Advanced Monitoring and Procedures for Small Animal Emergency and Critical Care

Description:

Advanced Monitoring and Procedures for Small Animal Emergency and Critical Care.

Detailed, standardized, step-by-step protocols for easy access to essential information in small animal emergency rooms and intensive care units.

Advanced Monitoring and Procedures for Small Animal Emergency and Critical Care, Second Edition offers a complete and clinically oriented reference for step-by-step detail on a wide range of procedures in the small animal emergency room and intensive care unit. Each protocol provides detailed instructions grounded in the evidence. The book is carefully designed for ease of use, with concise but comprehensive explanations, useful equipment lists, protocols called out in boxes, and extensive reference lists.

In the revised and expanded Second Edition, information has been updated and expanded throughout, and information and chapters have been added in many important areas, including veterinary point-of-care ultrasound (VPOCUS), veterinary CPR, blood banking and transfusion medicine, advanced techniques for mechanical ventilation, and veterinary health care team wellbeing. A companion website offers the protocols in Word for editing and use in practice and the figures from the book in PowerPoint.

Specific topics covered in Advanced Monitoring and Procedures for Small Animal Emergency and Critical Care include:

• The cardiovascular system, covering catheterization of the venous compartment, arterial puncture and catheterization, cardiac VPOCUS, principles of electrocardiography, and electrocardiogram interpretation
• The respiratory system, covering oxygen therapy, pulse oximetry and CO-oximetry, blood gas analysis, pleural space and lung VPOCUS, tracheal intubation, and temporary tracheostomy
• The urinary and abdominal systems, covering urethral catheterization, abdominal VPOCUS, peritoneal dialysis, technical management of hemodialysis patients, and peritoneal evaluation
• Transfusion medicine, covering blood banking, blood typing, cross-matching, and administration of blood and other biological products

Advanced Monitoring and Procedures for Small Animal Emergency and Critical Care presents invaluable and accessible information for emergency situations, making it a highly useful reference for veterinary practitioners, veterinary technicians and nurses, veterinary students, small animal emergency and critical care residents, small animal emergency and critical care specialists, and emergency and critical care veterinary technicians and nurse specialists.

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Table of contents :

Cover
Title Page
Copyright Page
Contents
List of Contributors
Preface to the Second Edition
Acknowledgments
About the Companion Website
Section One Fundamental Elements of Emergency and Critical Care Practice
Chapter 1 Triage
Telephone Triage
Hospital Triage
The ABCDEs
Airway and Breathing
Circulation
Dysfunction or Disability of the Neurologic System
Exposure/Examination
Body Temperature
Point-of-Care Ultrasound
Summary
References
Chapter 2 The Small Animal Emergency Room
Physical Plant
ER Design and Flow
Back-up Power
Security
Entrance and Lobby
Comfort Rooms
Treatment Area
The Isolation Ward
In-House Laboratory
Diagnostic Imaging
Staff Spaces
Utility Spaces
Equipment
Imaging
The In-House Laboratory
Patient Monitors and Equipment
Fluid and Drug Administration
Thermal Support
Oxygen
Anesthesia Waste Gas Scavenging
Medical Vacuum
Inventory
Medical Supplies
Airway Management
Breathing
Circulation
Additional Supplies
Pharmacy
Shock and Cardiopulmonary Arrest
Anti-Infectives
Analgesics, Sedation, and Anesthesia
Intoxications
Gastrointestinal Medications
Endocrine Emergencies
Urogenital Emergencies
Ophthalmologic Emergencies
Neurological Emergencies
Staffing the Emergency Practice
Hospital Management and Systems
Medical Records
Practice Management Software
Other Information Management
Management
Summary
References
Chapter 3 Intensive Care Unit Design
The Design Process
Development
Location in the Hospital
Facility Configuration
ICU Size
The Ground Plan
Staff Work Areas
Patient Area
Ancillary Rooms
Facilities Outside the ICU Complex
Interior Design
Environment
Utilities
Floors, Walls, and Ceilings
Furnishings
Medical Equipment
Special Design Considerations
Infection Prevention and Control
Written Communications
Safety and Security Measures
References
Recommended Reading
Chapter 4 Developing and Using Checklists in Practice
Introduction
Why Checklists?
Types of Checklists
Design Considerations
Testing
Implementation
Modification
Ongoing Accountability
Celebrate Successes
Checklists Help Build a Reliable Culture of Safety
References
Chapter 5 Medical Charting
Medical Record Documentation
Medical Record Organization
Medical Record Format
Components of a Complete Medical Record
Client Information
Patient Information
Presenting Complaint
History
Physical Examination
Problem Lists
Progress Notes
Communication Log
Comments
Other Additions to the Patient Record
Clinician Order Sheets and Treatment/Flow Sheets
Clinician Orders
Treatment Sheets
Daily Patient Flow Sheets
Patient Identification
Patient Weight
Nutritional Considerations
Laboratory Measurements
Patient Treatments and Observations
Medications
Fluids
Body Systems Evaluations
Cardiovascular System
Respiratory System
Nervous System
Urinary System
Computerized or Electronic Medical Record
Patient Privacy
Conclusions
References
Chapter 6 Point-of-Care Ultrasound for Emergency and Critical Care
