Small Animal Critical Care Medicine

3rd Edition - December 2, 2022
Authors: Deborah Silverstein, Kate Hopper
Language: English
Hardback ISBN:
9 7 8 - 0 - 3 2 3 - 7 6 4 6 9 - 8

The 3rd edition of your #1 go-to resource for veterinary critical care, Small Animal Critical Care Medicine, has been significantly updated to focus specifically on diag… Read more

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The 3rd edition of your #1 go-to resource for veterinary critical care, Small Animal Critical Care Medicine, has been significantly updated to focus specifically on diagnostic and management strategies for the sickest veterinary patients. It covers critical care medical therapy, monitoring, and prognosis — from assessment and stabilization through the entire course of intensive care treatment. To make therapeutic decisions easier, clear and practical guidelines address underlying clinical findings, pathophysiology, outpatient follow-up, and long-term care. Editors Deborah Silverstein and Kate Hopper, along with leading experts from the veterinary emergency and critical care profession, have created this indispensable resource to help you and your team provide the highest standard of care for your critically ill patients.

Cover image
Title page
Table of Contents
Copyright
Dedication
Contributors
Foreword
Video TOC
List of Illustrations
List of Tables
Part I. Key Critical Care Concepts
1. Evaluation and triage of the critically ill patient
Introduction
Primary survey
Supporting diagnostics
Summary
Selected references
References
2. Physical examination and daily assessment of the critically ill patient
Physical examination
Point-of-care ultrasound
Monitoring and laboratory data
Drug dosages and metabolism
Nutrition
Nursing care
References
3. Hemostasis
Overview of platelet structure and function
Primary hemostasis and the three-stage model of platelet activation
Secondary hemostasis
Overview of fibrinolysis
Immunothrombosis
Summary
References
4. Cardiopulmonary resuscitation
Preparedness and prevention
Basic life support
Monitoring
Advanced life support
Open-chest CPR
Prognosis
References
5. Postcardiac arrest care
Propagating sustained ROSC
Systemic response to ischemia and reperfusion: Sepsis-like syndrome
Post-cardiac arrest brain injury
Neurologic assessment and prognostication
Myocardial dysfunction
Persistent precipitating pathology
References
6. Classification and initial management of shock states
Pathophysiology
Clinical presentation of circulatory shock
Diagnostics and monitoring
Treatment
References
7. SIRS, MODS, and sepsis
Background
Evolution of definitions
Assessment of MODS severity
The apple score
Assessment of animals with SIRS or MODS
Summary
References
8. Oxygen toxicity
Pathophysiology
Cellular effect of oxidative injury
Ischemia-reperfusion injury
Clinical effects of hyperoxia
Hyperoxia in the critically ill
Hyperbaric oxygen therapy
Antioxidants
Prevention and treatment of oxygen toxicity
References
9. The endothelial surface layer
Introduction
The importance of the ESL in critical illness
Structure and function
Fluid movement across the endothelium
Shedding of the ESL
Methods for detection of ESL shedding
ESL shedding in dogs and cats
Protection of the ESL in disease
Conclusion
References
10. Hyperthermia and fever
Thermoregulation
Hyperthermia
True fever
Inadequate heat dissipation
Benefits and detriments of fever
Clinical approach to the hyperthermic patient
Nonspecific therapy for febrile patients
The febrile intensive care patient
References
11. Interstitial edema
Microvascular filtration
Lymphatic drainage
Serosal transudation
Antiedema mechanisms
Mechanisms of edema formation
Chronic edemagenic conditions
Conclusion
References
12. Patient suffering in the intensive care unit
Maslow’s hierarchy of needs and primal alert signals
References
13. Predictive scoring systems in veterinary medicine
Definition
Outcome probability vs. clinical decision aid tools
Applications in clinical practice
Applications in hospital management
Applications in research
Demonstration of effective or ineffective randomization in randomized controlled trials
Reduction of required sample sizes
Construction of scoring systems
Critical appraisal
Conclusion
References
Part II. Respiratory Disorders
14. Control of breathing
Central control of breathing
Descending pathways
Chemoreceptors and response to blood gases
Other sensory receptors
Abnormalities in the control of breathing
References
15. Oxygen therapy
Arterial oxygen content
Indications for oxygen therapy
Methods of oxygen administration
Complications of oxygen therapy
References
16. Hypoxemia
Collection of blood samples for in vitro measurement
Recognition of hypoxemia
Mechanisms of hypoxemia
Estimating the magnitude of the venous admixture
References
17. Hypoventilation
Definitions and measurement
Mechanisms and etiologies of hypercapnia
Clinical signs
Diagnosis
Treatment
References
18. Upper airway disease
History and clinical signs
Patient evaluation
Stabilization of patients with upper airway obstruction
Diagnostics
Diseases of the upper airway
References
19. Tracheal collapse: Management & indications for tracheal stents
Etiology
Clinical signs
Diagnostic evaluation
Medical management
Tracheal rings
Tracheal stenting
Post-stenting management considerations
Tracheal stent complications
Stenting for tracheal neoplasia
References
20. Feline bronchopulmonary disease
History and physical examination
Laboratory testing
Lung function testing
Airway sampling
