Epistemic_Statements  

CORD-19:dc97e1de3b69da13f534f15afdcedbf48064c69d JSONTXT 8 Projects

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Id Subject Object Predicate Lexical cue
T1 16-41 Epistemic_statement denotes Is there a patent airway?
T2 146-177 Epistemic_statement denotes If possible, extend the tongue.
T3 314-407 Epistemic_statement denotes If there is no evidence of breathing or the gum color is blue, begin mouth-to-nose breathing.
T4 529-567 Epistemic_statement denotes Is there evidence of cardiac function?
T5 763-787 Epistemic_statement denotes Is there any hemorrhage?
T6 967-1030 Epistemic_statement denotes Do not use a tourniquet, because this can cause further damage.
T7 1560-1708 Epistemic_statement 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.
T8 1931-2001 Epistemic_statement denotes If the animal is breathing, what are the respiratory rate and pattern?
T9 2472-2550 Epistemic_statement denotes Is there evidence of expiratory distress with an abdominal push on exhalation?
T10 3457-3664 Epistemic_statement 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?
T11 3937-4156 Epistemic_statement 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.
T12 4157-4296 Epistemic_statement denotes Survey radiographs may reveal pneumothorax, pulmonary contusions, diaphragmatic hernia, pleural or abdominal effusion, or pneumoperitoneum.
T13 5263-5367 Epistemic_statement denotes The examinations take only small amounts of time and can reveal whether ongoing fluid loss is occurring.
T14 6453-6608 Epistemic_statement 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.
T15 6782-6892 Epistemic_statement denotes Avoid changing positions with needles in place because iatrogenic puncture of intraabdominal organs may occur.
T16 7164-7316 Epistemic_statement 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.
T17 7729-7898 Epistemic_statement 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.
T18 8055-8235 Epistemic_statement 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.
T19 8236-8328 Epistemic_statement denotes Topical ointments may be applied (silver sulfadiazine, chlorhexidine ointment) if necessary.
T20 8329-8539 Epistemic_statement 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) .
T21 8746-8831 Epistemic_statement denotes Next, apply strips of adhesive tape to the patient's paw on either side, if possible.
T22 8992-9101 Epistemic_statement denotes Turn the adhesive strips around so that the adhesive layer can be secured to the intermediary layer in place.
T23 9498-9649 Epistemic_statement 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.
T24 9650-9765 Epistemic_statement denotes Finally, delivery of medications into the wound can occur to promote the development of healthy granulation tissue.
T25 10300-10427 Epistemic_statement denotes Granulation tissue can grow through gauze mesh or adhere to foam sponges and can be ripped away at the time of bandage removal.
T26 10428-10494 Epistemic_statement denotes Hemorrhage and disruption of the granulation tissue bed can occur.
T27 10495-10606 Epistemic_statement denotes Later in the repair process, granulation tissue can exude sanguineous drainage and have some epithelialization.
T28 10647-10759 Epistemic_statement denotes The contact layer should be some form of nonadherent dressing, foam sponge, hydrogel, or hydrocolloid substance.
T29 10760-10859 Epistemic_statement denotes The intermediate layer and outer layers should be absorbent material and porous tape, respectively.
T30 10860-10942 Epistemic_statement denotes With nonadherent dressings, wounds with viscous exudates may not be absorbed well.
T31 10943-11040 Epistemic_statement denotes This may be advantageous and enhance epithelialization, provided that complications do not occur.
T32 11041-11171 Epistemic_statement denotes Infection, exuberant granulation tissue, or adherence of absorbent materials to the wound may occur and delay the healing process.
T33 11645-11861 Epistemic_statement 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.
T34 13237-13335 Epistemic_statement denotes Foam dressings also can be applied to exudative wounds after a healthy granulation bed has formed.
T35 14376-14473 Epistemic_statement denotes The sugar can be eliminated from the bandaging process once a healthy granulation bed is present.
T36 14474-14801 Epistemic_statement 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.
T37 15413-15497 Epistemic_statement denotes This method prevents excessive pressure and potential impairment of venous drainage.
T38 15498-15680 Epistemic_statement 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.
T39 16165-16428 Epistemic_statement 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.
T40 16429-16603 Epistemic_statement 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.
T41 16604-16839 Epistemic_statement 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.
T42 16966-17233 Epistemic_statement 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.
T43 17234-17389 Epistemic_statement denotes Minor Hemorrhage Some wounds such as lacerations have minor bleeding or hemorrhage that require an immediate bandage until definitive care can be provided.
T44 17612-17816 Epistemic_statement 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.
T45 17817-17910 Epistemic_statement denotes The pressure bandage serves to control hemorrhage but should not be left on for long periods.
T46 17911-18030 Epistemic_statement denotes Pressure bandages that have been left on for too long can impair nerve function and lead to tissue necrosis and slough.
T47 18031-18140 Epistemic_statement denotes Therefore pressure bandages should be used in the hospital only, so that the patient can be observed closely.
T48 18141-18265 Epistemic_statement denotes If hemorrhage through the bandage occurs, place another bandage over the first until the wound can be repaired definitively.
T49 18266-18379 Epistemic_statement denotes Removal of the first bandage will only disrupt any clot that has formed and cause additional hemorrhage to occur.
T50 18525-18621 Epistemic_statement denotes As with all bandages, a contact layer, an intermediate layer, and an outer layer should be used.
T51 18692-18803 Epistemic_statement denotes The intermediate layer should be thick absorbent material, followed by a top layer of elastic bandage material.
T52 18804-19223 Epistemic_statement 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.
T53 19224-19348 Epistemic_statement denotes The bandage should be smooth with consecutive layers of even pressure on the limb, starting distally and working proximally.
T54 19349-19530 Epistemic_statement 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.
T55 19651-19787 Epistemic_statement 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.
T56 19788-19971 Epistemic_statement 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.
T57 19972-20067 Epistemic_statement denotes An external pin splint is required when fractures or luxations are associated with open wounds.
T58 20068-20206 Epistemic_statement 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.
T59 20511-20677 Epistemic_statement 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.
T60 20678-20757 Epistemic_statement denotes If the toes spread, spreading of the footpad can delay or impair wound healing.
T61 22320-22478 Epistemic_statement 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.
T62 25892-26104 Epistemic_statement 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.
T63 28171-28328 Epistemic_statement 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.
T64 28800-28968 Epistemic_statement 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.
T65 29041-29233 Epistemic_statement 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.
T66 29325-29609 Epistemic_statement 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.
T67 29719-29883 Epistemic_statement 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.
T68 30137-30354 Epistemic_statement 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.
T69 30671-30812 Epistemic_statement 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.
T70 30813-30986 Epistemic_statement 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.
T71 31394-31505 Epistemic_statement denotes Donor animals can be used as needed or can have scheduled collections to replenish the stock of blood products.
T72 31506-31682 Epistemic_statement 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) .
T73 31683-31865 Epistemic_statement 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.
T74 31866-32019 Epistemic_statement denotes Canine donors also should be screened initially for Lyme disease, Babesia, Rocky Mountain spotted fever (Rickettsia rickettsii), Ehrlichia, and Brucella.
T75 32159-32321 Epistemic_statement 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.
T76 32322-32418 Epistemic_statement denotes A healthy donor safely can donate 10 to 20 mL/kg of whole blood every 3 to 4 weeks if necessary.
T77 32419-32538 Epistemic_statement denotes Feline blood donors ideally should weigh more than 8 lb, be 1 to 8 years of age, and have never received a transfusion.
T78 32539-32604 Epistemic_statement denotes In addition, donor cats should be screened for feline 1 obtained.
T79 32605-32795 Epistemic_statement 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.
T80 32796-32891 Epistemic_statement denotes No more than 11 to 15 mL/kg should be obtained at any given time from a feline donor (Box 1-5).
T81 32995-33069 Epistemic_statement denotes Take a stepwise approach for every patient that may require a transfusion.
T82 33070-33146 Epistemic_statement denotes If a patient is at risk for blood loss or is anemic, consider a transfusion.
T83 33666-33745 Epistemic_statement denotes Use a separate pipette for each transfer because cross-contamination can occur.
T84 34987-35071 Epistemic_statement denotes Score agglutination with the following scoring scale: 4+ One solid clump of cells 3+
T85 35072-35104 Epistemic_statement denotes Several large clumps of cells 2+
T86 35105-35160 Epistemic_statement denotes Medium-sized clumps of cells with a clear background 1+
T87 35161-35324 Epistemic_statement 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.
T88 35437-35589 Epistemic_statement denotes Exercise caution when administering larger volumes to small patients or those with cardiac insufficiency, because volume overload potentially can occur.
T89 35590-35722 Epistemic_statement denotes If RBC products are to be administered, at minimum a blood typing procedure should be performed before type-specific blood is given.
T90 35899-36081 Epistemic_statement 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.
T91 36082-36218 Epistemic_statement denotes A common misconception is that administration of whole blood or packed RBCs should occur when patient PCV decreases to a certain number.
T92 36646-36772 Epistemic_statement denotes Fresh whole blood and platelet-rich plasma also can be administered in cases of severe thrombocytopenia and thrombocytopathia.
T93 36773-36852 Epistemic_statement denotes Stored whole blood and packed RBCs can be administered in patients with anemia.
T94 37006-37014 Epistemic_statement denotes Consider
T95 37015-37929 Epistemic_statement 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)
T96 37930-38368 Epistemic_statement 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)
T97 38369-38619 Epistemic_statement 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.
T98 39119-39264 Epistemic_statement denotes Frozen plasma also will suffice in cases of severe hypoproteinemia, warfarin-like compound intoxication, and factor IX deficiency (hemophilia B).
T99 39265-39524 Epistemic_statement 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.
T100 39582-39643 Epistemic_statement denotes Whenever possible, type-specific RBCs should be administered.
T101 39857-40039 Epistemic_statement 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.
T102 40040-40351 Epistemic_statement 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.
T103 40352-40530 Epistemic_statement 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.
T104 40599-40691 Epistemic_statement denotes Blood products should be warmed slowly to 37° C before they are administered to the patient.
T105 40833-40945 Epistemic_statement denotes RBC and plasma products should be administered in a blood administration set containing a 170-μm in-line filter.
T106 40946-41060 Epistemic_statement denotes Smaller in-line filters (20 μm) also can be used in cases in which extremely small volumes are to be administered.
T107 41061-41215 Epistemic_statement 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.
T108 41216-41437 Epistemic_statement 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.
T109 41834-41994 Epistemic_statement 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.
T110 41995-42100 Epistemic_statement 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.
T111 42256-42418 Epistemic_statement 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.
T112 42490-42597 Epistemic_statement denotes In general, plasma transfusion should not exceed 22 mL/kg during a 24-hour period for normovolemic animals.
T113 42925-43017 Epistemic_statement denotes The average rate of plasma infusion in a normovolemic patient should not exceed 22 mL/kg/hr.
T114 43018-43100 Epistemic_statement denotes In acute need situations, plasma can be delivered at rates up to 5 to 6 mL/kg/min.
T115 43224-43421 Epistemic_statement 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.
T116 43667-43812 Epistemic_statement 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.
T117 44933-45087 Epistemic_statement denotes Use of Cryoprecipitate Plasma cryoprecipitate can be purchased or manufactured through the partial thawing and then centrifugation of fresh frozen plasma.
T118 45088-45274 Epistemic_statement 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).
T119 45541-45748 Epistemic_statement 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.
T120 45749-45845 Epistemic_statement denotes In dogs, blood and plasma transfusions can be administered intravenously (IV) or intraosseously.
T121 46193-46292 Epistemic_statement denotes Blood can be administered at variable rates, but the routine figure of 4 to 5 mL/min often is used.
T122 46293-46348 Epistemic_statement denotes Normovolemic animals can receive blood at 22 mL/kg/day.
T123 46451-46661 Epistemic_statement denotes To calculate the approximate volume of blood needed to raise hematocrit levels, use the following formula for the dog: Surgical emergencies and shock may require several times this volume within a short period.
T124 46916-47109 Epistemic_statement 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.
T125 47236-47380 Epistemic_statement denotes In addition, any subsequent mismatched transfusions may cause an immediate reaction (usually mild) and rapid destruction of the transfused RBCs.
T126 47549-47671 Epistemic_statement denotes Incompatible blood transfusions to breeding females can result in isoimmunization and in hemolytic disease in the puppies.
T127 47672-47870 Epistemic_statement 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.
T128 47992-48104 Epistemic_statement denotes The stress of restraint and handling can push these critically ill patients over the edge and cause them to die.
T129 48176-48239 Epistemic_statement denotes The critically ill cat should be cradled in a towel or blanket.
T130 48240-48428 Epistemic_statement 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.
T131 48429-48513 Epistemic_statement denotes Blood can be administered by way of the cephalic, medial saphenous, or jugular vein.
T132 48514-48598 Epistemic_statement denotes Intramedullary infusion is also possible, if vascular access cannot be accomplished.
T133 48767-48867 Epistemic_statement denotes The following formula can be used to estimate the volume of blood required for transfusion in a cat:
T134 48868-48985 Epistemic_statement denotes Anticoagulated blood volume (mL) PCV desired PCV of recipient Body mass (kg) 70 PCV of donor in anticoagulant − = × ×
T135 48986-49100 Epistemic_statement denotes The exact overall incidence and clinical significance of transfusion reactions in veterinary medicine are unknown.
T136 49101-49207 Epistemic_statement denotes Several studies have been performed that document the incidence of transfusion reactions in dogs and cats.
T137 49303-49443 Epistemic_statement denotes Transfusion reactions can be immune-mediated and non-immune-mediated and can happen immediately or can be delayed until after a transfusion.
T138 49444-49598 Epistemic_statement 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.
T139 50243-50451 Epistemic_statement 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.
T140 50452-50632 Epistemic_statement 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.
T141 50633-50745 Epistemic_statement denotes A general guideline for patient monitoring is first to start the transfusion slowly during the first 15 minutes.
T142 51311-51457 Epistemic_statement denotes Other clinical signs of a transfusion reaction may include tachycardia, tremors, collapse, dyspnea, weakness, hypotension, collapse, and seizures.
T143 51458-51630 Epistemic_statement denotes Severe intravascular hemolytic reactions may occur within minutes of the start of the transfusion, causing hemoglobinemia, hemoglobinuria, DIC, and clinical signs of shock.
T144 51631-51743 Epistemic_statement denotes Extravascular hemolytic reactions typically occur later and will result in hyperbilirubinemia and bilirubinuria.
T145 51744-51988 Epistemic_statement 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.
T146 52341-52470 Epistemic_statement denotes In most cases discontinuation of the transfusion and administration of drugs to stop the hypersensitivity reaction will be suffi-
T147 52471-52723 Epistemic_statement 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.
T148 52724-52907 Epistemic_statement 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.
T149 53471-53608 Epistemic_statement 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.
T150 53609-53786 Epistemic_statement 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).
T151 56177-56258 Epistemic_statement denotes Values less than 0 cm H 2 O are associated with absolute or relative hypovolemia.
T152 56259-56395 Epistemic_statement 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.
T153 56396-56521 Epistemic_statement denotes Values greater than 15 cm H 2 O may be correlated with congestive heart failure (CHF) and the development of pulmonary edema.
T154 57057-57208 Epistemic_statement denotes • Two lengths of intravenous extension tubing • Three-way stopcock • Heparinized 0.9% saline solution • 20-mL syringe • Manometer or ruler (centimeter)
T155 57209-57360 Epistemic_statement denotes The diagnosis of intracellular fluid deficit is difficult and is based more on the presence of hypernatremia or hyperosmolality than on clinical signs.
T156 57361-57517 Epistemic_statement 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.
T157 57518-57778 Epistemic_statement 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) .
T158 58080-58253 Epistemic_statement 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.
T159 58870-58945 Epistemic_statement denotes Depending on the altitude, the Pco 2 in dogs can range from 32 to 44 mm Hg.
T160 59155-59262 Epistemic_statement denotes Ideally, obtain an arterial blood sample so that you can monitor the patient's oxygenation and ventilation.
T161 59335-59437 Epistemic_statement denotes Determine whether the blood sample is arterial or venous by looking at the oxygen saturation (Sao 2 ).
T162 59438-59575 Epistemic_statement 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.
T163 59685-59774 Epistemic_statement denotes If the pH is within the normal range, an acid-base disturbance may or may not be present.
T164 59863-60526 Epistemic_statement 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: 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.
T165 60653-60786 Epistemic_statement 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).
T166 61006-61067 Epistemic_statement denotes Vomiting of stomach contents Diuretic therapy Posthypercapnia
T167 61068-61418 Epistemic_statement 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.
T168 61419-61551 Epistemic_statement denotes † The metabolic acidosis early in renal failure may be hyperchloremic and later may convert to typical increased anion gap acidosis.
T169 61779-61979 Epistemic_statement denotes Ethylene glycol intoxication Salicylate intoxication Other rare intoxications (e.g., paraldehyde or methanol) Diabetic ketoacidosis* Uremic acidosis † Lactic acidosis normAl Anion gAP (hyPerChloremiC)
T170 61980-62290 Epistemic_statement 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.
T171 62627-62769 Epistemic_statement denotes Next, you must determine whether the disorders present are primary disorders or an expected compensation for disorders in the opposing system.
T172 62902-63002 Epistemic_statement denotes Use the chart in Table 1 -6 to evaluate whether the appropriate degree of compensation is occurring.
T173 63101-63196 Epistemic_statement denotes If the response falls outside the expected range, a mixed acid-base disorder is likely present.
T174 63200-63337 Epistemic_statement denotes Finally, you must determine whether the patient's acid-base disturbance is compatible with the history and physical examination findings.
T175 63338-63519 Epistemic_statement 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.
T176 64542-64757 Epistemic_statement 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.
T177 64907-64974 Epistemic_statement denotes Changes in serum potassium can affect cardiac conduction adversely.
T178 64975-65119 Epistemic_statement denotes Hyperkalemia lowers the resting membrane potential and makes cardiac cells, particularly those of the atria, more susceptible to depolarization.
T179 65120-65296 Epistemic_statement 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.
T180 65297-65425 Epistemic_statement denotes Further increases in serum potassium can be associated with bradycardia, ventricular fibrillation, and cardiac asystole (death).
T181 65983-66185 Epistemic_statement 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).
T182 66319-66423 Epistemic_statement denotes Treatment with a fluid that does not contain potassium (preferably 0.9% sodium chloride) is recommended.
T183 66424-66518 Epistemic_statement denotes Hypokalemia elevates the resting membrane potential and results in cellular hyperpolarization.
T184 66519-66662 Epistemic_statement denotes Hypokalemia may be associated with ventricular dysrhythmias, but the ECG changes are not as characteristic as those observed with hyperkalemia.
T185 66846-67025 Epistemic_statement 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.
T186 67289-67394 Epistemic_statement denotes Patients with moderate to severe metabolic acidosis may benefit from bicarbonate supplementation therapy.
T187 67555-67863 Epistemic_statement 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.
T188 68006-68096 Epistemic_statement denotes Bicarbonate concentration also can be artifactually decreased in patients with severe DKA.
T189 68097-68286 Epistemic_statement 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.
T190 68287-68421 Epistemic_statement denotes If the bicarbonate measurement of base deficit is known, the following formula can be used as a gauge for bicarbonate supplementation:
T191 68422-68635 Epistemic_statement 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:
T192 68636-68682 Epistemic_statement denotes mOsm / kg 2[(Na ) (K )] BUN / 2.8 Glucose / 18
T193 68683-68805 Epistemic_statement denotes where sodium and potassium are measured in milliequivalents, and BUN and glucose are measured in milligrams per deciliter.
T194 68908-68992 Epistemic_statement denotes The difference between the measured Box 1-10 differential diagnoses for hyPerkalemia
T195 68993-69166 Epistemic_statement 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)
T196 69167-69686 Epistemic_statement 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)*
T197 69687-70462 Epistemic_statement 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: Fluid, electrolyte, and acid-base disorders in small animal practice, St Louis, 2005, Elsevier.
T198 70463-70646 Epistemic_statement denotes *Likely to cause hyperkalemia only in conjunction with other contributing factors (e.g., other drugs, decreased renal function, or concurrent administration of potassium supplements).
T199 70693-70785 Epistemic_statement denotes 1 osmolality and the calculated osmolality (the osmolal gap) should be less than 10 mOsm/kg.
T200 70786-70912 Epistemic_statement denotes If the osmolal gap is greater than 20 mOsm/kg, consider the presence of unmeasured anions such as ethylene glycol metabolites.
T201 71261-71394 Epistemic_statement denotes Patients with hyponatremia or hypernatremia may have decreased, normal, or increased total body sodium content (Boxes 1-12 and 1-13).
T202 71558-71775 Epistemic_statement 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.
T203 71776-71968 Epistemic_statement 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.
T204 71969-72362 Epistemic_statement 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.
T205 72563-72664 Epistemic_statement denotes In almost all circumstances, an animal will correct its sodium balance with simple fluid restoration.
T206 72665-72977 Epistemic_statement denotes If severe hypernatremia exists that suggests a free water deficit, however, the free water deficit should be calculated from the following formula: 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).
T207 73098-73190 Epistemic_statement denotes The difference between these concentrations, Na + − (Cl − + ) has been called the anion gap.
T208 73191-73230 Epistemic_statement denotes The normal anion gap is 12 to 25 mEq/L.
T209 73231-73419 Epistemic_statement 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).
T210 73420-73535 Epistemic_statement denotes Abnormalities in the anion gap may be helpful in determining the cause of metabolic acidosis (Boxes 1-14 and 1-15).
T211 73536-73662 Epistemic_statement denotes The colloid oncotic pressure of blood is associated primarily with large-molecular-weight colloidal substances in circulation.
T212 73954-74134 Epistemic_statement 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.
T213 74205-74392 Epistemic_statement 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.
T214 74393-74559 Epistemic_statement 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.
T215 74560-74677 Epistemic_statement denotes Oncotic pressure can be restored with the use of artificial or synthetic colloids or natural colloids (see Colloids).
T216 74893-74993 Epistemic_statement denotes The patient's daily metabolic water (fluid) requirements can be calculated by the following formula:
T217 74994-75112 Epistemic_statement denotes Administration of an isotonic crystalloid fluid for maintenance requirements often can produce iatrogenic hypokalemia.
T218 75675-75820 Epistemic_statement denotes One milliliter of water weighs approximately 1 g. This fact allows calculation of the patient's fluid deficit, if ongoing losses can be measured.
T219 75821-75933 Epistemic_statement denotes When a patient is first presented, however, the body weight before a fluid deficit has occurred rarely is known.
T220 75934-76135 Epistemic_statement 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.
T221 76322-76496 Epistemic_statement 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.
T222 76497-76763 Epistemic_statement 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.
T223 76764-76955 Epistemic_statement denotes Note: 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.
T224 76956-77053 Epistemic_statement denotes 1 also can be treated with isotonic fluids with or without supplemental electrolytes and buffers.
T225 77234-77427 Epistemic_statement 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.
T226 77681-77838 Epistemic_statement 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.
T227 77839-77941 Epistemic_statement denotes Administration of a large volume of crystalloid fluids can cause dilutional anemia and coagulopathies.
T228 78787-78974 Epistemic_statement 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.
T229 78975-79177 Epistemic_statement 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.
T230 80283-80377 Epistemic_statement denotes Albumin levels less than 2.0 g/dL have been associated with increased morbidity and mortality.
T231 80378-80568 Epistemic_statement 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.
T232 80749-80855 Epistemic_statement denotes Recommended albumin infusion rates are 2 to 5 mL/kg over 4 hours, after pretreatment with diphenhydramine.
T233 81232-81353 Epistemic_statement denotes Extreme reactions, however, have not been reported in clinically hypoalbuminemic patients into which albumin was infused.
T234 81444-81522 Epistemic_statement denotes For these reasons, albumin therapy may be beneficial, but it is not innocuous.
T235 81523-81628 Epistemic_statement denotes The perceived benefit must outweigh the potential risk of acute and chronic reactions in canine patients.
T236 81840-81953 Epistemic_statement denotes Hetastarch can bind with vWF and cause prolongation of the ACT and APTT; however, it does not cause coagulopathy.
T237 81954-82141 Epistemic_statement 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.
T238 82516-82755 Epistemic_statement 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.
T239 82917-83104 Epistemic_statement 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.
T240 83105-83254 Epistemic_statement 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.
T241 83255-83396 Epistemic_statement denotes Fluids administered too quickly can cause diuresis to occur, such that the majority of the fluids administered will be excreted in the urine.
T242 83397-83557 Epistemic_statement 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.
T243 83940-84107 Epistemic_statement 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.
T244 84108-84254 Epistemic_statement denotes SQ administered fluids should never take the place of IV administered fluids in a hypovolemic patient or one with severe interstitial dehydration.
T245 84255-84370 Epistemic_statement denotes Intramedullary (intraosseous) infusion works well in small patients in which vascular access cannot be established.
T246 84371-84508 Epistemic_statement denotes Shock doses of fluids and other substances, including blood products, can be administered under pressure through an intraosseous cannula.
T247 84509-84644 Epistemic_statement denotes Because of the inherent discomfort and risk of osteomyelitis with intraosseous infusion, establish vascular access as soon as possible.
T248 85386-85478 Epistemic_statement denotes This will allow personnel to detect major discrepancies and calculation errors more readily.
T249 85479-85563 Epistemic_statement denotes The volume actually delivered should be recorded in the record by nursing personnel.
T250 85564-85694 Epistemic_statement denotes All additives should be listed clearly on the bottle on a piece of adhesive tape or a special label manufactured for this purpose.
T251 85695-85849 Epistemic_statement 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.
T252 87217-87293 Epistemic_statement denotes Two tubes should be palpable: the orogastric tube and the patient's trachea.
T253 87331-87459 Epistemic_statement denotes You can verify location by blowing into the proximal end of the tube and simultaneously auscultating the stomach for borborygmi.
T254 88138-88258 Epistemic_statement denotes Inadequate tissue perfusion caused by low cardiac output or vascular obstruction also can result in circulatory hypoxia.
T255 88361-88471 Epistemic_statement denotes This form of hypoxia can be observed with various toxin ingestions (bromethalin, cyanide) and in septic shock.
T256 88472-88679 Epistemic_statement 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).
T257 89224-89434 Epistemic_statement 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.
T258 89497-89742 Epistemic_statement 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.
T259 89743-89818 Epistemic_statement denotes The formula for calculating oxygen content of arterial blood is as follows:
T260 89819-90040 Epistemic_statement 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.
T261 90416-90568 Epistemic_statement denotes The underlying cause of the hypoxia also must be identified and treated, for chronic, lifelong oxygen therapy is rarely feasible in veterinary patients.
T262 90569-90707 Epistemic_statement denotes If hemoglobin levels are low because of anemia, oxygen supplementation must occur along with RBC transfusions to increase hemoglobin mass.
T263 90708-90896 Epistemic_statement 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.
T264 90897-90998 Epistemic_statement denotes The goal of oxygen therapy is to increase the amount of oxygen bound to hemoglobin in arterial blood.
T265 90999-91110 Epistemic_statement denotes Oxygen supplementation can be by hood, oxygen cage or tent, nasal or nasopharyngeal catheter, or tracheal tube.
T266 91111-91196 Epistemic_statement denotes In rare cases, administration of oxygen with mechanical ventilation may be indicated.
T267 91481-91641 Epistemic_statement denotes Administration of supplemental oxygen increases Pao 2 and may inhibit the central respiratory drive, leading to hypoventilation and possibly respiratory arrest.
T268 91741-91891 Epistemic_statement 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.
T269 92295-92354 Epistemic_statement denotes Animals may become overheated with an oxygen hood in place.
T270 92447-92542 Epistemic_statement denotes Commercially available Plexiglas oxygen cages can be purchased from a variety of manufacturers.
T271 92728-92919 Epistemic_statement 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).
T272 92920-93007 Epistemic_statement denotes High flow rates may be required to eliminate nitrogen and carbon dioxide from the cage.
T273 93089-93350 Epistemic_statement 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.
T274 94897-95023 Epistemic_statement 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.
T275 95413-95559 Epistemic_statement 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.
T276 95664-95836 Epistemic_statement 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.
T277 97470-97794 Epistemic_statement 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.
T278 98019-98110 Epistemic_statement denotes Thus Sao 2 as detected by a pulse oximeter is not reliable if carboxyhemoglobin is present.
T279 98731-98934 Epistemic_statement 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.
T280 99010-99203 Epistemic_statement 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.
T281 99303-99408 Epistemic_statement denotes Alternatively, a noninvasive method to determine end-tidal carbon dioxide is through use of a capnograph.
T282 99896-99943 Epistemic_statement denotes This value also can be displayed as a waveform.
T283 100632-100724 Epistemic_statement denotes If a plateau is not reached and notching of the waveform occurs, check the system for leaks.
T284 100725-100892 Epistemic_statement 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.
T285 100893-100957 Epistemic_statement denotes The Sodasorb in the system should be replaced if it has expired.
T286 100958-101060 Epistemic_statement denotes Conversely, low end-tidal carbon dioxide may be associated with a decrease in perfusion or blood flow.
T287 101061-101207 Epistemic_statement denotes Decreased perfusion can be associated with low end-tidal carbon dioxide values, particularly during cardiopulmonary cerebral resuscitation (CPCR).
T288 101325-101479 Epistemic_statement 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.
T289 101668-101800 Epistemic_statement denotes Thoracocentesis may be diagnostic to determine whether air or fluid is present and to characterize the nature of the fluid obtained.
T290 101801-101967 Epistemic_statement 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.
T291 102198-102289 Epistemic_statement denotes Ideally, thoracocentesis should be performed within the seventh to ninth intercostal space.
T292 103332-103438 Epistemic_statement denotes In general, air is located dorsally and fluid is located more ventrally, although this is not always true.
T293 103877-104006 Epistemic_statement denotes Thoracostomy tubes also can be placed to drain rapidly accumulating pleural effusion and for the medical management of pyothorax.
T294 104214-104295 Epistemic_statement denotes This will facilitate creating a subcutaneous tunnel around the thoracostomy tube.
T295 105040-105284 Epistemic_statement 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.
T296 106273-106414 Epistemic_statement 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.
T297 106918-107036 Epistemic_statement 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.
T298 108828-108836 Epistemic_statement denotes Hackett
T299 108837-109150 Epistemic_statement 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.
T300 109151-109349 Epistemic_statement 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.
T301 109564-109815 Epistemic_statement 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.
T302 111048-111149 Epistemic_statement denotes Remove the obturator, and then insert the inner cannula, which can be removed for cleaning as needed.
T303 111561-111675 Epistemic_statement denotes Any oxygen source should be humidi- fied with sterile water or saline to prevent drying of the respiratory mucosa.
T304 111976-112260 Epistemic_statement 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.
T305 112571-112670 Epistemic_statement denotes Primary closure of the wounds could predispose the patient to subcutaneous emphysema and infection.
T306 113945-114114 Epistemic_statement 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.
T307 114216-114613 Epistemic_statement 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) .
T308 115285-115473 Epistemic_statement 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.
T309 115474-115617 Epistemic_statement denotes Conversely, in a patient with excessive urination or diarrhea, a lateral or medial saphenous catheter is likely to become contaminated quickly.
T310 115618-115818 Epistemic_statement 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.
T311 115922-116023 Epistemic_statement denotes In emergent situations, placement of a catheter may be necessary under less than ideal circumstances.
T312 116957-117105 Epistemic_statement denotes Consider using a central venous catheter whenever multiple repeated blood samples will need to be collected from a patient during the hospital stay.
T313 117106-117358 Epistemic_statement 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) .
T314 117490-117570 Epistemic_statement denotes Over-the-wire central venous catheters can be placed by the Seldinger technique.
T315 117657-117739 Epistemic_statement denotes Central catheters also can be placed via the Seldinger or over-the-wire technique.
T316 117853-117918 Epistemic_statement denotes Each kit minimally should contain an over-the-needle catheter to
T317 117919-118144 Epistemic_statement 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.
T318 118145-118286 Epistemic_statement denotes Additional accessories can include a paper drape, sterile gauze, a scalpel blade, local anesthetic, 22-gauge needles, and 3-or 6-mL syringes.
T319 118980-119066 Epistemic_statement denotes The local anesthetic should not be injected into the underlying vessel (Figure 1-15) .
T320 120839-121030 Epistemic_statement 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.
T321 121031-121125 Epistemic_statement denotes As long as the catheter is functional without complications, the catheter can remain in place.
T322 121417-121604 Epistemic_statement 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) .
T323 122574-122697 Epistemic_statement denotes The catheter site can be covered with a cotton ball impregnated with antimicrobial ointment and layers of bandage material.
T324 122844-122932 Epistemic_statement denotes The femoral artery can be catheterized for placement of an indwelling arterial catheter.
T325 122933-123068 Epistemic_statement denotes Indwelling arterial catheters can be used for continuous invasive arterial BP monitoring and for procurement of arterial blood samples.
T326 124589-124788 Epistemic_statement 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.
T327 125447-125545 Epistemic_statement denotes Any vessel that can be catheterized percutaneously also can be catheterized with surgical cutdown.
T328 126567-126719 Epistemic_statement denotes Remove catheters placed surgically as soon as possible and exchange them for a percutaneously placed catheter to prevent infection and thrombophlebitis.
T329 126825-126927 Epistemic_statement denotes An indwelling catheter can remain in place for as long as it is functional and no complications occur.
T330 127316-127430 Epistemic_statement denotes Swelling of the paw can signify that the catheter tape and bandage are too tight and are occluding venous outflow.
T331 127431-127593 Epistemic_statement 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.
T332 127594-127838 Epistemic_statement 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.
T333 127908-128024 Epistemic_statement denotes Animals should wear Elizabethan collars or other forms of restraint if they lick or chew at the catheter or bandage.
T334 128025-128222 Epistemic_statement 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.
T335 128547-128812 Epistemic_statement 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.
T336 128903-129055 Epistemic_statement denotes Contraindications to intraosseous infusion include avian species (which have pneumatic bones), fractures, and sepsis, because osteomyelitis can develop.
T337 129056-129251 Epistemic_statement 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.
T338 129821-129892 Epistemic_statement denotes This will shift the sciatic nerve out of the way of catheter placement.
T339 130101-130183 Epistemic_statement denotes You may feel a pop or decreased resistance as the needle enters the marrow cavity.
T340 130390-130451 Epistemic_statement denotes A spinal needle with an internal stylette also can be placed.
T341 130719-130814 Epistemic_statement denotes The patient should wear an Elizabethan collar to prevent disruption or removal of the catheter.
T342 130815-130952 Epistemic_statement denotes The intraosseous catheter can be maintained as any peripheral catheter, with frequent flushing and daily evaluation of the catheter site.
T343 130953-131084 Epistemic_statement denotes Beal MW, Hughes D: Vascular access: theory and techniques in the small animal emergency patient, Clin Tech Small Anim Pract 15 (2)
T344 131085-131198 Epistemic_statement denotes The definition of pain has been debated philosophically over the ages and has changed as knowledge has increased.
T345 131199-131314 Epistemic_statement denotes Pain is defined as an unpleasant sensory or emotional experience associated with actual or perceived tissue damage.
T346 131421-131601 Epistemic_statement 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.
T347 131688-131939 Epistemic_statement 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 132053-132630 Epistemic_statement 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.
