Veterinary Emergency and Critical Care Procedures E-Book

Timothy B. Hackett

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 150

Veröffentlichungsjahr: 2024

Beschreibung

Updated edition of a practical step-by-step guide to common procedures in emergency and critical care medicine for dogs and cats

Veterinary Emergency and Critical Care Procedures, Third Edition delivers a highly practical step-by-step guide to common life-saving procedures in canine and feline practice. Presenting concise descriptions of techniques accompanied by full-color clinical photographs, this book is designed for easy reference in an emergency situation.

This newly revised and updated Third Edition includes the latest developments in the field of emergency and critical care medicine, with new information on the Mila Seldinger thoracostomy tube placement, over-the-wire blind intubation using a rigid polypropylene catheter and ET tube, use of an introducer to facilitate placement of esophagostomy tubes, as well as transoral airway washes.

Each procedure includes information on the indications for the technique, potential risks, and equipment required, with helpful hints for avoiding complications. A companion website features video clips demonstrating most procedures.

This new edition includes information on:

• Cardiopulmonary resuscitation based on the latest RECOVER guidelines, covering closed and open chest CPR as well as basic and advanced life support
• Vascular access techniques, including peripheral venous catheters, percutaneous facilitation, vascular cutdown, central venous catheters, and arterial catheterization
• Oxygen supplementation and management of upper airway obstruction, covering nasal and nasopharyngeal oxygen catheters, and intratracheal oxygen supplementation
• Thoracocentesis and thoracostomy tube placement, management of open sucking chest wounds, and analgesia and local anesthesia to block rib fractures

Veterinary Emergency and Critical Care Procedures is a must-have reference for any veterinarian or veterinary technician dealing with emergent canine and feline patients, along with veterinary and veterinary technology students.

Leseprobe

Table of Contents

Cover

Table of Contents

Series Page

Title Page

Copyright Page

Preface

Companion Website

List of Abbreviations

CHAPTER 1: Vascular Access Techniques

INTRODUCTION

PERIPHERAL CATHETERIZATION

CENTRAL VENOUS CATHETER PLACEMENT

OVER‐THE‐WIRE CATHETERS (SELDINGER TECHNIQUE)

JUGULAR CENTRAL THROUGH‐THE‐NEEDLE CATHETER PLACEMENT

LATERAL SAPHENOUS OVER‐THE‐WIRE (SELDINGER) CATHETER

AURICULAR VENOUS CATHETER

ARTERIAL CATHETERIZATION

VASCULAR CUTDOWN

INTRAOSSEOUS CATHETERIZATION

PLACEMENT OF INTRAOSSEOUS CATHETER PLACEMENT IN THE HUMERUS

INTRAOSSEOUS CATHETERIZATION USING THE EZ‐IO DEVICE

THREE SYRINGE TECHNIQUE FOR BLOOD SAMPLE COLLECTION

SUGGESTED READING

CHAPTER 2: Respiratory Emergencies: Thoracocentesis, Local Anesthesia for Rib Fracture, Management of Open Sucking Chest Wounds, and Thoracostomy Tube Placement

