1Monitoring Equipment
Pulse oximeter
Capnography
Blood gas analysis
2Blood Pressure Monitoring
Indirect Doppler
Oscillometric
Dynamap
Cardell
Direct Arterial catheter
Transducer
Monitor
3Indirect Blood Pressure
Measures systolic pressures Apply occlusion cuff over appendage
Cuff should be 40% of the circumference of leg
Place snugly around leg, tape in place
4Indirect Blood Pressure
Cuff is placed on: Mid foreleg distal to hock
Base of tail
Below the stifle in cats
5Doppler
Seemingly more accurate
Has more clinical uses
6Direct Blood Pressure
Techniques Invasive
More accurate
Requires arterial catheter placement
Requires transducer and mechanical transmitter
Records systolic, diastolic, and mean pressures continuously through series of waveforms
7Ideal Blood Pressure Values
Mean blood pressure ranges from 75-90 mm Hg Systolic blood pressures >175 mm Hg indicates
hypertension
Pulses should be palpable if the mean arterial blood pressure is >60 mm Hg
Systolic values >90 mm Hg and diastolic values >60 mm Hg are required to maintain adequate perfusion of vital organs
8Central Venous Pressure
Crude way to monitor a patient’s cardiac output via a jugular catheter in anterior vena cava
Used as a marker in fluid therapy to assess a patient’s response to treatment
Useful marker in determining perfusion status
9Central Venous Pressure
Normal central venous pressure is 0-5 cm H2O
Values <0 indicate hypovolemia, dehydration, or inadequate fluid therapy
Values or trends >8 or 10 indicate an increase in vascular volume and adequate fluid therapy
Sudden increases in CVP or values >10 may indicate venous congestion, increased thoracic pressure, and volume overload
10Coagulation Status
Helpful in assessing unexplained bleeding
Helpful in detecting DIC
Methods Evaluation of a blood smear
May detect red blood cell morphology changes and provide an estimation of platelet numbers
11Coagulation Status
Methods Buccal mucosal bleeding time (BMBT)
Evaluates platelet function
Can be used as an in-house screening test for von Willebrand’s disease
12Renal System Monitoring
Standard monitoring includes urine-specific gravity before IV fluids (if possible)
Laboratory markers include the BUN, creatinine, phosphorous
13Renal System Monitoring
Urine output should be estimated in all animals and recorded in the medical record Critical cases require close monitoring of urine production
through indwelling urinary catheters or specifically designed cages that allow urine to drain through a grate to be collected
Minimum urine production is 2-4 ml/kg/hr
14Central Nervous System Monitoring Note changes in mentation, level of consciousness, and
respiratory patterns
Changes may be subtle
Acute changes in neurologic status should be reported immediately
15Central Nervous System Monitoring Frequent monitoring of pupillary size and
responsiveness to light
Early signs of increased intracranial pressure include mental dullness, tachypnea, tachycardia, and dilated pupils
Later signs include bradycardia, fixed pinpoint pupils, seizures, coma, and death
Early recognition and intervention are key to the management
16Abdominal Cavity Evaluation Examined initially by palpation
Palpation can detect abdominal distension
Distension possible due to fluid accumulation, organ enlargement, and intestinal gas
17Abdominal Pain
Detected by the presence of discomfort, splinting, or vocalization
Animals with unexplained abdominal pain or distension warrant further investigation and monitoring
18Abdominocentesis
Procedure to confirm the presence of abdominal fluid and to collect samples for fluid analysis
Abdominocentesis is commonly performed to detect active hemorrhage, infection (peritonitis), ascites, uroabdomen, and neoplastic effusions
19Abdominocentesis
If only a small amount of fluid is collected, a four-quadrant tap may be performed in which the four areas of the abdomen centered around the umbilicus are sampled
20Thoracocentesis
May be performed as an emergency diagnostic procedure in animals with severe respiratory distress
Performed with the animal comfortably restrained in sternal recumbency
21Urinary Obstruction
Common emergency
Causes
Urinary stones, tumors, trauma, and/or inflammation
Obstructions can be fatal
Metabolic abnormalities can develop quickly
May develop secondary kidney damage
May even rupture the urinary system and leak urine into the abdomen
22Toxicities
Patient history is crucial What did the animal ingest?
When did the animal ingest it?
Is the animal showing any clinical signs?
Was the ingestion witnessed or suspected?
Are there other animals or children who could also be exposed?
23Toxicities
Manufacturer labels contain important information Advise client to bring label to the veterinary practice with
the pet
Additional information may be obtained from poison control centers
24Toxicities
Treatment Based on the toxin ingested
Inducing vomiting should be cautiously considered
Vomiting contraindicated for ingestion of caustic substances and petroleum products
25Toxicities
Inducing vomiting Apomorphine is a potent emetic agent
Directly stimulates the vomiting centers of the brain to cause vomiting
Used only in dogs
Absorbed across the conjunctival membranes of the eye
Small tablets may be placed in the conjunctival sac until vomiting has occurred
Can be flushed from the conjunctiva to terminate the vomiting episode
26Toxicities
Induction of vomiting in cats Very challenging!
Xylazine (a sedative drug) often used
Household remedies
Hydrogen peroxide and syrup of ipecac
Hydrogen peroxide administered orally will reliably result in vomiting due to bitter taste and gastric irritation