T349 132631-132946 Epistemic_statement 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.
T350 132947-133198 Epistemic_statement 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.
T351 133199-133311 Epistemic_statement denotes Ascending afferent nerves to the limbic system are believed to be responsible for the emotional aspects of pain.
T352 133382-133564 Epistemic_statement 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.
T353 133565-133695 Epistemic_statement denotes In contrast, chronic pain is a long-standing physical disorder or emotional distress that is slow in onset and difficult to treat.
T354 133696-133765 Epistemic_statement denotes Both types of pain can be classified further based on site of origin.
T355 133856-133964 Epistemic_statement denotes Visceral pain arises from abdominal or thoracic viscera and primarily is associated with serosal irritation.
T356 134037-134208 Epistemic_statement 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.
T357 134696-134801 Epistemic_statement denotes Hyperglycemia is produced and may persist because of production of glucagon and relative lack of insulin.
T358 135003-135081 Epistemic_statement denotes Protein catabolism is a common occurrence and major concern regarding healing.
T359 135294-135466 Epistemic_statement denotes Powerful evidence indicates that local anesthetic, sympathetic agonist, and opioid neural blockade may produce a modification of the responses to these physiologic changes.
T360 135908-136028 Epistemic_statement denotes Effective pain control can be achieved only when the signs of pain can be assessed effectively, reliably, and regularly.
T361 136398-136621 Epistemic_statement 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.
T362 137107-137209 Epistemic_statement denotes Pediatric and neonatal animals seem to have a lower threshold for pain and anxiety than older animals.
T363 137210-137341 Epistemic_statement denotes In any species, the duration and type of pain make it more (acute) or less (chronic) likely to be expressed or exhibited outwardly.
T364 137342-137486 Epistemic_statement denotes Unfamiliarity with normal behaviors typical of a particular species or breed makes recognition of their pain behaviors and responses impossible.
T365 137487-137566 Epistemic_statement denotes The definition and recognition of pain in an individual animal are challenging.
T366 137788-137928 Epistemic_statement denotes A goal of analgesia is to treat all animals with analgesic drugs and modalities as preemptively as possible and using a multimodal approach.
T367 137929-138063 Epistemic_statement denotes Use analgesic treatment as a tool for diagnosis of pain in the event that recognition of these phenomena is difficult for the patient.
T368 138064-138232 Epistemic_statement 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.
T369 138533-138679 Epistemic_statement denotes Baseline observations, especially observations from someone who has known the animal well, can be helpful to serial behavior and pain assessments.
T370 138866-138979 Epistemic_statement denotes Regardless of the scale or method used to assess pain, the caregiver must recognize the limitations of the scale.
T371 138980-139088 Epistemic_statement denotes If in doubt regarding whether pain is present or not, analgesic therapy should be used as a diagnostic tool.
T372 139089-139226 Epistemic_statement denotes Classic behaviors associated with pain in dogs and cats include abnormal postures, gaits, movements, and behaviors (Boxes 1-21 and 1-22).
T373 139227-139557 Epistemic_statement 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.
T374 139940-140067 Epistemic_statement denotes Again, the severity of the pain may not correlate with the severity of any pathologic condition that may or may not be present.
T375 140068-140245 Epistemic_statement 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.
T376 140576-140729 Epistemic_statement 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.
T377 140730-140928 Epistemic_statement 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.
T378 141105-141219 Epistemic_statement denotes For example, using a nonsteroidal antiinflammatory drug (NSAID) in an animal with renal failure would not be wise.
T379 141220-141364 Epistemic_statement denotes Remember to account for current medications that the patient may be taking that may augment or interfere with the analgesic or anesthetic drugs.
T380 141784-141997 Epistemic_statement 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.
T381 142252-142394 Epistemic_statement denotes An opioid is any natural or synthetic drug that is derived from the poppy, which interacts with opiate receptors identified on cell membranes.
T382 143154-143279 Epistemic_statement denotes Cardiac depression is secondary only to bradycardia and is more likely with certain opioids such as morphine and oxymorphone.
T383 143280-143421 Epistemic_statement denotes Narcotics produce few if any clinically significant cardiovascular effects in dogs and cats; they are considered cardiac soothing or sparing.
T384 143573-143665 Epistemic_statement denotes Opioids directly stimulate the chemoreceptor trigger zone and may cause nausea and vomiting.
T385 143666-143812 Epistemic_statement denotes Most opioids depress the cough reflex via a central mechanism; this may be helpful in patients recovering from endotracheal intubation irritation.
T386 145125-145361 Epistemic_statement 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).
T387 145580-145843 Epistemic_statement 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.
T388 145895-146157 Epistemic_statement 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.
T389 146158-146295 Epistemic_statement denotes Inhibition of COX-1 and COX-2 can inhibit the protective effects and impair platelet aggregation and lead to gastrointestinal ulceration.
T390 146387-146647 Epistemic_statement 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.
T391 146648-146767 Epistemic_statement denotes Trauma patients should be stabilized completely regarding vascular volume, tone, and pressure before the use of NSAIDs.
T392 146768-147044 Epistemic_statement 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.
T393 147045-147315 Epistemic_statement 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.
T394 147523-147737 Epistemic_statement 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.
T395 147738-147817 Epistemic_statement denotes NSAIDs can be used in many settings of acute and chronic pain and inflammation.
T396 148129-148280 Epistemic_statement 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.
T397 149068-149308 Epistemic_statement 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.
T398 149427-149627 Epistemic_statement 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.
T399 149628-149854 Epistemic_statement 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.
T400 150014-150245 Epistemic_statement 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.
T401 150396-150686 Epistemic_statement 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.
T402 151177-151362 Epistemic_statement 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.
T403 151440-151619 Epistemic_statement 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.
T404 151620-151748 Epistemic_statement denotes Amantadine is another NMDA blocker that has been used for its antiviral properties and stabilizing effects in Parkinson disease.
T405 151749-151849 Epistemic_statement denotes Amantadine has been used for neuropathic pain in human beings but is available only in an oral form.
T406 151850-151935 Epistemic_statement denotes Suggested starting doses for cats and dogs range from 3 to 5 mg/kg orally (PO) daily.
T407 151936-152070 Epistemic_statement denotes When the drug is given PO or IV, patients are unlikely to develop behavioral or cardiorespiratory effects with ketamine or amantadine.
T408 152259-152386 Epistemic_statement denotes Although the parent compound has very weak opioid activity, the metabolites have excellent binding affinity for the μ receptor.
T409 152387-152525 Epistemic_statement 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.
T410 152526-152665 Epistemic_statement denotes Regardless of its affinity for the opioid receptors, the true mechanism of action of tramadol in companion animals remains largely unknown.
T411 152730-152864 Epistemic_statement denotes Originally introduced as an antiepileptic drug, the mechanism of action of gabapentin remains somewhat unclear in veterinary medicine.
T412 153500-153617 Epistemic_statement denotes Local anesthetics may be used to block peripheral nerves or inhibit nerve "zones" through use of regional techniques.
T413 154234-154370 Epistemic_statement denotes Mexiletine, an oral sodium channel blocker, can be used as an alternative to injectable lidocaine for provision of background analgesia.
T414 154718-154832 Epistemic_statement denotes Local anesthetics also may be administered epidurally, intrathoracically, intraperitoneally, and intraarticularly.
T415 155354-155419 Epistemic_statement denotes Epinephrine-free and preservative-free solutions are recommended.
T416 155547-155699 Epistemic_statement 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.
T417 156310-156476 Epistemic_statement 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.
T418 156647-156872 Epistemic_statement 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.
T419 156950-157111 Epistemic_statement 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.
T420 157519-157736 Epistemic_statement 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.
T421 157737-157930 Epistemic_statement 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.
T422 159092-159175 Epistemic_statement denotes The block should be repeated every 3 hours in dogs and every 8 to 12 hours in cats.
T423 159414-159560 Epistemic_statement denotes Nerve locatorguided techniques are much more accurate and successful than blind placement of local anesthetic; however, even the latter is useful.
T424 161280-161403 Epistemic_statement denotes Epidural catheters used for the instillation of drugs through CRI or intermittent injection can be placed in dogs and cats.
T425 161572-161743 Epistemic_statement 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.
T426 162438-162539 Epistemic_statement denotes Discrete intercostal nerve blocks can provide effective analgesia for traumatic or postsurgical pain.
T427 162791-162849 Epistemic_statement denotes Palpate the intercostal space as far dorsally as possible.
T428 163751-163954 Epistemic_statement 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.
T429 163955-164092 Epistemic_statement denotes In some cases it may be difficult initially to distinguish between true abdominal pain or referred pain from intervertebral disk disease.
T430 164093-164310 Epistemic_statement 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.
T431 164311-164423 Epistemic_statement denotes Often the patient's signalment and history can increase the index of suspicion for a particular disease process.
T432 164424-164556 Epistemic_statement denotes A thorough history often is overlooked or postponed in the initial stages of resuscitation of the patient with acute abdominal pain.
T433 164557-164735 Epistemic_statement 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.
T434 164736-164893 Epistemic_statement 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?
T435 165246-165322 Epistemic_statement denotes 1 ❏ Has your animal ingested any garbage, compost, or table scraps recently?
T436 165767-165902 Epistemic_statement denotes ❏ 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?
T437 166712-166742 Epistemic_statement denotes Is there respiratory distress?
T438 166869-166975 Epistemic_statement denotes Auscult the patient's thorax for crackles, which may signify aspiration pneumonia resulting from vomiting.
T439 167092-167184 Epistemic_statement denotes Many patients in pain have tachycardia, which may or may not be accompanied by dysrhythmias.
T440 167185-167362 Epistemic_statement denotes If a patient's heart rate is inappropriately bradycardic, consider hyperkalemia, in association with hypoadrenocorticism, whipworm infestation, or urinary obstruction or trauma.
T441 167363-167505 Epistemic_statement denotes Evaluate the patient's hydration status by examining skin turgor, mucous membrane dryness, and whether the eyes appear sunken in their orbits.
T442 167506-167675 Epistemic_statement 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.
T443 167676-167790 Epistemic_statement denotes Posture and spinal reflexes can assist in making a diagnosis of intervertebral disk disease versus abdominal pain.
T444 168106-168221 Epistemic_statement denotes Reddish discoloration of the periumbilical area often is associated with the presence of intraabdominal hemorrhage.
T445 168222-168342 Epistemic_statement denotes It may be necessary to shave the fur to inspect the skin and underlying structures visually for bruising and ecchymoses.
T446 168554-168735 Epistemic_statement 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.
T447 169859-170017 Epistemic_statement denotes Fluid therapy also should be based on the most likely differential diagnoses, with specific fluid types administered according to the primary disease process.
T448 170176-170395 Epistemic_statement 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.
T449 170632-170832 Epistemic_statement 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.
T450 170833-170998 Epistemic_statement 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.
T451 171236-171450 Epistemic_statement 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
T452 171451-171577 Epistemic_statement denotes Obtain a urinalysis via cystocentesis whenever possible, except in cases of suspected pyometra or transitional cell carcinoma.
T453 171578-171691 Epistemic_statement denotes Azotemia in the presence of nonconcentrated (isosthenuric or hyposthenuric) urine suggests primary renal disease.
T454 171839-171938 Epistemic_statement denotes Renal tubular casts may be present in cases of acute renal ischemia or toxic insult to the kidneys.
T455 171939-172009 Epistemic_statement denotes Bacteriuria and pyuria may be present with infection and inflammation.
T456 172010-172207 Epistemic_statement 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.
T457 172356-172566 Epistemic_statement 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.
T458 172567-172859 Epistemic_statement 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.
T459 172964-173064 Epistemic_statement denotes The serum glucose level can sometimes decrease in animals with sepsis, including septic peritonitis.
T460 173203-173466 Epistemic_statement 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.
T461 173467-173596 Epistemic_statement denotes Obtain abdominal radiographs as one of the first diagnostic tests when deciding whether to pursue medical or surgical management.
T462 173728-173960 Epistemic_statement 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.
T463 174789-174900 Epistemic_statement denotes Abdominal paracentesis (abdominocentesis) often is the deciding factor in whether to perform immediate surgery.
T464 175052-175229 Epistemic_statement 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.
T465 175327-175427 Epistemic_statement denotes Elevated abdominal fluid lipase or amylase compared with serum supports a diagnosis of pancreatitis.
T466 176125-176299 Epistemic_statement 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) .
T467 176444-176615 Epistemic_statement 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.
T468 177018-177197 Epistemic_statement 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.
T469 177305-177423 Epistemic_statement denotes In cases of septic peritonitis, the abdomen may be left open, or a drain may be placed for further suction and lavage.
T470 177424-177568 Epistemic_statement denotes The routine use of antibiotics in irrigation solutions is contraindicated because the antibiotics can irritate the peritoneum and delay healing.
T471 177911-178111 Epistemic_statement 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.
T472 178774-179458 Epistemic_statement 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
T473 179459-179746 Epistemic_statement 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.
T474 179747-179819 Epistemic_statement denotes Clinical signs associated with anaphylaxis differ between dogs and cats.
T475 179820-179942 Epistemic_statement denotes In dogs, clinical signs may include restlessness, vomiting, diarrhea, hematochezia, circulatory collapse, coma, and death.
T476 179943-180026 Epistemic_statement denotes In cats, clinical signs often are associated with respiratory system abnormalities.
T477 180027-180190 Epistemic_statement denotes Clinical signs may include ptyalism, pruritus, vomiting, incoordination, bronchoconstriction, pulmonary edema and hemorrhage, laryngeal edema, collapse, and death.
T478 180397-180515 Epistemic_statement denotes Concurrently, an assistant should establish vascular or intraosseous access to administer drugs and fluids (Box 1-25).
T479 180516-180596 Epistemic_statement denotes Differential diagnoses to consider for anaphylactic shock include the following:
T480 180597-180676 Epistemic_statement denotes The patient should be hospitalized until complete resolution of clinical signs.
T481 180677-180886 Epistemic_statement 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.
T482 181778-181879 Epistemic_statement denotes Although this type of reaction causes patient discomfort, it rarely poses a life-threatening problem.
T483 181962-182043 Epistemic_statement denotes The facial edema also may be accompanied by mild to severe generalized urticaria.
T484 182044-182124 Epistemic_statement denotes Some animals may paw at the face, rub at the eyes, or have vomiting or diarrhea.
T485 182461-182573 Epistemic_statement denotes Many times, however, the inciting cause is not known and is likely an exposure to a stinging insect or arachnid.
T486 183043-183157 Epistemic_statement denotes After partial or complete resolution of clinical signs, the animal can be discharged to its owner for observation.
T487 183158-183250 Epistemic_statement denotes In dogs, mild vomiting or diarrhea may occur within 1 to 2 days after this type of reaction.
T488 183251-183322 Epistemic_statement denotes Wherever possible, exposure to the inciting allergen should be avoided.
T489 183324-183583 Epistemic_statement 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.
T490 183753-183874 Epistemic_statement denotes Despite this, however, anesthetic-related complications are frequent and need to be recognized and treated appropriately.
T491 184466-184538 Epistemic_statement denotes The respiratory tidal volume can be measured with a Wright respirometer.
T492 184648-184934 Epistemic_statement 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).
T493 184935-185110 Epistemic_statement 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.
T494 185111-185250 Epistemic_statement denotes The work of breathing also may be increased because of increased resistance of the anesthesia circuit and increased dead space ventilation.
T495 185596-185826 Epistemic_statement 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]).
T496 185827-186204 Epistemic_statement 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.
T497 186388-186559 Epistemic_statement 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.
T498 186560-186685 Epistemic_statement denotes Bradycardia, tachycardia, cardiac dysrhythmias, and vascular dilation can lead to hypotension and inadequate organ perfusion.
T499 186811-186855 Epistemic_statement denotes Many anesthetic drugs can cause bradycardia.
T500 187095-187195 Epistemic_statement denotes A mean arterial BP less than 60 mm Hg can result in inadequate tissue perfusion and oxygen delivery.
T501 187248-187410 Epistemic_statement 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.
T502 188197-188376 Epistemic_statement 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.
T503 188377-188453 Epistemic_statement denotes Is there a P wave for every QRS complex, and a QRS complex for every P wave?
T504 188454-188561 Epistemic_statement denotes During anesthesia, fluid, acid-base, and electrolyte imbalances can predispose the patient to dysrhythmias.
T505 188562-188694 Epistemic_statement denotes Sympathetic and parasympathetic stimulation, including during the process of intubation, can predispose the patient to dysrhythmias.
T506 188695-188842 Epistemic_statement denotes If the patient's plane of anesthesia is too light, perception of pain can cause catecholamine release, sensitizing the myocardium to ectopic beats.
T507 188843-188978 Epistemic_statement denotes Atrioventricular (AV) blockade can be induced with the administration of α 2 -agonist medications, including xylazine and medetomidine.
T508 188979-189052 Epistemic_statement denotes Thiobarbiturates (thiopental) can induce ventricular ectopy and bigeminy.
T509 189053-189204 Epistemic_statement denotes Although these dysrhythmias may not be harmful in the awake patient, anesthetized patients are at a particular risk of dysrhythmia-induced hypotension.
T510 189347-189476 Epistemic_statement denotes Awakening during anesthesia can occur and can be caused by equipment failure and, although no one likes to admit it, human error.
T511 189566-189834 Epistemic_statement 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.
T512 190495-190907 Epistemic_statement 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
T513 190908-191000 Epistemic_statement denotes • Stabilize acid-base and electrolyte balance before anesthetic induction whenever possible.
T514 191463-191541 Epistemic_statement denotes • Avoid surgical manipulation to the heart or great vessels whenever possible.
T515 191715-191920 Epistemic_statement 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.
T516 192147-192196 Epistemic_statement denotes ❏ Is there any possibility of any toxin exposure?
T517 192197-192248 Epistemic_statement denotes ❏ If so, when and how much did your animal consume?
T518 192249-192286 Epistemic_statement denotes ❏ Is there any possibility of trauma?
T519 192602-192788 Epistemic_statement 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).
T520 192789-192976 Epistemic_statement 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.
T521 192977-193205 Epistemic_statement 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).
T522 193206-193425 Epistemic_statement denotes Abnormalities associated with coagulopathies include petechiae and ecchymoses, epistaxis, gingival bleeding, hematuria, hemarthrosis, melena, and hemorrhagic cavity (pleural and peritoneal or retroperitoneal) effusions.
T523 193426-193604 Epistemic_statement 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.
T524 194729-194862 Epistemic_statement denotes In some cases the platelet count still may be within the normal reference range but has significantly decreased in the last 24 hours.
T525 194937-194992 Epistemic_statement denotes ACT, APTT, and PT may be rapid and shorter than normal.
T526 195291-195386 Epistemic_statement denotes AT levels can be measured at commercial laboratories and in some large veterinary institutions.
T527 195387-195467 Epistemic_statement denotes The end products of thrombosis and subsequent fibrinolysis also can be measured.
T528 195468-195555 Epistemic_statement denotes Fibrinogen levels may decline, although this test is not sensitive or specific for DIC.
T529 196092-196304 Epistemic_statement 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.
T530 196724-196836 Epistemic_statement denotes Aspirin (5 mg/kg PO bid in dogs; every third day in cats) also can be administered to prevent platelet adhesion.
T531 197076-197161 Epistemic_statement denotes Female hemophiliacs can result when a hemophiliac male is bred with a carrier female.
T532 197460-197517 Epistemic_statement denotes Mild to moderate internal or external bleeding can occur.
T533 197518-197618 Epistemic_statement denotes Clinical signs of umbilical cord bleeding can become apparent in some animals shortly after weaning.
T534 197619-197707 Epistemic_statement denotes Gingival hemorrhage, hemarthrosis, gastrointestinal hemorrhage, and hematomas may occur.
T535 197953-198096 Epistemic_statement 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.
T536 198173-198403 Epistemic_statement denotes A number of variants of the disease have been described: 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).
T537 198473-198627 Epistemic_statement 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.
T538 199427-199491 Epistemic_statement denotes Platelet counts are normal, but bleeding times can be prolonged.
T539 199572-199790 Epistemic_statement 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.
T540 200465-200513 Epistemic_statement denotes Estrus and postpartum bleeding may be prolonged.
T541 200641-200866 Epistemic_statement 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).
T542 200962-201184 Epistemic_statement 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.
T543 201548-201658 Epistemic_statement denotes Factor X deficiency has been documented in Cocker Spaniels and resembles fadingpuppy syndrome in newborn dogs.
T544 201659-201733 Epistemic_statement denotes Internal or umbilical bleeding can occur, and affected dogs typically die.
T545 201734-201769 Epistemic_statement denotes Bleeding may be mild in adult dogs.
T546 201890-201991 Epistemic_statement denotes Factor XII deficiency has been documented as an inherited autosomal recessive trait in domestic cats.
T547 201992-202091 Epistemic_statement denotes Heterozygotes can be detected because they have a partial deficiency (50% of normal) of factor XII.
T548 202232-202372 Epistemic_statement denotes Factor XI deficiency is an autosomal disease that has been documented in Kerry Blue Terriers, Great Pyrenees, and English Springer Spaniels.
T549 202373-202434 Epistemic_statement denotes In affected individuals, protracted bleeding may be observed.
T550 202667-202759 Epistemic_statement denotes Usually, this can be accomplished in the form of fresh frozen plasma transfusion (20 mL/kg).
T551 202760-202869 Epistemic_statement denotes If anemia is present because of severe hemorrhage, fresh whole blood or packed RBCs also can be administered.
T552 202870-203068 Epistemic_statement 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.
T553 203248-203294 Epistemic_statement denotes Doses can be repeated until hemorrhage ceases.
T554 203295-203521 Epistemic_statement 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.
T555 203522-203710 Epistemic_statement 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.
T556 203810-203907 Epistemic_statement denotes A supply of fresh frozen plasma and RBCs should be on hand, should uncontrolled hemorrhage occur.
T557 203908-203960 Epistemic_statement denotes Platelets are essential to normal blood coagulation.
T558 204598-204823 Epistemic_statement denotes Platelet abnormalities can include decreased platelet production (thrombocytopenia), decreased platelet function (thrombocytopathia), increased platelet destruction, increased platelet consumption, and platelet sequestration.
T559 204885-205038 Epistemic_statement 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).
T560 205145-205433 Epistemic_statement 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.
T561 205823-205912 Epistemic_statement denotes Platelet function defects (thrombocytopenia and thrombocytopathia) can affect both sexes.
T562 205913-205964 Epistemic_statement denotes Clinical signs can resemble von Willebrand disease.
T563 206088-206210 Epistemic_statement denotes Platelet count can be decreased because of problems with production, increased consumption, sequestration, or destruction.
T564 206634-206874 Epistemic_statement 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.
T565 207355-207418 Epistemic_statement denotes Antiplatelet antibodies can be measured by a PF-3 release test.
T566 207691-207817 Epistemic_statement denotes Primary immune-mediated thrombocytopenia has an unknown cause and most frequently is seen in middle-aged to older female dogs.
T567 208119-208595 Epistemic_statement 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.
T568 208596-208723 Epistemic_statement denotes If tick-borne illnesses are suspected, antibody titers for E. canis, A. phagocytophilum, and R. rickettsii should be performed.
T569 209106-209288 Epistemic_statement 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).
T570 209289-209502 Epistemic_statement 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.
T571 209503-209816 Epistemic_statement 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.
T572 210011-210139 Epistemic_statement 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.
T573 210140-210183 Epistemic_statement denotes Thrombocytopenia also can occur in the cat.
T574 210184-210348 Epistemic_statement denotes Causes for thrombocytopenia in cats include infections (29%), neoplasia (20%), cardiac disease (7%), primary immune-mediated disease (2%), and unknown causes (20%).
T575 210793-210860 Epistemic_statement denotes Affected animals can spontaneously hemorrhage anywhere in the body.
T576 210861-211221 Epistemic_statement 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.
T577 211279-211380 Epistemic_statement denotes A PIVKA (protein induced by vitamin K absence or antagonism) test also can be performed, if possible.
T578 211783-212003 Epistemic_statement 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.
T579 212247-212356 Epistemic_statement denotes The location of the burn is also important in assessing its severity and potential to cause loss of function.
T580 212483-212711 Epistemic_statement 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.
T581 212712-212823 Epistemic_statement denotes The skin cools slowly and warms slowly, considerations that become important when initiating therapy for burns.
T582 212824-212995 Epistemic_statement 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.
T583 213083-213347 Epistemic_statement 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.
T584 213506-213608 Epistemic_statement denotes The affected epidermis initially appears erythematous and then quickly desquamates within 3 to 6 days.
T585 213654-213802 Epistemic_statement denotes Deep partial-thickness, or second-degree, burns involve the epidermis and dermis and are associated with subcutaneous edema, inflammation, and pain.
T586 213803-213965 Epistemic_statement 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.
T587 214891-215057 Epistemic_statement denotes At the time of presentation, first examine the patient and ascertain whether airway obstruction, impaired ventilatory function, circulatory shock, or pain is present.
T588 215559-215645 Epistemic_statement denotes Whenever possible, avoid placing a catheter through an area of burned or damaged skin.
T589 215754-215950 Epistemic_statement 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.
T590 216206-216290 Epistemic_statement denotes Next, assess the total body surface area affected, as this will determine prognosis.
T591 216291-216495 Epistemic_statement 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.
T592 216649-216859 Epistemic_statement 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.
T593 216860-216939 Epistemic_statement denotes Superficial burns appear as singed fur with desquamating, easily epilated hair.
T594 216940-217010 Epistemic_statement denotes This condition t a B l e 1 -3 1 Percent Burn estimation: rule of nines
T595 217011-217162 Epistemic_statement 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.
T596 217251-217420 Epistemic_statement 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.
T597 217528-217702 Epistemic_statement 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.
T598 217820-217973 Epistemic_statement denotes Central venous catheters can be placed to administer crystalloid and colloid fluids, parenteral nutrition if necessary, antibiotics, and analgesic drugs.
T599 218079-218257 Epistemic_statement denotes Respiratory function can be impaired because of concurrent smoke inhalation, thermal damage to the upper airways and alveoli, and carboxyhemoglobin or methemoglobin intoxication.
T600 218258-218360 Epistemic_statement denotes Respiratory function also can be impaired because of burn injury to the skin around the thoracic cage.
T601 218361-218497 Epistemic_statement denotes Thoracic radiographs may reveal patchy interstitial to alveolar infiltrates associated with pulmonary edema, pneumonia, and atelectasis.
T602 219074-219209 Epistemic_statement denotes Monitor serum electrolytes, albumin, and colloid oncotic pressure closely because derangements can be severe as burns become exudative.
T603 219210-219422 Epistemic_statement 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.
T604 219544-219735 Epistemic_statement 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).
T605 219846-220017 Epistemic_statement 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.
T606 220191-220365 Epistemic_statement 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.
T607 220421-220532 Epistemic_statement denotes Monitor the patient closely for serous nasal discharge, chemosis, and rales, which may signify pulmonary edema.
T608 220600-220680 Epistemic_statement denotes Infused fluid should equal fluid output in the form of urine and wound exudates.
T609 220681-220788 Epistemic_statement denotes Acute weight loss signifies acute fluid loss and that crystalloid fluid infusion should be more aggressive.
T610 220982-221113 Epistemic_statement denotes Adjunct colloidal support can be provided with synthetic colloids including hetastarch or hemoglobin-based oxygen carriers (HBOCs).
T611 221706-221814 Epistemic_statement denotes Depending on the thickness of the burn, epilation and eschar formation and separation may take 2 to 10 days.
T612 222287-222435 Epistemic_statement denotes The most common cause of electrical injury is associated with an animal chewing on lowvoltage alternating current electrical cords in the household.
T613 222794-222884 Epistemic_statement denotes Burns on the face, paws, commissures of the mouth, tongue, and soft palate may be present.
T614 222885-223043 Epistemic_statement denotes Electrical injury causes a massive release of catecholamines and can predispose the patient to noncardiogenic pulmonary edema within 36 hours of the incident.
T615 223044-223154 Epistemic_statement denotes Clinical signs may be isolated to the pulmonary system, including orthopnea, pulmonary crackles, and cyanosis.
T616 223243-223328 Epistemic_statement denotes Early after electrical injury the wound may appear small and white, black, or yellow.
T617 223329-223416 Epistemic_statement denotes Later the wound may become larger as tissue sloughs because of damaged vascular supply.
T618 223458-223531 Epistemic_statement denotes Auscultate the lungs to determine whether pulmonary crackles are present.
T619 223532-223679 Epistemic_statement denotes If the patient's condition is stable, thoracic radiographs may demonstrate an interstitial to alveolar lung pattern in the dorsocaudal lung fields.
T620 224762-224887 Epistemic_statement denotes The use of glucocorticoids has no proven benefit and may impair respiratory immune function and is therefore contraindicated.
T621 224888-224991 Epistemic_statement denotes Oral burns may require debridement and advancement flaps if large defects or oronasal fistulas develop.
T622 225252-225430 Epistemic_statement denotes Chemical burns are associated with a number of inciting causes, including oxidizing agents, reducing agents, corrosive chemicals, protoplasmic poisons, desiccants, and vesicants.
T623 225431-225623 Epistemic_statement 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.
T624 225718-225800 Epistemic_statement denotes Chilling can be avoided by then wrapping the patient in a second or third blanket.
T625 225801-225842 Epistemic_statement denotes Placement of ointments should be avoided.
T626 225905-226053 Epistemic_statement 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.
T627 226054-226243 Epistemic_statement 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.
T628 226244-226322 Epistemic_statement denotes Remove collars or leashes that may act as tourniquets or constricting devices.
T629 226748-226861 Epistemic_statement denotes Debride any wounds carefully, knowing that the full extent of the wound may not manifest itself for several days.
T630 227151-227254 Epistemic_statement denotes Contact the local or national animal poison control center regarding whether to attempt neutralization.
T631 227458-227552 Epistemic_statement denotes The routine use of antibiotics may promote the development of a resistant bacterial infection.
T632 227553-227604 Epistemic_statement denotes First-generation cephalosporin can be administered.
T633 227605-227727 Epistemic_statement denotes If a more serious infection develops, perform culture and susceptibility testing to direct appropriate antibiotic therapy.
T634 227728-227827 Epistemic_statement denotes The wound can heal by second intention or may require reconstructive repair for definitive closure.
T635 227939-227997 Epistemic_statement denotes The goal of radiation therapy is to kill neoplastic cells.
T636 228257-228514 Epistemic_statement 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.
T637 228703-228801 Epistemic_statement denotes Radiation injury can occur early and appear at the later stage of the course of radiation therapy.
T638 228802-228874 Epistemic_statement denotes Late effects can be delayed and occur 6 months to years after treatment.
T639 229063-229205 Epistemic_statement denotes Thirddegree changes cause deeper moist desquamation, and fourth-degree changes are associated with complete dermal destruction and ulceration.
T640 229206-229306 Epistemic_statement denotes During the early stages of radiation injury, affected tissues may appear erythematous and edematous.
T641 229307-229405 Epistemic_statement denotes Wound exudates may be moist, or the skin may appear dry and scaly with desquamation or ulceration.
T642 229406-229537 Epistemic_statement denotes Later the area may scar and depigment or may have induration, atrophy, telangiectasia, keratosis, and decreased adnexal structures.
T643 229662-229773 Epistemic_statement denotes No-bite, or Elizabethan, collars or loose clothing can be used to protect the area from patient-induced injury.
T644 229774-229904 Epistemic_statement 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 ).
T645 229905-230081 Epistemic_statement 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.
T646 230082-230170 Epistemic_statement denotes Topical and systemic antibiotics (cephalexin, 22 mg/kg PO tid) also can be administered.
T647 230171-230247 Epistemic_statement denotes Avoid antibiotics that can be sensitized by radiation (e.g., metronidazole).
T648 230248-230387 Epistemic_statement denotes Because most radiation burns are associated with a known exposure to radiation therapy, the cause of the patient's injury usually is known.
T649 230388-230642 Epistemic_statement 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.
T650 230643-230818 Epistemic_statement denotes Treatment of radiation injury involves making the patient as comfortable as possible with analgesic drugs, preventing self-mutilation, and using staged debridement techniques.
T651 230819-230893 Epistemic_statement denotes Wounds can heal by second intention or may require reconstructive surgery.
T652 231085-231237 Epistemic_statement 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.
T653 231238-231400 Epistemic_statement 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.
T654 231444-231565 Epistemic_statement denotes Should you proceed with intubation, cardiac compressions and drugs, or do the owners want you to perform open-chest CPCR?
T655 231566-231747 Epistemic_statement 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.
T656 232079-232399 Epistemic_statement 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.
T657 232796-233015 Epistemic_statement 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.
T658 233897-234165 Epistemic_statement 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.
T659 234486-234601 Epistemic_statement denotes The patient should be positioned in dorsal (>7 kg) or lateral (<7 kg) recumbency for external cardiac compressions.
T660 234602-234695 Epistemic_statement denotes Approximately 80 to 120 external compressions should be performed over the patient's sternum.
T661 234696-234813 Epistemic_statement denotes A team member should palpate for a peripheral pulse to determine whether cardiac compressions are actually effective.
T662 234814-235010 Epistemic_statement 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.
T663 235197-235242 Epistemic_statement denotes The oxygen flow rate should be 150 mL/kg/min.
T664 235498-235662 Epistemic_statement 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.
T665 236095-236187 Epistemic_statement denotes This maneuver appears to work better in cats than dogs at return to spontaneous respiration.
T666 236924-237154 Epistemic_statement 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.
T667 237680-237846 Epistemic_statement 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.
T668 237847-237936 Epistemic_statement denotes If vascular access is available, epinephrine (0.02 to 0.04 mg/kg) can be administered IV.
T669 237937-238023 Epistemic_statement denotes No drug should ever be administered directly into the heart by intracardiac injection.
T670 238024-238330 Epistemic_statement 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.
T671 238774-238929 Epistemic_statement denotes Although discontinuation of thoracic compressions can decrease the chance of success during CPCR, you must intermittently evaluate the ECG monitor for any
T672 238930-239107 Epistemic_statement 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.
T673 239108-239164 Epistemic_statement denotes The rhythm can appear different from patient to patient.
T674 239392-239485 Epistemic_statement denotes EMD is thought to be associated with high doses of endogenous endorphins and high vagal tone.
T675 239821-239876 Epistemic_statement denotes Ventricular fibrillation can be coarse (Figure 1 -29) .
T676 240372-240479 Epistemic_statement denotes Electrical defibrillation of a patient who has alcohol on the ECG leads can lead to fire and thermal burns.
T677 240952-241064 Epistemic_statement denotes The complexes often appear wide and bizarre without a palpable apex beat or functional contraction of the heart.
T678 241065-241143 Epistemic_statement denotes This is just one example of EMD, as many shapes and complexes may be observed.
T679 241144-241162 Epistemic_statement denotes drugs can be used.
T680 241246-241336 Epistemic_statement denotes If amiodarone is unavailable, magnesium chloride can be administered (30 mg/ kg IV or IT).
T681 241337-241515 Epistemic_statement 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.
T682 241516-241595 Epistemic_statement denotes Amiodarone (0.5 mg/kg IV) also can be used to convert ventricular fibrillation.
T683 241706-241923 Epistemic_statement 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) .
