Critical care monitoring.

Small mammals and birds present unique challenges for the clinician in treatment of life-threatening conditions. Numerous books have been written on shock, critical care, and cardiopulmonary resuscitation in small animals. The basic protocols can be adapted for use in small mammals and birds. A general review of the pathophysiology of shock is important to the understanding of fluid therapy plans discussed in this article. Using the general principles of cardiopulmonary-cerebral resuscitation in small animals, protocols are discussed for use in birds and small mammals.     

Critical care monitoring considerations for the diabetic patient

Diabetes mellitus (DM) is a common endocrine disease encountered in the emergency and critical care setting. The diabetic Ketoacidotic (DKA) animal represents an extreme of the DM patient with regard to hyperglycemia and acid-base and electrolyte derangements. Prompt diagnosis of DKA in a critical patient and rapid initiation of appropriate therapy are necessary for a positive outcome. The steps of treatment, in order of importance, include initiation of intravenous fluid therapy, insulin therapy, electrolyte replacement, and reversal of the metabolic acidosis. The main goals of therapy--including correction of dehydration, electrolyte abnormalities and acidosis via aggressive fluid therapy with electrolyte supplementation and correction of ketoacidosis and hyperglycemia via initiation of insulin therapy--can be achieved if these steps are followed. Because of the severity of metabolic alterations in the DKA animal, frequent and careful monitoring are paramount because they will allow the clinician to tailor treatment to each case.     

Critical care of the rabbit.

Emergency and critical care principles are similar for all mammals. However, because they are stressed easily, rabbits require specialized handling techniques. Rabbits must be evaluated efficiently and stabilized quickly before moving into the definitive diagnostic phase of their care. A thorough clinical history, systematic physical examination, and multiple diagnostic tests are ideal, but when a rabbit is in critical condition, emergency stabilization and fluid resuscitation must take priority. Common emergency presentations include gastrointestinal disorders, such as prolonged anorexia, respiratory distress, neoplasia, neurologic symptoms, exposure to toxins, trauma, and urinary tract infections or obstruction.     

Perioperative supportive care and monitoring.

Supportive care minimizes the adverse physiologic effects of anesthesia, surgery, and preexisting disease. Monitoring detects physiologic perturbations, ensures appropriate anesthetic depth, and assesses the efficacy of supportive care. The principles of monitoring and supportive care are similar in small exotic species; however, an understanding of comparative anatomy, physiology, and pathophysiology is necessary to apply these principles.     

Critical care cardiology

Management of the critical care cardiology patient often requires a rapid, accurate diagnostic and therapeutic strategy. A wide range of cardiovascular drugs is available for treatment of shock, congestive heart failure, and arrhythmias.     

Critical care surgical techniques

A veterinarian dealing with critical and trauma patients must be proficient with techniques for tracheostomy, thoracostomy tube placement for chest drainage, diagnostic peritoneal lavage, and autotransfusion. The utilization of these techniques may be life-saving in the critical patient. A tracheostomy is indicated in any patient with upper airway obstruction that cannot be managed with supplemental oxygen and/or orotracheal intubation. A tracheostomy tube with an inner cannula is preferred. Tracheostomy tubes should be cleaned at 3- to 4-h intervals, and methods should be employed to decrease thick tracheal secretions and to remove them from the trachea. A patient with a tracheostomy tube should be monitored continuously. A thoracostomy tube is indicated in any patient with large and/or continuous accumulation of air, blood, fluid, or chyle in the pleural space. The thoracostomy tube should be at least the same size as the patient's main stem bronchus. The thoracostomy tube is placed aseptically at the seventh intercostal space at the junction of the upper one third and lower two thirds of the lateral chest wall. Fluid or air may be removed from the chest intermittently with a three-way stopcock attached to the thoracostomy tube and a 60-ml syringe. If continuous drainage is needed, a continuous underwater seal and suction system should be used. Diagnostic abdominal paracentesis and peritoneal lavage are useful techniques in the determination of abdominal trauma, hollow viscus rupture, peritonitis, hepatic trauma, and urinary system trauma. When a multiholed catheter and lavage are used, the accuracy of detecting abdominal trauma is 95 per cent. When only needle paracentesis is used, the accuracy drops to 47 per cent. Abdominal lavage fluid can be analyzed for bacteria, whole blood, white blood cells, free bilirubin, creatinine, blood urea nitrogen, amylase, alkaline phosphatase, and alanine aminotransferase. Large volumes of whole blood recovered from abdominal or thoracic paracentesis can be reinfused into the patient if needed, providing it is not contaminated or markedly hemolyzed. The blood should be collected aseptically into blood bottles or bags. If the bleeding is ongoing or the blood only a few hours old, anticoagulants should be used. If the hemorrhage is several hours old, then clotting and defibrination has already occurred and the blood can be collected into "dry" bags or bottles. Before use, abdominal blood should be analyzed for urine, bile or fecal contamination. Blood collected from the thoracic cavity is much less likely to be contaminated. Autotransfused blood is administered through a standard blood administration set.     

Critical care of pet birds. Procedures, therapeutics, and patient support.

Critically ill birds must be recognized, accurately assessed, and provided rapid appropriate treatment. This article presents a method of assessment and supportive care for critically ill birds. A problem-oriented approach based on clinical signs is presented, accompanied by suggested diagnostic tests. Techniques used to treat critically ill birds are also discussed.     

Invertebrate care.

Invertebrates are attracting increasing interest within the veterinary profession. They are also significant in their own right; as the Council of Europe's "Charter on Invertebrates" points out, they are the most important component of wild fauna as well as providing food, contributing to agriculture and forestry, and aiding medicine,industry, and crafts. Whenever invertebrates are kept in captivity they should be subject to high standards of management and care and veterinary attention-whether by the veterinarian or by the veterinary technician-should be based on sound biological and humanitarian principles.     

Critical difference of some bovine haematological parameters.

The purpose of the present study was to calculate the critical difference between 2 analytical results for the red blood cell count (RBC), the white blood cell count (WBC), the haemoglobin concentration (Hb), and the haematocrit (PCV) in blood from Red Danish Dairy cows. The critical difference can help to judge whether the difference between 2 consecutive analytical results from the same animal may be safely ascribed to natural variation or not. To calculate the critical differences, blood samples from 20 clinically healthy lactating cows were collected once daily for 5 consecutive days. The total variance of the analytical results was divided into the component of variance between cows (S2Inter), the component of variance for days within cows (S2Intra), and the component of variance for measurements (S2Anal) using nested analysis of variance. The critical difference was then calculated from S2Intra and S2Anal as 0.61 x 10(12)/l for RBC, 2.2 x 10(9)/l for WBC, 0.79 mmol/l for Hb, and 0.07 for PCV. The critical differences may be used as guidelines to indicate potentially important changes in the parameters. However, the analytical results should not be assessed by the critical differences alone, but should also be compared to the corresponding reference intervals.     

Neonatal critical care.

The first few minutes after a neonate's birth may determine the quality of its entire life. Immediate care includes prevention of hypothermia, clearing of nasal and oral passages, stimulation of ventilation and oxygenation, and, in a few cases, advanced life support. Any additional stress during the first weeks of life can also result in neonatal morbidity and mortality. Care of the diseased newborn must focus not only on treatment of the underlying disease but on aggressive supportive care. A safe, warm, clean, proper environment and adequate nutrition are essential.