Page 213 - Basic Monitoring in Canine and Feline Emergency Patients

● ● Heart rate: 180 beats/min
● ● Temperature: 102.8°F (39.3°C)
Box 10.1. Clinical conditions that may
VetBooks.ir predispose an animal to intra-abdominal ● ● Respiratory rate: 28 breaths/min
● ● Blood pressure: 80 mmHg (systolic)
hypertension.
• Abdominal surgery, especially laparotomy His abdomen was very tense on palpation and he
closed under tension seemed to be significantly more uncomfortable
• Trauma than he was the previous day. A fluid bolus of crys-
• Pancreatitis talloids (20 mL/kg IV over 15 minutes) did not
• Peritonitis improve his blood pressure. A quick abdominal
• Retroperitoneal bleed ultrasound scan (AFAST—see Chapter 7) did not
• Major burns reveal any free fluid or obvious cause for his
• Gross ascites abdominal discomfort. A urinary catheter was
• Large abdominal mass placed and used to measure an IAP, which was
• Gastrointestinal obstruction
• Peritoneal dialysis elevated at 19 mmHg. Repeat IAP measurement
• Pyometra 2 hours later was still elevated at 20 mmHg. Nico’s
• Hemoabdomen blood work was unchanged from the day of pres-
• Diaphragmatic hernia entation and he did not have any evidence of new
• Mechanical ventilation with positive-end expiratory organ dysfunction.
pressures above 10 mm Hg Due to the sustained increase in Nico’s IAP, he
• Massive fluid replacement or blood transfusion was diagnosed with IAH. Nico was treated with
• Pelvic fractures aggressive pain management by increasing his fen-
• Fluid overload
tanyl dose to 5 μg/kg/h and adding lidocaine and
ketamine for additional analgesia. An epidural
catheter was inserted to provide additional regional
analgesia. A nasogastric tube was placed and about
200 mL of gastric fluid was removed. Nico was
affect IAP readings (anxiety, sedation, recumbency,
etc.), serial elevated measurements should be deter- also started on a metoclopramide constant rate
mined before significant therapeutic decisions are infusion (2 mg/kg/day) and erythromycin (1 mg/kg
made. In addition, normal values of IAP have been via nasogastric tube every 8 hours) to help promote
determined in different groups of human patients gastrointestinal motility.
(mechanically ventilated, spontaneously breathing, About an hour after those changes were made,
postoperative patients, post-abdominal trauma). Nico was significantly more comfortable. His heart
Since these values have not been determined for rate had decreased to 80 beats/min and his blood
similar subgroups of veterinary patients, IAP results pressure had increased to 110 mmHg (systolic).
should be interpreted cautiously. Along the same Nico showed remarkable clinical improvement and
lines, IAP measurement should only be performed in his IAP had come down to 8 mmHg on the next
patients with risk factors and clinical signs of IAH. recheck. Nico’s IAP was monitored every 4 hours
Measuring IAP may cause iatrogenic contamina- and his analgesics were slowly tapered over the
tion and infection of the urinary bladder, thus next 2–3 days, as long as he remained comfortable.
patients should be closely monitored for any indica- Nico was discharged after 5 days of hospitaliza-
tions of development of a urinary tract infection. tion, once he started eating on his own and was
able to keep his food down.
Case study
10.2 Central Venous Pressure
Nico, a 12-year-old, male castrated Labrador Monitoring
Retriever was being hospitalized for severe acute
pancreatitis. He had been doing well in the hospital Basic anatomy and physiology
on an isotonic crystalloid at 60 mL/kg/day, fentanyl The central venous pressure (CVP) is the pressure
at 3 μg/kg/h and an anti-emetic (maropitant). recorded from the cranial vena cava. Due to the
On his second day of hospitalization, Nico was cranial vena cava’s proximity to the right atrium,
laterally recumbent. His vitals were as follows: the CVP also represents the right atrial pressure.

Manometer-based Monitoring 205