GROUP PROJECT INFORMATION

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GROUP PROJECT INFORMATION

• TURN IN ON DAY OF PRESENTATION
• Minimum group size 2 and maximum 4
• Presentation time maximum 10 minutes
• Group topic and names due Monday 02/07/2011
• Presentations 02/ 08 02/10/2011
• BRING A VISUAL AID CLIENT INFORMATION
• Inform
• Educate
• Empower

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GROUP PROJECT INFORMATION

• ONE page hard copy with the following
  information
• The toxic agent
• How the animal may be exposed to it
• What clinical signs the animal might show
• Which bodily systems if affects
• The treatment
• EACH GROUP MEMBERS NAME MUST BE ON THE PAGE THAT
  IS TURNED IN TO ME (NO CREDIT WILL BE GIVEN IF
  THERE IS NO PARTICIPATION)

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ADVERSITY

• Lifes challenges are not supposed to paralyze
  you, they are supposed to help you discover who
  you are.
• - Bernice Johnson Reagon

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Emergency Procedures
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ABC

• A Establish airway
• B Breathe for animal
• C Maintain circulation with thoracic
  compressions and IV fluids

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Triage of Emergency Patients

• Initial exam (by RVT)
• Wear gloves
• Animal muzzled (use discretion)
• Minimize movement of patient
• Initial Assessment (30-60 sec from rostral
• direction)
• Mentation (level of consciousness)
• A Alert
• V Verbally responsive
• P responsive to painful stimuli
• U Unresponsive
• Extend head/neck to provide clear airway check
  for patency
• Breathing/respiratory pattern (shallow, labored,
  rapid, obstructed)
• Abnormal body/limb posture (fracture, paralysis)
• Presence of blood or other material around patient

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Triage of Emergency Patients

• Initial Assessment (continued)
• Breathing/respiratory pattern
• Total/Partial blockage of airways (Requires
  immediate Rx)
• Exaggerated inspirations
• Nasal flare, open mouth, extended head/neck
• Cyanosis
• Breathing assessment
• Watch chest wall movement
• Auscult lungs bilaterally to r/o hemo- or
  pneumothorax

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Triage of Emergency Patients

• Vital signs (taken after initial assessment)
• HR, pulse rate (same as HR?), strength
• RR
• mm color, CRT
• Temp
• BP
• High HR, high BP? pain
• High HR, low BP ? hypovolemic shock
• Baseline data
• ECG
• Chem panel, CBC

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Triage of Emergency Patients

• History (mnemonic)
• A Allergies
• M Medications
• P Past History
• L Lasts (meals, defecation, urination,
  medication)
• E Events (What is the problem now?)
• How long since injury
• Cause of injury (HBC, dog fight, gunshot)
• Evidence of loss of consciousness
• Blood loss?
• Deterioration/improvement since accident (good
  indicator of Prognosis)
• Any other underlying medical conditions/medication
  s

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Triage of Emergency Patients

• Treatment to restore life/health
• Analgesics for pain
• Once airway patency and heart beat are
  established (these are critical for life)
• Control hemorrhage
• Pressure bandages (sterile gauze, laparotomy
  pads, towels)
• If bleed thru, do not remove initial bandage,
  apply another on top
• On distal extremity, BP cuff can be placed
  proximal to wound (avoid tourniquet if possible)

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Triage of Emergency Patients

• Control hemorrhage
• External counterpressure using body wrap of
  pelvic limbs, pelvis, and abdomen
• Insert urinary catheter to monitor urine output
• Use towels, cotton rolls, duct tape, etc
• Monitor respirations (diaphragm/abdominal
  breathing compromised)
• Leave on until hemodynamically stable (6-24 h)
• Monitor BP during removal
• If BP drops gt5 mm Hg, stop removal infuse more
  fluids
• If BP continues to drop, reapply wrap

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SHOCK RECOGNITION AND TREATMENT

• SHOCK is inadequate tissue perfusion resulting in
  poor oxygen delivery
• Cardiogenic
• Distributive
• Obstructive
• Hypovolemic

