Textbook of Small Animal Emergency Medicine

Textbook of Small Animal Emergency Medicine

Contents

Contributors

Dedication

Preface

About the Companion Website

Section 1 Emergency Medicine Overview

1 Goals in Veterinary Emergency Medicine

The 40-Year Evolution of Goals in Veterinary Emergency Medicine

The Patient

The Client and the Team

Principles of Primary Survey, Resuscitation, Secondary Survey and Definitive or Refined Diagnostics and Treatment of Veterinary Emergency Patients

References

2 Triage

Introduction

Telephone Triage

First Aid and Transport

Waiting Room Triage

Investigation and Stabilization of the Patient

History

Emergency Physical Examination

Emergency Stabilization

References

Section 2 Common Conditions in Emergency Medicine

3 Neurological Disorders

Initial Management of the Acute Neurological Patient

Neuroanatomic Localization

Initial Assessment

Consciousness

Posture and Body Position

Abnormal Movements

Ambulation and Gait

Cranial Nerves

Neurolocalization

Approach to Differential Diagnoses

References

4 Respiratory Distress

Introduction

Does Oxygen Help?

Signalment

Any Relevant Past Medical History? What Has Happened Today?

Is There Hyperthermia or Hypothermia?

Is There Loud Breathing?

Is There Any Cough or Wheeze?

Are There Extra Lung Sounds?

What Does Point-of-Care Ultrasound Show You?

What Should I Tell the Owner?

References

5 Ventricular Ectopy

Introduction

Presentation

Diagnosis

Causes

Non-Cardiac Causes

Cardiac Causes

Treatment

Class I Antiarrhythmics

Class II Antiarrhythmics

Class III Antiarrhythmics

Other Antiarrhythmics

Defibrillation

6 Acute Abdomen

History and Physical Examination

Clinical Pathology

Abdominal Imaging

Collection of Peritoneal Effusion

Analysis of Peritoneal Effusion

Abdominal Surgery

Nutritional Support

Conclusion

References

7 The Collapsed Patient

Introduction

Pathophysiology of Syncope

Causes of Syncope

Cardiac Syncope

Reflex-Mediated Syncope

Collapse or Syncope-Like Conditions

Patient Evaluation and Risk Stratification

Blood Pressure

ECG

Long-Term Monitoring

Bloodwork

Treatment

References

8 Global Approach to the Trauma Patient

Introduction

Pathophysiology

Triage Evaluation and Intervention

Further Evaluation

Diagnostic Imaging

Conclusion

References

9 Reproductive Emergencies

Introduction

Female Reproductive Emergencies

Vaginal Discharge

Swollen Vulva or Mass Lesion

Reproductive Emergencies of the Pregnant Patient

Reproductive Emergencies of the Periparturient Patient

Male Reproductive Emergencies

Paraphimosis and Priapism

Prostate Disorders

Testicular Torsion

References

10 Anemia

Introduction

Etiology

Consequences of Anemia

Clinical Signs

Diagnosis

History

Physical Examination

Laboratory Assessment

Diagnostic Approach

Decreased Erythropoiesis

Hemorrhagic Anemia

Hemolytic Anemia

References

11 Jaundice

Definition

Physiology

Pathophysiology

Evaluation of the Icteric Patient

Physical Examination

Diagnostic Evaluation

Treatment

References

12 Ophthalmic Emergencies

Proptosis

Eyelid Lacerations

Corneal Lacerations

Deep Corneal Ulcers

Primary Glaucoma

Acute Anterior Uveitis

Anterior Lens Luxation

Acute Blindness

References

13 Vomiting, Regurgitation, and Diarrhea

Differentiation Between Vomiting and Regurgitation

Vomiting

Physiology of Vomiting

Differential Diagnoses

Clinical Approach

General Treatment Guidelines

Regurgitation

Differential Diagnoses

Clinical Approach

General Treatment Guidelines

Prognosis

Diarrhea

Gastrointestinal Causes

Extragastrointestinal Causes

Clinical Approach

Treatment

References

14 Dysuria

Introduction

Alteration in Volume or Frequency of Urination

Dysuria

Stranguria

Pollakiuria

Decreased Size of Urine Stream

Reflex Dyssynergia

Urinary Obstruction

Periuria

Incontinence

Polyuria/Polydipsia

Alteration in Urine Consistency

Discolored Urine

Malodorous Urine

Crystalluria or Small Uroliths in Urine

Other Clinical Findings That May Be Associated With Lower Urinary Tract Disease

Abdominal Fluid

Excessive Licking of Prepuce or Vulva

Blood Dripping from Prepuce or Vulva

Prostatomegaly

Purulent Discharge from Prepuce or Vulva

Painful Rectal Examination

Painful Defecation

Painful or Abnormal Gait of Rear Limbs

Fever

Physical Examination Findings in Patients with Lower Urinary Tract Signs

Additional Analytical Procedures in Patients with Dysuria

Management of Patients with Dysuria

References

15 Dermatological and Ear Disease

Dermatological Emergencies

Pyotraumatic Dermatitis

Pyoderma

Otitis Externa

Ectoparasites

Atopy

Conclusion

References

16 Toxin Exposure

Introduction

References

17 Epistaxis

Introduction

Pathophysiology

Further Laboratory Evaluation

Nasal Imaging

Nasal Biopsy

Emergency Management

Conclusion

References

18 Fever

Physiology of Normal Thermoregulation

What is Fever?

Is Fever Helpful or Harmful?

