RESUMO
OBJECTIVE: To describe and compare prothrombin time (PT), activated partial thromboplastin time (aPTT), thromboelastography (TEG), HCT, and platelet count measurements in a hemorrhage/over-resuscitation model. DESIGN: Randomized crossover study. SETTING: University teaching hospital. ANIMALS: Six cats. INTERVENTIONS: Anesthetized cats underwent 3 treatments at 2-month intervals. The treatments were as follows: NHR-no controlled hemorrhage and sham resuscitation; LRS-controlled hemorrhage and lactated Ringer's solution (LRS) for resuscitation; and Voluven-controlled hemorrhage and 6% tetrastarch 130/0.4 for resuscitation. The LRS and Voluven were administered at 60 and 20 mL/kg/h, respectively, for 120 minutes. Blood samples were drawn for PT, aPTT, TEG, HCT, and platelet count measurements at a healthy check (T - 7d), after controlled hemorrhage (T0), at 60 and 120 minutes of resuscitation (T60 and T120), and at 24 hours after completion of resuscitation (T24h). Data were analyzed using a general linear mixed model approach (significance was P < 0.05). MEASUREMENTS AND MAIN RESULTS: Total median blood loss (controlled hemorrhage and blood sampling from T0 to T120) at T120 was 11.4, 31.0, and 30.8 mL/kg for NHR, LRS, and Voluven, respectively. PT and aPTT during LRS and Voluven were prolonged at T60 and T120 compared to NHR (P < 0.001). On TEG, the reaction time, kinetic time, and alpha-angle were within reference intervals for cats at all time points in all treatments, while maximum amplitude was less than the reference interval (40 mm) at T0, T60, and T120 during Voluven and at T60 and T120 during LRS compared to NHR (both P < 0.001). The HCT and platelet count were significantly lower at T60 and T120 during LRS and Voluven compared to NHR (P < 0.001). CONCLUSIONS: Hypocoagulopathy was observed during hemorrhage and liberal fluid resuscitation. Prolongation of PT and aPPT and decreased clot strength may have been caused by hemodilution and platelet loss.
Assuntos
Estudos Cross-Over , Tempo de Protrombina , Ressuscitação , Lactato de Ringer , Tromboelastografia , Animais , Gatos , Tromboelastografia/veterinária , Tromboelastografia/métodos , Lactato de Ringer/administração & dosagem , Lactato de Ringer/farmacologia , Contagem de Plaquetas/veterinária , Tempo de Protrombina/veterinária , Hematócrito/veterinária , Tempo de Tromboplastina Parcial/veterinária , Ressuscitação/veterinária , Ressuscitação/métodos , Hemorragia/veterinária , Hemorragia/sangue , Doenças do Gato/sangue , Derivados de Hidroxietil Amido/farmacologia , Derivados de Hidroxietil Amido/administração & dosagem , Masculino , Feminino , Gelatina/administração & dosagem , Gelatina/farmacologia , SuccinatosRESUMO
OBJECTIVE: To determine if tissue oxygen saturation (StO2) correlates with oxygen delivery (DO2) and/or cardiac output (CO) in a canine hemorrhagic shock model. ANIMALS: 8 healthy purpose-bred dogs. METHODS: Dogs were anesthetized, and hemorrhagic shock was induced by withdrawing up to 60% of total blood volume, targeting a mean arterial pressure (MAP) of 40 mm Hg. The withdrawn blood was returned to the patient in 2 equal aliquots. Data was collected at 4 time points: 10 minutes after MAP was stabilized under anesthesia (time point [TP]-1), 10 minutes after up to 60% of blood volume was removed to target a MAP of 40 mm Hg (TP2), 10 minutes after the return of 50% of shed blood (TP3), and 10 minutes after the return of the remaining 50% of shed blood (TP4). Total blood volume withdrawn, StO2, CO, heart rate, and MAP were recorded, and DO2 was calculated at each TP. RESULTS: Mean StO2 significantly decreased between TP1 (77.8% [± 9.54]) and TP2 (44.8% [± 19.5]; P < .001 vs TP1). Mean StO2 increased to 63.1% (± 9.85) at TP3, but remained significantly lower compared to TP1 (P = .002). There was no difference between mean StO2 at TP4 (82.5% [± 12.6]) versus TP1 (P = .466). StO2 has a strong, positive correlation to both CO (r = 0.80; P < .001) and DO2 (r = 0.75; P < .001). CLINICAL RELEVANCE: A decrease in StO2 may be used in conjunction with physical examination findings and diagnostic parameters to support a diagnosis of shock. The return of shed blood was correlated with increases in StO2, DO2, and CO, suggesting that StO2 may be used as a marker of adequate resuscitation.
