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24 Cards in this Set
- Front
- Back
- 3rd side (hint)
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Define Trauma
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Any force or exposure from the environment which causes undesirable changes, injury, or death in the affected animal
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What are the general worrisome net results of trauma?
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Poor Perfusion/Oxygenation due to:
Hypovolemia Shock Poor Ventilation |
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What is the goal of INITIAL treatment?
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Ensure adequate delivery of O2 to all tissues
How is this goal achieved? (5 steps) |
1. Assure a reliable Airway
2. Restore normal intrapleural pressure 3. Assure normal function of bellows apparatus 4. Maintain normal alveolar ventilation 5. Maintain effective circulation |
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What are the 5 basic parts of the Overall Management Plan?
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1. Eliminate immediate threats to life
2. Initial examination and resuscitation 3. Stabilization and re-evaluation 4. Definitive repair 5. Convalescence |
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Number 1 step if animal is comatose or stuporous?
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INTUBATE
Extend neck, clear pharynx of mucus, blood, vomit --- insert tube if reflexes are absent or depressed. |
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Stridor
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High Pitched Inspiratory Wheeze
Indicative of? |
Upper airway obstruction.
(Laryngeal/Trachel injury, commonly seen with bite wounds) O2 via face mask, maybe tube/trach. |
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Subcutaneous emphysema of the neck
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Air under the skin - suggests leaking trachea.
*Air under chest is suggestive of leaky pleural cavity - ie pneumothorax |
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Indicators of Tension Pneumothorax?
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dyspnea, restlessness, decreased lung sounds, hyperresonance
Treatment? |
Immediate Thoracocentesis
(continuous drainage often needed) |
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How do you treat an open chest wound?
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1. Put chest tube through the existing wound.
2. Restore normal negative intrapleural pressure by aspiration |
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What is the action of the obturator externus?
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-lateral rotator (NOT ADDUCTION)
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What changes occur in advanced shock?
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Arteriole constriction causes severe tissue damage downstream - so they open up and POSTCAPILLARY Sphincters are constricted.
Stagnation of blood in Cap Beds. Cells become Waterlogged Cells switch to Anaerobic |
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Oxygen delivery to cells depends on what main factors?
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Arterial O2 content x Cardiac Output
*The Hemoglobin content (carries 97% of blood O2) x [SV x HR] How do we try to increase the O2 delivery? |
HR is usually already up in trauma patient.
Therefore - increase SV by giving fluids. If very Hemodilute (less than 30% PCV) then give blood as well. |
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If you are trying to increase SV to help with reperfusion --- what do you use and what do you dose?
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Warm Balanced Electrolyte Soln
at 45-90 mL/kg-hr |
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Should you administer corticosteroids?
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Maybe - it's contraversial.
Might be good within 2 hours of Hemorrhagic Shock. Ups CO, SV, Inhibits Inflamm Paths, might help prevent Reperfusion Injury |
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Okay, patient alive - Airway secured, Hemorrhages controlled, Ventilation adequate.... now what?
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Re-examine.
More thorough physical! What are you monitoring? |
TPR (T - core and web), MM-CRT
Urine output, EKG, PCV/TS/Dex, BP |
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Would you ever take an animal into surgery before it became stable?
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Only with Severe Ongoing Hemorrhage which does not respond to transfusion.
How do you know if you should open up the chest or abdomen? |
Do a chest tap and a belly tap to find where bleed is coming from - hemorrhage will not clot when removed.
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When do you have to be weary of the fluid rate to increase SV?
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If animal has Pulmonary Contusion.
Don't want to fix heart by causing respiratory failure! What is the current dose for a suspected contusion? |
10-15 mL/kg-hr
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Ideally you'd like:
PCV = Total Solids = Albumin = |
PCV 25-30%
Total Solids 4-5 g/dL Albumin at least 2 g/dL |
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Okay... cardiovascular and pulmonary function are stable - now what?
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Re-Evaluate - be wary of missed diagnoses - seek a definitive Tx
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Occult Injuries
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Urinary Leakage, Ruptured Bladder, Lacerated Urethra
Ischemia/Necrosis or Rupture of Bowel and or Biliary Tree |
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Ischemic/Necrotic Bowel leads to Septic Peritonitis
What are the signs? |
Can be notice 6-24hrs after trauma
Pain, Vomition, Fever Take rads to confirm Fairly uncommon |
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What about noticing urinary issues?
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hematuria, dysuria, anuria, sublumbar pain.
vomition, dehydration, polydypsia. Azotemia, Hyponatremia, Hyperkalemia Evident by 24hrs |
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And bile occult issues?
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May not develop for 2 weeks after injury.
Distension, icterus, anorexia. |
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What is 'convalescence' in this setting?
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Educating the owner and making sure they understand and do everything they can to assist in the healing process of their animal.
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