Treatment
Prognosis
References
21. Lower airway disease in dogs
Introduction
Diagnosis of underlying conditions
Standard treatment
Disease exacerbation
Conclusion
References
22. Pulmonary hypertension
Definitions and terminology
Pathophysiology
Assessment of PH
Classification of PH
Clinical findings
Diagnostic evaluation
Clinical management
Prognosis and monitoring
References
23. Pulmonary edema
Pathophysiology
Clinical presentation
Diagnostic tests
Treatment
Prognosis
References
24. Pneumonia
Pathology
Pathophysiology
Specific types of pneumonia
Clinical features
Diagnostic approach
Therapeutic approach
Prevention
Prognosis and outcome
References
25. Acute respiratory distress syndrome
Introduction
Pathophysiology
Causes/risk factors
Diagnostic criteria
Management
Prognosis
References
26. Pulmonary contusions and hemorrhage
Pathophysiology and pathology
Diagnosis
Management
Prognosis and outcome
Atraumatic pulmonary hemorrhage
Diagnostic evaluation
Treatment
Prognosis and outcome
References
27. Pulmonary thromboembolism
Pathophysiology
History and clinical signs
Physical examination
Diagnostic testing
Classification of acute pulmonary thromboembolism
Treatment and prophylaxis
References
28. Chest wall disease
Chest wall anatomy and function
Diagnosis of chest wall disease
Causes of chest wall disease
Spinal cord and neuromuscular disease
Obesity
References
29. Pleural space disease
Pleural space
Physical examination
Imaging
Thoracocentesis
Pleural effusion
Pneumothorax
Diaphragmatic hernia
Reexpansion pulmonary edema
Acknowledgment
References
30. Respiratory distress look-alikes
Introduction
Control of respiration
Extrapulmonary causes of decreased oxygen delivery
Metabolic derangements
Hyperthermia
Behavioral
Brain disease
Drugs
Summary
References
Part III. Advanced Respiratory Support
31. High flow nasal oxygen
Introduction
Physiological benefits of high flow nasal oxygen (see Box 31.1)
High flow nasal oxygen in small animal critical care
Practical guidance for using high flow nasal oxygen
References
32. Mechanical ventilation—core concepts
Physiology
The ventilator breath
Ventilator settings
Ventilator alarms
Indications for mechanical ventilation
Initiation of mechanical ventilation
Goals
Complications
Troubleshooting
Prognosis
References
33. Mechanical ventilation—advanced concepts
Introduction
Patient–ventilator asynchrony
Lung protective ventilation
Refractory hypoxemia
Pressure modes of advanced mechanical ventilation
References
34. Jet ventilation
Physics and physiology
Equipment
Indications
Disadvantages
Monitoring of gas exchange during jet ventilation
Ventilator settings
References
35. Ventilator waveforms
Waveform types
Patient–ventilator dyssynchrony
Summary
References
36. Anesthesia and monitoring of the ventilator patient
Injectable anesthetics
Adjunct agents
Making an anesthesia plan for the ventilator patient
Withdrawal of anesthesia for ventilator weaning
Monitoring of the mechanically ventilated patient
References
37. Nursing care of the ventilator patient
General monitoring
Airway management
Oral care
Eye care
Urinary care
Gastrointestinal tract care
Recumbent patient care
Apparatus care
References
38. Discontinuing mechanical ventilation
When to wean
Anesthetic considerations
Approaches to weaning
Weaning prediction
Tracheostomy and weaning
Extubation
References
39. Ventilator-induced lung injury
Definitions
Mechanisms of ventilator-induced lung injury
Histopathology
Clinical relevance
Prevention
References
40. Ventilator-associated pneumonia
Pathogenesis
Diagnosis
Prevention
Treatment
References
Part IV. Cardiovascular Disorders
41. Mechanisms of heart failure
Neurohormonal aspects of heart failure
Myocardial remodeling
Abnormal calcium ion handling
Abnormal myocardial energy production
Global cardiac function
Clinical staging and assessment of heart failure
References
42. Ventricular failure and myocardial infarction
Diagnosis
Treatment
References
43. Feline cardiomyopathy
Classification and etiology of feline cardiomyopathy
Pathophysiology
Clinical presentation and findings
Diagnostic approach
Treatment
References
44. Canine cardiomyopathy
Dilated cardiomyopathy
Arrhythmogenic right ventricular cardiomyopathy
Hypertrophic cardiomyopathy
Atrioventricular myopathy
References
45. Canine myxomatous mitral valve disease
Introduction
Pathology and pathophysiology
Historical and physical examination findings
Clinicopathologic findings and cardiac biomarkers
Thoracic radiographic findings
Cardiac and thoracic ultrasound findings
Emergency management
Management of complicating factors
Monitoring
Long-term management
Prognosis
References
46. Blunt cardiac injury
Definitions and pathogenesis
Diagnosis and clinical assessment
Treatment
Summary
References
47. Pericardial diseases
Pericardial effusion
Cardiac tamponade
Clinical presentation
Diagnosis
Management of cardiac tamponade
Constrictive pericardial disease
Congenital pericardial disease
References
48. Bradyarrhythmias and conduction disturbances
Definition
Differential diagnosis
Treatment
References
49. Supraventricular tachyarrhythmias
Introduction
Electrocardiographic diagnosis
Treatment
References
50. Ventricular tachyarrhythmias
Introduction
Definitions
Electrocardiographic diagnosis
Causes of ventricular tachycardia
Practical approach to ventricular tachycardia treatment
References
51. Myocarditis
Infectious myocarditis
Noninfectious myocarditis
Diagnosis
Treatment
References
52. Cardiac biomarkers
Blood-based cardiac biomarkers