T684 242389-242479 Epistemic_statement denotes This algorithm is organized according to whether an electrical defibrillator is available.
T685 242480-242611 Epistemic_statement denotes After each intervention step, the electrocardiogram (ECG) should be reevaluated and the next step initiated if V-fib is still seen.
T686 242612-242702 Epistemic_statement denotes If a new arrhythmia develops, the appropriate therapy for that rhythm should be initiated.
T687 242703-242805 Epistemic_statement denotes If a sinus rhythm is seen with a palpable apex beat, postresuscitation measures should be implemented.
T688 243745-243842 Epistemic_statement denotes If the heart does not seem to be filling, administer fluids IV or directly into the right atrium.
T689 243843-243977 Epistemic_statement denotes The descending aorta can be cross-clamped with a Rummel tourniquet or red rubber catheter to improve perfusion to the brain and heart.
T690 244138-244375 Epistemic_statement 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.
T691 244376-244605 Epistemic_statement 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]).
T692 245766-246109 Epistemic_statement 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.
T693 246232-246315 Epistemic_statement denotes In a euvolemic patient, normal urine output should be no less than 1 to 2 mL/kg/hr.
T694 246546-246639 Epistemic_statement denotes Monitor serum lactate as a rough indicator of organ perfusion and cellular oxygen extraction.
T695 246787-246995 Epistemic_statement 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.
T696 246996-247322 Epistemic_statement 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.
T697 247632-247827 Epistemic_statement 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.
T698 248199-248261 Epistemic_statement denotes The ECG is critical to the accurate diagnosis of dysrhythmias.
T699 248446-248581 Epistemic_statement 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.
T700 248715-248858 Epistemic_statement denotes Ventricular dysrhythmias may manifest as isolated ventricular premature complexes, couplets, or triplets; bigeminy; or ventricular tachycardia.
T701 249014-249150 Epistemic_statement denotes Idioventricular rhythm usually is less than 130 beats/min and may alternate spontaneously with sinus arrhythmias (Figures 1-31 to 1-34).
T702 249641-249746 Epistemic_statement denotes Occasionally, supraventricular dysrhythmias may be associated with respiratory or other systemic illness.
T703 249747-249998 Epistemic_statement 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.
T704 249999-250229 Epistemic_statement 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.
T705 250230-250319 Epistemic_statement denotes In the dog, atrial fibrillation most commonly is associated with dilative cardiomyopathy.
T706 250320-250430 Epistemic_statement denotes Rarely and primarily in giant breed dogs, lone atrial fibrillation can occur with no underlying heart disease.
T707 250577-250765 Epistemic_statement 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.
T708 250766-250837 Epistemic_statement denotes The ECG is critical to the diagnosis of a supraventricular dysrhythmia.
T709 251037-251191 Epistemic_statement denotes In most cases of a supraventricular dysrhythmia, some evidence of atrial 1 activity including P waves, atrial flutter, or atrial fibrillation is apparent.
T710 251192-251337 Epistemic_statement denotes In some cases, it may be difficult to diagnose the exact rhythm without slowing the rate down mechanically or through pharmacologic intervention.
T711 251338-251453 Epistemic_statement denotes Once a rhythm diagnosis has been made, appropriate treatment strategies can be implemented (Figures 1-35 and 1-36).
T712 251454-251711 Epistemic_statement 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.
T713 251712-251995 Epistemic_statement 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.
T714 252156-252622 Epistemic_statement 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.
T715 252928-253006 Epistemic_statement denotes The bolus can be repeated an additional three times (total dose 8 mg/kg) over
T716 253007-253224 Epistemic_statement 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.
T717 253297-253424 Epistemic_statement 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.
T718 253579-253684 Epistemic_statement denotes Procainamide (4 mg/kg IV slowly over 3 to 5 minutes) also can be used to control ventricular tachycardia.
T719 253875-253974 Epistemic_statement denotes Chronic oral therapy may or may not be necessary in the treatment of acute ventricular tachycardia.
T720 254151-254421 Epistemic_statement 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.
T721 254532-254799 Epistemic_statement 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.
T722 255209-255374 Epistemic_statement 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.
T723 255840-255910 Epistemic_statement denotes The goal of therapy is rhythm control or, in most cases, rate control.
T724 255911-256081 Epistemic_statement 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.
T725 256186-256480 Epistemic_statement 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.
T726 256872-257011 Epistemic_statement 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.
T727 257229-257450 Epistemic_statement 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.
T728 257579-257761 Epistemic_statement 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.
T729 258115-258346 Epistemic_statement 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.
T730 258347-258528 Epistemic_statement 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.
T731 258617-258717 Epistemic_statement denotes Less commonly, atrial standstill is associated with atrial cardiomyopathy or silent atrium syndrome.
T732 258854-259023 Epistemic_statement 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.
T733 259024-259203 Epistemic_statement 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.
T734 259492-259661 Epistemic_statement denotes Less commonly, AV block has been associated with digoxin toxicity, magnesium oversupplementation, cardiomyopathy, endocarditis, or infectious myocarditis (Lyme disease).
T735 259773-259883 Epistemic_statement denotes First-and second-degree AV block may not be hemodynamically significant and therefore may not require therapy.
T736 260085-260145 Epistemic_statement denotes Atropine is rarely successful in treating complete AV block.
T737 260355-260436 Epistemic_statement denotes Consultation with a veterinary cardiologist who implants pacemakers is suggested.
T738 260541-260650 Epistemic_statement denotes Sick sinus syndrome most commonly is recognized in the Miniature Schnauzer, although any dog can be affected.
T739 260746-260824 Epistemic_statement denotes In the cat, sinus node degeneration usually is associated with cardiomyopathy.
T740 260825-260974 Epistemic_statement denotes Dysfunction of the sinus node may manifest as marked bradycardia with periods of sinus arrest followed by junctional or ventricular escape complexes.
T741 261331-261493 Epistemic_statement 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).
T742 262178-262384 Epistemic_statement 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.
T743 262385-262521 Epistemic_statement denotes Mitral valve disease tends to affect older toy breeds such as miniature Poodles, Chihuahuas, and younger Cavalier King Charles Spaniels.
T744 262816-262926 Epistemic_statement denotes Secondary mitral and tricuspid valvular insufficiency may result from chronic stretching of the valve annulus.
T745 262927-263090 Epistemic_statement denotes This type of heart disease typically is associated with giant breed dogs including Irish Wolfhounds, English Mastiffs, Great Danes, Boxers, and Doberman Pinschers.
T746 263091-263167 Epistemic_statement denotes A rare form of the disease has been documented in young Labrador Retrievers.
T747 263168-263295 Epistemic_statement denotes Acute exacerbation of dilated cardiomyopathy may be related to the development of a dysrhythmia, including atrial fibrillation.
T748 263395-263497 Epistemic_statement denotes CHF resulting from hypertrophic cardiomyopathy can occur in animals as young as 6 to 10 months of age.
T749 263691-263828 Epistemic_statement denotes Other cardiomyopathies, including unclassified, restrictive, and dilated cardiomyopathies, are less common but also can occur in the cat.
T750 264410-264549 Epistemic_statement denotes In some cases, it is difficult to distinguish between CHF and feline lower airway disease (asthma) without performing thoracic radiographs.
T751 265679-265768 Epistemic_statement denotes Left atrial enlargement may be observed as a "backpack" sign at the caudal cardiac waist.
T752 265769-265863 Epistemic_statement denotes Cardiomegaly of the right or left side also may be present in cases of valvular insufficiency.
T753 265864-265992 Epistemic_statement denotes In cats, increased sternal contact and a classic valentine-shaped heart may be observed in cases of hypertrophic cardiomyopathy.
T754 265993-266112 Epistemic_statement denotes Perform a vertebral heart score (sum) to measure cardiac size and determine whether cardiomegaly is present (Box 1-38).
T755 266113-266216 Epistemic_statement denotes Also obtain arterial BP and ECG readings to determine whether hypotension and dysrhythmias are present.
T756 266217-266411 Epistemic_statement denotes Atrial fibrillation, ventricular premature contractions, and supraventricular tachycardia are common rhythm disturbances that can affect cardiac output adversely and influence treatment choices.
T757 266772-266933 Epistemic_statement denotes Echocardiography can be a useful tool in making a diagnosis of pericardial effusion, dilated or hypertrophic cardiomyopathy, cardiac neoplasia, and endocarditis.
T758 267030-267252 Epistemic_statement 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.
T759 267328-267475 Epistemic_statement denotes After initial administration of furosemide, morphine, and oxygen, clinical signs of respiratory distress should show improvement within 30 minutes.
T760 267629-267742 Epistemic_statement denotes Vasodilation should be the next step in the management of refractory cases, provided that a normal BP is present.
T761 267743-267947 Epistemic_statement 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.
T762 267948-268028 Epistemic_statement denotes The goal of nitroprusside therapy is to maintain a mean arterial BP of 60 mm Hg.
T763 268029-268126 Epistemic_statement denotes Sodium nitroprusside should not be considered in cases of refractory CHF with severe hypotension.
T764 268388-268539 Epistemic_statement 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.
T765 268620-268792 Epistemic_statement 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.
T766 268793-268916 Epistemic_statement denotes At low doses, dobutamine, primarily a β-adrenergic agonist, will improve cardiac output with minimal effects on heart rate.
T767 268992-269123 Epistemic_statement denotes Despite the minimal effects of dobutamine on heart rate, sinus tachycardia or ventricular dysrhythmias may develop during infusion.
T768 269491-269623 Epistemic_statement denotes In chronic management of CHF resulting from dilated cardiomyopathy or advanced mitral disease, however, digoxin is extremely useful.
T769 269624-269760 Epistemic_statement denotes Oral digitalization protocols have been developed but are risky in that dysrhythmias and severe gastrointestinal side effects can occur.
T770 269761-269840 Epistemic_statement denotes The vertebral heart sum can be calculated by performing the following steps: 1.
T771 270416-270551 Epistemic_statement denotes Add the two numbers together to yield the vertebral heart sum; a vertebral heart sum greater than 10.5 is consistent with cardiomegaly.
T772 272524-272575 Epistemic_statement denotes A right axis deviation may be seen on ECG tracings.
T773 272764-272879 Epistemic_statement denotes Circulating microfilariae may be observed on peripheral blood smears or in the buffy coat of microhematocrit tubes.
T774 273145-273273 Epistemic_statement denotes Treatment involves surgical removal of as many of the adult heartworms as possible from the right jugular vein and right atrium.
T775 273274-273401 Epistemic_statement denotes Glucocorticosteroids are recommended to decrease inflammation and microangiopathic disease associated with heartworm infection.
T776 273558-273736 Epistemic_statement 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.
T777 274107-274323 Epistemic_statement 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.
T778 274544-274653 Epistemic_statement denotes The presence of pericardial effusion can impede venous return to the heart and thus adversely affect preload.
T779 275133-275318 Epistemic_statement denotes Physical examination abnormalities may include muffled heart sounds, thready femoral pulses, pulsus paradoxus, jugular venous distension, weakness, tachycardia, cyanosis, and tachypnea.
T780 275319-275467 Epistemic_statement denotes ECG findings may include low amplitude QRS complexes (<0.5 mV), sinus tachycardia, ventricular dysrhythmias, or electrical alternans (Figure 1-39) .
T781 275468-275677 Epistemic_statement 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.
T782 275678-275857 Epistemic_statement 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) .
T783 275858-276057 Epistemic_statement 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.
T784 277494-277621 Epistemic_statement denotes Clot formation could signify that you have penetrated the right ventricle inadvertently or that active hemorrhage is occurring.
T785 277622-277694 Epistemic_statement denotes Withdraw as much of the fluid as possible, and then remove the catheter.
T786 277804-278011 Epistemic_statement 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.
T787 278012-278099 Epistemic_statement denotes Clinical signs may be limited to incessant head shaking or scratching of the ear canal.
T788 278401-278474 Epistemic_statement denotes Stimulation of the ear canal can cause awakening and shaking of the head.
T789 279093-279185 Epistemic_statement denotes If pain and discomfort are severe, systemically effective opioids or NSAIDs may be required.
T790 279406-279543 Epistemic_statement denotes Perform a complete aural examination to determine whether a foreign body or tumor is present and whether the tympanic membrane is intact.
T791 279969-280142 Epistemic_statement 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.
T792 280293-280367 Epistemic_statement denotes Fever, pain, vomiting, and severe depression may accompany clinical signs.
T793 280611-280787 Epistemic_statement 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.
T794 281197-281315 Epistemic_statement denotes If the tympanic membrane is not ruptured but appears swollen and erythematous, a myringotomy may need to be performed.
T795 281316-281465 Epistemic_statement 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.
T796 281947-282080 Epistemic_statement denotes In some cases, swelling can be so severe that the hematoma breaks open, bathing the patient and external living environment in blood.
T797 282153-282270 Epistemic_statement denotes Perform a complete aural examination to determine whether an aural foreign body, otitis externa, or atopy is present.
T798 282327-282351 Epistemic_statement denotes Treat underlying causes.
T799 282565-282657 Epistemic_statement denotes Many techniques have been described to surgically tack down the skin overlying the hematoma.
T800 283171-283320 Epistemic_statement 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.
T801 283871-284038 Epistemic_statement denotes Electrical current passing through the body can produce severe dysrhythmias, including supraventricular or ventricular tachycardia and first-and third-degree AV block.
T802 284039-284133 Epistemic_statement denotes The electrical current also can produce tissue destruction from heat and electrothermal burns.
T803 284324-284458 Epistemic_statement denotes Ventricular fibrillation can occur, although that depends on the intensity and path of the electrical current and duration of contact.
T804 284621-284714 Epistemic_statement denotes Often the skin at the commissures of the mouth appears white or yellow and firm to the touch.
T805 284715-284800 Epistemic_statement denotes Muscle fasciculations, loss of consciousness, and ventricular fibrillation may occur.
T806 284920-285011 Epistemic_statement denotes Noncardiogenic pulmonary edema can develop up to 24 to 36 hours after the initial incident.
T807 285305-285497 Epistemic_statement 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.
T808 285498-285583 Epistemic_statement denotes Positive inotropes and pressor drugs may be necessary to treat shock and hypotension.
T809 285584-285708 Epistemic_statement denotes Opioid drugs (morphine, hydromorphone, oxymorphone) may be useful in controlling anxiety until the pulmonary edema resolves.
T810 285878-286082 Epistemic_statement 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.
T811 286471-286551 Epistemic_statement denotes If the uterus is edematous, physical replacement may be difficult or impossible.
T812 286552-286692 Epistemic_statement denotes Application of a hypertonic solution such as hypertonic (7%) saline or dextrose (50%) to the exposed endometrium can help shrink the tissue.
T813 286693-286882 Epistemic_statement 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.
T814 287941-288035 Epistemic_statement denotes Clinical signs of pyometra are associated with the presence of bacterial endotoxin and sepsis.
T815 288248-288326 Epistemic_statement denotes If the cervix is open, purulent or mucoid 1 vaginal discharge may be observed.
T816 288894-288979 Epistemic_statement denotes Open pyometra also can become life-threatening and so should be treated aggressively.
T817 289045-289270 Epistemic_statement 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.
T818 289400-289532 Epistemic_statement denotes Although less successful than ovariohysterectomy, medical therapy may be attempted in breeding bitches as an alternative to surgery.
T819 290112-290225 Epistemic_statement denotes As the corpus luteum degrades under the influence of prostaglandin F 2α , serum progesterone levels will decline.
T820 290226-290332 Epistemic_statement denotes Prostaglandin F 2α is an abortifacient and thus should not be administered to the pregnant bitch or queen.
T821 290333-290469 Epistemic_statement 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.
T822 290610-290648 Epistemic_statement denotes In a very ill animal, death can occur.
T823 290649-290740 Epistemic_statement denotes The efficacy of prostaglandin F 2α is limited, and more than one treatment may be required.
T824 290741-290879 Epistemic_statement denotes The bitch should be bred on the next heat cycle and then spayed because progressive cystic endometrial hyperplasia will continue to occur.
T825 291103-291131 Epistemic_statement denotes Sepsis can progress rapidly.
T826 291304-291386 Epistemic_statement denotes Physical examination may reveal fever, dehydration, and a turgid distended uterus.
T827 291458-291538 Epistemic_statement denotes An enlarged uterus can be observed on abdominal radiographs and ultrasonography.
T828 291908-292029 Epistemic_statement denotes If the patient's condition is not critical and the animal is a valuable breeding bitch, medical therapy can be attempted.
T829 292292-292349 Epistemic_statement denotes Either drug should be used concurrently with antibiotics.
T830 292350-292442 Epistemic_statement denotes uTerine ruPTure Rupture of the gravid uterus is rare in cats and dogs but has been reported.
T831 292443-292539 Epistemic_statement denotes Uterine rupture may occur as a consequence of parturition or result from blunt abdominal trauma.
T832 292540-292654 Epistemic_statement denotes Fetuses expelled into the abdominal cavity may be resorbed but more commonly cause the development of peritonitis.
T833 292655-292730 Epistemic_statement denotes If fetal circulation is not disrupted, the fetus actually may live to term.
T834 292779-292871 Epistemic_statement denotes An ovariohysterectomy with removal of the extrauterine puppies and membranes is recommended.
T835 292872-293067 Epistemic_statement 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.
T836 293068-293211 Epistemic_statement denotes If uterine rupture occurs because of pyometra, peritonitis is likely, and copious peritoneal lavage should be performed at the time of surgery.
T837 293212-293357 Epistemic_statement denotes The patient should be placed on 7 to 14 days of antibiotic therapy (amoxicillin or amoxicillin and clavulanic acid [Clavamox] with enrofloxacin).
T838 293615-293671 Epistemic_statement denotes Vaginal prolapse can be confused with vaginal neoplasia.
T839 293907-293964 Epistemic_statement denotes The proliferation can lead to dysuria or anuria, however.
T840 294368-294536 Epistemic_statement 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.
T841 294537-294623 Epistemic_statement denotes The patient should wear an Elizabethan collar at all times to prevent self-mutilation.
T842 294778-294876 Epistemic_statement denotes Dystocia Dystocia, or difficult birth, can occur in the dog and cat but is more common in the dog.
T843 294877-295171 Epistemic_statement 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.
T844 295172-295359 Epistemic_statement 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.
T845 295360-295484 Epistemic_statement denotes Maternal-fetal disproportion, or large fetus size in relation to the bitch or queen, also can result in dystocia (Box 1-40).
T846 295485-295847 Epistemic_statement 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.
T847 295971-296069 Epistemic_statement denotes If the puppies or kittens are in a normal position for birth, medical management can be attempted.
T848 296412-296490 Epistemic_statement denotes In some cases, hypoglycemia or hypocalcemia can contribute to uterine inertia.
T849 296873-297023 Epistemic_statement 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.
T850 297024-297104 Epistemic_statement denotes In some cases there may have been a history of delivery of a live or dead fetus.
T851 297105-297149 Epistemic_statement denotes Vaginal discharge may or may not be present.
T852 297470-297575 Epistemic_statement denotes If there are viable fetuses, the uterus should be delivered en mass and the puppies or kittens delivered.
T853 297659-297790 Epistemic_statement 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.
T854 297884-297974 Epistemic_statement denotes In some cases the fetus is found, or there may be evidence of fetal membranes or remnants.
T855 298083-298158 Epistemic_statement denotes In cats, herpesvirus, coronavirus, and FeLV can cause spontaneous abortion.
T856 298159-298292 Epistemic_statement denotes In both species, trauma, hormonal factors, environmental pathogens, drugs, and fetal factors also can result in spontaneous abortion.
T857 298491-298724 Epistemic_statement 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.
T858 298725-298814 Epistemic_statement denotes Estradiol cypionate is not approved for use in the bitch or queen and is not recommended.
T859 299904-300060 Epistemic_statement denotes Side effects can occur within 5 to 40 minutes of injection and include restlessness, panting, salivation, abdominal pain, urination, vomiting, and diarrhea.
T860 300642-300738 Epistemic_statement denotes Prostaglandin F 2α should be used only in healthy queens (100 to 250 mcg/kg SQ q24h for 2 days).
T861 301027-301199 Epistemic_statement 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.
T862 301200-301269 Epistemic_statement denotes Scrotal injuries should be categorized as superficial or penetrating.
T863 301746-301905 Epistemic_statement denotes Prognosis is generally favorable; however, semen quality may be affected for months after injury because of scrotal swelling and increased scrotal temperature.
T864 301906-302013 Epistemic_statement denotes Penetrating injuries to the scrotum are more serious and are associated with severe swelling and infection.
T865 302241-302421 Epistemic_statement 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.
T866 302422-302507 Epistemic_statement denotes In affected animals, the scrotum can become extremely inflamed, swollen, and painful.
T867 302508-302567 Epistemic_statement denotes If left untreated, pyogranulomatous dermatitis can develop.
T868 302568-302702 Epistemic_statement denotes Make an attempt to determine whether an underlying systemic illness is present that could predispose the animal to scrotal dermatitis.
T869 302703-302853 Epistemic_statement denotes Widespread vasculitis with scrotal edema, pain, fever, and dermatitis has been associated with R. rickettsii infection (Rocky Mountain spotted fever).
T870 302854-302927 Epistemic_statement denotes B. canis also has been associated with scrotal irritation and dermatitis.
T871 302928-303092 Epistemic_statement denotes If scrotal dermatitis follows from an infectious cause, empiric use of glucocorticosteroids potentially can make the condition worse by suppressing immune function.
T872 303093-303187 Epistemic_statement denotes Empiric treatment with antibiotics also potentially can confound making an accurate diagnosis.
T873 303188-303269 Epistemic_statement denotes Treatment of scrotal dermatitis is to eliminate predisposing causes, if possible.
T874 303451-303585 Epistemic_statement denotes Topical medications, including tar shampoo, tetracaine, neomycin, and petroleum, can cause further irritation and are contraindicated.
T875 304294-304392 Epistemic_statement denotes Trauma to the epididymis or testicle can cause testicular pain and swelling of one or both testes.
T876 304594-304714 Epistemic_statement denotes Nonpenetrating injuries to the scrotum and testicle rarely may cause acute testicular hemorrhage or hydrocele formation.
T877 305053-305174 Epistemic_statement denotes Increased scrotal temperature and testicular inflammation can affect semen quality for months after the initial incident.
T878 305313-305495 Epistemic_statement 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.
T879 305641-305779 Epistemic_statement denotes If an intraabdominal testicular torsion is present, pain, lethargy, anorexia, and vomiting can occur (see Acute Condition in the Abdomen).
T880 305780-305819 Epistemic_statement denotes An intraabdominal mass may be palpable.
T881 306795-306961 Epistemic_statement 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.
T882 306962-307072 Epistemic_statement denotes If a bacterial culture cannot be performed, initiate fluoroquinolone therapy (enrofloxacin, 10 mg/kg PO q24h).
T883 307073-307177 Epistemic_statement denotes Doxycycline (5 mg/kg PO bid for 7 days) has been shown to suppress but not eradicate B. canis infection.
T884 307178-307280 Epistemic_statement denotes Testicular inflammation and increased temperature can affect sperm quality for months after infection.
T885 307281-307443 Epistemic_statement denotes The most common causes of acute prostatitis are associated with acute bacterial infection (E. coli, Proteus species, Pseudomonas species, and Mycoplasma species).
T886 307723-307817 Epistemic_statement denotes The patient often appears in pain and depressed and may be dehydrated on physical examination.
T887 307818-307910 Epistemic_statement denotes Symmetric or asymmetric prostatomegaly and prostate pain may be evident on rectal palpation.
T888 307911-308092 Epistemic_statement 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.
T889 308093-308155 Epistemic_statement denotes Death can occur within 2 days if a prostatic abscess ruptures.
T890 308156-308333 Epistemic_statement 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.
T891 308334-308497 Epistemic_statement denotes Prostatic samples may be obtained from the prostatic portion of the ejaculate, prostatic massage, urethral discharge, urine, or (less commonly) prostatic aspirate.
T892 308498-308621 Epistemic_statement denotes Although semen samples can yield positive bacterial cultures, dogs with acute prostatitis are often unwilling to ejaculate.
T893 308622-308728 Epistemic_statement denotes Radiography may reveal an enlarged prostate, but this alone does not confirm the diagnosis of prostatitis.
T894 308878-308969 Epistemic_statement denotes Aspiration of the affected tissue potentially can wick infection into periprostatic tracks.
T895 308970-309157 Epistemic_statement 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.
T896 309298-309450 Epistemic_statement denotes Enrofloxacin (10 mg/kg PO sid) can penetrate the inflamed prostatic tissue and is effective in treating gram-negative and Mycoplasma species infections.
T897 309451-309522 Epistemic_statement denotes Ciprofloxacin does not appear to penetrate prostatic tissue as readily.
T898 309688-309820 Epistemic_statement denotes Castration is recommended because benign prostatic hyperplasia may be a predisposing factor in the development of acute prostatitis.
T899 309821-309977 Epistemic_statement 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.
T900 309978-310154 Epistemic_statement 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.
T901 310155-310264 Epistemic_statement denotes If a prostatic abscess is present, perform marsupialization, surgical drainage, or ultrasonographic drainage.
T902 310265-310428 Epistemic_statement denotes Surgical therapy is associated with a large incidence of complications, including incontinence, chronic drainage from fistulas and stomas, septic shock, and death.
T903 310505-310598 Epistemic_statement denotes Os penis fractures can occur with minimal soft tissue damage but cause hematuria and dysuria.
T904 311577-311669 Epistemic_statement denotes Small lacerations can be managed with cold compresses and one to several absorbable sutures.
T905 312139-312252 Epistemic_statement denotes Mucosal edema, hemorrhage, self-mutilation, and necrosis requiring penile amputation can occur if left untreated.
T906 312383-312486 Epistemic_statement denotes Examine the base of the penis for hair rings that can prevent retraction of the penis into the prepuce.
T907 313002-313133 Epistemic_statement denotes In severe cases, a urinary catheter may need to be placed to prevent urethral obstruction, until penile swelling and edema resolve.
T908 313402-313727 Epistemic_statement 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.
T909 313728-313875 Epistemic_statement 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) .
T910 313942-313995 Epistemic_statement denotes Clinical signs associated with the prolapsed urethra
T911 313996-314073 Epistemic_statement denotes include excessive licking of the prepuce, stranguria, and preputial bleeding.
T912 314219-314326 Epistemic_statement denotes In most cases, however, the prolapse occurs in intact young dogs, making neoplastic conditions less likely.
T913 314327-314441 Epistemic_statement denotes Treatment for urethral prolapse should occur at the time of diagnosis to prevent selfinduced trauma and infection.
T914 314588-314673 Epistemic_statement denotes The purse-string suture can remain in place for up to 5 days until definitive repair.
T915 314830-314955 Epistemic_statement denotes In some cases, surgical resection of the prolapsed tissue with apposition of the urethral and penile mucosa can be attempted.
T916 315093-315191 Epistemic_statement denotes Recurrence of prolapse can occur with either technique, particularly if the inciting event recurs.
T917 315192-315352 Epistemic_statement 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.
T918 315354-315576 Epistemic_statement 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.
T919 315688-315732 Epistemic_statement denotes The skin also may appear black and necrotic.
T920 315872-315931 Epistemic_statement denotes Analgesics may be required to alleviate patient discomfort.
T921 316002-316108 Epistemic_statement denotes The use of prophylactic antibiotics is controversial because it can promote resistant bacterial infection.
T922 316109-316173 Epistemic_statement denotes Use of antibiotics should be based on the presence of infection.
T923 316174-316297 Epistemic_statement denotes Treatments that are ineffective and may be harmful include rubbing of the affected areas, pressure bandages, and ointments.
T924 316298-316401 Epistemic_statement denotes Corticosteroids can decrease cellular immunity and promote infection and are therefore contraindicated.
T925 316402-316477 Epistemic_statement denotes Many frostbitten areas that appear nonviable can regain function gradually.
T926 316527-316673 Epistemic_statement denotes Affected areas may take several days to a week before fully manifesting areas of demarcation between healthy viable and necrotic nonviable tissue.
T927 317120-317547 Epistemic_statement 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.
T928 317642-317774 Epistemic_statement denotes If the animal is not breathing or is severely hypoventilating, endotracheal intubation with mechanical ventilation may be necessary.
T929 317998-318140 Epistemic_statement denotes Rewarming should occur in the form of external circulating warm water blankets, radiant heat, and circulating warm air blankets (Bair Hugger).
T930 318207-318376 Epistemic_statement 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]).
T931 318545-318621 Epistemic_statement denotes The body temperature should rise slowly, ideally no more than 1° F per hour.
T932 318622-318772 Epistemic_statement denotes Because the response of the body to drugs is unpredictable, avoid administering drugs whenever possible, until the body temperature returns to normal.
T933 318937-319190 Epistemic_statement 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.
T934 319191-319335 Epistemic_statement denotes Brachycephalic breeds, obese animals, dogs with laryngeal paralysis, and older animals with cardiovascular disease can be particularly affected.
T935 319683-319912 Epistemic_statement 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.
T936 319913-320138 Epistemic_statement 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.
T937 320139-320193 Epistemic_statement denotes Excessive panting can result in respiratory alkalosis.
T938 320247-320368 Epistemic_statement denotes Loss of water in excess of solutes such as sodium and chloride can lead to a free water deficit and severe hypernatremia.
T939 320433-320514 Epistemic_statement denotes Severe abnormalities in electrolytes and pH can lead to cerebral edema and death.
T940 320713-320807 Epistemic_statement denotes At the scene the veterinarian or caretaker can spray the animal with tepid (not 1 cold) water.
T941 320876-321047 Epistemic_statement denotes Cold water and ice will cause extreme peripheral vasoconstriction, inhibiting the patient's ability to dissipate heat through conductive and convective cooling mechanisms.
T942 321048-321160 Epistemic_statement denotes As a result, core body temperature will continue to rise despite the good intentions of attendants at the scene.
T943 321243-321626 Epistemic_statement 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. 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.
T944 322104-322239 Epistemic_statement denotes Administer antibiotics if there are any signs of gastrointestinal bleeding that will predispose the patient to bacterial translocation.
T945 323432-323556 Epistemic_statement denotes Animals with malignant hyperthermia should avoid any predisposing factors, including exertion, hyperthermia, and anesthesia.
T946 323942-324049 Epistemic_statement denotes Sometimes it is difficult to assess whether an animal has been bitten by a poisonous or nonpoisonous snake.
T947 324121-324212 Epistemic_statement denotes Both snakes make similar noise and can be alarming if noticed on a hike or in the backyard.
T948 324213-324291 Epistemic_statement denotes Whenever possible, identify the offending reptile but never risk being bitten.
T949 324575-324702 Epistemic_statement denotes However, large boas or pythons also can inflict large crushing injuries that can cause severe trauma, including bony fractures.
T950 324842-325001 Epistemic_statement 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.
T951 325148-325251 Epistemic_statement denotes If clinical signs of envenomation occur, modify the patient's treatment appropriately and aggressively.
T952 325939-326182 Epistemic_statement 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.
T953 326183-326412 Epistemic_statement 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.
T954 326413-326621 Epistemic_statement 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.
T955 326622-326686 Epistemic_statement denotes Clinical signs of envenomation may take several hours to appear.
T956 326857-326939 Epistemic_statement denotes First aid measures by animal caretakers do little to prevent further envenomation.
T957 327061-327194 Epistemic_statement denotes To determine whether an animal has been envenomated by a pit viper, examine a peripheral blood smear for the presence of echinocytes.
T958 327195-327287 Epistemic_statement denotes Echinocytes will appear within 15 minutes of envenomation and may disappear within 48 hours.
T959 327288-327442 Epistemic_statement denotes Other treatment should be initiated 1 as rapidly and aggressively as possible, although controversy exists regarding whether some therapies are warranted.
T960 327667-327770 Epistemic_statement denotes Because pit viper venom consists of multiple fractions, treat each envenomation as a complex poisoning.
T961 328035-328119 Epistemic_statement denotes Opioid analgesics are potent and should be administered at the time of presentation.
T962 328183-328407 Epistemic_statement 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.
T963 328716-328861 Epistemic_statement denotes Clinically, however, patients that receive antivenin are more comfortable and leave the hospital sooner than those that do not receive antivenin.
T964 328862-328926 Epistemic_statement denotes The exact dose of antivenin is unknown in small animal patients.
T965 329206-329364 Epistemic_statement 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.
T966 330031-330313 Epistemic_statement 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).
T967 331002-331298 Epistemic_statement 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.
T968 331299-331376 Epistemic_statement denotes Clinical signs may be delayed for as long as 18 hours after the initial bite.
T969 331377-331523 Epistemic_statement denotes Immediate treatment with antivenin is necessary in cases of coral snake envenomation before the clinical signs become apparent, whenever possible.
T970 331841-331956 Epistemic_statement denotes Respiratory and cardiovascular support should occur with mechanical ventilation and intravenous crystalloid fluids.
T971 332663-332715 Epistemic_statement denotes Several weeks may elapse before a complete recovery.
T972 332717-332882 Epistemic_statement 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.
T973 332883-333005 Epistemic_statement denotes The immature female can be recognized by a colorful pattern of red, brown, and beige on the dorsal surface of the abdomen.
T974 333006-333069 Epistemic_statement denotes Adult and immature females are equally capable of envenomation.
T975 333335-333456 Epistemic_statement 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.
T976 333600-333672 Epistemic_statement denotes Affected animals may demonstrate clinical signs of acute abdominal pain.
T977 333673-333721 Epistemic_statement denotes Tonic-clonic convulsions may occur but are rare.
T978 333722-333821 Epistemic_statement denotes In cats, paralytic signs predominate and appear early as an ascending lower motor neuron paralysis.
T979 333822-333877 Epistemic_statement denotes Increased salivation, vomiting, and diarrhea may occur.
T980 333979-334054 Epistemic_statement denotes Myoglobinemia and myoglobinuria can occur because of extreme muscle damage.
T981 334055-334182 Epistemic_statement denotes Management of black widow spider envenomation should be aggressive in the cat and dog, particularly when the exposure is known.
T982 334183-334316 Epistemic_statement denotes In many cases, however, the diagnosis is made based on clinical signs, biochemical abnormalities, and lack of another apparent cause.
T983 334317-334420 Epistemic_statement denotes Antivenin (one vial) is available and should be administered after pretreatment with 1 diphenhydramine.
T984 334767-334893 Epistemic_statement denotes Brown spiders are found primarily in the southern half of the United States but have been documented as far north as Michigan.
T985 335160-335230 Epistemic_statement denotes The ulcer can take months to heal and often leaves a disfiguring scar.
T986 335231-335336 Epistemic_statement denotes Systemic reactions are rare but can include hemolysis, fever, thrombocytopenia, weakness, and joint pain.
T987 335337-335361 Epistemic_statement denotes Fatalities are possible.
T988 335362-335649 Epistemic_statement 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.
T989 335650-335719 Epistemic_statement denotes Dapsone has been recommended at a dose of 1 mg/kg PO tid for 10 days.
T990 335721-335836 Epistemic_statement denotes The animal should have its mouth rinsed out thoroughly with tap water even before presentation to the veterinarian.
T991 335956-336098 Epistemic_statement 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.
T992 336199-336273 Epistemic_statement denotes Ventricular dysrhythmias can be controlled first with esmolol (0.1 mg/kg).
