Practical Approach to the Small Animal Emergency Patient

A concise, accessible guide to clinical decision making in veterinary emergency medicine focused on the thought process in selecting diagnostic and treatment options Practical Approach to the Small Animal Emergency Patient helps veterinarians identify the critical questions to identify diagnostic and therapeutic priorities when faced with an emergency situation. The book reviews important decision points for common emergencies and emphasizes how to think, not just what to do. The first section of the book covers general principles of emergency medicine topics such as triage, sedation and lab work selection, while the latter part of the book applies those principles to common emergency presentations. The intention of this book is not to provide the clinician with an exhaustive review of pathophysiology, but uses current research and decision making tools to provide the clinician with the questions and tools to decide whether a certain intervention is appropriate. Each chapter also includes a section on client communication to help guide new clinicians in speaking with family members about diagnostic testing, treatment approaches, and prognosis. Written by a board-certified criticalist and practicing veterinarian in emergency medicine, Practical Approach to the Small Animal Emergency Patient includes information on: - Fluid therapy, covering fluid requirements, fluid selection, patients with heart murmurs, and correcting electrolyte abnormalities- Sedation and analgesia, covering appropriate use and risks of inadequate or inappropriate sedation- Diabetic emergencies including diabetic ketoacidosis, hyperglycemic nonketotic syndrome, and hypoglycemia- Treatment for car accidents, penetrating trauma, and dog bite wounds- Gastrointestinal distress, covering surgical versus non-surgical causes, the need for imaging, and difference between inpatient and outpatient assessment Practical Approach to the Small Animal Emergency Patient is an essential guide for clinicians, particularly new graduates and emergency doctors, seeking to gain confidence and improve their decision-making in emergency situations.

Michael Verschoor-Kirss, DVM, DACVECC, is Staff Criticalist at VCA South Shore Animal Hospital in South Weymouth, Massachusetts, USA.

Table of Contents   Part I: Practical approaches for the emergent patient Chapter 1: The triage exam................................................................................ 5 - The triage history and presenting complaint - The triage physical exam - Initial diagnostic and stabilization options Chapter 2: Rational lab work selection and "diagnostic stewardship"..................... 14 - Determining the need for testing - Speed versus accuracy: Point of care and send out lab work - Testing for a purpose: Rule in versus rule out lab testing Chapter 3: Selecting appropriate imaging studies................................................ 22 - History and physical exam to justify imaging - Limitations and risks of diagnostic imaging Chapter 4 Intravenous Fluid Therapy: Yes, no, how much, how fast........................ 29 - Assessing hydration and volume status - Creating a fluid therapy plan - Fluid therapy for the patient with a heart murmur Chapter 5: Analgesia and sedation.................................................................... 43 - Risk/benefit of (in)appropriate sedation and analgesia - Cardiopulmonary effects of sedatives and analgesics - Building a sedation protocol - Sedating the patient with a heart murmur Chapter 6: Use of antibiotics in the emergent patient........................................... 60 - Assessing the need for antibiotics - A location-based approach to antimicrobial therapy - Risk factors for multidrug resistant infections Chapter 7: Decision making for hospital admission.............................................. 74 - Benefits of hospitalization - Owner goals of care   Part II: Clinical reasoning for common diseases and presentations Chapter 8: Approach to the "down dog"............................................................. 78 - Differentiating between cardiovascular, neurologic, and toxicologic disease Chapter 9: Diabetic Emergencies....................................................................... 86 - Differentiating diabetes mellitus from stress hyperglycemia - Managing the "healthy" diabetic - Assessing the "sick" diabetic - Evaluating cats on SGLT-2 inhibitors - Fluid and insulin therapy for DK/DKA and HHS patients - The hypoglycemic diabetic Chapter 10: Trauma...................................................................................... 107 - Initial patient assessment and stabilization in trauma - Managing traumatic brain injury/craniomaxillofacial trauma and the role for CT - Imaging and treatment of thoracic trauma - Assessment and management of abdominal trauma and cavitary effusions - Fracture and soft tissue injury assessment and stabilization - Decision making and prognosis with vertebral fractures - Stabilization and management of penetrating thoracic or abdominal wounds - Bite wound assessment Chapter 11: Spontaneous hemoabdomen......................................................... 148 - Patient assessment and stabilization - Utility of imaging - Transfusion decision making - Surgical timing - Likelihood of hemangiosarcoma - Perioperative monitoring Chapter 12: Gastric dilatation and volvulus (GDV).............................................. 167 - Patient evaluation and stabilization - The prognostic role of lactate - Surgical timing - Perioperative complications Chapter 13: The blocked cat........................................................................... 176 - Stabilizing the hyperkalemic UO - Urethral rupture and the un-unblockable cat - Recurrent urethral obstruction Chapter 14: Approach to vomiting and diarrhea................................................. 192 - Surgical versus non-surgical causes and the need for imaging - Medical versus surgical management for foreign body obstruction - Assessing the inpatient versus outpatient GI distress Chapter 15: Dyspnea..................................................................................... 210 - Upper versus lower airway localization - Point of care ultrasound in the dyspneic patient - Evaluating for congestive heart failure - Oxygen therapy and fallback strategies for the dyspneic patient Chapter 16: Neurologic emergencies................................................................ 232 - Managing the 1st time seizure - Value of advanced imaging in the seizure patient - Stabilizing and treating cluster seizures and status epilepticus - Approaching the "chronic" seizure patient - Vestibular disease - Decision making and management for spinal cord disease Chapter 17: Immune mediated hemolytic anemia (IMHA) and thrombocytopenia (ITP) 260 - Diagnosis and testing for IMHA/ITP - Transfusion decision making in IMHA/ITP - Initial immunosuppression for IMHA/ITP - Thromboprophylaxis in IMHA - Hemorrhage management for ITP - Use of adjunctive therapies Chapter 18: Approach to the azotemic pet........................................................ 280 - Identifying acute, acute on chronic, and chronic kidney failure - Differentiating and managing acute, acute on chronic, and chronic renal failure - When to monitor urinary output - Managing oligo/anuria - Considerations for hemodialysis Chapter 19: Managing the chronic disease patient............................................. 296 - Assessing for progression of chronic disease - Common medication side effects - Medication adjustment options Chapter 20: Toxin ingestion management......................................................... 305 - Induction of emesis - Decision making for charcoal administration - Use of intralipid emulsion - Indications for intravenous fluid diuresis - Extracorporeal therapy Chapter 21 Client communication and palliative care......................................... 316 - Diagnosis and decision making - Identifying goals of care - Tools to maintain patient comfort and dignity - Discussing euthanasia Chapter 22: Cardiac emergencies..................................................................... 322 - Initial and fallback treatments for congestive heart failure - Diagnosis, treatment, and prognosis for feline arterial thromboembolism (ATE) - Arrhythmia identification and management Chapter 23: Reproductive Emergencies............................................................ 349 - Dystocia identification - Medical and surgical management of dystocia - Neonatal resuscitation and postpartum conditions - Pyometra management Chapter 24: Cardiopulmonary-Cerebral Resuscitation (CPCR)............................... 361 - Reversible causes for cardiac arrest - Managing the traumatic cardiac arrest - Terminating resuscitative efforts - Post resuscitation care