Clinical use of NT-proBNP and BNP testing in the emergency setting
Clinical use of cardiac troponin in the emergency setting
Important limitations and considerations involving cardiac biomarker testing
References
53. Systemic hypertension
Normal determinants of blood pressure
Pathogenesis of systemic hypertension
Definitions and causes of systemic hypertension
Adverse effects associated with systemic hypertension
Diagnosis of systemic hypertension
Treatment of systemic hypertension
References
54. Cardiopulmonary bypass
Introduction
Fundamentals of cardiopulmonary bypass
Postoperative management and complications
Summary
Acknowledgments
References
Part V. Electrolyte and Acid-Base Disturbances
55. Sodium disorders
Distribution of body water
Osmolality and osmotic pressure
Regulation of plasma osmolality
Total body sodium content versus plasma sodium concentration
Hypernatremia
Hyponatremia
Clinical signs of hyponatremia
A rapid drop in plasma sodium concentration and cerebral edema
Volume expansion in the hypovolemic patient that is hyponatremic or hypernatremic
References
56. Potassium disorders
Normal distribution of potassium in the body and its steady state regulation
Hypokalemia: Definition and causes
Management of hypokalemia
Anticipated complications
Hyperkalemia: Definition and causes
Pseudohyperkalemia
Consequences
Treatment of hyperkalemia
Acknowledgements
References
57. Calcium disorders
Calcium homeostasis
Calcium measurement
Hypercalcemia
Hypocalcemia
References
58. Magnesium and phosphate disorders
Magnesium
Phosphate
References
59. Traditional acid-base analysis
Introduction
Sample collection and handling
Traditional approach
Acid-base analysis
Causes of acid-base abnormalities
Bicarbonate therapy
References
60. Nontraditional acid-base analysis
The strong ion difference approach
Semiquantitative approach
Conclusion
Clinical examples
References
61. Hyperlactatemia
Biochemistry
Physiology
Etiology of hyperlactatemia
d-lactate
Clinical use
Prognostic use
Diagnostic use
Lactate as a therapeutic endpoint
References
62. Urine osmolality and electrolytes
Introduction
Urine osmolality
Urinary sodium
Urine potassium
Urine chloride
Free water clearance
References
Part VI. Fluid Therapy
63. Assessment of hydration
Variability in assessing hydration
Distribution and control of total body water
Measuring total body water
Clinical assessment of hydration status
Hypotonic fluid loss
Isotonic fluid loss
Special challenges
Conclusion
References
64. Assessment of intravascular volume
Introduction
Defining a fluid bolus
Mini-bolus and passive leg raising
Conclusions
References
65. Crystalloids and hemoglobin-based oxygen-carrying solutions
Crystalloids
Hypotonic fluids
Hypertonic fluids
Acid-base effects of crystalloids
Hemoglobin-based oxygen-carrying solutions
Conclusion
Acknowledgement
References
66. Colloid solutions
Synthetic starch colloids
Natural colloids
Conclusion
References
67. Daily intravenous fluid therapy
Total body water
Movement of fluids within the body
Fluid therapy plan
Fluid type
Monitoring
Discontinuation of fluid therapy
Acknowledgements
References
68. Shock fluids and fluid challenge
Administration of shock fluids
Resuscitation endpoints and monitoring
Shock fluids
Hypotensive resuscitation
Fluid challenge
References
69. Transfusion medicine
Introduction
Anemia and RBC transfusions
Platelet transfusions
Plasma transfusions
Albumin transfusions
Blood sources and donor management
Blood donation
Blood banking
References
70. Blood types, pretransfusion compatibility, and transfusion reactions
Blood types
Precompatibility testing
Transfusion reactions
Storage lesion
Leukoreduction
Transfusion administration and monitoring
References
71. Hemorrhagic shock
Assessment of the hemorrhagic shock patient
Management of controlled hemorrhage
Management of uncontrolled hemorrhage
Special considerations
References
Part VII. Endocrine Disorders
72. The diabetic patient in the ICU
Insulin
Nutritional support
References
73. Diabetic ketoacidosis
Pathophysiology
Signalment
History and clinical manifestation
Diagnosis
Additional diagnostic evaluation
Therapy
Outcome
References
74. Hyperglycemic hyperosmolar syndrome
Pathogenesis
History and clinical signs
Physical examination
Diagnostic criteria
Treatment
Monitoring
Postcrisis therapy
Prognosis
References
75. Hypoglycemia
Normal glucose homeostasis
Clinical signs and consequences of hypoglycemia
Diagnosis of hypoglycemia
Causes of hypoglycemia
Treatment of hypoglycemic crisis
References
76. Diabetes insipidus
Osmotic regulation and pathophysiology of diabetes insipidus
Implications of diabetes insipidus in the critically ill patient
References
77. Syndrome of inappropriate antidiuretic hormone secretion
Normal physiology
Syndrome of inappropriate antidiuretic hormone
Etiology
Diagnosis
Management
References
78. Thyroid storm
Pathogenesis
Precipitating events
Clinical signs
Diagnosis
Laboratory abnormalities
Treatment
Outcome
References
79. Hypothyroid crisis in the dog
Pathophysiology
Risk factors
Clinical signs and physical examination findings
Clinical pathology
Differential diagnosis
Treatment
Outcome
References
80. Pheochromocytoma
Clinical signs
Diagnosis
Treatment
Prognosis
References
81. Critical illness-related corticosteroid insufficiency
Background
Pathophysiology
Clinical manifestations
Diagnosing CIRCI in people
Diagnosing CIRCI in dogs and cats
Treating CIRCI in people
Treating CIRCI in dogs and cats
Prognosis
References
82. Hypoadrenocorticism
Who is affected?
