Advanced Monitoring and Procedures for Small Animal Emergency and Critical Care

Advanced Monitoring and Procedures for Small Animal Emergency and Critical Care Detailed, standardized, step-by-step protocols for easy access to essential information in small animal emergency rooms and intensive care units Advanced Monitoring and Procedures for Small Animal Emergency and Critical Care, Second Edition offers a complete and clinically oriented reference for step-by-step detail on a wide range of procedures in the small animal emergency room and intensive care unit. Each protocol provides detailed instructions grounded in the evidence. The book is carefully designed for ease of use, with concise but comprehensive explanations, useful equipment lists, protocols called out in boxes, and extensive reference lists. In the revised and expanded Second Edition, information has been updated and expanded throughout, and information and chapters have been added in many important areas, including veterinary point-of-care ultrasound (VPOCUS), veterinary CPR, blood banking and transfusion medicine, advanced techniques for mechanical ventilation, and veterinary health care team wellbeing. A companion website offers the protocols in Word for editing and use in practice and the figures from the book in PowerPoint. Specific topics covered in Advanced Monitoring and Procedures for Small Animal Emergency and Critical Care include: The cardiovascular system, covering catheterization of the venous compartment, arterial puncture and catheterization, cardiac VPOCUS, principles of electrocardiography, and electrocardiogram interpretation The respiratory system, covering oxygen therapy, pulse oximetry and CO-oximetry, blood gas analysis, pleural space and lung VPOCUS, tracheal intubation, and temporary tracheostomy The urinary and abdominal systems, covering urethral catheterization, abdominal VPOCUS, peritoneal dialysis, technical management of hemodialysis patients, and peritoneal evaluation Transfusion medicine, covering blood banking, blood typing, cross-matching, and administration of blood and other biological products Advanced Monitoring and Procedures for Small Animal Emergency and Critical Care presents invaluable and accessible information for emergency situations, making it a highly useful reference for veterinary practitioners, veterinary technicians and nurses, veterinary students, small animal emergency and critical care residents, small animal emergency and critical care specialists, and emergency and critical care veterinary technicians and nurse specialists. Cover Title Page Copyright Page Contents List of Contributors Preface to the Second Edition Acknowledgments About the Companion Website Section One Fundamental Elements of Emergency and Critical Care Practice Chapter 1 Triage Telephone Triage Hospital Triage The ABCDEs Airway and Breathing Circulation Dysfunction or Disability of the Neurologic System Exposure/Examination Body Temperature Point-of-Care Ultrasound Summary References Chapter 2 The Small Animal Emergency Room Physical Plant ER Design and Flow Back-up Power Security Entrance and Lobby Comfort Rooms Treatment Area The Isolation Ward In-House Laboratory Diagnostic Imaging Staff Spaces Utility Spaces Equipment Imaging The In-House Laboratory Patient Monitors and Equipment Fluid and Drug Administration Thermal Support Oxygen Anesthesia Waste Gas Scavenging Medical Vacuum Inventory Medical Supplies Airway Management Breathing Circulation Additional Supplies Pharmacy Shock and Cardiopulmonary Arrest Anti-Infectives Analgesics, Sedation, and Anesthesia Intoxications Gastrointestinal Medications Endocrine Emergencies Urogenital Emergencies Ophthalmologic Emergencies Neurological Emergencies Staffing the Emergency Practice Hospital Management and Systems Medical Records Practice Management Software Other Information Management Management Summary References Chapter 3 Intensive Care Unit Design The Design Process Development Location in the Hospital Facility Configuration ICU Size The Ground Plan Staff Work Areas Patient Area Ancillary Rooms Facilities Outside the ICU Complex Interior Design Environment Utilities Floors, Walls, and Ceilings Furnishings Medical Equipment Special Design Considerations Infection Prevention and Control Written Communications