Assuntos
Débito Cardíaco , Oxigênio , Ressuscitação , Choque Hemorrágico , Animais , Cães , Choque Hemorrágico/veterinária , Choque Hemorrágico/terapia , Choque Hemorrágico/metabolismo , Débito Cardíaco/fisiologia , Ressuscitação/veterinária , Oxigênio/metabolismo , Oxigênio/sangue , Masculino , Doenças do Cão/metabolismo , Doenças do Cão/fisiopatologia , Feminino , Saturação de Oxigênio/fisiologiaRESUMO
OBJECTIVE: To provide a video tutorial describing intraperitoneal (IP) and intracoelomic (IC) therapeutics (IP/IC fluid therapy, euthanasia, direct peritoneal resuscitation). ANIMALS: Dogs, cats, and exotic pets. METHODS: Peritoneal and coelomic centesis allows for delivery of fluids or to perform euthanasia. The peritoneal and coelomic membranes contain a vast network of capillaries and lymphatics that allow absorption of fluids and blood products. Needles are inserted aseptically IP or IC at species-specific locations to avoid iatrogenic damage. In mammals, the needle is inserted in a periumbilical location at a 1- to 2-cm radius from the umbilicus, while the needle is inserted into the ventral inguinal fossa in chelonians and lateroventrally in lizards and snakes. Direct peritoneal resuscitation is a human technique in which a dextrose/electrolyte solution infused IP reduces ischemia-reperfusion injury, edema, and tissue necrosis to improve mortality in patients with diseases like shock and sepsis or who require acute abdominal surgery. RESULTS: Isotonic crystalloids are given IP/IC at 10- to 20-mL/kg doses (smaller volumes in reptiles) and blood products at standard calculated doses. Sodium pentobarbital without phenytoin (3 mL/4.5 kg) is used for IP/IC euthanasia. CLINICAL RELEVANCE: Being aware of multiple routes for fluid and blood product administration allows treatment in animals for which intravenous or intraosseous catheterization is undesirable or impossible. While intravenous or intraosseous routes are always preferred, especially for resuscitation, familiarity with locations for IP/IC fluid and euthanasia is useful. Techniques like direct peritoneal resuscitation are not currently used in animals but might be translated to veterinary cases in the future.
Assuntos
Hidratação , Animais , Cães , Gatos , Hidratação/veterinária , Animais de Estimação , Animais Exóticos , Doenças do Gato/terapia , Ressuscitação/veterinária , Ressuscitação/métodos , Doenças do Cão/terapia , Eutanásia AnimalRESUMO
BACKGROUND: Hypothermia is a cause of neonatal calf death in cold climates. Practical and effective rewarming methods are important for bovine health within affected regions. HYPOTHESIS/OBJECTIVES: To compare the rewarming rate and blood analytes (glucose, lactate, and cortisol) of calves resuscitated with forced air with warm water bath, with or without oral administration of caffeine. ANIMALS: Twenty healthy neonatal Holstein bull calves. METHODS: In this randomized, prospective study, calves born healthy and without history of dystocia were cooled to 32°C rectal temperature then thermally resuscitated using either forced air rewarming or warm water bath (40°C) with or without oral administration of caffeine. Rectal temperatures were used to quantify recovery rate. Measurements of glucose, lactate, and cortisol were recorded for every 2°C change in rectal temperature. RESULTS: Rectal temperature decline (0.03°C per minute) and total cooling time (191.0 ± 33.3 minutes) did not significantly differ among treatment groups. Calves were successfully resuscitated to 38°C by either method. Time required to euthermia using warm water was significantly faster (0.1°C per minute; 64.3 ± 17.8 minute; P < .05) than forced air (0.05°C per minute; 123.1 ± 20.0 minutes). Caffeine had no significant effect on resuscitation rate (P = .14; 95% CI, -0.002 to 0.024) in either treatment; however, caffeine was associated with reduced time to euthermia by 8.3 and 10.8 minutes, respectively. Changes in metabolic variables (glucose, lactate, and cortisol), were inversely related to rectal temperature with no statistical significance among rewarming methods. CONCLUSIONS AND CLINICAL IMPORTANCE: Although warm water submersion is faster, forced air rewarming is an effective alternative for restoration of euthermia.