Etiology
Clinical presentation
Diagnosis
Treatment
Associated disorders
Prognosis
References
Part VIII. Neurologic Disorders
83. Neurological evaluation of the ICU patient
Mentation
Gait and posture
Cranial nerves
Proprioceptive positioning
Segmental reflexes
Sensation/nociception
Neurologically abnormal
Clinical challenges in the critical patient with neurological disease
Next steps
References
84. Seizures and status epilepticus
Definitions
Classification
Pathophysiology
Etiology
Diagnostic plan
Treatment plan
References
85. Intracranial hypertension
Normal physiology of the brain
Clinical assessment of intracranial hypertension
Treatment of ICH
Prognosis
References
86. Tetanus
Etiology
Pathogenesis
Clinical presentation
Diagnosis
Treatment
Prognosis
References
87. Hepatic encephalopathy
Causes of hepatic encephalopathy
Diagnosing hepatic encephalopathy
Managing hepatic encephalopathy
References
Part IX. Infectious Disorders
88. Hospital-associated infections and zoonoses
HAI in dogs and cats
Risk factors
Antimicrobial-resistant nosocomial pathogens
Zoonoses, anthropozoonoses and HAI’s in the ICU
Conclusions
References
89. Febrile neutropenia
Neutrophil physiology
Pathophysiology of neutropenia
Clinical presentation and diagnostic tests
Treatment and supportive care
References
90. Sepsis and septic shock
Introduction
Current sepsis definitions
Pathobiology of sepsis
Diagnosis
Resuscitation and treatment of sepsis and septic shock
Prognosis
References
91. Bacterial infections
Introduction
Bacterial structure and taxonomy
Diagnosis of bacterial infections
Gram-positive bacteria of clinical importance
Gram-negative bacteria of clinical importance
Mycoplasma and intracellular bacteria of clinical importance
Treatment and prevention of bacterial infections
Conclusion
References
92. Fungal infections
Fungal organisms
Diagnosis
Treatment and outcome
References
93. Viral infections
Canine distemper virus infection
Influenza virus infections
Other emerging respiratory viral infections of dogs
Feline panleukopenia
Feline respiratory viral disease
Feline infectious peritonitis
Severe acute respiratory syndrome coronavirus-2
References
94. Canine parvovirus infection
Parvoviridae
Epidemiology
Risk factors for infection
Transmission and pathogenesis
Clinical signs
Clinical pathology
Sepsis, systemic inflammatory response syndrome, and coagulation
Diagnostic investigations
Diagnostic imaging
Treatment
Nutrition
Antiviral drugs
Outpatient protocol
Controversial therapies
Prevention of transmission
Prognosis
References
95. Infective endocarditis
Pathophysiology
Incidence, signalment, and presenting complaint
Predisposing factors
Etiologic agents
Clinical abnormalities
Clinicopathologic abnormalities
Diagnosis
Treatment
Prognosis
References
96. Urosepsis
Introduction
Pathogenesis
Causes of urosepsis
Conclusion
References
97. Necrotizing soft tissue infections
Diagnosis
Treatment
Extracorporeal plasma treatment
Conclusion
References
98. Catheter-related bloodstream infections
Pathophysiology
Definitions
Risk factors
Incidence
Diagnosis
Treatment
Prevention
Acknowledgements
References
99. Multidrug-resistant infections
Definitions
Risk factors for multidrug-resistant organisms
Escalation versus deescalation therapy
Specific multidrug-resistant organisms
References
100. Infectious disease control in the ICU
Health care-associated infections and biosafety
HCAIs in intensive care settings
HCAI prevention and control
Surveillance
Active infection control
Feedback to stakeholders
Dedicated biosafety team
References
Part X. Hematologic Disorders
101. Hypercoagulable states
Mechanisms of thrombophilia
Diagnostics
Common conditions in veterinary medicine
Management of hypercoagulable conditions
Conclusion
References
102. Feline aortic thromboembolism
Introduction
Pathophysiology
Clinical presentation
Diagnosis
Prognosis
Thrombolysis in fate
Antiplatelet therapy in fate
Anti-coagulant therapy in fate
Nursing and supportive care in fate
Prevention of fate
References
103. Platelet disorders
Acquired thrombocytopenia
Acquired platelet disorders
Congenital platelet disorders
General diagnostic approach to platelet disorders
Treatment of platelet disorders
References
104. Coagulopathy in the ICU
Normal hemostasis
Abnormal bleeding tendency
Clinical signs associated with hemostatic dysfunction
Laboratory tests for hemostasis
Hemostatic disorders in critically ill animals
Therapeutic management of coagulopathy
References
105. Management of the bleeding patient in the ICU
Diagnostic approach to a bleeding patient
Treatment of the bleeding patient
Suggested reading
References
106. Anemia in the ICU
Introduction
Oxygen transport by erythrocytes
Erythropoiesis