EMERGENCY AIRWAY ACCESS

TEMPORARY TRACHEOSTOMY TUBE PLACEMENT

TRACHEOSTOMY TUBE CARE

THORACOCENTESIS

MANAGEMENT OF AN OPEN SUCKING/PENETRATING CHEST WOUND

LOCAL ANESTHETIC BLOCKS FOR RIB FRACTURES OR FLAIL CHEST

THORACOSTOMY TUBE PLACEMENT

THORACOSTOMY TUBE – TROCAR

ALTERNATE METHOD OF THORACOSTOMY TUBE PLACEMENT WITHOUT A TROCAR

THORACOSTOMY TUBE PLACEMENT USING OVER‐THE‐WIRE SELDINGER TECHNIQUE

SUGGESTED READING

CHAPTER 3: Oxygen Supplementation and Respiratory Sampling Techniques

NASAL AND NASOPHARYNGEAL OXYGEN CATHETER PLACEMENT

OXYGEN HOOD

TRANSORAL WASH

SUGGESTED READING

CHAPTER 4: Pericardiocentesis

INTRODUCTION

SUGGESTED READING

CHAPTER 5: Nutritional Support and Orogastric Lavage

INTRODUCTION

NASOESOPHAGEAL AND NASOGASTRIC TUBES

SUPPLIES NEEDED

ESOPHAGOSTOMY TUBES

PLACEMENT OF ESOPHAGOSTOMY TUBE USING INTRODUCER

OROGASTRIC LAVAGE

SUGGESTED READING

CHAPTER 6: Urinary Catheter Placement, Urohydropulsion, and Temporary Antepubic Cystostomy Catheter Placement

URINARY CATHETER PLACEMENT IN MALE AND FEMALE DOGS

URETHRAL CATHETERIZATION IN MALE AND FEMALE CATS

UROHYDROPULSION

TEMPORARY ANTEPUBIC CYSTOSTOMY TUBE PLACEMENT

SUGGESTED READING

CHAPTER 7: Abdominocentesis and Diagnostic Peritoneal Lavage

ABDOMINOCENTESIS

DIAGNOSTIC PERITONEAL LAVAGE

ABDOMINAL DRAINAGE CATHETER

SUGGESTED READING

CHAPTER 8: Cardiopulmonary Resuscitation

INTRODUCTION

CLOSED‐CHEST CPR

ADVANCED LIFE SUPPORT (ALS)

OPEN‐CHEST CPR

CLOSING THE THORAX AFTER OPEN‐CHEST CPR

SUGGESTED READING

CHAPTER 9: Continuous Rate Infusions

INTRODUCTION

PHARMACOKINETICS

CALCULATIONS

SUGGESTED READING

CHAPTER 10: Product Guide and Supplies

CHAPTER 1: ARTERIAL AND VENOUS CATHETERIZATION

CHAPTER 2: THORACOCENTESIS, THORACOSTOMY TUBE

CHAPTER 3: OXYGEN SUPPLEMENTATION

CHAPTER 4: PERICARDIOCENTESIS

CHAPTER 5: ENTERAL FEEDING AND OROGASTRIC LAVAGE

CHAPTER 6: URETHRAL CATHETERIZATION, URINARY HYDROPULSION, ANTEPUBIC CYSTOSTOMY CATHETER

CHAPTER 8: CARDIOPULMONARY RESUSCITATION

Index

End User License Agreement

List of Tables

Chapter 8

Table 8.1. Have an assistant draw up drugs as necessary using the following ...

Chapter 9

Table 9.1. Table of drugs commonly administered as constant rate infusions....

List of Illustrations

Chapter 1

Fig. 1.1. Restraint for jugular catheterization. Place the patient in latera...

Fig. 1.2. Restraint for cephalic catheterization. Place the patient in stern...

Fig. 1.3. Restraint for lateral saphenous vascular catheterization. Place th...

Fig. 1.4. Restraint for medial saphenous catheterization. Place the patient ...

Fig. 1.5. Restraint for cephalic catheterization. The animal is positioned i...

Fig. 1.6. Supplies needed for peripheral catheterization.

Fig. 1.7. Have an assistant restrain and clip the antebrachium circumferenti...

Fig. 1.8. If the skin is very tough, or if the animal is very dehydrated, ma...

Fig. 1.9a. Have an assistant occlude the vessel. Wearing gloves (nonsterile)...

Fig. 1.9b. Watch for a flash of blood, the push the catheter off of the styl...

Fig. 1.10a. Have an assistant occlude the vessel just over the point of cath...

Fig. 1.10b. Have an assistant occlude the catheter to prevent backflow of bl...

Fig. 1.11. Tape the catheter around the hub and limb with a half‐inch length...

Fig. 1.12. Finish taping the catheter in place with layers of 1‐inch white a...

Fig. 1.13. Place a T‐port flushed with heparinized saline and flush the cath...

Fig. 1.14. Supplies needed for through‐the‐needle catheter placement.

Fig. 1.15. Place the patient in lateral recumbency.

Fig. 1.16. Aseptically clip and scrub over the proposed site of catheter pla...