How to Differentiate Fever from Hyperthermia

History

Clinical Signs

Primary Differentials for Cause of Fever

Early Diagnostics to Consider for Febrile Patients

Treatments to Consider

References

Section 3 Emergency Conditions by System

A. Neurological Disorders

19 Traumatic Brain Injury

Introduction

Pathophysiology

Physical Examination

Systemic Assessment

Neurological Assessment

Diagnostic Imaging

Treatment

Initial Stabilization

Treatment Strategies Specific for TBI

Prognosis

References

20 Altered Mentation

Introduction

Initial Assessment (see Chapter 2)

Neuroanatomy

Neurological Examination

Mental Status and Neurological States of Consciousness

Neuro-ophthalmological Signs

Postural Response

Respiratory Patterns

Differential Diagnoses and Diagnostic Approach

Diagnostic Approach

Laboratory Testing

Advanced Neurological Testing

Treatment and Monitoring

Conclusion

References

21 Seizures

Introduction

History

Initial Patient Assessment (see Chapter 2)

Neurological Examination

Differential Diagnoses

Quick Assessment Tests

Extended Laboratory Tests and Diagnostic Images

Emergency Management

Benzodiazepines

Phenobarbital

Levetiracetam

Propofol

Ketamine

Dexmedetomidine

Acepromazine

Intracranial Pressure

Long-term Management of Seizures

References

22 Intracranial Disease

Clinical Signs

Diagnostic Tests

Differential Diagnoses and Prognosis

Neoplasia

Immune Mediated

Infectious

Vascular

Metabolic

Congenital Malformation

Trauma

References

23 Vestibular Disease

Introduction

Clinical Signs (Table 23.1)

Peripheral Vestibular Disease

Central Vestibular Disease

Paradoxical Vestibular Disease

Bilateral Peripheral Vestibular Disease

Common Causes of Vestibular Disease (Table 23.2)

Peripheral Vestibular Disease

Central Vestibular Disease

Diagnostics

References

24 Spinal Trauma

Causes

Pathophysiology

Initial Approach

Neurological Assessment

Localizing spinal cord lesions

Severity and Prognostication

Diagnosis

Radiography

Myelography

Computed Tomography

Magnetic Resonance Imaging

Treatment of Spinal Cord Injury

Management of Secondary Spinal Cord Injury

Management of Primary Spinal Cord Injury

Nursing, Rehabilitation, and Ongoing Care

References

25 Intervertebral Disk Disease

Introduction

Applied Anatomy

Pathogenesis

Disk Protrusion and Extrusion

Clinical Signs

Diagnostics

Treatment

Medical Management

Surgical Management of IVDH

References

26 Diskospondylitis

Introduction

Pathophysiology

Causative Agents

Signalment

Clinical Signs

Diagnosis

Radiography

Cross-Sectional Imaging

Laboratory Tests

Treatment

Prognosis

Complications

References

27 Lower Motor Neuron Disease

Introduction

Clinical Signs

Diagnosis and Initial Approach

Causes of Generalized Lower Motor Neuron Paresis

Acute Polyradiculoneuritis

Tick Paralysis

Botulism

Fulminant Myasthenia Gravis

Other Causes

References

B. Respiratory Disease

28 Brachycephalic Syndrome

Introduction

Systemic Consequences of the Brachycephalic Obstructive Airway Syndrome

Acute Upper Airway Obstruction: Current Concepts

Treatment of Brachycephalic Syndrome

Future Directions

References

29 Feline Upper Respiratory Complex

Introduction

Causes/Infectious Agents

Feline Herpesvirus-1

Feline Calicivirus

Clinical Presentation

Feline Herpesvirus-1

Feline Calicivirus

Risk Factors

Diagnosis

Treatment (Table 29.2)

Supportive Treatment

Antibiotics

Antivirals

Prevention

Prognosis

References

30 Laryngeal Paralysis

Introduction

Clinical Signs

Emergency Treatment

Emergency Diagnostic Tests

Long-Term Management

Prognosis

References

31 Tracheobronchial Injury and Collapse

Anatomy and Physiology of the Trachea

Emergency Management

Tracheobronchial Injury

Clinical Signs and Physical Examination Findings

Diagnostic Testing

Treatment of Tracheobronchial Injuries

Tracheal and Bronchial Collapse

Clinical Signs and Physical Examination Findings

Diagnostic Testing

Treatment of Tracheobronchial Collapse

References

32 Acute Airway Obstruction

Emergency Examination

Emergency Stabilization

Diagnostics

Complications of Upper Airway Obstruction

Diseases Causing Upper Airway Obstruction (Table 32.1)

Diseases of the Nasal Passage and Nasopharynx

Diseases of the Larynx and Pharynx

Diseases of the Trachea and Bronchi

References

33 Exacerbations of Chronic Bronchitis

Introduction

Disease Syndrome

Diagnosis

Treatment (Table 33.1)

Causes of Exacerbation

Airway Collapse

Mucus Obstruction

Bronchiectasis

Infection

Pulmonary Hypertension

Obesity Hypoventilation Syndrome

Emergency Management of Disease Exacerbations

References

34 Feline Lower Airway Disease

Introduction

Patient History

Initial Assessment

Emergency Treatment

Differential Diagnosis

Feline Asthma

Chronic Bronchitis

Lungworm Disease

Heartworm-Associated Respiratory Disease

References

35 Puppy Pneumonia

Introduction

Clinical Approach

Diagnostic Testing

Treatment Options

Prognosis

Brachycephalic Dogs

References

36 Coughing and Hemoptysis

Introduction

Physiology

Differential Diagnosis

Hemoptysis

Infectious Tracheobronchitis

Foreign Body

Anatomical Disruption

Neoplasia

Diagnostic Approach

Treatment

References

37 Bronchopneumonia

Introduction

Types of Pneumonia

Bacterial Pneumonia

Aspiration Pneumonia

Viral Pneumonia

Fungal Pneumonia

Protozoal Pneumonia

Parasitic Pneumonia

Physical Examination Findings

Diagnostics

Diagnostic Imaging

Clinicopathological Evaluation

Lung Function and Hemodynamic Monitoring

Airway Sampling for Cytology and Microbiology

Treatment

Antimicrobials

Supportive Care

Long-Term Therapy

Prognosis

References

38 Cardiogenic Pulmonary Edema

Introduction

Diuretics

Vasodilators

Positive Inotropes

Vasopressors

Sedatives

Oxygen Therapy

Other Therapies

References

39 Neurogenic Pulmonary Edema

Introduction

Pathogenesis

Blast Theory [1]

Direct Pulmonary Vascular Effect

Summary of Pathogenesis

Clinical Characteristics of Neurogenic Pulmonary Edema

Diagnosis

Initial Approach and Management

Monitoring the Effectiveness of Therapy

Prognosis

References

40 Submersion Injury

Introduction

Definitions

Precipitating Factors

Pathophysiology

Complications of Submersion Injury

Diagnosis and Treatment

Outcome

References

41 Pulmonary Hemorrhage

Etiology and Pathogenesis

Etiology

Pathogenesis

Patient Evaluation

History and Physical Examination Findings

Diagnosis

Radiography

Lung Ultrasound (see Chapter 182)