Physiological adaptation to anemia
Characterization of anemia
Clinical approach to anemia in the ICU
Therapeutic approach to anemia
References
107. Dyshemoglobinemias
Introduction
Causes of dyshemoglobinemia
Diagnosis of dyshemoglobinemias
References
108. Acute hemolytic disorders
Evaluation of the patient with hemolysis
Fragmentation hemolysis
Toxicant-induced hemolysis
Heritable hemolysis
Infection-related hemolysis
Immune-mediated hemolysis
References
Part XI. Intraabdominal Disorders
109. Acute abdominal pain
Diagnostic evaluation
Surgical versus medical management
References
110. Acute pancreatitis
Pathophysiology
Clinical presentation
Diagnosis
Determining severity
Treatment
Outcome
Conclusion
References
111. Acute cholecystitis
Clinical findings
Common causes of cholecystitis in dogs and cats
Conclusion
References
112. Hepatitis and cholangiohepatitis
Introduction
Historical findings
Physical examination findings
Causes of hepatitis and cholangiohepatitis in dogs and cats
References
113. Hepatic failure
Pathophysiology
Clinical signs
Diagnosis
Therapy
Prognosis
Future therapies
References
114. Portal hypertension
Pathogenesis of PH
Classification of PH
Diagnosis of PH
Clinical consequences of PH
Treatment of PH
References
115. Portosystemic shunt management
Preoperative stabilization
Medical management
Surgical options
Postoperative monitoring
Postoperative complications
Prognosis
References
116. Acute gastroenteritis
Gastroenteritis
History and physical examination
Diagnostic testing
Therapeutic approach
Prognosis
References
117. Gastrointestinal hemorrhage
Etiology
History and physical examination
Diagnostic tests
Treatment
Prognosis
References
118. Regurgitation and vomiting
Differentiation of vomiting and regurgitation
Regurgitation
Vomiting
Conclusion
References
119. Diarrhea
Pathophysiologic mechanisms of diarrhea
Iatrogenic causes of diarrhea
Primary gastrointestinal causes of diarrhea
Extra-gastrointestinal diseases causing diarrhea
Diagnostic evaluation
Treatment
Conclusions
References
120. Peritonitis
Etiology
Diagnostics
Treatment
Postoperative therapy and monitoring
Conclusion
References
Part XII. Urogenital Disorders
121. Acute kidney injury
Etiology
Pathophysiology
Clinical presentation
Diagnosis
Treatment
Prognosis
References
122. Chronic kidney disease
Etiology
Pathophysiology
Clinical presentation
Diagnosis
Treatment
Long-term management
Advanced therapeutic modalities
Prognosis
References
123. Kidney transplantation
Indications
Case selection
Donor selection
Preoperative management
Anesthetic management
Surgery
Postoperative management and perioperative complications
Long-term management and complications
Canine transplantation
Conclusion
References
Part XIII. Nutrition
124. Nutritional assessment
Impacts of nutritional support during critical illness
Screening systems used for nutritional assessments
Conclusion
References
125. Nutritional modulation of critical illness
Omega-3 fatty acids
Antioxidants
Immune-modulating nutrients
Nucleotides
Probiotics
Conclusion
References
126. Enteral nutrition
Introduction
Importance of nutritional support
Pathophysiology of malnutrition
Nutritional assessment
Assessing nutritional needs
When to initiate feeding
Choosing the most appropriate feeding tube
Nutritional plan
Implementing nutritional plan
Monitoring and reassessment
Complications
Conclusions
References
127. Parenteral nutrition
Introduction
Indications for PN support
Parenteral nutrition
Components of parenteral nutrition
Formulation of parenteral nutrition solutions
Administering parenteral nutrition
Monitoring
Complications
Summary
References
Part XIV. Trauma
128. Traumatic brain injury
Incidence and prevalence of head injury
General approach to the patient with a head injury
Pathophysiology
Neurologic assessment
Diagnostic tests and monitoring
Treatment
Prognosis
References
129. Wound management
Wound healing principles
Initial patient assessment
Debridement and lavage
Dressing and bandaging
Wound closure
Additional wound management modalities
Antimicrobial therapy
Patient care
Complications
Prognosis
References
130. Thermal burn injury
Definitions
Patient assessment and medical management
Burn wound management
References
Part XV. Anesthesia and Pain Management
131. Pain assessment
Pain assessment guidelines and tools
Pain assessment in critically ill patients
References
132. Sedation of the critically ill patient
Introduction
Specific drug techniques for sedation
References
133. Anesthesia in the critically ill patient
Stabilization
Premedication
Induction
Induction agents
Maintenance anesthesia
Anesthesia monitoring
Recovery
Summary
References
134. Analgesia and constant rate infusions