Assuntos
Animais Recém-Nascidos , Cafeína , Doenças dos Bovinos , Hipotermia , Animais , Bovinos , Hipotermia/veterinária , Cafeína/administração & dosagem , Masculino , Doenças dos Bovinos/terapia , Doenças dos Bovinos/tratamento farmacológico , Estudos Prospectivos , Reaquecimento , Ressuscitação/veterinária , Hidrocortisona/sangue , Administração Oral , Banhos/veterinária , Glicemia/análise , Ácido Láctico/sangue , Temperatura Corporal/efeitos dos fármacos , Distribuição AleatóriaRESUMO
OBJECTIVE: To describe placement of an aortic occlusion catheter in aortic zone 1 (Z1) and aortic zone 3 (Z3) in dogs and to compare time to placement in these zones with and without external chest compressions (ECC). Additional evaluations of time to placement in Z1 with time for resuscitative thoracotomy with aortic clamping (RT-AC) were performed. DESIGN: Prospective ex vivo study. SETTING: University teaching hospital. ANIMALS: Ten canine cadavers. INTERVENTIONS: Ten cadaver dogs were obtained from client donation after euthanasia. Cadavers were randomized to have balloon catheter placement into the right or left femoral artery via cutdown, with or without ECC. The xiphoid was used as an external anatomical landmark for Z1, and the spinous process of the 5th lumbar vertebra was used for Z3. Balloon placement was confirmed with radiography. Time to balloon placement in Z1 and Z3 and time to RT-AC were recorded. MEASUREMENTS AND MAIN RESULTS: Median body weight was 23.5 kg (9-40 kg). Median time to Z1 placement was 6.6 minutes (4.6-12.4 minutes) with ECC and 6.9 minutes (3.3-13.1 minutes) without ECC and was not statistically different (P = 0.5). Median time to RT-AC was 1 minute (0.6-1.4 minutes), which was significantly faster than time to balloon placement in Z1 with or without ECC (P = 0.004 and P = 0.002, respectively). CONCLUSIONS: Endovascular balloon occlusion of the aorta can be achieved by cutdown with and without ECC, but RT-AC is faster. Successful balloon position in Z1 could be achieved with knowledge of external anatomical landmarks, but landmarks for Z3 need further study.
Assuntos
Oclusão com Balão , Doenças do Cão , Procedimentos Endovasculares , Choque Hemorrágico , Animais , Aorta , Oclusão com Balão/veterinária , Cadáver , Catéteres , Constrição , Cães , Procedimentos Endovasculares/veterinária , Estudos Prospectivos , Ressuscitação/veterinária , Choque Hemorrágico/terapia , Choque Hemorrágico/veterinária , Toracotomia/veterináriaRESUMO
Water is essential for life. Without adequate fluid intake, normal body functioning becomes impaired and ultimately can lead to death. A fluid therapy plan should be considered for any small animal patient that has either inadequate fluid intake, excessive fluid loss, or both. A simplified approach to fluid therapy begins with an understanding of the composition of fluid and its distribution within the body. Next, consideration of electrolyte loss, acid-base disturbances, perfusion impairment, and loss of protein also becomes important when replenishing deficits by using various fluids that are commercially available to small animal practitioners.
Assuntos
Coloides , Hidratação , Albuminas/uso terapêutico , Animais , Coloides/uso terapêutico , Soluções Cristaloides/uso terapêutico , Hidratação/veterinária , Soluções Isotônicas/uso terapêutico , Ressuscitação/veterináriaRESUMO
BACKGROUND: Hemorrhagic shock is a common condition that may lead to hemodynamic instability, decreased oxygen delivery, cellular hypoxia, organ damage, and ultimately death. CLINICAL IMPORTANCE: This review addresses the pathophysiology of hemorrhagic shock. Hemorrhagic shock can be rapidly fatal and is the leading cause of death in human trauma patients. Understanding the pathophysiology of hemorrhagic shock is imperative in understanding the current hemostatic and resuscitative strategies and is foundational to the development of new therapeutic options. KEY POINTS: Shock is a state of inadequate cellular energy production and can be triggered by many causes Both traumatic and non-traumatic causes of hemorrhage can lead to the development of hemorrhagic shock Prompt recognition and attenuation of hemorrhage is paramount in preventing the onset or potentiation of hemorrhagic shock Acute hemorrhage produces distinct physiological responses depending on the magnitude and rate of hemorrhage. Hemorrhagic shock may be directly related to the initial injury but may also be exacerbated and complicated by a post-traumatic coagulopathy, termed acute traumatic coagulopathy.
