Page 123 - BSAVA Guide to Pain Management in Small Animal Practice

BSAVA Guide to Pain Management in Small Animal Practice

VetBooks.ir CASE EXAMPLE CONTINUED multimodal analgesia including ketamine and

lidocaine both as CRIs. hese can be given as
TREATMENT separate infusions or mixed together in the
same bag, which is more convenient though
Initial analgesia with mu agonist opioids has much less exibility to titrate the right
would be ideal, though cautious use is dose of the analgesics to the patient.
required if the patient requires vasopressors If concerned about the cardiovascular
to maintain adequate mean arterial blood stability of the patient e.g. sepsis , then start
pressure 6 mm g . Patients often re uire at the lower end of the dose.

e ex p e oad tra c accident

PRESENTATION AND HISTORY abdomen, from injury to the gastro intestinal
tract, urogenital system, or abdominal
Both dogs and cats, usually young, can be musculature abdominal wall rupture .
victims of a road tra c accident. ogs are
often witnessed to have been hit by a car; TREATMENT
with cats it is usually presumed when they
return home. u agonist opioids would be the rst line of
treatment; the intramuscular route could be
considered if there is any di culty in obtaining
CLINICAL SIGNS
intravenous access. Additional pain
Respiratory signs are common secondary to medications, such as NSAI s, can be
pulmonary contusions. Orthopaedic and soft considered once the patient is deemed
tissue in uries can be signi cant. cardiovascularly stable, with adequate
sustained blood pressure. The variation in
SIGNS OF PAIN analgesia provided is likely to re ect the
individual patient’s response, the severity of
Signs of pain are often focal and relate to the their injuries and pre-emptive analgesia, for
main site of injury. The main focus is on the example, for fracture stabilization. It is always
obvious musculoskeletal injuries, though head better to start with a drug that can be titrated
injuries, for example, can include ocular, to e ect than to start with drug that cannot be
dental, neurological and dermatological escalated. It is not uncommon for these
burns pain. If the patient has nerve damage, patients, depending on the time of their injury
this can be misleading in their pain assess- relative to presentation, to become more
ment. Signs attributable to an acute abdomen painful after initial assessment as their
can be seen with traumatic injuries to the endogenous endorphins wear o .

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