Safety and Security Measures References Recommended Reading Chapter 4 Developing and Using Checklists in Practice Introduction Why Checklists? Types of Checklists Design Considerations Testing Implementation Modification Ongoing Accountability Celebrate Successes Checklists Help Build a Reliable Culture of Safety References Chapter 5 Medical Charting Medical Record Documentation Medical Record Organization Medical Record Format Components of a Complete Medical Record Client Information Patient Information Presenting Complaint History Physical Examination Problem Lists Progress Notes Communication Log Comments Other Additions to the Patient Record Clinician Order Sheets and Treatment/Flow Sheets Clinician Orders Treatment Sheets Daily Patient Flow Sheets Patient Identification Patient Weight Nutritional Considerations Laboratory Measurements Patient Treatments and Observations Medications Fluids Body Systems Evaluations Cardiovascular System Respiratory System Nervous System Urinary System Computerized or Electronic Medical Record Patient Privacy Conclusions References Chapter 6 Point-of-Care Ultrasound for Emergency and Critical Care Introduction Machine Settings, Transducers, and Materials for ECC VPOCUS Transducer Movements Indications Serial VPOCUS Limitations Conclusions References Section Two Cardiovascular Procedures and Monitoring Chapter 7 Catheterization of the Venous Compartment Selection of Catheter Insertion Site and Type Peripheral Catheter Placement Peripheral Cutdown Techniques Central Venous Access Catheter Types for Central Veins Central Venous Catheter Placement Techniques Ultrasound-Guided Venous Access Alternate Vascular Access Options Intraosseous Catheterization Care of Intravascular Devices Catheter Flushing Peripheral Intravenous Catheters Central Intravenous Catheters Complications Acknowledgment References Chapter 8 Arterial Puncture and Catheterization Arterial Puncture Procedure Sublingual Venipuncture Arterial Catheter Placement Site Selection Aseptic Technique Analgesia Percutaneous Facilitation Securing the Arterial Catheter Dorsal Pedal Artery Catheterization Femoral Artery Catheterization Auricular Artery Catheterization Radial Artery Catheterization Coccygeal Artery Catheterization Arterial Catheter Care Complications Associated with Arterial Puncture or Catheter Placement Contraindications to Arterial Puncture and Catheterization Troubleshooting References Chapter 9 Ultrasound-Guided Vascular Access Indications for Ultrasound-Guided Vascular Access Techniques Complications of Ultrasound-Guided Vascular Access Ultrasound-Guided Vascular Access Simulators References Chapter 10 Principles of Electrocardiography Cardiac Electrical Activity The Wave of Depolarization The Electrocardiogram Recording the Wave of Depolarization Einthoven’s Triangle and the Principle of Leads Standard ECG Leads ECG Measurement in the Emergency Room and Intensive Care Unit Electrode Placement and Patient Positioning Types of Electrodes Electrocardiogram Recording Ambulatory Continuous ECG Monitoring and Telemetry Ambulatory Continuous ECG Monitoring ECG Telemetry Equipment Problems Leading to ECG Artifacts Acknowledgments References Chapter 11 Electrocardiogram Interpretation Introduction Acquiring an Electrocardiogram The Diagnostic Electrocardiogram Continuous Monitoring Electrocardiogram Waveforms Stepwise Interpretation of the Electrocardiogram Determine the Heart Rate Evaluate the Overall Rhythm Evaluate the Complexes and Intervals Compare Measurements with Normal Ranges Recognizing Artifacts Summary Skill Sets Skill Set 1: Distinguishing 60-Cycle Interference from Atrial Fibrillation or Atrial Flutter Skill Set 2: Distinguishing Third-Degree Atrioventricular Block from Atrioventricular Dissociation Skill Set 3: Distinguishing APCs from Ventricular Premature Complexes Skill Set 4: Distinguishing Ventricular Tachycardia from Supraventricular Tachycardia Skill Set 5: Distinguishing Ventricular Premature Complexes from Ventricular Escape Beats Skill Set 6: Recognition of Pulseless Electrical Activity Skill Set 7: Distinguishing Ventricular Tachycardia from Accelerated Idioventricular Rhythm Skill Set 8: Recognition of Ventricular Flutter and Fibrillation Skill Set 9: Recognition of ST Segment Elevation or Depression Skill Set 10: