Transcript education - Dr. Roberta Dev Anand

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
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
Anaphylaxis/Allergic reactions
• Signs
– Sudden onset of vom/diarrhea
– Shock
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• Gums are pale
• Limbs are cold
• HR rapid, weak
Face scratching (early sign)
Respiratory distress
Collapse
Seizures
Coma
Death
Anaphylaxis/Allergic reactions
• Rx (this is an extreme emergency)
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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
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
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
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
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
Emergency Drugs in Cats
Emergency Drugs in Dogs
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
Pain Management
• Signs
– Vocalization
– ↑HR
– ↑RR
– Restlessness, abnormal posturing, unwilling to move
– ↑ Body temperature
– ↑BP
– Inappetence
– Aggression
– Facial expression, trembling
– Depression, insomnia
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
Pain Management
• Pain Relief
– Nonpharmacologic interventions (differentiate
pain vs stress)
• Give relief from:
– Boredom, Thirst, Anxiety, Need to urinate/defecate
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Clean bedding/padding
Reduce light/sound
Stroking pet, calming speech
Owner visits (±)
Minimize painful events (reduce #, improve skills in
injections, blood draw]
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
Pain Management
• Drug Options
– Nonsteroidal Antiinflammatory Drugs (NSAIDs)
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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
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μ: analgesia, sedation, and resp depression
Κ: analgesia and sedation
Σ: depression, excitement, anxiety
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• Side effects
– Vomiting, constipation, excitement, bradycardia, panting
• Metabolized by liver; excreted by kidneys
– Use caution with hepatic, renal disease
Pain Management
• Opioids
– Morphine sulfate
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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
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
Pain Management
• Opioids
– Antagonists
• Naloxone HCl
– Reversal occurs within 1-2 min
– Can be used to reverse anesthesia (Inovar-Vet)