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Shock

• Types of Shock
• Cardiogenicresults from heart failure
• ? blood pumped by heart
• HCM, DCM, valvular insufficiency/stenosis
• Distributiveblood flow maldistribution
  (Vasodilation)
• Sepsis, anaphylaxis ??arteriole resistance ?loss
  of fluid from vessels to interstitial spaces
  ??BP? ? blood return to heart
• Obstructivephysical obstruction in circ system
• HW disease ? heart pumping against the adult worm
  blockage
• Gastric torsion ??blood return to heart
• Hypovolemicdecreased intravascular volume
• Most common in small animals
• Blood loss, dehydration from excessive
  vomiting/diarrhea, effusion of fluid into 3rd
  spaces

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Hypovolemic Shock

• Pathophysiology of hypovolemic shock
• ?blood vol ??venous return, ?vent filling
  ??stroke vol, ?CO ??BP
• Stage I Compensation
• Baroreceptors detect hypotension (?BP)
• Sympathetic reflex(Epi, Norepi, cortisol
  released from adrenals)
• ? HR, contractility
• Constriction of arterioles (?BP) to skin (cold,
  clammy), muscles, kidneys, GI tract not brain,
  heart
• Renin (kidney)?angiotensin (blood)?aldosterone
  (adrenals) reflex
• ? Na and water retention ? ? intravascular vol
  (?BP)
• PE findings
• Tachycardia
• Prolonged cap refill time
• Pale mm

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Hypovolemic Shock

• Pathophysiology of hypovolemic shock
• Stage II Decompensation
• Tachycardia
• Delayed cap refill time
• Muddy mm (loss of pink color, more brown than
  pink)
• BP is dropping
• Altered mental state
• Stage III Irreversible shock
• PE findings worsen
• cannot revive
• death will occur

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Shock

• Treatment the goal of therapy is to improve O2
  delivery
• O2 supplementation
• Face mask
• O2 cage/hoods
• Transtracheal/nasal insufflation
• Venous access
• Cephalic
• Saphenous
• Jugular
• Intraosseous

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Oxygen supplementation
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Fluid Administration
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Shock

• Treatment
• Fluid resuscitation (O2 delivery is improved by
  ?CO)
• 1. Crystalloids
• Isotonic solutions (electrolytes Na, Cl-, K,
  bicarbonate)
• Examples (body fluid280-300 mOsm/L)
• Lactated Ringers (273 mOsm/L)
• Normal saline (0.9) (308 mOsm/L)
• Dose Dog 80-90 ml/kg/hr
• Cat 50-55 ml/kg/hr
• Hypertonic solutionswhen lg vol of fluid cannot
  be administered rapidly enough
• Examples7.5 saline
• Causes fluid shift from intracellular space?
  intravascular space ??vascular vol ??venous
  return ? ?CO
• Also causes vasodilation ? ? tissue perfusion
• Dose 4-6 ml/kg over 5 min
• Hypotonic solutions should never be used for
  hypovolemic shock
• Examples5 Dex in water (252 mOsm/L)

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Shock

• Treatment
• Fluid resuscitation (O2 delivery is improved by
  ?CO)
• 2. Colloids
• Large molecular wt solutions that do not leave
  vascular system
• Better blood volume expanders than crystalloids
• 50-80 of infused volume stays in blood vessels
• Examples
• Whole blood
• Plasma
• Dextran 70

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Shock

• Rx (continued)
• Sympathomimetics
• Use only after adequate fluid administration if
  BP and tissue perfusion have not returned to
  normal
• Dopamine (Inotropin)
• 0.5-3.0 µg/kg/min
• Dilation of renal, mesenteric, coronary vessels
• 3.0-7.5 µg/kg/min
• ? contractility of heart
• ? HR
• gt7.5µg/kg/min
• Vasoconstriction
• Dobutamine (Dobutrex)
• 5-15 µg/kg/min
• ? contractility of heart (min effect on HR)

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Shock

• Monitoring
• Hemodynamic/metabolic sequelae of shock are
  continually changing
• Physical Parameters
• Respiratory
• Color of mm
• RR
• Breathing efforts smooth?
• Breathing pattern regular?
• Auscultation normal?
• Cardiovascular
• HR normal?
• ECG normal?
• Color of mm
• Cap refill time (1-2 sec)
• Urine production? (1-2 ml/kg/hr)
• Weak pulse? ? ?stroke volume

