrievers, Chesapeake Bay Retrievers,
T17 198793-198841 Sentence denotes Miniature Schnauzers, and Pembroke Welsh Corgis.
T18 198842-198880 Sentence denotes Two forms of genetic expression occur.
T19 198881-199079 Sentence denotes The first is autosomal recessive disease, in which homozygous von Willebrand disease individuals have a bleeding disorder, whereas heterozygous individuals carry the trait but are clinically normal.
T20 199080-199293 Sentence denotes The second variant of genetic expression involves an autosomal dominant disease with incomplete expression such that heterozygous individuals are affected carriers and homozygous individuals are severely affected.
T21 199294-199368 Sentence denotes Von Willebrand disease has high morbidity but fortunately a low mortality.
T22 199369-199426 Sentence denotes Dogs with 30% or less than normal vWF tend to hemorrhage.
T23 199427-199491 Sentence denotes Platelet counts are normal, but bleeding times can be prolonged.
T24 199492-199571 Sentence denotes The APTT can be slightly prolonged when factor VIII is less than 50% of normal.
T25 199572-199790 Sentence denotes Routine screening tests are nondiagnostic for this disease, although in a predisposed breed with a normal platelet count, a prolonged buccal mucosa bleeding time strongly supports a diagnosis of von Willebrand disease.
T26 199791-199965 Sentence denotes Documentation of clinical bleeding with low or undetectable levels of factor VIII antigen or platelet-related activities of vWF support a diagnosis of von Willebrand disease.
T27 199966-200073 Sentence denotes Recessive animals have zero vWF antigen (a subunit of factor III); heterozygotes have 15% to 60% of normal.
T28 200074-200165 Sentence denotes In the incompletely dominant form, levels of vWF antigen are reduced (less than 7% to 60%).
T29 200166-200464 Sentence denotes Clinical signs in affected animals include epistaxis, hematuria, diarrhea with melena, penile bleeding, lameness, hemarthrosis, hematoma formation, and excessive bleeding with routine procedures such as nail trimming, ear cropping, tail docking, surgical procedures (spay, neuter), and lacerations.
T30 200465-200513 Sentence denotes Estrus and postpartum bleeding may be prolonged.
T31 200514-200640 Sentence denotes A DNA test to detect carriers of the vWF gene is available through VetGen (Ann Arbor, Michigan) and Michigan State University.
T32 200641-200866 Sentence denotes Patients with von Willebrand disease should avoid drugs known to affect platelet function adversely (sulfonamide, ampicillin, chloramphenicol, antihistamines, theophylline, phenothiazine tranquilizers, heparin, and estrogen).
T33 200867-200961 Sentence denotes Hemophilia B is an X-linked recessive trait that occurs with less frequency that hemophilia A.
T34 200962-201184 Sentence denotes The disease has been reported in Scottish Terriers, Shetland and Old English Sheepdogs, Saint Bernards, Cocker Spaniels, Alaskan Malamutes, Labrador Retrievers, Bichon Frises, Airedale Terriers, and British Shorthair cats.
T35 201185-201252 Sentence denotes Carrier females have low (40% to 60% of normal) factor IX activity.
T36 201253-201306 Sentence denotes Clinical signs are more severe than for hemophilia A.
T37 201307-201429 Sentence denotes Congenital deficiencies of factor VII have been reported as an autosomal, incompletely dominant characteristic in Beagles.
T38 201430-201475 Sentence denotes Heterozygotes have 50% factor VII deficiency.
T39 201476-201502 Sentence denotes Bleeding tends to be mild.
T40 201503-201547 Sentence denotes The PT is prolonged in affected individuals.
T41 201548-201658 Sentence denotes Factor X deficiency has been documented in Cocker Spaniels and resembles fadingpuppy syndrome in newborn dogs.
T42 201659-201733 Sentence denotes Internal or umbilical bleeding can occur, and affected dogs typically die.
T43 201734-201769 Sentence denotes Bleeding may be mild in adult dogs.
T44 201770-201889 Sentence denotes In severe cases, factor X levels are reduced to 20% of normal; in mild cases, factor X levels are 20% to 70% of normal.
T45 201890-201991 Sentence denotes Factor XII deficiency has been documented as an inherited autosomal recessive trait in domestic cats.
T46 201992-202091 Sentence denotes Heterozygotes can be detected because they have a partial deficiency (50% of normal) of factor XII.
T47 202092-202146 Sentence denotes Homozygote cats have less than 2% factor XII activity.
T48 202147-202231 Sentence denotes Deficiency of Hageman factor usually does not result in bleeding or other disorders.
T49 202232-202372 Sentence denotes Factor XI deficiency is an autosomal disease that has been documented in Kerry Blue Terriers, Great Pyrenees, and English Springer Spaniels.
T50 202373-202434 Sentence denotes In affected individuals, protracted bleeding may be observed.
T51 202435-202546 Sentence denotes Homozygotes have low factor XI activity (<20% of normal), and heterozygotes have 40% to 60% of normal activity.
T52 202547-202666 Sentence denotes The management of congenital defects of hemostasis typically involves replenishing the clotting factor that is present.
T53 202667-202759 Sentence denotes Usually, this can be accomplished in the form of fresh frozen plasma transfusion (20 mL/kg).
T54 202760-202869 Sentence denotes If anemia is present because of severe hemorrhage, fresh whole blood or packed RBCs also can be administered.
T55 202870-203068 Sentence denotes Recent research has investigated the use of recombinant gene therapy in the treatment of specific factor deficiencies in dogs; however, the therapy is not yet available for use in clinical practice.
T56 203069-203247 Sentence denotes In cases of von Willebrand disease, administration of fresh frozen plasma (10 to 20 mL/ kg) or cryoprecipitate (1 unit/10 kg body mass) provides vWF, factor VIII, and fibrinogen.
T57 203248-203294 Sentence denotes Doses can be repeated until hemorrhage ceases.
T58 203295-203521 Sentence denotes 1-Desamino-8-d-arginine vasopressin (DDAVP) also can be administered (1 mcg/kg SQ or IV diluted in 0.9% saline given over 10 to 20 minutes) to the donor and patient to increase the release of stored vWF from endothelial cells.
T59 203522-203710 Sentence denotes A fresh whole blood transfusion can be obtained from the donor and immediately administered to the patient, or it can be spun down and the fresh plasma administered if RBCs are not needed.
T60 203711-203809 Sentence denotes Administer a dose of DDAVP to any affected dog before initiating any elective surgical procedures.
T61 203810-203907 Sentence denotes A supply of fresh frozen plasma and RBCs should be on hand, should uncontrolled hemorrhage occur.
T62 203908-203960 Sentence denotes Platelets are essential to normal blood coagulation.
T63 203961-204110 Sentence denotes After a vessel has been damaged, release of vasoactive amines causes vasoconstriction and sluggish flow of blood in an attempt to squelch hemorrhage.
T64 204111-204216 Sentence denotes Platelets become activated by platelet activating factor, and attach to the damaged vascular endothelium.
T65 204217-204334 Sentence denotes Normal platelet adhesion depends on mediators such as calcium, fibrinogen, vWF antigen, and a portion of factor VIII.
T66 204335-204597 Sentence denotes After adhesion, the platelets undergo primary aggregation and release a variety of chemical mediators, including adenosine diphosphate, prostaglandins, serotonin, epinephrine, thromboplastin, and thromboxane A, that promote secondary aggregation and contraction.
T67 204598-204823 Sentence denotes Platelet abnormalities can include decreased platelet production (thrombocytopenia), decreased platelet function (thrombocytopathia), increased platelet destruction, increased platelet consumption, and platelet sequestration.
T68 204824-204884 Sentence denotes Thrombocytopathia refers to platelet function abnormalities.
T69 204885-205038 Sentence denotes Alterations in platelet function can affect platelet adhesion or aggregation or release of vasoactive substances that help form a stable clot (Box 1-32).
T70 205039-205144 Sentence denotes In von Willebrand disease there is a deficiency in vWF antigen that results in altered platelet adhesion.
T71 205145-205433 Sentence denotes Vascular purpuras are reported and have been seen in collagen abnormalities such as Ehlers-Danlos syndrome, which can be inherited as an autosomal dominant trait with complete penetrance and has been recognized in German Shepherd Dogs, Dachshunds, Saint Bernards, and Labrador Retrievers.
T72 205434-205582 Sentence denotes Thrombasthenic thrombopathia is a hereditary autosomal dominant abnormality that has been described in Otterhounds, Foxhounds and Scottish Terriers.
T73 205583-205700 Sentence denotes In this condition, platelets do not aggregate normally in response to adenosine diphosphate and thrombin stimulation.
T74 205701-205822 Sentence denotes Evaluation of platelet function is based on a total platelet count, buccal mucosa bleeding time, and thromboelastography.
T75 205823-205912 Sentence denotes Platelet function defects (thrombocytopenia and thrombocytopathia) can affect both sexes.
T76 205913-205964 Sentence denotes Clinical signs can resemble von Willebrand disease.
T77 205965-206087 Sentence denotes In most cases, buccal mucosa bleeding time will be prolonged, but platelet count and clotting test results will be normal.
T78 206088-206210 Sentence denotes Platelet count can be decreased because of problems with production, increased consumption, sequestration, or destruction.
T79 206211-206354 Sentence denotes Causes of accelerated platelet destruction are typically immune-mediated autoantibodies, drug antibodies, infection, and isoimmune destruction.
T80 206355-206539 Sentence denotes Consumption and sequestration usually are caused by DIC, vasculitis, microangiopathic hemolytic anemia, severe vascular injury, hemolytic uremic syndrome, and gram-negative septicemia.
T81 206540-206633 Sentence denotes Primary thrombocytopenia with no known cause has been called idiopathic thrombocytic purpura.
T82 206634-206874 Sentence denotes In approximately 80% of the cases, thrombocytopenia is associated with immune-mediated destruction caused by immunemediated hemolytic anemia, systemic lupus erythematosus, rheumatoid arthritis, DIC, and diseases that affect the bone marrow.
T83 206875-206988 Sentence denotes In systemic lupus erythematosus, 20% to 30% of the affected dogs have concurrent idiopathic thrombocytic purpura.
T84 206989-207132 Sentence denotes When immunemediated hemolytic anemia and idiopathic thrombocytic purpura are present in the same patient, the disease is called Evans syndrome.
T85 207133-207273 Sentence denotes PF-3 is a non-complement-fixing antibody that is produced in the spleen and affects peripheral and bone marrow platelets and megakaryocytes.
T86 207274-207354 Sentence denotes Antibodies directed against platelets are usually of the IgG subtype in animals.
T87 207355-207418 Sentence denotes Antiplatelet antibodies can be measured by a PF-3 release test.
T88 207419-207524 Sentence denotes Platelet counts with immune-mediated destruction typically are less than 50,000 platelets per microliter.
T89 207525-207690 Sentence denotes Infectious causes of thrombocytopenia include Ehrlichia canis, Anaplasma phagocytophilum (formerly Ehrlichia equi), and R. rickettsii (Rocky Mountain spotted fever).
T90 207691-207817 Sentence denotes Primary immune-mediated thrombocytopenia has an unknown cause and most frequently is seen in middle-aged to older female dogs.
T91 207818-207949 Sentence denotes Breed predispositions include Cocker Spaniels, German Shepherd Dogs, Poodles (toy, miniature, standard), and Old English Sheepdogs.
T92 207950-208118 Sentence denotes Thrombocytopenia usually manifests as petechiae, ecchymoses of skin and mucous membranes, hyphema, gingival and conjunctival bleeding, hematuria, melena, and epistaxis.
T93 208119-208595 Sentence denotes To make a diagnosis of idiopathic thrombocytic purpura, measure the severity of thrombocytopenia (<50,000 platelets per microliter) and analyze the peripheral blood smear for evidence of platelet fragmentation or microthrombocytosis; normal to increased numbers of megakaryocytes in the bone marrow, detection of antiplatelet antibody, and increased platelet counts after starting glucocorticoid therapy are expected, and other causes of thrombocytopenia should be eliminated.
T94 208596-208723 Sentence denotes If tick-borne illnesses are suspected, antibody titers for E. canis, A. phagocytophilum, and R. rickettsii should be performed.
T95 208724-208907 Sentence denotes Treatment of immune-mediated thrombocytopenia involves suppression of the immune system to stop the immune-mediated destruction and to stimulate platelet release from the bone marrow.
T96 208908-209105 Sentence denotes Traditionally, the gold standard to suppress the immune system is to use glucocorticoids (prednisone or prednisolone, 2 to 4 mg/kg PO bid divided, or dexamethasone, 0.1 to 0.3 mg/kg IV or PO q12h).
T97 209106-209288 Sentence denotes More recently, human serum IgG also has been used (0.2 to 0.5 g/kg IV in saline over 8 hours; pretreat with 1 mg of diphenhydramine per kilogram 15 minutes before starting infusion).
T98 209289-209502 Sentence denotes Vincristine (0.5 mg/m 2 IV once) can stimulate the release of platelets from the bone marrow if megakaryocytic precursors are present; however, the platelets released may be immature and potentially nonfunctional.
T99 209503-209816 Sentence denotes Treatment with fresh whole blood or packed RBCs is appropriate if anemia is present; however, unless specific platelet-rich plasma has been purchased from a blood 1 bank, fresh whole blood contains relatively few platelets, which are short-lived (2 hours) and will not effectively raise the platelet count at all.
T100 209817-210010 Sentence denotes Finally, long-term therapy is usually in the form of azathioprine (2 mg/kg PO once daily, tapered to 1 mg/kg daily to every other day after 1 week) and cyclosporine (10 to 25 mg/kg PO divided).
T101 210011-210139 Sentence denotes If a tick-borne illness is suspected, administer doxycycline (5 to 10 mg/kg PO bid) for 4 weeks or if titers come back negative.
T102 210140-210183 Sentence denotes Thrombocytopenia also can occur in the cat.
T103 210184-210348 Sentence denotes Causes for thrombocytopenia in cats include infections (29%), neoplasia (20%), cardiac disease (7%), primary immune-mediated disease (2%), and unknown causes (20%).
T104 210349-210448 Sentence denotes In one study of cats with feline leukemia and myeloproliferative disease, 44% had thrombocytopenia.
T105 210449-210545 Sentence denotes Warfarin and coumarin derivatives are the major class of rodenticides used in the United States.
T106 210546-210792 Sentence denotes Vitamin K-antagonist rodenticides inhibit the epoxidase reaction and deplete active vitamin K, causing a depletion of vitamin K-dependent coagulation factors (II, VII, IX, X) within 24 hours to 1 week of ingestion, depending on the ingested dose.
T107 210793-210860 Sentence denotes Affected animals can spontaneously hemorrhage anywhere in the body.
T108 210861-211221 Sentence denotes Clinical signs can include hemoptysis, respiratory difficulty, cough, gingival bleeding, epistaxis, hematuria, hyphema, conjunctival bleeding, petechiae and ecchymoses, cavity hemorrhage (pleural, peritoneal, retroperitoneal) with acute weakness, lethargy or collapse, hemarthrosis with lameness, deep muscle bleeds, and intracranial or spinal cord hemorrhage.
T109 211222-211278 Sentence denotes Diagnosis of vitamin K antagonism includes prolonged PT.
T110 211279-211380 Sentence denotes A PIVKA (protein induced by vitamin K absence or antagonism) test also can be performed, if possible.
T111 211381-211640 Sentence denotes Treatment of vitamin K antagonist rodenticide intoxication and other causes of vitamin K deficiency involves supplementation with vitamin K 1 (phytonadione, 5 mg/kg SQ once with 25-gauge needle in multiple sites, and then 2.5 mg/kg PO bid to tid for 30 days).
T112 211641-211782 Sentence denotes Never administer injections of vitamin K IM, because of the risk of causing deep muscle hematomas, or IV, because of the risk of anaphylaxis.
T113 211783-212003 Sentence denotes The PT should be rechecked 2 days after the last vitamin K capsule has been administered, because some of the second-generation warfarin derivates are fat-soluble, and treatment may be required for an additional 2 weeks.
T114 212004-212074 Sentence denotes Table 1 -30 summarizes criteria for interpreting coagulation profiles.
T115 212075-212091 Sentence denotes Thrombocytopenia
T116 212093-212181 Sentence denotes Thermal burns are fortunately a relatively infrequent occurrence in veterinary patients.
T117 212182-212246 Sentence denotes Box 1-33 lists various causes of malicious and accidental burns.
T118 212247-212356 Sentence denotes The location of the burn is also important in assessing its severity and potential to cause loss of function.
T119 212357-212482 Sentence denotes Burns on the perineum, feet, face, and ears are considered to be the most severe because of loss of function and severe pain.
T120 212483-212711 Sentence denotes Often the severity of thermal injury is difficult to assess in animals because the hair coat potentially can mask clinical signs and because the thermal injury can continue after the animal has been removed from the heat source.
T121 212712-212823 Sentence denotes The skin cools slowly and warms slowly, considerations that become important when initiating therapy for burns.
T122 212824-212995 Sentence denotes The severity of thermal injury is associated with the temperature to which the animal is exposed, the duration of contact, and the ability of the tissue to dissipate heat.
T123 212996-213082 Sentence denotes The tissue closest to the heat source undergoes necrosis and has decreased blood flow.
T124 213083-213347 Sentence denotes The severity of thermal burn injury is associated directly with the temperature to which the animal is exposed, the percentage of total body surface area affected, the thickness of injured tissue, and whether underlying complications with other body systems occur.
T125 213348-213505 Sentence denotes Prognosis largely depends on the total body surface area affected ( Superficial partial-thickness, or first-degree, burns offer the most favorable prognosis.
T126 213506-213608 Sentence denotes The affected epidermis initially appears erythematous and then quickly desquamates within 3 to 6 days.
T127 213609-213653 Sentence denotes In most cases fur grows back without a scar.
T128 213654-213802 Sentence denotes Deep partial-thickness, or second-degree, burns involve the epidermis and dermis and are associated with subcutaneous edema, inflammation, and pain.
T129 213803-213965 Sentence denotes Deep partial-thickness burns heal from deeper adnexal tissues and from the wound edges and are associated with an increased chance of scarring and depigmentation.
T130 213966-214119 Sentence denotes The most severe type is the full-thickness, or third-degree, burn, in which thermal injury destroys the entire thickness of the skin and forms an eschar.
T131 214120-214193 Sentence denotes Thrombosis of superficial and deeper skin vasculature and gangrene occur.
T132 214194-214242 Sentence denotes Treatment involves sequential wound debridement.
T133 214243-214329 Sentence denotes Healing occurs by second intention and reepithelialization or by wound reconstruction.
T134 214330-214384 Sentence denotes In most cases scarring is extensive in affected areas.
T135 214385-214564 Sentence denotes Burns over greater than 20% of total body surface area will have systemic effects, including impaired cardiovascular function, pulmonary dysfunction, and impaired immune function.
T136 214565-214630 Sentence denotes Burned tissue, with capillary damage, has increased permeability.
T137 214631-214890 Sentence denotes The release of inflammatory cytokines, oxygen-derived free radical species, prostaglandins, leukotrienes, histamine, serotonin, and kinins results in increased vascular permeability and leakage of plasma proteins into the interstitium and extravascular space.
T138 214891-215057 Sentence denotes At the time of presentation, first examine the patient and ascertain whether airway obstruction, impaired ventilatory function, circulatory shock, or pain is present.
T139 215058-215147 Sentence denotes If necessary, establish an airway with endotracheal intubation or emergency tracheostomy.
T140 215148-215202 Sentence denotes Next, cool the burned area(s) with topical cool water.
T141 215203-215260 Sentence denotes Use care to avoid overcooling and iatrogenic hypothermia.
T142 215261-215444 Sentence denotes The best approach is to cool only one portion of the patient's body at a time, then dry, and repeat the process for all affected areas to avoid overcooling and iatrogenic hypothermia.
T143 215445-215558 Sentence denotes Establish vascular access and administer appropriate and judicious analgesic drugs and intravenous fluid therapy.
T144 215559-215645 Sentence denotes Whenever possible, avoid placing a catheter through an area of burned or damaged skin.
T145 215646-215753 Sentence denotes In the early stages of burn injury, shock doses of intravenous crystalloid fluids usually are not required.
T146 215754-215950 Sentence denotes Later, however, as severe tissue exudation occurs, protein and fluid losses can become extensive, necessitating aggressive crystalloid and colloid support to treat hypovolemia and hypoproteinemia.
T147 215951-216050 Sentence denotes Flush the eyes with sterile saline and examine behind the third eyelids for any particulate matter.
T148 216051-216129 Sentence denotes Stain the corneas to make sure that superficial corneal burns are not present.
T149 216130-216205 Sentence denotes Treat superficial corneal burns with triple antibiotic ophthalmic ointment.
T150 216206-216290 Sentence denotes Next, assess the total body surface area affected, as this will determine prognosis.
T151 216291-216495 Sentence denotes Depending on the extent of the damage, decide whether the burn is superficial and local therapy is indicated or whether more severe injuries exist that may involve systemic therapy or possibly euthanasia.
T152 216496-216648 Sentence denotes In most cases the diagnosis of thermal burns is based on a clinical history of having been in a house fire, in a clothes dryer, or under a heating lamp.
T153 216649-216859 Sentence denotes Too frequently, however, thermal burns become apparent days after an elective surgical procedure in which the patient was placed on a faulty heating pad rather than a circulating warm water or warm air blanket.
T154 216860-216939 Sentence denotes Superficial burns appear as singed fur with desquamating, easily epilated hair.
T155 216940-217010 Sentence denotes This condition t a B l e 1 -3 1 Percent Burn estimation: rule of nines
T156 217011-217162 Sentence denotes Head 9% Torso 18% Forelimb (per limb) 9% Hindlimb (per limb) 18% 1 also can resemble a superficial or deeper dermatophytosis if the history is unknown.
T157 217163-217250 Sentence denotes Other differential diagnoses include immune-mediated vasculitis or erythema multiforme.
T158 217251-217420 Sentence denotes Unless the superficial dermis is blistered, it may be difficult to distinguish among a thermal burn, a chemical burn, or an electrical burn if the trauma went unnoticed.
T159 217421-217527 Sentence denotes Management of burn injury largely depends on the depth of injury and the total body surface area affected.
T160 217528-217702 Sentence denotes Partial thickness burns and those affecting less than 15% of the total body surface area will require support in the form of antibiotic ointment and systemic analgesic drugs.
T161 217703-217819 Sentence denotes Burns affecting greater than 15% of total body surface area or deep-thickness burns require more aggressive therapy.
T162 217820-217973 Sentence denotes Central venous catheters can be placed to administer crystalloid and colloid fluids, parenteral nutrition if necessary, antibiotics, and analgesic drugs.
T163 217974-218078 Sentence denotes Monitor perfusion parameters closely, including heart rate, BP, capillary refill time, and urine output.
T164 218079-218257 Sentence denotes Respiratory function can be impaired because of concurrent smoke inhalation, thermal damage to the upper airways and alveoli, and carboxyhemoglobin or methemoglobin intoxication.
T165 218258-218360 Sentence denotes Respiratory function also can be impaired because of burn injury to the skin around the thoracic cage.
T166 218361-218497 Sentence denotes Thoracic radiographs may reveal patchy interstitial to alveolar infiltrates associated with pulmonary edema, pneumonia, and atelectasis.
T167 218498-218610 Sentence denotes Bronchoscopy often reveals edema, inflammation, particulate matter, and ulceration of the tracheobronchial tree.
T168 218611-218742 Sentence denotes In some cases, upper airway inflammation is so severe that an emergency tracheostomy must be performed to treat airway obstruction.
T169 218743-218939 Sentence denotes Administer supplemental humidified oxygen at 50 to 100 mL/kg/min via endotracheal tube, tracheostomy, nasal or intratracheal tube, or hood oxygen if respiratory function and hypoxemia are present.
T170 218940-219073 Sentence denotes Perform blood work, including determination of hematocrit, albumin, BUN, creatinine, and glucose levels, at the time of presentation.
T171 219074-219209 Sentence denotes Monitor serum electrolytes, albumin, and colloid oncotic pressure closely because derangements can be severe as burns become exudative.
T172 219210-219422 Sentence denotes The goal of fluid therapy in the burn patient is to establish and maintain intravascular and interstitial fluid volume, normalize electrolyte and acid-base status, and maintain serum albumin and oncotic pressure.
T173 219423-219543 Sentence denotes In the first 24 hours after burn injury, direct fluid therapy to maintaining the patient's metabolic fluid requirements.
T174 219544-219735 Sentence denotes Crystalloid fluids in the form of Normosol-R, Plasma-Lyte M, or lactated Ringer's solution can be administered according to the patient's electrolyte and acid-base status (see Fluid Therapy).
T175 219736-219789 Sentence denotes Monitor urine output, and keep it at 1 to 2 mL/kg/hr.
T176 219790-219845 Sentence denotes Avoid overhydration in the early stages of burn injury.
T177 219846-220017 Sentence denotes In affected burn patients, calculate the amount of fluid that should be administered over a 24-hour period from the formula 1 to 4 mL/kg × percent total body surface area.
T178 220018-220127 Sentence denotes Administer half of this calculated dose over the first 8 hours and the remaining half over the next 16 hours.
T179 220128-220190 Sentence denotes In cats, administer only 50% to 75% of this calculated volume.
T180 220191-220365 Sentence denotes To administer this volume while also avoiding fluid overload is often difficult in critically ill patients with pulmonary involvement associated with smoke inhalation injury.
T181 220366-220420 Sentence denotes Avoid colloids in the first 6 hours after burn injury.
T182 220421-220532 Sentence denotes Monitor the patient closely for serous nasal discharge, chemosis, and rales, which may signify pulmonary edema.
T183 220533-220599 Sentence denotes As burns become exudative, weigh the patient at least twice daily.
T184 220600-220680 Sentence denotes Infused fluid should equal fluid output in the form of urine and wound exudates.
T185 220681-220788 Sentence denotes Acute weight loss signifies acute fluid loss and that crystalloid fluid infusion should be more aggressive.
T186 220789-220981 Sentence denotes Ideally, keep the patient's serum albumin equal to or greater than 2.0 g/dL and total protein between 4.0 and 6.5 g/dL using a combination of fresh frozen plasma or concentrated human albumin.
T187 220982-221113 Sentence denotes Adjunct colloidal support can be provided with synthetic colloids including hetastarch or hemoglobin-based oxygen carriers (HBOCs).
T188 221114-221223 Sentence denotes Keep serum potassium within 3.5 to 4.5 mEq/L using potassium chloride or potassium phosphate supplementation.
T189 221224-221421 Sentence denotes If potassium supplementation exceeds 80 to 100 mEq/L and the patient continues to have severe refractory hypokalemia, administer magnesium chloride (0.75 mEq/kg/day) to enhance potassium retention.
T190 221422-221508 Sentence denotes If anemia occurs, administer packed RBCs or whole blood (see Blood Component Therapy).
T191 221509-221594 Sentence denotes Lavage wounds daily with lactated Ringer's solution or 0.9% sodium chloride solution.
T192 221595-221705 Sentence denotes Place wet-to-dry bandages or bandages soaked in silver sulfadiazine or nitrofurazone ointment over the wounds.
T193 221706-221814 Sentence denotes Depending on the thickness of the burn, epilation and eschar formation and separation may take 2 to 10 days.
T194 221815-221883 Sentence denotes At each bandage change, debride devitalized tissue to normal tissue.
T195 221884-222038 Sentence denotes Perform staged partial or total escharectomy, and leave the wound to heal by second intention or by reconstruction using skin advancement flaps or grafts.
T196 222039-222139 Sentence denotes Maintain meticulous sterility at all times, given that burn patients are at high risk for infection.
T197 222140-222215 Sentence denotes Administer broad-spectrum antibiotics including cefazolin and enrofloxacin.
T198 222216-222286 Sentence denotes Perform wound culture if a resistant bacterial infection is suspected.
T199 222287-222435 Sentence denotes The most common cause of electrical injury is associated with an animal chewing on lowvoltage alternating current electrical cords in the household.
T200 222436-222565 Sentence denotes Damage is caused by the current flowing through the path of least resistance, causing heat and thrombosis of vessels and neurons.
T201 222566-222611 Sentence denotes In some cases, the owner witnesses the event.
T202 222612-222793 Sentence denotes In other cases, the owner presents the patient because of vague nonspecific signs, and characteristic abnormalities on physical examination support a diagnosis of electrical injury.
T203 222794-222884 Sentence denotes Burns on the face, paws, commissures of the mouth, tongue, and soft palate may be present.
T204 222885-223043 Sentence denotes Electrical injury causes a massive release of catecholamines and can predispose the patient to noncardiogenic pulmonary edema within 36 hours of the incident.
T205 223044-223154 Sentence denotes Clinical signs may be isolated to the pulmonary system, including orthopnea, pulmonary crackles, and cyanosis.
T206 223155-223242 Sentence denotes Assess the patient's lips, tongue, soft palate, gingivae, and commissures of the mouth.
T207 223243-223328 Sentence denotes Early after electrical injury the wound may appear small and white, black, or yellow.
T208 223329-223416 Sentence denotes Later the wound may become larger as tissue sloughs because of damaged vascular supply.
T209 223417-223457 Sentence denotes Assess the patient's respiratory status.
T210 223458-223531 Sentence denotes Auscultate the lungs to determine whether pulmonary crackles are present.
T211 223532-223679 Sentence denotes If the patient's condition is stable, thoracic radiographs may demonstrate an interstitial to alveolar lung pattern in the dorsocaudal lung fields.
T212 223680-223802 Sentence denotes Measure the patient's heart rate, BP, oxygenation as determined by pulse oximetry or arterial blood gas, and urine output.
T213 223803-224006 Sentence denotes Immediate treatment consists of judicious use of analgesics for the burn injury, antibiotics (cefazolin, 22 mg/kg q8h; cephalexin, 22 mg/kg q8h), and humidified supplemental oxygen (50 to 100 mL/kg/min).
T214 224007-224082 Sentence denotes Direct fluid therapy at meeting the patient's metabolic fluid requirements.
T215 224083-224208 Sentence denotes Because of the risk of development of noncardiogenic pulmonary edema, avoid overzealous administration of crystalloid fluids.
T216 224209-224380 Sentence denotes Differential diagnoses for the patient with electrical burn injury include chemical or thermal burn, immune-mediated glossitis, cardiogenic pulmonary edema, and pneumonia.
T217 224381-224568 Sentence denotes Management of the patient with electrical burn injury primarily involves the administration of analgesic agents, supplemental humidified oxygen, and topical treatment of electrical burns.
T218 224569-224761 Sentence denotes The noncardiogenic pulmonary edema is typically unresponsive to diuretics (e.g., furosemide), bronchodilators (e.g., aminophylline), and splanchnic vascular dilators (e.g., low-dose morphine).
T219 224762-224887 Sentence denotes The use of glucocorticoids has no proven benefit and may impair respiratory immune function and is therefore contraindicated.
T220 224888-224991 Sentence denotes Oral burns may require debridement and advancement flaps if large defects or oronasal fistulas develop.
T221 224992-225130 Sentence denotes If oral injury is severe, place an esophagostomy or percutaneous gastrostomy tube to ensure adequate nutrition during the healing process.
T222 225131-225251 Sentence denotes If an animal survives the initial electrical incident, prognosis is generally favorable with aggressive supportive care.
T223 225252-225430 Sentence denotes Chemical burns are associated with a number of inciting causes, including oxidizing agents, reducing agents, corrosive chemicals, protoplasmic poisons, desiccants, and vesicants.
T224 225431-225623 Sentence denotes The treatment for chemical burns differs slightly from that for thermal burns, so it remains important to investigate the cause of the burn when providing initial treatment, whenever possible.
T225 225624-225717 Sentence denotes At the scene, advise the owner to wrap the patient in a clean towel or blanket for transport.
T226 225718-225800 Sentence denotes Chilling can be avoided by then wrapping the patient in a second or third blanket.
T227 225801-225842 Sentence denotes Placement of ointments should be avoided.
T228 225843-225904 Sentence denotes Encourage immediate transport to the nearest triage facility.
T229 225905-226053 Sentence denotes The first and foremost consideration when treating a patient with chemical burns is to remove the animal from the inciting cause or offending agent.
T230 226054-226243 Sentence denotes Make no attempt to neutralize alkaline or acid substances because the procedure potentially could cause an exothermic reaction, leading to thermal injury in addition to the chemical injury.
T231 226244-226322 Sentence denotes Remove collars or leashes that may act as tourniquets or constricting devices.
T232 226323-226495 Sentence denotes Flush affected areas with copious amounts of cool water for several minutes, not cooling more than 10% to 20% of the body at any one time to prevent iatrogenic hypothermia.
T233 226496-226555 Sentence denotes Support breathing by extending the patient's head and neck.
T234 226556-226650 Sentence denotes Carefully clip the fur over affected areas for further evaluation of the extent of the injury.
T235 226651-226747 Sentence denotes Lavage exposed eyes with sterile saline, and stain the cornea to evaluate for any corneal burns.
T236 226748-226861 Sentence denotes Debride any wounds carefully, knowing that the full extent of the wound may not manifest itself for several days.
T237 226862-226968 Sentence denotes Then cover the wounds with antibiotic burn ointment such as silver sulfadiazine and an occlusive dressing.
T238 226969-227150 Sentence denotes Without a history of exposure, the differential diagnosis for any chemical burn includes thermal burn, necrotizing vasculitis, erythema multiforme, and superficial or deep pyoderma.
T239 227151-227254 Sentence denotes Contact the local or national animal poison control center regarding whether to attempt neutralization.
T240 227255-227358 Sentence denotes Perform daily bandage changes with staged debridement as the full extent of the wound manifests itself.
T241 227359-227457 Sentence denotes Place antimicrobial ointment and silver sulfadiazine ointment over the wound to prevent infection.
T242 227458-227552 Sentence denotes The routine use of antibiotics may promote the development of a resistant bacterial infection.
T243 227553-227604 Sentence denotes First-generation cephalosporin can be administered.
T244 227605-227727 Sentence denotes If a more serious infection develops, perform culture and susceptibility testing to direct appropriate antibiotic therapy.
T245 227728-227827 Sentence denotes The wound can heal by second intention or may require reconstructive repair for definitive closure.
T246 227828-227938 Sentence denotes The primary cause of radiation injury in small animal patients is radiation therapy for neoplastic conditions.
T247 227939-227997 Sentence denotes The goal of radiation therapy is to kill neoplastic cells.
T248 227998-228143 Sentence denotes An unfortunate side effect is damage to adjacent normal tissue that results in necrosis, fibrosis, and impaired circulation to the affected area.
T249 228144-228256 Sentence denotes Radiation burns result in dermatitis, mucositis, impaired surgical wound healing, and chronic nonhealing wounds.
T250 228257-228514 Sentence denotes In many cases, secondary radiation injury to normal tissue can be prevented or its degree decreased with careful radiation planning and mapping of the radiation field, such that radiation exposure of normal tissue is limited to the smallest extent possible.
T251 228515-228702 Sentence denotes With the advent of three-dimensional imaging modalities such as computed tomography (CT) and magnetic resonance imaging (MRI), this has become more routine in veterinary oncology to date.
T252 228703-228801 Sentence denotes Radiation injury can occur early and appear at the later stage of the course of radiation therapy.
T253 228802-228874 Sentence denotes Late effects can be delayed and occur 6 months to years after treatment.
T254 228875-228959 Sentence denotes The degree of radiation injury is categorized based on the depth of tissue affected.
T255 228960-229008 Sentence denotes First-degree changes 1 cause cutaneous erythema.
T256 229009-229062 Sentence denotes Second-degree changes cause superficial desquamation.
T257 229063-229205 Sentence denotes Thirddegree changes cause deeper moist desquamation, and fourth-degree changes are associated with complete dermal destruction and ulceration.
T258 229206-229306 Sentence denotes During the early stages of radiation injury, affected tissues may appear erythematous and edematous.
T259 229307-229405 Sentence denotes Wound exudates may be moist, or the skin may appear dry and scaly with desquamation or ulceration.
T260 229406-229537 Sentence denotes Later the area may scar and depigment or may have induration, atrophy, telangiectasia, keratosis, and decreased adnexal structures.
T261 229538-229661 Sentence denotes Treatment for radiation dermatitis is to irrigate the area with warmed saline and to protect the area from self-mutilation.
T262 229662-229773 Sentence denotes No-bite, or Elizabethan, collars or loose clothing can be used to protect the area from patient-induced injury.
T263 229774-229904 Sentence denotes Mucositis can be treated with topical green tea baths and the administration of an oral solution of l-glutamine powder (4 g/m 2 ).
T264 229905-230081 Sentence denotes Local irrigation with Xylocaine or lidocaine viscous jelly can be used in dogs but should be avoided in cats because of the risk of inducing hemolytic anemia and neurotoxicity.
T265 230082-230170 Sentence denotes Topical and systemic antibiotics (cephalexin, 22 mg/kg PO tid) also can be administered.
T266 230171-230247 Sentence denotes Avoid antibiotics that can be sensitized by radiation (e.g., metronidazole).
T267 230248-230387 Sentence denotes Because most radiation burns are associated with a known exposure to radiation therapy, the cause of the patient's injury usually is known.
T268 230388-230642 Sentence denotes If an animal is presented to you with a scar, however, differential diagnoses may include nasal planum solar dermatitis, pemphigus foliaceus, discoid lupus, superficial necrolytic dermatitis, superficial or deep pyoderma, chemical burn, and thermal burn.
T269 230643-230818 Sentence denotes Treatment of radiation injury involves making the patient as comfortable as possible with analgesic drugs, preventing self-mutilation, and using staged debridement techniques.
T270 230819-230893 Sentence denotes Wounds can heal by second intention or may require reconstructive surgery.
T271 230895-230997 Sentence denotes Cardiopulmonary arrest is the abrupt cessation of spontaneous and effective ventilation and perfusion.
T272 230998-231084 Sentence denotes Cardiac arrest must be treated rapidly and aggressively to have any chance of success.
T273 231085-231237 Sentence denotes The goal of CPCR is to perform effective thoracic compressions such that an adequate amount of oxygen is delivered to the brain and other vital tissues.
T274 231238-231400 Sentence denotes At the time of admission into the hospital, all patients, regardless of their disease process, should have a plan in the event that cardiopulmonary arrest occurs.
T275 231401-231443 Sentence denotes Do the owners want to proceed with 1 CPCR?
T276 231444-231565 Sentence denotes Should you proceed with intubation, cardiac compressions and drugs, or do the owners want you to perform open-chest CPCR?
T277 231566-231747 Sentence denotes Among the most important aspects of cardiopulmonary resuscitation are to anticipate whether a patient is rapidly decompensating and likely to arrest and to be prepared at all times.
T278 231748-231890 Sentence denotes Stock a crash cart at all times with the equipment and drugs necessary in the event that cardiopulmonary resuscitation is required (Box 1-34).
T279 231891-232078 Sentence denotes By having routine drills in the hospital on cadavers or stuffed animals, your emergency team can become efficient at performing the responsibilities and jobs required for successful CPCR.
T280 232079-232399 Sentence denotes The staff should know how to recognize impending signs of a decompensating patient, clinical signs of cardiac arrest, how to call for an emergency in the hospital, how to intubate patients, and how to start cardiac compressions, hook up an electrocardiograph, and draw up the drugs required to treat various arrhythmias.
T281 232400-232795 Sentence denotes Conditions that predispose a patient to cardiopulmonary arrest include vagal stimulation, cellular hypoxia, septicemia, endotoxemia, severe acid-base and electrolyte derangements, prolonged seizures, pneumonia, pleural or pericardial effusion, severe multisystemic trauma, electrical shock, urinary obstruction or damage, acute respiratory distress syndrome (ARDS), and use of anesthetic agents.
T282 232796-233015 Sentence denotes The acute onset of bradycardia, change in mucous membrane color and capillary refill time, change in respiratory pattern, and change in mentation are signs of possible deterioration and impending cardiopulmonary arrest.
T283 233016-233373 Sentence denotes The diagnosis of cardiopulmonary arrest is based on the absence of effective ventilation, severe cyanosis, absence of a palpable pulse or apex heartbeat, absence of heart sounds, and ECG evidence of asystole or other nonperfusing rhythm such as electrical-mechanical dissociation (EMD; i.e., pulseless electrical activity [PEA]) or ventricular fibrillation.
T284 233374-233722 Sentence denotes The goals of CPCR are to obtain airway access, provide artificial ventilation and supplemental oxygen, implement cardiac compressions and cardiovascular support, recognize and treat dysrhythmias and arrhythmias, and provide stabilization and treatment for cardiovascular, pulmonary, and cerebral function in the event of a successful resuscitation.
T285 233723-233896 Sentence denotes Even with aggressive treatment and management, the overall success of CPCR is less than 5% in critically ill or traumatized patients and 20% to 30% in anesthetized patients.
T286 233897-234165 Sentence denotes Basic life support involves rapid intubation to gain airway access, artificial ventilation, and cardiac compressions to promote blood flow and delivery of oxygen to the brain and other important tissues (Figure 1 -26 is breathing, and C is compression and circulation.
T287 234166-234209 Sentence denotes Recently, the paradigm has shifted to CABs.
T288 234210-234485 Sentence denotes While a team member is grabbing an endotracheal tube, clearing the airway of foreign debris, and establishing airway access through endotracheal intubation, a second person starts external cardiac compressions to deliver oxygen that is in the bloodstream to the vital organs.
T289 234486-234601 Sentence denotes The patient should be positioned in dorsal (>7 kg) or lateral (<7 kg) recumbency for external cardiac compressions.
T290 234602-234695 Sentence denotes Approximately 80 to 120 external compressions should be performed over the patient's sternum.
T291 234696-234813 Sentence denotes A team member should palpate for a peripheral pulse to determine whether cardiac compressions are actually effective.
T292 234814-235010 Sentence denotes If a peripheral pulse cannot be palpated for every chest compression, change the patient's position and have a larger individual perform compressions, or initiate open-chest cardiac resuscitation.
T293 235011-235196 Sentence denotes Once the patient has been intubated, tie in the endotracheal tube and attach it to an oxygen source (anesthetic machine or mechanical ventilator or Ambu bag) for artificial ventilation.
T294 235197-235242 Sentence denotes The oxygen flow rate should be 150 mL/kg/min.
T295 235243-235303 Sentence denotes Give two long breaths, and then 12 to 16 breaths per minute.
T296 235304-235497 Sentence denotes Simultaneous ventilation with thoracic compression increases the pressure difference in the thorax and allows more forward flow of oxygenated blood through the great vessels into the periphery.
T297 235498-235662 Sentence denotes If possible, a third team member can initiate interposed abdominal compressions, compressing the abdomen when the thoracic cage is relaxed, to improve forward flow.
T298 235663-235898 Sentence denotes If only one person is available to perform the thoracic compressions and ventilation, give two breaths for every 15 compressions (i.e., 15 thoracic compressions followed by two long breaths, and then start thoracic compressions again).
T299 235899-236094 Sentence denotes The Jen Chung maneuver can be performed by placing a 25-to 22-gauge hypodermic needle through the skin of the nasal philtrum and twisting the needle into the periosteum to stimulate respirations.
T300 236095-236187 Sentence denotes This maneuver appears to work better in cats than dogs at return to spontaneous respiration.
T301 236188-236366 Sentence denotes Advanced life support during CPCR involves ECG, pulse oximetry and capnometry monitoring, administration of drugs, and the administration of intravenous fluids (in select cases).
T302 236367-236494 Sentence denotes Most of the drugs used during CPCR can be administered directly into the lungs from the endotracheal tube (intratracheal tube).
T303 236495-236618 Sentence denotes Therefore only in select instances is it necessary to establish vascular or intraosseous access during CPCR (Figure 1-27 ).
T304 236619-236923 Sentence denotes If an animal experiences cardiopulmonary arrest because of extreme hemorrhage or hypovolemia, inappropriate vasodilation caused by sepsis or systemic inflammation, or vasodilation resulting from anesthesia, the administration of shock volumes (90 mL/kg/hr in dogs and 44 mL/kg/hr in cats) is appropriate.
T305 236924-237154 Sentence denotes If a patient is euvolemic and experiences cardiopulmonary arrest, however, an increase in circulating fluid volume actually can impair coronary artery perfusion by increasing diastolic arterial BP and is therefore contraindicated.
T306 237155-237254 Sentence denotes Place a capnograph on the end or side of the endotracheal tube to measure end-tidal carbon dioxide.
T307 237255-237362 Sentence denotes Asystole is one of the most common rhythm disturbances that causes cardiac arrest in small animal patients.
T308 237363-237551 Sentence denotes One of the most important things to do when the ECG indicates asystole is to make sure that the ECG monitor is working properly and that all ECG leads are attached properly to the patient.
T309 237552-237679 Sentence denotes If asystole is truly present, reverse any opiate, α 2 -agonist, or benzodiazepine drugs with their appropriate reversal agents.
T310 237680-237846 Sentence denotes Low-dose epinephrine (0.02 to 0.04 mg/kg diluted with 5 mL sterile saline) can be administered directly into the endotracheal tube via a rigid or red rubber catheter.
T311 237847-237936 Sentence denotes If vascular access is available, epinephrine (0.02 to 0.04 mg/kg) can be administered IV.
T312 237937-238023 Sentence denotes No drug should ever be administered directly into the heart by intracardiac injection.
T313 238024-238330 Sentence denotes Unless the heart is in the veterinarian's hand during open-chest CPCR, intracardiac injection is risky and potentially could lacerate a coronary artery or cause the myocardium to become more irritable and refractory to other therapies, if a drug is delivered into the myocardium and not into the ventricle.
T314 238331-238394 Sentence denotes For these reasons, intracardiac injections are contraindicated.
T315 238395-238469 Sentence denotes Administer atropine (0.04 mg/kg IV, IO) immediately after the epinephrine.
T316 238470-238595 Sentence denotes Atropine, a vagolytic drug, serves to decrease tonic vagal inhibition of the sinoatrial and AV nodes and increase heart rate.
T317 238596-238773 Sentence denotes Administer atropine and epinephrine every 2 to 5 minutes during asystole while cardiac compressions, interposed abdominal compressions, and artificial ventilation are continued.
T318 238774-238928 Sentence denotes Although discontinuation of thoracic compressions can decrease the chance of success during CPCR, you must intermittently evaluate the ECG monitor for any
T319 238930-239107 Sentence denotes EMD, also known as pulseless electrical activity, is an electrical rhythm that may look wide, bizarre, and irregular with no associated mechanical contraction of the ventricles.
T320 239108-239164 Sentence denotes The rhythm can appear different from patient to patient.
T321 239165-239295 Sentence denotes EMD is one of the more common nonperfusing rhythms observed during cardiopulmonary arrest in small animal patients (Figure 1-28) .
T322 239296-239391 Sentence denotes When EMD is identified, first confirm the rhythm and proceed with CPCR as previously described.
T323 239392-239485 Sentence denotes EMD is thought to be associated with high doses of endogenous endorphins and high vagal tone.
T324 239486-239651 Sentence denotes The treatment of choice for EMD is high-dose atropine (4 mg/kg IV, intratracheal [IT] [10 times the normal dose]) and naloxone hydrochloride (0.03 mg/kg IV, IO, IT).
T325 239652-239735 Sentence denotes Administer epinephrine (0.02 to 0.04 mg/kg diluted in 5 mL sterile 0.9% saline IT).
T326 239736-239820 Sentence denotes If the rhythm does not change within 2 minutes, consider open-chest cardiac massage.
T327 239821-239876 Sentence denotes Ventricular fibrillation can be coarse (Figure 1 -29) .
T328 239877-239986 Sentence denotes Patients with coarse ventricular fibrillation are easier to defibrillate than those with fine defibrillation.
T329 239987-240083 Sentence denotes If ventricular fibrillation is identified, initiate CPCR as described previously (Figure 1-30) .
T330 240084-240176 Sentence denotes If an electrical defibrillator is available, administer 5 J/kg of direct current externally.
T331 240177-240371 Sentence denotes When a patient in cardiopulmonary arrest is attached to ECG leads, it is important to use contact electrode paste, water-soluble gel such as K-Y jelly, or water, rather than any form of alcohol.
T332 240372-240479 Sentence denotes Electrical defibrillation of a patient who has alcohol on the ECG leads can lead to fire and thermal burns.
T333 240480-240581 Sentence denotes Reverse any opioid, α 2 -agonist, and phenothiazine drugs that have been administered to the patient.
T334 240582-240792 Sentence denotes If fine ventricular fibrillation is identified, administer epinephrine (0.02 to 0.04 mg/kg in 5 mL sterile 0.9% saline IT) to attempt to convert fine ventricular fibrillation to coarse ventricular fibrillation.
T335 240793-240863 Sentence denotes After administration of epinephrine, repeat electrical defibrillation.
T336 240864-240951 Sentence denotes If an electrical defibrillator is not available, chemical defibrillator activity (PEA).
T337 240952-241064 Sentence denotes The complexes often appear wide and bizarre without a palpable apex beat or functional contraction of the heart.
T338 241065-241162 Sentence denotes This is just one example of EMD, as many shapes and complexes may be observed. drugs can be used.
T339 241163-241245 Sentence denotes Amiodarone (0.5 mg/kg IV) is the treatment of choice for ventricular fibrillation.
T340 241246-241336 Sentence denotes If amiodarone is unavailable, magnesium chloride can be administered (30 mg/ kg IV or IT).
T341 241337-241515 Sentence denotes Even if an electrical defibrillator is available, magnesium chloride can increase the success of converting ventricular fibrillation to asystole or some other rhythm during CPCR.
T342 241516-241595 Sentence denotes Amiodarone (0.5 mg/kg IV) also can be used to convert ventricular fibrillation.
T343 241596-241705 Sentence denotes If drug therapy and external thoracic compressions are ineffective after 2 minutes, consider open-chest CPCR.
T344 241706-241923 Sentence denotes Perform open-chest CPCR immediately if a pathologic condition exists that prevents enough of a change in intrathoracic pressure that closed-chest CPCR will not be effective in promoting forward blood flow (Box 1-35) .
T345 241924-241998 Sentence denotes To perform open-chest CPCR, place the patient in right lateral recumbency.
T346 241999-242125 Sentence denotes Clip a wide strip of fur over the left fifth to seventh intercostal space and quickly aseptically scrub over the clipped area.
T347 242126-242137 Sentence denotes Using a No.
T348 242138-242277 Sentence denotes 10 scalpel blade, incise over the fifth intercostal space through the skin and subcutaneous tissue to the level of the intercostal muscles.
T349 242278-242388 Sentence denotes With Mayo scissors, make a blunt stab incision through the intercostal muscles in the left sixth intercostal .
T350 242389-242479 Sentence denotes This algorithm is organized according to whether an electrical defibrillator is available.
T351 242480-242611 Sentence denotes After each intervention step, the electrocardiogram (ECG) should be reevaluated and the next step initiated if V-fib is still seen.
T352 242612-242702 Sentence denotes If a new arrhythmia develops, the appropriate therapy for that rhythm should be initiated.
T353 242703-242805 Sentence denotes If a sinus rhythm is seen with a palpable apex beat, postresuscitation measures should be implemented.
T354 242806-242812 Sentence denotes space.
T355 242813-242955 Sentence denotes Make sure that the person who is breathing for the patient deflates the lungs as you make the stab incision to avoid iatrogenic lung puncture.
T356 242956-243104 Sentence denotes After the stab incision, open the tips of the Mayo scissors and quickly open the muscle dorsally and ventrally to the sternum with a sliding motion.
T357 243105-243217 Sentence denotes Avoid the internal thoracic artery at the sternum and the intercostal arteries at the caudal aspect of each rib.
T358 243218-243424 Sentence denotes Cut the rib adjacent to the sternum and push it behind the rib in front of and at the caudal aspect of the incision to allow more room and better visualization if a rib-spreading retractor is not available.
T359 243425-243468 Sentence denotes Visualize the heart in the pericardial sac.
T360 243469-243559 Sentence denotes Visualize the phrenic nerve, and incise the pericardium just ventral to the phrenic nerve.
T361 243560-243599 Sentence denotes Make sure to not cut the phrenic nerve.
T362 243600-243842 Sentence denotes Grasp the heart in your hand(s) and gently squeeze it from apex to base, allowing time for the ventricle to fill before the next "contraction. " If the heart does not seem to be filling, administer fluids IV or directly into the right atrium.
T363 243843-243977 Sentence denotes The descending aorta can be cross-clamped with a Rummel tourniquet or red rubber catheter to improve perfusion to the brain and heart.
T364 243978-244137 Sentence denotes Postresuscitation care involves careful monitoring and management of the adverse effects of hypoxia and reperfusion injury on the brain and other vital organs.
T365 244138-244375 Sentence denotes The first 4 hours after an arrest are most critical, because this is the time period in which an animal is most likely to rearrest unless the underlying cause of the initial arrest has been determine and treated ( 1 oxygen must continue.
T366 244376-244605 Sentence denotes The efficacy of oxygenation and ventilation can be monitored using a Wright respirometer, pulse oximetry, capnometry, and arterial blood gas analyses (see also Pulse Oximetry and Capnometry [End-Tidal Carbon Dioxide Monitoring]).
T367 244606-244723 Sentence denotes Once an animal has been extubated, administer supplemental oxygen (50 to 100 mL/kg/min) (see Oxygen Supplementation).
T368 244724-244782 Sentence denotes The brain is sensitive to ischemia and reperfusion injury.
T369 244783-244928 Sentence denotes The effects of cellular hypoxia and reperfusion include the development of oxygen-derived free radical species that contribute to cerebral edema.
T370 244929-245143 Sentence denotes Administer mannitol (0.5 to 1 g/kg IV over 5 to 10 minutes), followed by furosemide (1 mg/kg IV) 20 minutes later, to all patients that have experienced cardiopulmonary arrest and have had successful resuscitation.
T371 245144-245275 Sentence denotes Mannitol and furosemide work synergistically to decrease cerebral edema formation and scavenge oxygen-derived free radical species.
T372 245276-245482 Sentence denotes The combination of cardiac arrest, myocardial ischemia and acidosis, and external or internal cardiac compressions often makes the myocardium irritable and predisposed to dysrhythmias after successful CPCR.
T373 245483-245613 Sentence denotes Start lidocaine (1 to 2 mg/kg IV, followed by 50 to 100 mcg/kg/min IV CRI) in all patients after successful resuscitative efforts.
T374 245614-245723 Sentence denotes Monitor the ECG continuously for the presence of cardiac dysrhythmias and recurrence of nonperfusing rhythms.
T375 245724-245765 Sentence denotes Perform direct or indirect BP monitoring.
T376 245766-246109 Sentence denotes If a patient's systolic BP is less than 80 mm Hg, diastolic pressure is less than 40 mm Hg, or mean arterial BP is less than 60 mm Hg, administer positive inotropic drugs (dobutamine, 1 to 20 mcg/kg/min) and pressor agents (epinephrine, 0.02 to 0.04 mg/kg IV, IO, IT) to improve cardiac contractility, cardiac output, and core organ perfusion.
T377 246110-246180 Sentence denotes The kidneys are sensitive to decreased perfusion and cellular hypoxia.
T378 246181-246231 Sentence denotes Place a urinary catheter and monitor urine output.
T379 246232-246315 Sentence denotes In a euvolemic patient, normal urine output should be no less than 1 to 2 mL/kg/hr.
T380 246316-246471 Sentence denotes If urine output is low, administer low-dose dopamine (3 to 5 mcg/kg/min IV CRI) in an attempt to dilate afferent renal vessels and improve renal perfusion.
T381 246472-246545 Sentence denotes Maintain acid-base and electrolyte status within normal reference ranges.
T382 246546-246639 Sentence denotes Monitor serum lactate as a rough indicator of organ perfusion and cellular oxygen extraction.
T383 246640-246785 Sentence denotes The presence of elevated or rising serum lactate in the face of aggressive cardiorespiratory and cerebral support makes prognosis less favorable.
T1 246787-246995 Sentence denotes Cardiac dysrhythmias can encompass a wide range of clinical syndromes that vary in their clinical significance and signs, depending on the rate and frequency and whether coexisting cardiac disease is present.
T2 246996-247322 Sentence denotes Ventricular and supraventricular dysrhythmias can occur because of primary myocardial disease or some other, secondary underlying disease process, including thoracic trauma, sepsis, systemic inflammatory response syndrome (SIRS), pancreatitis, GDV, splenic disease, hypoxia, uremia, and acid-base and electrolyte disturbances.
T3 247323-247495 Sentence denotes Common cardiac causes of dysrhythmias include dilative cardiomyopathy, end-stage degenerative valvular disease, infectious endocarditis, myocarditis, and cardiac neoplasia.
T4 247496-247631 Sentence denotes In the cat, hypertrophy, restrictive and unclassified cardiomyopathies, and hyperthyroidism are the most common causes of dysrhythmias.
T5 247632-247827 Sentence denotes In addition to arising from structural cardiac or systemic disease, dysrhythmias can occur as an adverse effect of some drugs, including digoxin, dobutamine, aminophylline, and anesthetic agents.
T6 247828-247983 Sentence denotes Immediate action depends largely on recognition of the primary or secondary cause of the dysrhythmia and treatment of the dysrhythmia and underlying cause.
T7 247984-248198 Sentence denotes Diagnosis of cardiac dysrhythmias is based on abnormal physical examination findings on thoracic or cardiac auscultation, the presence of abnormal pulse rhythm and its quality, and recognition of ECG abnormalities.
T8 248199-248261 Sentence denotes The ECG is critical to the accurate diagnosis of dysrhythmias.
T9 248262-248445 Sentence denotes Ventricular dysrhythmias arise from ectopic foci in the ventricles that cause the wave of depolarization to spread from cell to cell rather than spread through fast-conducting tissue.
T10 248446-248581 Sentence denotes This causes the QRS complex to appear wide and bizarre, unless the ectopic focus originates close to the AV node high in the ventricle.
T11 248582-248714 Sentence denotes Other ECG features of ventricular dysrhythmias include a T wave polarity that is opposite to the QRS complex and nonrelated P waves.
T12 248715-248858 Sentence denotes Ventricular dysrhythmias may manifest as isolated ventricular premature complexes, couplets, or triplets; bigeminy; or ventricular tachycardia.
T13 248859-249013 Sentence denotes Relatively slow ventricular tachycardia is known as an idioventricular rhythm and is not as hemodynamically significant as faster ventricular tachycardia.
T14 249014-249150 Sentence denotes Idioventricular rhythm usually is less than 130 beats/min and may alternate spontaneously with sinus arrhythmias (Figures 1-31 to 1-34).
T15 249151-249199 Sentence denotes Unifocal premature ventricular complexes (PVCs).
T16 249200-249300 Sentence denotes All the PVCs are the same shape and size and originate from the same ectopic focus in the ventricle.
T17 249301-249370 Sentence denotes Note that this rhythm is actually an example of ventricular bigeminy.
T18 249371-249640 Sentence denotes Supraventricular dysrhythmias arise from ectopic foci in the atria and are commonly associated with atrial dilatation and structural heart disease such as advanced acquired or congenital heart disease, cardiomyopathies, cardiac neoplasia, or advanced heartworm disease.
T19 249641-249746 Sentence denotes Occasionally, supraventricular dysrhythmias may be associated with respiratory or other systemic illness.
T20 249747-249998 Sentence denotes Sustained supraventricular tachycardia in the absence of underlying structural heart or systemic disease is disturbing and should alert the clinician that an accessory pathway conduction disturbance may be present, particularly in Labrador Retrievers.
T21 249999-250229 Sentence denotes Supraventricular dysrhythmias can manifest as isolated premature complexes (atrial premature complexes or contractions), sustained or paroxysmal supraventricular tachycardia (atrial tachycardia), or atrial fibrillation or flutter.
T22 250230-250319 Sentence denotes In the dog, atrial fibrillation most commonly is associated with dilative cardiomyopathy.
T23 250320-250430 Sentence denotes Rarely and primarily in giant breed dogs, lone atrial fibrillation can occur with no underlying heart disease.
T24 250431-250576 Sentence denotes Atrial fibrillation and the resultant sustained elevation in ventricular rate are presumed to progress to dilative cardiomyopathy in such breeds.
T25 250577-250765 Sentence denotes By comparison, atrial fibrillation is relatively uncommon in cats because of the small size of their atria but is associated most commonly with hypertrophic and restrictive cardiomyopathy.
T26 250766-250837 Sentence denotes The ECG is critical to the diagnosis of a supraventricular dysrhythmia.
T27 250838-251036 Sentence denotes The ECG usually demonstrates a normal appearance to the QRS complex unless aberrant conduction occurs in the ventricles, in which case the QRS can be wide but still originate from above the AV node.
T28 251037-251191 Sentence denotes In most cases of a supraventricular dysrhythmia, some evidence of atrial 1 activity including P waves, atrial flutter, or atrial fibrillation is apparent.
T29 251192-251337 Sentence denotes In some cases, it may be difficult to diagnose the exact rhythm without slowing the rate down mechanically or through pharmacologic intervention.
T30 251338-251453 Sentence denotes Once a rhythm diagnosis has been made, appropriate treatment strategies can be implemented (Figures 1-35 and 1-36).
T31 251454-251711 Sentence denotes Treatment of ventricular dysrhythmias largely depends on the number of ectopic foci discharging, the rate and character of the dysrhythmia, and whether the presence of the abnormal beats is of adverse hemodynamic consequence, including risk of sudden death.
T32 251712-251995 Sentence denotes Many ventricular dysrhythmias, including slow idioventricular rhythms, ventricular bigeminy, or intermittent ventricular premature complexes, do not warrant antiarrhythmic therapy unless the patient is hypotensive and the dysrhythmia is thought to be contributing to the hypotension.
T33 251996-252155 Sentence denotes In such cases, correction of the underlying disease process including hypoxia, pain, or anxiety often alleviates or decreases the incidence of the dysrhythmia.
T34 252156-252622 Sentence denotes More serious ventricular dysrhythmias that warrant antiarrhythmic therapy (Table 1 -33) include sustained ventricular tachycardia (>160 beats/min in dogs; >220 beats/min in cats), multifocal ventricular premature complexes originating from more than one place in the ventricles, and the presence of R-on-T phenomena, in which the T wave of the preceding complex is superimposed on the QRS of the next complex with no return to isoelectric shelf in between complexes.
T35 252623-252689 Sentence denotes Treat these ventricular dysrhythmias immediately and aggressively.
T36 252690-252785 Sentence denotes In dogs, the mainstay of emergency treatment for ventricular dysrhythmias is lidocaine therapy.
T37 252786-252927 Sentence denotes Administer lidocaine (1 to 2 mg/kg intravenous bolus) over a period of 5 minutes to prevent the adverse side effects of seizures or vomiting.
T38 252928-253005 Sentence denotes The bolus can be repeated an additional three times (total dose 8 mg/kg) over
T39 253007-253296 Sentence denotes Procainamide 10-20 mg/kg PO q6-8h Sotalol 1-3 mg/kg PO q12h (start low, then titrate upward to effect) Mexiletine* 4-10 mg/kg PO q8h Atenolol 0.25-1.0 mg/kg PO q12-24h (start low, titrate upward to effect) PO, Orally. *Do not use for longer than 2 weeks because of idiosyncratic blindness.
T40 253297-253424 Sentence denotes 15 minutes, or the patient can be placed on a CRI (50 to 100 mcg/kg/min) if control of ventricular tachycardia is accomplished.
T41 253425-253578 Sentence denotes Also correct the patient's magnesium and potassium deficiencies to maximize the success of lidocaine therapy in the treatment of ventricular tachycardia.
T42 253579-253684 Sentence denotes Procainamide (4 mg/kg IV slowly over 3 to 5 minutes) also can be used to control ventricular tachycardia.
T43 253685-253800 Sentence denotes If procainamide is successful at controlling ventricular tachycardia, administer it as a CRI (25 to 40 mcg/kg/min).
T44 253801-253874 Sentence denotes Side effects of procainamide include vomiting, diarrhea, and hypotension.
T45 253875-253974 Sentence denotes Chronic oral therapy may or may not be necessary in the treatment of acute ventricular tachycardia.
T46 253975-254150 Sentence denotes The decision to continue antiarrhythmic therapy depends on the underlying disease process and the expectation of persistent arrhythmogenesis of the underlying disease process.
T47 254151-254421 Sentence denotes Oral antiarrhythmic therapy is warranted in cases in which a serious ventricular dysrhythmia is recognized but the animal does not require hospitalization, such as the syncopal Boxer with intermittent ventricular dysrhythmias and no evidence of structural heart disease.
T48 254422-254531 Sentence denotes It deserves emphasis that asymptomatic, low-grade ventricular dysrhythmias probably do not require treatment.
T49 254532-254799 Sentence denotes If maintenance therapy for ventricular dysrhythmias is needed, use an oral drug based on the underlying disease process, clinical familiarity, class of drug, administration frequency, owner compliance, concurrent medications, cost, and potential adverse side effects.
T50 254800-254890 Sentence denotes In the cat the mainstay of antiarrhythmic therapy is the use of a β-adrenergic antagonist.
T51 254891-255208 Sentence denotes In the acute management of ventricular dysrhythmias in cases of hypertrophic, restrictive, or unclassified cardiomyopathies, consider using injectable esmolol (0.05 to 1.0 mg/kg IV slowly to effect) or propranolol (0.02 to 0.06 mg/kg IV slowly to effect), particularly if the dysrhythmia results from hyperthyroidism.
T52 255209-255374 Sentence denotes For chronic oral ventricular antiarrhythmic therapy in cats, propranolol (2.5 to 5.0 mg PO per cat q8h) or atenolol (6.25 to 12.5 mg PO per cat q12-24h) can be used.
T53 255375-255511 Sentence denotes The decision to treat supraventricular dysrhythmias depends on the ventricular rate and the hemodynamic consequences of the dysrhythmia.
T54 255512-255626 Sentence denotes For intermittent isolated atrial premature contractions, couplets, and triplets, usually no treatment is required.
T55 255627-255754 Sentence denotes When the ventricular rate exceeds 180 beats/min, diastolic filling time is shortened, causing the heart to not fill adequately.
T56 255755-255839 Sentence denotes The consequence is decreased cardiac output and decreased coronary artery perfusion.
T57 255840-255910 Sentence denotes The goal of therapy is rhythm control or, in most cases, rate control.
T58 255911-256081 Sentence denotes In cases of atrial fibrillation and CHF, conversion to a normal sinus rhythm rarely can be achieved, although electrocardioversion or pharmacoconversion can be attempted.
T59 256082-256185 Sentence denotes In the dog a vagal maneuver can be attempted by pressing on the eyeballs or massaging the carotid body.
T60 256186-256480 Sentence denotes For sustained supraventricular tachycardia, diltiazem (0.25 mg/kg IV), esmolol (0.05 to 0.1mg/kg, titrated upward to a cumulative dose of 0.5 mg/kg IV), or propranolol (0.04 to 0.1 mg/kg IV slowly to effect) can be administered in an attempt to slow the ventricular rate in emergent situations.
T61 256481-256796 Sentence denotes Administer oral diltiazem (0.5 mg/kg PO q8h), diltiazem (Dilacor XR) (1.5 to 6 mg/kg PO q12-24h), propranolol (0.1 to 0.2 mg/kg tid, PO titrated up to a maximum of 1.5 mg/kg PO q8h), atenolol (0.25 to 1 mg/kg PO q12-24h), or digoxin (0.005 to 0.01 mg/kg bid or 0.22 mg/m 2 PO bid for dogs weighing more than 15 kg).
T62 256797-256871 Sentence denotes In the cat a vagal maneuver can be attempted by ocular or carotid massage.
T63 256872-257011 Sentence denotes Diltiazem [Dilacor] (30 to 60 mg PO q12-24h), propranolol (2.5 to 10 mg/PO q8h), or atenolol (6.25 mg PO q12-24h) also can be administered.
T64 257012-257138 Sentence denotes If structural heart disease is present, treat pulmonary edema and start angiotensin-converting enzyme (ACE) inhibitor therapy.
T65 257139-257228 Sentence denotes Table 1 -34 summarizes the drugs used in the management of supraventricular dysrhythmias.
T66 257229-257450 Sentence denotes Severe bradycardia often results from systemic disease, drug therapy, anesthetic agents, or hypothermia and thus rarely requires specific therapy except to treat or reverse the underlying mechanisms promoting bradycardia.
T67 257451-257578 Sentence denotes Hemodynamically significant bradyarrhythmias that must be treated include atrial standstill, AV block, and sick sinus syndrome.
T68 257579-257761 Sentence denotes Atrial standstill most commonly is associated with hyperkalemia and is seen most often in urinary obstruction, renal failure, urinary trauma with uroabdomen, and hypoadrenocorticism.
T69 257762-257914 Sentence denotes Characteristic ECG abnormalities observed in atrial standstill are an absence of P waves, widened QRS complexes, and tall spiked T waves (Figure 1-37) .
T70 257915-258114 Sentence denotes The treatment for hyperkalemia-induced atrial standstill is to correct the underlying cause and to drive potassium intracellularly and protect the myocardium from the adverse effects of hyperkalemia.
T71 258115-258346 Sentence denotes Regular insulin (0.25 to 0.5 units/kg IV) followed by dextrose (1 g/unit insulin IV, followed by 2.5% dextrose CRI to prevent hypoglycemia) or sodium bicarbonate (1 mEq/kg IV) can be administered to drive potassium intracellularly.
T72 258347-258528 Sentence denotes Calcium gluconate (0.5 mL/kg of 20% solution IV over 5 minutes) also can be administered as a cardioprotective drug until the cause of hyperkalemia has been identified and resolved.
T73 258529-258616 Sentence denotes Also administer sodium chloride fluids (0.9% sodium chloride IV) to promote kaliuresis.
T74 258617-258717 Sentence denotes Less commonly, atrial standstill is associated with atrial cardiomyopathy or silent atrium syndrome.
T75 258718-258853 Sentence denotes Persistent atrial standstill has been recognized without electrolyte abnormalities in the English Springer Spaniel and the Siamese cat.
T76 258854-259023 Sentence denotes Short-term therapy for persistent atrial standstill includes atropine (0.04 mg/kg SQ) until definitive treatment by implantation of a cardiac pacemaker can be performed.
T77 259024-259203 Sentence denotes Complete or third-degree AV block or high-grade symptomatic second-degree AV block can be hemodynamically significant when ventricular rates are less than 60 beats/min in the dog.
T78 259204-259322 Sentence denotes Classic clinical signs include weakness, exercise intolerance, lethargy, anorexia, syncope, and occasionally seizures.
T79 259323-259491 Sentence denotes Advanced AV block usually is caused by advanced t a B l e 1 -3 4 Parenteral and oral management of supraventricular dysrhythmias idiopathic degeneration of the AV node.
T80 259492-259661 Sentence denotes Less commonly, AV block has been associated with digoxin toxicity, magnesium oversupplementation, cardiomyopathy, endocarditis, or infectious myocarditis (Lyme disease).
T81 259662-259772 Sentence denotes An accurate diagnosis is made based on the ECG findings of nonconducted P waves with ventricular escape beats.
T82 259773-259883 Sentence denotes First-and second-degree AV block may not be hemodynamically significant and therefore may not require therapy.
T83 259884-260039 Sentence denotes Initially treat third-degree (complete) or symptomatic high-grade second-degree atrioventricular block (<60 beats/min) with atropine (0.04 mg/kg SQ or IM).
T84 260040-260084 Sentence denotes Perform a follow-up ECG in 15 to 20 minutes.
T85 260085-260145 Sentence denotes Atropine is rarely successful in treating complete AV block.
T86 260146-260290 Sentence denotes Also attempt treatment with isoproterenol (0.04 to 0.08 mcg/kg/min IV CRI or 0.4 mg in 250 mL 5% dextrose in water IV slowly), a pure β-agonist.
T87 260291-260354 Sentence denotes Definitive treatment involves permanent pacemaker implantation.
T88 260355-260436 Sentence denotes Consultation with a veterinary cardiologist who implants pacemakers is suggested.
T89 260437-260540 Sentence denotes Never attempt to convert or treat the observed ventricular escape beats with lidocaine ( Figure 1-38) .
T90 260541-260650 Sentence denotes Sick sinus syndrome most commonly is recognized in the Miniature Schnauzer, although any dog can be affected.
T91 260651-260745 Sentence denotes Sick sinus syndrome usually results from idiopathic degeneration of the sinus node in the dog.
T92 260746-260824 Sentence denotes In the cat, sinus node degeneration usually is associated with cardiomyopathy.
T93 260825-260974 Sentence denotes Dysfunction of the sinus node may manifest as marked bradycardia with periods of sinus arrest followed by junctional or ventricular escape complexes.
T94 260975-261145 Sentence denotes A variant of sick sinus syndrome is the presence of severe bradycardia followed by periods of supraventricular tachycardia, often termed bradycardia-tachycardia syndrome.
T95 261146-261225 Sentence denotes The most common clinical signs are syncope, exercise intolerance, and lethargy.
T96 261226-261330 Sentence denotes Treatment of sick sinus syndrome involves permanent pacemaker implantation by a veterinary cardiologist.
T97 261331-261493 Sentence denotes Less severe cases of sick sinus syndrome can be managed medically, at least short-term, with atropine (0.04 mg/kg IM) or Propantheline (0.25 to 0.5 mg/kg PO q8h).
T98 261494-261504 Sentence denotes Abbott JA:
T99 261505-261603 Sentence denotes Beta-blockage in the management of systolic dysfunction, Vet Clin North Am Small Anim Pract 34 (5)
T100 261605-261723 Sentence denotes The majority of animals with CHF are older animals that have some acquired heart disease that developed later in life.
T101 261724-261781 Sentence denotes Congenital defects are rarer than acquired heart disease.
T102 261782-261880 Sentence denotes The most common congenital defect observed in dogs and in some cats is a patent ductus arteriosus.
T103 261881-262005 Sentence denotes The most common acquired cardiac disease in dogs is chronic valvular disease, or endocardiosis (mitral valve endocardiosis).
T104 262006-262177 Sentence denotes In endocardiosis, the AV valves chronically lose the ability to close effectively, causing abnormalities in blood flow, including regurgitation during ventricular systole.
T105 262178-262384 Sentence denotes In most cases, disease progression is chronic and slow, although acute exacerbations and onset of clinical signs can be associated with stress, rupture of chordae tendinae, or ingestion of a high-salt meal.
T106 262385-262521 Sentence denotes Mitral valve disease tends to affect older toy breeds such as miniature Poodles, Chihuahuas, and younger Cavalier King Charles Spaniels.
T107 262522-262653 Sentence denotes The second most common cause of acquired heart disease is dilated cardiomyopathy, which is a disease of primary myocardial failure.
T108 262654-262815 Sentence denotes In dilated cardiomyopathy the muscular wall of the heart becomes thin and weak as the myocardium dilates, causing a decrease in contractility and cardiac output.
T109 262816-262926 Sentence denotes Secondary mitral and tricuspid valvular insufficiency may result from chronic stretching of the valve annulus.
T110 262927-263090 Sentence denotes This type of heart disease typically is associated with giant breed dogs including Irish Wolfhounds, English Mastiffs, Great Danes, Boxers, and Doberman Pinschers.
T111 263091-263167 Sentence denotes A rare form of the disease has been documented in young Labrador Retrievers.
T112 263168-263295 Sentence denotes Acute exacerbation of dilated cardiomyopathy may be related to the development of a dysrhythmia, including atrial fibrillation.
T113 263296-263394 Sentence denotes In cats, hypertrophic cardiomyopathy is the most common form of acquired cardiac disease observed.
T114 263395-263497 Sentence denotes CHF resulting from hypertrophic cardiomyopathy can occur in animals as young as 6 to 10 months of age.
T115 263498-263690 Sentence denotes Hypertrophic cardiomyopathy is characterized by stiff, noncompliant ventricles that do not relax during diastole, resulting in an increase in left atrial pressures and left atrial enlargement.
T116 263691-263828 Sentence denotes Other cardiomyopathies, including unclassified, restrictive, and dilated cardiomyopathies, are less common but also can occur in the cat.
T117 263829-263929 Sentence denotes Cats often develop acute exacerbations of clinical signs because of stress or arterial embolization.
T118 263930-264069 Sentence denotes The rapid diagnosis of CHF often is made based on the history given by the owner, signalment, and physical examination findings (Box 1-36).
T119 264070-264317 Sentence denotes Typical physical examination findings include a cardiac murmur or gallop dysrhythmia, abnormal breath sounds, respiratory difficulty and orthopnea, tachycardia, weak pulse quality, cool peripheral extremities, and pale or cyanotic mucous membrane.
T120 264318-264409 Sentence denotes Initiate immediate treatment based on physical examination findings and index of suspicion.
T121 264410-264549 Sentence denotes In some cases, it is difficult to distinguish between CHF and feline lower airway disease (asthma) without performing thoracic radiographs.
T122 264550-264667 Sentence denotes Let the animal rest and become stabilized before attempting any stressful procedures, including thoracic radiographs.
T123 264668-264938 Sentence denotes Immediate treatment consists of administering supplemental oxygen, decreasing circulating fluid volume with furosemide, dilating pulmonary and splanchnic capacitance vessels with topical nitroglycerine and morphine, and alleviating patient anxiety and stress (Box 1-37).
T124 264939-265088 Sentence denotes Primary differential diagnoses are made based primarily on the patient's breed, age, clinical signs, history, and physical examination abnormalities.
T125 265089-265280 Sentence denotes The most common differential diagnoses in a patient with CHF are cardiac abnormalities and respiratory disease (chronic bronchitis [asthma], pulmonary hypertension, cor pulmonale, neoplasia).
T126 265281-265438 Sentence denotes Postpone diagnostic tests in any patient with suspected CHF until the immediate treatments have taken effect and the patient is cardiovascularly more stable.
T127 265439-265582 Sentence denotes In most cases, lateral and dorsoventral thoracic radiographs are one of the most important diagnostic tools in helping make a diagnosis of CHF.
T128 265583-265678 Sentence denotes Increased perihilar interstitial to alveolar infiltrates are characteristic of pulmonary edema.
T129 265679-265768 Sentence denotes Left atrial enlargement may be observed as a "backpack" sign at the caudal cardiac waist.
T130 265769-265863 Sentence denotes Cardiomegaly of the right or left side also may be present in cases of valvular insufficiency.
T131 265864-265992 Sentence denotes In cats, increased sternal contact and a classic valentine-shaped heart may be observed in cases of hypertrophic cardiomyopathy.
T132 265993-266112 Sentence denotes Perform a vertebral heart score (sum) to measure cardiac size and determine whether cardiomegaly is present (Box 1-38).
T133 266113-266216 Sentence denotes Also obtain arterial BP and ECG readings to determine whether hypotension and dysrhythmias are present.
T134 266217-266411 Sentence denotes Atrial fibrillation, ventricular premature contractions, and supraventricular tachycardia are common rhythm disturbances that can affect cardiac output adversely and influence treatment choices.
T135 266412-266494 Sentence denotes Box 1-36 common Presenting signs of congestive heart failure as rePorted By oWners
T136 266496-266614 Sentence denotes The echocardiogram is a useful noninvasive and nonstressful method to determine the degree of cardiac disease present.
T137 266615-266660 Sentence denotes The echocardiogram is largely user-dependent.
T138 266661-266771 Sentence denotes The quality of the study is based on the experience of the operator and the quality of the ultrasound machine.
T139 266772-266933 Sentence denotes Echocardiography can be a useful tool in making a diagnosis of pericardial effusion, dilated or hypertrophic cardiomyopathy, cardiac neoplasia, and endocarditis.
T140 266934-267029 Sentence denotes The medical management of CHF is designed to improve cardiac output and relieve clinical signs.
T141 267030-267252 Sentence denotes The immediate goal of therapy is to reduce abnormal fluid accumulation and provide adequate cardiac output by increasing contractility, decreasing preload and ventricular afterload, and/or normalizing cardiac dysrhythmias.
T142 267253-267327 Sentence denotes Strict cage rest is of utmost importance when managing a patient with CHF.
T143 267328-267475 Sentence denotes After initial administration of furosemide, morphine, and oxygen, clinical signs of respiratory distress should show improvement within 30 minutes.
T144 267476-267547 Sentence denotes If no improvement is observed, administer repeated doses of furosemide.
T145 267548-267628 Sentence denotes Reevaluate severe cases that are refractory to this standard treatment protocol.
T146 267629-267742 Sentence denotes Vasodilation should be the next step in the management of refractory cases, provided that a normal BP is present.
T147 267743-267947 Sentence denotes Sodium nitroprusside is a potent balanced vasodilator that should be administered (1 to 10 mcg/kg/min IV CRI), taking care to monitor BP continuously because severe vasodilation and hypotension can occur.
T148 267948-268028 Sentence denotes The goal of nitroprusside therapy is to maintain a mean arterial BP of 60 mm Hg.
T149 268029-268126 Sentence denotes Sodium nitroprusside should not be considered in cases of refractory CHF with severe hypotension.
T150 268127-268387 Sentence denotes For more long-term management of CHF, ACE inhibitors including enalapril (0.5 mg/kg PO q12-24h), benazepril (0.5 mg/kg PO q24h), and lisinopril (0.5 mg/kg PO q24h) have become the mainstay of therapy to reduce sodium and fluid retention and decrease afterload.
T151 268388-268539 Sentence denotes Balanced inodilators such as pimobendan (0.5 mg/kg PO) can also be administered both in the acute congestive failure setting and for long-term therapy.
T152 268540-268619 Sentence denotes Start ACE inhibition as soon as a patient is able to tolerate oral medications.
T153 268620-268792 Sentence denotes Dobutamine (2.5 to 10 mcg/kg/min CRI diluted in 5% dextrose in water) can be administered to improve cardiac contractility, particularly in cases of dilated cardiomyopathy.
T154 268793-268916 Sentence denotes At low doses, dobutamine, primarily a β-adrenergic agonist, will improve cardiac output with minimal effects on heart rate.
T155 268917-268991 Sentence denotes Dobutamine must be given as a CRI with careful, continuous ECG monitoring.
T156 268992-269123 Sentence denotes Despite the minimal effects of dobutamine on heart rate, sinus tachycardia or ventricular dysrhythmias may develop during infusion.
T157 269124-269187 Sentence denotes Cats are more sensitive to the effects of dobutamine than dogs.
T158 269188-269240 Sentence denotes Monitor carefully for seizures and facial twitching.
T159 269241-269365 Sentence denotes Digoxin is a cardiac glycoside that acts as a positive inotrope and negative chronotrope in the long-term management of CHF.
T160 269366-269490 Sentence denotes Digoxin has a long (24 hours in dogs, 60 hours in cats) half-life and so has minimal use in the emergency management of CHF.
T161 269491-269623 Sentence denotes In chronic management of CHF resulting from dilated cardiomyopathy or advanced mitral disease, however, digoxin is extremely useful.
T162 269624-269760 Sentence denotes Oral digitalization protocols have been developed but are risky in that dysrhythmias and severe gastrointestinal side effects can occur.
T163 269761-269837 Sentence denotes The vertebral heart sum can be calculated by performing the following steps:
T164 269838-269840 Sentence denotes 1.
T165 269841-269966 Sentence denotes Measure the long axis of the heart from the apex to the carina on the lateral view and mark the distance on a sheet of paper.
T166 269967-269969 Sentence denotes 2.
T167 269970-270205 Sentence denotes Measure the length of the long axis of the heart in terms of vertebral bodies, starting by counting caudally from the fourth thoracic vertebra; count the number of vertebrae that are covered by the length of the long axis of the heart.
T168 270206-270208 Sentence denotes 3.
T169 270209-270314 Sentence denotes Measure the short axis of the heart at the caudal vena cava, perpendicular to the long axis of the heart.
T170 270315-270317 Sentence denotes 4.
T171 270318-270412 Sentence denotes Count the number of thoracic vertebrae covered by the short axis of the heart, starting at T4.
T172 270413-270415 Sentence denotes 5.
T173 270416-270551 Sentence denotes Add the two numbers together to yield the vertebral heart sum; a vertebral heart sum greater than 10.5 is consistent with cardiomegaly.
T174 270552-270681 Sentence denotes Cats with CHF often have fulminant pulmonary edema, pleural effusion, arterial thromboembolism, or some combination of all three.
T175 270682-270815 Sentence denotes If the pleural effusion is significant, perform therapeutic thoracocentesis to relieve pulmonary atelectasis and improve oxygenation.
T176 270816-270948 Sentence denotes Once the diagnosis of CHF has been made and initial management undertaken, formulate a plan for continued management and monitoring.
T177 270949-271084 Sentence denotes Tailor the therapeutic plan to the patient based on the cause of the CHF, the presence of concurrent diseases, and response to therapy.
T178 271085-271357 Sentence denotes An important and often overlooked part of the successful emergency management of CHF is open communication with the owner regarding the owner's emotional and financial commitment to immediate and long-term management to ensure appropriate quality of life for each patient.
T179 271358-271537 Sentence denotes Caval syndrome resulting from severe heartworm disease is caused by the rapid maturation of a large quantity of adult worms in the right atrium and cranial and caudal venae cavae.
T180 271538-271694 Sentence denotes Most cases of caval syndrome occur in regions of the world where heartworm disease is highly endemic and dogs spend a large portion of time living outdoors.
T181 271695-272030 Sentence denotes Caval syndrome is recognized by the following clinical signs and results of biochemical analyses: acute renal and hepatic failure, enlarged right atrium and posterior vena cava, ascites, hemoglobinuria, anemia, acute collapse, respiratory distress, DIC, jugular pulses, circulating microfilariae, and sometimes tricuspid insufficiency.
T182 272031-272252 Sentence denotes Immediate action in cases of caval syndrome in dogs involves immediate stabilization of the cardiovascular and respiratory systems with supplemental oxygen, furosemide (4 mg/kg IV), and careful crystalloid fluid infusion.
T183 272253-272422 Sentence denotes Diagnosis of caval syndrome is based on clinical signs of cardiogenic shock with right ventricular heart failure, intravascular hemolysis, and renal and hepatic failure.
T184 272423-272523 Sentence denotes Thoracic radiographs reveal cardiomegaly of the right side and enlarged tortuous pulmonary arteries.
T185 272524-272575 Sentence denotes A right axis deviation may be seen on ECG tracings.
T186 272576-272763 Sentence denotes Clinicopathologic changes observed include azotemia, inflammatory leukogram, regenerative anemia, eosinophilia, elevated hepatocellular enzyme activities, hemoglobinuria, and proteinuria.
T187 272764-272879 Sentence denotes Circulating microfilariae may be observed on peripheral blood smears or in the buffy coat of microhematocrit tubes.
T188 272880-272937 Sentence denotes Heartworm antigen test results will be strongly positive.
T189 272938-273144 Sentence denotes Echocardiographic changes include visualization of a large number of heartworms in the right atrium, pulmonary arteries, and vena cava; tricuspid insufficiency; and right atrial and ventricular enlargement.
T190 273145-273273 Sentence denotes Treatment involves surgical removal of as many of the adult heartworms as possible from the right jugular vein and right atrium.
T191 273274-273401 Sentence denotes Glucocorticosteroids are recommended to decrease inflammation and microangiopathic disease associated with heartworm infection.
T192 273402-273557 Sentence denotes For more long-term management, administer adulticide therapy several weeks after surgery, followed by routine microfilaricide therapy and then prophylaxis.
T193 273558-273736 Sentence denotes Doxycycline (10 mg/kg PO bid) also should be administered for a period of 4 weeks, as Wolbachia, a species of bacteria, is often associated with the Dirofilaria immitis nematode.
T194 273737-273861 Sentence denotes Adulticidal activity of ivermectin is augmented when doxycycline is used concurrently in the treatment of heartworm disease.
