Monitoring Equipment

1. Monitoring Equipment Pulse oximeter Capnography Blood gas analysis

2. Blood Pressure Monitoring Indirect Doppler Oscillometric Dynamap Cardell Direct Arterial catheter Transducer Monitor

3. Indirect 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

4. Indirect Blood Pressure Cuff is placed on: Mid foreleg distal to hock Base of tail Below the stifle in cats

5. Doppler Seemingly more accurate Has more clinical uses

6. Direct 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

7. Ideal 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

8. Central 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

9. Central 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

10. Coagulation 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

11. Coagulation Status Methods Buccal mucosal bleeding time (BMBT) Evaluates platelet function Can be used as an in-house screening test for von Willebrand’s disease

12. Renal System Monitoring • Standard monitoring includes urine-specific gravity before IV fluids (if possible) • Laboratory markers include the BUN, creatinine, phosphorous

13. Renal 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

14. Central 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

15. Central 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

16. Abdominal Cavity Evaluation Examined initially by palpation Palpation can detect abdominal distension Distension possible due to fluid accumulation, organ enlargement, and intestinal gas

17. Abdominal Pain Detected by the presence of discomfort, splinting, or vocalization Animals with unexplained abdominal pain or distension warrant further investigation and monitoring

18. Abdominocentesis 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

19. Abdominocentesis 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

20. Thoracocentesis May be performed as an emergency diagnostic procedure in animals with severe respiratory distress Performed with the animal comfortably restrained in sternal recumbency

21. Urinary 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

22. Toxicities 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?

23. Toxicities 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

24. Toxicities Treatment Based on the toxin ingested Inducing vomiting should be cautiously considered Vomiting contraindicated for ingestion of caustic substances and petroleum products

25. Toxicities 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

26. Toxicities 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