Fig. 1.17. Drape the sterile field, and then occlude the jugular vein at the...

Fig. 1.18. Wearing sterile gloves, tent the skin over the proposed site of c...

Fig. 1.19. Insert the needle into the vessel. In some cases, you will feel a...

Fig. 1.20. Once the catheter is pushed to the hub securely, remove the style...

Fig. 1.21. Flush the catheter with heparinized saline.

Fig. 1.22. Remove the needle from the vessel, and secure the plastic pieces ...

Fig. 1.23. Secure the plastic pieces and catheter hub in place to the skin....

Fig. 1.24. Place sterile gauze squares over the site of catheter insertion, ...

Fig. 1.25. Next, secure cotton roll gauze over the catheter site.

Fig. 1.26. Finally, secure a final outer layer over the catheter bandage. Th...

Fig. 1.27. Supplies needed for placement of a through the needle catheter. I...

Fig. 1.28. Place the patient in lateral recumbency. In this case, an assista...

Fig. 1.29. Clip the distal limb circumferentially in between the stifle and ...

Fig. 1.30. Insert the needle of the over‐the‐needle catheter through the ski...

Fig. 1.31. Remove the stylette from the catheter. Do not let go of the cathe...

Fig. 1.32. Remove the long through‐the‐needle catheter from its attachment t...

Fig. 1.33. Insert the long, through‐the‐needle catheter through the smaller ...

Fig. 1.34. Push the long catheter into the vessel to its entire length and s...

Fig. 1.35. Secure the hub of both catheters with ½‐inch white tape.

Fig. 1.36. Remove the stylette from the long catheter (here, the white piece...

Fig. 1.37. Cover the catheter insertion site with a piece of sterile gauze....

Fig. 1.38. Wrap additional lengths of 1‐inch white tape over and under the c...

Fig. 1.39. Wrap the limb and catheter, starting distally, with cotton roll g...

Fig. 1.40. Secure the cotton roll gauze with Kling.

Fig. 1.41. Place a final wrap of Vetrap around the limb and catheter. The t‐...

Fig. 1.42. The skin is clipped and aseptically scrubbed as previously descri...

Fig. 1.43. The J‐wire supplied with an over‐the‐wire catheter kit. The shape...

Fig. 1.44. Draw the “J” of the J‐wire back into its introducer.

Fig. 1.45. Gently seat the introducer into the catheter hub, and insert the ...

Fig. 1.46. Remove the short catheter from the vessel and off of the wire.

Fig. 1.47. Insert the vascular dilator over the wire.

Fig. 1.48. Using the scalpel blade provided in the kit, make a small nick in...

Fig. 1.49. Push the vascular dilator over the wire, through the skin incisio...

Fig. 1.50. Flush all ports of the over‐the‐wire catheter.

Fig. 1.51. Insert the catheter over the wire. Pull the wire slowly out of th...

Fig. 1.52. The wire will eventually appear out one of the proximal ports.

Fig. 1.53. Once the wire has passed through the proximal port of the cathete...

Fig. 1.54. Remove the wire, and then flush all ports of the catheter again w...

Fig. 1.55. Suture the catheter to the skin with nonabsorbable suture.

Fig. 1.56a. Bandage the catheter.

Fig. 1.56b. Bandage the catheter.

Fig. 1.57. Clip and aseptically scrub along the lateral ear margin to visual...

Fig. 1.58. Have an assistant occlude the vessel proximally.

Fig. 1.59. Hold the ear in the non‐dominant hand, and insert the over‐the‐ne...

Fig. 1.60. Once a flash of blood is observed in the catheter hub, push the c...

Fig. 1.61. Place a length of half‐inch tape around the catheter hub and arou...

Fig. 1.62. Place a second length of 1‐inch white tape under the catheter, an...

Fig. 1.63. Place non‐adhesive bandage material over the catheter. Note: Subs...

Fig. 1.64. Place the patient in lateral recumbency. Clip and aseptically scr...

Fig. 1.65. Palpate the pulse just distal to the tarsus to place a dorsal ped...

Fig. 1.66. Insert the over‐the‐needle catheter through the skin at a 30° to ...