Assuntos
Transtornos da Coagulação Sanguínea , Choque Hemorrágico , Animais , Transtornos da Coagulação Sanguínea/veterinária , Hemorragia/veterinária , Hemostasia , Humanos , Ressuscitação/veterinária , Choque Hemorrágico/terapia , Choque Hemorrágico/veterináriaRESUMO
BACKGROUND: Blood products, crystalloids, and colloid fluids are used in the medical treatment of severe hemorrhage in horses with a goal of providing sufficient blood flow and oxygen delivery to vital organs. The fluid treatments for hemorrhage will vary depending upon severity and duration and whether hemorrhage is controlled or uncontrolled. DESCRIPTION: With acute and severe controlled hemorrhage, treatment is focused on rapidly increasing perfusion pressure and blood flow to vital organs. This can most easily be accomplished in field cases by the administration of hypertonic saline. If isotonic crystalloids are used for resuscitation, the volume administered should be at least as great as the estimated blood loss. Following crystalloid resuscitation, clinical signs, HCT, and laboratory evidence of tissue hypoxia may help determine the need for a whole blood transfusion. In uncontrolled hemorrhage, crystalloid resuscitation is often more conservative and is referred to as "permissive hypotension." The goal of "permissive hypotension" would be to provide enough perfusion pressure to vital organs such that function is maintained while keeping blood pressure below the normal range in the hope that clot formation will not be disrupted. Whole blood and fresh frozen plasma in addition to aminocaproic acid are indicated in most horses with severe uncontrolled hemorrhage. SUMMARY: Blood transfusion is a life-saving treatment for severe hemorrhage in horses. No precise HCT serves as a transfusion trigger; however, an HCT < 15%, lack of appropriate clinical response, or significant improvement in plasma lactate following crystalloid resuscitation and loss of 25% or more of blood volume is suggestive of the need for whole blood transfusion. Mathematical formulas may be used to estimate the amount of blood required for transfusion following severe but controlled hemorrhage, but these are not very accurate and, in practice, transfusion volume should be approximately 40% of estimated blood loss. KEY POINTS: Modest hemorrhage, <15% of blood volume (<12 mL/kg), can be fully compensated by physiological mechanisms and generally does not require fluid or blood product therapy. More severe hemorrhage, >25% of blood volume (> 20 mL/kg), often requires crystalloid or blood product replacement, while acute loss of greater than 30% (>24 mL/kg) of blood volume may result in hemorrhagic shock requiring resuscitation treatments Uncontrolled hemorrhage is a common occurrence in equine practice, and is most commonly associated with abdominal bleeding (eg, uterine artery rupture in mares). If the hemorrhage can be controlled such as by ligation of a bleeding vessel, then initial efforts to resuscitate the horse should focus on increasing perfusion pressure and blood flow to organs as quickly as possible with crystalloids or colloids while assessing need for whole blood transfusion. While fluid therapy is being administered every effort to physically control hemorrhage should be made using ligatures, application of compression, surgical methods, and local hemostatic agents like collagen-, gelatin-, and cellulose-based products, fibrin, yunnan baiyao (YB), and synthetic glues Although some synthetic colloids have been shown to be associated with acute kidney injury in people receiving resuscitation therapy,20 this undesirable effect in horses has not been reported.