Computed Tomography

Echocardiography

Transtracheal Wash, Bronchoalveolar Lavage, Cytopathology, Histopathology, and Culture

Hematology: Complete Blood Count, Serum Chemistry, Coagulation Testing, and Other Laboratory Tests

Advanced Pulmonary Testing

Treatment

Outcome

References

42 Pulmonary Thromboembolism

Introduction

Risk Factors

Pathophysiology

Clinical Signs

Diagnosis

Coagulation Testing

Thoracic Radiographs

Arterial Blood Gas

Echocardiography

CT Pulmonary Angiography

Biomarkers

Management

Mechanical Ventilation

Anticoagulants and Thrombolytics

References

43 Primary and Metastatic Pulmonary Neoplasia

Introduction

Diagnostic Tests

Imaging

Laboratory Tests

Treatment and Prognosis

Pulmonary Carcinoma

Metastatic Pulmonary Nodules

Mesothelioma and Carcinomatosis

Conclusion

References

44 Pneumothorax

Anatomy

Pathogenesis

Traumatic Pneumothorax

Iatrogenic Pneumothorax

Spontaneous Pneumothorax

Clinical Consequences of Pneumothorax

Physical Examination

Diagnosis

Thoracocentesis

Ultrasound (see Chapter 182)

Radiography

Computed Tomography

Determining the Underlying Cause of Pneumothorax

Treatment

Thoracostomy Tubes

Continuous Suction

Pleurodesis and Blood Patching

Lung Lobectomy

Medical Therapy for Secondary Spontaneous Pneumothorax

References

45 Pleural Effusion

Introduction

Clinical Signs

Initial Treatment

Types of Effusions

Transudates

Hemorrhagic Effusion

Neoplastic Effusion

Exudates

Chylous Effusions

Conclusion

References

46 Pyothorax

Introduction

Etiology

Microbiology

Signalment

Clinical Signs and Physical Examination Findings

Diagnosis

Clinicopathological Findings

Thoracic Imaging

Treatment

Antimicrobial Therapy

Thoracic Drainage

Thoracic Lavage

Surgical Management

Prognosis

References

47 Diaphragmatic Hernia

Anatomy

Types of Hernias

Congenital

Acquired

Clinical Signs

Congenital

Acquired

Diagnosis

Physical Examination

Diagnostic Imaging

Laboratory Assessment

Treatment

Surgical Intervention

Postoperative Care

Complications and Prognosis

References

48 Penetrating Thoracic Trauma

Introduction

Etiology

Physical Examination and Diagnostics

Treatment

Fluid and Blood Products

Respiratory Stabilization

Pain Management

Antibiotics

Surgical Indications and Procedures

Anesthetic Considerations

Surgical Management

Prognosis

References

49 Blunt Thoracic Trauma

Introduction

Etiology

Pathophysiology

Physical Examination and Diagnostics

Treatment

Surgical Indications

Prognosis

References

50 Look-Alike Causes of Respiratory Distress

Introduction

Look-Alike Causes of Respiratory Distress

Decreased Oxygen Delivery (DO2)

Acid–Base Disorders

Brain Disease

Behavioral and Thermal Receptor Causes

Drugs

References

C. Cardiovascular Disease

51 Mechanisms of Heart Failure

What is Heart Failure?

Neuroendocrine Systems in Heart Failure

Maladaptive Responses in Heart Failure

Global Cardiac Function in Heart Failure

Treatment

Conclusion

References

52 Congenital Cardiovascular Disease

Introduction

Diagnosis

Cyanosis

Congestive Heart Failure

Syncope/Collapse

Conclusion

References

53 Arrhythmias

Introduction

Tachycardias

Supraventricular Tachycardia

Ventricular Tachycardia

Treating Supraventricular Tachycardias

Treating Ventricular Tachycardias

Bradycardias

References

54 Pericardial Effusion

Etiology

Pathophysiology

Clinical Presentation

Diagnostic Testing

Pericardiocentesis

Management and Prognosis

References

55 Dilated Cardiomyopathy

Introduction

Etiology

Signalment, Prevalence, and Incidence

Stages

Diagnosis

Presentation, Clinical Signs, and Physical Examination Findings

Diagnostic Tests

Electrocardiographic Findings

Focused Ultrasound Findings

Thoracic Radiographic Findings

Echocardiographic Findings

NT-proBNP Testing

Other Ancillary Tests

Treatment

Prognosis

References

Further Reading

56 Feline Hypertrophic Cardiomyopathy

Introduction and Definitions

Pathology and Pathophysiology

Diastolic Dysfunction and Congestive Heart Failure

Arterial Thromboembolism

Presentation and Clinical Signs

Initial Stabilization

Congestive Heart Failure

Arterial Thromboembolism

Diagnostic Tests

Thoracic Radiography

Echocardiography

Biomarkers

Other Diagnostics

Chronic Therapy

Prognosis

References

57 Valvular Heart Disease

Introduction

Myxomatous Valvular Degeneration

Diagnosis (Table 57.1)

Signalment and Historical Findings

Physical Examination

Echocardiography

Focused Assessment by Sonographic Technique

Radiography

Biomarkers

Pathophysiology of Congestive Heart Failure (see Chapter 51)

Left-Sided Congestive Heart Failure

Right-Sided Congestive Heart Failure

Pulmonary Hypertension Due to Left-Sided Heart Disease

Left Atrial Tears

Treatment (Table 57.2)

Prognosis

References

58 Heartworm Disease

Introduction

Pathophysiology

Clinical Presentation and Physical Examination

Diagnosis (Table 58.1)