Fig. 1.67. Once a flash of blood is observed in the catheter hub, feed the c...

Fig. 1.68. Remove the stylette. Arterial blood should flow in a pulsatile ma...

Fig. 1.69. Secure the catheter in place with a length of ½‐inch white tape. ...

Fig. 1.70. Secure the arterial catheter in place with additional lengths of ...

Fig.1.71. Attach a heparinized t‐port to the arterial catheter.

Figs. 1.72a–b. Clearly label the arterial catheter, and also mark “not for I...

Fig. 1.73. Supplies needed for vascular cutdown

Fig. 1.74. After clipping the fur and aseptically scrubbing the clipped area...

Fig. 1.75. Tent the skin over the site of proposed vascular catheterization....

Fig. 1.76. Visualize the vessel under the skin incision.

Fig. 1.77. Bluntly dissect the fascia over the vessel using a curved mosquit...

Fig. 1.78a. Lift the vessel to the skin surface.

Fig. 1.78b. Absorbable stay sutures can be used to help elevated the vessel ...

Fig. 1.79a. A catheter introducer can be used to help guide a catheter into ...

Fig. 1.79b. After carefully making a small nick incision in the vessel with ...

Fig. 1.80. With the vessel raised to the skin surface, gently puncture the v...

Fig. 1.81. Insert the catheter through the needle into the vessel.

Fig. 1.82. Pull the needle off of the catheter. Do not let go of the cathete...

Fig. 1.83. For this type of catheter, cut the proximal end of the catheter t...

Fig. 1.84. Insert the proximal end of the catheter to the clam‐shell adapter...

Fig. 1.85. Attach a t‐port and flush the catheter with heparinize saline. No...

Fig. 1.86. Supplies needed for intraosseous catheterization.

Fig. 1.87. Abduct the femur such that the stifle is pushed medially and the ...

Fig. 1.88. Palpate the greater (major trochanteric fossa of femur). The inte...

Fig. 1.89. Spinal needle placed into the intertrochanteric fossa of the femu...

Figs. 1.90a–b. Once the needle is in the correct position, infuse a small am...

Fig. 1.91. Secure a piece of ½‐ or 1‐inch tape around the hub of the cathete...

Fig. 1.92. Patients will tolerate the intraosseous (IO) catheter quite well....

Fig. 1.93. Radiograph demonstrating immediate movement of iodinated contrast...

Fig. 1.94. Greater tubercle of the proximal humerus on a skeleton.

Fig. 1.95. Palpate the greater tubercle of the humerus.

Fig. 1.96. Infiltrate through the skin and underlying fascia to the level of...

Fig. 1.97. Make a small nick incision through the skin with a number 11 scal...

Fig. 1.98. Insert the IO catheter/Jamshidi IO needle device through the skin...

Fig. 1.99. Bend the limb such that the distal humerus/elbow is almost at a 9...

Fig. 1.100. Once the catheter is seated in place in the marrow cavity, remov...

Fig. 1.101. Flush the catheter with sterile 0.9% saline solution. If seated ...

Fig. 1.102. Set‐up for intraosseous catheterization using the EZ‐IO device. ...

Fig. 1.103. Place patient in lateral recumbency, then clip and aseptically s...

Fig. 1.104. Infiltrate the skin and underlying fascia with a small bleb of 2...

Fig. 1.105. Make a small nick incision over the proximal medial tibia throug...

Fig. 1.106. Palpate the flat portion of the proximal medial tibia and insert...

Fig. 1.107. The EZ‐IO catheter and stylette inserted in the proximal medial ...

Fig. 1.108. Once the catheter is firmly inserted into the bone, remove the i...

Fig. 1.109. Attach a t‐port to the EZ‐IO catheter and flush with sterile hep...

Fig. 1.110. Supplies needed for blood sample collection using the three‐syri...

Fig. 1.111. Infuse 0.5 mL of heparinized saline into the catheter to flush t...

Fig. 1.112. Use a second empty syringe, and withdraw the volume of nonhepari...

Fig. 1.113. Give the original heparinized sample back to the patient through...

Chapter 2

Fig. 2.1. Supplies needed for emergent airway intubation.