T195 273863-273954 Sentence denotes Pericardial effusion often develops as a consequence of neoplasia in the older dog and cat.
T196 273955-274106 Sentence denotes The most common types of neoplasia that affect the heart and pericardium include hemangiosarcoma, chemodectoma, mesothelioma, and metastatic neoplasia.
T197 274107-274323 Sentence denotes More rarely, other causes of pericardial effusion include benign idiopathic pericardial effusion, coagulopathy, left atrial rupture in dogs with chronic mitral valvular insufficiency, infection, or pericardial cysts.
T198 274324-274439 Sentence denotes Regardless of the cause of the effusion, the development of pericardial tamponade adversely affects cardiac output.
T199 274440-274501 Sentence denotes Cardiac output is a function of heart rate and stroke volume.
T200 274502-274543 Sentence denotes Stroke volume depends on cardiac preload.
T201 274544-274653 Sentence denotes The presence of pericardial effusion can impede venous return to the heart and thus adversely affect preload.
T202 274654-274770 Sentence denotes In addition, as preload decreases, heart rate reflexively increases in an attempt to maintain normal cardiac output.
T203 274771-274895 Sentence denotes As heart rate increases more than 160 beats/min, diastolic filling is impaired further, and cardiac output further declines.
T204 274896-275132 Sentence denotes Animals with pericardial effusion often demonstrate the classic signs of hypovolemic or cardiogenic shock: anorexia, weakness, lethargy, cyanosis, cool peripheral extremities, tachycardia, weak thready pulses, hypotension, and collapse.
T205 275133-275318 Sentence denotes Physical examination abnormalities may include muffled heart sounds, thready femoral pulses, pulsus paradoxus, jugular venous distension, weakness, tachycardia, cyanosis, and tachypnea.
T206 275319-275467 Sentence denotes ECG findings may include low amplitude QRS complexes (<0.5 mV), sinus tachycardia, ventricular dysrhythmias, or electrical alternans (Figure 1-39) .
T207 275468-275677 Sentence denotes Thoracic radiographs often demonstrate a globoid cardiac silhouette, although the cardiac silhouette rarely may appear 1 normal with concurrent clinical signs of cardiogenic shock in cases of acute hemorrhage.
T208 275678-275857 Sentence denotes In such cases the removal of even small amounts of pericardial effusion by pericardiocentesis can increase cardiac output exponentially and alleviate clinical signs (Table 1-35) .
T209 275858-276057 Sentence denotes Unless an animal is dying before your eyes, ideally perform an echocardiogram to attempt to determine whether a right atrial, right auricular, or heart base mass is present before pericardiocentesis.
T210 276058-276145 Sentence denotes Before attempting pericardiocentesis, assemble all of the required supplies (Box 1-39).
T211 276146-276199 Sentence denotes To perform pericardiocentesis, follow this procedure:
T212 276200-276202 Sentence denotes 1.
T213 276203-276254 Sentence denotes Place the patient in sternal or lateral recumbency.
T214 276255-276257 Sentence denotes 2.
T215 276258-276336 Sentence denotes Attach ECG leads to monitor the patient for dysrhythmias during the procedure.
T216 276337-276339 Sentence denotes 3.
T217 276340-276429 Sentence denotes Clip a 6-cm square caudal to the right elbow over the fifth to seventh intercostal space.
T218 276430-276432 Sentence denotes 4.
T219 276433-276625 Sentence denotes Aseptically scrub the clipped area, and infuse 1 to 2 mg of 2% lidocaine per kilogram mixed with a small amount of sodium bicarbonate just dorsal to the sternum at the sixth intercostal space.
T220 276626-276706 Sentence denotes Bury the needle to the hub, and inject the lidocaine as you withdraw the needle.
T221 276707-276709 Sentence denotes 5.
T222 276710-276836 Sentence denotes While the local anesthetic is taking effect, assemble the intravenous extension tubing, three-way stopcock, and 60-mL syringe.
T223 276837-276839 Sentence denotes 6.
T224 276840-276964 Sentence denotes Wearing sterile gloves, make a small nick incision in the skin to decrease drag on the needle and catheter during insertion.
T225 276965-276967 Sentence denotes 7.
T226 276968-277134 Sentence denotes Slowly insert the needle and catheter, watching for a flash of blood in the hub of the needle and simultaneously watching for cardiac dysrhythmias on the ECG monitor.
T227 277135-277137 Sentence denotes 8.
T228 277138-277297 Sentence denotes Once a flash of blood is observed in the hub of the needle, advance the catheter off of the stylette further into the pericardial sac, and remove the stylette.
T229 277298-277300 Sentence denotes 9.
T230 277301-277416 Sentence denotes Attach the length of intravenous extension tubing to the catheter, and have an assistant withdraw the fluid slowly.
T231 277417-277420 Sentence denotes 10.
T232 277421-277493 Sentence denotes Place a small amount of fluid in a red-topped tube, and watch for clots.
T233 277494-277621 Sentence denotes Clot formation could signify that you have penetrated the right ventricle inadvertently or that active hemorrhage is occurring.
T234 277622-277694 Sentence denotes Withdraw as much of the fluid as possible, and then remove the catheter.
T235 277695-277802 Sentence denotes Monitor the patient closely for fluid reaccumulation and recurrence of clinical signs of cardiogenic shock.
T236 277804-278011 Sentence denotes Foreign bodies within the ear canal (e.g., foxtails) can manifest as emergencies because of acute inflammation and pressure necrosis of the tissue of the external auditory meatus causing pain and discomfort.
T237 278012-278099 Sentence denotes Clinical signs may be limited to incessant head shaking or scratching of the ear canal.
T238 278100-278234 Sentence denotes Complete examination of the ear canal and removal of any foreign body often require administration of a short-acting anesthetic agent.
T239 278235-278400 Sentence denotes Once the animal has been restrained sufficiently and placed under anesthesia, carefully examine the ear canal and remove any foreign material with alligator forceps.
T240 278401-278474 Sentence denotes Stimulation of the ear canal can cause awakening and shaking of the head.
T241 278475-278564 Sentence denotes Use care to not perforate the tympanum or cause trauma to the ear canal with the forceps.
T242 278565-278679 Sentence denotes Heat-fix any purulent material within the ear canal and examine it cytologically for bacteria or fungal organisms.
T243 278680-278775 Sentence denotes Gently irrigate the ear canal with warm sterile saline to remove excessive debris and exudates.
T244 278776-278877 Sentence denotes Use care to avoid excessive pressure (>50 mm Hg) to avoid iatrogenic damage to the tympanic membrane.
T245 278878-278987 Sentence denotes After removal of all debris and detritus, gently wipe the internal and external ear canal with sterile gauze.
T246 278988-279092 Sentence denotes Place a topical antimicrobial-antifungal-steroid ointment such as Otomax in the ear every 8 to 12 hours.
T247 279093-279185 Sentence denotes If pain and discomfort are severe, systemically effective opioids or NSAIDs may be required.
T248 279186-279311 Sentence denotes Otitis externa is a common emergency that causes excessive head shaking, scratching, and purulent malodorous aural discharge.
T249 279312-279405 Sentence denotes Clean the ear canal with an irrigating solution such as Epi-Otic and wipe it clean of debris.
T250 279406-279543 Sentence denotes Perform a complete aural examination to determine whether a foreign body or tumor is present and whether the tympanic membrane is intact.
T251 279544-279630 Sentence denotes Heat-fix any discharge and examine it cytologically for bacteria and fungal organisms.
T252 279631-279713 Sentence denotes After careful cleansing, instill a topical antibiotic-antifungal-steroid ointment.
T253 279714-279968 Sentence denotes In severe cases in which the ear canal has scarred and closed down with chronicity, consider administering systemically effective antibiotics (cephalexin, 22 mg/kg PO tid) and antifungal agents (ketoconazole, 10 mg/kg PO q12h) instead of topical therapy.
T254 279969-280142 Sentence denotes Systemically effective steroids (prednisone or prednisolone, 0.5 mg/kg PO q12h) may be indicated in cases of severe inflammation to decrease pruritus and patient discomfort.
T255 280143-280292 Sentence denotes Presentation of a patient with otitis interna often is characterized by torticollis, head tilt, nystagmus, circling to the affected side, or rolling.
T256 280293-280367 Sentence denotes Fever, pain, vomiting, and severe depression may accompany clinical signs.
T257 280368-280443 Sentence denotes Most cases of severe otitis interna are accompanied by severe otitis media.
T258 280444-280491 Sentence denotes Both conditions must be treated simultaneously.
T259 280492-280610 Sentence denotes The most common causes of otitis interna are Staphylococcus aureus, Pseudomonas species, E. coli, and Proteus species.
T260 280611-280787 Sentence denotes Otitis interna can develop by infection spreading across the tympanic membrane, through the eustachian tubes, or by hematogenous spread from the blood supply to the middle ear.
T261 280788-280853 Sentence denotes In most cases of otitis media, the tympanic membrane is ruptured.
T262 280854-280966 Sentence denotes Perform a culture and susceptibility test of the debris behind the tympanic membrane and within the aural canal.
T263 280967-281006 Sentence denotes Carefully clean the external ear canal.
T264 281007-281091 Sentence denotes Medicate with a topical combination antibiotic, antifungal, and antibiotic ointment.
T265 281092-281196 Sentence denotes Administer high-dose antibiotics (cephalexin, 22 mg/kg PO q8h, or enrofloxacin, 10 to 20 mg/kg PO q24h).
T266 281197-281315 Sentence denotes If the tympanic membrane is not ruptured but appears swollen and erythematous, a myringotomy may need to be performed.
T267 281316-281465 Sentence denotes If clinical signs of otitis media persist despite topical and systemic therapy, x-ray, CT, or MRI examination of the tympanic bullae may be required.
T268 281466-281644 Sentence denotes Chronic shaking of the head and ears or aural trauma (bite wounds) causes disruption of the blood vessels and leads to the development of unilateral or bilateral aural hematomas.
T269 281645-281854 Sentence denotes Aural hematomas are clinically significant because they cause patient discom-1 fort and are often caused by the presence of some other underlying problem such as otitis externa, atopy, or aural foreign bodies.
T270 281855-281946 Sentence denotes Acute swelling of the external ear pinna with fluid is characteristic of an aural hematoma.
T271 281947-282080 Sentence denotes In some cases, swelling can be so severe that the hematoma breaks open, bathing the patient and external living environment in blood.
T272 282081-282152 Sentence denotes When a patient has an aural hematoma, investigate the underlying cause.
T273 282153-282270 Sentence denotes Perform a complete aural examination to determine whether an aural foreign body, otitis externa, or atopy is present.
T274 282271-282326 Sentence denotes Carefully examine and gently clean the inner ear canal.
T275 282327-282351 Sentence denotes Treat underlying causes.
T276 282352-282564 Sentence denotes Management of an aural hematoma involves draining the hemorrhagic fluid from the aural tissue and tacking the skin down in multiple places to prevent reaccumulation of fluid until the secondary cause is resolved.
T277 282565-282657 Sentence denotes Many techniques have been described to surgically tack down the skin overlying the hematoma.
T278 282658-282809 Sentence denotes After the animal has been placed under general anesthesia, lance the hematoma down the middle with a scalpel blade and remove the fluid and blood clot.
T279 282810-282911 Sentence denotes Tack down the skin with multiple through-and-through interrupted or mattress sutures through the ear.
T280 282912-283060 Sentence denotes Some clinicians prefer to suture through and attach a sponge or length of x-ray film to the front and back of the ear for stabilization and support.
T281 283061-283170 Sentence denotes More recently, a laser has been used to drill holes in the hematoma and tack the skin down in multiple areas.
T282 283171-283320 Sentence denotes Compress the ear against the head with a compression bandage, whenever possible, for 5 to 7 days after the initial surgery, and then recheck the ear.
T283 283321-283434 Sentence denotes The patient must wear an Elizabethan collar until the surgical wound and hematoma heal to prevent selfmutilation.
T284 283435-283570 Sentence denotes Also systemically treat underlying causative factors, such as otitis externa, with antibiotics, antifungals, and steroids as indicated.
T285 283571-283653 Sentence denotes Investigate and treat other underlying causes such as hypothyroidism or allergies.
T286 283654-283658 Sentence denotes Bass
T287 283660-283760 Sentence denotes Electrical injury usually is observed in young animals after they have chewed on an electrical cord.
T288 283761-283870 Sentence denotes Other causes of electrical injury include use of defective electrical equipment or being struck by lightning.
T289 283871-284038 Sentence denotes Electrical current passing through the body can produce severe dysrhythmias, including supraventricular or ventricular tachycardia and first-and third-degree AV block.
T290 284039-284133 Sentence denotes The electrical current also can produce tissue destruction from heat and electrothermal burns.
T291 284134-284323 Sentence denotes Exposure to electrical current also commonly results in noncardiogenic pulmonary edema caused by massive catecholamine release and increase in pulmonary vascular pressures during the event.
T292 284324-284458 Sentence denotes Ventricular fibrillation can occur, although that depends on the intensity and path of the electrical current and duration of contact.
T293 284459-284620 Sentence denotes Clinical signs of electrical injury include acute onset of respiratory distress with moist rales, and localized necrosis or thermal burns of the lips and tongue.
T294 284621-284714 Sentence denotes Often the skin at the commissures of the mouth appears white or yellow and firm to the touch.
T295 284715-284800 Sentence denotes Muscle fasciculations, loss of consciousness, and ventricular fibrillation may occur.
T296 284801-284919 Sentence denotes Thoracic radiographs often reveal an increased interstitial to alveolar lung pattern in 1 the dorsocaudal lung fields.
T297 284920-285011 Sentence denotes Noncardiogenic pulmonary edema can develop up to 24 to 36 hours after the initial incident.
T298 285012-285098 Sentence denotes The first 24 hours are the most critical for the patient, and then prognosis improves.
T299 285099-285304 Sentence denotes The most important aspects of the treatment of the patient with noncardiogenic pulmonary edema are to minimize stress and to provide supplemental oxygen, with positive pressure ventilation, when necessary.
T300 285305-285497 Sentence denotes Although treatment with vasodilators (low-dose morphine) and diuretics (furosemide) can be attempted, noncardiogenic pulmonary edema is typically resistant to vasodilator and diuretic therapy.
T301 285498-285583 Sentence denotes Positive inotropes and pressor drugs may be necessary to treat shock and hypotension.
T302 285584-285708 Sentence denotes Opioid drugs (morphine, hydromorphone, oxymorphone) may be useful in controlling anxiety until the pulmonary edema resolves.
T303 285709-285826 Sentence denotes Administer broad-spectrum antibiotics (cefazolin; amoxicillin and clavulanic acid [Clavamox]) to treat thermal burns.
T304 285827-285877 Sentence denotes Use analgesic drugs to control patient discomfort.
T305 285878-286082 Sentence denotes If thermal burns are extensive and prohibit adequate food intake, place a feeding tube as soon as the patient's cardiovascular and respiratory functions are stable and the patient can tolerate anesthesia.
T306 286084-286193 Sentence denotes uTerine ProlAPse Prolapse of the uterus occurs in the immediate postparturient period in the bitch and queen.
T307 286194-286310 Sentence denotes Excessive straining during or after parturition causes the uterus to prolapse caudally through the vagina and vulva.
T308 286311-286347 Sentence denotes Immediate intervention is necessary.
T309 286348-286396 Sentence denotes Examine the bitch or queen for a retained fetus.
T310 286397-286470 Sentence denotes Treatment consists of general anesthesia to replace the prolapsed tissue.
T311 286471-286551 Sentence denotes If the uterus is edematous, physical replacement may be difficult or impossible.
T312 286552-286692 Sentence denotes Application of a hypertonic solution such as hypertonic (7%) saline or dextrose (50%) to the exposed endometrium can help shrink the tissue.
T313 286693-286882 Sentence denotes That, combined with gentle massage to stimulate uterine contraction and involution and lubrication with sterile lubricating jelly, can aid in replacement of the organ into its proper place.
T314 286883-287011 Sentence denotes To ensure proper placement in the abdominal cavity and to prevent recurrence, perform an exploratory laparotomy and hysteropexy.
T315 287012-287097 Sentence denotes Postoperatively, administer oxytocin (5 to 20 units IM) to cause uterine contraction.
T316 287098-287171 Sentence denotes If the uterus contracts, it is usually not necessary to suture the vulva.
T317 287172-287211 Sentence denotes Administer antibiotics postoperatively.
T318 287212-287269 Sentence denotes Recurrence is uncommon, even with subsequent pregnancies.
T319 287270-287412 Sentence denotes If the tissue is damaged or too edematous to replace or if the tissue is devitalized, traumatized, or necrotic, perform an ovariohysterectomy.
T320 287413-287498 Sentence denotes In some instances, replacement of the damaged tissue is not necessary before removal.
T321 287499-287537 Sentence denotes Pyometra occurs in both dogs and cats.
T322 287538-287676 Sentence denotes The disease process occurs as a result of infection overlying cystic endometrial hyperplasia under the constant influence of progesterone.
T323 287677-287940 Sentence denotes During the 2-month luteal phase after estrus or following copulation, artificial insemination, or administration of hormones (particularly estradiol or progesterone), the myometrium becomes relaxed and produces a quiescent environment for bacterial proliferation.
T324 287941-288035 Sentence denotes Clinical signs of pyometra are associated with the presence of bacterial endotoxin and sepsis.
T325 288036-288115 Sentence denotes Affected animals become lethargic and anorexic early in the course of pyometra.
T326 288116-288247 Sentence denotes Polyuria with secondary polydipsia is often present because of the influence of bacterial endotoxin on renal tubular concentration.
T327 288248-288326 Sentence denotes If the cervix is open, purulent or mucoid 1 vaginal discharge may be observed.
T328 288327-288437 Sentence denotes Later in the course of pyometra, vomiting, diarrhea, and progressive debilitation resulting from sepsis occur.
T329 288438-288669 Sentence denotes Diagnosis is based on clinical signs in an intact queen or bitch and radiographic or ultrasonographic evidence of a fluid-filled tubular density in the ventrocaudal abdomen, adjacent to the urinary bladder (Figures 1-40 and 1-41) .
T330 288670-288837 Sentence denotes Treatment of open and closed pyometra involves correction of fluid and electrolyte abnormalities, administration of broad-spectrum antibiotics, and ovariohysterectomy.
T331 288838-288893 Sentence denotes Closed pyometra is a life-threatening septic condition.
T332 288894-288979 Sentence denotes Open pyometra also can become life-threatening and so should be treated aggressively.
T333 288980-289044 Sentence denotes In closed pyometra, conservative medical therapy is not advised.
T334 289045-289270 Sentence denotes Administration of prostaglandins and oxytocin do not reliably cause the cervix to open and can result in ascending infection from the uterus into the abdomen or uterine rupture, both of which can result in severe peritonitis.
T335 289271-289399 Sentence denotes For animals with an open pyometra, ovariohysterectomy is the most reliable treatment for chronic cystic endometrial hyperplasia.
T336 289400-289532 Sentence denotes Although less successful than ovariohysterectomy, medical therapy may be attempted in breeding bitches as an alternative to surgery.
T337 289533-289643 Sentence denotes The most widely used medical therapy in the breeding queen and bitch is administration of prostaglandin F 2α .
T338 289644-289727 Sentence denotes This drug has not been approved for use in the queen or bitch in the United States.
T339 289728-289815 Sentence denotes To proceed with medical management of pyometra, first determine the size of the uterus.
T340 289816-289921 Sentence denotes Start the patient on antibiotic therapy (ampicillin, 22 mg/kg IV q6h, or enrofloxacin, 10 mg/kg PO q24h).
T341 289922-290040 Sentence denotes Administer the prostaglandin F 2α (250 mcg/kg SQ q24h) for 2 to 7 days until the size of the uterus approaches normal.
T342 290041-290111 Sentence denotes Measure serum progesterone concentrations if the bitch is in diestrus.
T343 290112-290225 Sentence denotes As the corpus luteum degrades under the influence of prostaglandin F 2α , serum progesterone levels will decline.
T344 290226-290332 Sentence denotes Prostaglandin F 2α is an abortifacient and thus should not be administered to the pregnant bitch or queen.
T345 290333-290469 Sentence denotes Clinical signs of a reaction to prostaglandin F 2α can occur within 5 to 60 minutes in the bitch and can last for as long as 20 minutes.
T346 290470-290609 Sentence denotes Clinical signs of a reaction include restlessness, hypersalivation, panting, vomiting, defecation, abdominal pain, fever, and vocalization.
T347 290610-290648 Sentence denotes In a very ill animal, death can occur.
T348 290649-290740 Sentence denotes The efficacy of prostaglandin F 2α is limited, and more than one treatment may be required.
T349 290741-290879 Sentence denotes The bitch should be bred on the next heat cycle and then spayed because progressive cystic endometrial hyperplasia will continue to occur.
T350 290880-291001 Sentence denotes Acute metritis is an acute bacterial infection of the uterus that typically occurs within 1 to 2 weeks after parturition.
T351 291002-291102 Sentence denotes The most common organism observed in metritis is E. coli ascending from the vulva and vaginal vault.
T352 291103-291131 Sentence denotes Sepsis can progress rapidly.
T353 291132-291303 Sentence denotes Clinical signs of acute metritis include inability to nurse puppies, anorexia, lethargy, foul-smelling purulent-sanguineous vaginal discharge, vomiting, or acute collapse.
T354 291304-291386 Sentence denotes Physical examination may reveal fever, dehydration, and a turgid distended uterus.
T355 291387-291457 Sentence denotes Septic inflammation will be observed on vaginal cytologic examination.
T356 291458-291538 Sentence denotes An enlarged uterus can be observed on abdominal radiographs and ultrasonography.
T357 291539-291677 Sentence denotes Treatment of acute metritis is directed at restoring hydration status with intravenous fluids and treating the infection with antibiotics.
T358 291678-291796 Sentence denotes Because the primary cause of metritis is E. coli infection, start enrofloxacin therapy (10 mg/kg IV or PO once daily).
T359 291797-291907 Sentence denotes As soon as the patient's cardiovascular status is stable enough for anesthesia, perform an ovariohysterectomy.
T360 291908-292029 Sentence denotes If the patient's condition is not critical and the animal is a valuable breeding bitch, medical therapy can be attempted.
T361 292030-292291 Sentence denotes Medical management of acute bacterial metritis includes administration of oxytocin (5 to 10 units q3h for three treatments) or administration of prostaglandin F 2α (250 mcg/kg/day for 2 to 5 days) to evacuate the uterine exudate and increase uterine blood flow.
T362 292292-292442 Sentence denotes Either drug should be used concurrently with antibiotics. uTerine ruPTure Rupture of the gravid uterus is rare in cats and dogs but has been reported.
T363 292443-292539 Sentence denotes Uterine rupture may occur as a consequence of parturition or result from blunt abdominal trauma.
T364 292540-292654 Sentence denotes Fetuses expelled into the abdominal cavity may be resorbed but more commonly cause the development of peritonitis.
T365 292655-292730 Sentence denotes If fetal circulation is not disrupted, the fetus actually may live to term.
T366 292731-292778 Sentence denotes Uterine rupture is an acute surgical emergency.
T367 292779-292871 Sentence denotes An ovariohysterectomy with removal of the extrauterine puppies and membranes is recommended.
T368 292872-293067 Sentence denotes If only one horn of the uterus is affected, a unilateral ovariohysterectomy can be performed to salvage the remaining unaffected puppies and preserve the breeding potential of the valuable bitch.
T369 293068-293211 Sentence denotes If uterine rupture occurs because of pyometra, peritonitis is likely, and copious peritoneal lavage should be performed at the time of surgery.
T370 293212-293357 Sentence denotes The patient should be placed on 7 to 14 days of antibiotic therapy (amoxicillin or amoxicillin and clavulanic acid [Clavamox] with enrofloxacin).
T371 293358-293515 Sentence denotes Vaginal prolapse occurs from excessive proliferation and hyperplasia of vaginal tissue while under the influence of estrogen during proestrus (Figure 1-42) .
T372 293516-293614 Sentence denotes The hyperplastic tissue usually recedes during diestrus but reappears with subsequent heat cycles.
T373 293615-293671 Sentence denotes Vaginal prolapse can be confused with vaginal neoplasia.
T374 293672-293793 Sentence denotes The former condition occurs primarily in younger animals, whereas the latter condition occurs primarily in older animals.
T375 293794-293906 Sentence denotes Treatment for vaginal hyperplasia or prolapse generally is not required if the tissue remains within the vagina.
T376 293907-293964 Sentence denotes The proliferation can lead to dysuria or anuria, however.
T377 293965-294062 Sentence denotes In some cases, the tissue becomes dried out and devitalized or becomes traumatized by the animal.
T378 294063-294122 Sentence denotes Such extreme cases warrant immediate surgical intervention.
T379 294123-294367 Sentence denotes The treatment for vaginal prolapse consists of ovariohysterectomy to remove the influence of estrogen, placement of an indwelling urinary catheter if the patient is dysuric, and protection of the hyperplastic tissue until it recedes on its own.
T380 294368-294536 Sentence denotes Although surgical resection of the hyperplastic tissue has been recommended, excessive hemorrhage after removal can occur, and so the procedure should not be attempted.
T381 294537-294623 Sentence denotes The patient should wear an Elizabethan collar at all times to prevent self-mutilation.
T382 294624-294733 Sentence denotes Administer broad-spectrum antibiotics for a minimum of 7 to 14 days or until the hyperplastic tissue recedes.
T383 294734-294777 Sentence denotes Keep the tissue clean with saline solution.
T384 294778-294876 Sentence denotes Dystocia Dystocia, or difficult birth, can occur in the dog and cat but is more common in the dog.
T385 294877-295171 Sentence denotes A diagnosis of dystocia is made based on the time of onset of visible labor and the time in which the last puppy or no puppy has been born, the intensity and timing of contractions, the timing of when the amniotic membranes first appear, the condition of the bitch, and the timing of gestation.
T386 295172-295359 Sentence denotes Causes of dystocia can be maternal or fetal and include primary or secondary uterine inertia, narrowing of the pelvic canal, hypocalcemia, psychological disturbances, and uterine torsion.
T387 295360-295484 Sentence denotes Maternal-fetal disproportion, or large fetus size in relation to the bitch or queen, also can result in dystocia (Box 1-40).
T388 295485-295847 Sentence denotes Obtain an abdominal radiograph for all cases of suspected dystocia at the time of presentation to determine the size of the fetus, the presentation of the fetus (both anterior and posterior presentations can be normal in the bitch or queen, but fetal malpositioning can cause dystocia), and whether there is radiographic evidence of a uterine rupture or torsion.
T389 295848-295970 Sentence denotes If maternal-fetal disproportion, uterine torsion, or uterine rupture is observed, take the patient immediately to surgery.
T390 295971-296069 Sentence denotes If the puppies or kittens are in a normal position for birth, medical management can be attempted.
T391 296070-296113 Sentence denotes Clip the perineum and aseptically scrub it.
T392 296114-296204 Sentence denotes Wearing sterile gloves, insert a lubricated finger into the vagina and palpate the cervix.
T393 296205-296284 Sentence denotes Massage (or "feather") the dorsal wall of the vagina to stimulate contractions.
T394 296285-296411 Sentence denotes Place an intravenous catheter, and administer oxytocin (2 to 20 units IM), repeating up to three times at 30-minute intervals.
T395 296412-296490 Sentence denotes In some cases, hypoglycemia or hypocalcemia can contribute to uterine inertia.
T396 296491-296598 Sentence denotes Administration of a calcium-containing solution (lactated Ringer's solution) with 2.5% dextrose is advised.
T397 296599-296669 Sentence denotes Alternately, administer 10% calcium gluconate (100 mg/5 kg IV slowly).
T398 296670-296751 Sentence denotes If labor has not progressed after 1 hour, immediately perform a cesarean section.
T1 296752-296872 Sentence denotes Uterine torsion is an uncommon emergency seen in the gravid and nongravid uterus and has been reported in dogs and cats.
T2 296873-297023 Sentence denotes The onset of clinical signs of abdominal pain and straining as if to whelp or queen or defecate is usually acute and constitutes a surgical emergency.
T3 297024-297104 Sentence denotes In some cases there may have been a history of delivery of a live or dead fetus.
T4 297105-297149 Sentence denotes Vaginal discharge may or may not be present.
T5 297150-297264 Sentence denotes Radiographs or ultrasound examination reveals a fluid-filled or air-filled tubular density in the ventral abdomen.
T6 297265-297469 Sentence denotes Treatment consists of placing an intravenous catheter, stabilizing the patient's cardiovascular status with intravenous fluids and sometimes blood products, and performing an immediate ovariohysterectomy.
T7 297470-297575 Sentence denotes If there are viable fetuses, the uterus should be delivered en mass and the puppies or kittens delivered.
T8 297576-297658 Sentence denotes The expulsion of one or more fetuses before term is known as spontaneous abortion.
T9 297659-297790 Sentence denotes In dogs and cats, it is possible to expel or abort one or more fetuses and still carry viable fetuses to term and deliver normally.
T10 297791-297883 Sentence denotes Clinical signs of spontaneous abortion include vaginal discharge and abdominal contractions.
T11 297884-297974 Sentence denotes In some cases the fetus is found, or there may be evidence of fetal membranes or remnants.
T12 297975-298082 Sentence denotes Causes of spontaneous abortion in dogs include Brucella canis, herpesvirus, coronavirus, and toxoplasmosis.
T13 298083-298158 Sentence denotes In cats, herpesvirus, coronavirus, and FeLV can cause spontaneous abortion.
T14 298159-298292 Sentence denotes In both species, trauma, hormonal factors, environmental pathogens, drugs, and fetal factors also can result in spontaneous abortion.
T15 298293-298397 Sentence denotes The safest method of pregnancy termination in the bitch or queen is by performing an ovariohysterectomy.
T16 298398-298490 Sentence denotes Oral diethylstilbestrol is not an effective mechanism of pregnancy termination in the bitch.
T17 298491-298724 Sentence denotes A so-called mismating shot, an injection of estradiol cypionate (0.02 mg/lb IM) is effective at causing termination of an early pregnancy but can be associated with severe side effects, including bone marrow suppression and pyometra.
T18 298725-298814 Sentence denotes Estradiol cypionate is not approved for use in the bitch or queen and is not recommended.
T19 298815-299650 Sentence denotes • Fetus lodged in birth canal • Presence of vaginal stricture or band of tissue preventing normal delivery • Prolonged gestation (>70 days) • Drop in rectal temperature (<100° F) with no evidence of labor • Green vaginal discharge and no evidence of delivery of fetus • No puppies delivered after 2 to 3 hours of a visible amniotic sac • Strong contractions with no puppy or kitten delivered after 30 minutes • Weak, infrequent contractions with no puppy delivered in 4 hours from onset of labor • More than 2 hours have passed with no evidence of further contraction or delivery of a puppy • Signs of systemic illness or pain: depression, weakness, sepsis 1 Prostaglandin F 2α is a natural abortifacient in the bitch if treatment is started within 5 days of cytologic evidence of diestrus (noncornified epithelium on a vaginal smear).
T20 299651-299758 Sentence denotes The prostaglandin F 2α causes lysis of the corpora lutea and a rapid decline in progesterone concentration.
T21 299759-299903 Sentence denotes The prostaglandin F 2α is administered for a total of eight injections (250 mcg/kg q12h for 4 days), along with atropine (100 to 500 mcg/kg SQ).
T22 299904-300060 Sentence denotes Side effects can occur within 5 to 40 minutes of injection and include restlessness, panting, salivation, abdominal pain, urination, vomiting, and diarrhea.
T23 300061-300174 Sentence denotes Walking the patient for 20 to 30 minutes after each treatment sometimes decreases the intensity of the reactions.
T24 300175-300243 Sentence denotes Bitches in the first half of the pregnancy often resorb the embryos.
T25 300244-300375 Sentence denotes If prostaglandin F 2α is administered in the second half of the pregnancy, the fetuses are aborted within 5 to 7 days of treatment.
T26 300376-300488 Sentence denotes Measure serum progesterone concentrations at the end of treatment to ensure complete lysis of the corpus luteum.
T27 300489-300563 Sentence denotes Prostaglandin F 2α is not approved for pregnancy termination in the bitch.
T28 300564-300641 Sentence denotes In cats, prostaglandin F 2α can terminate pregnancy after day 4 of gestation.
T29 300642-300738 Sentence denotes Prostaglandin F 2α should be used only in healthy queens (100 to 250 mcg/kg SQ q24h for 2 days).
T30 300739-300864 Sentence denotes Side effects in the queen are similar to those observed in the bitch but typically have a shorter duration (2 to 20 minutes).
T31 300865-300937 Sentence denotes Prostaglandin F 2α is not approved for use in cats in the United States.
T32 300938-301025 Sentence denotes The use of prostaglandin F 2α does not preclude breeding and pregnancy at a later date.
T33 301027-301199 Sentence denotes In the dog and cat the majority of injuries to the scrotum are associated with animal fights or shearing and abrasive injuries sustained in accidents involving automobiles.
T34 301200-301269 Sentence denotes Scrotal injuries should be categorized as superficial or penetrating.
T35 301270-301396 Sentence denotes Treatment of superficial injuries to the scrotum includes cleaning the wound with dilute antimicrobial cleanser and drying it.
T36 301397-301610 Sentence denotes Administer antiinflammatory doses of steroids (prednisolone, 0.5 to 1.0 mg/kg PO q12-24h) or NSAIDs (carprofen, 2.2 mg/kg PO q12h in dogs) for the first several days after scrotal injury to prevent or treat edema.
T37 301611-301672 Sentence denotes Administer topical antibiotic ointment until the wound heals.
T38 301673-301745 Sentence denotes In most cases, place an Elizabethan 1 collar to prevent self-mutilation.
T39 301746-301905 Sentence denotes Prognosis is generally favorable; however, semen quality may be affected for months after injury because of scrotal swelling and increased scrotal temperature.
T40 301906-302013 Sentence denotes Penetrating injuries to the scrotum are more serious and are associated with severe swelling and infection.
T41 302014-302072 Sentence denotes Surgically explore and debride penetrating scrotal wounds.
T42 302073-302134 Sentence denotes Administer systemically effective antibiotics and analgesics.
T43 302135-302240 Sentence denotes In extreme cases, particularly those that involve the testicle, consider castration and scrotal ablation.
T44 302241-302421 Sentence denotes Scrotal dermatitis is common in intact male dogs and can be associated with direct physical injury, self-infliction from licking, chemical irritation, burns, or contact dermatitis.
T45 302422-302507 Sentence denotes In affected animals, the scrotum can become extremely inflamed, swollen, and painful.
T46 302508-302567 Sentence denotes If left untreated, pyogranulomatous dermatitis can develop.
T47 302568-302702 Sentence denotes Make an attempt to determine whether an underlying systemic illness is present that could predispose the animal to scrotal dermatitis.
T48 302703-302853 Sentence denotes Widespread vasculitis with scrotal edema, pain, fever, and dermatitis has been associated with R. rickettsii infection (Rocky Mountain spotted fever).
T49 302854-302927 Sentence denotes B. canis also has been associated with scrotal irritation and dermatitis.
T50 302928-303092 Sentence denotes If scrotal dermatitis follows from an infectious cause, empiric use of glucocorticosteroids potentially can make the condition worse by suppressing immune function.
T51 303093-303187 Sentence denotes Empiric treatment with antibiotics also potentially can confound making an accurate diagnosis.
T52 303188-303269 Sentence denotes Treatment of scrotal dermatitis is to eliminate predisposing causes, if possible.
T53 303270-303346 Sentence denotes Keep an Elizabethan collar in place at all times to prevent self-mutilation.
T54 303347-303450 Sentence denotes Bathe the scrotum with a mild antimicrobial soap and dry it to remove any offending chemical irritants.
T55 303451-303585 Sentence denotes Topical medications, including tar shampoo, tetracaine, neomycin, and petroleum, can cause further irritation and are contraindicated.
T56 303586-303697 Sentence denotes Use oral or parenteral administration of glucocorticosteroids or NSAIDs to control discomfort and inflammation.
T57 303698-303847 Sentence denotes Scrotal hernias occur when the contents of the abdomen (intestines, fat, mesentery, omentum) protrude through the inguinal ring into the scrotal sac.
T58 303848-303976 Sentence denotes Like inguinal hernias, scrotal hernias are surgical emergencies only if intestinal incarceration or vascular obstruction occurs.
T59 303977-304097 Sentence denotes Differential diagnoses for scrotal hernias include epididymitis, orchitis, testicular torsion, and testicular neoplasia.
T60 304098-304293 Sentence denotes Definitive therapy for a scrotal hernia involves exploratory laparotomy and surgical reduction of the contents of the hernia, surgical correction of the rent in the inguinal ring, and castration.
T61 304294-304392 Sentence denotes Trauma to the epididymis or testicle can cause testicular pain and swelling of one or both testes.
T62 304393-304489 Sentence denotes Treat penetrating trauma to the testicle by castration to prevent infection and self-mutilation.
T63 304490-304593 Sentence denotes Administer oral antibiotics (amoxicillin or amoxicillin-clavulanate) for 7 to 10 days after the injury.
T64 304594-304714 Sentence denotes Nonpenetrating injuries to the scrotum and testicle rarely may cause acute testicular hemorrhage or hydrocele formation.
T65 304715-304799 Sentence denotes Palpation of the affected area often reveals a peritesticular, soft, compliant area.
T66 304800-304945 Sentence denotes Treatment consists of cool compresses on the scrotum and testicle and administration of antiinflammatory doses of glucocorticosteroids or NSAIDs.
T67 304946-305052 Sentence denotes If the swelling does not resolve spontaneously in 5 to 7 days, consider surgical exploration and drainage.
T68 305053-305174 Sentence denotes Increased scrotal temperature and testicular inflammation can affect semen quality for months after the initial incident.
T69 305175-305312 Sentence denotes Testicular torsion, or torsion of the spermatic cord, causes rotation of the testicle, ultimately causing obstruction to venous drainage.
T70 305313-305495 Sentence denotes Testicular torsion often is associated with a neoplastic mass of a retained testicle within the abdomen but also can be observed with nonneoplastic testes located within the scrotum.
T71 305496-305640 Sentence denotes The predominant clinical signs are pain, stiff stilted gait, and the presence of an abnormally swollen testicle (if located within the scrotum).
T72 305641-305779 Sentence denotes If an intraabdominal testicular torsion is present, pain, lethargy, anorexia, and vomiting can occur (see Acute Condition in the Abdomen).
T73 305780-305819 Sentence denotes An intraabdominal mass may be palpable.
T74 305820-305940 Sentence denotes Perform an abdominal or testicular ultrasound, preferably with color flow Doppler to evaluate perfusion to the testicle.
T75 305941-306000 Sentence denotes Treatment involves surgical removal of the involved testes.
T76 306001-306157 Sentence denotes Bacterial infections of the testicle or epididymis most commonly are caused by ascending infections of the normal bacterial flora of the prepuce or urethra.
T77 306158-306252 Sentence denotes Common inhabitants include E. coli, S. aureus, Streptococcus species, and Mycobacterium canis.
T78 306253-306345 Sentence denotes B. canis and R. rickettsii are also capable of causing orchitis and epididymitis in the dog.
T79 306346-306464 Sentence denotes Clinical signs of orchitis or epididymitis include testicular enlargement, stiff stilted gait, and reluctance to walk.
T80 306465-306592 Sentence denotes Physical examination often reveals a fever and self-induced trauma to the scrotum from licking or chewing at the inflamed area.
T81 306593-306682 Sentence denotes Collect a semen sample by ejaculation, and culture it to identify the causative organism.
T82 306683-306794 Sentence denotes Alternately, collect samples by needle aspiration of the affected organ(s) and test serologically for B. canis.
T83 306795-306961 Sentence denotes Treatment of infectious orchitis involves a minimum of 3 to 4 weeks of specific antimicrobial therapy, based on culture and susceptibility testing, whenever possible.
T84 306962-307072 Sentence denotes If a bacterial culture cannot be performed, initiate fluoroquinolone therapy (enrofloxacin, 10 mg/kg PO q24h).
T85 307073-307177 Sentence denotes Doxycycline (5 mg/kg PO bid for 7 days) has been shown to suppress but not eradicate B. canis infection.
T86 307178-307280 Sentence denotes Testicular inflammation and increased temperature can affect sperm quality for months after infection.
T87 307281-307443 Sentence denotes The most common causes of acute prostatitis are associated with acute bacterial infection (E. coli, Proteus species, Pseudomonas species, and Mycoplasma species).
T88 307444-307548 Sentence denotes Less common causes include fungal infection (Blastomyces dermatitidis) or anaerobic bacterial infection.
T89 307549-307722 Sentence denotes Acute prostatitis is characterized by fever, caudal abdominal pain, lethargy, anorexia, blood in the ejaculate, hematuria, dyschezia, and occasionally stranguria or dysuria.
T90 307723-307817 Sentence denotes The patient often appears in pain and depressed and may be dehydrated on physical examination.
T91 307818-307910 Sentence denotes Symmetric or asymmetric prostatomegaly and prostate pain may be evident on rectal palpation.
T92 307911-308092 Sentence denotes In severely affected dogs, clinical signs of tachycardia, hyperemic or injected mucous membranes, bounding pulses, lethargy, dehydration, and fever may be present because of sepsis.
T93 308093-308155 Sentence denotes Death can occur within 2 days if a prostatic abscess ruptures.
T94 308156-308333 Sentence denotes Diagnosis of acute prostatitis is confirmed based on the presenting clinical signs, neutrophilic leukocytosis (with or without a left shift), and positive urine culture results.
T95 308334-308497 Sentence denotes Prostatic samples may be obtained from the prostatic portion of the ejaculate, prostatic massage, urethral discharge, urine, or (less commonly) prostatic aspirate.
T96 308498-308621 Sentence denotes Although semen samples can yield positive bacterial cultures, dogs with acute prostatitis are often unwilling to ejaculate.
T97 308622-308728 Sentence denotes Radiography may reveal an enlarged prostate, but this alone does not confirm the diagnosis of prostatitis.
T98 308729-308877 Sentence denotes Abdominal ultrasound often reveals prostatic abscessation and allows for the collection of samples from the affected area(s) via prostatic aspirate.
T99 308878-308969 Sentence denotes Aspiration of the affected tissue potentially can wick infection into periprostatic tracks.
T100 308970-309157 Sentence denotes Cytologic examination of the patient's ejaculate or prostatic wash from a dog with acute prostatitis reveals numerous inflammatory cells, and such samples may contain bacterial organisms.
T101 309158-309297 Sentence denotes The treatment of a patient with acute prostatitis is directed at correcting dysuria and constipation associated with prostatic enlargement.
T102 309298-309450 Sentence denotes Enrofloxacin (10 mg/kg PO sid) can penetrate the inflamed prostatic tissue and is effective in treating gram-negative and Mycoplasma species infections.
T103 309451-309522 Sentence denotes Ciprofloxacin does not appear to penetrate prostatic tissue as readily.
T104 309523-309687 Sentence denotes Alternatives to enrofloxacin therapy are trimethoprim-sulfamethoxazole (30 mg/ kg PO q12h) or chloramphenicol (25 to 50 mg/kg PO q8h) for a minimum of 2 to 3 weeks.
T105 309688-309820 Sentence denotes Castration is recommended because benign prostatic hyperplasia may be a predisposing factor in the development of acute prostatitis.
T106 309821-309977 Sentence denotes Do not perform castration until the patient has been on antibiotic therapy for a minimum of 7 days, to prevent the surgical complication of scirrhous cords.
T107 309978-310154 Sentence denotes Finasteride (Proscar, 0.1-0.5 mg/kg PO q24h), an antiandrogen 5α-reductase inhibitor, may help reduce the size of prostatic tissue until the effects of castration are observed.
T108 310155-310264 Sentence denotes If a prostatic abscess is present, perform marsupialization, surgical drainage, or ultrasonographic drainage.
T109 310265-310428 Sentence denotes Surgical therapy is associated with a large incidence of complications, including incontinence, chronic drainage from fistulas and stomas, septic shock, and death.
T110 310429-310504 Sentence denotes Fracture of the os penis is an uncommon condition encountered in male dogs.
T111 310505-310598 Sentence denotes Os penis fractures can occur with minimal soft tissue damage but cause hematuria and dysuria.
T112 310599-310681 Sentence denotes On physical examination, urethral obstruction and crepitus in the penis are found.
T113 310682-310760 Sentence denotes A lateral abdominal radiograph is usually sufficient to document the fracture.
T114 310761-310871 Sentence denotes Treatment consists of conservative therapy, in most cases, and consists primarily of analgesia administration.
T115 310872-310983 Sentence denotes If the urethra also is damaged, place a urethral catheter for 5 to 7 days to allow the urethral mucosa to heal.
T116 310984-311182 Sentence denotes Fractures of the os penis that are comminuted or severe enough to cause urethral obstruction require open reduction and fixation, partial penile amputation, or antescrotal (prescrotal) urethrostomy.
T117 311183-311289 Sentence denotes Lacerations of the penis cause significant bleeding because of the extensive vascular supply to the penis.
T118 311290-311372 Sentence denotes Dogs and cats tend to lick penile lacerations and prevent adequate clot formation.
T119 311373-311459 Sentence denotes Sedation or general anesthesia often is required to evaluate and treat the laceration.
T120 311460-311576 Sentence denotes After sedation or general anesthesia, place a urinary catheter and examine the penis under 1 a stream of cold water.
T121 311577-311669 Sentence denotes Small lacerations can be managed with cold compresses and one to several absorbable sutures.
T122 311670-311713 Sentence denotes Extensive suturing usually is not required.
T123 311714-311824 Sentence denotes Prevent erection by isolating the patient from females in estrus or allowing excitement or excessive activity.
T124 311825-311880 Sentence denotes Place an Elizabethan collar to prevent self-mutilation.
T125 311881-311939 Sentence denotes Initiate systemic antibiotic therapy to prevent infection.
T126 311940-312039 Sentence denotes The inability to withdraw the penis into the prepuce in male dogs or cats is known as paraphimosis.
T127 312040-312138 Sentence denotes Paraphimosis usually develops after an erection in young male dogs and in older dogs after coitus.
T128 312139-312252 Sentence denotes Mucosal edema, hemorrhage, self-mutilation, and necrosis requiring penile amputation can occur if left untreated.
T129 312253-312382 Sentence denotes Treatment consists of applying cold water to the penis and reducing edema with application of an osmotic substance such as sugar.
T130 312383-312486 Sentence denotes Examine the base of the penis for hair rings that can prevent retraction of the penis into the prepuce.
T131 312487-312601 Sentence denotes Rinse the penis carefully with cold water and lubricate it with sterile lubricant and replace it into the prepuce.
T132 312602-312755 Sentence denotes If the penis cannot be reduced easily into the prepuce, anesthetize the patient and make a small incision at the lateral aspect of the preputial opening.
T133 312756-312820 Sentence denotes Replace the penis and close the incision with absorbable suture.
T134 312821-312910 Sentence denotes Place a purse-string suture and leave it in place for several days to prevent recurrence.
T135 312911-313001 Sentence denotes Instill topical antimicrobial ointment with steroids into the prepuce several times a day.
T136 313002-313133 Sentence denotes In severe cases, a urinary catheter may need to be placed to prevent urethral obstruction, until penile swelling and edema resolve.
T137 313134-313218 Sentence denotes Place an Elizabethan collar to prevent excessive licking during the healing process.
T138 313219-313401 Sentence denotes Prolapse of the distal urethra is a condition usually confined to intact male English Bulldogs, although isolated incidences also have been reported in Yorkshire and Boston Terriers.
T139 313402-313727 Sentence denotes The exact cause of this condition is unknown but usually is associated with a condition that causes increased intraabdominal pressure or urethral straining, including sexual excitement, coughing, vomiting, obstructed airway or brachycephalic airway syndrome, urethral calculi, genitourinary tract infection, and masturbation.
T140 313728-313875 Sentence denotes The urethral prolapse usually appears as a mushroom-tip congested, irritated mass at the end of the penis that may or may not bleed (Figure 1-44) .
T141 313876-313941 Sentence denotes In some cases, bleeding occurs or worsens with sexual excitement.
T142 313942-313994 Sentence denotes Clinical signs associated with the prolapsed urethra
T143 313996-314073 Sentence denotes include excessive licking of the prepuce, stranguria, and preputial bleeding.
T144 314074-314218 Sentence denotes Once the mass is observed, other differential diagnoses include transmissible venereal tumor, urethral polyp, trauma, urethritis, and neoplasia.
T145 314219-314326 Sentence denotes In most cases, however, the prolapse occurs in intact young dogs, making neoplastic conditions less likely.
T146 314327-314441 Sentence denotes Treatment for urethral prolapse should occur at the time of diagnosis to prevent selfinduced trauma and infection.
T147 314442-314587 Sentence denotes Immediate therapy includes manual reduction of the prolapsed tissue and placement of a purse-string suture around an indwelling urinary catheter.
T148 314588-314673 Sentence denotes The purse-string suture can remain in place for up to 5 days until definitive repair.
T149 314674-314771 Sentence denotes Until the time of surgery, place an Elizabethan collar on the patient to prevent self-mutilation.
T150 314772-314829 Sentence denotes Several forms of surgical correction have been described.
T151 314830-314955 Sentence denotes In some cases, surgical resection of the prolapsed tissue with apposition of the urethral and penile mucosa can be attempted.
T152 314956-315092 Sentence denotes More recently, a technique involving placement of several mattress sutures to reduce and secure the prolapsed tissue has been described.
T153 315093-315191 Sentence denotes Recurrence of prolapse can occur with either technique, particularly if the inciting event recurs.
T154 315192-315352 Sentence denotes Because there may be a genetic predisposition in this breed and because the prolapse can recur with sexual excitement, neutering should strongly be recommended.
T155 315354-315576 Sentence denotes Local freezing or frostbite most commonly affects the peripheral tissues of the ears, tail, paws, and genitalia that are sparsely covered with fur, are poorly vascularized, and may have been traumatized previously by cold.
T156 315577-315687 Sentence denotes Clinical signs of frostbite are paleness and appearance of a blanched pink to white discoloration to the skin.
T157 315688-315732 Sentence denotes The skin also may appear black and necrotic.
T158 315733-315871 Sentence denotes Immediate treatment consists of slowly rewarming the affected area with moist heat at 29.5° C (85° F) or by immersion in warm water baths.
T159 315872-315931 Sentence denotes Analgesics may be required to alleviate patient discomfort.
T160 315932-316001 Sentence denotes Carefully dry the injured areas and protect them from further trauma.
T161 316002-316108 Sentence denotes The use of prophylactic antibiotics is controversial because it can promote resistant bacterial infection.
T162 316109-316173 Sentence denotes Use of antibiotics should be based on the presence of infection.
T163 316174-316297 Sentence denotes Treatments that are ineffective and may be harmful include rubbing of the affected areas, pressure bandages, and ointments.
T164 316298-316401 Sentence denotes Corticosteroids can decrease cellular immunity and promote infection and are therefore contraindicated.
T165 316402-316477 Sentence denotes Many frostbitten areas that appear nonviable can regain function gradually.
T166 316478-316526 Sentence denotes Use care when removing areas of necrotic tissue.
T167 316527-316673 Sentence denotes Affected areas may take several days to a week before fully manifesting areas of demarcation between healthy viable and necrotic nonviable tissue.
T168 316674-316904 Sentence denotes Chilling of the entire body from exposure or immersion in extremely cold water results in a decrease in core body temperature and physiologic processes that becomes irreversible when the body temperature falls below 24° C (75° F).
T169 316905-317019 Sentence denotes Mild hypothermia occurs at 32° to 37° C, moderate hypothermia at 28° to 32° C, and severe hypothermia below 28° C.
T170 317020-317119 Sentence denotes The duration of exposure and the general condition of the animal influences its ability to survive.
T171 317120-317547 Sentence denotes Clinical signs and consequences associated with hypothermia include shivering, vasoconstriction, mental depression, hypotension, sinus bradycardia, hypoventilation with decreased respiratory rate, increased blood viscosity, muscle stiffness, atrial and ventricular irritability, decreased level of consciousness, decreased oxygen consumption, metabolic (lactic) acidosis, respiratory acidosis, and coagulopathies including DIC.
T172 317548-317641 Sentence denotes If the animal is breathing, administer warm, humidified oxygen at 4 to 10 breaths per minute.
T173 317642-317774 Sentence denotes If the animal is not breathing or is severely hypoventilating, endotracheal intubation with mechanical ventilation may be necessary.
T174 317775-317842 Sentence denotes Place an intravenous catheter and infuse warmed crystalloid fluids.
T175 317843-317946 Sentence denotes If the blood glucose is less than 60 mg/dL, add supplemental dextrose (2.5%) to the crystalloid fluids.
T176 317947-317997 Sentence denotes Monitor the core body temperature and ECG closely.
T177 317998-318140 Sentence denotes Rewarming should occur in the form of external circulating warm water blankets, radiant heat, and circulating warm air blankets (Bair Hugger).
T178 318141-318206 Sentence denotes Never use a heating pad, to avoid iatrogenic thermal burn injury.
T179 318207-318376 Sentence denotes Severe hypothermia may require core rewarming in the form of intraperitoneal fluids (10 to 20 mL of lactated Ringer's solution per kilogram, warmed to 39.4° C [103° F]).
T180 318377-318544 Sentence denotes Place a temporary peritoneal dialysis catheter, and repeat the dialysis every 30 minutes until the patient's body temperature reaches 36.6° to 37.7° C (98° to 100° F).
T181 318545-318621 Sentence denotes The body temperature should rise slowly, ideally no more than 1° F per hour.
T182 318622-318772 Sentence denotes Because the response of the body to drugs is unpredictable, avoid administering drugs whenever possible, until the body temperature returns to normal.
T183 318773-318936 Sentence denotes Complications observed during rewarming include DIC, cardiac dysrhythmias including cardiac arrest, pneumonia, pulmonary edema, CNS edema, ARDS, and renal failure.
T184 318937-319190 Sentence denotes hyPerThermiA And heAT-induCed illness (heAT sTroke) Heat stroke and heat-induced illness in dogs can be associated with excessive exertion, exposure to high environmental temperatures, stress, and other factors that cause an inability to dissipate heat.
T185 319191-319335 Sentence denotes Brachycephalic breeds, obese animals, dogs with laryngeal paralysis, and older animals with cardiovascular disease can be particularly affected.
T186 319336-319417 Sentence denotes Hyperthermia is defined as a rectal temperature of 41° to 43° C (105° to 110° F).
T187 319418-319520 Sentence denotes Clinical signs of hyperthermia include congested hyperemic mucous membranes, tachycardia, and panting.
T188 319521-319682 Sentence denotes More severe clinical signs include collapse (heat prostration), ataxia, vomiting, diarrhea, hypersalivation, muscle tremors, loss of consciousness, and seizures.
T189 319683-319912 Sentence denotes Heat-induced illness can affect all major organ systems in the body because of denaturation of cellular proteins and enzyme activities, inappropriate shunting of blood, hypotension, decreased oxygen delivery, and lactic acidosis.
T190 319913-320138 Sentence denotes Cardiac dysrhythmias, interstitial and intracellular dehydration, intravascular hypovolemia, central nervous dysfunction, slough of gastrointestinal mucosa, oliguria, and coagulopathies can be seen as organ function declines.
T191 320139-320193 Sentence denotes Excessive panting can result in respiratory alkalosis.
T192 320194-320246 Sentence denotes Poor tissue perfusion results in metabolic acidosis.
T193 320247-320368 Sentence denotes Loss of water in excess of solutes such as sodium and chloride can lead to a free water deficit and severe hypernatremia.
T194 320369-320432 Sentence denotes A marked increase in PCV occurs because of the free water loss.
T195 320433-320514 Sentence denotes Severe abnormalities in electrolytes and pH can lead to cerebral edema and death.
T196 320515-320712 Sentence denotes Treatment goals for the patient with heat-induced illness are to lower the core body temperature and support cardiovascular, respiratory, renal, gastrointestinal, neurologic, and hepatic functions.
T197 320713-320807 Sentence denotes At the scene the veterinarian or caretaker can spray the animal with tepid (not 1 cold) water.
T198 320808-320875 Sentence denotes Immersion in cold water or ice baths is absolutely contraindicated.
T199 320876-321047 Sentence denotes Cold water and ice will cause extreme peripheral vasoconstriction, inhibiting the patient's ability to dissipate heat through conductive and convective cooling mechanisms.
T200 321048-321160 Sentence denotes As a result, core body temperature will continue to rise despite the good intentions of attendants at the scene.
T201 321161-321242 Sentence denotes Animals that have been cooled to the point of hypothermia have a worse prognosis.
T202 321243-321464 Sentence denotes Once the animal has been presented to the veterinarian, the goal is to cool the animal's body temperature with towels soaked in tepid water, cool intravenous fluids, and fans until the temperature has decreased to 103° F.
T203 321465-321626 Sentence denotes Organ system monitoring and support are based on the severity and duration of the heat stroke and the ability of the body to compensate and respond to treatment.
T204 321627-321776 Sentence denotes Management of the patient with heat-induced illness involves prompt aggressive cooling without being overzealous and creating iatrogenic hypothermia.
T205 321777-321937 Sentence denotes Administer cool intravenous crystalloid fluids to replenish volume and interstitial hydration and correct the patient's acid-base and electrolyte abnormalities.
T206 321938-322103 Sentence denotes Management consists of Rule of 20 monitoring (see Rule of 20), taking care to evaluate, restore, and maintain normal cardiac rhythm, BP, urine output, and mentation.
T207 322104-322239 Sentence denotes Administer antibiotics if there are any signs of gastrointestinal bleeding that will predispose the patient to bacterial translocation.
T208 322240-322387 Sentence denotes Monitor results of baseline chemistry tests including a complete blood count, biochemical panel, platelet count, coagulation tests, and urinalysis.
T209 322388-322499 Sentence denotes Treat coagulopathies including DIC aggressively and promptly (see also Disseminated Intravascular Coagulation).
T210 322500-322582 Sentence denotes Severe changes in mentation including stupor or coma worsen a patient's prognosis.
T211 322583-322750 Sentence denotes After initial therapy, monitor the patient for a minimum of 24 to 48 hours for secondary organ damage, including renal failure, myoglobinuria, cerebral edema, and DIC.
T212 322751-322840 Sentence denotes Dogs that are going to die of heat-induced illness usually die within the first 24 hours.
T213 322841-322915 Sentence denotes Animals that survive longer than 24 hours have a more favorable prognosis.
T214 322917-323172 Sentence denotes Immediate treatment consists of cooling the patient with cooling measures as for hyperthermia and heat-induced illness (see the previous discussion) and eliminating the cause (e.g., exertion, anesthesia, or neuromuscular blockers such as succinylcholine).
T215 323173-323302 Sentence denotes If the patient is under general anesthesia, hyperventilate the patient to help eliminate carbon dioxide and respiratory acidosis.
T216 323303-323431 Sentence denotes Administer dantrolene sodium (1 to 2 mg/kg IV) to stabilize the sarcoplasmic reticulum and decrease its permeability to calcium.
T217 323432-323556 Sentence denotes Animals with malignant hyperthermia should avoid any predisposing factors, including exertion, hyperthermia, and anesthesia.
T218 323557-323673 Sentence denotes After an episode of malignant hyperthermia, administer crystalloid fluids IV to aid in the elimination of myoglobin.
T219 323674-323774 Sentence denotes Monitor renal function closely for myoglobinuria and pigment damage to the renal tubular epithelium.
T220 323775-323829 Sentence denotes Monitor and correct acid-base and electrolyte changes.
T221 323830-323841 Sentence denotes Walters JM:
T222 323842-323855 Sentence denotes Hyperthermia.
T223 323856-323880 Sentence denotes In Wingfield WE, editor:
T224 323881-323941 Sentence denotes The veterinary ICU book, Jackson, Wyo, 2001, Teton Newmedia.
T225 323942-324049 Sentence denotes Sometimes it is difficult to assess whether an animal has been bitten by a poisonous or nonpoisonous snake.
T226 324050-324120 Sentence denotes In Colorado, the bull snake closely resembles the prairie rattlesnake.
T227 324121-324212 Sentence denotes Both snakes make similar noise and can be alarming if noticed on a hike or in the backyard.
T228 324213-324291 Sentence denotes Whenever possible, identify the offending reptile but never risk being bitten.
T229 324292-324373 Sentence denotes Know what types of venomous creatures are in the geographic area of the practice.
T230 324374-324536 Sentence denotes If an animal has been bitten by a nonpoisonous snake, usually the bite marks are small with multiple small tooth punctures, and the bite is relatively nonpainful.
T231 324537-324574 Sentence denotes Usually local reaction is negligible.
T232 324575-324702 Sentence denotes However, large boas or pythons also can inflict large crushing injuries that can cause severe trauma, including bony fractures.
T233 324703-324841 Sentence denotes Treatment for a nonpoisonous snakebite involves clipping the bite wound and carefully cleaning the area with antimicrobial scrub solution.
T234 324842-325001 Sentence denotes Broad-spectrum antibiotics (e.g., amoxicillin-clavulanate, 16.25 mg/kg PO q12h) are indicated because of the extensive bacterial flora in the mouths of snakes.
T235 325002-325147 Sentence denotes Monitor all snakebite victims for a minimum of 8 hours after the incident, particularly when the species of the offending reptile is in question.
T236 325148-325251 Sentence denotes If clinical signs of envenomation occur, modify the patient's treatment appropriately and aggressively.
T237 325252-325347 Sentence denotes The two major groups of venomous snakes in North America are the pit viper and the coral snake.
T238 325348-325382 Sentence denotes All venomous snakes are dangerous.
T239 325383-325615 Sentence denotes The severity of any given bite depends on the toxicity of the venom, the amount of venom injected, the site of envenomation, the size of the animal bitten, and the time from bite and envenomation to appropriate medical intervention.
T240 325616-325797 Sentence denotes The majority of reptile envenomations in the United States are inflicted by pit vipers, including the water moccasin (cottonmouth), copperhead, and numerous species of rattlesnakes.
T241 325798-325938 Sentence denotes Pit vipers are characterized by a deep pit located between the eye and nostril, elliptic pupils, and retractable front fangs (Figure 1-45) .
T242 325939-326182 Sentence denotes Localized clinical signs of pit viper envenomation may include the presence of bleeding puncture wounds, local edema close to puncture wounds, immediate severe pain or collapse, edema, petechiae, and ecchymosis with subsequent tissue necrosis.
T243 326183-326412 Sentence denotes Systemic signs of pit viper envenomation may include hypotension, shock, coagulopathies, lethargy, weakness, muscle fasciculations, lymphangitis, rhabdomyolysis, and neurologic signs including respiratory depression and seizures.
T244 326413-326621 Sentence denotes Neurologic signs largely are associated with 1 envenomation by the Mojave and canebrake rattlesnakes, although a potent neurotoxin, Mojave toxin A, also has been identified in other subspecies of rattlesnake.
T245 326622-326686 Sentence denotes Clinical signs of envenomation may take several hours to appear.
T246 326687-326764 Sentence denotes Hospitalize all suspected victims and monitor them for a minimum of 24 hours.
T247 326765-326856 Sentence denotes The severity of envenomation cannot be judged solely on the basis of local tissue reaction.
T248 326857-326939 Sentence denotes First aid measures by animal caretakers do little to prevent further envenomation.
T249 326940-327060 Sentence denotes The most important aspect of initiating therapy is to transport the animal to the nearest veterinary emergency facility.
T250 327061-327194 Sentence denotes To determine whether an animal has been envenomated by a pit viper, examine a peripheral blood smear for the presence of echinocytes.
T251 327195-327287 Sentence denotes Echinocytes will appear within 15 minutes of envenomation and may disappear within 48 hours.
T252 327288-327442 Sentence denotes Other treatment should be initiated 1 as rapidly and aggressively as possible, although controversy exists regarding whether some therapies are warranted.
T253 327443-327666 Sentence denotes The mainstay of therapy is to improve tissue perfusion with intravenous crystalloid fluids, prevent pain with judicious use of analgesic drugs, and, when necessary, reverse or negate the effects of the venom with antivenin.
T254 327667-327770 Sentence denotes Because pit viper venom consists of multiple fractions, treat each envenomation as a complex poisoning.
T255 327771-328034 Sentence denotes Obtain vascular access and administer intravenous crystalloid fluids (one fourth of a calculated shock dose) according to the patient's perfusion parameters of heart rate, BP, and capillary refill time (see also Management of the Shock Patient and Fluid Therapy).
T256 328035-328163 Sentence denotes Opioid analgesics are potent and should be administered at the time of presentation. (See also Pharmacologic Means to Analgesia:
T257 328164-328182 Sentence denotes Major Analgesics.)
T258 328183-328407 Sentence denotes The use of diphenhydramine and glucocorticoids has fallen out of favor, as there is no benefit to their use, and in humans the use of glucocorticoids with snakebite has been shown to increase patient morbidity and mortality.
T259 328408-328579 Sentence denotes Polyvalent antivenin is necessary in many cases of pit viper envenomation, except in most cases of prairie rattlesnake (Crotalus viridis viridis) envenomation in Colorado.
T260 328580-328715 Sentence denotes A recent study demonstrated no difference in outcome with or without the use of antivenin in cases of prairie rattlesnake envenomation.
T261 328716-328861 Sentence denotes Clinically, however, patients that receive antivenin are more comfortable and leave the hospital sooner than those that do not receive antivenin.
T262 328862-328926 Sentence denotes The exact dose of antivenin is unknown in small animal patients.
T263 328927-329011 Sentence denotes Administer a dose of at least one vial of antivenin to neutralize circulating venom.
T264 329012-329092 Sentence denotes Mix antivenin with a swirling, rather than a shaking motion, to prevent foaming.
T265 329093-329205 Sentence denotes Mix the antivenin with a 250-mL bag of 0.9% saline, and then administer it slowly over a period of 2 to 4 hours.
T266 329206-329364 Sentence denotes In smaller patients the antivenin can be diluted in a smaller volume of fluid, depending on the patient's body weight, and given over the same period of time.
T267 329365-329557 Sentence denotes During the administration of antivenin, monitor the animal closely for clinical signs of angioneurotic edema, urticaria, tachyarrhythmias, vomiting, diarrhea, and weakness during the infusion.
T268 329558-329729 Sentence denotes Administration of antivenin into the bite site is relatively contraindicated and ineffective because uptake is delayed, and systemic effects are the more life-threatening.
T269 329730-329940 Sentence denotes Management of pit viper envenomation largely involves maintenance of normal tissue perfusion with intravenous fluids, decreasing patient discomfort with analgesia, and negating circulating venom with antivenin.
T270 329941-330030 Sentence denotes Hydrotherapy to the affected bite site with tepid water is often soothing to the patient.
T271 330031-330313 Sentence denotes The empiric use of antibiotics is controversial but is recommended because of the favorable environment created by a snakebite (i.e., impregnation of superficial gram-positive bacteria and gram-negative bacteria from the mouth of the snake into a site of edematous necrotic tissue).
T272 330314-330403 Sentence denotes Administer amoxicillin-clavulanate (16.25 mg/kg PO q12h) or cephalexin (22 mg/kg PO q8h).
T273 330404-330474 Sentence denotes Also consider administration of NSAIDs (carprofen, 2.2 mg/kg PO q12h).
T274 330475-330670 Sentence denotes Monitor the patient closely for signs of local tissue necrosis and the development of thrombocytopenia and coagulopathies including DIC (see Management of Disseminated Intravascular Coagulation).
T275 330671-330733 Sentence denotes Treat coagulopathies aggressively to prevent end-organ damage.
T276 330734-331001 Sentence denotes Coral snakes are characterized by brightly colored bands encircling the body, with red and black separated by yellow. "Red on black, friend of Jack; red on yellow, kill a fellow." Types of coral snakes include the Eastern coral, Texas coral, and Sonoran coral snakes.
T277 331002-331298 Sentence denotes Clinical signs of coral snake envenomation may include small puncture wounds, transient initial pain, muscle fasciculations, weakness, difficulty swallowing or dysphagia, ascending lower motor neuron paralysis, miotic pinpoint pupils, bulbar paralysis, respiratory collapse, and severe hemolysis.
T278 331299-331376 Sentence denotes Clinical signs may be delayed for as long as 18 hours after the initial bite.
T279 331377-331523 Sentence denotes Immediate treatment with antivenin is necessary in cases of coral snake envenomation before the clinical signs become apparent, whenever possible.
T280 331524-331589 Sentence denotes Support respiration during paralysis with mechanical ventilation.
T281 331590-331682 Sentence denotes Secure the patient's airway with a cuffed endotracheal tube to prevent aspiration pneumonia.
T282 331683-331738 Sentence denotes Clinical signs will progress rapidly once they develop.
T283 331739-331840 Sentence denotes Rapid administration with antivenin is the mainstay of therapy in suspected coral snake envenomation.
T284 331841-331956 Sentence denotes Respiratory and cardiovascular support should occur with mechanical ventilation and intravenous crystalloid fluids.
T285 331957-332004 Sentence denotes Keep the patient warm and dry in a quiet place.
T286 332005-332094 Sentence denotes Turn the patient every 4 to 6 hours to prevent atelectasis and decubitus ulcer formation.
T287 332095-332178 Sentence denotes Maintain cleanliness using a urinary catheter and closed urinary collection system.
T288 332179-332290 Sentence denotes Perform passive range of motion and deep muscle massage to prevent disuse atrophy of limb muscles and function.
T289 332291-332662 Sentence denotes Treat aspiration pneumonia aggressively with broad-spectrum antibiotics (ampicillin, 22 mg/kg IV q6h, with enrofloxacin, 10 mg/kg IV q24h, and then change to oral once tolerated and the patient is able to swallow) for 2 weeks past the resolution of radiographic signs of pneumonia; intravenous fluids; and nebulization with sterile saline and coupage chest physiotherapy.
T290 332663-332715 Sentence denotes Several weeks may elapse before a complete recovery.
T291 332717-332882 Sentence denotes The adult black widow spider (Latrodectus species) can be recognized by a red to orange hourglass-shaped marking on the underside of a globous, shiny, black abdomen.
T292 332883-333005 Sentence denotes The immature female can be recognized by a colorful pattern of red, brown, and beige on the dorsal surface of the abdomen.
T293 333006-333069 Sentence denotes Adult and immature females are equally capable of envenomation.
T294 333070-333137 Sentence denotes The male is unable to penetrate the skin because of its small size.
T295 333138-333208 Sentence denotes Black widow spiders are found throughout the United States and Canada.
T296 333209-333334 Sentence denotes Black widow spider venom is neurotoxic and acts presynaptically, releasing large amounts of acetylcholine and norepinephrine.
T297 333335-333456 Sentence denotes There appears to be a seasonal variation in the potency of the venom; it is lowest in the spring and highest in the fall.
T298 333457-333545 Sentence denotes In dogs, envenomation results in hyperesthesia, muscle fasciculations, and hypertension.
T299 333546-333599 Sentence denotes Muscle rigidity without tenderness is characteristic.
T300 333600-333672 Sentence denotes Affected animals may demonstrate clinical signs of acute abdominal pain.
T301 333673-333721 Sentence denotes Tonic-clonic convulsions may occur but are rare.
T302 333722-333821 Sentence denotes In cats, paralytic signs predominate and appear early as an ascending lower motor neuron paralysis.
T303 333822-333877 Sentence denotes Increased salivation, vomiting, and diarrhea may occur.
T304 333878-333978 Sentence denotes Serum biochemistry profiles often reveal significant elevations in creatine kinase and hypocalcemia.
T305 333979-334054 Sentence denotes Myoglobinemia and myoglobinuria can occur because of extreme muscle damage.
T306 334055-334182 Sentence denotes Management of black widow spider envenomation should be aggressive in the cat and dog, particularly when the exposure is known.
T307 334183-334316 Sentence denotes In many cases, however, the diagnosis is made based on clinical signs, biochemical abnormalities, and lack of another apparent cause.
T308 334317-334420 Sentence denotes Antivenin (one vial) is available and should be administered after pretreatment with 1 diphenhydramine.
T309 334421-334607 Sentence denotes If antivenin is unavailable, administer a slow infusion of calciumcontaining fluid such as lactated Ringer's solution with calcium gluconate while carefully monitoring the patient's ECG.
T310 334608-334716 Sentence denotes The small brown nonaggressive brown spider is characterized by a violin-shaped marking on the cephalothorax.
T311 334717-334766 Sentence denotes The neck of the violin points toward the abdomen.
T312 334767-334893 Sentence denotes Brown spiders are found primarily in the southern half of the United States but have been documented as far north as Michigan.
T313 334894-335006 Sentence denotes The venom of the brown spider has a potent dermatonecrolytic effect and starts with a classic bull's-eye lesion.
T314 335007-335159 Sentence denotes The lesion then develops into an indolent ulcer into dependent tissues promoted by complement fixation and influx of neutrophils into the affected area.
T315 335160-335230 Sentence denotes The ulcer can take months to heal and often leaves a disfiguring scar.
T316 335231-335336 Sentence denotes Systemic reactions are rare but can include hemolysis, fever, thrombocytopenia, weakness, and joint pain.
T317 335337-335361 Sentence denotes Fatalities are possible.
T318 335362-335649 Sentence denotes Immediate management of an animal with brown spider envenomation is difficult because there is no specific antidote and because clinical signs may be delayed until necrosis of the skin and underlying tissues becomes apparent through the patient's fur 7 to 14 days after the initial bite.
T319 335650-335719 Sentence denotes Dapsone has been recommended at a dose of 1 mg/kg PO tid for 10 days.
T320 335721-335836 Sentence denotes The animal should have its mouth rinsed out thoroughly with tap water even before presentation to the veterinarian.
T321 335837-335955 Sentence denotes If the animal is unconscious or actively seizing and cannot protect its airway, flushing the mouth is contraindicated.
T322 335956-336098 Sentence denotes Once an animal is presented to the veterinarian, the veterinarian should place an intravenous catheter and monitor the patient's 1 ECG and BP.
T323 336099-336198 Sentence denotes Attempt seizure control with diazepam (0.5 mg/kg IV) or pentobarbital (5 to 15 mg/kg IV to effect).
T324 336199-336273 Sentence denotes Ventricular dysrhythmias can be controlled first with esmolol (0.1 mg/kg).
T325 336274-336388 Sentence denotes If esmolol is ineffective, administer a longer-acting parenteral β-antagonist such as propranolol (0.05 mg/kg IV).
T326 336389-336507 Sentence denotes Ventricular tachycardia also can be treated with lidocaine (1 to 2 mg/kg IV, followed by 50 to 100 mcg/kg/min IV CRI).
T327 336508-336601 Sentence denotes Case management largely depends on supportive care and treating clinical signs as they occur.
T328 336602-336789 Sentence denotes Monitor baseline acid-base and electrolyte balance because severe metabolic acidosis may occur that should be treated with intravenous fluids and sodium bicarbonate (0.25 to 1 mEq/kg IV).
T329 336790-336837 Sentence denotes Monitor ECG, BP, and mentation changes closely.
T330 336838-336880 Sentence denotes Control seizures and cardiac dysrhythmias.
T331 336881-336890 Sentence denotes Eubig PA:
T332 336891-336955 Sentence denotes Bufo species intoxication: big toad, big problem, Vet Med 96 (8)
T333 336957-337042 Sentence denotes Lizards of the family Helodermatidae are the only two poisonous lizards in the world.
T334 337043-337103 Sentence denotes They are found in the Southwestern United States and Mexico.
T335 337104-337165 Sentence denotes The venom glands are located on either side of the lower jaw.
T336 337166-337252 Sentence denotes Because these lizards are typically lethargic and nonaggressive, bite wounds are rare.
T337 337253-337377 Sentence denotes The lizards have grooved teeth that introduce the venom with a chewing motion as the lizard holds tenaciously to the victim.
T338 337378-337459 Sentence denotes The majority of affected dogs are bitten on the upper lip, which is very painful.
T339 337460-337555 Sentence denotes There are no proven first aid measures for bites from Gila monsters or Mexican bearded lizards.
T340 337556-337672 Sentence denotes The lizard can be disengaged by inserting a prying instrument between the jaws and pushing at the back of the mouth.
T341 337673-337736 Sentence denotes The teeth of the lizard are brittle and break off in the wound.
T342 337737-337856 Sentence denotes Topical irrigation with lidocaine and probing with a needle will aid in finding and removing the teeth from the victim.
T343 337857-337892 Sentence denotes Bite wounds will bleed excessively.
T344 337893-338025 Sentence denotes Irrigate wounds with sterile saline or lactated Ringer's solution, and place compression on the affected area until bleeding ceases.
T345 338026-338062 Sentence denotes Monitor the patient for hypotension.
T346 338063-338175 Sentence denotes Establish intravenous access, and administer intravenous fluids according to the patient's perfusion parameters.
T347 338176-338254 Sentence denotes Antibiotic therapy is indicated because of the bacteria in the lizard's mouth.
T348 338255-338340 Sentence denotes Because no antidote is available, treatment is supportive according to patient signs.
T349 338341-338463 Sentence denotes The majority of musculoskeletal emergencies are the result of external trauma, most commonly from motor vehicle accidents.
T350 338464-338554 Sentence denotes Blunt trauma invokes injury to multiple organ systems as a rule, rather than an exception.
T351 338555-338708 Sentence denotes Because of this, massive musculoskeletal injuries are assigned a relatively low priority during the initial triage and treatment of a traumatized animal.
T352 338709-338789 Sentence denotes Perform a rapid primary survey and institute any lifesaving emergency therapies.
T353 338790-338902 Sentence denotes Adhere to A CRASH PLAN or the ABCs of resuscitation (see Initial Emergency Examination, Management, and Triage).
T354 338903-339158 Sentence denotes Although musculoskeletal injuries are assigned a relatively lower priority, the degree of recovery from these injuries and financial obligation for fracture repair sometimes become critical factors in a client's decision whether to pursue further therapy.
T355 339159-339298 Sentence denotes One of the most important deciding factors is the long-term prognosis for the patient to have a good quality of life after fracture repair.
T356 339299-339473 Sentence denotes The initial management of musculoskeletal injuries is important in ensuring the best chance for maximal recovery with minimal complications after definitive surgical fracture
T357 339475-339607 Sentence denotes Immediately after the initial primary survey of a patient, perform a more thorough examination, including an orthopedic examination.
T358 339608-339802 Sentence denotes Multiple injuries often are observed in falls from a height (e.g., "high-rise syndrome"), motor vehicle accidents, gunshot wounds, and encounters with other animals (e.g., "big-dog-little-dog").
T359 339803-339974 Sentence denotes Address the most lifethreatening injuries, and palliate musculoskeletal injuries until more definitive repair can be attempted when the patient's condition is more stable.
T360 339975-340161 Sentence denotes In animals with the history of potential for multiple injuries, search thoroughly and meticulously for areas of injury to the spinal column and extremities and for small puncture wounds.
T361 340162-340337 Sentence denotes Helpful signs that can provide a clue as to an underlying injury include swelling, bruising, abnormal motion, and crepitus (caused by subcutaneous emphysema or bony fracture).
T362 340338-340400 Sentence denotes If the patient is alert, look for areas of tenderness or pain.
T363 340401-340507 Sentence denotes In unconscious or depressed patients, reexamine the patient after the patient becomes more mentally alert.
T364 340508-340640 Sentence denotes Injuries often are missed during the initial examination in obtunded patients because of the early response and attenuation of pain.
T365 340641-340762 Sentence denotes Unconscious or immobile patients must have radiographic examination of the spinal column after stabilization and support.
T366 340763-340872 Sentence denotes Palpate the skull carefully for obvious depressions or crepitus that may be associated with a skull fracture.
T367 340873-341144 Sentence denotes Localization of the injury can be determined by motion in abnormal locations, swelling caused by hemorrhage or edema, pain during gentle movement or palpation, deformity, angular change, or a significant increase or decrease in normal range of motion of bones and joints.
T368 341145-341236 Sentence denotes Perform a rectal examination in all cases to palpate for pelvic fractures and displacement.
T369 341237-341380 Sentence denotes Once the diagnosis of a fracture or luxation has been confirmed, look for any evidence of skin lacerations or punctures near the fracture site.
T370 341381-341509 Sentence denotes In long-haired breeds, clipping the fur near the fracture site often is necessary to perform a thorough examination of the area.
T371 341510-341605 Sentence denotes If any wounds are found, the fracture is classified as an open fracture until proven otherwise.
T372 341606-341716 Sentence denotes In some cases the open fracture is obvious, with a large section of bone fragment protruding through the skin.
T373 341717-341839 Sentence denotes In other cases the puncture wound may be subtle, with only a small amount of blood or a pinpoint hole in the skin surface.
T374 341840-342056 Sentence denotes Characteristics observed with open fractures include bone penetration, fat droplets or marrow elements in blood coming from the wound, subcutaneous emphysema on radiographs, and lacerations in the area of a fracture.
T375 342057-342124 Sentence denotes Protect the patient from further injury or contamination of wounds.
T376 342125-342335 Sentence denotes Excessive palpation to intentionally produce crepitus is inappropriate because it causes severe patient 1 discomfort and has the potential to cause severe soft tissue and neurologic injury at the fracture site.
T377 342336-342502 Sentence denotes Sedation and analgesia aid in making the examination more comfortable for the patient and allow localization of the injury and comparison with the opposite extremity.
T378 342503-342646 Sentence denotes Higher-quality radiographs can be performed to determine the extent of the injury when the animal is sedated adequately and pain is controlled.
T379 342647-342727 Sentence denotes iniTiAl FrACTure mAnAgemenT Sedate the patient judiciously with analgesic drugs.
T380 342728-342865 Sentence denotes Opioid drugs work well for orthopedic pain, produce minimal cardiorespiratory depression, and can be reversed with naloxone if necessary.
T381 342866-342972 Sentence denotes Handle the fracture site gently to avoid causing further pain and soft tissue injury at the fracture site.
T382 342973-343105 Sentence denotes Rough or careless handling of a fracture site can cause a closed fracture to penetrate through the skin and become an open fracture.
T383 343106-343224 Sentence denotes Cover open fractures immediately to prevent contamination of the fracture with nosocomial infection from the hospital.
T384 343225-343330 Sentence denotes Administer a first-generation cephalosporin (cephalexin, 22 mg/kg PO q8h, or cefazolin, 22 mg/kg IV q8h).
T385 343331-343453 Sentence denotes The bandage also serves to control hemorrhage and prevent desiccation of the bones and surrounding soft tissue structures.
T386 343454-343655 Sentence denotes Leave the initial bandages in place until the patient's cardiorespiratory status has been determined to be stable and more definitive wound management can occur in a clean, preferably sterile location.
T387 343656-343751 Sentence denotes Examine the neurologic status and cardiovascular status of the limb before and after treatment.
T388 343752-343920 Sentence denotes Determine the vascular status of the limb by checking the color and temperature of the limb, the state of distal pulses, and the degree of bleeding from a cut nail bed.
T389 343921-344115 Sentence denotes In patients with severe cardiovascular compromise and hypotension caused by hemorrhagic shock, the viability of the limb may be in question until the cardiovascular status and BP are normalized.
T390 344116-344222 Sentence denotes Reduction of the fracture or straightening of gross deformities may return normal vascularity to the limb.
T391 344223-344307 Sentence denotes When checking neurologic status, examine for motor and sensory function to the limb.
T392 344308-344465 Sentence denotes Swelling may increase pressure on the nerves as they run through osteofascial compartments, resulting in decreased sensory or motor function, or neuropraxia.
T393 344466-344537 Sentence denotes Diminished function often returns to normal once the swelling subsides.
T394 344538-344798 Sentence denotes Serial physical examinations in the patient and response to initial stabilization therapy can lead to a higher index of suspicion that more occult injuries are present, such as a diaphragmatic hernia, perforated bowel, lacerated liver or spleen, or uroabdomen.
T395 344799-344903 Sentence denotes To prevent ongoing trauma, reduce any fracture and then stabilize the site above and below the fracture.
T396 344904-345010 Sentence denotes A modified Robert Jones splint or bandage often works well for fractures involving the distal extremities.
T397 345011-345153 Sentence denotes Fractures of the humerus or femur are difficult to immobilize without the use of spica or over-the-hip coaptation splints to prevent mobility.
T398 345154-345290 Sentence denotes Inappropriate bandaging of humerus or femur fractures can result in a fulcrum effect and worsen the soft tissue and neurologic injuries.
T399 345291-345434 Sentence denotes Further displacement of vertebral bodies or luxations can cause cord compression or laceration such that return to function becomes impossible.
T400 345435-345727 Sentence denotes Immediately place any patient with a suspected spinal injury on a flat surface, and tape down the animal to prevent further movement until the spine has been cleared by a minimum of two orthogonal radiographic views (lateral and ventrodorsal views performed as a cross-table x-ray technique).
T401 345728-345874 Sentence denotes Wounds associated with musculoskeletal trauma are common and include injury to the bones, joints, tendons, and surrounding musculature (Box 1-42).
T402 345875-346039 Sentence denotes Major problems associated with these cases are the presence of soft tissue trauma that makes wound closure hazardous or impossible because of the risk of infection.
T403 346040-346207 Sentence denotes Chronic deep infection of traumatized wounds can cause delayed healing and sequestra to develop, particularly if there is avascular bone or cartilage within the wound.
T1 346208-346341 Sentence denotes In the early management of an open fracture, the areas should be splinted without pulling any exposed bone back into the soft tissue.
T2 346342-346503 Sentence denotes The wound should not be probed or soaked, as nosocomial bacteria and other external contaminants can be introduced 1 into the wound, leading to severe infection.
T3 346504-346712 Sentence denotes Because of the risk of actually causing infection, probing, flushing, or replacing tissues back into the wound should be performed at the time of formal debridement when the patient is physiologically stable.
T4 346713-346883 Sentence denotes Bactericidal antibiotic therapy with a first-generation cephalosporin should be started immediately to obtain adequate concentrations of antibiotics at the fracture site.
T5 346884-346998 Sentence denotes The duration of antibiotic therapy should ideally be limited to 2 to 3 days to prevent the risk of superinfection.
T6 346999-347159 Sentence denotes Treatment of open musculoskeletal injury involves three considerations: initial inspection and wound debridement, stabilization and repair, and wound bandaging.
T7 347160-347229 Sentence denotes Initial inspection and wound debridement include the following steps:
T8 347230-347232 Sentence denotes 1.
T9 347233-347439 Sentence denotes After the patient's cardiovascular status has been stabilized and it has been determined that the patient can withstand anesthesia, place the animal under general anesthesia and remove the temporary splint.
T10 347440-347442 Sentence denotes 2.
T11 347443-347496 Sentence denotes Keeping the wound covered, shave the surrounding fur.
T12 347497-347499 Sentence denotes 3.
T13 347500-347574 Sentence denotes Remove the covering and then place sterile lubricant jelly over the wound.
T14 347575-347622 Sentence denotes Shave the fur to the edges of the wound margin.
T15 347623-347625 Sentence denotes 4.
T16 347626-347678 Sentence denotes Wash away any entrapped fur and the lubricant jelly.
T17 347679-347681 Sentence denotes 5.
T18 347682-347735 Sentence denotes Complete an antiseptic scrub of the surrounding skin.
T19 347736-347738 Sentence denotes 6.
T20 347739-347846 Sentence denotes If the wound is a small puncture (e.g., gunshot pellets or bites), probe the wound with a sterile hemostat.
T21 347847-347918 Sentence denotes Perform thorough debridement if tissues deep to the hole are cavitated.
T22 347919-347959 Sentence denotes If not deep, create a hole for drainage.
T23 347960-347962 Sentence denotes 7.