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Shock

• Monitoring
• Physiologic Monitoring Parameters
• O2 Saturation
• Pulse oximetrynoninvasive
• Normal Hb saturations (SpO2)gt95
• SpO2lt90--serious hypoxemia
• Arterial BPa product of CO, vascular capacity,
  blood volume
• If one is subnormal, the other 2 try to
  compensate to maintain BP

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Shock

• Monitoring
• Laboratory Parameters
• Hematocrit (PCV)
• Increase ?dehydration
• Decrease ?blood loss
• Electrolytes (what is that?)
• Proper balance needed for proper cell function
• Fluid therapy may alter the balance supplement
  fluid as needed
• Arterial pH and blood gases
• PaCO2 tells how well patient is ventilating
• PaCO2 lt35 mm Hg ? hyperventilation
• PaCO2 gt45 mm Hg ? hypoventilation
• PaO2 Tells how well patient is being oxygenated
• PaO2 lt90 mm Hg ? hypoxemia
• pH tells acid/base status of patient
• lt7.35 ? acidosis
• gt7.45 ? alkalosis

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VISION

• It is a terrible thing to see and have no
  vision.
• -Helen Keller

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CPCR

• CARDIOPULMONARY CEREBROVASCULAR RESUSCITATION

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Cardiopulmonary Arrest and Resuscitation (CPR)

• Cardiopulmonary Arrest (CPA) sudden cessation of
  effective ventilation and circulation.
• Causes
• Anesthesia
• Trauma
• Infections (e.g. pneumonia)
• Heart disease
• Autoimmune disease
• Malignancy
• Trauma

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Cardiopulmonary Resuscitation

• Resuscitation Team Members
• Should be 3-5 members
• Team leaderVeterinarian or RVT with most
  experience
• All members have several responsibilities
• Provide ventilation
• Chest compression
• Establish IV line
• Administer drugs
• Attach monitoring equipment
• Record resuscitation efforts
• Monitor teams effectiveness
• Teams should practice on a regular basis to stay
  sharp

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Cardiopulmonary Resuscitation

• Facilities
• Adequate room for entire team and equipment
• O2 source
• Good lighting
• Crash cart with all needed Rx (should be checked
  at beginning of each shift)
• Defibrillators
• Electrocardiogram
• Suction
• Table to perform chest compression
• Grated surgery prep table not solid enough for
  chest compression
• Use board underneath patient
• Recognition
• RVT should ID patients at risk and observe any
  deterioration
• Preventing an arrest is easier than treating one

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Cardiopulmonary Resuscitation

• Standard Emergency Supplies (on crash cart)
• Pharmaceuticals --Venous access supplies
• Atropine ? Butterfly cath
• Epinephrine ? IV caths
• Vasopressin ? IV drip sets
• 2 lidocaine (w/o epi) ? Bone marrow needles
• Na bicarb ? Syringes
• Ca chloride or gluconate ? Hypodermic needles
  (var sizes)
• Lactated Ringers, hypertonic saline, ?
  Adhesive tape
• dextran 70, hetastarch ? Tourniquet
• Airway access supplies --Miscellaneous supplies
• Laryngoscope ? Gauze pads (3 x 3)
• Endotracheal tubes (variety of sizes) ?
  Stethoscope
• Lubricating jelly ? Minor surgery pack
• Roll gauze ? Suture material
• ? Scalpel blades
• ? Surgeons gloves

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Cardiopulmonary Resuscitation

• Basic Life Support (Phase I)
• Remember the priorities (ABC Airway, Breathing,
  Circulation)
• Establish patent Airway
• Endotracheal tube
• Tracheostomy tube for upper airway obstruction
• Suction to remove blood, mucus, pulmonary edema
  fluid, vomit
• Artificial ventilation (Breathing)
• Ambu-Bag
• Anesthetic machine
• Ventilate once every 3-5 sec
• Chest compressions in between breaths if working
  alone
• 1 to 2 times per second (80 times per minute for
  a large dog and 120 times for a small dog or cat)
• 10 compression for every 2 breaths (or 51)