Distinguishing Bundle Branch Block from Ventricular Rhythms Acknowledgments References Chapter 12 Fluid-Filled Hemodynamic Monitoring Systems Driving Pressure, Resistance, and Blood Flow Determinants of Intravascular Pressure Determinants of Systemic Arterial Pressure Determinants of Central Venous Pressure Determinants of Pulmonary Arterial Pressure Indications for Direct Intravascular Pressure Monitoring Types of Direct Intravascular Pressure Monitoring Systems Measurement System Components Intravascular Catheter Noncompliant Tubing Water Manometer Pressure Transducer Assembling the Electronic Direct Pressure Measurement System Technical Aspects of the Electronic Direct Pressure Measurement System Zeroing the Transducer Calibrating the System Leveling the Transducer Dynamic Response of the System Effect of the Measuring System’s Natural Frequency Effect of a System’s Damping Coefficient Determining the System’s Dynamic Response Optimizing Dynamic Response by Altering a Monitoring System’s Natural Frequency and Damping Coefficient Summary Acknowledgments References Chapter 13 Direct Systemic Arterial Blood Pressure Monitoring Indications for Direct Arterial Pressure Monitoring Advantages and Disadvantages of Indirect Blood Pressure Monitoring Advantages and Disadvantages of Direct Arterial Pressure Monitoring Continuous Direct Arterial Blood Pressure Equipment and Setup Normal Arterial Pressure Waveforms Calculations Derived from the Arterial Pressure Waveform Calculations of Arterial Blood Pressure Variation Other Uses for the Arterial Pressure Waveform Abnormal Arterial Pressure Waveforms Technical Problems that Cause Abnormal Arterial Pressure Waveforms Patient Problems that Cause Abnormal Arterial Pressure Waveforms Thresholds of Concern for Arterial Pressure Value and Waveform Abnormalities Troubleshooting Abnormal Waveforms Conclusions References Chapter 14 Noninvasive Arterial Blood Pressure Monitoring Comparison of Blood Pressure Monitoring Modalities Validation of Noninvasive Arterial Blood Pressure Monitoring Indications for Noninvasive Blood Pressure Monitoring Hypotension Hypertension Noninvasive Blood Pressure Monitoring Methods Doppler Ultrasound Standard Oscillometry High Definition Oscillometry Optimizing Reliability of Noninvasive Arterial Blood Pressure Measurements Conclusion Acknowledgments References Chapter 15 Central Venous Pressure Monitoring Determinants of Central Venous Pressure Indications for the Measurement of Central Venous Pressure Risks Reference Interval Measurement Technique Catheter Selection and Placement General Principles Zeroing and Leveling Intermittent Central Venous Pressure Measurement Continuous Central Venous Pressure Measurement Maintenance of the Continuous CVP System CVP Interpretation Potential Sources of Interpretation Errors Performing a Fluid Challenge The Normal CVP Waveform Determining the CVP from the Normal Waveform Abnormal CVP Waveforms Respiratory Changes Arrhythmias Pericardial Effusion with Cardiac Tamponade Tricuspid Regurgitation Pulmonic Stenosis and Pulmonary Hypertension Alternative Techniques for Assessing Vascular Volume Conclusion References Chapter 16 Cardiac Output Monitoring Indications for Cardiac Output Measurement Cardiac Output Measurement Indicator Dilution Techniques Balloon-Tipped Thermodilution Catheter Insertion of the Balloon-Tipped Thermodilution Catheter and Complications Thermodilution Cardiac Output Measurement Lithium Cardiac Output Measurement Other Measurements and Calculations Other Methods of Estimating Cardiac Output The Fick Method Arterial–Venous Oxygen Content, Oxygen Extraction, Venous Oxygen, Arterial–Venous Oxygen Saturation Carbon Dioxide-Based Fick Venous–Arterial Partial Pressure of Carbon Dioxide Pulse Contour Methods Transthoracic Impedance and Bioreactance Doppler Ultrasound Other Methods Interpreting Measurements Conclusion Acknowledgments References Chapter 17 Point-of-Care Cardiac Ultrasound Equipment, Patient Preparation, and Image Acquisition for Cardiac Veterinary Point-of-Care Ultrasound Two-Dimensional Echocardiography M-Mode Echocardiography Cardiac Veterinary Point-of-Care Ultrasound Windows and Views Two-Dimensional Right Parasternal Views Subxiphoid View Interpretation of Cardiac Veterinary Point-of-Care Ultrasound Findings