Introduction
Machine Settings, Transducers, and Materials for ECC VPOCUS
Transducer Movements
Indications
Serial VPOCUS
Limitations
Conclusions
References
Section Two Cardiovascular Procedures and Monitoring
Chapter 7 Catheterization of the Venous Compartment
Selection of Catheter Insertion Site and Type
Peripheral Catheter Placement
Peripheral Cutdown Techniques
Central Venous Access
Catheter Types for Central Veins
Central Venous Catheter Placement Techniques
Ultrasound-Guided Venous Access
Alternate Vascular Access Options
Intraosseous Catheterization
Care of Intravascular Devices
Catheter Flushing
Peripheral Intravenous Catheters
Central Intravenous Catheters
Complications
Acknowledgment
References
Chapter 8 Arterial Puncture and Catheterization
Arterial Puncture
Procedure
Sublingual Venipuncture
Arterial Catheter Placement
Site Selection
Aseptic Technique
Analgesia
Percutaneous Facilitation
Securing the Arterial Catheter
Dorsal Pedal Artery Catheterization
Femoral Artery Catheterization
Auricular Artery Catheterization
Radial Artery Catheterization
Coccygeal Artery Catheterization
Arterial Catheter Care
Complications Associated with Arterial Puncture or Catheter Placement
Contraindications to Arterial Puncture and Catheterization
Troubleshooting
References
Chapter 9 Ultrasound-Guided Vascular Access
Indications for Ultrasound-Guided Vascular Access
Techniques
Complications of Ultrasound-Guided Vascular Access
Ultrasound-Guided Vascular Access Simulators
References
Chapter 10 Principles of Electrocardiography
Cardiac Electrical Activity
The Wave of Depolarization
The Electrocardiogram
Recording the Wave of Depolarization
Einthoven’s Triangle and the Principle of Leads
Standard ECG Leads
ECG Measurement in the Emergency Room and Intensive Care Unit
Electrode Placement and Patient Positioning
Types of Electrodes
Electrocardiogram Recording
Ambulatory Continuous ECG Monitoring and Telemetry
Ambulatory Continuous ECG Monitoring
ECG Telemetry
Equipment Problems Leading to ECG Artifacts
Acknowledgments
References
Chapter 11 Electrocardiogram Interpretation
Introduction
Acquiring an Electrocardiogram
The Diagnostic Electrocardiogram
Continuous Monitoring
Electrocardiogram Waveforms
Stepwise Interpretation of the Electrocardiogram
Determine the Heart Rate
Evaluate the Overall Rhythm
Evaluate the Complexes and Intervals
Compare Measurements with Normal Ranges
Recognizing Artifacts
Summary
Skill Sets
Skill Set 1: Distinguishing 60-Cycle Interference from Atrial Fibrillation or Atrial Flutter
Skill Set 2: Distinguishing Third-Degree Atrioventricular Block from Atrioventricular Dissociation
Skill Set 3: Distinguishing APCs from Ventricular Premature Complexes
Skill Set 4: Distinguishing Ventricular Tachycardia from Supraventricular Tachycardia
Skill Set 5: Distinguishing Ventricular Premature Complexes from Ventricular Escape Beats
Skill Set 6: Recognition of Pulseless Electrical Activity
Skill Set 7: Distinguishing Ventricular Tachycardia from Accelerated Idioventricular Rhythm
Skill Set 8: Recognition of Ventricular Flutter and Fibrillation
Skill Set 9: Recognition of ST Segment Elevation or Depression
Skill Set 10: Distinguishing Bundle Branch Block from Ventricular Rhythms
Acknowledgments
References
Chapter 12 Fluid-Filled Hemodynamic Monitoring Systems
Driving Pressure, Resistance, and Blood Flow
Determinants of Intravascular Pressure
Determinants of Systemic Arterial Pressure
Determinants of Central Venous Pressure
Determinants of Pulmonary Arterial Pressure
Indications for Direct Intravascular Pressure Monitoring
Types of Direct Intravascular Pressure Monitoring Systems
Measurement System Components
Intravascular Catheter
Noncompliant Tubing
Water Manometer
Pressure Transducer
Assembling the Electronic Direct Pressure Measurement System
Technical Aspects of the Electronic Direct Pressure Measurement System
Zeroing the Transducer
Calibrating the System
Leveling the Transducer
Dynamic Response of the System
Effect of the Measuring System’s Natural Frequency
Effect of a System’s Damping Coefficient
Determining the System’s Dynamic Response
Optimizing Dynamic Response by Altering a Monitoring System’s Natural Frequency and Damping Coefficient
Summary
Acknowledgments
References
Chapter 13 Direct Systemic Arterial Blood Pressure Monitoring
Indications for Direct Arterial Pressure Monitoring
Advantages and Disadvantages of Indirect Blood Pressure Monitoring
Advantages and Disadvantages of Direct Arterial Pressure Monitoring
Continuous Direct Arterial Blood Pressure Equipment and Setup
Normal Arterial Pressure Waveforms
Calculations Derived from the Arterial Pressure Waveform
Calculations of Arterial Blood Pressure Variation
Other Uses for the Arterial Pressure Waveform
Abnormal Arterial Pressure Waveforms
Technical Problems that Cause Abnormal Arterial Pressure Waveforms
Patient Problems that Cause Abnormal Arterial Pressure Waveforms
Thresholds of Concern for Arterial Pressure Value and Waveform Abnormalities
Troubleshooting Abnormal Waveforms
Conclusions
References
Chapter 14 Noninvasive Arterial Blood Pressure Monitoring
Comparison of Blood Pressure Monitoring Modalities
Validation of Noninvasive Arterial Blood Pressure Monitoring
Indications for Noninvasive Blood Pressure Monitoring
Hypotension
Hypertension
Noninvasive Blood Pressure Monitoring Methods
Doppler Ultrasound
Standard Oscillometry
High Definition Oscillometry
Optimizing Reliability of Noninvasive Arterial Blood Pressure Measurements
Conclusion
Acknowledgments
References
Chapter 15 Central Venous Pressure Monitoring