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CPR

• http//www.youtube.com/watch?vVJGlsYHI9cU

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Cardiopulmonary Resuscitation Intubation
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Cardiopulmonary Resuscitation

• Basic Life Support (Phase I)
• Circulation
• External cardiac compression
• Lateral recumbencyone/both hands on thorax over
  heart (4th-5th intercostal space)
• In larger patients, arms extended, elbows locked
• In small patients, thumb and first 2 fingers to
  compress chest
• Rate of compression 80-120/min

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Cardiopulmonary Resuscitation

• Basic Life Support (Phase I)
• Circulation
• Internal cardiac compression
• More effective than external compression
• ?CO, ?BP, higher survival rate
• Indications
• Rib fractures
• Pleural effusion
• Pneumothorax
• If not responsive after 5 min of external cardiac
  compression
• Preparation
• Clip hair ASAP, no surgical scrub
• Incision at 7th and 8th intercostal space
• With a gloved hand, compress heart between
  fingers and palm (Do not puncture heart with
  finger tips or twist heart)
• After spontaneous beating returns, flush chest
  cavity with saline, perform sterile scrub of skin
  and close

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Cardiopulmonary Resuscitation

• Basic Life Support (Phase I)
• Assessing effectiveness (must be done frequently)
• Improved color of mm
• Palpable pulse during cardiopulmonary
  resuscitation (difficult)
• If efforts are not effective, do something
  differently
• Use different hand
• Change person performing compression
• Ventilate with every 2nd or 3rd chest compression
• Compress chest where it is widest in lg breed
  dogs
• Apply counter-pressure to abdomen (hand, sandbag)
• Prevents posterior displacement of diaphragm and
  increases intrathoracic pressure

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Cardiopulmonary Resuscitation

• Advanced Life Support (Phase II)
• Add 2 priorities to ABC--D E (administer Drugs,
  Electricaldefibrillate)
• Drugs
• Fluids
• Lactated Ringers is standard (do not use
  Dextrose)
• Initial dose Dogs40 ml/kg
• (rapidly IV) Cats20 ml/kg
• Atropineparasympatholytic effects (blocks
  parasympathetic effects)
• 0.02-0.04 mg/kg
• ?HR
• ?secretions
• Epinephrineadrenergic effects
• 0.02-0.2 mg/kg
• Arterial and venous vasoconstriction? ?BP

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Cardiopulmonary Resuscitation

• Advanced Life Support (Phase II)
• Add 2 priorities to ABC--D E (administer Drugs,
  Electricaldefibrillate)
• Drugs (continued)
• 2 Lidocaine (Used to treat cardiac arrhythmias)
• Dogs 1-2 mg/kg
• Cats 0.5-1.0 mg/kg
• Sodium bicarb (For metabolic acidosis)
• 0.5 mEq/kg per 5 min or cardiac arrest
• Vasopressin (ADH)
• 0.8 U/kg

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Cardiopulmonary Resuscitation

• Advanced Life Support (Phase II)
• Add 2 priorities to ABC--D E (administer Drugs,
  Electricaldefibrillate)
• Drugs (continued)
• Route of drug administration
• Jugular veinclose to heart drugs will get to
  heart quicker
• Cephalic, saphenousfollow drugs with 10-30 ml
  saline flush
• Intraosseousintramedullary cannula into femur,
  humerus, wing of ilium, tibial crest
• Intratrachealfor limited of drugs atropine,
  lidocaine, epinephrine
• Intracardiaclast resort several complications
  can occur
• Depends on
• Speed of access
• Technical ability
• Difficulties encountered
• Rate of drug delivery

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Cardiopulmonary Resuscitation

• Advanced Life Support (Phase II)
• Add 2 priorities to ABC--D E (administer Drugs,
  Electricaldefibrillate)
• ElectricalDefibrillate
• Purposeeliminate asynchronous electrical
  activity in heart muscles by depolarizing all
  cardiac muscle fibers hopefully, the fibers will
  repolarize uniformly and start beating with
  coordinated contractions
• Paddles (with electrical gel) placed on each side
  of chest
• Yell CLEAR before discharging electrical
  current
• Start with low charge and increase as needed
• External 3-5 J/kg
• Internal 0.2-0.4 J/kg

