Page 135 - Basic Monitoring in Canine and Feline Emergency Patients

recommendations. In addition to the frequent sacculectomy and wedge resection of his nares. He
changes, all attachments and tubing must be was stable under anesthesia and was transferred to
VetBooks.ir ordered directly from the manufacturer which can the recovery area. The nurse noticed it was taking
him a very long time to wake up and she was
limit its availability.
unable to extubate him. His vital signs (heart rate,
respiratory rate, systolic blood pressure, and
6.6 Case Studies oxygenation level via pulse oximetry (SpO )) were
2
closely monitored and recorded to be within nor-
Case study 1: The importance of close mal limits. He had received 0.1 mg/kg hydromor-
monitoring until patient is fully recovered
phone 1-hour prior.
A 2-year-old male neutered healthy French Bulldog When his ETCO was checked it was found to be
2
underwent soft palate resection, everted laryngeal elevated (over 70 mmHg) (Fig. 6.16). The patient

ETCO 2

Invasive blood pressure
reading

Fig. 6.16. Multiparameter monitor attached to an intubated patient recovering from anesthesia. Note the ETCO is
2
elevated (75 mmHg) while all other vital signs including invasive blood pressure and heart rate are within normal limits.

was manually ventilated and hydromorphone was level improved while receiving 100% oxygen sup-
reversed with naloxone. The patient’s ETCO plementation and assist-controlled breathing with
2
improved and he was successfully extubated. Please pressure support. The patient was closely moni-
note that elevated levels of carbon dioxide can act tored and serial readings of his ETCO , SPO ,
2
2
to make a patient continue to be anesthetized and invasive blood pressure, and heart rate/rhythm
in humans can cause drowsiness. were recorded. All his vital signs were within nor-
It is important to monitor every patient’s vital mal limits, including capnograph readings consist-
signs (including ETCO , SPO blood pressure, ently between 45–50 mmHg. When an arterial
2,
2
electrocardiogram, etc.) until the animal is fully blood gas was performed, the PaCO was noted to
2
recovered and able to swallow on its own. be 82 mmHg. There were three possible reasons
for the huge difference between the ETCO read-
2
ing and the actual PaCO in this dog.
Case study 2: The importance of serial 2
ETCO and PaCO monitoring 1. Increased dead space: it is possible that there
2
2
A 13-year-old male neutered Brussels Griffon with were areas of the lung that were not perfused.
a history of severe mitral and tricuspid valve regur- Therefore, it is possible that the alveoli were not
gitation was recently diagnosed with a solitary receiving carbon dioxide back from those areas.
lung mass in the right caudal lung lobe. A lateral Alternatively, there could have been areas of the
right thoracotomy and a right caudal lung lobec- lung that were not well ventilated due to atelectasis
tomy were performed. The patient’s PaO 2 hours and collapse of the airways leading to decreased gas
2
after surgery on 4 L/min nasal oxygen was exchange. Atelectasis is common in patients who
50 mmHg. Mechanical ventilation was instituted have been in a particular position for a long period
due to severe hypoxemia. The patient’s oxygenation of time receiving surgery.
Capnography 127