T24 347963-348049 Sentence denotes Flush the wound with a physiologic solution (lactated Ringer's solution is preferred).
T25 348050-348052 Sentence denotes 8.
T26 348053-348094 Sentence denotes Debride the wound from outward to inward.
T27 348095-348197 Sentence denotes Cut away damaged areas of skin and deeper tissues to open up underlying cavitations and tissue injury.
T28 348198-348244 Sentence denotes Minimal soft tissue trauma and devitalization.
T29 348245-348395 Sentence denotes When associated with a fracture, wound is created from the inside out by penetration of bone fragments through the skin, or from a low-energy gunshot.
T30 348396-348434 Sentence denotes Simple or comminuted fracture pattern.
T31 348435-348480 Sentence denotes Good stability of the two main bone segments.
T32 348481-348610 Sentence denotes Treatment and prognosis are good and similar to those of a closed injury if wound is debrided and stabilized within 6 to 8 hours.
T33 348611-348661 Sentence denotes Moderate soft tissue contusion and devitalization.
T34 348662-348732 Sentence denotes When associated with a fracture, wound is created from the outside in.
T35 348733-348819 Sentence denotes Major deep injury with considerable soft tissue stripping from bone and muscle damage.
T36 348820-348858 Sentence denotes Simple or comminuted fracture pattern.
T37 348859-348994 Sentence denotes Prognosis is good if wound is debrided within 6 hours of injury and provided rigid stabilization with a bone plate or external fixator.
T38 348995-349029 Sentence denotes Results from major external force.
T39 349030-349129 Sentence denotes Severe damage and necrosis of skin, subcutaneous tissue, muscle, nerve, bone, tendon, and arteries.
T40 349130-349257 Sentence denotes Soft tissue damage may vary from crush injury to shearing injury associated with bite wounds or low-speed automobile accidents.
T41 349258-349340 Sentence denotes Requires immediate and delayed sequential debridement and rigid external fixation.
T42 349341-349377 Sentence denotes Can require prolonged healing times.
T43 349378-349396 Sentence denotes Guarded prognosis.
T44 349397-349401 Sentence denotes 1 9.
T45 349402-349497 Sentence denotes Continuously irrigate with warm physiologic solution (lactated Ringer's solution is preferred).
T46 349498-349578 Sentence denotes The stream must be strong enough to flush debris out of the bottom of the wound.
T47 349579-349664 Sentence denotes To accomplish this, attach a 20-gauge needle to a 35-mL syringe (will deliver 7 psi).
T48 349665-349705 Sentence denotes Excise any obviously devitalized tissue.
T49 349706-349709 Sentence denotes 10.
T50 349710-349783 Sentence denotes Do not remove any bone fragments that are firmly attached to soft tissue.
T51 349784-349915 Sentence denotes Do not cut into healthy soft tissue to find bullet or bone fragments, unless the bullet can cause injury to joints or nerve tissue.
T52 349916-349919 Sentence denotes 11.
T53 349920-350035 Sentence denotes Do a primary repair of tendons and nerves if the wound is type I and recent (within 8 hours of the initial injury).
T54 350036-350153 Sentence denotes If the wound is too severe or if there is obvious infection, tag the ends of the tendons and nerves for later repair.
T55 350154-350349 Sentence denotes It is best to stabilize and repair open fractures as soon as the patient's cardiovascular and respiratory status can tolerate general anesthesia, provided that adequate stabilization is possible.
T56 350350-350569 Sentence denotes If this is not possible because of the level of experience of the surgeon or the lack of necessary equipment, it is best to perform wound management and place a temporary splint until definitive repair can be performed.
T57 350570-350638 Sentence denotes Wound bandaging is discussed in the section on bandaging techniques.
T58 350639-350748 Sentence denotes Structural injuries to the joints are common and can involve both ligaments and articular cartilage injuries.
T59 350749-350920 Sentence denotes Cartilage does not heal well; therefore, injuries involving articular cartilage can lead to a significant loss of function and degenerative joint disease (osteoarthritis).
T60 350921-351082 Sentence denotes Cartilage injuries that are superficial evoke a short-lived enzymatic and metabolic response that does not stimulate enough cellular growth to repair the defect.
T61 351083-351177 Sentence denotes Superficial lesions remain as defects but do not progress to chondromalacia or osteoarthritis.
T62 351178-351318 Sentence denotes Deep cartilage lacerations that extend to subchondral bone produce an exuberant healing response from the cells of the underlying cartilage.
T63 351319-351399 Sentence denotes In many cases, this material undergoes degeneration and leads to osteoarthritis.
T64 351400-351486 Sentence denotes Impact injuries to surface cartilage can cause chondrocyte and underlying bone injury.
T65 351487-351590 Sentence denotes These lesions rapidly progress to osteoarthritis; however, they may be totally or partially reversible.
T66 351591-351698 Sentence denotes Treatment of grade I injuries requires short-term coaptation splints; such injuries carry a good prognosis.
T67 351699-351847 Sentence denotes Grade II injuries require surgical treatment with a suture stent and consistent postoperative coaptation splints to heal and maintain good function.
T68 351848-351961 Sentence denotes Healing of grade III injuries often is a problem, and suture stents or surgical reapproximation may be indicated.
T69 351962-352089 Sentence denotes Failure to immobilize joints that are frequently flexed (elbow and stifle) can result in late complications of ligament repair.
T70 352090-352315 Sentence denotes Ligamentous injuries of joints, particularly the collateral ligaments of the stifle, elbow, and hock, and carpal hyperextension injuries are commonly missed and may require surgical fixation, including arthrodesis (Box 1-43).
T71 352316-352445 Sentence denotes Fractures in immature animals differ from those in adults in that young puppies and kittens have a great ability to remodel bone.
T72 352446-352529 Sentence denotes Remodeling is dependent on the age of the patient and the location of the fracture.
T73 352530-352592 Sentence denotes The younger the puppy or kitten and the closer the fracture to
T74 352593-352608 Sentence denotes Grade I sprain:
T75 352609-352671 Sentence denotes Rupture of a portion of the ligament with minimal lengthening.
T76 352672-352722 Sentence denotes Preservation of anatomic and mechanical integrity.
T77 352723-352739 Sentence denotes Grade II sprain:
T78 352740-352788 Sentence denotes A portion of the ruptured ligament is stretched.
T79 352789-352825 Sentence denotes Ligament is longer but still intact.
T80 352826-352843 Sentence denotes Grade III sprain:
T81 352844-352873 Sentence denotes Complete ligament disruption.
T82 352874-352996 Sentence denotes 1 the epiphysis or growth plate, the greater the potential for remodeling and the development of angular limb deformities.
T83 352997-353090 Sentence denotes Remodeling occurs more effectively in long-limbed breeds of dogs than in short-limbed breeds.
T84 353091-353248 Sentence denotes Fractures through the growth plate of immature animals may potentially cause angular limb deformities, joint dislocations or incongruity, and osteoarthritis.
T85 353249-353372 Sentence denotes This form of injury is commonly observed in the distal ulnar growth plate and the proximal and distal radial growth plates.
T86 353373-353470 Sentence denotes High-rise syndrome in cats is seen in cats that fall from a height, usually greater than 30 feet.
T87 353471-353600 Sentence denotes It occurs most frequently in high-rise buildings in urban areas where cats lie on window ledges and suddenly fall out the window.
T88 353601-353886 Sentence denotes The most common lesions observed in cats that fall from heights are thoracic injuries (rib and sternal fractures, pneumothorax, and pulmonary contusions) and facial and oral trauma (lip avulsions, mandibular symphyseal fractures, fractures of the hard palate, and maxillary fractures).
T89 353887-354042 Sentence denotes Limb and spinal cord fractures and luxations, radius and ulna fractures, abdominal trauma, urinary tract trauma, and diaphragmatic hernias are also common.
T90 354043-354156 Sentence denotes The injuries sustained are often found in combination, rather than as an isolated injury of one area of the body.
T91 354157-354278 Sentence denotes Follow the mnemonic A CRASH PLAN when managing a cat with high-rise syndrome, and immediately treat the animal for shock.
T92 354279-354409 Sentence denotes Following cardiovascular and respiratory stabilization, evaluate thoracic and abdominal radiographs, including those of the spine.
T93 354410-354496 Sentence denotes Evaluate the bladder closely, making sure that the cat is able to urinate effectively.
T94 354497-354570 Sentence denotes Examine the hard palate, maxilla, and mandibular symphysis for fractures.
T95 354571-354674 Sentence denotes Palpate the pelvis and carefully manipulate all limbs to examine for fractures or ligamentous injuries.
T96 354675-354726 Sentence denotes Finally, perform a complete neurologic examination.
T97 354727-354848 Sentence denotes Patients that fall less than five stories often have a more guarded prognosis than patients that fall from higher levels.
T98 354850-354969 Sentence denotes Sometimes the owner witnesses the ingestion of a foreign body during play, such as throwing a stick or fetching a ball.
T99 354970-355060 Sentence denotes Cats tend to play with string or thread that becomes caught around the base of the tongue.
T100 355061-355206 Sentence denotes In many cases, however, ingestion of the foreign object is not witnessed, and diagnosis is made based on clinical signs and physical examination.
T101 355207-355344 Sentence denotes Foreign bodies lodged in the oral cavity often cause irritation and discomfort, including difficulty breathing and difficulty swallowing.
T102 355345-355459 Sentence denotes Often, an animal paws at its mouth in an attempt to dislodge a stick or bones wedged across the roof of the mouth.
T103 355460-355566 Sentence denotes Irritation, inability to close the mouth, and blockage of the oropharynx can result in excessive drooling.
T104 355567-355666 Sentence denotes The saliva may appear blood-tinged owing to concurrent soft tissue trauma (Figures 1-46 and 1-47) .
T105 355667-355810 Sentence denotes Obstruction of the glottis by a foreign body (e.g., tennis ball or toy) can result in cyanosis secondary to an obstructed airway and hypoxemia.
T106 355811-355901 Sentence denotes In many cases the object is small enough to enter the larynx but too large to be expelled.
T107 355902-356021 Sentence denotes If a foreign object is lodged in the mouth for more than several days, halitosis and purulent discharge may be present.
T108 356022-356160 Sentence denotes Many animals are anxious at the time of presentation and may require sedation or a light plane of anesthesia to remove the foreign object.
T109 356161-356308 Sentence denotes The animal may bite personnel and may have bitten the owner during his or her attempt to remove the object from the mouth en route to the hospital.
T110 356309-356432 Sentence denotes Propofol (4 to 7 mg/kg IV) with diazepam (0.5 to 1 mg/kg IV) is an 1 excellent combination for a light plane of anesthesia.
T111 356433-356606 Sentence denotes Exercise caution when anesthetizing a patient with a ball lodged in the airway, as further compromise of respiratory function may occur and cause worsening of the hypoxemia.
T112 356607-356688 Sentence denotes Before inducing anesthesia, assemble all supplies necessary to remove the object.
T113 356689-356832 Sentence denotes Make sure that rigid towel clamps, sponge forceps, and bone forceps are on hand, because the foreign object is often very slippery with saliva.
T114 356833-356927 Sentence denotes Hemostats and Carmalt forceps may slip and not be useful in the removal of the foreign object.
T115 356928-357022 Sentence denotes Place a peripheral intravenous catheter to secure vascular access before anesthetic induction.
T116 357023-357148 Sentence denotes Have available the supplies necessary for an emergency tracheostomy if the foreign object cannot be removed by usual methods.
T117 357149-357263 Sentence denotes Induce a light plane of anesthesia and then grasp the object with the sponge forceps or towel clamps, and extract.
T118 357264-357358 Sentence denotes Monitor the cardiorespiratory status of the animal at all times during the extraction process.
T119 357359-357564 Sentence denotes If you are unable to remove the object, and if severe respiratory distress, including cyanosis, bradycardia, or ventricular dysrhythmias, develops, perform a tracheostomy distal to the site of obstruction.
T120 357565-357669 Sentence denotes Once the foreign body has been removed, administer supplemental flow-by oxygen until the animal awakens.
T121 357670-357828 Sentence denotes If laryngeal edema or stridor on inspiration is present, administer a dose of dexamethasone sodium phosphate (0.25 mg/kg IV, IM, SQ) to decrease inflammation.
T122 357829-357968 Sentence denotes The patient should be carefully monitored for 24 hours, because noncardiogenic pulmonary edema can develop secondary to airway obstruction.
T123 357969-358028 Sentence denotes Esophageal foreign bodies pose a serious medical emergency.
T124 358029-358130 Sentence denotes It is helpful if the owner witnessed ingestion of the object and noted rapid onset of clinical signs.
T125 358131-358293 Sentence denotes In many cases, however, ingestion is not witnessed, and the diagnosis must be made based on clinical signs, thoracic radiographs, and results of a barium swallow.
T126 358294-358405 Sentence denotes The most common clinical signs are excessive salivation with drooling, gulping, and regurgitation after eating.
T127 358406-358457 Sentence denotes Many animals will make repeated swallowing motions.
T128 358458-358597 Sentence denotes Some animals exhibit a rigid "sawhorse" stance, with reluctance to move immediately after foreign body ingestion and esophageal entrapment.
T129 358598-358738 Sentence denotes After completing a physical examination, evaluate cervical and thoracic radiographs to determine the location of the esophageal obstruction.
T130 358739-358876 Sentence denotes Esophageal foreign objects are lodged most commonly at the base of the heart, the carina, or just orad to the lower esophageal sphincter.
T131 358877-359015 Sentence denotes If the object has been lodged for several days, pleural effusion and pneumomediastinum may be present secondary to esophageal perforation.
T132 359016-359161 Sentence denotes Endoscopy is useful for both diagnosis and removal of the foreign object; however, it is invasive and requires general anesthesia (Figure 1-48) .
T133 359162-359303 Sentence denotes Remove foreign objects lodged in the esophagus with a rigid or flexible endoscope after the patient has been placed under general anesthesia.
T134 359304-359452 Sentence denotes Evaluate the integrity of the esophagus both before and after removal of the material because focal perforation or pressure necrosis can be present.
T135 359453-359557 Sentence denotes Necrosis of the mucosa and submucosa of the esophagus often leads to stricture formation or perforation.
T136 359558-359639 Sentence denotes Attempt to retrieve the object with a flexible fiberoptic endoscope if available.
T137 359640-359683 Sentence denotes Rigid tube endoscopy can also be performed.
T138 359684-359831 Sentence denotes In many cases, smooth objects that cannot be easily grasped can be pushed into the stomach and allowed to dissolve or may be removed by gastrotomy.
T139 359832-360048 Sentence denotes If the foreign body is firmly lodged in the esophagus and cannot be pulled or pushed into the stomach, or if perforation has already occurred, the prognosis for return to function without strictures is not favorable.
T140 360049-360155 Sentence denotes In such cases, referral to a surgical specialist is recommended for esophagostomy or esophageal resection.
T141 360156-360365 Sentence denotes After removal of the object, carefully examine the esophagus and then administer gastroprotectant agents (famotidine, 0.5 mg/kg PO bid; sucralfate slurry, 0.5 to 1.0 g/dog PO tid) for a minimum of 5 to 7 days.
T142 360366-360456 Sentence denotes To rest the esophagus, the patient should receive nothing per os (NPO) for 24 to 48 hours.
T143 360457-360602 Sentence denotes If esophageal irritation or erosion is moderate to severe, a percutaneous gastrotomy tube should be placed for feeding until the esophagus heals.
T144 360603-360841 Sentence denotes Perform repeat endoscopy every 7 days to evaluate the healing process and to determine whether stricture formation is occurring. sTomACh Persistent vomiting immediately or soon after eating is often associated with a gastric foreign body.
T145 360842-360931 Sentence denotes In some cases, the owner knows that the patient has ingested a foreign body of some kind.
T146 360932-361155 Sentence denotes In other cases, continued vomiting despite lack of response to conservative 1 treatment (NPO status, antiemetics, gastroprotectant drugs) prompts further diagnostic procedures, including abdominal radiographs and bloodwork.
T147 361156-361268 Sentence denotes Obstruction to gastric outflow and vomiting of hydrochloric acid often cause a hypochloremic metabolic acidosis.
T148 361269-361334 Sentence denotes Radiopaque gastric foreign bodies may be observed on plain films.
T149 361335-361462 Sentence denotes Radiolucent cloth material may require a barium series to delineate the shape and location of the foreign body ( Figure 1-49) .
T150 361463-361540 Sentence denotes Treatment consists of removal with flexible endoscopy or a simple gastrotomy.
T151 361541-361718 Sentence denotes Most animals with uncomplicated gastric foreign bodies are relatively healthy, but any metabolic and electrolyte abnormalities should be corrected before anesthesia and surgery.
T152 361719-361848 Sentence denotes Small intestinal obstruction can be caused by foreign bodies, tumors, intussusception, volvulus, or strangulation within hernias.
T153 361849-362007 Sentence denotes Regardless of the cause, clinical signs of small intestinal obstruction depend on the location and degree of obstruction and whether the bowel has perforated.
T154 362008-362193 Sentence denotes Clinical signs associated with a high small intestinal obstruction are usually more severe and more rapid in onset compared with partial or complete obstruction of the jejunum or ileum.
T155 362194-362387 Sentence denotes Complete obstructions that allow no fluid or chyme to pass are worse than partial obstructions, which can cause intermittent clinical signs interspersed with periods of normality (Table 1 -36).
T156 362388-362563 Sentence denotes The most common clinical signs associated with a complete small intestinal obstruction are anorexia, vomiting, lethargy, depression, dehydration, and sometimes abdominal pain.
T157 362564-362745 Sentence denotes Early clinical signs may be limited to anorexia and depression, making a diagnosis challenging unless the owner has a suspicion that the animal ingested some kind of foreign object.
T158 362746-362919 Sentence denotes Obstructions cranial to the common bile duct and pancreatic papillae lead to vomiting of gastric contents, namely hydrochloric acid, and a hypochloremic metabolic alkalosis.
T159 362920-363065 Sentence denotes Obstructions caudal to the common bile duct and pancreatic papillae result in loss of other electrolytes and sometimes mixed acid-base disorders.
T160 363066-363235 Sentence denotes Eventually, all animals with small intestinal obstruction vomit and have fluid loss into dilated segments of bowel, leading to dehydration and electrolyte abnormalities.
T161 363236-363315 Sentence denotes Increased luminal pressure causes decreased lymphatic drainage and bowel edema.
T162 363316-363375 Sentence denotes The bowel wall eventually becomes ischemic and may rupture.
T163 363376-363461 Sentence denotes Linear foreign bodies should be suspected in any vomiting patient, particularly cats.
T164 363462-363592 Sentence denotes String or thread often is looped around the base of the tongue and can be visualized in many cases by a thorough oral examination.
T165 363593-363842 Sentence denotes To look properly under the tongue, grasp the top of the animal's head with one hand, and pull the lower jaw open with the index finger of the opposite hand while pushing up the thumb simultaneously on the tongue in between the intermandibular space.
T166 363843-363922 Sentence denotes Thread and string can be observed lying along the ventral aspect of the tongue.
T167 363923-364049 Sentence denotes In some cases, if a linear foreign body is lodged very caudally, it cannot be visualized without heavy sedation or anesthesia.
T168 364050-364169 Sentence denotes Linear foreign bodies eventually cause bowel obstruction and perforation of the intestines along the mesenteric border.
T169 364170-364383 Sentence denotes The foreign material (e.g., string, thread, cloth, pantyhose) becomes lodged proximally, and the intestines become plicated as the body attempts to push the material caudally through the intestines (Figure 1-50) .
T170 364384-364515 Sentence denotes Continued peristalsis eventually causes a sawing motion of the material and perforation of the mesenteric border of the intestines.
T171 364516-364625 Sentence denotes Once peritonitis occurs, the prognosis is less favorable unless prompt and aggressive treatment is initiated.
T172 364626-364831 Sentence denotes Reevaluate any patient that does not respond to conservative symptomatic therapy, performing a complete blood count and serum biochemical panel (including electrolytes) and obtaining abdominal radiographs.
T173 364832-364977 Sentence denotes Intestinal masses may be palpable on physical examination and are often associated with signs of discomfort or pain when palpating over the mass.
T174 364978-365051 Sentence denotes Radiography and abdominal ultrasound are the most useful diagnostic aids.
T175 365052-365190 Sentence denotes Plain radiographs may be diagnostic when the foreign object is radiodense or there is characteristic dilation or plication of bowel loops.
T176 365191-365296 Sentence denotes As a rule of thumb, the width of a loop of small bowel should be no larger than twice the width of a rib.
T177 365297-365414 Sentence denotes Diagnosis of small intestinal obstruction or ileus can be based on the appearance of stacking loops of dilated bowel.
T178 365415-365495 Sentence denotes Comparison of the width of the bowel with the width of a rib is often performed.
T179 365496-365642 Sentence denotes With mild dilation, the bowel width is three to four times the rib width; with extensive dilation, five to six times the rib width (Figure 1-51) .
T180 365643-365779 Sentence denotes In cases of linear foreign bodies, C-areas (comma-shaped areas) of gas trapped in the plicated bowel will appear stacked on one another.
T181 365780-365939 Sentence denotes Blunt, wedge-shaped areas of gas or square linear areas of gas adjacent to a distended bowel loop are characteristic of a foreign body lodged in the intestine.
T182 365940-366069 Sentence denotes Contrast radiography is indicated when confirmation of the suspected diagnosis is necessary and ultrasonography is not available.
T183 366070-366152 Sentence denotes Contrast material may outline the object or abruptly stop orad to the obstruction.
T184 366153-366243 Sentence denotes The definitive treatment of any type of small intestinal foreign body is surgical removal.
T185 366244-366424 Sentence denotes Linear foreign bodies sometimes pass, but they should never be left untreated in a patient that is demonstrating clinical signs of inappetence, vomiting, lethargy, and dehydration.
T186 366425-366522 Sentence denotes The timing of surgery is critical because the risk of intestinal perforation increases with time.
T187 366523-366622 Sentence denotes Before surgery, correct any acid-base and electrolyte abnormalities with intravenous fluid therapy.
T188 366623-366661 Sentence denotes Administer broad-spectrum antibiotics.
T189 366662-366823 Sentence denotes Perform an enterotomy or intestinal resection and anastomosis as soon as possible once the patient's acid-base status and electrolyte status have been corrected.
T190 366825-366901 Sentence denotes Clinical signs of a foreign body in the large bowel are usually nonexistent.
T191 366902-367087 Sentence denotes In most cases, if a foreign object has passed successfully through the small bowel, it will pass through the large bowel without incident unless bowel perforation and peritonitis occur.
T192 367088-367207 Sentence denotes Penetrating foreign bodies such as needles often cause localized or generalized peritonitis, abdominal pain, and fever.
T193 367208-367295 Sentence denotes Hematochezia may be present if the foreign object causes abrasion of the rectal mucosa.
T194 367296-367357 Sentence denotes Symptomatic patients should have abdominal radiographs taken.
T195 367358-367502 Sentence denotes Colonoscopy or exploratory laparotomy should be performed if survey radiographs are suggestive of a large intestinal obstruction or perforation.
T196 367503-367577 Sentence denotes In most cases, large intestinal foreign bodies will pass without incident.
T197 367578-367647 Sentence denotes Surgery is required to treat perforations, peritonitis, or abscesses.
T198 367648-367797 Sentence denotes Foreign bodies in the rectum and anus often are the result of ingestion of bones, wood material, needles, and thread or malicious external insertion.
T199 367798-367904 Sentence denotes Often the material can pass through the entire gastrointestinal tract and then get stuck in the anal ring.
T200 367905-367982 Sentence denotes Clinical signs include hematochezia and dyschezia with straining to defecate.
T201 367983-368136 Sentence denotes Diagnosis is made by visual examination of the item in the anus, or by careful digital palpation after heavy sedation or short-acting general anesthesia.
T202 368137-368262 Sentence denotes Radiography is helpful in locating needles that have penetrated the rectum and lodged in the perirectal or perinatal tissues.
T203 368263-368339 Sentence denotes Treatment consists of careful removal of the needle digitally or surgically.
T204 368340-368462 Sentence denotes Intussusception is the acute invagination of one segment of bowel (the intussusceptum) into another (the intussuscipiens).
T205 368463-368536 Sentence denotes The proximal segment always invaginates into the distal segment of bowel.
T206 368537-368769 Sentence denotes Intussusception most commonly occurs in puppies and kittens younger than 1 year of age but can occur in an animal of any age with hypermotility of the small bowel, gastrointestinal parasites, and severe viral or bacterial enteritis.
T207 368770-368868 Sentence denotes Intussusception occurs primarily in the small bowel in the jejunum, ileum, and ileocolic junction.
T208 368869-368949 Sentence denotes Clinical signs include vomiting, abdominal discomfort, and hemorrhagic diarrhea.
T209 368950-369094 Sentence denotes Usually, hemorrhagic diarrhea is the first noticeable sign and in puppies may be caused by parvoviral enteritis, with secondary intussusception.
T210 369095-369156 Sentence denotes Usually, the obstruction is partial with mild clinical signs.
T211 369157-369234 Sentence denotes More serious clinical signs develop as the obstruction becomes more complete.
T212 369235-369439 Sentence denotes Differential diagnoses include hemorrhagic gastroenteritis (HGE), parvoviral enteritis, gastrointestinal parasites, intestinal foreign body, bacterial enteritis, and other causes of vomiting and diarrhea.
T213 369440-369614 Sentence denotes The diagnosis of intussusception is often made based on palpation of a sausage-shaped firm, tubular structure in the abdomen accompanied by clinical signs and abdominal pain.
T214 369615-369742 Sentence denotes Plain radiographs may demonstrate segmental or generalized dilated segments of bowel, depending on the duration of the problem.
T215 369743-369881 Sentence denotes Ultrasonographs of the palpable mass resemble the layers of an onion, with hyperechoic intestinal walls separated by less echogenic edema.
T216 369882-370084 Sentence denotes Treatment consists of correction of the patient's acid-base and electrolyte abnormalities with intravenous fluids and surgical reduction or removal of the intussusception with resection and anastomosis.
T217 370085-370219 Sentence denotes Although enteroplication has been suggested, the technique has fallen out of favor because of the increased risk of later obstruction.
T218 370220-370316 Sentence denotes The primary cause of intestinal inflammation and hypermotility must be identified and corrected.
T219 370317-370382 Sentence denotes Gastric dilatation can occur with or without volvulus in the dog.
T220 370383-370618 Sentence denotes GDV occurs primarily in large-and giant-breed dogs with deep chests, such as the Great Dane, Labrador Retriever, Saint Bernard, German Shepherd Dog, Gordon Setter, Irish Setter, Standard Poodle, Bernese Mountain Dog, and Bassett Hound.
T221 370619-370712 Sentence denotes The risk of GDV increases with age; however, it can be seen in dogs as young as 4 months old.
T222 370713-370802 Sentence denotes Deep, narrow-chested breeds are more likely to develop GDV than dogs with broader chests.
T223 370803-370965 Sentence denotes The overall mortality for surgically treated GDV ranges from 10% to 18%, with most deaths occurring in patients that required splenectomy and partial gastrectomy.
T224 370966-371119 Sentence denotes Clinical signs of GDV include abdominal distension, unproductive vomiting or retching, lethargy, weakness, sometimes straining to defecate, and collapse.
T225 371120-371273 Sentence denotes The owner may think that the animal is vomiting productively because of the white foamy froth (saliva) that is not able to pass into the twisted stomach.
T226 371274-371417 Sentence denotes In some cases there is a history of the dog's being fed a large meal or consuming a large quantity of water before the onset of clinical signs.
T227 371418-371575 Sentence denotes Instruct the owner of any patient with a predisposition for and clinical signs of GDV to transport the animal to the nearest veterinary facility immediately.
T228 371576-371668 Sentence denotes Physical examination often reveals a distended abdomen with a tympanic area on auscultation.
T229 371669-371802 Sentence denotes In dogs with very deep chests, it may be difficult to appreciate abdominal distension if the stomach is tucked up under the rib cage.
T230 371803-371954 Sentence denotes Depending on the stage of shock, the patient may have sinus tachycardia with bounding pulses, cardiac dysrhythmias with pulse deficits, or bradycardia.
T231 371955-372051 Sentence denotes The mucous membranes may appear red and injected or pale with a prolonged capillary refill time.
T232 372052-372119 Sentence denotes The patient may appear anxious and attempt to retch unproductively.
T233 372120-372211 Sentence denotes If the patient is nonambulatory at the time of presentation, the prognosis is more guarded.
T234 372212-372488 Sentence denotes The definitive diagnosis of GDV is based on clinical signs, physical examination findings, and radiographic appearance of gas distension of the gastric fundus with dorsocranial displacement of the pylorus and duodenum (the "double-bubble" or "Popeye arm" sign) (Figure 1-52) .
T235 372489-372621 Sentence denotes In simple gastric dilatation without volvulus, there is gas distension of the stomach, with anatomy appearing normal on radiography.
T236 372622-372754 Sentence denotes With "food bloat, " or gastric distension from overconsumption of food, ingesta are visible in the distended stomach (Figure 1-53) .
T237 372755-372966 Sentence denotes As soon as a patient with possible GDV is presented, place a large-bore intravenous catheter in the cephalic vein(s) and assess the patient's ECG, BP, heart rate, capillary refill time, and respiratory function.
T238 372967-373127 Sentence denotes Obtain blood samples for a complete blood count, serum biochemistry profile, immediate lactate measurement, and coagulation tests before taking any radiographs.
T239 373128-373282 Sentence denotes Rapidly infuse a colloid (hydroxyethyl starch, 5 mL/kg IV bolus) along 1 with shock volumes of a crystalloid fluid (up to 90 mL/kg (see section on shock).
T240 373283-373423 Sentence denotes Monitor perfusion parameters (heart rate, BP, capillary refill time, and ECG) and titrate fluid therapy according to the patient's response.
T241 373424-373488 Sentence denotes The use of short-acting glucocorticosteroids is not recommended.
T242 373489-373605 Sentence denotes No detailed studies have proved them to be beneficial versus not using glucocorticosteroids in the patient with GDV.
T243 373606-373702 Sentence denotes Attempt gastric decompression, either with placement of an orogastric tube or by trocharization.
T244 373703-373961 Sentence denotes To place an orogastric tube, position the distal end of the tube at the level of the patient's last rib (Figure 1-54) and place it adjacent to the animal's thorax; then put a piece of tape around the tube where it comes out of the mouth, once it is in place.
T245 373962-374120 Sentence denotes Put a roll of 2-inch tape in the patient's mouth behind the canine teeth and then secure the roll in place by taping the mouth closed around the roll of tape.
T246 374121-374246 Sentence denotes Lubricate the tube with lubricating jelly and slowly insert the tube through the center of the roll of tape into the stomach.
T247 374247-374298 Sentence denotes The passing of the tube does not rule out volvulus.
T248 374299-374540 Sentence denotes In some cases, the front legs of the patient need to be elevated, and the caudal aspect of the patient lowered (front legs standing on a table with back legs on the ground) to allow gravity to pull the stomach down to allow the tube to pass.
T249 374541-374639 Sentence denotes Once the tube has been passed, air within the stomach is relieved, and the stomach can be lavaged.
T250 374640-374741 Sentence denotes The presence of gastric mucosa or blood in the efflux from the tube makes the prognosis more guarded.
T251 374742-375062 Sentence denotes If an orogastric tube cannot be passed, clip and aseptically scrub the patient's lateral abdomen and then insert a 16-gauge over-the-needle catheter. "Pinging" the animal's side with simultaneous auscultation allows determination of the location that is most tympanic-that is, the proper location for catheter insertion.
T252 375063-375178 Sentence denotes Once intravenous fluids have been started in the animal, take a right lateral abdominal radiograph to document GDV.
T253 375179-375331 Sentence denotes If no volvulus is present, the owner may elect for more conservative care, and the animal should be monitored in the hospital for a minimum of 24 hours.
T254 375332-375510 Sentence denotes Because some cases of GDV intermittently twist and untwist, the owner should be cautioned that although the stomach is not twisted at that moment, volvulus can occur at any time.
T255 375511-375647 Sentence denotes If radiographs demonstrate food bloat, induce emesis (apomorphine, 0.04 mg/kg IV) or perform orogastric lavage under general anesthesia.
T256 375648-375702 Sentence denotes Documentation of GDV constitutes a surgical emergency.
T257 375703-375773 Sentence denotes After diagnosis of GDV, continue administration of intravenous fluids.
T258 375774-375945 Sentence denotes Serum lactate measurements greater than 6.0 mmol/L are associated with an increased risk of gastric necrosis, requirement for partial gastrectomy, and increased mortality.
T259 375946-376116 Sentence denotes If serum lactate does not decrease by more than 4 mmol/L, or 42.5% of original serum lactate concentrations, after fluid resuscitation and surgery, the prognosis worsens.
T260 376117-376223 Sentence denotes Administer fresh frozen plasma (20 mL/kg) to patients with thrombocytopenia or prolonged PT, APTT, or ACT.
T261 376224-376430 Sentence denotes Cardiac dysrhythmias, particularly ventricular dysrhythmias, are common in cases of GDV and are thought to occur secondary to ischemia and proinflammatory cytokines released during volvulus and reperfusion.
T262 376431-376673 Sentence denotes Lidocaine (1 to 2 mg/kg followed by 50 mcg/kg/min IV CRI) can be used to preemptively treat cardiac dysrhythmias that are associated with ischemia-reperfusion injury, or administration can be started when ventricular dysrhythmias are present.
T263 376674-376756 Sentence denotes Correct any electrolyte abnormalities, including hypokalemia and hypo- magnesemia.
T264 376757-376928 Sentence denotes The use of NSAIDs (flunixin meglumine, carprofen, ketoprofen) that can potentially decrease renal perfusion and predispose to gastric ulcers is absolutely contraindicated.
T265 376929-377085 Sentence denotes Administer analgesic drugs (fentanyl, 2 mcg/kg IV bolus, followed by 3 to 20 mcg/ kg/hr IV CRI; or hydromorphone, 0.1 mg/kg IV) before anesthetic induction.
T266 377086-377234 Sentence denotes After a balanced anesthesia protocol has been carried out, the patient should be taken immediately to surgery for gastric derotation and gastropexy.
T267 377235-377368 Sentence denotes Postoperatively, assess the patient's ECG, BP, platelet count, coagulation parameters, and gastric function (see section Rule of 20).
T268 377369-377478 Sentence denotes If no resection is required, the animal can be given small amounts of water beginning 12 hours after surgery.
T269 377479-377609 Sentence denotes Depending on the severity of the patient's condition, small amounts of a bland diet can be offered 12 to 24 hours postoperatively.
T270 377610-377767 Sentence denotes Continue supportive care with analgesia and crystalloid fluids until the patient is able to tolerate oral analgesic drugs (tramadol, 1 to 3 mg/kg PO q8-12h).
T271 377768-377972 Sentence denotes Once the patient is ambulatory and able to eat and drink on its own, it can be released from the hospital; instruct the owner to feed the animal multiple small meals throughout the day for the first week.
T272 377973-378082 Sentence denotes When the intestines twist around the root of the mesentery, a small intestinal or mesenteric volvulus occurs.
T273 378083-378206 Sentence denotes The problem is most common in the young German Shepherd Dog, although it has been observed in other large and giant breeds.
T274 378207-378306 Sentence denotes Predisposing factors include pancreatic atrophy, gastrointestinal disease, trauma, and splenectomy.
T275 378307-378517 Sentence denotes Clinical signs of mesenteric volvulus include vomiting, hemorrhagic diarrhea, bowel distension, acute onset of clinical signs of shock, abdominal pain, brick-red mucous membranes (septicemia), and sudden death.
T276 378518-378620 Sentence denotes Diagnosis is based on an index of suspicion and the presence of clinical signs in a predisposed breed.
T277 378621-378711 Sentence denotes Plain radiographs often reveal grossly distended loops of bowel in a palisade gas pattern.
T278 378712-378820 Sentence denotes In some dogs, multiple, tear-drop-shaped, gas-filled loops appear to rise from a focal point in the abdomen.
T279 378821-378902 Sentence denotes Usually, massive distension of the entire small bowel is observed (Figure 1-55) .
T280 378903-379064 Sentence denotes The presence of pneumoperitoneum or lack of abdominal detail secondary to the presence of abdominal fluid is characteristic of bowel perforation and peritonitis.
T281 379065-379159 Sentence denotes Severe generalized distension of the small intestine, characteristic of a mesenteric volvulus.
T282 379160-379242 Sentence denotes This constitutes an immediate surgical emergency, and the prognosis is often poor.
T283 379243-379336 Sentence denotes This condition is most common in young German Shepherd Dogs but can be observed in any breed.
T284 379337-379463 Sentence denotes In a patient with mesenteric volvulus, immediate aggressive action is necessary for the animal to have any chance of survival.
T285 379464-379731 Sentence denotes Treatment consists of massive volumes of intravenous crystalloid and colloid fluids (see section on intravenous therapy), broad-spectrum antibiotics (ampicillin, 22 mg/kg IV tid to qid, with enrofloxacin, 10 mg/kg IV once daily), and surgical correction of the bowel.
T286 379732-379922 Sentence denotes Because of the massive release of proinflammatory cytokines, bacterial translocation, and ischemia, treatment for shock is of paramount importance (see sections on the Rule of 20 and shock).
T287 379923-379986 Sentence denotes The prognosis for any patient with mesenteric volvulus is poor.
T288 379987-380058 Sentence denotes Obstipation (obstructive constipation) is most common in the older cat.
T289 380059-380233 Sentence denotes In cases of simple constipation, rehydrating the animal with intravenous fluids and stool softeners is often sufficient for it to regain the ability to have a bowel movement.
T290 380234-380339 Sentence denotes Obstipation, however, is caused by a dynamic ileus of the large bowel that eventually leads to megacolon.
T291 380340-380412 Sentence denotes Affected cats usually are anorexic, lethargic, and extremely dehydrated.
T292 380413-380596 Sentence denotes Treatment consists of rehydration with intravenous crystalloid fluids, correction of electrolyte abnormalities, enemas, and promotility agents such as cisapride (0.5 mg/kg PO q8-24h).
T293 380597-380725 Sentence denotes The use of phosphate enemas in cats is absolutely contraindicated because of the risk of causing acute, fatal hyperphosphatemia.
T294 380726-380915 Sentence denotes In many cases the patient should be placed under general anesthesia, and manual deobstipation performed with warm water soapy enemas and a gloved finger to relieve and disimpact the rectum.
T295 380916-381001 Sentence denotes Stool softeners such as lactulose and docusate stool softener (DSS) may also be used.
T296 381002-381124 Sentence denotes Predisposing causes of obstipation such as narrowing of the pelvic canal, perineal hernia, and tumors should be ruled out.
T297 381125-381242 Sentence denotes Adenocarcinoma is the most common neoplasm of the gastrointestinal tract that causes partial to complete obstruction.
T298 381243-381380 Sentence denotes Adenocarcinomas tend to be annular and constricting, and they may cause progressive obstruction of the lumen of the small or large bowel.
T299 381381-381511 Sentence denotes Siamese cats tend to have adenocarcinomas in the small intestine, whereas in dogs the tumor tends to occur in the large intestine.
T300 381512-381667 Sentence denotes Clinical signs of adenocarcinoma are both acute and chronic and consist of anorexia, weight loss, and progressive vomiting that occur over weeks to months.
T301 381668-381742 Sentence denotes Effusion may be present if metastasis to peritoneal surfaces has occurred.
T302 381743-381981 Sentence denotes Diagnosis is based on clinical signs and physical examination findings of a palpable abdominal mass, radiographic evidence of an abdominal mass and small or large intestinal obstruction, or ultrasonographic evidence of an intestinal mass.
T303 381982-382053 Sentence denotes Treatment consists of surgical resection of the affected bowel segment.
T304 382054-382244 Sentence denotes The prognosis for long-term survival (10 to 12 months) is good if the mass is completely resected and if other clinical signs of cachexia or metastasis are observed at the time of diagnosis.
T305 382245-382370 Sentence denotes Median survival is 15 to 30 weeks if metastases to lymph nodes, liver, or the peritoneum are absent at the time of diagnosis.
T306 382371-382409 Sentence denotes In dogs the prognosis is more guarded.
T307 382410-382510 Sentence denotes Leiomyoma and leiomyosarcoma are tumors that can cause partial or complete obstruction of the bowel.
T308 382511-382622 Sentence denotes Clinical signs are often referred to progressive anemia, including weakness, lethargy, inappetence, and melena.
T309 382623-382749 Sentence denotes Hypoglycemia can be observed as a paraneoplastic syndrome or because of sepsis and peritonitis secondary to bowel perforation.
T310 382750-382830 Sentence denotes Leiomyomas are most commonly observed at the cecocolic junction or in the cecum.
T311 382831-382919 Sentence denotes Surgical resection and anastomosis are usually curative and carry a favorable prognosis.
T312 382920-383040 Sentence denotes Incarceration of a loop of bowel into congenital or acquired defects in the body wall can cause small bowel obstruction.
T313 383041-383117 Sentence denotes Pregnant females and young animals with congenital hernias are most at risk.
T314 383118-383224 Sentence denotes Rarely, older animals with perineal hernias and animals of any age with traumatic hernias can be affected.
T315 383225-383351 Sentence denotes Clinical signs are consistent with a small intestinal obstruction: anorexia, vomiting, lethargy, abdominal pain, and weakness.
T316 383352-383459 Sentence denotes Diagnosis is often made based on physical examination of a reducible or nonreducible mass in the body wall.
T317 383460-383522 Sentence denotes Hernias whose contents are reducible are usually asymptomatic.
T318 383523-383672 Sentence denotes Treatment consists of supportive care and rehydration, administration of broad-spectrum antibiotics, and surgical correction of the body wall hernia.
T319 383673-383786 Sentence denotes In some cases, intestinal resection and anastomosis of the affected area is necessary when bowel ischemia occurs.
T320 383787-383952 Sentence denotes The potential for bowel perforation should be suspected whenever there is any penetrating injury (knife, gunshot wound, bite wound, stick impalement) of the abdomen.
T321 383953-384110 Sentence denotes Injuries that result in bowel ischemia and rupture can also occur secondary to nonpenetrating blunt trauma or shear forces (e.g., big dog-little dog or cat).
T322 384111-384198 Sentence denotes Perforation of the stomach and small and large intestines can occur with use of NSAIDs.
T323 384199-384334 Sentence denotes Diagnosis of bowel perforation first depends on the alertness to the possibility that the bowel may have been perforated or penetrated.
T324 384335-384443 Sentence denotes As a general rule, all penetrating injuries of the abdomen should be investigated by exploratory laparotomy.
T325 384444-384593 Sentence denotes DPL can be performed; however, early after penetrating injury of the bowel, DPL findings may be negative or nondiagnostic until peritonitis develops.
T326 384594-384793 Sentence denotes Whenever any patient with blunt or penetrating abdominal trauma does not respond to initial fluid therapy, or responds and then deteriorates, the index of suspicion for bowel injury should be raised.
T327 384794-385132 Sentence denotes The findings of pneumoperitoneum on abdominal radiographs or of intracellular bacteria, extracellular bacteria, bile pigment, or bowel contents in fluid obtained by abdominocentesis or DPL fluid or cloudy appearance of such fluids (see sections on abdominocentesis and diagnostic peritoneal lavage) warrant immediate surgical exploration.
T328 385133-385374 Sentence denotes Treatment largely consists of stabilizing the patient's cardiovascular and electrolyte status with intravenous fluids, administering broad-spectrum antibiotics, and performing definitive surgical exploration and repair of injured structures.
T329 385375-385539 Sentence denotes Prolapse of the rectum is observed most frequently secondary to parasitism and gastrointestinal viral infections in young puppies and kittens with chronic diarrhea.
T330 385540-385678 Sentence denotes Older animals with rectal prolapse often have an underlying problem such as a tumor or mucosal lesion that causes straining and dyschezia.
T331 385679-385761 Sentence denotes The diagnosis of a rectal prolapse is made based on physical examination findings.
T332 385762-385871 Sentence denotes The diagnosis of rectal prolapse is sometimes difficult to distinguish from small intestinal intussusception.
T333 385872-385963 Sentence denotes In rare cases the intussusception can invaginate through the large bowel, rectum, and anus.
T334 385964-386179 Sentence denotes The two entities are distinguished from each other by inserting a lubricated thermometer or blunt probe into the cul-de-sac formed by the junction of the prolapsed mucosa and mucocutaneous junction at the anal ring.
T335 386180-386271 Sentence denotes Inability to insert the probe or thermometer indicates that the rectal mucosa is prolapsed.
T336 386272-386361 Sentence denotes Passage of the probe signifies that the prolapsed segment is actually the intussusceptum.
T337 386362-386477 Sentence denotes Treatment can be performed easily if the prolapse is acute and the rectal mucosa is not too irritated or edematous.
T338 386478-386550 Sentence denotes The presence of severely necrotic tissue warrants surgical intervention.
T339 386551-386756 Sentence denotes To reduce an acute rectal prolapse, after placing the patient under general anesthesia, lubricate the prolapsed tissue and gently push it back into the rectum, using a lubricated syringe or syringe casing.
T340 386757-386838 Sentence denotes Apply a loose purse-string suture, leaving it in place for a minimum of 48 hours.
T341 386839-386889 Sentence denotes Deworm the patient and administer stool softeners.
T342 386890-386996 Sentence denotes If a rectal prolapse cannot be reduced, or if the tissue is nonviable, surgical intervention is warranted.
T343 386997-387130 Sentence denotes In patients in which viable tissue does not stay reduced with a purse-string suture, a colopexy can be performed during a laparotomy.
T344 387131-387331 Sentence denotes First, place tension on the colon to reduce the prolapse, and then suture the colon to the peritoneum of the lateral abdominal wall 1 with two to three rows of 2-0 or 3-0 monofilament suture material.
T345 387332-387391 Sentence denotes If the prolapsed tissue is nonviable, it must be amputated.
T346 387392-387502 Sentence denotes Place four stay sutures at 90-degree intervals through the wall of the prolapse at the mucocutaneous junction.
T347 387503-387711 Sentence denotes Resect the prolapse distal to the stay sutures and then reestablish the rectal continuity by suturing the seromuscular layers together in one circumferential line and the mucosal layers together in the other.
T348 387712-387760 Sentence denotes Replace the suture incision into the anal canal.
T349 387761-387847 Sentence denotes After surgery, deworm the patient and administer a stool softener and analgesic drugs.
T350 387848-387965 Sentence denotes Avoid using thermometers or other probes in the immediate postoperative period because they may disrupt suture lines.
T351 387966-388242 Sentence denotes Acute gastritis may be associated with a variety of clinical conditions, including oral hemorrhage, ingestion of highly fermentable indigestible foods or garbage, toxins, foreign bodies, renal or hepatic failure, inflammatory bowel disease, and bacterial and viral infections.
T352 388243-388297 Sentence denotes Diarrhea often accompanies or follows acute gastritis.
T353 388298-388378 Sentence denotes HGE often occurs as a shocklike syndrome with a rapidly rising hematocrit level.
T354 388379-388517 Sentence denotes Clinical signs of gastritis include depression, lethargy, anterior abdominal pain, excessive water consumption, vomiting, and dehydration.
T355 388518-388665 Sentence denotes Differential diagnosis of acute gastritis includes pancreatitis, hepatic or renal failure, gastrointestinal obstruction, and toxicities (Box 1-44).
T356 388666-388751 Sentence denotes The diagnosis is often a diagnosis of exclusion of other causes (see preceding text).
T357 388752-388844 Sentence denotes A careful and thorough examination of the vomitus may be helpful in arriving at a diagnosis.
T358 388845-389133 Sentence denotes A complete blood count, serum biochemistry profile including amylase and lipase, parvovirus test (in young puppies), fecal flotation and cytology, abdominal radiographs (plain and/ or contrast studies), and abdominal ultrasound may be warranted to rule out other causes of acute vomiting.
T359 389134-389257 Sentence denotes While diagnostic tests are being performed, treatment consists of withholding all food and water for a minimum of 24 hours.
T360 389258-389399 Sentence denotes After calculating the patient's degree of dehydration, administer a balanced crystalloid fluid to normalize acid-base and electrolyte status.
T361 389400-389546 Sentence denotes Control vomiting with antiemetics such as metoclopramide, prochlorperazine, chlorpromazine, dolasetron, ondansetron, and maropitant (Table 1 -37).
T362 389547-389840 Sentence denotes If vomiting is accompanied by diarrhea, administer broad-spectrum antibiotics (cefazolin, 22 mg/kg IV q8h, with metronidazole, 10 mg/kg IV q8h; or ampicillin, 22 mg/kg IV q6-8h, with enrofloxacin, 10 mg/kg IV q24h) to decrease the risk of bacterial translocation and bacteremia and septicemia.
T363 389841-390017 Sentence denotes Although antacids (famotidine, ranitidine, cimetidine) do not have a direct antiemetic effect, their use can decrease gastric acidity and esophageal irritation during vomiting.
T364 390018-390304 Sentence denotes If gastritis is secondary to uremia or NSAID use, administer gastroprotectant and antiemetic drugs (ranitidine, 1 mg/kg PO q12h; sucralfate, 0.25 to 1 g/dog PO q8h; or omeprazole, 0.5 to 1 mg/kg PO q24h) to decrease acid secretion and coat areas of gastric ulceration (see Table 1 -37).
T365 390305-390667 Sentence denotes Once food and water can be tolerated, the patient can be placed on an oral diet and medications, and intravenous fluids can be discontinued. hemorrhAgiC gAsTroenTeriTis HGE is severe hemorrhagic vomiting and diarrhea of acute onset, most commonly observed in young small-breed dogs (e.g., Poodles, Miniature Dachshunds, Miniature Schnauzers) 2 to 4 years of age.
T366 390668-390796 Sentence denotes Clinical signs develop rapidly and include vomiting and fetid diarrhea with hemorrhage, often strawberry jam-like in appearance.
T367 390797-390837 Sentence denotes The hematocrit can rise from 55% to 75%.
T368 390838-390925 Sentence denotes Often, the animal is extremely hypovolemic but has no apparent signs of abdominal pain.
T369 390926-391096 Sentence denotes There is no known cause of HGE, although Clostridium perfringens, E. coli, Campylobacter species, and viral infections have been suggested but not consistently confirmed.
T370 391097-391301 Sentence denotes Other differential diagnoses of hematemesis and hemorrhagic diarrhea include coronavirus, parvovirus, vascular stasis, sepsis, hepatic cirrhosis with portal hypertension, and other causes of severe shock.
T371 391302-391540 Sentence denotes Immediate treatment consists of placement of a large-bore intravenous catheter and replenishment of intravascular fluid volume with crystalloid fluids (up to 90 mL/kg) while carefully monitoring the patient's hematocrit and total protein.
T372 391541-391710 Sentence denotes Administer broad-spectrum antibiotics (ampicillin, 22 mg/kg IV q6-8h, and enrofloxacin, 10 mg/kg IV q24h) because of the high risk of bacterial translocation and sepsis.
T373 391711-391750 Sentence denotes Control vomiting with antiemetic drugs.
T374 391751-391942 Sentence denotes Monitor the patient's platelet count and coagulation tests for impending DIC, and administer fresh frozen plasma and heparin as needed (see section on disseminated intravascular coagulation).
T375 391943-392141 Sentence denotes When vomiting has ceased for 24 hours, offer the animal small amounts of water and then a bland diet (e.g., boiled chicken and rice or boiled ground beef and rice mixed with low-fat cottage cheese).
T376 392142-392216 Sentence denotes Pancreatitis occurs most frequently in dogs but can occur in cats as well.
T377 392217-392378 Sentence denotes In dogs the onset of pancreatitis is sometimes preceded by ingestion of a fatty meal or the administration of drugs (e.g., potassium bromide or glucocorticoids).
T378 392379-392555 Sentence denotes Glucocorticoids can increase the viscosity of pancreatic secretions and induce ductal proliferation, resulting in narrowing and obstruction of the lumen of the pancreatic duct.
T379 392556-392790 Sentence denotes Pancreatitis can also occur after blunt or penetrating abdominal trauma, high duodenal obstruction causing outflow obstruction of the pancreatic papilla, pancreatic ischemia, duodenal reflux, biliary disease, and hyperadrenocorticism.
T380 392791-392920 Sentence denotes In cats, acute necrotizing pancreatitis is associated with anorexia, lethargy, hyperglycemia, icterus, and sometimes acute death.
T381 392921-393039 Sentence denotes Chronic pancreatitis is more common in cats and results in intermittent vomiting, anorexia, weight loss, and lethargy.
T382 393040-393206 Sentence denotes Predisposing causes of chronic pancreatitis in cats include pancreatic flukes, viral infection, hepatic lipidosis, drugs, organophosphate toxicity, and toxoplasmosis.
T383 393207-393937 Sentence denotes Chlorpromazine (Thorazine) 0.2-0.5 mg/kg IM q8h, 0.05 mg/kg IV q4h, 1.0 mg/kg per rectum q8h (dog) Prochlorperazine (Compazine) 0.1 mg/kg IM q6h, 0.5 mg/kg IV, IM q8h seroTonin AnTAgonisTs Dolasetron (Anzemet) 0.1-0.3 mg/kg IV q24h Ondansetron (Zofran) 0.6-1.0 mg/kg IV q12h oThers Metoclopramide (Reglan) † Neurokinin receptor antagonist Maropitant 0.2-0.5 mg/kg SQ q8h, 1.0-2.0 mg/kg/day IV, 3 mg/kg IM q8h (dog) 1 mg/kg SQ once daily for no more than 5 consecutive days 2 mg/kg PO once daily for no more than 5 consecutive days IM, Intramuscularly; IV, intravenously; PO, orally; SQ, subcutaneously. *All doses apply to dogs and cats unless otherwise noted. † Do not use until a gastrointestinal obstruction has been ruled out.
T384 393938-394036 Sentence denotes Clinical signs of acute pancreatitis include sudden severe vomiting, abdominal pain, and lethargy.
T385 394037-394140 Sentence denotes Depending on the severity of pancreatic inflammation, depression, hypotension, and SIRS may be present.
T386 394141-394188 Sentence denotes Subacute cases may have minimal clinical signs.
T387 394189-394294 Sentence denotes Severe pancreatic edema can result in vascular changes and ischemia that perpetuates severe inflammation.
T388 394295-394360 Sentence denotes Hypovolemic shock and DIC can also decrease pancreatic perfusion.
T389 394361-394438 Sentence denotes Severe pancreatic edema, autolysis, and ischemia lead to pancreatic necrosis.
T390 394439-394503 Sentence denotes Duodenal irritation is manifested as both vomiting and diarrhea.
T391 394504-394626 Sentence denotes Pain may be localized to the right upper abdominal quadrant or may be generalized if peripancreatic saponification occurs.
T392 394627-394713 Sentence denotes Differential diagnosis of pancreatitis is the same as for any other cause of vomiting.
T393 394714-394891 Sentence denotes Complications that occur in patients with severe pancreatitis include dehydration, acid-base and electrolyte abnormalities, hyperlipemia, hypotension, and localized peritonitis.
T394 394892-394971 Sentence denotes Hepatic necrosis, lipidosis, congestion, and abnormal architecture can develop.
T395 394972-395209 Sentence denotes Inflammatory mediators (bradykinin, phospholipase A, elastase, myocardial depressant factor, and bacterial endotoxins) stimulate the inflammatory cascade and can lead to SIRS, with severe hypotension, clotting system activation, and DIC.
T396 395210-395351 Sentence denotes Electrolyte imbalances and hypovolemia secondary to vomiting all can lead to multiple organ dysfunction syndrome (MODS) and ultimately death.
T397 395352-395457 Sentence denotes If a patient survives an episode of acute pancreatitis, long-term sequelae can include diabetes mellitus.
T398 395458-395600 Sentence denotes Monitor patients with recurrent pancreatitis for clinical signs of polyuria and polydipsia (PU/PD), polyphagia, hyperglycemia, and glucosuria.
T1 395601-395818 Sentence denotes The diagnosis of pancreatitis is based on the presence of clinical signs (which may be absent in cats), laboratory findings, and ultrasonographic evidence of pancreatic edema and increased peripancreatic echogenicity.
T2 395819-396050 Sentence denotes Serum biochemistry analyses can sometimes support a diagnosis of pancreatitis; however, serum amylase and lipase are often unreliable indicators of pancreatitis, depending on the chronicity of the process in the individual patient.
T3 396051-396107 Sentence denotes Both serum amylase and lipase are excreted in the urine.
T4 396108-396248 Sentence denotes Impaired renal clearance or function can cause artifactual elevations of serum amylase and lipase in the absence of pancreatic inflammation.
T5 396249-396363 Sentence denotes Furthermore, serum lipase levels can be elevated as a result of gastrointestinal obstruction (e.g., foreign body).
T6 396364-396533 Sentence denotes Early in the course of the disease, levels can be two to six times normal, but they may decrease to within normal ranges at the time of presentation to the veterinarian.
T7 396534-396674 Sentence denotes The transient nature of amylase elevation makes this test difficult to interpret, and it is not highly sensitive if a normal value is found.
T8 396675-396738 Sentence denotes Lipase levels also increase later in the course of the disease.
T9 396739-396830 Sentence denotes Amylase and lipase should be tested concurrently with the rest of the biochemistry profile.
T10 396831-396984 Sentence denotes Other changes often observed are elevations in BUN and creatinine levels secondary to dehydration and prerenal azotemia, hyperglycemia, and hyperlipemia.
T11 396985-397108 Sentence denotes Hypocalcemia can occur secondary to peripancreatic fat saponification, and its presence warrants a more negative prognosis.
T12 397109-397230 Sentence denotes A more specific measure is pancreatic lipase immunoreactivity, which becomes elevated in dogs and cats with pancreatitis.
T13 397231-397388 Sentence denotes This test, combined with ultrasonographic or CT evidence of pancreatitis, is the most sensitive and specific test available for making an accurate diagnosis.
T14 397389-397492 Sentence denotes However, because the results of this test take time to obtain, animals must be treated in the meantime.
T15 397493-397585 Sentence denotes Abdominal effusion or fluid from DPL can be compared with serum amylase and lipase activity.
T16 397586-397752 Sentence denotes Abdominal lipase and amylase concentrations in the fluid greater than in the peripheral blood are characteristic of chemical peritonitis associated with pancreatitis.
T17 397753-398007 Sentence denotes WBC counts greater than 1000 cells/mm 3 , the presence of bacteria, toxic neutrophils, glucose levels less than 50 mg/dL, or lactate levels greater than in serum are characteristic of septic peritonitis, and immediate exploratory laparotomy is warranted.
T18 398008-398201 Sentence denotes If a biopsy sample obtained during laparotomy does not demonstrate inflammation, this does not rule out pancreatitis, because disease can be focal in nature and yet cause severe clinical signs.
T19 398202-398329 Sentence denotes Abdominal radiographs may sometimes reveal a loss of abdominal detail or a ground glass appearance in the right upper quadrant.
T20 398330-398518 Sentence denotes Pancreatic edema and duodenal irritation can displace the gastric axis toward the left with dorsomedial displacement of the proximal duodenum (the "backward 7" or "shepherd's crook" sign).
T21 398519-398599 Sentence denotes Ultrasonography and CT are more sensitive in making a diagnosis of pancreatitis.
T22 398600-398852 Sentence denotes Treatment of pancreatitis is largely supportive in nature and is designed to correct hypovolemia and electrolyte imbalances, prevent or reverse shock, maintain vital organ perfusion, alleviate discomfort and pain, and prevent vomiting (see Rule of 20).
T23 398853-398929 Sentence denotes When treating pancreatitis in dogs, all food and water should be restricted.
T24 398930-399003 Sentence denotes However, food should not be withheld from cats with chronic pancreatitis.
T25 399004-399062 Sentence denotes Give fresh frozen plasma to replenish α 2 -macroglobulins.
T26 399063-399243 Sentence denotes Administer antiemetics such as chlorpromazine (use with caution in a hypovolemic or hypotensive patient), dolasetron, ondansetron, or metoclopramide to prevent or control vomiting.
T27 399244-399535 Sentence denotes Analgesic drugs can be provided in the form of CRI (fentanyl, 3-7 mcg/kg/hr IV CRI, and lidocaine, 30 to 50 mcg/kg/min IV CRI), intrapleural injection (lidocaine, 1 to 2 mg/kg q8h), or intermittent parenteral injections (morphine, 0.25 to 1 mg/kg SQ, IM; hydromorphone, 0.1 mg/ kg IM or SQ).
T28 399536-399609 Sentence denotes Because the pancreas must be rested, consider using parenteral nutrition.
T29 399610-399742 Sentence denotes Acute hepatic failure may be associated with toxins, adverse reaction to prescription medication, and bacterial or viral infections.
T30 399743-399955 Sentence denotes The most frequent clinical signs observed in a patient with acute hepatic failure are anorexia, lethargy, vomiting, icterus, bleeding, and CNS depression or seizures (associated with hepatic encephalopathy [HE]).
T31 399956-400038 Sentence denotes Differential diagnosis and causes of acute hepatic failure are listed in Box 1-45.
T32 400039-400297 Sentence denotes Diagnosis of acute hepatic failure is based on clinical signs and biochemical evidence of hepatocellular (aspartate aminotransferase [AST], alanine aminotransferase [ALT]) and cholestatic (ALP, total bilirubin, γ-glutamyltransferase [GGT]) enzyme elevations.
T33 400298-400493 Sentence denotes Ultrasonography may be helpful in distinguishing the architecture of the liver, but unless a mass or abscess is present, it cannot provide a specific diagnosis of the cause of the hepatic damage.
T34 400494-400677 Sentence denotes Management of the patient with acute hepatic failure includes correction of dehydration and acid-base and electrolyte abnormalities, as shown in the following list: ❏ Hypoalbuminemia:
T35 400678-400709 Sentence denotes Plasma or concentrated albumin.
T36 400710-400816 Sentence denotes Plasma also is an excellent source of clotting factors that can become depleted. ❏ Clotting abnormalities:
T37 400817-400908 Sentence denotes Vitamin K 1 (2.5 mg/kg SQ or PO q8-12h) to restore available vitamin K 1 . ❏ Severe anemia:
T38 400909-400953 Sentence denotes Fresh or stored blood. ❏ Gastric hemorrhage:
T39 400954-401038 Sentence denotes Gastroprotectant drugs (omeprazole, ranitidine, famotidine, cimetidine, sucralfate).
T40 401039-401195 Sentence denotes Hypertension is defined as a consistent elevation in systolic BP >200 mm Hg, consistent diastolic BP >110 mm Hg, and consistent mean arterial BP >130 mm Hg.
T41 401196-401494 Sentence denotes The effects of systemic hypertension include left ventricular hypertrophy, cerebrovascular accident, renal vascular injury, optic nerve edema, hyphema, retinal vascular tortuosity, retinal hemorrhage, retinal detachment, vomiting, neurologic defects, coma, and excessive bleeding from cut surfaces.
T42 401495-401606 Sentence denotes Patients with systemic hypertension should have a thorough diagnostic workup to determine the underlying cause.
T43 401607-401734 Sentence denotes Although uncommon, hypertensive emergencies can occur with pheochromocytoma, acute renal failure, and acute glomerulonephritis.
T44 401735-401919 Sentence denotes Sodium nitroprusside (1 to 10 mcg/kg/min IV CRI) or diltiazem (0.3 to 0.5 mg/kg IV given slowly over 10 minutes, followed by 1-5 mcg/kg/min) can be used to treat systemic hypertension.
T45 401920-402005 Sentence denotes With the use of sodium nitroprusside or diltiazem, monitor carefully for hypotension.
T46 402006-402098 Sentence denotes Diagnosis is based on consistent elevations in systolic, diastolic, and/or mean arterial BP.
T47 402099-402393 Sentence denotes Because many of the clinical signs associated with systemic hypertension involve hemorrhage into some closed cavity, other causes of hemorrhage, such as vasculitis, thrombocytopenia, thrombocytopathia, and hepatic or renal failure, should be investigated (see section on coagulation disorders).
T48 402394-402881 Sentence denotes Diagnostic testing is based on clinical signs and index of suspicion for an underlying disease and may include a complete blood count; urinalysis; urine protein/creatinine ratio; adrenocorticotropic hormone (ACTH) stimulation test; thoracic and abdominal radiographs; thoracic and abdominal ultrasound; tick serology; brain CT or MRI; and assays of serum electrolytes, aldosterone concentration, T4, endogenous thyroid-stimulating hormone (TSH), plasma catecholamine, and growth hormone.
T49 402882-402991 Sentence denotes Management of systemic hypertension involves treatment of the primary underlying disorder, whenever possible.
T50 402992-403124 Sentence denotes Long-term adjunctive management includes sodium restriction in the form of cooked or prescription diets to decrease fluid retention.
T51 403125-403219 Sentence denotes Obese animals should be placed on dietary restrictions and undergo a weight reduction program.
T52 403220-403456 Sentence denotes Thiazide and loop diuretics may be used to decrease sodium retention and circulating blood volume. α-adrenergic and β-adrenergic blockers may be used, but they are largely ineffective as monotherapeutic agents for treating hypertension.
T53 403457-403593 Sentence denotes Calcium channel blockers and ACE inhibitors are the mainstay of therapy in the treatment of hypertension in dogs and cats (Table 1-39) .
T54 403595-403732 Sentence denotes diABeTiC keToACidosis DKA is a potentially fatal and terminal consequence of unregulated insulin deficiency and possible glucagon excess.
T55 403733-403859 Sentence denotes In the absence of insulin, unregulated lipolysis results in the β-hydroxylation of fatty acids by abnormal hepatic metabolism.
T56 403860-403956 Sentence denotes As a result, ketoacidsnamely, acetoacetic acid, β-hydroxybutyric acid, and acetone-are produced.
T57 403957-404110 Sentence denotes Early in the course of the disease, patients exhibit clinical signs associated with diabetes mellitus: weight loss, polyuria, polyphagia, and polydipsia.
T58 404111-404300 Sentence denotes Later, as ketoacids stimulate the chemoreceptor trigger zone, vomiting and dehydration occur, with resulting hypovolemia, hypotension, severe depression, abdominal pain, oliguria, and coma.
T59 404301-404406 Sentence denotes At the time of presentation, often a strong odor of ketones (acetone) is present on the patient's breath.
T60 404407-404504 Sentence denotes Physical examination often reveals dehydration, severe depression or coma, and hypovolemic shock.
T61 404505-404664 Sentence denotes In extreme cases the patient exhibits a slow, deep Kussmaul respiratory pattern in an attempt to blow off excess CO 2 to compensate for the metabolic acidosis.
T62 404665-405035 Sentence denotes A serum biochemistry profile and complete blood count often reveal prerenal azotemia, severe hyperglycemia (blood glucose >400 mg/dL), hyperosmolarity (>330 mOsm/kg), lipemia, hypernatremia (sodium >145 mEq/L), elevated hepatocellular and cholestatic enzyme t a B l e 1 -3 9 drugs used to treat systemic hypertension 1 activities, high anion gap, and metabolic acidosis.
T63 405036-405184 Sentence denotes Although a whole-body potassium deficit is usually present, the serum potassium may appear artifactually elevated in response to metabolic acidosis.
T64 405185-405280 Sentence denotes With severe metabolic acidosis, potassium moves extracellularly in exchange for a hydrogen ion.
T65 405281-405385 Sentence denotes Phosphorus too moves intracellularly in response to acidosis, and serum phosphorus is usually decreased.
T66 405386-405450 Sentence denotes Hypophosphatemia >2 mg/dL can result in intravascular hemolysis.
T67 405451-405545 Sentence denotes Urinalysis often reveals 4+ glucosuria, ketonuria, and a specific gravity of 1.030 or greater.
T68 405546-405655 Sentence denotes The urine of all diabetic animals should be cultured to rule out a urinary tract infection or pyelonephritis.
T69 405656-405721 Sentence denotes Treatment of a patient with DKA presents a therapeutic challenge.
T70 405722-406040 Sentence denotes Treatment is aimed at providing adequate insulin to normalize cellular glucose metabolism, correcting acidbase and electrolyte imbalances, rehydrating and restoring perfusion, correcting acidosis, providing carbohydrate sources for use during insulin administration, and identifying any precipitating cause of the DKA.
T71 406041-406133 Sentence denotes Obtain blood samples for a complete blood count and serum biochemistry electrolyte profiles.
T72 406134-406245 Sentence denotes Whenever possible, insert a central venous catheter for fluid infusion and procurement of repeat blood samples.
T73 406246-406395 Sentence denotes Calculate the patient's dehydration deficit and maintenance fluid requirements and give appropriate fluid and electrolytes over a period of 24 hours.
T74 406396-406526 Sentence denotes It is advisable to rehydrate patients with severe hyperosmolarity for a minimum of 6 hours before starting insulin administration.
T75 406527-406681 Sentence denotes Use a balanced electrolyte solution (e.g., Plasma-Lyte A, Normosol-R, lactated Ringer's solution) or 0.9% saline solution for maintenance and rehydration.
T76 406682-406823 Sentence denotes Balanced electrolyte solutions contain small amounts of potassium and bicarbonate precursors that aid in the treatment of metabolic acidosis.
T77 406824-406951 Sentence denotes Treat animals with severe metabolic acidosis with an >11 mEq/L or a pH <7.1 with supplemental bicarbonate (0.25 to 0.5 mEq/kg).
T78 406952-407051 Sentence denotes Add supplemental dextrose to the patient's fluids as a carbohydrate source during insulin infusion.
T79 407052-407161 Sentence denotes Both insulin and carbohydrates are necessary for the proper metabolism of ketone bodies in patients with DKA.
T80 407162-407295 Sentence denotes The rate and type of fluid and amount of dextrose supplementation will change according to the patient's blood glucose concentration.
T81 407296-407407 Sentence denotes Serum potassium will drop rapidly as the metabolic acidosis is corrected with fluid and insulin administration.
T82 407408-407557 Sentence denotes Measure serum potassium every 8 hours, if possible, and supplement accordingly (see section on fluid therapy for chart of potassium supplementation).
T83 407558-407749 Sentence denotes If the patient's potassium requirement exceeds 100 mEq/L, or if the rate of potassium infusion approaches 0.5 mEq/kg/hr in the face of continued hypokalemia, magnesium should be supplemented.
T84 407750-407863 Sentence denotes Magnesium is required as a cofactor for many enzymatic processes and for normal function of the Na,K-ATPase pump.
T85 407864-407949 Sentence denotes Hypomagnesemia is a common electrolyte disturbance in many forms of critical illness.
T86 407950-408087 Sentence denotes Replenishing magnesium (MgCl 2 , 0.75 mEq/kg/day IV CRI) often helps to correct the refractory hypokalemia observed in patients with DKA.
T87 408088-408214 Sentence denotes Patients with hypophosphatemia that approaches 2.0 mmol/L should receive potassium phosphate (0.01 to 0.03 mmol/kg/hr IV CRI).
T88 408215-408395 Sentence denotes When providing potassium phosphate supplementation, be aware of the additional potassium added to the patient's fluids, so as to not exceed recommended rates of potassium infusion.
T89 408396-408597 Sentence denotes To determine the amount of potassium chloride (KCl) to add along with potassium phosphate (KPO 4 ), use the following formula: mEq K derived from KCl Total mEq of K to be administered over 24 hours mEq
T90 408598-408793 Sentence denotes Clinical signs of severe hypophosphatemia include muscle weakness, rhabdomyolysis, intravascular hemolysis, and decreased cerebral function that can lead to depression, stupor, seizures, or coma.
T91 408794-408913 Sentence denotes insulin AdminisTrATion Regular insulin can be administered either IM or as a CRI in the treatment of patients with DKA.
T92 408914-408962 Sentence denotes Subcutaneous insulin should not be administered.
T93 408963-409127 Sentence denotes Because of the severe dehydration present in most patients with DKA, subcutaneous insulin is poorly absorbed and is not effective until hydration has been restored.
T94 409128-409273 Sentence denotes In the low-dose intravenous method, place regular insulin (1.1 units/kg for a cat, and 2.2 units/kg for a dog) in 250 mL of 0.9% saline solution.
T95 409274-409382 Sentence denotes Run 50 mL of this mixture through the intravenous line to allow the insulin to adsorb to the plastic tubing.
T96 409383-409475 Sentence denotes Administer the patient's insulin fluid rate according to blood glucose levels (Table 1-40) .
T97 409476-409576 Sentence denotes Adjust the patient's total fluid volume according to changes in the insulin fluid rate as necessary.
T98 409577-409738 Sentence denotes In many cases, multiple bags of fluids are necessary because they must be changed when fluctuations in blood glucose concentrations occur in response to therapy.
T99 409739-409816 Sentence denotes Infusion of the insulin mixture should be in a separate intravenous catheter.
T100 409817-409932 Sentence denotes To replenish hydration, use a second intravenous line for the more rapid infusion of non-insulin-containing fluids.
T101 409933-410054 Sentence denotes To administer the regular insulin IM, first give 0.22 unit/kg IM and then recheck the patient's blood glucose every hour.
T102 410055-410194 Sentence denotes Additional injections of regular insulin (0.11 unit/kg IM) should be administered based on the patient's response to subsequent injections.
T103 410195-410357 Sentence denotes Once the patient's blood glucose falls to 200 to 250 mg/dL, add 2.5% to 5% dextrose to the fluids to maintain the blood glucose concentration at 200 to 300 mg/dL.
T104 410358-410549 Sentence denotes Continue intramuscular injection of regular insulin (0.1 to 0.4 unit/kg q4-6h) until the patient is rehydrated, no longer vomiting, and able to tolerate oral fluids and food without vomiting.
T105 410550-410691 Sentence denotes Even in patients with intramuscular regular insulin therapy, a central venous catheter should be placed for frequent blood sample collection.
T106 410692-410799 Sentence denotes As the patient begins to respond to therapy, monitor electrolytes, glucose, and acid-base status carefully.
T107 410800-410860 Sentence denotes Hypokalemia, hypophosphatemia, and hypomagnesemia can occur.
T108 410861-411085 Sentence denotes When the patient's hydration and acid-base status has normalized and the patient is able to tolerate oral food and water, a longer-acting insulin can be administered as for treatment of a patient with uncomplicated diabetes.
T109 411086-411147 Sentence denotes Extreme hyperosmolarity can result in a coma, if uncorrected.
T110 411148-411301 Sentence denotes In patients with diabetes mellitus, hyperglycemia and hypernatremia secondary to osmotic diuresis and free water loss can lead to severe hyperosmolarity.
T111 411302-411359 Sentence denotes In dogs, normal serum osmolality is <300 mOsm/L of serum.
T112 411360-411425 Sentence denotes Hyperosmolarity is expected when serum osmolality is >340 mOsm/L.
T113 411426-411544 Sentence denotes If equipment for determining serum osmolarity is not available, osmolarity can be calculated by the following formula:
T114 411545-411721 Sentence denotes Osm / L 2(Na K) (glucose / 18) (BUN / 2.8) = + + + Patients with severe dehydration, hyperglycemia, hypernatremia, and azotemia may experience cerebral edema without ketonemia.
T115 411722-411913 Sentence denotes Treatment is directed solely at rehydrating the patient and slowly reducing blood glucose levels using a hypotonic solution such as 0.45% NaCl + 2.5% dextrose or 5% dextrose in water (D 5 W).
T116 411914-412004 Sentence denotes After the initial rehydration period, administer potassium supplementation conservatively.
T117 412005-412253 Sentence denotes Whenever a patient with hypoglycemia is presented, consider the following important factors: the age at onset, the nature of the hypoglycemic episode (transient, persistent, or recurrent), and the pattern based on the patient's history (Box 1-46) .
T118 412254-412366 Sentence denotes Treatment of hypoglycemia is directed at providing glucose supplementation and determining any underlying cause.
T119 412367-412492 Sentence denotes Administer supplemental dextrose (25% to 50% dextrose, 2 to 5 mL/kg IV; or 10% dextrose, 20 mL/kg PO) as quickly as possible.
T120 412493-412606 Sentence denotes Do not attempt oral glucose supplementation in any patient having a seizure or if the airway cannot be protected.
T121 412607-412828 Sentence denotes Administer intravenous fluids (e.g., Normosol-R, lactated Ringer's solution, 0.9% saline solution) with 2.5% to 5% supplemental dextrose until the patient is eating and able to maintain euglycemia without supplementation.
T122 412829-412990 Sentence denotes In some cases (e.g., insulinoma), eating or administration of supplemental dextrose can promote insulin secretion and exacerbate clinical signs and hypoglycemia.
T123 412991-413189 Sentence denotes In cases of refractory hypoglycemia secondary to iatrogenic insulin overdose, glucagon (50 ng/kg IV bolus, then 10 to 40 ng/kg/min IV CRI) can also be administered, along with supplemental dextrose.
T124 413190-413373 Sentence denotes To make a glucagon infusion of 1000 ng/mL, reconstitute 1 mL (1 mg/mL) of glucagon according to the manufacturer's instructions and add this amount to 1000 mL of 0.9% saline solution.
T125 413374-413477 Sentence denotes The diagnosis of eclampsia (puerperal tetany) is often made on the basis of history and clinical signs.
T126 413478-413587 Sentence denotes Clinical signs can become evident when total calcium decreases to <8.0 mg/ dL in dogs and <7.0 mg/dL in cats.
T127 413588-413697 Sentence denotes The disease is often observed in small, excitable dogs, and stress may play a complicating role in the cause.
T128 413698-413774 Sentence denotes In most bitches the disease manifests itself 1 to 3 weeks after parturition.
T129 413775-413852 Sentence denotes In some cases, however, clinical signs can develop before parturition occurs.
T130 413853-413897 Sentence denotes Hypophosphatemia may accompany hypocalcemia.
T131 413898-414168 Sentence denotes Clinical signs of hypocalcemia include muscle tremors or fasciculations, panting, restlessness, aggression, hypersensitivity, disorientation, muscle cramping, hyperthermia, stiff gait, seizures, tachycardia, a prolonged QT interval on ECG, PU/PD, and respiratory arrest.
T132 414169-414298 Sentence denotes Treatment of eclampsia consists of slow, cautious calcium supplementation (10% calcium gluconate, 0.15 ml/kg IV over 30 minutes).
T133 414299-414369 Sentence denotes Severe refractory tetanus can be controlled with intravenous diazepam.
T134 414370-414495 Sentence denotes Supportive care includes intravenous fluid administration and cooling (see section on hyperthermia and heat-induced illness).
T135 414496-414636 Sentence denotes Instruct the owner to give the patient oral calcium supplements (e.g., 1 or 2 tablets of Tums bid or tid) after discharge from the hospital.
T136 414637-414753 Sentence denotes Also instruct the owner about how to wean the puppies, allowing the bitch to dry up, in order to prevent recurrence.
T137 414754-414897 Sentence denotes Recurrence with subsequent pregnancies is common, particularly in patients that receive calcium supplementation during gestation (Table 1-41) .
T138 414898-414961 Sentence denotes hyPerCAlCemiA Hypercalcemia can occur from a variety of causes.
T139 414962-415084 Sentence denotes The GOSH DARN IT mnemonic can be used to remember the various causes of hypercalcemia in small animal patients (Box 1-47).
T140 415085-415223 Sentence denotes The gastrointestinal, renal, and nervous systems are most commonly affected, particularly when serum total calcium rises above 16.0 mg/dL.
T141 415224-415317 Sentence denotes Clinical signs of severe hypercalcemia include muscle weakness, vomiting, seizures, and coma.
T142 415318-415415 Sentence denotes ECG abnormalities include prolonged PR interval, rapid QT interval, and ventricular fibrillation.
T143 415416-415547 Sentence denotes The most serious clinical signs are often seen when hypercalcemia is observed in combination with hyperphosphatemia or hypokalemia.
T144 415548-415699 Sentence denotes Pay special attention to the "calcium × phosphorus product. " If this product exceeds 70, dystrophic calcification can occur, leading to renal failure.
T145 415700-415796 Sentence denotes Renal complications include PU/PD, dehydration, and loss of renal tubular concentrating ability.
T146 415797-415910 Sentence denotes Renal blood flow and the glomerular filtration rate (GFR) are impaired when serum total calcium exceeds 20 mg/dL.
T147 415911-416084 Sentence denotes The extent, location, and number of renal tubular injuries are the main factors in determining whether renal damage secondary to hypercalcemia is reversible or irreversible.
T148 416085-416303 Sentence denotes Emergency therapy of hypercalcemia is warranted when severe renal compromise, cardiac dysfunction, or neurologic abnormalities are present, or if no clinical signs occur but the calcium × phosphorus product exceeds 70.
T149 416304-416402 Sentence denotes The treatment of choice is correction of the underlying cause of hypercalcemia, whenever possible.
T150 416403-416571 Sentence denotes In some cases the results of diagnostic tests take time, and emergency therapy should be initiated immediately, before a definitive cause of the hypercalcemia is found.
T151 416572-416656 Sentence denotes Emergency management of hypercalcemia consists of reduction of serum calcium levels.
T152 416657-416771 Sentence denotes Administer intravenous fluids (0.9% saline solution) to expand extracellular fluid volume and promote calciuresis.
T153 416772-416902 Sentence denotes To promote diuresis, initial intravenous fluid rates should approach two to three times maintenance levels (120 to 180 mL/kg/day).
T154 416903-416979 Sentence denotes Potassium supplementation may be required to prevent iatrogenic hypokalemia.
T155 416980-417082 Sentence denotes Administration of a loop diuretic such as furosemide (2 to 5 mg/kg IV) will promote calcium excretion.
T156 417083-417223 Sentence denotes Calcitonin (4 IU per kilogram IM q12h for cats and 8 IU per kilogram SQ q24h for dogs) can be administered to decrease serum calcium levels.
T157 417224-417384 Sentence denotes In severe refractory hypercalcemia secondary to cholecalciferol toxicity, more aggressive calcitonin therapy (4 to 7 IU per kilogram SQ q6-8h) can be attempted.
T158 417385-417452 Sentence denotes Side effects of calcitonin treatment include vomiting and diarrhea.
T159 417453-417580 Sentence denotes Alternatively, bisphosphonates (pamidronate, 1.02 to 2.0 mg/kg IV) are useful in rapidly reducing serum calcium concentrations.
T160 417581-417719 Sentence denotes Glucocorticosteroids reduce calcium release from the bone, decrease intestinal absorption of calcium, and promote renal calcium excretion.
T161 417720-417853 Sentence denotes Administer glucocorticosteroids only after the underlying cause of hypercalcemia has been determined and appropriate therapy started.
T162 417854-418087 Sentence denotes Because many forms of neoplasia can result in hypercalcemia as a paraneoplastic syndrome, empiric use of glucocorticosteroids can induce multiple drug resistance, making the tumor refractory to the effects of chemotherapeutic agents.
T163 418089-418230 Sentence denotes Hypoadrenocorticism is most commonly observed in young to middle-aged female dogs, but it can occur in animals of any age, gender, and breed.
T164 418231-418515 Sentence denotes Clinical signs, which are referable to deficiency in glucocorticoid (cortisol) and mineralocorticoid (aldosterone) hormones, may develop slowly over time, leading to a waxing and waning course; acute clinical signs occur when >90% of the adrenal functional reserve has been destroyed.
T165 418516-418599 Sentence denotes In such cases, complete adrenocortical collapse can result in an addisonian crisis.
T166 418600-418704 Sentence denotes Lack of aldosterone causes a lack of renal sodium and water retention, and impaired potassium excretion.
T167 418705-418969 Sentence denotes The most significant clinical signs associated with hypoadrenocorticism are depression, lethargy, weakness, anorexia, shaking, shivering, vomiting, diarrhea, weight loss, abdominal pain, weakness, hypotension, dehydration, and inappropriate bradycardia (Box 1-48).
T168 418970-419158 Sentence denotes The diagnosis of hypoadrenocorticism is made based on the patient's clinical signs in combination with electrolyte abnormalities that include hyperkalemia, hyponatremia, and hypochloremia.
T169 419159-419276 Sentence denotes Serum sodium concentration (115 to 130 mEq/L) is often greatly reduced, and serum potassium is elevated (>6.0 mEq/L).
T170 419277-419386 Sentence denotes A sodium:potassium ratio of <27 is characteristic of hypoadrenocorticism, although not exactly pathognomonic.
T171 419387-419551 Sentence denotes Electrocardiographic changes associated with hyperkalemia include inappropriate bradycardia, absence of p waves, elevated spiked T waves, and widened QRS complexes.
T172 419552-419731 Sentence denotes Other, more variable bloodwork abnormalities include a lack of a stress leukogram, eosinophilia, hypoglycemia, hyperphosphatemia, hypercalcemia, azotemia, and hypocholesterolemia.
T173 419732-419815 Sentence denotes A definitive diagnosis of hypoadrenocorticism is based on an ACTH stimulation test.
T174 419816-419978 Sentence denotes In patients with hypoadrenocorticism, baseline cortisol levels are usually low, with a lack of appropriate cortisol release after administration of ACTH analogue.
T175 419979-420168 Sentence denotes Rarely, animals with "atypical" hypoadrenocorticism lose glucocorticoid-secreting ability from the zona fasciculata but retain mineralocorticoid secretory ability from the zona glomerulosa.
T176 420169-420347 Sentence denotes Atypical addisonian patients have normal serum electrolytes but still have clinical signs of vomiting, diarrhea, weakness, lethargy, inappetence, muscle wasting, and weight loss.
T177 420348-420441 Sentence denotes The diagnosis is more difficult in such cases because of the presence of normal electrolytes.
T178 420442-420524 Sentence denotes An ACTH stimulation test should be considered, particularly in predisposed breeds.
T179 420525-420749 Sentence denotes Treatment of hypoadrenocorticism includes placement of a large-bore intravenous catheter, infusion of intravenous crystalloid fluids (0.9% saline solution), and replenishment of glucocorticoid and mineralocorticoid hormones.
T180 420750-420831 Sentence denotes Administer dexamethasone or dexamethasone-sodium phosphate (0.5 to 1.0 mg/kg IV).
T181 420832-421000 Sentence denotes Dexamethasone will not interfere with the ACTH stimulation test, unlike longer-acting steroids (e.g., prednisolone, methylprednisolone sodium succinate, triamcinolone).
T182 421001-421096 Sentence denotes Depending on the severity of the patient's condition, consider monitoring using the Rule of 20.
T183 421097-421190 Sentence denotes Administer antiemetics and gastroprotectant drugs to treat nausea, vomiting, and hematemesis.
T184 421191-421316 Sentence denotes Give the patient broad-spectrum antibiotics (ampicillin, 22 mg/kg IV q6h) if hematochezia or hemorrhagic diarrhea is present.
T185 421317-421428 Sentence denotes If severe gastrointestinal blood loss occurs, whole blood, packed RBCs, or fresh frozen plasma may be required.
T186 421429-421477 Sentence denotes Control hypoglycemia with 2.5% to 5.0% dextrose.
T187 421478-421643 Sentence denotes Use sodium bicarbonate, regular insulin with dextrose, or calcium gluconate to correct severe hyperkalemia with atrial standstill (see section on atrial standstill).
T188 421644-421789 Sentence denotes Chronic therapy for hypoadrenocorticism consists of mineralocorticoid and glucocorticosteroids supplementation for the rest of the animal's life.
T189 421790-421964 Sentence denotes Mineralocorticoid supplementation can be in the form of desoxycorticosterone pivalate (DOCP) (2.2 mg/kg IM) or fludrocortisone acetate (0.1 mg/2.5 to 5 kg body weight daily).
T190 421965-422293 Sentence denotes Fludrocortisone acetate possesses both mineralocorticoid and glucocorticoid activities and can be used as the sole daily treatment of hypoadrenocorticism. (Because fludrocortisone is poorly absorbed in some dogs, it may not completely normalize electrolyte abnormalities in these animals.) DOCP is primarily a mineralocorticoid.