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Cardiopulmonary Resuscitation
DEFIBRILLATORS
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Cardiopulmonary Resuscitation
VENTRICULAR FIBRILLATION
NORMAL EKG
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Cardiopulmonary Resuscitation

• Prolonged Life Support (Phase III)
• Once heart is beating on its own, monitor the
  following
• HR and rhythm
• Antiarrhythmic drugs
• Correct electrolyte abnormalities
• BP
• Peripheral perfusion
• Color of mm
• Cap refill time
• urine output
• RR and character of breathing
• Adequate breathing
• Auscultory sounds
• Mental status
• Improving or deteriorating
• UC Davis study survival rate at 1 wk for cardiac
  resuscitation patients
• Dogs 3.8
• Cats 2.3

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CPR
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EDUCATION

• Education is what survives after what has been
  learned has been forgotten.
• - B.F. Skinner

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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

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Anaphylaxis/Allergic reactions

• Signs
• Sudden onset of vom/diarrhea
• Shock
• Gums are pale
• Limbs are cold
• HR rapid, weak
• Face scratching (early sign)
• Respiratory distress
• Collapse
• Seizures
• Coma
• Death

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Anaphylaxis/Allergic reactions

• Rx (this is an extreme emergency)
• 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

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Heat Stroke (Hyperthermia)

• Requires immediate treatment
• Dogs do not cool as well as humans (dont 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

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Heat Stroke

• Signs
• Rapid, frantic, noisy breathing
• Tongue/mm bright red, thick saliva
• Vomiting/diarrheamay be bloody
• Rectal temp gt105
• Unsteady/stagger
• Coma/death

Prevention
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Heat Stroke

• Complications
• Multi-system organ failure
• Denatures proteins
• Hypotension
• Lactic acidosis
• Decreased oxygen delivery
• Electrolyte abnormalities gt cerebral edema and
  death
• Coagulopathies gt DIC
• If survives the first 24 hrs, prognosis is more
  favorable

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Heat Stroke

• TREATMENT Mild cases move dog to a/c building or
  car
• Temp gt104º, immerged in cool water, hose down
• Temp gt106º, cool water enema (cool to 103º)
• Temp gt109 leads to multiple organ failure
• STOP COOLING EFFORTS AT 103º
• IV fluids
• Corticosteroids

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Emergency Drugs in Cats
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Emergency Drugs in Dogs
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Pain Management

• Misconceptions about animal pain
• Animals do not experience pain
• Pain doesnt 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

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Pain Management

• Signs
• Vocalization
• ?HR
• ?RR
• Restlessness, abnormal posturing, unwilling to
  move
• ? Body temperature
• ?BP
• Inappetence
• Aggression
• Facial expression, trembling
• Depression, insomnia

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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

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Pain Management

• Pain Relief
• Nonpharmacologic interventions (differentiate
  pain vs stress)
• Give relief from
• Boredom, Thirst, Anxiety, Need to
  urinate/defecate
• Clean bedding/padding
• Reduce light/sound
• Stroking pet, calming speech
• Owner visits ()
• Minimize painful events (reduce , improve skills
  in injections, blood draw

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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

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Pain Management

• Drug Options
• Nonsteroidal Antiinflammatory Drugs (NSAIDs)
• 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
• µ analgesia, sedation, and resp depression
• ? analgesia and sedation
• S depression, excitement, anxiety
• ?
• Side effects
• Vomiting, constipation, excitement, bradycardia,
  panting
• Metabolized by liver excreted by kidneys
• Use caution with hepatic, renal disease

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Pain Management

• Opioids
• Morphine sulfate
• 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

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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
• ? agonist µ antagonist
• Analgesic effect questionable (gt1 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

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Pain Management

• Opioids
• Antagonists
• Naloxone HCl
• Reversal occurs within 1-2 min
• Can be used to reverse anesthesia (Inovar-Vet)

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PERSEVERANCE

• Sometimes the best way out is through.