Serology

Radiography

Echocardiography

Clinical Pathology

Treatment of Specific Syndromes

Eosinophilic Pneumonitis

Heartworm Disease in Cats and Heartworm-Associated Respiratory Disease

Pulmonary Thromboembolism

Right-Sided Congestive Heart Failure

Caval Syndrome

Complications After Microfilaricidal or Adulticidal Therapy

References

59 Pulmonary Hypertension

Pathophysiology

Defining Pulmonary Hypertension

Pulmonary Hypertension at the Cellular Level

Classification of Pulmonary Hypertension

Common Veterinary Causes of Pulmonary Hypertension

Cor Pulmonale

Definition and Description

Clinical Presentation

Patient Signalment and History

Recognizing Pulmonary Hypertension

Patient History

Diagnosis

Emergent Diagnostics

Completing the Diagnostic Plan

Treatment

Therapy in the Acute Setting

Long-Term Therapy Options

Follow-Up and Prognosis

References

60 Bradyarrhythmias and Pacemakers

Introduction and Definitions

Physiological Bradyarrhythmias

Iatrogenic Bradyarrhythmias

Pathological Bradyarrhythmias

Atrioventricular Block (AVB)

Sick Sinus Syndrome

Persistent Atrial Standstill

Clinical Management of Dogs and Cats with Bradyarrhythmias

Initial Stabilization

Indications for Permanent Pacing

Work-Up of Dogs and Cats with Bradyarrhythmias

References

61 Myocarditis

Introduction

Parvovirus

Chagas’ Disease

Lyme Disease

Bartonella

Toxoplasmosis

Traumatic Myocarditis

Diagnosis

Treatment

Further Reading

62 Thromboembolic Disease

Introduction

Pathophysiology of Thrombosis

Diagnosis of Thrombosis

General Aspects of the Treatment and Prevention of Thrombosis

Feline Aortic Thromboembolism

Canine Aortic Thrombosis

Portal Vein Thrombosis

Splenic Thrombosis

Mesenteric Thrombosis

Caval Thrombosis

Cerebral Infarction

Myocardial Thrombosis

References

63 Systemic Arterial Hypertension

Introduction

Pathophysiology of Systemic Hypertension

Target Organ Damage Caused by Systemic Hypertension

Neurological Target Organ Damage

Ocular Target Organ Damage

Cardiovascular Target Organ Damage

Renal Target Organ Damage

Conditions Associated with Systemic Hypertension

Clinical Recognition of Systemic Hypertension

Clinical Presentation

Blood Pressure Measurement

Treatment of the Patient with Systemic Hypertension

Prognosis and Long-Term Management

References

D. Hematological and Oncological Disorders

64 Leukocytosis and Leukopenia

Introduction

Leukocytosis

Neutrophilia

Neoplasia

Other Cell Lines

Treatment

Leukopenia

Neutropenia

Lymphopenia

Treatment

References

65 Non-Regenerative Anemia

Introduction

Erythropoiesis

Pathophysiological Response to Non-Regenerative Anemia

Diagnostic Approach

Bone Marrow Sampling and Analysis

Primary Bone Marrow Disorders

Secondary Extramarrow Disorders

Therapies for Non-Regenerative Anemia

References

66 Hemolytic Anemia

Introduction

History and Physical Examination

Laboratory Assessment

Differential Diagnoses for Hemolytic Anemia

Immune-Mediated Hemolytic Anemia (IMHA)

Alloimmune Hemolytic Anemia

Oxidative Hemolysis

Zinc and Copper Toxicity

Erythroparasites

Inherited Erythrocyte Defects

Microangiopathic Hemolysis

Hypophosphatemia

References

67 Thrombocytopenia

Platelets

Thrombocytopenia Etiology

Clinical Signs

Diagnosis

Treatment

References

68 Fibrinolysis and Antifibrinolytics

Introduction

Physiology of Fibrinolysis

Disorders of Fibrinolysis

Hyperfibrinolysis

Hypofibrinolysis

Evaluation of the Fibrinolytic System

D-dimers

Euglobulin Clot Lysis Time (ECLT)

tPA Assays

Plasminogen

Plasminogen Activator Inhibitor-1

Thrombin-Activatable Fibrinolysis Inhibitor

Alpha-2-Antiplasmin

Viscoelastic Testing

Management of Hyperfibrinolysis

Therapeutic Fibrinolysis

References

69 Congenital Coagulopathy

Introduction

Dogs

Cats

Animals Presenting with Unexplained Hemorrhage

Animals with Known Inherited Defects

Von Willebrand’s Disease

Hemophilia A

Hemophilia B

Conclusion

References

70 Acquired Coagulopathy

General Approach

Anticoagulant-Associated Coagulopathy

Heparins

Antiplatelet Drugs

Novel Oral Anticoagulants

General Management

Specific Management

Disseminated Intravascular Coagulation

Pathogenesis

Diagnosis

Treatment

Acute Traumatic Coagulopathy

Hepatobiliary Disorders

Pathophysiology

Diagnosis and Treatment

Diagnosis and Treatment

Neoplasia

References

71 Antithrombotics in the Emergency Room

Introduction

References

72 Sick Oncology Patients in the Emergency Room

Introduction

Febrile Neutropenia and Sepsis

Hypercalcemia

Acute Tumor Lysis Syndrome

Thromboembolism and Hemostatic Abnormalities

Hemangiosarcoma

Conclusion

References

73 Paraneoplastic Syndromes

Hypercalcemia of Malignancy

Hypoglycemia

Polycythemia

Anemia

Thrombocytopenia

Coagulopathies/Disseminated Intravascular Coagulation

Hypertrophic Osteopathy

Fever

Miscellaneous

References

E. Esophageal and Abdominal Disease

74 Vomiting and Regurgitation

Vomiting

Physiology

Sequelae of Vomiting

Diagnostics

Therapy

Regurgitation

Physiology

Sequelae

Diagnostics

Treatment

References

75 Esophageal Foreign Bodies

Introduction

Presentation

Diagnosis

Treatment

Outcome

Esophagitis

Esophageal Perforation

Esophageal Stricture

References

76 Diarrhea

Introduction

Diagnostic Approach

Causes of Diarrhea (Table 76.1)