T993 336389-336507 Epistemic_statement 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).
T994 336602-336789 Epistemic_statement 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).
T995 337166-337252 Epistemic_statement denotes Because these lizards are typically lethargic and nonaggressive, bite wounds are rare.
T996 337556-337672 Epistemic_statement denotes The lizard can be disengaged by inserting a prying instrument between the jaws and pushing at the back of the mouth.
T997 338903-339158 Epistemic_statement 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.
T998 339803-339974 Epistemic_statement 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.
T999 339975-340161 Epistemic_statement 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.
T1000 340162-340337 Epistemic_statement 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).
T1001 340641-340762 Epistemic_statement denotes Unconscious or immobile patients must have radiographic examination of the spinal column after stabilization and support.
T1002 340763-340872 Epistemic_statement denotes Palpate the skull carefully for obvious depressions or crepitus that may be associated with a skull fracture.
T1003 340873-341144 Epistemic_statement 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.
T1004 341237-341380 Epistemic_statement 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.
T1005 341717-341839 Epistemic_statement 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.
T1006 342125-342335 Epistemic_statement 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.
T1007 342503-342646 Epistemic_statement denotes Higher-quality radiographs can be performed to determine the extent of the injury when the animal is sedated adequately and pain is controlled.
T1008 342728-342865 Epistemic_statement denotes Opioid drugs work well for orthopedic pain, produce minimal cardiorespiratory depression, and can be reversed with naloxone if necessary.
T1009 342973-343105 Epistemic_statement denotes Rough or careless handling of a fracture site can cause a closed fracture to penetrate through the skin and become an open fracture.
T1010 343454-343655 Epistemic_statement 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.
T1011 343921-344115 Epistemic_statement 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.
T1012 344116-344222 Epistemic_statement denotes Reduction of the fracture or straightening of gross deformities may return normal vascularity to the limb.
T1013 344308-344465 Epistemic_statement denotes Swelling may increase pressure on the nerves as they run through osteofascial compartments, resulting in decreased sensory or motor function, or neuropraxia.
T1014 344538-344798 Epistemic_statement 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.
T1015 345011-345153 Epistemic_statement 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.
T1016 345154-345290 Epistemic_statement denotes Inappropriate bandaging of humerus or femur fractures can result in a fulcrum effect and worsen the soft tissue and neurologic injuries.
T1017 345291-345434 Epistemic_statement denotes Further displacement of vertebral bodies or luxations can cause cord compression or laceration such that return to function becomes impossible.
T1018 345728-345874 Epistemic_statement denotes Wounds associated with musculoskeletal trauma are common and include injury to the bones, joints, tendons, and surrounding musculature (Box 1-42).
T1019 345875-346039 Epistemic_statement 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.
T1020 346040-346207 Epistemic_statement 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.
T1021 346208-346341 Epistemic_statement denotes In the early management of an open fracture, the areas should be splinted without pulling any exposed bone back into the soft tissue.
T1022 346342-346503 Epistemic_statement 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.
T1023 346504-346712 Epistemic_statement 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.
T1024 346713-346883 Epistemic_statement denotes Bactericidal antibiotic therapy with a first-generation cephalosporin should be started immediately to obtain adequate concentrations of antibiotics at the fracture site.
T1025 346884-346998 Epistemic_statement denotes The duration of antibiotic therapy should ideally be limited to 2 to 3 days to prevent the risk of superinfection.
T1026 347233-347439 Epistemic_statement 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.
T1027 348245-348395 Epistemic_statement 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.
T1028 348662-348732 Epistemic_statement denotes When associated with a fracture, wound is created from the outside in.
T1029 348859-348994 Epistemic_statement denotes Prognosis is good if wound is debrided within 6 hours of injury and provided rigid stabilization with a bone plate or external fixator.
T1030 349341-349377 Epistemic_statement denotes Can require prolonged healing times.
T1031 349784-349915 Epistemic_statement 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.
T1032 350036-350153 Epistemic_statement denotes If the wound is too severe or if there is obvious infection, tag the ends of the tendons and nerves for later repair.
T1033 350154-350349 Epistemic_statement 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.
T1034 350350-350569 Epistemic_statement 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.
T1035 350639-350748 Epistemic_statement denotes Structural injuries to the joints are common and can involve both ligaments and articular cartilage injuries.
T1036 350749-350920 Epistemic_statement denotes Cartilage does not heal well; therefore, injuries involving articular cartilage can lead to a significant loss of function and degenerative joint disease (osteoarthritis).
T1037 351400-351486 Epistemic_statement denotes Impact injuries to surface cartilage can cause chondrocyte and underlying bone injury.
T1038 351487-351590 Epistemic_statement denotes These lesions rapidly progress to osteoarthritis; however, they may be totally or partially reversible.
T1039 351848-351961 Epistemic_statement denotes Healing of grade III injuries often is a problem, and suture stents or surgical reapproximation may be indicated.
T1040 351962-352089 Epistemic_statement denotes Failure to immobilize joints that are frequently flexed (elbow and stifle) can result in late complications of ligament repair.
T1041 352090-352315 Epistemic_statement 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).
T1042 352874-352996 Epistemic_statement denotes 1 the epiphysis or growth plate, the greater the potential for remodeling and the development of angular limb deformities.
T1043 353091-353248 Epistemic_statement denotes Fractures through the growth plate of immature animals may potentially cause angular limb deformities, joint dislocations or incongruity, and osteoarthritis.
T1044 355061-355206 Epistemic_statement denotes In many cases, however, ingestion of the foreign object is not witnessed, and diagnosis is made based on clinical signs and physical examination.
T1045 355460-355566 Epistemic_statement denotes Irritation, inability to close the mouth, and blockage of the oropharynx can result in excessive drooling.
T1046 355567-355666 Epistemic_statement denotes The saliva may appear blood-tinged owing to concurrent soft tissue trauma (Figures 1-46 and 1-47) .
T1047 355667-355810 Epistemic_statement 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.
T1048 355811-355901 Epistemic_statement denotes In many cases the object is small enough to enter the larynx but too large to be expelled.
T1049 355902-356021 Epistemic_statement denotes If a foreign object is lodged in the mouth for more than several days, halitosis and purulent discharge may be present.
T1050 356022-356160 Epistemic_statement 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.
T1051 356161-356308 Epistemic_statement 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.
T1052 356433-356606 Epistemic_statement 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.
T1053 356833-356927 Epistemic_statement denotes Hemostats and Carmalt forceps may slip and not be useful in the removal of the foreign object.
T1054 357359-357564 Epistemic_statement 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.
T1055 357829-357968 Epistemic_statement denotes The patient should be carefully monitored for 24 hours, because noncardiogenic pulmonary edema can develop secondary to airway obstruction.
T1056 358131-358293 Epistemic_statement 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.
T1057 358406-358457 Epistemic_statement denotes Many animals will make repeated swallowing motions.
T1058 358877-359015 Epistemic_statement denotes If the object has been lodged for several days, pleural effusion and pneumomediastinum may be present secondary to esophageal perforation.
T1059 359016-359161 Epistemic_statement denotes Endoscopy is useful for both diagnosis and removal of the foreign object; however, it is invasive and requires general anesthesia (Figure 1-48) .
T1060 359304-359452 Epistemic_statement denotes Evaluate the integrity of the esophagus both before and after removal of the material because focal perforation or pressure necrosis can be present.
T1061 359640-359683 Epistemic_statement denotes Rigid tube endoscopy can also be performed.
T1062 359684-359831 Epistemic_statement 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.
T1063 360049-360155 Epistemic_statement denotes In such cases, referral to a surgical specialist is recommended for esophagostomy or esophageal resection.
T1064 360457-360602 Epistemic_statement denotes If esophageal irritation or erosion is moderate to severe, a percutaneous gastrotomy tube should be placed for feeding until the esophagus heals.
T1065 360603-360731 Epistemic_statement denotes Perform repeat endoscopy every 7 days to evaluate the healing process and to determine whether stricture formation is occurring.
T1066 360732-360841 Epistemic_statement denotes sTomACh Persistent vomiting immediately or soon after eating is often associated with a gastric foreign body.
T1067 361156-361268 Epistemic_statement denotes Obstruction to gastric outflow and vomiting of hydrochloric acid often cause a hypochloremic metabolic acidosis.
T1068 361269-361334 Epistemic_statement denotes Radiopaque gastric foreign bodies may be observed on plain films.
T1069 361335-361462 Epistemic_statement denotes Radiolucent cloth material may require a barium series to delineate the shape and location of the foreign body ( Figure 1-49) .
T1070 361541-361718 Epistemic_statement denotes Most animals with uncomplicated gastric foreign bodies are relatively healthy, but any metabolic and electrolyte abnormalities should be corrected before anesthesia and surgery.
T1071 361719-361848 Epistemic_statement denotes Small intestinal obstruction can be caused by foreign bodies, tumors, intussusception, volvulus, or strangulation within hernias.
T1072 361849-362007 Epistemic_statement 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.
T1073 362008-362193 Epistemic_statement 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.
T1074 362194-362387 Epistemic_statement 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).
T1075 362388-362563 Epistemic_statement denotes The most common clinical signs associated with a complete small intestinal obstruction are anorexia, vomiting, lethargy, depression, dehydration, and sometimes abdominal pain.
T1076 362564-362745 Epistemic_statement 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.
T1077 363316-363375 Epistemic_statement denotes The bowel wall eventually becomes ischemic and may rupture.
T1078 363376-363461 Epistemic_statement denotes Linear foreign bodies should be suspected in any vomiting patient, particularly cats.
T1079 363462-363592 Epistemic_statement 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.
T1080 363843-363922 Epistemic_statement denotes Thread and string can be observed lying along the ventral aspect of the tongue.
T1081 363923-364049 Epistemic_statement denotes In some cases, if a linear foreign body is lodged very caudally, it cannot be visualized without heavy sedation or anesthesia.
T1082 364384-364515 Epistemic_statement denotes Continued peristalsis eventually causes a sawing motion of the material and perforation of the mesenteric border of the intestines.
T1083 364832-364977 Epistemic_statement denotes Intestinal masses may be palpable on physical examination and are often associated with signs of discomfort or pain when palpating over the mass.
T1084 365052-365190 Epistemic_statement denotes Plain radiographs may be diagnostic when the foreign object is radiodense or there is characteristic dilation or plication of bowel loops.
T1085 365191-365296 Epistemic_statement 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.
T1086 365297-365414 Epistemic_statement denotes Diagnosis of small intestinal obstruction or ileus can be based on the appearance of stacking loops of dilated bowel.
T1087 365940-366069 Epistemic_statement denotes Contrast radiography is indicated when confirmation of the suspected diagnosis is necessary and ultrasonography is not available.
T1088 366070-366152 Epistemic_statement denotes Contrast material may outline the object or abruptly stop orad to the obstruction.
T1089 366425-366522 Epistemic_statement denotes The timing of surgery is critical because the risk of intestinal perforation increases with time.
T1090 366662-366823 Epistemic_statement 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.
T1091 366902-367087 Epistemic_statement 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.
T1092 367208-367295 Epistemic_statement denotes Hematochezia may be present if the foreign object causes abrasion of the rectal mucosa.
T1093 367296-367357 Epistemic_statement denotes Symptomatic patients should have abdominal radiographs taken.
T1094 367358-367502 Epistemic_statement denotes Colonoscopy or exploratory laparotomy should be performed if survey radiographs are suggestive of a large intestinal obstruction or perforation.
T1095 367798-367904 Epistemic_statement denotes Often the material can pass through the entire gastrointestinal tract and then get stuck in the anal ring.
T1096 368537-368769 Epistemic_statement 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.
T1097 368950-369094 Epistemic_statement denotes Usually, hemorrhagic diarrhea is the first noticeable sign and in puppies may be caused by parvoviral enteritis, with secondary intussusception.
T1098 369615-369742 Epistemic_statement denotes Plain radiographs may demonstrate segmental or generalized dilated segments of bowel, depending on the duration of the problem.
T1099 370085-370219 Epistemic_statement denotes Although enteroplication has been suggested, the technique has fallen out of favor because of the increased risk of later obstruction.
T1100 370317-370382 Epistemic_statement denotes Gastric dilatation can occur with or without volvulus in the dog.
T1101 370619-370712 Epistemic_statement denotes The risk of GDV increases with age; however, it can be seen in dogs as young as 4 months old.
T1102 370713-370802 Epistemic_statement denotes Deep, narrow-chested breeds are more likely to develop GDV than dogs with broader chests.
T1103 371120-371273 Epistemic_statement 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.
T1104 371669-371802 Epistemic_statement 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.
T1105 371803-371954 Epistemic_statement denotes Depending on the stage of shock, the patient may have sinus tachycardia with bounding pulses, cardiac dysrhythmias with pulse deficits, or bradycardia.
T1106 371955-372051 Epistemic_statement denotes The mucous membranes may appear red and injected or pale with a prolonged capillary refill time.
T1107 372052-372119 Epistemic_statement denotes The patient may appear anxious and attempt to retch unproductively.
T1108 372755-372966 Epistemic_statement 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.
T1109 373424-373488 Epistemic_statement denotes The use of short-acting glucocorticosteroids is not recommended.
T1110 374541-374639 Epistemic_statement denotes Once the tube has been passed, air within the stomach is relieved, and the stomach can be lavaged.
T1111 375179-375331 Epistemic_statement 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.
T1112 375332-375510 Epistemic_statement 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.
T1113 375774-375945 Epistemic_statement 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.
T1114 376224-376430 Epistemic_statement 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.
T1115 376431-376673 Epistemic_statement 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.
T1116 376757-376928 Epistemic_statement denotes The use of NSAIDs (flunixin meglumine, carprofen, ketoprofen) that can potentially decrease renal perfusion and predispose to gastric ulcers is absolutely contraindicated.
T1117 377086-377234 Epistemic_statement denotes After a balanced anesthesia protocol has been carried out, the patient should be taken immediately to surgery for gastric derotation and gastropexy.
T1118 377369-377478 Epistemic_statement denotes If no resection is required, the animal can be given small amounts of water beginning 12 hours after surgery.
T1119 377479-377609 Epistemic_statement denotes Depending on the severity of the patient's condition, small amounts of a bland diet can be offered 12 to 24 hours postoperatively.
T1120 377768-377972 Epistemic_statement 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.
T1121 378083-378206 Epistemic_statement denotes The problem is most common in the young German Shepherd Dog, although it has been observed in other large and giant breeds.
T1122 378712-378820 Epistemic_statement denotes In some dogs, multiple, tear-drop-shaped, gas-filled loops appear to rise from a focal point in the abdomen.
T1123 379243-379336 Epistemic_statement denotes This condition is most common in young German Shepherd Dogs but can be observed in any breed.
T1124 380234-380339 Epistemic_statement denotes Obstipation, however, is caused by a dynamic ileus of the large bowel that eventually leads to megacolon.
T1125 380726-380915 Epistemic_statement 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.
T1126 380916-381001 Epistemic_statement denotes Stool softeners such as lactulose and docusate stool softener (DSS) may also be used.
T1127 381002-381124 Epistemic_statement denotes Predisposing causes of obstipation such as narrowing of the pelvic canal, perineal hernia, and tumors should be ruled out.
T1128 381243-381380 Epistemic_statement denotes Adenocarcinomas tend to be annular and constricting, and they may cause progressive obstruction of the lumen of the small or large bowel.
T1129 381668-381742 Epistemic_statement denotes Effusion may be present if metastasis to peritoneal surfaces has occurred.
T1130 382054-382244 Epistemic_statement 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.
T1131 382410-382510 Epistemic_statement denotes Leiomyoma and leiomyosarcoma are tumors that can cause partial or complete obstruction of the bowel.
T1132 382623-382749 Epistemic_statement denotes Hypoglycemia can be observed as a paraneoplastic syndrome or because of sepsis and peritonitis secondary to bowel perforation.
T1133 382920-383040 Epistemic_statement denotes Incarceration of a loop of bowel into congenital or acquired defects in the body wall can cause small bowel obstruction.
T1134 383118-383224 Epistemic_statement denotes Rarely, older animals with perineal hernias and animals of any age with traumatic hernias can be affected.
T1135 383225-383351 Epistemic_statement denotes Clinical signs are consistent with a small intestinal obstruction: anorexia, vomiting, lethargy, abdominal pain, and weakness.
T1136 383787-383952 Epistemic_statement 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.
T1137 383953-384110 Epistemic_statement 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).
T1138 384111-384198 Epistemic_statement denotes Perforation of the stomach and small and large intestines can occur with use of NSAIDs.
T1139 384199-384334 Epistemic_statement denotes Diagnosis of bowel perforation first depends on the alertness to the possibility that the bowel may have been perforated or penetrated.
T1140 384335-384443 Epistemic_statement denotes As a general rule, all penetrating injuries of the abdomen should be investigated by exploratory laparotomy.
T1141 384444-384593 Epistemic_statement denotes DPL can be performed; however, early after penetrating injury of the bowel, DPL findings may be negative or nondiagnostic until peritonitis develops.
T1142 384594-384793 Epistemic_statement 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.
T1143 385540-385678 Epistemic_statement denotes Older animals with rectal prolapse often have an underlying problem such as a tumor or mucosal lesion that causes straining and dyschezia.
T1144 385762-385871 Epistemic_statement denotes The diagnosis of rectal prolapse is sometimes difficult to distinguish from small intestinal intussusception.
T1145 385872-385963 Epistemic_statement denotes In rare cases the intussusception can invaginate through the large bowel, rectum, and anus.
T1146 386180-386271 Epistemic_statement denotes Inability to insert the probe or thermometer indicates that the rectal mucosa is prolapsed.
T1147 386362-386477 Epistemic_statement denotes Treatment can be performed easily if the prolapse is acute and the rectal mucosa is not too irritated or edematous.
T1148 386890-386996 Epistemic_statement denotes If a rectal prolapse cannot be reduced, or if the tissue is nonviable, surgical intervention is warranted.
T1149 386997-387130 Epistemic_statement denotes In patients in which viable tissue does not stay reduced with a purse-string suture, a colopexy can be performed during a laparotomy.
T1150 387848-387965 Epistemic_statement denotes Avoid using thermometers or other probes in the immediate postoperative period because they may disrupt suture lines.
T1151 387966-388242 Epistemic_statement 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.
T1152 388752-388844 Epistemic_statement denotes A careful and thorough examination of the vomitus may be helpful in arriving at a diagnosis.
T1153 388845-389133 Epistemic_statement 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.
T1154 389841-390017 Epistemic_statement denotes Although antacids (famotidine, ranitidine, cimetidine) do not have a direct antiemetic effect, their use can decrease gastric acidity and esophageal irritation during vomiting.
T1155 390305-390445 Epistemic_statement 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.
T1156 390797-390837 Epistemic_statement denotes The hematocrit can rise from 55% to 75%.
T1157 390926-391096 Epistemic_statement 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.
T1158 392142-392216 Epistemic_statement denotes Pancreatitis occurs most frequently in dogs but can occur in cats as well.
T1159 392379-392555 Epistemic_statement 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.
T1160 392556-392790 Epistemic_statement 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.
T1161 392791-392920 Epistemic_statement denotes In cats, acute necrotizing pancreatitis is associated with anorexia, lethargy, hyperglycemia, icterus, and sometimes acute death.
T1162 393040-393206 Epistemic_statement denotes Predisposing causes of chronic pancreatitis in cats include pancreatic flukes, viral infection, hepatic lipidosis, drugs, organophosphate toxicity, and toxoplasmosis.
T1163 394037-394140 Epistemic_statement denotes Depending on the severity of pancreatic inflammation, depression, hypotension, and SIRS may be present.
T1164 394141-394188 Epistemic_statement denotes Subacute cases may have minimal clinical signs.
T1165 394189-394294 Epistemic_statement denotes Severe pancreatic edema can result in vascular changes and ischemia that perpetuates severe inflammation.
T1166 394295-394360 Epistemic_statement denotes Hypovolemic shock and DIC can also decrease pancreatic perfusion.
T1167 394504-394626 Epistemic_statement denotes Pain may be localized to the right upper abdominal quadrant or may be generalized if peripancreatic saponification occurs.
T1168 394892-394971 Epistemic_statement denotes Hepatic necrosis, lipidosis, congestion, and abnormal architecture can develop.
T1169 394972-395209 Epistemic_statement 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.
T1170 395210-395351 Epistemic_statement denotes Electrolyte imbalances and hypovolemia secondary to vomiting all can lead to multiple organ dysfunction syndrome (MODS) and ultimately death.
T1171 395352-395457 Epistemic_statement denotes If a patient survives an episode of acute pancreatitis, long-term sequelae can include diabetes mellitus.
T1172 395601-395818 Epistemic_statement 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.
T1173 395819-396050 Epistemic_statement 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.
T1174 396108-396248 Epistemic_statement denotes Impaired renal clearance or function can cause artifactual elevations of serum amylase and lipase in the absence of pancreatic inflammation.
T1175 396249-396363 Epistemic_statement denotes Furthermore, serum lipase levels can be elevated as a result of gastrointestinal obstruction (e.g., foreign body).
T1176 396364-396533 Epistemic_statement 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.
T1177 396739-396830 Epistemic_statement denotes Amylase and lipase should be tested concurrently with the rest of the biochemistry profile.
T1178 396985-397108 Epistemic_statement denotes Hypocalcemia can occur secondary to peripancreatic fat saponification, and its presence warrants a more negative prognosis.
T1179 397389-397492 Epistemic_statement denotes However, because the results of this test take time to obtain, animals must be treated in the meantime.
T1180 397753-398007 Epistemic_statement 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.
T1181 398008-398201 Epistemic_statement 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.
T1182 398202-398329 Epistemic_statement denotes Abdominal radiographs may sometimes reveal a loss of abdominal detail or a ground glass appearance in the right upper quadrant.
T1183 398330-398518 Epistemic_statement 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).
T1184 398600-398852 Epistemic_statement 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).
T1185 398853-398929 Epistemic_statement denotes When treating pancreatitis in dogs, all food and water should be restricted.
T1186 398930-399003 Epistemic_statement denotes However, food should not be withheld from cats with chronic pancreatitis.
T1187 399244-399535 Epistemic_statement 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).
T1188 399610-399742 Epistemic_statement denotes Acute hepatic failure may be associated with toxins, adverse reaction to prescription medication, and bacterial or viral infections.
T1189 400298-400493 Epistemic_statement 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.
T1190 400710-400790 Epistemic_statement denotes Plasma also is an excellent source of clotting factors that can become depleted.
T1191 401495-401606 Epistemic_statement denotes Patients with systemic hypertension should have a thorough diagnostic workup to determine the underlying cause.
T1192 401607-401734 Epistemic_statement denotes Although uncommon, hypertensive emergencies can occur with pheochromocytoma, acute renal failure, and acute glomerulonephritis.
T1193 401735-401919 Epistemic_statement 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.
T1194 402099-402393 Epistemic_statement 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).
T1195 402394-402881 Epistemic_statement 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.
T1196 402882-402991 Epistemic_statement denotes Management of systemic hypertension involves treatment of the primary underlying disorder, whenever possible.
T1197 403125-403219 Epistemic_statement denotes Obese animals should be placed on dietary restrictions and undergo a weight reduction program.
T1198 403220-403318 Epistemic_statement denotes Thiazide and loop diuretics may be used to decrease sodium retention and circulating blood volume.
T1199 403319-403456 Epistemic_statement denotes α-adrenergic and β-adrenergic blockers may be used, but they are largely ineffective as monotherapeutic agents for treating hypertension.
T1200 403595-403732 Epistemic_statement denotes diABeTiC keToACidosis DKA is a potentially fatal and terminal consequence of unregulated insulin deficiency and possible glucagon excess.
T1201 403957-404110 Epistemic_statement denotes Early in the course of the disease, patients exhibit clinical signs associated with diabetes mellitus: weight loss, polyuria, polyphagia, and polydipsia.
T1202 404665-405035 Epistemic_statement 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.
T1203 405036-405184 Epistemic_statement denotes Although a whole-body potassium deficit is usually present, the serum potassium may appear artifactually elevated in response to metabolic acidosis.
T1204 405386-405450 Epistemic_statement denotes Hypophosphatemia >2 mg/dL can result in intravascular hemolysis.
T1205 405546-405655 Epistemic_statement denotes The urine of all diabetic animals should be cultured to rule out a urinary tract infection or pyelonephritis.
T1206 406134-406245 Epistemic_statement denotes Whenever possible, insert a central venous catheter for fluid infusion and procurement of repeat blood samples.
T1207 407162-407295 Epistemic_statement denotes The rate and type of fluid and amount of dextrose supplementation will change according to the patient's blood glucose concentration.
T1208 407408-407557 Epistemic_statement denotes Measure serum potassium every 8 hours, if possible, and supplement accordingly (see section on fluid therapy for chart of potassium supplementation).
T1209 407558-407749 Epistemic_statement 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.
T1210 408215-408395 Epistemic_statement 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.
T1211 408396-408597 Epistemic_statement 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
T1212 408598-408793 Epistemic_statement 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.
T1213 408914-408962 Epistemic_statement denotes Subcutaneous insulin should not be administered.
T1214 409739-409816 Epistemic_statement denotes Infusion of the insulin mixture should be in a separate intravenous catheter.
T1215 410055-410194 Epistemic_statement denotes Additional injections of regular insulin (0.11 unit/kg IM) should be administered based on the patient's response to subsequent injections.
T1216 410550-410691 Epistemic_statement denotes Even in patients with intramuscular regular insulin therapy, a central venous catheter should be placed for frequent blood sample collection.
T1217 410800-410860 Epistemic_statement denotes Hypokalemia, hypophosphatemia, and hypomagnesemia can occur.
T1218 411086-411147 Epistemic_statement denotes Extreme hyperosmolarity can result in a coma, if uncorrected.
T1219 411148-411301 Epistemic_statement denotes In patients with diabetes mellitus, hyperglycemia and hypernatremia secondary to osmotic diuresis and free water loss can lead to severe hyperosmolarity.
T1220 411360-411425 Epistemic_statement denotes Hyperosmolarity is expected when serum osmolality is >340 mOsm/L.
T1221 411426-411544 Epistemic_statement denotes If equipment for determining serum osmolarity is not available, osmolarity can be calculated by the following formula:
T1222 411545-411721 Epistemic_statement 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.
T1223 412005-412253 Epistemic_statement 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) .
T1224 412367-412492 Epistemic_statement 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.
T1225 412991-413189 Epistemic_statement 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.
T1226 413478-413587 Epistemic_statement denotes Clinical signs can become evident when total calcium decreases to <8.0 mg/ dL in dogs and <7.0 mg/dL in cats.
T1227 413588-413697 Epistemic_statement denotes The disease is often observed in small, excitable dogs, and stress may play a complicating role in the cause.
T1228 413775-413852 Epistemic_statement denotes In some cases, however, clinical signs can develop before parturition occurs.
T1229 413853-413897 Epistemic_statement denotes Hypophosphatemia may accompany hypocalcemia.
T1230 414299-414369 Epistemic_statement denotes Severe refractory tetanus can be controlled with intravenous diazepam.
T1231 414637-414753 Epistemic_statement denotes Also instruct the owner about how to wean the puppies, allowing the bitch to dry up, in order to prevent recurrence.
T1232 414898-414961 Epistemic_statement denotes hyPerCAlCemiA Hypercalcemia can occur from a variety of causes.
T1233 414962-415084 Epistemic_statement denotes The GOSH DARN IT mnemonic can be used to remember the various causes of hypercalcemia in small animal patients (Box 1-47).
T1234 415610-415699 Epistemic_statement denotes If this product exceeds 70, dystrophic calcification can occur, leading to renal failure.
T1235 415911-416084 Epistemic_statement 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.
T1236 416304-416402 Epistemic_statement denotes The treatment of choice is correction of the underlying cause of hypercalcemia, whenever possible.
T1237 416403-416571 Epistemic_statement 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.
T1238 416772-416902 Epistemic_statement denotes To promote diuresis, initial intravenous fluid rates should approach two to three times maintenance levels (120 to 180 mL/kg/day).
T1239 416903-416979 Epistemic_statement denotes Potassium supplementation may be required to prevent iatrogenic hypokalemia.
T1240 417083-417223 Epistemic_statement 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.
T1241 417224-417384 Epistemic_statement 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.
T1242 417453-417580 Epistemic_statement denotes Alternatively, bisphosphonates (pamidronate, 1.02 to 2.0 mg/kg IV) are useful in rapidly reducing serum calcium concentrations.
T1243 417720-417853 Epistemic_statement denotes Administer glucocorticosteroids only after the underlying cause of hypercalcemia has been determined and appropriate therapy started.
T1244 417854-418087 Epistemic_statement 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.
T1245 418089-418230 Epistemic_statement 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.
T1246 418231-418515 Epistemic_statement 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.
T1247 418516-418599 Epistemic_statement denotes In such cases, complete adrenocortical collapse can result in an addisonian crisis.
T1248 418705-418969 Epistemic_statement 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).
T1249 419387-419551 Epistemic_statement denotes Electrocardiographic changes associated with hyperkalemia include inappropriate bradycardia, absence of p waves, elevated spiked T waves, and widened QRS complexes.
T1250 419979-420168 Epistemic_statement denotes Rarely, animals with "atypical" hypoadrenocorticism lose glucocorticoid-secreting ability from the zona fasciculata but retain mineralocorticoid secretory ability from the zona glomerulosa.
T1251 420348-420441 Epistemic_statement denotes The diagnosis is more difficult in such cases because of the presence of normal electrolytes.
T1252 420442-420524 Epistemic_statement denotes An ACTH stimulation test should be considered, particularly in predisposed breeds.
T1253 421317-421428 Epistemic_statement denotes If severe gastrointestinal blood loss occurs, whole blood, packed RBCs, or fresh frozen plasma may be required.
T1254 421790-421964 Epistemic_statement 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).
T1255 421965-422119 Epistemic_statement denotes Fludrocortisone acetate possesses both mineralocorticoid and glucocorticoid activities and can be used as the sole daily treatment of hypoadrenocorticism.
T1256 422120-422254 Epistemic_statement denotes (Because fludrocortisone is poorly absorbed in some dogs, it may not completely normalize electrolyte abnormalities in these animals.)
T1257 422386-422499 Epistemic_statement denotes In dogs, iatrogenic hypoadrenocorticism can be caused by abrupt discontinuation of glucocorticosteroid treatment.
T1258 422500-422669 Epistemic_statement denotes Long-term glucocorticosteroid supplementation can downregulate the pituitary gland's excretion of endogenous ACTH and the zona fasciculata's ability to excrete cortisol.
T1259 422670-422764 Epistemic_statement denotes However, the zona glomerulosa's ability to secrete aldosterone does not appear to be affected.
T1260 423004-423128 Epistemic_statement denotes After immediate emergency treatment, the patient should be weaned slowly from exogenous glucocorticosteroid supplementation.
T1261 423801-424043 Epistemic_statement 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.
T1262 424184-424292 Epistemic_statement denotes Start the patient on methimazole as quickly as possible, and consider the use of radioactive iodine therapy.
T1263 424294-424449 Epistemic_statement denotes Four classes of neurologic injuries can seriously jeopardize a patient's life: head injuries, spinal cord and vertebral column injuries, coma, and seizure.
T1264 424503-424645 Epistemic_statement denotes Head injuries can be associated with skin and superficial lacerations, concussions, fractures, and hemorrhage (intracranial and extracranial).
T1265 424646-424711 Epistemic_statement denotes Fractures may be extracranial, linear, or depressed intracranial.
T1266 424712-424795 Epistemic_statement denotes Hemorrhage can be extradural, intradural, subdural, subarachnoid, or intracerebral.
T1267 424796-425003 Epistemic_statement 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) .
T1268 425566-425753 Epistemic_statement 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.
T1269 425754-425879 Epistemic_statement 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.
T1270 425880-426034 Epistemic_statement denotes Maintain blood glucose within normal reference ranges whenever possible, because hyperglycemia is a negative prognostic indicator in cases of head trauma.
T1271 426690-426861 Epistemic_statement 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) .
T1272 426862-427035 Epistemic_statement 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.
T1273 427036-427087 Epistemic_statement denotes Pupils can be normal in size, mydriatic, or miotic.
T1274 427088-427223 Epistemic_statement denotes Whenever a pupil appears miotic, direct ocular injury with uveitis or secondary miosis from brachial plexus injury should be ruled out.
T1275 427224-427285 Epistemic_statement denotes The eyes should always be examined to rule out ocular trauma.
T1276 427286-427425 Epistemic_statement denotes In a patient with head trauma, a change from dilated to constricted to normal pupil size is suggestive of improvement in clinical function.
T1277 427426-427600 Epistemic_statement 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.
T1278 427601-427729 Epistemic_statement denotes Bilateral miotic pupils with normal nystagmus and ocular movements are associated with diffuse cerebral or diencephalic lesions.
T1279 427730-427827 Epistemic_statement denotes Miotic pupils that become mydriatic indicate a progressive midbrain lesion with a poor prognosis.
T1280 427828-428017 Epistemic_statement 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.
T1281 428018-428111 Epistemic_statement denotes Asymmetric pupils are seen in patients with rostral brainstem lesions and can change rapidly.
T1282 428245-428319 Epistemic_statement denotes Appears lethargic and has sluggish response to external stimuli Confusion:
T1283 428320-428363 Epistemic_statement denotes May appear confused or aggressive Delirium:
T1284 428364-428430 Epistemic_statement denotes Vocalization, inappropriate response to external stimuli Semicoma:
T1285 428431-428489 Epistemic_statement denotes Unconscious but responds to external noxious stimuli Coma:
T1286 428490-428592 Epistemic_statement denotes Unconscious with no response to noxious stimuli 1 Visual deficits are common with intracranial injury.
T1287 428593-428725 Epistemic_statement denotes Lesions that are less severe and limited to the cerebrum produce contralateral menace deficits with normal pupillary light response.
T1288 428726-428836 Epistemic_statement denotes Bilateral cerebral edema can cause blindness with a normal response to light if the midbrain is not disturbed.
T1289 428837-428963 Epistemic_statement denotes A patient that is severely depressed and recumbent may not respond to menacing gestures, even when visual pathways are intact.
T1290 428964-429081 Epistemic_statement denotes Ocular, optic tract, optic nerve, or optic chiasm lesions can interfere with vision and the pupillary light response.
T1291 429082-429219 Epistemic_statement denotes Brainstem contusion and cerebral edema may produce blindness and dilated unresponsive pupils owing to disturbance of the oculomotor area.
T1292 429258-429391 Epistemic_statement denotes Cranial nerve abnormalities can indicate direct contusion or laceration of the neurons in the brainstem or where they exit the skull.
T1293 429588-429794 Epistemic_statement 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.
T1294 429922-430097 Epistemic_statement 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.
T1295 430516-430588 Epistemic_statement denotes In patients with severe CNS depression, this reflex may not be observed.
T1296 430802-430889 Epistemic_statement denotes Any intracranial injury may be accompanied by a concurrent cervical spinal cord injury.
T1297 430975-431119 Epistemic_statement 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.
T1298 431120-431260 Epistemic_statement denotes At least two orthogonal views may be required to see fractures; however, do not manipulate the patient until radiography has been completed.
T1299 431261-431442 Epistemic_statement 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.
