L2: Diagnosis and Treatment of Toxicity (Martyniuk) Flashcards
(49 cards)
In a patient with intoxication, what should you do first?
assess patient, evaluating for immediate life-threatening problems. Assess:
-Cardiac (brady/tachycardia)
-Respiratory (apnea, shallow breathing)
-Seizures
-Hemorrhage
-Temperature (hypothermia)
Then obtain brief history including duration of signs, initial signs, age, prior health status, environment, diet
3 most lethal compounds for small animal
rodenticide
ethylene glycol
organophosphates (pesticides)
Respiratory maintenance
- unconscious, paralyzed, paretic, or severe resp. distress patients are candidates for intubation
- intubation required if no voluntary breathing effort or if you plan to do gastric lavage
- prevent aspiration of vomitus by placing head lower than body
Control of breathing
- if animal hypoventilating (hypercapnic PCO2 >45mmHg, acidotic pH 7.35), ventilation with room air may be required
- if hypoxemia present (PO2 < 65mmHg), treat with 40% oxygen. May need assisted ventilation
Control of CNS activity
Hyperactivity (seizures):
- Diazepam (tx of choice if etiology unknown)
- Phenobarbital (or pentobarbital)
- Methocarbamol (causes skeletal m. relaxation and may be useful in controlling seizures)
- most are GABA agonists (GABA is inhibitory for seizures)
Depression:
-Analeptics such as Doxapram (can make stabilization difficult)
Things to do while stabilizing the patient
- obtain venous access and draw for laboratory profile and potential diagnostic testing (ideally pre-medicating)
- once stable, perform thorough PE
- fluid therapy (balance electrolyte solution for shock/dehydration)
- monitor urine output
less than what percent of poisonings are intentional?
1%
health history should include:
- illness in past few months
- recent animal exposure
- vax current
- medications, sprays, dips, antihelmintics, etc. in past few months
current clinical history should include:
- how long problem present
- when observed sick
- when animal last seen healthy (if dead)
- size of herd
- morbidity/mortality numbers
CNS CS ex.
head-pressing, circling, ataxia, seizures, depression,etc.
GI CS ex.
vomiting, diarrhea, painful abdomen, painful constipation, etc.
Renal CS ex.
PU, proteinuria, anuria, kidney enzyme abnormalities, etc.
Hepatic CS ex.
jaundice, elevated liver enzymes
Cardiac CS ex.
arrythmias, brady/tachycardia, BP changes
Hematopoietic CS ex.
anemia, hemoglobinemia, MetHb, petechia, etc.
Diet History
- what diet
- changes in diet
- method of feeding
- presence of moldy/spoiled food
- drinking water osurce
- water supply changes
1 priority pollutant for human consumption concerns
arsenic
blood gas can rule out:
hypoxia
ancillary support
- maintain hydration
- monitor urine output
- monitor resp, cardiac, neuro status
- manage CS as they develop
- manage 2ary hepatic or renal injury
- admin. GI protectants/anti-emetic
symptomatic care
maintain body temp
alleviate pain
prevent irritation of skin and membranes (ie. demulcents, sucralfate, kaolin-pectin)
when to induce emesis
- only after animal fully stabilized
- within 60 minutes of known toxic ingestion (can be effective 3-4 hours later depending on toxin)
- save vomitus!
contraindications to inducing emesis
- corrosives, volatile hydrocarbons, petroleum distillates
- seizures/convulsions
- horses, ruminants, rodents, rabbits
- unconscious, no gag reflex, coma
activated charcoal
- administer early to prevent toxicant absorption
- works well for pesticides, pharmaceuticals
- repeated doses q4-6hours
- contra: corrosive agents, ethylene glycol, Fe
vomiting removes what percent of stomach contents?
40-50%