Analgesia
Opioids
Nonsteroidal antiinflammatory drugs
α2-adrenergic agonists
Transdermal analgesics
N-methyl-D-aspartate receptor antagonists
Acepromazine
Infiltrative and local anesthetics
Epidural analgesics
Constant rate infusions
Morphine-lidocaine-ketamine
Conclusion
References
135. Physical rehabilitation for the critical care patient
Introduction
Pain management
Passive therapy
Active therapy
Pulmonary therapy
Summary
References
136. Integrative veterinary medicine for the intensive care unit patient
Acupuncture
Massage therapy
Photomedicine (laser therapy and light-emitting diode)
Pulsed electromagnetic field therapy
Music therapy
Botanical medications and challenges for the critically ill patient
Conclusion
References
Part XVI. Environmental Emergencies
137. Smoke inhalation
Introduction and epidemiology
Pathophysiology
Physical examination
Diagnosis and initial assessment
Treatment
Prognosis
References
138. Hypothermia
Classification
Review of thermoregulation
Physiologic effects of hypothermia
Core body temperature measurement
Rewarming
Therapy
Cardiopulmonary resuscitation
References
139. Heat stroke
Introduction
Physiology, pathogenesis, and pathophysiology
Physical examination
Laboratory evaluation
Treatment and monitoring
Prognosis
References
140. Drowning and submersion injury
Definitions
Incidence and epidemiology
Pathophysiology of injury
Diagnostic tests and monitoring
Treatment
Outcome
References
Part XVII. Miscellaneous Disorders
141. Anaphylaxis
Mechanisms of anaphylaxis
Histamine
Clinical manifestations
Diagnosis
Treatment
References
142. Gas embolism
Gas embolization associated with intravenous access
Gas embolization during scoping procedures
Gas embolization during surgery
Gas embolization during cardiac procedures
Gas embolization from lung biopsy
Gas embolization during hyperbaric therapy
Detection of air emboli
Management of air embolism
References
143. Subcutaneous emphysema
Introduction
Causes
Pathophysiology
Clinical presentation
Diagnostics
Treatment
Outcome
References
144. Ocular disease in the intensive care unit
Warning signs of developing ocular disease
Ocular diseases most likely to develop in the ICU patient
References
145. Critically ill neonatal and pediatric patients
Physical examination findings
Laboratory values
Imaging: Radiographs
Intravenous and intraosseous catheterization
Fluid requirements
Temperature control
Nutrition
Monitoring
Pharmacology
Sepsis
Conclusion
References
146. Critically ill geriatric patients
Laboratory values
Imaging
Fluid therapy
Nutrition
Pharmacology
Neurological function
Conclusion
References
Part XVIII. Pharmacology
147. Catecholamines
Hypotension
Decreased myocardial contractility
Catecholamine drugs
Norepinephrine
Choosing the right catecholamine
Combination therapies
Push-dose vasopressors
Other effects of catecholamines
Acknowledgements
References
148. Vasopressin
Physiology of vasopressin
Physiologic effects of vasopressin
Pharmacology
Clinical uses
Adverse effects
Vasopressin antagonists
References
149. Antihypertensives
Antihypertensive drugs
Goals of treatment
References
150. Pimobendan
Mechanisms of action
Pharmacology
Clinical uses
Adverse effects
Conclusions
References
151. Diuretics
Physiology of diuresis and antidiuresis
Pharmacology
Indications for diuretic therapy
References
152. Appetite stimulants
Introduction
Defining abnormal appetite
Appetite regulation
Nutritional assessment and patient monitoring
When to intervene
Appetite stimulants
Summary
References
153. Gastrointestinal protectants
Proton pump inhibitors
Sucralfate
Histamine-2 receptor antagonists
Prostaglandin analogs
Traditional oral antacids that titrate gastric acid
Future drug therapy
Potential complications of increased gastric pH
References
154. Antiemetics and prokinetics
Antiemetics
Prokinetic drugs
References
155. Opioid agonists and antagonists
Terminology and history
Opioid receptors and mechanism of action
Physiologic effects of opioids
Metabolism and excretion
Potency and effectiveness of opioids
Epidural opioids
Characteristics of clinically useful opioids
Opioid antagonists: Naloxone, nalmefene, and naltrexone
References
156. Benzodiazepines
Action
Diazepam versus midazolam
Benzodiazepine effects
Benzodiazepines and cats
Indications
Hepatic encephalopathy
References
157. α2-agonists and antagonists
α2 adrenoceptors
Effects of α2-agonists
Imidazoline receptors
Drugs
Clinical use
α2-antagonists
Conclusion
References
158. Nonsteroidal antiinflammatory drugs
Brief overview of cox enzymes and prostaglandin production
Potential adverse effects
Other antiinflammatory drugs
Selecting candidates for the administration of NSAIDs in critical care
References