Assuntos
Doenças dos Cavalos , Substitutos do Plasma , Animais , China , Coloides , Feminino , Hidratação/veterinária , Hemorragia/terapia , Hemorragia/veterinária , Doenças dos Cavalos/terapia , Cavalos , Soluções Isotônicas/uso terapêutico , Substitutos do Plasma/uso terapêutico , Ressuscitação/veterináriaRESUMO
OBJECTIVES: To evaluate the maximum in vitro flow rate of 6 types of polyurethane over-the-wire double lumen catheters using both ports, for high volume fluid resuscitation in large animal species. SETTINGS: University teaching hospital. DESIGN: Prospective in vitro experimental study. INTERVENTIONS: The flow rate of both ports of 6 polyurethane double lumen over-the-wire catheters (11 and 13-Fr, 15 and 20 cm long, elliptical and tapered tip designs) and 2 types of infusion (with or without pressure bags) were tested on a factorial scheme (6 × 2) in triplicate, using commercial isotonic crystalloid (0.9% NaCl) and synthetic colloid (6% Hydroxyethyl starch, 130/0.4). MEASUREMENTS AND MAIN RESULTS: Flow rates were influenced by catheter diameter, length, tip design and presence or absence of pressure bags (P < 0.05). Mean flow rates during non-pressurized 0.9% NaCl infusion ranged from 584 mL/min (35 L/h; 11-Fr x 15 cm x tapered tip catheter) to 905 mL/min (54 L/h; 13-Fr x 15 cm x elliptical tip catheter). Mean flow rates during non-pressurized synthetic colloid infusion varied from 404 mL/min (24 L/h; 11-Fr x 15 cm x tapered tip catheter) to 724 mL/min (43 L/h; 13-Fr x 15 cm x elliptical tip catheter). Mean flow rates during pressurized infusion were 1.72 and 2.02 times greater than those obtained by gravity alone for 0.9% NaCl and synthetic colloid, respectively (P < 0.05). CONCLUSIONS: Highest in vitro flow rates were achieved when larger diameter, shorter and elliptical tip catheters were used during 0.9% NaCl infusion. Catheter diameter, tip design but not length influenced the flow rate during synthetic colloid infusion. The use of pressure bags significantly increased the flow rate of all catheters, for both solutions.
Assuntos
Catéteres , Hidratação , Animais , Catéteres/veterinária , Soluções Cristaloides , Hidratação/veterinária , Estudos Prospectivos , Ressuscitação/veterináriaRESUMO
Hemorrhage is a significant cause of death among military working dogs and in civilian canine trauma. While research specifically aimed at canine trauma is limited, many principles from human trauma resuscitation apply. Trauma with significant hemorrhage results in shock and inadequate oxygen delivery to tissues. This leads to aberrations in cellular metabolism, including anaerobic metabolism, decreased energy production, acidosis, cell swelling, and eventual cell death. Considering blood and endothelium as a single organ system, blood failure is a syndrome of endotheliopathy, coagulopathy, and platelet dysfunction. In severe cases following injury, blood failure develops and is induced by inadequate oxygen delivery in the presence of hemorrhage, tissue injury, and acute stress from trauma. Severe hemorrhagic shock is best treated with hemostatic resuscitation, wherein blood products are used to restore effective circulating volume and increase oxygen delivery to tissues without exacerbating blood failure. The principles of hemostatic resuscitation have been demonstrated in severely injured people and the authors propose an algorithm for applying this to canine patients. The use of plasma and whole blood to resuscitate severely injured canines while minimizing the use of crystalloids and colloids could prove instrumental in improving both mortality and morbidity. More work is needed to understand the canine patient that would benefit from hemostatic resuscitation, as well as to determine the optimal resuscitation strategy for these patients.
Assuntos
Transfusão de Sangue/veterinária , Doenças do Cão/terapia , Cães , Ressuscitação/veterinária , Choque Hemorrágico/veterinária , Ferimentos e Lesões/veterinária , Animais , Doenças do Cão/sangue , Cães/sangue , Cães/fisiologia , Hemostasia , Humanos , Choque Hemorrágico/sangue , Choque Hemorrágico/terapia , Cães Trabalhadores/sangue , Cães Trabalhadores/fisiologia , Ferimentos e Lesões/sangue , Ferimentos e Lesões/terapiaRESUMO
OBJECTIVE: To evaluate the effectiveness of intravenous fluid resuscitation in hypotensive cats in an emergency room setting. Secondary objectives were to investigate changes in heart rate (HR) and body temperature (BT) in response to fluid resuscitation, and the association of these changes with patient survival. DESIGN: Retrospective study. SETTING: University teaching hospital. ANIMALS: Eighty-two cats with confirmed hypotension. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Medical records from 2012 to 2019 were searched for cats that had documented systemic arterial hypotension (blood pressure measured using a Doppler ultrasonic flow probe [DBP] < 90 mm Hg) on presentation to the emergency room. Data collected included patient characteristics and DBP, HR, and BT before and after fluid resuscitation, type and volume of fluids administered, and outcome. The median DBP before and after resuscitative fluid therapy in all cats was 65 mm Hg (range, 20-85 mm Hg) and 80 mm Hg (range, 20-128 mm Hg), respectively (P < 0.001). However, only 30 cats (37%) were classified as responders to fluid resuscitation (DBP ≥ 90 mm Hg following bolus therapy). The mean HR and median BT before resuscitative fluid therapy was 159/min and 36.7°C. Following fluid resuscitation, where measured, the mean HR and median BT was 154/min (P = 1.00) and 35.9°C (P = 1.00). No significant differences in HR and BT were identified between responders and non-responders. Cats had a low survival rate of 7%. All survivors (n = 5) were initially bradycardic (HR < 160/min), compared to only 45% of non-survivors (P = 0.4). CONCLUSIONS: Bolus fluid resuscitation effectively increases blood pressure in hypotensive cats; however, it does not result in normalization of blood pressure, HR, or BT in the majority of cases.