Primary Gastrointestinal Disease

Extraintestinal Diseases

Treatment

Supportive Treatment

Fluid Therapy

Antiparasitic and Antimicrobial Therapy

Dietary Therapy

Other Therapies

References

77 Hematemesis and Gastrointestinal Hemorrhage

Introduction

Etiology and Pathophysiology

Clinical Signs and Physical Examination

Laboratory Evaluation

Diagnostic Imaging

Endoscopy

Exploratory Laparotomy

Treatment

Prognosis

References

78 Parvovirus Enteritis

Pathogenesis

Clinical Signs

Diagnostic Tests

Treatment and Monitoring

Prognosis

Husbandry Considerations

References

79 Hemorrhagic Gastroenteritis

Introduction

Investigation into the Underlying Etiology

Clinical Recognition and Diagnosis

Emergency Stabilization and Treatment

Prognosis

References

80 Protein-Losing Enteropathy

Introduction

Pathophysiology

Clinical Presentations and Laboratory Data

Treatment

Hypoalbuminemia

Hypercoagulability

Nutritional and Fluid Support

Calcium Homeostasis

Immunosuppressive Therapy

Prognosis and Follow-Up Care

Protein-Losing Enteropathy in Feline Patients

References

81 Gastrointestinal Obstruction

Introduction

Etiology

Pathophysiology

Clinical Signs and Physical Exam

Diagnostics

Radiography

Specific Conditions

Non-Obstructive Foreign Body

Linear Foreign Bodies

Intussusception

Postoperative Complications and Care

Overview

References

82 Gastric Dilation-Volvulus

Introduction

Diagnosis and Treatment

Surgical Management

Outcome

References

83 Mesenteric Torsion

Introduction

Pathophysiology

History and Clinical Signs

Diagnostics

Treatment

References

84 Hemoperitoneum

Introduction

History and Signalment

Clinical Signs and Physical Examination Findings

Initial Treatment and Stabilization

Diagnostics

Definitive Care and Prognosis

References

85 Splenic Disease

Splenic Disease in the Emergent Patient

Splenic Masses in Dogs

Splenic Torsion

Splenic Trauma

Splenic Infarction

Splenic Abscesses

Miscellaneous Conditions Causing Diffuse Splenomegaly in Dogs

Feline Splenic Disease

References

86 Pancreatitis

Introduction

Pathophysiology

History, Signalment, and Clinical Signs

Diagnosis

Diagnostic Imaging

Fluid Analysis

Biopsy and FNA

Scoring Disease and Assessing Severity

Treatment

Prognosis and Owner Communication

References

87 Peritonitis

Introduction

Etiology

Immune Response

Signalment and History

Physical Examination

Diagnostics

Treatment

Fluid Therapy

Antimicrobial Therapy

Pain Management

Antiemetics, Antacids, and Prokinetics

Nutrition

Prognosis

References

88 Postoperative Complications Presenting to the Emergency Service

Introduction

Surgical Site Complications

Associated Complications

Conclusion

References

89 Biliary Disease

Introduction

Overview of Anatomy and Physiology

Presenting Signs and Initial Physical Examination

Diagnostics

Stabilization

Cardiovascular System

Respiratory System

Neurological System

Acute Medical Therapy

Surgery

Prognosis

References

90 Acute Liver Failure

Introduction

Pathophysiology

Presenting Complaint and Clinical Signs

Cardiovascular Signs

Respiratory Signs

Neurological Signs

Renal Signs

Causes

Diagnostic Tests

Emergency Stabilization and Treatment

Prognosis

Conclusion

References

91 Feeding Tube Complications

Introduction

Complications Associated with Placement of Feeding Tubes

Complications Associated with Feeding Tube Use

Complications Encountered After Placement of Feeding Tubes

Conclusion

References

92 Anorectal Disease

Introduction

Anatomy

Perforation

Rectal Prolapse

Other Diseases

Anal Sac Diseases

Rectal Neoplasia

Perianal Fistulae

References

93 Constipation

Introduction

History

Physical Examination

Diagnostics

Treatment

Disimpaction of Feces

Maintenance Therapy

Prognosis

References

F. Urogenital Disorders

94 Acute Azotemia

Introduction

Prerenal Azotemia

Intrinsic Renal Azotemia

Postrenal Azotemia

Diagnosis of Acute Azotemia

Physical Examination and History

Initial Diagnostics

Treatment

References

95 Oliguria

Pathogenesis of Oligoanuria

Patient Assessment and Initial Diagnostics

Managing the Oligoanuric Patient

Converting Oligoanuria to Polyuria

Extracorporeal Renal Replacement Therapy

References

96 Urinary Tract Infections

Definition

Incidence and Pathogenesis

History and Physical Examination

Diagnosis

Therapy

Management of Particular Conditions

Subclinical Bacteriuria

Urinary Tract Infections Associated with Urinary Catheters

Acute Prostatitis

Acute Pyelonephritis

References

97 Urolithiasis

Introduction

Diagnosis of Uroliths

Management of Uroliths Associated with Urinary Obstruction

Management of Uroliths Unassociated with Urinary Obstruction

Medical Treatment

Minimally Invasive Techniques

Surgical Treatment

References

98 Feline Ureteral Obstruction: Diagnosis and Management

Introduction

Etiology

Treatment of Feline Ureteral Obstructions

Traditional Surgery

Interventional Options

Postoperative Management

Conclusion

References

99 Feline Lower Urinary Tract Obstruction

Pathogenesis of Obstruction

Predisposing Factors

Pathophysiology of Obstruction

History and Clinical Signs

Initial Stabilization

Urethral Catheterization

Diagnostic Evaluation

Postobstructive Care

Alternative Management Protocols

At-Home Care

Prognosis

References

100 Urethral Trauma

Incidence

Patient Evaluation

Diagnosis

Treatment

Conservative Management

Surgical Management

Complications

Stricture Management

Outcome

References

101 Lyme Nephritis

Introduction

Transmission, Prevalence, and an Experimental Model of Canine Lyme Disease

Presentation of Field Cases with Presumptive Lyme Nephritis [1–4,15]

Diagnostic Work-Up to Stage Disease and Rule Out Other Differentials [1–4,9,10]

Renal Biopsy

Treatment (Table 101.2)

Monitoring

Prevention, Tick Control and Lyme Vaccination

References

102 Chronic Kidney Disease

Introduction

Pathophysiology

Presentation

Diagnostics

Laboratory Tests

Imaging

Monitoring

Stabilization and Initial Therapy

Fluid Therapy

Management of Anemia

Hypertension (see Chapter 63)