159. Gabapentin
Use of gabapentin for anxiolysis
Neuropathic pain
Seizures
Adverse effects of gabapentin
Pharmacokinetics and dosing
Summary
References
160. Tramadol
Mechanisms of action
Pharmacology
Clinical uses
Adverse effects
Conclusions
References
161. Trazodone
Mechanism of action
Adverse effects
Medication interactions
Serotonin syndrome
References
162. Cannabinoid medicine in intensive care unit patients
Regulatory hurdles
Veterinary research
Cannabis basics for critical care providers
Visions for veterinary cannabinoid medicine
References
163. Anticonvulsants
Introduction
Phenobarbital
Bromide
Zonisamide
Levetiracetam
Benzodiazepines (see also Chapter 156)
Imepitoin
Cannabinoids (see also Chapter 162)
References
164. Antiplatelet drugs
Platelet physiology
Antiplatelet drugs
References
165. Anticoagulants
Pathogenesis
Indications for anticoagulant use
Anticoagulants
Conclusion
References
166. Thrombolytic agents
Pathophysiology of thrombolysis
Streptokinase
Urokinase
Tissue plasminogen activator
Other thrombolytic agents
Indications for thrombolysis
References
167. Hemostatic drugs
Systemic hemostasis
Local hemostasis
Dressings
References
168. Antiarrhythmic agents
Classification schemes
Class I antiarrhythmic agents
Class III antiarrhythmic agents
Class IV antiarrhythmic agents
Other antiarrhythmic agents
Antiarrhythmic devices and procedures
References
169. Inhaled medications
Introduction
Principles of aerosol deposition in the lungs
Delivery systems
Clinical applications
Conclusion
References
170. Complications of chemotherapy agents
Principles of chemotherapy
Testing for chemotherapy drug sensitivity
Toxicities and treatment of chemotherapy-related emergencies
References
171. Antitoxins and antivenoms
Tetanus antitoxin
Tick antitoxin
Botulism antitoxin
Black widow spider antivenom
Scorpion antivenom
Snake antivenom
References
Part XIX. Antimicrobial Therapy
172. Antimicrobial use in the critical care patient
Principles of antimicrobial prescriptions
Antimicrobial stewardship and deescalation
Conclusion
References
173. β-lactam antimicrobials
Mechanism of action
Resistance to β-lactams
Pharmacokinetics
Specific antimicrobials
Dosing
Adverse effects
References
174. Aminoglycosides
Introduction
Spectrum
Mechanism of action
Pharmacology
Nonparenteral use of aminoglycoside
References
175. Fluoroquinolones
Introduction
Mechanism of action
Spectrum of activity
Pharmacology
Resistance
Clinical use
Dosing and administration
Adverse effects
Selected fluoroquinolones
Acknowledgements
References
176. Antifungal therapy
Classes of antifungal drugs
Recommendations for specific fungal infections
References
177. Miscellaneous antibiotics
Introduction
Metronidazole
Chloramphenicol
Clindamycin
Tetracycline
Sulfonamides and trimethoprim
Antimicrobials used specifically to treat multidrug-resistant pathogens
Acknowledgements
References
Part XX. Extracorporeal Therapy
178. Renal replacement therapies
Principles of dialysis
Indications
Contraindications
Components of dialysis
Dialysis prescription
Complications and other considerations
Outcome and prognosis
Summary
References
179. Apheresis
Equipment
Principles of apheresis
Indications
Future applications
References
180. Extracorporeal therapies for blood purification
Introduction
Medical management of intoxications
Basic pharmacokinetics
Considerations for blood purification with ECT
Treatment modalities
Treatment guidelines
Conclusions
References
Part XXI. Monitoring
181. Hemodynamic monitoring
Continuous electrocardiogram monitoring
Blood pressure monitoring
Central venous pressure monitoring
Pulmonary artery pressure monitoring
Mixed venous and central venous oxygen saturation
Sonographic assessment of caudal vena cava collapsibility
References
182. Cardiac output monitoring
Normal determinants of cardiac output
Indications for monitoring cardiac output
Measurement of cardiac output
Conclusions
References
183. Electrocardiogram evaluation
Indications
Electrocardiographic principles
Technique and placement of the ECG
Electrocardiogram waveforms
Electrocardiogram interpretation
Effects of disease states on the electrocardiogram
References
184. Oximetry monitoring
Oxygen transport
Technology of oximetry
Co-oximetry
Pulse oximetry
References
185. Colloid osmotic pressure and osmolality
Colloid osmotic pressure
Osmolality
References
186. Coagulation and platelet monitoring
Assessment of primary hemostasis
Assessment of secondary hemostasis
Assessment of fibrinolysis
Global assessment of coagulation – viscoelastic testing (see also Chapter 187, viscoelastic monitoring)
Monitoring anticoagulation – anti-Xa activity assay
References
187. Viscoelastic monitoring
Introduction
Instrumentation