Assuntos
Hidratação , Hipotensão , Animais , Pressão Sanguínea , Hidratação/veterinária , Hipotensão/terapia , Hipotensão/veterinária , Ressuscitação/veterinária , Estudos RetrospectivosRESUMO
OBJECTIVES: To describe patient characteristics of dogs with septic shock, investigate markers of disease severity, and assess treatment impact on outcome. DESIGN: Retrospective study. SETTING: Single center, university veterinary teaching intensive care unit. ANIMALS: Thirty-seven dogs with septic shock. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Mean number of organ dysfunction was 3.24 ± 1.0, and included cardiovascular (100%), respiratory (73%), hematologic (68%), renal (49%), and hepatic (32%) dysfunction. The gastrointestinal tract was the most common source of sepsis. Mean blood pressure prior to resuscitation was 50 ± 8 mm Hg. All dogs were given IV fluids before vasopressor therapy with a mean rate of 12.1 ± 11.0 mL/kg/h. All dogs were given antimicrobials, administered within a mean of 4.3 ± 5.7 hours after diagnosis. Dopamine or norepinephrine was administered IV, respectively in 51.3% and 37.8% of dogs, with a mean duration of hypotension of 2.6 ± 3.0 hours. Mortality rate was 81.1%. Survivors were more likely to have a feeding tube (P = 0.007) and to have gastrointestinal sepsis (P = 0.012), and less likely to have respiratory dysfunction (P < 0.001). APPLEFull scores (P = 0.014) and time to antimicrobial therapy (P = 0.047) were identified as predictors of mortality. Treatment bundles consisting of 7 interventions that may improve outcomes in people with septic shock were evaluated. Survivors received 4.1 ± 1.3 interventions, whereas nonsurvivors received 2.4 ± 1.4 (P = 0.003). CONCLUSIONS: Septic shock in dogs confers a guarded prognosis. Early antimicrobial therapy and the utilization of treatment bundles may increase survivability in dogs with septic shock. More research is warranted to investigate the impact of specific interventions on survival.
Assuntos
Doenças do Cão/tratamento farmacológico , Sepse/veterinária , Choque Séptico/veterinária , Animais , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Cães , Dopamina/administração & dosagem , Dopamina/uso terapêutico , Feminino , Unidades de Terapia Intensiva , Masculino , Norepinefrina/administração & dosagem , Norepinefrina/uso terapêutico , Ressuscitação/veterinária , Estudos Retrospectivos , Sepse/terapia , Índice de Gravidade de Doença , Choque Séptico/tratamento farmacológico , Choque Séptico/patologia , Resultado do TratamentoRESUMO
Traumatic injuries in small animals are a common cause for presentation to emergency departments. Severe traumatic injury results in a multitude of systemic responses, which can exacerbate initial tissue damage. Trauma resuscitation should focus on the global goals of controlling hemorrhage, improving tissue hypoperfusion, and minimizing ongoing inflammation and morbidity through the concept of "damage-control resuscitation." This approach focuses on the balanced use of blood products, hemorrhage control, and minimizing aggressive crystalloid use. Although these tenets may not be directly applicable to every veterinary patient with trauma, they provide guidance when managing the most severely injured subpopulation of these patients.