T191 422294-422385 Sentence denotes Give supplemental glucocorticosteroids in the form of prednis(ol)one (0.25 to 1 mg/kg/day).
T192 422386-422499 Sentence denotes In dogs, iatrogenic hypoadrenocorticism can be caused by abrupt discontinuation of glucocorticosteroid treatment.
T193 422500-422669 Sentence denotes Long-term glucocorticosteroid supplementation can downregulate the pituitary gland's excretion of endogenous ACTH and the zona fasciculata's ability to excrete cortisol.
T194 422670-422764 Sentence denotes However, the zona glomerulosa's ability to secrete aldosterone does not appear to be affected.
T195 422765-422911 Sentence denotes Clinical signs of iatrogenic hypoadrenocorticism include inability to compensate for stress, weakness, lethargy, vomiting, diarrhea, and collapse.
T196 422912-423003 Sentence denotes Treatment of iatrogenic hypoadrenocorticism is the same as for naturally occurring disease.
T197 423004-423128 Sentence denotes After immediate emergency treatment, the patient should be weaned slowly from exogenous glucocorticosteroid supplementation.
T198 423129-423219 Sentence denotes Severe hyperthyroidism can manifest as a medical emergency as a result of hypermetabolism.
T199 423220-423415 Sentence denotes Clinical signs in affected cats with severe thyrotoxicosis include fever, severe tachycardia (heart rate >240 beats/min), vomiting, hypertension, CHF with pulmonary edema, and fulminant collapse.
T200 423416-423619 Sentence denotes Clinical signs typically manifest as an end stage of chronic debilitation associated with hyperthyroidism and are often preceded by polyphagia, weight loss, cardiac murmur, PU/PD, vomiting, and diarrhea.
T201 423620-423800 Sentence denotes Treatment of thyrotoxicosis includes antagonizing the adrenergic activity by administration of a β-adrenergic blocker (esmolol, 25 to 50 mcg/kg/min, or propranolol, 0.02 mg/kg/hr).
T202 423801-424043 Sentence denotes Administration of glucocorticosteroids (dexamethasone, 1 mg/kg) may inhibit the conversion of thyroxine (T 4 ) to the active form triiodothyronine (T 3 ) and decrease peripheral tissue responsiveness to T 3 , effectively blocking its effects.
T203 424044-424099 Sentence denotes Correct hypoglycemia with supplemental dextrose (2.5%).
T204 424100-424183 Sentence denotes Use care to avoid overhydration in a patient with cardiac failure or insufficiency.
T205 424184-424292 Sentence denotes Start the patient on methimazole as quickly as possible, and consider the use of radioactive iodine therapy.
T206 424294-424449 Sentence denotes Four classes of neurologic injuries can seriously jeopardize a patient's life: head injuries, spinal cord and vertebral column injuries, coma, and seizure.
T207 424450-424502 Sentence denotes The separate entities are discussed in this section.
T208 424503-424645 Sentence denotes Head injuries can be associated with skin and superficial lacerations, concussions, fractures, and hemorrhage (intracranial and extracranial).
T209 424646-424711 Sentence denotes Fractures may be extracranial, linear, or depressed intracranial.
T210 424712-424795 Sentence denotes Hemorrhage can be extradural, intradural, subdural, subarachnoid, or intracerebral.
T211 424796-425003 Sentence denotes Immediately perform a baseline physical examination of an animal with head trauma at the time of presentation to assess neurologic status and determine whether progressive deterioration exists (Table 1-42) .
T212 425004-425097 Sentence denotes During the initial examination, note the patient's ABCs (airway, breathing, and circulation).
T213 425098-425132 Sentence denotes If necessary, establish an airway.
T214 425133-425190 Sentence denotes Always supply supplemental oxygen to maintain Spo 2 >90%.
T215 425191-425306 Sentence denotes Place an intravenous catheter and start increments of a shock dose of intravenous fluids (1/4 of 90 mL/kg for dogs:
T216 425307-425326 Sentence denotes 44 mL/kg for cats).
T217 425327-425399 Sentence denotes In order to maintain cerebral perfusion pressure, BP must be normalized.
T218 425400-425565 Sentence denotes If other concurrent injuries are suspected (e.g., pulmonary contusions), administer synthetic colloid fluids (hydroxyethyl starch, 5 to 10 mL/kg IV) to normalize BP.
T219 425566-425753 Sentence denotes Although the use of colloids is controversial because of their potential to leak into the calvarium, the benefits of reestablishing cerebral perfusion far outweigh the risks of their use.
T220 425754-425879 Sentence denotes Hypertonic saline (7.5% NaCl, 3 to 5 mL/kg IV) can also be administered over 10 to 15 minutes to expand intravascular volume.
T221 425880-426034 Sentence denotes Maintain blood glucose within normal reference ranges whenever possible, because hyperglycemia is a negative prognostic indicator in cases of head trauma.
T222 426035-426200 Sentence denotes If tremors or seizures cause hyperthermia or increased metabolism, active cooling of the patient is warranted (see sections on hyperthermia and heat-induced injury).
T223 426201-426307 Sentence denotes All patients with head trauma should receive care and monitoring based on the Rule of 20 (see Rule of 20).
T224 426308-426506 Sentence denotes The emergenCy neurologiC exAminATion Examine the patient's level of consciousness, response to various stimuli, pupil size and reactivity to light, physiologic nystagmus, and cranial nerve deficits.
T225 426507-426584 Sentence denotes In dogs, damage to the midbrain often produces coma and decerebrate rigidity.
T226 426585-426689 Sentence denotes Initial consciousness followed by unconsciousness or stupor usually involves an injury to the brainstem.
T227 426690-426861 Sentence denotes Brainstem lesions can be caused by compressive skull fractures, extradural or subdural hematomas, or herniation through the foramen magnum from cerebral edema (Box 1-49) .
T228 426862-427035 Sentence denotes The patient's pupil size and response to light can be used to localize a diagnosis and give a rough prognosis for severity of disease and possibility for return to function.
T229 427036-427087 Sentence denotes Pupils can be normal in size, mydriatic, or miotic.
T230 427088-427223 Sentence denotes Whenever a pupil appears miotic, direct ocular injury with uveitis or secondary miosis from brachial plexus injury should be ruled out.
T231 427224-427285 Sentence denotes The eyes should always be examined to rule out ocular trauma.
T232 427286-427425 Sentence denotes In a patient with head trauma, a change from dilated to constricted to normal pupil size is suggestive of improvement in clinical function.
T233 427426-427600 Sentence denotes Bilateral mydriatic pupils that are unresponsive to light in an unconscious animal are a grave prognostic sign and usually indicate an irreversible severe midbrain contusion.
T234 427601-427729 Sentence denotes Bilateral miotic pupils with normal nystagmus and ocular movements are associated with diffuse cerebral or diencephalic lesions.
T235 427730-427827 Sentence denotes Miotic pupils that become mydriatic indicate a progressive midbrain lesion with a poor prognosis.
T236 427828-428017 Sentence denotes Unilateral, slowly progressive pupillary abnormalities in the absence of direct ocular injury are characteristic of brainstem compression or herniation caused by progressive brain swelling.
T237 428018-428111 Sentence denotes Asymmetric pupils are seen in patients with rostral brainstem lesions and can change rapidly.
T238 428112-428244 Sentence denotes Unresponsive pupils that are seen in the midposition occur with brainstem lesions that extend into the medulla and are a grave sign.
T239 428245-428319 Sentence denotes Appears lethargic and has sluggish response to external stimuli Confusion:
T240 428320-428363 Sentence denotes May appear confused or aggressive Delirium:
T241 428364-428430 Sentence denotes Vocalization, inappropriate response to external stimuli Semicoma:
T242 428431-428489 Sentence denotes Unconscious but responds to external noxious stimuli Coma:
T243 428490-428592 Sentence denotes Unconscious with no response to noxious stimuli 1 Visual deficits are common with intracranial injury.
T244 428593-428725 Sentence denotes Lesions that are less severe and limited to the cerebrum produce contralateral menace deficits with normal pupillary light response.
T245 428726-428836 Sentence denotes Bilateral cerebral edema can cause blindness with a normal response to light if the midbrain is not disturbed.
T246 428837-428963 Sentence denotes A patient that is severely depressed and recumbent may not respond to menacing gestures, even when visual pathways are intact.
T247 428964-429081 Sentence denotes Ocular, optic tract, optic nerve, or optic chiasm lesions can interfere with vision and the pupillary light response.
T248 429082-429219 Sentence denotes Brainstem contusion and cerebral edema may produce blindness and dilated unresponsive pupils owing to disturbance of the oculomotor area.
T249 429220-429257 Sentence denotes Examine all cranial nerves carefully.
T250 429258-429391 Sentence denotes Cranial nerve abnormalities can indicate direct contusion or laceration of the neurons in the brainstem or where they exit the skull.
T251 429392-429500 Sentence denotes Cranial nerves that are initially normal then later lose function indicate a progressively expanding lesion.
T252 429501-429587 Sentence denotes When specific cranial nerve deficits are present, the prognosis is considered guarded.
T253 429588-429794 Sentence denotes Clinical signs such as rolling to one side, torticollis, head tilt, and abnormal nystagmus are usually associated with petrosal bone or cerebellomedullary lesions that produce vestibular neuron dysfunction.
T254 429795-429921 Sentence denotes Fractures of the petrosal temporal bone often cause hemorrhage and cerebrospinal fluid (CSF) leak from the external ear canal.
T255 429922-430097 Sentence denotes If the lesion is limited to the membranous labyrinth, the loss of balance will be toward the injured side and the quick phase of the nystagmus will be toward the injured side.
T256 430098-430328 Sentence denotes Normal physiologic nystagmus requires that the pathway be between the peripheral vestibular neurons and the pontomedullary vestibular nuclei to the nuclei of the cranial nerves that innervate the extraocular muscles (III, IV, VI).
T257 430329-430375 Sentence denotes Severe brainstem lesions disrupt this pathway.
T258 430376-430515 Sentence denotes Disruption of the pathway manifests as an inability to produce normal physiologic nystagmus by moving the patient's head from side to side.
T259 430516-430588 Sentence denotes In patients with severe CNS depression, this reflex may not be observed.
T260 430589-430648 Sentence denotes Next, assess postural changes and motor function abilities.
T261 430649-430801 Sentence denotes A loss of the normal oculocephalic (doll's eye) reflex is an early sign of brainstem hemorrhage and a late sign of brainstem compression and herniation.
T262 430802-430889 Sentence denotes Any intracranial injury may be accompanied by a concurrent cervical spinal cord injury.
T263 430890-430974 Sentence denotes Handle animals with such injuries with extreme care to avoid causing further damage.
T264 430975-431119 Sentence denotes Whenever there is uncertainty whether a spinal cord lesion exists, strap the patient down to a flat surface and obtain radiographs of the spine.
T265 431120-431260 Sentence denotes At least two orthogonal views may be required to see fractures; however, do not manipulate the patient until radiography has been completed.
T266 431261-431442 Sentence denotes Cross-table views, in which the Bucky is turned perpendicular to the patient's spine, with a radiograph plate secured behind the patient, may be required to minimize patient motion.
T267 431443-431526 Sentence denotes In patients with cerebral lesions, hemiparesis usually resolves within 1 to 3 days.
T268 431527-431664 Sentence denotes Evaluation of cranial nerve function at frequent intervals may reveal an initial injury or a progressively expanding lesion in the brain.
T269 431665-431834 Sentence denotes Signs of vestibular disorientation, marked head tilt, and abnormal nystagmus occur with contusions of the membranous labyrinth and fracture of the petrous temporal bone.
T270 431835-431906 Sentence denotes Hemorrhage and CSF otorrhea may be visible from the external ear canal.
T271 431907-431990 Sentence denotes Rolling movements indicate an injury to the cerebellar-medullary vestibular system.
T272 431991-432096 Sentence denotes Respiratory dysfunction and abnormal respiratory patterns are sometimes observed with severe head injury.
T273 432097-432290 Sentence denotes Lesions of the diencephalon produce Cheyne-Stokes respirations, in which the patient takes progressively larger and larger breaths, pauses, then takes progressively smaller and smaller breaths.
T274 432291-432376 Sentence denotes Mesencephalic lesions cause hyperventilation and can result in respiratory alkalosis.
T275 432377-432445 Sentence denotes Medullary lesions result in a choppy, irregular respiratory pattern.
T276 432446-432562 Sentence denotes Clinical signs of respiratory dysfunction in the absence of primary respiratory damage indicate a guarded prognosis.
T277 432563-432683 Sentence denotes After injury, seizures may be associated with intracranial hemorrhage, trauma, or an expanding intracranial mass lesion.
T278 432684-432741 Sentence denotes Immediately begin medical therapy to control the seizure.
T279 432742-432825 Sentence denotes Administer diazepam (0.5 mg/kg IV or 0.1 to 0.5 mg/kg/hr IV CRI) to treat seizures.
T280 432826-432982 Sentence denotes If diazepam is not effective in combination with other treatments to control intracranial edema, consider giving pentobarbital (5 to 15 mg/kg IV to effect).
T281 432983-433147 Sentence denotes Loading doses of 1 phenobarbital (16 to 20 mg/kg IV divided into four or five doses, given every 20 to 30 minutes) may be beneficial in preventing further seizures.
T282 433148-433272 Sentence denotes Severe refractory seizures or decreased mentation may be associated with cerebral edema and increased intracranial pressure.
T283 433273-433387 Sentence denotes Mannitol, an osmotic diuretic, is effective at reducing cerebral edema (0.5 to 1.0 g/kg IV over 10 to 15 minutes).
T284 433388-433504 Sentence denotes Mannitol also acts as a free radical scavenger that can inhibit the effects of cerebral ischemia-reperfusion injury.
T285 433505-433610 Sentence denotes Mannitol works synergistically with furosemide (1 mg/kg IV given 20 minutes after the mannitol infusion).
T286 433611-433732 Sentence denotes Corticosteroids have not been demonstrated to be beneficial in the treatment of head trauma and may induce hyperglycemia.
T287 433733-433824 Sentence denotes Hyperglycemia has been shown to be a negative prognostic indicator in cases of head trauma.
T288 433825-433908 Sentence denotes Also, glucocorticoids can suppress immune system function and impair wound healing.
T289 433909-434045 Sentence denotes Because of the known risks and lack of known benefits of glucocorticosteroids, their use in treatment of head trauma is contraindicated.
T290 434046-434111 Sentence denotes The prognosis for any patient with severe head trauma is guarded.
T291 434112-434273 Sentence denotes Management of head trauma patients may include intense nursing care for a period of weeks to months, depending on the presence and extent of concurrent injuries.
T292 434274-434396 Sentence denotes If progressive loss of consciousness occurs, surgery for decompression of compressive skull injuries should be considered.
T293 434397-434521 Sentence denotes The most common injury associated with head trauma in small animals is a contusion with hemorrhage in the midbrain and pons.
T294 434522-434601 Sentence denotes Subdural or extradural hemorrhage with space-occupying blood clots is uncommon.
T295 434602-434690 Sentence denotes Diagnostic tests of head trauma may include skull radiographs, CT, and MRI of the brain.
T296 434691-434830 Sentence denotes Special studies can help detect edema and hemorrhage in the brain and brainstem and aid in arriving at an accurate diagnosis and prognosis.
T297 434831-434987 Sentence denotes A CSF tap is contraindicated in patients with head trauma because of the risk of causing a rapid decrease in intracranial pressure and brainstem herniation.
T298 434988-435103 Sentence denotes If a compressive skull fracture is present, the patient should be stabilized for surgery to remove the compression.
T299 435104-435242 Sentence denotes Surgery to alleviate increased intracranial pressure is rarely performed in veterinary medicine because of the poor prognosis and results.
T300 435243-435431 Sentence denotes In some cases when a lesion can be localized to one area, 1-to 2-cm burr holes can be placed through the skull over the affected area of the cerebrum, exposing the underlying brain tissue.
T301 435432-435477 Sentence denotes Blood clots can be removed through the holes.
T302 435478-435591 Sentence denotes The bone flap may or may not be replaced, depending on the surgeon's preference and the degree of brain swelling.
T303 435592-435706 Sentence denotes Spinal cord injuries may be associated with trauma, disk rupture, fractures, and dislocation of the spinal column.
T304 435707-435784 Sentence denotes Proceed with caution when moving a patient with suspected spinal cord injury.
T305 435785-435847 Sentence denotes Avoid flexion, extension, and torsion of the vertebral column.
T306 435848-436024 Sentence denotes All animals that are unconscious after a traumatic event should be considered to have cervical or thoracolumbar spinal injury until proved otherwise by radiography, CT, or MRI.
T307 436025-436186 Sentence denotes The animal should be moved onto a flat surface (e.g., board, door, window, picture frame) and taped down to prevent motion and further displacement of vertebrae.
T308 436187-436305 Sentence denotes Sedation with analgesics or tranquilizers may be necessary to keep the animal immobile and to minimize patient motion.
T309 436306-436437 Sentence denotes Whenever possible, avoid the use of narcotics in patients with head trauma because of the risk of increasing intracranial pressure.
T310 436438-436567 Sentence denotes As in other emergencies, the ABCs should be evaluated, and the patient treated for shock, hemorrhage, and respiratory compromise.
T311 436568-436708 Sentence denotes Once the cardiovascular and respiratory systems have been evaluated and stabilized, a more thorough neurologic examination can be performed.
T312 436709-436875 Sentence denotes Protrusion of an intervertebral disk indicates that the disk is bulging into the vertebral canal as a result of dorsal shifting of the nuclear pulposus disk material.
T313 436876-437004 Sentence denotes Disk extrusion refers to the rupture of the outer disk membrane and extrusion of the nuclear material into the vertebral column.
T314 437005-437094 Sentence denotes In dogs and cats, there are 36 intervertebral disks that potentially can cause a problem.
T315 437095-437306 Sentence denotes Chondrodystrophic breeds of dogs are predisposed to endochondral ossification and include the Dachshund, Shih Tzu, French Bulldog, Bassett Hound, Welsh Corgi, American Spaniel, Beagle, Lhasa Apso, and Pekingese.
T316 437307-437529 Sentence denotes Initial examination of the patient with suspected intervertebral disk disease includes identifying the neuroanatomic location of the lesion based on clinical signs and neurologic deficits and then establishing a prognosis.
T317 437530-437624 Sentence denotes The neurologic examination should be carried out without excessive manipulation of the animal.
T318 437625-437730 Sentence denotes The presence of pain, edema, hemorrhage, or a visible deformity may localize an area of vertebral injury.
T319 437731-437884 Sentence denotes Once an area of suspected lesion is localized based on physical examination findings, take radiographs to establish a diagnosis and to institute therapy.
T320 437885-438014 Sentence denotes In most cases, the animal must receive a short-acting anesthetic for proper radiographic technique and to prevent further injury.
T321 438015-438188 Sentence denotes Lateral and cross-table ventrodorsal or dorsoventral radiographs require less manipulation of the animal compared with traditional ventrodorsal and dorsoventral projections.
T322 438189-438276 Sentence denotes Myelography is often required to delineate the location of the herniated disk material.
T323 438277-438381 Sentence denotes Prognosis in spinal cord injury depends on the extent of the injury and the reversibility of the damage.
T324 438382-438538 Sentence denotes Perception of noxious stimuli, or the presence of "deep pain, " by the animal when the stimulus is applied caudal to the level of the lesion is a good sign.
T325 438539-438665 Sentence denotes To apply a noxious stimulus, apply firm pressure to a toe on one of the rear limbs using a thick hemostat or a pair of pliers.
T326 438666-438832 Sentence denotes Flexion or withdrawal of the limb is simply a local spinal reflex and should not be perceived as a positive response to or patient perception of the noxious stimulus.
T327 438833-439032 Sentence denotes Turning of the head, vocalization, dilation of the pupils, change in respiratory rate or character, or attempts to bite are behaviors that are more consistent with perception of the noxious stimulus.
T328 439033-439149 Sentence denotes Absence of perception of the noxious stimulus ("loss of deep pain") is a very poor prognosis for return to function.
T329 439150-439252 Sentence denotes Focal lesions are usually associated with vertebral fractures and displacement of the vertebral canal.
T330 439253-439429 Sentence denotes Focal lesions in one or more of the spinal cord segments from T3 to T4 can cause complete dysfunction of the injured tissue as a result of concussion, contusion, or laceration.
T331 439430-439515 Sentence denotes The degree of structural damage cannot be determined from the neurologic signs alone.
T332 439516-439660 Sentence denotes Transverse focal lesions result in paraplegia, with intact pelvic limb spinal reflexes and analgesia of the limbs and body caudal to the lesion.
T333 439661-439737 Sentence denotes Clinical signs in patients with spinal injury are summarized in Table 1 -43.
T334 439738-439832 Sentence denotes Carefully evaluate the cardiovascular and respiratory status of patients with spinal injuries.
T335 439833-439950 Sentence denotes Immediately address specific injuries such as pneumothorax, pulmonary contusions, hypovolemic shock, and open wounds.
T336 439951-440157 Sentence denotes If there is palpable or radiographic evidence of a vertebral lesion causing compressive injury, surgery is the treatment of choice unless the displacement has compromised most or all of the vertebral canal.
T337 440158-440310 Sentence denotes Displacements through 50% to 100% of the vertebral canal are associated with a poor prognosis, particularly if deep pain is absent caudal to the lesion.
T338 440311-440330 Sentence denotes In the absence of a
T339 440331-440616 Sentence denotes Cranial to C6 Spastic tetraplegia or tetraparesis Hyperreflexive, all four limbs Severe injury: possible death from respiratory failure C6-T2 Tetraparesis or tetraplegia Depressed thoracic limb spinal reflexes (lower motor neuron) Hyperreflexive pelvic limbs (upper motor neuron) T1-T3
T340 440617-440993 Sentence denotes Horner syndrome (prolapsed nictitans, enophthalmos, and miosis) T3-L3 Schiff-Sherrington syndrome (extensor rigidity of thoracic limbs, flaccid paralysis with atonia, areflexia, and analgesia of pelvic limbs) 1 radiographic lesion and in the presence of continued neurologic deficits, an MRI or CT scan or myelography is warranted to localize a potentially correctable lesion.
T341 440994-441257 Sentence denotes Surgical exploration can be considered: with the objectives of providing spinal cord decompression by hemilaminectomy or laminectomy with removal of disk material or blood clots, realign and stabilize the vertebral column, and perform a meningotomy, if necessary.
T342 441258-441396 Sentence denotes Place the patient on a backboard or other rigid surface, taped down for transport and sedated, to be transported to a surgical specialist.
T343 441397-441544 Sentence denotes The presence of worsening or ascending clinical signs may signify ascending-descending myelomalacia and is characteristic of a very poor prognosis.
T344 441545-441708 Sentence denotes In acute spinal trauma, the use of glucocorticoids has been the mainstay of therapy; however, controversy exists regarding whether they actually offer any benefit.
T345 441709-441771 Sentence denotes Traditional glucocorticosteroid therapy is listed in Box 1-50.
T346 441772-441894 Sentence denotes More recently, the use of propylene glycol has proved to be beneficial in the treatment of acute traumatic herniated disk.
T347 441895-441985 Sentence denotes High-dose glucocorticoids should be used only for the first 48 hours after initial injury.
T348 441986-442072 Sentence denotes Side effects of glucocorticosteroid therapy include gastric and intestinal ulceration.
T349 442073-442263 Sentence denotes The prophylactic use of gastroprotectant drugs will not prevent gastrointestinal ulcer formation; however, if signs of gastrointestinal ulcer are present, institute gastroprotectant therapy.
T350 442264-442368 Sentence denotes Management of the patient with spinal cord injury includes aggressive nursing care and physical therapy.
T351 442369-442582 Sentence denotes Many patients with spinal cord injury have little to no control over bladder function, which results in chronic dribbling or retention of urine and overdistension of the urinary bladder with overflow incontinence.
T352 442583-442687 Sentence denotes Urinary bladder retention can lead to urinary tract infection, bladder atony, and overflow incontinence.
T353 442688-442781 Sentence denotes Manual expression of the bladder several times a day may be enough to keep the bladder empty.
T354 442782-443039 Sentence denotes Alternatively, place a urinary catheter to maintain patient cleanliness and to keep the bladder decompressed. (See the discussion of urinary catheterization in Section 5.) Paralytic ileus and fecal retention are frequent complications of spinal cord injury.
T355 443040-443172 Sentence denotes To help prevent constipation, provide highly digestible foods and maintain the patient's hydration with oral and intravenous fluids.
T356 443173-443246 Sentence denotes Mild enemas or stool softeners can also be used to treat fecal retention.
T357 443247-443362 Sentence denotes To prevent decubital ulcer formation, turn the patient every 4 to 6 hours, and use clean, dry, soft padded bedding.
T358 443363-443488 Sentence denotes Apply deep muscle massage and passive range of motion exercises to prevent disuse atrophy of the muscles and dependent edema.
T359 443489-443571 Sentence denotes The radial nerve innervates the extensor muscles of the elbow, carpus, and digits.
T360 443572-443712 Sentence denotes The radial nerve also supplies sensory innervation to the distal craniolateral surface of the forearm and the dorsal surface of the forepaw.
T361 443713-443823 Sentence denotes Injuries to the radial nerve at the level of the elbow result in an inability to extend the carpus and digits.
T362 443824-443904 Sentence denotes As a result, the animal walks and bears weight on the dorsal surface of the paw.
T363 443905-443974 Sentence denotes There is also loss of cutaneous sensation, which leads to paw injury.
T364 443975-444123 Sentence denotes Injuries to the radial nerve above the elbow (in the shoulder area) result in an inability to extend the elbow and bear weight on the affected limb.
T365 444124-444221 Sentence denotes It can take weeks before the full extent of the injury and any return to function are manifested.
T366 444222-444357 Sentence denotes The animal may need to be placed in a carpal flexion sling or have eventual amputation if distal limb injury or self-mutilation occurs.
T367 444359-444463 Sentence denotes The sciatic nerve primarily innervates the caudal thigh muscles that flex the stifle and extend the hip.
T368 444464-444580 Sentence denotes The tibial branch of the sciatic nerve innervates the caudal leg muscles that extend the tarsus and flex the digits.
T369 444581-444690 Sentence denotes The tibial nerve provides the sole cutaneous sensory innervation to the plantar aspect of the paw and digits.
T370 444691-444828 Sentence denotes The peroneal branch of the sciatic nerve provides the sole sensory cutaneous innervation to the dorsal surface of the paw (Table 1 -44) .
T371 444829-445106 Sentence denotes Sciatic nerve injury may occur with pelvic fractures, particularly those that involve the body of the ileum at the greater ischiatic notch, or with sacroiliac luxations that contuse the L6 and L7 spinal nerves that pass ventral to the sacrum to contribute to the sciatic nerve.
T372 445107-445283 Sentence denotes With sciatic nerve injury, there is decreased stifle flexion and overflexion of the hock (tibial nerve), and the animal walks on the dorsal surface of the paw (peroneal nerve).
T373 445284-445427 Sentence denotes Clinical signs of tibial or peroneal damage are seen with femur fractures or with inadvertent injection of drugs into the caudal thigh muscles.
T1 445428-445492 Sentence denotes The femoral nerve innervates the extensor muscles of the stifle.
T2 445493-445635 Sentence denotes The saphenous branch of the femoral nerve provides the sole cutaneous innervation to an area on the medial distal thigh, the leg, and the paw.
T3 445636-445720 Sentence denotes The femoral nerve is protected by muscles and is rarely injured in pelvic fractures.
T4 445721-445893 Sentence denotes Clinical signs of femoral nerve injury are inability to support weight on the pelvic limb, absence of a patellar reflex, and analgesia in the area of cutaneous innervation.
T5 445894-445970 Sentence denotes Coma is complete loss of consciousness, with no response to noxious stimuli.
T6 445971-446064 Sentence denotes In some animals presented in a coma or stuporous state, the immediate cause will be apparent.
T7 446065-446149 Sentence denotes In other cases, however, a careful and thorough diagnostic workup must be performed.
T8 446150-446256 Sentence denotes A coma scale devised to assist in the clinical evaluation of the comatose patient is shown in Table 1 -45.
T9 446257-446413 Sentence denotes Whenever an animal is presented in a comatose state, immediately secure the airway by placing an endotracheal tube (see section on endotracheal intubation).
T10 446414-446497 Sentence denotes If necessary, provide respiratory assistance or, at a minimum, supplemental oxygen.
T11 446498-446554 Sentence denotes Control existing hemorrhage and treat shock, if present.
T12 446555-446606 Sentence denotes Take a careful and thorough history from the owner.
T13 446607-446722 Sentence denotes Make careful note of any seizure, trauma, or toxin exposure, and whether prior episodes of coma have ever occurred.
T14 446723-446828 Sentence denotes Perform a careful physical examination, taking note of the patient's temperature, pulse, and respiration.
T15 446829-447002 Sentence denotes An elevated temperature may suggest the presence of systemic infection, such as pneumonia or hepatitis, or a brain lesion with loss of hypothalamic thermoregulatory control.
T16 447003-447091 Sentence denotes Very high temperatures associated with shock and coma are often observed in animals with
T17 447093-447159 Sentence denotes heat stroke (see section on heat stroke and heat-induced illness).
T18 447160-447238 Sentence denotes Circulatory collapse or barbiturate overdose can produce coma and hypothermia.
T19 447239-447312 Sentence denotes Abnormal respiratory patterns also may be observed in a comatose patient.
T20 447313-447399 Sentence denotes Hypoventilation may occur with elevated intracranial pressure or barbiturate overdose.
T21 447400-447511 Sentence denotes Rapid respiratory rate may be associated with pneumonia, metabolic acidosis (DKA, uremia), or brainstem injury.
T22 447512-447564 Sentence denotes Examine the skin for any bruises or external trauma.
T23 447565-447643 Sentence denotes Examine the mucous membranes and make note of color and capillary refill time.
T24 447644-447770 Sentence denotes Icterus with petechiae or ecchymotic hemorrhage in a comatose patient may be associated with end-stage hepatic failure and HE.
T25 447771-447874 Sentence denotes Smell the patient's breath for the odor of ketones, which may signify DKA or end-stage hepatic failure.
T26 447875-447925 Sentence denotes Finally, conduct a complete neurologic evaluation.
T27 447926-448048 Sentence denotes The presence of asymmetric neurologic signs may suggest an intracranial mass lesion (e.g., hemorrhage, neoplasia, injury).
T28 448049-448203 Sentence denotes Usually, toxicities or metabolic disturbances (e.g., DKA, HE) cause symmetric clinical signs of neurologic dysfunction, with cerebral signs predominating.
T29 448204-448269 Sentence denotes In HE, pupils are usually normal in size and responsive to light.
T30 448270-448351 Sentence denotes With toxicities the pupils are abnormal in size and may be unresponsive to light.
T31 448352-448484 Sentence denotes Obtain a complete blood count and serum biochemistry profile and perform urinalysis and specific tests for glucosuria and ketonuria.
T32 448485-448614 Sentence denotes Findings of a drastically elevated blood glucose with glucosuria, ketonuria, and high specific gravity are characteristic of DKA.
T33 448615-448815 Sentence denotes Fever t a B l e 1 -4 5 small animal coma scale (sacs)* *Neurologic function is assessed for each of the three categories and a grade of 1 to 6 is assigned according to the descriptions for each grade.
T34 448816-448872 Sentence denotes The total score is the sum of the three category scores.
T35 448873-448993 Sentence denotes This scale is designed to assist the clinician in evaluating the neurologic status of the craniocerebral trauma patient.
T36 448994-449180 Sentence denotes As a guideline and according to clinical impressions, a consistent total score of 3 to 8 represents a grave prognosis, 9 to 14 a poor to guarded prognosis, and 15 to 18 a good prognosis.
T37 449181-449335 Sentence denotes (Modified from the Glasgow Coma Scale used in humans.) 1 and uremic encephalopathy are characterized by severe azotemia with a low urine specific gravity.
T38 449336-449414 Sentence denotes If barbiturate intoxication is suspected, save urine for later toxin analysis.
T39 449415-449517 Sentence denotes Evaluate urine sediment for calcium oxalate crystalluria, which may indicate ethylene glycol toxicity.
T40 449518-449625 Sentence denotes Calculate plasma osmolality (see following section) to check for nonketotic hyperosmolar diabetes mellitus.
T41 449626-449682 Sentence denotes Elevated blood ammonia levels may be associated with HE.
T42 449683-449804 Sentence denotes In uncontrolled diabetes mellitus, hyperosmolarity can result in clinical signs of disorientation, prostration, and coma.
T43 449805-449868 Sentence denotes Plasma osmolarity can be calculated from the following formula:
T44 449869-450010 Sentence denotes mOsm / L 2(Na K) (glucose /18) (BUN / 2.8) = + + + Clinical signs of hyperosmolarity can occur when the plasma osmolarity exceeds 340 mOsm/L.
T45 450011-450183 Sentence denotes Treatment of DKA or nonketotic hyperosmolar syndrome is aimed at reducing ketoacid production, stimulating carbohydrate use, and impeding peripheral release of fatty acids.
T46 450184-450334 Sentence denotes The treatment of choice is rehydration and provision of supplemental regular insulin and a carbohydrate source (see section on diabetic ketoacidosis).
T47 450335-450385 Sentence denotes During ketosis, insulin resistance may be present.
T48 450386-450591 Sentence denotes Slow rehydration with 0.9% saline solution or other balanced crystalloid fluids (e.g., Normosol-R, Plasma-Lyte A, lactated Ringer's solution) should occur, with the goal of rehydration over 24 to 48 hours.
T49 450592-450678 Sentence denotes Too-rapid rehydration can result in cerebral edema and exacerbation of clinical signs.
T50 450679-450772 Sentence denotes HE is characterized by an abnormal mental state associated with severe hepatic insufficiency.
T51 450773-450848 Sentence denotes The most common cause of HE is congenital or acquired portosystemic shunts.
T52 450849-450933 Sentence denotes Acute hepatic destruction can also be caused by toxins, drugs, or infectious causes.
T53 450934-450986 Sentence denotes HE is considered a medical emergency (Table 1 -46) .
T54 450987-451129 Sentence denotes Absorption of ammonia and other nitrogenous substances from the gastrointestinal tract is thought to be one of the complicating factors in HE.
T55 451130-451330 Sentence denotes Prevent absorption of ammonia and other nitrogenous substances from the gastrointestinal tract by restricting dietary protein to 15% to 20% for dogs and to 30% to 35% (on a dry matter basis) for cats.
T56 451331-451421 Sentence denotes Dietary protein should be from a nonanimal plant source (e.g., soybean) whenever possible.
T57 451422-451481 Sentence denotes Caloric requirements are met with lipids and carbohydrates.
T58 451482-451634 Sentence denotes Clinical Signs Also, prescribe cleansing enemas to rid the colon of residual material, and antibiotic therapy to reduce gastrointestinal tract bacteria.
T59 451635-451700 Sentence denotes Neomycin (15 mg/kg q6h) can be administered as a retention enema.
T60 451701-451809 Sentence denotes Metronidazole (7.5 mg/kg PO, q8-12h) or amoxicillin-clavulanate (16.25 mg PO q12h) can also be administered.
T61 451810-451956 Sentence denotes Administer lactulose (2.5 to 5.0 mL q8h for cats; 2.5 to 15 mL q8h for dogs) to trap ammonia in the colon to prevent absorption (see Table 1 -46).
T62 451957-452045 Sentence denotes Administer lactulose PO to an alert animal or as a retention enema to a comatose animal.
T63 452046-452157 Sentence denotes If lactulose is not available, Betadine retention enemas will change colonic pH and prevent ammonia absorption.
T64 452158-452232 Sentence denotes A side effect of lactulose administration (PO) is soft to diarrheic stool.
T65 452233-452387 Sentence denotes A seizure is a transient disturbance of brain function that is sudden in onset, ceases spontaneously, and has a tendency to recur, depending on the cause.
T66 452388-452573 Sentence denotes Most seizures are generalized and result in a loss of consciousness and severe involuntary contraction of the skeletal muscles, resulting in tonic-clonic limb activity and opisthotonus.
T67 452574-452636 Sentence denotes Mastication, salivation, urination, and defecation are common.
T68 452637-452794 Sentence denotes Partial (petit mal) seizures range from limited limb activity, facial muscle twitching, and episodic behavioral abnormalities to brief loss of consciousness.
T69 452795-452856 Sentence denotes Similar clinical signs also can occur with syncopal episodes.
T70 452857-452947 Sentence denotes Conduct a careful cardiac examination in any patient with a history of petit mal seizures.
T71 452948-453068 Sentence denotes Seizures of any form constitute a medical emergency, particularly when they occur in clusters, or as status epilepticus.
T72 453069-453177 Sentence denotes Most seizures are of short duration and may have subsided by the time the animal is presented for treatment.
T73 453178-453293 Sentence denotes Whenever a seizure occurs, however, it is important that the animal not inadvertently injure itself or a bystander.
T74 453294-453535 Sentence denotes It is important to evaluate whether the patient has a coexisting disease that can predispose it to seizures, such as hepatic failure, uremia, diabetes mellitus, hypoglycemia, toxin exposure, insulin-secreting tumors, and thiamine deficiency.
T75 453536-453642 Sentence denotes Many toxins are responsible for clinical signs of tremors or seizures (see section on poisons and toxins).
T76 453643-453785 Sentence denotes Treatment of a primary disease entity can help control seizures in some cases, provided that the underlying cause is investigated and treated.
T77 453786-453882 Sentence denotes Status epilepticus, a state of continuous uncontrolled seizure activity, is a medical emergency.
T78 453883-454071 Sentence denotes When an animal is in a state of status epilepticus, immediately place a lateral or medial saphenous intravenous catheter and administer diazepam (0.5 mg/kg IV) to help control the seizure.
T79 454072-454158 Sentence denotes In most cases, the seizure must be controlled before a diagnostic workup is attempted.
T80 454159-454317 Sentence denotes Whenever possible, however, blood samples should be collected before administration of any anticonvulsant agent because of the risk of incorrect test results.
T81 454318-454462 Sentence denotes For example, the propylene glycol carrier in diazepam can cause a false-positive ethylene glycol test result when using an in-house testing kit.
T82 454463-454610 Sentence denotes Whenever possible, check blood glucose levels, particularly in young puppies or kittens, to evaluate and treat hypoglycemia as a cause of seizures.
T83 454611-454671 Sentence denotes If hypoglycemia exists, administer 25% dextrose (1 g/kg IV).
T84 454672-454783 Sentence denotes If diazepam partially controls the status epilepticus, administer a CRI (0.1 mg/kg/hr in 5% dextrose in water).
T85 454784-454897 Sentence denotes Diazepam is sensitive to light, and the bag and infusion line must be covered to prevent degradation of the drug.
T86 454898-455062 Sentence denotes If diazepam fails to control status epilepticus, give pentobarbital (5 to 15 mg/kg IV to effect) or propofol (3 to 7 mg/kg IV, then 0.4 mg/kg/min IV CRI to effect).
T87 455063-455168 Sentence denotes The animal's airway should be intubated and protected while the patient is kept in the drug-induced coma.
T88 455169-455266 Sentence denotes Protracted cases of seizures may require mannitol and furosemide therapy to treat cerebral edema.
T89 455267-455384 Sentence denotes Administer intravenous fluids (balanced crystalloid at maintenance doses [see section on intravenous fluid therapy]).
T90 455385-455456 Sentence denotes The patient should be turned every 4 to 6 hours to prevent atelectasis.
T91 455457-455585 Sentence denotes Insert a urinary catheter for cleanliness, and place the animal on soft dry padded bedding to prevent decubital ulcer formation.
T92 455586-455795 Sentence denotes Depending on the length of time that the patient is rendered unconscious, apply passive range of motion exercises and deep muscle massage to prevent disuse atrophy of the muscles and dependent or disuse edema.
T93 455796-456012 Sentence denotes Monitor the patient's oxygenation and ventilation status by arterial blood gas measurement or pulse oximetry and capnometry (see the discussion of blood gas 1 monitoring, pulse oximetry, and capnometry in Section 5).
T94 456013-456122 Sentence denotes Administer supplemental oxygen to any patient that is hypoxemic secondary to hypoventilation or other causes.
T95 456123-456210 Sentence denotes Severe refractory seizures can result in the development of neurogenic pulmonary edema.
T96 456211-456297 Sentence denotes Lubricate the animal's eyes every 4 hours to prevent drying out and corneal abrasions.
T97 456298-456593 Sentence denotes Depending on the cause of the seizure, administer phenobarbital (at a loading dose of 16 to 20 mg/kg IV given in four to five injections, every 20 to 30 minutes; make sure that the patient is rousable between injections) or levetiracetam (Keppra, 20 mg/kg PO Q8 hours or 20 mg/kg IV slow bolus).
T98 456594-456662 Sentence denotes Seizures in cats often are associated with structural brain disease.
T99 456663-456799 Sentence denotes The occurrence of partial focal seizures is unequivocally associated with a focal cerebral lesion and acquired structural brain disease.
T100 456800-456907 Sentence denotes An initial high frequency of seizures is also a strong indication that structural brain disease is present.
T101 456908-457181 Sentence denotes Seizure activity in cats may occur as mild generalized seizures or complex partial seizures and may be associated with systemic disorders such as FIP virus, toxoplasmosis, Cryptococcus infection, lymphosarcoma, meningiomas, ischemic encephalopathy, and thiamine deficiency.
T102 457182-457349 Sentence denotes Thiamine deficiency in the cat can be a medical emergency characterized by dilated pupils, ataxic gait, cerebellar tremor, abnormal oculocephalic reflex, and seizures.
T103 457350-457422 Sentence denotes Treatment consists of administration of thiamine (50 mg/day) for 3 days.
T104 457423-457456 Sentence denotes 1 Syring RS, Otto CM, Drobatz KJ:
T105 457457-457505 Sentence denotes Hyperglycemia in dogs and cats with head trauma:
T106 457506-457556 Sentence denotes 122 cases (1997-1999) , J Am Vet Med Assoc 218 (7)
T107 457558-457679 Sentence denotes An ocular emergency is any serious condition that causes or threatens to cause severe pain, deformity, or loss of vision.
T108 457680-457805 Sentence denotes Treat ocular emergencies immediately, within 1 to several hours after the emergency, whenever possible (Boxes 1-51 and 1-52).
T109 457806-457896 Sentence denotes To assess the location and degree of ocular injury, perform a complete ocular examination.
T110 457897-458094 Sentence denotes In some cases, short-acting sedation or general anesthesia in conjunction with topical local anesthetic may be necessary to perform the examination, because of patient discomfort and blepharospasm.
T111 458095-458199 Sentence denotes The equipment listed in Box 1-53 may be necessary and may be invaluable in making an accurate diagnosis.
T112 458200-458295 Sentence denotes To perform a systematic and thorough ocular examination, first obtain a history from the owner.
T113 458296-458348 Sentence denotes Has there been any prior incident of ocular disease?
T114 458349-458419 Sentence denotes Is there any history of trauma or known chemical irritant or exposure?
T115 458420-458499 Sentence denotes Did the owner attempt any irrigation or medical techniques before presentation?
T116 458500-458535 Sentence denotes When was the problem first noticed?
T117 458536-458594 Sentence denotes Has it changed at all since the owner noticed the problem?
T118 458595-458702 Sentence denotes After a history has been obtained, examine the patient's eyes for discharge, blepharospasm, or photophobia.
T119 458703-458763 Sentence denotes If any discharge is present, note its color and consistency.
T120 458764-458845 Sentence denotes Do not attempt to force the eyelids open if the patient is in extreme discomfort.
T121 458846-458936 Sentence denotes Administer a short-acting sedative and topical local anesthetic such as 0.5% proparacaine.
T122 458937-458987 Sentence denotes Note the posi- tion of the globe within its orbit.
T123 458988-459080 Sentence denotes If the eye is exophthalmic, strabismus and protrusion of the third eyelid are often visible.
T124 459081-459115 Sentence denotes Exposure keratitis may be present.
T125 459116-459264 Sentence denotes In cases of retrobulbar or zygomatic salivary gland inflammation, the patient will resist opening the mouth and exhibit signs of discomfort or pain.
T126 459265-459337 Sentence denotes Note any swelling, contusions, abrasions, or lacerations of the eyelids.
T127 459338-459410 Sentence denotes Note whether the lids are able to close completely and cover the cornea.
T128 459411-459488 Sentence denotes If a laceration of the lid is present, determine the depth of the laceration.
T129 459489-459563 Sentence denotes Palpate the orbit for fractures, swelling, pain, crepitus, and cellulitis.
T130 459564-459637 Sentence denotes Examine the cornea and sclera for penetrating injury or foreign material.
T131 459638-459716 Sentence denotes The use of lid retractors or small forceps can be very helpful in these cases.
T132 459717-459825 Sentence denotes If a wound appears to penetrate completely into the globe, look for loss of uveal tissue, lens, or vitreous.
T133 459826-459906 Sentence denotes Do not put any pressure on the globe, because intraocular herniation may result.
T134 459907-459989 Sentence denotes Examine the conjunctiva for hemorrhage, chemosis, lacerations, and foreign bodies.
T135 459990-460070 Sentence denotes Examine the superior and inferior conjunctival cul-de-sacs for foreign material.
T136 460071-460229 Sentence denotes In such cases, placement of a topical anesthetic and use of a moistened cotton swab are invaluable to sweep the conjunctival fornix to pick up foreign bodies.
T137 460230-460364 Sentence denotes Use small, fine-tipped forceps to retract the third eyelid away from the globe and examine behind the third eyelid for foreign bodies.
T138 460365-460455 Sentence denotes Next, examine the cornea for opacities, ulcers, foreign bodies, abrasions, or lacerations.
T139 460456-460554 Sentence denotes Place a small amount of fluorescein stain mixed with sterile water or saline on the dorsal sclera.
T140 460555-460672 Sentence denotes Close the eye to disperse the stain over the surface of the cornea, then flush gently with sterile saline irrigation.
T141 460673-460714 Sentence denotes Examine the cornea again for any defects.
T142 460715-460845 Sentence denotes A linear defect perpendicular to the long axis of the eye should alert the clinician to investigate the conjunctiva for dystechia.
T143 460846-460927 Sentence denotes Record the pupil size, shape, and response to light (both direct and consensual).
T144 460928-461024 Sentence denotes Examine the anterior chamber and note its depth and whether hyphema or aqueous flare is present.
T145 461025-461076 Sentence denotes Is the lens clear and is it in the normal position?
T146 461077-461167 Sentence denotes Lens luxation can cause the lens tissue to touch the cornea and cause acute corneal edema.
T147 461168-461234 Sentence denotes Measure intraocular pressure with a Schiotz tonometer or Tono-Pen.
T148 461235-461472 Sentence denotes Finally, dilate the pupil and examine the posterior chamber using a direct or indirect ophthalmoscope to look for intraocular hemorrhage, retinal hemorrhage, retinal detachment, tortuous retinal vessels, optic neuritis, and inflammation.
T149 461473-461606 Sentence denotes The basic surgical instruments listed in Box 1-54 may be useful in the treatment of ocular lacerations and other ophthalmic injuries.
T150 461607-461701 Sentence denotes Bite wounds and automobile trauma commonly cause lacerations and abrasions of the lid margins.
T151 461702-461882 Sentence denotes The lids can be considered to be two-layer structures, with the anterior composed of the skin and orbicularis muscle and the posterior layer composed of the tarsus and conjunctiva.
T152 461883-462021 Sentence denotes The openings of the meibomian glands in the lid margin form the approximate line separating the lids into anterior and posterior segments.
T153 462022-462162 Sentence denotes Splitting the lid into these two segments facilitates the use of sliding skin flaps to close wound defects, if necessary. • Suture material:
T154 462163-462354 Sentence denotes 6-0 silk, 4-0 nylon, 7-0 collagen, 6-0 ophthalmic gut, 7-0 nylon 1 Clean and thoroughly but gently irrigate the wound with sterile saline solution before attempting any lid laceration repair.
T155 462355-462421 Sentence denotes Use sterile saline solution to irrigate the wound and conjunctiva.
T156 462422-462553 Sentence denotes A 1% povidone-iodine scrub can be used on the skin, taking care to avoid getting any scrub material in the soft tissues of the eye.
T157 462554-462651 Sentence denotes Drape the eye with an adhesive ocular drape, if possible, to prevent further wound contamination.
T158 462652-462730 Sentence denotes Trim the ragged wound edges, but be very conservative with tissue debridement.
T159 462731-462826 Sentence denotes Leave as much tissue as possible to ensure proper wound contracture with minimal lid deformity.
T160 462827-462966 Sentence denotes Close a small lid wound with a figure-of-eight or two-layered simple interrupted suture of absorbable suture material or nylon in the skin.
T161 462967-463048 Sentence denotes The lid margins must be absolutely apposed to prevent postoperative lid notching.
T162 463049-463164 Sentence denotes Direct blunt trauma to the eye can cause severe ecchymosis because of the excellent vascular supply of the eyelids.
T163 463165-463275 Sentence denotes Other associated ocular injuries such as orbital hemorrhage, proptosis, and corneal laceration may also occur.
T164 463276-463459 Sentence denotes Trauma, allergic reactions, inflammation of the sebaceous glands (hordeolum), thrombocytopenia, and vitamin K antagonist rodenticide intoxication can all cause ecchymoses of the lids.
T165 463460-463544 Sentence denotes Treat eyelid ecchymoses initially with cool compresses, followed by warm compresses.
T166 463545-463613 Sentence denotes Resorption of blood can occur 3 to 10 days after the initial insult.
T167 463614-463789 Sentence denotes Ocular allergies respond well to topical application (dexamethasone ophthalmic ointment q6-8h) and systemic administration of glucocorticosteroids, along with cool compresses.
T168 463790-463926 Sentence denotes In order to fully assess the conjunctiva for abnormalities, it may be necessary to carefully dissect it away from the underlying sclera.
T169 463927-464087 Sentence denotes When performing this dissection, do not place undue pressure on the globe because of the risk of herniation of the intraocular contents through a scleral wound.
T170 464088-464198 Sentence denotes Repair large conjunctival lacerations with 6-0 absorbable sutures, using an interrupted or continuous pattern.
T171 464199-464292 Sentence denotes Carefully approximate the margins of the conjunctiva to prevent formation of inclusion cysts.
T172 464293-464402 Sentence denotes When large areas of the conjunctiva have been damaged, advancement flaps may be required to close the defect.
T173 464403-464520 Sentence denotes Subconjunctival hemorrhage is a common sequela of head trauma, and it may also be observed in various coagulopathies.
T174 464521-464616 Sentence denotes By itself it is not a serious problem, but it may signify severe underlying intraocular damage.
T175 464617-464660 Sentence denotes A complete ocular examination is indicated.
T176 464661-464907 Sentence denotes Other causes of subconjunctival hemorrhage include thrombocytopenia, autoimmune hemolytic anemia, hemophilia, leptospirosis, vitamin K antagonist rodenticide intoxication, severe systemic infection or inflammation, and prolonged labor (dystocia).
T177 464908-464990 Sentence denotes Uncomplicated subconjunctival hemorrhage usually clears on its own within 14 days.
T178 464991-465189 Sentence denotes If the conjunctiva is exposed because of swelling and hemorrhage, administer a topical protective triple antibiotic ophthalmic ointment every 6 to 8 hours until the conjunctival hemorrhage resolves.
T179 465190-465265 Sentence denotes Toxic, acid, and alkaline chemical injuries to the eye can sometimes occur.
T180 465266-465407 Sentence denotes The severity of the injury caused by ocular burns depends on the concentration, type, and pH of the chemical and on the duration of exposure.
T181 465408-465462 Sentence denotes Weak acids do not penetrate biologic tissue very well.
T182 465463-465602 Sentence denotes The hydrogen ion precipitates the protein on contact and therefore provides some protection to the corneal stroma and intraocular contents.
T183 465603-465686 Sentence denotes Precipitation of corneal proteins produces a ground-glass appearance in the cornea.
T184 465687-465905 Sentence denotes Alkaline solutions and very strong acids penetrate tissues rapidly, causing saponification of the plasma membrane, denaturation of collagen, and vascular thrombosis within the conjunctiva, episclera, and anterior uvea.
T185 465906-466039 Sentence denotes Severe pain, blepharospasm, and photophobia are produced by exposure of free nerve endings in the corneal epithelium and conjunctiva.
T186 466040-466106 Sentence denotes Severe alkaline burns cause an increase 1 in intraocular pressure.
T187 466107-466259 Sentence denotes Intraocular prostaglandins are released, and the intraocular aqueous pH increases, producing changes in the blood-aqueous barrier and secondary uveitis.
T188 466260-466393 Sentence denotes Uveitis with anterior synechia formation, eventual chronic glaucoma, phthisis, secondary cataract, and corneal perforation can occur.
T189 466394-466534 Sentence denotes Healing of the corneal epithelium is usually accomplished by neovascularization and sliding and increased mitosis of the corneal epithelium.
T190 466535-466702 Sentence denotes Severe stromal burns within the cornea heal by degradation and removal of necrotic debris, followed by replacement of the collagen matrix and corneal epithelial cells.
T191 466703-466832 Sentence denotes The release of collagenase, endopeptidase, and cathepsins from polymorphonuclear cells serves to cause further corneal breakdown.
T192 466833-466928 Sentence denotes In severe cases, only PMNs may be present, and fibroblasts may never invade the corneal stroma.
T193 466929-467017 Sentence denotes All chemical burns should be washed copiously with any clean aqueous solution available.
T194 467018-467134 Sentence denotes If any sticky paste or powder is adherent to the conjunctival sac, remove it with moist cotton swabs and irrigation.
T195 467135-467234 Sentence denotes Begin mydriasis and cycloplegia by topical application of 1% atropine ophthalmic drops or ointment.
T196 467235-467343 Sentence denotes Start antibiotic therapy with triple antibiotic ophthalmic ointment or Gentocin ointment every 6 to 8 hours.
T197 467344-467413 Sentence denotes Treat secondary glaucomas with topical carbonic anhydrase inhibitors.
T198 467414-467561 Sentence denotes To avoid fibrinous adhesions and symblepharon formation, keep the conjunctival cul-de-sacs free of proteinaceous exudate, which can form adhesions.
T199 467562-467595 Sentence denotes Analgesics are required for pain.
T200 467596-467707 Sentence denotes Oral nonsteroidal antiinflammatory agents such as carprofen, ketoprofen, meloxicam, or aspirin are recommended.
T201 467708-467859 Sentence denotes Persistent epithelial erosions may require a conjunctival flap left in place for 3 to 4 weeks or placement of a topical collagen shield (contact lens).
T202 467860-467962 Sentence denotes Topical antibiotics, mydriatics, and lubricants (Lacri-Lube or Puralube ointment) should also be used.
T203 467963-468033 Sentence denotes Strong acid or alkali burns can result in severe corneal stromal loss.
T204 468034-468108 Sentence denotes In the past, topical N-acetylcysteine (10% Mucomyst) has been recommended.
T205 468109-468140 Sentence denotes This treatment is very painful.
T206 468141-468302 Sentence denotes Other treatments are also available, such as ethylenediaminetetraacetic acid (EDTA) (0.2 M solution) and patient serum to inhibit mammalian collagenase activity.
T207 468303-468380 Sentence denotes To prepare patient serum, obtain 10 to 12 mL of whole blood from the patient.
T208 468381-468645 Sentence denotes Spin it down in a serum separator tube after a clot forms and then place the serum in a red-topped tube on the patient's cage. (The contents of the tube are viable for 4 days without refrigeration.) Apply the serum topically to the affected eye every 1 to 2 hours.
T209 468646-468737 Sentence denotes Avoid using topical steroids because they inhibit fibroblast formation and corneal healing.
T210 468738-468889 Sentence denotes In severe cases, if conjunctival swelling and chemosis also are present, antiinflammatory doses of oral steroids can be administered in the short term.
T211 468890-469035 Sentence denotes Oral steroids and NSAIDs should never be administered to the patient concurrently, because of the risk of gastrointestinal ulcer and perforation.
T212 469036-469131 Sentence denotes Corneal abrasions are associated with severe pain, blepharospasm, lacrimation, and photophobia.
T213 469132-469232 Sentence denotes Animals with such intense pain are often difficult to examine until analgesia has been administered.
T214 469233-469385 Sentence denotes Topical use of proparacaine (0.5% proparacaine hydrochloride) is usually sufficient to permit relaxation of the eyelids so that the eye can be examined.
T215 469386-469560 Sentence denotes Using a focal source of illumination and an eye loupe, examine the cornea, inferior and superior conjunctival fornices, and medial aspect of the nictitans for foreign bodies.
T216 469561-469725 Sentence denotes Place a sterile drop of saline on a fluorescein-impregnated strip, and touch the superior conjunctiva once to allow the stain to spread onto the surface of the eye.
T217 469726-469833 Sentence denotes Irrigate the eye to remove excess stain and then examine the corneal surface for any areas of stain uptake.
T218 469834-469942 Sentence denotes If an area of the cornea persistently remains green, there is damage to the corneal epithelium in that area.
T219 469943-470107 Sentence denotes Initial treatment consists of application of a topical mydriatic (1 drop of 1% atropine in affected eye q12h) to prevent anterior synechiae and improve cycloplegia.
T220 470108-470228 Sentence denotes Triple antibiotic ointment is the treatment of choice (a 1 ⁄4-inch strip in the affected eye q8h) until the ulcer heals.
T221 470229-470375 Sentence denotes In some cases, nonhealing ulcers (e.g., Boxer ulcer, indolent ulcer) form in which the epithelial growth does not adhere to the underlying cornea.
T222 470376-470473 Sentence denotes Gently debride the loose edges of the ulcer or erosion with a cotton swab and topical anesthesia.
T223 470474-470731 Sentence denotes More severe cases in which only minimal healing has occurred after 7 days of treatment require grid keratectomy, in 1 which a 25-gauge needle is used to gently scratch the surface of the abrasion or ulcer in the form of a grid to promote neovascularization.
T224 470732-470791 Sentence denotes Apply a topical anesthetic before performing the procedure.
T225 470792-470862 Sentence denotes A collagen contact lens also may be required to promote wound healing.
T226 470863-470981 Sentence denotes All corneal abrasions should be reevaluated in 48 hours, and then every 4 to 7 days thereafter until they have healed.
T227 470982-471262 Sentence denotes Acute infectious keratitis secondary to bacterial infection is characterized by mucopurulent ocular discharge, rapidly progressing epithelial and corneal stromal loss, inflammatory cellular infiltrates into the corneal stroma, and secondary uveitis, often with hypopyon formation.
T228 471263-471356 Sentence denotes Confirmation of infectious keratitis is based on corneal scrapings and a positive Gram stain.
T229 471357-471487 Sentence denotes Initial treatment for bacterial keratitis consists of systemic antibiotics and topical ciprofloxacin (0.3% eye drops or ointment).
T230 471488-471575 Sentence denotes Penetrating injuries through the cornea may result in prolapse of intraocular contents.
T231 471576-471708 Sentence denotes Frequently, pieces of uveal tissue or fibrin effectively but temporarily seal the defect and permit the anterior chamber to re-form.
T232 471709-471917 Sentence denotes Avoid manipulation of these wounds until the animal has been anesthetized, as struggling or excitement can promote loss or dislodgement of the temporary seal and cause the intraocular contents to be extruded.
T233 471918-472041 Sentence denotes Superficial corneal lacerations need not be sutured and can be treated the same as a superficial corneal ulcer or abrasion.
T234 472042-472169 Sentence denotes If the laceration penetrates more than 50% of the thickness of the cornea or extends more than 3 to 4 mm, it should be sutured.
T235 472170-472241 Sentence denotes When placing sutures in the cornea, it is helpful to use magnification.
T236 472242-472294 Sentence denotes Referral to a veterinary ophthalmologist is advised.
T237 472295-472429 Sentence denotes If a veterinary ophthalmologist is not available, use 7-0 or 8-0 silk, collagen, or nylon sutures on a micropoint spatula-type needle.
T238 472430-472526 Sentence denotes Use a simple interrupted suture pattern and leave the sutures in place for a minimum of 3 weeks.
T239 472527-472649 Sentence denotes Because many corneal lacerations are jagged and corneal edema forms, most of the wound edges cannot be tightly juxtaposed.
T240 472650-472743 Sentence denotes In such cases, pull a conjunctival flap across the wound to prevent leakage of aqueous fluid.
T241 472744-472869 Sentence denotes Never suture through the full thickness of the cornea; rather, the suture should pass through the middle third of the cornea.
T242 472870-473008 Sentence denotes After closure of the corneal wound, the anterior chamber must be re-formed to prevent anterior synechia formation with secondary glaucoma.
T243 473009-473110 Sentence denotes Taking care to avoid iris injury, use a 25-or 26-gauge needle to insert sterile saline at the limbus.
T244 473111-473227 Sentence denotes Any defect in the suture line will be apparent because of leakage of the fluid from the site and should be repaired.
T245 473228-473308 Sentence denotes Incarceration of uveal tissue in corneal wounds is a difficult surgical problem.
T246 473309-473554 Sentence denotes Persistent incarceration of uveal tissue can result in development of a chronic wick in the cornea, a shallow anterior chamber, chronic irritation, edema, vascularization of the cornea, and intraocular infection that can lead to panophthalmitis.
T247 473555-473620 Sentence denotes Referral to a veterinary ophthalmologist is strongly recommended.
T248 473621-473737 Sentence denotes The most common foreign bodies associated with ocular injuries in small animals are birdshot, BB pellets, and glass.
T249 473738-473827 Sentence denotes The site of intraocular penetration of the foreign bodies may be obscured by the eyelids.
T250 473828-473949 Sentence denotes A foreign body entering the eye may penetrate the cornea and fall into the anterior chamber or become lodged in the iris.
T251 473950-474030 Sentence denotes Foreign bodies may occasionally penetrate the lens capsule, producing cataracts.
T252 474031-474174 Sentence denotes Some metallic high-speed foreign bodies may penetrate the cornea, iris, and lens to lodge in the posterior wall of the eye or vitreous chamber.
T253 474175-474248 Sentence denotes Direct visualization of a foreign body is the best means of localization.
T254 474249-474378 Sentence denotes Examination of the eye with an indirect ophthalmoscope or biomicroscope (if available) is invaluable for locating foreign bodies.
T255 474379-474482 Sentence denotes Indirect visualization of the ocular foreign body can also be achieved through radiographic techniques.
T256 474483-474582 Sentence denotes Three separate views should be obtained to determine 1 the plane of location of the foreign object.
T257 474583-474716 Sentence denotes CT or MRI may prove useful, although scatter from the foreign body may make it difficult to directly visualize with these techniques.
T258 474717-474837 Sentence denotes Ocular ultrasound is perhaps the most useful and refined radiographic technique for locating intraocular foreign bodies.
T259 474838-474989 Sentence denotes Before any foreign body is removed from the eye, the risks and surgical danger of removing it must be weighed against the risks of leaving it in place.
T260 474990-475086 Sentence denotes Metallic foreign bodies in the anterior chamber are much easier to remove than nonmagnetic ones.
T261 475087-475200 Sentence denotes Attempted removal of foreign objects from the vitreous chamber of the eye has consistently produced poor results.
T262 475201-475324 Sentence denotes For the best chance of recovery, ocular foreign bodies should be removed by a veterinary ophthalmologist whenever possible.
T263 475325-475401 Sentence denotes Blunt trauma to the globe can result in luxation or subluxation of the lens.
T264 475402-475485 Sentence denotes The subluxated lens may move anteriorly and make the anterior chamber more shallow.
T265 475486-475566 Sentence denotes Trembling of the iris (iridodonesis) may be noticed when the lens is subluxated.
T266 475567-475698 Sentence denotes In complete luxation, the lens may fall totally into the anterior chamber and obstruct aqueous outflow, causing secondary glaucoma.
T267 475699-475760 Sentence denotes Alternatively, the lens may be lost into the vitreous cavity.
T268 475761-475906 Sentence denotes Luxation of the lens is almost always associated with rupture of the hyaloid membrane and herniation of the vitreous through the pupillary space.
T269 475907-476086 Sentence denotes Emergency surgery for lens luxation is required if the lens is entirely within the anterior chamber or incarcerated within the pupil, causing a secondary pupillary block glaucoma.
T270 476087-476231 Sentence denotes Acute elevation in intraocular pressure can cause vision loss within 48 hours; thus, lens removal should be accomplished as quickly as possible.
T271 476232-476288 Sentence denotes Referral to a veterinary ophthalmologist is recommended.
T272 476289-476390 Sentence denotes Severe trauma to the globe or a direct blow to the head can result in retinal or vitreous hemorrhage.
T273 476391-476457 Sentence denotes There may be large areas of subretinal or intraretinal hemorrhage.
T274 476458-476558 Sentence denotes Subretinal hemorrhage assumes a discrete globular form, and the blood appears reddish-blue in color.
T275 476559-476608 Sentence denotes The retina is detached at the site of hemorrhage.
T276 476609-476808 Sentence denotes Superficial retinal hemorrhage may assume a flame-shaped appearance, and preretinal or vitreous hemorrhage assumes a bright-red amorphous appearance, obliterating the underlying retinal architecture.
T277 476809-476917 Sentence denotes Retinal and vitreous hemorrhage secondary to trauma usually resorbs spontaneously over a 2-to 3-week period.
T278 476918-477050 Sentence denotes Unfortunately, vitreous hemorrhage, as it organizes, can produce vitreous traction bands that eventually produce retinal detachment.
T279 477051-477204 Sentence denotes Expulsive choroid hemorrhage can occur at the time of injury and usually leads to retinal detachment, severe visual impairment, and total loss of vision.
T280 477205-477335 Sentence denotes Treatment of vitreal and retinal hemorrhage includes rest and correction of factors that may predispose to intraocular hemorrhage.
T281 477336-477424 Sentence denotes More complicated cases may require vitrectomy performed by a veterinary ophthalmologist.
T282 477425-477484 Sentence denotes Hyphema refers to blood in the anterior chamber of the eye.
T283 477485-477554 Sentence denotes The most common traumatic cause of hyphema is an automobile accident.
T284 477555-477634 Sentence denotes Hyphema may also occur because of penetrating ocular wounds and coagulopathies.
T285 477635-477708 Sentence denotes Blood within the eye may come from the anterior or posterior uveal tract.
T286 477709-477854 Sentence denotes Trauma to the eye may result in iridodialysis or a tearing of the iris at its root, permitting excessive bleeding from the iris and ciliary body.
T287 477855-477949 Sentence denotes Usually, simple hyphema resolves spontaneously in 7 to 10 days and does not cause vision loss.
T288 477950-478162 Sentence denotes Loss of vision that follows bleeding into the anterior chamber is associated with secondary ocular injuries such as glaucoma, traumatic iritis, cataract, retinal detachment, endophthalmitis, and corneal scarring.
T289 478163-478261 Sentence denotes Treatment of hyphema must be individualized, but there are severe general principles of treatment.
T290 478262-478340 Sentence denotes First, stop ongoing hemorrhage and prevent further bleeding whenever possible.
T291 478341-478423 Sentence denotes This may involve correction of the underlying cause, if a coagulopathy is present.
T292 478424-478575 Sentence denotes Next, aid in the elimination of blood from the anterior chamber, control secondary glaucoma, and treat associated injuries, including traumatic iritis.
T293 478576-478637 Sentence denotes Finally, detect and treat any late complications of glaucoma.
T294 478638-478733 Sentence denotes In most cases of traumatic hyphema, little can be done to arrest or prevent ongoing hemorrhage.
T295 478734-478801 Sentence denotes It is best to restrict the animal's activity and prohibit exertion.
T296 478802-478889 Sentence denotes Rebleeding can occur within 5 days, and intraocular pressure must be monitored closely.
T297 478890-479021 Sentence denotes After 5 to 7 days, the blood in the anterior chamber will change color from a bright red to bluish-black ("eight-ball hemorrhage").
T298 479022-479167 Sentence denotes If total hyphema persists and intraocular pressure rises despite therapy, surgical intervention by a veterinary ophthalmologist may be necessary.
T299 479168-479265 Sentence denotes The primary route of escape of RBCs from the anterior chamber is via the anterior drainage angle.
T300 479266-479367 Sentence denotes Iris absorption and phagocytosis play a minor role in the removal of blood from the anterior chamber.
T301 479368-479568 Sentence denotes Because of the associated traumatic iritis in hyphema, topical administration of a glucocorticoid (1% dexamethasone drops or 1% prednisolone drops) is advised to control anterior chamber inflammation.
T302 479569-479623 Sentence denotes A cycloplegic agent (1% atropine) should also be used.
T303 479624-479846 Sentence denotes The formation of fibrin in the anterior chamber of the eye secondary to hemorrhage can produce adhesions of the iris and secondary glaucoma (see section on glaucoma secondary to hyphema) by blocking the trabecular network.
T304 479847-480005 Sentence denotes Hyphema secondary to retinal detachment (Collie ectasia syndrome) and end-stage glaucoma are extremely difficult to treat medically and have a poor prognosis.
T305 480006-480098 Sentence denotes Proptosis of the globe is common secondary to trauma, particularly in brachycephalic breeds.
T306 480099-480267 Sentence denotes Proptosis of the globe in dolichocephalic breeds requires a greater degree of initiating contusion than the brachycephalic breeds because the orbits are so much deeper.
T307 480268-480412 Sentence denotes Therefore, secondary damage to the eye and CNS associated with proptosis of the globe may be greater in the Collie or Greyhound than in the Pug.
T308 480413-480530 Sentence denotes When proptosis occurs, carefully evaluate the cardiovascular system for evidence of hypovolemic or hemorrhagic shock.
T309 480531-480578 Sentence denotes Examine the respiratory and neurologic systems.
T310 480579-480638 Sentence denotes Be sure to establish an airway and treat shock, if present.
T311 480639-480777 Sentence denotes Control hemorrhage and stabilize the cardiovascular system before attempting to replace the globe within its orbit or perform enucleation.
T312 480778-480988 Sentence denotes During the initial management of the cardiovascular and respiratory systems, the eye should be covered with an ophthalmic grade ointment or sponges soaked in sterile saline to prevent the globe from drying out.
T313 480989-481166 Sentence denotes Proptosis of the globe can be associated with serious intraocular problems including iritis, chorioretinitis, retinal detachment, lens luxation, and avulsion of the optic nerve.
T314 481167-481253 Sentence denotes Stain the surface of the eye with fluorescein to look for topical abrasions or ulcers.
T315 481254-481364 Sentence denotes Carefully examine the sclera, cornea, and conjunctiva for penetrating injuries that may allow aqueous leakage.
T316 481365-481429 Sentence denotes Evaluate the size, location, and response to light of the pupil.
T317 481430-481486 Sentence denotes A reactive pupil is better than a mydriatic fixed pupil.
T318 481487-481672 Sentence denotes Topical administration of a mydriatic (atropine 1%) to prevent persistent miosis and synechia formation is indicated, along with topical and oral antibiotics and oral analgesic therapy.
T319 481673-481746 Sentence denotes Reposition the proptosed globe with the patient under general anesthesia.
T320 481747-481813 Sentence denotes Make a lateral canthotomy incision to widen the palpebral fissure.
T321 481814-481892 Sentence denotes Lavage the globe with sterile saline irrigation to remove any external debris.
T322 481893-482109 Sentence denotes Place a copious amount of triple antibiotic ophthalmic ointment on the surface of the eye and then gently press the globe into the orbit using the flat side of a scalpel handle or a moistened sterile surgical sponge.
T323 482110-482218 Sentence denotes Do not probe the retroorbital space with a needle or attempt to reduce intraocular pressure by paracentesis.
T324 482219-482330 Sentence denotes When the globe is replaced in the orbit, close the lateral canthotomy incision with simple interrupted sutures.
T325 482331-482424 Sentence denotes Place three nonpenetrating mattress sutures in the lid margins but do not draw them together.
T326 482425-482586 Sentence denotes Tighten the lid sutures through small pieces of a red rubber catheter or length of intravenous extension tubing to prevent the sutures from causing lid necrosis.
T327 482587-482664 Sentence denotes Leave the medial canthus of the eye open in order to allow topical treatment.
T328 482665-482755 Sentence denotes Postoperative treatment is directed at preventing further iritis and preventing infection.
T329 482756-482854 Sentence denotes Administer systemic broad-spectrum antibiotics (Clavamox, 16.25 mg/kg PO bid) and analgesic drugs.
T330 482855-483041 Sentence denotes Apply topical triple antibiotic ophthalmic ointment ( 1 ⁄4 inch in affected eye q6-8h) and atropine (1% in affected eye q12h) to prevent infection, cycloplegia, and 1 anterior synechiae.
T331 483042-483167 Sentence denotes Antiinflammatory doses of systemic steroids can also be added to the treatment if severe periorbital inflammation is present.
T332 483168-483302 Sentence denotes Systemic steroids should never be used in conjunction with NSAIDs, because of the risk of gastrointestinal ulceration and perforation.
T333 483303-483363 Sentence denotes The sutures should remain in place for a minimum of 3 weeks.
T334 483364-483422 Sentence denotes After this time, remove the sutures and inspect the globe.
T335 483423-483465 Sentence denotes If proptosis recurs, repeat the treatment.
T336 483466-483543 Sentence denotes After proptosis, strabismus is common secondary to periorbital muscle injury.
T337 483544-483612 Sentence denotes Even after extensive treatment, vision in the eye may still be lost.
T338 483613-483674 Sentence denotes Nonvisual eyes can remain in place, but phthisis may develop.
T339 483675-483893 Sentence denotes Carbonic anhydrase inhibitors such as acetazolamide and dichlorphenamide decrease aqueous secretion and may effectively reduce intraocular pressure if the trabecular outflow is still functioning at 40% of its capacity.
T340 483894-484018 Sentence denotes An eye with a poorly functional trabecular outflow system will respond poorly to therapy with carbonic anhydrase inhibitors.
T341 484019-484123 Sentence denotes Osmotic agents such as mannitol or glycerol may be helpful in controlling glaucoma secondary to hyphema.
T342 484124-484236 Sentence denotes Reduction in vitreous chamber size can make the anterior chamber deeper and may allow increased aqueous outflow.
T343 484237-484454 Sentence denotes Evacuation of blood or blood clots from the anterior chamber is not advisable unless the glaucoma cannot be controlled medically or there is no indication after a prolonged period of time that blood is being resorbed.
T344 484455-484579 Sentence denotes Tissue plasminogen activator (t-PA) has proved to be useful in lysing blood clots and preventing excessive fibrin formation.
T345 484580-484690 Sentence denotes The t-PA is reconstituted to make a solution of 250 mcg/mL, which is then frozen at −70° C in 0.5-mL aliquots.
T346 484691-484767 Sentence denotes The thawed, warmed reconstituted t-PA is injected into the anterior chamber.
T347 484768-485025 Sentence denotes Blind probing of the anterior chamber of the eye and surgical intervention in an attempt to remove blood clots can cause serious complications such as rebleeding, lens luxation, iris damage, and damage to the corneal epithelium and therefore is not advised.
T348 485026-485117 Sentence denotes Acute glaucoma is a rise in intraocular pressure that is not compatible with normal vision.
T349 485118-485215 Sentence denotes Glaucoma may manifest as early acute congestive or noncongestive glaucoma or as endstage disease.
T350 485216-485464 Sentence denotes Cardinal signs of glaucoma are a sudden onset of pain, photophobia, lacrimation, deep episcleral vascular engorgement, edematous insensitive cornea, shallow anterior chamber depth, dilated unresponsive pupil, loss of visual acuity, and buphthalmia.
T351 485465-485601 Sentence denotes Intraocular pressure usually exceeds 40 mm Hg but may be normal or only slightly increased if glaucoma is secondary to anterior uveitis.
T352 485602-485690 Sentence denotes Most forms of clinical glaucoma in dogs are secondary to some other intraocular problem.
T353 485691-485904 Sentence denotes Primary glaucoma is recognized in some breeds, including the Bassett Hound, Cocker Spaniel, Samoyed, Bouvier des Flandres, and some Terrier breeds, either from goniodysgenesis or a predisposition to lens luxation.
T354 485905-486070 Sentence denotes Other common causes of acute glaucoma are anterior uveitis and intumescent lens secondary to rapid cataract development, particularly in dogs with diabetes mellitus.
T355 486071-486215 Sentence denotes Treatment involves investigation of the underlying cause of the sudden rise in intraocular pressure and rapid reduction in intraocular pressure.
T356 486216-486362 Sentence denotes Permanent visual impairment is often associated with chronically buphthalmic globes or the presence of rippling or striae formation on the cornea.
T357 486363-486419 Sentence denotes Referral to a veterinary ophthalmologist is recommended.
T358 486420-486541 Sentence denotes If the eye is still visual and not buphthalmic, the prognosis is favorable, depending on the cause of the acute glaucoma.
T359 486542-486716 Sentence denotes Treatment to reduce intraocular pressure consists of improving aqueous outflow, reducing intraocular volume with osmotic agents, and reducing aqueous formation (Table 1-47) .
T360 486717-486860 Sentence denotes The use of topical mydriatic agents in acute glaucoma is contraindicated because of the risk of making lens luxation or anterior uveitis worse.
T361 486861-486999 Sentence denotes Referral to a veterinary ophthalmologist for emergency surgery is indicated in cases of iris bombe, intumescent lens, or lens subluxation.
T362 487000-487092 Sentence denotes Administer osmotic agents to reduce the size of the vitreous body and the amount of aqueous.
T363 487093-487281 Sentence denotes Osmotic agents create an osmotic gradient between the intraocular fluids and the vascular bed, thus allowing osmotic removal of fluid independent of the aqueous inflow and outflow systems.
T364 487282-487421 Sentence denotes If no other treatments are available, oral glycerol (50%, 1-2 ml/kg or 1-2 g/kg PO) can be used to effectively reduce intraocular pressure.
T365 487422-487495 Sentence denotes An adverse side effect of oral glycerol treatment is protracted vomiting.
T366 487496-487538 Sentence denotes Do not use glycerol in a diabetic patient.
T367 487539-487657 Sentence denotes Mannitol (0.5-1 g/kg IV over 10-20 minutes) also effectively reduces intraocular pressure but does not cause vomiting.
T368 487658-487760 Sentence denotes Carbonic anhydrase inhibitors can be used to reduce intraocular volume by reducing aqueous production.
T369 487761-487976 Sentence denotes Oral administration of dichlorphenamide, methazolamide, and acetazolamide (2 to 4 mg/kg) is usually not very effective alone in reducing aqueous volume and intraocular pressure and also can cause metabolic acidosis.
T370 487977-488149 Sentence denotes Topical carbonic anhydrase inhibitors appear to be more effective (dorzolamide, Trusopt) when used in conjunction with topical β-blockers (timolol, 0.5% solution only BID).
T371 488150-488266 Sentence denotes The most effective treatment for acute pressure reduction is use of a topical prostaglandin inhibitor (latanoprost).
T372 488267-488447 Sentence denotes Usually just one or two drops effectively reduces intraocular pressure in the emergency stages, until the patient can be referred to a veterinary ophthalmologist the following day.
T373 488448-488569 Sentence denotes Many clinical conditions that are presented as emergencies may be caused in part or wholly by the presence of a neoplasm.
T374 488570-488621 Sentence denotes Paraneoplastic signs are summarized in Table 1 -48.
T375 488622-488828 Sentence denotes Prompt identification of the neoplasia combined with knowledge of treatment, expected response to therapy, and long-term prognosis can aid owners and practitioners in making appropriate treatment decisions.
T376 488829-488939 Sentence denotes Hemorrhage or effusion can occur in any body cavity as a result of the presence of benign or malignant tumors.
T377 488940-489010 Sentence denotes Tumors secrete anticoagulants to allow angiogenesis to grow unchecked.
T378 489011-489130 Sentence denotes Hemorrhage often occurs as a result of rupture of a neoplasm or invasion of a neoplasm into a major vascular structure.
T379 489131-489257 Sentence denotes Effusion may be the result of direct fluid production by the mass or may be caused by obstruction of lymphatic or venous flow.
T380 489258-489370 Sentence denotes Hemorrhagic effusions in the abdominal cavity occur most commonly with neoplastic masses of the spleen or liver.
T381 489371-489443 Sentence denotes The most common causes are hemangiosarcoma and hepatocellular carcinoma.
T382 489444-489670 Sentence denotes Clinical signs associated with acute abdominal hemorrhage, regardless of the cause, are related to hypovolemic shock and decreased perfusion and include pale mucous membranes, tachycardia, anemia, lethargy, and acute collapse.
T383 489671-490009 Sentence denotes Treatment for abdominal hemorrhage includes placement of a large-bore peripheral cephalic catheter and starting one fourth of a shock dose (90 mL/kg for dogs and 44 mL/kg for cats) of intravenous crystalloid fluids, taking care to carefully monitor perfusion parameters of heart rate, capillary refill time, mucous membrane color, and BP.
T384 490010-490159 Sentence denotes Administer intravenous colloids such as hydroxyethyl starch or pentastarch (5 to 10 mL/kg IV bolus) to restore intravascular volume and normotension.
T385 490160-490330 Sentence denotes Treat severe anemia with whole blood or packed RBCs to improve oxygen-carrying capacity and oxygen delivery (see sections on transfusion medicine and treatment of shock).
T386 490331-490418 Sentence denotes Confirm the presence of hemoabdomen abdominocentesis (see section on abdominocentesis).
T387 490419-490498 Sentence denotes The presence of nonclotting hemorrhagic effusion is consistent with free blood.
T388 490499-490580 Sentence denotes PCV of the fluid is usually the same or higher than that of the peripheral blood.
T389 490581-490674 Sentence denotes An abdominal compression bandage can be placed while further diagnostics are being performed.
T390 490675-490832 Sentence denotes In cases of acute hemoabdomen, obtain right lateral, left lateral, and ventrodorsal or dorsoventral thoracic radiographs to help rule out obvious metastasis.
T391 490833-490935 Sentence denotes Monitor the patient's ECG and correct dysrhythmias as necessary (see section on cardiac dysrhythmias).
T392 490936-490988 Sentence denotes Surgery is indicated once the patient is stabilized.
T393 490989-491084 Sentence denotes In some cases, hemorrhage is so severe that the patient should be taken immediately to surgery.
T394 491085-491234 Sentence denotes When recommending surgery for a hemorrhaging intraabdominal mass, it is important to discuss likely diagnoses and long-term prognosis with the owner.
T395 491235-491296 Sentence denotes Hemangiosarcoma usually involves the spleen or liver or both.
T396 491297-491392 Sentence denotes The presence of free abdominal hemorrhage is associated with a malignant tumor in 80% of cases.
T397 491393-491484 Sentence denotes Even when free abdominal hemorrhage is not present, the tumor is malignant in 50% of cases.
T398 491485-491724 Sentence denotes Approximately 66% (two thirds) of masses in the spleen are malignant (hemangiosarcoma, lymphoma, mast cell tumor, malignant fibrous histiocytoma, leiomyosarcoma, fibrosarcoma), and approximately one third are benign (hematoma, hemangioma).
T399 491725-491840 Sentence denotes Hepatocellular carcinoma usually affects one liver lobe (usually the left), and surgery is the treatment of choice.
T400 491841-491922 Sentence denotes With complete surgical excision, median survival in dogs is longer than 300 days.
T401 491923-492000 Sentence denotes If diffuse disease is observed at the time of surgery, the prognosis is poor.
T402 492001-492144 Sentence denotes Nonhemorrhagic effusions are associated with mesothelioma, lymphoma, carcinomatosis, or any mass that causes vascular or lymphatic obstruction.
T403 492145-492331 Sentence denotes Clinical signs of respiratory distress and abdominal distension with nonhemorrhagic effusions are usually slowly progressive in onset and not as severe as those observed with hemorrhage.
T404 492332-492401 Sentence denotes Treatment is usually aimed at identification of the underlying cause.
T405 492402-492464 Sentence denotes Obtain a fluid sample via thoracocentesis or abdominocentesis.
T406 492465-492591 Sentence denotes To obtain further cells for cytologic evaluation, aspirate fluid from the thoracic or abdominal mass with ultrasound guidance.
T407 492592-492735 Sentence denotes Cytologic evaluation of the fluid will often elucidate the causative Mesothelioma is a rare tumor most commonly observed in urban environments.
T408 492736-492806 Sentence denotes In humans, mesothelioma has been associated with exposure to asbestos.
T409 492807-492917 Sentence denotes It is sometimes difficult to differentiate between reactive mesothelial cells and malignant mesothelial cells.
T410 492918-492976 Sentence denotes Treatment is aimed at controlling the neoplastic effusion.
T411 492977-493097 Sentence denotes Intracavitary cisplatin has been demonstrated to slow rates of fluid reaccumulation but is largely a palliative therapy.
T412 493098-493178 Sentence denotes Lymphoma is another type of tumor that can cause thoracic or abdominal effusion.
T413 493179-493251 Sentence denotes Cytologic evaluation of the fluid usually reveals abundant lymphoblasts.
T414 493252-493404 Sentence denotes Treatment with multiagent chemotherapy protocols, with or without adjunctive radiation therapy, can prevent tumor remission and stop fluid accumulation.
T415 493405-493537 Sentence denotes Carcinomatosis occurs as a result of diffuse seeding of the abdominal cavity with malignant carcinomas and carries a poor prognosis.
T416 493538-493609 Sentence denotes Carcinomatosis may occur de novo or from metastasis of a primary tumor.
T417 493610-493746 Sentence denotes Treatment consists of fluid removal when respiratory difficulty occurs, with or without intracavitary cisplatin as a palliative measure.
T418 493747-493825 Sentence denotes Cisplatin should never be used in cats because of fatal acute pulmonary edema.
T419 493826-493965 Sentence denotes Clinical signs of hemorrhagic thoracic effusion include acute respiratory distress, anemia, hypovolemic or cardiogenic shock, and collapse.
T420 493966-494047 Sentence denotes Hemorrhagic thoracic effusions are rare in association with neoplastic effusions.
T421 494048-494139 Sentence denotes A notable exception is intrathoracic hemorrhage in young dogs with osteosarcoma of the rib.
T422 494140-494212 Sentence denotes Hemorrhage can result when a primary lung tumor erodes through a vessel.
T423 494213-494315 Sentence denotes Hemangiosarcoma of the lungs or right auricular area can also result in hemorrhagic thoracic effusion.
T424 494316-494471 Sentence denotes In many cases, hemorrhage may be confined to the pericardial sac with a right auricular mass, causing a globoid cardiac silhouette on thoracic radiographs.
T425 494472-494697 Sentence denotes Treatment consists of pericardiocentesis (see section on pericardial effusion and pericardiocentesis) and placement of a pericardial window, or the mass may be removed if it is in the right auricular appendage and resectable.
T426 494698-494821 Sentence denotes Although surgery can resolve clinical signs of right-sided heart failure, metastatic disease often develops soon afterward.
T427 494822-494988 Sentence denotes Nonhemorrhagic thoracic effusion is more common than hemorrhagic thoracic effusion and is caused most commonly by mesothelioma, lymphoma, carcinomatosis, and thymoma.
T428 494989-495078 Sentence denotes Clinical signs develop gradually and include respiratory difficulty, cyanosis, and cough.
T429 495079-495122 Sentence denotes Supplemental oxygen should be administered.
T430 495123-495188 Sentence denotes In many cases, thoracocentesis can be therapeutic and diagnostic.
T431 495189-495301 Sentence denotes Obtain thoracic radiographs both before and after thoracocentesis to determine whether a mass effect is present.
T432 495302-495372 Sentence denotes After identification of a cause, definitive therapy can be instituted.