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TOXICOLOGIC EMERGENCIES
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Toxicologic Emergencies

• Signs will vary depending on character of toxic
  compound
• Toxicity can result from exposure via many routes
• Ingestion
• Inhalation
• Skin contact
• Injection

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Toxicologic Emergencies

• Top 10 Toxicoses (2005)
• Human medication (ibuprofen, acetominophen,
  anti-depressants)
• Insecticidesflea and tick
• Rodenticidesanticoagulants
• Veterinary medication
• Household cleanersbleach, detergents
• Plantssago palm, lily, azalea
• Herbicides
• Chocolatehighest in food category
• Home improvement productssolvents, adhesives,
  paint, wood glue
• Fertilizers

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Toxicologic Emergencies

• HISTORY
• ASSESS
• STABILIZE
• Administer oxygen
• Control seizures
• Correct cardiovascular abnormalities
• DECONTAMINATION
• Emetics
• Activated charcoal
• Gastointestinal protectants
• CONTROL CLINICAL SIGNS
• GOOD NURSING CARE
• PREVENT FURTHER EXPOSURE

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Toxicologic Emergencies external exposure

• Ocular exposure
• Rinse eyes with copious saline for 20-30 min
• Chemical burns treated with lubricating ointment
  and suture lids closed
• Use corticosteroids only if corneal epithelium is
  intact
• Skin exposure
• Bathe with mild detergent (liquid dish soap)
• Bather should wear protective clothing (gloves,
  goggles)

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Toxicologic Emergencies

• Ingestion
• Induce vomitingif chemical not caustic animal
  conscious, not seizing
• Syrup of ipecac, apomorphine, Xylazine, H2O2 (not
  reliable), salt (not recommmended)
• Dilute caustic substances with milk, water
• Gastric lavagelarge bore stomach tube light
  anesthesia w/ endotracheal tube
• Administer absorbentsactivated charcoal inhibits
  GI absorption
• Give orally or via stom tube
• Enemas/cathartics to eliminate toxins more rapidly

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Toxicological Emergencies
ACTIVATED CHARCOAL WITH OR WITHOUT A CATHARTIC
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Toxicologic Emergencies

• Methylxanthines (caffeine,
• theobromine, theophylline
• Found in coffee, tea, chocolate,
• other stimulants
• Toxic Dose of caffeine and theobromine in dogs
  100-200 mg/kg (other sources 250-500mg)
• Milk Chocolate44-60 mg/oz
• Dark chocolate-150 mg/oz
• Baking Chocolate390-450 mg/oz

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Toxicologic Emergencies

• Clinical signs of methylxanthine/chocolate
  toxicosis (caffeine, theobromine)
• Increased HR, RR
• Anxiety
• Vomiting/diarrhea
• Seizures, coma
• Cardiac arrhythmias
• Treatment
• Induce vomiting
• Activated charcoal
• Control seizues
• Fluid therapy

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Toxicologic Emergencies

• Rodenticides
• 1. Anticoagulants (warfarin, pindone,
  bromadiolone, brodifacoum)
• Work by binding Vit K, which inhibits synthesis
  of factors II, VI, IX, X
• This effect occurs within 6-40 h in a dog effect
  may last 1-4 wk

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Toxicological Emergencies

• Clinical signs (occur after depletion of clotting
  factors)
• Lethargy
• Vom/dia with blood melena
• Anorexia
• Ataxia
• Dyspnea
• Epistaxis, scleral hemorrhage, pale mm
• Treatment
• Vit K 3-5 mg/kg PO for up to 21 d depending on
  anticoagulant used
• Induce vomiting activated charcoal
• Whole blood transfusion if anemic

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Toxicologic Emergencies

• Rodenticides
• CholecalciferolVit D3 used in Quintox, rampage,
  Rat-Be-Gone
• -causes Ca reabsorption from bone, intestine,
  kidneys causing hypercalcemia (gt11.5 mg/dl) and
  cardiotoxicity
• Clinical signs (12-36 h after ingestion)
• Kidney failure
• Anorexia
• Vomiting
• Tissue mineralization
• Cardiovascular abnormalities
• Muscle weakness
• arrhythmias