Interpretation of the Left Atrium–Aortic Root Ratio Interpretation of the Left Ventricular Mushroom View Interpretation of Right Parasternal Long-Axis Views Interpretation of Pericardial Effusion Caudal Vena Cava Assessment at the Subxiphoid Window Cardiac Veterinary Point-of-Care Ultrasound for Assessment of Mechanical Cardiac Activity During Cardiac Arrest References Chapter 18 Pericardiocentesis The Pericardium Pericardial Space Disease Hemodynamic Changes Associated with Pericardial Effusion Clinical Signs Associated with Pericardial Effusion Physical Examination Pulsus Paradoxus Diagnosis of Pericardial Effusion Echocardiography Radiography Alternative Imaging Modalities Electrocardiography Blood Testing Pericardial Fluid Analysis Emergency Treatment of Pericardial Effusion Pericardiocentesis Longer-Term Treatment of Pericardial Effusion Complications Post-Pericardiocentesis Monitoring Acknowledgments References Chapter 19 Monitoring Tissue Perfusion: Clinicopathologic Aids and Advanced Techniques Clinical Monitoring of Tissue Perfusion Physical Examination Arterial Blood Pressure Monitoring Urine Output Clinical Imaging Standard Clinicopathologic/Metabolic Markers of Tissue Perfusion Advanced Tissue Perfusion Monitoring Techniques Near-Infrared Spectroscopy Microcirculation Visualization Transcutaneous O2 and CO2 Monitoring Regional Capnography Thermography Cutaneous Laser Doppler Urine Partial Pressure of Oxygen Microdialysis Conclusion Acknowledgment References Chapter 20 Cardiopulmonary Resuscitation Preparing for a Cardiopulmonary Arrest Staff Training in Preparation for Cardiopulmonary Arrest Notifying the Staff of Cardiopulmonary Arrest Equipment and Drugs Required Recognizing Cardiopulmonary Arrest Initiating Basic Life Support Compressions Providing Ventilation Cardiopulmonary Resuscitation Basic Life Support Cycle Advanced Life Support Monitors Vascular Access Anesthetic or Sedative Drug Reversal Electrocardiogram and Patient Evaluation Vasopressors Parasympatholytics Buffers Fibrillation Treatment Return of Spontaneous Circulation Post-Cardiac Arrest Care References Chapter 21 Open-Chest Cardiopulmonary Resuscitation Indications for Open-Chest Cardiopulmonary Resuscitation Rationale for Performing Open-Chest Cardiopulmonary Resuscitation Preparing for Open-Chest Cardiopulmonary Resuscitation Equipment and Environmental Preparedness Choice of Approach Performing an Emergency Lateral Thoracotomy Performing an Emergency Transdiaphragmatic Thoracotomy Complications of Thoracotomy in the Emergency Setting Performing Internal Cardiac Massage Internal Defibrillation Augmentation Techniques Post-Resuscitation Care Surgical Closure Antimicrobials and Analgesia Post-Resuscitation Monitoring Summary References Chapter 22 Defibrillation Atrial Compared with Ventricular Fibrillation Defibrillation Compared with Cardioversion Equipment Safety Concerns Indications for Defibrillation Defibrillation Procedure and Technique Cardioversion of Refractory, Severe Ventricular Tachycardia Indications Synchronization with the Cardiac Cycle Procedure Energy Dose Selection Drug and Defibrillator Interactions Patient Care in the Post-Cardioversion or Post-Defibrillation Period Acknowledgments References Chapter 23 Temporary Cardiac Pacing Indications for Temporary Pacing Terminology Types of Temporary Pacing Pacing Physiology Pulse Generators and Their Operation Pacing Modes Output Pulse Sensitivity Atrioventricular Delay Rate Refractory Period Temporary Transvenous Pacing Temporary Transcutaneous Pacing Transcutaneous Pacing Electrode Location Transcutaneous Pacing Electrode Size Performing Transcutaneous Cardiac Pacing Temporary Epicardial Pacing Thump Pacing Transesophageal Pacing Transthoracic Pacing Nursing Care of the Patient Undergoing Temporary Pacing Monitoring the Patient with a Temporary Pacemaker Troubleshooting Failure to Capture Undersensing Oversensing Summary Acknowledgment References Section Three Respiratory Procedures and Monitoring Chapter 24 Oxygen Therapy Normal Oxygenation and Hypoxemia Indications for Oxygen Supplementation Methods of Oxygen Supplementation Flow-by Oxygen Face Mask Oxygen Hood or Elizabethan Collar Oxygen Cage Nasal Oxygen Transtracheal Oxygen Heated Humidified High-Flow Nasal Oxygen Oxygen Delivery via Artificial