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EDUCATION

EDUCATION. “Education is what survives after what has been learned has been forgotten.” - B.F. Skinner. Anaphylaxis/Allergic reactions. Rare, life-threatening reactions to something injected or ingested Untreated, it results in shock, resp/cardiac failure, and death

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EDUCATION

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  1. EDUCATION “Education is what survives after what has been learned has been forgotten.” - B.F. Skinner

  2. Anaphylaxis/Allergic reactions Rare, life-threatening reactions to something injected or ingested Untreated, it results in shock, resp/cardiac failure, and death IgE Antibodies to allergen bind to mast cells; on subsequent exposure, the Ag-Ab reaction causes massive release of histamine and other inflammatory mediators Histamine → vasodilation → ↓BP • Initiating factors • Insects • Vaccines • Antibiotics • Certain hormones • Other medications • Foods

  3. Anaphylaxis/Allergic reactions • Signs • Sudden onset of vom/diarrhea • Shock • Gums are pale • Limbs are cold • HR rapid, weak • Face scratching (early sign) • Respiratory distress • Collapse • Seizures • Coma • Death

  4. Anaphylaxis/Allergic reactions • Rx (this is an extreme emergency) • Eliminate cause • Epinephrine • H1 antihistamines (Diphenhydramine) • IV fluids • Corticosteroids • Oxygen • Prevention • There is no way to predict what will bring on an anaphylactic reaction the first time • Always inform vet if animal has had previous reaction to vaccine • Owners should have an ‘epi-pen’ with them at all times

  5. Heat Stroke (Hyperthermia) Requires immediate treatment Dogs do not cool as well as humans (don’t sweat) • Causes • Left in hot car • Water deprivation • Obesity/older • Chained without shade in hot weather • Muzzled under a hot dryer • Short-nosed breed (esp Pug, Bulldog)/heavy coat • Heart/Resp disease or any condition that impairs breathing or ability to cool body • Lack of acclimatization/exercise

  6. Heat Stroke • Signs • Rapid, frantic, noisy breathing • Tongue/mm bright red, thick saliva • Vomiting/diarrhea—may be bloody • Rectal temp >105° • Unsteady/stagger • Coma/death Prevention

  7. Heat Stroke • Complications • Multi-system organ failure • Denatures proteins • Hypotension • Lactic acidosis • Decreased oxygen delivery • Electrolyte abnormalities => cerebral edema and death • Coagulopathies => DIC • If survives the first 24 hrs, prognosis is more favorable

  8. Heat Stroke • TREATMENT Mild cases: move dog to a/c building or car • Temp >104º, immerged in cool water, hose down • Temp >106º, cool water enema (cool to 103º) • Temp >109° leads to multiple organ failure STOP COOLING EFFORTS AT 103º • IV fluids • Corticosteroids

  9. Emergency Drugs in Cats

  10. Emergency Drugs in Dogs

  11. Pain Management • Misconceptions about animal pain • Animals do not experience pain • Pain doesn’t really affect how animal responds to treatment • Signs of pain are too subjective to be assessed • Pain is good because it limits activity • Analgesia interferes with accurate assessment of treatment • Pain management not major concern in LA (except horses) • Pain shows weakness/fragility (Lab vs Collie) • Fresh ideas about animal pain • Analgesia increases chance of recovery in critically ill • Pain associated with diagnostic test should be minimized • Morally correct thing to do

  12. Pain Management • Signs • Vocalization • ↑HR • ↑RR • Restlessness, abnormal posturing, unwilling to move • ↑ Body temperature • ↑BP • Inappetence • Aggression • Facial expression, trembling • Depression, insomnia

  13. Pain Management • Sequelae to untreated pain • Neuroendocrine responses • Excessive release of pit, adr, panc hormones • Cause immunosuppression and disturbances of growth, development, and healing • Cardiovascular compromise • ↑BP, HR, intracranial pressure • Coagulopathies • ↑platelet reactivity, DIC • Long-term recumbency • Decubital ulcers • Poor appetite/nutrition • Hypoproteinemia→slow healing

  14. Pain Management • Pain Relief • Nonpharmacologic interventions (differentiate pain vs stress) • Give relief from: • Boredom, Thirst, Anxiety, Need to urinate/defecate • Clean bedding/padding • Reduce light/sound • Stroking pet, calming speech • Owner visits (±) • Minimize painful events (reduce #, improve skills in injections, blood draw]

  15. Pain Management • Questions the Vet Tech must continually ask (you are in charge of pain meds) • Is patient at acceptable comfort level • Are there any contraindications to giving pain meds • What is the appropriate (safe, effective) med for this patient

  16. Pain Management • Drug Options • NonsteroidalAntiinflammatory Drugs (NSAIDs) • Most widely used • Extremely effective for acute pain • Most effective when used preemptively (before tissue injury) • Usually not adequate to manage surgical pain • COX-2 NSAIDs do not cause damage to stomach lining • Opioids • Most commonly used in critically injured animals • Rapid onset of action; effective; safe • 4 types of receptors • μ: analgesia, sedation, and resp depression • Κ: analgesia and sedation • Σ: depression, excitement, anxiety • Δ • Side effects • Vomiting, constipation, excitement, bradycardia, panting • Metabolized by liver; excreted by kidneys • Use caution with hepatic, renal disease

  17. Pain Management • Opioids • Morphine sulfate • Used for max analgesia/sedation • Inexpensive • Side-effects: systemic hypotension, vomiting • Cats particularly sensitive • Oxymorphone • 10x potency of morphine • Much more expensive; less resp depression and GI stimulation • Side-effects: depression, sensory hypersensitivity • Hydromorphone • Similar effects of Oxymorphone • More widely available, less expensive than Oxymorphone

  18. Pain Management • Opioids • Fentanyl citrate • Extremely potent • Rapid onset, short duration when administered IM or IV • Transdermal patch • 3-day duration • Shave hair, apply to the skin • Butorphanol Tartrate • Κ agonist; μ antagonist • Analgesic effect questionable (>1 h); good sedative (~2 h) • More expensive than morphine • Less vomiting, resp. depression • Buprenorphine • Partial mu agonist • 30x potency of morphine; longer duration • good absorption via buccal mucosa

  19. Pain Management • Opioids • Antagonists • Naloxone HCl • Reversal occurs within 1-2 min • Can be used to reverse anesthesia (Inovar-Vet)

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