T1 495373-495444 Sentence denotes Mesotheliomas are rare and are associated with diffuse serosal disease.
T2 495445-495487 Sentence denotes They are more common in dogs than in cats.
T3 495488-495569 Sentence denotes Effusions caused by mesotheliomas can affect the pleural or pericardial cavities.
T4 495570-495937 Sentence denotes Treatment is directed at removing effusion fluid and controlling reaccumulation with use of intracavitary platinum compounds; carboplatin and cisplatin can be used in dogs. (Cisplatin and carboplatin should never be used in cats.) Chemical or physical pleurodesis may be helpful in controlling reaccumulation of fluid, but it is very painful in small animal patients.
T5 495938-496032 Sentence denotes Thoracic effusion secondary to lymphoma often is associated with an anterior mediastinal mass.
T6 496033-496110 Sentence denotes T-cell lymphoma is the most common type of mediastinal mass observed in dogs.
T7 496111-496210 Sentence denotes B-cell lymphoma is associated with a decreased response to chemotherapy and shorter survival times.
T8 496211-496314 Sentence denotes Treatment consists of combination chemotherapy with or without radiation therapy to decrease mass size.
T9 496315-496471 Sentence denotes Carcinomatosis is a diffuse disease of the pleural cavity that often is a result of metastasis from a primary pulmonary carcinoma or mammary adenocarcinoma.
T10 496472-496587 Sentence denotes Treatment is similar to that for mesothelioma and is aimed at controlling the effusion and delaying its recurrence.
T11 496588-496640 Sentence denotes Thymomas have been documented in both dogs and cats.
T12 496641-496846 Sentence denotes Dogs most commonly are presented with a cough, whereas cats are presented with clinical signs of respiratory distress and a restrictive respiratory pattern associated with the presence of pleural effusion.
T13 496847-496918 Sentence denotes An anterior mediastinal mass is often observed on thoracic radiographs.
T14 496919-497015 Sentence denotes In some cases the pleural effusion must be drained via thoracocentesis before a mass is visible.
T15 497016-497156 Sentence denotes Ultrasound-guided aspiration and cytologic evaluation of the mass reveal a malignant epithelial tumor with small lymphocytes and mast cells.
T16 497157-497214 Sentence denotes Prognosis is good if the tumor can be completely excised.
T17 497215-497319 Sentence denotes Treatment consists of surgical removal with or without presurgical radiation therapy to shrink the mass.
T18 497320-497409 Sentence denotes Paraneoplastic syndromes of myasthenia gravis have been documented in dogs with thymomas.
T19 497410-497535 Sentence denotes If megaesophagus or aspiration pneumonia is present, the prognosis is more guarded because of the high rate of complications.
T20 497536-497700 Sentence denotes Obstructive lesions affecting the urinary tract can be extramural (intraabdominal, pelvic, or retroperitoneal) or intramural (urethral, bladder, or urethral wall) .
T21 497701-497787 Sentence denotes Transitional cell carcinoma is the most common type of bladder tumor observed in dogs.
T22 497788-497955 Sentence denotes Prostatic adenocarcinoma, or neoplasia of the sublumbar lymph nodes (lymphoma, adenocarcinoma from apocrine gland adenocarcinoma), also can cause urethral obstruction.
T23 497956-498061 Sentence denotes Treatment is aimed at relieving the obstruction and then attempting to identify the cause of the disease.
T24 498062-498134 Sentence denotes To alleviate the obstruction, pass a urinary catheter whenever possible.
T25 498135-498312 Sentence denotes Perform cystocentesis only as a last resort because of the risk of seeding the peritoneal cavity with tumor cells if transitional cell carcinoma is the cause of the obstruction.
T26 498313-498415 Sentence denotes Institute supportive therapy including intravenous fluids and correction of electrolyte abnormalities.
T27 498416-498517 Sentence denotes Plain radiographs may reveal a mass lesion or may not be helpful without double contrast cystography.
T28 498518-498609 Sentence denotes Abdominal ultrasound is more sensitive in identifying a mass lesion in the urinary bladder.
T29 498610-498687 Sentence denotes Masses in the pelvic urethra are difficult to visualize with ultrasonography.
T30 498688-498736 Sentence denotes Double contrast cystourethrography is preferred.
T31 498737-498862 Sentence denotes Once the patient has been stabilized, biopsy or surgery is indicated to identify the cause of the mass and attempt resection.
T32 498863-498982 Sentence denotes Urine tests for transitional cell carcinoma are available for identification of transitional cell carcinoma in the dog.
T33 498983-499121 Sentence denotes Complete surgical excision of transitional cell carcinoma or removal of benign tumors of the urinary bladder yields a favorable prognosis.
T34 499122-499172 Sentence denotes Poorer prognosis is seen with incomplete excision.
T35 499173-499289 Sentence denotes Many transitional cell carcinomas are located in the trigone region of the bladder and cannot be completely excised.
T36 499290-499390 Sentence denotes The NSAID piroxicam is helpful in alleviating clinical signs for a reported 7-month median survival.
T37 499391-499483 Sentence denotes In some dogs, cisplatin and carboplatin may delay recurrence of transitional cell carcinoma.
T38 499484-499604 Sentence denotes Tumors of the prostate gland are always malignant and occur with equal frequency in castrated and uncastrated male dogs.
T39 499605-499766 Sentence denotes Diagnosis of prostatic tumors is based on ultrasonographic evidence of a mass effect or prostatomegaly and on transrectal or transabdominal aspiration or biopsy.
T40 499767-499941 Sentence denotes Surgery, chemotherapy, and radiation therapy generally are unrewarding over the long term, although palliative radiation therapy may relieve clinical signs for 2 to 6 months.
T41 499942-500145 Sentence denotes Luminal tumors of the gastrointestinal tract typically cause obstruction, with slowly progressive clinical signs including vomiting, inappetence, and weight loss or with acute severe protracted vomiting.
T42 500146-500262 Sentence denotes Extraluminal obstructive lesions usually arise from adhesions, or strangulation may occur, resulting in obstruction.
T43 500263-500348 Sentence denotes Perforation of the mass through the gastric or intestinal wall can cause peritonitis.
T44 500349-500587 Sentence denotes Treatment consists of initial stabilization and rehydration, evaluation for evidence of metastasis, and surgical resection of the affected area in cases of adenocarcinoma, leiomyoma, leiomyosarcoma, and obstructive or perforated lymphoma.
T45 500588-500687 Sentence denotes Gastric and intestinal adenocarcinoma are the most common gastrointestinal tumors observed in dogs.
T46 500688-500769 Sentence denotes Affected animals typically have a history of anorexia, weight loss, and vomiting.
T47 500770-500831 Sentence denotes Obtain an abdominal ultrasound before performing any surgery.
T48 500832-500966 Sentence denotes Fine needle aspirates of the mass and adjacent lymph nodes are usually diagnostic and can determine whether there is local metastasis.
T49 500967-501051 Sentence denotes Many tumors are not resectable, and metastasis occurs in approximately 70% of cases.
T50 501052-501135 Sentence denotes Dogs with smaller tumors that can be resected typically have longer survival times.
T51 501136-501280 Sentence denotes Leiomyosarcomas occur in the intestines of dogs and carry a more favorable prognosis than adenocarcinoma if the mass can be completely resected.
T52 501281-501354 Sentence denotes With complete resection, the average survival time is longer than 1 year.
T53 501355-501438 Sentence denotes The paraneoplastic syndrome of hypoglycemia has been observed with this tumor type.
T54 501439-501537 Sentence denotes Gastrointestinal lymphoma is the most common tumor of the gastrointestinal tract observed in cats.
T55 501538-501583 Sentence denotes In comparison, it is relatively rare in dogs.
T56 501584-501733 Sentence denotes Unless there is complete obstruction or perforation of the gastrointestinal tract, surgical treatment for gastrointestinal lymphoma is not indicated.
T57 501734-501891 Sentence denotes Rather, multiple chemotherapy drugs are used in combination to achieve remission and resolution of the clinical signs of anorexia, weight loss, and vomiting.
T58 501892-501935 Sentence denotes Treatment responses unfortunately are poor.
T59 501936-502073 Sentence denotes Mast cell tumors of the gastrointestinal tract typically manifest as gastrointestinal ulceration and hemorrhage in up to 83% of patients.
T60 502074-502224 Sentence denotes The gastrointestinal hemorrhage that occurs with mast cell tumors results from increased acid secretion as a result of histamine receptor stimulation.
T61 502225-502335 Sentence denotes Treatment consists of histamine or proton pump inhibition (ranitidine, famotidine, cimetidine, or omeprazole).
T62 502336-502377 Sentence denotes Bowel perforation is a rare complication.
T63 502378-502471 Sentence denotes Many chemotherapy agents exert their effects on rapidly dividing normal and neoplastic cells.
T64 502472-502612 Sentence denotes Normal tissues that are commonly affected include the bone marrow, gastrointestinal tract, skin and hair follicles, and reproductive organs.
T65 502613-502685 Sentence denotes Some drugs have unique organ-specific toxicities that must be monitored.
T66 502686-502862 Sentence denotes Knowledge and recognition of the expected type and onset of complications can alleviate their severity by permitting rapid treatment when complications occur (see Table 1 -48).
T67 502863-502990 Sentence denotes Neutropenia is the most common bone marrow toxicity observed secondary to chemotherapy in small animal patients (Table 1 -49) .
T68 502991-503039 Sentence denotes In most cases the neutropenia is dose-dependent.
T69 503040-503143 Sentence denotes The nadir, or lowest neutrophil count, is typically observed 5 to 10 days after chemotherapy treatment.
T70 503144-503286 Sentence denotes Once the nadir occurs, bone marrow recovery is observed, with an increase in circulating neutrophils within 36 to 72 hours (see Table 1 -49) .
T71 503287-503366 Sentence denotes Treatment of myelosuppression is largely supportive to treat or prevent sepsis.
T72 503367-503466 Sentence denotes Prophylactic antibiotics are recommended in the afebrile patient with a neutrophil count <2000/mcL.
T73 503467-503545 Sentence denotes Acceptable antibiotics include trimethoprim-sulfa and amoxicillin-clavulanate.
T74 503546-503998 Sentence denotes Mild to none Not observed Vincristine (low-dose), l-asparaginase, glucocorticosteroids Moderate 7-10 days Melphalan, cisplatin, mitoxantrone, actinomycin D Severe 7-10 days Doxorubicin, cyclophosphamide, vinblastine 1 Granulocyte colony-stimulating factor (G-CSF) (e.g., Neupogen) is a recombinant human product that stimulates the release of neutrophils from the bone marrow, and its use shortens the recovery time after myelosuppressive drug therapy.
T75 503999-504114 Sentence denotes Disadvantages of G-CSF include antibody production in response to the drug within 4 weeks of use and its high cost.
T76 504115-504251 Sentence denotes To prevent ongoing neutropenia, subsequent chemotherapy doses should be decreased by 25%, and the interval between treatments increased.
T77 504252-504323 Sentence denotes Whenever possible, overlap of myelosuppressive drugs should be avoided.
T78 504324-504439 Sentence denotes Acute gastrointestinal toxicity can occur within 6 to 12 hours after administration of cisplatin and actinomycin D.
T79 504440-504612 Sentence denotes In many cases, pretreatment with the antiemetic metoclopramide, butorphanol, chlorpromazine, dolasetron or ondansetron can prevent chemotherapy-induced nausea and vomiting.
T80 504613-504762 Sentence denotes Vomiting can also occur as a delayed side effect 3 to 5 days after treatment with doxorubicin (Adriamycin), actinomycin D, methotrexate, and Cytoxan.
T81 504763-504854 Sentence denotes In delayed reactions, vomiting and diarrhea are caused by damage to intestinal crypt cells.
T82 504855-504963 Sentence denotes Treatment consists of administration of antiemetics, intravenous fluids, and a bland highly digestible diet.
T83 504964-505048 Sentence denotes Doxorubicin also can cause hemorrhagic colitis within 5 to 7 days of administration.
T84 505049-505133 Sentence denotes Treatment includes a bland diet, metronidazole, and tylosin tartrate (Tylan powder).
T85 505134-505214 Sentence denotes Paralytic ileus can be observed 2 to 5 days after administration of vincristine.
T86 505215-505364 Sentence denotes This side effect is more common in humans than animals and can be treated with metoclopramide once a gastrointestinal obstruction has been ruled out.
T87 505365-505501 Sentence denotes Cardiotoxicity Doxorubicin (Adriamycin) causes a dose-dependent dilative cardiomyopathy when the cumulative dose reaches 90-240 mg/m 2 .
T88 505502-505595 Sentence denotes In many cases, however, clinical signs do not occur until the cumulative dose is 240 mg/m 2 .
T89 505596-505636 Sentence denotes The myocardial lesions are irreversible.
T90 505637-505754 Sentence denotes Treatment of cardiac dysrhythmias is dependent on the type of dysrhythmia (see section on treatment of dysrhythmias).
T91 505755-505960 Sentence denotes Discontinue doxorubicin and administer diuretics and positive inotropic therapy for dilative cardiomyopathy in order to delay the progression of CHF (see sections on treatment of congestive heart failure).
T92 505961-506137 Sentence denotes If abnormalities are shown on electrocardiography performed before beginning therapy, substitute liposome-encapsulated doxorubicin or mitoxantrone in the chemotherapy protocol.
T93 506138-506291 Sentence denotes Cardioprotectant drugs such as vitamin E, selenium, and N-acetylcysteine have shown some promise in the prevention of doxorubicin-induced cardiotoxicity.
T94 506292-506350 Sentence denotes Cyclophosphamide can cause a sterile hemorrhagic cystitis.
T95 506351-506443 Sentence denotes Damage to the urinary bladder mucosa and vessels is caused by the toxic metabolite acrolein.
T96 506444-506584 Sentence denotes Clinical signs of sterile hemorrhagic cystitis include a history of cyclophosphamide administration, stranguria, hematuria, and pollakiuria.
T97 506585-506806 Sentence denotes Treatment for sterile hemorrhagic cystitis is discontinuation of the drug, treatment of any underlying urinary tract infection with antibiotic therapy based on susceptibility testing, and intravesicle drug administration.
T98 506807-506916 Sentence denotes In extremely refractory cases, surgical debridement and cauterization of the bladder mucosa may be necessary.
T99 506917-507043 Sentence denotes Prevention of sterile hemorrhagic cystitis includes emptying the bladder frequently and administering the drug in the morning.
T100 507044-507101 Sentence denotes Concurrent administration of prednisone can induce PU/PD.
T101 507102-507202 Sentence denotes If sterile hemorrhagic cystitis occurs, chlorambucil can be substituted as a chemotherapeutic agent.
T102 507203-507326 Sentence denotes Anaphylactic reactions have been observed with the administration of l-asparaginase, Adriamycin, etoposide, and paclitaxel.
T103 507327-507473 Sentence denotes The risk of anaphylaxis increases with repeated administration, although in some animals anaphylaxis will occur on the first exposure to the drug.
T104 507474-507686 Sentence denotes Treatment consists of administration of epinephrine, diphenhydramine, 1 famotidine, and glucocorticosteroids, as with any other life-threatening allergic reaction (see section on treatment of allergic reactions).
T105 507687-507897 Sentence denotes To decrease the risk of an adverse reaction, give diphenhydramine (For dogs up to 20 lbs, 10 mg IV; For dogs 20-60 lbs, 20 mg IV; and for dogs over 60 lbs, 30 mg IV) 15 to 30 minutes before drug administration.
T106 507898-507996 Sentence denotes Slowing the rate of intravenous infusion also can decrease the chance of an anaphylactic reaction.
T107 507997-508151 Sentence denotes Acute tumor lysis results from massive destruction of neoplastic cells after chemotherapy or radiation, particularly in veterinary patients with lymphoma.
T108 508152-508291 Sentence denotes The release of cellular contents after cell death can result in hyperkalemia, hyperphosphatemia, azotemia, hyperuricemia, and hypocalcemia.
T109 508292-508389 Sentence denotes Risk factors for acute tumor lysis include high tumor burden and preexisting renal insufficiency.
T110 508390-508563 Sentence denotes Treatment for suspected acute tumor lysis includes intravenous fluid diuresis, antiemetics if the patient is vomiting, and broad-spectrum antibiotics if diarrhea is present.
T111 508564-508650 Sentence denotes Cisplatin can cause a fatal irreversible pulmonary edema in cats, even at low dosages.
T112 508651-508750 Sentence denotes 5-Fluorouracil (5-FU) can cause a severe neurotoxicity in cats that results in ataxia and seizures.
T113 508751-508787 Sentence denotes Never use cisplatin or 5-FU in cats.
T114 508789-508846 Sentence denotes Poisoning cases benefit from a rapid, organized approach.
T115 508847-509003 Sentence denotes Key points in this approach are giving appropriate advice over the telephone, being able to access information sources, and providing appropriate treatment.
T116 509004-509099 Sentence denotes Only a few classes of poisons account for the majority of toxicities reported in dogs and cats.
T117 509100-509256 Sentence denotes Every veterinarian should develop a familiarity with the clinical management of rodenticide and insecticide toxicity and be prepared with antidotes on hand.
T118 509257-509398 Sentence denotes Beyond the most common toxins, the spectrum of possibilities is endless, and the veterinarian must rely on appropriate information resources.
T119 509399-509509 Sentence denotes It is important to have available a comprehensive source of pharmaceutical and plant identification resources.
T120 509510-509684 Sentence denotes Remarkably, considering the myriad potentially toxic substances to which an animal can be exposed, relatively few specific antidotes are commonly used in veterinary medicine.
T121 509685-509934 Sentence denotes Because of the lack of specific antidotes, the veterinarian must treat each toxicity with general methods of poison management, applying basic critical care in the treatment of specific clinical signs associated with the poison exposure or toxicity.
T122 509935-510073 Sentence denotes The adage "Treat the patient, not the poison" often comes into play when the exact toxic substance is unknown or has no specific antidote.
T123 510074-510286 Sentence denotes Before an animal arrives, the staff should be prepared to ask specific questions over the phone and provide initial advice for clients, particularly if the animal lives some distance from the hospital (Box 1-55).
T124 510287-510367 Sentence denotes It is important to have access to a database of information on toxic substances.
T125 510368-510444 Sentence denotes Thousands of potentially toxic substances are available on the market today.
T126 510445-510627 Sentence denotes The American Society for the Prevention of Cruelty to Animals (ASPCA) Animal Poison Control Center provides direct access to veterinary toxicologists 24 hours a day, 365 days a year.
T127 510628-510722 Sentence denotes For additional information, call the nearest veterinary school or emergency center (Box 1-56).
T128 510723-510777 Sentence denotes Also, see Section 6 for a table of emergency hotlines.
T129 510778-510908 Sentence denotes Check your local telephone book for a poison control center listing under emergency numbers, usually found inside the front cover.
T130 510909-511214 Sentence denotes Although these numbers are for organizations dealing with human poisonings, they have access to extensive poison and toxin databases and can potentially provide useful information for veterinarians, particularly regarding antidotal substances suitable for out-of-the-ordinary toxins and human medications.
T131 511215-511429 Sentence denotes Information on the toxic ingredients in thousands of medications, insecticides, pesticides, and other registered commercial products has been confidentially placed by the government in these poison control centers.
T132 511430-511528 Sentence denotes As new products are marketed, information regarding toxin ingredients is forwarded to the centers.
T133 511529-511727 Sentence denotes Various e-mail discussion lists can serve as an informative resource for practitioners, but access generally requires an initial subscription and may have the disadvantage of delayed response times.
T134 511728-511823 Sentence denotes They are useful for ideas on standard and long-term therapy, but not 1 emergency stabilization.
T135 511824-511931 Sentence denotes An exception to this is the Veterinary Interactive Network (VIN), which posts message board communications.
T136 511932-512060 Sentence denotes Previous communications from veterinarians who treated a case with the same poison or toxin can be accessed with a subscription.
T137 512061-512132 Sentence denotes Many manufacturers operate an information service about their products.
T138 512133-512240 Sentence denotes If the product label or name is available, check for a telephone number that may route you to a specialist.
T139 512241-512294 Sentence denotes There are six essential steps in treating toxicities:
T140 512295-512297 Sentence denotes 1.
T141 512298-512334 Sentence denotes Performing a physical examination 2.
T142 512335-512375 Sentence denotes Stabilizing the patient's vital signs 3.
T143 512376-512404 Sentence denotes Taking a thorough history 4.
T144 512405-512452 Sentence denotes Preventing continued absorption of the toxin 5.
T145 512453-512503 Sentence denotes Administering specific antidotes when available 6.
T146 512504-512669 Sentence denotes Facilitating clearance or metabolism of the absorbed toxin It is most important to provide symptomatic and supportive care both during and after emergency treatment.
T147 512670-512749 Sentence denotes Immediately on presentation, perform a brief but thorough physical examination.
T148 512750-512861 Sentence denotes Obtain a minimum database as well as serum, urine, or orogastric lavage samples for later toxicologic analyses.
T149 512862-513162 Sentence denotes It is important at this time to systematically evaluate the patient's physical status, focusing particularly on the toxins most common to a particular geographic location and the organ systems most commonly affected by toxins in veterinary medicine-namely, the neurologic and gastrointestinal tracts.
T150 513163-513245 Sentence denotes A checklist is useful when performing a complete physical examination (Box 1-57) .
T151 513246-513342 Sentence denotes The minimum database includes a urine sample, PCV, total protein, serum urea, and serum glucose.
T152 513343-513509 Sentence denotes The information obtained from these simple cage-side tests is useful for determining dehydration, hemoconcentration, azotemia (renal or prerenal), and hypoglycemia or
T153 513511-513534 Sentence denotes What is the pupil size?
T154 513535-513573 Sentence denotes What is the pupil reactivity to light?
T155 513574-513617 Sentence denotes Are the ocular examination findings normal?
T156 513618-513660 Sentence denotes What is the sensitivity to light or sound?
T157 513661-513666 Sentence denotes Nose:
T158 513667-513725 Sentence denotes Is it moist, dry, bubbling, or frothy, or caked with dirt?
T159 513726-513733 Sentence denotes Throat:
T160 513734-513783 Sentence denotes Are there any characteristic odors on the breath?
T161 513784-513879 Sentence denotes Are there any traces of foreign material on the tongue or in the crevices of the teeth or gums?
T162 513880-513956 Sentence denotes Are there petechiae or ecchymosis on the gums or bleeding from the gum line?
T163 513957-513991 Sentence denotes What is the mucous membrane color?
T164 513992-514056 Sentence denotes Is it normal and pink, or dark red (injected), pale, or icteric?
T165 514057-514091 Sentence denotes What is the capillary refill time?
T166 514092-514120 Sentence denotes Is it fast, normal, or slow?
T167 514121-514154 Sentence denotes What is the patient's heart rate?
T168 514155-514212 Sentence denotes Are there any pulse deficits or dysrhythmias auscultated?
T169 514213-514250 Sentence denotes What is the patient's blood pressure?
T170 514251-514292 Sentence denotes What is the quality of the femoral pulse?
T171 514293-514360 Sentence denotes Is it synchronous with the heart rate, or are there dropped pulses?
T172 514361-514417 Sentence denotes Is the pulse bounding, normal, thready, or not palpable?
T173 514418-514467 Sentence denotes What is shown on the patient's electrocardiogram?
T174 514468-514507 Sentence denotes What is the patient's respiratory rate?
T175 514508-514552 Sentence denotes What is the patient's respiratory character?
T176 514553-514593 Sentence denotes Is it normal, fast, shallow, or labored?
T177 514594-514636 Sentence denotes What do you hear on thoracic auscultation?
T178 514637-514691 Sentence denotes Do you hear harsh airway sounds or pulmonary crackles?
T179 514692-514733 Sentence denotes What is the patient's rectal temperature?
T180 514734-514764 Sentence denotes Is there excessive salivation?
T181 514765-514807 Sentence denotes Is there evidence of vomiting or diarrhea?
T182 514808-514839 Sentence denotes Is abdominal palpation painful?
T183 514840-514916 Sentence denotes Do the intestinal loops feel normal, or are they fluid-filled or gas-filled?
T184 514917-514965 Sentence denotes What are the color and consistency of the feces?
T185 514966-515002 Sentence denotes Is there a palpable urinary bladder?
T186 515003-515029 Sentence denotes Is there urine production?
T187 515030-515061 Sentence denotes What is the color of the urine?
T188 515062-515089 Sentence denotes What is the patient's gait?
T189 515090-515123 Sentence denotes Is the patient weak or recumbent?
T190 515124-515146 Sentence denotes Is the patient ataxic?
T191 515147-515193 Sentence denotes Does the patient display signs of hypermetria?
T192 515194-515226 Sentence denotes Are there muscle fasciculations?
T193 515227-515260 Sentence denotes Is there increased extensor tone?
T194 515261-515292 Sentence denotes What is the patient's attitude?
T195 515293-515353 Sentence denotes Score the animal's level of consciousness on a simple scale:
T196 515354-515461 Sentence denotes Alert Responds to voice Responds to touch Responds to painful or noxious stimulus Unresponsive: unconscious
T197 515462-515532 Sentence denotes inTegumenT Are there wet patches that smell of a particular substance?
T198 515533-515582 Sentence denotes Is there any evidence of erythema or ulcerations?
T199 515583-515657 Sentence denotes Does a black light cause the muzzle, paws, prepuce, or vulva to fluoresce?
T200 515658-515705 Sentence denotes Should be normal in poisonings 1 hyperglycemia.
T201 515706-515867 Sentence denotes When appropriate, obtain samples for serum biochemistry profiles, serum electrolytes, blood gases, serum osmolality, complete hemogram, and coagulation profiles.
T202 515868-516012 Sentence denotes Samples of serum, urine, and any vomitus or orogastric lavage contents should be collected and saved for toxicologic analyses as required later.
T203 516013-516191 Sentence denotes Stabilization of vital signs includes four major goals of treatment: maintain respiration, maintain cardiovascular function, control CNS excitation, and control body temperature.
T204 516192-516419 Sentence denotes In any patient with clinical signs of respiratory distress or respiratory dysfunction, supplemental oxygen should be administered via flow-by, oxygen hood, oxygen cage, or nasal, nasopharyngeal, or transtracheal oxygen sources.
T205 516420-516460 Sentence denotes Ventilatory assistance may be necessary.
T206 516461-516588 Sentence denotes Irritant or corrosive substances can cause damage to the oropharyngeal mucosa to such an extent that airway obstruction occurs.
T207 516589-516650 Sentence denotes When necessary, a temporary tracheostomy should be performed.
T208 516651-516759 Sentence denotes Arterial blood gases, pulse oximetry, and capnometry may be required to monitor oxygenation and ventilation.
T209 516760-516929 Sentence denotes At the time of presentation, immediately place an intravenous catheter for administration of intravenous fluids, inotropes, antiarrhythmics, and antidotes, if necessary.
T210 516930-517058 Sentence denotes The initial fluid of choice is a balanced crystalloid solution such as Normosol-R, Plasma-Lyte M, or lactated Ringer's solution.
T211 517059-517150 Sentence denotes Fluid therapy can later be changed based on the patient's acid-base and electrolyte status.
T212 517151-517225 Sentence denotes Some toxins can cause severe dysrhythmias and hypertension or hypotension.
T213 517226-517385 Sentence denotes Monitor BP and perform electrocardiography, and correct any abnormalities according to standard therapy (see sections on hypotension and cardiac dysrhythmias).
T214 517386-517472 Sentence denotes Some toxins cause hemolysis, methemoglobinemia, Heinz body anemia, and coagulopathies.
T215 517473-517564 Sentence denotes Whole blood, fresh frozen plasma, or packed RBCs should be available and used if necessary.
T216 517565-517646 Sentence denotes Treat methemoglobinemia with a combination of ascorbic acid and N-acetylcysteine.
T217 517647-517730 Sentence denotes Many toxins affect the CNS, producing clinical signs of excitation and/or seizures.
T218 517731-517804 Sentence denotes Diazepam is the drug of choice for most but not all seizures and tremors.
T219 517805-517983 Sentence denotes If an animal has CNS excitation secondary to the ingestion of selective norepinephrine reuptake inhibitors, avoid using diazepam, as it can potentially exacerbate clinical signs.
T220 517984-518186 Sentence denotes Muscle relaxants such as guaifenesin (110 mg/kg IV) or methocarbamol (50 to 220 mg/kg IV not to exceed 330 mg/kg/day) may be required to control muscle spasm and tremors associated with some toxicities.
T221 518187-518274 Sentence denotes Consider animals that are in status epilepticus because of toxin exposure at high risk.
T222 518275-518367 Sentence denotes Such patients may not require the full dose of anesthetics or sedatives for seizure control.
T223 518368-518530 Sentence denotes Give phenobarbital (bolus 2-5 mg/kg IV, can repeat every 20 minutes 2 times) or pentobarbital (5 to 15 mg/kg IV to effect) for longer-term management of seizures.
T224 518531-518632 Sentence denotes Core body temperature can easily increase or decrease secondary to increased muscle activity or coma.
T225 518633-518735 Sentence denotes Animals may be hypothermic or hyperthermic, depending on the toxin ingested and the stage of toxicity.
T226 518736-518881 Sentence denotes Manage hypothermia with circulating hot water or hot air blankets, or place bubble wrap or Saran wrap around the animal's peripheral extremities.
T227 518882-519256 Sentence denotes Manage hyperthermia by placing lukewarm wet towels on the patient until the rectal temperature has decreased to 39.5° C (103° F). (See section on hyperthermia and heat-induced illness.) If sedatives or anesthetics have been used, initial hyperthermia may initially resolve because of hypothalamic loss of thermoregulatory control; cool water bathing should not be performed.
T228 519257-519461 Sentence denotes When the patient is first presented to the veterinarian, have the owner complete a toxicologic history form (Figure 1-56) while the animal is being initially assessed and vital signs are being stabilized.
T229 519462-519593 Sentence denotes When initial stabilization of vital signs has been accomplished, the veterinarian can discuss the patient's history with the owner.
T230 519594-519699 Sentence denotes In urgent situations, the veterinarian should obtain a brief history as an initial procedure (Box 1-58) .
T231 519700-519916 Sentence denotes Knowing when the animal was last seen as normal provides a time frame in which the toxic substance was most likely accessed, allowing differential diagnoses to be ranked in some order of probability by rate of onset.
T232 519917-520042 Sentence denotes In eliciting a history from the owner about the animal's access to poisons, it is important not to take anything for granted.
T233 520043-520047 Sentence denotes Many
T234 520049-520114 Sentence denotes When did you first notice that something was wrong with your pet?
T235 520115-520172 Sentence denotes When was the last time you noticed your pet act normally?
T236 520173-520214 Sentence denotes What was the first abnormal sign noticed?
T237 520215-520270 Sentence denotes What other conditions have developed and what are they?
T238 520271-520304 Sentence denotes How soon did other signs develop?
T239 520305-520368 Sentence denotes Have the signs become better or worse since you first saw them?
T240 520369-520401 Sentence denotes What is the name of the product?
T241 520402-520443 Sentence denotes Do you have the container with you today?
T242 520444-520495 Sentence denotes Is it a liquid concentrate, dilute spray, or solid?
T243 520496-520562 Sentence denotes How long ago do you think that your pet was exposed to the poison?
T244 520563-520594 Sentence denotes Where do you think it happened?
T245 520595-520696 Sentence denotes Do you have any over-the-counter or prescription medications that your animal may have had access to?
T246 520697-520741 Sentence denotes Did you give any medications to your animal?
T247 520742-520797 Sentence denotes Is there any possibility of recreational drug exposure?
T248 520798-520842 Sentence denotes Did your pet eat this morning or last night?
T249 520843-520871 Sentence denotes What is he/she normally fed?
T250 520872-520937 Sentence denotes Is there a chance that your pet may have gotten into the garbage?
T251 520938-520989 Sentence denotes Have you fed table scraps or anything new recently?
T252 520990-521002 Sentence denotes If so, what?
T253 521003-521063 Sentence denotes Has your pet been off your property in the last 24-48 hours?
T254 521064-521099 Sentence denotes Does your pet run loose unattended?
T255 521100-521167 Sentence denotes Has your pet had any antiflea/tick medication within the last week?
T256 521168-521242 Sentence denotes Your pet's environment Is your animal kept inside or outside of the house?
T257 521243-521315 Sentence denotes Is your pet kept in a fenced-in yard or allowed to run loose unattended?
T258 521316-521392 Sentence denotes Does your pet have access to neighboring properties (even for a short time)?
T259 521393-521438 Sentence denotes Where has your pet been in the last 24 hours?
T260 521439-521507 Sentence denotes Has your pet traveled outside of your immediate geographic location?
T261 521508-521520 Sentence denotes If so, when?
T262 521521-521571 Sentence denotes Has your pet been to rural areas in the last week?
T263 521572-521615 Sentence denotes Has there been any gardening work recently?
T264 521616-521660 Sentence denotes Does your pet have access to a compost pile?
T265 521661-521714 Sentence denotes Any fertilizers or weed killer used in the last week?
T266 521715-521760 Sentence denotes Any construction work or renovation recently?
T267 521761-521816 Sentence denotes Any mouse or rat poison in your house, yard, or garage?
T268 521817-521897 Sentence denotes Any cleaning products used inside or outside the house within the last 48 hours?
T269 521898-521911 Sentence denotes If so, which?
T270 521912-522156 Sentence denotes Have you changed your radiator fluid or does a car leak antifreeze? owners do not realize how poisonous some substances can be, such as insecticide products, garbage, cleaning chemicals, and over-the-counter (OTC) drugs commonly used by humans.
T271 522157-522391 Sentence denotes Many owners will deny that an animal could have ingested anything that might be toxic, not wanting to believe that the source of the toxin is within their household or property, particularly if recreational drug exposure is suspected.
T272 522392-522778 Sentence denotes It is useful to phrase questions in a neutral fashion-for example, "Is such-and-such present on the premises?" rather than "Could the dog have eaten such-and-such?" If recreational drug exposure is suspected, another way to question the owners is to ask whether they have had any guests in their house recently who may have had such-and-such (e.g., marijuana, cocaine, methamphetamine).
T273 522779-522857 Sentence denotes This approach serves to minimize the suggestion of any bias or preconceptions.
T274 522858-523060 Sentence denotes When questioning an owner about recent events, it is useful to realize and acknowledge that disruption in the household routine is a distinct factor in the occurrence of accidents, including poisonings.
T275 523061-523212 Sentence denotes Examples of such disruptive events include moving from the house, a family member being ill or in the hospital, and renovations or recent construction.
T276 523213-523316 Sentence denotes While these events are occurring, the safeguards followed by a normally careful owner may be disrupted.
T277 523317-523459 Sentence denotes Often, doors or gates may be left open, animals may be outside instead of inside (or vice versa), and inexperienced people may be pet-sitters.
T278 523460-523607 Sentence denotes Once owners are made aware of the importance of assessing such risks, they are often able to provide insight into otherwise baffling circumstances.
T279 523608-523746 Sentence denotes Various methods can be used to remove toxins from the gastrointestinal tract, including emesis, orogastric lavage, cathartics, and enemas.
T280 523747-523829 Sentence denotes Adsorbents, ion exchange resins, or precipitating or chelating agents may be used.
T281 523830-523922 Sentence denotes Removal of a toxic substance from the body surface may be necessary, depending on the toxin.
T282 523923-524088 Sentence denotes The use of both emesis and orogastric lavage is less and less frequent in human medicine because of the risk of aspiration pneumonia and doubts about their efficacy.
T283 524089-524277 Sentence denotes Currently, management of poisonings in human medicine relies heavily on the use of activated charcoal combined with sorbitol as a cathartic, when appropriate, and supportive critical care.
T284 524278-524518 Sentence denotes It should be emphasized, however, that the majority of poisonings in humans are the result of overdoses of drugs (illicit or otherwise) that involve a relatively small volume and rapid absorption and for which this treatment is appropriate.
T285 524519-524681 Sentence denotes Furthermore, adoption of the approach rests on the availability of a hospital intensive care infrastructure, which is not always available in veterinary practice.
T286 524682-524890 Sentence denotes Induce emesis if the animal's physiology and neurologic status are stable (i.e., the animal does not have respiratory depression or is not actively seizing, obtunded, unable to swallow or protect its airway).
T287 524891-524941 Sentence denotes Do not administer the same emetic more than twice.
T288 524942-525064 Sentence denotes If the emetic doesn't work after two doses, give a different emetic or perform orogastric lavage under general anesthesia.
T289 525065-525234 Sentence denotes Emetics are strictly contraindicated for toxicity from petroleum-based products and corrosives because of the risk of aspiration pneumonia and further esophageal damage.
T290 525235-525409 Sentence denotes Emetics may also be of little value if poisons with antiemetic properties have been ingested, such as benzodiazepines, tricyclic antidepressants, and marijuana (Table 1-50) .
T291 525410-525450 Sentence denotes When was the animal last seen as normal?
T292 525451-525481 Sentence denotes What clinical signs developed?
T293 525482-525522 Sentence denotes How fast did the clinical signs develop?
T294 525523-525560 Sentence denotes When was the onset of clinical signs?
T295 525561-525597 Sentence denotes What is the animal's activity level?
T296 525598-525654 Sentence denotes Does the animal have access to any poisonous substances?
T297 525655-525789 Sentence denotes This includes known toxins or chemicals, over-the-counter or prescription medications (including the owner's), and recreational drugs.
T298 525790-525873 Sentence denotes Various emetics traditionally have been recommended for use in veterinary medicine.
T299 525874-525973 Sentence denotes Many have fallen out of favor because of the risk of causing adverse consequences and side effects.
T300 525974-526159 Sentence denotes Apomorphine (0.04 mg/kg IV or 0.25 mg/kg in the conjunctival sac) remains the standard but is less useful in certain situations in which the poison causes CNS excitation or stimulation.
T301 526160-526186 Sentence denotes It is ineffective in cats.
T302 526187-526240 Sentence denotes Other emetics include xylazine and hydrogen peroxide.
T303 526241-526336 Sentence denotes Do not use table salt because of the risk of severe oropharyngeal irritation and hypernatremia.
T304 526337-526475 Sentence denotes Do not use mustard powder or dishwashing liquid detergent because of the risk of severe oropharyngeal, esophageal, and gastric irritation.
T305 526476-526556 Sentence denotes Orogastric lavage is described in detail in the section on emergency procedures.
T306 526557-526676 Sentence denotes Gastric lavage is contraindicated in treatment of toxicity from petroleum-based compounds and acid or alkali ingestion.
T307 526677-526786 Sentence denotes The procedure can be messy but is very effective if performed within 1 to 2 hours of ingestion of the poison.
T308 526787-526864 Sentence denotes To prevent aspiration, the patient should be placed under general anesthesia.
T309 526865-526976 Sentence denotes Keep the animal's head lowered during the procedure to prevent aspiration of stomach contents into the trachea.
T310 526977-527108 Sentence denotes It is sometimes helpful to put the animal in both right and left lateral recumbency to allow complete emptying of gastric contents.
T311 527109-527174 Sentence denotes Repeat the procedure until the fluid runs clear from the stomach.
T312 527175-527316 Sentence denotes In some cases in which solid material has been ingested, this process can take a long time, so be prepared with a large volume of warm water.
T313 527317-527450 Sentence denotes Following successful evacuation and lavage, administer a slurry of activated charcoal through the orogastric tube before removing it.
T314 527451-527546 Sentence denotes Keep the endotracheal tube cuffed and in t a B l e 1 -5 0 list of emetics and recommended doses
T315 527547-527689 Sentence denotes How Supplied 1 place until the animal is semiconscious, is starting the fight the tube, and is visibly able to swallow and protect its airway.
T316 527690-527848 Sentence denotes Enemas are useful to facilitate the action of cathartics and in cases in which the poison is a solid material (e.g., compost, snail bait, garbage) (Box 1-59).
T317 527849-527887 Sentence denotes It is best to use just lukewarm water.
T318 527888-528168 Sentence denotes Commercially available phosphate enema solutions can cause severe electrolyte disturbances (hyperphosphatemia, hyponatremia, hypocalcemia, and hypomagnesemia) and acid-base abnormalities (metabolic acidosis); therefore they are absolutely contraindicated in small animal patients.
T319 528169-528279 Sentence denotes The fluid volume required depends on the size of the animal and the state of its lower gastrointestinal tract.
T320 528280-528357 Sentence denotes As with orogastric lavage, continue the procedure until the water runs clear.
T321 528358-528515 Sentence denotes If difficulty is encountered emptying the lower gastrointestinal tract, repeat the enema in 1 or 2 hours, rather than being overzealous on the first attempt.
T322 528516-528702 Sentence denotes Cathartics are useful for hastening gastrointestinal elimination of toxins, and they are particularly useful for elimination of most solid toxicants (e.g., compost, garbage, snail bait).
T323 528703-528765 Sentence denotes Cathartics can be used in conjunction with activated charcoal.
T324 528766-528928 Sentence denotes Do not use magnesiumbased cathartics in patients with CNS depression, because hypermagnesemia can worsen this disorder and also cause cardiac rhythm disturbances.
T325 528929-529081 Sentence denotes Activated charcoal (1-4 g/kg PO or 5-20 ml of a 20% slurry) is the safest and to date the most effective adsorbent for the treatment of ingested toxins.
T326 529082-529200 Sentence denotes Activated charcoal can be administered after emesis or orogastric lavage or can be administered as the sole treatment.
T327 529201-529359 Sentence denotes Various preparations are available on the market, including dry powder, compressed tablets, granules, liquid suspensions, and concentrated paste preparations.
T328 529360-529483 Sentence denotes Commercially available products are relatively inexpensive and should be used whenever possible for ease of administration.
T329 529484-529598 Sentence denotes Vegetable-origin activated charcoal is the most efficient adsorbent and binds compounds with weak, nonionic bonds.
T330 529599-529771 Sentence denotes Some preparations are combined with sorbitol to provide simultaneous administration of an adsorbent and a cathartic; this combination has been shown to be most efficacious.
T331 529772-529941 Sentence denotes Repeated administration of activated charcoal every 4 to 6 hours has been shown to be beneficial in the management of a toxin that undergoes enterohepatic recirculation.
T332 529942-530121 Sentence denotes Administering an oily cathartic or mixing the activated charcoal with food only serves to reduce the absorptive surface of the activated charcoal and therefore is not recommended.
T333 530122-530338 Sentence denotes In general, substances that are very soluble and are rapidly absorbed are not well adsorbed by activated charcoal, including alkalis, nitrates, mineral acids, ethanol, methanol, ferrous sulfate, ammonia, and cyanide.
T334 530339-530405 Sentence denotes Use nonsterile nonspermicidal water-soluble lubricants (K-Y Jelly)
T335 530406-530589 Sentence denotes Old intravenous fluid bag Enema bag 60-to 120-mL syringe Fluid Warm water, with or without hand or liquid dish soap 1 Kaolin and bentonite are clays that have been used as adsorbents.
T336 530590-530646 Sentence denotes Both are usually less effective than activated charcoal.
T337 530647-530749 Sentence denotes However, they are reported to be better adsorbents than activated charcoal for the herbicide paraquat.
T338 530750-530813 Sentence denotes Ion exchange resins can ionically bind certain drugs or toxins.
T339 530814-530954 Sentence denotes Cholestyramine is one such resin, commonly used in human medicine to bind intestinal bile acids and thereby decrease cholesterol absorption.
T340 530955-531103 Sentence denotes Its application in toxicology extends to the absorption of fat-soluble toxins such as organochlorine and certain acidic compounds such as digitalis.
T341 531104-531277 Sentence denotes Ion exchange resins also have been used to delay or reduce the absorption of phenylbutazone, warfarin, chlorothiazide, tetracycline, phenobarbital, and thyroid preparations.
T342 531278-531421 Sentence denotes Precipitating, chelating, and diluting agents are used primarily in the management of heavy metal intoxications, such as alkaloids or oxalates.
T343 531422-531547 Sentence denotes They work by binding preferentially to the metal ion and creating a more soluble complex that is amenable to renal excretion.
T344 531548-531798 Sentence denotes Chelating agents that are available include calcium EDTA, deferoxamine, and d-penicillamine. d-Penicillamine has a wide application for a number of metal toxicities but tends to be used for long-term chronic therapy because it can be administered PO.
T345 531799-532012 Sentence denotes Various agents used for nonspecific dilution of toxins, including Milk of Magnesia and egg whites, although old-fashioned, still have wide application in many cases in which low-grade irritants have been ingested.
T346 532013-532175 Sentence denotes Bathing the animal is an important aspect of treatment for topical exposures to toxins such as insecticidal products, petroleum-based products, and aromatic oils.
T347 532176-532224 Sentence denotes Bathing an animal is not an innocuous procedure.
T348 532225-532285 Sentence denotes To avoid hypothermia and shock, use warm water at all times.
T349 532286-532354 Sentence denotes Actively dry the animal to further minimize the risk of hypothermia.
T350 532355-532454 Sentence denotes When bathing the animal, use rubber gloves and a plastic apron to avoid exposure to noxious agents.
T351 532455-532509 Sentence denotes In most cases, a mild dishwashing soap is appropriate.
T352 532510-532585 Sentence denotes Medicated or antibacterial shampoos are less appropriate in this situation.
T353 532586-532711 Sentence denotes For petroleum-based products in particular, Dawn dishwashing liquid, which "cuts the grease, " works well to remove the oils.
T354 532712-532810 Sentence denotes If Dawn is not available, mechanics' hand cleaners or coconut oil-based soaps can be used instead.
T355 532811-533013 Sentence denotes As a general principle, best results are obtained by barely wetting the patient's fur until the detergent is worked well into the fur, keeping the amount of water to a minimum until ready for the rinse.
T356 533014-533139 Sentence denotes Oil-based paint is best removed by clipping rather than by attempting removal with solvents, because solvents are also toxic.
T357 533140-533249 Sentence denotes To remove powder products, brush and vacuum the animal before bathing it to eliminate further toxic exposure.
T358 533250-533393 Sentence denotes With caustic alkaline or acidic products, the primary treatment is to dilute and flush the skin with warm water; do not attempt neutralization.
T359 533394-533495 Sentence denotes Neutralization can cause an exothermic reaction that causes further damage to the underlying tissues.
T360 533496-533648 Sentence denotes For ocular exposures, irrigate the eyes for a minimum of 20 to 30 minutes with warm (body temperature) tap water or warmed 0.9% sterile saline solution.
T361 533649-533756 Sentence denotes The use of neutralizing substances is not recommended because of the risk of causing further ocular damage.
T362 533757-533882 Sentence denotes After adequate irrigation, treat chemical burns of the eyes with lubricating ointments and possibly a temporary tarsorrhaphy.
T363 533883-533932 Sentence denotes Atropine may be indicated as a cycloplegic agent.
T364 533933-533991 Sentence denotes Systemic NSAIDs can be used to control patient discomfort.
T365 533992-534171 Sentence denotes Daily follow-up examinations are required because epithelial damage may be delayed, especially with alkali burns, and it is difficult to predict the final extent of ocular damage.
T366 534172-534261 Sentence denotes Topical glucocorticosteroids are contraindicated if the corneal epithelium is not intact.
T367 534262-534522 Sentence denotes If severe conjunctival swelling is present with a corneal ulcer, parenteral glucocorticosteroids can be administered to help alleviate inflammation, but NSAIDs should not be used simultaneously because of the risk of gastrointestinal ulceration or perforation.
T368 534523-534671 Sentence denotes Whenever possible, administer specific antidotes to negate the effects of the toxin and prevent conversion of the substance to the toxic metabolite.
T369 534672-534740 Sentence denotes Three categories of agents are used in the management of poisonings.
T370 534741-534782 Sentence denotes The first category is specific antidotes.
T371 534783-534866 Sentence denotes Unfortunately, few specific antidotes are available for use in veterinary medicine.
T372 534867-535031 Sentence denotes The second, broader category of antidotes includes those drugs used in the symptomatic management of clinical signs, which are part of our routine veterinary stock.
T373 535032-535133 Sentence denotes Drugs such as atropine, sedatives, steroids, antiarrhythmics, and β-blockers fall into this category.
T374 535134-535242 Sentence denotes The third category comprises nonspecific decontaminants such as activated charcoal, cathartics, and emetics.
T375 535243-535275 Sentence denotes These were discussed previously.
T376 535276-535369 Sentence denotes Many patients benefit from efforts to enhance clearance or metabolism of the absorbed toxins.
T377 535370-535581 Sentence denotes Some specific therapies have been developed for this purpose, including 4-methylpyrazole for ethylene glycol toxicity and specific antibodies such as Digibind (digoxin immune Fab [ovine]) for digitalis toxicity.
T378 535582-535638 Sentence denotes Other strategies are aimed at promoting renal excretion.
T379 535639-535775 Sentence denotes Renal excretion strategies include diuresis, ion trapping, and peritoneal dialysis or hemodialysis (see section on peritoneal dialysis).
T380 535776-535883 Sentence denotes Diuresis and ion trapping are applicable to a large number of toxins and are discussed here in more detail.
T381 535884-535953 Sentence denotes Other toxins respond to urine acidification and urine alkalinization.
T382 535954-536099 Sentence denotes Enhancing renal excretion of substances is most useful for those organic substances that are present in significant concentrations in the plasma.
T383 536100-536254 Sentence denotes Substances that are nonionic and lipid-soluble, such as certain herbicides, are likely to be less affected by attempts to promote rapid renal elimination.
T384 536255-536408 Sentence denotes Before diuresis or ion trapping is started, intravenous fluid therapy should be adequate as determined by normal CVP, urine output, and mean arterial BP.
T385 536409-536553 Sentence denotes If any of these values is less than normal, use other measures to ensure adequate renal perfusion, including but not limited to CRI of dopamine.
T386 536554-536626 Sentence denotes Simple fluid diuresis can influence the excretion of certain substances.
T387 536627-536802 Sentence denotes The use of mannitol as an osmotic diuretic may reduce the passive reabsorption of some toxic substances in the proximal renal convoluted tubule by reducing water reabsorption.
T388 536803-536853 Sentence denotes Dextrose (50%) can be used as an osmotic diuretic.
T389 536854-536962 Sentence denotes Furosemide can be used to promote diuresis, but again, there is no substitute for intravenous fluid therapy.
T390 536963-537067 Sentence denotes The use of mannitol, dextrose, and furosemide is contraindicated in hypotensive or hypovolemic patients.
T391 537068-537165 Sentence denotes Take care to avoid causing dehydration with any diuretic; CVP monitoring is strongly recommended.
T392 537166-537301 Sentence denotes Ion trapping is based on the principle that ionized substances do not cross renal tubular membranes easily and are not well reabsorbed.
T393 537302-537463 Sentence denotes If the urinary pH can be changed so that the toxin's chemical equilibrium shifts to its ionized form, then that toxin can be "trapped" in the urine and excreted.
T394 537464-537583 Sentence denotes Alkaline urine favors the ionization of acidic compounds, and acidic urine favors the ionization of alkaline compounds.
T395 537584-537662 Sentence denotes Toxins that are amenable to ion trapping are mostly weak acids and weak bases.
T396 537663-537726 Sentence denotes Ammonium chloride can be used to promote urinary acidification.
T397 537727-537924 Sentence denotes Contraindications to the use of ammonium chloride include preexisting metabolic acidosis, hepatic or renal insufficiency, and hemolysis or rhabdomyolysis leading to hemoglobinuria or myoglobinuria.
T398 537925-537987 Sentence denotes Signs of ammonia intoxication include CNS depression and coma.
T399 537988-538089 Sentence denotes When performing urine acidification, frequently check the serum potassium concentration and urine pH.
T400 538090-538159 Sentence denotes Urine alkalinization can be performed with use of sodium bicarbonate.
T401 538160-538319 Sentence denotes Contraindications to the use of sodium bicarbonate include metabolic alkalosis (particularly with concurrent use of furosemide), hypocalcemia, and hypokalemia.
T402 538320-538415 Sentence denotes As with urine acidification, monitor the serum potassium concentration and urine pH frequently.
T403 538416-538547 Sentence denotes The major steps in management of poisonings discussed here must be accompanied by application of the fundamentals of critical care.
T404 538548-538618 Sentence denotes Respiratory and cardiovascular support have been discussed previously.
T405 538619-538739 Sentence denotes Renal and gastrointestinal function and analgesia are particularly important in the management of the poisoning patient.
T406 538740-538810 Sentence denotes Maintenance of renal perfusion is a priority in the poisoning patient.
T407 538811-538888 Sentence denotes Fluid, electrolyte, and acid-base balance must be controlled and be accurate.
T408 538889-539081 Sentence denotes Poisoning patients are at particularly high risk for renal damage and acute renal failure, whether by primary toxic insult to the renal parenchyma or by acute or prolonged renal hypoperfusion.
T409 539082-539240 Sentence denotes For this reason, a protocol that aims at preventing oliguria and ensuing renal failure is one of the therapeutic strategies that should be routinely employed.
T410 539241-539280 Sentence denotes This protocol is described in Box 1-60.
T411 539281-539413 Sentence denotes Gastrointestinal protectant drugs may be indicated for the management of poisons that are gastrointestinal irritants or ulcerogenic.
T412 539414-539535 Sentence denotes Commonly used gastroprotectant drugs include cimetidine, ranitidine, famotidine, omeprazole, sucralfate, and misoprostol.
T413 539536-539593 Sentence denotes Antiemetics may be used to suppress intractable vomiting.
T414 539594-539746 Sentence denotes Metoclopramide is commonly used, although newer antiemetics such as maropitant is now considered to be the drug of choice for centrally mediated nausea.
T415 539747-539833 Sentence denotes Antiemetics that work by different mechanisms can be used in combination as necessary.
T416 539834-540045 Sentence denotes Examples are dopamine DA 2 -receptor antagonists such as prochlorperazine, 5-hydroxytryptamine antagonists such as ondansetron and dolasetron, and H 1 -receptor antagonists such as diphenhydramine and meclizine.
T417 540046-540116 Sentence denotes Analgesics are more appropriate to treat poisonings than once thought.
T418 540117-540243 Sentence denotes Common effects of poisons including severe gastroenteritis and topical burns or ulcerations may warrant the use of analgesics.
T419 540244-540344 Sentence denotes Longer-acting analgesics such as morphine, hydromorphone, and buprenorphine are particularly useful.
T420 540345-540530 Sentence denotes Nutritional support may be necessary in the form of enteral or parenteral feeding in patients that have esophageal or gastric damage or that need to be sedated for long periods of time.
T421 540531-540533 Sentence denotes 1.
T422 540534-540635 Sentence denotes Administer crystalloid intravenous fluids at maintenance rates using a balanced electrolyte solution.
T423 540636-540638 Sentence denotes 2.
T424 540639-540710 Sentence denotes Perform urinary catheterization and collection to monitor urine output.
T425 540711-540713 Sentence denotes 3.
T426 540714-540772 Sentence denotes Monitor serum urea nitrogen and creatinine every 12 hours.
T427 540773-540775 Sentence denotes 4.
T428 540776-540822 Sentence denotes Monitor serum electrolytes every 6 to 8 hours.
T429 540823-540825 Sentence denotes 5.
T430 540826-540877 Sentence denotes Monitor central venous pressure every 2 to 4 hours.
T431 540878-540880 Sentence denotes 6.
T432 540881-540955 Sentence denotes Treat oliguria, defined as a drop in urine output to less than 1 mL/kg/hr.
T433 540956-540958 Sentence denotes 7.
T434 540959-541032 Sentence denotes Initiate a fluid challenge with a crystalloid or colloid (5 mL/kg) bolus.
T435 541033-541035 Sentence denotes 8.
T436 541036-541148 Sentence denotes Start dopamine at 3 to 5 mcg/kg/min if no response to the crystalloid or colloid bolus occurs within 30 minutes.
T437 541149-541152 Sentence denotes 9a.
T438 541153-541257 Sentence denotes Consider mannitol (0.5 to 1 g/kg IV) administration if no response to dopamine occurs within 30 minutes.
T439 541258-541261 Sentence denotes 9b.
T440 541262-541396 Sentence denotes Consider furosemide (4 to 8 mg/kg IV, or 0.66 to 1 mg/kg/hr IV CRI) if no response to dopamine or mannitol occurs in 30 to 60 minutes.
T441 541397-541400 Sentence denotes 10.
T442 541401-541548 Sentence denotes If hypertensive and oliguric or anuric, consider diltiazem 0.1 to 0.5 mg/kg IV, then 1 to 5 mcg/kg/min; must be careful to monitor for hypotension.
T443 541549-541552 Sentence denotes 11.
T444 541553-541679 Sentence denotes If no response to furosemide, peritoneal dialysis or hemodialysis is indicated immediately, particularly if anuria is present.
T445 541680-541727 Sentence denotes CRI, Constant rate infusion; IV, intravenously.
T446 541728-541861 Sentence denotes Endoscopy may be useful in assessing the degree of esophageal and gastric damage, particularly after ingestion of caustic substances.
T447 541862-541953 Sentence denotes Acetaminophen (paracetamol) is the active ingredient in Tylenol and many OTC cold products.
T448 541954-541970 Sentence denotes Pathophysiology:
T449 541971-542117 Sentence denotes Acetaminophen is converted in the liver to N-acetyl-P-benzoquinonimine, a toxic substance that can cause oxidative injury of RBCs and hepatocytes.
T450 542118-542133 Sentence denotes Clinical Signs:
T451 542134-542390 Sentence denotes Clinical signs of acetaminophen toxicity include respiratory distress from lack of oxygen-carrying capacity, cyanosis, methemoglobinemia (chocolate-brown appearance of the blood and mucous membranes), lethargy, vomiting, and facial and paw swelling (cats).
T452 542391-542402 Sentence denotes Toxic Dose:
T453 542403-542480 Sentence denotes The toxic dose of acetaminophen is 100 mg/kg for dogs, and 50 mg/kg for cats.
T454 542481-542491 Sentence denotes Treatment:
T455 542492-542631 Sentence denotes Treatment of acetaminophen toxicity includes induction of emesis or orogastric lavage if the substance has been ingested within 30 minutes.
T456 542632-542679 Sentence denotes Activated charcoal should also be administered.
T457 542680-542768 Sentence denotes In cases of severe anemia, give supplemental oxygen along with a packed RBC transfusion.
T458 542769-542839 Sentence denotes Administer intravenous fluids to maintain renal and hepatic perfusion.
T459 542840-543152 Sentence denotes N-acetylcysteine (140 mg/kg PO or IV once, then 70 mg/kg IV PO or IV q6h for seven treatments), vitamin C (100 mg/kg PO q8h [feline], 100 to 500 mg/kg PO q8h [canine]), and cimetidine (5 to 15 mg/kg IV, IM, SQ, PO q6-12) are the treatments of choice for methemoglobinemia in patients with acetaminophen toxicity.
T460 543153-543169 Sentence denotes Pathophysiology:
T461 543170-543276 Sentence denotes Hydrochloric, nitric, and phosphoric acids cause chemical burns through contact with the skin and/or eyes.
T462 543277-543338 Sentence denotes Localized superficial coagulative necrosis occurs on contact.
T463 543339-543354 Sentence denotes Clinical Signs:
T464 543355-543498 Sentence denotes Usually the patient's skin is painful to the touch or the animal may lick or chew at an irritated area that is not visible under the hair coat.
T465 543499-543510 Sentence denotes Toxic Dose:
T466 543511-543618 Sentence denotes Toxic dose is dependent on concentration of solution that comes in contact with skin, eyes, or oral mucosa.
T467 543619-543629 Sentence denotes Treatment:
T468 543630-543766 Sentence denotes If the chemical is swallowed, do not induce emesis or perform orogastric lavage, because of the risk of worsening esophageal irritation.
T469 543767-543859 Sentence denotes Rinse the patient's skin and eyes with warm water or warm saline for a minimum of 1 ⁄2 hour.
T470 543860-543944 Sentence denotes Use analgesics and treat corneal ulcers (see section on corneal ulcers) as required.
T471 543945-544067 Sentence denotes Do not attempt chemical neutralization, because of the risk of causing an exothermic reaction and worsening tissue injury.
T1 544068-544187 Sentence denotes Aflatoxin (Aspergillus flavus) is found in moldy feed grains; it also has been reported after ingestion of moldy bread.
T2 544188-544203 Sentence denotes Clinical Signs:
T3 544204-544363 Sentence denotes Clinical signs of toxicity occur after ingestion and include vomiting, diarrhea, and acute hepatitis, and coagulopathy; abortion may occur in pregnant bitches.
T4 544364-544380 Sentence denotes Pathophysiology:
T5 544381-544600 Sentence denotes Alcohols cause disruption of neuronal membrane structure, impaired motor coordination, CNS excitation followed by depression, and stupor that can lead to cardiac and respiratory arrest, depending on the amount ingested.
T6 544601-544612 Sentence denotes Toxic Dose:
T7 544613-544647 Sentence denotes 4.1 to 8.0 g/kg PO Clinical Signs:
T8 544648-544714 Sentence denotes Affected animals may appear excited and then ataxic and lethargic.
T9 544715-544803 Sentence denotes Contact or inhalant injury can occur, causing dermal irritation and cutaneous hyperemia.
T10 544804-544843 Sentence denotes Methanol also can cause hepatotoxicity.
T11 544844-544854 Sentence denotes Treatment:
T12 544855-544958 Sentence denotes Induce and maintain a patent airway, and stabilize the patient's cardiovascular and respiratory status.
T13 544959-545110 Sentence denotes Control CNS excitation with diazepam (0.5 to 1 mg/kg IV), if necessary, and control the patient's body temperature (both hypothermia and hyperthermia).
T14 545111-545299 Sentence denotes Induce vomiting if the patient is alert and can protect its airway; otherwise, perform orogastric lavage with the patient under general anesthesia with a cuffed endotracheal tube in place.
T15 545300-545350 Sentence denotes Alcohols do not bind well with activated charcoal.
T16 545351-545409 Sentence denotes Treat dermal exposure by bathing the area with warm water.
T17 545410-545426 Sentence denotes Pathophysiology:
T18 545427-545550 Sentence denotes If ingested, sodium or potassium hydroxide can cause severe contact dermatitis or irritation of the gastrointestinal tract.
T19 545551-545618 Sentence denotes Esophageal burns and full-thickness coagulative necrosis can occur.
T20 545619-545630 Sentence denotes Toxic Dose:
T21 545631-545722 Sentence denotes Toxic dose is dependent on the concentration of solution that comes in contact with animal.
T22 545723-545733 Sentence denotes Treatment:
T23 545734-545850 Sentence denotes If an animal ingests a caustic alkali substance, feed the animal four egg whites mixed with 1 quart of warmed water.
T24 545851-545963 Sentence denotes Perform endoscopy within 24 hours to evaluate the extent of injury and to place a feeding tube, in severe cases.
T25 545964-546079 Sentence denotes Do not induce emesis, and do not perform orogastric lavage, because of the risk of worsening esophageal irritation.
T26 546080-546199 Sentence denotes In cases of contact exposure to the skin or eyes, rinse the exposed area with warm water baths for at least 30 minutes.
T27 546200-546274 Sentence denotes Administer gastroprotectant, antiemetic, and analgesic drugs as necessary.
T28 546275-546394 Sentence denotes Avoid neutralization, which can cause a hyperthermic reaction and worsen injury to the skin and gastrointestinal tract.
T29 546395-546505 Sentence denotes Amitraz is the active ingredient in ascaricides and antitick and antimite products such as Mitaban and Taktic.
T30 546506-546522 Sentence denotes Pathophysiology:
T31 546523-546592 Sentence denotes Amitraz exerts its toxic effects by causing α-adrenergic stimulation.
T32 546593-546604 Sentence denotes Toxic Dose:
T33 546605-546635 Sentence denotes 10 to 20 mg/kg Clinical Signs:
T34 546636-546857 Sentence denotes Clinical signs are similar to those observed with administration of xylazine: bradycardia, CNS depression, ataxia, hypotension, hyperglycemia, hypothermia, cyanotic mucous membranes, polyuria, mydriasis, emesis, and coma.
T35 546858-546868 Sentence denotes Treatment:
T36 546869-547019 Sentence denotes Treatment of amitraz intoxication includes cardiovascular support with intravenous crystalloid fluids and induction of emesis in asymptomatic animals.
T37 547020-547085 Sentence denotes If clinical signs are present, orogastric lavage may be required.
T38 547086-547140 Sentence denotes Many toxic compounds are impregnated in a collar form.
T39 547141-547252 Sentence denotes If the patient has ingested a collar and does not vomit it, it should be removed using endoscopy or gastrotomy.
T40 547253-547336 Sentence denotes Administer activated charcoal to prevent or delay absorption of the toxic compound.
T41 547337-547505 Sentence denotes Yohimbine (0.11 mg/kg IV slowly) or atipamezole (50 mcg/kg IM), both α-adrenergic antagonists, are the treatment(s) of choice to reverse the clinical signs of toxicity.
T42 547506-547701 Sentence denotes Avoid the use of atropine, because it can potentially increase the viscosity of respiratory secretions and cause gastrointestinal ileus, thus promoting increased absorption of the toxic compound.
T43 547702-547869 Sentence denotes Ammonium hydroxide, or cleaning ammonia, can be caustic at high concentrations (see Alkalis and Caustics) and cause severe injury to the respiratory system if inhaled.
T44 547870-547944 Sentence denotes Administer gastroprotectant, antiemetic, and analgesic drugs as necessary.
T45 547945-548198 Sentence denotes If pneumonia or pulmonary edema occurs secondary to aspiration of ammonia into the airways and alveolar spaces, treatment is largely supportive with supplemental oxygen administration, antibiotics, fluid therapy, and mechanical ventilation as necessary.
T46 548199-548302 Sentence denotes Diuretics may or may not be useful in the treatment of pulmonary edema secondary to ammonia inhalation.
T47 548303-548404 Sentence denotes Amphetamines may be in the form of prescription medications or illicit drugs such as methamphetamine.
T48 548405-548421 Sentence denotes Pathophysiology:
T49 548422-548596 Sentence denotes Amphetamines cause CNS excitation owing to neurosynaptic stimulation, resulting in hypersensitivity to noise and motion, agitation, tremors, vomiting, diarrhea, and seizures.
T50 548597-548612 Sentence denotes Clinical Signs:
T51 548613-548732 Sentence denotes Clinical signs of amphetamine toxicity include muscle tremors, tachyarrhythmias, mydriasis, ptyalism, and hyperthermia.
T52 548733-548743 Sentence denotes Treatment:
T53 548744-548810 Sentence denotes Amphetamines are rapidly absorbed from the gastrointestinal tract.
T54 548811-548940 Sentence denotes Treatment includes administration of intravenous fluids to maintain hydration and renal perfusion and correction of hyperthermia.
T55 548941-549129 Sentence denotes Administer sedative drugs such as chlorpromazine (10-18 mg/kg IV) to control agitation and tremors, and diazepam (0.5 to 1 mg/kg IV) or levetiracetam (20 mg/kg PO q8h) to control seizures.
T56 549130-549224 Sentence denotes Urinary acidification can promote excretion and prevent reabsorption from the urinary bladder.
T57 549225-549392 Sentence denotes In severe cases, treat cerebral edema with a combination of mannitol (0.5 to 1 g/kg IV) followed by furosemide (1 mg/kg IV) to control increased intracranial pressure.
T58 549393-549424 Sentence denotes Antifreeze See Ethylene Glycol.
T59 549425-549656 Sentence denotes Antihistamines (loratadine, diphenhydramine, doxylamine, clemastine, meclizine, dimenhydrinate, chlorpheniramine, cyclizine, terfenadine, hydroxyzine) are available as OTC and prescription allergy and anti-motion sickness products.
T60 549657-549673 Sentence denotes Pathophysiology:
T61 549674-549770 Sentence denotes These agents cause sedation at lower doses and agitation, tremors, and seizures at higher doses.
T62 549771-549786 Sentence denotes Clinical Signs:
T63 549787-549924 Sentence denotes Clinical signs of antihistamine toxicity include restlessness, nausea, vomiting, agitation, seizures, hyperthermia, and tachyarrhythmias.
T64 549925-549936 Sentence denotes Toxic Dose:
T65 549937-549999 Sentence denotes Toxic dose is dependent on the type of antihistamine ingested.
T66 550000-550010 Sentence denotes Treatment:
T67 550011-550120 Sentence denotes Treatment of antihistamine intoxication is largely symptomatic and supportive, as there is no known antidote.
T68 550121-550343 Sentence denotes If ingestion is recent (within 1 to 2 hours) and the patient is not actively seizing and can protect its airway, induce emesis or perform orogastric lavage, followed by administration of activated charcoal and a cathartic.
T69 550344-550393 Sentence denotes Monitor the patient's heart rate, rhythm, and BP.
T70 550394-550498 Sentence denotes Treat cardiac arrhythmias, if present, with appropriate therapies (see section on cardiac dysrhythmias).
T71 550499-550572 Sentence denotes Administer cooling measures and intravenous fluids to treat hyperthermia.
T72 550573-550665 Sentence denotes A CRI of methocarbamol (55 to 220 mg/kg IV to effect) can be used to control muscle tremors.
T73 550666-550739 Sentence denotes α-Naphthylthiourea (ANTU) is manufactured as a white or blue-gray powder.
T74 550740-550824 Sentence denotes Pathophysiology: ANTU is a gastric irritant that induces emesis if stomach is empty.
T75 550825-550967 Sentence denotes The toxin is well absorbed from the stomach in the presence of food and causes increased pulmonary capillary permeability and pulmonary edema.
T76 550968-550983 Sentence denotes Clinical Signs:
T77 550984-551131 Sentence denotes Clinical signs include vomiting, ptyalism, cough, increased respiratory rate and effort, cyanosis, respiratory difficulty, and respiratory failure.
T78 551132-551168 Sentence denotes Ataxia and weakness may be observed.
T79 551169-551180 Sentence denotes Toxic Dose:
T80 551181-551254 Sentence denotes The toxic dose in dogs is 10 to 40 mg/kg, and in cats is 75 to 100 mg/kg.
T81 551255-551317 Sentence denotes Younger dogs appear to be more resistant to its toxic effects.
T82 551318-551328 Sentence denotes Treatment:
T83 551329-551385 Sentence denotes Treatment of ANTU toxicity includes respiratory support.
T84 551386-551460 Sentence denotes Mechanical ventilation may be required in severe cases of pulmonary edema.
T85 551461-551528 Sentence denotes If an animal does not vomit, orogastric lavage should be performed.
T86 551529-551601 Sentence denotes Administer gastrointestinal protectant, antiemetic, and analgesic drugs.
T87 551602-551799 Sentence denotes Cardiovascular support in the form of intravenous crystalloids should be administered with caution, because of the risk of exacerbating increased capillary permeability and causing pulmonary edema.
T88 551800-551968 Sentence denotes Inorganic arsenic (arsenic trioxide, sodium arsenite, sodium arsenate) is the active ingredient in many herbicides, defoliants, and insecticides, including ant killers.
T89 551969-551985 Sentence denotes Pathophysiology:
T90 551986-552077 Sentence denotes Arsenic compounds interfere with cellular respiration by combining with sulfhydryl enzymes.
T91 552078-552093 Sentence denotes Clinical Signs:
T92 552094-552236 Sentence denotes Clinical signs of toxicity include severe gastroenteritis, muscle weakness, capillary damage, hypotension, renal failure, seizures, and death.
T93 552237-552286 Sentence denotes In many cases, clinical signs are acute in onset.
T94 552287-552298 Sentence denotes Toxic Dose:
T95 552299-552395 Sentence denotes The toxic dose of sodium arsenate is 100 to 150 mg/kg; that of sodium arsenite is 1 to 25 mg/kg.
T96 552396-552462 Sentence denotes Sodium arsenite is less toxic, although cats are very susceptible.
T97 552463-552473 Sentence denotes Treatment:
T98 552474-552555 Sentence denotes Treatment of arsenic toxicity involves procuring and maintaining a patent airway.
T99 552556-552686 Sentence denotes Administer intravenous crystalloid fluids to correct hypotension and hypovolemia, and normalize acid-base and electrolyte balance.
T100 552687-552783 Sentence denotes If no clinical signs are present and if the compound was ingested within 2 hours, induce emesis.
T101 552784-552890 Sentence denotes If clinical signs are present, perform orogastric lavage followed by administration of activated charcoal.
T102 552891-552982 Sentence denotes If dermal exposure has occurred, thoroughly bathe the animal to prevent further absorption.
T103 552983-553063 Sentence denotes Dimercaprol (BAL, 3 to 4 mg/kg IM q8h) can be administered as a chelating agent.
T104 553064-553282 Sentence denotes N-acetylcysteine (Mucomyst) (for cats, 140 to 240 mg/kg PO IV, then 70 mg/kg PO IV q6h for 3 days; for dogs, 280 mg/kg PO or IV, then 140 mg/kg PO IV q4h for 3 days) has been shown to decrease arsenic toxicity in rats.
T105 553283-553299 Sentence denotes Pathophysiology:
T106 553300-553515 Sentence denotes Aspirin causes inhibition of the production of prostaglandins, a high anion gap metabolic acidosis, gastrointestinal ulceration, hypophosphatemia, and decreased platelet aggregation when ingested in high quantities.
T107 553516-553531 Sentence denotes Clinical Signs:
T108 553532-553640 Sentence denotes Clinical signs of aspirin toxicity include tachypnea, vomiting, anorexia, lethargy, hematemesis, and melena.
T109 553641-553718 Sentence denotes Toxic Dose: >50 mg/kg/24 hours in dogs; >25 mg/kg/24 hours in cats Treatment:
T110 553719-553771 Sentence denotes Treatment of aspirin toxicity is largely supportive.
T111 553772-553916 Sentence denotes If the ingestion was recent (within the last hour), induce emesis or perform orogastric lavage followed by administration of activated charcoal.
T112 553917-554017 Sentence denotes Administer intravenous crystalloid fluids to maintain hydration and correct acid-base abnormalities.
T113 554018-554131 Sentence denotes Administer synthetic prostaglandin analogues (misoprostol, 5 mcg/kg PO), gastroprotectant drugs, and antiemetics.
T114 554132-554182 Sentence denotes Alkalinization of the urine can enhance excretion.
T115 554183-554219 Sentence denotes Baclofen Baclofen is a GABA agonist.
T116 554220-554236 Sentence denotes Pathophysiology:
T117 554237-554328 Sentence denotes Baclofen is a centrally acting muscle relaxant, causing increased serotonergic stimulation.
T118 554329-554344 Sentence denotes Clinical Signs:
T119 554345-554471 Sentence denotes Clinical signs of toxicity include vomiting, ataxia, vocalization, disorientation, seizures, hypoventilation, coma, and apnea.
T120 554472-554483 Sentence denotes Toxic Dose:
T121 554484-554538 Sentence denotes Clinical signs can occur at doses as low as 1.3 mg/kg.
T122 554539-554549 Sentence denotes Treatment:
T123 554550-554641 Sentence denotes Treatment of baclofen ingestion includes induction of emesis if the animal is asymptomatic.
T124 554642-554679 Sentence denotes Otherwise, perform orogastric lavage.
T125 554680-554767 Sentence denotes Emesis or orogastric lavage should be followed by administration of activated charcoal.
T126 554768-554909 Sentence denotes Perform intravenous crystalloid fluid diuresis to promote elimination of the toxin, maintain renal perfusion, and normalize body temperature.
T127 554910-555001 Sentence denotes Supplemental oxygen or mechanical ventilation may be required for hypoventilation or apnea.
T128 555002-555114 Sentence denotes If seizures occur, avoid the use of diazepam, which is a GABA agonist and can potentially worsen clinical signs.
T129 555115-555376 Sentence denotes Control seizures with intravenous phenobarbital (bolus 2-5 mg/kg IV, can repeat every 20 minutes 2 times), pentobarbital (5 to 15 mg/kg IV slowly to effect), propofol (3 to 6 mg/kg IV, then 8 to 12 mg/kg/hr IV CRI to effect), or levetiracetam (20 mg/kg PO q8h).
T130 555377-555567 Sentence denotes Supportive care (eye lubrication, urinary catheter placement for patient cleanliness, passive range-of-motion exercises, soft heavy bedding to prevent decubitus ulcer formation) is required.
T131 555568-555615 Sentence denotes Clinical signs usually resolve in several days.
T132 555616-555658 Sentence denotes Seizures warrant a more guarded prognosis.
T133 555659-555784 Sentence denotes Phenobarbital, pentobarbital, and thiopental are used in veterinary medicine as anticonvulsants and for anesthetic induction.
T134 555785-555829 Sentence denotes Accidental or iatrogenic exposure can occur.
T135 555830-555846 Sentence denotes Pathophysiology:
T136 555847-555986 Sentence denotes Barbiturates such as phenobarbital are GABA agonists and induce CNS depression by inhibiting. acetylcholine, norepinephrine, and glutamine.
T137 555987-556002 Sentence denotes Clinical Signs:
T138 556003-556136 Sentence denotes Clinical signs of barbiturate overdose or toxicity include weakness, lethargy, hypotension, hypoventilation, stupor, coma, and death.
T139 556137-556197 Sentence denotes Paradoxical reactions and agitation or excitement can occur.
T140 556198-556209 Sentence denotes Toxic Dose:
T141 556210-556256 Sentence denotes Toxic dose is dependent on substance ingested.
T142 556257-556267 Sentence denotes Treatment:
T143 556268-556381 Sentence denotes Treatment of barbiturate toxicity includes maintenance and support of the cardiovascular and respiratory systems.
T144 556382-556519 Sentence denotes If clinical signs are absent and the patient can protect its airway, induce emesis, then administer repeated doses of activated charcoal.
T145 556520-556575 Sentence denotes Perform orogastric lavage if emesis is contraindicated.
T146 556576-556633 Sentence denotes Administer supplemental oxygen if hypoventilation occurs.
T147 556634-556682 Sentence denotes Some animals may require mechanical ventilation.
T148 556683-556741 Sentence denotes Administer intravenous fluids to control perfusion and BP.
T149 556742-556842 Sentence denotes Positive inotropic drugs may be required if dose-dependent decrease in cardiac output and BP occurs.
T150 556843-556949 Sentence denotes Alkalinization of the urine and peritoneal dialysis can be performed to enhance excretion and elimination.
T151 556950-557014 Sentence denotes Hemodialysis should be considered in severe cases, if available.
T152 557015-557198 Sentence denotes Given the large number of battery-powered toys, remote control devices, and electronic hand-held personal data equipment, ingestion of batteries is commonplace in veterinary patients.
T153 557199-557215 Sentence denotes Pathophysiology:
T154 557216-557356 Sentence denotes Automotive and dry cell batteries contain sulfuric acid, which can be irritating on contact with the eyes, skin, and gastrointestinal tract.
T155 557357-557492 Sentence denotes Button batteries, which contain sodium or potassium hydroxide, cause contact irritation and sometimes esophageal perforation if chewed.
T156 557493-557508 Sentence denotes Clinical Signs:
T157 557509-557604 Sentence denotes Clinical signs are largely dependent on the area of contact with sodium or potassium hydroxide.
T158 557605-557668 Sentence denotes Dermal injury can occur in the form of erythema and blistering.
T159 557669-557747 Sentence denotes Gastrointestinal signs include vomiting, hematemesis, inappetence, and melena.
T160 557748-557759 Sentence denotes Toxic Dose:
T161 557760-557820 Sentence denotes Clinical signs are largely dependent on the amount ingested.
T162 557821-557831 Sentence denotes Treatment:
T163 557832-557969 Sentence denotes To treat exposure, rinse the eyes and skin with copious amounts of warm tap water or sterile saline solution for a minimum of 30 minutes.
T164 557970-558042 Sentence denotes If ingestion occurred, administer gastroprotectant and antiemetic drugs.
T165 558043-558195 Sentence denotes Induction of emesis and orogastric lavage is absolutely contraindicated because of the risk of aspiration pneumonia and worsening esophageal irritation.
T166 558196-558333 Sentence denotes No attempt should be made at performing neutralization because of the risk of causing an exothermic reaction and worsening tissue damage.
T167 558334-558378 Sentence denotes Administer analgesics to control discomfort.
T168 558379-558451 Sentence denotes Benzoyl peroxide is the active ingredient in many OTC acne preparations.
T169 558452-558468 Sentence denotes Pathophysiology:
T170 558469-558566 Sentence denotes Ingestion can result in production of hydrogen peroxide, gastroenteritis, and gastric dilatation.
T171 558567-558627 Sentence denotes Topical exposure can cause dermal irritation and blistering.
T172 558628-558643 Sentence denotes Clinical Signs:
T173 558644-558731 Sentence denotes Clinical signs include vomiting, abdominal distension, dermal erythema, and blistering.
T174 558732-558743 Sentence denotes Toxic Dose:
T175 558744-558793 Sentence denotes Signs of toxicity are dependent on dose ingested.
T176 558794-558804 Sentence denotes Treatment:
T177 558805-558926 Sentence denotes If an animal has ingested benzoyl peroxide, do not induce emesis, because of the risk of worsening esophageal irritation.
T178 558927-558962 Sentence denotes Instead, perform orogastric lavage.
T179 558963-559082 Sentence denotes Administer gastroprotectant and antiemetic medications and closely observe the patient for signs of gastric dilatation.
T180 559083-559235 Sentence denotes β-Adrenergic agonists, including terbutaline, albuterol (salbutamol), and metaproterenol, are commonly used in inhaled form for the treatment of asthma.
T181 559236-559322 Sentence denotes Animals commonly are exposed to the compounds after chewing on their owners' inhalers.
T182 559323-559475 Sentence denotes Pathophysiology: B1 agonist stimulation results in tachycardia; beta-2 agonist stimulation results in vasodilation, hypotension, and reflex tachycardia.
T183 559476-559543 Sentence denotes Potassium shifts intracellularly and results in severe hypokalemia.
T184 559544-559559 Sentence denotes Clinical Signs:
T185 559560-559654 Sentence denotes Clinical signs of β-adrenergic stimulation include tachycardia, muscle tremors, and agitation.
T186 559655-559684 Sentence denotes Severe hypokalemia can occur.
T187 559685-559696 Sentence denotes Toxic Dose:
T188 559697-559807 Sentence denotes In most cases, dependent on amount left in inhaler, puncture of inhaler allows entire contents to be absorbed.
T189 559808-559818 Sentence denotes Treatment:
T190 559819-560186 Sentence denotes Treatment of β-adrenergic agonist intoxication includes treatment with β-blockers (propranolol (0.02 to 0.08 mg/kg IV slowly to effect), esmolol (0.05 to 0.1 mg/kg IV slowly to effect, then 50 to 200 mcg/kg/min IV CRI), atenolol (0.5 to 1 mg/kg PO q12h [canine], 6.25 to 12.5 mg/cat PO q12-24h [feline]), intravenous fluids, and intravenous potassium supplementation.
T191 560187-560309 Sentence denotes Diazepam (0.5 to 1 mg/kg IV) or acepromazine (0.025-0.2 mg/ kg IV) may be administered for sedation and muscle relaxation.
T192 560310-560459 Sentence denotes Sodium hypochlorite is available in dilute (3% to 6%) or concentrated (50% industrial strength or swimming pool) solutions for a variety of purposes.
T193 560460-560476 Sentence denotes Pathophysiology:
T194 560477-560588 Sentence denotes Sodium hypochlorite can cause severe contact irritation and tissue destruction, depending on the concentration.
T195 560589-560636 Sentence denotes Affected animals may have a bleached hair coat.
T196 560637-560652 Sentence denotes Clinical Signs:
T197 560653-560782 Sentence denotes Clinical signs include bleached hair coat, erythema, blistering, vomiting and hematemesis, ptyalism, and inappetence if ingested.
T198 560783-560794 Sentence denotes Toxic Dose:
T199 560795-560845 Sentence denotes Clinical signs are dependent on quantity ingested.
T200 560846-560929 Sentence denotes Even small quantities can cause dermal irritation and gastrointestinal disturbance.
T201 560930-560940 Sentence denotes Treatment:
T202 560941-561050 Sentence denotes Treatment of exposure includes dilution with copious amounts of warm water or saline baths and ocular lavage.
T203 561051-561186 Sentence denotes Induction of emesis and orogastric lavage is absolutely 1 contraindicated because of the risk of causing further esophageal irritation.
T204 561187-561352 Sentence denotes To treat ingestion, give the animal milk or large amounts of water, in combination with gastroprotectant and antiemetic drugs, to dilute the contents in the stomach.
T205 561353-561435 Sentence denotes Administration of sodium bicarbonate or Milk of Magnesia is no longer recommended.
T206 561436-561539 Sentence denotes Nonchlorine bleaches (sodium peroxide or sodium perborate) have a moderate toxic potential if ingested.
T207 561540-561556 Sentence denotes Pathophysiology:
T208 561557-561602 Sentence denotes Sodium peroxide can cause gastric distension.
T209 561603-561784 Sentence denotes Sodium perborate can cause severe gastric irritation, with vomiting and diarrhea; renal damage and CNS excitation followed by depression can occur, depending on the amount ingested.
T210 561785-561800 Sentence denotes Clinical Signs:
T211 561801-561911 Sentence denotes Clinical signs include vomiting, diarrhea, agitation followed by lethargy or depression, and gastric dilation.
T212 561912-561923 Sentence denotes Toxic Dose:
T213 561924-562030 Sentence denotes Six-percent sodium hypochlorite (undiluted) can cause irritation to the skin, eyes, and orogastric mucosa.
T214 562031-562041 Sentence denotes Treatment:
T215 562042-562254 Sentence denotes To treat dermal or ocular exposure, rinse the skin or eyes with copious amounts of warm tap water or sterile saline for a minimum of 30 minutes; treat ocular injuries as necessary, if corneal burns have occurred.
T216 562255-562335 Sentence denotes If the bleach has been ingested, do induce emesis and perform orogastric lavage.
T217 562336-562379 Sentence denotes Administer Milk of Magnesia (2 to 3 mL/kg).
T218 562380-562446 Sentence denotes Boric acid is the active ingredient in many ant and roach killers.
T219 562447-562463 Sentence denotes Pathophysiology:
T220 562464-562491 Sentence denotes Pathophysiology is unknown.
T221 562492-562507 Sentence denotes Clinical Signs:
T222 562508-562629 Sentence denotes Clinical signs include vomiting (blue-green vomitus), blue-green stools, renal damage, and CNS excitation and depression.
T223 562630-562641 Sentence denotes Toxic Dose:
T224 562642-562664 Sentence denotes 1 to 3 g/kg Treatment:
T225 562665-562853 Sentence denotes Treatment of boric acid or borate ingestion includes gastric decontamination with induction of emesis or orogastric lavage, followed by administration of a cathartic to hasten elimination.
T226 562854-562920 Sentence denotes Activated charcoal is not useful to treat ingestion of this toxin.
T227 562921-562986 Sentence denotes Administer intravenous fluid therapy to maintain renal perfusion.
T228 562987-563049 Sentence denotes Administer gastroprotectant and antiemetic drugs as necessary.
T229 563050-563143 Sentence denotes Clostridium botulinum endospores can be found in carrion, food, garbage, and the environment.
T230 563144-563276 Sentence denotes Ingestion of endospores and C. botulinum endotoxin rarely can cause generalized neuromuscular blockade of spinal and cranial nerves.
T231 563277-563292 Sentence denotes Clinical Signs:
T232 563293-563379 Sentence denotes Clinical signs include miosis, anisocoria, lower motor neuron weakness, and paralysis.
T233 563380-563453 Sentence denotes Respiratory paralysis, megaesophagus, and aspiration pneumonia can occur.
T234 563454-563512 Sentence denotes Clinical signs usually develop within 6 days of ingestion.
