Emergency Quick Assessment Immediate: PCV/TP, glucose, BUN Get samples to run later Blood (8-10cc) EDTA tube (2-3cc) Lithium heparin tube (2-3cc) Potassium citrate tube (2-3cc) Red top clot tube (2-3cc) urine

Emergency Quick Assessment Urinalysis If you need a urinalysis later, you need a sample prior to fluid therapy, before specific gravity is diluted If fever, you may want urine for possible culture prior to antibiotic therapy Use a 5-8Fr x 36” infant feeding tube to catheterize male dog > 75 pounds Use US guidance if needed for cystocentesis of small bladder

Emergency Quick Assessment Indications for Diagnostic Abdominocentesis Palpable fluid wave Owner reports abdominal bloating Suspect abdominal hemorrhage Acute collapse, pale mucous membranes, weak pulses, low blood pressure, + anemia Suspect peritonitis – shock and abdominal pain Fluid seen on AFAST® ultrasound

Emergency Quick Assessment Diagnostic abdominal tap technique 4 quadrants - R cranial, L cranial, R caudal, L caudal Diagnostic Peritoneal Lavage

Emergency Quick Assessment AFAST® Technique HR site – half way between umbilicus and table (R lateral) 20-22g 1-1/2 needle or butterfly no syringe – gravity drip into tubes Put fluid in EDTA and red top tubes for analysis EDTA - Spin down & direct for cytology red top tube for culture if needed (closed - syringe) Run EDTA through CBC machine for cell counts Fluid Analysis Handout

Ascites Transudate or Modified Transudate Remove enough fluid to alleviate dyspnea, and allow comfortable chest x-rays & abdominal ultrasound Bloodwork and abdominal ultrasound to determine the cause, and treat accordingly If cause is congestive heart failure, remove all fluid Hemorrhage - usually a surgical problem, unless Coagulopathy or anaphylaxis is identified and treated Traumatic hemorrhage resolves spontaneously (serial AFAST®), + auto-transfusion Non-septic exudate, chyle – tap if dyspneic Rarely surgical

Ascites Septic exudate, uroabdomen, bile peritonitis – usually surgical Multiple species of bacteria suggest GI perforation Plant material is very strong evidence If no bacteria are seen, look for phagocytosed bacteria in WBC, and for toxic changes in the neutrophils Feline Infectious Peritonitis (FIP) fluid High protein – mucoid strings (TP > 5-10 g/dl) Cell count usually <5,000/ul & almost always <10,000/ul Mononuclear cells usually > segs Albumin:glob usually <0.8: <0.45 is strong evidence

Ascites Compare abdominal fluid to plasma/serum Abdominal amylase and lipase > plasma/serum Pancreatitis Abdominal fluid glucose <50 mg/dl and <plasma/serum often indicative of bacterial peritonitis Abdominal bilirubin > plasma/serum Gallbladder/biliary tract rupture Abdominal creat > plasma/serum (BUN the same) Ruptured urinary tract Abd. triglycerides > serum; Abd. Cholesterol < serum chyle Abdominal coronavirus PCR or AB titer >> serum FIP