Airway Endotracheal Intubation Tracheostomy Tube Placement Hyperbaric Oxygen Monitoring the Response to Oxygen Therapy Complications of Oxygen Therapy Oxygen Toxicity Absorption Atelectasis Hypercapnia Extrapulmonary Toxicity Summary References Chapter 25 Pulse Oximetry and Co-Oximetry History of Oximetry Monitoring Hemoglobin Oxygen Saturation Dyshemoglobinemias Functional Compared with Fractional Hemoglobin Saturation Types and Technology of Oximeters Pulse Oximetry Understanding the Technology Indications for Pulse Oximetry Equipment Options and Care Performing Pulse Oximetry Interpreting the SpO2 Reading Factors Affecting Pulse Oximetry Measurements Accuracy Concerns in Pulse Oximetry Co-Oximetry Understanding the Technology Indications for Co-Oximetry Equipment Options and Care Performing Co-Oximetry Factors Affecting Co-Oximetry Measurements Pulse Co-Oximetry Summary Acknowledgment References Chapter 26 Blood Gas Analysis Abnormalities in Oxygenation and Ventilation Blood Gas Analyzers Transcutaneous Blood Gas Monitoring Measuring Arterial Blood Gases Arterial Blood Sampling Arterial Blood Sample Handling Measurement with a Blood Gas Analyzer Evaluating Arterial Blood Gas Results Assessment of the Partial Pressure of Carbon Dioxide Assessment of the Partial Pressure of Oxygen in Arterial Blood Pulmonary Function Assessment Using Arterial Blood Gas Data Alveolar to Arterial Oxygen Gradient The “120” Rule PaO2/FiO2 (“The P : F Ratio”) FiO2 × 5 Calculation of the Total Oxygen Content Venous Samples Venous Partial Pressure of Carbon Dioxide Venous Partial Pressure of Oxygen Saturation of Hemoglobin with Oxygen Summary Acknowledgment References Chapter 27 Point-of-Care Lung and Pleural Space Ultrasound Indications for Pleural and Lung Ultrasound Patient Positioning and Machine Settings Curvilinear Transducer Linear Transducer Phased Array Transducer Technique and Identification of Normal Lung Ultrasound Images Compared With Pathology Pleural and Lung Ultrasound Scanning Technique Normal Structures and Signs Abnormal Findings in Patients with Pleural Space and Pulmonary Pathology Pneumothorax Means of Assessing for a Pneumothorax Lung Sliding/Glide Sign Rules Out Pneumothorax Where Sliding is Identified B-Lines Rule Out Pneumothorax at the Location Where They are Identified Lung Point Confirms Pneumothorax Abnormal Abdominal Curtain Signs Rule in Pneumothorax Alveolar Interstitial Syndrome (Wet Lung) Alveolar Consolidation Limitations of Pleural and Lung Ultrasound References Chapter 28 Tracheal Intubation Indications Equipment Needed for Intubation Endotracheal Tubes Oropharyngeal Airway (Laryngeal Mask) Laryngoscope with Illumination Stylets Lidocaine Injectable Solution (2%) Securing the Endotracheal Tube Choosing Appropriate Endotracheal Tube Size Choosing the Endotracheal Tube Width Choosing the Endotracheal Tube Length Intubation Techniques Intubating Dogs Intubating Cats Cuff Inflation Intubation of Difficult Airways Techniques to Confirm Endotracheal Tube Location Extubation Risks and Complications of Tracheal Intubation Summary Acknowledgment References Chapter 29 Temporary Tracheostomy Indications Equipment Positioning and Aseptic Preparation Procedure Contraindications Possible Complications During the Procedure Nursing Care Considerations for Patients with Temporary Tracheostomy Tubes Airway Humidification Tracheostomy Site Hygiene Tube Tie Inspection Tracheostomy Tube Suctioning Tracheostomy Tube Cleaning Replacement of Tracheostomy Tubes General Patient Observations Environmental Considerations and Patient Hygiene Attention to Hydration Status Tracheostomy Tube Removal Summary Acknowledgement Chapter 30 Capnography Terminology Physiology Types of Carbon Dioxide Analyzers Mainstream Sidestream Equipment Setup Technology of Carbon Dioxide Measurement Infrared Absorption Raman Scatter Mass Spectrometry Indications for Capnography/Capnometry Confirming Correct Endotracheal Tube Placement Detection of Apnea Monitoring Ventilation Monitoring Pulmonary Perfusion Correct Nasogastric Tube Placement Equipment Problems Interpretation of the Capnogram Phase I Phase II Phase III Phase IV Abnormal Capnograms Abnormal Phase I Abnormal Phase II Abnormal Phase III Abnormal Phase IV Summary References Chapter 31 Mechanical Ventilation Indications for