T1300 431527-431664 Epistemic_statement denotes Evaluation of cranial nerve function at frequent intervals may reveal an initial injury or a progressively expanding lesion in the brain.
T1301 431835-431906 Epistemic_statement denotes Hemorrhage and CSF otorrhea may be visible from the external ear canal.
T1302 431907-431990 Epistemic_statement denotes Rolling movements indicate an injury to the cerebellar-medullary vestibular system.
T1303 432291-432376 Epistemic_statement denotes Mesencephalic lesions cause hyperventilation and can result in respiratory alkalosis.
T1304 432563-432683 Epistemic_statement denotes After injury, seizures may be associated with intracranial hemorrhage, trauma, or an expanding intracranial mass lesion.
T1305 432983-433147 Epistemic_statement 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.
T1306 433148-433272 Epistemic_statement denotes Severe refractory seizures or decreased mentation may be associated with cerebral edema and increased intracranial pressure.
T1307 433388-433504 Epistemic_statement denotes Mannitol also acts as a free radical scavenger that can inhibit the effects of cerebral ischemia-reperfusion injury.
T1308 433611-433732 Epistemic_statement denotes Corticosteroids have not been demonstrated to be beneficial in the treatment of head trauma and may induce hyperglycemia.
T1309 433733-433824 Epistemic_statement denotes Hyperglycemia has been shown to be a negative prognostic indicator in cases of head trauma.
T1310 433825-433908 Epistemic_statement denotes Also, glucocorticoids can suppress immune system function and impair wound healing.
T1311 434112-434273 Epistemic_statement 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.
T1312 434274-434396 Epistemic_statement denotes If progressive loss of consciousness occurs, surgery for decompression of compressive skull injuries should be considered.
T1313 434602-434690 Epistemic_statement denotes Diagnostic tests of head trauma may include skull radiographs, CT, and MRI of the brain.
T1314 434691-434830 Epistemic_statement denotes Special studies can help detect edema and hemorrhage in the brain and brainstem and aid in arriving at an accurate diagnosis and prognosis.
T1315 434988-435103 Epistemic_statement denotes If a compressive skull fracture is present, the patient should be stabilized for surgery to remove the compression.
T1316 435104-435242 Epistemic_statement denotes Surgery to alleviate increased intracranial pressure is rarely performed in veterinary medicine because of the poor prognosis and results.
T1317 435243-435431 Epistemic_statement 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.
T1318 435432-435477 Epistemic_statement denotes Blood clots can be removed through the holes.
T1319 435478-435591 Epistemic_statement denotes The bone flap may or may not be replaced, depending on the surgeon's preference and the degree of brain swelling.
T1320 435592-435706 Epistemic_statement denotes Spinal cord injuries may be associated with trauma, disk rupture, fractures, and dislocation of the spinal column.
T1321 435848-436024 Epistemic_statement 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.
T1322 436025-436186 Epistemic_statement 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.
T1323 436187-436305 Epistemic_statement denotes Sedation with analgesics or tranquilizers may be necessary to keep the animal immobile and to minimize patient motion.
T1324 436306-436437 Epistemic_statement denotes Whenever possible, avoid the use of narcotics in patients with head trauma because of the risk of increasing intracranial pressure.
T1325 436438-436567 Epistemic_statement denotes As in other emergencies, the ABCs should be evaluated, and the patient treated for shock, hemorrhage, and respiratory compromise.
T1326 436568-436708 Epistemic_statement denotes Once the cardiovascular and respiratory systems have been evaluated and stabilized, a more thorough neurologic examination can be performed.
T1327 436709-436875 Epistemic_statement 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.
T1328 437005-437094 Epistemic_statement denotes In dogs and cats, there are 36 intervertebral disks that potentially can cause a problem.
T1329 437530-437624 Epistemic_statement denotes The neurologic examination should be carried out without excessive manipulation of the animal.
T1330 437625-437730 Epistemic_statement denotes The presence of pain, edema, hemorrhage, or a visible deformity may localize an area of vertebral injury.
T1331 438666-438832 Epistemic_statement 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.
T1332 439150-439252 Epistemic_statement denotes Focal lesions are usually associated with vertebral fractures and displacement of the vertebral canal.
T1333 439253-439429 Epistemic_statement 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.
T1334 439430-439515 Epistemic_statement denotes The degree of structural damage cannot be determined from the neurologic signs alone.
T1335 439951-440157 Epistemic_statement 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.
T1336 440158-440310 Epistemic_statement 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.
T1337 440311-440330 Epistemic_statement denotes In the absence of a
T1338 440331-440616 Epistemic_statement 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
T1339 440617-440993 Epistemic_statement 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.
T1340 440994-441257 Epistemic_statement 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.
T1341 441397-441544 Epistemic_statement denotes The presence of worsening or ascending clinical signs may signify ascending-descending myelomalacia and is characteristic of a very poor prognosis.
T1342 441545-441708 Epistemic_statement 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.
T1343 441895-441985 Epistemic_statement denotes High-dose glucocorticoids should be used only for the first 48 hours after initial injury.
T1344 442073-442263 Epistemic_statement denotes The prophylactic use of gastroprotectant drugs will not prevent gastrointestinal ulcer formation; however, if signs of gastrointestinal ulcer are present, institute gastroprotectant therapy.
T1345 442583-442687 Epistemic_statement denotes Urinary bladder retention can lead to urinary tract infection, bladder atony, and overflow incontinence.
T1346 442688-442781 Epistemic_statement denotes Manual expression of the bladder several times a day may be enough to keep the bladder empty.
T1347 442782-442891 Epistemic_statement denotes Alternatively, place a urinary catheter to maintain patient cleanliness and to keep the bladder decompressed.
T1348 443173-443246 Epistemic_statement denotes Mild enemas or stool softeners can also be used to treat fecal retention.
T1349 444124-444221 Epistemic_statement denotes It can take weeks before the full extent of the injury and any return to function are manifested.
T1350 444222-444357 Epistemic_statement 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.
T1351 444829-445106 Epistemic_statement 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.
T1352 445636-445720 Epistemic_statement denotes The femoral nerve is protected by muscles and is rarely injured in pelvic fractures.
T1353 446065-446149 Epistemic_statement denotes In other cases, however, a careful and thorough diagnostic workup must be performed.
T1354 446257-446413 Epistemic_statement denotes Whenever an animal is presented in a comatose state, immediately secure the airway by placing an endotracheal tube (see section on endotracheal intubation).
T1355 446607-446722 Epistemic_statement denotes Make careful note of any seizure, trauma, or toxin exposure, and whether prior episodes of coma have ever occurred.
T1356 446829-447002 Epistemic_statement 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.
T1357 447003-447092 Epistemic_statement denotes Very high temperatures associated with shock and coma are often observed in animals with
T1358 447093-447159 Epistemic_statement denotes heat stroke (see section on heat stroke and heat-induced illness).
T1359 447160-447238 Epistemic_statement denotes Circulatory collapse or barbiturate overdose can produce coma and hypothermia.
T1360 447239-447312 Epistemic_statement denotes Abnormal respiratory patterns also may be observed in a comatose patient.
T1361 447313-447399 Epistemic_statement denotes Hypoventilation may occur with elevated intracranial pressure or barbiturate overdose.
T1362 447400-447511 Epistemic_statement denotes Rapid respiratory rate may be associated with pneumonia, metabolic acidosis (DKA, uremia), or brainstem injury.
T1363 447644-447770 Epistemic_statement denotes Icterus with petechiae or ecchymotic hemorrhage in a comatose patient may be associated with end-stage hepatic failure and HE.
T1364 447771-447874 Epistemic_statement denotes Smell the patient's breath for the odor of ketones, which may signify DKA or end-stage hepatic failure.
T1365 447926-448048 Epistemic_statement denotes The presence of asymmetric neurologic signs may suggest an intracranial mass lesion (e.g., hemorrhage, neoplasia, injury).
T1366 448270-448351 Epistemic_statement denotes With toxicities the pupils are abnormal in size and may be unresponsive to light.
T1367 449415-449517 Epistemic_statement denotes Evaluate urine sediment for calcium oxalate crystalluria, which may indicate ethylene glycol toxicity.
T1368 449626-449682 Epistemic_statement denotes Elevated blood ammonia levels may be associated with HE.
T1369 449683-449804 Epistemic_statement denotes In uncontrolled diabetes mellitus, hyperosmolarity can result in clinical signs of disorientation, prostration, and coma.
T1370 449805-449868 Epistemic_statement denotes Plasma osmolarity can be calculated from the following formula:
T1371 449869-450010 Epistemic_statement 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.
T1372 450335-450385 Epistemic_statement denotes During ketosis, insulin resistance may be present.
T1373 450386-450591 Epistemic_statement 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.
T1374 450592-450678 Epistemic_statement denotes Too-rapid rehydration can result in cerebral edema and exacerbation of clinical signs.
T1375 450849-450933 Epistemic_statement denotes Acute hepatic destruction can also be caused by toxins, drugs, or infectious causes.
T1376 450987-451129 Epistemic_statement denotes Absorption of ammonia and other nitrogenous substances from the gastrointestinal tract is thought to be one of the complicating factors in HE.
T1377 451331-451421 Epistemic_statement denotes Dietary protein should be from a nonanimal plant source (e.g., soybean) whenever possible.
T1378 451635-451700 Epistemic_statement denotes Neomycin (15 mg/kg q6h) can be administered as a retention enema.
T1379 451701-451809 Epistemic_statement denotes Metronidazole (7.5 mg/kg PO, q8-12h) or amoxicillin-clavulanate (16.25 mg PO q12h) can also be administered.
T1380 452795-452856 Epistemic_statement denotes Similar clinical signs also can occur with syncopal episodes.
T1381 453069-453177 Epistemic_statement denotes Most seizures are of short duration and may have subsided by the time the animal is presented for treatment.
T1382 453178-453293 Epistemic_statement denotes Whenever a seizure occurs, however, it is important that the animal not inadvertently injure itself or a bystander.
T1383 453294-453535 Epistemic_statement 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.
T1384 453643-453785 Epistemic_statement denotes Treatment of a primary disease entity can help control seizures in some cases, provided that the underlying cause is investigated and treated.
T1385 454159-454317 Epistemic_statement denotes Whenever possible, however, blood samples should be collected before administration of any anticonvulsant agent because of the risk of incorrect test results.
T1386 454318-454462 Epistemic_statement 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.
T1387 454463-454610 Epistemic_statement denotes Whenever possible, check blood glucose levels, particularly in young puppies or kittens, to evaluate and treat hypoglycemia as a cause of seizures.
T1388 455063-455168 Epistemic_statement denotes The animal's airway should be intubated and protected while the patient is kept in the drug-induced coma.
T1389 455169-455266 Epistemic_statement denotes Protracted cases of seizures may require mannitol and furosemide therapy to treat cerebral edema.
T1390 455385-455456 Epistemic_statement denotes The patient should be turned every 4 to 6 hours to prevent atelectasis.
T1391 456123-456210 Epistemic_statement denotes Severe refractory seizures can result in the development of neurogenic pulmonary edema.
T1392 456594-456662 Epistemic_statement denotes Seizures in cats often are associated with structural brain disease.
T1393 456663-456799 Epistemic_statement denotes The occurrence of partial focal seizures is unequivocally associated with a focal cerebral lesion and acquired structural brain disease.
T1394 456908-457181 Epistemic_statement 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.
T1395 457182-457349 Epistemic_statement denotes Thiamine deficiency in the cat can be a medical emergency characterized by dilated pupils, ataxic gait, cerebellar tremor, abnormal oculocephalic reflex, and seizures.
T1396 457423-457557 Epistemic_statement denotes 1 Syring RS, Otto CM, Drobatz KJ: Hyperglycemia in dogs and cats with head trauma: 122 cases (1997-1999) , J Am Vet Med Assoc 218 (7)
T1397 457558-457679 Epistemic_statement denotes An ocular emergency is any serious condition that causes or threatens to cause severe pain, deformity, or loss of vision.
T1398 457680-457805 Epistemic_statement denotes Treat ocular emergencies immediately, within 1 to several hours after the emergency, whenever possible (Boxes 1-51 and 1-52).
T1399 457897-458094 Epistemic_statement 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.
T1400 458095-458199 Epistemic_statement denotes The equipment listed in Box 1-53 may be necessary and may be invaluable in making an accurate diagnosis.
T1401 458349-458419 Epistemic_statement denotes Is there any history of trauma or known chemical irritant or exposure?
T1402 458536-458594 Epistemic_statement denotes Has it changed at all since the owner noticed the problem?
T1403 459081-459115 Epistemic_statement denotes Exposure keratitis may be present.
T1404 459338-459410 Epistemic_statement denotes Note whether the lids are able to close completely and cover the cornea.
T1405 459411-459488 Epistemic_statement denotes If a laceration of the lid is present, determine the depth of the laceration.
T1406 459638-459716 Epistemic_statement denotes The use of lid retractors or small forceps can be very helpful in these cases.
T1407 459717-459825 Epistemic_statement denotes If a wound appears to penetrate completely into the globe, look for loss of uveal tissue, lens, or vitreous.
T1408 459826-459906 Epistemic_statement denotes Do not put any pressure on the globe, because intraocular herniation may result.
T1409 460715-460845 Epistemic_statement denotes A linear defect perpendicular to the long axis of the eye should alert the clinician to investigate the conjunctiva for dystechia.
T1410 460928-461024 Epistemic_statement denotes Examine the anterior chamber and note its depth and whether hyphema or aqueous flare is present.
T1411 461077-461167 Epistemic_statement denotes Lens luxation can cause the lens tissue to touch the cornea and cause acute corneal edema.
T1412 461473-461606 Epistemic_statement denotes The basic surgical instruments listed in Box 1-54 may be useful in the treatment of ocular lacerations and other ophthalmic injuries.
T1413 461702-461882 Epistemic_statement 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.
T1414 462022-462143 Epistemic_statement denotes Splitting the lid into these two segments facilitates the use of sliding skin flaps to close wound defects, if necessary.
T1415 462422-462553 Epistemic_statement 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.
T1416 462554-462651 Epistemic_statement denotes Drape the eye with an adhesive ocular drape, if possible, to prevent further wound contamination.
T1417 462731-462826 Epistemic_statement denotes Leave as much tissue as possible to ensure proper wound contracture with minimal lid deformity.
T1418 463049-463164 Epistemic_statement denotes Direct blunt trauma to the eye can cause severe ecchymosis because of the excellent vascular supply of the eyelids.
T1419 463165-463275 Epistemic_statement denotes Other associated ocular injuries such as orbital hemorrhage, proptosis, and corneal laceration may also occur.
T1420 463545-463613 Epistemic_statement denotes Resorption of blood can occur 3 to 10 days after the initial insult.
T1421 463790-463926 Epistemic_statement denotes In order to fully assess the conjunctiva for abnormalities, it may be necessary to carefully dissect it away from the underlying sclera.
T1422 464293-464402 Epistemic_statement denotes When large areas of the conjunctiva have been damaged, advancement flaps may be required to close the defect.
T1423 464403-464520 Epistemic_statement denotes Subconjunctival hemorrhage is a common sequela of head trauma, and it may also be observed in various coagulopathies.
T1424 464521-464616 Epistemic_statement denotes By itself it is not a serious problem, but it may signify severe underlying intraocular damage.
T1425 465190-465265 Epistemic_statement denotes Toxic, acid, and alkaline chemical injuries to the eye can sometimes occur.
T1426 466260-466393 Epistemic_statement denotes Uveitis with anterior synechia formation, eventual chronic glaucoma, phthisis, secondary cataract, and corneal perforation can occur.
T1427 466833-466928 Epistemic_statement denotes In severe cases, only PMNs may be present, and fibroblasts may never invade the corneal stroma.
T1428 466929-467017 Epistemic_statement denotes All chemical burns should be washed copiously with any clean aqueous solution available.
T1429 467414-467561 Epistemic_statement denotes To avoid fibrinous adhesions and symblepharon formation, keep the conjunctival cul-de-sacs free of proteinaceous exudate, which can form adhesions.
T1430 467596-467707 Epistemic_statement denotes Oral nonsteroidal antiinflammatory agents such as carprofen, ketoprofen, meloxicam, or aspirin are recommended.
T1431 467708-467859 Epistemic_statement 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).
T1432 467860-467962 Epistemic_statement denotes Topical antibiotics, mydriatics, and lubricants (Lacri-Lube or Puralube ointment) should also be used.
T1433 467963-468033 Epistemic_statement denotes Strong acid or alkali burns can result in severe corneal stromal loss.
T1434 468034-468108 Epistemic_statement denotes In the past, topical N-acetylcysteine (10% Mucomyst) has been recommended.
T1435 468738-468889 Epistemic_statement denotes In severe cases, if conjunctival swelling and chemosis also are present, antiinflammatory doses of oral steroids can be administered in the short term.
T1436 468890-469035 Epistemic_statement denotes Oral steroids and NSAIDs should never be administered to the patient concurrently, because of the risk of gastrointestinal ulcer and perforation.
T1437 469036-469131 Epistemic_statement denotes Corneal abrasions are associated with severe pain, blepharospasm, lacrimation, and photophobia.
T1438 469132-469232 Epistemic_statement denotes Animals with such intense pain are often difficult to examine until analgesia has been administered.
T1439 469233-469385 Epistemic_statement 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.
T1440 469834-469942 Epistemic_statement denotes If an area of the cornea persistently remains green, there is damage to the corneal epithelium in that area.
T1441 470792-470862 Epistemic_statement denotes A collagen contact lens also may be required to promote wound healing.
T1442 470863-470981 Epistemic_statement denotes All corneal abrasions should be reevaluated in 48 hours, and then every 4 to 7 days thereafter until they have healed.
T1443 471488-471575 Epistemic_statement denotes Penetrating injuries through the cornea may result in prolapse of intraocular contents.
T1444 471918-472041 Epistemic_statement denotes Superficial corneal lacerations need not be sutured and can be treated the same as a superficial corneal ulcer or abrasion.
T1445 472042-472169 Epistemic_statement 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.
T1446 472295-472429 Epistemic_statement 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.
T1447 472527-472649 Epistemic_statement denotes Because many corneal lacerations are jagged and corneal edema forms, most of the wound edges cannot be tightly juxtaposed.
T1448 472744-472869 Epistemic_statement denotes Never suture through the full thickness of the cornea; rather, the suture should pass through the middle third of the cornea.
T1449 473111-473227 Epistemic_statement denotes Any defect in the suture line will be apparent because of leakage of the fluid from the site and should be repaired.
T1450 473228-473308 Epistemic_statement denotes Incarceration of uveal tissue in corneal wounds is a difficult surgical problem.
T1451 473309-473554 Epistemic_statement 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.
T1452 473555-473620 Epistemic_statement denotes Referral to a veterinary ophthalmologist is strongly recommended.
T1453 473621-473737 Epistemic_statement denotes The most common foreign bodies associated with ocular injuries in small animals are birdshot, BB pellets, and glass.
T1454 473738-473827 Epistemic_statement denotes The site of intraocular penetration of the foreign bodies may be obscured by the eyelids.
T1455 473828-473949 Epistemic_statement denotes A foreign body entering the eye may penetrate the cornea and fall into the anterior chamber or become lodged in the iris.
T1456 473950-474030 Epistemic_statement denotes Foreign bodies may occasionally penetrate the lens capsule, producing cataracts.
T1457 474031-474174 Epistemic_statement 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.
T1458 474379-474482 Epistemic_statement denotes Indirect visualization of the ocular foreign body can also be achieved through radiographic techniques.
T1459 474483-474582 Epistemic_statement denotes Three separate views should be obtained to determine 1 the plane of location of the foreign object.
T1460 474583-474716 Epistemic_statement denotes CT or MRI may prove useful, although scatter from the foreign body may make it difficult to directly visualize with these techniques.
T1461 474717-474837 Epistemic_statement denotes Ocular ultrasound is perhaps the most useful and refined radiographic technique for locating intraocular foreign bodies.
T1462 475201-475324 Epistemic_statement denotes For the best chance of recovery, ocular foreign bodies should be removed by a veterinary ophthalmologist whenever possible.
T1463 475325-475401 Epistemic_statement denotes Blunt trauma to the globe can result in luxation or subluxation of the lens.
T1464 475402-475485 Epistemic_statement denotes The subluxated lens may move anteriorly and make the anterior chamber more shallow.
T1465 475486-475566 Epistemic_statement denotes Trembling of the iris (iridodonesis) may be noticed when the lens is subluxated.
T1466 475567-475698 Epistemic_statement denotes In complete luxation, the lens may fall totally into the anterior chamber and obstruct aqueous outflow, causing secondary glaucoma.
T1467 475699-475760 Epistemic_statement denotes Alternatively, the lens may be lost into the vitreous cavity.
T1468 475761-475906 Epistemic_statement denotes Luxation of the lens is almost always associated with rupture of the hyaloid membrane and herniation of the vitreous through the pupillary space.
T1469 476087-476231 Epistemic_statement denotes Acute elevation in intraocular pressure can cause vision loss within 48 hours; thus, lens removal should be accomplished as quickly as possible.
T1470 476232-476288 Epistemic_statement denotes Referral to a veterinary ophthalmologist is recommended.
T1471 476289-476390 Epistemic_statement denotes Severe trauma to the globe or a direct blow to the head can result in retinal or vitreous hemorrhage.
T1472 476391-476457 Epistemic_statement denotes There may be large areas of subretinal or intraretinal hemorrhage.
T1473 476458-476558 Epistemic_statement denotes Subretinal hemorrhage assumes a discrete globular form, and the blood appears reddish-blue in color.
T1474 476609-476808 Epistemic_statement 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.
T1475 476918-477050 Epistemic_statement denotes Unfortunately, vitreous hemorrhage, as it organizes, can produce vitreous traction bands that eventually produce retinal detachment.
T1476 477051-477204 Epistemic_statement 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.
T1477 477205-477335 Epistemic_statement denotes Treatment of vitreal and retinal hemorrhage includes rest and correction of factors that may predispose to intraocular hemorrhage.
T1478 477336-477424 Epistemic_statement denotes More complicated cases may require vitrectomy performed by a veterinary ophthalmologist.
T1479 477555-477634 Epistemic_statement denotes Hyphema may also occur because of penetrating ocular wounds and coagulopathies.
T1480 477635-477708 Epistemic_statement denotes Blood within the eye may come from the anterior or posterior uveal tract.
T1481 477709-477854 Epistemic_statement 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.
T1482 477950-478162 Epistemic_statement 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.
T1483 478262-478340 Epistemic_statement denotes First, stop ongoing hemorrhage and prevent further bleeding whenever possible.
T1484 478341-478423 Epistemic_statement denotes This may involve correction of the underlying cause, if a coagulopathy is present.
T1485 478638-478733 Epistemic_statement denotes In most cases of traumatic hyphema, little can be done to arrest or prevent ongoing hemorrhage.
T1486 478802-478889 Epistemic_statement denotes Rebleeding can occur within 5 days, and intraocular pressure must be monitored closely.
T1487 479022-479167 Epistemic_statement denotes If total hyphema persists and intraocular pressure rises despite therapy, surgical intervention by a veterinary ophthalmologist may be necessary.
T1488 479368-479568 Epistemic_statement 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.
T1489 479569-479623 Epistemic_statement denotes A cycloplegic agent (1% atropine) should also be used.
T1490 479624-479846 Epistemic_statement 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.
T1491 479847-480005 Epistemic_statement denotes Hyphema secondary to retinal detachment (Collie ectasia syndrome) and end-stage glaucoma are extremely difficult to treat medically and have a poor prognosis.
T1492 480268-480412 Epistemic_statement 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.
T1493 480778-480988 Epistemic_statement 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.
T1494 480989-481166 Epistemic_statement 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.
T1495 481254-481364 Epistemic_statement denotes Carefully examine the sclera, cornea, and conjunctiva for penetrating injuries that may allow aqueous leakage.
T1496 483042-483167 Epistemic_statement denotes Antiinflammatory doses of systemic steroids can also be added to the treatment if severe periorbital inflammation is present.
T1497 483168-483302 Epistemic_statement denotes Systemic steroids should never be used in conjunction with NSAIDs, because of the risk of gastrointestinal ulceration and perforation.
T1498 483303-483363 Epistemic_statement denotes The sutures should remain in place for a minimum of 3 weeks.
T1499 483544-483612 Epistemic_statement denotes Even after extensive treatment, vision in the eye may still be lost.
T1500 483613-483674 Epistemic_statement denotes Nonvisual eyes can remain in place, but phthisis may develop.
T1501 483675-483893 Epistemic_statement 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.
T1502 484019-484123 Epistemic_statement denotes Osmotic agents such as mannitol or glycerol may be helpful in controlling glaucoma secondary to hyphema.
T1503 484124-484236 Epistemic_statement denotes Reduction in vitreous chamber size can make the anterior chamber deeper and may allow increased aqueous outflow.
T1504 484768-485025 Epistemic_statement 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.
T1505 485118-485215 Epistemic_statement denotes Glaucoma may manifest as early acute congestive or noncongestive glaucoma or as endstage disease.
T1506 485465-485601 Epistemic_statement denotes Intraocular pressure usually exceeds 40 mm Hg but may be normal or only slightly increased if glaucoma is secondary to anterior uveitis.
T1507 486216-486362 Epistemic_statement denotes Permanent visual impairment is often associated with chronically buphthalmic globes or the presence of rippling or striae formation on the cornea.
T1508 486363-486419 Epistemic_statement denotes Referral to a veterinary ophthalmologist is recommended.
T1509 486861-486999 Epistemic_statement denotes Referral to a veterinary ophthalmologist for emergency surgery is indicated in cases of iris bombe, intumescent lens, or lens subluxation.
T1510 487282-487421 Epistemic_statement 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.
T1511 487658-487760 Epistemic_statement denotes Carbonic anhydrase inhibitors can be used to reduce intraocular volume by reducing aqueous production.
T1512 487761-487976 Epistemic_statement 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.
T1513 487977-488149 Epistemic_statement 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).
T1514 488267-488447 Epistemic_statement 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.
T1515 488448-488569 Epistemic_statement denotes Many clinical conditions that are presented as emergencies may be caused in part or wholly by the presence of a neoplasm.
T1516 488622-488828 Epistemic_statement 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.
T1517 488829-488939 Epistemic_statement denotes Hemorrhage or effusion can occur in any body cavity as a result of the presence of benign or malignant tumors.
T1518 489131-489257 Epistemic_statement denotes Effusion may be the result of direct fluid production by the mass or may be caused by obstruction of lymphatic or venous flow.
T1519 489444-489670 Epistemic_statement 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.
T1520 490419-490498 Epistemic_statement denotes The presence of nonclotting hemorrhagic effusion is consistent with free blood.
T1521 490581-490674 Epistemic_statement denotes An abdominal compression bandage can be placed while further diagnostics are being performed.
T1522 490989-491084 Epistemic_statement denotes In some cases, hemorrhage is so severe that the patient should be taken immediately to surgery.
T1523 491085-491234 Epistemic_statement denotes When recommending surgery for a hemorrhaging intraabdominal mass, it is important to discuss likely diagnoses and long-term prognosis with the owner.
T1524 491297-491392 Epistemic_statement denotes The presence of free abdominal hemorrhage is associated with a malignant tumor in 80% of cases.
T1525 492001-492144 Epistemic_statement denotes Nonhemorrhagic effusions are associated with mesothelioma, lymphoma, carcinomatosis, or any mass that causes vascular or lymphatic obstruction.
T1526 492145-492331 Epistemic_statement 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.
T1527 492592-492735 Epistemic_statement denotes Cytologic evaluation of the fluid will often elucidate the causative Mesothelioma is a rare tumor most commonly observed in urban environments.
T1528 492736-492806 Epistemic_statement denotes In humans, mesothelioma has been associated with exposure to asbestos.
T1529 492807-492917 Epistemic_statement denotes It is sometimes difficult to differentiate between reactive mesothelial cells and malignant mesothelial cells.
T1530 493098-493178 Epistemic_statement denotes Lymphoma is another type of tumor that can cause thoracic or abdominal effusion.
T1531 493252-493404 Epistemic_statement denotes Treatment with multiagent chemotherapy protocols, with or without adjunctive radiation therapy, can prevent tumor remission and stop fluid accumulation.
T1532 493538-493609 Epistemic_statement denotes Carcinomatosis may occur de novo or from metastasis of a primary tumor.
T1533 493747-493825 Epistemic_statement denotes Cisplatin should never be used in cats because of fatal acute pulmonary edema.
T1534 493966-494047 Epistemic_statement denotes Hemorrhagic thoracic effusions are rare in association with neoplastic effusions.
T1535 494140-494212 Epistemic_statement denotes Hemorrhage can result when a primary lung tumor erodes through a vessel.
T1536 494213-494315 Epistemic_statement denotes Hemangiosarcoma of the lungs or right auricular area can also result in hemorrhagic thoracic effusion.
T1537 494316-494471 Epistemic_statement 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.
T1538 494472-494697 Epistemic_statement 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.
T1539 494698-494821 Epistemic_statement denotes Although surgery can resolve clinical signs of right-sided heart failure, metastatic disease often develops soon afterward.
T1540 495079-495122 Epistemic_statement denotes Supplemental oxygen should be administered.
T1541 495123-495188 Epistemic_statement denotes In many cases, thoracocentesis can be therapeutic and diagnostic.
T1542 495189-495301 Epistemic_statement denotes Obtain thoracic radiographs both before and after thoracocentesis to determine whether a mass effect is present.
T1543 495302-495372 Epistemic_statement denotes After identification of a cause, definitive therapy can be instituted.
T1544 495373-495444 Epistemic_statement denotes Mesotheliomas are rare and are associated with diffuse serosal disease.
T1545 495488-495569 Epistemic_statement denotes Effusions caused by mesotheliomas can affect the pleural or pericardial cavities.
T1546 495570-495742 Epistemic_statement 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.
T1547 495743-495800 Epistemic_statement denotes (Cisplatin and carboplatin should never be used in cats.)
T1548 495801-495937 Epistemic_statement denotes Chemical or physical pleurodesis may be helpful in controlling reaccumulation of fluid, but it is very painful in small animal patients.
T1549 495938-496032 Epistemic_statement denotes Thoracic effusion secondary to lymphoma often is associated with an anterior mediastinal mass.
T1550 496111-496210 Epistemic_statement denotes B-cell lymphoma is associated with a decreased response to chemotherapy and shorter survival times.
T1551 496588-496640 Epistemic_statement denotes Thymomas have been documented in both dogs and cats.
T1552 496641-496846 Epistemic_statement 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.
T1553 497157-497214 Epistemic_statement denotes Prognosis is good if the tumor can be completely excised.
T1554 497320-497409 Epistemic_statement denotes Paraneoplastic syndromes of myasthenia gravis have been documented in dogs with thymomas.
T1555 497536-497700 Epistemic_statement denotes Obstructive lesions affecting the urinary tract can be extramural (intraabdominal, pelvic, or retroperitoneal) or intramural (urethral, bladder, or urethral wall) .
T1556 497788-497955 Epistemic_statement denotes Prostatic adenocarcinoma, or neoplasia of the sublumbar lymph nodes (lymphoma, adenocarcinoma from apocrine gland adenocarcinoma), also can cause urethral obstruction.
T1557 498062-498134 Epistemic_statement denotes To alleviate the obstruction, pass a urinary catheter whenever possible.
T1558 498416-498517 Epistemic_statement denotes Plain radiographs may reveal a mass lesion or may not be helpful without double contrast cystography.
T1559 498610-498687 Epistemic_statement denotes Masses in the pelvic urethra are difficult to visualize with ultrasonography.
T1560 498737-498862 Epistemic_statement denotes Once the patient has been stabilized, biopsy or surgery is indicated to identify the cause of the mass and attempt resection.
T1561 499173-499289 Epistemic_statement denotes Many transitional cell carcinomas are located in the trigone region of the bladder and cannot be completely excised.
T1562 499391-499483 Epistemic_statement denotes In some dogs, cisplatin and carboplatin may delay recurrence of transitional cell carcinoma.
T1563 499767-499941 Epistemic_statement 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.
T1564 499942-500145 Epistemic_statement 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.
T1565 500146-500262 Epistemic_statement denotes Extraluminal obstructive lesions usually arise from adhesions, or strangulation may occur, resulting in obstruction.
T1566 500263-500348 Epistemic_statement denotes Perforation of the mass through the gastric or intestinal wall can cause peritonitis.
T1567 500832-500966 Epistemic_statement denotes Fine needle aspirates of the mass and adjacent lymph nodes are usually diagnostic and can determine whether there is local metastasis.
T1568 501052-501135 Epistemic_statement denotes Dogs with smaller tumors that can be resected typically have longer survival times.
T1569 501136-501280 Epistemic_statement denotes Leiomyosarcomas occur in the intestines of dogs and carry a more favorable prognosis than adenocarcinoma if the mass can be completely resected.
T1570 501538-501583 Epistemic_statement denotes In comparison, it is relatively rare in dogs.
T1571 502336-502377 Epistemic_statement denotes Bowel perforation is a rare complication.
T1572 503367-503466 Epistemic_statement denotes Prophylactic antibiotics are recommended in the afebrile patient with a neutrophil count <2000/mcL.
T1573 504115-504251 Epistemic_statement denotes To prevent ongoing neutropenia, subsequent chemotherapy doses should be decreased by 25%, and the interval between treatments increased.
T1574 504252-504323 Epistemic_statement denotes Whenever possible, overlap of myelosuppressive drugs should be avoided.
T1575 504324-504612 Epistemic_statement denotes Acute gastrointestinal toxicity can occur within 6 to 12 hours after administration of cisplatin and actinomycin D. In many cases, pretreatment with the antiemetic metoclopramide, butorphanol, chlorpromazine, dolasetron or ondansetron can prevent chemotherapy-induced nausea and vomiting.
T1576 504613-504762 Epistemic_statement denotes Vomiting can also occur as a delayed side effect 3 to 5 days after treatment with doxorubicin (Adriamycin), actinomycin D, methotrexate, and Cytoxan.
T1577 504964-505048 Epistemic_statement denotes Doxorubicin also can cause hemorrhagic colitis within 5 to 7 days of administration.
T1578 505134-505214 Epistemic_statement denotes Paralytic ileus can be observed 2 to 5 days after administration of vincristine.
T1579 505215-505364 Epistemic_statement 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.
T1580 505502-505595 Epistemic_statement denotes In many cases, however, clinical signs do not occur until the cumulative dose is 240 mg/m 2 .
T1581 506138-506291 Epistemic_statement denotes Cardioprotectant drugs such as vitamin E, selenium, and N-acetylcysteine have shown some promise in the prevention of doxorubicin-induced cardiotoxicity.
T1582 506292-506350 Epistemic_statement denotes Cyclophosphamide can cause a sterile hemorrhagic cystitis.
T1583 506807-506916 Epistemic_statement denotes In extremely refractory cases, surgical debridement and cauterization of the bladder mucosa may be necessary.
T1584 507044-507101 Epistemic_statement denotes Concurrent administration of prednisone can induce PU/PD.
T1585 507102-507202 Epistemic_statement denotes If sterile hemorrhagic cystitis occurs, chlorambucil can be substituted as a chemotherapeutic agent.
T1586 507327-507473 Epistemic_statement denotes The risk of anaphylaxis increases with repeated administration, although in some animals anaphylaxis will occur on the first exposure to the drug.