85
Toxicological Emergencies

• Diagnosis
• Hx of exposure
• Usually discovered on routine Chem panel (?blood
  Ca)
• Treatment
• Induce vom/activated charcoal if ingestion
  occurred with 2 h
• Furosemide x 2-4 wk increases Ca excretion in
  urine
• Prednisone x 2-4 wk decreases Ca reabsorption
  from bones/intesine
• Calcitonin to lower blood Ca concentration

86
Toxicologic Emergencies

• Rodenticides
• Bromethalin
• -uncoupler of oxidative phosphorylation in CNS
  (stops production of ATP)
• -Causes cerebral edema
• -found in Assault, Vengence, Trounce
• -Toxic Dose Dog 4.7 mg/kg
• Cats 1.8 mg/kg
• Clinical signs (gt24 h after ingestion of high
  dose 1-5 d--low dose)
• Excitement, tremors, seizures
• Depression, ataxia
• Rx (will take 2-3 wk to know if animal will
  survive)
• Purge GI tract if exposure recent
• Reduce cerebral edema with Mannitol and
  glucocorticoids
• Seizure control with Diazepam and Phenobarbital

87
Toxicologic Emergencies

• Acetaminophen
• Common OTC drug for analgesia
• Toxic dose Dog160-600 mg/kg
• Cat50-60 mg/kg (2 doses in 24 h is almost
  always fatal)
• Clinical signs (starts within 1-2 h of ingestion)
• Vomiting, salivation
• Facial and paw edema
• Depression
• Dyspnea
• Pale mm
• Cyanosis due to methemoglobinemia
• Pxpoor
• Rx
• Induce vom/activated charcoal
• Antidote N-Acetylcysteine (loading dose
  of140-280 mg/kg PO, IV, then at 70 mg/kg PO, IV
  QID x 2-3 d

88
Toxicological Emergencies
89
Toxicologic Emergencies

• Metals
• Lead toxicity more common in dogs than cats
• Source
• Lead paint (prior to 1970s) is primary source
• Batteries, linoleum, plumbing supplies, ceramic
  containers, lead pipes, fishing sinkers, shotgun
  pellets
• Clinical signs (Usually involves signs of GI and
  nervous systems)
• Anorexia
• Vom/dir
• Abd pain
• -CNS signs do not show initially
• Blindness, seizures, ataxia, tremors, unusual
  behavior

90
Toxicologic Emergencies

• Metals
• Lead toxicity
• Dx
• Large nucleated RBCs basophilic stipling
• Blood lead conc gt35 µg/ml
• Rx
• Remove lead from GI tract (cathartic, Sx)
• Chelators (to bind the Pb in blood stream and
  hasten its removal)
• -Calcium EDTA (ethylene diamine tetra acetic
  acid)
• -Penicillamine
• IV fluids for dehydration and to speed removal
  via kidneys
• Diazepam, Phenobarbital to control seizures

91
Toxicologic Emergencies

• Metals
• Zinc Toxicosis
• Usually from ingested pennies, galvanized
• metal, zinc oxide ointment
• Clinical signs
• Vomiting
• CNS depression
• Lethargy
• Dx
• Hx of exposure
• Clinical signs
• Rx
• Remove metal objects endoscopically or
• surgically
• IV fluid therapy
• Ca EDTA chelation

92
Toxicologic Emergencies

• Ethylene Glycol (antifreeze sweet taste)
• Lethal dose Cat1.5 ml/kg
• Dog6.6 ml/kg
• Signs (onset within 12 h of ingestion)
• CNS depression, ataxia (may appear intoxicated)
• Vomiting
• PD/PU
• Seizures, coma, death
• Acute renal failure
• Dx
• Hx, signs
• Ethylene Glycol Poison Testan 8 min test used in
  cats and dogs
• Calcium oxalate crystals
• Rx
• Emesis, adsorbents if ingestion within 3 h of
  presentation
• IV fluids, NaBicarb for acidosis
• Ethanol inhibits ethylene glycol metabolism Dogs
  (Cats) 20 ethanol5.5 (5.0) ml/kg q6h x 5,
  then q8h x 4
• 4-methylpyrazole has been shown to be effective