Determinants of Central Venous Pressure
Indications for the Measurement of Central Venous Pressure
Risks
Reference Interval
Measurement Technique
Catheter Selection and Placement
General Principles
Zeroing and Leveling
Intermittent Central Venous Pressure Measurement
Continuous Central Venous Pressure Measurement
Maintenance of the Continuous CVP System
CVP Interpretation
Potential Sources of Interpretation Errors
Performing a Fluid Challenge
The Normal CVP Waveform
Determining the CVP from the Normal Waveform
Abnormal CVP Waveforms
Respiratory Changes
Arrhythmias
Pericardial Effusion with Cardiac Tamponade
Tricuspid Regurgitation
Pulmonic Stenosis and Pulmonary Hypertension
Alternative Techniques for Assessing Vascular Volume
Conclusion
References
Chapter 16 Cardiac Output Monitoring
Indications for Cardiac Output Measurement
Cardiac Output Measurement
Indicator Dilution Techniques
Balloon-Tipped Thermodilution Catheter
Insertion of the Balloon-Tipped Thermodilution Catheter and Complications
Thermodilution Cardiac Output Measurement
Lithium Cardiac Output Measurement
Other Measurements and Calculations
Other Methods of Estimating Cardiac Output
The Fick Method
Arterial–Venous Oxygen Content, Oxygen Extraction, Venous Oxygen, Arterial–Venous Oxygen Saturation
Carbon Dioxide-Based Fick
Venous–Arterial Partial Pressure of Carbon Dioxide
Pulse Contour Methods
Transthoracic Impedance and Bioreactance
Doppler Ultrasound
Other Methods
Interpreting Measurements
Conclusion
Acknowledgments
References
Chapter 17 Point-of-Care Cardiac Ultrasound
Equipment, Patient Preparation, and Image Acquisition for Cardiac Veterinary Point-of-Care Ultrasound
Two-Dimensional Echocardiography
M-Mode Echocardiography
Cardiac Veterinary Point-of-Care Ultrasound Windows and Views
Two-Dimensional Right Parasternal Views
Subxiphoid View
Interpretation of Cardiac Veterinary Point-of-Care Ultrasound Findings
Interpretation of the Left Atrium–Aortic Root Ratio
Interpretation of the Left Ventricular Mushroom View
Interpretation of Right Parasternal Long-Axis Views
Interpretation of Pericardial Effusion
Caudal Vena Cava Assessment at the Subxiphoid Window
Cardiac Veterinary Point-of-Care Ultrasound for Assessment of Mechanical Cardiac Activity During Cardiac Arrest
References
Chapter 18 Pericardiocentesis
The Pericardium
Pericardial Space Disease
Hemodynamic Changes Associated with Pericardial Effusion
Clinical Signs Associated with Pericardial Effusion
Physical Examination
Pulsus Paradoxus
Diagnosis of Pericardial Effusion
Echocardiography
Radiography
Alternative Imaging Modalities
Electrocardiography
Blood Testing
Pericardial Fluid Analysis
Emergency Treatment of Pericardial Effusion
Pericardiocentesis
Longer-Term Treatment of Pericardial Effusion
Complications
Post-Pericardiocentesis Monitoring
Acknowledgments
References
Chapter 19 Monitoring Tissue Perfusion: Clinicopathologic Aids and Advanced Techniques
Clinical Monitoring of Tissue Perfusion
Physical Examination
Arterial Blood Pressure Monitoring
Urine Output
Clinical Imaging
Standard Clinicopathologic/Metabolic Markers of Tissue Perfusion
Advanced Tissue Perfusion Monitoring Techniques
Near-Infrared Spectroscopy
Microcirculation Visualization
Transcutaneous O2 and CO2 Monitoring
Regional Capnography
Thermography
Cutaneous Laser Doppler
Urine Partial Pressure of Oxygen
Microdialysis
Conclusion
Acknowledgment
References
Chapter 20 Cardiopulmonary Resuscitation
Preparing for a Cardiopulmonary Arrest
Staff Training in Preparation for Cardiopulmonary Arrest
Notifying the Staff of Cardiopulmonary Arrest
Equipment and Drugs Required
Recognizing Cardiopulmonary Arrest
Initiating Basic Life Support
Compressions
Providing Ventilation
Cardiopulmonary Resuscitation Basic Life Support Cycle
Advanced Life Support
Monitors
Vascular Access
Anesthetic or Sedative Drug Reversal
Electrocardiogram and Patient Evaluation
Vasopressors
Parasympatholytics
Buffers
Fibrillation Treatment
Return of Spontaneous Circulation
Post-Cardiac Arrest Care
References
Chapter 21 Open-Chest Cardiopulmonary Resuscitation
Indications for Open-Chest Cardiopulmonary Resuscitation
Rationale for Performing Open-Chest Cardiopulmonary Resuscitation
Preparing for Open-Chest Cardiopulmonary Resuscitation
Equipment and Environmental Preparedness
Choice of Approach
Performing an Emergency Lateral Thoracotomy
Performing an Emergency Transdiaphragmatic Thoracotomy
Complications of Thoracotomy in the Emergency Setting
Performing Internal Cardiac Massage
Internal Defibrillation
Augmentation Techniques
Post-Resuscitation Care
Surgical Closure
Antimicrobials and Analgesia
Post-Resuscitation Monitoring
Summary
References
Chapter 22 Defibrillation
Atrial Compared with Ventricular Fibrillation
Defibrillation Compared with Cardioversion
Equipment
Safety Concerns
Indications for Defibrillation
Defibrillation Procedure and Technique
Cardioversion of Refractory, Severe Ventricular Tachycardia
Indications
Synchronization with the Cardiac Cycle
Procedure
Energy Dose Selection
Drug and Defibrillator Interactions
Patient Care in the Post-Cardioversion or Post-Defibrillation Period
Acknowledgments
References
Chapter 23 Temporary Cardiac Pacing
Indications for Temporary Pacing
Terminology
Types of Temporary Pacing
Pacing Physiology
Pulse Generators and Their Operation
Pacing Modes
Output Pulse
Sensitivity
Atrioventricular Delay
Rate
Refractory Period
Temporary Transvenous Pacing
Temporary Transcutaneous Pacing
Transcutaneous Pacing Electrode Location
Transcutaneous Pacing Electrode Size