T235 563513-563524 Sentence denotes Toxic Dose:
T236 563525-563616 Sentence denotes Ingestion of preformed botulinum toxin causes toxicity; signs dependent on amount ingested.
T237 563617-563640 Sentence denotes Differential Diagnoses:
T238 563641-563767 Sentence denotes Differential diagnoses include acute polyradiculoneuritis (coonhound paralysis), bromethalin intoxication, and tick paralysis.
T239 563768-563778 Sentence denotes Treatment:
T240 563779-563880 Sentence denotes Treatment of botulism is largely supportive; although an antitoxin exists, it often is of no benefit.
T241 563881-564110 Sentence denotes Treatment may include administration of intravenous fluids, frequent turning of the patient and passive range-of-motion exercises to prevent disuse muscle atrophy, and supplemental oxygen administration or mechanical ventilation.
T242 564111-564164 Sentence denotes Administer amoxicillin, ampicillin, or metronidazole.
T243 564165-564225 Sentence denotes Recovery may be prolonged, up to 3 to 4 weeks in some cases.
T244 564226-564303 Sentence denotes Bromethalin is the active ingredient in some brands of mouse and rat poisons.
T245 564304-564410 Sentence denotes It usually is packaged as 0.01% bromethalin in green or tan pellets and is packaged in 16-to 42.5-g packs.
T246 564411-564427 Sentence denotes Pathophysiology:
T247 564428-564493 Sentence denotes Pathophysiology involves uncoupling of oxidative phosphorylation.
T248 564494-564509 Sentence denotes Clinical Signs:
T249 564510-564632 Sentence denotes An acute syndrome of vomiting, tremors, extensor rigidity, and seizures occurs within 24 hours of ingestion of high doses.
T250 564633-564801 Sentence denotes Delayed clinical signs occur within 3 to 7 days of ingestion of a lower dose and include posterior paresis progressing to ascending paralysis, CNS depression, and coma.
T251 564802-564809 Sentence denotes Toxic :
T252 564810-564874 Sentence denotes The toxic dose for dogs is 6.25 mg/kg (dog) and 1.8 mg/kg (cat).
T253 564875-564946 Sentence denotes Bromethalin causes toxicity by uncoupling of oxidative phosphorylation.
T254 564947-565069 Sentence denotes An acute syndrome of vomiting, tremors, extensor rigidity, and seizures occurs within 24 hours of ingestion of high doses.
T255 565070-565238 Sentence denotes Delayed clinical signs occur within 3 to 7 days of ingestion of a lower dose and include posterior paresis progressing to ascending paralysis, CNS depression, and coma.
T256 565239-565249 Sentence denotes Treatment:
T257 565250-565472 Sentence denotes Treatment of known bromethalin ingestion includes induction of emesis or orogastric lavage, and repeated doses of activated charcoal every 4 to 6 hours for 3 days, because bromethalin undergoes enterohepatic recirculation.
T258 565473-565674 Sentence denotes Supportive care includes intravenous fluids, anticonvulsants, muscle relaxants (methocarbamol up to 220 mg/kg/ day IV to effect), frequent turning of the patient, and passive range-of-motion exercises.
T259 565675-565790 Sentence denotes Supplemental oxygen and/or mechanical ventilation may be required in patients with coma and severe hypoventilation.
T260 565791-565902 Sentence denotes Administer mannitol (0.5 to 1 g/kg) in conjunction with furosemide (1 mg/kg IV) if cerebral edema is suspected.
T261 565903-565978 Sentence denotes The majority of caffeine toxicities occur in dogs that ingest coffee beans.
T262 565979-565995 Sentence denotes Pathophysiology:
T263 565996-566041 Sentence denotes Caffeine causes phosphodiesterase inhibition.
T264 566042-566057 Sentence denotes Clinical Signs:
T265 566058-566206 Sentence denotes Clinical signs include cardiac tachyarrhythmias, CNS stimulation (hyperexcitability and seizures), diuresis, gastric ulcers, vomiting, and diarrhea.
T266 566207-566279 Sentence denotes Muscle tremors and seizures can occur, resulting in severe hyperthermia.
T267 566280-566321 Sentence denotes Toxic Dose: LD 50 of 140 mg/kg Treatment:
T268 566322-566422 Sentence denotes Treatment of caffeine toxicity is largely symptomatic and supportive, as there is no known antidote.
T269 566423-566519 Sentence denotes If clinical signs are not apparent and the patient is able to protect its airway, induce emesis.
T270 566520-566620 Sentence denotes Alternatively, orogastric lavage can be performed, followed by administration of activated charcoal.
T271 566621-566681 Sentence denotes Administer diazepam (0.5 to 1 mg/kg IV) to control seizures.
T272 566682-566951 Sentence denotes Administer β-adrenergic blockers (e.g., esmolol, 50 to 100 mcg/kg IV bolus, 50 to 200 mcg/kg/min IV CRI; propranolol, 0.04 to 0.1 mg/kg IV slowly to effect; atenolol, 0.5 to 2 mg/kg PO q12h [canine], 6.25 to 12.5 mg/cat PO q12-24h [feline]) to control tachyarrhythmias.
T273 566952-567023 Sentence denotes Give intravenous fluids to maintain hydration and correct hyperthermia.
T274 567024-567160 Sentence denotes The patient should be walked frequently or have a urinary catheter placed to prevent reabsorption of the toxin from the urinary bladder.
T275 567161-567237 Sentence denotes Carbamate compounds are found in agricultural and home insecticide products.
T276 567238-567326 Sentence denotes Examples of carbamates include carbofuran, aldicarb, propoxur, carbaryl, and methiocarb.
T277 567327-567343 Sentence denotes Pathophysiology:
T278 567344-567416 Sentence denotes Carbamate compounds function by causing acetylcholinesterase inhibition.
T279 567417-567550 Sentence denotes Toxic amounts cause CNS excitation, muscarinic acetylcholine overload, and SLUD (salivation, lacrimation, urination, and defecation).
T280 567551-567614 Sentence denotes Miosis, vomiting, and diarrhea result from muscarinic overload.
T281 567615-567658 Sentence denotes Nicotinic overload produces muscle tremors.
T282 567659-567708 Sentence denotes Toxicity can result in seizures, coma, and death.
T283 567709-567720 Sentence denotes Toxic Dose:
T284 567721-567760 Sentence denotes The toxic dose of each compound varies.
T285 567761-567776 Sentence denotes Clinical Signs:
T286 567777-567910 Sentence denotes Toxic amounts cause CNS excitation, muscarinic acetylcholine overload, and SLUD (salivation, lacrimation, urination, and defecation).
T287 567911-567974 Sentence denotes Miosis, vomiting, and diarrhea result from muscarinic overload.
T288 567975-568018 Sentence denotes Nicotinic overload produces muscle tremors.
T289 568019-568068 Sentence denotes Toxicity can result in seizures, coma, and death.
T290 568069-568079 Sentence denotes Treatment:
T291 568080-568195 Sentence denotes Treatment of carbamate intoxication includes maintaining an airway and, if necessary, using artificial ventilation.
T292 568196-568296 Sentence denotes Administer intravenous crystalloid fluids to control 1 the patient's hydration, BP, and temperature.
T293 568297-568331 Sentence denotes Cooling measures may be warranted.
T294 568332-568425 Sentence denotes Induce emesis if the substance was ingested within 60 minutes and the animal is asymptomatic.
T295 568426-568517 Sentence denotes Give repeated doses of activated charcoal if the animal can swallow and protect its airway.
T296 568518-568564 Sentence denotes Control seizures with diazepam (0.5 mg/kg IV).
T297 568565-568594 Sentence denotes Bathe the patient thoroughly.
T298 568595-568702 Sentence denotes Atropine (0.2 mg/kg IV) is useful in controlling some of the muscarinic signs associated with the toxicity.
T299 568703-568786 Sentence denotes Pralidoxime hydrochloride (2-PAM) is not useful in cases of carbamate intoxication.
T300 568787-568880 Sentence denotes Control muscle tremors with methocarbamol (up to 220 mg/kg IV) or guaifenesin (110 mg/kg IV).
T301 568881-568966 Sentence denotes In humans, ingestion or inhalation of 3 to 5 mL of carbon tetrachloride can be fatal.
T302 568967-568990 Sentence denotes The prognosis is grave.
T303 568991-569006 Sentence denotes Clinical Signs:
T304 569007-569134 Sentence denotes Clinical signs of carbon tetrachloride toxicity include vomiting and diarrhea, then progressive respiratory and CNS depression.
T305 569135-569189 Sentence denotes Ventricular dysrhythmias and hepatorenal damage ensue.
T306 569190-569201 Sentence denotes Toxic Dose:
T307 569202-569233 Sentence denotes Toxic at very small quantities.
T308 569234-569244 Sentence denotes Treatment:
T309 569245-569399 Sentence denotes Treatment of carbon tetrachloride inhalation includes procurement and maintenance of a patent airway with supplemental oxygen, and cardiovascular support.
T310 569400-569528 Sentence denotes To treat ingestion, administer activated charcoal, and give intravenous fluids to maintain hydration and support renal function.
T311 569529-569721 Sentence denotes Chlorinated hydrocarbons include dichlorodiphenyltrichloroethane (DDT), methoxychlor, lindane, dieldrin, aldrin, chlordane, chlordecone, Perthane, toxaphene, heptachlor, mirex, and endosulfan.
T312 569722-569738 Sentence denotes Pathophysiology:
T313 569739-569882 Sentence denotes Chlorinated hydrocarbons exert their toxic effects by an unknown mechanism and can be absorbed through the skin and the gastrointestinal tract.
T314 569883-569894 Sentence denotes Toxic Dose:
T315 569895-569934 Sentence denotes The toxic dose of each compound varies.
T316 569935-569950 Sentence denotes Clinical Signs:
T317 569951-570200 Sentence denotes Clinical signs are similar to those observed in organophosphate toxicity: CNS excitation, seizures, SLUD (salivation, lacrimation, urination, defecation), excessive bronchial secretions, vomiting, diarrhea, muscle tremors, and respiratory paralysis.
T318 570201-570279 Sentence denotes Secondary toxicity from toxic metabolites can cause renal and hepatic failure.
T319 570280-570379 Sentence denotes Chronic exposure may cause anorexia, vomiting, weight loss, tremors, seizures, and hepatic failure.
T320 570380-570442 Sentence denotes The clinical course can be prolonged in small animal patients.
T321 570443-570453 Sentence denotes Treatment:
T322 570454-570563 Sentence denotes Treatment of chlorinated hydrocarbon toxicity is largely supportive in nature, as there is no known antidote.
T323 570564-570606 Sentence denotes Procure and maintain the patient's airway.
T324 570607-570662 Sentence denotes Normalize the body temperature to prevent hyperthermia.
T325 570663-570769 Sentence denotes If the substance was just ingested and the patient is not demonstrating any clinical signs, induce emesis.
T326 570770-570873 Sentence denotes If the patient is symptomatic, perform orogastric lavage followed by activated charcoal administration.
T327 570874-570932 Sentence denotes Bathe the patient thoroughly in cases of topical exposure.
T328 570933-570997 Sentence denotes Administer intravenous crystalloid fluids to maintain hydration.
T329 570998-571061 Sentence denotes These compounds do not appear to be amenable to fluid diuresis.
T330 571062-571270 Sentence denotes Chlorphenoxy derivatives are found in 2,4-diphenoxyacetic acid (2,4-D); 2,4,5-trichlorophenoxyacetic acid (2,4,5-T); 2-methyl-4-chlorophenoxyacetic acid (MCPA); meta-chlorophenylpiperazine (mCPP); and Silvex.
T331 571271-571287 Sentence denotes Pathophysiology:
T332 571288-571363 Sentence denotes Chlorphenoxy derivatives exert their toxic effects by an unknown mechanism.
T333 571364-571379 Sentence denotes Clinical Signs:
T334 571380-571437 Sentence denotes Gastroenteritis (vomiting, diarrhea) and muscle rigidity.
T335 571438-571449 Sentence denotes Toxic Dose:
T336 571450-571557 Sentence denotes The LD 50 of 2,4-D is 100 mg/kg; however, the toxic dose appears to be much lower in small animal patients.
T337 571558-571568 Sentence denotes Treatment:
T338 571569-571678 Sentence denotes Treatment of chlorphenoxy derivative toxicity is largely supportive in nature, as there is no known antidote.
T339 571679-571755 Sentence denotes Secure the patient's airway and administer supplemental oxygen as necessary.
T340 571756-571808 Sentence denotes Control CNS excitation with diazepam (0.5 mg/kg IV).
T341 571809-571899 Sentence denotes Intravenous crystalloid fluid diuresis and urinary alkalinization can promote elimination.
T342 571900-571959 Sentence denotes Administer gastroprotectant and antiemetic drugs as needed.
T343 571960-571976 Sentence denotes Pathophysiology:
T344 571977-572092 Sentence denotes The toxic effects of chocolate are related to theobromine and interference with or inhibition of phosphodiesterase.
T345 572093-572108 Sentence denotes Clinical Signs:
T346 572109-572300 Sentence denotes Clinical signs include CNS stimulation (tremors, anxiety, seizures), myocardial stimulation (tachycardia and tachyarrhythmias), diuresis, and (at very high doses) gastrointestinal ulceration.
T347 572301-572407 Sentence denotes Potential side effects include gastroenteritis and pancreatitis owing to the fat content of the chocolate.
T348 572408-572419 Sentence denotes Toxic Dose:
T349 572420-572608 Sentence denotes Various types of chocolate have different concentrations of theobromine and thus can cause clinical signs of toxicity with ingestion of varying amounts of chocolate, depending on the type.
T350 572609-572667 Sentence denotes The toxic dose of theobromine is 100 to 150 mg/kg in dogs.
T351 572668-572759 Sentence denotes Milk chocolate contains 44 mg/oz (154 mg/100 g) of chocolate and has a low toxic potential.
T352 572760-572871 Sentence denotes Semisweet chocolate contains 150 mg/oz (528 mg/100 g), and baking chocolate contains 390 mg/oz (1365 mg/100 g).
T353 572872-572995 Sentence denotes Semisweet and baking chocolate, being the most concentrated, have a moderate to severe toxic potential, even in large dogs.
T354 572996-573006 Sentence denotes Treatment:
T355 573007-573360 Sentence denotes Treatment of chocolate toxicity includes obtaining and maintaining a protected airway (if necessary), administering intravenous fluid diuresis, inducing emesis or performing orogastric lavage followed by administration of repeated doses of activated charcoal, and placing a urinary catheter to prevent reabsorption of the toxin from the urinary bladder.
T356 573361-573471 Sentence denotes With treatment, the condition of most dogs returns to normal within 12 to 24 hours (t ½ = 17.5 hours in dogs).
T357 573472-573604 Sentence denotes Cholecalciferol is found in some rodenticides and also as active vitamin D in dietary or vitamin supplements (OTC and prescription).
T358 573605-573621 Sentence denotes Pathophysiology:
T359 573622-573777 Sentence denotes Increased intestinal and renal reabsorption of calcium occurs, causing an increase in serum calcium and dystrophic mineralization of the kidneys and liver.
T360 573778-573793 Sentence denotes Clinical Signs:
T361 573794-573908 Sentence denotes Clinical signs include lethargy, anorexia, vomiting, constipation, and renal pain within 2 to 3 days of ingestion.
T362 573909-573991 Sentence denotes Seizures, muscle twitching, and CNS depression may be observed at very high doses.
T363 573992-574101 Sentence denotes As renal failure progresses, PU/PD, vomiting and hematemesis, uremic oral ulcers, and melena may be observed.
T364 574102-574113 Sentence denotes Toxic Dose:
T365 574114-574137 Sentence denotes 2 to 3 mg/kg Treatment:
T366 574138-574291 Sentence denotes If the compound was ingested recently (within 2 to 4 hours) induce emesis or perform orogastric lavage, followed by administration of activated charcoal.
T367 574292-574364 Sentence denotes Check the patient's serum calcium once daily for 3 days after ingestion.
T368 574365-574620 Sentence denotes If clinical signs of toxicity or hypercalcemia are present, decrease serum calcium with loop diuretics (furosemide, 2 to 5 mg/kg PO or IV q12h) and glucocorticosteroids (prednisone or prednisolone, 2 to 3 mg/ kg PO bid) to promote renal calcium excretion.
T369 574621-574816 Sentence denotes In severe cases, salmon calcitonin (4 to 6 IU per kg SQ q2-12h in dogs) or bisphosphonate compounds (pamidronate 1 to 2 mg/kg in 150 mL 0.9% saline, administered IV over 2 hours) may be required.
T370 574817-574858 Sentence denotes Deicers See Ethylene Glycol and Alcohols.
T371 574859-574924 Sentence denotes Denture cleaners contain sodium perborate as the active compound.
T372 574925-574941 Sentence denotes Pathophysiology:
T373 574942-575055 Sentence denotes Sodium perborate can cause severe direct irritation of the mucous membranes and may also act as a CNS depressant.
T374 575056-575071 Sentence denotes Clinical Signs:
T375 575072-575236 Sentence denotes Clinical signs are similar to those seen if bleach or boric acid compound is ingested, namely vomiting, diarrhea, CNS excitation then depression, and renal failure.
T376 575237-575247 Sentence denotes Treatment:
T377 575248-575432 Sentence denotes Treatment for ingestion of denture cleaner includes gastric decontamination along with induction of emesis or orogastric lavage and administration of a cathartic to hasten elimination.
T378 575433-575507 Sentence denotes Activated charcoal is not useful for treatment of ingestion of this toxin.
T379 575508-575573 Sentence denotes Administer intravenous fluid therapy to maintain renal perfusion.
T380 575574-575636 Sentence denotes Administer gastroprotectant and antiemetic drugs as necessary.
T381 575637-575717 Sentence denotes Deodorants are usually composed of aluminum chloride and aluminum chlorohydrate.
T382 575718-575762 Sentence denotes Both have a moderate potential for toxicity.
T383 575763-575779 Sentence denotes Pathophysiology:
T384 575780-575806 Sentence denotes Contact irritation occurs.
T385 575807-575822 Sentence denotes Clinical Signs:
T386 575823-575926 Sentence denotes Ingestion of deodorant compounds can cause oral irritation or necrosis, gastroenteritis, and nephrosis.
T387 575927-575937 Sentence denotes Treatment:
T388 575938-576058 Sentence denotes Treatment of deodorant ingestion includes orogastric lavage and administration of antiemetic and gastroprotectant drugs.
T389 576059-576132 Sentence denotes Anionic detergents include sulfonated or phosphorylated forms of benzene.
T390 576133-576149 Sentence denotes Pathophysiology:
T391 576150-576223 Sentence denotes Pathophysiology involves denaturation of proteins and contact irritation.
T392 576224-576239 Sentence denotes Clinical Signs:
T393 576240-576381 Sentence denotes Anionic detergents cause significant mucosal damage and edema, gastrointestinal irritation, CNS depression, seizures, and possible hemolysis.
T394 576382-576433 Sentence denotes Ocular exposure can cause corneal ulcers and edema.
T395 576434-576445 Sentence denotes Toxic Dose:
T396 576446-576545 Sentence denotes Dishwashing liquid is an example of an anionic detergent that can be toxic at doses of 1 to 5 g/kg.
T397 576546-576556 Sentence denotes Treatment:
T398 576557-576651 Sentence denotes Treatment of anionic detergent exposure is largely symptomatic, as there is no known antidote.
T399 576652-576821 Sentence denotes To treat topical toxicity, flush the patient's eyes and skin with warmed tap water or 0.9% saline solution for a minimum of 30 minutes, taking care to avoid hypothermia.
T400 576822-576911 Sentence denotes To treat ingestion, feed the patient milk and large amounts of water to dilute the toxin.
T401 576912-576989 Sentence denotes Do not induce emesis, because of the risk of worsening esophageal irritation.
T402 576990-577087 Sentence denotes To dilute the toxin, perform orogastric lavage, followed by administration of activated charcoal.
T403 577088-577180 Sentence denotes Closely monitor the patient's respiratory status, because oropharyngeal edema can be severe.
T404 577181-577258 Sentence denotes If necessary, perform endotracheal intubation in cases of airway obstruction.
T405 577259-577316 Sentence denotes Monitor the patient for signs of intravascular hemolysis.
T406 577317-577431 Sentence denotes Administer intravenous crystalloid fluids to maintain hydration until the patient is able to tolerate oral fluids.
T407 577432-577543 Sentence denotes Cationic detergents and disinfectants include quaternary ammonia compounds, isopropyl alcohol, and isopropanol.
T408 577544-577560 Sentence denotes Pathophysiology:
T409 577561-577696 Sentence denotes Quaternary ammonia compounds have a serious toxic potential and cause severe irritation and corrosion of the mucous membranes and skin.
T410 577697-577712 Sentence denotes Clinical Signs:
T411 577713-577875 Sentence denotes Some compounds also can cause clinical signs similar to those observed with anticholinesterase compounds, including muscle tremors, seizures, paralysis, and coma.
T412 577876-577905 Sentence denotes Methemoglo binemia can occur.
T413 577906-577916 Sentence denotes Treatment:
T414 577917-578079 Sentence denotes Treatment of cationic detergent exposure includes careful bathing and ocular rinsing of the patient for a minimum of 30 minutes, taking care to avoid hypotension.
T415 578080-578153 Sentence denotes Secure the patient's airway and monitor the patient's respiratory status.
T416 578154-578199 Sentence denotes Administer supplemental oxygen, if necessary.
T417 578200-578298 Sentence denotes Place an intravenous catheter and administer intravenous crystalloid fluids to maintain hydration.
T418 578299-578382 Sentence denotes Do not induce emesis, because of the risk of causing further esophageal irritation.
T419 578383-578472 Sentence denotes Give milk or large amounts of water PO, as tolerated by the patient, to dilute the toxin.
T420 578473-578618 Sentence denotes Nonionic detergents include alkyl and aryl polyether sulfates, alcohols, and sulfonates; alkyl phenol; polyethylene glycol; and phenol compounds.
T421 578619-578670 Sentence denotes Phenols are particularly toxic in cats and puppies.
T422 578671-578687 Sentence denotes Pathophysiology:
T423 578688-578827 Sentence denotes Some compounds can be metabolized to glycolic and oxalic acid, causing renal damage similar to that observed with ethylene glycol toxicity.
T424 578828-578843 Sentence denotes Clinical Signs:
T425 578844-578925 Sentence denotes Clinical signs of exposure include severe gastroenteritis and topical irritation.
T426 578926-579065 Sentence denotes Some compounds can be metabolized to glycolic and oxalic acid, causing renal damage similar to that observed with ethylene glycol toxicity.
T427 579066-579076 Sentence denotes Treatment:
T428 579077-579189 Sentence denotes Topical and ocular exposure should be treated with careful bathing or ocular irrigation for at least 30 minutes.
T429 579190-579258 Sentence denotes Administer activated charcoal to prevent absorption of the compound.
T430 579259-579338 Sentence denotes As tolerated, give dilute milk or straight tap water PO to dilute the compound.
T431 579339-579449 Sentence denotes Administer antiemetic and gastroprotectant drugs to control vomiting and decrease gastrointestinal irritation.
T432 579450-579566 Sentence denotes Administer intravenous crystalloid fluids to maintain hydration and decrease the potential for renal tubular damage.
T433 579567-579695 Sentence denotes Monitor the patient's acid-base and electrolyte status and correct any abnormalities with appropriate intravenous fluid therapy.
T434 579696-579763 Sentence denotes Dichlone (Phygon) is a dipyridyl compound that is a CNS depressant.
T435 579764-579780 Sentence denotes Pathophysiology:
T436 579781-579866 Sentence denotes Dichlone reacts with thiol enzymes to cause methemoglobinemia and hepatorenal damage.
T437 579867-579882 Sentence denotes Clinical Signs:
T438 579883-579977 Sentence denotes Clinical signs include CNS depression, somnolence, PU/PD, then vomiting and uremic ulceration.
T439 579978-579989 Sentence denotes Toxic Dose:
T440 579990-580026 Sentence denotes The LD 50 in rats is 25 to 50 mg/kg.
T441 580027-580037 Sentence denotes Treatment:
T442 580038-580176 Sentence denotes To treat dichlone ingestion, induce emesis or perform orogastric lavage, followed by administration of activated charcoal and a cathartic.
T443 580177-580214 Sentence denotes Procure and maintain a patent airway.
T444 580215-580278 Sentence denotes Perform intravenous fluid diuresis to maintain renal perfusion.
T445 580279-580422 Sentence denotes N-acetylcysteine (140 mg/kg PO or IV once then 70 mg/kg PO or IV q6h for seven treatments) may be useful in the treatment of methemoglobinemia.
T446 580423-580535 Sentence denotes Diethyltoluamide (DEET) is the active ingredient in many insect repellants (e.g., Off, Cutters, Hartz Blockade).
T447 580536-580552 Sentence denotes Pathophysiology:
T448 580553-580684 Sentence denotes The mechanism of action of DEET is not fully understood, but it acts as a lipophilic neurotoxin within 5 to 10 minutes of exposure.
T449 580685-580734 Sentence denotes Cats appear to be particularly sensitive to DEET.
T450 580735-580750 Sentence denotes Clinical Signs:
T451 580751-580881 Sentence denotes Clinical signs of toxicity include aimless gazing, hypersalivation, chewing motions, and muscle tremors that progress to seizures.
T452 580882-580957 Sentence denotes Recumbency and death can occur within 30 minutes of exposure at high doses.
T453 580958-580969 Sentence denotes Toxic Dose:
T454 580970-581046 Sentence denotes A lethal dermal dose is 1.8 g/kg; if ingested, the lethal dose is much less.
T455 581047-581099 Sentence denotes The toxic dose of dermal exposure in dogs is 7 g/kg.
T456 581100-581110 Sentence denotes Treatment:
T457 581111-581193 Sentence denotes Treatment of DEET toxicity is largely supportive, as there are no known antidotes.
T458 581194-581280 Sentence denotes Procure and maintain a patent airway and perform mechanical ventilation, if necessary.
T459 581281-581415 Sentence denotes Place an intravenous catheter and administer intravenous crystalloid fluids to 1 control hydration and treat hypotension as necessary.
T460 581416-581478 Sentence denotes Treat seizures with diazepam (0.5 mg/ kg IV) or phenobarbital.
T461 581479-581564 Sentence denotes Because of the rapid onset of clinical signs, induction of emesis is contraindicated.
T462 581565-581644 Sentence denotes Perform orogastric lavage if the compound was ingested within the last 2 hours.
T463 581645-581702 Sentence denotes Administer multiple repeated doses of activated charcoal.
T464 581703-581766 Sentence denotes Cooling measures should be implemented to control hyperthermia.
T465 581767-581870 Sentence denotes If dermal exposure has occurred, bathe the patient thoroughly to avoid further exposure and absorption.
T466 581871-581960 Sentence denotes Diquat is a dipyridyl compound that is the active ingredient in some herbicide compounds.
T467 581961-581977 Sentence denotes Pathophysiology:
T468 581978-582091 Sentence denotes Like paraquat, diquat induces its toxic effects by causing the production of oxygen-derived free radical species.
T469 582092-582107 Sentence denotes Clinical Signs:
T470 582108-582208 Sentence denotes Clinical signs of diquat intoxication include anorexia, vomiting, diarrhea, and acute renal failure.
T471 582209-582324 Sentence denotes Massive dehydration and electrolyte imbalances can occur as a result of fluid loss into the gastrointestinal tract.
T472 582325-582336 Sentence denotes Toxic Dose:
T473 582337-582375 Sentence denotes The LD 50 of diquat is 25 to 50 mg/kg.
T474 582376-582386 Sentence denotes Treatment:
T475 582387-582462 Sentence denotes Treatment of diquat intoxication is similar to that for paraquat ingestion.
T476 582463-582538 Sentence denotes If the animal ingested diquat within 1 hour of presentation, induce emesis.
T477 582539-582592 Sentence denotes In clinical cases, orogastric lavage may be required.
T478 582593-582735 Sentence denotes Both emesis and orogastric lavage should be followed by administration of kaolin or bentonite as an adsorbent, rather than activated charcoal.
T479 582736-582854 Sentence denotes Place an intravenous catheter and administer crystalloid fluids to restore volume status and maintain renal perfusion.
T480 582855-582876 Sentence denotes Monitor urine output.
T481 582877-582975 Sentence denotes If oliguria or anuria occurs, treatment with mannitol, furosemide, and dopamine may be considered.
T482 582976-583064 Sentence denotes Ecstasy (3,4-methylenedioxymethamphetamine; MDMA) is a recreational drug used by humans.
T483 583065-583081 Sentence denotes Pathophysiology:
T484 583082-583118 Sentence denotes Ecstasy causes release of serotonin.
T485 583119-583190 Sentence denotes A urine drug screening test can be used to detect the presence of MDMA.
T486 583191-583202 Sentence denotes Toxic Dose:
T487 583203-583289 Sentence denotes Clinical signs occur at 9 mg/kg; death occurs at doses greater than 15 mg/kg (canine).
T488 583290-583305 Sentence denotes Clinical Signs:
T489 583306-583459 Sentence denotes Clinical signs of intoxication are related to the serotonin syndrome (excitation, hyperthermia, tremors, and hypertension), and seizures may be observed.
T490 583460-583470 Sentence denotes Treatment:
T491 583471-583558 Sentence denotes Treatment of ecstasy intoxication is largely supportive, as there is no known antidote.
T492 583559-583661 Sentence denotes Administer intravenous fluids to maintain hydration, correct acid-base status, and treat hyperthermia.
T493 583662-583900 Sentence denotes Serotonin antagonist drugs (cyproheptadine 1.1 mg/kg PO in dogs-repeat in 4-6 hours until signs resolve; 2-4 mg PO per cat -repeat in 4-6 hours until signs resolve) can be dissolved and administered per rectum to alleviate clinical signs.
T494 583901-583996 Sentence denotes Intravenous propranolol (0.05 to 0.08 mg/kg IV to effect) has additional antiserotonin effects.
T495 583997-584057 Sentence denotes Administer diazepam (0.5 to 2 mg/kg IV) to control seizures.
T496 584058-584167 Sentence denotes If cerebral edema is suspected, administer mannitol (0.5 to 1 mg/kg IV), followed by furosemide (1 mg/kg IV).
T497 584168-584319 Sentence denotes Ethylene glycol is most commonly found in antifreeze solutions but is also in some paints, photography developer solutions, and windshield wiper fluid.
T498 584320-584336 Sentence denotes Pathophysiology:
T499 584337-584387 Sentence denotes Ethylene glycol in itself is only minimally toxic.
T500 584388-584638 Sentence denotes However, when it is metabolized to glycolate, glyoxal, glyoxylate, and oxalate, the metabolites cause an increased anion gap metabolic acidosis and precipitation of calcium oxalate crystals in the renal tubules, renal failure, and (ultimately) death.
T501 584639-584647 Sentence denotes Testing:
T502 584648-584789 Sentence denotes Colorimetric tests that can be performed in most veterinary hospitals can detect larger quantities of ethylene glycol in the patient's serum.
T503 584790-585066 Sentence denotes In a dog with clinical signs of ethylene glycol intoxication and renal impairment or failure, a negative result of a test for the presence of calcium oxalate crystalluria means that there is no more ethylene glycol in 1 the patient's serum because it has all been metabolized.
T504 585067-585131 Sentence denotes Cats are very sensitive to the toxic effects of ethylene glycol.
T505 585132-585263 Sentence denotes In many cases a cat may have ingested a toxic dose, but because the sensitivity of the assay is low, test results will be negative.
T506 585264-585302 Sentence denotes Lack of treatment can result in death.
T507 585303-585318 Sentence denotes Clinical Signs:
T508 585319-585374 Sentence denotes There are three phases of ethylene glycol intoxication.
T509 585375-585487 Sentence denotes In the first 1 to 12 hours after ingestion (stage I), the patient may appear lethargic, disoriented, and ataxic.
T510 585488-585585 Sentence denotes In stage II (12 to 24 hours after ingestion), the patient improves and appears clinically normal.
T511 585586-585774 Sentence denotes In stage III (24 to 72 hours after ingestion), the patient demonstrates clinical signs of renal failure (PU/PD) that progress to uremic renal failure (vomiting, lethargy, oral ulceration).
T512 585775-585816 Sentence denotes Finally, seizures, coma, and death occur.
T513 585817-585828 Sentence denotes Toxic Dose:
T514 585829-585891 Sentence denotes The toxic dose in dogs is 6.6 mL/kg, and in cats is 1.5 mL/kg.
T515 585892-586031 Sentence denotes The toxin is absorbed quite readily from the gastrointestinal tract and can be detected in the patient's serum within an hour of ingestion.
T516 586032-586042 Sentence denotes Treatment:
T517 586043-586106 Sentence denotes Begin treatment of known ethylene glycol ingestion immediately.
T518 586107-586202 Sentence denotes Induce emesis or perform orogastric lavage and administer repeated doses of activated charcoal.
T519 586203-586294 Sentence denotes Place an intravenous catheter and perform crystalloid fluid diuresis with a known antidote.
T520 586295-586505 Sentence denotes The treatment of choice for dogs and cats is administration of 4-methylpyrazole (4-MP), which directly inhibits alcohol dehydrogenase, thus preventing the conversion of ethylene glycol to its toxic metabolites.
T521 586506-586541 Sentence denotes The doses for dogs and cats differ.
T522 586542-586649 Sentence denotes For dogs, the initial dose is 20 mg/kg IV, followed by 15 mg/kg at 12 and 24 hours and 5 mg/kg at 36 hours.
T523 586650-586799 Sentence denotes In cats, treatment is with 4-MP at 6.25 the dose for dogs (that is, 125 mg/kg IV once, then 31.25 mg/ kg IV at 12, 24, and 36 hours after ingestion).
T524 586800-586886 Sentence denotes 4-MP is effective only if administered within 3 hours of ingestion of ethylene glycol.
T525 586887-586963 Sentence denotes Cats will demonstrate signs of sedation and hypothermia with this treatment.
T526 586964-587212 Sentence denotes If 4-MP is not available, administer ethanol (600 mg/kg IV loading dose, followed by 100 mg/kg/hr, or as a 20% solution [for dogs, 5.5 mL/kg IV q4h for five treatments, then q6h for five more treatments; for cats, 5 mL/kg q8h for four treatments]).
T527 587213-587295 Sentence denotes Grain alcohol (190 proof) contains approximately 715 mg of ethanol per milliliter.
T528 587296-587357 Sentence denotes Antiemetics and gastroprotective agents should be considered.
T529 587358-587472 Sentence denotes Urinary alkalinization and peritoneal dialysis may enhance the elimination of ethylene glycol and its metabolites.
T530 587473-587601 Sentence denotes Many fertilizers are on the market and may be composed of urea or ammonium salts, phosphates, nitrates, potash, and metal salts.
T531 587602-587689 Sentence denotes Fertilizers have a moderate toxic potential, depending on the type and amount ingested.
T532 587690-587706 Sentence denotes Pathophysiology:
T533 587707-587814 Sentence denotes Fertilizers are a contact irritant, causing oxidative damage to RBCs and hemoglobin, forming methemoglobin.
T534 587815-587830 Sentence denotes Clinical Signs:
T535 587831-587931 Sentence denotes Clinical signs of fertilizer ingestion include vomiting, diarrhea, metabolic acidosis, and diuresis.
T536 587932-588016 Sentence denotes Nitrates or nitrites can cause formation of methemoglobin and chocolate-brown blood.
T537 588017-588119 Sentence denotes Electrolyte disturbances include hyperkalemia, hyperphosphatemia, hyperammonemia, and hyperosmolality.
T538 588120-588131 Sentence denotes Toxic Dose:
T539 588132-588187 Sentence denotes Toxic dose is dependent on type of fertilizer ingested.
T540 588188-588198 Sentence denotes Treatment:
T541 588199-588383 Sentence denotes Treatment of fertilizer ingestion includes cardiovascular support and administration of milk or a mixture of egg whites and water, followed by induction of emesis or orogastric lavage.
T542 588384-588462 Sentence denotes Correct electrolyte abnormalities as they occur (see section on hyperkalemia).
T543 588463-588526 Sentence denotes Administer antiemetic and gastroprotectant drugs, as necessary.
T544 588527-588594 Sentence denotes Administer intravenous fluids to control hydration and maintain BP.
T545 588595-588658 Sentence denotes N-acetylcysteine may be useful if methemoglobinemia is present.
T546 588659-588786 Sentence denotes Fipronil is the active ingredient in Frontline, a flea-control product; it is also found in household termite-control products.
T547 588787-588803 Sentence denotes Pathophysiology:
T548 588804-588880 Sentence denotes Fipronil exerts its effects by GABA antagonism and can cause CNS excitation.
T549 588881-588896 Sentence denotes Clinical Signs:
T550 588897-588965 Sentence denotes Clinical signs include muscle fasciculations, tremors, and seizures.
T551 588966-589003 Sentence denotes Toxic Dose: >0.3 mg/kg/day Treatment:
T552 589004-589161 Sentence denotes Treatment of fipronil toxicity includes treatment of CNS excitation, treatment of hyperthermia by cooling measures, and administration of activated charcoal.
T553 589162-589278 Sentence denotes Fire extinguisher fluid contains chlorobromomethane or methyl bromide, both of which have a serious toxic potential.
T554 589279-589295 Sentence denotes Pathophysiology:
T555 589296-589342 Sentence denotes Fire extinguisher fluid is a contact irritant.
T556 589343-589451 Sentence denotes When it is ingested, the compounds can be converted to methanol and cause high anion gap metabolic acidosis.
T557 589452-589467 Sentence denotes Clinical Signs:
T558 589468-589528 Sentence denotes Signs attributable to dermal or ocular irritation can occur.
T559 589529-589708 Sentence denotes If ingested, the compounds can be converted to methanol and cause high anion gap metabolic acidosis, CNS excitation and depression, aspiration pneumonitis, and hepatorenal damage.
T560 589709-589719 Sentence denotes Treatment:
T561 589720-589881 Sentence denotes To treat ocular or dermal exposure to fire extinguisher fluids, flush the eyes or skin with warmed tap water or 0.9% saline solution for a minimum of 30 minutes.
T562 589882-590013 Sentence denotes Do not induce emesis or perform orogastric lavage to treat ingestion, because of the risk of causing severe aspiration pneumonitis.
T563 590014-590078 Sentence denotes Gastroprotectant and antiemetic drugs may be used, if indicated.
T564 590079-590151 Sentence denotes Administer intravenous fluids to maintain hydration and renal perfusion.
T565 590152-590256 Sentence denotes Supplemental oxygen or mechanical ventilation may be required in severe cases of aspiration pneumonitis.
T566 590257-590494 Sentence denotes Fireplace colors contain salts of heavy metals-namely, copper rubidium, cesium, lead, arsenic, antimony, barium, selenium, and zinc-all of which have moderate toxic potential, depending on the amount ingested and the size of the patient.
T567 590495-590510 Sentence denotes Clinical Signs:
T568 590511-590613 Sentence denotes Clinical signs are largely associated with gastrointestinal irritation (vomiting, diarrhea, anorexia).
T569 590614-590685 Sentence denotes Zinc toxicity can cause intravascular hemolysis and hepatorenal damage.
T570 590686-590696 Sentence denotes Treatment:
T571 590697-590822 Sentence denotes To treat ingestion of fireplace colors, administer cathartics, activated charcoal, and gastroprotectant and antiemetic drugs.
T572 590823-590944 Sentence denotes Place an intravenous catheter for intravenous crystalloid fluid administration to maintain hydration and renal perfusion.
T573 590945-591030 Sentence denotes Specific chelating agents may be useful in hastening elimination of the heavy metals.
T574 591031-591155 Sentence denotes Fireworks contain oxidizing agents (nitrates and chlorates) and metals (mercury, copper, strontium, barium, and phosphorus).
T575 591156-591172 Sentence denotes Pathophysiology:
T576 591173-591206 Sentence denotes Fireworks are a contact irritant.
T577 591207-591222 Sentence denotes Clinical Signs:
T578 591223-591282 Sentence denotes Ingestion of fireworks can cause HGE and methemoglobinemia.
T579 591283-591293 Sentence denotes Treatment:
T580 591294-591400 Sentence denotes To treat firework ingestion, induce emesis or perform orogastric lavage and administer activated charcoal.
T581 591401-591533 Sentence denotes Administer specific chelating drugs if the amount and type of metal are known, and administer gastroprotectant and antiemetic drugs.
T582 591534-591629 Sentence denotes If methemoglobinemia occurs, administer N-acetylcysteine; a blood transfusion may be necessary.
T583 591630-591760 Sentence denotes Fuels such as barbecue lighter fluid, gasoline, kerosene, and oils (mineral, fuel, lubricating) are petroleum distillate products.
T584 591761-591777 Sentence denotes Pathophysiology:
T585 591778-591928 Sentence denotes Fuels have low toxic potential if ingested but can cause severe aspiration pneumonitis if as little as 1 mL is inhaled into the tracheobronchial tree.
T586 591929-592047 Sentence denotes Clinical Signs: CNS depression, mucosal damage, hepatorenal insufficiency, seizures, and corneal irritation can occur.
T587 592048-592058 Sentence denotes Treatment:
T588 592059-592132 Sentence denotes If fuels are ingested, administer gastroprotectant and antiemetics drugs.
T589 592133-592228 Sentence denotes Do not induce emesis or perform orogastric lavage, because of the risk of aspiration pneumonia.
T590 592229-592336 Sentence denotes To 1 treat topical exposure, rinse the skin and eyes copiously with warm tap water or 0.9% saline solution.
T591 592337-592400 Sentence denotes Administer antiemetic and gastroprotectant drugs, as necessary.
T592 592401-592503 Sentence denotes Administer intravenous fluids to maintain hydration and treat acid-base and electrolyte abnormalities.
T593 592504-592524 Sentence denotes Gasolines See Fuels.
T594 592525-592585 Sentence denotes Glue, Children's Children's glue contains polyvinyl acetate.
T595 592586-592602 Sentence denotes Pathophysiology:
T596 592603-592650 Sentence denotes Children's glue has a very low toxic potential.
T597 592651-592698 Sentence denotes If inhaled, the compound can cause pneumonitis.
T598 592699-592714 Sentence denotes Clinical Signs:
T599 592715-592802 Sentence denotes Clinical signs are attributable to pneumonitis: coughing, increased respiratory effort.
T600 592803-592813 Sentence denotes Treatment:
T601 592814-592984 Sentence denotes Treatment for polyvinyl acetate exposure should be performed as clinical signs of pneumonitis (increased respiratory effort, cough, lethargy, respiratory distress) occur.
T602 592985-593027 Sentence denotes Superglue contains methyl-2-cyanoacrylate.
T603 593028-593044 Sentence denotes Pathophysiology:
T604 593045-593106 Sentence denotes Superglue is a contact irritant and causes dermal irritation.
T605 593107-593122 Sentence denotes Clinical Signs:
T606 593123-593197 Sentence denotes Clinical signs include dermal irritation, glue stuck on fur, and erythema.
T607 593198-593209 Sentence denotes Toxic Dose:
T608 593210-593274 Sentence denotes Toxic dose is dependent on quantity to which patient is exposed.
T609 593275-593285 Sentence denotes Treatment:
T610 593286-593307 Sentence denotes Do not induce emesis.
T611 593308-593435 Sentence denotes Do not bathe the animal, and do not apply other compounds (acetone, turpentine) in an attempt to remove the glue from the skin.
T612 593436-593508 Sentence denotes The fur can be shaved, using care to avoid damaging the underlying skin.
T613 593509-593568 Sentence denotes The affected area should be allowed to exfoliate naturally.
T1 593569-593799 Sentence denotes Gorilla Glue, or Elmer's Probond, contains the compound diphenylmethane diisocyanate, which, when ingested and exposed to moisture in the stomach and esophagus, expands to more than four times its original volume, then solidifies.
T2 593800-593890 Sentence denotes The result is that the glue can adhere to the esophagus and stomach and cause obstruction.
T3 593891-593907 Sentence denotes Pathophysiology:
T4 593908-594057 Sentence denotes Pathophysiology involves physical expansion and then adherence of glue product to esophagus and stomach, causing a mechanical obstruction to outflow.
T5 594058-594073 Sentence denotes Clinical Signs:
T6 594074-594194 Sentence denotes Clinical signs include ptyalism, vomiting, inappetence, lethargy, abdominal pain, abdominal distension, and hematemesis.
T7 594195-594206 Sentence denotes Toxic Dose:
T8 594207-594259 Sentence denotes Any ingestion can result in esophageal foreign body.
T9 594260-594270 Sentence denotes Treatment:
T10 594271-594356 Sentence denotes Treatment involves physical (surgical) removal of glue from esophagus and/or stomach.
T11 594357-594414 Sentence denotes Glyophosate is an herbicide found in Roundup and Kleenup.
T12 594415-594431 Sentence denotes Pathophysiology:
T13 594432-594496 Sentence denotes If applied properly, the product has a very low toxic potential.
T14 594497-594512 Sentence denotes Clinical Signs:
T15 594513-594629 Sentence denotes Clinical signs of toxicity include dermal and gastric irritation, including dermal erythema, anorexia, and vomiting.
T16 594630-594655 Sentence denotes CNS depression can occur.
T17 594656-594666 Sentence denotes Treatment:
T18 594667-594826 Sentence denotes Treatment includes thorough bathing in cases of dermal exposure, and induction of emesis or orogastric lavage followed by administration of activated charcoal.
T19 594827-594889 Sentence denotes Administer antiemetic and gastroprotectant drugs as necessary.
T20 594890-594977 Sentence denotes Administer intravenous crystalloid fluids to prevent dehydration secondary to vomiting.
T21 594978-595052 Sentence denotes Grapes and raisins have been reported to cause renal failure in some dogs.
T22 595053-595069 Sentence denotes Pathophysiology:
T23 595070-595127 Sentence denotes The toxic principle and mechanism of toxicity is unknown.
T24 595128-595143 Sentence denotes Clinical Signs:
T25 595144-595329 Sentence denotes Clinical signs occur within 24 hours of ingestion of raisins or grapes and include vomiting, anorexia, lethargy, and diarrhea (often with visible raisins or grapes in the fecal matter).
T26 595330-595439 Sentence denotes Within 48 hours, dogs demonstrate signs of acute renal failure (PU/PD, vomiting) that can progress to anuria.
T27 595440-595451 Sentence denotes Toxic Dose:
T28 595452-595478 Sentence denotes The toxic dose is unknown.
T29 595479-595489 Sentence denotes Treatment:
T30 595490-595630 Sentence denotes To treat known ingestion of raisins or grapes, induce emesis or perform orogastric lavage, followed by repeated doses of activated charcoal.
T31 595631-595742 Sentence denotes If clinical signs of vomiting and diarrhea are present, administer intravenous fluids and monitor urine output.
T32 595743-595846 Sentence denotes Aggressive intravenous fluid therapy, in conjunction with maintenance of renal perfusion, is necessary.
T33 595847-596046 Sentence denotes In cases of anuric renal failure, dopamine (1 to 3 mcg/kg/min IV CRI), furosemide (4 to 8 mg/kg or 0.7 to 1 mg/kg/hr IV CRI), and mannitol (0.5 to 1 g/kg IV) can be useful in increasing urine output.
T34 596047-596152 Sentence denotes Peritoneal dialysis or hemodialysis may be necessary in cases of severe oliguric or anuric renal failure.
T35 596153-596397 Sentence denotes Calcium channel blockers such as amlodipine (0.1 to 0.4 mg/kg PO q24h [canine] and 0.625 to 1.25 mg/cat q24h [feline]) and diltiazem (0.1 to 0.25 mg/kg IV slowly to effect, then 2 to 6 mcg/kg/min CRI) can be used to treat systemic hypertension.
T36 596398-596557 Sentence denotes Supportive care includes treatment of hyperkalemia and administration of gastroprotectant and antiemetic drugs and (if the animal is eating) phosphate binders.
T37 596558-596599 Sentence denotes Hexachlorophene See Detergents, Nonionic.
T38 596600-596673 Sentence denotes Aromatic hydrocarbons include phenols, cresols, toluene, and naphthalene.
T39 596674-596722 Sentence denotes All have a moderate toxic potential if ingested.
T40 596723-596739 Sentence denotes Pathophysiology:
T41 596740-596792 Sentence denotes Oxidative damage to red blood cells and hepatocytes.
T42 596793-596808 Sentence denotes Clinical Signs:
T43 596809-596942 Sentence denotes Clinical signs include CNS depression, hepatorenal damage, muscle tremors, pneumonia, methemoglobinemia, and intravascular hemolysis.
T44 596943-596953 Sentence denotes Treatment:
T45 596954-597060 Sentence denotes If an aromatic hydrocarbon is ingested, do not induce emesis, because of the risk of aspiration pneumonia.
T46 597061-597136 Sentence denotes A dilute milk solution or water can be administered to dilute the compound.
T47 597137-597163 Sentence denotes Perform orogastric lavage.
T48 597164-597234 Sentence denotes Carefully monitor the patient's respiratory and cardiovascular status.
T49 597235-597301 Sentence denotes Administer supplemental oxygen if aspiration pneumonia is present.
T50 597302-597427 Sentence denotes To treat topical exposure, thoroughly rinse the eyes and skin with copious amounts of warm tap water or 0.9% saline solution.
T51 597428-597478 Sentence denotes Ibuprofen See Nonsteroidal Antiinflammatory Drugs.
T52 597479-597543 Sentence denotes Imidacloprid is the compound used in the flea product Advantage.
T53 597544-597560 Sentence denotes Pathophysiology:
T54 597561-597637 Sentence denotes Clinical signs of toxicity are related to nicotinic cholinergic stimulation.
T55 597638-597653 Sentence denotes Clinical Signs:
T56 597654-597723 Sentence denotes Clinical signs include neuromuscular excitation followed by collapse.
T57 597724-597770 Sentence denotes The compound may induce respiratory paralysis.
T58 597771-597782 Sentence denotes Toxic Dose:
T59 597783-597841 Sentence denotes Even small amounts can be toxic if used on cats Treatment:
T60 597842-597951 Sentence denotes To treat imidacloprid toxicity, procure and maintain a patent airway with supplemental oxygen administration.
T61 597952-598124 Sentence denotes Control CNS excitation with diazepam (0.5 to 1 mg/ kg IV), phenobarbital (10 to 20 mg/kg IV slowly), or propofol (3 to 6 mg/kg IV, then 0.1-0.6 mg/kg/min IV CRI to effect).
T62 598125-598217 Sentence denotes Administer enemas to hasten gastrointestinal elimination, and administer activated charcoal.
T63 598218-598283 Sentence denotes Bathe the animal thoroughly to prevent further dermal absorption.
T64 598284-598349 Sentence denotes Closely monitor the patient's oxygenation and ventilation status.
T65 598350-598441 Sentence denotes If severe hypoventilation or respiratory paralysis occurs, initiate mechanical ventilation.
T66 598442-598493 Sentence denotes Lawn fertilizers are a common source of iron salts.
T67 598494-598510 Sentence denotes Pathophysiology:
T68 598511-598576 Sentence denotes Pathophysiology involves gastroenteritis and myocardial toxicity.
T69 598577-598592 Sentence denotes Clinical Signs:
T70 598593-598665 Sentence denotes Clinical signs include vomiting, hematemesis, lethargy, and inappetence.
T71 598666-598677 Sentence denotes Toxic Dose:
T72 598678-598806 Sentence denotes Iron and iron salts can cause severe gastroenteritis, myocardial toxicity, and hepatic damage if high enough doses are ingested.
T73 598807-598817 Sentence denotes Treatment:
T74 598818-598966 Sentence denotes Treatment of ingestion of iron and iron salts includes cardiovascular support in the form of intravenous fluids and antiarrhythmic drugs, as needed.
T75 598967-599038 Sentence denotes Induce emesis or perform orogastric lavage for gastric decontamination.
T76 599039-599126 Sentence denotes A cathartic can be administered to promote elimination from the gastrointestinal tract.
T77 599127-599219 Sentence denotes Antiemetic and gastroprotectant drugs should be administered to prevent nausea and vomiting.
T78 599220-599323 Sentence denotes In some cases, radiographs can aid in making a diagnosis of whether the compound was actually ingested.
T79 599324-599391 Sentence denotes Iron toxicity can be treated with the chelating agent deferoxamine.
T80 599392-599612 Sentence denotes Ivermectin is a GABA agonist that is used in commercial heartworm prevention and anthelmintic compounds and can be toxic in predisposed breeds, including Collies, Collie crosses, Old English Sheepdogs, and some Terriers.
T81 599613-599629 Sentence denotes Pathophysiology:
T82 599630-599777 Sentence denotes Ivermectin is a GABA neurotransmitter agonist in susceptible animals (hereditable mdr1 gene defect allows ivermectin to cross blood-brain barrier).
T83 599778-599793 Sentence denotes Clinical Signs:
T84 599794-600008 Sentence denotes Clinical signs of ivermectin toxicity include vomiting, ataxia, hypersalivation, agitation, tremors, hyperactivity, hyperthermia, hypoventilation, coma, seizures, signs of circulatory shock, bradycardia, and death.
T85 600009-600096 Sentence denotes Clinical signs often occur within 2 to 24 hours after ingestion or iatrogenic overdose.
T86 600097-600238 Sentence denotes Blood ivermectin levels can be measured, but diagnosis is often made based on clinical signs and knowledge of exposure in predisposed breeds.
T87 600239-600266 Sentence denotes There is no known antidote.
T88 600267-600347 Sentence denotes The clinical course can be prolonged for weeks to months before recovery occurs.
T89 600348-600358 Sentence denotes Treatment:
T90 600359-600526 Sentence denotes To treat known exposure, induce emesis or perform orogastric lavage if the substance was ingested was within 1 hour of presentation and the patient is not symptomatic.
T91 600527-600557 Sentence denotes Administer activated charcoal.
T92 600558-600744 Sentence denotes Control seizures with phenobarbital (10 to 20 mg/kg IV slowly), pentobarbital (5 to 15 mg/kg IV slowly to effect), or propofol (3 to 6 mg/kg IV, then 0.1-0.6 mg/kg/min IV CRI to effect).
T93 600745-600839 Sentence denotes Diazepam, which potentially can worsen central nervous system stimulation, is contraindicated.
T94 600840-600930 Sentence denotes Administer intravenous fluids to maintain perfusion and hydration, and treat hyperthermia.
T95 600931-601266 Sentence denotes Supportive care may be necessary, including supplemental oxygen (or mechanical ventilation, if necessary), frequent turning of the patient and passive range-of-motion exercises, placement of a urinary catheter to maintain patient cleanliness and monitor urine output, lubrication of the eyes, and parenteral nutrition (see Rule of 20).
T96 601267-601357 Sentence denotes Specific antidotes used to treat ivermectin toxicity include physostigmine and picrotoxin.
T97 601358-601506 Sentence denotes Physostigmine therapy was beneficial in some patients for a short period; picrotoxin caused severe violent seizures and therefore should be avoided.
T98 601507-601622 Sentence denotes Lead is ubiquitous and is found in some paints, car batteries, fishing equipment (sinkers), and plumbing materials.
T99 601623-601639 Sentence denotes Pathophysiology:
T100 601640-601752 Sentence denotes Lead causes toxicity by inhibiting sulfur-containing enzymes, leading to increased RBC fragility and CNS damage.
T101 601753-601768 Sentence denotes Clinical Signs:
T102 601769-601888 Sentence denotes Clinical signs of hyperexcitability, dementia, vocalization, seizures, and lower motor neuron polyneuropathy can occur.
T103 601889-601986 Sentence denotes Affected animals may appear blind, or vomiting, anorexia, and constipation or diarrhea may occur.
T104 601987-601998 Sentence denotes Toxic Dose:
T105 601999-602037 Sentence denotes Lead can be toxic at doses of 3 mg/kg.
T106 602038-602122 Sentence denotes If ingestion of more than 10 to 25 mg of lead per kilogram occurs, death can result.
T107 602123-602131 Sentence denotes Testing:
T108 602132-602207 Sentence denotes If lead toxicity is suspected, blood and urine lead levels can be measured.
T109 602208-602218 Sentence denotes Treatment:
T110 602219-602307 Sentence denotes Treatment of lead toxicity is supportive and is directed at treatment of clinical signs.
T111 602308-602356 Sentence denotes Control seizures with diazepam or phenobarbital.
T112 602357-602491 Sentence denotes If cerebral edema is present, administer mannitol (0.5 to 1.0 g/kg IV), followed by furosemide (1 mg/kg IV 20 minutes after mannitol).
T113 602492-602558 Sentence denotes Sodium or magnesium sulfate should be administered as a cathartic.
T114 602559-602755 Sentence denotes Initiate chelation therapy with dimercaprol (2 to 5 mg/kg IM q4h for 2 days, then 2 to 5 mg/ kg IM q8h on Day 3, then 2 to 5 mg/kg IM q12h for 10 days ) or penicillamine (10 to 15 mg/ kg PO q12h).
T115 602756-603012 Sentence denotes If a lead object is identified in the gastrointestinal tract on radiographs, remove the object using endoscopy or exploratory laparotomy. d-Limonene, Linalool d-Limonene and linalool are components of citrus oil extracts used in some flea-control products.
T116 603013-603028 Sentence denotes Clinical Signs:
T117 603029-603121 Sentence denotes Clinical signs of toxicity include hypersalivation, muscle tremors, ataxia, and hypothermia.
T118 603122-603133 Sentence denotes Toxic Dose:
T119 603134-603210 Sentence denotes The toxic dose is unknown, but cats appear to be very sensitive to exposure.
T120 603211-603221 Sentence denotes Treatment:
T121 603222-603436 Sentence denotes Treatment of d-Limonene and linalool exposure includes treatment of hypothermia, administration of activated charcoal to prevent further absorption, and careful, thorough bathing to prevent further dermal exposure.
T122 603437-603503 Sentence denotes Loperamide is an opioid derivative that is used to treat diarrhea.
T123 603504-603520 Sentence denotes Pathophysiology:
T124 603521-603632 Sentence denotes Loperamide has opioid effects on the GI tract and causes CNS signs at central opioid receptors at higher doses.
T125 603633-603648 Sentence denotes Clinical Signs:
T126 603649-603775 Sentence denotes Clinical signs of loperamide intoxication include constipation, ataxia, nausea, and sedation; vomiting and cramping may occur.
T127 603776-603934 Sentence denotes Toxic Dose: >0.6 mg/kg-vomiting, cramping; >1.25 mg/kg-ataxia and CNS depression; >5 mg/kg-hemorrhagic enteritis and posterior paresis or paralysis Treatment:
T128 603935-604044 Sentence denotes Induce emesis or perform orogastric lavage, followed by administration of activated charcoal and a cathartic.
T129 604045-604121 Sentence denotes Naloxone may be beneficial in the temporary reversal of ataxia and sedation.
T130 604122-604201 Sentence denotes Ingestion of even small quantities of macadamia nuts can be toxic to some dogs.
T131 604202-604325 Sentence denotes Macadamia nuts are often covered with chocolate, so a combination of macadamia nut and theobromine toxicity may be present.
T132 604326-604342 Sentence denotes Pathophysiology:
T133 604343-604392 Sentence denotes The toxic principle in macadamia nuts is unknown.
T134 604393-604408 Sentence denotes Clinical Signs:
T135 604409-604515 Sentence denotes Ingestion of macadamia nuts can cause clinical signs of vomiting, ataxia, and ascending paralysis in dogs.
T136 604516-604549 Sentence denotes Toxic Dose: >2.4 mg/kg Treatment:
T137 604550-604577 Sentence denotes There is no known antidote.
T138 604578-604740 Sentence denotes Treatment consists of supportive care, including administration of intravenous fluids and antiemetics and placement of a urinary catheter for patient cleanliness.
T139 604741-604794 Sentence denotes Clinical signs resolve in most cases within 72 hours.
T140 604795-604884 Sentence denotes Delta-9 tetrahydrocannabinol (THC) is the active ingredient in the plant Cannabis sativa.
T141 604885-604995 Sentence denotes Largely known for its use as a recreational drug, marijuana is now sold for medicinal purposes in some states.
T142 604996-605168 Sentence denotes Extraction of THC oil from the plant product into butter or oil and use in food products and baked goods have increased the potential for THC toxicity in companion animals.
T143 605169-605185 Sentence denotes Pathophysiology:
T144 605186-605321 Sentence denotes Marijuana interacts with norepinephrine, dopamine, serotonin, and acetylcholine neurotransmitters in the frontal cortex and cerebellum.
T145 605322-605337 Sentence denotes Clinical Signs:
T146 605338-605482 Sentence denotes Marijuana is a hallucinogen that can cause CNS depression, ataxia, mydriasis, increased sensitivity to motion or sound, salivation, and tremors.
T147 605483-605573 Sentence denotes Along with these findings, a classic clinical sign is the sudden onset of dribbling urine.
T148 605574-605582 Sentence denotes Testing:
T149 605583-605682 Sentence denotes Urine can be tested with drug test kits for tetrahydrocannabinoid, the toxic compound in marijuana.
T150 605683-605838 Sentence denotes However, urine drug screening tests are not always sensitive or specific in urine of dogs, as dog metabolites of THC sometimes differ from those of humans.
T151 605839-605850 Sentence denotes Toxic Dose:
T152 605851-605920 Sentence denotes The lethal dose is >3 g/kg; clinical signs occur at much lower doses.
T153 605921-605931 Sentence denotes Treatment:
T154 605932-606026 Sentence denotes There is no known antidote for marijuana toxicity; therefore treatment is largely symptomatic.
T155 606027-606112 Sentence denotes Place an intravenous catheter and administer intravenous fluids to support hydration.
T156 606113-606162 Sentence denotes Administer atropine if severe bradycardia exists.
T157 606163-606271 Sentence denotes Induction of emesis can be attempted but, because of the antiemetic effects of THC, is usually unsuccessful.
T158 606272-606357 Sentence denotes Orogastric lavage can be performed, followed by repeated doses of activated charcoal.
T159 606358-606411 Sentence denotes Clinical signs usually resolve within 12 to 16 hours.
T160 606412-606546 Sentence denotes "Strike Anywhere" matches, safety matches, and the striking surface of matchbook covers contain iron phosphorus or potassium chlorate.
T161 606547-606562 Sentence denotes Clinical Signs:
T162 606563-606708 Sentence denotes Both compounds have a low toxic potential but can cause clinical signs of gastroenteritis and methemoglobinemia if large quantities are ingested.
T163 606709-606720 Sentence denotes Toxic Dose:
T164 606721-606784 Sentence denotes Even small amounts can be caustic and cause gastric irritation.
T165 606785-606795 Sentence denotes Treatment:
T166 606796-606975 Sentence denotes Treatment of match and matchbook ingestion includes gastric decontamination with induction of emesis or orogastric lavage and administration of activated charcoal and a cathartic.
T167 606976-607078 Sentence denotes If methemoglobinemia occurs, administer N-acetylcysteine, intravenous fluids, and supplemental oxygen.
T168 607079-607145 Sentence denotes Metaldehyde is the active ingredient in most brands of snail bait.
T169 607146-607162 Sentence denotes Pathophysiology:
T170 607163-607250 Sentence denotes The exact mechanism of toxicity is unknown but may involve inhibition of GABA channels.
T171 607251-607266 Sentence denotes Clinical Signs:
T172 607267-607433 Sentence denotes Clinical signs associated with metaldehyde toxicity include severe muscle tremors, CNS excitation, and hyperthermia, which occur within 15 to 30 minutes of ingestion.
T173 607434-607471 Sentence denotes Diarrhea and convulsions can develop.
T174 607472-607559 Sentence denotes If hyperthermia is severe, renal failure secondary to myoglobinuria and DIC can result.
T175 607560-607631 Sentence denotes Delayed hepatic failure has been described days after initial recovery.
T176 607632-607731 Sentence denotes If metaldehyde toxicosis is suspected, analysis of urine, serum, and stomach contents is warranted.
T177 607732-607743 Sentence denotes Toxic Dose:
T178 607744-607764 Sentence denotes 180 mg/kg Treatment:
T179 607765-607879 Sentence denotes To treat metaldehyde toxicity, procure and maintain a patent airway and control CNS excitation and muscle tremors.
T180 607880-607965 Sentence denotes If an animal has just ingested the metaldehyde and is not symptomatic, induce emesis.
T181 607966-608023 Sentence denotes If clinical signs are present, perform orogastric lavage.
T182 608024-608129 Sentence denotes Both emesis and orogastric lavage should be followed by administration of one dose of activated charcoal.
T183 608130-608258 Sentence denotes Administer intravenous fluids to control hyperthermia, prevent dehydration, and correct acid-base and electrolyte abnormalities.
T184 608259-608364 Sentence denotes Methocarbamol (55 to 220 mg/kg IV slowly to effect) is the treatment of choice to control muscle tremors.
T185 608365-608440 Sentence denotes Diazepam (0.5 to 1 mg/kg IV) can be used to control seizures if they occur.
T186 608441-608467 Sentence denotes Mothballs See Naphthalene.
T187 608468-608497 Sentence denotes Not all mushrooms are edible.
T188 608498-608593 Sentence denotes Mushroom species can appear similar, and mushrooms can be toxic to humans and domestic animals.
T189 608594-608763 Sentence denotes Mushroom toxicity is most common in areas of the country with moist environments that allow mushrooms to grow and where animals have free roaming access to the outdoors.
T190 608764-608780 Sentence denotes Pathophysiology:
T191 608781-608864 Sentence denotes Mushroom ingestion most commonly causes activation of the autonomic nervous system.
T192 608865-608880 Sentence denotes Clinical Signs:
T193 608881-608970 Sentence denotes Clinical signs include tremors, agitation, restlessness, hyperexcitability, and seizures.
T194 608971-609051 Sentence denotes In some cases SLUD (salivation, lacrimation, urination, and defecation) is seen.
T195 609052-609124 Sentence denotes Some mushrooms (Amanita species) also can cause hepatocellular toxicity.
T196 609125-609202 Sentence denotes Clinical signs include vomiting, anorexia, lethargy, and progressive icterus.
T197 609203-609214 Sentence denotes Toxic Dose:
T198 609215-609268 Sentence denotes Toxic dose is dependent on type of mushroom ingested.
T199 609269-609279 Sentence denotes Treatment:
T200 609280-609333 Sentence denotes Treatment of mushroom toxicity is largely supportive.
T201 609334-609470 Sentence denotes If the mushroom was ingested within the last 2 hours, induce emesis or perform orogastric lavage and then administer activated charcoal.
T202 609471-609708 Sentence denotes Symptomatic treatment includes intravenous fluids to promote diuresis and treat hyperthermia and skeletal muscle relaxants to control tremors and seizures (methocarbamol, 55 to 220 mg/kg IV slowly to effect; diazepam, 0.5 to 1 mg/kg IV).
T203 609709-609825 Sentence denotes If Amanita ingestion is suspected, administer hepatoprotectant agents including milk thistle (50 to 250 mg PO q24h).
T204 609826-609911 Sentence denotes Mycotoxins from Penicillium species are found in moldy foods, cream cheese, and nuts.
T205 609912-609928 Sentence denotes Pathophysiology:
T206 609929-610077 Sentence denotes These mycotoxins have an unknown mechanism of action, although it is suspected to involve failure of neurotransmitter release at peripheral and CNS.
T207 610078-610145 Sentence denotes A vomitogenic action of toxin on chemoreceptor trigger zone occurs.
T208 610146-610161 Sentence denotes Clinical Signs:
T209 610162-610259 Sentence denotes Clinical signs of intoxication include vomiting, tremors, agitation, hyperesthesia, and seizures.
T210 610260-610268 Sentence denotes Testing:
T211 610269-610484 Sentence denotes If tremorgenic mycotoxin toxicity is suspected, a sample of the patient's serum and gastric contents or vomitus can be submitted to the Michigan State University Veterinary Toxicology Laboratory for tremorgen assay.
T212 610485-610496 Sentence denotes Toxic Dose:
T213 610497-610582 Sentence denotes Small amounts are toxic, depending on the amount ingested and the size of the animal.
T214 610583-610593 Sentence denotes Treatment:
T215 610594-610621 Sentence denotes There is no known antidote.
T216 610622-610698 Sentence denotes Perform orogastric lavage, followed by administration of activated charcoal.
T217 610699-610802 Sentence denotes Repeated doses of activated charcoal are recommended, as the toxin undergoes enterohepatic circulation.
T218 610803-611001 Sentence denotes Control tremors and seizures with methocarbamol (55 to 220 mg/kg IV to effect), diazepam (0.5 to 1 mg/kg IV), phenobarbital (10 to 20 mg/kg IV slowly), or pentobarbital (5 to 15 mg/kg IV to effect).
T219 611002-611079 Sentence denotes Administer intravenous fluids to control hyperthermia and maintain hydration.
T220 611080-611246 Sentence denotes In cases in which cerebral edema is suspected secondary to severe refractory seizures, administer intravenous mannitol (0.5 to 1 g/kg IV) and furosemide (1 mg/kg IV).
T221 611247-611328 Sentence denotes Naphthalene is the active ingredient in mothballs and has a high toxic potential.
T222 611329-611345 Sentence denotes Pathophysiology:
T223 611346-611425 Sentence denotes Oxidative damage to red blood cells and hemoglobin, hepatotoxic Clinical Signs:
T224 611426-611563 Sentence denotes Clinical signs associated with naphthalene toxicity include vomiting, methemoglobinemia, CNS stimulation, seizures, and hepatic toxicity.
T225 611564-611625 Sentence denotes A complete blood count often reveals Heinz bodies and anemia.
T226 611626-611637 Sentence denotes Toxic Dose:
T227 611638-611690 Sentence denotes 411 mg/kg (dogs), smaller amounts in cats Treatment:
T228 611691-611750 Sentence denotes Do not induce emesis if naphthalene ingestion is suspected.
T229 611751-611829 Sentence denotes If the ingestion was within 1 hour of presentation, perform orogastric lavage.
T230 611830-612002 Sentence denotes Control seizures with diazepam (0.5 to 1 mg/kg IV) or phenobarbital (10 to 20 mg/kg IV slowly) Administer intravenous fluids to control hyperthermia and maintain hydration.
T231 612003-612151 Sentence denotes N-acetylcysteine (140 mg/kg PO or 1 IV once, then 70 mg/kg IV or PO q6h for seven treatments) can play a role in the treatment of methemoglobinemia.
T232 612152-612214 Sentence denotes A packed RBC transfusion may be necessary if anemia is severe.
T233 612215-612280 Sentence denotes Observe the patient for clinical signs associated with hepatitis.
T234 612281-612405 Sentence denotes Nicotine toxicity occurs in animals as the result of ingestion of cigarettes, nicotinecontaining gum, and some insecticides.
T235 612406-612422 Sentence denotes Pathophysiology:
T236 612423-612548 Sentence denotes Nicotine stimulates autonomic ganglia at low doses and blocks autonomic ganglia and the neuromuscular junction at high doses.
T237 612549-612585 Sentence denotes Absorption after ingestion is rapid.
T238 612586-612601 Sentence denotes Clinical Signs:
T239 612602-612706 Sentence denotes Clinical signs include hyperexcitability and SLUD (salivation, lacrimation, urination, and defecation) .
T240 612707-612824 Sentence denotes Muscle tremors, respiratory muscle fatigue or hypoventilation, tachyarrhythmias, seizures, coma, and death can occur.
T241 612825-612866 Sentence denotes Toxic Dose: LD 50 is 9.2 mg/kg Treatment:
T242 612867-613031 Sentence denotes If the patient is presented within 1 hour of ingestion and has no clinical signs, induce emesis, followed by administration of repeated doses of activated charcoal.
T243 613032-613103 Sentence denotes In patients with clinical signs of toxicity, perform orogastric lavage.
T244 613104-613201 Sentence denotes Administer intravenous fluids to maintain hydration and promote diuresis, and treat hyperthermia.
T245 613202-613286 Sentence denotes Administer atropine (0.022 to 0.044 mg/kg IV, IM, SQ) to treat cholinergic symptoms.
T246 613287-613340 Sentence denotes Urinary acidification can promote nicotine excretion.
T247 613341-613460 Sentence denotes NSAIDs include ibuprofen, ketoprofen, carprofen, diclofenac, naproxen, celecoxib, valdecoxib, rofecoxib, and deracoxib.
T248 613461-613529 Sentence denotes Pathophysiology: NSAIDs cause inhibition of prostaglandin synthesis.
T249 613530-613545 Sentence denotes Clinical Signs:
T250 613546-613632 Sentence denotes Clinical signs include gastrointestinal ulceration, renal failure, and hepatotoxicity.
T251 613633-613713 Sentence denotes Ibuprofen toxicity has been associated with seizures in dogs, cats, and ferrets.
T252 613714-613725 Sentence denotes Toxic Dose:
T253 613726-613784 Sentence denotes The toxic dose varies with the specific compound ingested.
T254 613785-613795 Sentence denotes Treatment:
T255 613796-613941 Sentence denotes To treat NSAID toxicity, induce emesis or perform orogastric lavage, followed by administration of multiple repeated doses of activated charcoal.
T256 613942-614031 Sentence denotes Place an intravenous catheter for crystalloid fluid diuresis to maintain renal perfusion.
T257 614032-614220 Sentence denotes Administer the synthetic prostaglandin analogue misoprostol (5 to 7.5 mcg/kg PO or per rectum Q12h, dog; 5 mcg/ kg PO or per rectum Q12h, cat) to help maintain gastric and renal perfusion.
T258 614221-614297 Sentence denotes Control seizures, if present, with intravenous diazepam (0.5 to 1 mg/kg IV).
T259 614298-614399 Sentence denotes Administer gastroprotectant and antiemetic drugs to control vomiting and gastrointestinal hemorrhage.
T260 614400-614524 Sentence denotes Continue intravenous fluid diuresis for a minimum of 48 hours, with frequent monitoring of the patient's BUN and creatinine.
T261 614525-614684 Sentence denotes When the BUN and creatinine levels are normal or have plateaued for 24 hours, slowly decrease fluid diuresis 25% per day until maintenance levels are restored.
T262 614685-614858 Sentence denotes Onions, garlic, and chives contain sulfoxide compounds that can cause oxidative damage of RBCs, leading to Heinz body anemia, methemoglobinemia, and intravascular hemolysis.
T263 614859-614875 Sentence denotes Pathophysiology:
T264 614876-615004 Sentence denotes Pathophysiology involves oxidative damage of RBCs, leading to Heinz body anemia, methemoglobinemia, and intravascular hemolysis.
T265 615005-615020 Sentence denotes Clinical Signs:
T266 615021-615126 Sentence denotes Clinical signs of toxicity include weakness, lethargy, tachypnea, tachycardia, and pale mucous membranes.
T267 615127-615159 Sentence denotes Vomiting and diarrhea can occur.
T268 615160-615260 Sentence denotes Intravascular hemolysis can cause hemoglobinuria and pigment damage of the renal tubular epithelium.
T269 615261-615344 Sentence denotes Heinz bodies may be observed on cytologic evaluation of the peripheral blood smear.
T270 615345-615356 Sentence denotes Toxic Dose:
T271 615357-615424 Sentence denotes Ingestion of >0.5% of onions per body weight of animal 1 Treatment:
T272 615425-615637 Sentence denotes Treatment of onion, chive, and garlic toxicity includes administration of intravenous fluid diuresis and induction of emesis or orogastric lavage, followed by administration of activated charcoal and a cathartic.
T273 615638-615709 Sentence denotes In cases of severe anemia, packed RBC transfusion should be considered.
T274 615710-615796 Sentence denotes Opiate drugs include heroin, morphine, oxymorphone, fentanyl, meperidine, and codeine.
T275 615797-615813 Sentence denotes Pathophysiology:
T276 615814-615885 Sentence denotes Opiate compounds bind to specific opioid receptors throughout the body.
T277 615886-615901 Sentence denotes Clinical Signs:
T278 615902-616038 Sentence denotes Clinical signs include miosis or mydriasis (cats) and CNS excitation, followed by ataxia and CNS depression, leading to stupor and coma.
T279 616039-616101 Sentence denotes Hypoventilation, bradycardia, hypoxia, and cyanosis can occur.
T280 616102-616113 Sentence denotes Toxic Dose:
T281 616114-616204 Sentence denotes Toxic dose is dependent on type of substance or opiate ingested and body weight of animal.
T282 616205-616215 Sentence denotes Treatment:
T283 616216-616395 Sentence denotes To treat known overdose or ingestion of an opiate compound, induce emesis (in asymptomatic animals) or perform orogastric lavage, followed by administration of activated charcoal.
T284 616396-616504 Sentence denotes Administer intravenous fluids and supplemental oxygen to support the cardiovascular and respiratory systems.
T285 616505-616576 Sentence denotes Mechanical ventilation may be necessary until hypoventilation resolves.
T286 616577-616770 Sentence denotes Administer repeated doses of naloxone (0.04 mg/kg IV, IM, SQ [canine], 0.005 to 0.01 mg/kg IV, IM, SQ [feline]) as a specific antidote to reverse clinical signs of narcosis and hypoventilation.
T287 616771-616858 Sentence denotes If seizures are present (meperidine toxicity), administer diazepam (0.5 to 1 mg/kg IV).
T288 616859-616950 Sentence denotes Organophosphate compounds traditionally are used in flea-control products and insecticides.
T289 616951-617056 Sentence denotes Common examples of organophosphates include chlorpyrifos, coumaphos, diazinon, dichlorvos, and malathion.
T290 617057-617073 Sentence denotes Pathophysiology:
T291 617074-617138 Sentence denotes Organophosphate toxicity causes acetylcholinesterase inhibition.
T292 617139-617154 Sentence denotes Clinical Signs:
T293 617155-617226 Sentence denotes Clinical signs include CNS stimulation, including tremors and seizures.
T294 617227-617345 Sentence denotes Muscarinic acetylcholine overload causes the classic SLUD signs of salivation, lacrimation, urination, and defecation.
T295 617346-617438 Sentence denotes Miosis, excessive bronchial secretions, muscle tremors, and respiratory paralysis can occur.
T296 617439-617624 Sentence denotes An intermediate syndrome of generalized weakness, hypoventilation, and eventual paralysis with ventral cervical ventroflexion that may require mechanical ventilation has been described.
T297 617625-617633 Sentence denotes Testing:
T298 617634-617750 Sentence denotes If organophosphate toxicity is suspected, whole-blood acetylcholinesterase activity can be measured and will be low.
T299 617751-617762 Sentence denotes Toxic Dose:
T300 617763-617857 Sentence denotes The toxic dose varies, depending on the particular compound and individual animal sensitivity.
T301 617858-617868 Sentence denotes Treatment:
T302 617869-618234 Sentence denotes Treatment of toxicity includes careful and thorough bathing in cases of dermal exposure and, if the substance was ingested, gastric decontamination with induction of emesis or orogastric lavage, followed by administration of activated charcoal, and administration of the antidote 2-PAM (50 mg/kg IV over 30 minutes [canine] , 20 mg/kg IV over 30 minutes [feline] ).
T303 618235-618291 Sentence denotes Atropine can help control the muscarinic clinical signs.
T304 618292-618484 Sentence denotes Supportive care in the form of cooling measures, intravenous crystalloid fluids, and supplemental oxygen or mechanical ventilation may be required, depending on the severity of clinical signs.
T305 618485-618589 Sentence denotes Paintballs are gelatin capsules that contain multiple colors of paint in a sorbitol or glycerol carrier.
T306 618590-618709 Sentence denotes Ingestion of large amounts of paintballs can cause neurologic signs, electrolyte abnormalities, and occasionally death.
T307 618710-618726 Sentence denotes Pathophysiology:
T308 618727-618996 Sentence denotes When large quantities of these osmotically active sugars are ingested, osmotic shifts of fluid cause a sudden onset of neurologic or gastrointestinal signs, including ataxia, seizures, and osmotic diarrhea caused by massive fluid shifts into the gastrointestinal tract.
T309 618997-619117 Sentence denotes The loss of water in excess of solute can result in hypernatremia, a free water deficit, and increased serum osmolality.
T310 619118-619133 Sentence denotes Clinical Signs:
T311 619134-619188 Sentence denotes Clinical signs include ataxia, seizures, and diarrhea.
T312 619189-619199 Sentence denotes Treatment:
T313 619200-619369 Sentence denotes After orogastric lavage, treatment of ingestion includes administering warm water enemas to help speed the movement of the paintballs through the gastrointestinal tract.
T314 619370-619541 Sentence denotes Do not administer activated charcoal (usually in a propylene glycol carrier), because the compound's cathartic action will pull more fluid into the gastrointestinal tract.
T315 619542-619612 Sentence denotes Baseline electrolytes should be obtained and then carefully monitored.
T316 619613-619788 Sentence denotes If severe hypernatremia develops, administer hypotonic solutions such as 0.45% NaCl + 2.5% dextrose or 5% dextrose in water after calculating the patient's free water deficit.
T317 619789-619951 Sentence denotes Because of the large volume of fluid loss, intravenous fluid rates may seem excessive but are necessary to normalize acid-base, electrolyte, and hydration status.
T318 619952-620151 Sentence denotes In most cases these patients can survive if the problem is recognized promptly and corrected with careful electrolyte monitoring, aggressive decontamination strategies, and intravenous fluid support.
T319 620152-620182 Sentence denotes Paracetamol See Acetaminophen.
T320 620183-620206 Sentence denotes Paraffin Wax See Fuels.
T321 620207-620283 Sentence denotes Paraquat, a dipyridyl compound, is the active ingredient in some herbicides.
T322 620284-620300 Sentence denotes Pathophysiology:
T323 620301-620420 Sentence denotes Pathophysiology involves oxygen-derived free radical species in the lungs, and eventually multiorgan failure and death.
T324 620421-620436 Sentence denotes Clinical Signs:
T325 620437-620536 Sentence denotes Clinical signs include initial CNS excitation, then intractable vomiting, ataxia, stupor, and coma.
T326 620537-620559 Sentence denotes Seizures may be noted.
T327 620560-620678 Sentence denotes Within 2 to 3 days, clinical signs associated with severe respiratory distress and ARDS can develop, leading to death.
T328 620679-620775 Sentence denotes Chronic effects include pulmonary fibrosis, if the patient survives the initial toxicity period.
T329 620776-620837 Sentence denotes The prognosis for paraquat toxicity is generally unfavorable.
T330 620838-620849 Sentence denotes Toxic Dose:
T331 620850-620890 Sentence denotes The LD 50 of paraquat is 25 to 50 mg/kg.
T332 620891-620901 Sentence denotes Treatment:
T333 620902-621019 Sentence denotes To treat paraquat ingestion, remove the toxin from the gastrointestinal tract as rapidly as possible after ingestion.
T334 621020-621049 Sentence denotes There are no known antidotes.
T335 621050-621160 Sentence denotes If the compound was ingested within the past hour and the animal is able to protect its airway, induce emesis.
T336 621161-621198 Sentence denotes Otherwise, perform orogastric lavage.
T337 621199-621305 Sentence denotes Activated charcoal is not as effective as clay or bentonite adsorbents for removing this particular toxin.
T338 621306-621451 Sentence denotes Early in the course of paraquat toxicity, oxygen therapy is contraindicated because of the risk of producing oxygen-derived free radical species.
T339 621452-621539 Sentence denotes Later, oxygen therapy, including mechanical ventilation, is necessary if ARDS develops.
T340 621540-621722 Sentence denotes Experimentally, free radical scavengers (N-acetylcysteine, vitamin C, vitamin E, SAMe) have been shown to be useful in preventing damage caused by oxygenderived free radical species.
T341 621723-621828 Sentence denotes Hemoperfusion may be useful in eliminating the toxin, if it is performed early in the course of toxicity.
T342 621829-621861 Sentence denotes Pennies See Zinc and Zinc Oxide.
T343 621862-621960 Sentence denotes Pennyroyal oil is an herbal flea-control compound that contains menthofuran as its toxic compound.
T344 621961-622044 Sentence denotes Two plant species (Mentha pulegium and Hedeoma pulegioides) contain pennyroyal oil.
T345 622045-622061 Sentence denotes Pathophysiology:
T346 622062-622117 Sentence denotes Pathophysiology involves glutathione depletion in cats.
T347 622118-622205 Sentence denotes The toxic agent pulegone is metabolized to a hepatotoxic metabolite called menthofuran.
T348 622206-622221 Sentence denotes Clinical Signs:
T349 622222-622331 Sentence denotes Menthofuran is hepatotoxic and may cause gastrointestinal hemorrhage and coagulopathies, seizures, and death.
T350 622332-622343 Sentence denotes Toxic Dose:
T351 622344-622421 Sentence denotes Toxic dose is unknown; toxic dose as low as 2 g/kg in dogs has been reported.
T352 622422-622432 Sentence denotes Treatment:
T353 622433-622608 Sentence denotes To treat toxicity, administer a cathartic and activated charcoal and antiemetic and gastroprotectant drugs, and thoroughly bathe the animal to prevent further dermal exposure.
T354 622609-622640 Sentence denotes Phenobarbital See Barbiturates.
T355 622641-622825 Sentence denotes Phencyclidine ("angel dust") is an illicit recreational drug that causes both CNS depression and excitation, decreased cardiac output, and hypotension; death can occur at higher doses.
T356 622826-622842 Sentence denotes Pathophysiology:
T357 622843-622896 Sentence denotes The drug is a nonnarcotic, nonbarbiturate anesthetic.
T358 622897-622912 Sentence denotes Clinical Signs:
T359 622913-623047 Sentence denotes Clinical signs include mydriasis, tachycardia, tonic-clonic seizures, tremors, muscle rigidity, jaw snapping, opisthotonus, and death.
T360 623048-623059 Sentence denotes Toxic Dose:
T361 623060-623105 Sentence denotes 1.1 mg/kg (cats), 2.5 mg/kg (dogs) Treatment:
T362 623106-623256 Sentence denotes To treat phencyclidine toxicity, place an intravenous catheter and administer intravenous fluids and antiarrhythmic drugs to maintain organ perfusion.
T363 623257-623353 Sentence denotes Administer supplemental oxygen, and administer diazepam (0.5 to 1 mg/kg IV) to control seizures.
T364 623354-623407 Sentence denotes Urine alkalinization can help eliminate the compound.
T365 623408-623487 Sentence denotes Phenylephrine is an α-adrenergic agonist in many OTC decongestant preparations.
T366 623488-623504 Sentence denotes Pathophysiology:
T367 623505-623610 Sentence denotes Pathophysiology involves stimulation of α-adrenergic receptors, causing vasoconstriction and tachycardia.
T368 623611-623626 Sentence denotes Clinical Signs:
T369 623627-623758 Sentence denotes Clinical signs of intoxication include mydriasis, tachypnea, agitation, hyperactivity, and abnormal flybiting and staring behavior.
T370 623759-623836 Sentence denotes Tachycardia, bradycardia, hypertension, hyperthermia, and seizures can occur.
T371 623837-623848 Sentence denotes Toxic Dose:
T372 623849-623916 Sentence denotes 1 mg/kg-vomiting; 3 mg/kg-tachyarrhythmias, hypertension Treatment:
T373 623917-624072 Sentence denotes To treat phenylephrine toxicity, place an intravenous catheter and give intravenous fluids to maintain hydration, promote diuresis, and treat hyperthermia.
T374 624073-624403 Sentence denotes Administer prazosin (1 to 4 mg/kg PO q8-12h [canine], 0.5 mg PO q8-12h [feline]) or sodium nitroprusside (1 to 2 mcg/kg/min IV CRI, titrating up slowly until desired BP is reached, carefully monitoring for hypotension) to treat hypertension, antiarrhythmic drugs as necessary, and diazepam (0.5 to 1 mg/kg IV) to control seizures.