Provets recommendations
Tracing, parameters, and global coagulation indices
Viscoelastic assays
VCM-Vet
Clinical applications
Limitations
Acknowledgements
References
188. Intraabdominal pressure monitoring
Definitions and incidence
Risk factors
Pathophysiology
Methods of intraabdominal pressure measurement
Physiologic effects of intraabdominal hypertension
General considerations
Acknowledgments
References
189. Point-of-care ultrasound in the ICU
Equipment
Binary or closed questions
Abdominal pocus
Pleural and lung ultrasound
Cardiac pocus
Ultrasound-guided vascular access
References
190. Capnography
Nondiverting and diverting monitors
Technology
Physiology
Capnogram interpretation
References
191. Intracranial pressure monitoring
Intracranial pressure
Intracranial pressure monitoring systems
ICP monitoring in small animals
References
192. Urine output
Measurement of urine output
Determinants of urine output
Normal urine output
Abnormal urine output
Fluid balance
References
Part XXII. Procedures
193. Peripheral venous catheterization
Catheter types
Catheter insertion site
Percutaneous insertion technique
Challenging vascular access
Intraosseous cannulation
Complications associated with catheterization
Catheter maintenance
References
194. Intraosseous catheterization
Introduction
Physiology
Indications
Contraindications
Methods
Complications
References
195. Central venous catheterization
General concepts
Catheter types
Catheter insertion site
Catheter insertion
Ultrasound guided central venous catheter insertion
Complications and catheter maintenance
Central venous catheter removal
Summary
References
196. Blood film evaluation
Blood film preparation
Blood film evaluation
White blood cell responses1,2
Red blood cell responses
Platelet responses
Leukemia (myeloid and lymphoid)
References
197. Endotracheal intubation and tracheostomy
Introduction
Endotracheal intubation
Tracheostomy
Summary
References
198. Thoracocentesis
Indications
Materials
Techniques
Diagnostic evaluation of the aspirate
Postprocedure care
Complications
References
199. Thoracostomy tube placement and drainage
Introduction
Indications
Materials
Techniques
Drainage
Maintenance and care
Removal
Complications
References
200. Abdominocentesis
Indications
Technique
Abdominal fluid analysis
Conclusion
References
201. Arterial catheterization
Patient preparation
Percutaneous arterial catheter placement
Ultrasound-guided arterial catheterization
Surgical cutdown for arterial catheter placement
Maintenance of the arterial catheter
Complications of arterial catheterization
Three-syringe technique
References
202. Blood gas sampling
Introduction
Sampling basics
Temperature correction
Preanalytical error
Analytical errors
Summary
References
203. Temporary cardiac pacing
Indications for temporary cardiac pacing
Description of the temporary pacemaker systems
Troubleshooting
Complications
References
204. Cardioversion
Definitions
Mechanism of cardioversion
Cardioverter-defibrillator
Approach to synchronized cardioversion
References
205. Defibrillation
Introduction
Mechanism of action
Equipment
Technique and timing
Precautions
Monitoring and post resuscitation care
References
206. Cerebrospinal fluid sampling and interpretation
CSF formation and functions
Indications for CSF collection and analysis
Contraindications and risks of CSF tap
CSF collection techniques
Analysis of CSF
Interpretation of common CSF findings
References
207. Urinary catheterization
Indications
Risk and complications
Catheter types
Placement technique
Securing the catheter
Closed collection system
Care of an indwelling urinary catheter
References
208. Urinary diversion techniques
Upper urinary tract
Lower urinary tract
Conclusions
References
Part XXIII. Intensive Care Unit Design and Management
209. Intensive care unit facility design
The design process
Location in the hospital
Arrangement and size
Unit configuration
Utilities
Environmental aspects
Details and common design elements
References
210. Management of the intensive care unit
Staffing
Veterinarians
Nursing staff
Scheduling
Staff/patient ratio
Communication
Handling stress and burnout
References
211. Client communication, grief, and veterinary wellness
Other client considerations
Understanding grief and loss
Veterinary wellness and well-being
Partnering with mental health professionals
References
212. Prevention of compassion fatigue and burnout
Introduction
Compassion fatigue
Burnout
Helpful resources
References
Appendices
Index

Life Sciences

Physical Sciences & Engineering

Social Sciences & Humanities

Health

Small Animal Critical Care Medicine

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Deborah Silverstein

Kate Hopper