Performing Transcutaneous Cardiac Pacing
Temporary Epicardial Pacing
Thump Pacing
Transesophageal Pacing
Transthoracic Pacing
Nursing Care of the Patient Undergoing Temporary Pacing
Monitoring the Patient with a Temporary Pacemaker
Troubleshooting
Failure to Capture
Undersensing
Oversensing
Summary
Acknowledgment
References
Section Three Respiratory Procedures and Monitoring
Chapter 24 Oxygen Therapy
Normal Oxygenation and Hypoxemia
Indications for Oxygen Supplementation
Methods of Oxygen Supplementation
Flow-by Oxygen
Face Mask
Oxygen Hood or Elizabethan Collar
Oxygen Cage
Nasal Oxygen
Transtracheal Oxygen
Heated Humidified High-Flow Nasal Oxygen
Oxygen Delivery via Artificial Airway
Endotracheal Intubation
Tracheostomy Tube Placement
Hyperbaric Oxygen
Monitoring the Response to Oxygen Therapy
Complications of Oxygen Therapy
Oxygen Toxicity
Absorption Atelectasis
Hypercapnia
Extrapulmonary Toxicity
Summary
References
Chapter 25 Pulse Oximetry and Co-Oximetry
History of Oximetry Monitoring
Hemoglobin Oxygen Saturation
Dyshemoglobinemias
Functional Compared with Fractional Hemoglobin Saturation
Types and Technology of Oximeters
Pulse Oximetry
Understanding the Technology
Indications for Pulse Oximetry
Equipment Options and Care
Performing Pulse Oximetry
Interpreting the SpO2 Reading
Factors Affecting Pulse Oximetry Measurements
Accuracy Concerns in Pulse Oximetry
Co-Oximetry
Understanding the Technology
Indications for Co-Oximetry
Equipment Options and Care
Performing Co-Oximetry
Factors Affecting Co-Oximetry Measurements
Pulse Co-Oximetry
Summary
Acknowledgment
References
Chapter 26 Blood Gas Analysis
Abnormalities in Oxygenation and Ventilation
Blood Gas Analyzers
Transcutaneous Blood Gas Monitoring
Measuring Arterial Blood Gases
Arterial Blood Sampling
Arterial Blood Sample Handling
Measurement with a Blood Gas Analyzer
Evaluating Arterial Blood Gas Results
Assessment of the Partial Pressure of Carbon Dioxide
Assessment of the Partial Pressure of Oxygen in Arterial Blood
Pulmonary Function Assessment Using Arterial Blood Gas Data
Alveolar to Arterial Oxygen Gradient
The “120” Rule
PaO2/FiO2 (“The P : F Ratio”)
FiO2 × 5
Calculation of the Total Oxygen Content
Venous Samples
Venous Partial Pressure of Carbon Dioxide
Venous Partial Pressure of Oxygen
Saturation of Hemoglobin with Oxygen
Summary
Acknowledgment
References
Chapter 27 Point-of-Care Lung and Pleural Space Ultrasound
Indications for Pleural and Lung Ultrasound
Patient Positioning and Machine Settings
Curvilinear Transducer
Linear Transducer
Phased Array Transducer
Technique and Identification of Normal Lung Ultrasound Images Compared With Pathology
Pleural and Lung Ultrasound Scanning Technique
Normal Structures and Signs
Abnormal Findings in Patients with Pleural Space and Pulmonary Pathology
Pneumothorax
Means of Assessing for a Pneumothorax
Lung Sliding/Glide Sign Rules Out Pneumothorax Where Sliding is Identified
B-Lines Rule Out Pneumothorax at the Location Where They are Identified
Lung Point Confirms Pneumothorax
Abnormal Abdominal Curtain Signs Rule in Pneumothorax
Alveolar Interstitial Syndrome (Wet Lung)
Alveolar Consolidation
Limitations of Pleural and Lung Ultrasound
References
Chapter 28 Tracheal Intubation
Indications
Equipment Needed for Intubation
Endotracheal Tubes
Oropharyngeal Airway (Laryngeal Mask)
Laryngoscope with Illumination
Stylets
Lidocaine Injectable Solution (2%)
Securing the Endotracheal Tube
Choosing Appropriate Endotracheal Tube Size
Choosing the Endotracheal Tube Width
Choosing the Endotracheal Tube Length
Intubation Techniques
Intubating Dogs
Intubating Cats
Cuff Inflation
Intubation of Difficult Airways
Techniques to Confirm Endotracheal Tube Location
Extubation
Risks and Complications of Tracheal Intubation
Summary
Acknowledgment
References
Chapter 29 Temporary Tracheostomy
Indications
Equipment
Positioning and Aseptic Preparation
Procedure
Contraindications
Possible Complications During the Procedure
Nursing Care Considerations for Patients with Temporary Tracheostomy Tubes
Airway Humidification
Tracheostomy Site Hygiene
Tube Tie Inspection
Tracheostomy Tube Suctioning
Tracheostomy Tube Cleaning
Replacement of Tracheostomy Tubes
General Patient Observations
Environmental Considerations and Patient Hygiene
Attention to Hydration Status
Tracheostomy Tube Removal
Summary
Acknowledgement
Chapter 30 Capnography
Terminology
Physiology
Types of Carbon Dioxide Analyzers
Mainstream
Sidestream
Equipment Setup
Technology of Carbon Dioxide Measurement
Infrared Absorption
Raman Scatter
Mass Spectrometry
Indications for Capnography/Capnometry
Confirming Correct Endotracheal Tube Placement
Detection of Apnea
Monitoring Ventilation
Monitoring Pulmonary Perfusion
Correct Nasogastric Tube Placement
Equipment Problems
Interpretation of the Capnogram
Phase I
Phase II
Phase III
Phase IV
Abnormal Capnograms
Abnormal Phase I
Abnormal Phase II
Abnormal Phase III
Abnormal Phase IV
Summary
References
Chapter 31 Mechanical Ventilation
Indications for Mechanical Ventilation
Ventilator Settings
Ventilator Breath Types
Tidal Volume
Airway Pressure
Trigger Variable
Positive End Expiratory Pressure
Inspiration to Expiration Ratio/Respiratory Rate
Alarms
Guidelines for Initial Ventilator Settings
Initial Stabilization on the Ventilator
Lung Disease
Goals of Mechanical Ventilation
PaO2
Partial Pressure of Carbon Dioxide in Arterial Blood
Weaning from Ventilation
Record Keeping
Ventilator Patient Monitoring
Artificial Airway Care
Humidification
Artificial Airway
Summary
References
Chapter 32 Ventilator Waveform Analysis