Assuntos
Gatos/lesões , Soluções Cristaloides/uso terapêutico , Cães/lesões , Ressuscitação/veterinária , Ferimentos e Lesões/veterinária , Animais , Soluções Cristaloides/administração & dosagemRESUMO
The aim of this study was to gain a greater understanding of the detection, treatment, and monitoring of hypovolemic shock (HVS) in dogs by general practitioners in the United Kingdom (UK). An online survey was devised and distributed by email to first opinion practices in the UK. All veterinarians working in first opinion practice treating small animals were eligible to complete the survey. Most respondents (nâ¯=â¯164, 93%) were confident with HVS diagnosis. Isotonic crystalloid fluids were the most common fluid type for first-line treatment and administered as a 10-30 mL/kg bolus over 10-30 minutes by 57% respondents. Initial intravenous isotonic crystalloid fluid rates for HVS management ranged from maintenance fluid requirements to 90 mL/kg/hr for an undefined time period. A synthetic colloid was the most popular second-line fluid choice, typically considered after a total administered volume of 60-90 mL/kg of isotonic crystalloid fluids. Only 72 respondents (40.7%) were able to measure blood lactate in-house, which was used routinely by 36 respondents (20.3%) for initial treatment decision making. Respondents treating HVS most frequently were more likely to use lactate for initial decision making (P = .008). This study highlighted variabilities in the initial approach, fluid management strategies and monitoring instituted by UK general practitioners when faced with canine patients in HVS. This suggests that there is a discrepancy in what is determined to be the most optimal diagnostic and treatment plan for canine HVS patients.
Assuntos
Doenças do Cão/diagnóstico , Padrões de Prática Médica , Choque/veterinária , Animais , Doenças do Cão/terapia , Cães , Hidratação/veterinária , Humanos , Ressuscitação/veterinária , Choque/diagnóstico , Choque/terapia , Inquéritos e Questionários , Reino Unido , Médicos VeterináriosRESUMO
OBJECTIVE: To determine whether a balloon for resuscitative endovascular balloon occlusion of the aorta (REBOA) could be accurately placed in the descending aorta between the left subclavian and celiac arteries (zone I) by using external anatomic landmarks in dogs. STUDY DESIGN: Cadaver study. SAMPLE POPULATION: Fifteen canine cadavers of 3 weight categories (10-20, 20-30, and ≥ 30 kg). METHODS: Percutaneous catheterization of the femoral artery was attempted under ultrasonographic guidance; when unsuccessful, an arterial cutdown was performed to place an introducer sheath. Distance was measured between the introducer sheath and the target region, located ventral to the epaxial muscles at the level of the 12th thoracic vertebra. The balloon was advanced the measured distance, and placement was confirmed with fluoroscopy. The volume of iohexol solution required to inflate balloons was recorded. Histopathology was performed on the aortas of the first 5 dogs. RESULTS: Three catheters were placed under ultrasonographic guidance. Balloons were successfully placed into zone I in 15 of 15 cadavers. Balloons were inflated with a median 0.4 mL/kg (range, 0.21-0.67) of iohexol solution. Minor changes were identified in 2 of 5 dogs examined with histopathology (linear defects in 1 dog, small focal dissection in the other). CONCLUSION: A balloon for REBOA was consistently placed in the target zone I without fluoroscopic guidance. CLINICAL SIGNIFICANCE: Fluoroscopy may not be required for zone I REBOA in dogs. Additional studies are warranted to evaluate the feasibility of REBOA in clinical dogs with hemoperitoneum.