93
Toxicological Emergencies
THE PROBLEM
THE SOLUTION
94
Toxicologic Emergencies

• Snail Bait (Metaldehyde, methiocarb)
• Metaldehyde mechanism unknown
• Methiocarb is a carbamate and parasympathomimetic
• Signs
• Hypersalivation
• Incoordination
• Muscle fasciculations
• Hyperesthesia
• Tachycardia
• Seizures
• Rx
• Emesis and absorbents
• Pentobarbital, muscle relaxants to control CNS
  hyperactivity

95
Toxicologic Emergencies

• Garbage Toxicity
• Common in dogs not in cats
• Enterotoxin-producing bacteria include
• Strep, Salmonella, Bacillus
• Signs (within min to h after ingestion)
• Anorexia, lethargy
• Vom/dia
• Ataxia, tremors
• Enterotoxic shock can cause death
• Rx
• IV Fluid therapy
• Broad-spec antibiotics
• Intestinal protectants
• Muscle relaxers or Valium may be needed to
  control tremors
• Corticosteroids to counter endotoxic shock

96
Toxicologic Emergencies

• Insecticides
• Pyrethrins, Pyrethroids, Permethrins
• Common ingredients of flea/tick sprays, dips,
  shampoos, etc
• If used according to instructions, toxicity
  rarely occurs if overused, toxicity can result
• Signs
• Hypersalivation
• Vom/dia
• Tremors, hyperexcitability or lethargy
• Later, dyspnea, tremors, seizures can occur
• Rx
• Bathe animal to remove excess
• Induce vomiting/charcoal/cathartics for ingestion
• Diazepam may be necessary for mild tremors
• Methocarbamol, a muscle relaxer, for
  moderate-severe tremors
• Atropine for hypersalivation and bradycardia

97
Toxicologic Emergencies

• Insecticides
• Organophosphates and Carbamates
• Inhibit cholinesterase activity (break down of
  Ach is inhibited)
• Highly fat-soluble easily absorbed from skin and
  GI tract
• Found in dips, sprays, dusts, etc for fleas and
  ticks, and flys
• Signs
• Salivation
• Lacrimation
• Urinary incontinence
• Diarrhea
• Dyspnea
• Emesis, gastrointestinal cramping
• -May progress to
• Seizures, coma, resp depression, death
• Rx
• Bathe animal
• Charcoal if ingested
• Atropine (0.2-0.4 mg/kg half IV, half IM or SQ)
• Praloxime chloride (20 mg/kg BID till signs
  subside)reactivates cholinesterase

98
Toxicologic Emergencies

• Plant Toxicity
• Most common in confined and juvenile animals
• Usually from ornamental, indoor plants
• Severity varies with plants
• ID scientific plant name (florist, greenhouse)
• Araceae family (most from this family)
• Dumb cane, split-leaf philodendron
• Contain calcium oxalate crystals
• Signs
• Hypersalivation, oral mucosal edema, local
  pruritis
• -Large amount of plant may cause
• Vomiting, dysphagia, dyspnea, abd pain,
  vocalization, hemorrhage
• Rx
• Rinse mouth with milk or water to remove Ca
  Oxalate crystals
• GI decontamination (protectants) may be needed

99
Dumb Cane (Dieffenbachia)

• aka Mother-in-laws tongue
• Oral irritation intense burning, excess
  salivation

100
Split Leaf Philodendron

• Oxalate crystals like Dieffenbachia
• Oral irritation intense burning, excess
  salivation

101
Lily of the Valley

• Contains cardiac glucosides
• Cardiac arrythmias, death

102
Azalea (Rhododendron)

• Hypotension, cardiovascular collapse, death

103
Sago Palm

• ALL PARTS OF THE PLANT ARE TOXIC
• Coagulopathy
• Liver failure

104
Toxicologic Emergencies

• Phone advice to give owners (legal issues)
• Protect yourself from exposure before handling
  animal
• Gloves, protective clothing
• Protect yourself from animal because poisoned
  animals may act strangely
• Protect animal from further exposure by removing
  pet from source
• Bring sample of vomit, feces, urine
• Bring container/package that toxin was in and a
  sample of the toxin (plant material, rat bait,
  etc)