Scalars
Scalars in Different Modes of Ventilation
Pressure–Volume and Flow–Volume Loops
Pressure–Volume Loops
Flow–Volume Loops
Spontaneous Breath Loops
Loop Interpretation
Basic Pulmonary Mechanics Measured During Mechanical Ventilation
Practice Problems
Problem 1
Problem 2
Problem 3
Problem 4
Problem 5
Problem 6
Problem 7
Problem 8
Summary
Recommended Reading
Chapter 33 Alternative Methods of Augmented Ventilation
High-Frequency Ventilation
Background
Definitions
How High-Frequency Ventilation Works
Major Applications and Indications
Contraindications
Veterinary Studies of High-Frequency Ventilation
Other Novel Ventilation Strategies
High Flow Oxygen Therapy
Pediatric Helmet
Summary
References
Recommended Reading
Chapter 34 Pleural Space Drainage
Thoracocentesis
Indications
Procedure for Thoracocentesis
Complications
Thoracostomy Tube Placement
Indications
Thoracostomy Tube Placement
Thoracostomy Tube Maintenance
Thoracostomy Tube Removal
Chest Tube Drainage Systems
Continuous Suction Drainage Systems
Non-suction Drainage
Manual Drainage of the Thoracostomy Tube
Pain Management
Handling Samples for Fluid Analysis
References
Section Four Urinary and Gastrointestinal Procedures
Chapter 35 Urethral Catheterization
Indications for Urethral Catheterization
Urethral Catheters
Design
Stylets
Diameter
Length
Closed Collection Systems
Catheter Placement and Maintenance
Asepsis and Infection Control
Basic Guidelines
Catheter Placement
Catheter Selection
Sedation
Patient Preparation
Catheter Preparation
Lubrication and Local Anesthesia
Species and Sex-Specific Instructions
Female Dog
Female Cat or Small Female Dog
Male Cat
Male Dog
Care and Maintenance of Indwelling Catheter Systems
Securing the Catheter and Collection System
Management of Indwelling Urinary Catheter and Collection System
Basic Techniques for Difficult Catheterizations
Decompressive Cystocentesis for Urethral Obstruction
Retropulsion for Urethral Obstruction
Deflating a Foley Balloon
Acknowledgment
References
Chapter 36 Peritoneal Dialysis
Indications
Performing Peritoneal Dialysis
Catheter Types
Site Selection, Preparation, and Catheter Placement
Dialysate Solutions
Catheter Management
Performing Peritoneal Dialysis Exchanges
Monitoring
Complications
Contraindications
The Future of Peritoneal Dialysis
Summary
References
Chapter 37 Technical Management of Hemodialysis
Patient Selection
Acute Kidney Disease
Chronic Kidney Disease
Toxin Removal
Patient Considerations
Equipment
Machines
Water Treatment System
Extracorporeal Circuit
Catheters
Placement
Location
Care and Maintenance
Performing Hemodialysis
Hemodialysis Machine Preparation
Patient Preparation
Starting Treatment
Ending Treatment
Monitoring During the Hemodialysis Treatment
Blood Pressure
Coagulation
Access Pressure and Blood Flows
Hematocrit
Blood Volume
Oxygenation
Adequacy
Other Parameters
Record Keeping
Complications and Special Considerations
Technical Complications
Hypotension
Dialysis Disequilibrium Syndrome
Hemorrhage
Respiratory Complications
Gastrointestinal Complications
Thrombosis
Catheter
Systemic
Prevention
Infection
Edema
Malnutrition
Aluminum Toxicity
Anemia
Medication Dosing
Patient Care
Outcomes
Summary
References
Chapter 38 Peritoneal Evaluation
Signalment and History
Physical Examination
Abdominal Imaging
Veterinary Point of Care Ultrasound (POCUS)
Abdominal Radiographs
Diagnostic Abdominal Ultrasound
Abdominal Computed Tomography (CT)
Abdominal Fluid Sampling
Blind and Ultrasound-Guided Abdominocentesis
Open Compared With Closed Needle Technique
Four-Quadrant Technique
Diagnostic Peritoneal Lavage
Analysis of Peritoneal Effusion
Intra-Abdominal Pressure (IAP) Monitoring
Exploratory Laparotomy
References
Chapter 39 Point-of-Care Abdominal Ultrasound
Patient Positioning and Machine Settings
Abdominal Point-of-Care Ultrasound Technique
Subxiphoid
Umbilical
Urinary Bladder
Right Paralumbar
Left Paralumbar
Specific Questions
Abdominal Effusion
Pneumoperitoneum
Gastrointestinal Ileus
Gall Bladder Wall Thickening (Halo Sign)
Urine Production
Ureteral Obstruction
Pitfalls of Abdominal Point-of-Care Ultrasound
Hepatic Vessels
Edge Shadowing
Intestinal and Stomach Wall and Contents
Mirror Image Artifact
Acute Hemorrhage or Very Cellular Effusions
References
Chapter 40 Specialized Gastrointestinal Techniques
Auscultation of Gastrointestinal Sounds
Gastric Intubation
Introduction
Orogastric Intubation
Nasogastric Intubation for Gastric Decompression
Indications
Technique
Considerations for the Patient with Gastric Dilation and Volvulus
Analgesia/Sedation
Trocarization
Conservative Management of Gastric Dilation and Volvulus
Considerations for Food Engorgement
Gastric Fluid Aspirate pH Monitoring
Indications
Gastric Residual Volume Monitoring
Indications
Gastrointestinal Decontamination
Gastric Lavage
Nasogastric Intubation for Decontamination
Activated Charcoal Administration
Catharsis
Enemas
Indications
Techniques
Rectal Catheters
References
Chapter 41 Postoperative Peritoneal Drainage Techniques
Open Abdominal Drainage
Changing the Abdominal Bandages
Vacuum-Assisted Drainage
Active Closed-Suction Drains
Managing Closed-Suction Drains
Percutaneous Catheter Drainage
Managing a Fenestrated Catheter
Conclusion
References
Section Five Nutrition
Chapter 42 Nutritional Requirements in Critical Illness
Basic Physiology of Malnutrition in Critical Illness
Rationale for Providing Nutrition in Critical Illness
Nutritional Assessment
Nutritional Plan
Nutritional Requirements
Calculation of Nutritional Requirements
Nutritional Requirements in Special Cases
