1. Emergency and Critical Care Special Topics Part 1

3. What we’ll cover… ECC & the VTNE Triage Signs, treatment & monitoring of critical patients Respiratory, Cardio, CNS, Renal, Repro, Toxins CPCR Emergency Drugs Emergency equipment/supplies

5. VTNE Moment When monitoring patients on fluids and/or patients undergoing diuresis, urine output is an important consideration. The normal urine production for a healthy dog or cat is approximately a.5-10 ml/kg/hr b.1-2 ml/kg/hr c.15-20 ml/kg/hr d.25-30 ml/kg/hr

6. VTNE Moment When monitoring patients on fluids and/or patients undergoing diuresis, urine output is an important consideration. The normal urine production for a healthy dog or cat is approximately a.5-10 ml/kg/hr b.1-2 ml/kg/hr c.15-20 ml/kg/hr d.25-30 ml/kg/hr Make it real!

7. PART ONE: TRIAGE

8. What do you do first? Triage - French “To sort”during WW1 First Contact - “Ring Ring” Get their digits!! What requires immediate care? What can we tell them? DO NOT STALL! and DO NOT FREAK! Keep It Cool, Daddio

9. What do you REMEMBER? Triage into what 3 groups? Most important body systems (in order)?

10. In the hospital Initial Triage = 3 groups Immediate care Take to treatment area Can wait PRIMARY ASSESSMENT 5 min convo – What to include? Critical systems FIRST Palpate abdomen Initial treatment on Level-one acuity Say to owner? SECONDARY EVAL After p has been checked in… What should this include? What’s the scoop?

11. Respiratory System Patency – Stertor vs stridor Rate – 1:2 Causes? Pattern - Current + Changes Apnea Cheyne-Stokes Kussmaul Paradoxical When to place on supp 02? Effort is a clue Stance MM: Blue is Bad, Pink is ….?

12. Cardiovascular System HOW TO QUICKLY asseSs this system? Why is Mentation IMPORTANT? LOOK LISTEN FEEL

13. Neurologic System P WHAT ARE WE LOOKING FOR? LOC: NORMAL, DULL, OBTUNDED, STUPOROUS, COMATOSE AMBULATION THE EYES ARE THE KEY TO THE SOUL… TBI - TRAUMATIC BRAIN INJURY FIXED AND DILATED = ? ANISOCORIA NYSTAGMUS PLR PAIN RESPONSE SEIZURES – POSTICTAL

14. Initial Triage After the R, C, And N systems comes abdominal palpation What are we looking for? What tells us they’re in pain?

15. Running Towards the fire What kinds of questions should you ask? What’s appropriate vs what's not? A note about urgency…

16. Part 2: Next Steps Emergency and Critical Care

17. Diagnostics BLOOD – Big 3/4 SPO2 BP ECG FAST- “Focused Assessment with sonography in Trauma” HYDRATION STATUS

18. BLOOD!!! What do these tell us?? PCV TP BG AzostiX

19. PULSE OXIMETRY SpO2 Every technician’s nightmare Handy but insensitive Quick & easy

20. MonitorinG BLOOD PRESSURE BLOO WHAT IS IT & WHAT CAN IT TELL US? TRENDS DIRECT VS INDIRECT DOPPLER VS OSCILLOMETRIC

21. INDIRECT BP: DOPPLER ONE-TIME ULTRASOUND FLOW DETECTOR ULTRASONIC PROBE AND OCCLUDING CUFF AUDIBLE SIGNAL CAN MONITOR FLOW PIZOELECTRIC CRYSTALS - $$ Sphygmomanometer

22. INDIRECT BP: Oscillometric SINGLE OR REPEATED READINGS MACHINE DETECTS OSCILLATIONS INTEGRATED MONITORING USEFUL IF ANESTHETIZED LESS USEFUL IF SMALL, CONSCIOUS, OR IN SHOCK

23. ECG Electrical conductance Confirms arrythmias TRAUMA SHOCK SYNCOPE DRUGS TOXINS Many conditions affect the heart Display + Print Telemetry leads via clip or patch

24. FAST FOCUSED ASSESSMENT WITH SONOGRAPHY FOR TRAUMA DZ ABD/THORACIC HEMORRHAGE, PNEUMOTHORAX ACUTE/BLUNT TRAUMA HIGHLY SPECIFIC MINIMAL TRAINING

25. Hydration Status Most common causes of Dehydration? 5% dehydrated BEFORE clinical signs are seen Dehydration Turgor MM EYES HAPPENS TO? PCV TS USG Dehydrated vs. Hypovolemic

26. Oxygen Therapy, etc. caution — Stress = higher rate of cardiac arrest BREATHING BUT HYPOXIC How do we administer? FLOWBY BAG LINES/PRONGS COLLARS CAGES HUMIDIFICATION 02 tx can get in the way of other dX OXYGEN TOXICITY

27. Shock Inadequate tissue perfusion & energy production Compensation! A disease of symptoms Therapy optimizes O2 delivery Types CARDIOGENIC DISTRIBUTIVE OBSTRUCTIVE HYPOVOLEMIC

28. Advanced Emergency Techniques Abdominocentesis Dx tool Drain AsCites Thoracocentesis Dx and therapeutic Drain Edema, Effusion Thoracic Drain Placement Surgical Procedure Must be 100% sterile Tracheostomy Tube Placement Only indicated iF life threatening upper Airway Obstructions Jackson-Pratt Drain

29. Videos of specialty Procedures Thoracocentesis s ThORacic Drain Placement Tracheostomy