Medical Nursing Week 8

• stay calm
• triage
• assessment
• A-   airway
• B-   breathing
• C-   circulation
•    Shock- loss of blood pressure and circulation and water
•    Trauma
•    Hemorrage
• Primary and secondary survey of patient
•    Burns
•    Fractures

• Problems that warrant emergencies
•   Trauma
•   Profuse Diarrhea
•   Urethral obstruction
•   Labored breathing
•   seizures-status seizures- continuous seizures
•   loss of consciousness
• excessive bleeding
• poisoning
• prolapse of organs
• snake bites
• heat prostration- heat exhaustion
• open wounds
• anemia
• burns
• dystocia
• shock
• Schiff-Sherrington posture is characterized by thoracic limb extension with normal to sometimes decreased tone and reflexes in the pelvic limb

• Decreased blood volume and pressure
• Trauma  (Hypovolemic)
• Toxins ans Sepsis (Endotoxic)
• Cardiac Failure (cardiogenic)
• Anaphylaxis (Anaphylactic) allergic reaction

• Pale to white mucous membrane color
• Weak pulse pressure
• Hypothermic
• Increased Hct

• IV Fluids- Colloids
• Keep warm
• Control cause of problem
• Corticosteroids

• Trauma
• Surgery
• Toxicity
• Internal organ rupture

• Bleeding
• Arterial- squirting and pulsating- more of an emergency
• Venous- dark and slow
• Shock

• Control hemorrhage- clamp
• Bandages
• Surgery

• Trauma
•    Abrasions
•    Incisions
•   lacerations
•    punctures
•    abscess

Open wound

• control hemorrhage
• clean and flush wound
• surgery
• Bandage

Golden rule is 6 hours to close an open wound

• Prolonged exposure to heat
• Caught in dryers
• Left in cars

• Cellular necrosis and cerebral edema occurs following Hyperthermia.
• Temperatures above 107 degrees

• Temperatures above 107
• Panting and salivation
• Tachycardia
• Brick red mucous membranes
• Respiratory distress
• Stupor to seizures
• Hemorrhagic diarrhea and vomiting

• Cool body Temperature
•     Ice bath
•     alcohol pads
• IV fluids for shock
• Corticosteroids
•  Mannitol- diuretic
•     cerebral edema
• Lasix- diuretic
•    anuria
•    pulmonary edema

• May lead to renal failure
• metabolic acidosis

• Over consumption of coagulation factors causing a hemmorhagic crisis and thrombosis
• Petechiation, Ecchymosis and bleeding
• Death usually results

small purplish spot on a body surface, such as the skin or a mucous membrane, caused by a minute hemorrhage

passage of blood from ruptured blood vessels into subcutaneous tissue, marked by a purple discoloration of the skin

• 1st degree superficial
•    Involves entire epidermis
•    Painful
•    Erythematous
•    Healing is rapid

• 2nd degree (Partial thickness)
•    Involves epidermis and dermis
•    Painful and hair may be intact
•    Subcutaneous edema- blistering
•    Heals slowly after skin slough

• 3rd Degree (full thickness)
• Entire skin is destroyed (epidermis and dermis)
• Painfulll and hair falls out
• Skin may be black color
• Healing is slow and skin grafts needed

• Thermal burns
•    Heat pads
•    Stoves
•    Fire
•    Scalding fluid
• Electrical
• Chemical burns

• If presented within 2 hours, apply cold compresses in chilled saline or water for 30 minutes.
• 1st degree
• analgesics
• clip and clean area
• Debride necrotic tissue
• antimicrobial ointments
•       Silvadeen
•       Nitrofurazone
• Bandage wounds

• 2ns degree
• Treat shock
• Analgesics
• Clean and debride tissue
• Antimicrobial dressing
• Skin graft
• Temperature regulation

• 3rd degree
• If extensive damage, prognosis poor
• Treat as 2nd degree burns
• Consider euthanasia

• Prevent absorption- emesis
• Gastric lavage- stomach pump
• Induce vomiting
• Enemia
• Toxiban- Activated charcoal
•  Red top of toxiban has sorbitol in it. The sorbitol promotes diarrhea.
• Blue top has no sorbitol in it

• Prevent tissue absorption
•    Intravenous fluid diuresis- flush it out
• Antidote if present
• Long term damage 
•     Blood profile and urinalysis

• Effects Neuromuscular junctions to cause muscle tremors and seizures
• Usually occurs 1-4 hours after ingestion

• Anxiety, hyperesthesia and ataxia
• Muscle tremors to seizures
• Hyperthermia and tachypnic
• Metabolic acidosis- condition that occurs when the body produces too much acid or when the kidneys are not removing enough acid from the body

• Induce vomiting
•   apomorphine 0.3mg/kg IV or 1.5-6mg dissolved into conjunctival sac
•     Cats- Xylazine 0.44-1.1mg/kg Im or SQ
•   gastric lavage if unconscious
•   Enema
• Activated Charcoal 1-2oz./10lbs
• Valium
• Muscle Relaxants
•    Antidote- Methocarbamol (robaxin) 150mg/kg IV
•    IV fluids and hospitalization
• Oxygen as needed
•  Enema
•    Toxiban or sorbitol

• Insecticide agents
• Mechanism of action is to inhibit acetylcholinesterase activity at the neuromuscular junctions, shich results in excess of acetylcholine and increased parasympathetic activity. (pupillary constriction)