Fig. 2.2. The patient in the series of images had a firm but friable mass wa...

Fig. 2.3. Place the patient in sternal recumbency and insert your nondominan...

Fig. 2.4. Insert a rigid polypropylene catheter or red rubber catheter past ...

Fig. 2.5. Cut the proximal end off of the polypropylene or red rubber cathet...

Fig. 2.6. Remove the polypropylene or red rubber catheter once the endotrach...

Fig. 2.7. Setup for tracheostomy tube placement includes sterile drape mater...

Fig. 2.8. If a prefabricated tracheostomy tube is not available, a tracheost...

Fig. 2.9. Drape the sterile field with sterile drapes secured with towel cla...

Fig. 2.10. Make a vertical skin incision over the trachea caudal to the lary...

Fig. 2.11. Bluntly dissect the underlying fascia and sternohyoid muscles ove...

Fig. 2.12. Once the trachea is visible, secure small Gelpi retractors around...

Fig. 2.13. Place two sutures around adjacent tracheal rings. Prior to placem...

Fig. 2.14. Make a small incision in between tracheal rings. Take care to avo...

Fig. 2.15. Have an assistant remove the endotracheal tube. The tracheostomy ...

Fig. 2.16. Insert the tracheostomy tube and (internal obturator, if present)...

Fig. 2.17. If present, remove the internal obturator and replace with an inn...

Fig. 2.18. Label the stay sutures “Up” and “Down” to identify each, in the e...

Figs. 2.19a–b. VD and lateral thoracic radiographs of a cat with pleural eff...

Fig. 2.20. Provide flow‐by or mask oxygen to the patient.

Fig. 2.21. Supplies needed for thoracocentesis.

Fig. 2.22. Point‐of‐care ultrasound can be useful in detecting pockets of pl...

Fig. 2.23. Ultrasound image of thorax with echogenic pleural effusion. The b...

Figs. 2.24a–b. Clip a square in the middle of the thorax, then aseptically s...

Fig. 2.25. The bevel of the needle is the slanted, open area of the needle t...

Fig. 2.26. Schematic of a canine thorax/skeleton showing the bevel of the ne...

Fig. 2.27. Insert the needle through the skin and intercostal muscles in the...

Fig. 2.28. Insert the needle in between rib spaces in the center of the clip...

Figs. 2.29a–b. Inserting the needle into the pleural space of a cat and dog....

Fig. 2.30. Once the needle is inserted into the pleural space direct the nee...

Fig. 2.31. Have an assistant withdraw fluid or air from the pleural space.

Figs. 2.32a–b. Save fluid in plain and EDTA tube for cytology and analysis. ...

Fig. 2.33. Supplies needed for management of an open sucking chest wound.

Fig. 2.34. Clip a broad area around the thoracic wound, removing fur from ar...

Fig. 2.35. Take a sterile glove and cut a piece large enough to cover the en...

Fig. 2.36. Place the sterile glove over the wound.

Fig. 2.37. Sterile glove is in place, creating a barrier or seal between the...

Fig. 2.38. Setup for local anesthesia of the ribs includes 2% lidocaine, a 3...

Fig. 2.39. Radiograph demonstrating fractures of the eleventh to thirteenth ...

Fig. 2.40. Demonstration on a skeleton where the needle is inserted at the d...

Fig. 2.41. Aseptically scrub the lateral thorax with chlorhexidine, then dra...

Fig. 2.42. Insert the needle perpendicular to the dorsocaudal aspect of the ...

Fig. 2.43. Supplies needed for placement of a trocarized thoracostomy tube....

Fig. 2.44. Clip and aseptically scrub the lateral thorax as previously descr...

Fig. 2.45. Pick up the skin at the dorsal aspect of the seventh to ninth int...

Fig. 2.46. Insert the trocarized thoracostomy tube through the skin incision...

Fig. 2.47. Grasp the trocarized tube at the base and push through the interc...

Fig. 2.48. Remove the trocar from the thoracostomy tube and clamp the preatt...

Fig. 2.49. Place a horizontal mattress suture around the tube to decrease sp...