Burns
Tetanus
Sepsis
Complications of Providing Nutrition in the Critically Ill
Summary
References
Chapter 43 Enteral Diets for Critically Ill Patients
Nutrient Considerations for Critical Care Diets
Energy
Protein
Fat
Carbohydrates
Amino Acids
Other Nutrients
Enteral Diets
Liquid Enteral Diets
Canned Enteral Diets
Blended Commercial Diet Slurries
Home-Cooked Diet Blended Slurries
Preparation Instructions for Blended Slurries
Supplements
Considerations for Specific Underlying Conditions
Gastrointestinal Disease
Adverse Reactions to Food
Fat Intolerance
Kidney Disease
Liver Disease
Initiating Nutritional Support
Monitoring
References
Chapter 44 Assisted Enteral Feeding
Introduction
Enticing Voluntary Eating
Tube Route Selection
Nasoesophageal and Nasogastric Tubes
Placement and Verification
Feeding
Complications and Troubleshooting
Esophageal Tubes
Placement and Verification
Feeding
Stoma Site Care
Complications and Troubleshooting
Gastrostomy Tubes
Placement
Feeding
Stoma Site Care
Complications and Troubleshooting
Jejunostomy Tubes
Placement
Feeding
Tube and Site Care
Complications and Troubleshooting
Summary
Acknowledgment
References
Chapter 45 Parenteral Nutrition
Indications for Parenteral Nutrition
When to Initiate Support
How Much to Feed
Central and Peripheral Nutrition
Composition of the Solution
Compounding Parenteral Nutrition Solutions
Maintenance of the Infusion and Catheter
Contraindications and Complications
Metabolic Complications
Mechanical Complications
Septic Complications
Conclusion
Summary
References
Section Six Analgesia and Anesthesia
Chapter 46 Drug Administration
Treatment Sheet Orders
Medical Records
Routes of Drug Administration
Drug Delivery: Venous Access
Drug Delivery: Enteral
Feeding Tubes
Oral Medications
Drug Delivery: Subcutaneous Route
Drug Delivery: Transdermal Patch
Drug Delivery: Intramuscular Route
Constant Rate Infusion
Intravenous Nutritional Support
Fluid Additives
Agents Used to Treat Specific Toxicities
Antibiotics
Inotropes and Vasoactive Agents
Analgesics and Anesthetics
Chemotherapeutic Agents
Drug Overdose
References
Chapter 47 Pain Recognition and Management
Nociceptive Physiology
Nociception
Transmission and Modulation
Allodynia
Central Sensitization/“Wind-Up”
Importance of Pain Control
Pain Recognition
Pain Scales
Multimodal Analgesia
Timing of Analgesic Administration
Contraindications and Complications of Pain Management
References
Chapter 48 Systemic Analgesia
Opioids
Analgesic Effects
Central Nervous System Effects
Cardiovascular Effects
Respiratory Effects
Urinary Effects
Gastrointestinal Effects
Hepatic Effects
Effects on Body Temperature
Opioid Tolerance and Addiction
Regulations Involved in Clinical Use of Opioids
Systemic Administration of Opioids
Morphine
Fentanyl, Remifentanil, Sufentanil, Alfentanil
Oxymorphone and Hydromorphone
Methadone
Pethidine (Meperidine)
Buprenorphine
Butorphanol
Codeine
Naloxone and Naltrexone
Tramadol
Nonsteroidal Anti-Inflammatory Drugs
Cyclo-Oxygenase 1 and 2
Analgesic Effects
Adverse Effects
Nonsteroidal Anti-Inflammatory Drugs in the Critical Patient
Alpha-2 Agonists
Medetomidine
Dexmedetomidine
Xylazine
Adjunctive Analgesia
Lidocaine
Ketamine
Amantadine
Gabapentin
Acetaminophen
References
Chapter 49 Local Anesthesia
Pharmacology
Common Local Anesthetics
Lidocaine
Bupivacaine
Liposomal Encapsulated Bupivacaine
Ropivacaine
Levobupivacaine
Mepivacaine
Local Anesthetic Adjuvants
Dexmedetomidine
Opioids
Selected Locoregional Techniques
Local Infiltration and Line Blocks
Intrapleural Local Anesthesia
Intercostal Nerve Blocks
Intraperitoneal Local Anesthesia
Radial, Ulnar, Median, and Musculocutaneous Nerve Block
Sacrococcygeal Epidurals
Lumbosacral Epidurals
Local Anesthetic Toxicosis
References
Chapter 50 Monitoring the Anesthetized Patient
Anesthesia Monitoring Record
Physical Parameters Under Anesthesia
Eye Position
Jaw Tone
Mucous Membranes/Capillary Refill Time
Response to Stimulation
Heart Rate
Respiratory Rate
Blood Pressure
Doppler Blood Pressure Measurement
Oscillometric Blood Pressure Measurement
Direct Arterial Blood Pressure Measurement
Oxygen Saturation
Plethysmographic Variability Index
Body Temperature
End-Tidal Inhalant Concentrations
References
Chapter 51 Nursing Care of the Long-Term Anesthetized Patient
Basic Indications for Long-Term Anesthesia
Physical Complications Associated with Long-Term Anesthesia and Immobility
Immobility Complications
Neuromuscular Weakness
Atelectasis
Venous Stasis
Ocular Complications
Complications Associated with the Oral Cavity
Complications Associated with the Urogenital Tract
Gastrointestinal Complications
Recumbent Patient Care
Patient Positioning
Decubitus Ulcer Prevention and Management
Early Mobility
Eye Care
Oral Care
Bladder Care
Gastrointestinal Tract
Techniques to Decrease Stimulation
Summary
References
Chapter 52 Neuromuscular Blockade
Introduction
Indications
Reversal of Neuromuscular Block
Complications
Monitoring of Neuromuscular Function
Patterns of Stimulation
Clinical Monitoring, Maintenance, and Reversal of Neuromuscular Block
Current and Future Advancements in Neuromuscular Blockade
Troubleshooting
Open Circuit
Inability to Calibrate and Erroneous Values
Unstable Values
References
Section Seven Clinicopathologic Techniques
Chapter 53 Blood Sample Collection and Handling
Safety Concerns
Venous Blood Sample Collection
Venipuncture Equipment
Order of Draw
Venipuncture Sites and Considerations
Venous Blood Sample Collection from a Catheter
Sample Collection from Peripheral Intravenous Catheters
