Analgesia in critical care.

All medical interventions, including the provision of analgesia, are associated with risks and benefits, which, when considered together, comprise that intervention's risk/benefit ratio. All interventions have alternatives (including no intervention), and each alternative possesses its own risk/benefit ratio. Clinical decision making involves comparing and contrasting the risk/benefit ratios of alternative interventions (relative risk/benefit ratio). The most formidable limitations of drug treatment relate to their potential to produce pharmacologic side effects or complications. Careful monitoring and the use of strategies for preventing and managing drug side effects are often all that is required to maintain efficacy.     

Small mammal critical care.

In emergency situations, veterinarians often are presented with critical patients of any species. The principles for critical care in traditional species such as the dog or cat can be applied to other small mammals. Although there are many unique aspects of the anatomy and physiology of different species, emergency care of small mammals can be instituted with the adaptation of products found in many general practices. Careful assessment of the patient, prioritization of the injuries, and rapid intervention can be life saving in any species.     

Amphibian emergency and critical care.

Amphibians present unique challenges for the clinician in the diagnosis and treatment of life-threatening conditions. Their adaptability to both aquatic and terrestrial lifestyles leaves them vulnerable to dehydration and fluid overload, either of which may accompany serious disease. This article presents the most common emergency conditions in amphibians, the physiologic basis of disease, and a guide to the diagnosis and treatment of amphibian emergencies.     

Emergency and critical care of fish.

Most fish emergencies are the result of inappropriate environmental conditions and primary or secondary infectious disease or trauma. The immediate response should be to increase aeration, provide suitable water, and decrease stressors. A thorough history, evaluation of the fish and their environment, and some rapid diagnostic tests (particularly direct and stained cytology) often provide the information needed to make a diagnosis and render appropriate treatment. When cohorts are at risk and the patient is unlikely to recover, euthanasia and necropsy are recommended to reach a definitive diagnosis. Some common emergencies include ammonia and nitrite toxicity; low dissolved oxygen; copper and chlorine toxicity; gas supersaturation; and certain bacterial, protozoal, and viral diseases.     

Nutritional support in critical care patients.

Malnutrition in the form of insufficient nutrient intake to support tissue metabolism undermines appropriate medical or surgical therapeutic management of a case. The major consequences of malnutrition in all patients are decreased immunocompetence, decreased tissue synthesis and repair, and altered intermediary drug metabolism. A practical goal is to begin nutritional support within 24 hours of the injury, illness, or presentation. There are only two methods by which nutrients can be supplied to the body: enteral and parenteral. General guidelines are presented to help establish a foundation.     

Emergency and critical care of fish.

The keeping of fish as pets is a hobby that has experienced increasing popularity over the past decade. The hobby has also become more sophisticated in recent years and a growing number of veterinarians are gaining clinical experience and knowledge in the area of pet fish medicine. The opportunity to apply this knowledge to a pet fish problem can be a rewarding experience. This article focuses on managing acute and critical problems of pet fish at times when veterinary intervention is required within an emergency time frame.     

Emergency and critical care of rodents.

Rodents may be presented on an emergency basis with various conditions causing debilitation and disease. Common causes of emergent presentations include trauma, respiratory disease, dental disease, gastrointestinal disease, reproductive disorders, and urinary tract obstruction. Emergency treatment should always include immediate stabilization of the patient until the patient is able to tolerate diagnostic testing and additional therapeutics. Rodent patients benefit from supportive care, including thermal, fluid, and nutritional support. Administration of cardiopulmonary resuscitation, antibiotics, and analgesics through various routes is also appropriate. This article presents an overview of emergency medicine in rodents, including emergency procedures, handling and restraint, triage and patient assessment, sample collection, and supportive care procedures. The most common emergency presentations for rodents are also discussed.     

Emergency and critical care of ferrets.

Gastrointestinal disease, neoplasia, cardiac disease, and endocrinopathy are among the most common syndromes affecting the ferret that presents in an emergency situation. Knowledge of these and other disease processes, indicated diagnostic testing, and immediate treatment protocols are critical to provide efficient and effective care to the ferret in crisis.     

Coagulopathy in the equine critical care patient.

Disseminated intravascular coagulation (DIC) is a clinicopathologic syndrome resulting from a multitude of underlying causes that manifests itself clinically as hemostatic/fibrinolytic failure. There is much debate on the definition, diagnosis, and treatment of DIC, a situation that is most likely the result of the multifaceted clinical presentation of the syndrome and the fact that patient outcome is often influenced by the underlying disease process. The fact that DIC increases morbidity and mortality in critical care patients is well established, but the exact mechanism of what specifically occurs on a microvascular level is still often argued.     

Emergency and critical care of pet birds.

Critically ill birds must be assessed accurately and provided with immediate supportive care. This article reviews the assessment and diagnostics required for evaluating the critical avian patient. The most common emergencies seen in pet birds are discussed. Diagnostics and treatments protocols are provided to help direct the practitioner toward a complete recovery.     

Respiratory pharmacotherapy in emergency and critical care medicine.

Successful pharmacologic management of most respiratory diseases is possible. All moderately to severely affected animals benefit from rest and supplemental oxygen. Careful identification of the underlying cause as well as an understanding of the pathophysiology behind various diseases is essential to successful patient outcome.     

Metabolic acid-base disorders in the critical care unit.

The recognition and management of acid-base disorders is a commonplace activity in the critical care unit, and the role of weak and strong acids in the genesis of metabolic acid-base disorders is reviewed. The clinical approach to patients with metabolic alkalosis and metabolic acidosis is discussed in this article.     

Cardiac emergencies and problems of the critical care patient.

Cardiac disease and dysfunction can occur as a primary disorder(ie, with pathology situated in one or more of the cardiac structures) or can be classified as a secondary problem when it occurs in patients with another primary problem that has affected the heart either directly or indirectly. Primary cardiac problems are encountered in horses presented to emergency clinics; however,this occurs much less frequently in equine critical patients than cardiac problems arising secondary to other conditions. Nevertheless,if primary or secondary cardiac problems are not identified and addressed, they certainly contribute to the morbidity and mortality of critical care patients.     

Feline trauma and critical care medicine

The initial management of the traumatized cat can be a challenging, but rewarding, task for the veterinarian. The pathophysiology of shock, its clinical presentation, and basic elements of treatment are universal to all species. Special care must be taken when dealing with injured cats, due to their increased susceptibility to stress and tendency toward severe hypothermia in shock. The development of pulmonary edema in response to excessive fluid loads, especially in the face of pulmonary injury, must be borne in mind when establishing treatment regimens. The keys to successful management of the traumatized cat lie in correct assessment of the extent and nature of injuries, rapid institution of rational therapy, and constant re-evaluation of the animal's response throughout the post-traumatic period.     

Neonatal adjustments.

Pharmacodynamic responses by neonates are the same as those for adults, but physiologic differences and pathophysiologic changes can affect pharmacokinetic values sufficiently to require adjustments in dosage regimens used for calves. Adjunctive care may be necessary for some patients to correct or maintain perfusion and temperature of tissues so that absorption and distribution may be adequate. Intravenous administration may be the only route appropriate for some critically ill patients. Anatomic sites and formulation of products administered by extravascular parenteral routes markedly can affect absorption of those products and subsequent clinical response to treatment.