Management of Gastrointestinal Signs

Dose Reduction

Prognosis and Long-Term Management

Conclusion

References

103 Uroabdomen

Etiology and Pathogenesis

Clinical Signs and Physical Examination Findings

Diagnosis and Laboratory Evaluation

Laboratory Findings

Imaging Findings

Emergent Stabilization

Treatment

Complications and Prognosis

References

104 Urethral Prolapse

Urethral Prolapse

Diagnosis

Treatment

References

105 Discolored Urine

Introduction

Examination of the Urine Specimen

Abnormal Urine Sediment Color

Hematuria

Other Cells or Particles

Abnormal Urine Supernatant Color

Endogenous Pigments

Exogenous Pigments

Multifactorial Urine Discoloration

Pigment-Induced Renal Injury

Conclusion

References

106 Urinary Diversion in the Emergency Room

Urinary Catheterization

Indications

Contraindications

Complications

Percutaneous Nephrostomy Tube

Indications

Complications

Percutaneous Antegrade Urethral Catheterization

Indications

Complications

Cystoscopy and Urethroscopy

Indications

Complications

Cystostomy Tubes

Indications

Complications

Peritoneal Drainage

Indications

Complications

References

G. Acid-base, Electrolyte and Endocrine Disorders

107 Acid–Base Disorders

Introduction

Sample Considerations

Acid–Base Regulation

Acid–Base Analysis

Evaluate pH

Determine the Primary Disorder

Compensation

Primary Versus Mixed Disorders

Acid–Base Disorders

Respiratory Alkalosis

Respiratory Acidosis

Metabolic Alkalosis

Metabolic Acidosis

Acid–Base and Prognosis

Case Example 1

Case Example 2

Case Example 3

References

108 Sodium and Water Balance

Introduction

Hyponatremia

Etiology

Clinical Signs

Diagnosis

Treatment

Hypernatremia

Etiology

Clinical Signs

Diagnosis

Treatment

Prognosis

References

109 Potassium Disorders

Introduction

Potassium Homeostasis

Hypokalemia

Definition and Etiology

Symptoms

Treatment

Hyperkalemia

Definition and Etiology

Symptoms

Treatment

References

110 Calcium, Magnesium, and Phosphorus Disorders

Introduction

Phosphorus Homeostasis

Hypophosphatemia

Hyperphosphatemia

Calcium Homeostasis

Hypocalcemia

Hypercalcemia

Magnesium Homeostasis

Hypomagnesemia

Hypermagnesemia

References

111 Hypoglycemia

Introduction

Pathophysiology

Clinical Signs

Causes of Hypoglycemia

Excess Secretion of Insulin or Insulin-Like Factors

Decreased Glucose Production

Excess Glucose Consumption

Drug-Associated Causes

Spurious

Diagnosis

Treatment of a Hypoglycemic Crisis

References

112 Hyperglycemia

Introduction

Stress Hyperglycemia

Diabetes Mellitus

Insulin Deficiency and Insulin Resistance

References

113 Complicated Diabetes Mellitus

Introduction

Pathogenesis

History and Physical Examination

Diagnostic Evaluation in the Emergency Room

Triage Panel

Measure Blood Glucose Concentration

Measure Ketones and Assess Degree of Acidemia

Quantify Degree of Hyperosmolality

Assess Electrolyte Abnormalities

Stabilization and Emergency Treatment

Restore Effective Circulating Volume (see Chapter 153)

Provide Ongoing Fluid Therapy

Treat Electrolyte Abnormalities

Initiate Insulin Therapy

Identify and Treat Concurrent Diseases

Post-crisis Therapy for Diabetes Mellitus

Outcome

References

114 Adrenal Gland Disorders

Introduction

Pheochromocytoma

Incidence

Pathophysiology

Clinical Signs and Physical Examination

Diagnostic Results

Treatment

Surgical Outcome and Prognostic Factors

Hyperaldosteronism

Incidence

Pathophysiology

Clinical Signs and Physical Examination

Diagnostic Results

Treatment and Prognosis

Hyperadrenocorticism

Pathophysiology

Clinical Signs and Physical Examination

Diagnostic Results

Treatment and Prognosis

References

115 Hypoadrenocorticism

Etiology and Pathogenesis

Anatomy and Pathophysiology

Mineralocorticoid Deficiency

Glucocorticoid Deficiency

Patient Evaluation

History and Physical Examination Findings

Feline Hypoadrenocorticism

Diagnosis

Emergency Cage-Side Tests and Imaging

Complete Blood Count (CBC)

Serum Chemistry Panel

Resting or Basal Serum Cortisol Levels

ACTH Stimulation Testing

Cortisol-to-Adrenocorticotropic Hormone Ratio

Primary Versus Secondary Hypoadrenocorticism

Treatment

Fluid Therapy

Hyperkalemia

Acidosis

Glucocorticoids

Chronic Management

Complications

Outcome

References

116 Thyroid Disorders

Introduction

Thyroid Physiology

Thyroid Testing

Hyperthyroidism

Hypothyroidism

Clinical Presentations

Hyperthyroidism

Hypertensive Retinopathy

Thyroid Storm

Iatrogenic Hyperthyroidism

Hypothyroidism

Myxedema Coma

References

117 Diabetes Insipidus

Introduction

Pathophysiology

Recognizing Diabetes Insipidus in the Emergency Patient

History

Physical Examination

Clinicopathological Abnormalities

Definitive Diagnosis

Treatment

Water Replacement

AVP Administration

Complications of Treatment – Cerebral Edema

Patient Discharge

Prognosis

References

H. Reproductive Disorders

118 Dystocia

Female Reproductive Anatomy and the Physiology of Parturition

Anatomy

Physiology of Parturition

Estimating Expected Date of Parturition

Stages of Parturition

Dystocia

Risk Factors

Classifying Dystocia

When is Examination of the Bitch or Queen Warranted?