Sample Collection from Central Intravenous Catheters
Discard Method
Push–Pull or Mixing Method
Inline Sampling
Blood Culture Samples
Arterial Blood Sample Collection
Direct Arterial Puncture
Arterial Catheter Sampling
Proper Specimen Handling
Handling of Venous Samples
Troubleshooting Technical Problems Associated with Blood Sample Collection and Handling
Hemolysis
Sample Dilution
Platelet Clumping
Delayed Sample Separation or Analysis
Troubleshooting Patient Problems Associated with Blood Sampling
Iatrogenic Anemia from Frequent Sampling
Hematoma Formation
Summary
Acknowledgment
References
Chapter 54 In-House Hematologic Evaluation
Introduction
Composition of Blood
Sample Collection and Handling
Safety
Blood Collection and Handling for Hematologic Evaluation
Microhematocrit Tube Evaluation
Packed Cell Volume
Buffy Coat
Plasma Appearance
Total Protein
Fibrinogen
Blood Smear Preparation
Staining Samples
Blood Smear Evaluation
Background, Quality and Feathered Edge
Erythrocytes
Leukocytes
Platelets
Coagulation
Activated Clotting/Coagulation Time
Activated Partial Thromboplastin Time and Prothrombin Time
Buccal Mucosal Bleeding Time
Blood Typing
Dogs
Cats
References
Chapter 55 In-House Evaluation of Hemostasis
Testing for Defects in Primary Hemostasis
Platelet Count
Platelet Evaluation via Thrombogram
Blood Smear Platelet Estimate
Buccal Mucosal Bleeding Time
Secondary Hemostasis
Prothrombin Time and Activated Partial Thromboplastin Time
Activated Clotting Time
Viscoelastic Testing
Whole-Blood Clotting Time
References
Chapter 56 Electrolyte Evaluation
Methods of Electrolyte Quantification
Individual Electrolytes
Sodium
Chloride
Potassium
Phosphorus
Calcium
Calcium Concentration Measurement
Magnesium
References
Chapter 57 Acid–Base Evaluation
Sampling and Storage of Blood for Acid–Base Measurement
Overview of Acid–Base Interpretation
Other Measures of the Metabolic Contribution
Compensation
Acid–Base Analysis
Simple Versus Mixed Disturbances
The Respiratory Component of the Acid–Base Balance
Respiratory Acidosis
Respiratory Alkalosis
The Metabolic Component of Acid–Base Balance
Metabolic Acidosis
Metabolic Alkalosis
Anion Gap
Acknowledgment
References
Chapter 58 Osmolality and Colloid Osmotic Pressure
Physiology of Water Movement: Osmolality
Physiology of Water Movement: Colloid Osmotic Pressure
Calculating Plasma Osmolality
Measuring Plasma Osmolality
Measuring Colloid Osmotic Pressure
References
Chapter 59 Body Fluid Collection and Handling
Urine
Collection
Sample Handling and Preservation
Transtracheal and Endotracheal Tube Washes and Bronchoalveolar Lavage
Sample Handling and Preservation
Pericardial Effusion
Sample Handling and Preservation
Abdominal Effusion
Sample Handling and Preservation
Pleural Effusion
Sample Handling and Preservation
Cerebrospinal Fluid
Sample Handling and Preservation
Synovial Fluid
Sample Handling and Preservation
References
Chapter 60 Urinalysis in Acutely and Critically Ill Dogs and Cats
What Is Urinalysis?
Urine Sample Collection and Handling
Urinalysis
Physical Properties
Urine Specific Gravity
Methods
Chemical Properties
Methods
Urine pH
Urine Occult Blood
Urine Glucose
Urine Ketones
Urine Bilirubin
Urobilinogen
Urine Protein
Urine Sediment Examination
Methods
Red Blood Cells
White Blood Cells
Epithelial Cells
Crystals
Casts
Bacteriuria
Others
Other Techniques
Urine Protein to Creatinine Ratio Measurement
Urine Osmolality
Urine Electrolytes
Urinary Biomarkers
Toxin Screening
References
Chapter 61 Cytology
Indications for Cytologic Evaluation
Effusion Analysis
Pericardial Effusions
Joint Effusions
Lymph Node Evaluation
Mass Evaluation
Skin and Ears
Equipment Required
Slide Preparation
Fluid
Tissue
Staining
Slide Scanning and Evaluation
Troubleshooting
Nondiagnostic Samples
Staining Problems
Conclusion
References
Section Eight Infection Control
Chapter 62 Minimizing Healthcare-Associated Infections
Bacteria Associated with Healthcare-Associated Infections
Methicillin-Resistant Staphylococci
Extended Spectrum Beta-Lactamase-Producing Escherichia coli
Vancomycin-Resistant Enterococci
Transmission of Infection and Colonization
Control Strategies for Nosocomial Infection
Hand Hygiene
How to Perform a Hygienic Handwash
Hand Rubs
Timing of Hand Hygiene and Use of Gloves
Environmental Cleaning
Barrier Nursing and Isolation
Antimicrobial Stewardship
Role of Screening for Pathogenic Bacteria
Summary
Acknowledgment
References
Chapter 63 Care of Indwelling Device Insertion Sites
Complications
The Value of Protocols
General Care of Insertion Sites
Bandaging
Handling
Maintenance
Care of Associated Lines and Connections
General Management of Device Insertion Site Infection
Insertion Site Preparation for Peripheral Venous and Arterial Catheters
Catheter Selection
Site Selection and Preparation
Dressing
Care and Maintenance of Existing Peripheral Vascular Catheter Insertion Sites
Complications of Indwelling Vascular Catheters
Catheter, Line, or Dressing Damage or Dislodgement
Edema Distal to the Catheter Insertion Site
Swelling Extending Proximal to the Insertion Site
Redness, Heat, Swelling, Pain, or Purulence at the Catheter Insertion Site
Oozing at the Catheter Insertion Site
Complications Specific to Arterial Lines
Central Venous Catheters and Peripherally Inserted Central Catheters
Indications
Site Preparation and Insertion
Dressing
Care and Maintenance
Complications
Intraosseous Catheter Insertion Sites
Insertion
Maintenance
Complications of Intraosseous Catheters
Thoracostomy Tube Insertion Site Maintenance
Nephrostomy Tube Insertion Site Maintenance
Cystostomy Insertion Site Maintenance