T1587 507898-507996 Epistemic_statement denotes Slowing the rate of intravenous infusion also can decrease the chance of an anaphylactic reaction.
T1588 508152-508291 Epistemic_statement denotes The release of cellular contents after cell death can result in hyperkalemia, hyperphosphatemia, azotemia, hyperuricemia, and hypocalcemia.
T1589 508564-508650 Epistemic_statement denotes Cisplatin can cause a fatal irreversible pulmonary edema in cats, even at low dosages.
T1590 508651-508750 Epistemic_statement denotes 5-Fluorouracil (5-FU) can cause a severe neurotoxicity in cats that results in ataxia and seizures.
T1591 509100-509256 Epistemic_statement denotes Every veterinarian should develop a familiarity with the clinical management of rodenticide and insecticide toxicity and be prepared with antidotes on hand.
T1592 509510-509684 Epistemic_statement 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.
T1593 509685-509934 Epistemic_statement 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.
T1594 509935-510073 Epistemic_statement 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.
T1595 510074-510286 Epistemic_statement 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).
T1596 510368-510444 Epistemic_statement denotes Thousands of potentially toxic substances are available on the market today.
T1597 510909-511214 Epistemic_statement 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.
T1598 511529-511727 Epistemic_statement 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.
T1599 511932-512060 Epistemic_statement denotes Previous communications from veterinarians who treated a case with the same poison or toxin can be accessed with a subscription.
T1600 512133-512240 Epistemic_statement denotes If the product label or name is available, check for a telephone number that may route you to a specialist.
T1601 513535-513573 Epistemic_statement denotes What is the pupil reactivity to light?
T1602 513618-513660 Epistemic_statement denotes What is the sensitivity to light or sound?
T1603 513957-513991 Epistemic_statement denotes What is the mucous membrane color?
T1604 514057-514091 Epistemic_statement denotes What is the capillary refill time?
T1605 514121-514154 Epistemic_statement denotes What is the patient's heart rate?
T1606 514213-514250 Epistemic_statement denotes What is the patient's blood pressure?
T1607 514251-514292 Epistemic_statement denotes What is the quality of the femoral pulse?
T1608 514418-514467 Epistemic_statement denotes What is shown on the patient's electrocardiogram?
T1609 514468-514507 Epistemic_statement denotes What is the patient's respiratory rate?
T1610 514508-514552 Epistemic_statement denotes What is the patient's respiratory character?
T1611 514594-514636 Epistemic_statement denotes What do you hear on thoracic auscultation?
T1612 514692-514733 Epistemic_statement denotes What is the patient's rectal temperature?
T1613 514765-514807 Epistemic_statement denotes Is there evidence of vomiting or diarrhea?
T1614 514917-514965 Epistemic_statement denotes What are the color and consistency of the feces?
T1615 514966-515002 Epistemic_statement denotes Is there a palpable urinary bladder?
T1616 515003-515029 Epistemic_statement denotes Is there urine production?
T1617 515030-515061 Epistemic_statement denotes What is the color of the urine?
T1618 515062-515089 Epistemic_statement denotes What is the patient's gait?
T1619 515227-515260 Epistemic_statement denotes Is there increased extensor tone?
T1620 515261-515292 Epistemic_statement denotes What is the patient's attitude?
T1621 515533-515582 Epistemic_statement denotes Is there any evidence of erythema or ulcerations?
T1622 515658-515705 Epistemic_statement denotes Should be normal in poisonings 1 hyperglycemia.
T1623 515868-516012 Epistemic_statement denotes Samples of serum, urine, and any vomitus or orogastric lavage contents should be collected and saved for toxicologic analyses as required later.
T1624 516192-516419 Epistemic_statement 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.
T1625 516420-516460 Epistemic_statement denotes Ventilatory assistance may be necessary.
T1626 516461-516588 Epistemic_statement denotes Irritant or corrosive substances can cause damage to the oropharyngeal mucosa to such an extent that airway obstruction occurs.
T1627 516589-516650 Epistemic_statement denotes When necessary, a temporary tracheostomy should be performed.
T1628 516651-516759 Epistemic_statement denotes Arterial blood gases, pulse oximetry, and capnometry may be required to monitor oxygenation and ventilation.
T1629 517059-517150 Epistemic_statement denotes Fluid therapy can later be changed based on the patient's acid-base and electrolyte status.
T1630 517151-517225 Epistemic_statement denotes Some toxins can cause severe dysrhythmias and hypertension or hypotension.
T1631 517473-517564 Epistemic_statement denotes Whole blood, fresh frozen plasma, or packed RBCs should be available and used if necessary.
T1632 517805-517983 Epistemic_statement 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.
T1633 517984-518186 Epistemic_statement 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.
T1634 518275-518367 Epistemic_statement denotes Such patients may not require the full dose of anesthetics or sedatives for seizure control.
T1635 518368-518530 Epistemic_statement 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.
T1636 518531-518632 Epistemic_statement denotes Core body temperature can easily increase or decrease secondary to increased muscle activity or coma.
T1637 518633-518735 Epistemic_statement denotes Animals may be hypothermic or hyperthermic, depending on the toxin ingested and the stage of toxicity.
T1638 519068-519256 Epistemic_statement denotes 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.
T1639 519462-519593 Epistemic_statement denotes When initial stabilization of vital signs has been accomplished, the veterinarian can discuss the patient's history with the owner.
T1640 519594-519699 Epistemic_statement denotes In urgent situations, the veterinarian should obtain a brief history as an initial procedure (Box 1-58) .
T1641 519700-519916 Epistemic_statement 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.
T1642 520271-520304 Epistemic_statement denotes How soon did other signs develop?
T1643 520369-520401 Epistemic_statement denotes What is the name of the product?
T1644 520595-520696 Epistemic_statement denotes Do you have any over-the-counter or prescription medications that your animal may have had access to?
T1645 520742-520797 Epistemic_statement denotes Is there any possibility of recreational drug exposure?
T1646 520843-520871 Epistemic_statement denotes What is he/she normally fed?
T1647 520872-520937 Epistemic_statement denotes Is there a chance that your pet may have gotten into the garbage?
T1648 520990-521002 Epistemic_statement denotes If so, what?
T1649 521980-522156 Epistemic_statement denotes 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.
T1650 522157-522391 Epistemic_statement 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.
T1651 522557-522778 Epistemic_statement denotes 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).
T1652 523213-523316 Epistemic_statement denotes While these events are occurring, the safeguards followed by a normally careful owner may be disrupted.
T1653 523317-523459 Epistemic_statement 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.
T1654 523608-523746 Epistemic_statement denotes Various methods can be used to remove toxins from the gastrointestinal tract, including emesis, orogastric lavage, cathartics, and enemas.
T1655 523747-523829 Epistemic_statement denotes Adsorbents, ion exchange resins, or precipitating or chelating agents may be used.
T1656 523830-523922 Epistemic_statement denotes Removal of a toxic substance from the body surface may be necessary, depending on the toxin.
T1657 524278-524518 Epistemic_statement 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.
T1658 525235-525409 Epistemic_statement 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) .
T1659 525451-525481 Epistemic_statement denotes What clinical signs developed?
T1660 525482-525522 Epistemic_statement denotes How fast did the clinical signs develop?
T1661 525561-525597 Epistemic_statement denotes What is the animal's activity level?
T1662 525790-525873 Epistemic_statement denotes Various emetics traditionally have been recommended for use in veterinary medicine.
T1663 526677-526786 Epistemic_statement denotes The procedure can be messy but is very effective if performed within 1 to 2 hours of ingestion of the poison.
T1664 526787-526864 Epistemic_statement denotes To prevent aspiration, the patient should be placed under general anesthesia.
T1665 527175-527316 Epistemic_statement 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.
T1666 527451-527546 Epistemic_statement denotes Keep the endotracheal tube cuffed and in t a B l e 1 -5 0 list of emetics and recommended doses
T1667 527547-527689 Epistemic_statement 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.
T1668 527888-528168 Epistemic_statement 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.
T1669 528703-528765 Epistemic_statement denotes Cathartics can be used in conjunction with activated charcoal.
T1670 528766-528928 Epistemic_statement denotes Do not use magnesiumbased cathartics in patients with CNS depression, because hypermagnesemia can worsen this disorder and also cause cardiac rhythm disturbances.
T1671 529082-529200 Epistemic_statement denotes Activated charcoal can be administered after emesis or orogastric lavage or can be administered as the sole treatment.
T1672 529360-529483 Epistemic_statement denotes Commercially available products are relatively inexpensive and should be used whenever possible for ease of administration.
T1673 529599-529771 Epistemic_statement 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.
T1674 529772-529941 Epistemic_statement 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.
T1675 529942-530121 Epistemic_statement 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.
T1676 530647-530749 Epistemic_statement denotes However, they are reported to be better adsorbents than activated charcoal for the herbicide paraquat.
T1677 530750-530813 Epistemic_statement denotes Ion exchange resins can ionically bind certain drugs or toxins.
T1678 531104-531277 Epistemic_statement denotes Ion exchange resins also have been used to delay or reduce the absorption of phenylbutazone, warfarin, chlorothiazide, tetracycline, phenobarbital, and thyroid preparations.
T1679 531422-531547 Epistemic_statement denotes They work by binding preferentially to the metal ion and creating a more soluble complex that is amenable to renal excretion.
T1680 531641-531798 Epistemic_statement denotes 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.
T1681 532712-532810 Epistemic_statement denotes If Dawn is not available, mechanics' hand cleaners or coconut oil-based soaps can be used instead.
T1682 533394-533495 Epistemic_statement denotes Neutralization can cause an exothermic reaction that causes further damage to the underlying tissues.
T1683 533649-533756 Epistemic_statement denotes The use of neutralizing substances is not recommended because of the risk of causing further ocular damage.
T1684 533757-533882 Epistemic_statement denotes After adequate irrigation, treat chemical burns of the eyes with lubricating ointments and possibly a temporary tarsorrhaphy.
T1685 533883-533932 Epistemic_statement denotes Atropine may be indicated as a cycloplegic agent.
T1686 533933-533991 Epistemic_statement denotes Systemic NSAIDs can be used to control patient discomfort.
T1687 533992-534171 Epistemic_statement 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.
T1688 534262-534522 Epistemic_statement 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.
T1689 534523-534671 Epistemic_statement denotes Whenever possible, administer specific antidotes to negate the effects of the toxin and prevent conversion of the substance to the toxic metabolite.
T1690 536100-536254 Epistemic_statement 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.
T1691 536255-536408 Epistemic_statement 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.
T1692 536409-536553 Epistemic_statement 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.
T1693 536554-536626 Epistemic_statement denotes Simple fluid diuresis can influence the excretion of certain substances.
T1694 536627-536802 Epistemic_statement 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.
T1695 536803-536853 Epistemic_statement denotes Dextrose (50%) can be used as an osmotic diuretic.
T1696 536854-536962 Epistemic_statement denotes Furosemide can be used to promote diuresis, but again, there is no substitute for intravenous fluid therapy.
T1697 537068-537165 Epistemic_statement denotes Take care to avoid causing dehydration with any diuretic; CVP monitoring is strongly recommended.
T1698 537302-537463 Epistemic_statement 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.
T1699 537663-537726 Epistemic_statement denotes Ammonium chloride can be used to promote urinary acidification.
T1700 538090-538159 Epistemic_statement denotes Urine alkalinization can be performed with use of sodium bicarbonate.
T1701 538416-538547 Epistemic_statement denotes The major steps in management of poisonings discussed here must be accompanied by application of the fundamentals of critical care.
T1702 538889-539081 Epistemic_statement 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.
T1703 539082-539240 Epistemic_statement 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.
T1704 539281-539413 Epistemic_statement denotes Gastrointestinal protectant drugs may be indicated for the management of poisons that are gastrointestinal irritants or ulcerogenic.
T1705 539536-539593 Epistemic_statement denotes Antiemetics may be used to suppress intractable vomiting.
T1706 539747-539833 Epistemic_statement denotes Antiemetics that work by different mechanisms can be used in combination as necessary.
T1707 540046-540116 Epistemic_statement denotes Analgesics are more appropriate to treat poisonings than once thought.
T1708 540117-540243 Epistemic_statement denotes Common effects of poisons including severe gastroenteritis and topical burns or ulcerations may warrant the use of analgesics.
T1709 540345-540530 Epistemic_statement 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.
T1710 541401-541548 Epistemic_statement 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.
T1711 541553-541679 Epistemic_statement denotes If no response to furosemide, peritoneal dialysis or hemodialysis is indicated immediately, particularly if anuria is present.
T1712 541728-541861 Epistemic_statement denotes Endoscopy may be useful in assessing the degree of esophageal and gastric damage, particularly after ingestion of caustic substances.
T1713 541954-542117 Epistemic_statement denotes Pathophysiology: Acetaminophen is converted in the liver to N-acetyl-P-benzoquinonimine, a toxic substance that can cause oxidative injury of RBCs and hepatocytes.
T1714 542632-542679 Epistemic_statement denotes Activated charcoal should also be administered.
T1715 543339-543498 Epistemic_statement denotes Clinical Signs: 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.
T1716 544068-544187 Epistemic_statement denotes Aflatoxin (Aspergillus flavus) is found in moldy feed grains; it also has been reported after ingestion of moldy bread.
T1717 544188-544363 Epistemic_statement denotes Clinical Signs: Clinical signs of toxicity occur after ingestion and include vomiting, diarrhea, and acute hepatitis, and coagulopathy; abortion may occur in pregnant bitches.
T1718 544364-544600 Epistemic_statement denotes Pathophysiology: 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.
T1719 544601-544714 Epistemic_statement denotes Toxic Dose: 4.1 to 8.0 g/kg PO Clinical Signs: Affected animals may appear excited and then ataxic and lethargic.
T1720 544715-544803 Epistemic_statement denotes Contact or inhalant injury can occur, causing dermal irritation and cutaneous hyperemia.
T1721 544804-544843 Epistemic_statement denotes Methanol also can cause hepatotoxicity.
T1722 545111-545299 Epistemic_statement 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.
T1723 545410-545550 Epistemic_statement denotes Pathophysiology: If ingested, sodium or potassium hydroxide can cause severe contact dermatitis or irritation of the gastrointestinal tract.
T1724 545551-545618 Epistemic_statement denotes Esophageal burns and full-thickness coagulative necrosis can occur.
T1725 546275-546394 Epistemic_statement denotes Avoid neutralization, which can cause a hyperthermic reaction and worsen injury to the skin and gastrointestinal tract.
T1726 547020-547085 Epistemic_statement denotes If clinical signs are present, orogastric lavage may be required.
T1727 547141-547252 Epistemic_statement denotes If the patient has ingested a collar and does not vomit it, it should be removed using endoscopy or gastrotomy.
T1728 547506-547701 Epistemic_statement 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.
T1729 547702-547869 Epistemic_statement 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.
T1730 548199-548302 Epistemic_statement denotes Diuretics may or may not be useful in the treatment of pulmonary edema secondary to ammonia inhalation.
T1731 548303-548404 Epistemic_statement denotes Amphetamines may be in the form of prescription medications or illicit drugs such as methamphetamine.
T1732 550121-550343 Epistemic_statement 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.
T1733 550573-550665 Epistemic_statement denotes A CRI of methocarbamol (55 to 220 mg/kg IV to effect) can be used to control muscle tremors.
T1734 551132-551168 Epistemic_statement denotes Ataxia and weakness may be observed.
T1735 551255-551317 Epistemic_statement denotes Younger dogs appear to be more resistant to its toxic effects.
T1736 551386-551460 Epistemic_statement denotes Mechanical ventilation may be required in severe cases of pulmonary edema.
T1737 551461-551528 Epistemic_statement denotes If an animal does not vomit, orogastric lavage should be performed.
T1738 551602-551799 Epistemic_statement 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.
T1739 552784-552890 Epistemic_statement denotes If clinical signs are present, perform orogastric lavage followed by administration of activated charcoal.
T1740 552983-553063 Epistemic_statement denotes Dimercaprol (BAL, 3 to 4 mg/kg IM q8h) can be administered as a chelating agent.
T1741 553064-553282 Epistemic_statement 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.
T1742 553283-553515 Epistemic_statement denotes Pathophysiology: 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.
T1743 554132-554182 Epistemic_statement denotes Alkalinization of the urine can enhance excretion.
T1744 554472-554538 Epistemic_statement denotes Toxic Dose: Clinical signs can occur at doses as low as 1.3 mg/kg.
T1745 554680-554767 Epistemic_statement denotes Emesis or orogastric lavage should be followed by administration of activated charcoal.
T1746 554910-555001 Epistemic_statement denotes Supplemental oxygen or mechanical ventilation may be required for hypoventilation or apnea.
T1747 555002-555114 Epistemic_statement denotes If seizures occur, avoid the use of diazepam, which is a GABA agonist and can potentially worsen clinical signs.
T1748 555115-555376 Epistemic_statement 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).
T1749 555785-555829 Epistemic_statement denotes Accidental or iatrogenic exposure can occur.
T1750 556137-556197 Epistemic_statement denotes Paradoxical reactions and agitation or excitement can occur.
T1751 556382-556519 Epistemic_statement denotes If clinical signs are absent and the patient can protect its airway, induce emesis, then administer repeated doses of activated charcoal.
T1752 556634-556682 Epistemic_statement denotes Some animals may require mechanical ventilation.
T1753 556742-556842 Epistemic_statement denotes Positive inotropic drugs may be required if dose-dependent decrease in cardiac output and BP occurs.
T1754 556843-556949 Epistemic_statement denotes Alkalinization of the urine and peritoneal dialysis can be performed to enhance excretion and elimination.
T1755 556950-557014 Epistemic_statement denotes Hemodialysis should be considered in severe cases, if available.
T1756 557199-557356 Epistemic_statement denotes Pathophysiology: Automotive and dry cell batteries contain sulfuric acid, which can be irritating on contact with the eyes, skin, and gastrointestinal tract.
T1757 557605-557668 Epistemic_statement denotes Dermal injury can occur in the form of erythema and blistering.
T1758 558196-558333 Epistemic_statement denotes No attempt should be made at performing neutralization because of the risk of causing an exothermic reaction and worsening tissue damage.
T1759 558452-558566 Epistemic_statement denotes Pathophysiology: Ingestion can result in production of hydrogen peroxide, gastroenteritis, and gastric dilatation.
T1760 558567-558627 Epistemic_statement denotes Topical exposure can cause dermal irritation and blistering.
T1761 559655-559684 Epistemic_statement denotes Severe hypokalemia can occur.
T1762 560187-560309 Epistemic_statement 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.
T1763 560460-560588 Epistemic_statement denotes Pathophysiology: Sodium hypochlorite can cause severe contact irritation and tissue destruction, depending on the concentration.
T1764 560589-560636 Epistemic_statement denotes Affected animals may have a bleached hair coat.
T1765 560846-560929 Epistemic_statement denotes Even small quantities can cause dermal irritation and gastrointestinal disturbance.
T1766 561353-561435 Epistemic_statement denotes Administration of sodium bicarbonate or Milk of Magnesia is no longer recommended.
T1767 561540-561602 Epistemic_statement denotes Pathophysiology: Sodium peroxide can cause gastric distension.
T1768 561603-561784 Epistemic_statement 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.
T1769 561912-562030 Epistemic_statement denotes Toxic Dose: Six-percent sodium hypochlorite (undiluted) can cause irritation to the skin, eyes, and orogastric mucosa.
T1770 562447-562491 Epistemic_statement denotes Pathophysiology: Pathophysiology is unknown.
T1771 563050-563143 Epistemic_statement denotes Clostridium botulinum endospores can be found in carrion, food, garbage, and the environment.
T1772 563144-563276 Epistemic_statement denotes Ingestion of endospores and C. botulinum endotoxin rarely can cause generalized neuromuscular blockade of spinal and cranial nerves.
T1773 563380-563453 Epistemic_statement denotes Respiratory paralysis, megaesophagus, and aspiration pneumonia can occur.
T1774 563513-563616 Epistemic_statement denotes Toxic Dose: Ingestion of preformed botulinum toxin causes toxicity; signs dependent on amount ingested.
T1775 563768-563880 Epistemic_statement denotes Treatment: Treatment of botulism is largely supportive; although an antitoxin exists, it often is of no benefit.
T1776 563881-564110 Epistemic_statement 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.
T1777 564165-564225 Epistemic_statement denotes Recovery may be prolonged, up to 3 to 4 weeks in some cases.
T1778 564875-564946 Epistemic_statement denotes Bromethalin causes toxicity by uncoupling of oxidative phosphorylation.
T1779 565675-565790 Epistemic_statement denotes Supplemental oxygen and/or mechanical ventilation may be required in patients with coma and severe hypoventilation.
T1780 566207-566279 Epistemic_statement denotes Muscle tremors and seizures can occur, resulting in severe hyperthermia.
T1781 566423-566519 Epistemic_statement denotes If clinical signs are not apparent and the patient is able to protect its airway, induce emesis.
T1782 566520-566620 Epistemic_statement denotes Alternatively, orogastric lavage can be performed, followed by administration of activated charcoal.
T1783 567024-567160 Epistemic_statement denotes The patient should be walked frequently or have a urinary catheter placed to prevent reabsorption of the toxin from the urinary bladder.
T1784 567659-567708 Epistemic_statement denotes Toxicity can result in seizures, coma, and death.
T1785 568019-568068 Epistemic_statement denotes Toxicity can result in seizures, coma, and death.
T1786 568297-568331 Epistemic_statement denotes Cooling measures may be warranted.
T1787 568426-568517 Epistemic_statement denotes Give repeated doses of activated charcoal if the animal can swallow and protect its airway.
T1788 568595-568702 Epistemic_statement denotes Atropine (0.2 mg/kg IV) is useful in controlling some of the muscarinic signs associated with the toxicity.
T1789 568881-568966 Epistemic_statement denotes In humans, ingestion or inhalation of 3 to 5 mL of carbon tetrachloride can be fatal.
T1790 569722-569882 Epistemic_statement denotes Pathophysiology: Chlorinated hydrocarbons exert their toxic effects by an unknown mechanism and can be absorbed through the skin and the gastrointestinal tract.
T1791 570201-570279 Epistemic_statement denotes Secondary toxicity from toxic metabolites can cause renal and hepatic failure.
T1792 570280-570379 Epistemic_statement denotes Chronic exposure may cause anorexia, vomiting, weight loss, tremors, seizures, and hepatic failure.
T1793 570380-570442 Epistemic_statement denotes The clinical course can be prolonged in small animal patients.
T1794 570663-570769 Epistemic_statement denotes If the substance was just ingested and the patient is not demonstrating any clinical signs, induce emesis.
T1795 570998-571061 Epistemic_statement denotes These compounds do not appear to be amenable to fluid diuresis.
T1796 571271-571363 Epistemic_statement denotes Pathophysiology: Chlorphenoxy derivatives exert their toxic effects by an unknown mechanism.
T1797 571438-571557 Epistemic_statement denotes Toxic Dose: The LD 50 of 2,4-D is 100 mg/kg; however, the toxic dose appears to be much lower in small animal patients.
T1798 571960-572092 Epistemic_statement denotes Pathophysiology: The toxic effects of chocolate are related to theobromine and interference with or inhibition of phosphodiesterase.
T1799 572301-572407 Epistemic_statement denotes Potential side effects include gastroenteritis and pancreatitis owing to the fat content of the chocolate.
T1800 572408-572608 Epistemic_statement denotes Toxic Dose: 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.
T1801 572668-572759 Epistemic_statement denotes Milk chocolate contains 44 mg/oz (154 mg/100 g) of chocolate and has a low toxic potential.
T1802 572872-572995 Epistemic_statement denotes Semisweet and baking chocolate, being the most concentrated, have a moderate to severe toxic potential, even in large dogs.
T1803 573909-573991 Epistemic_statement denotes Seizures, muscle twitching, and CNS depression may be observed at very high doses.
T1804 573992-574101 Epistemic_statement denotes As renal failure progresses, PU/PD, vomiting and hematemesis, uremic oral ulcers, and melena may be observed.
T1805 574365-574620 Epistemic_statement 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.
T1806 574621-574816 Epistemic_statement 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.
T1807 574925-575055 Epistemic_statement denotes Pathophysiology: Sodium perborate can cause severe direct irritation of the mucous membranes and may also act as a CNS depressant.
T1808 575718-575762 Epistemic_statement denotes Both have a moderate potential for toxicity.
T1809 575807-575926 Epistemic_statement denotes Clinical Signs: Ingestion of deodorant compounds can cause oral irritation or necrosis, gastroenteritis, and nephrosis.
T1810 576224-576381 Epistemic_statement denotes Clinical Signs: Anionic detergents cause significant mucosal damage and edema, gastrointestinal irritation, CNS depression, seizures, and possible hemolysis.
T1811 576382-576433 Epistemic_statement denotes Ocular exposure can cause corneal ulcers and edema.
T1812 576434-576545 Epistemic_statement denotes Toxic Dose: Dishwashing liquid is an example of an anionic detergent that can be toxic at doses of 1 to 5 g/kg.
T1813 577088-577180 Epistemic_statement denotes Closely monitor the patient's respiratory status, because oropharyngeal edema can be severe.
T1814 577544-577696 Epistemic_statement denotes Pathophysiology: Quaternary ammonia compounds have a serious toxic potential and cause severe irritation and corrosion of the mucous membranes and skin.
T1815 577697-577875 Epistemic_statement denotes Clinical Signs: Some compounds also can cause clinical signs similar to those observed with anticholinesterase compounds, including muscle tremors, seizures, paralysis, and coma.
T1816 577876-577905 Epistemic_statement denotes Methemoglo binemia can occur.
T1817 578671-578827 Epistemic_statement denotes Pathophysiology: Some compounds can be metabolized to glycolic and oxalic acid, causing renal damage similar to that observed with ethylene glycol toxicity.
T1818 578926-579065 Epistemic_statement denotes Some compounds can be metabolized to glycolic and oxalic acid, causing renal damage similar to that observed with ethylene glycol toxicity.
T1819 579066-579189 Epistemic_statement denotes Treatment: Topical and ocular exposure should be treated with careful bathing or ocular irrigation for at least 30 minutes.
T1820 579450-579566 Epistemic_statement denotes Administer intravenous crystalloid fluids to maintain hydration and decrease the potential for renal tubular damage.
T1821 580279-580422 Epistemic_statement 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.
T1822 580536-580684 Epistemic_statement denotes Pathophysiology: The mechanism of action of DEET is not fully understood, but it acts as a lipophilic neurotoxin within 5 to 10 minutes of exposure.
T1823 580685-580734 Epistemic_statement denotes Cats appear to be particularly sensitive to DEET.
T1824 580882-580957 Epistemic_statement denotes Recumbency and death can occur within 30 minutes of exposure at high doses.
T1825 581703-581766 Epistemic_statement denotes Cooling measures should be implemented to control hyperthermia.
T1826 582209-582324 Epistemic_statement denotes Massive dehydration and electrolyte imbalances can occur as a result of fluid loss into the gastrointestinal tract.
T1827 582539-582592 Epistemic_statement denotes In clinical cases, orogastric lavage may be required.
T1828 582593-582735 Epistemic_statement denotes Both emesis and orogastric lavage should be followed by administration of kaolin or bentonite as an adsorbent, rather than activated charcoal.
T1829 582877-582975 Epistemic_statement denotes If oliguria or anuria occurs, treatment with mannitol, furosemide, and dopamine may be considered.
T1830 583119-583190 Epistemic_statement denotes A urine drug screening test can be used to detect the presence of MDMA.
T1831 583290-583459 Epistemic_statement denotes Clinical Signs: Clinical signs of intoxication are related to the serotonin syndrome (excitation, hyperthermia, tremors, and hypertension), and seizures may be observed.
T1832 583662-583900 Epistemic_statement 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.
T1833 584388-584638 Epistemic_statement 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.
T1834 584639-584789 Epistemic_statement denotes Testing: Colorimetric tests that can be performed in most veterinary hospitals can detect larger quantities of ethylene glycol in the patient's serum.
T1835 585132-585263 Epistemic_statement 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.
T1836 585264-585302 Epistemic_statement denotes Lack of treatment can result in death.
T1837 585375-585487 Epistemic_statement denotes In the first 1 to 12 hours after ingestion (stage I), the patient may appear lethargic, disoriented, and ataxic.
T1838 585488-585585 Epistemic_statement denotes In stage II (12 to 24 hours after ingestion), the patient improves and appears clinically normal.
T1839 585892-586031 Epistemic_statement 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.
T1840 586887-586963 Epistemic_statement denotes Cats will demonstrate signs of sedation and hypothermia with this treatment.
T1841 587296-587357 Epistemic_statement denotes Antiemetics and gastroprotective agents should be considered.
T1842 587358-587472 Epistemic_statement denotes Urinary alkalinization and peritoneal dialysis may enhance the elimination of ethylene glycol and its metabolites.
T1843 587473-587601 Epistemic_statement denotes Many fertilizers are on the market and may be composed of urea or ammonium salts, phosphates, nitrates, potash, and metal salts.
T1844 587602-587689 Epistemic_statement denotes Fertilizers have a moderate toxic potential, depending on the type and amount ingested.
T1845 587932-588016 Epistemic_statement denotes Nitrates or nitrites can cause formation of methemoglobin and chocolate-brown blood.
T1846 588595-588658 Epistemic_statement denotes N-acetylcysteine may be useful if methemoglobinemia is present.
T1847 588787-588880 Epistemic_statement denotes Pathophysiology: Fipronil exerts its effects by GABA antagonism and can cause CNS excitation.
T1848 589162-589278 Epistemic_statement denotes Fire extinguisher fluid contains chlorobromomethane or methyl bromide, both of which have a serious toxic potential.
T1849 589343-589451 Epistemic_statement denotes When it is ingested, the compounds can be converted to methanol and cause high anion gap metabolic acidosis.
T1850 589452-589528 Epistemic_statement denotes Clinical Signs: Signs attributable to dermal or ocular irritation can occur.
T1851 589529-589708 Epistemic_statement 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.
T1852 590014-590078 Epistemic_statement denotes Gastroprotectant and antiemetic drugs may be used, if indicated.
T1853 590152-590256 Epistemic_statement denotes Supplemental oxygen or mechanical ventilation may be required in severe cases of aspiration pneumonitis.
T1854 590257-590494 Epistemic_statement 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.
T1855 590495-590613 Epistemic_statement denotes Clinical Signs: Clinical signs are largely associated with gastrointestinal irritation (vomiting, diarrhea, anorexia).
T1856 590614-590685 Epistemic_statement denotes Zinc toxicity can cause intravascular hemolysis and hepatorenal damage.
T1857 590945-591030 Epistemic_statement denotes Specific chelating agents may be useful in hastening elimination of the heavy metals.
T1858 591207-591282 Epistemic_statement denotes Clinical Signs: Ingestion of fireworks can cause HGE and methemoglobinemia.
T1859 591401-591533 Epistemic_statement denotes Administer specific chelating drugs if the amount and type of metal are known, and administer gastroprotectant and antiemetic drugs.
T1860 591534-591629 Epistemic_statement denotes If methemoglobinemia occurs, administer N-acetylcysteine; a blood transfusion may be necessary.
T1861 591761-591928 Epistemic_statement denotes Pathophysiology: 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.
T1862 591929-592047 Epistemic_statement denotes Clinical Signs: CNS depression, mucosal damage, hepatorenal insufficiency, seizures, and corneal irritation can occur.
T1863 592586-592650 Epistemic_statement denotes Pathophysiology: Children's glue has a very low toxic potential.
T1864 592651-592698 Epistemic_statement denotes If inhaled, the compound can cause pneumonitis.
T1865 592803-592984 Epistemic_statement denotes Treatment: Treatment for polyvinyl acetate exposure should be performed as clinical signs of pneumonitis (increased respiratory effort, cough, lethargy, respiratory distress) occur.
T1866 593436-593508 Epistemic_statement denotes The fur can be shaved, using care to avoid damaging the underlying skin.
T1867 593509-593568 Epistemic_statement denotes The affected area should be allowed to exfoliate naturally.
T1868 593800-593890 Epistemic_statement denotes The result is that the glue can adhere to the esophagus and stomach and cause obstruction.
T1869 594195-594259 Epistemic_statement denotes Toxic Dose: Any ingestion can result in esophageal foreign body.
T1870 594415-594496 Epistemic_statement denotes Pathophysiology: If applied properly, the product has a very low toxic potential.
T1871 594630-594655 Epistemic_statement denotes CNS depression can occur.
T1872 595053-595127 Epistemic_statement denotes Pathophysiology: The toxic principle and mechanism of toxicity is unknown.
T1873 595330-595439 Epistemic_statement denotes Within 48 hours, dogs demonstrate signs of acute renal failure (PU/PD, vomiting) that can progress to anuria.
T1874 595440-595478 Epistemic_statement denotes Toxic Dose: The toxic dose is unknown.
T1875 595631-595742 Epistemic_statement denotes If clinical signs of vomiting and diarrhea are present, administer intravenous fluids and monitor urine output.
T1876 595847-596046 Epistemic_statement 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.
T1877 596047-596152 Epistemic_statement denotes Peritoneal dialysis or hemodialysis may be necessary in cases of severe oliguric or anuric renal failure.
T1878 596153-596397 Epistemic_statement 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.
T1879 597061-597136 Epistemic_statement denotes A dilute milk solution or water can be administered to dilute the compound.
T1880 597544-597637 Epistemic_statement denotes Pathophysiology: Clinical signs of toxicity are related to nicotinic cholinergic stimulation.
T1881 597724-597770 Epistemic_statement denotes The compound may induce respiratory paralysis.
T1882 597771-597951 Epistemic_statement denotes Toxic Dose: Even small amounts can be toxic if used on cats Treatment: To treat imidacloprid toxicity, procure and maintain a patent airway with supplemental oxygen administration.
T1883 598666-598806 Epistemic_statement denotes Toxic Dose: Iron and iron salts can cause severe gastroenteritis, myocardial toxicity, and hepatic damage if high enough doses are ingested.
T1884 599039-599126 Epistemic_statement denotes A cathartic can be administered to promote elimination from the gastrointestinal tract.
T1885 599127-599219 Epistemic_statement denotes Antiemetic and gastroprotectant drugs should be administered to prevent nausea and vomiting.
T1886 599220-599323 Epistemic_statement denotes In some cases, radiographs can aid in making a diagnosis of whether the compound was actually ingested.
T1887 599324-599391 Epistemic_statement denotes Iron toxicity can be treated with the chelating agent deferoxamine.
T1888 599392-599612 Epistemic_statement 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.
T1889 600097-600238 Epistemic_statement denotes Blood ivermectin levels can be measured, but diagnosis is often made based on clinical signs and knowledge of exposure in predisposed breeds.
T1890 600267-600347 Epistemic_statement denotes The clinical course can be prolonged for weeks to months before recovery occurs.
T1891 600745-600839 Epistemic_statement denotes Diazepam, which potentially can worsen central nervous system stimulation, is contraindicated.
T1892 600931-601266 Epistemic_statement 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).
T1893 601358-601506 Epistemic_statement denotes Physostigmine therapy was beneficial in some patients for a short period; picrotoxin caused severe violent seizures and therefore should be avoided.