Mechanical Ventilation Ventilator Settings Ventilator Breath Types Tidal Volume Airway Pressure Trigger Variable Positive End Expiratory Pressure Inspiration to Expiration Ratio/Respiratory Rate Alarms Guidelines for Initial Ventilator Settings Initial Stabilization on the Ventilator Lung Disease Goals of Mechanical Ventilation PaO2 Partial Pressure of Carbon Dioxide in Arterial Blood Weaning from Ventilation Record Keeping Ventilator Patient Monitoring Artificial Airway Care Humidification Artificial Airway Summary References Chapter 32 Ventilator Waveform Analysis Scalars Scalars in Different Modes of Ventilation Pressure–Volume and Flow–Volume Loops Pressure–Volume Loops Flow–Volume Loops Spontaneous Breath Loops Loop Interpretation Basic Pulmonary Mechanics Measured During Mechanical Ventilation Practice Problems Problem 1 Problem 2 Problem 3 Problem 4 Problem 5 Problem 6 Problem 7 Problem 8 Summary Recommended Reading Chapter 33 Alternative Methods of Augmented Ventilation High-Frequency Ventilation Background Definitions How High-Frequency Ventilation Works Major Applications and Indications Contraindications Veterinary Studies of High-Frequency Ventilation Other Novel Ventilation Strategies High Flow Oxygen Therapy Pediatric Helmet Summary References Recommended Reading Chapter 34 Pleural Space Drainage Thoracocentesis Indications Procedure for Thoracocentesis Complications Thoracostomy Tube Placement Indications Thoracostomy Tube Placement Thoracostomy Tube Maintenance Thoracostomy Tube Removal Chest Tube Drainage Systems Continuous Suction Drainage Systems Non-suction Drainage Manual Drainage of the Thoracostomy Tube Pain Management Handling Samples for Fluid Analysis References Section Four Urinary and Gastrointestinal Procedures Chapter 35 Urethral Catheterization Indications for Urethral Catheterization Urethral Catheters Design Stylets Diameter Length Closed Collection Systems Catheter Placement and Maintenance Asepsis and Infection Control Basic Guidelines Catheter Placement Catheter Selection Sedation Patient Preparation Catheter Preparation Lubrication and Local Anesthesia Species and Sex-Specific Instructions Female Dog Female Cat or Small Female Dog Male Cat Male Dog Care and Maintenance of Indwelling Catheter Systems Securing the Catheter and Collection System Management of Indwelling Urinary Catheter and Collection System Basic Techniques for Difficult Catheterizations Decompressive Cystocentesis for Urethral Obstruction Retropulsion for Urethral Obstruction Deflating a Foley Balloon Acknowledgment References Chapter 36 Peritoneal Dialysis Indications Performing Peritoneal Dialysis Catheter Types Site Selection, Preparation, and Catheter Placement Dialysate Solutions Catheter Management Performing Peritoneal Dialysis Exchanges Monitoring Complications Contraindications The Future of Peritoneal Dialysis Summary References Chapter 37 Technical Management of Hemodialysis Patient Selection Acute Kidney Disease Chronic Kidney Disease Toxin Removal Patient Considerations Equipment Machines Water Treatment System Extracorporeal Circuit Catheters Placement Location Care and Maintenance Performing Hemodialysis Hemodialysis Machine Preparation Patient Preparation Starting Treatment Ending Treatment Monitoring During the Hemodialysis Treatment Blood Pressure Coagulation Access Pressure and Blood Flows Hematocrit Blood Volume Oxygenation Adequacy Other Parameters Record Keeping Complications and Special Considerations Technical Complications Hypotension Dialysis Disequilibrium Syndrome Hemorrhage Respiratory Complications Gastrointestinal Complications Thrombosis Catheter Systemic Prevention Infection Edema Malnutrition Aluminum Toxicity Anemia Medication Dosing Patient Care Outcomes Summary References Chapter 38 Peritoneal Evaluation Signalment and History Physical Examination Abdominal Imaging Veterinary Point of Care Ultrasound (POCUS) Abdominal Radiographs Diagnostic Abdominal Ultrasound Abdominal Computed Tomography (CT) Abdominal Fluid Sampling Blind and Ultrasound-Guided Abdominocentesis Open Compared With Closed Needle Technique Four-Quadrant Technique Diagnostic Peritoneal Lavage Analysis of Peritoneal Effusion Intra-Abdominal Pressure (IAP) Monitoring Exploratory Laparotomy References Chapter 39 Point-of-Care Abdominal