Surgical Drain Insertion Site Maintenance
Closed-Suction Drain Insertion Sites
Penrose Drain Insertion Sites
Postoperative Wound Infusion Catheter Maintenance
Feeding Tube Insertion Sites
Nasoesophageal and Nasogastric Tube Insertion Sites
Esophagostomy, Percutaneous, Endoscopically-Placed Gastric and Jejunostomy Tube Insertion Sites
Epidural Catheter Insertion Sites
Summary
References
Chapter 64 Antiseptics, Disinfectants, and Sterilization
Antiseptics
Alcohol
Chlorhexidine
Iodophors
Disinfectants
Aldehydes
Halogens/Hypochlorites
Oxidizing Agents
Phenols
Quaternary Ammoniums
Sterilization
Autoclaves
Gas Sterilization
Flash Sterilization
Glutaraldehyde
Bacterial Resistance to Antiseptics and Disinfectants
Intrinsic Resistance
Biofilms
Aseptic Techniques
Handwashing
Aseptic Surgical Preparation: Personnel
Aseptic Surgical Preparation: Patient
Summary
Acknowledgment
Futher Reading
Chapter 65 Personnel Precautions for Patients with Zoonotic Disease
Zoonotic Disease Transmission
Types of Zoonotic Diseases
Bacterial Diseases
Fungal infections
Viral Infections
Fecally Transmitted Zoonotic Pathogens
Other Zoonotic Diseases
Personnel Protection
Hand hygiene
Barrier Protection
Prevention of Transmission
Vector Control
Client Education
Vaccination
Reporting Procedures
Staff Awareness and Training
Legal and Public Health Issues
Summary
References
Section Nine Transfusion Medicine
Chapter 66 Blood Typing and Crossmatching
Canine Blood Types
Feline Blood Types
Blood Typing
Crossmatch Considerations
Crossmatching Methods
References
Chapter 67 Blood Transfusion
Packed Red Blood Cells
Definitions
Indications
Dose
Blood Types and Pretransfusion Testing
In Practice
Adverse Effects and Reactions
Plasma Products
Definitions
Indications
Dose
In Practice
Adverse Effects and Reactions
Platelets
Definition
Indications
Dose
In Practice
Reactions
Alternatives to Platelet Transfusion
References
Chapter 68 Administration of Other Biological Products
Vaccines
Adverse Reactions
Administration Protocols, Monitoring, and Interventions
Albumin Solutions
Concentrated Human Serum Albumin Solution
Canine Albumin
Human Intravenous Immunoglobulin
Adverse Reactions
Administration Protocols
Specific Immunoglobulin Therapy
Snake Envenomation
Tetanus
Digitalis Glycosides
Thrombolytic Agents
Summary
References
Chapter 69 Blood Banking
Introduction
Obtaining Blood Products
Commercial Blood Banks
Other Hospitals
In-Hospital Collection
Donor Sources
Canine Donors
Feline Donors
Processing and Storage of Blood Products
Processing
Storage
Quality Assurance
Maintenance of Equipment
Maintenance of Blood Product Logs
Blood Product Quality Control
Acknowledgment
References
Section Ten Nursing Care of Specific Populations
Chapter 70 Care of the Patient with Intracranial Disease
Serial Neurologic Examinations
Nursing Care
Patient Monitoring
Advanced Monitoring Techniques
Summary
References
Chapter 71 Care of the Burned Animal
Introduction
Classification of Burns
Medical Considerations
Principles of Burn Wound Management
General Recommendations
Wound Management
References
Chapter 72 Care of the Environmentally Injured Animal
Cold-Induced Injury
Nonfreezing Injuries
Freezing Injury
Hypothermia
Heat-Induced Injury
Classification of Heat-Induced Injuries
Causes of Heat Injury
Initial Management Considerations
Monitor for and Treat Concurrent Problems
Open Wounds and Necrotic Tissue
Considerations in Wound Management
Antibiotic Use in Patients with Open or Necrotic Wounds
Open Fractures
References
Chapter 73 Blood Glucose Monitoring and Glycemic Control
Abnormalities in Glucose Homeostasis
Hypoglycemia
Hyperglycemia
Blood Glucose Monitoring
Methods of Measuring Glucose Concentration
Glycemic Control
Treatment of Hyperglycemia
Treatment of Hypoglycemia
Conclusion
References
Chapter 74 Critical Nursing Care of the Neonate
Small-Animal Neonatal Physiology
Cesarean Section: Emergency (Surgical Management of Dystocia) or Elective
Neonatal Resuscitation
APGAR Scoring
Management of the Umbilicus And Placenta
Postnatal Support
Neonatal Examination
Neonatal Diagnostics
Early Neonatal Problems
Neonatal Immunodeficiency
Fading Neonates
Congenital and Acquired Abnormalities
Cardiovascular
Respiratory
Gastrointestinal
Musculoskeletal
Neurologic
Urogenital Disorders
Ophthalmologic
Dermatologic
Miscellaneous
References
Chapter 75 Safe Handling and Care of Patients Exposed to Radioactive and Anti-Neoplastic Agents
Radiation
Definitions and Terms
Dose Limits
Radiopharmaceuticals
Veterinary Uses
Concept of Half-Life
Radiation Protection
External Beam Radiation Protection
Radionucleotide Safety
Chemotherapy
Limiting Exposure
Chemotherapy Elimination
References
Chapter 76 Handling the Suspected Cruelty Case
Veterinary Roles
Recognizing and Reporting
Forensic Evaluation
Medical Care
Documentation of the Suspected Cruelty Victim
History
Physical Examination
Photography
Videography
Laboratory Tests
Diagnostic Imaging
Injuries
Physical Abuse
Neglect
Special Considerations for Deceased Animals
Summary
Section Eleven Wellness for the Veterinary Health Care Team
Chapter 77 Self-Compassion: The Cornerstone of Wellbeing
Introduction
Compassion Fatigue
How to Address Compassion Fatigue
Burnout
Self-Care and Wellbeing
Introducing Self-Compassion
Self-Compassion: What is It?
Self-Compassion: Three Core Elements
Kindness
Common Humanity
Mindfulness
Self-Compassion: What it is Not
Self-Compassion Is Not Self-Pity
Self-Compassion Is Not Self-Indulgence
Self-Compassion Is Not Self-Esteem
Self-Compassion Assessments
Conclusion
References
Index
EULA