Clinical Examination

Diagnostics

Indicators for Intervention

Medical Management of Dystocia

Surgical Management

Postoperative Care and Management

References

119 Eclampsia

Introduction

Etiopathogenesis

Diagnosis

Treatment (Box 119.1)

Prevention

References

120 Neonatal Resuscitation

Physical Examination

Respiratory Concerns

Cardiac Concerns

Hypothermia

Dehydration and Fluid Therapy

Hypoglycemia

Sepsis

When to Stop Resuscitation Efforts

References

121 Diseases of the Neonate

Introduction

Epizootiology

Physiology

Neonatal Disorders in the Immediate Postpartum Period

Disorders of Metabolism

Anasarca

Ciliary Dyskinesia

Hydrocephalus

Umbilical Herniation

Bowel Malformation: Agenesis or Duplication

Patent Urachus

Cleft Palate

Neonatal Isoerythrolysis (see Chapter 66)

Immunodeficiency

Neonatal Ophthalmia

Limb Deformities: Amelia, Hemimelia (Absence of a Limb or Distal Portion of a Limb), Pelvic Limb Hyperextension

Neonatal Disorders in the Later Postpartum Period

Orphans

Aspiration Pneumonia

Swimmer Puppies

Juvenile Cellulitis

Bacterial Overgrowth Syndrome-Associated Diarrhea

Urinary Ectopia

Hypoglycemia

Fading Puppy Syndrome: Neonatal Bacterial Septicemia and Herpes Infection (CHV-1)

Trauma

References

122 Metritis and Mastitis

Metritis

Clinical Signs

Diagnostics

Treatment

Mastitis

Clinical Signs

Diagnostics

Treatment

References

123 Pyometra

Signalment, Clinical Presentation, and Associated Disease

Diagnostics

Treatment

Stabilization

Antibiotic Therapy

Surgical Versus Medical Management

Surgical Management

Medical Management

References

124 Prostatic Disease

Introduction

Anatomy

Diagnostics

Prostatic Disorders

Benign Prostatic Hyperplasia and Cystic Benign Prostatic Hyperplasia

Squamous Metaplasia

Paraprostatic Cysts

Infectious Prostatitis

Prostatic Neoplasia

References

125 Uterine and Vaginal Prolapse

Uterine Prolapse

Etiopathogenesis

Diagnosis

Treatment

Vaginal Prolapse

True Vaginal Prolapse

Vaginal Fold Prolapse (Canine Only)

References

126 Penile, Preputial, and Testicular Disease

Priapism

Pathophysiology

Clinical Presentation

Diagnostics

Therapy

Paraphimosis

Pathophysiology

Clinical Presentation

Diagnostics

Therapy

Phimosis

Pathophysiology

Clinical Presentation

Diagnostics

Therapy

Persistent Penile Frenulum

Pathophysiology

Clinical Presentation

Diagnostics

Therapy

Balanoposthitis

Pathophysiology

Clinical Presentation

Diagnostics

Therapy

Urethral Prolapse (see Chapter 104)

Pathophysiology

Clinical Presentation

Diagnostics

Therapy

Penile Trauma

Pathophysiology

Clinical Presentation

Diagnostics

Therapy

Infectious Orchitis and Epididymitis

Pathophysiology

Clinical Presentation

Diagnostics

Therapy

Testicular Torsion

Pathophysiology

Clinical Presentation

Diagnostics

Therapy

Scrotal Dermatitis

Pathophysiology

Clinical Presentation

Diagnostics

Therapy

References

I. Common Toxins

127 Decontamination and Toxicological Analyses of the Poisoned Patient

Introduction

Gastrointestinal Decontamination

Emetic Agents

Gastric Lavage

Activated Charcoal

Multidose Activated Charcoal

Complications

Administration of Charcoal

Toxicological Analyses

Conclusion

References

128 Lipid “Rescue” Therapy

Introduction

Available Formulations

Historical Use in Human Medicine

Use in Veterinary Medicine

Mechanism of Action

Recommended Dosing

Potential Complications

References

129 Blood Purification Techniques for Intoxications

Introduction

Intermittent Hemodialysis

Prolonged Intermittent HD and Continuous Therapies

Hemoperfusion

Combination Hemodialysis/Hemoperfusion

Apheresis

Indications for the Use of Extracorporeal Therapies in Treatment of Poisoning

Medical Management for Intoxications

Conclusion

References

130 Rodenticide Toxicity

Introduction

Decontamination

Anticoagulant Rodenticides

Neurotoxic Rodenticides

Cholecalciferol Rodenticides

Phosphide Rodenticides

Aldicarb Rodenticide

References

131 Ethylene Glycol Intoxication

Introduction

Clinical Signs

Diagnostic Testing

Treatment

Hemodialysis

References

132 Acetaminophen Intoxication

Introduction

Pharmacokinetics and Toxicokinetics

Toxic Doses

Clinical Signs

Gross and Histological Lesions

Diagnosis

Treatment

N-Acetylcysteine

Ascorbic Acid

Silymarin

Histamine Receptor Antagonists

S-Adenosyl Methionine

Methylene Blue

Prognosis

References

133 Non-Steroidal Anti-Inflammatory Drug Intoxications

Mechanism of Action

Pharmacokinetics

Adverse Effects

Gastrointestinal Toxicity

Renal Injury

Hepatic Injury

Coagulation and Hematological Issues

Neurological Complications

Treatment of NSAID Intoxication

References

134 Grape, Raisin, and Lily Ingestion

Grape, Raisin, and Currant Nephrotoxicity Pathogenesis

Lily Nephrotoxicity Pathogenesis

Physical Examination

Initial Diagnostics

Management of Non-Azotemic Animals Shortly After Exposure

Managing Patients with Established Acute Kidney Injury

Prognosis

References

135 Recreational Drug Intoxications

Cocaine

Mechanism and Toxicokinetics

Clinical Signs

Differential Diagnoses

Diagnostics

Treatment

Prognosis

Methamphetamine

Mechanism and Toxicokinetics

Clinical Signs

Diagnostics and Treatment

Differential Diagnoses

Prognosis

Marijuana

Mechanism and Toxicokinetics

Clinical Signs

Differential Diagnoses

Diagnostics

Treatment

Prognosis

Conclusion

References

136 Household Toxins

Decontamination

Common Household Toxin Exposures

Foods

Outdoor Products

Cleaning Products

Foreign Objects

Conclusion

References

J. Skin and Soft Tissue Disease

137 Life-Threatening Dermatological Emergencies

Dermatological Emergencies

Methicillin-Resistant Staphylococcal Infections (MRSIs)