Ultrasound Patient Positioning and Machine Settings Abdominal Point-of-Care Ultrasound Technique Subxiphoid Umbilical Urinary Bladder Right Paralumbar Left Paralumbar Specific Questions Abdominal Effusion Pneumoperitoneum Gastrointestinal Ileus Gall Bladder Wall Thickening (Halo Sign) Urine Production Ureteral Obstruction Pitfalls of Abdominal Point-of-Care Ultrasound Hepatic Vessels Edge Shadowing Intestinal and Stomach Wall and Contents Mirror Image Artifact Acute Hemorrhage or Very Cellular Effusions References Chapter 40 Specialized Gastrointestinal Techniques Auscultation of Gastrointestinal Sounds Gastric Intubation Introduction Orogastric Intubation Nasogastric Intubation for Gastric Decompression Indications Technique Considerations for the Patient with Gastric Dilation and Volvulus Analgesia/Sedation Trocarization Conservative Management of Gastric Dilation and Volvulus Considerations for Food Engorgement Gastric Fluid Aspirate pH Monitoring Indications Gastric Residual Volume Monitoring Indications Gastrointestinal Decontamination Gastric Lavage Nasogastric Intubation for Decontamination Activated Charcoal Administration Catharsis Enemas Indications Techniques Rectal Catheters References Chapter 41 Postoperative Peritoneal Drainage Techniques Open Abdominal Drainage Changing the Abdominal Bandages Vacuum-Assisted Drainage Active Closed-Suction Drains Managing Closed-Suction Drains Percutaneous Catheter Drainage Managing a Fenestrated Catheter Conclusion References Section Five Nutrition Chapter 42 Nutritional Requirements in Critical Illness Basic Physiology of Malnutrition in Critical Illness Rationale for Providing Nutrition in Critical Illness Nutritional Assessment Nutritional Plan Nutritional Requirements Calculation of Nutritional Requirements Nutritional Requirements in Special Cases Burns Tetanus Sepsis Complications of Providing Nutrition in the Critically Ill Summary References Chapter 43 Enteral Diets for Critically Ill Patients Nutrient Considerations for Critical Care Diets Energy Protein Fat Carbohydrates Amino Acids Other Nutrients Enteral Diets Liquid Enteral Diets Canned Enteral Diets Blended Commercial Diet Slurries Home-Cooked Diet Blended Slurries Preparation Instructions for Blended Slurries Supplements Considerations for Specific Underlying Conditions Gastrointestinal Disease Adverse Reactions to Food Fat Intolerance Kidney Disease Liver Disease Initiating Nutritional Support Monitoring References Chapter 44 Assisted Enteral Feeding Introduction Enticing Voluntary Eating Tube Route Selection Nasoesophageal and Nasogastric Tubes Placement and Verification Feeding Complications and Troubleshooting Esophageal Tubes Placement and Verification Feeding Stoma Site Care Complications and Troubleshooting Gastrostomy Tubes Placement Feeding Stoma Site Care Complications and Troubleshooting Jejunostomy Tubes Placement Feeding Tube and Site Care Complications and Troubleshooting Summary Acknowledgment References Chapter 45 Parenteral Nutrition Indications for Parenteral Nutrition When to Initiate Support How Much to Feed Central and Peripheral Nutrition Composition of the Solution Compounding Parenteral Nutrition Solutions Maintenance of the Infusion and Catheter Contraindications and Complications Metabolic Complications Mechanical Complications Septic Complications Conclusion Summary References Section Six Analgesia and Anesthesia Chapter 46 Drug Administration Treatment Sheet Orders Medical Records Routes of Drug Administration Drug Delivery: Venous Access Drug Delivery: Enteral Feeding Tubes Oral Medications Drug Delivery: Subcutaneous Route Drug Delivery: Transdermal Patch Drug Delivery: Intramuscular Route Constant Rate Infusion Intravenous Nutritional Support Fluid Additives Agents Used to Treat Specific Toxicities Antibiotics Inotropes and Vasoactive Agents Analgesics and Anesthetics Chemotherapeutic Agents Drug Overdose References Chapter 47 Pain Recognition and Management Nociceptive Physiology Nociception Transmission and Modulation Allodynia Central Sensitization/“Wind-Up” Importance of Pain Control Pain Recognition Pain Scales Multimodal Analgesia Timing of Analgesic Administration Contraindications and Complications of Pain Management References Chapter 48 Systemic Analgesia Opioids Analgesic Effects Central Nervous