Fig. 2.50. Setup required for placement of a non‐trocarized thoracostomy tub...

Fig. 2.51. Insert a hemostat through the skin incision, over the seventh to ...

Fig. 2.52. Gently push the tip of the hemostat through the intercostal space...

Fig. 2.53. Measure the red rubber catheter from the tube entrance site to th...

Fig. 2.54. Place a horizontal mattress suture and a finger‐trap suture aroun...

Fig. 2.55. Supplies needed for placement of an over‐the‐wire thoracostomy tu...

Fig. 2.56. Clip then aseptically scrub the lateral thorax then injection of ...

Fig. 2.57. Insert the over‐the‐needle catheter perpendicularly through the i...

Fig. 2.58. Push the needle and catheter into the thorax then remove the styl...

Figs. 2.59a–c. The J wire is curved to prevent laceration of the lung and gr...

Fig. 2.60. Remove the catheter, and then insert the dilator over the wire, p...

Fig. 2.61. Remove the dilator from the wire, and then insert the thoracostom...

Figs. 2.62a–b. Push the thoracostomy tube over the wire into the thorax by a...

Fig. 2.63. Suture the catheter in place then cover with impermeable bandage ...

Chapter 3

Fig. 3.1. Supplies needed for placement of a nasal or nasopharyngeal oxygen ...

Fig. 3.2. Instill several drops of dilute 2% lidocaine or proparacaine into ...

Fig. 3.3. For placement of a nasal oxygen catheter, the tip of the tube is p...

Fig. 3.4. For placement of a nasopharyngeal oxygen catheter, the tip of the ...

Fig. 3.5. Lubricate the tip of the tube with sterile lubricant jelly or oint...

Fig. 3.6. Hold the tube as close to its tip, adjacent, and as close to the n...

Fig. 3.7. When placing a nasopharyngeal oxygen catheter, pinch the dorsolate...

Fig. 3.8. Place a stay suture adjacent to the nostril, and then secure the t...

Fig. 3.9. Suture the tube to the stay suture with a finger‐trap. Place a sec...

Fig. 3.10. Commercially available oxygen hoods.

Figs. 3.11a–b. In some cases, a small puppy or kitten or exotic species can ...

Fig. 3.12. To manufacture your own oxygen hood, cover the front three‐fourth...

Fig. 3.13. Secure the plastic wrap in place with adhesive tape.

Fig. 3.14. Secure the hood around the patient’s head with a length of gauze....

Fig. 3.15. Supplies needed for sample collection via transoral wash.

Fig. 3.16. After induction of anesthesia, wear sterile gloves to pass a new,...

Fig. 3.17. Pass a red rubber tube or rigid polypropylene catheter through th...

Fig. 3.18. Instill 5 to 10 mL of sterile 0.9% saline into the airways via th...

Fig. 3.19. Following instillation of sterile saline into the trachea, have a...

Fig. 3.20. Withdraw the fluid from the polypropylene catheter. Note: Not all...

Fig. 3.21. The sample collected can be submitted for fluid analysis, cytolog...

Chapter 4

Fig. 4.1. Electrical alternans is a characteristic ECG abnormality observed ...

Figs. 4.2a–b. Ventrodorsal and lateral thoracic radiographs from a patient w...

Fig. 4.3. Lateral thoracic silhouette from a dog with minimal pericardial ef...

Fig. 4.4. Supplies needed to perform a pericardiocentesis include antimicrob...

Fig. 4.5. Clip a large area of fur on the right lateral thoracic wall, cauda...

Fig. 4.6. Aseptically scrub the clipped area with antimicrobial scrub.

Fig. 4.7. Insert a bleb of 2% lidocaine dorsal to the sternum and just cauda...

Fig. 4.8. Rescrub the clipped area and drape with sterile field towels. Make...

Fig. 4.9. Wearing sterile gloves, insert the over‐the‐needle catheter throug...

Fig. 4.10. Watch for a flash of blood in the hub of the catheter.

Fig. 4.11. Once a flash of blood is observed, push the catheter off of the s...

Fig. 4.12. Attach the hub of the catheter to the male end of the length of I...