Veterinary Clinical Medicine-I (General and Systemic)

EMERGENCY MANAGEMENT OF CASES

The following should be evaluated and treated accordingly.

• Airway
• Breathing or respiratory depression or respiratory failure
  • A patent airway should be established with cuffed endotracheal tube.
  • Mechanical ventillation or oxygen should be used
  • Centrally acting respiratory stimulant should be used if necessary Doxapram – 1 mg / kg b.wt i/v) excessive dose cause seizures or the animal may relapse to coma.
  • Nalaxone – 0.04 mg/kg .wt. i/v, i/v, s/c – for respiratory depression caused due to opiate exposure.
  • Cardiac arrhythmias of several types can occur.

Types of arrhythmia	Poison	Treatment
Sinus Bradycardia	Opioid Carbamate Β – blockers Phenothiazine	A tropine : 0.01 – 0.2 mg/kg b.wt i/v or i/m Glycopyidate : 0.005 – 0.01 mg/kg b.wt. i/v or i/m
Atrio ventricular block	Digitalis	A tropine – 0.01 – 0.2 mg/kg b.wt. i/v or i/m Dopamine – 3-5 mg/kg b.wt / min Iroproterenol – 0.01 mg/kg b.wt / min i/v
Atrial stand still	Hyperkalemia	Saline i/v Sodium bi carbonate Insulin with dextrose
Ventricular Tachycardia		Lidocaine Hydrochloride – 2-3 mg/kg b.wt. slow i/v

Shock

• Signs:Tachycardia
  • Hypotension (prolonged capillary refill time, weak pulse)
  • Rapid respiration
  • Hypothermia
  • Weakness, restlessness, depression
  • Reduced urine output
  • Coma, papillary dilatation
• Steps
  • Ensure patent airway (intubate)
  • Haemorrhage – direct pressure / bandage / tourniquet / ligation
  • Fluid therapy – maintain PCV between 20 & 50 %, add 50 ml of 50% dextrose to each time of fluid.
  • Whole blood, colloids: eg: Dextran – 20 – 40 ml/kg b.wt. for 24 hrs.
  • Glucocorticoids
    • eg. Hydrocortisone sodium succinate – 8-20 mg/kg b.wt. i/v
    • (Onset of action:- 1-4 minutes)
    • Prednisolone sodium succinate – 20-25 mg/kg b.wt i/v
    • Dexamethasone – 1-4 mg/kg b.wt (i/v or s/c)
  • Vassoactive substances
    • eg. Dopamine – 5 mg in 250 ml 5% dextrose i/v
    • Sodiumbicarbonate – 0.3 x body weight x base deficit
      • 1-2 meq / kg b.wt i/v bdus
      • 1-2 meq added in each litre of solution
  • Broad spectrum antibiotics
  • Diuretics
    • Eg; Frusemide – 2-4 mg/kg b.wt i/v or s/c
    • Heparin - 100 – 200 IU/kg b.wt i/v
    • - 600 iv/kg b.wt s/c

CNS Dysfunction

• Seizures may be associated with hypoxia, vomiting, hypothermia and acidosis. It should be controlled before the specific cause is known.
  • Diazepam – 0.5 mg/kg i/v as it has short half life and must be readministered every 10-15 min for upto several treatment.
  • Phenobarbitone– 6 mg/kg b.wt i/v
  • Pentobarbitone – used carefully to induce light anaesthesia
• Recently proposed concept
  • Proposal – 3-5 mg/kg b.wt. i/v administered after diazepam. These phenoarbitolne or pentobarbitone opiod anaesthesia.
• Analeptics
  • To treat CNS depression
  • Dexopram / Nalaxone used
  • Phenothiazine tranquilizers
  • Prolonged vomition and diarrhea – CNS cause
• Hypothermia / Hyperthermia
  • Hypothermia – use of blankets, warm water bottles, heating pads, warm i/v fluids intraperitoneally.
  • Hyperthermia – cold pack, ice pack, cold i/v fluids.