T375 624404-624538 Sentence denotes Phenylpropanolamine has both αand β-adrenergic agonist effects and is used primarily in the treatment of urinary incontinence in dogs.
T376 624539-624624 Sentence denotes The drug was taken off of the market for use in humans because of the risk of stroke.
T377 624625-624641 Sentence denotes Pathophysiology:
T378 624642-624781 Sentence denotes Phenylpropanolamine is an αand β-adrenergic receptor agonist, causing vasoconstriction, tachyarrhythmias, and hypertension at higher doses.
T379 624782-624797 Sentence denotes Clinical Signs:
T380 624798-624968 Sentence denotes Clinical signs of phenylpropanolamine intoxication include hyperactivity, hyperthermia, mydriasis, tachyarrhythmias or bradycardia, hypertension, agitation, and seizures.
T381 624969-624980 Sentence denotes Toxic Dose:
T382 624981-625120 Sentence denotes 1-5 mg/kg-vomiting, tachycardia, hyperactivity; 5 to 10 mg/kg-vomiting, tachycardia, hyperactivity, hyperthermia, hypertension 1 Treatment:
T383 625121-625736 Sentence denotes To treat toxicity, administer prazosin (1 to 4 mg/kg PO q8-12h [canine], 0.5 mg PO q8-12h [feline]) or nitroprusside (1 to 2 mcg/kg/min IV CRI, titrating up slowly until desired BP is reached, carefully monitoring for hypotension) to control hypertension; a β-blocker (esmolol, 50 to 100 mcg/kg IV bolus, 50 to 200 mcg/kg/min IV CRI; propranolol, 0.04 to 0.1 mg/kg IV slowly to effect; atenolol, 0.5 to 1 mg/kg PO q12h [canine], 6.25 to 12.5 mg/cat PO q12-24h [feline]) to control tachyarrhythmias; diazepam (0.5 to 1 mg/kg IV) to control seizures; and intravenous fluids to maintain hydration and promote diuresis.
T384 625737-625791 Sentence denotes Urine acidification may aid in facilitating excretion.
T385 625792-625835 Sentence denotes If bradycardia occurs, do not use atropine.
T386 625836-625897 Sentence denotes Pine Oil Disinfectants See Detergents, Nonionic and Alcohols.
T387 625898-625968 Sentence denotes Piperazine is a relative of ivermectin used for anthelmintic purposes.
T388 625969-625985 Sentence denotes Pathophysiology:
T389 625986-626015 Sentence denotes Piperazine is a GABA agonist.
T390 626016-626031 Sentence denotes Clinical Signs:
T391 626032-626119 Sentence denotes Clinical signs include cervical and truncal ataxia, tremors, seizures, coma, and death.
T392 626120-626131 Sentence denotes Toxic Dose:
T393 626132-626157 Sentence denotes 30 to 55 mg/kg Treatment:
T394 626158-626341 Sentence denotes If ingestion was recent and if no clinical signs of toxicity are present, induce emesis or perform orogastric lavage, followed by administration of a cathartic and activated charcoal.
T395 626342-626369 Sentence denotes There is no known antidote.
T396 626370-626524 Sentence denotes Treatment includes supportive care in the form of intravenous fluids and administration of phenobarbital or methocarbamol to control seizures and tremors.
T397 626525-626620 Sentence denotes Diazepam, a GABA agonist, is contraindicated, because it can potentially worsen clinical signs.
T398 626621-626664 Sentence denotes Urine acidification may hasten elimination.
T399 626665-626706 Sentence denotes Clinical signs can last from 3 to 5 days.
T400 626707-626859 Sentence denotes Pseudoephedrine is an αand β-adrenergic agonist that is a component of many OTC decongestants and is used in the manufacture of crystal methamphetamine.
T401 626860-626876 Sentence denotes Pathophysiology:
T402 626877-627008 Sentence denotes Pathophysiology involves αand β-adrenergic receptor agonist activity, causing vasoconstriction, tachyarrhythmias, and hypertension.
T403 627009-627024 Sentence denotes Clinical Signs:
T404 627025-627186 Sentence denotes Clinical signs of toxicity include severe restlessness, tremors, mydriasis, agitation, hyperthermia, tachyarrhythmias or bradycardia, hypertension, and seizures.
T405 627187-627198 Sentence denotes Toxic Dose:
T406 627199-627246 Sentence denotes Clinical signs of toxicity are seen at 3 mg/kg.
T407 627247-627257 Sentence denotes Treatment:
T408 627258-627788 Sentence denotes To treat toxicity, administer activated charcoal, intravenous fluids to promote diuresis and treat hyperthermia, chlorpromazine to combat α-adrenergic effects, a β-blocker (propranolol, 0.04 to 0.1 mg/kg IV slowly to effect; esmolol, 50 to 100 mcg/kg IV bolus, 50 to 200 mcg/kg/min IV CRI; atenolol, 0.5 to 1 mg/kg PO q12h [canine], 6.25 to 12.5 mg/cat PO q12-24h [feline]) to treat β-adrenergic effects, and cyproheptadine (0.5 to 1.1 mg/kg POq12h or per rectum dog, 2 mg/k cat PO or per rectum) to combat serotoninergic effects.
T409 627789-628000 Sentence denotes Pyrethrin and pyrethroid compounds are extracted from chrysanthemums and include allethrin, decamethrin, tralomethrin, fenpropathrin, prallethrin, sumithrin, permethrin, tetramethrin, cyfluthrin, and resmethrin.
T410 628001-628017 Sentence denotes Pathophysiology:
T411 628018-628198 Sentence denotes Pyrethrin and pyrethroid compounds cause depolarization and blockade of nerve membrane potentials, causing clinical signs of tremors, seizures, respiratory distress, and paralysis.
T412 628199-628228 Sentence denotes Contact dermatitis can occur.
T413 628229-628244 Sentence denotes Clinical Signs:
T414 628245-628323 Sentence denotes Clinical signs include tremors, seizures, respiratory distress, and paralysis.
T415 628324-628443 Sentence denotes The oral toxicity is fairly low; however, the compounds can be significantly harmful if inhaled or applied to the skin.
T416 628444-628452 Sentence denotes Testing:
T417 628453-628666 Sentence denotes To distinguish between pyrethrin or pyrethroid toxicity and organophosphate toxicity, acetylcholinesterase levels should be obtained; they will be normal if pyrethrins are the cause of the animal's clinical signs.
T418 628667-628678 Sentence denotes Toxic Dose:
T419 628679-628748 Sentence denotes Spot-On flea products labeled for dogs contain 45% to 60% permethrin.
T420 628749-628777 Sentence denotes Permethrin is toxic to cats.
T421 628778-628788 Sentence denotes Treatment:
T422 628789-628856 Sentence denotes Treatment of toxicity is supportive, as there is no known antidote.
T423 628857-628946 Sentence denotes Carefully bathe the animal in lukewarm water to prevent further oral and dermal exposure.
T424 628947-629007 Sentence denotes Both hyperthermia and hypothermia can worsen clinical signs.
T425 629008-629078 Sentence denotes Administer activated charcoal to decrease enterohepatic recirculation.
T426 629079-629171 Sentence denotes Atropine (0.02 to 0.04 mg/kg IV, IM, SQ) may control clinical signs of excessive salivation.
T427 629172-629262 Sentence denotes To control muscle tremors, administer methocarbamol (50 to 220 mg/kg IV slowly to effect).
T428 629263-629381 Sentence denotes Administer diazepam (0.5 to 1 mg/kg IV) or phenobarbital (10 to 20 mg/kg IV slowly) to control seizures, as necessary.
T429 629382-629444 Sentence denotes Rotenone is used as a common garden and delousing insecticide.
T430 629445-629502 Sentence denotes Fish and birds are very susceptible to rotenone toxicity.
T431 629503-629519 Sentence denotes Pathophysiology:
T432 629520-629592 Sentence denotes Rotenone inhibits mitochondrial electron transport and nerve conduction.
T433 629593-629608 Sentence denotes Clinical Signs:
T434 629609-629703 Sentence denotes Clinical signs of tissue irritation and hypoglycemia can occur after topical or oral exposure.
T435 629704-629770 Sentence denotes If the compound is inhaled, CNS depression and seizures can occur.
T436 629771-629781 Sentence denotes Treatment:
T437 629782-629893 Sentence denotes To treat toxicity, perform orogastric lavage, followed by administration of a cathartic and activated charcoal.
T438 629894-629978 Sentence denotes Bathe the animal carefully to prevent further dermal exposure and further ingestion.
T439 629979-630083 Sentence denotes Administer diazepam (0.5 to 1 mg/kg IV) or phenobarbital (10 to 20 mg/kg IV slowly) to control seizures.
T440 630084-630119 Sentence denotes The prognosis generally is guarded.
T441 630120-630149 Sentence denotes Rubbing Alcohol See Alcohols.
T442 630150-630174 Sentence denotes Salicylates See Aspirin.
T443 630175-630284 Sentence denotes Salt used for thawing ice commonly contains calcium chloride, a compound that has a moderate toxic potential.
T444 630285-630301 Sentence denotes Pathophysiology:
T445 630302-630422 Sentence denotes Calcium chloride produces strong local irritation and can cause gastroenteritis and gastrointestinal ulcers if ingested.
T446 630423-630438 Sentence denotes Clinical Signs:
T447 630439-630498 Sentence denotes Clinical signs include erythema, vomiting, and hematemesis.
T448 630499-630509 Sentence denotes Treatment:
T449 630510-630583 Sentence denotes Treatment of ingestion includes dilution with milk, water, or egg whites.
T450 630584-630660 Sentence denotes Perform orogastric lavage, followed by administration of activated charcoal.
T451 630661-630725 Sentence denotes Administer intravenous crystalloid fluids to maintain hydration.
T452 630726-630813 Sentence denotes Administer antiemetic and gastroprotectant drugs to treat gastroenteritis and vomiting.
T453 630814-630923 Sentence denotes Selenium sulfide shampoos (e.g., Selsun Blue) have a low toxic potential and primarily cause gastroenteritis.
T454 630924-630940 Sentence denotes Pathophysiology:
T455 630941-630985 Sentence denotes Pathophysiology involves gastric irritation.
T456 630986-631001 Sentence denotes Clinical Signs:
T457 631002-631034 Sentence denotes Clinical signs include vomiting.
T458 631035-631045 Sentence denotes Treatment:
T459 631046-631160 Sentence denotes Treatment of ingestion includes dilution with water, milk, or egg whites and administration of activated charcoal.
T460 631161-631238 Sentence denotes Carefully and thoroughly rinse the skin and eyes to prevent further exposure.
T461 631239-631323 Sentence denotes Administer antiemetic and gastroprotectant drugs in cases of severe gastroenteritis.
T462 631324-631363 Sentence denotes Shoe Polish See Hydrocarbons, Aromatic.
T463 631364-631485 Sentence denotes Some silver polishes contains the alkali substance sodium carbonate and cyanide salts and have a serious toxic potential.
T464 631486-631502 Sentence denotes Pathophysiology:
T465 631503-631567 Sentence denotes Pathophysiology involves disruption of electron transport chain.
T466 631568-631583 Sentence denotes Clinical Signs:
T467 631584-631659 Sentence denotes Ingestion results in rapid onset of vomiting and possibly cyanide toxicity.
T468 631660-631670 Sentence denotes Treatment:
T469 631671-631810 Sentence denotes To treat ingestion, monitor and maintain the patient's respiration and cardiovascular status and administer intravenous crystalloid fluids.
T470 631811-631875 Sentence denotes Induce emesis, followed by administration of activated charcoal.
T471 631876-631948 Sentence denotes Administer sodium nitrite or sodium thiosulfate IV for cyanide toxicity.
T472 631949-632060 Sentence denotes Bath soap (bar soap) usually has low toxic potential and causes mild gastroenteritis with vomiting if ingested.
T473 632061-632077 Sentence denotes Pathophysiology:
T474 632078-632113 Sentence denotes Bar soaps cause gastric irritation.
T475 632114-632129 Sentence denotes Clinical Signs:
T476 632130-632175 Sentence denotes Clinical signs include vomiting, hematemesis.
T477 632176-632187 Sentence denotes Toxic Dose:
T478 632188-632218 Sentence denotes Small quantities may be toxic.
T479 632219-632229 Sentence denotes Treatment:
T480 632230-632424 Sentence denotes To treat ingestion, include dilution with water, administration of intravenous fluids to maintain hydration, and administration of antiemetic and gastroprotectant drugs to treat gastroenteritis.
T481 632425-632543 Sentence denotes Sodium fluoroacetate is a colorless, odorless, tasteless compound that causes uncoupling of oxidative phosphorylation.
T482 632544-632560 Sentence denotes Pathophysiology:
T483 632561-632725 Sentence denotes Pathophysiology involves uncoupling of oxidative phosphorylation, prevention of adenosine triphosphate (ATP) production and cellular metabolism, and cerebral edema.
T484 632726-632741 Sentence denotes Clinical Signs:
T485 632742-632840 Sentence denotes Clinical signs of toxicity include CNS excitation, seizures, and coma secondary to cerebral edema.
T486 632841-632866 Sentence denotes The prognosis is guarded.
T487 632867-632878 Sentence denotes Toxic Dose:
T488 632879-632932 Sentence denotes The toxic dose in dogs and cats is 0.05 to 1.0 mg/kg.
T489 632933-632943 Sentence denotes Treatment:
T490 632944-633075 Sentence denotes To treat toxicity, procure and maintain a patent airway, monitor and stabilize the cardiovascular status, and control hyperthermia.
T491 633076-633152 Sentence denotes Perform orogastric lavage, followed by administration of activated charcoal.
T492 633153-633230 Sentence denotes If clinical signs are not present at the time of presentation, induce emesis.
T493 633231-633299 Sentence denotes Administer intravenous fluids and supplemental oxygen, as necessary.
T494 633300-633470 Sentence denotes Strattera (atomoxetine hydrochloride) is a selective norepinephrine reuptake inhibitor used in the treatment of attention-deficit/hyperactivity disorder (ADHD) in humans.
T495 633471-633487 Sentence denotes Pathophysiology:
T496 633488-633551 Sentence denotes Pathophysiology involves accumulation of norepinephrine in CNS.
T497 633552-633567 Sentence denotes Clinical Signs:
T498 633568-633707 Sentence denotes Clinical signs of toxicity include cardiac tachyarrhythmias, hypertension, disorientation, agitation, trembling, tremors, and hyperthermia.
T499 633708-633719 Sentence denotes Toxic Dose:
T500 633720-633848 Sentence denotes Peak serum concentrations occur in dogs within 3 to 4 hours of ingestion, with a peak half-life at 4 to 5 hours after ingestion.
T501 633849-633859 Sentence denotes Treatment:
T502 633860-633934 Sentence denotes Treatment of intoxication is largely symptomatic and supportive in nature.
T503 633935-634013 Sentence denotes First, induce emesis if the patient is conscious and has an intact gag reflex.
T504 634014-634054 Sentence denotes Orogastric lavage can also be performed.
T505 634055-634175 Sentence denotes Administer one dose of activated charcoal to prevent further absorption of the compound from the gastrointestinal tract.
T506 634176-634228 Sentence denotes Identify cardiac dysrhythmias and treat accordingly.
T507 634229-634471 Sentence denotes Control hypertension with sodium nitroprusside (1 to 2 mcg/kg/min IV CRI, titrating up slowly until desired BP is reached, carefully monitoring for hypotension) or diltiazem (0.1 to 0.25 mg/kg IV slowly to effect, then 2 to 6 mcg/kg/min CRI).
T508 634472-634605 Sentence denotes Administer acepromazine (0.02 to 0.05 mg/kg IV) or chlorpromazine (0.2 to 0.5 mg/kg IM q8h, 0.05 mg/ kg IV q4h) to control agitation.
T509 634606-634676 Sentence denotes Do not use diazepam, because it can potentially worsen clinical signs.
T510 634677-634750 Sentence denotes Administer intravenous fluids to maintain hydration and promote diuresis.
T511 634751-634842 Sentence denotes Strychnine is the active ingredient in pesticides used to control rodents and other vermin.
T512 634843-634859 Sentence denotes Pathophysiology:
T513 634860-634919 Sentence denotes Strychnine antagonizes spinal inhibitory neurotransmitters.
T514 634920-634935 Sentence denotes Clinical Signs:
T515 634936-635012 Sentence denotes Clinical signs include severe muscle tremors, muscle rigidity, and seizures.
T516 635013-635092 Sentence denotes Clinical signs are stimulated or exacerbated by noise, touch, light, and sound.
T517 635093-635154 Sentence denotes Mydriasis, hyperthermia, and respiratory paralysis can occur.
T518 635155-635163 Sentence denotes Testing:
T519 635164-635261 Sentence denotes If strychnine toxicity is suspected, gastric contents should be collected and saved for analysis.
T520 635262-635273 Sentence denotes Toxic Dose:
T521 635274-635335 Sentence denotes The toxic dose in dogs is 0.75 mg/kg, and in cats is 2 mg/kg.
T522 635336-635395 Sentence denotes Strychnine antagonizes spinal inhibitory neurotransmitters.
T523 635396-635406 Sentence denotes Treatment:
T524 635407-635480 Sentence denotes If the animal is asymptomatic at the time of presentation, induce emesis.
T525 635481-635538 Sentence denotes If clinical signs are present, perform orogastric lavage.
T526 635539-635636 Sentence denotes Both emesis and orogastric lavage should be followed by the administration of activated charcoal.
T527 635637-635769 Sentence denotes Administer intravenous crystalloid fluids to support the cardiovascular system, aid in cooling measures, and improve renal diuresis.
T528 635770-635912 Sentence denotes Treat CNS stimulation with methocarbamol (55 to 220 mg/kg IV to effect), diazepam (2-5 mg/kg IV), or phenobarbital (10 to 20 mg/kg IV slowly).
T529 635913-636035 Sentence denotes The animal should have cotton packed in its ears to prevent noise stimulation, and should be placed in a quiet, dark room.
T530 636036-636122 Sentence denotes Styptic pencils contain potassium alum sulfate, a compound with a low toxic potential.
T531 636123-636139 Sentence denotes Pathophysiology:
T532 636140-636252 Sentence denotes Ingestion of styptic pencils is corrosive because of the release of sulfuric acid during hydrolysis of the salt.
T533 636253-636292 Sentence denotes Styptic pencils are a gastric irritant.
T534 636293-636308 Sentence denotes Clinical Signs:
T535 636309-636341 Sentence denotes Clinical signs include vomiting.
T536 636342-636352 Sentence denotes Treatment:
T537 636353-636558 Sentence denotes Treatment of ingestion includes dilution with Milk of Magnesia or water, administration of antiemetic and gastroprotectant drugs, and administration of intravenous crystalloid fluids to maintain hydration.
T538 636559-636642 Sentence denotes Do not induce emesis, because of the risk of causing further esophageal irritation.
T539 636643-636657 Sentence denotes Tar See Fuels.
T540 636658-636724 Sentence denotes Tea tree (Melaleuca) oil is an herbal-origin flea-control product.
T541 636725-636779 Sentence denotes The toxic principles in tea tree oil are monoterpenes.
T542 636780-636796 Sentence denotes Pathophysiology:
T543 636797-636828 Sentence denotes The pathophysiology is unknown.
T544 636829-636844 Sentence denotes Clinical Signs:
T545 636845-636922 Sentence denotes Clinical signs include neuromuscular weakness and ataxia and hepatic failure.
T546 636923-636934 Sentence denotes Toxic Dose:
T547 636935-636999 Sentence denotes Direct application of 100% tea tree oil results in a toxic dose.
T548 637000-637010 Sentence denotes Treatment:
T549 637011-637137 Sentence denotes Treatment of tea tree oil toxicity includes administration of cathartics and activated charcoal to prevent further absorption.
T550 637138-637200 Sentence denotes Carefully bathe the animal to prevent further dermal exposure.
T551 637201-637314 Sentence denotes Tetanus spores from Clostridium tetani organisms are ubiquitous in the soil and feces, particularly in barnyards.
T552 637315-637439 Sentence denotes Cases have been reported in dogs after tooth eruption and after abdominal surgeries performed with cold sterilization packs.
T553 637440-637494 Sentence denotes Anaerobic wound infections can contain tetanus spores.
T554 637495-637511 Sentence denotes Pathophysiology:
T555 637512-637610 Sentence denotes The neurotoxin from C. tetani inhibits spinal inhibitory neurons, causing motor neuron excitation.
T556 637611-637626 Sentence denotes Clinical Signs:
T557 637627-637763 Sentence denotes Extensor muscle rigidity ("sawhorse stance"), erect ears, and risus sardonicus (a sardonic grin) are characteristic features of tetanus.
T558 637764-637774 Sentence denotes Treatment:
T559 637775-637851 Sentence denotes Administer tetanus antitoxin if toxin has not already been bound in the CNS.
T560 637852-637934 Sentence denotes To eliminate the source of the toxin (e.g., abscess), open and debride all wounds.
T561 637935-638031 Sentence denotes Intravenous administration of ampicillin or penicillin G is the treatment of choice for tetanus.
T562 638032-638201 Sentence denotes Supportive care in the form of skeletal muscle relaxants, intravenous fluids and parenteral nutrition, and nursing care to prevent decubitus ulcer formation is required.
T563 638202-638260 Sentence denotes In extreme cases, mechanical ventilation may be necessary.
T564 638261-638330 Sentence denotes Triazine compounds include atrazine, prometone, and monuron (Telvar).
T565 638331-638347 Sentence denotes Pathophysiology:
T566 638348-638401 Sentence denotes The toxic mechanism of triazine compounds is unknown.
T567 638402-638417 Sentence denotes Clinical Signs:
T568 638418-638564 Sentence denotes Clinical signs include salivation, ataxia, hyporeflexia, contact dermatitis, hepatorenal damage, muscle spasms, respiratory difficulty, and death.
T569 638565-638575 Sentence denotes Treatment:
T570 638576-638753 Sentence denotes Treatment of triazine exposure includes cardiovascular and renal support in the form of intravenous crystalloid fluids, inotropic drugs, and antiarrhythmic agents, as necessary.
T571 638754-638795 Sentence denotes If the exposure is recent, induce emesis.
T572 638796-638864 Sentence denotes Perform orogastric lavage in animals that cannot protect the airway.
T573 638865-638973 Sentence denotes Emesis and orogastric lavage should be followed by the administration of activated charcoal and a cathartic.
T574 638974-639039 Sentence denotes Carefully bathe the patient to prevent further dermal absorption.
T575 639040-639329 Sentence denotes A variety of tricyclic antidepressants are available for use in both humans and animals, including amitriptyline, amoxapine, desipramine, doxepin, fluoxetine (Prozac), fluvoxamine (Luvox), imipramine, nortriptyline, paroxetine (Paxil), protriptyline, sertraline (Zoloft), and trimipramine.
T576 639330-639346 Sentence denotes Pathophysiology:
T577 639347-639512 Sentence denotes Selective serotonin reuptake inhibitors (SSRIs) are rapidly absorbed from the digestive tract, with peak serum concentrations occurring 2 to 8 hours after ingestion.
T578 639513-639603 Sentence denotes The elimination half-life for each drug differs in dogs but typically last 16 to 24 hours.
T579 639604-639690 Sentence denotes SSRIs inhibit the reuptake of serotonin, causing serotonin to accumulate in the brain.
T580 639691-639744 Sentence denotes This can cause "serotonin syndrome. " Clinical Signs:
T581 639745-639883 Sentence denotes Clinical signs include trembling, seizures, hyperthermia, ptyalism or hypersalivation, cramping or abdominal pain, vomiting, and diarrhea.
T582 639884-639999 Sentence denotes Other clinical signs of SSRI intoxication include depression, tremors, bradycardia, tachyarrhythmias, and anorexia.
T583 640000-640126 Sentence denotes Any animal that has ingested an SSRI should be promptly treated and carefully observed for at least 72 hours for side effects.
T584 640127-640138 Sentence denotes Toxic Dose:
T585 640139-640208 Sentence denotes Toxic dose is dependent on type of tricyclic antidepressant ingested.
T586 640209-640219 Sentence denotes Treatment:
T587 640220-640359 Sentence denotes The treatment of suspected SSRI intoxication involves gastric decontamination if the patient is not depressed and has an intact gag reflex.
T588 640360-640511 Sentence denotes Perform orogastric lavage and administer activated charcoal to prevent further toxin absorption and hasten elimination from the gastrointestinal tract.
T589 640512-640555 Sentence denotes Treat other clinical signs symptomatically.
T590 640556-640608 Sentence denotes Administer intravenous diazepam to control seizures.
T591 640609-640650 Sentence denotes Treat tachyarrhythmias according to type.
T592 640651-640733 Sentence denotes Administer methocarbamol (55 to 220 mg/kg IV to effect) to control muscle tremors.
T593 640734-640838 Sentence denotes Cyproheptadine (2 mg/kg), a serotonin antagonist, can be dissolved in water and administered per rectum.
T594 640839-640860 Sentence denotes Turpentine See Fuels.
T595 640861-640940 Sentence denotes Vitamin K-antagonist rodenticides are commonly found in pelleted or block form.
T596 640941-640957 Sentence denotes Pathophysiology:
T597 640958-641060 Sentence denotes These agents inhibit the activation of the vitamin K-dependent coagulation factors II, VII, IX, and X.
T598 641061-641076 Sentence denotes Clinical Signs:
T599 641077-641143 Sentence denotes Clinical signs of hemorrhage occur within 2 to 7 days of exposure.
T600 641144-641453 Sentence denotes Hemorrhage can occur anywhere in the body and can manifest as petechiation of the skin or mucous membranes, hemorrhagic sclera, epistaxis, pulmonary parenchymal or pleural hemorrhage, gastrointestinal hemorrhage, pericardial hemorrhage, hematuria, retroperitoneal hemorrhage, hemarthrosis, and CNS hemorrhage.
T601 641454-641668 Sentence denotes Clinical signs include respiratory distress, cough, bleeding from the gums or into the eyes, ataxia, paresis, paralysis, seizures, hematuria, joint swelling, lameness, lethargy, weakness, inappetence, and collapse.
T602 641669-641677 Sentence denotes Testing:
T603 641678-641746 Sentence denotes Diagnosis is made based on clinical signs and a prolonged ACT or PT.
T604 641747-641861 Sentence denotes The PIVKA (proteins induced by vitamin K antagonism) test may be helpful but usually cannot be performed in house.
T605 641862-642062 Sentence denotes Slight thrombocytopenia may be present secondary to hemorrhage; however, blood levels usually do not reach the critical level of <50,000 platelets per microliter to cause clinical signs of hemorrhage.
T606 642063-642172 Sentence denotes In some cases, severe stress-induced hyperglycemia and glucosuria may be present but resolve within 24 hours.
T607 642173-642183 Sentence denotes Treatment:
T608 642184-642255 Sentence denotes If the rodenticide was ingested within the last 2 hours, induce emesis.
T609 642256-642334 Sentence denotes Alternatively, orogastric lavage can be performed in an uncooperative patient.
T610 642335-642428 Sentence denotes Both emesis and orogastric lavage should be followed by administration of activated charcoal.
T611 642429-642480 Sentence denotes The stomach contents can be submitted for analysis.
T612 642481-642618 Sentence denotes After successful treatment, administer oral vitamin K for 30 days after the exposure; or a check PT 2 days after gastric decontamination.
T613 642619-642688 Sentence denotes If the PT is prolonged, administer fresh frozen plasma and vitamin K.
T614 642689-642788 Sentence denotes If the PT is normal, gastric decontamination was successful, and no further treatment is necessary.
T615 642789-642994 Sentence denotes If an animal shows clinical signs of intoxication, administer activated clotting factors in the form of fresh frozen plasma (20 mL/kg) and vitamin K 1 (5 mg/kg SQ in multiple sites with a 24-gauge needle).
T616 642995-643074 Sentence denotes Packed RBCs or fresh whole blood may be required if the patient is also anemic.
T617 643075-643187 Sentence denotes Supportive care in the form of supplemental oxygen may be necessary in cases of pulmonary or pleural hemorrhage.
T618 643188-643380 Sentence denotes After initial therapy and discharge, the patient should receive vitamin K 1 (2.5 mg/kg PO q8-12h for 30 days), and PT should be checked 2 days after the last vitamin K capsule is administered.
T619 643381-643506 Sentence denotes In some cases, depending on the type of anticoagulant ingested, an additional 2 weeks of vitamin K 1 therapy may be required.
T1 643507-643693 Sentence denotes Xylitol is a sugar alcohol that, when ingested by humans, does not cause a significant increase in blood glucose and therefore does not stimulate insulin release from the human pancreas.
T2 643694-643808 Sentence denotes In dogs, however, xylitol causes a massive rapid and dose-dependent release of insulin from pancreatic beta cells.
T3 643809-643825 Sentence denotes Pathophysiology:
T4 643826-643874 Sentence denotes This agent causes insulin release from pancreas.
T5 643875-643946 Sentence denotes After insulin release, clinically significant hypoglycemia can develop.
T6 643947-644023 Sentence denotes Toxic Dose: >0.1 g/kg hypoglycemia, >0.5 g/kg hepatotoxicity Clinical Signs:
T7 644024-644153 Sentence denotes Clinical signs include hypoglycemia, vomiting, weakness, ataxia, mental depression, hypokalemia, hypoglycemic seizures, and coma.
T8 644154-644314 Sentence denotes Clinical signs associated with xylitol ingestion can be seen within 30 minutes of ingestion and can last for more than 12 hours, even with aggressive treatment.
T9 644315-644409 Sentence denotes Cases of acute hepatic necrosis, with vomiting, icterus, coagulopathies, and death, can occur.
T10 644410-644420 Sentence denotes Treatment:
T11 644421-644492 Sentence denotes Known xylitol ingestion should be treated as for other toxin ingestion.
T12 644493-644627 Sentence denotes If no neurologic abnormalities exist at the time the patient is seen, induce emesis, followed by administration of activated charcoal.
T13 644628-644780 Sentence denotes It remains unknown at this time whether activated charcoal actually delays or prevents the absorption of xylitol from the canine gastrointestinal tract.
T14 644781-644877 Sentence denotes If clinical signs have already developed, perform orogastric lavage and gastric decontamination.
T15 644878-645063 Sentence denotes Blood glucose concentrations should be analyzed and maintained with supplemental dextrose as a CRI (2.5% to 5%) until normoglycemia can be maintained with multiple frequent small meals.
T16 645064-645151 Sentence denotes Hypokalemia may develop because it is driven intracellularly by the actions of insulin.
T17 645152-645248 Sentence denotes Treat hypokalemia with supplemental potassium chloride by infusion, not to exceed 0.5 mEq/kg/hr.
T18 645249-645302 Sentence denotes Zephiran See Detergents, Cationic, and Disinfectants.
T19 645303-645399 Sentence denotes Pennies minted in the United States after 1982 contain large amounts of zinc rather than copper.
T20 645400-645502 Sentence denotes Other sources of zinc include zinc oxide ointment and hardware such as that found in metal bird cages.
T21 645503-645519 Sentence denotes Pathophysiology:
T22 645520-645609 Sentence denotes Zinc toxicity causes intravascular hemolysis, anemia, gastroenteritis, and renal failure.
T23 645610-645625 Sentence denotes Clinical Signs:
T24 645626-645723 Sentence denotes Clinical signs include vomiting, lethargy, icterus, hemoglobinemia, hemoglobinuria, and diarrhea.
T25 645724-645735 Sentence denotes Toxic Dose:
T26 645736-645762 Sentence denotes The toxic dose is unknown.
T27 645763-645834 Sentence denotes Pennies minted after 1982 contain large quantities of zinc, not copper.
T28 645835-645845 Sentence denotes Treatment:
T29 645846-646148 Sentence denotes If zinc toxicity is suspected, take an abdominal radiograph to document the presence of the metal in the stomach or intestines. (If zinc-containing ointment was ingested, this will not be visible on radiographs.) Induce emesis or perform orogastric lavage, depending on the size of the object ingested.
T30 646149-646256 Sentence denotes Often, small objects such as pennies can be retrieved using endoscopy or surgical gastrotomy or enterotomy.
T31 646257-646380 Sentence denotes Always take an additional radiograph after the removal procedure to ensure that all objects have been successfully removed.
T32 646381-646466 Sentence denotes Administer intravenous fluids to maintain renal perfusion and promote fluid diuresis.
T33 646467-646516 Sentence denotes Administer gastroprotectant and antiemetic drugs.
T34 646517-646611 Sentence denotes Chelation therapy with succimer, calcium EDTA, dimercaprol, or penicillamine may be necessary.
T35 646612-646706 Sentence denotes Do not administer calcium EDTA if the patient is dehydrated, because renal failure can result.
T36 646707-646756 Sentence denotes Severe anemia should be treated with packed RBCs.
T37 646757-646963 Sentence denotes Respiratory emergencies consist of any problem that impairs delivery of oxygen to the level of the alveoli or diffusion of oxygen across the alveolar capillary membrane into the pulmonary capillary network.
T38 646964-647108 Sentence denotes Decreased respiratory rate or tidal volume can result in hypoxia and buildup of carbon dioxide, or hypercarbia, leading to respiratory acidosis.
T39 647109-647334 Sentence denotes Conditions most frequently encountered result in airflow obstruction, prevention of normal lung expansion, 1 interference with pulmonary gas exchange (ventilation-perfusion mismatch), and alterations of pulmonary circulation.
T40 647335-647504 Sentence denotes Evaluation of the patient with respiratory distress is often challenging, because the most minimal stress can cause rapid deterioration, or even death in critical cases.
T41 647505-647711 Sentence denotes Careful observation of the patient from a distance often allows the clinician to determine the severity of respiratory distress and localize the lesion based on the patient's respiratory pattern and effort.
T42 647712-647805 Sentence denotes Animals in respiratory distress often have a rapid respiratory rate (>30 breaths per minute).
T43 647806-647903 Sentence denotes As respiratory distress progresses, the patient may appear anxious and start openmouth breathing.
T44 647904-648059 Sentence denotes The animal often develops an orthopneic posture, characterized by neck extension, open-mouthed breathing, and elbows abducted or pulled away from the body.
T45 648060-648132 Sentence denotes Cyanosis of the mucous membranes often indicates extreme decompensation.
T46 648133-648315 Sentence denotes Clinical signs of respiratory distress can develop acutely or from decompensation of a more chronic problem that was preceded by a cough, noisy respirations, or exercise intolerance.
T47 648316-648409 Sentence denotes Localization of the cause of respiratory distress is essential to successful case management.
T48 648410-648661 Sentence denotes In any patient with clinical signs of respiratory distress, the differential diagnosis should include primary pulmonary parenchymal disease, airway disease, thoracic cage disorders, CHF, dyshemoglobinemias (carbon monoxide, methemoglobin), and anemia.
T49 648662-648890 Sentence denotes Careful observation of the patient's respiratory pattern can aid in making a diagnosis of upper airway disease or obstruction, primary pulmonary parenchymal disease, pleural space disease, and abnormalities of the thoracic cage.
T50 648891-649038 Sentence denotes It is often helpful to rest a hand on the patient and breathe along with the patient's effort, to confirm the periods of inhalation and exhalation.
T51 649039-649114 Sentence denotes The pharynx, larynx, and extrathoracic trachea constitute the upper airway.
T52 649115-649227 Sentence denotes Obstructive lesions are associated with a marked inspiratory wheeze or stridor and slow deep inspiratory effort.
T53 649228-649322 Sentence denotes Auscultation of the larynx and trachea may reveal more subtle obstructions of normal air flow.
T54 649323-649391 Sentence denotes Stridor can usually be auscultated without the use of a stethoscope.
T55 649392-649423 Sentence denotes Lung sounds are usually normal.
T56 649424-649527 Sentence denotes The neck should be carefully palpated for a mass lesion, tracheal collapse, and subcutaneous emphysema.
T57 649528-649615 Sentence denotes Subcutaneous emphysema suggests tracheal damage or collapse secondary to severe trauma.
T58 649616-649710 Sentence denotes In some cases there is a history of voice, or bark, change secondary to laryngeal dysfunction.
T59 649711-649844 Sentence denotes Differential diagnosis is usually based on the patient's signalment, history, and index of suspicion of a particular disease process.
T60 649845-649919 Sentence denotes Differential diagnoses of upper airway obstruction are listed in Box 1-61.
T61 649920-650010 Sentence denotes Diseases of the pleural space often are associated with a restrictive respiratory pattern.
T62 650011-650105 Sentence denotes Inspiratory efforts are short, rapid, and shallow, and there is often a marked abdominal push.
T63 650106-650187 Sentence denotes The pattern has been referred to as a choppy "dysynchronous" respiratory pattern.
T64 650188-650281 Sentence denotes Depending on the disease present, lung sounds may be muffled ventrally and enhanced dorsally.
T65 650282-650355 Sentence denotes Percussion of the thorax reveals decreased resonance if fluid is present.
T66 650356-650405 Sentence denotes Increased resonance is present with pneumothorax.
T67 650406-650545 Sentence denotes Decreased compressibility of the anterior thorax may be present with an anterior mediastinal mass lesion, particularly in cats and ferrets.
T68 650546-650663 Sentence denotes A pneumothorax or diaphragmatic hernia is commonly associated with evidence of trauma, with or without rib fractures.
T69 650664-650735 Sentence denotes Respiratory distress caused by hemothorax may be exacerbated by anemia.
T70 650736-650905 Sentence denotes Differential diagnoses for patients with evidence of pleural cavity disease include pneumothorax, diaphragmatic hernia, neoplasia, and various types of pleural effusion.
T71 650906-651038 Sentence denotes Primary pulmonary parenchymal disease can involve the intrathoracic airways, alveoli, interstitial space, and pulmonary vasculature.
T72 651039-651228 Sentence denotes A rapid, shallow, restrictive respiratory pattern may be observed with a marked push on exhalation, particularly with obstructive airway disease such as chronic bronchitis (asthma) in cats.
T73 651229-651284 Sentence denotes Crackles or wheezes are heard on thoracic auscultation.
T74 651285-651602 Sentence denotes Differential diagnoses for pulmonary parenchymal disease include cardiogenic and noncardiogenic pulmonary edema, pneumonia, feline bronchitis (asthma), pulmonary contusion, aspiration pneumonitis, pulmonary thromboembolism (PTE), neoplasia, infection (bacterial, fungal, protozoal, viral) , and/or chronic bronchitis.
T75 651603-651689 Sentence denotes Other abnormal respiratory patterns may be evident, and warrant further consideration.
T76 651690-651856 Sentence denotes Tachypnea present in the absence of other signs of respiratory distress can be a normal response to nonrespiratory problems, including pain, hyperthermia, and stress.
T77 651857-652054 Sentence denotes A restrictive respiratory pattern with minimal thoracic excursions can be associated with diseases of neuromuscular function, including ascending polyradiculoneuritis, botulism, and tick paralysis.
T78 652055-652156 Sentence denotes If adequate ventilation cannot be maintained by the patient, mechanical ventilation may be indicated.
T79 652157-652262 Sentence denotes Kussmaul respiration manifests as very slow, very deep respirations when a metabolic acidosis is present.
T80 652263-652435 Sentence denotes This type of respiratory pattern typically is observed in patients with severe diabetic ketoacidosis and renal failure in a compensatory attempt to blow off carbon dioxide.
T81 652436-652538 Sentence denotes Cheyne-Stokes respiration is usually observed with a defect in the central respiratory control center.
T82 652539-652667 Sentence denotes The classic pattern of Cheyne-Stokes respiration is normal or hyperventilation followed by a period of apnea or hypoventilation.
T83 652668-652835 Sentence denotes In cases of lower cervical cord damage or damage to the central respiratory control center in the CNS, the diaphragm alone may assume most of the ventilatory movement.
T84 652836-652946 Sentence denotes With diaphragmatic fatigue, severe hypoventilation and resultant hypoxemia may require mechanical ventilation.
T85 652947-653063 Sentence denotes immediATe mAnAgemenT Immediate management of any patient in respiratory distress is to minimize stress at all costs.
T86 653064-653207 Sentence denotes Relatively benign procedures such as radiography or intravenous catheter placement can be fatal in patients with severe respiratory compromise.
T87 653208-653274 Sentence denotes Stabilization should always precede further diagnostic evaluation.
T88 653275-653379 Sentence denotes In some cases, sedation may be required before any diagnostics are performed, to prevent further stress.
T89 653380-653486 Sentence denotes All patients should receive some form of supplemental oxygen, either by mask, cage, or flow-by techniques.
T90 653487-653704 Sentence denotes In cases in which a severe pneumothorax or pleural effusion is suspected, perform therapeutic and diagnostic thoracocentesis bilaterally to allow lung reexpansion and alleviate respiratory distress, whenever possible.
T91 653705-653854 Sentence denotes If thoracocentesis alone is not effective at maintaining lung reexpansion, place a thoracostomy tube (particularly in cases of tension pneumothorax).
T92 653855-653986 Sentence denotes If hypovolemic or hemorrhagic shock is present, initiate treatment while stabilizing the respiratory system (see section on shock).
T93 653987-654072 Sentence denotes If an animal is suspected of having an upper airway obstruction, reestablish airflow.
T94 654073-654241 Sentence denotes In cases of laryngeal paralysis, tracheal collapse, and brachycephalic airway syndrome, sedation is often very useful in alleviating the distress of airway obstruction.
T95 654242-654321 Sentence denotes In cases of laryngeal collapse, however, sedation may make the condition worse.
T96 654322-654485 Sentence denotes If laryngeal edema is severe, administer a dose of short-acting glucocorticosteroids (dexamethasone sodium phosphate) to decrease laryngeal inflammation and edema.
T97 654486-654620 Sentence denotes If a foreign body is lodged in the pharynx, perform the Heimlich maneuver by thrusting bluntly several times on the patient's sternum.
T98 654621-654811 Sentence denotes Objects such as balls or bones may be small enough to enter the larynx but too large to be expelled; rapid-acting general anesthesia will be necessary to facilitate dislodgement and removal.
T99 654812-654949 Sentence denotes If the obstruction cannot be removed, bypassing the obstruction with an endotracheal tube or temporary tracheostomy should be considered.
T100 654950-655055 Sentence denotes In an emergency, a temporary transtracheal oxygen catheter can quickly be placed in the following manner.
T101 655056-655151 Sentence denotes Connect a 20-or 22-gauge needle to a length of intravenous extension tubing and a 3-mL syringe.
T102 655152-655240 Sentence denotes Place the male connector of the syringe into the female portion of the extension tubing.
T103 655241-655375 Sentence denotes Cut off the syringe plunger and connect the resulting blunt end to a length of flexible tubing attached to a humidified oxygen source.
T104 655376-655532 Sentence denotes Run the oxygen at 10 L/min to provide adequate oxygenation until a tracheostomy can be performed. (See sections on oxygen supplementation and tracheostomy.)
T105 655533-655762 Sentence denotes Once the animal's condition has been stabilized, specific diagnostic tests, including arterial blood gas analyses, thoracic radiographs, and/or transtracheal wash, can be performed, depending on the patient's condition and needs.
T106 655763-655890 Sentence denotes Specific therapies for management of upper airway obstruction, pleural space disease, and pulmonary disease are discussed next.
T107 655891-656097 Sentence denotes Upper airway obstruction can occur as a result of intraluminal or extraluminal mass lesions or foreign bodies in the oropharynx (abscess, neoplasia), laryngeal paralysis, trauma, and anatomic abnormalities.
T108 656098-656227 Sentence denotes Clinical signs of an upper airway obstruction are associated with an animal's extreme efforts to inhale air past the obstruction.
T109 656228-656331 Sentence denotes Marked negative pressure occurs in the extrathoracic airways and can cause worsening of clinical signs.
T110 656332-656394 Sentence denotes Mucosal edema and inflammation further worsen the obstruction.
T111 656395-656499 Sentence denotes Therapy for upper airway obstruction is aimed at breaking the cycle of anxiety and respiratory distress.
T112 656500-656612 Sentence denotes Administer the anxiolytic tranquilizer acepromazine (0.02 to 0.05 mg/kg IV, IM, SQ) to decrease patient anxiety.
T113 656613-656701 Sentence denotes Many animals develop hyperthermia from increased respiratory effort and extreme anxiety.
T114 656702-656858 Sentence denotes Implement cooling measures in the form of cool intravenous fluids and wet towels soaked in tepid water placed over the animal (see section on hyperthermia).
T115 656859-656941 Sentence denotes Administer supplemental oxygen in a manner that is least stressful for the animal.
T116 656942-657092 Sentence denotes Short-acting glucocorticosteroids can also be administered (dexamethasone sodium phosphate, 0.25 mg/kg IV, SQ, IM) to decrease edema and inflammation.
T117 657093-657386 Sentence denotes If the airway obstruction is severe and there is no response to initial measures to alleviate anxiety and decrease inflammation, establish control of ventilation by placement of an endotracheal tube (see section on endotracheal intubation), tracheal oxygen catheter, or temporary tracheostomy.
T118 657387-657532 Sentence denotes To obtain airway control, administer a rapid-acting anesthetic (propofol, 4 to 7 mg/kg IV to effect), and intubate with a temporary tracheostomy.
T119 657533-657659 Sentence denotes An intratracheal oxygen catheter can be placed with sedation and/or a local anesthetic (see technique for transtracheal wash).
T120 657660-657845 Sentence denotes Laryngeal paralysis is a congenital or acquired condition that occurs primarily in largebreed dogs secondary to denervation of the arytenoid cartilages by the recurrent laryngeal nerve.
T121 657846-657946 Sentence denotes Congenital laryngeal paralysis occurs in the Bouvier des Flandres, Siberian Husky, and Bull Terrier.
T122 657947-658041 Sentence denotes Acquired laryngeal paralysis occurs in Labrador Retrievers, Saint Bernards, and Irish Setters.
T123 658042-658209 Sentence denotes Acquired laryngeal paralysis can be idiopathic, acquired secondary to trauma to the recurrent laryngeal nerve, or can be a component of systemic neuromuscular disease.
T124 658210-658260 Sentence denotes Although rare, this condition also occurs in cats.
T125 658261-658367 Sentence denotes With dysfunction of the recurrent laryngeal nerve, the intrinsic laryngeal muscles atrophy and degenerate.
T126 658368-658534 Sentence denotes As a result, the vocal folds and arytenoid cartilage move in a paramedian position within the airway and fail to abduct during inhalation, causing airway obstruction.
T127 658535-658607 Sentence denotes Laryngeal paralysis can be partial or complete, unilateral or bilateral.
T128 658608-658737 Sentence denotes In many cases a change in bark is noted before the development of clinical signs of respiratory distress or exercise intolerance.
T129 658738-658921 Sentence denotes When a patient demonstrates severe inspiratory stridor (with or without hyperthermia), initiate stabilization with anxiolytic tranquilizers, supplemental oxygen, and cooling measures.
T130 658922-659068 Sentence denotes Once the patient's condition has been stabilized, definitive measures to accurately document and assess the patient's airway should be considered.
T131 659069-659248 Sentence denotes Place the patient under very heavy sedation with short-acting barbiturates or propofol (4 to 7 mg/kg IV) and observe the arytenoid cartilages closely in all phases of respiration.
T132 659249-659329 Sentence denotes Administer just enough drug to allow careful examination without getting bitten.
T133 659330-659476 Sentence denotes If the arytenoid cartilages do not abduct during inhalation, administer Dopram (doxapram hydrochloride, 1 to 5 mg/kg IV) to stimulate respiration.
T134 659477-659612 Sentence denotes Absent or paradoxical laryngeal motion (closed during inspiration and open during exhalation) is characteristic of laryngeal paralysis.
T135 659613-659753 Sentence denotes Correction of the defect involves documentation and treatment of any underlying disorder and surgical repair of the area to open the airway.
T136 659754-659885 Sentence denotes Partial laryngectomy, arytenoid lateralization ("tie-back" surgery), or removal of the vocal folds has been used with some success.
T137 659886-659942 Sentence denotes Aspiration pneumonitis is common after these procedures.
T138 659943-660077 Sentence denotes Brachycephalic airway syndrome is associated with a series of anatomic abnormalities that collectively increase resistance to airflow.
T139 660078-660178 Sentence denotes Affected animals typically have stenotic nares, an elongated soft palate, and a hypoplastic trachea.
T140 660179-660240 Sentence denotes Components of the syndrome can occur alone or in combination.
T141 660241-660464 Sentence denotes In severe cases, laryngeal saccular edema and eversion, and eventual pharyngeal collapse, can occur secondary to the severe increase in intrathoracic airway pressure required to overcome the resistance of the upper airways.
T142 660465-660550 Sentence denotes Specific airway anomalies can be identified with general anesthesia and laryngoscopy.
T143 660551-660621 Sentence denotes Severe respiratory distress should be treated as discussed previously.
T144 660622-660691 Sentence denotes Treatment requires surgical correction of the anatomic abnormalities.
T145 660692-660814 Sentence denotes In animals with laryngeal collapse, surgical correction may not be possible, and a permanent tracheostomy may be required.
T146 660815-661080 Sentence denotes Because an elongated soft palate and stenotic nares can be identified before the onset of clinical signs, surgical correction to improve airflow when the animal is young may decrease the negative intrathoracic pressure necessary to move air past these obstructions.
T147 661081-661188 Sentence denotes The chronic consequences of everted laryngeal saccules and laryngeal collapse potentially can be prevented.
T148 661189-661267 Sentence denotes Tracheal collapse is common in middle-aged and older toy and small-breed dogs.
T149 661268-661378 Sentence denotes The owner typically reports a chronic cough that is readily induced by excitement or palpation of the trachea.
T150 661379-661568 Sentence denotes The cough often sounds like a "goose honk. " Diagnostic confirmation is obtained by lateral radiography or fluoroscopy of the cervical and thoracic trachea during all phases of respiration.
T151 661569-661719 Sentence denotes Acute decompensation is uncommon but does occur, particularly with excitement, exercise, and increased environmental temperatures or ambient humidity.
T152 661720-661920 Sentence denotes Therapy of the patient with acute respiratory distress secondary to tracheal collapse includes sedation, administration of supplemental oxygen, and provision of cooling measures to treat hyperthermia.
T153 661921-662061 Sentence denotes Cough suppressants (hydrocodone bitartrate-homatropine methylbromide, 0.25 mg/kg PO q8-12h, or butorphanol, 0.5 mg/kg PO q6-12h) are useful.
T154 662062-662156 Sentence denotes Tracheal collapse is a dynamic process that usually involves both the upper and lower airways.
T155 662157-662219 Sentence denotes Because of this, bypassing the obstruction is often difficult.
T156 662220-662334 Sentence denotes Tracheal stents have been used with limited success in combination with treatment of chronic lower airway disease.
T157 662335-662446 Sentence denotes Crush or bite injuries to the neck can result in fractures or avulsion of the laryngeal or tracheal cartilages.
T158 662447-662572 Sentence denotes Bypassing the obstructed area may be necessary until the patient is stable and can undergo surgical correction of the injury.
T159 662573-662662 Sentence denotes If there is avulsion of the cranial trachea, it may be difficult to intubate the patient.
T160 662663-662847 Sentence denotes A long, rigid urinary catheter can be inserted past the area of avulsion into the distal segment, and an endotracheal tube passed over the rigid catheter, to establish a secure airway.
T161 662848-662943 Sentence denotes Neck injury can also result in damage to the recurrent laryngeal nerve and laryngeal paralysis.
T162 662944-663026 Sentence denotes Foreign bodies can lodge in the nasal cavity, pharynx, larynx, and distal trachea.
T163 663027-663137 Sentence denotes Signs of foreign bodies in the nares include acute sneezing and pawing at or rubbing the muzzle on the ground.
T164 663138-663226 Sentence denotes If the object is not removed, sneezing continues and a chronic nasal discharge develops.
T165 663227-663305 Sentence denotes Respiratory distress is uncommon, but the foreign body is severely irritating.
T166 663306-663410 Sentence denotes Pharyngeal and tracheal foreign bodies can cause severe obstruction to airflow and respiratory distress.
T167 663411-663540 Sentence denotes Diagnosis of a foreign body is based on the patient history, physical examination findings, and thoracic or cervical radiographs.
T168 663541-663666 Sentence denotes Smaller foreign bodies lodged in the distal airways may not be apparent radiographically but can cause pulmonary atelectasis.
T169 663667-663783 Sentence denotes Foreign bodies of the nose or pharynx can often be removed with alligator forceps with the patient under anesthesia.
T170 663784-664003 Sentence denotes If removal is not possible with forceps, flushing the nasal cavity from cranial to caudal (pack the back of the mouth with gauze to prevent aspiration) can sometimes dislodge the foreign material into the gauze packing.
T171 664004-664032 Sentence denotes Rhinoscopy may be necessary.
T172 664033-664091 Sentence denotes If an endoscope is not available, an otoscope can be used.
T173 664092-664246 Sentence denotes Foreign objects lodged in the trachea can be small and function like a ball valve during inhalation and exhalation, causing episodic hypoxia and collapse.
T174 664247-664327 Sentence denotes When attempting to remove these objects, suspend the patient with its head down.
T175 664328-664418 Sentence denotes Remove the object with an alligator forceps, using a laryngoscope to aid in visualization.
T176 664419-664510 Sentence denotes Foreign bodies lodged in the trachea or bronchi require removal with endoscopic assistance.
T177 664511-664644 Sentence denotes Nasopharyngeal polyps (in cats, tumors, obstructive laryngitis, granulomas, abscesses, and cysts) can cause upper airway obstruction.
T178 664645-664689 Sentence denotes Clinical signs are usually gradual in onset.
T179 664690-664814 Sentence denotes The lesions can be identified through careful laryngoscopic examination performed with the patient under general anesthesia.
T180 664815-664899 Sentence denotes The nasopharynx above the soft palpate should always be included in the examination.
T181 664900-664968 Sentence denotes Pedunculated masses and cysts are excised at the time of evaluation.
T182 664969-665063 Sentence denotes Biopsy of diffusely infiltrative masses is indicated for histologic examination and prognosis.
T183 665064-665166 Sentence denotes It is impossible to distinguish obstructive laryngitis from neoplasia based on gross appearance alone.
T184 665167-665292 Sentence denotes Whenever possible, material should be collected from abscesses and granulomas for cytologic evaluation and bacterial culture.
T185 665293-665411 Sentence denotes Extraluminal masses impinge on and slowly compress the upper airways, resulting in slow progression of clinical signs.
T186 665412-665467 Sentence denotes Masses are usually identified by palpation of the neck.
T187 665468-665552 Sentence denotes Enlarged mandibular lymph nodes, thyroid tumors, and other neoplasms may be present.
T188 665553-665632 Sentence denotes Diagnosis is usually based on a combination of radiography and ultrasonography.
T189 665633-665721 Sentence denotes CT and/ or MRI is helpful in identifying the full extent and invasiveness of the lesion.
T190 665722-665789 Sentence denotes Definitive diagnosis is made with fine-needle aspiration or biopsy.
T191 665790-665828 Sentence denotes Many thyroid tumors bleed excessively.
T192 665829-665901 Sentence denotes The inside of each side of the hemithorax is covered in parietal pleura.
T193 665902-665948 Sentence denotes The lung lobes are covered in visceral pleura.
T194 665949-666062 Sentence denotes The two surfaces are in close contact with each other and are contiguous at the hilum under normal circumstances.
T195 666063-666175 Sentence denotes Pneumothorax refers to free air within the pleural space, accumulating between the parietal and visceral pleura.
T196 666176-666301 Sentence denotes The term pleural effusion refers to fluid accumulation in that area but does not reflect the amount or type of fluid present.
T197 666302-666417 Sentence denotes The mediastinal reflections of the pleura typically are thin in dogs and cats and usually, but not always, connect.
T198 666418-666486 Sentence denotes Bilateral involvement of pneumothorax or pleural effusion is common.
T199 666487-666613 Sentence denotes Both pneumothorax and pleural effusion compromise the lungs' ability to expand and result in hypoxia and respiratory distress.
T200 666614-666712 Sentence denotes Pneumothorax can be classified as open or closed, simple or complicated, and tension pneumothorax.
T201 666713-666813 Sentence denotes An open pneumothorax communicates with the external environment through a rent in the thoracic wall.
T202 666814-666920 Sentence denotes A closed pneumothorax results from tears in the visceral pleura but does not communicate with the outside.
T203 666921-667200 Sentence denotes A tension pneumothorax occurs as a result of a tear in the lung or chest wall that creates a flap valve, such that air is allowed to leave the lung and accumulate in the pleural space during inhalation, and closes to seal off exit of air from the pleural space during exhalation.
T204 667201-667324 Sentence denotes Tension pneumothorax can cause rapid decline in cardiopulmonary status and death if not recognized and treated immediately.
T205 667325-667407 Sentence denotes A simple pneumothorax is one that can be controlled with a simple thoracocentesis.
T206 667408-667524 Sentence denotes Complicated pneumothorax involves repeated accumulation of air, requiring placement of a thoracic drainage catheter.
T207 667525-667584 Sentence denotes In many cases, pneumothorax develops as a result of trauma.
T208 667585-667816 Sentence denotes Spontaneous pneumothorax occurs with rupture of cavitary lesions of the lung that may be congenital or acquired as a result of prior trauma, heartworm disease, airway disease (emphysema), paragonimiasis, neoplasia, or lung abscess.
T209 667817-667910 Sentence denotes Pneumothorax also rarely occurs as a result of esophageal tears or esophageal foreign bodies.
T210 667911-668174 Sentence denotes Rapid circulatory and respiratory compromise after traumatic pneumothorax can develop as a result of open or tension pneumothorax, rib fractures, airway obstruction, pulmonary contusions, hemothorax, cardiac dysrhythmias, cardiac tamponade, and hypovolemic shock.
T211 668175-668364 Sentence denotes Any patient that is rapidly decompensating after a traumatic episode must be quickly assessed, and emergency therapy initiated (see section on immediate management of trauma, A CRASH PLAN).
T212 668365-668547 Sentence denotes Diagnosis of pneumothorax is usually made based on a history of trauma; a rapid, shallow, restrictive respiratory pattern; and muffled heart and lung sounds on thoracic auscultation.
T213 668548-668747 Sentence denotes The clinical signs and history alone should prompt the clinician to perform a bilateral diagnostic and therapeutic thoracocentesis before taking thoracic radiographs (see section on thoracocentesis).
T214 668748-668845 Sentence denotes The stress of handling the patient for radiography can be deadly in severe cases of pneumothorax.
T215 668846-669058 Sentence denotes Although the mediastinum on both sides of the thorax connects, it is necessary to perform thoracocentesis on both sides to ensure maximal removal of free air in the pleural space and allow maximal lung expansion.
T216 669059-669249 Sentence denotes If negative pressure cannot be obtained, or if the patient rapidly reaccumulates air, place a thoracostomy tube connected to continuous suction. (See section on thoracostomy tube placement.)
T217 669250-669346 Sentence denotes Treat all penetrating wounds to the thorax as open sucking chest wounds unless proved otherwise.
T218 669347-669536 Sentence denotes To "close" an open sucking chest wound, clip the fur around the wound as quickly as possible, and place sterile lubricant jelly or antimicrobial ointment circumferentially around the wound.
T219 669537-669579 Sentence denotes Cut a sterile glove to provide a covering.
T220 669580-669748 Sentence denotes Place the covering over the wound, making sure to cover all of the sterile lubricant, thus creating a seal to close the wound temporarily from the external environment.
T221 669749-669833 Sentence denotes Evaluate the patient's thorax via thoracocentesis while placing a thoracostomy tube.
T222 669834-669959 Sentence denotes Once the patient's condition is stable, the open chest wound can be surgically explored, lavaged, and definitively corrected.
T223 669960-670076 Sentence denotes All animals with open chest wounds should receive antibiotics (first-generation cephalosporin) to prevent infection.
T224 670077-670137 Sentence denotes After stabilization, radiographs can be taken and evaluated.
T225 670138-670447 Sentence denotes Pneumothorax is confirmed by evidence of elevation of the cardiac silhouette above the sternum, increased density of the pulmonary parenchymal tissue, free air in between the parietal and visceral pleura (making the outline of the lungs visible), and absence of pulmonary vascular structures in the periphery.
T226 670448-670568 Sentence denotes Parenchymal lesions within the lungs are best identified after as much air as possible has been removed from the thorax.
T227 670569-670638 Sentence denotes Obtain left and right lateral and ventrodorsal or dorsoventral views.
T228 670639-670710 Sentence denotes A standing lateral view may reveal air-or fluid-filled cavitary masses.
T229 670711-670871 Sentence denotes If underlying pulmonary disease is suspected as a cause of spontaneous pneumothorax, a transtracheal wash, fecal flotation, and heartworm test may be indicated.
T230 670872-671127 Sentence denotes Treatment of pneumothorax includes immediate bilateral thoracocentesis, covering of any open chest wounds, administration of supplemental oxygen, and placement of a thoracostomy tube if negative pressure cannot be obtained or if air rapidly reaccumulates.
T231 671128-671305 Sentence denotes Serial radiography, CT, or MRI should be performed in dogs with spontaneous pneumothorax, because the condition can be associated with generalized pulmonary parenchymal disease.
T232 671306-671405 Sentence denotes Strict cage rest is required until air stops accumulating and the thoracostomy tube can be removed.
T233 671406-671506 Sentence denotes The patient's chest tube should be aspirated every 4 hours after continuous suction is discontinued.
T234 671507-671577 Sentence denotes If no air reaccumulates after 24 hours, the chest tube can be removed.
T235 671578-671636 Sentence denotes Exercise restriction is indicated for a minimum of 1 week.
T236 671637-671825 Sentence denotes If bullae or mass lesions are present, exploratory thoracotomy should be considered as a diagnostic and potentially therapeutic option for long-term management in prevention of recurrence.
T237 671826-671948 Sentence denotes Pleural fluid cytologic analysis is indicated for all patients with pleural effusion before administration of antibiotics.
T238 671949-672126 Sentence denotes The general term pleural effusion means a collection of fluid in the space between the parietal and visceral pleura but does not indicate what kind or how much fluid is present.
T239 672127-672255 Sentence denotes Clinical signs associated with pleural effusion depend on how much 1 fluid is present and how rapidly the fluid has accumulated.
T240 672256-672439 Sentence denotes Clinical signs associated with pleural effusion include respiratory distress, reluctance to lie down, labored breathing with an abdominal component on exhalation, cough, and lethargy.
T241 672440-672640 Sentence denotes Auscultation of the thorax may reveal muffled heart and lung sounds ventrally and increased lung sounds dorsally, although pockets of fluid may be present, depending on the chronicity of the effusion.
T242 672641-672697 Sentence denotes Percussion of the thorax may reveal decreased resonance.
T243 672698-672785 Sentence denotes In stable patients, the presence of pleural effusion can be confirmed radiographically.
T244 672786-672913 Sentence denotes Radiographic confirmation of the pleural effusion should include right and left lateral and dorsoventral or ventrodorsal views.
T245 672914-673014 Sentence denotes A handling or standing lateral view should be obtained if an anterior mediastinal mass is suspected.
T246 673015-673100 Sentence denotes The standing lateral view will allow the fluid to collect in the costophrenic recess.
T247 673101-673254 Sentence denotes In patients with respiratory distress, muffled heart and lung sounds, and suspicion of pleural effusion, thoracocentesis should be performed immediately.
T248 673255-673310 Sentence denotes Thoracocentesis can be both therapeutic and diagnostic.
T249 673311-673445 Sentence denotes Radiography is contraindicated because the procedure can cause undue stress and exacerbation of clinical signs in an unstable patient.
T250 673446-673618 Sentence denotes Pleural effusion can cause severe respiratory distress and can be the result of a number of factors that must be considered when implementing an appropriate treatment plan.
T251 673619-673745 Sentence denotes Pathology of the pleura is almost always a secondary process except for primary bacterial pleuritis and pleural mesotheliomas.
T252 673746-673963 Sentence denotes Causes of pleural effusion in the cat and dog include pyothorax, FIP, CHF, chylothorax, heartworm disease, hemothorax, hypoalbuminemia, lung lobe torsions, neoplasia, diaphragmatic hernia, and pancreatitis (Box 1-62).
T253 673964-674069 Sentence denotes In stable animals, diagnosis of pleural effusion can be made based on thoracic radiography or ultrasound.
T254 674070-674156 Sentence denotes Thoracic radiographs can show whether the pleural effusion is unilateral or bilateral.
T255 674157-674206 Sentence denotes Effusions in dogs and cats are usually bilateral.
T256 674207-674347 Sentence denotes The lung parenchyma and the cardiac silhouette cannot be fully evaluated until most of the fluid has been evacuated from the pleural cavity.
T257 674348-674470 Sentence denotes After thoracocentesis, radiography should be performed with left and right lateral and ventrodorsal or dorsoventral views.
T258 674471-674543 Sentence denotes In cases of suspected heart failure, echocardiography also is necessary.
T259 674544-674629 Sentence denotes Pleural fluid cytologic analysis is indicated for all patients with pleural effusion.
T260 674630-674793 Sentence denotes Collect specimens before administering antibiotics, whenever possible, because treatment with antibiotics can make a septic condition (pyothorax) appear nonseptic.
T261 674794-674899 Sentence denotes The remainder of the diagnostic workup and treatment is based on the type of fluid present (Table 1 -51).
T262 674900-675004 Sentence denotes The fluid may be a transudate, nonseptic exudate, septic exudate or chylous, hemorrhagic, or neoplastic.
T263 675005-675168 Sentence denotes Ultrasonographic evaluation of the thorax can be helpful in identifying intrathoracic masses, diaphragmatic hernias, lung lobe torsions, and cardiac abnormalities.
T264 675169-675266 Sentence denotes Unlike radiography, ultrasonography is facilitated by the presence of fluid in the pleural space.
T265 675267-675327 Sentence denotes Pyothorax refers to a septic effusion of the pleural cavity.
T266 675328-675417 Sentence denotes The infection is generally the result of a combination of aerobic and anaerobic bacteria.
T267 675418-675455 Sentence denotes Rarely, fungal organisms are present.
T268 675456-675704 Sentence denotes The source of the underlying organisms is rarely identified, particularly in cats, but infection can be caused by penetrating wounds through the chest wall or esophagus, migrating foreign bodies (especially grass awns), and primary lung infections.
T269 675705-675840 Sentence denotes The most common organisms associated with pyothorax in the cat are Pasteurella species, Bacteroides species, and Fusobacterium species.
T270 675841-675914 Sentence denotes Fever is often present in addition to clinical signs of pleural effusion.
T271 675915-675940 Sentence denotes Septic shock is uncommon.
T272 675941-676148 Sentence denotes Diagnosis of pyothorax is made based on cytologic analysis and the demonstration of intracellular and extracellular bacteria, toxin neutrophils and macrophages, and sometimes the presence of sulfur granules.
T273 676149-676233 Sentence denotes Gram stains of the fluid can assist in the initial identification of some organisms.
T274 676234-676333 Sentence denotes Bacterial cultures are indicated for bacteria identification and antibiotic susceptibility testing.
T275 676334-676440 Sentence denotes Administration of antibiotics before cytologic evaluation can cause a septic effusion to appear nonseptic.
T276 676441-676669 Sentence denotes Emergency treatment for pyothorax involves placement of an intravenous catheter, intravenous fluids to treat hypovolemic shock, and broad-spectrum antibiotics (ampicillin, 22 mg/kg IV q6-8h; and enrofloxacin, 2.5 mg/kg IV q12h).
T277 676670-676789 Sentence denotes Chloramphenicol (45 to 60 mg/kg PO q8h) also is an appropriate antibiotic to use for penetration into pockets of fluid.
T278 676790-677044 Sentence denotes Administration of a β-lactam antibiotic (ampicillin or amoxicillin, 25 to 50 mg/kg PO q12h) with a β-lactamase inhibitor (amoxicillin clavulanate, 20 mg/kg PO q12h, or ampicillin sulbactam) is helpful for achieving better coverage of Bacteroides species.
T279 677045-677095 Sentence denotes Treatment of pyothorax differs in the cat and dog.
T280 677096-677233 Sentence denotes In the cat, placement of one or two thoracic drainage catheters is recommended to allow continuous drainage of the intrathoracic abscess.
T281 677234-677286 Sentence denotes Inadequate drainage can result in treatment failure.
T282 677287-677434 Sentence denotes Fluid should be evaluated and the pleural cavity lavaged with 10 mL of warmed 0.9% saline or lactated Ringer's solution per kilogram every 8 hours.
T283 677435-677513 Sentence denotes Approximately 75% of the infused volume should be recovered after each lavage.
T284 677514-677629 Sentence denotes In dogs, or in cats with refractory pyothorax, perform an exploratory thoracotomy to remove any nidus of infection.
T285 677630-677729 Sentence denotes A foreign body that can be removed at the time of surgery may be visible, but this finding is rare.
T286 677730-677825 Sentence denotes Antibiotics are indicated for a minimum of 6 to 8 weeks after removal of the thoracostomy tube.
T287 677826-677937 Sentence denotes Early diagnosis and aggressive treatment result in a good prognosis in the majority of patients with pyothorax.
T288 677938-678039 Sentence denotes In cats, clinical signs of ptyalism and hypothermia at the time of presentation worsen the prognosis.
T289 678040-678137 Sentence denotes Chylothorax refers to the abnormal accumulation of chyle (lymphatic fluid) in the pleural cavity.
T290 678138-678315 Sentence denotes The cisterna chili is the dilated collection pool of lymphatic ducts in the abdomen that accumulate chyle before entry into the thoracic duct located within the thoracic cavity.
T291 678316-678373 Sentence denotes The thoracic duct enters the thorax at the aortic hiatus.
T292 678374-678421 Sentence denotes Numerous tributaries or collateral ducts exist.
T293 678422-678571 Sentence denotes The functions of the lymphatic vessels collectively serve to deliver triglycerides and fat-soluble vitamins into the peripheral vascular circulation.
T294 678572-678738 Sentence denotes Damage of the thoracic duct or lymphatic system or obstruction to lymphatic flow can result in the development of chylous effusion in the pleural or peritoneal space.
T295 678739-678823 Sentence denotes It is difficult to identify chylous effusions based on their milky appearance alone.
T296 678824-678989 Sentence denotes To identify a chylous effusion versus a pseudochylous effusion, the triglyceride and cholesterol levels of the fluid must be compared with those of peripheral blood.
T297 678990-679086 Sentence denotes Chylous effusions have a higher triglyceride and lower cholesterol levels than peripheral blood.
T298 679087-679189 Sentence denotes Pseudochylous effusions have a higher cholesterol and lower triglyceride levels than peripheral blood.
T299 679190-679272 Sentence denotes Disease processes that can result in chylous effusions are listed in the Box 1-63.
T300 679273-679409 Sentence denotes Clinical signs associated with chylous effusion are typical of any pleural effusion and of the disease process that caused the effusion.
T301 679410-679481 Sentence denotes Weight loss may be evident, depending on the chronicity of the process.
T302 679482-679624 Sentence denotes The diagnosis is made based on thoracocentesis, cytology, and biochemical evaluation of the fluid (i.e., triglyceride and cholesterol levels).
T303 679625-679728 Sentence denotes The fluid often appears milky or blood-tinged but can be clear if the patient has significant anorexia.
T304 679729-679789 Sentence denotes Typical cytologic characteristics are listed in Table 1 -52.
T305 679790-679943 Sentence denotes Lymphangiography can be used to confirm trauma to the thoracic duct, but this is usually not necessary unless surgical ligation is going to be attempted.
T306 679944-680020 Sentence denotes The diagnostic evaluation must also attempt to identify an underlying cause.
T307 680021-680133 Sentence denotes Therapy for chylothorax is difficult and primarily involves documentation and treatment of the underlying cause.
T308 680134-680375 Sentence denotes If an underlying cause is not found, treatment is largely supportive and consists of intermittent thoracocentesis to drain the fluid as it accumulates and causes respiratory dysfunction, nutritional support, and maintenance of fluid balance.
T309 680376-680544 Sentence denotes A variety of surgical techniques, including ligation of the thoracic duct, pleural-peritoneal shunts, and pleurodesis, have been attempted but have had limited success.
T310 680545-680712 Sentence denotes Most recently, the combination of thoracic duct ligation with subtotal pericardectomy has been shown to improve surgical success rates in the treatment of chylothorax.
T311 680713-680822 Sentence denotes Rutin, a bioflavonoid, has been used with limited success in the treatment of idiopathic chylothorax in cats.
T312 680823-680873 Sentence denotes Prognosis in many cases of chylothorax is guarded.
T313 680874-681042 Sentence denotes Extensive hemorrhage into the pleural cavity can cause fulminant respiratory distress resulting from sudden hypovolemia and anemia and interference with lung expansion.
T314 681043-681192 Sentence denotes Hemothorax typically is associated with trauma, systemic coagulopathy, lung lobe torsions, and erosive lesions within the thorax (usually neoplasia).
T315 681193-681271 Sentence denotes Diagnosis of hemothorax involves obtaining a fluid sample via thoracocentesis.
T316 681272-681397 Sentence denotes Hemorrhagic effusion must be differentiated from systemic blood inadvertently collected during the thoracocentesis procedure.
T317 681398-681581 Sentence denotes Unless the hemorrhage is peracute, fluid in cases of hemothorax is rapidly defibrinated and will not clot, has a PCV less than that of venous blood, and contains RBCs and macrophages.
T318 681582-681699 Sentence denotes Hemorrhagic effusions also usually contain a disproportionately higher number of WBCs compared with peripheral blood.
T319 681700-681843 Sentence denotes Hemothorax commonly is the sole clinical sign observed in animals with vitamin K-antagonist rodenticide intoxication and systemic coagulopathy.
T320 681844-682000 Sentence denotes Whenever an animal demonstrates signs of a hemorrhagic pleural effusion, perform coagulation testing immediately to determine whether a coagulopathy exists.
T321 682001-682092 Sentence denotes The PT test is fast and can be performed as a cage-side test (see section on coagulopathy).
T322 682093-682175 Sentence denotes Therapy for hemorrhagic pleural effusions should address the blood and fluid loss.
T323 682176-682272 Sentence denotes Administer intravenous crystalloid fluids and RBC products (see section on transfusion therapy).
T324 682273-682458 Sentence denotes When necessary, administer coagulation factors in the form of fresh whole blood or fresh frozen plasma, along with Vitamin K 1 (5 mg/kg/day SQ in multiple sites with a 25-gauge needle).
T325 682459-682619 Sentence denotes If severe respiratory distress is present, evacuate the blood within the pleural space via thoracocentesis until clinical signs of respiratory distress resolve.
T326 682620-682732 Sentence denotes Fluid that remains aids in the recovery of the patient, because RBCs and proteins eventually will be reabsorbed.
T327 682733-682823 Sentence denotes Autotransfusion can be performed to salvage blood and reinfuse it into the anemic patient.
T328 682824-682946 Sentence denotes In cases of neoplastic or traumatic uncontrollable hemorrhagic effusions, surgical exploration of the thorax is warranted.
T329 682947-683102 Sentence denotes Diaphragmatic hernia, or a rent in the diaphragm, can result in the protrusion of abdominal organs into the thoracic cavity and impair pulmonary expansion.
T330 683103-683203 Sentence denotes Organs that are commonly herniated into the thorax include the liver, stomach, and small intestines.
T331 683204-683294 Sentence denotes Diaphragmatic hernia usually is secondary to trauma but can occur as a congenital anomaly.
T332 683295-683459 Sentence denotes In cases of trauma, rib fractures, pulmonary contusions, traumatic myocarditis, hemothorax, and shock are also often present concurrently with diaphragmatic hernia.
T333 683460-683540 Sentence denotes Respiratory distress can be caused by any one or a combination of these lesions.
T334 683541-683684 Sentence denotes Animals with prior or chronic diaphragmatic hernias may have minimal clinical signs despite the presence of abdominal organs within the thorax.
T335 683685-683790 Sentence denotes Clinical signs of acute or severe diaphragmatic hernia include respiratory distress, cyanosis, and shock.
T336 683791-683917 Sentence denotes A diagnosis of diaphragmatic hernia is made based on the patient's history (traumatic event), clinical signs, and radiographs.
T337 683918-684015 Sentence denotes In some cases, ultrasonography or contrast peritoneography is necessary to confirm the diagnosis.
T338 684016-684142 Sentence denotes Contrast radiographs may show the presence of the stomach or intestines within the thorax after oral administration of barium.
T339 684143-684253 Sentence denotes Never administer barium directly into the peritoneal cavity or in cases of suspected gastrointestinal rupture.
T340 684254-684417 Sentence denotes Treatment of a patient with a diaphragmatic hernia includes cardiovascular and respiratory system stabilization before attempting surgical repair of the diaphragm.
T341 684418-684579 Sentence denotes If the stomach is within the thorax, or if the patient's respiratory distress cannot be alleviated with medical management alone, immediate surgery is necessary.
T342 684580-684750 Sentence denotes If the respiratory distress is minimal and the stomach is not located within the thorax, surgery can be postponed until the patient is a more stable anesthetic candidate.
T343 684751-684876 Sentence denotes At the time of surgery, the abdominal organs are replaced into the abdominal cavity, and the rent in the diaphragm is closed.
T344 684877-684946 Sentence denotes Air must be evacuated from the thorax after closure of the diaphragm.
T345 684947-685050 Sentence denotes If chronic diaphragmatic hernia is repaired, the complication of reexpansion pulmonary edema can occur.
T346 685051-685126 Sentence denotes Cardiac injury is a common complication secondary to blunt thoracic trauma.
T347 685127-685401 Sentence denotes In most cases, cardiac injury manifests as arrhythmias, including multiple premature ventricular contractions (PVCs), ventricular tachycardia, ST segment depression or elevation secondary to myocardial hypoxemia, and atrial fibrillation (see section on cardiac emergencies).
T348 685402-685454 Sentence denotes Myocardial infarction and cardiac failure can occur.
T349 685455-685621 Sentence denotes Careful and repeated assessments of the patient's BP and ECG tracing should be a part of any diagnostic workup for a patient that has sustained blunt thoracic trauma.
T350 685622-685705 Sentence denotes Rib fractures are associated with localized pain and painful respiratory movements.
T351 685706-685755 Sentence denotes Radiographs are helpful to confirm the diagnosis.
T352 685756-685832 Sentence denotes Careful palpation may reveal crepitus and instability of the fractured ribs.
T353 685833-686014 Sentence denotes Common problems associated with rib fractures include 1 pulmonary contusions, pericardial laceration, traumatic myocarditis, diaphragmatic hernia, and splenic laceration or rupture.
T354 686015-686143 Sentence denotes A flail segment results from rib fractures of more than three adjacent ribs that produce a "floating segment" of the chest wall.
T355 686144-686272 Sentence denotes The flail segment moves paradoxically with respiration-that is, it moves inward during inhalation and outward during exhalation.
T356 686273-686407 Sentence denotes Respiratory distress is associated with the pain caused by the fractures and the presence of traumatic underlying pulmonary pathology.
T357 686408-686659 Sentence denotes Therapy for rib fractures and flail chest includes administration of supplemental oxygen, treatment of pneumothorax or diaphragmatic hernia, and administration of systemic and local anesthesia to alleviate the discomfort associated with the fractures.
T358 686660-686774 Sentence denotes Although controversial, positioning the patient with the flail segment up may reduce pain and improve ventilation.
T359 686775-686899 Sentence denotes Avoid the use of chest wraps, which do nothing to stabilize the flail segment and can further impair respiratory excursions.
T360 686900-687099 Sentence denotes After administration of a systemic analgesic, administer a local anesthetic at the dorsocaudal and ventrocaudal segment of each fractured rib, and in one rib in front of and behind the flail segment.
T361 687100-687211 Sentence denotes Often, pulmonary function will improve once the pain associated with rib fractures has been adequately treated.
T362 687212-687321 Sentence denotes In rare cases in which the flail segment involves five or more ribs, surgical stabilization may be necessary.
T363 687322-687402 Sentence denotes Single rib fractures or smaller flail segments are allowed to heal on their own.
T364 687403-687717 Sentence denotes Feline BronChiTis (Feline loWer AirWAy diseAse, AsThmA) Feline bronchitis has a variety of names (bronchial asthma, asthma, acute bronchitis, allergic bronchitis, chronic asthmatic bronchitis, feline lower airway disease) and refers to the acute onset of respiratory distress secondary to narrowing of the bronchi.
T365 687718-687832 Sentence denotes Cats may have an acute onset of a severe restrictive respiratory pattern associated with lower airway obstruction.
T366 687833-688014 Sentence denotes Acute bronchitis in cats typically has an inflammatory component in the lower airways, resulting in acute bronchoconstriction, excessive mucus production, and inflammatory exudates.
T367 688015-688124 Sentence denotes In cats with chronic bronchitis, there may be damage of the bronchial epithelium and fibrosis of the airways.
T368 688125-688274 Sentence denotes These patients often have a history if intermittent exacerbation of clinical signs, intermittent cough, and periods of normality throughout the year.
T369 688275-688500 Sentence denotes Because there appears to be an allergic or inflammatory component in feline bronchitis, clinical signs can be acutely exacerbated by stress and the presence of aerosolized particles such as perfume, smoke, and carpet powders.
T370 688501-688624 Sentence denotes Causes of feline bronchitis include heartworm disease, parasitic infestation (lungworms), and (rarely) bacterial infection.
T371 688625-688746 Sentence denotes On presentation, the patient should be placed in an oxygen cage and allowed to rest while being observed from a distance.
T372 688747-688858 Sentence denotes Postpone performing stressful diagnostic procedures until the patient's respiratory status has been stabilized.
T373 688859-689118 Sentence denotes After careful thoracic auscultation, administer a short-acting bronchodilator (terbutaline, 0.01 mg/kg SQ or IM) along with a glucocorticosteroid (dexamethasone sodium phosphate, 1 mg/kg IM, SQ, IV) to alleviate immediate bronchospasm and airway inflammation.
T374 689119-689260 Sentence denotes Clinical signs of feline bronchitis are characterized by a short, rapid respiratory pattern with prolonged expiration with an abdominal push.
T375 689261-689307 Sentence denotes Wheezes may be heard on thoracic auscultation.
T376 689308-689468 Sentence denotes In some cases, no abnormalities are found on auscultation, but abnormalities become acutely worse when the patient is stimulated to cough by tracheal palpation.
T377 689469-689584 Sentence denotes Radiographs may reveal a hyperinflated lung field with bronchial markings and caudal displacement of the diaphragm.
T378 689585-689655 Sentence denotes In some cases, consolidation of the right middle lung lobe is present.
T379 689656-689764 Sentence denotes A complete blood count and serum biochemistry profile can be performed, but results usually are unrewarding.
T380 689765-689813 Sentence denotes In endemic areas, a heartworm test is warranted.
T381 689814-689927 Sentence denotes Fecal examination by flotation and the Baermann technique is helpful in ruling out lungworms and other parasites.
T382 689928-690023 Sentence denotes Bronchoalveolar lavage or transtracheal wash is useful for cytologic and bacterial examination.
T383 690024-690344 Sentence denotes Long-term management of feline bronchitis includes isolation from environmental exposure to potential allergens (litter dust, perfumes, smoke, incense, carpet powders) and treatment of bronchoconstriction and inflammation with a combination of oral and inhaled glucocorticosteroids and bronchodilators (see Table 1 -52).
T384 690345-690433 Sentence denotes Antibiotic therapy is contraindicated unless a pure culture of a pathogen is documented.
T385 690434-690634 Sentence denotes Oral therapy with steroids and bronchodilators should be used for a minimum of 4 weeks after an acute exacerbation and then gradually decreased to the lowest dose possible to alleviate clinical signs.
T386 690635-690783 Sentence denotes Metered dose inhalers are now available (www.aerokat.com) for administration of inhaled bronchodilators (90 mcg of albuterol per puff) and steroids.
T387 690784-690925 Sentence denotes Fluticasone (Flovent, 100 mcg/puff ) can be administered initially every 12 hours for 1 week and then decreased to once daily, in most cases.
T388 690926-691115 Sentence denotes Inhaled glucocorticosteroids are not absorbed systemically, and therefore patients do not develop the adverse side effects sometimes documented with oral glucocorticosteroid administration.
T389 691116-691315 Sentence denotes Because it takes time for glucocorticosteroids to reach peak effects in the lungs, administration of inhaled glucocorticosteroids should overlap with oral prednisolone administration for 5 to 7 days.
T390 691316-691539 Sentence denotes In some cats with previously undocumented cardiac disease, the use of glucocorticoids has been associated with sodium and fluid retention to such an extent that pulmonary vascular overload and pulmonary edema have occurred.
T391 691540-691608 Sentence denotes Pulmonary contusions are a common sequela of blunt traumatic injury.
T392 691609-691699 Sentence denotes A contusion basically is a bruise characterized by edema, hemorrhage, and vascular injury.
T393 691700-691806 Sentence denotes Contusions may be present at the time of presentation or can develop over the first 24 hours after injury.
T394 691807-692021 Sentence denotes A diagnosis of pulmonary contusion can be made based on auscultation of pulmonary crackles, presence of respiratory distress, and the presence of patchy interstitial to alveolar infiltrates on thoracic radiographs.
T395 692022-692140 Sentence denotes Radiographic signs can lag behind the development of clinical signs of respiratory distress and hypoxemia by 24 hours.
T396 692141-692189 Sentence denotes Treatment of pulmonary contusions is supportive.
T397 692190-692272 Sentence denotes Administer supplemental oxygen in a manner that is least stressful for the animal.
T398 692273-692404 Sentence denotes Arterial blood gas analysis or pulse oximetry can be used to determine the degree of hypoxemia and monitor the response to therapy.
T399 692405-692540 Sentence denotes Intravenous fluids should be administered with caution to avoid exacerbating pulmonary hemorrhage or fluid accumulation in the alveoli.
T400 692541-692600 Sentence denotes Treat other conditions associated with the traumatic event.
T401 692601-692769 Sentence denotes Possible complications of pulmonary contusions are rare but include bacterial infection, abscessation, lung lobe consolidation, and the development of cavitary lesions.
T402 692770-692900 Sentence denotes The routine use of antibiotics or steroids in cases of pulmonary contusions is contraindicated unless external wounds are present.
T403 692901-693048 Sentence denotes Empiric antibiotic use without evidence of external injury or known infection can potentially increase the risk of a resistant bacterial infection.
T404 693049-693174 Sentence denotes Steroids have been shown to decrease pulmonary alveolar macrophage function and impair wound healing and are contraindicated.
T1 693175-693413 Sentence denotes Aspiration pneumonia can occur in animals as a result of abnormal laryngeal or pharyngeal protective mechanisms or can be secondary to vomiting during states of altered mentation, including anesthesia, recovery from anesthesia, and sleep.
T2 693414-693589 Sentence denotes Megaesophagus, systemic polyneuropathy, myasthenia gravis, and localized oropharyngeal defects such as cleft palate can increase the risk of developing aspiration pneumonitis.
T3 693590-693755 Sentence denotes Iatrogenic causes of aspiration pneumonia include improper placement of nasogastric feeding tubes, overly aggressive force-feeding, and oral administration of drugs.
T4 693756-693904 Sentence denotes Aspiration of contents into the airways can cause mechanical airway obstruction, bronchoconstriction, chemical damage to the alveoli, and infection.
T5 693905-693953 Sentence denotes Severe inflammation and airway edema are common.
T6 693954-693998 Sentence denotes Pulmonary hemorrhage and necrosis can occur.
T7 693999-694253 Sentence denotes Diagnosis of aspiration pneumonia is based on clinical signs of pulmonary parenchymal disease, a history consistent with vomiting or other predisposing causes, and thoracic radiographs demonstrating a bronchointerstitial to alveolar pulmonary infiltrate.