T1894 601753-601888 Epistemic_statement denotes Clinical Signs: Clinical signs of hyperexcitability, dementia, vocalization, seizures, and lower motor neuron polyneuropathy can occur.
T1895 601889-601986 Epistemic_statement denotes Affected animals may appear blind, or vomiting, anorexia, and constipation or diarrhea may occur.
T1896 601987-602037 Epistemic_statement denotes Toxic Dose: Lead can be toxic at doses of 3 mg/kg.
T1897 602038-602122 Epistemic_statement denotes If ingestion of more than 10 to 25 mg of lead per kilogram occurs, death can result.
T1898 602123-602207 Epistemic_statement denotes Testing: If lead toxicity is suspected, blood and urine lead levels can be measured.
T1899 602492-602558 Epistemic_statement denotes Sodium or magnesium sulfate should be administered as a cathartic.
T1900 602756-602893 Epistemic_statement denotes If a lead object is identified in the gastrointestinal tract on radiographs, remove the object using endoscopy or exploratory laparotomy.
T1901 603122-603210 Epistemic_statement denotes Toxic Dose: The toxic dose is unknown, but cats appear to be very sensitive to exposure.
T1902 603633-603775 Epistemic_statement denotes Clinical Signs: Clinical signs of loperamide intoxication include constipation, ataxia, nausea, and sedation; vomiting and cramping may occur.
T1903 604045-604121 Epistemic_statement denotes Naloxone may be beneficial in the temporary reversal of ataxia and sedation.
T1904 604122-604201 Epistemic_statement denotes Ingestion of even small quantities of macadamia nuts can be toxic to some dogs.
T1905 604202-604325 Epistemic_statement denotes Macadamia nuts are often covered with chocolate, so a combination of macadamia nut and theobromine toxicity may be present.
T1906 604326-604392 Epistemic_statement denotes Pathophysiology: The toxic principle in macadamia nuts is unknown.
T1907 604393-604515 Epistemic_statement denotes Clinical Signs: Ingestion of macadamia nuts can cause clinical signs of vomiting, ataxia, and ascending paralysis in dogs.
T1908 604996-605168 Epistemic_statement 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.
T1909 605169-605321 Epistemic_statement denotes Pathophysiology: Marijuana interacts with norepinephrine, dopamine, serotonin, and acetylcholine neurotransmitters in the frontal cortex and cerebellum.
T1910 605322-605482 Epistemic_statement denotes Clinical Signs: Marijuana is a hallucinogen that can cause CNS depression, ataxia, mydriasis, increased sensitivity to motion or sound, salivation, and tremors.
T1911 605574-605682 Epistemic_statement denotes Testing: Urine can be tested with drug test kits for tetrahydrocannabinoid, the toxic compound in marijuana.
T1912 605683-605838 Epistemic_statement 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.
T1913 606163-606271 Epistemic_statement denotes Induction of emesis can be attempted but, because of the antiemetic effects of THC, is usually unsuccessful.
T1914 606272-606357 Epistemic_statement denotes Orogastric lavage can be performed, followed by repeated doses of activated charcoal.
T1915 606547-606708 Epistemic_statement denotes Clinical Signs: Both compounds have a low toxic potential but can cause clinical signs of gastroenteritis and methemoglobinemia if large quantities are ingested.
T1916 606709-606784 Epistemic_statement denotes Toxic Dose: Even small amounts can be caustic and cause gastric irritation.
T1917 607146-607250 Epistemic_statement denotes Pathophysiology: The exact mechanism of toxicity is unknown but may involve inhibition of GABA channels.
T1918 607251-607433 Epistemic_statement denotes Clinical Signs: Clinical signs associated with metaldehyde toxicity include severe muscle tremors, CNS excitation, and hyperthermia, which occur within 15 to 30 minutes of ingestion.
T1919 607434-607471 Epistemic_statement denotes Diarrhea and convulsions can develop.
T1920 607472-607559 Epistemic_statement denotes If hyperthermia is severe, renal failure secondary to myoglobinuria and DIC can result.
T1921 607632-607731 Epistemic_statement denotes If metaldehyde toxicosis is suspected, analysis of urine, serum, and stomach contents is warranted.
T1922 607966-608023 Epistemic_statement denotes If clinical signs are present, perform orogastric lavage.
T1923 608024-608129 Epistemic_statement denotes Both emesis and orogastric lavage should be followed by administration of one dose of activated charcoal.
T1924 608365-608440 Epistemic_statement denotes Diazepam (0.5 to 1 mg/kg IV) can be used to control seizures if they occur.
T1925 608498-608593 Epistemic_statement denotes Mushroom species can appear similar, and mushrooms can be toxic to humans and domestic animals.
T1926 609052-609124 Epistemic_statement denotes Some mushrooms (Amanita species) also can cause hepatocellular toxicity.
T1927 609912-610077 Epistemic_statement denotes Pathophysiology: These mycotoxins have an unknown mechanism of action, although it is suspected to involve failure of neurotransmitter release at peripheral and CNS.
T1928 610260-610484 Epistemic_statement denotes Testing: 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.
T1929 610699-610802 Epistemic_statement denotes Repeated doses of activated charcoal are recommended, as the toxin undergoes enterohepatic circulation.
T1930 611247-611328 Epistemic_statement denotes Naphthalene is the active ingredient in mothballs and has a high toxic potential.
T1931 611329-611563 Epistemic_statement denotes Pathophysiology: Oxidative damage to red blood cells and hemoglobin, hepatotoxic Clinical Signs: Clinical signs associated with naphthalene toxicity include vomiting, methemoglobinemia, CNS stimulation, seizures, and hepatic toxicity.
T1932 612003-612151 Epistemic_statement 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.
T1933 612152-612214 Epistemic_statement denotes A packed RBC transfusion may be necessary if anemia is severe.
T1934 612215-612280 Epistemic_statement denotes Observe the patient for clinical signs associated with hepatitis.
T1935 612707-612824 Epistemic_statement denotes Muscle tremors, respiratory muscle fatigue or hypoventilation, tachyarrhythmias, seizures, coma, and death can occur.
T1936 613633-613713 Epistemic_statement denotes Ibuprofen toxicity has been associated with seizures in dogs, cats, and ferrets.
T1937 614685-614858 Epistemic_statement denotes Onions, garlic, and chives contain sulfoxide compounds that can cause oxidative damage of RBCs, leading to Heinz body anemia, methemoglobinemia, and intravascular hemolysis.
T1938 615127-615159 Epistemic_statement denotes Vomiting and diarrhea can occur.
T1939 615160-615260 Epistemic_statement denotes Intravascular hemolysis can cause hemoglobinuria and pigment damage of the renal tubular epithelium.
T1940 615261-615344 Epistemic_statement denotes Heinz bodies may be observed on cytologic evaluation of the peripheral blood smear.
T1941 615638-615709 Epistemic_statement denotes In cases of severe anemia, packed RBC transfusion should be considered.
T1942 616039-616101 Epistemic_statement denotes Hypoventilation, bradycardia, hypoxia, and cyanosis can occur.
T1943 616505-616576 Epistemic_statement denotes Mechanical ventilation may be necessary until hypoventilation resolves.
T1944 617346-617438 Epistemic_statement denotes Miosis, excessive bronchial secretions, muscle tremors, and respiratory paralysis can occur.
T1945 617439-617624 Epistemic_statement denotes An intermediate syndrome of generalized weakness, hypoventilation, and eventual paralysis with ventral cervical ventroflexion that may require mechanical ventilation has been described.
T1946 617625-617750 Epistemic_statement denotes Testing: If organophosphate toxicity is suspected, whole-blood acetylcholinesterase activity can be measured and will be low.
T1947 618235-618291 Epistemic_statement denotes Atropine can help control the muscarinic clinical signs.
T1948 618292-618484 Epistemic_statement 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.
T1949 618590-618709 Epistemic_statement denotes Ingestion of large amounts of paintballs can cause neurologic signs, electrolyte abnormalities, and occasionally death.
T1950 618997-619117 Epistemic_statement denotes The loss of water in excess of solute can result in hypernatremia, a free water deficit, and increased serum osmolality.
T1951 619370-619541 Epistemic_statement 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.
T1952 619542-619612 Epistemic_statement denotes Baseline electrolytes should be obtained and then carefully monitored.
T1953 619789-619951 Epistemic_statement 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.
T1954 619952-620151 Epistemic_statement 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.
T1955 620537-620559 Epistemic_statement denotes Seizures may be noted.
T1956 620560-620678 Epistemic_statement denotes Within 2 to 3 days, clinical signs associated with severe respiratory distress and ARDS can develop, leading to death.
T1957 620891-621019 Epistemic_statement denotes Treatment: To treat paraquat ingestion, remove the toxin from the gastrointestinal tract as rapidly as possible after ingestion.
T1958 621540-621722 Epistemic_statement 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.
T1959 621723-621828 Epistemic_statement denotes Hemoperfusion may be useful in eliminating the toxin, if it is performed early in the course of toxicity.
T1960 622206-622331 Epistemic_statement denotes Clinical Signs: Menthofuran is hepatotoxic and may cause gastrointestinal hemorrhage and coagulopathies, seizures, and death.
T1961 622332-622421 Epistemic_statement denotes Toxic Dose: Toxic dose is unknown; toxic dose as low as 2 g/kg in dogs has been reported.
T1962 622641-622825 Epistemic_statement 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.
T1963 623354-623407 Epistemic_statement denotes Urine alkalinization can help eliminate the compound.
T1964 623759-623836 Epistemic_statement denotes Tachycardia, bradycardia, hypertension, hyperthermia, and seizures can occur.
T1965 625737-625791 Epistemic_statement denotes Urine acidification may aid in facilitating excretion.
T1966 626525-626620 Epistemic_statement denotes Diazepam, a GABA agonist, is contraindicated, because it can potentially worsen clinical signs.
T1967 626621-626664 Epistemic_statement denotes Urine acidification may hasten elimination.
T1968 626665-626706 Epistemic_statement denotes Clinical signs can last from 3 to 5 days.
T1969 628199-628228 Epistemic_statement denotes Contact dermatitis can occur.
T1970 628324-628443 Epistemic_statement denotes The oral toxicity is fairly low; however, the compounds can be significantly harmful if inhaled or applied to the skin.
T1971 628444-628666 Epistemic_statement denotes Testing: 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.
T1972 628947-629007 Epistemic_statement denotes Both hyperthermia and hypothermia can worsen clinical signs.
T1973 629079-629171 Epistemic_statement denotes Atropine (0.02 to 0.04 mg/kg IV, IM, SQ) may control clinical signs of excessive salivation.
T1974 629593-629703 Epistemic_statement denotes Clinical Signs: Clinical signs of tissue irritation and hypoglycemia can occur after topical or oral exposure.
T1975 629704-629770 Epistemic_statement denotes If the compound is inhaled, CNS depression and seizures can occur.
T1976 630175-630284 Epistemic_statement denotes Salt used for thawing ice commonly contains calcium chloride, a compound that has a moderate toxic potential.
T1977 630285-630422 Epistemic_statement denotes Pathophysiology: Calcium chloride produces strong local irritation and can cause gastroenteritis and gastrointestinal ulcers if ingested.
T1978 630814-630923 Epistemic_statement denotes Selenium sulfide shampoos (e.g., Selsun Blue) have a low toxic potential and primarily cause gastroenteritis.
T1979 631364-631485 Epistemic_statement denotes Some silver polishes contains the alkali substance sodium carbonate and cyanide salts and have a serious toxic potential.
T1980 631568-631659 Epistemic_statement denotes Clinical Signs: Ingestion results in rapid onset of vomiting and possibly cyanide toxicity.
T1981 631949-632060 Epistemic_statement denotes Bath soap (bar soap) usually has low toxic potential and causes mild gastroenteritis with vomiting if ingested.
T1982 632176-632218 Epistemic_statement denotes Toxic Dose: Small quantities may be toxic.
T1983 633153-633230 Epistemic_statement denotes If clinical signs are not present at the time of presentation, induce emesis.
T1984 634014-634054 Epistemic_statement denotes Orogastric lavage can also be performed.
T1985 634606-634676 Epistemic_statement denotes Do not use diazepam, because it can potentially worsen clinical signs.
T1986 635093-635154 Epistemic_statement denotes Mydriasis, hyperthermia, and respiratory paralysis can occur.
T1987 635155-635261 Epistemic_statement denotes Testing: If strychnine toxicity is suspected, gastric contents should be collected and saved for analysis.
T1988 635481-635538 Epistemic_statement denotes If clinical signs are present, perform orogastric lavage.
T1989 635539-635636 Epistemic_statement denotes Both emesis and orogastric lavage should be followed by the administration of activated charcoal.
T1990 635913-636035 Epistemic_statement denotes The animal should have cotton packed in its ears to prevent noise stimulation, and should be placed in a quiet, dark room.
T1991 636036-636122 Epistemic_statement denotes Styptic pencils contain potassium alum sulfate, a compound with a low toxic potential.
T1992 636780-636828 Epistemic_statement denotes Pathophysiology: The pathophysiology is unknown.
T1993 637440-637494 Epistemic_statement denotes Anaerobic wound infections can contain tetanus spores.
T1994 638202-638260 Epistemic_statement denotes In extreme cases, mechanical ventilation may be necessary.
T1995 638331-638401 Epistemic_statement denotes Pathophysiology: The toxic mechanism of triazine compounds is unknown.
T1996 638865-638973 Epistemic_statement denotes Emesis and orogastric lavage should be followed by the administration of activated charcoal and a cathartic.
T1997 639691-639728 Epistemic_statement denotes This can cause "serotonin syndrome. "
T1998 640000-640126 Epistemic_statement denotes Any animal that has ingested an SSRI should be promptly treated and carefully observed for at least 72 hours for side effects.
T1999 640734-640838 Epistemic_statement denotes Cyproheptadine (2 mg/kg), a serotonin antagonist, can be dissolved in water and administered per rectum.
T2000 641144-641453 Epistemic_statement 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.
T2001 641747-641861 Epistemic_statement denotes The PIVKA (proteins induced by vitamin K antagonism) test may be helpful but usually cannot be performed in house.
T2002 641862-642062 Epistemic_statement 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.
T2003 642063-642172 Epistemic_statement denotes In some cases, severe stress-induced hyperglycemia and glucosuria may be present but resolve within 24 hours.
T2004 642256-642334 Epistemic_statement denotes Alternatively, orogastric lavage can be performed in an uncooperative patient.
T2005 642335-642428 Epistemic_statement denotes Both emesis and orogastric lavage should be followed by administration of activated charcoal.
T2006 642429-642480 Epistemic_statement denotes The stomach contents can be submitted for analysis.
T2007 642995-643074 Epistemic_statement denotes Packed RBCs or fresh whole blood may be required if the patient is also anemic.
T2008 643075-643187 Epistemic_statement denotes Supportive care in the form of supplemental oxygen may be necessary in cases of pulmonary or pleural hemorrhage.
T2009 643188-643380 Epistemic_statement 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.
T2010 643381-643506 Epistemic_statement denotes In some cases, depending on the type of anticoagulant ingested, an additional 2 weeks of vitamin K 1 therapy may be required.
T2011 643694-643808 Epistemic_statement denotes In dogs, however, xylitol causes a massive rapid and dose-dependent release of insulin from pancreatic beta cells.
T2012 643875-643946 Epistemic_statement denotes After insulin release, clinically significant hypoglycemia can develop.
T2013 644154-644314 Epistemic_statement 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.
T2014 644315-644409 Epistemic_statement denotes Cases of acute hepatic necrosis, with vomiting, icterus, coagulopathies, and death, can occur.
T2015 644410-644492 Epistemic_statement denotes Treatment: Known xylitol ingestion should be treated as for other toxin ingestion.
T2016 644628-644780 Epistemic_statement denotes It remains unknown at this time whether activated charcoal actually delays or prevents the absorption of xylitol from the canine gastrointestinal tract.
T2017 644781-644877 Epistemic_statement denotes If clinical signs have already developed, perform orogastric lavage and gastric decontamination.
T2018 644878-645063 Epistemic_statement 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.
T2019 645064-645151 Epistemic_statement denotes Hypokalemia may develop because it is driven intracellularly by the actions of insulin.
T2020 645724-645762 Epistemic_statement denotes Toxic Dose: The toxic dose is unknown.
T2021 645974-646058 Epistemic_statement denotes (If zinc-containing ointment was ingested, this will not be visible on radiographs.)
T2022 646149-646256 Epistemic_statement denotes Often, small objects such as pennies can be retrieved using endoscopy or surgical gastrotomy or enterotomy.
T2023 646517-646611 Epistemic_statement denotes Chelation therapy with succimer, calcium EDTA, dimercaprol, or penicillamine may be necessary.
T2024 646612-646706 Epistemic_statement denotes Do not administer calcium EDTA if the patient is dehydrated, because renal failure can result.
T2025 646707-646756 Epistemic_statement denotes Severe anemia should be treated with packed RBCs.
T2026 646964-647108 Epistemic_statement denotes Decreased respiratory rate or tidal volume can result in hypoxia and buildup of carbon dioxide, or hypercarbia, leading to respiratory acidosis.
T2027 647335-647504 Epistemic_statement 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.
T2028 647806-647903 Epistemic_statement denotes As respiratory distress progresses, the patient may appear anxious and start openmouth breathing.
T2029 648133-648315 Epistemic_statement 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.
T2030 648316-648409 Epistemic_statement denotes Localization of the cause of respiratory distress is essential to successful case management.
T2031 648410-648661 Epistemic_statement 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.
T2032 648662-648890 Epistemic_statement 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.
T2033 649115-649227 Epistemic_statement denotes Obstructive lesions are associated with a marked inspiratory wheeze or stridor and slow deep inspiratory effort.
T2034 649228-649322 Epistemic_statement denotes Auscultation of the larynx and trachea may reveal more subtle obstructions of normal air flow.
T2035 649323-649391 Epistemic_statement denotes Stridor can usually be auscultated without the use of a stethoscope.
T2036 649424-649527 Epistemic_statement denotes The neck should be carefully palpated for a mass lesion, tracheal collapse, and subcutaneous emphysema.
T2037 649528-649615 Epistemic_statement denotes Subcutaneous emphysema suggests tracheal damage or collapse secondary to severe trauma.
T2038 649920-650010 Epistemic_statement denotes Diseases of the pleural space often are associated with a restrictive respiratory pattern.
T2039 650188-650281 Epistemic_statement denotes Depending on the disease present, lung sounds may be muffled ventrally and enhanced dorsally.
T2040 650406-650545 Epistemic_statement denotes Decreased compressibility of the anterior thorax may be present with an anterior mediastinal mass lesion, particularly in cats and ferrets.
T2041 650664-650735 Epistemic_statement denotes Respiratory distress caused by hemothorax may be exacerbated by anemia.
T2042 650906-651038 Epistemic_statement denotes Primary pulmonary parenchymal disease can involve the intrathoracic airways, alveoli, interstitial space, and pulmonary vasculature.
T2043 651039-651228 Epistemic_statement 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.
T2044 651603-651689 Epistemic_statement denotes Other abnormal respiratory patterns may be evident, and warrant further consideration.
T2045 651690-651856 Epistemic_statement 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.
T2046 651857-652054 Epistemic_statement denotes A restrictive respiratory pattern with minimal thoracic excursions can be associated with diseases of neuromuscular function, including ascending polyradiculoneuritis, botulism, and tick paralysis.
T2047 652055-652156 Epistemic_statement denotes If adequate ventilation cannot be maintained by the patient, mechanical ventilation may be indicated.
T2048 652668-652835 Epistemic_statement 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.
T2049 652836-652946 Epistemic_statement denotes With diaphragmatic fatigue, severe hypoventilation and resultant hypoxemia may require mechanical ventilation.
T2050 653064-653207 Epistemic_statement denotes Relatively benign procedures such as radiography or intravenous catheter placement can be fatal in patients with severe respiratory compromise.
T2051 653208-653274 Epistemic_statement denotes Stabilization should always precede further diagnostic evaluation.
T2052 653275-653379 Epistemic_statement denotes In some cases, sedation may be required before any diagnostics are performed, to prevent further stress.
T2053 653487-653704 Epistemic_statement 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.
T2054 654242-654321 Epistemic_statement denotes In cases of laryngeal collapse, however, sedation may make the condition worse.
T2055 654486-654620 Epistemic_statement denotes If a foreign body is lodged in the pharynx, perform the Heimlich maneuver by thrusting bluntly several times on the patient's sternum.
T2056 654621-654811 Epistemic_statement 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.
T2057 654812-654949 Epistemic_statement denotes If the obstruction cannot be removed, bypassing the obstruction with an endotracheal tube or temporary tracheostomy should be considered.
T2058 654950-655055 Epistemic_statement denotes In an emergency, a temporary transtracheal oxygen catheter can quickly be placed in the following manner.
T2059 655376-655473 Epistemic_statement denotes Run the oxygen at 10 L/min to provide adequate oxygenation until a tracheostomy can be performed.
T2060 655533-655762 Epistemic_statement 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.
T2061 655891-656097 Epistemic_statement 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.
T2062 656098-656227 Epistemic_statement denotes Clinical signs of an upper airway obstruction are associated with an animal's extreme efforts to inhale air past the obstruction.
T2063 656228-656331 Epistemic_statement denotes Marked negative pressure occurs in the extrathoracic airways and can cause worsening of clinical signs.
T2064 656942-657092 Epistemic_statement denotes Short-acting glucocorticosteroids can also be administered (dexamethasone sodium phosphate, 0.25 mg/kg IV, SQ, IM) to decrease edema and inflammation.
T2065 657533-657659 Epistemic_statement denotes An intratracheal oxygen catheter can be placed with sedation and/or a local anesthetic (see technique for transtracheal wash).
T2066 658042-658209 Epistemic_statement 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.
T2067 658210-658260 Epistemic_statement denotes Although rare, this condition also occurs in cats.
T2068 658535-658607 Epistemic_statement denotes Laryngeal paralysis can be partial or complete, unilateral or bilateral.
T2069 658922-659068 Epistemic_statement denotes Once the patient's condition has been stabilized, definitive measures to accurately document and assess the patient's airway should be considered.
T2070 659754-659885 Epistemic_statement denotes Partial laryngectomy, arytenoid lateralization ("tie-back" surgery), or removal of the vocal folds has been used with some success.
T2071 659943-660077 Epistemic_statement denotes Brachycephalic airway syndrome is associated with a series of anatomic abnormalities that collectively increase resistance to airflow.
T2072 660179-660240 Epistemic_statement denotes Components of the syndrome can occur alone or in combination.
T2073 660241-660464 Epistemic_statement 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.
T2074 660465-660550 Epistemic_statement denotes Specific airway anomalies can be identified with general anesthesia and laryngoscopy.
T2075 660551-660621 Epistemic_statement denotes Severe respiratory distress should be treated as discussed previously.
T2076 660692-660814 Epistemic_statement denotes In animals with laryngeal collapse, surgical correction may not be possible, and a permanent tracheostomy may be required.
T2077 660815-661080 Epistemic_statement 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.
T2078 661081-661188 Epistemic_statement denotes The chronic consequences of everted laryngeal saccules and laryngeal collapse potentially can be prevented.
T2079 662157-662219 Epistemic_statement denotes Because of this, bypassing the obstruction is often difficult.
T2080 662335-662446 Epistemic_statement denotes Crush or bite injuries to the neck can result in fractures or avulsion of the laryngeal or tracheal cartilages.
T2081 662447-662572 Epistemic_statement denotes Bypassing the obstructed area may be necessary until the patient is stable and can undergo surgical correction of the injury.
T2082 662573-662662 Epistemic_statement denotes If there is avulsion of the cranial trachea, it may be difficult to intubate the patient.
T2083 662663-662847 Epistemic_statement 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.
T2084 662848-662943 Epistemic_statement denotes Neck injury can also result in damage to the recurrent laryngeal nerve and laryngeal paralysis.
T2085 662944-663026 Epistemic_statement denotes Foreign bodies can lodge in the nasal cavity, pharynx, larynx, and distal trachea.
T2086 663306-663410 Epistemic_statement denotes Pharyngeal and tracheal foreign bodies can cause severe obstruction to airflow and respiratory distress.
T2087 663541-663666 Epistemic_statement denotes Smaller foreign bodies lodged in the distal airways may not be apparent radiographically but can cause pulmonary atelectasis.
T2088 663667-663783 Epistemic_statement denotes Foreign bodies of the nose or pharynx can often be removed with alligator forceps with the patient under anesthesia.
T2089 663784-664003 Epistemic_statement 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.
T2090 664004-664032 Epistemic_statement denotes Rhinoscopy may be necessary.
T2091 664033-664091 Epistemic_statement denotes If an endoscope is not available, an otoscope can be used.
T2092 664092-664246 Epistemic_statement 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.
T2093 664511-664644 Epistemic_statement denotes Nasopharyngeal polyps (in cats, tumors, obstructive laryngitis, granulomas, abscesses, and cysts) can cause upper airway obstruction.
T2094 664690-664814 Epistemic_statement denotes The lesions can be identified through careful laryngoscopic examination performed with the patient under general anesthesia.
T2095 664815-664899 Epistemic_statement denotes The nasopharynx above the soft palpate should always be included in the examination.
T2096 665064-665166 Epistemic_statement denotes It is impossible to distinguish obstructive laryngitis from neoplasia based on gross appearance alone.
T2097 665167-665292 Epistemic_statement denotes Whenever possible, material should be collected from abscesses and granulomas for cytologic evaluation and bacterial culture.
T2098 665412-665467 Epistemic_statement denotes Masses are usually identified by palpation of the neck.
T2099 665468-665552 Epistemic_statement denotes Enlarged mandibular lymph nodes, thyroid tumors, and other neoplasms may be present.
T2100 666614-666712 Epistemic_statement denotes Pneumothorax can be classified as open or closed, simple or complicated, and tension pneumothorax.
T2101 667201-667324 Epistemic_statement denotes Tension pneumothorax can cause rapid decline in cardiopulmonary status and death if not recognized and treated immediately.
T2102 667325-667407 Epistemic_statement denotes A simple pneumothorax is one that can be controlled with a simple thoracocentesis.
T2103 667585-667816 Epistemic_statement 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.
T2104 667817-667910 Epistemic_statement denotes Pneumothorax also rarely occurs as a result of esophageal tears or esophageal foreign bodies.
T2105 667911-668174 Epistemic_statement 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.
T2106 668548-668747 Epistemic_statement 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).
T2107 668748-668845 Epistemic_statement denotes The stress of handling the patient for radiography can be deadly in severe cases of pneumothorax.
T2108 668846-669058 Epistemic_statement 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.
T2109 669347-669536 Epistemic_statement 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.
T2110 669834-669959 Epistemic_statement denotes Once the patient's condition is stable, the open chest wound can be surgically explored, lavaged, and definitively corrected.
T2111 669960-670076 Epistemic_statement denotes All animals with open chest wounds should receive antibiotics (first-generation cephalosporin) to prevent infection.
T2112 670077-670137 Epistemic_statement denotes After stabilization, radiographs can be taken and evaluated.
T2113 670448-670568 Epistemic_statement denotes Parenchymal lesions within the lungs are best identified after as much air as possible has been removed from the thorax.
T2114 670639-670710 Epistemic_statement denotes A standing lateral view may reveal air-or fluid-filled cavitary masses.
T2115 670711-670871 Epistemic_statement denotes If underlying pulmonary disease is suspected as a cause of spontaneous pneumothorax, a transtracheal wash, fecal flotation, and heartworm test may be indicated.
T2116 671128-671305 Epistemic_statement 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.
T2117 671306-671405 Epistemic_statement denotes Strict cage rest is required until air stops accumulating and the thoracostomy tube can be removed.
T2118 671406-671506 Epistemic_statement denotes The patient's chest tube should be aspirated every 4 hours after continuous suction is discontinued.
T2119 671507-671577 Epistemic_statement denotes If no air reaccumulates after 24 hours, the chest tube can be removed.
T2120 671637-671825 Epistemic_statement 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.
T2121 671949-672126 Epistemic_statement 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.
T2122 672127-672255 Epistemic_statement denotes Clinical signs associated with pleural effusion depend on how much 1 fluid is present and how rapidly the fluid has accumulated.
T2123 672256-672439 Epistemic_statement 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.
T2124 672440-672640 Epistemic_statement 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.
T2125 672641-672697 Epistemic_statement denotes Percussion of the thorax may reveal decreased resonance.
T2126 672698-672785 Epistemic_statement denotes In stable patients, the presence of pleural effusion can be confirmed radiographically.
T2127 672786-672913 Epistemic_statement denotes Radiographic confirmation of the pleural effusion should include right and left lateral and dorsoventral or ventrodorsal views.
T2128 672914-673014 Epistemic_statement denotes A handling or standing lateral view should be obtained if an anterior mediastinal mass is suspected.
T2129 673015-673100 Epistemic_statement denotes The standing lateral view will allow the fluid to collect in the costophrenic recess.
T2130 673101-673254 Epistemic_statement denotes In patients with respiratory distress, muffled heart and lung sounds, and suspicion of pleural effusion, thoracocentesis should be performed immediately.
T2131 673255-673310 Epistemic_statement denotes Thoracocentesis can be both therapeutic and diagnostic.
T2132 673311-673445 Epistemic_statement denotes Radiography is contraindicated because the procedure can cause undue stress and exacerbation of clinical signs in an unstable patient.
T2133 673446-673618 Epistemic_statement 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.
T2134 673964-674069 Epistemic_statement denotes In stable animals, diagnosis of pleural effusion can be made based on thoracic radiography or ultrasound.
T2135 674070-674156 Epistemic_statement denotes Thoracic radiographs can show whether the pleural effusion is unilateral or bilateral.
T2136 674207-674347 Epistemic_statement denotes The lung parenchyma and the cardiac silhouette cannot be fully evaluated until most of the fluid has been evacuated from the pleural cavity.
T2137 674348-674470 Epistemic_statement denotes After thoracocentesis, radiography should be performed with left and right lateral and ventrodorsal or dorsoventral views.
T2138 674630-674793 Epistemic_statement denotes Collect specimens before administering antibiotics, whenever possible, because treatment with antibiotics can make a septic condition (pyothorax) appear nonseptic.
T2139 674900-675004 Epistemic_statement denotes The fluid may be a transudate, nonseptic exudate, septic exudate or chylous, hemorrhagic, or neoplastic.
T2140 675005-675168 Epistemic_statement denotes Ultrasonographic evaluation of the thorax can be helpful in identifying intrathoracic masses, diaphragmatic hernias, lung lobe torsions, and cardiac abnormalities.
T2141 675418-675455 Epistemic_statement denotes Rarely, fungal organisms are present.
T2142 675456-675704 Epistemic_statement 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.
T2143 675705-675840 Epistemic_statement denotes The most common organisms associated with pyothorax in the cat are Pasteurella species, Bacteroides species, and Fusobacterium species.
T2144 676149-676233 Epistemic_statement denotes Gram stains of the fluid can assist in the initial identification of some organisms.
T2145 676334-676440 Epistemic_statement denotes Administration of antibiotics before cytologic evaluation can cause a septic effusion to appear nonseptic.
T2146 677096-677233 Epistemic_statement denotes In the cat, placement of one or two thoracic drainage catheters is recommended to allow continuous drainage of the intrathoracic abscess.
T2147 677234-677286 Epistemic_statement denotes Inadequate drainage can result in treatment failure.
T2148 677287-677434 Epistemic_statement 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.
T2149 677435-677513 Epistemic_statement denotes Approximately 75% of the infused volume should be recovered after each lavage.
T2150 677630-677729 Epistemic_statement denotes A foreign body that can be removed at the time of surgery may be visible, but this finding is rare.
T2151 678572-678738 Epistemic_statement 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.
T2152 678739-678823 Epistemic_statement denotes It is difficult to identify chylous effusions based on their milky appearance alone.
T2153 679190-679272 Epistemic_statement denotes Disease processes that can result in chylous effusions are listed in the Box 1-63.
T2154 679273-679409 Epistemic_statement denotes Clinical signs associated with chylous effusion are typical of any pleural effusion and of the disease process that caused the effusion.
T2155 679410-679481 Epistemic_statement denotes Weight loss may be evident, depending on the chronicity of the process.
T2156 679625-679728 Epistemic_statement denotes The fluid often appears milky or blood-tinged but can be clear if the patient has significant anorexia.
T2157 679790-679943 Epistemic_statement 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.
T2158 680021-680133 Epistemic_statement denotes Therapy for chylothorax is difficult and primarily involves documentation and treatment of the underlying cause.
T2159 680545-680712 Epistemic_statement 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.
T2160 680713-680822 Epistemic_statement denotes Rutin, a bioflavonoid, has been used with limited success in the treatment of idiopathic chylothorax in cats.
T2161 680874-681042 Epistemic_statement denotes Extensive hemorrhage into the pleural cavity can cause fulminant respiratory distress resulting from sudden hypovolemia and anemia and interference with lung expansion.
T2162 681043-681192 Epistemic_statement denotes Hemothorax typically is associated with trauma, systemic coagulopathy, lung lobe torsions, and erosive lesions within the thorax (usually neoplasia).
T2163 681844-682000 Epistemic_statement denotes Whenever an animal demonstrates signs of a hemorrhagic pleural effusion, perform coagulation testing immediately to determine whether a coagulopathy exists.
T2164 682001-682092 Epistemic_statement denotes The PT test is fast and can be performed as a cage-side test (see section on coagulopathy).
T2165 682093-682175 Epistemic_statement denotes Therapy for hemorrhagic pleural effusions should address the blood and fluid loss.
T2166 682620-682732 Epistemic_statement denotes Fluid that remains aids in the recovery of the patient, because RBCs and proteins eventually will be reabsorbed.
T2167 682733-682823 Epistemic_statement denotes Autotransfusion can be performed to salvage blood and reinfuse it into the anemic patient.
T2168 682824-682946 Epistemic_statement denotes In cases of neoplastic or traumatic uncontrollable hemorrhagic effusions, surgical exploration of the thorax is warranted.
T2169 682947-683102 Epistemic_statement 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.
T2170 683204-683294 Epistemic_statement denotes Diaphragmatic hernia usually is secondary to trauma but can occur as a congenital anomaly.
T2171 683460-683540 Epistemic_statement denotes Respiratory distress can be caused by any one or a combination of these lesions.
T2172 683541-683684 Epistemic_statement denotes Animals with prior or chronic diaphragmatic hernias may have minimal clinical signs despite the presence of abdominal organs within the thorax.
T2173 684016-684142 Epistemic_statement denotes Contrast radiographs may show the presence of the stomach or intestines within the thorax after oral administration of barium.
T2174 684580-684750 Epistemic_statement 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.
T2175 684947-685050 Epistemic_statement denotes If chronic diaphragmatic hernia is repaired, the complication of reexpansion pulmonary edema can occur.
T2176 685051-685126 Epistemic_statement denotes Cardiac injury is a common complication secondary to blunt thoracic trauma.
T2177 685402-685454 Epistemic_statement denotes Myocardial infarction and cardiac failure can occur.
T2178 685455-685621 Epistemic_statement 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.
T2179 685622-685705 Epistemic_statement denotes Rib fractures are associated with localized pain and painful respiratory movements.
T2180 685756-685832 Epistemic_statement denotes Careful palpation may reveal crepitus and instability of the fractured ribs.
