Page 17 - Basic Monitoring in Canine and Feline Emergency Patients

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Fig. 1.4. The AlphaTRAK 2 (Zoetis, Parsippany, New
Jersey, USA) is a point-of-care glucometer developed
specifically for veterinary species. It measures blood
glucose in a whole blood sample where glucose
is found both in the plasma and attached to the
membrane of red blood cells. Because the distribution
of glucose in these locations differs between species,
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the advantage of the AlphaTRAK is that it is Fig. 1.5. The i-STAT (Abbott Laboratories, Abbott
programmed with the normal distribution of glucose Park, Illinois, USA) handheld cartridge-based point-
for both cats and dogs. Using a human glucometer will of-care instrument. Two of the available cartridges
underestimate the blood glucose level because the available for this system are pictured. Both of these
distribution of glucose in humans is different.
cartridges include blood glucose readings.

self-contained, user friendly, easily transportable, 1.4 Interpretation of Findings
and requires a relatively small volume of blood for
multiple tests to be performed, it lends itself well Physical exam
to the emergent evaluation process. Some disad-
vantages of POCT include concerns regarding Mentation
accuracy of results, quality control of the devices, Changes in mental status can provide key infor-
and difficulty integrating patient data into the mation when assessing a patient. Determining if
patient’s medical record since these units are often the patient is alert, responsive, aware, and appro-
self-contained and not networked into the elec- priately engaged versus if the patient is nonre-
tronic medical record. Over the years, POCT has sponsive, stuporous, obtunded, or comatose is
advanced tremendously such that some of these often key when making initial recommendations
concerns have been alleviated. for the need for immediate therapy. If there are
There are various instruments available to per- changes in mentation, it is important to establish
form various types of testing but, as with every if the altered mental status is a result of primary
diagnostic test, any results from POCT should be neurologic disease versus being secondary to an
interpreted in the context of the patient and its ‘extracranial’ cause such as a toxin or poor perfu-
physical exam. In emergent patients, assessments of sion from shock. If there is concern that the men-
PCV/TP, BG ± lactate, and often some form of stat tation changes are secondary, the focus should be
venous blood gas/electrolyte panel are commonly identification and interventions to improve the
performed as part of data collection during initial underlying cause prior to reassessing the patient’s
stabilization. mentation.

Physical Examination and Point-of-care Testing 9