T8 694254-694418 Sentence denotes The most common site is the right middle lung lobe, although the pneumonia 1 can occur anywhere, depending on the position of the patient at the time of aspiration.
T9 694419-694525 Sentence denotes A transtracheal wash or bronchoalveolar lavage is useful for bacterial culture and susceptibility testing.
T10 694526-694689 Sentence denotes Treatment of aspiration pneumonia includes antibiotic therapy for the infection, administration of supplemental oxygen, and loosening of the debris in the airways.
T11 694690-694742 Sentence denotes Administer intravenous fluids to maintain hydration.
T12 694743-694853 Sentence denotes Nebulization with sterile saline and chest physiotherapy (coupage) should be performed at least every 8 hours.
T13 694854-695042 Sentence denotes Antibiotics to consider in the treatment of aspiration pneumonia include ampicillinand enrofloxacin, amoxicillin-clavulanate, ampicillin-sulbactam, trimethoprim sulfa, and chloramphenicol.
T14 695043-695105 Sentence denotes The use of glucocorticosteroids is absolutely contraindicated.
T15 695106-695215 Sentence denotes Continue antibiotic therapy for a minimum of 2 weeks after the resolution of radiographic signs of pneumonia.
T16 695216-695332 Sentence denotes Pulmonary edema arises from the accumulation of fluid in the pulmonary interstitial alveolar spaces and the airways.
T17 695333-695387 Sentence denotes Ventilation-perfusion abnormalities result in hypoxia.
T18 695388-695584 Sentence denotes Pulmonary edema can be caused by increased pulmonary vasculature hydrostatic pressure, decreased pulmonary oncotic pressure, obstruction of lymphatic drainage, or increased capillary permeability.
T19 695585-695627 Sentence denotes Multiple factors can occur simultaneously.
T20 695628-695733 Sentence denotes The most common cause of edema is increased pulmonary hydrostatic pressure resulting from left-sided CHF.
T21 695734-695860 Sentence denotes Decreased plasma oncotic pressure with albumin <1.5 g/dL can also result in accumulation of fluid in the pulmonary parenchyma.
T22 695861-695989 Sentence denotes Overzealous intravenous crystalloid fluid administration can result in dilution of serum oncotic pressure and vascular overload.
T23 695990-696055 Sentence denotes Obstruction of lymphatic drainage is usually caused by neoplasia.
T24 696056-696222 Sentence denotes Other causes of pulmonary edema include pulmonary thromboembolic disease, severe upper airway obstruction (noncardiogenic pulmonary edema), seizures, and head trauma.
T25 696223-696335 Sentence denotes Increased capillary permeability is associated with a variety of diseases that cause severe inflammation (SIRS).
T26 696336-696452 Sentence denotes The resultant pulmonary edema contains a high amount of protein and is known as acute respiratory distress syndrome.
T27 696453-696699 Sentence denotes ARDS can be associated with pulmonary or extrapulmonary causes, including direct lung injury from trauma, aspiration pneumonia, sepsis, pancreatitis, smoke inhalation, oxygen toxicity, electrocution, and immune-mediated hemolytic anemia with DIC.
T28 696700-696839 Sentence denotes Diagnosis of pulmonary edema is made based on clinical signs of respiratory distress and the presence of crackles on thoracic auscultation.
T29 696840-696953 Sentence denotes In severe cases, cyanosis and fulminant blood-tinged frothy edema fluid may be present in the mouth and nostrils.
T30 696954-697128 Sentence denotes Immediate management includes administration of furosemide (up to 8 mg/kg IV, IM, SQ, PO q1-2h [canine], up to 4 mg/kg IV, IM, SQ, PO q1-2h [feline]) and supplemental oxygen.
T31 697129-697293 Sentence denotes Sedation with low-dose morphine sulfate (0.025 to 0.1 mg/kg IV) is helpful in dilating the splanchnic capacitance vasculature and relieving anxiety for the patient.
T32 697294-697402 Sentence denotes If fluid overload is suspected secondary to intravenous fluid administration, fluids should be discontinued.
T33 697403-697530 Sentence denotes Severely hypoalbuminemic patients should receive concentrated human albumin (2 mL/kg of a 25% solution) or fresh frozen plasma.
T34 697531-697666 Sentence denotes Furosemide as a CRI (0.66 to 1.0 mg/ kg/hr) also can dilate the pulmonary vasculature and decrease fluid accumulation in cases of ARDS.
T35 697667-697851 Sentence denotes After initial stabilization of the patient, thoracic radiographs and an echocardiogram should be assessed to determine cardiac side, pulmonary vascular size, and cardiac contractility.
T36 697852-697951 Sentence denotes Further diagnostic testing may be required to determine other underlying causes of pulmonary edema.
T37 697952-698048 Sentence denotes Heart failure is managed with vasodilators, diuretics, oxygen, and sometimes positive inotropes.
T38 698049-698189 Sentence denotes Treatment ultimately consists of administration of supplemental oxygen, minimal stress and patient handling, and judicious use of diuretics.
T39 698190-698413 Sentence denotes In cases of cardiogenic pulmonary edema, administer furosemide (up to 8 mg/kg IV, IM, SQ, PO q1-2h [canine], up to 4 mg/kg IV, IM, SQ, PO q1-2h [feline]) every 30 to 60 minutes until the patient loses 7% of its body weight.
T40 698414-698535 Sentence denotes Positive inotropic and antiarrhythmic therapy may be necessary to improve cardiac contractility and control dysrhythmias.
T41 698536-698731 Sentence denotes The clinician 1 should determine whether the cause of the pulmonary edema is secondary to CHF with pulmonary vascular overload, volume overload, hypoalbuminemia, or increased permeability (ARDS).
T42 698732-698834 Sentence denotes Pulmonary edema secondary to ARDS typically is refractory to supplemental oxygen and diuretic therapy.
T43 698835-698894 Sentence denotes In many cases, mechanical ventilation should be considered.
T44 698895-699171 Sentence denotes A diagnosis of PTE is difficult to make and is based on clinical signs of respiratory distress consistent with PTE, lack of other causes of hypoxemia, a high index of suspicion in susceptible animals, the presence of a condition associated with PTE, and radiographic findings.
T45 699172-699360 Sentence denotes Virchow's triad consists of vascular endothelial injury, sluggish blood flow with increased vascular stasis, and a hypercoagulable state as predisposing factors for thromboembolic disease.
T46 699361-699696 Sentence denotes Clinical conditions that predispose an animal to PTE include hyperadrenocorticism, DIC, catheterization of blood vessels, bacterial endocarditis, protein-losing nephropathy or enteropathy, hyperviscosity syndromes, heat-induced illness, pancreatitis, diabetes mellitus, inflammatory bowel disease, and immune-mediated hemolytic anemia.
T47 699697-699764 Sentence denotes Definitive diagnosis requires angiography or a lung perfusion scan.
T48 699765-699874 Sentence denotes Clinical signs associated with PTE include an acute onset of tachypnea, tachycardia, orthopnea, and cyanosis.
T49 699875-699970 Sentence denotes If the embolism is large, the patient may respond poorly to supplemental oxygen administration.
T50 699971-700055 Sentence denotes Pulmonary hypertension can cause a split second heart sound on cardiac auscultation.
T51 700056-700153 Sentence denotes In some cases a normal thoracic radiograph is present in the face of severe respiratory distress.
T52 700154-700196 Sentence denotes This is a classic finding in cases of PTE.
T53 700197-700400 Sentence denotes Potential radiographic abnormalities include dilated, tortuous, or blunted pulmonary arteries; wedgeshaped opacities in the lungs distal to an obstructed artery; and interstitial to alveolar infiltrates.
T54 700401-700445 Sentence denotes The right side of the heart may be enlarged.
T55 700446-700629 Sentence denotes Echocardiography can show right-sided heart enlargement, tricuspid regurgitation, pulmonary hypertension, and evidence of underlying cardiac disease, possibly with clots in the atria.
T56 700630-700744 Sentence denotes Measurement of AT and D-dimer levels can be useful in the identification of hypercoagulable states, including DIC.
T57 700745-700881 Sentence denotes Treatment of any patient with AT deficiency or DIC includes replenishment of AT and clotting factors in the form of fresh frozen plasma.
T58 700882-701031 Sentence denotes Treatment of PTE includes therapy for cardiovascular shock, oxygen supplementation, and thrombolytic therapy (see section on thromboembolic therapy).
T59 701032-701255 Sentence denotes For short-term treatment, administer heparin (heparin sodium, 200-500 units/kg SQ once [canine]; 200-300 units/kg SQ once [feline], followed by 100 units of unfractionated heparin per kilogram q8h; or fractionated heparin).
T60 701256-701323 Sentence denotes Thrombolytic therapy may include t-PA, streptokinase, or urokinase.
T61 701324-701445 Sentence denotes Long-term therapy with low-molecular-weight heparin or warfarin may be required to prevent further thromboembolic events.
T62 701446-701533 Sentence denotes Ideally, management should include treatment and elimination of the underlying disease.
T63 701534-701615 Sentence denotes Smoke inhalation commonly occurs when an animal is trapped in a burning building.
T64 701616-701793 Sentence denotes The most severe respiratory complications of smoke inhalation are seen in animals that are close enough to the flames to also sustain burn injuries (see section on burn injury).
T65 701794-701962 Sentence denotes At the scene, many animals are unconscious from the effects of hypoxia, hypercapnia, carbon monoxide intoxication, and hydrogen cyanide gases that accumulate in a fire.
T66 701963-702121 Sentence denotes Carbon monoxide produces hypoxia by avidly binding to and displacing oxygen binding to hemoglobin, resulting in severe impairment of oxygen-carrying capacity.
T67 702122-702271 Sentence denotes The percentage of carboxyhemoglobin in peripheral blood depends on the amount or carbon monoxide in inhaled gases and the length of time of exposure.
T68 702272-702419 Sentence denotes Clinical signs of carbon monoxide intoxication include cyanosis, nausea, vomiting, collapse, respiratory failure, loss of consciousness, and death.
T69 702420-702523 Sentence denotes Smoke inhalation of superheated particles also causes damage to the upper airways and respiratory tree.
T70 702524-702590 Sentence denotes The larynx can become severely edematous and obstruct inspiration.
T71 702591-702765 Sentence denotes Emergency endotracheal intubation, tracheal oxygen, or tracheostomy tube may be required in the initial resuscitation of the patient, depending on the extent of airway edema.
T72 702766-702865 Sentence denotes Inhalation of noxious gases and particles can cause damage to the terminal respiratory bronchioles.
T73 702866-703001 Sentence denotes Specific noxious gases that can cause alveolar damage include combustible particles from plastic, rubber, and other synthetic products.
T74 703002-703060 Sentence denotes Pulmonary edema, bacterial infection, and ARDS can result.
T75 703061-703241 Sentence denotes In any case of smoke inhalation, the first and foremost treatment is to get the animal away from the source of the flames and smoke and administer supplemental oxygen at the scene.
T76 703242-703387 Sentence denotes At the time of presentation, carefully examine the animal's eyes, mouth, and oropharynx Suction soot and debris from the mouth and upper airways.
T77 703388-703458 Sentence denotes Evaluate the patient's respiratory rate, rhythm, and pulmonary sounds.
T78 703459-703575 Sentence denotes Arterial blood gases should be analyzed with co-oximetry to evaluate the Pao 2 and carboxyhemoglobin concentrations.
T79 703576-703752 Sentence denotes Evaluation of Sao 2 by pulse oximetry is not accurate in cases of smoke inhalation, as the Pao 2 may appear normal, even when large quantities of carboxyhemoglobin are present.
T80 703753-703943 Sentence denotes Radiographs are helpful in determining the extent of pulmonary involvement, although radiographic signs may lag behind the appearance of clinical respiratory abnormalities by 16 to 24 hours.
T81 703944-704174 Sentence denotes Bronchoscopy and bronchoalveolar lavage provide a more thorough and accurate evaluation of the respiratory tree; however, these procedures should be performed only in patients whose cardiovascular and respiratory status is stable.
T82 704175-704424 Sentence denotes Management of the patient with smoke inhalation includes maintaining a patent airway, administering supplemental oxygen, correcting hypoxemia and acid-base abnormalities, preventing infection, and treating thermal burns (see section on burn injury).
T83 704425-704551 Sentence denotes If severe laryngeal edema is present, a temporary tracheostomy may be necessary to allow adequate oxygenation and ventilation.
T84 704552-704758 Sentence denotes Glucocorticosteroids should not be empirically used in the treatment of smoke inhalation, because of the risk of decreasing pulmonary alveolar macrophage function and increasing the potential for infection.
T85 704759-704877 Sentence denotes In cases of severe laryngeal edema, however, glucocorticosteroids may be necessary to decrease edema and inflammation.
T86 704878-705151 Sentence denotes The use of empiric antibiotics is contraindicated unless clinical signs of deterioration and bacterial pneumonia develop. ePisTAxis Epistaxis can be caused by facial trauma, a foreign body, bacterial or fungal rhinitis, neoplasia, coagulopathies, and systemic hypertension.
T87 705152-705240 Sentence denotes Acute, severe bilateral hemorrhage without exudate is suggestive of a systemic disorder.
T88 705241-705312 Sentence denotes A history of chronic nasal discharge usually accompanies nasal disease.
T89 705313-705381 Sentence denotes Acute unilateral epistaxis can occur with nasal or systemic disease.
T90 705382-705456 Sentence denotes In most cases, cage rest is sufficient to temporarily diminish blood loss.
T91 705457-705568 Sentence denotes Sedation (acepromazine, 0.02 to 0.05 mg/kg IV, IM, SQ) may be helpful in alleviating anxiety and decreasing BP.
T92 705569-705667 Sentence denotes The hypotensive effects of acepromazine are potentially harmful if severe blood loss has occurred.
T93 705668-705797 Sentence denotes If evidence of hypovolemia is present (see section on hypovolemic shock), intravenous fluid resuscitation should be administered.
T94 705798-705930 Sentence denotes Rapid assessment of clotting ability, with a platelet count estimate and clotting profile (ACT or APTT and PT), should be performed.
T95 705931-706085 Sentence denotes If epistaxis secondary to vitamin K-antagonist rodenticide intoxication is suspected, administer vitamin K 1 and fresh frozen plasma or fresh whole blood.
T96 706086-706272 Sentence denotes Persistent hemorrhage from a nasal disorder can be treated with dilute epinephrine (1:100,000) into the nasal cavity with the nose pointed toward the ceiling to promote vasoconstriction.
T97 706273-706451 Sentence denotes If this fails, the animal can be anesthetized, the nasal cavity packed with gauze, and the caudal oropharynx and external nares covered with umbilical tape to control hemorrhage.
T98 706452-706528 Sentence denotes Rhinoscopy should be performed to determine the cause of ongoing hemorrhage.
T99 706529-706687 Sentence denotes Continued excessive hemorrhage can be controlled with ligation of the carotid artery on the side of the hemorrhage or with percutaneous arterial embolization.
T100 706688-706888 Sentence denotes Wounds have been classified in several ways according their degree of tissue integrity, causative force, degree of contamination and duration, and degree of contamination and infection (Table 1 -53) .
T101 706889-707011 Sentence denotes There are also unique causes of wounds such as burns, psychogenic dermatoses, frostbite, decubital ulcers, and snake bite.
T102 707012-707100 Sentence denotes The animal should be transported to the nearest veterinary facility for definitive care.
T103 707101-707242 Sentence denotes The wound should be covered or packed with dry gauze or clean linen to protect the wound and to prevent further hemorrhage and contamination.
T104 707243-707356 Sentence denotes If an open fracture is present, the limb should be splinted without placing the exposed bone back into the wound.
T105 707357-707542 Sentence denotes Replacing the exposed bone fragment back through the skin wound can cause further damage to underlying soft tissue structures and increase the degree of contamination of deeper tissues.
T106 707543-707698 Sentence denotes If a spinal fracture is suspected, the patient should be transported on a stable flat surface to prevent further spinal mobilization and neurologic injury.
T107 707699-707858 Sentence denotes At the time of presentation, first refer to the ABCs of trauma care, taking care to evaluate and stabilize the patient's cardiovascular and respiratory status.
T108 707859-708066 Sentence denotes After a complete physical examination and history, ancillary diagnostic techniques can be performed if the patient is hemodynamically stable (see section on triage, assessment, and treatment of emergencies).
T109 708067-708251 Sentence denotes Initially, every patient with a superficial wound should receive some degree of analgesia and an injection of a first-generation cephalosporin, preferably within 3 hours of the injury.
T110 708252-708350 Sentence denotes Evaluate the wound after the patient's cardiovascular and respiratory status have been stabilized.
T111 708351-708455 Sentence denotes Always cover an open wound before taking an animal to the hospital, to prevent a 1 nosocomial infection.
T112 708456-708528 Sentence denotes Evaluate limb wounds for neural, vascular, and orthopedic abnormalities.
T113 708529-708593 Sentence denotes Carefully examine the structures deep to the superficial wounds.
T114 708594-708718 Sentence denotes When there has been a delay in assessment of the wound, obtain samples for culture and antimicrobial susceptibility testing.
T115 708719-708881 Sentence denotes If the wound is older and obviously infected, a Gram stain can help guide appropriate antimicrobial therapy pending results of culture and susceptibility testing.
T116 708882-709082 Sentence denotes Place a support bandage saturated with a water-soluble antibiotic ointment or nonirritating antimicrobial solution (e.g., 0.05% chlorhexidine, if bone or joint tissue is not exposed) around the wound.
T117 709083-709256 Sentence denotes In addition to a first-generation cephalosporin, other appropriate antibiotic choices include amoxicillin-clavulanate, trimethoprimsulfadiazine, amoxicillin, and ampicillin.
T118 709257-709317 Sentence denotes If gram-negative flora are present, administer enrofloxacin.
T119 709318-709430 Sentence denotes Administer the antibiotics of choice for a minimum of 7 days unless a change of antibiotic therapy is indicated.
T120 709431-709498 Sentence denotes Rights were not granted to include this figure in electronic media.
T121 709499-709539 Sentence denotes Please refer to the printed publication.
T122 709540-709747 Sentence denotes At the time of wound cleansing or definitive wound repair, the patient should be placed under general anesthesia with endotracheal intubation, unless the procedure will be brief (i.e., less than 10 minutes).
T123 709748-709889 Sentence denotes In such cases, a short-acting anesthetic combination (analgesia + propofol, analgesia + ketamine and diazepam) can be administered to effect.
T124 709890-710062 Sentence denotes Heavy sedation with infiltration of a local anesthetic may also be appropriate for very small wounds, depending on the location of the wound and temperament of the patient.
T125 710063-710204 Sentence denotes Protect the wound by packing it with sterile gauze sponges soaked in sterile saline, or with water-soluble lubricating gel such as K-Y jelly.
T126 710205-710351 Sentence denotes Clip the fur surrounding the wound, moving from the inner edge of the wound outward, to help prevent wound contamination with fur or other debris.
T127 710352-710501 Sentence denotes Scrub the wound and surrounding skin with an antimicrobial soap and solution such as dilute chlorhexidine until the area is free of all gross debris.
T128 710502-710656 Sentence denotes Gross debris within the wound itself can be flushed using a 30-mL syringe filled with sterile saline or lactated Ringer's solution and an 18-gauge needle.
T129 710657-710720 Sentence denotes Pressure-lavage systems are also available for use, if desired.
T130 710721-710859 Sentence denotes Grossly contaminated wounds can be rinsed first with warm tap water to eliminate gross contamination, and then prepared as just described.
T131 710860-710944 Sentence denotes Debride the wound, removing skin and other soft tissue that is not obviously viable.
T132 710945-711078 Sentence denotes Obviously viable and questionable tissue should remain, and the wound should be left open for frequent reassessment on a daily basis.
T133 711079-711121 Sentence denotes Remove any dark or white segments of skin.
T134 711122-711257 Sentence denotes Questionable skin edges may or may not regain viability and should be left in place for 48 hours, so the wound can fully reveal itself.
T135 711258-711321 Sentence denotes Excise grossly contaminated areas of fat and underlying fascia.
T136 711322-711441 Sentence denotes Blood vessels that are actively bleeding should be ligated to control hemorrhage, if collateral circulation is present.
T137 711442-711549 Sentence denotes If nerve bundles are ligated cleanly in a clean wound, the nerve edges should be reapposed and anastomosed.
T138 711550-711673 Sentence denotes If gross contamination is present, however, definitive neurologic repair should be delayed until healthy tissue is present.
T139 711674-711742 Sentence denotes Excise contaminated muscle until healthy bleeding tissue is present.
T140 711743-711824 Sentence denotes Anastamose tendon lacerations if the wound is clean and not grossly contaminated.
T141 711825-711988 Sentence denotes If gross contamination is present, the tendon can be temporarily anastomosed and a splint placed on the limb until definitive repair of healthy tissue is possible.
T142 711989-712080 Sentence denotes Thoroughly lavage open wounds to a joint with sterile saline or lactated Ringer's solution.
T143 712081-712214 Sentence denotes Infusion of chlorhexidine or povidone-iodine solution into the joint can cause a decrease in cartilage repair and is contraindicated.
T144 712215-712267 Sentence denotes Smooth sharp edges and remove any obvious fragments.
T145 712268-712360 Sentence denotes Whenever possible, the joint capsule and ligaments should be partially or completely closed.
T146 712361-712531 Sentence denotes After removal of bullets and metal fragments, the subcutaneous tissue and skin should be left open to heal by second intention or should be partially closed with a drain.
T147 712532-712569 Sentence denotes The joint should then be immobilized.
T148 712570-712723 Sentence denotes Injuries and exposed bone should be carefully lavaged, taking care to remove any gross debris without pushing the debris further into the bone and wound.
T149 712724-712833 Sentence denotes The bone should be covered with a moist dressing and stabilized until definitive fracture repair can be made.
T150 712834-712969 Sentence denotes This type of injury typically is seen with shearing injuries of the distal extremities caused by interaction with slow-moving vehicles.
T151 712970-713057 Sentence denotes Perform wet-to-dry or enzymatic debridement until a healthy granulation bed is present.
T152 713058-713170 Sentence denotes If large areas of contamination are present (e.g., necrotizing fasciitis), en bloc debridement may be necessary.
T153 713171-713311 Sentence denotes En bloc debridement consists of complete excision of badly infected wounds without entering the wound cavity, to prevent systemic infection.
T154 713312-713499 Sentence denotes This technique should be used only if there is sufficient skin and soft tissue to allow later closure and it can be performed without damaging any major nerves, tendons, or blood vessels.
T155 713500-713605 Sentence denotes Open wounds often are managed by second intention healing, delayed primary closure, or secondary closure.
T156 713606-713761 Sentence denotes See the section on wound management and bandaging for a more complete discussion of the use of various bandaging materials in the treatment of open wounds.
T157 713762-713985 Sentence denotes If an animal is presented very shortly after a wound has occurred and contamination and trauma are minimal, the wound can be closed after induction of anesthesia and careful preparation of the wound and surrounding tissues.
T158 713986-714087 Sentence denotes Close any dead space under the skin with absorbable suture material in an interrupted suture pattern.
T159 714088-714133 Sentence denotes Avoid incising major blood vessels or nerves.
T160 714134-714244 Sentence denotes Close the subcutaneous tissues with absorbable suture material in an interrupted or continuous suture pattern.
T161 714245-714365 Sentence denotes Take care that there is not too much tension on the wound, or else surgical dehiscence will occur with patient movement.
T162 714366-714440 Sentence denotes Close the skin with nonabsorbable suture or surgical staples (2-0 to 4-0).
T163 714441-714684 Sentence denotes If there is any doubt at the time of repair about tissue status or inability to close all dead space, place a passive drain (Penrose drain) so that the proximal end of the drain is anchored in the proximal aspect of the wound with a suture(s).
T164 714685-714782 Sentence denotes Leave the ends long so that the suture can be accurately identified at the time of drain removal.
T165 714783-714871 Sentence denotes Pass the suture through the skin, through the drain, and out the other side of the skin.
T166 714872-715075 Sentence denotes Place the rest of the drain into the wound and then secure it at the most ventral portion of the wound or exit hole in the most dependent area of the body, to allow drainage and prevent seroma formation.
T167 715076-715141 Sentence denotes Close the subcutaneous tissue over the drain before skin closure.
T168 715142-715315 Sentence denotes During wound closure, be sure to not incorporate the subcutaneous or skin sutures into the drain, or it will not be possible to remove the drain without reopening the wound.
T169 715316-715358 Sentence denotes Bandage the area to prevent contamination.
T170 715359-715431 Sentence denotes The drain can be removed once drainage is minimal (usually 3 to 5 days).
T171 715432-715562 Sentence denotes Active drains can be constructed or purchased; their use is indicated in wounds that are free of material that can plug the drain.
T172 715563-715676 Sentence denotes To construct a small suction drain, remove the female portion or catheter hub at the end of a butterfly catheter.
T173 715677-715827 Sentence denotes Fenestrate the tubing so that there are multiple side holes, taking care to avoid making the holes larger than 50% of the circumference of the tubing.
T174 715828-715906 Sentence denotes Place the tubing into the wound via a small stab incision distal to the wound.
T175 715907-716024 Sentence denotes Use a purse-string suture around the tubing to facilitate a tight seal and prevent the tubing from exiting the wound.
T176 716025-716162 Sentence denotes After wound closure, insert the butterfly needle into a 5-to 10-mL evacuated blood collection tube to allow fluid to drain into the tube.
T177 716163-716238 Sentence denotes Incorporate the tube into the bandage, and replace it when it becomes full.
T178 716239-716354 Sentence denotes Alternatively, the butterfly portion of the system can be removed and the tube fenestrated as described previously.
T179 716355-716431 Sentence denotes Place the tube into the wound and suture it in place to create a tight seal.
T180 716432-716537 Sentence denotes Secure the catheter hub to a syringe in which the plunger has been drawn back slightly to create suction.
T181 716538-716659 Sentence denotes Insert a metal pin or 16-to 18-gauge needle through the plunger at the top of the barrel to hold it at the desired level.
T182 716660-716747 Sentence denotes Incorporate the suction apparatus into the bandage and replace it when it becomes full.
T183 716748-716923 Sentence denotes Delayed primary closure should be considered when there is heavy contamination, purulent exudate, residual necrotic debris, skin tension, edema and erythema, and lymphangitis.
T184 716924-717056 Sentence denotes Delayed primary closure usually is made 3 to 5 days after the initial wound infliction and open wound management has been performed.
T185 717057-717169 Sentence denotes Once healthy tissue is observed, the skin edges should be debrided and the wound closed as with primary closure.
T186 717170-717327 Sentence denotes seCondAry Wound Closure Secondary wound closure should be considered when infection and tissue trauma necessitate open wound management for more than 5 days.
T187 717328-717416 Sentence denotes Secondary wound closure is performed after the development of a healthy granulation bed.
T188 717417-717507 Sentence denotes This technique also is useful when a wound has dehisced and has formed granulation tissue.
T189 717508-717668 Sentence denotes If the wound edges can be manipulated into apposition and if epithelialization has not begun, the wound can be cleansed and the wound edges apposed and sutured.
T190 717669-717710 Sentence denotes This is known as early secondary closure.
T191 717711-717919 Sentence denotes Late secondary closure should be performed whenever there is a considerable amount of granulation tissue, the edges of the wound cannot be manipulated into position, and epithelialization has already started.
T192 717920-718017 Sentence denotes In such cases, the wound should be cleaned, and the skin edges debrided to remove the epithelium.
T193 718018-718159 Sentence denotes The remaining wound edges are then sutured over the granulation tissue ( Drain may be incorporated into the repair and prevent drain removal.
T194 718160-718342 Sentence denotes Active drains High negative pressure may cause tissue injury; highly productive wounds may necessitate changing the evacuated blood tubes several times a day with constructed drains.
T195 718343-718450 Sentence denotes Shock is defined as a state of inadequate circulating volume and inability to meet cellular oxygen demands.
T196 718451-718520 Sentence denotes There are three types of shock: hypovolemic, cardiogenic, and septic.
T197 718521-718635 Sentence denotes Early recognition of the type of shock present is crucial in the successful clinical management of shock syndrome.
T198 718636-718720 Sentence denotes Tissue oxygen delivery is based on cardiac output and arterial oxygen concentration.
T199 718721-718876 Sentence denotes Knowledge of the components of normal oxygen delivery is essential to the treatment of shock in the critical patient. where Q = heart rate x stroke volume.
T200 718877-719091 Sentence denotes Stroke volume is affected by preload, afterload, and cardiac contractility. where Hb = hemoglobin concentration, Sao 2 = oxygen saturation, and Pao 2 = arterial partial pressure of oxygen in millimeters of mercury.
T201 719092-719452 Sentence denotes Therefore factors that can adversely affect oxygen delivery include inadequate preload or loss of circulating volume, severe peripheral vasoconstriction and increased afterload, depressed cardiac contractility, tachycardia and decreased diastolic filling, cardiac dysrhythmias, inadequate circulating hemoglobin, and inadequate oxygen saturation of hemoglobin.
T202 719453-719584 Sentence denotes During septic shock, enzymatic dysfunction and decreased cellular uptake and use of oxygen also contribute to anaerobic glycolysis.
T203 719585-719813 Sentence denotes An inadequate circulating volume may develop secondary to maldistribution of available blood volume (traumatic, septic, and cardiogenic origin) or as a result of absolute hypovolemia (whole blood or loss of extracellular fluid).
T204 719814-720120 Sentence denotes Normally the animal compensates by (1) splenic and vascular constriction to translocated blood from venous capacitance vessels to central arterial circulation, (2) arteriolar constriction to help maintain diastolic BP and tissue perfusion, and (3) an increase in heart rate to help maintain cardiac output.
T205 720121-720231 Sentence denotes Arteriolar vasoconstrictions support perfusion to the brain and heart at the expense of other visceral organs.
T206 720232-720374 Sentence denotes If vasoconstriction is severe enough to interfere with delivery of adequate tissue oxygen for a sufficient period of time, the animal may die.
T207 720375-720504 Sentence denotes Hypovolemic shock can result from acute hemorrhage or from severe fluid loss from vomiting, diarrhea, or third spacing of fluids.
T208 720505-720648 Sentence denotes Early in shock, baroreceptors in the carotid body and aortic arch sense a decrease in wall stretch from a decrease in circulating fluid volume.
T209 720649-720847 Sentence denotes Tonic inhibition of sympathetic tone via vagal stimulation is diminished, and heart rate and contractility increase and peripheral vessels constrict to compensate for the decrease in cardiac output.
T210 720848-720977 Sentence denotes The compensatory mechanisms protect and support blood supply to the brain and heart at the expense of peripheral organ perfusion.
T211 720978-721018 Sentence denotes This is called early compensatory shock.
T212 721019-721143 Sentence denotes Early compensatory shock is characterized by tachycardia, normal to fast capillary refill time, tachypnea, and normothermia.
T213 721144-721231 Sentence denotes As shock progresses, the body loses its ability to compensate for ongoing fluid losses.
T214 721232-721394 Sentence denotes Early decompensatory shock is characterized by tachycardia, tachypnea, delayed capillary refill time, normotension to hypotension, and a fall in body temperature.
T215 721395-721530 Sentence denotes End-stage decompensatory shock is characterized by bradycardia, markedly prolonged capillary refill time, hypothermia, and hypotension.
T216 721531-721601 Sentence denotes Aggressive treatment is necessary for any hope of a favorable outcome.
T217 721602-722036 Sentence denotes Septic shock should be considered in any patient with a known infection, recent instrumentation that could potentially introduce infection (indwelling intravenous or urinary catheter, surgery or penetrating injury), disorders or medical therapy that could compromise immune function (diabetes mellitus, immunodeficiency virus, parvovirus or feline 1 panleukopenia virus infection, stress, malnutrition, glucocorticoids, chemotherapy).
T218 722037-722153 Sentence denotes The presence of bacteria, viruses or rickettsiae, protozoa, or fungal organisms in the blood constitutes septicemia.
T219 722154-722328 Sentence denotes Septic shock is characterized by the presence of sepsis and refractory hypotension that is unresponsive to standard aggressive fluid therapy and inotropic or pressor support.
T220 722329-722392 Sentence denotes Septic shock and other causes of inflammation can lead to SIRS.
T221 722393-722533 Sentence denotes In animals, the presence of two or more of the criteria in Table 1 -55 in the presence of suspected inflammation or sepsis constitutes SIRS.
T222 722534-722655 Sentence denotes Clinical signs associated with sepsis may be vague and nonspecific, including weakness, lethargy, vomiting, and diarrhea.
T223 722656-722718 Sentence denotes Cough and pulmonary crackles may be associated with pneumonia.
T224 722719-722774 Sentence denotes Decreased lung sounds may be associated with pyothorax.
T225 722775-722842 Sentence denotes Abdominal pain and fluid may be associated with septic peritonitis.
T226 722843-722913 Sentence denotes Vaginal discharge may or may not be present in patients with pyometra.
T227 722914-723056 Sentence denotes Diagnostic tests should include a WBC count, serum biochemical profile, coagulation tests, thoracic and abdominal radiographs, and urinalysis.
T228 723057-723209 Sentence denotes The WBC count in a septic patient that is appropriately responding to the infection will be elevated, with a left-shifted neutrophilia and leukocytosis.
T229 723210-723320 Sentence denotes A degenerative left shift, with leukopenia with elevated band neutrophils, suggests an overwhelming infection.
T230 723321-723436 Sentence denotes Biochemical analyses may demonstrate hypoglycemia and nonspecific hepatocellular and cholestatic enzyme elevations.
T231 723437-723573 Sentence denotes In the most severe cases, metabolic (lactic) acidosis, coagulopathies, and end-organ failure, including anuria and ARDS, may be present.
T232 723574-723672 Sentence denotes Cardiogenic shock occurs as a result of cardiac output inadequate to meet cellular oxygen demands.
T233 723673-723802 Sentence denotes Cardiogenic shock is associated with primary cardiomyopathies, cardiac dysrhythmias, pericardial fluid, and pericardial fibrosis.
T234 723803-724067 Sentence denotes Abnormalities seen on physical examination often are similar to those seen in other categories of shock, but they can also include cardiac murmurs, dysrhythmias, pulmonary rales, bloody frothy pulmonary edema fluid from the nares or mouth, orthopnea, and cyanosis.
T235 724068-724329 Sentence denotes It is important to distinguish the primary cause of shock before implementing treatment (Table 1-56) , whenever possible, because the treatment for a suspected ruptured hemangiosarcoma differs markedly from the treatment for end-stage dilatative cardiomyopathy.
T236 724330-724516 Sentence denotes The patient's clinical signs may be similar and include a peritoneal fluid wave, but the treatment for hypovolemia can dramatically worsen the CHF secondary to dilatative cardiomyopathy.
T237 724517-724609 Sentence denotes When a patient has some form of shock, immediate vascular access is of paramount importance.
T238 724610-724753 Sentence denotes Place a large-bore peripheral or central venous catheter for the infusion of crystalloid or colloid fluids, blood component therapy, and drugs.
T239 724754-724926 Sentence denotes Monitor the patient's cardiopulmonary status (by ECG), BP, oxygen saturation (as determined by pulse oximetry or arterial blood gas analyses), hematocrit, BUN, and glucose.
T240 724927-725211 Sentence denotes Ancillary diagnostics, including thoracic and abdominal radiography, urinalysis, serum biochemistry profile, coagulation tests, complete blood count, abdominal ultrasound, and echocardiography, should be performed as determined by the individual patient's needs and the type of shock.
T241 725213-725328 Sentence denotes The rule oF 20* The following list, called the Rule of 20, is a guideline for case management of the shock patient.
T242 725329-725445 Sentence denotes Consideration of each aspect of the Rule of 20 on a daily basis ensures that major organ systems are not overlooked.
T243 725446-725564 Sentence denotes The list also provides a means to integrate and relate changes in different organ systems functions with one another.*
T244 725565-725702 Sentence denotes The treatment of hypovolemic and septic shock requires the placement of large-bore intravenous catheters in peripheral and central veins.
T245 725703-725829 Sentence denotes If vascular access cannot be obtained percutaneously or by cutdown methods, intraosseous catheterization should be considered.
T246 725830-725930 Sentence denotes Once vascular access is achieved, rapidly administer large volumes of crystalloid or colloid fluids.
T247 725931-726187 Sentence denotes As a rule of thumb, administer 1 ⁄4 of a calculated shock dose of fluids-that is, 1 ⁄4 × (90 mL/kg/hr) in dogs and 1 ⁄4 × (44 mL/kg/hr) in cats-of a balanced crystalloid fluid (Normosol-R, Plasma-Lyte M, lactated Ringer's solution, or 0.9% sterile saline).
T248 726188-726339 Sentence denotes Reassess the patient's perfusion parameters (heart rate, capillary refill time, BP, urine output) on a continual basis to direct further fluid therapy.
T249 726340-726452 Sentence denotes Synthetic colloid fluids (hydroxyethyl starch) can also be administered in the initial resuscitation from shock.
T250 726453-726770 Sentence denotes A guideline is to administer 5 to 10 mL/kg of hydroxyethyl starch as a bolus over 10 to 15 minutes and then reassess perfusion parameters. † Hypertonic saline (0.7% NaCl, 4 mL/kg) can be used in cases of hemorrhagic shock to temporarily restore intravascular fluid volume by drawing fluid from the interstitial space.
T251 726771-726979 Sentence denotes Because this type of fluid resuscitation is short-lived, hypertonic saline should always be used with another crystalloid or colloid fluid, and it should not be used in patients with interstitial dehydration.
T252 726980-727337 Sentence denotes If hemorrhagic shock is present, the goal should be to return a patient's BP to normal (not supraphysiologic) levels (i.e., systolic pressure 90 to 100 mm Hg, diastolic t a B l e 1 -5 6 clinical signs of shock syndrome pressure >40 mm Hg, and mean arterial pressure ≥60 mm Hg) to avoid iatrogenically causing clots to fall off and hemorrhage to start again.
T253 727338-727474 Sentence denotes In critically ill patients, fluid loss can be measured in the form of urine, vomit, diarrhea, body cavity effusions, and wound exudates.
T254 727475-727616 Sentence denotes In addition, insensible losses (those that cannot be readily measured from sweat, panting, and cellular metabolism) constitute 20 mL/ kg/day.
T255 727617-727807 Sentence denotes Measurement of fluid "ins and outs" in conjunction with the patient's CVP, hematocrit, albumin, and colloid oncotic pressure can help guide fluid therapy (see also section on fluid therapy).
T256 727808-727910 Sentence denotes Maintenance of normotension is necessary for adequate oxygen delivery to meet cellular energy demands.
T257 727911-728052 Sentence denotes BP can be measured using direct arterial catheterization, or through indirect means such as Doppler plethysmography or oscillometric methods.
T258 728053-728137 Sentence denotes The systolic pressure should remain at or greater than 90 to 100 mm Hg at all times.
T259 728138-728308 Sentence denotes The diastolic pressure is very important, too, as it constitutes two thirds of the mean arterial pressure; it must be greater than 40 mm Hg for coronary artery perfusion.
T260 728309-728398 Sentence denotes The mean arterial pressure should be greater than 60 mm Hg for adequate tissue perfusion.
T261 728399-728580 Sentence denotes If fluid resuscitation and pain management are not adequate in restoring BP to normal, vasoactive drugs including positive inotropes and pressors should be considered (Table 1 -57).
T262 728581-728702 Sentence denotes In cases of cardiogenic shock, vasodilator drugs (Table 1 -58) can be used to decrease vascular resistance and afterload.
T263 728703-728807 Sentence denotes Low-dose morphine (0.025-0.05 mg/kg IV, IM) dilates splanchnic vessels and helps reduce pulmonary edema.
T264 728808-728932 Sentence denotes Furosemide (1 mg/kg/hr) also can dilate pulmonary vasculature and potentially reduce edema fluid formation in cases of ARDS.
T265 728933-728999 Sentence denotes Cardiac output is a function of both heart rate and stroke volume.
T266 729000-729129 Sentence denotes Stroke volume (or the amount of blood that the ventricle pumps in 1 minute) is affected by preload, afterload, and contractility.
T267 729130-729239 Sentence denotes During hypovolemic shock, there is a fall in cardiac preload owing to a decrease in circulating blood volume.
T268 729240-729581 Sentence denotes During septic and cardiogenic shock, there is a decrease in contractility secondary to inherent defects of the myocardium or because of the negative inotropic effects of inflammatory cytokines such as tumor necrosis factor (TNF)-α, myocardial depressant factor, interleukin (IL)-1, and IL-10 released during sepsis and systemic inflammation.
T269 729582-729759 Sentence denotes Afterload also may be increased because of the compensatory mechanisms and neurohumoral activation of the renin-angiotensin-aldosterone axis in hypovolemic or cardiogenic shock.
T270 729760-729958 Sentence denotes As heart rate increases to compensate for a decline in cardiac output, myocardial oxygen demand increases and diastolic filling t a B l e 1 -5 7 sympathomimetic drugs used to treat cardiogenic shock
T271 729959-730501 Sentence denotes Receptor Activity Dose (Intravenous) Dopamine DA 1 , DA 2 , α +++ , 5-25 mcg/kg/min (blood pressure support)* β +++ 1-5 mcg/kg/min (renal afferent diuresis) Dobutamine α + , β +++ 3-20 mcg/kg/min* (blood pressure support, positive inotrope) Norepinephrine α +++ , β + 0.05-0.3 mg/kg/min; 0.01-0.02 mg/kg Phenylephrine α +++ , β 0 1-3 mcg/kg/min CRI Epinephrine α +++ , β +++ 0.02-0.5 mg/kg; 0.1-1 mcg/kg/min CRI +++, Strong receptor activity; +, weak receptor activity; 0, no receptor activity. * Monitor for tachyarrhythmias at higher doses.
T272 730502-730525 Sentence denotes 1 time becomes shorter.
T273 730526-730709 Sentence denotes Because the coronary arteries are perfused during diastole, coronary perfusion can be impaired, and myocardial lactic acidosis can develop, causing a further decline in contractility.
T274 730710-730949 Sentence denotes In addition to lactic acidosis, acid-base and electrolyte abnormalities, inflammatory cytokines, direct bruising of the myocardium from trauma, and areas of ischemia can further predispose the patient to ventricular or atrial dysrhythmias.
T275 730950-731010 Sentence denotes Cardiac dysrhythmias should be controlled whenever possible.
T276 731011-731088 Sentence denotes Treatment of bradycardia should be directed at treating the underlying cause.
T277 731089-731202 Sentence denotes Administer anticholinergic drugs such as atropine (0.04 mg/kg IM) or glycopyrrolate (0.02 mg/kg IM) as necessary.
T278 731203-731362 Sentence denotes In cases of third-degree or complete AV block, administer a pure β-agonist such as isoproterenol t a B l e 1 -5 8 drugs and doses used to induce vasodilatation
T279 731363-731537 Sentence denotes Dose and Method of Administration (Onset, Peak, Duration) Potential adverse effects 1 (0.04 to 0.08 mcg/kg/min IV CRI, or 0.4 mg in 250 mL of 5% dextrose in water IV slowly).
T280 731538-731594 Sentence denotes Perform passive rewarming if the patient is hypothermic.
T281 731595-731702 Sentence denotes Correct any underlying electrolyte abnormalities such as hyperkalemia, hypomagnesemia, and hypermagnesemia.
T282 731703-732047 Sentence denotes Treat ventricular dysrhythmias such as multifocal PVCs, sustained ventricular tachycardia >160 beats/min, and R on T phenomenon (the T wave of the preceding beat occurs superimposed on the QRS complex of the next beat, and there is no return to isoelectric shelf), and administer treatment if runs of ventricular tachycardia cause a drop in BP.
T283 732048-732146 Sentence denotes Intravenous lidocaine and procainamide are the first drugs of choice for ventricular dysrhythmias.
T284 732147-732238 Sentence denotes Supraventricular tachycardia can impair cardiac output by impairing diastolic filling time.
T285 732239-732358 Sentence denotes Control supraventricular dysrhythmias with calcium channel blockers, β-adrenergic blockers, or quinidine (Table 1-59) .
T286 732359-732498 Sentence denotes Albumin can decrease as a result of loss from the gastrointestinal tract, urinary system, and wound exudates or into body cavity effusions.
T287 732499-732634 Sentence denotes Albumin synthesis can decrease during various forms of shock owing to a preferential increase in hepatic acute phase protein synthesis.
T288 732635-732829 Sentence denotes Serum albumin contributes 80% of the colloid oncotic pressure of blood, in addition to its important roles as a free radical scavenger at sites of inflammation and as a drug and hormone carrier.
T289 732830-732953 Sentence denotes Albumin levels <2.0 g/dL have been associated with an increase in morbidity and mortality in human and veterinary patients.
T290 732954-733088 Sentence denotes Administer fresh frozen plasma (20 mL/kg) or concentrated human albumin (2 mL/kg of 25% solution) to maintain serum albumin ≥2.0 g/dL.
T291 733089-733171 Sentence denotes Additional oncotic support can be in the form of synthetic colloids, as indicated.
T292 733172-733301 Sentence denotes Lidocaine Fast sodium channel inhibition 1-4 mg/kg IV slowly, then 50-100 mcg/kg/min (dog); 0.25-1.0 mg/kg IV (cat)* Procainamide
T293 733302-733402 Sentence denotes Fast sodium channel inhibition 1-8 mg/kg IV, † slow (canine); 3-8 mg/ kg PO q6-8h (feline) Tocainide
T294 733403-733469 Sentence denotes Fast sodium channel inhibition 5-20 mg/kg PO q8h ‡ (dog) Quinidine
T295 733470-733574 Sentence denotes Fast sodium channel inhibition 6-10 mg/kg PO qid Propranolol β-Adrenergic blocker 0.02-0.06 mg/kg IV; 0.
T296 733576-733676 Sentence denotes Colloid oncotic pressure within the intravascular and interstitial spaces contributes to fluid flux.
T297 733677-733735 Sentence denotes Oncotic pressure can be measured with a colloid osmometer.
T298 733736-733772 Sentence denotes Normal oncotic pressure is 15 mm Hg.
T299 733773-733908 Sentence denotes In cases of sepsis and SIRS, increased vascular permeability increases the tendency for leakage of fluids into the interstitial spaces.
T300 733909-734161 Sentence denotes Colloids that can be administered until the source of albumin loss resolves include the synthetic colloids hydroxyethyl starch, concentrated human albumin (25% albumin, 2 mL/kg), canine albumin (3 to 6 mL/kg of the 16% solution), and plasma (20 mL/kg).
T301 734162-734347 Sentence denotes Oxygenation and ventilation can be evaluated by arterial blood gas analysis or by the noninvasive means of pulse oximetry and capnometry (see sections on pulse oximetry and capnometry).
T302 734348-734666 Sentence denotes Oxygen delivery can be impaired in cases of hypovolemic shock because of hemorrhage and anemia, resulting in a decrease in functional capacity to carry oxygen, and in cases of cardiogenic shock as a result of impaired ability to saturate hemoglobin caused by pulmonary edema in the lungs or decrease in cardiac output.
T303 734667-734818 Sentence denotes In septic shock, decreases in cardiac output caused by inflammatory cytokines and a decrease in cellular oxygen extraction can lead to lactic acidosis.
T304 734819-734938 Sentence denotes Increased cellular metabolism and decreases in respiratory function can lead to respiratory acidosis as CO 2 increases.
T305 734939-735045 Sentence denotes Administer supplemental oxygen via flow-by, nasal or nasopharyngeal catheter, oxygen hood, or oxygen cage.
T306 735046-735124 Sentence denotes Supplemental oxygen should be humidified and delivered at 50 to 100 mL/kg/min.
T307 735125-735355 Sentence denotes If oxygenation and ventilation are so impaired that the Pao 2 remains <60 mm Hg with the patient on supplemental oxygen, a Paco 2 >60 mm Hg, or severe respiratory fatigue, develops, and mechanical ventilation should be considered.
T308 735356-735492 Sentence denotes Glucose is a necessary fuel source for RBCs and neuronal tissues, and serum glucose should be maintained within normal reference ranges.
T309 735493-735632 Sentence denotes Glucose supplementation can be administered as 2.5% to 5% solutions in crystalloid fluids, or in parenteral and enteral nutrition products.
T310 735633-735705 Sentence denotes Arterial and venous pH can be measured by performing blood gas analyses.
T311 735706-735880 Sentence denotes Decrease in tissue perfusion, impaired oxygen delivery, and decreased oxygen extraction in the various forms of shock can lead to anaerobic metabolism and metabolic acidosis.
T312 735881-736060 Sentence denotes In most cases, improving tissue perfusion and oxygen delivery with crystalloid and colloid fluids, supplemental oxygen, and inotropic drugs will help normalize metabolic acidosis.
T313 736061-736206 Sentence denotes Serial measurements of serum lactate (normal, <2.5 mmol/L) can be used as a guide to evaluate the tissue response to fluid resuscitative efforts.
T314 736207-736273 Sentence denotes Serum electrolytes often become severely deranged in shock states.
T315 736274-736402 Sentence denotes Serum potassium, magnesium, sodium, chloride, and total and ionized calcium should be maintained within normal reference ranges.
T316 736403-736512 Sentence denotes If metabolic acidosis is severe, sodium bicarbonate can be administered by calculating the following formula:
T317 736513-736763 Sentence denotes Base deficit 0.3 Body weight in kg Bicarbonate to administer in mEq × × = Because iatrogenic metabolic alkalosis can occur, a conservative approach is to administer 1 ⁄4 of the calculated dose and then recheck the patient's pH and bicarbonate levels.
T318 736764-736893 Sentence denotes If the base excess is unknown, sodium bicarbonate can be administered in incremental doses of 1 mEq/kg until the pH is above 7.2.
T319 736894-737061 Sentence denotes Complications associated with bicarbonate therapy include iatrogenic hypocalcemia, metabolic alkalosis, paradoxical CSF acidosis, hypotension, restlessness, and death.
T320 737062-737180 Sentence denotes Massive trauma, neoplasia, sepsis, and systemic inflammation can all lead to coagulation abnormalities, including DIC.
T321 737181-737281 Sentence denotes Cage-side coagulation monitors are available for daily measurement of PT, APTT, and platelet counts.
T322 737282-737395 Sentence denotes Fibrin degradation products (fibrin split products) become elevated in DIC, trauma, hepatic disease, and surgery.
T323 737396-737559 Sentence denotes Coagulation proteins (clotting factors) and AT often are lost with other proteins in hypoproteinemia or are consumed when microclots are formed and then dissolved.
T324 737560-737613 Sentence denotes AT levels can be measured by commercial laboratories.
T325 737614-737705 Sentence denotes AT and clotting factors can be replenished in the form of fresh frozen plasma transfusions.
T326 737706-737828 Sentence denotes A more sensitive and specific test for DIC is the detection of D dimers, which can be measured by commercial laboratories.
T327 737829-738095 Sentence denotes Treatment for DIC involves treatment and resolution of the underlying disease and administration of AT and clotting factors in the form of fresh frozen plasma (20 mL/kg) and heparin (unfractionated, 50 to 100 units/kg SQ tid; fractionated [Lovenox], 1 mg/kg SQ bid).
T328 738096-738236 Sentence denotes Monitor the patient for changes in mental status, including stupor, coma, decreased ability to swallow and protect the airway, and seizures.
T329 738237-738357 Sentence denotes Elevation of the patient's head can help to protect the airway and decrease the risk of increased intracranial pressure.
T330 738358-738455 Sentence denotes Serum glucose should be maintained within normal levels to prevent hypoglycemia-induced seizures.
T331 738456-738532 Sentence denotes One of the major components of oxygen delivery is the binding to hemoglobin.
T332 738533-738605 Sentence denotes PCV must be kept above 20% to 30% for adequate cellular oxygen delivery.
T333 738606-738731 Sentence denotes Acid-base status can adversely affect oxygen offloading at the tissue level if metabolic or respiratory alkalosis is present.
T334 738732-738841 Sentence denotes Oxygen-carrying capacity and hemoglobin levels can be increased with administration of RBC component therapy.
T335 738842-738935 Sentence denotes Monitoring of renal function includes daily measurement of BUN, creatinine, and urine output.
T336 738936-739007 Sentence denotes Normal urine output in a hydrated euvolemic patient is 1 to 2 mL/kg/hr.
T337 739008-739092 Sentence denotes Fluid intake and output should be measured in cases of suspected oliguria or anuria.
T338 739093-739218 Sentence denotes In patients with oliguria or anuria, furosemide can be administered as a bolus (4 to 8 mg/kg) or by CRI (0.66 to 1 mg/kg/hr).
T339 739219-739294 Sentence denotes Mannitol should also be administered (0.5 to 1 g/kg over 10 to 15 minutes).
T340 739295-739406 Sentence denotes Dopamine (1 to 5 mcg/kg/min CRI) can be administered to dilate renal afferent vessels and improve urine output.
T341 739407-739501 Sentence denotes The patient's WBC count may be elevated, normal, or decreased, depending on the type of shock.
T342 739502-739573 Sentence denotes The decision to administer antibiotics should be made on a daily basis.
T343 739574-739726 Sentence denotes Superficial or deep Staphylococcus or Streptococcus infection usually can be treated with a first-generation cephalosporin (cefazolin, 22 mg/kg IV tid).
T344 739727-739997 Sentence denotes If a known source of infection is present, administer a broad-spectrum antibiotic (cefoxitin, 22 mg/kg IV tid; ampicillin, 22 mg/kg qid, or enrofloxacin, 5-10 mg/kg IV once daily (dogs), 5 mg/kg IV once daily (cats) pending results of culture and susceptibility testing.
T345 739998-740094 Sentence denotes If broader anaerobic coverage is required, metronidazole (10 mg/kg IV tid) should be considered.
T346 740095-740255 Sentence denotes Gentamicin (6-8 mg/kg/day or 2-4 mg/kg q8h) is a good choice for gram-negative sepsis, provided that the patient is well hydrated and has normal renal function.
T347 740256-740406 Sentence denotes Ideally, patients receiving any aminoglycoside antibiotic should have a daily urinalysis to check for renal tubular casts, which signify renal damage.
T348 740407-740442 Sentence denotes In dogs the gut is the shock organ.
T349 740443-740644 Sentence denotes Impaired gastrointestinal motility and vomiting should be aggressively treated with antiemetics and promotility drugs (dolasetron, 0.6 mg/kg IV once daily, and metoclopramide, 1 to 2 mg/kg/day IV CRI).
T350 740645-740730 Sentence denotes Metoclopramide is contraindicated in cases of suspected gastrointestinal obstruction.
T351 740731-740948 Sentence denotes Histamine-receptor 1 blockers such as famotidine (0.5 mg/kg bid IV) and ranitidine (0.5 to 2 mg/kg IV bid, tid) or proton-pump inhibitors (omeprazole, 0.5 to 1 mg/kg PO once daily) can be administered for esophagitis.
T352 740949-741043 Sentence denotes Administer sucralfate (0.25 to 1 g PO tid or 0.5-1 mg/kg IV q25h) to treat gastric ulceration.
T353 741044-741281 Sentence denotes If the gastrointestinal barrier function is diminished because of poor perfusion, infection, or inflammation, administer broad-spectrum antibiotics such as ampicillin (22 mg/kg IV qid) to prevent gastrointestinal bacterial translocation.
T354 741282-741403 Sentence denotes The course of drug therapy should be reviewed daily, and the patient should be monitored for potential drug interactions.
T355 741404-741525 Sentence denotes For example, metoclopramide and dopamine, working at the same receptor, can effectively negate the effects of each other.
T356 741526-741616 Sentence denotes Cimetidine, a cytochrome P450 enzyme inhibitor, can decrease the metabolism of some drugs.
T357 741617-741761 Sentence denotes Drugs that are avidly protein-bound may have an increase in unbound fraction with concurrent hypoalbuminemia or when hypoalbuminemia is present.
T358 741762-741895 Sentence denotes Decreased renal function may impair the renal clearance of some drugs, requiring increased administration interval or decreased dose.
T359 741896-741960 Sentence denotes Nutrition is of utmost importance in any critically ill patient.
T360 741961-742123 Sentence denotes Patients with septic shock may become hypermetabolic and require supraphysiologic nutrient caloric requirements, whereas others may actually become hypometabolic.
T361 742124-742247 Sentence denotes Enteral nutrition is preferred whenever possible, because enterocytes undergo atrophy without luminal nutrient stimulation.
T362 742248-742404 Sentence denotes A variety of enteral feeding tubes can be placed, depending on what portion of the gut is functional, to provide enteral nutrition in an inappetent patient.
T363 742405-742554 Sentence denotes Loss of gastrointestinal mucosal barrier function may predispose patients to the development of bacterial translocation and may contribute to sepsis.
T364 742555-742872 Sentence denotes If enteral nutrition is impossible because of protracted vomiting or gastrointestinal resection, glucose, lipid, and amino acid products are available that can be administered parenterally to meet nutrient needs until the gastrointestinal tract is functioning and the patient can be transitioned to enteral nutrition.
T1 742873-742931 Sentence denotes Assessment of pain in animals in shock can be challenging.
T2 742932-743139 Sentence denotes Pain can result in the release of catecholamines and glucocounterregulatory hormones that can impair nutrient assimilation and lead to negative nitrogen balance, impaired wound healing, and immunocompromise.
T3 743140-743263 Sentence denotes In any animal determined to be in pain, analgesic drugs should be administered to control pain and discomfort at all times.
T4 743264-743423 Sentence denotes Opioids are cardiovascularly friendly, and their effects can easily be reversed with naloxone if adverse effects such as hypotension and hypoventilation occur.
T5 743424-743540 Sentence denotes If the patient is nonambulatory, rotate the animal from side to side every 4 to 6 hours to prevent lung atelectasis.
T6 743541-743702 Sentence denotes Passive range-of-motion exercises and deep muscle massage should be performed to increase tissue perfusion, decrease dependent edema, and prevent disuse atrophy.
T7 743703-743812 Sentence denotes Animals should be kept completely dry on soft, padded bedding to prevent the development of decubital ulcers.
T8 743813-743932 Sentence denotes All bandages, wound sites, and catheter sites should be checked daily for the presence of swelling, erythema, and pain.
T9 743933-744047 Sentence denotes Soiled bandages should be changed to prevent strike-through and contamination of the underlying catheter or wound.
T10 744048-744123 Sentence denotes Hospitalization can be a stressful experience for patient and client alike.
T11 744124-744237 Sentence denotes Allowing brief visits and walks outside in the fresh air can improve a patient's temperament and decrease stress.
T12 744238-744356 Sentence denotes The preemptive use of analgesic drugs on a regular schedule (not PRN) should be used to prevent pain before it occurs.
T13 744357-744403 Sentence denotes Pain decreases the patient's ability to sleep.
T14 744404-744472 Sentence denotes Lack of sleep can promote further stress and impaired wound healing.
T15 744473-744581 Sentence denotes The use of glucocorticosteroids and antiprostaglandins in shock therapy remains a topic of wide controversy.
T16 744582-744917 Sentence denotes Although the use of these agents potentially may stabilize membranes, decrease the absorption of endotoxin, and decrease prostaglandin release, the routine use of glucocorticosteroids and antiprostaglandins can decrease renal perfusion and gastrointestinal blood flow, promoting gastrointestinal ulceration and impaired renal function.
T17 744918-745121 Sentence denotes The administration of supraphysiologic levels of glucocorticosteroids in patients in any type of shock can increase sodium and water retention, depress cellular immune function, and impair wound healing.
T18 745122-745279 Sentence denotes In clinical studies of small animal patients, the routine use of glucocorticosteroids and antiprostaglandins has not demonstrated definite improved survival.
T19 745280-745474 Sentence denotes The risks of therapy do outweigh the anecdotal reported benefits, and therefore the empiric use of glucocorticosteroids and antiprostaglandins in any shock patient is absolutely contraindicated.
T20 745475-745658 Sentence denotes The administration of glucocorticosteroids to patients with cardiac disease has been shown to promote sodium and water retention and can actually predispose to the development of CHF.
T21 745659-745954 Sentence denotes Systemic thromboembolism is most commonly recognized in cats with cardiomyopathies (hypertrophic, restrictive, unclassified, and dilatative) but can also occur in dogs with hyperadrenocorticism, DIC, SIRS, protein-losing enteropathy and nephropathy, and tumors affecting the aorta and vena cava.
T22 745955-746151 Sentence denotes Thrombosis occurs through a complex series of mechanisms when the components of Virchow's triad (hypercoagulable state, sluggish blood flow, and vascular endothelial injury or damage) are present.
T23 746152-746286 Sentence denotes In cats, blood flow through a severely stretched left atrium is a predisposing factor to the development of clots and thromboembolism.
T24 746287-746487 Sentence denotes The most common site of embolism is the aortic bifurcation, or "saddle thrombus. " Other, less common locations of thromboembolism include the forelimbs, kidneys, gastrointestinal tract, and cerebrum.
T25 746488-746818 Sentence denotes Diagnosis usually is made based on clinical signs of cool extremities, the presence of a cardiac murmur or gallop rhythm, auscultation of pulmonary crackles resulting from pulmonary edema, acute pain or paralysis of one or more peripheral extremities, respiratory distress, and pain and lack of a palpable pulse in affected limbs.
T26 746819-746921 Sentence denotes The affected nail beds and paw pads are cyanotic, and nails do not bleed when cut with a nail clipper.
T27 746922-747043 Sentence denotes Client education is one of the most important aspects of emergency management of the patient with thromboembolic disease.
T28 747044-747118 Sentence denotes Concurrent CHF occurs in 40% to 60% of cats with arterial thromboembolism.
T29 747119-747344 Sentence denotes More than 70% of cats are euthanized during the initial thromboembolic event because of the poor long-term prognosis and the high risk of recurrence within days to months after the initial event, even with aggressive therapy.
T30 747345-747519 Sentence denotes Although the long-term prognosis varies from 2 months to 2 years after initial diagnosis and treatment, in the majority of cats thromboembolic disease recurs within 9 months.
T31 747520-747618 Sentence denotes Rectal temperature hypothermia and bradycardia on presentation are negative prognostic indicators.
T32 747619-747787 Sentence denotes Immediate treatment of a patient with CHF and thromboembolic disease involves management of the CHF with furosemide, oxygen, and vasodilators (morphine, nitroprusside).
T33 747788-747909 Sentence denotes Additional management includes analgesia (butorphanol, 0.1 to 0.4 mg/kg IV, IM) and prevention of further clot formation.
T34 747910-747987 Sentence denotes Aspirin (10 mg/kg PO q48h) is beneficial because of its antiplatelet effects.
T35 747988-748165 Sentence denotes Heparin works in conjunction with AT to prevent further clot formation (500 units/kg IV, followed by 250 to 300 units/kg SQ q8h in cats, and 100 to 200 units/kg SQ q8h in dogs).
T36 748166-748303 Sentence denotes Acepromazine can cause peripheral vasodilation and decreased afterload but also can promote hypotension in a patient with concurrent CHF.
T37 748304-748380 Sentence denotes Acepromazine (0.05 mg/kg SQ) should be used with extreme caution, if at all.
T38 748381-748563 Sentence denotes The use of thrombolytic therapies (streptokinase, t-PA, urokinase), has been shown to not improve outcome, and may increase the risk of hemorrhage, reperfusion injury, and mortality.
T39 748564-748633 Sentence denotes For these reasons, the use of thrombolytic agents is not recommended.
T40 748634-748707 Sentence denotes In cats, the primary cause of arterial thromboembolism is cardiomyopathy.
T41 748708-748894 Sentence denotes Once an animal's condition is determined to be stable enough to allow diagnostic procedures, lateral and dorsoventral (DV) thoracic radiographs and an echocardiogram should be performed.
T42 748895-749041 Sentence denotes Ultrasound of the distal aorta and renal arteries should also be performed to determine the location of the clot and help establish the prognosis.
T43 749042-749541 Sentence denotes Other diagnostic procedures to evaluate the presence and cause of thromboembolism include a complete blood count, serum biochemistry profile, urinalysis (to rule out protein-losing nephropathy), urine protein:creatinine ratio, AT levels, ACTH stimulation test (to rule out hyperadrenocorticism), heartworm antigen test (in dogs), thyroid profile (to rule out hyperthyroidism in cats and hypothyroidism in dogs), thoracic radiographs, arterial blood gas analyses, coagulation tests, and Coombs' test.
T44 749542-749651 Sentence denotes Selective and nonselective angiography can also be performed to determine the exact location of the thrombus.
T45 749652-749784 Sentence denotes Long-term management of thromboembolism involves management of the underlying disease process and preventing further clot formation.
T46 749785-749944 Sentence denotes Most recently, the use of clopidogrel (Plavix, 3 to 5 mg/kg PO q24h [dog]; 18.75 to 37.5 mg PO q24h [cat]) has been recommended to help prevent clot formation.
T47 749945-750052 Sentence denotes In the past the combination of heparin then warfarin was used; however, it was often difficult to regulate.
T48 750053-750204 Sentence denotes This form of therapy involves first beginning heparin until the APTT becomes prolonged 1.5 times; then administering warfarin (0.06 to 0.09 mg/kg/day).
T49 750205-750322 Sentence denotes Monitoring therapy based on prothrombin time and the international normalized ratio (INR, 2.0 to 4.0) is recommended.
T50 750323-750423 Sentence denotes Low-dose aspirin 0.5 mg/kg PO q12-24h (canine), 25 mg/kg q56-84h (feline) also has been recommended.
T51 750424-750585 Sentence denotes Physical therapy with warm water bathing, deep muscle massage, and passive range-ofmotion exercises should be performed until the patient regains motor function.
T52 750586-750698 Sentence denotes Future therapy may involve the use of platelet receptor antagonists to prevent platelet activation and adhesion.
T53 750699-750775 Sentence denotes AzoTemiA Azotemia occurs when 75% or more of the nephrons are nonfunctional.
T54 750776-751017 Sentence denotes The magnitude of the azotemia alone cannot be used to determine whether the azotemia is prerenal, renal, or postrenal in origin or whether the disease process is acute or chronic, reversible or irreversible, or progressive or nonprogressive.
T55 751018-751115 Sentence denotes Before treatment for azotemia is begun, the location or cause of the azotemia must be identified.
T56 751116-751180 Sentence denotes Take a thorough history and then perform a physical examination.
T57 751181-751301 Sentence denotes Obtain blood and urine samples before initiating fluid therapy, for accurate assessment of the location of the azotemia.
T58 751302-751543 Sentence denotes For example, an azotemic animal with a history of vomiting and diarrhea that appears clinically dehydrated on physical examination should normally have a concentrated urine specific gravity (>1.045), reflecting the attempt to conserve fluid.
T59 751544-751679 Sentence denotes If this level is found, the azotemia is much less likely to be renal in origin, and the azotemia will likely resolve after rehydration.
T60 751680-751871 Sentence denotes If, however, the urine specific gravity is isosthenuric or hyposthenuric (1.007 to 1.015) in the presence of azotemia and dehydration, primary intrinsic renal insufficiency is likely present.
T61 751872-751968 Sentence denotes If the azotemia resolves with fluid therapy, the patient has prerenal and primary renal disease.
T62 751969-752072 Sentence denotes If the azotemia does not resolve after rehydration, the patient has prerenal and primary renal failure.
T63 752073-752290 Sentence denotes Dogs with hypoadrenocorticism can have both prerenal and primary renal disease secondary to the lack of mineralocorticoid (aldosterone) influence on the renal collecting duct and renal interstitial medullary gradient.
T64 752291-752405 Sentence denotes Medullary washout can occur, causing isosthenuric urine in the presence of dehydration from vomiting and diarrhea.
T65 752406-752536 Sentence denotes The patient often has azotemia from fluid loss (dehydration and urinary loss) and gastric or intestinal hemorrhage (elevated BUN).
T66 752537-752807 Sentence denotes The prerenal component will resolve with treatment with glucocorticoids and crystalloid fluids, but the renal component may take several weeks to resolve, until the medullary concentration gradient is reestablished with the treatment and influence of mineralocorticoids.
T67 752808-753003 Sentence denotes Drugs such as corticosteroids and diuretics can influence renal tubular uptake and excretion of fluid and cause a prerenal azotemia and isosthenuric urine in the absence of primary renal disease.
T68 753004-753174 Sentence denotes Treatment of azotemia includes calculation of the patient's dehydration estimate and maintenance fluid volumes, and administering that volume over the course of 24 hours.
T69 753175-753261 Sentence denotes Identify and treat underlying causes of prerenal azotemia (shock, vomiting, diarrhea).
T70 753262-753291 Sentence denotes Monitor urine output closely.
T71 753292-753374 Sentence denotes Once a patient is euvolemic, oliguria is defined as urine output <1 to 2 mL/kg/hr.
T72 753375-753469 Sentence denotes Urine output should return to normal in patients with prerenal azotemia as rehydration occurs.
T73 753470-753722 Sentence denotes If a patient remains oliguric after rehydration, consider the possibility of oliguric acute intrinsic renal failure, and administer additional fluid therapy based on the patient's urine output, body weight, CVP, and response to other medical therapies.
T74 753723-753946 Sentence denotes PrerenAl AzoTemiA Prerenal azotemia is caused by conditions that decrease renal perfusion, including hypovolemic shock, severe dehydration, hypoadrenocorticism, CHF, cardiac tamponade, cardiac dysrhythmias, and hypotension.
T75 753947-754020 Sentence denotes Once renal perfusion is restored, the kidneys can resume normal function.
T76 754021-754135 Sentence denotes GFR decreases when the mean arterial BP falls to less than 80 mm Hg in a patient with normal renal autoregulation.
T77 754136-754190 Sentence denotes Renal autoregulation can be impaired in some diseases.
T78 754191-754361 Sentence denotes Passive reabsorption of urea from the renal tubules can occur during states of low tubular flow (dehydration, hypotension) even if glomerular filtration is not decreased.
T79 754362-754492 Sentence denotes If renal hypoperfusion is not quickly restored, the condition can progress from prerenal disease to acute intrinsic renal failure.
T80 754493-754657 Sentence denotes Prerenal and renal azotemia can coexist in animals with primary renal disease, as a result of vomiting and ongoing polyuria in the absence of any oral fluid intake.
T81 754658-754826 Sentence denotes The treatment of prerenal azotemia consists of rehydration, antiemetic therapy, and treatment of the underlying cause of vomiting, diarrhea, or third spacing of fluids.
T82 754827-755001 Sentence denotes Acute intrinsic renal failure is characterized by an abrupt decline in renal function to the extent that azotemia and an inability to regulate solute and fluid balance occur.
T83 755002-755125 Sentence denotes Patients with acute intrinsic renal failure may be oliguric or polyuric, depending on the cause and state of renal failure.
T84 755126-755230 Sentence denotes In small animals, the most common causes of acute intrinsic renal failure are renal ischemia and toxins.
T85 755231-755325 Sentence denotes There are three phases of acute intrinsic renal failure: induction, maintenance, and recovery.
T86 755326-755541 Sentence denotes During the induction phase, some insult (ischemia or toxin) to the kidneys occurs, leading to a defective concentrating mechanism, decreased renal clearance of nitrogenous waste (azotemia), and polyuria or oliguria.
T87 755542-755660 Sentence denotes If treatment is initiated during the induction phase, progression to the maintenance phase potentially can be stopped.
T88 755661-755763 Sentence denotes As the induction phase progresses, there is worsening of the urine-concentrating ability and azotemia.
T89 755764-755868 Sentence denotes Renal tubular epithelial cells and renal tubular casts can be seen on examination of the urine sediment.
T90 755869-755895 Sentence denotes Glucosuria may be present.
T91 755896-756013 Sentence denotes The maintenance phase of acute intrinsic renal failure occurs after a critical amount of irreversible nephron injury.
T92 756014-756124 Sentence denotes Correction of the azotemia and removal of the cause of the problem do not result in return to normal function.
T93 756125-756237 Sentence denotes In patients with oliguria, the extent of nephron damage is greater than that observed in patients with polyuria.
T94 756238-756297 Sentence denotes The maintenance phase may last for several weeks to months.
T95 756298-756381 Sentence denotes Recovery of renal function may or may not occur, depending on the extent of injury.
T96 756382-756485 Sentence denotes The most serious complications (overhydration and hyperkalemia) are observed in patients with oliguria.
T97 756486-756556 Sentence denotes The recovery phase occurs with sufficient healing of damaged nephrons.
T98 756557-756616 Sentence denotes Azotemia may resolve, but concentrating defects may remain.
T99 756617-756780 Sentence denotes If the patient was oliguric in the maintenance phase, a marked diuresis develops during the recovery phase that may be accompanied by fluid and electrolyte losses.
T100 756781-756821 Sentence denotes This phase may last for weeks to months.
T101 756822-756958 Sentence denotes Treatment of acute intrinsic renal failure consists of determining the cause and ruling out obstruction or uroabdomen whenever possible.
T102 756959-757080 Sentence denotes A careful history can sometimes determine whether there has been exposure to nephrotoxic drugs, chemicals, or food items.
T103 757081-757229 Sentence denotes If ingestion or exposure to a toxic drug, chemical, or food occurred recently (within 2 to 4 hours), induce emesis with apomorphine (0.04 mg/kg IV).
T104 757230-757340 Sentence denotes Next, administer activated charcoal either PO or via stomach tube, to prevent further absorption of the toxin.
T105 757341-757768 Sentence denotes Obtain blood and urine samples for toxicologic analysis (e.g., ethylene glycol) and to determine whether azotemia or abnormalities in the urine sediment exist. (See sections on ethylene glycol, grapes and raisins, and nonsteroidal antiinflammatory drugs.) Obtain a complete blood count, biochemical profile, and urinalysis to determine the presence of signs of chronic renal failure, including PU/PD and nonregenerative anemia.
T106 757769-757862 Sentence denotes Radiographs and abdominal ultrasound can help in determining the chronicity of renal failure.
T107 757863-757972 Sentence denotes Normal renal size is 2.5 to 3.5 times the length of L2 in dogs and 2.4 to 3.0 times the length of L2 in cats.
T108 757973-758051 Sentence denotes Monitor the patient's body weight at least twice a day to avoid overhydration.
T109 758052-758112 Sentence denotes Also monitor urine output; normal output is 1 to 2 mL/kg/hr.
T110 758113-758196 Sentence denotes In cases of polyuric renal failure, massive fluid and electrolyte losses can occur.
T111 758197-758283 Sentence denotes Place a urinary catheter for patient cleanliness and to facilitate urine quantitation.
T112 758284-758342 Sentence denotes Measure fluid ins and outs (see section on fluid therapy).
T113 758343-758505 Sentence denotes After the patient has been rehydrated, the amount of fluids administered should equal maintenance and insensible needs plus the volume of urine produced each day.
T114 758506-758680 Sentence denotes If a urinary catheter cannot be placed or maintained, serial body weight measurements and CVP should be used to monitor the patient's fluid balance and prevent overhydration.
T115 758681-758806 Sentence denotes If the patient is oliguric (urine output <1 to 2 mL/kg/hr), pharmacologic intervention is necessary to increase urine output.
T116 758807-758879 Sentence denotes First, administer furosemide (2 to 4 mg/kg IV or 0.66 mg/kg/ hr IV CRI).
T117 758880-758958 Sentence denotes Repeat bolus doses of furosemide if there is no response to initial treatment.
T118 758959-759086 Sentence denotes If necessary, administer low-dose dopamine (0.5-3 mcg/kg/min IV CRI) to increase renal afferent dilatation and renal perfusion.
T119 759087-759155 Sentence denotes Dopamine and furosemide may be synergistic if administered together.
T120 759156-759279 Sentence denotes If dopamine and furosemide therapy is ineffective, administer mannitol (0.25 to 0.5 g/ kg IV) over 15-20 minutes once only.
T121 759280-759430 Sentence denotes Diltiazem may be effective in inducing diuresis in oligoanuric patients with hypertension (0.1 to 0.5 mg/kg IV slowly, followed by 1 to 5 mcg/kg/min).
T122 759431-759527 Sentence denotes If polyuria is present, management is simplified because of the decreased risk of overhydration.
T123 759528-759767 Sentence denotes If oliguria cannot be reversed, monitor the central venous pressure, body weight, and respiratory rate and effort, auscultate for crackles, and examine the patient carefully for signs of chemosis and the presence of serous nasal discharge.
T124 759768-759942 Sentence denotes Correct hyperkalemia with sodium bicarbonate (0.25 to 1.0 mEq/kg IV) or with insulin (0.25 units/kg) plus dextrose (1 g/unit of insulin IV, followed by 2.5% dextrose IV CRI).
T125 759943-760022 Sentence denotes Treat severe metabolic acidosis (pH <7.2 or <12 mEq/L) with sodium bicarbonate.
T126 760023-760118 Sentence denotes If anuria develops or oliguria is irreversible despite this therapy, begin peritoneal dialysis.
T127 760119-760211 Sentence denotes Perform a renal biopsy to establish a diagnosis and prognosis (see section on renal biopsy).
T128 760212-760293 Sentence denotes Administer gastroprotectant drugs and antiemetics to control nausea and vomiting.
T129 760294-760365 Sentence denotes If possible, avoid the use of nephrotoxic drugs and general anesthesia.
T130 760366-760479 Sentence denotes Initiate nutritional support in the form of an enteral feeding tube or parenteral nutrition as early as possible.
T131 760480-760629 Sentence denotes Once the patient enters the recovery phase, diuresis may occur, which can lead to dehydration and electrolyte imbalances (hyponatremia, hypokalemia).
T132 760630-760738 Sentence denotes Dehydration and electrolyte imbalances can be treated with parenteral fluid and electrolyte supplementation.
T133 760739-760866 Sentence denotes Postrenal azotemia is primarily caused by urethral obstruction or leakage from the urinary tract into the abdomen (uroabdomen).
T134 760867-760980 Sentence denotes Complete urinary tract obstruction and uroabdomen are both ultimately fatal within 3 to 5 days if left untreated.
T135 760981-761112 Sentence denotes In dogs, the most common causes of urethral obstruction are urinary (urethral) calculi or tumors of the urinary bladder or urethra.
T136 761113-761300 Sentence denotes In male cats, feline urologic syndrome (FUS) is the most common cause of urethral obstruction, although there has been an increased incidence of urethral calculi observed in recent years.
T137 761301-761408 Sentence denotes A ruptured urinary bladder is the most common cause of uroabdomen and is usually secondary to blunt trauma.
T138 761409-761583 Sentence denotes Clinical signs of urinary tract obstruction include dysuria, hematuria, inability to urinate or initiate an adequate stream of urine, and a distended painful urinary bladder.
T139 761584-761755 Sentence denotes Late in the course of obstructive disease, clinical signs referable to uremia and azotemia (vomiting, oral ulcers, hematemesis, dehydration, lethargy, and anorexia) occur.
T140 761756-761845 Sentence denotes The initial goal of treatment of urinary tract obstruction is to relieve the obstruction.
T141 761846-762018 Sentence denotes In male dogs a lubricated catheter can be inserted past the area of obstruction with the animal under heavy sedation or general anesthesia (see section on urohydropulsion).
T142 762019-762264 Sentence denotes Depending on the chronicity of the obstruction, serum electrolytes should be measured; an ECG should be obtained before any anesthetic drugs are administered, because of the cardiotoxic effects of hyperkalemia (see section on atrial standstill).
T143 762265-762321 Sentence denotes Correct fluid, electrolyte, and acid-base abnormalities.
T144 762322-762454 Sentence denotes If a urinary catheter cannot be placed, perform cystocentesis only as a last resort, because of the risk of urinary bladder rupture.
T145 762455-762569 Sentence denotes Definitive treatment includes identification and treatment of the underlying cause (tumor versus urinary calculi).
T146 762570-762620 Sentence denotes In most cases, surgical intervention is necessary.
T147 762621-762734 Sentence denotes If an unresectable tumor is present, a low-profile permanent cystostomy tube can be placed, if the owner desires.
T148 762735-762894 Sentence denotes Administration of piroxicam (Feldene, 0.3 mg/kg PO q24-48h) with or without chemotherapy may shrink the tumor mass and delay the progression of clinical signs.
T149 762895-763025 Sentence denotes A complete discussion of this disorder is beyond the scope of this text (see Additional Reading for other sources of information).
T150 763026-763119 Sentence denotes Feline lower urinary tract disease can cause urethral obstruction, particularly in male cats.
T151 763120-763228 Sentence denotes Clinical signs include stranguria, dribbling of small amounts of urine, lethargy, inappetence, and vomiting.
T152 763229-763364 Sentence denotes Often owners call with the primary complaint of constipation, because the cat is making frequent trips to the litter box and straining.
T153 763365-763490 Sentence denotes Cases with a duration of obstruction <36 hours are considered uncomplicated; those with a duration >36 hours are complicated.
T154 763491-763671 Sentence denotes Treatment of urethral obstruction includes stabilizing and normalizing the patient's electrolyte status, induction of sedation or general anesthesia, and relieving the obstruction.
T155 763672-763735 Sentence denotes Obtain blood samples for analysis of electrolyte abnormalities.
T156 763736-764008 Sentence denotes Treat hyperkalemia (K + >6.0 mEq/L) with sodium bicarbonate (0.25 to 1.0 mEq/kg IV), regular insulin (0.25 unit/ kg IV) plus dextrose (1 g/unit of insulin IV), followed by 2.5% dextrose IV CRI to prevent hypoglycemia; or calcium gluconate (0.5-1 ml/kg over 10-20 minutes).
T157 764009-764087 Sentence denotes Administer nonpotassium-containing intravenous fluids in 0.9% saline solution.
T158 764088-764169 Sentence denotes Obtain an ECG to assess for atrial standstill (see section on atrial standstill).
T159 764170-764235 Sentence denotes In some cases a urethral plug is visible at the tip of the penis.
T160 764236-764359 Sentence denotes The urethral plug can sometimes be manually extracted or massaged from the penis, and the obstruction temporarily relieved.
T161 764360-764479 Sentence denotes In such cases it is still necessary to pass a urethral catheter to flush sediment from the urethra and urinary bladder.
T162 764480-764652 Sentence denotes Unless a patient is obtunded, administer an anesthetic such as ketamine, atropine, or propofol (4 to 7 mg/kg IV) with diazepam IV for patient comfort and muscle relaxation.
T163 764653-764754 Sentence denotes Once the patient is under anesthesia or heavily sedated, urinary catheterization should be performed.
T164 764755-764815 Sentence denotes In some cases, it will be difficult to advance the catheter.
T165 764816-764897 Sentence denotes Lubricate a closedended Tomcat catheter and pass the tip into the distal urethra.
T166 764898-765012 Sentence denotes Fill a 12-mL syringe with sterile saline and sterile lubricant and connect the syringe to the hub of the catheter.
T167 765013-765131 Sentence denotes Pulse the fluid into the catheter as you gently move the catheter tip back and forth against the urethral obstruction.
T168 765132-765229 Sentence denotes When the catheter has been passed into the urinary bladder, obtain a urine sample for urinalysis.
T169 765230-765324 Sentence denotes Drain the bladder and flush with sterile saline solution until the urine efflux appears clear.
T170 765325-765479 Sentence denotes Remove the Tomcat catheter and insert a 3F to 5F red rubber tube or Argyle infant feeding catheter into the urethra for urine collection and quantitation.
T171 765480-765641 Sentence denotes Secure the urinary catheter to prepuce with a butterfly strip of 1-inch adhesive tape secured around the catheter and then sutured to either side of the prepuce.
T172 765642-765785 Sentence denotes The catheter should be connected to a closed urinary collection system for cleanliness and to reduce the risk of ascending bacterial infection.
T173 765786-765900 Sentence denotes An Elizabethan collar should be placed at all times to prevent the patient from damaging or removing the catheter.
T174 765901-766042 Sentence denotes When the urethral obstruction has been relieved and the catheter placed, continue intravenous fluid diuresis to alleviate postrenal azotemia.
T175 766043-766093 Sentence denotes Monitor the urine for bacteria and other sediment.
T176 766094-766148 Sentence denotes In some cases, postobstructive diuresis can be severe.
T177 766149-766256 Sentence denotes Carefully monitor fluid ins and outs, along with body weight, to maintain adequate hydration and perfusion.
T178 766257-766314 Sentence denotes The urinary catheter can be removed after 24 to 48 hours.
T179 766315-766440 Sentence denotes Palpate the bladder frequently to make sure that the patient is voiding normally and to detect the recurrence of obstruction.
T180 766441-766591 Sentence denotes In patients with severe penile or urethral trauma or edema, administer a short-acting steroid (dexamethasone sodium phosphate, 0.25 mg/kg IV, IM, SQ).
T181 766592-766825 Sentence denotes At the time of initial diagnosis and again at the time of discharge, clients need to be instructed about the longterm management of feline lower urinary tract disease at home, and informed of the risks and consequences of recurrence.
T182 766826-766915 Sentence denotes Uroabdomen can occur from trauma or leakage from the kidneys, ureter, or urinary bladder.
T183 766916-767086 Sentence denotes Clinical signs of uroabdomen (azotemia, uremia, hyperkalemia) can also occur secondary to third spacing of urine and leakage into muscular tissue from a ruptured urethra.
T184 767087-767167 Sentence denotes In most cases, urinary bladder trauma and rupture are secondary to blunt trauma.
T185 767168-767373 Sentence denotes Abdominocentesis should be performed in any animal with suspected blunt abdominal trauma, and any fluid obtained should be analyzed for creatinine or potassium and compared with the patient's serum levels.
T186 767374-767539 Sentence denotes An abdominal effusion that has a low PCV and a potassium or creatinine level greater than that of the patient's serum is consistent with the diagnosis of uroabdomen.
T187 767540-767579 Sentence denotes Uroabdomen is not a surgical emergency.
T188 767580-767748 Sentence denotes However, medical management consists of placement of a temporary abdominal drainage catheter into the abdomen to facilitate removal of urine from the peritoneal cavity.
T189 767749-767890 Sentence denotes To place the catheter, position the patient in dorsal or lateral recumbency and shave the ventral abdomen, as for any exploratory laparotomy.
T190 767891-768185 Sentence denotes Aseptically scrub the clipped area, and instill a local anesthetic (lidocaine, 1 to 2 mg/kg) caudal and to the right of the umbilicus, through the skin, subcutaneous tissues, and rectus abdominus muscles, inserting the lidocaine as you pull the needle out, thus creating an anesthetized tunnel.
T191 768186-768305 Sentence denotes Aseptically scrub the area again and drape with sterile field towels; then make a small stab incision through the skin.
T192 768306-768400 Sentence denotes Bluntly dissect through the subcutaneous tissue to the level of the external rectus abdominis.
T193 768401-768499 Sentence denotes Pick up the muscle with a thumb forceps, and make a small stab incision into the abdominal cavity.
T194 768500-768673 Sentence denotes Cut multiple holes in the side of a 14F to 16F red rubber tube or thoracic drainage catheter, using care not to make the cut wider than 50% of the circumference of the tube.
T195 768674-768749 Sentence denotes Insert the catheter into the abdominal cavity in a dorsal caudal direction.
T196 768750-768831 Sentence denotes Make sure that all holes in the catheter are located within the abdominal cavity.
T197 768832-768972 Sentence denotes Secure the tube by placing a purse-string suture around the tube entrance site in the abdominal musculature with absorbable suture material.
T198 768973-769045 Sentence denotes Close the dead space in the subcutaneous tissues with absorbable suture.
T199 769046-769148 Sentence denotes Close the skin around the tube with another purse-string suture secured using a finger-trap technique.
T200 769149-769244 Sentence denotes Connect the tube to a closed urinary collection system and bandage the catheter to the abdomen.
T201 769245-769410 Sentence denotes The tube can remain in place until the patient's cardiorespiratory status is stabilized enough to allow anesthesia and definitive repair of the urinary tract defect.