Assuntos
Aorta , Oclusão com Balão/veterinária , Cães/cirurgia , Procedimentos Endovasculares/veterinária , Ressuscitação/veterinária , Animais , Oclusão com Balão/métodos , Cadáver , Procedimentos Endovasculares/métodos , Fluoroscopia , Ressuscitação/métodosRESUMO
OBJECTIVES: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an emerging technology to augment proximal blood pressure during the resuscitation of patients with noncompressible torso hemorrhage. Currently, placement choice, supraceliac (Zone 1) versus infrarenal (Zone 3) aorta, depends on injury patterns, but remains a highly debated topic. We sought to compare the proximal hemodynamic support provided by Zone 1 versus Zone 3 REBOA placement and the degree of hemodynamic instability upon reperfusion following intervention. METHODS: Eighteen anesthetized swine underwent controlled hemorrhage of 25% total blood volume, followed by 45 minutes of Zone 1 REBOA, Zone 3 REBOA, or no intervention (control). They were then resuscitated with shed blood, aortic balloons were deflated, and 5 hours of critical care ensued prior to euthanasia. Physiologic parameters were recorded continuously, and blood was drawn for analysis at specified intervals. Significance was defined as p < 0.05. RESULTS: There were no significant differences between groups at baseline or during the initial 30 minutes of hemorrhage. During the intervention period, average proximal MAP was significantly greater in Zone 1 animals when compared with Zone 3 animals (127.9 ± 1.3 vs. 53.4 ± 1.1 mm Hg) and greater in Zone 3 animals when compared with control animals (42.9 ± 0.9 mm Hg). Lactate concentrations were significantly higher in Zone 1 animals (9.6 ± 0.4 mmol/L) when compared with Zone 3 animals (5.1 ± 0.3 mmol/L) and control animals (4.2 ± 0.8 mmol/L). CONCLUSIONS: In our swine model of hemorrhagic shock, Zone 3 REBOA provided minimal proximal hemodynamic support when compared with Zone 1 REBOA, albeit with less ischemic burden and instability upon reperfusion. In cases of impending hemodynamic collapse, Zone 1 REBOA placement may be more efficacious regardless of injury pattern, whereas Zone 3 should be reserved only for relatively stable patients with ongoing distal hemorrhage.
Assuntos
Aorta/cirurgia , Oclusão com Balão/métodos , Procedimentos Endovasculares/métodos , Ressuscitação/métodos , Choque Hemorrágico/cirurgia , Animais , Oclusão com Balão/veterinária , Cuidados Críticos/métodos , Modelos Animais de Doenças , Procedimentos Endovasculares/veterinária , Feminino , Hemodinâmica/fisiologia , Masculino , Traumatismo por Reperfusão/etiologia , Ressuscitação/veterinária , Choque Hemorrágico/fisiopatologia , Choque Hemorrágico/veterinária , SuínosRESUMO
Management of severe burn injury (SBI) requires prompt, complex, and aggressive care. Despite major advances in the management of SBI-including patient-targeted resuscitation, management of inhalation injuries, specific nutritional support, enhanced wound therapy, and infection control-the consequences of SBI often result in complex, multiorgan metabolic changes. Consensus guidelines and clinical evidence regarding specific management of small animal burn patients are lacking. This article aims to review updated therapeutic consideration for the systemic and local management of SBI that are proven effective to optimize outcomes in human burn patients and may translate to small animal patients.
Assuntos
Queimaduras/veterinária , Animais , Queimaduras/complicações , Queimaduras/terapia , Humanos , Apoio Nutricional/veterinária , Prognóstico , Ressuscitação/veterinária , Lesão por Inalação de Fumaça/complicações , Lesão por Inalação de Fumaça/terapia , Lesão por Inalação de Fumaça/veterináriaRESUMO
CASE DESCRIPTION A 14-year-old spayed female American Cocker Spaniel with bilateral otitis media and no evidence of cardiovascular instability was anesthetized to allow performance of a deep ear flush. CLINICAL FINDINGS Otoscopic examination of the left ear revealed evidence of chronic inflammation; the ear was flushed with sterile saline (0.9% NaCl) solution. Examination of the right ear revealed more severe chronic inflammation than in the left ear, including a ruptured tympanum (timing of rupture unknown). The right ear was flushed with sterile saline solution, and several drops of otic medication were instilled. During infusion of saline solution, the ECG revealed a rapid decrease in heart rate until no more electrical activity was noted. Pulse also ceased to be detectable via pulse oximetry and femoral artery palpation. TREATMENT AND OUTCOME Isoflurane was discontinued immediately after recognition of cardiac arrest. Shortly after, atropine (0.04 mg/kg [0.02 mg/lb]) and epinephrine (0.3 mg/kg [0.14 mg/lb]) were administered IV, chest compressions and ventilation were performed for 2 to 3 minutes, and 3 boluses (each 5 mL/kg) of lactated Ringer solution were administered IV. The dog was extubated 8 minutes after anesthesia was discontinued, and its recovery was monitored for the next 5 hours. No further incidents of cardiac arrest occurred after recovery from anesthesia. CLINICAL RELEVANCE This case represented a rarely documented potential complication associated with otic manipulation in a dog: cardiac arrest secondary to stimulation of the auricular branch of the vagus nerve. Veterinarians should be prepared for and warn clients of this possibility prior to otic flushing.