T2181 685833-686014 Epistemic_statement denotes Common problems associated with rib fractures include 1 pulmonary contusions, pericardial laceration, traumatic myocarditis, diaphragmatic hernia, and splenic laceration or rupture.
T2182 686144-686272 Epistemic_statement denotes The flail segment moves paradoxically with respiration-that is, it moves inward during inhalation and outward during exhalation.
T2183 686273-686407 Epistemic_statement denotes Respiratory distress is associated with the pain caused by the fractures and the presence of traumatic underlying pulmonary pathology.
T2184 686660-686774 Epistemic_statement denotes Although controversial, positioning the patient with the flail segment up may reduce pain and improve ventilation.
T2185 686775-686899 Epistemic_statement denotes Avoid the use of chest wraps, which do nothing to stabilize the flail segment and can further impair respiratory excursions.
T2186 687212-687321 Epistemic_statement denotes In rare cases in which the flail segment involves five or more ribs, surgical stabilization may be necessary.
T2187 687718-687832 Epistemic_statement denotes Cats may have an acute onset of a severe restrictive respiratory pattern associated with lower airway obstruction.
T2188 688015-688124 Epistemic_statement denotes In cats with chronic bronchitis, there may be damage of the bronchial epithelium and fibrosis of the airways.
T2189 688275-688500 Epistemic_statement 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.
T2190 688625-688746 Epistemic_statement denotes On presentation, the patient should be placed in an oxygen cage and allowed to rest while being observed from a distance.
T2191 688747-688858 Epistemic_statement denotes Postpone performing stressful diagnostic procedures until the patient's respiratory status has been stabilized.
T2192 689261-689307 Epistemic_statement denotes Wheezes may be heard on thoracic auscultation.
T2193 689469-689584 Epistemic_statement denotes Radiographs may reveal a hyperinflated lung field with bronchial markings and caudal displacement of the diaphragm.
T2194 689656-689764 Epistemic_statement denotes A complete blood count and serum biochemistry profile can be performed, but results usually are unrewarding.
T2195 689765-689813 Epistemic_statement denotes In endemic areas, a heartworm test is warranted.
T2196 690024-690344 Epistemic_statement 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).
T2197 690434-690634 Epistemic_statement 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.
T2198 690784-690925 Epistemic_statement 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.
T2199 691116-691315 Epistemic_statement 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.
T2200 691316-691539 Epistemic_statement 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.
T2201 691700-691806 Epistemic_statement denotes Contusions may be present at the time of presentation or can develop over the first 24 hours after injury.
T2202 691807-692021 Epistemic_statement 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.
T2203 692022-692140 Epistemic_statement denotes Radiographic signs can lag behind the development of clinical signs of respiratory distress and hypoxemia by 24 hours.
T2204 692273-692404 Epistemic_statement denotes Arterial blood gas analysis or pulse oximetry can be used to determine the degree of hypoxemia and monitor the response to therapy.
T2205 692405-692540 Epistemic_statement denotes Intravenous fluids should be administered with caution to avoid exacerbating pulmonary hemorrhage or fluid accumulation in the alveoli.
T2206 692601-692769 Epistemic_statement denotes Possible complications of pulmonary contusions are rare but include bacterial infection, abscessation, lung lobe consolidation, and the development of cavitary lesions.
T2207 692901-693048 Epistemic_statement denotes Empiric antibiotic use without evidence of external injury or known infection can potentially increase the risk of a resistant bacterial infection.
T2208 693049-693174 Epistemic_statement denotes Steroids have been shown to decrease pulmonary alveolar macrophage function and impair wound healing and are contraindicated.
T2209 693175-693413 Epistemic_statement 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.
T2210 693414-693589 Epistemic_statement denotes Megaesophagus, systemic polyneuropathy, myasthenia gravis, and localized oropharyngeal defects such as cleft palate can increase the risk of developing aspiration pneumonitis.
T2211 693756-693904 Epistemic_statement denotes Aspiration of contents into the airways can cause mechanical airway obstruction, bronchoconstriction, chemical damage to the alveoli, and infection.
T2212 693954-693998 Epistemic_statement denotes Pulmonary hemorrhage and necrosis can occur.
T2213 693999-694253 Epistemic_statement 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.
T2214 694254-694418 Epistemic_statement 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.
T2215 694743-694853 Epistemic_statement denotes Nebulization with sterile saline and chest physiotherapy (coupage) should be performed at least every 8 hours.
T2216 695388-695584 Epistemic_statement denotes Pulmonary edema can be caused by increased pulmonary vasculature hydrostatic pressure, decreased pulmonary oncotic pressure, obstruction of lymphatic drainage, or increased capillary permeability.
T2217 695585-695627 Epistemic_statement denotes Multiple factors can occur simultaneously.
T2218 695734-695860 Epistemic_statement denotes Decreased plasma oncotic pressure with albumin <1.5 g/dL can also result in accumulation of fluid in the pulmonary parenchyma.
T2219 695861-695989 Epistemic_statement denotes Overzealous intravenous crystalloid fluid administration can result in dilution of serum oncotic pressure and vascular overload.
T2220 696223-696335 Epistemic_statement denotes Increased capillary permeability is associated with a variety of diseases that cause severe inflammation (SIRS).
T2221 696453-696699 Epistemic_statement 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.
T2222 696840-696953 Epistemic_statement denotes In severe cases, cyanosis and fulminant blood-tinged frothy edema fluid may be present in the mouth and nostrils.
T2223 697294-697402 Epistemic_statement denotes If fluid overload is suspected secondary to intravenous fluid administration, fluids should be discontinued.
T2224 697531-697666 Epistemic_statement 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.
T2225 697667-697851 Epistemic_statement 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.
T2226 697852-697951 Epistemic_statement denotes Further diagnostic testing may be required to determine other underlying causes of pulmonary edema.
T2227 698414-698535 Epistemic_statement denotes Positive inotropic and antiarrhythmic therapy may be necessary to improve cardiac contractility and control dysrhythmias.
T2228 698536-698731 Epistemic_statement 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).
T2229 698835-698894 Epistemic_statement denotes In many cases, mechanical ventilation should be considered.
T2230 698895-699171 Epistemic_statement 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.
T2231 699765-699874 Epistemic_statement denotes Clinical signs associated with PTE include an acute onset of tachypnea, tachycardia, orthopnea, and cyanosis.
T2232 699875-699970 Epistemic_statement denotes If the embolism is large, the patient may respond poorly to supplemental oxygen administration.
T2233 699971-700055 Epistemic_statement denotes Pulmonary hypertension can cause a split second heart sound on cardiac auscultation.
T2234 700197-700400 Epistemic_statement 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.
T2235 700401-700445 Epistemic_statement denotes The right side of the heart may be enlarged.
T2236 700446-700629 Epistemic_statement denotes Echocardiography can show right-sided heart enlargement, tricuspid regurgitation, pulmonary hypertension, and evidence of underlying cardiac disease, possibly with clots in the atria.
T2237 700630-700744 Epistemic_statement denotes Measurement of AT and D-dimer levels can be useful in the identification of hypercoagulable states, including DIC.
T2238 701256-701323 Epistemic_statement denotes Thrombolytic therapy may include t-PA, streptokinase, or urokinase.
T2239 701324-701445 Epistemic_statement denotes Long-term therapy with low-molecular-weight heparin or warfarin may be required to prevent further thromboembolic events.
T2240 701446-701533 Epistemic_statement denotes Ideally, management should include treatment and elimination of the underlying disease.
T2241 702420-702523 Epistemic_statement denotes Smoke inhalation of superheated particles also causes damage to the upper airways and respiratory tree.
T2242 702524-702590 Epistemic_statement denotes The larynx can become severely edematous and obstruct inspiration.
T2243 702591-702765 Epistemic_statement 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.
T2244 702766-702865 Epistemic_statement denotes Inhalation of noxious gases and particles can cause damage to the terminal respiratory bronchioles.
T2245 702866-703001 Epistemic_statement denotes Specific noxious gases that can cause alveolar damage include combustible particles from plastic, rubber, and other synthetic products.
T2246 703002-703060 Epistemic_statement denotes Pulmonary edema, bacterial infection, and ARDS can result.
T2247 703459-703575 Epistemic_statement denotes Arterial blood gases should be analyzed with co-oximetry to evaluate the Pao 2 and carboxyhemoglobin concentrations.
T2248 703576-703752 Epistemic_statement 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.
T2249 703753-703943 Epistemic_statement 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.
T2250 703944-704174 Epistemic_statement 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.
T2251 704425-704551 Epistemic_statement denotes If severe laryngeal edema is present, a temporary tracheostomy may be necessary to allow adequate oxygenation and ventilation.
T2252 704552-704758 Epistemic_statement 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.
T2253 704759-704877 Epistemic_statement denotes In cases of severe laryngeal edema, however, glucocorticosteroids may be necessary to decrease edema and inflammation.
T2254 705000-705151 Epistemic_statement denotes ePisTAxis Epistaxis can be caused by facial trauma, a foreign body, bacterial or fungal rhinitis, neoplasia, coagulopathies, and systemic hypertension.
T2255 705152-705240 Epistemic_statement denotes Acute, severe bilateral hemorrhage without exudate is suggestive of a systemic disorder.
T2256 705313-705381 Epistemic_statement denotes Acute unilateral epistaxis can occur with nasal or systemic disease.
T2257 705457-705568 Epistemic_statement denotes Sedation (acepromazine, 0.02 to 0.05 mg/kg IV, IM, SQ) may be helpful in alleviating anxiety and decreasing BP.
T2258 705569-705667 Epistemic_statement denotes The hypotensive effects of acepromazine are potentially harmful if severe blood loss has occurred.
T2259 705668-705797 Epistemic_statement denotes If evidence of hypovolemia is present (see section on hypovolemic shock), intravenous fluid resuscitation should be administered.
T2260 705798-705930 Epistemic_statement denotes Rapid assessment of clotting ability, with a platelet count estimate and clotting profile (ACT or APTT and PT), should be performed.
T2261 706273-706451 Epistemic_statement 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.
T2262 706452-706528 Epistemic_statement denotes Rhinoscopy should be performed to determine the cause of ongoing hemorrhage.
T2263 706529-706687 Epistemic_statement denotes Continued excessive hemorrhage can be controlled with ligation of the carotid artery on the side of the hemorrhage or with percutaneous arterial embolization.
T2264 707012-707100 Epistemic_statement denotes The animal should be transported to the nearest veterinary facility for definitive care.
T2265 707101-707242 Epistemic_statement 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.
T2266 707243-707356 Epistemic_statement denotes If an open fracture is present, the limb should be splinted without placing the exposed bone back into the wound.
T2267 707357-707542 Epistemic_statement 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.
T2268 707543-707698 Epistemic_statement 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.
T2269 707859-708066 Epistemic_statement 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).
T2270 708719-708881 Epistemic_statement 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.
T2271 709540-709747 Epistemic_statement 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).
T2272 709748-709889 Epistemic_statement denotes In such cases, a short-acting anesthetic combination (analgesia + propofol, analgesia + ketamine and diazepam) can be administered to effect.
T2273 709890-710062 Epistemic_statement 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.
T2274 710502-710656 Epistemic_statement 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.
T2275 710721-710859 Epistemic_statement denotes Grossly contaminated wounds can be rinsed first with warm tap water to eliminate gross contamination, and then prepared as just described.
T2276 710945-711078 Epistemic_statement denotes Obviously viable and questionable tissue should remain, and the wound should be left open for frequent reassessment on a daily basis.
T2277 711122-711257 Epistemic_statement 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.
T2278 711322-711441 Epistemic_statement denotes Blood vessels that are actively bleeding should be ligated to control hemorrhage, if collateral circulation is present.
T2279 711442-711549 Epistemic_statement denotes If nerve bundles are ligated cleanly in a clean wound, the nerve edges should be reapposed and anastomosed.
T2280 711550-711673 Epistemic_statement denotes If gross contamination is present, however, definitive neurologic repair should be delayed until healthy tissue is present.
T2281 711825-711988 Epistemic_statement 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.
T2282 712081-712214 Epistemic_statement denotes Infusion of chlorhexidine or povidone-iodine solution into the joint can cause a decrease in cartilage repair and is contraindicated.
T2283 712268-712360 Epistemic_statement denotes Whenever possible, the joint capsule and ligaments should be partially or completely closed.
T2284 712361-712531 Epistemic_statement 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.
T2285 712532-712569 Epistemic_statement denotes The joint should then be immobilized.
T2286 712570-712723 Epistemic_statement 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.
T2287 712724-712833 Epistemic_statement denotes The bone should be covered with a moist dressing and stabilized until definitive fracture repair can be made.
T2288 713058-713170 Epistemic_statement denotes If large areas of contamination are present (e.g., necrotizing fasciitis), en bloc debridement may be necessary.
T2289 713312-713499 Epistemic_statement 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.
T2290 713762-713985 Epistemic_statement 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.
T2291 714441-714684 Epistemic_statement 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).
T2292 714685-714782 Epistemic_statement denotes Leave the ends long so that the suture can be accurately identified at the time of drain removal.
T2293 715142-715315 Epistemic_statement 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.
T2294 715359-715431 Epistemic_statement denotes The drain can be removed once drainage is minimal (usually 3 to 5 days).
T2295 715432-715562 Epistemic_statement denotes Active drains can be constructed or purchased; their use is indicated in wounds that are free of material that can plug the drain.
T2296 716239-716354 Epistemic_statement denotes Alternatively, the butterfly portion of the system can be removed and the tube fenestrated as described previously.
T2297 716748-716923 Epistemic_statement denotes Delayed primary closure should be considered when there is heavy contamination, purulent exudate, residual necrotic debris, skin tension, edema and erythema, and lymphangitis.
T2298 717057-717169 Epistemic_statement denotes Once healthy tissue is observed, the skin edges should be debrided and the wound closed as with primary closure.
T2299 717170-717327 Epistemic_statement denotes seCondAry Wound Closure Secondary wound closure should be considered when infection and tissue trauma necessitate open wound management for more than 5 days.
T2300 717508-717668 Epistemic_statement 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.
T2301 717711-717919 Epistemic_statement 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.
T2302 717920-718017 Epistemic_statement denotes In such cases, the wound should be cleaned, and the skin edges debrided to remove the epithelium.
T2303 718018-718159 Epistemic_statement denotes The remaining wound edges are then sutured over the granulation tissue ( Drain may be incorporated into the repair and prevent drain removal.
T2304 718160-718342 Epistemic_statement 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.
T2305 718521-718635 Epistemic_statement denotes Early recognition of the type of shock present is crucial in the successful clinical management of shock syndrome.
T2306 718721-718838 Epistemic_statement denotes Knowledge of the components of normal oxygen delivery is essential to the treatment of shock in the critical patient.
T2307 719092-719452 Epistemic_statement 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.
T2308 719585-719813 Epistemic_statement 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).
T2309 720232-720374 Epistemic_statement denotes If vasoconstriction is severe enough to interfere with delivery of adequate tissue oxygen for a sufficient period of time, the animal may die.
T2310 720375-720504 Epistemic_statement denotes Hypovolemic shock can result from acute hemorrhage or from severe fluid loss from vomiting, diarrhea, or third spacing of fluids.
T2311 721602-722036 Epistemic_statement 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).
T2312 722329-722392 Epistemic_statement denotes Septic shock and other causes of inflammation can lead to SIRS.
T2313 722534-722655 Epistemic_statement denotes Clinical signs associated with sepsis may be vague and nonspecific, including weakness, lethargy, vomiting, and diarrhea.
T2314 722656-722718 Epistemic_statement denotes Cough and pulmonary crackles may be associated with pneumonia.
T2315 722719-722774 Epistemic_statement denotes Decreased lung sounds may be associated with pyothorax.
T2316 722775-722842 Epistemic_statement denotes Abdominal pain and fluid may be associated with septic peritonitis.
T2317 722843-722913 Epistemic_statement denotes Vaginal discharge may or may not be present in patients with pyometra.
T2318 722914-723056 Epistemic_statement denotes Diagnostic tests should include a WBC count, serum biochemical profile, coagulation tests, thoracic and abdominal radiographs, and urinalysis.
T2319 723210-723320 Epistemic_statement denotes A degenerative left shift, with leukopenia with elevated band neutrophils, suggests an overwhelming infection.
T2320 723321-723436 Epistemic_statement denotes Biochemical analyses may demonstrate hypoglycemia and nonspecific hepatocellular and cholestatic enzyme elevations.
T2321 723437-723573 Epistemic_statement denotes In the most severe cases, metabolic (lactic) acidosis, coagulopathies, and end-organ failure, including anuria and ARDS, may be present.
T2322 723673-723802 Epistemic_statement denotes Cardiogenic shock is associated with primary cardiomyopathies, cardiac dysrhythmias, pericardial fluid, and pericardial fibrosis.
T2323 724068-724329 Epistemic_statement 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.
T2324 724330-724516 Epistemic_statement 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.
T2325 724927-725211 Epistemic_statement 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.
T2326 725329-725445 Epistemic_statement denotes Consideration of each aspect of the Rule of 20 on a daily basis ensures that major organ systems are not overlooked.
T2327 725703-725829 Epistemic_statement denotes If vascular access cannot be obtained percutaneously or by cutdown methods, intraosseous catheterization should be considered.
T2328 726340-726452 Epistemic_statement denotes Synthetic colloid fluids (hydroxyethyl starch) can also be administered in the initial resuscitation from shock.
T2329 726592-726770 Epistemic_statement denotes † 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.
T2330 726771-726979 Epistemic_statement 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.
T2331 726980-727337 Epistemic_statement 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.
T2332 727338-727474 Epistemic_statement denotes In critically ill patients, fluid loss can be measured in the form of urine, vomit, diarrhea, body cavity effusions, and wound exudates.
T2333 727475-727616 Epistemic_statement denotes In addition, insensible losses (those that cannot be readily measured from sweat, panting, and cellular metabolism) constitute 20 mL/ kg/day.
T2334 727617-727807 Epistemic_statement 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).
T2335 728053-728137 Epistemic_statement denotes The systolic pressure should remain at or greater than 90 to 100 mm Hg at all times.
T2336 728309-728398 Epistemic_statement denotes The mean arterial pressure should be greater than 60 mm Hg for adequate tissue perfusion.
T2337 728399-728580 Epistemic_statement 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).
T2338 728581-728702 Epistemic_statement denotes In cases of cardiogenic shock, vasodilator drugs (Table 1 -58) can be used to decrease vascular resistance and afterload.
T2339 728808-728932 Epistemic_statement denotes Furosemide (1 mg/kg/hr) also can dilate pulmonary vasculature and potentially reduce edema fluid formation in cases of ARDS.
T2340 729582-729759 Epistemic_statement 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.
T2341 730526-730709 Epistemic_statement 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.
T2342 730710-730949 Epistemic_statement 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.
T2343 730950-731010 Epistemic_statement denotes Cardiac dysrhythmias should be controlled whenever possible.
T2344 731011-731088 Epistemic_statement denotes Treatment of bradycardia should be directed at treating the underlying cause.
T2345 732147-732238 Epistemic_statement denotes Supraventricular tachycardia can impair cardiac output by impairing diastolic filling time.
T2346 732359-732498 Epistemic_statement denotes Albumin can decrease as a result of loss from the gastrointestinal tract, urinary system, and wound exudates or into body cavity effusions.
T2347 732499-732634 Epistemic_statement denotes Albumin synthesis can decrease during various forms of shock owing to a preferential increase in hepatic acute phase protein synthesis.
T2348 732830-732953 Epistemic_statement denotes Albumin levels <2.0 g/dL have been associated with an increase in morbidity and mortality in human and veterinary patients.
T2349 733089-733171 Epistemic_statement denotes Additional oncotic support can be in the form of synthetic colloids, as indicated.
T2350 733677-733735 Epistemic_statement denotes Oncotic pressure can be measured with a colloid osmometer.
T2351 733909-734161 Epistemic_statement 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).
T2352 734162-734347 Epistemic_statement 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).
T2353 734348-734666 Epistemic_statement 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.
T2354 734667-734818 Epistemic_statement denotes In septic shock, decreases in cardiac output caused by inflammatory cytokines and a decrease in cellular oxygen extraction can lead to lactic acidosis.
T2355 734819-734938 Epistemic_statement denotes Increased cellular metabolism and decreases in respiratory function can lead to respiratory acidosis as CO 2 increases.
T2356 735046-735124 Epistemic_statement denotes Supplemental oxygen should be humidified and delivered at 50 to 100 mL/kg/min.
T2357 735125-735355 Epistemic_statement 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.
T2358 735356-735492 Epistemic_statement denotes Glucose is a necessary fuel source for RBCs and neuronal tissues, and serum glucose should be maintained within normal reference ranges.
T2359 735493-735632 Epistemic_statement denotes Glucose supplementation can be administered as 2.5% to 5% solutions in crystalloid fluids, or in parenteral and enteral nutrition products.
T2360 735633-735705 Epistemic_statement denotes Arterial and venous pH can be measured by performing blood gas analyses.
T2361 735706-735880 Epistemic_statement 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.
T2362 735881-736060 Epistemic_statement 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.
T2363 736061-736206 Epistemic_statement 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.
T2364 736274-736402 Epistemic_statement denotes Serum potassium, magnesium, sodium, chloride, and total and ionized calcium should be maintained within normal reference ranges.
T2365 736403-736512 Epistemic_statement denotes If metabolic acidosis is severe, sodium bicarbonate can be administered by calculating the following formula:
T2366 736513-736763 Epistemic_statement 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.
T2367 736764-736893 Epistemic_statement 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.
T2368 737560-737613 Epistemic_statement denotes AT levels can be measured by commercial laboratories.
T2369 737614-737705 Epistemic_statement denotes AT and clotting factors can be replenished in the form of fresh frozen plasma transfusions.
T2370 737706-737828 Epistemic_statement denotes A more sensitive and specific test for DIC is the detection of D dimers, which can be measured by commercial laboratories.
T2371 738237-738357 Epistemic_statement denotes Elevation of the patient's head can help to protect the airway and decrease the risk of increased intracranial pressure.
T2372 738358-738455 Epistemic_statement denotes Serum glucose should be maintained within normal levels to prevent hypoglycemia-induced seizures.
T2373 738606-738731 Epistemic_statement denotes Acid-base status can adversely affect oxygen offloading at the tissue level if metabolic or respiratory alkalosis is present.
T2374 738732-738841 Epistemic_statement denotes Oxygen-carrying capacity and hemoglobin levels can be increased with administration of RBC component therapy.
T2375 739008-739092 Epistemic_statement denotes Fluid intake and output should be measured in cases of suspected oliguria or anuria.
T2376 739093-739218 Epistemic_statement 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).
T2377 739219-739294 Epistemic_statement denotes Mannitol should also be administered (0.5 to 1 g/kg over 10 to 15 minutes).
T2378 739295-739406 Epistemic_statement denotes Dopamine (1 to 5 mcg/kg/min CRI) can be administered to dilate renal afferent vessels and improve urine output.
T2379 739407-739501 Epistemic_statement denotes The patient's WBC count may be elevated, normal, or decreased, depending on the type of shock.
T2380 739502-739573 Epistemic_statement denotes The decision to administer antibiotics should be made on a daily basis.
T2381 739574-739726 Epistemic_statement denotes Superficial or deep Staphylococcus or Streptococcus infection usually can be treated with a first-generation cephalosporin (cefazolin, 22 mg/kg IV tid).
T2382 739727-739997 Epistemic_statement 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.
T2383 739998-740094 Epistemic_statement denotes If broader anaerobic coverage is required, metronidazole (10 mg/kg IV tid) should be considered.
T2384 740256-740406 Epistemic_statement denotes Ideally, patients receiving any aminoglycoside antibiotic should have a daily urinalysis to check for renal tubular casts, which signify renal damage.
T2385 740443-740644 Epistemic_statement 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).
T2386 740731-740948 Epistemic_statement 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.
T2387 741282-741403 Epistemic_statement denotes The course of drug therapy should be reviewed daily, and the patient should be monitored for potential drug interactions.
T2388 741404-741525 Epistemic_statement denotes For example, metoclopramide and dopamine, working at the same receptor, can effectively negate the effects of each other.
T2389 741526-741616 Epistemic_statement denotes Cimetidine, a cytochrome P450 enzyme inhibitor, can decrease the metabolism of some drugs.
T2390 741617-741761 Epistemic_statement denotes Drugs that are avidly protein-bound may have an increase in unbound fraction with concurrent hypoalbuminemia or when hypoalbuminemia is present.
T2391 741762-741895 Epistemic_statement denotes Decreased renal function may impair the renal clearance of some drugs, requiring increased administration interval or decreased dose.
T2392 741961-742123 Epistemic_statement denotes Patients with septic shock may become hypermetabolic and require supraphysiologic nutrient caloric requirements, whereas others may actually become hypometabolic.
T2393 742124-742247 Epistemic_statement denotes Enteral nutrition is preferred whenever possible, because enterocytes undergo atrophy without luminal nutrient stimulation.
T2394 742248-742404 Epistemic_statement 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.
T2395 742405-742554 Epistemic_statement denotes Loss of gastrointestinal mucosal barrier function may predispose patients to the development of bacterial translocation and may contribute to sepsis.
T2396 742555-742872 Epistemic_statement 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.
T2397 742873-742931 Epistemic_statement denotes Assessment of pain in animals in shock can be challenging.
T2398 742932-743139 Epistemic_statement 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.
T2399 743140-743263 Epistemic_statement denotes In any animal determined to be in pain, analgesic drugs should be administered to control pain and discomfort at all times.
T2400 743264-743423 Epistemic_statement denotes Opioids are cardiovascularly friendly, and their effects can easily be reversed with naloxone if adverse effects such as hypotension and hypoventilation occur.
T2401 743541-743702 Epistemic_statement denotes Passive range-of-motion exercises and deep muscle massage should be performed to increase tissue perfusion, decrease dependent edema, and prevent disuse atrophy.
T2402 743703-743812 Epistemic_statement denotes Animals should be kept completely dry on soft, padded bedding to prevent the development of decubital ulcers.
T2403 743813-743932 Epistemic_statement denotes All bandages, wound sites, and catheter sites should be checked daily for the presence of swelling, erythema, and pain.
T2404 743933-744047 Epistemic_statement denotes Soiled bandages should be changed to prevent strike-through and contamination of the underlying catheter or wound.
T2405 744048-744123 Epistemic_statement denotes Hospitalization can be a stressful experience for patient and client alike.
T2406 744124-744237 Epistemic_statement denotes Allowing brief visits and walks outside in the fresh air can improve a patient's temperament and decrease stress.
T2407 744238-744356 Epistemic_statement denotes The preemptive use of analgesic drugs on a regular schedule (not PRN) should be used to prevent pain before it occurs.
T2408 744473-744581 Epistemic_statement denotes The use of glucocorticosteroids and antiprostaglandins in shock therapy remains a topic of wide controversy.
T2409 744582-744917 Epistemic_statement 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.
T2410 744918-745121 Epistemic_statement 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.
T2411 745475-745658 Epistemic_statement 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.
T2412 745659-745954 Epistemic_statement 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.
T2413 745955-746151 Epistemic_statement 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.
T2414 747345-747519 Epistemic_statement 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.
T2415 748166-748303 Epistemic_statement denotes Acepromazine can cause peripheral vasodilation and decreased afterload but also can promote hypotension in a patient with concurrent CHF.
T2416 748304-748380 Epistemic_statement denotes Acepromazine (0.05 mg/kg SQ) should be used with extreme caution, if at all.
T2417 748381-748563 Epistemic_statement 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.
T2418 748564-748633 Epistemic_statement denotes For these reasons, the use of thrombolytic agents is not recommended.
T2419 748708-748894 Epistemic_statement 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.
T2420 748895-749041 Epistemic_statement 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.
T2421 749542-749651 Epistemic_statement denotes Selective and nonselective angiography can also be performed to determine the exact location of the thrombus.
T2422 749785-749944 Epistemic_statement 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.
T2423 749945-750052 Epistemic_statement denotes In the past the combination of heparin then warfarin was used; however, it was often difficult to regulate.
T2424 750205-750322 Epistemic_statement denotes Monitoring therapy based on prothrombin time and the international normalized ratio (INR, 2.0 to 4.0) is recommended.
T2425 750323-750423 Epistemic_statement denotes Low-dose aspirin 0.5 mg/kg PO q12-24h (canine), 25 mg/kg q56-84h (feline) also has been recommended.
T2426 750424-750585 Epistemic_statement denotes Physical therapy with warm water bathing, deep muscle massage, and passive range-ofmotion exercises should be performed until the patient regains motor function.
T2427 750586-750698 Epistemic_statement denotes Future therapy may involve the use of platelet receptor antagonists to prevent platelet activation and adhesion.
T2428 750776-751017 Epistemic_statement 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.
T2429 751302-751543 Epistemic_statement 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.
T2430 751544-751679 Epistemic_statement 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.
T2431 751680-751871 Epistemic_statement 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.
T2432 752073-752290 Epistemic_statement 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.
T2433 752291-752405 Epistemic_statement denotes Medullary washout can occur, causing isosthenuric urine in the presence of dehydration from vomiting and diarrhea.
T2434 752537-752807 Epistemic_statement 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.
T2435 752808-753003 Epistemic_statement 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.
T2436 753375-753469 Epistemic_statement denotes Urine output should return to normal in patients with prerenal azotemia as rehydration occurs.
T2437 753470-753722 Epistemic_statement 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.
T2438 753947-754020 Epistemic_statement denotes Once renal perfusion is restored, the kidneys can resume normal function.
T2439 754136-754190 Epistemic_statement denotes Renal autoregulation can be impaired in some diseases.
T2440 754191-754361 Epistemic_statement 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.
T2441 754362-754492 Epistemic_statement denotes If renal hypoperfusion is not quickly restored, the condition can progress from prerenal disease to acute intrinsic renal failure.
T2442 754493-754657 Epistemic_statement 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.
T2443 755002-755125 Epistemic_statement denotes Patients with acute intrinsic renal failure may be oliguric or polyuric, depending on the cause and state of renal failure.
T2444 755542-755660 Epistemic_statement denotes If treatment is initiated during the induction phase, progression to the maintenance phase potentially can be stopped.
T2445 755764-755868 Epistemic_statement denotes Renal tubular epithelial cells and renal tubular casts can be seen on examination of the urine sediment.
T2446 755869-755895 Epistemic_statement denotes Glucosuria may be present.
T2447 756014-756124 Epistemic_statement denotes Correction of the azotemia and removal of the cause of the problem do not result in return to normal function.
T2448 756238-756297 Epistemic_statement denotes The maintenance phase may last for several weeks to months.
T2449 756298-756381 Epistemic_statement denotes Recovery of renal function may or may not occur, depending on the extent of injury.
T2450 756557-756616 Epistemic_statement denotes Azotemia may resolve, but concentrating defects may remain.
T2451 756617-756780 Epistemic_statement 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.
T2452 756781-756821 Epistemic_statement denotes This phase may last for weeks to months.
T2453 756822-756958 Epistemic_statement denotes Treatment of acute intrinsic renal failure consists of determining the cause and ruling out obstruction or uroabdomen whenever possible.
T2454 756959-757080 Epistemic_statement denotes A careful history can sometimes determine whether there has been exposure to nephrotoxic drugs, chemicals, or food items.
T2455 757341-757500 Epistemic_statement 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.
T2456 757769-757862 Epistemic_statement denotes Radiographs and abdominal ultrasound can help in determining the chronicity of renal failure.
T2457 758113-758196 Epistemic_statement denotes In cases of polyuric renal failure, massive fluid and electrolyte losses can occur.
T2458 758343-758505 Epistemic_statement 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.
T2459 758506-758680 Epistemic_statement 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.
T2460 758880-758958 Epistemic_statement denotes Repeat bolus doses of furosemide if there is no response to initial treatment.
T2461 759087-759155 Epistemic_statement denotes Dopamine and furosemide may be synergistic if administered together.
T2462 759280-759430 Epistemic_statement 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).
T2463 760023-760118 Epistemic_statement denotes If anuria develops or oliguria is irreversible despite this therapy, begin peritoneal dialysis.
T2464 760294-760365 Epistemic_statement denotes If possible, avoid the use of nephrotoxic drugs and general anesthesia.
T2465 760366-760479 Epistemic_statement denotes Initiate nutritional support in the form of an enteral feeding tube or parenteral nutrition as early as possible.
T2466 760480-760629 Epistemic_statement denotes Once the patient enters the recovery phase, diuresis may occur, which can lead to dehydration and electrolyte imbalances (hyponatremia, hypokalemia).
T2467 760630-760738 Epistemic_statement denotes Dehydration and electrolyte imbalances can be treated with parenteral fluid and electrolyte supplementation.
T2468 761113-761300 Epistemic_statement 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.
T2469 761301-761408 Epistemic_statement denotes A ruptured urinary bladder is the most common cause of uroabdomen and is usually secondary to blunt trauma.
T2470 761846-762018 Epistemic_statement 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).
T2471 762019-762264 Epistemic_statement 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).
T2472 762322-762454 Epistemic_statement denotes If a urinary catheter cannot be placed, perform cystocentesis only as a last resort, because of the risk of urinary bladder rupture.
T2473 762621-762734 Epistemic_statement denotes If an unresectable tumor is present, a low-profile permanent cystostomy tube can be placed, if the owner desires.
T2474 762735-762894 Epistemic_statement 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.
T2475 763026-763119 Epistemic_statement denotes Feline lower urinary tract disease can cause urethral obstruction, particularly in male cats.
T2476 763365-763490 Epistemic_statement denotes Cases with a duration of obstruction <36 hours are considered uncomplicated; those with a duration >36 hours are complicated.
T2477 764236-764359 Epistemic_statement denotes The urethral plug can sometimes be manually extracted or massaged from the penis, and the obstruction temporarily relieved.
T2478 764360-764479 Epistemic_statement denotes In such cases it is still necessary to pass a urethral catheter to flush sediment from the urethra and urinary bladder.
T2479 764653-764754 Epistemic_statement denotes Once the patient is under anesthesia or heavily sedated, urinary catheterization should be performed.
T2480 764755-764815 Epistemic_statement denotes In some cases, it will be difficult to advance the catheter.
T2481 765230-765324 Epistemic_statement denotes Drain the bladder and flush with sterile saline solution until the urine efflux appears clear.
T2482 765642-765785 Epistemic_statement denotes The catheter should be connected to a closed urinary collection system for cleanliness and to reduce the risk of ascending bacterial infection.
T2483 765786-765900 Epistemic_statement denotes An Elizabethan collar should be placed at all times to prevent the patient from damaging or removing the catheter.
T2484 766094-766148 Epistemic_statement denotes In some cases, postobstructive diuresis can be severe.
T2485 766257-766314 Epistemic_statement denotes The urinary catheter can be removed after 24 to 48 hours.
T2486 766592-766825 Epistemic_statement 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.
T2487 766826-766915 Epistemic_statement denotes Uroabdomen can occur from trauma or leakage from the kidneys, ureter, or urinary bladder.
T2488 766916-767086 Epistemic_statement 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.
T2489 767168-767373 Epistemic_statement 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.
T2490 767374-767539 Epistemic_statement 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.
T2491 767580-767748 Epistemic_statement 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.
T2492 769245-769410 Epistemic_statement 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.