Burns

Frostbite

Drug Eruption

Vasculitis

Erythema Multiforme

Toxic Epidermal Necrolysis and Stevens–Johnson Syndrome

References

138 Severe Soft Tissue Infections

Introduction

Etiology

Pathophysiology

Clinical Features (Table 138.1)

Diagnosis (see Table 138.1)

Treatment (see Table 138.1)

Prognosis

References

K. Environmental Emergencies

139 Smoke Inhalation Toxicity

Introduction

Pathophysiology of Smoke Inhalation

Carbon Monoxide and Cyanide Exposure

Physical Examination Findings

Diagnostics

Treatment

Prognosis

References

140 Porcupine Quilling

Introduction

Prehospital Care

Quill Removal

Discharge Instructions

Complicated Quillings

Conclusion

References

141 Crotalinae Snake Envenomation

Introduction

Crotalinae Envenomation

Clinical Signs of Envenomation

Patient Evaluation and Stabilization

Antivenoms

Additional Therapies

References

142 Elapid Snake Envenomation: North American Coral Snakes and Australian Elapids (Tiger Snakes, Brown Snakes, Taipans, Death Adders, and Black Snakes)

Introduction

Elapid Species Identification

North America

Australia

Pathophysiology of Elapid Venoms

Neurotoxins

Procoagulant Toxins

Anticoagulant Toxins

Myotoxins

Hemolytic Toxins

Local-Acting Cytotoxins

Clinical Signs of Envenomation

Preparalytic Signs

Paralysis

Coagulopathy

Rhabdomyolysis

Hemolysis and Anemia

First Aid Advice for Owners

Treatment of Envenomation in Dogs and Cats

Asymptomatic Patients

References

143 Spider and Scorpion Envenomation

Spider Envenomation

Loxoscelism

Lactrodectism

Theraphosidae Spiders

Scorpion Envenomation

Pathophysiology of Envenomation

Clinical Effects of Scorpion Envenomation in People

Treatment of Scorpion Envenomation in People

Scorpion Envenomation in Dogs and Cats

References

144 Bufo Toad Toxicosis

Introduction

Incidence

Signalment

Clinical Signs of Envenomation

Diagnosis

Treatment and Monitoring

Prognosis

Acknowledgments

References

145 Hymenoptera Envenomation

Apoidea

Vespoidea

Formicidea

Venom

Lethal Dose

Clinical Manifestations of Envenomation

Immune-Mediated Response

Systemic Toxic Reactions

Diagnosis

Treatment

Treatment of Systemic Anaphylaxis

Treatment of Toxic and Delayed Reactions

References

146 Hypersensitivity and Anaphylaxis

Incidence and Definitions

Classification and Pathophysiology of Hypersensitivity Reactions and Anaphylaxis

Etiologies and Clinical Manifestations

Diagnosis

Treatment

Antihistamines

Glucocorticoids

Epinephrine

Bronchodilators

Intravenous Fluids and Other Ancillary Treatments

Prognosis

References

147 Canine Heat Stroke

Pathophysiology

Risk Factors for Developing Heat Stroke

Clinical Signs and Diagnosis

Hematological Disorders and Biochemical Abnormalities

Coagulation Disorders and Disseminated Intravascular Coagulation

Other Complications: Acute Kidney Injury, Central Nervous System Dysfunction, ARDS, Cardiac Arrhythmias, and Gastrointestinal Bacterial Translocation

Acute Kidney Injury

Central Nervous System Dysfunction

Acute Respiratory Distress Syndrome

Cardiac Arrhythmias

Gastrointestinal Bacterial Translocation

Treatment Options

Monitoring

Prognosis

Conclusion

References

148 Cold Exposure

Introduction

Pathophysiology of Effects of Cold Exposure [1–3,6–10]

Management [1–3,7–10]

Frostbite

Pathophysiology [1,2,16,20]

Management

References

149 Electrical and Lightning Injuries

Introduction

Electrical Injury

Mechanisms of Electrical Injury

Predisposition to Electrical Injury

Clinical Findings

Secondary Effects of Electrical Injury

Treatment of Electrical Injury

Prognosis

Lightning Injury

References

Section 4 Trauma and Resuscitation

A. Cardiopulmonary Resuscitation

150 Cardiopulmonary Resuscitation in the Emergency Room

Recognition of Cardiopulmonary Arrest

Airway Assessment

Breathing Assessment

Diagnosis of CPA

Basic Life Support

Chest Compressions

Ventilation

Advanced Life Support

Initiating ALS

Interpreting the ECG

Non-Shockable Arrest Rhythms

Shockable Arrest Rhythms

Prognosis

References

151 Small Animal Cardiopulmonary Resuscitation Initiatives

Strategically Advancing the Field of Veterinary CPR

Evidence-Based Consensus Small Animal CPR Guidelines

Knowledge Gaps

Glossary and Guidelines For Standardized Reporting

CPR Registry

Conclusion

References

B. Circulatory Shock

152 Pathophysiology of Shock

Introduction

Cellular Impact

Systemic Impact

Secondary Systemic Sequelae

Systemic Inflammatory Response

Coagulopathy

Mitochondrial Dysfunction

Microcirculatory Dysfunction

Multiple Organ Dysfunction Syndrome

Conclusion

References

153 Hypovolemic Shock

Pathophysiology of Hypovolemic Shock

Decompensation

Diagnosis of Hypovolemic Shock

Physical Examination

Blood Pressure

Electrocardiogram

Laboratory Tests

Diagnostic Imaging

Response to Treatment

Emerging Diagnostic Techniques

Treatment of Hypovolemic Shock

Resuscitation Endpoints

Complications of Hypovolemic Shock

References

154 Cardiogenic Shock

Introduction

Pathophysiology (see Chapter 152)

Incidence and Etiology

Diagnosis

Physical Examination

Electrocardiogram (ECG)

Thoracic Radiography

Laboratory Exam findings, Lactate, Biomarkers, and Arterial Blood Pressure

Echocardiography

Sublingual Microcirculation

Treatment and Monitoring

Conclusion

References