System Effects Cardiovascular Effects Respiratory Effects Urinary Effects Gastrointestinal Effects Hepatic Effects Effects on Body Temperature Opioid Tolerance and Addiction Regulations Involved in Clinical Use of Opioids Systemic Administration of Opioids Morphine Fentanyl, Remifentanil, Sufentanil, Alfentanil Oxymorphone and Hydromorphone Methadone Pethidine (Meperidine) Buprenorphine Butorphanol Codeine Naloxone and Naltrexone Tramadol Nonsteroidal Anti-Inflammatory Drugs Cyclo-Oxygenase 1 and 2 Analgesic Effects Adverse Effects Nonsteroidal Anti-Inflammatory Drugs in the Critical Patient Alpha-2 Agonists Medetomidine Dexmedetomidine Xylazine Adjunctive Analgesia Lidocaine Ketamine Amantadine Gabapentin Acetaminophen References Chapter 49 Local Anesthesia Pharmacology Common Local Anesthetics Lidocaine Bupivacaine Liposomal Encapsulated Bupivacaine Ropivacaine Levobupivacaine Mepivacaine Local Anesthetic Adjuvants Dexmedetomidine Opioids Selected Locoregional Techniques Local Infiltration and Line Blocks Intrapleural Local Anesthesia Intercostal Nerve Blocks Intraperitoneal Local Anesthesia Radial, Ulnar, Median, and Musculocutaneous Nerve Block Sacrococcygeal Epidurals Lumbosacral Epidurals Local Anesthetic Toxicosis References Chapter 50 Monitoring the Anesthetized Patient Anesthesia Monitoring Record Physical Parameters Under Anesthesia Eye Position Jaw Tone Mucous Membranes/Capillary Refill Time Response to Stimulation Heart Rate Respiratory Rate Blood Pressure Doppler Blood Pressure Measurement Oscillometric Blood Pressure Measurement Direct Arterial Blood Pressure Measurement Oxygen Saturation Plethysmographic Variability Index Body Temperature End-Tidal Inhalant Concentrations References Chapter 51 Nursing Care of the Long-Term Anesthetized Patient Basic Indications for Long-Term Anesthesia Physical Complications Associated with Long-Term Anesthesia and Immobility Immobility Complications Neuromuscular Weakness Atelectasis Venous Stasis Ocular Complications Complications Associated with the Oral Cavity Complications Associated with the Urogenital Tract Gastrointestinal Complications Recumbent Patient Care Patient Positioning Decubitus Ulcer Prevention and Management Early Mobility Eye Care Oral Care Bladder Care Gastrointestinal Tract Techniques to Decrease Stimulation Summary Advanced Monitoring and Procedures for Small Animal Emergency and Critical Care Detailed, standardized, step-by-step protocols for easy access to essential information in small animal emergency rooms and intensive care units Advanced Monitoring and Procedures for Small Animal Emergency and Critical Care, Second Edition offers a complete and clinically oriented reference for step-by-step detail on a wide range of procedures in the small animal emergency room and intensive care unit. Each protocol provides detailed instructions grounded in the evidence. The book is carefully designed for ease of use, with concise but comprehensive explanations, useful equipment lists, protocols called out in boxes, and extensive reference lists. In the revised and expanded Second Edition, information has been updated and expanded throughout, and information and chapters have been added in many important areas, including veterinary point-of-care ultrasound (VPOCUS), veterinary CPR, blood banking and transfusion medicine, advanced techniques for mechanical ventilation, and veterinary health care team wellbeing. A companion website offers the protocols in Word for editing and use in practice and the figures from the book in PowerPoint. Specific topics covered in Advanced Monitoring and Procedures for Small Animal Emergency and Critical Care include: The cardiovascular system, covering catheterization of the venous compartment, arterial puncture and catheterization, cardiac VPOCUS, principles of electrocardiography, and electrocardiogram interpretation The respiratory system, covering oxygen therapy, pulse oximetry and CO-oximetry, blood gas analysis, pleural space and lung VPOCUS, tracheal intubation, and temporary tracheostomy The urinary and abdominal systems, covering urethral catheterization, abdominal VPOCUS, peritoneal dialysis, technical management of hemodialysis patients, and peritoneal evaluation Transfusion medicine, covering blood banking, blood typing, ...HIBERNATE NOW