Page 9 - Basic Monitoring in Canine and Feline Emergency Patients

VetBooks.ir 1 Physical Examination

and Point-of-care Testing

Paula a. Johnson*

Purdue University College of Veterinary Medicine, West Lafayette,
Indiana, USA

The efficient, accurate, and timely assessment of include its immediate availability, use of basic
emergent patients is necessary to have successful senses (seeing, hearing, touching, and smelling),
outcomes. This chapter will review physical exami- and, with the exception of a stethoscope, lack of
nation (PE) and point-of-care blood testing (POCT), need for any special instrumentation. Additionally,
important first-line tools that guide therapeutic deci- it is cost-effective, provides a wealth of information
sion making in an emergency and critical care set- regarding the patient’s clinical status in a short
ting. The specific point-of-care tests to be covered period of time, and can be utilized for serial moni-
include packed cell volume/total protein (PCV/TP), toring to identify changes or trends in a patient’s
blood glucose (BG), ketone values, and blood lactate. condition or response to therapy.
Point-of-care instrumentation is available, which
also reports such parameters as electrolytes, blood
gas values, acid–base, and coagulation. Discussion of Point-of-care blood testing
these parameters as well as other point-of-care Blood glucose
assessments, including blood pressure and point-of-
care ultrasound, are covered elsewhere in this book. As the primary source of fuel for energy production
in most cells in the body, the availability and regu-
lation of glucose is necessary to sustain life. In most
1.1 Basic Physiology and Anatomy cases, glucose is present in ample amounts in mam-
mals although sometimes the ability to deliver the
Physical examination
glucose to the needed locations can be challenging.
As technology has evolved, more diagnostic instru- An example would be a diabetic patient who has
mentation that allows for quick or instantaneous ample circulating glucose but is unable to provide
test results is readily accessible; as a result, the that glucose to the mitochondria within the cells.
physical exam has seemingly decreased in its The concentration of glucose within the body is
importance and utility. However, no technology controlled within a set range during the resting
can replace the value of the physical exam, defined state. Table 1.1 lists the reference range for BG in
as ‘an examination of the bodily functions and canines and felines at rest. Normal BG levels are
condition of an individual,’ for the practicing clini- primarily maintained by the hormone insulin that
cian. The physical exam is a skill that has to be serves to transport glucose into the cells for conver-
nurtured, practiced, and fine-tuned by repetition sion to adenosine triphosphate (ATP) by the stages
and experience over time. In fact, the more experi- of aerobic metabolism (glycolysis, transport
enced the clinician, the more important the infor- through the tricarboxylic [TCA] cycle, and passage
mation that can be gleaned from the exam. The through the electron transport chain). Thus, insu-
benefits associated with performing thorough lin’s major effect is to lower the BG concentration.
physical exams are numerous. Those benefits BG levels are further regulated and the effects of

* Corresponding author: johns357@purdue.edu

© CAB International, 2020. Basic Monitoring in Canine and Feline Emergency Patients 1
(eds E.J. Thomovsky, P.A. Johnson and A.C. Brooks)