1 Monitoring Equipment  Pulse oximeter  Capnography  Blood gas analysis

2 Blood Pressure Monitoring  Indirect  Doppler  Oscillometric  Dynamap  Cardell  Direct  Arterial catheter  Transducer  Monitor

3 Indirect Blood Pressure  Measures systolic pressures  Apply occlusion cuff over appendage  Cuff should be 40% of the circumference of leg  Place snugly around leg, tape in place

4 Indirect Blood Pressure  Cuff is placed on:  Mid foreleg distal to hock  Base of tail  Below the stifle in cats

5 Doppler  Seemingly more accurate  Has more clinical uses

6 Direct Blood Pressure  Techniques  Invasive  More accurate  Requires arterial catheter placement  Requires transducer and mechanical transmitter  Records systolic, diastolic, and mean pressures continuously through series of waveforms

7 Ideal Blood Pressure Values  Mean blood pressure ranges from mm Hg  Systolic blood pressures >175 mm Hg indicates hypertension  Pulses should be palpable if the mean arterial blood pressure is >60 mm Hg  Systolic values >90 mm Hg and diastolic values >60 mm Hg are required to maintain adequate perfusion of vital organs

8 Central Venous Pressure  Crude way to monitor a patient’s cardiac output via a jugular catheter in anterior vena cava  Used as a marker in fluid therapy to assess a patient’s response to treatment  Useful marker in determining perfusion status

9 Central Venous Pressure  Normal central venous pressure is 0-5 cm H 2 O  Values <0 indicate hypovolemia, dehydration, or inadequate fluid therapy  Values or trends >8 or 10 indicate an increase in vascular volume and adequate fluid therapy  Sudden increases in CVP or values >10 may indicate venous congestion, increased thoracic pressure, and volume overload

10 Coagulation Status  Helpful in assessing unexplained bleeding  Helpful in detecting DIC  Methods  Evaluation of a blood smear  May detect red blood cell morphology changes and provide an estimation of platelet numbers

11 Coagulation Status  Methods  Buccal mucosal bleeding time (BMBT)  Evaluates platelet function  Can be used as an in-house screening test for von Willebrand’s disease

12 Renal System Monitoring  Standard monitoring includes urine-specific gravity before IV fluids (if possible)  Laboratory markers include the BUN, creatinine, phosphorous

13 Renal System Monitoring  Urine output should be estimated in all animals and recorded in the medical record  Critical cases require close monitoring of urine production through indwelling urinary catheters or specifically designed cages that allow urine to drain through a grate to be collected  Minimum urine production is 2-4 ml/kg/hr

14 Central Nervous System Monitoring  Note changes in mentation, level of consciousness, and respiratory patterns  Changes may be subtle  Acute changes in neurologic status should be reported immediately

15 Central Nervous System Monitoring  Frequent monitoring of pupillary size and responsiveness to light  Early signs of increased intracranial pressure include mental dullness, tachypnea, tachycardia, and dilated pupils  Later signs include bradycardia, fixed pinpoint pupils, seizures, coma, and death  Early recognition and intervention are key to the management

16 Abdominal Cavity Evaluation  Examined initially by palpation  Palpation can detect abdominal distension  Distension possible due to fluid accumulation, organ enlargement, and intestinal gas

17 Abdominal Pain  Detected by the presence of discomfort, splinting, or vocalization  Animals with unexplained abdominal pain or distension warrant further investigation and monitoring

18 Abdominocentesis  Procedure to confirm the presence of abdominal fluid and to collect samples for fluid analysis  Abdominocentesis is commonly performed to detect active hemorrhage, infection (peritonitis), ascites, uroabdomen, and neoplastic effusions

19 Abdominocentesis  If only a small amount of fluid is collected, a four-quadrant tap may be performed in which the four areas of the abdomen centered around the umbilicus are sampled

20 Thoracocentesis  May be performed as an emergency diagnostic procedure in animals with severe respiratory distress  Performed with the animal comfortably restrained in sternal recumbency

21 Urinary Obstruction  Common emergency  Causes  Urinary stones, tumors, trauma, and/or inflammation  Obstructions can be fatal  Metabolic abnormalities can develop quickly  May develop secondary kidney damage  May even rupture the urinary system and leak urine into the abdomen

22 Toxicities  Patient history is crucial  What did the animal ingest?  When did the animal ingest it?  Is the animal showing any clinical signs?  Was the ingestion witnessed or suspected?  Are there other animals or children who could also be exposed?

23 Toxicities  Manufacturer labels contain important information  Advise client to bring label to the veterinary practice with the pet  Additional information may be obtained from poison control centers

24 Toxicities  Treatment  Based on the toxin ingested  Inducing vomiting should be cautiously considered  Vomiting contraindicated for ingestion of caustic substances and petroleum products

25 Toxicities  Inducing vomiting  Apomorphine is a potent emetic agent  Directly stimulates the vomiting centers of the brain to cause vomiting  Used only in dogs  Absorbed across the conjunctival membranes of the eye  Small tablets may be placed in the conjunctival sac until vomiting has occurred  Can be flushed from the conjunctiva to terminate the vomiting episode

26 Toxicities  Induction of vomiting in cats  Very challenging!  Xylazine (a sedative drug) often used  Household remedies  Hydrogen peroxide and syrup of ipecac  Hydrogen peroxide administered orally will reliably result in vomiting due to bitter taste and gastric irritation