• S.L.U.D acronym
• Salivation, lacrimation, urination, defecation
• Dyspnea
• Muscle tremors to seizures
• Severe Depression
• Death due to respiratory failure

• Remove toxin
•    Bath and wash
• Ingestion
•   Emesis
•    Gastic lavage
• Activated charcoal (toxiban)
• enema
• Anticholinergic Treatment
•      Antidote- Atropine
•          0.2-2mg/kg IV,IM, SQ
•          Give 25% dose IV
•           Repeat 4-6 hours
• Pralidoxime chloride (2-PAM)
•     20mg.kg IV slow over 2 hours
•     Repeat 12 hours
•     2-PAM binds OP enzyme complex and then allows the release of cholinesterase
• Given only in 1st 24 hours of exposure
• Hospitalization and supportive fluids
• Sedation for tremors or seizures- diazepam

Glycopyrrolate- class of medications called anticholinergics

• Inhibits the formation of vitamin K which causes the decrease of Vitamin K coagulation factors (2, 7, 9, 10)
• Warfarin- cause bleeding
• Bromethalin- (pesticide) cause cerebral Edema (not good)
• Push Gavage
• Lavage - pushing out

• Depression
• Anemia
• Melena and hematuria
• Epistaxis
• Bruising and bleeding
• Respiratory distress
•    Hemorrage into body cavities

• History of ingestion
• CBC+PVC
• Coagulation panel (PT, PTT, ACT)
•    Prolonged values (high)
• PIVKA- Protein Induced by Vitamin K Absence
•    High levels indicated coagulopathy factors 2,7,9,10) - Vit K dirivatives.
•    Will determine coagulopathy in 4-6 hours of ingestion, others as PTT, PT require 12-24 hrs before they become prolonged.

• Induce emesis
• Activated Charcoal
• Gastirc lavage
• Enema
• Hospitalization and fluid support
•  Antidote- Vitamin K1
•     0.25-2.5mg/kg Bid SQ, IM
•      continue for 2-4 weeks
• Symptomatic signs

• Ethylene glycol is metabolized by the liver and kidneys to Toxic metabolites
• Glycoaldehyde is toxic to CNS
• Glycolate causes acidosis
• Oxylates crystals causes renal tubular necrosis and kidney failure
• Toxic dose
•   dog-6.6ml/kg
•   cat- 1.5ml/kg

• occurs in 3 stages
• Stage 1 (neurological signs)
•   depression ans stupor
•   seizures
•   Vomiting and anorexia
•   P/U and P/D
• Ataxia

• stage 2
• Cardiorespiratory
• Tachypnea (rapid breathing) and tachycardia
• Occurs 24-72 hours after ingestion

• Stage 3
• Renal signs
• Vomiting and diarrhea
• Azotemia
• Renal Failure

Ethylene Glycol Test- drawing blood

• 1. Gastric lavage or induce vomiting
• 2. Activated charcoal
• 3. Enema
• 4. Hospital care and fluid support
•           Diuresis
• 5. Antidotes to block metabolism of ethylene glycol by inhibiting alcohol dehydrogenase
•        20% Ethanol IV
•            5.5ml/kg IV every 4hours for 5 treatments, then TID for 4TX
• Antidote is alcohol
•   4-Methylpyrazole 4-MP
•         better than alcohol
•         do not use in cats
•         antidote does not work well after the first 24 hours after ingestion
• Supportive care and diuretics if anuric (non passage of urine)
• Prognosis poor if not caught within first 1-2 hours after ingestion

• Interferes with hemoglobin synthesis and RBC destruction, causing enemia
• CNS effects from capillary edema

• Occurs 3-5 days after ingestion
• Gastrointestinal signs
•      vomiting and diarrhea
•      anorexia
•      abdominal pain
• Neurological signs
•     ataxia and tremors
•     blindness and deafness
•     hysteria and chomping at jaw
• Anemia
•     nucleated RBC
• Blood lead concentration

• Gastric lavage or induce emesis
• Enema
• surgery to remove foreign body
• Specific antidote (chelating agents)
•    Ca EDTA (Versenate)
•    Penicillamone)
•    Dimercaprol (BAL)
• Hospital care and fluid diuresis
• Supportive Care

Inhibits postsynaptic junctions in the spinal cord and medulla

• Nervousness and stiffness
• Tonic-clonic seizures
• Extreme muscle rigidity
• Hypersensitivity to noise
• Death caused by Hypoxia

• Gastric lavage or induce emesis
• enema
• IV fluid diuresis
• Seizure control
•     Valium
•    pentobarbital
•    morphine is contraindicated due to spinal cord stimuli and respiratory depression

Beta-acetylcysteine

Chlorpromazine

Dimercaprol

• penicillamine
• Developed for chronic mercury poisoning, now seems most promising drug, no reports on dosage in animals.

Physostigmine salicylate

Doxapram

Chloride (sodium or ammonium salts

Oxygen

atropine sulfate

pralidoxime chloride (2-PAM)

D-Pencillamine (Cuprimine)

vitamin K1

• Whole blood plasma
• Neostigmine methylsulfate

• Edrophonium chloride (Tensilone, Roche), artificial respiration Methemoglobin (sodium nitrate is used to form methemoglobin)
• Sodium thiosulfate

• Potassium chloride
• Phenytoin
• Propranolol (beta-blocker)

• atropine sulfate
• Calcium borogluconate
• Glyceryl monoacetin (Sigma)
• Acetamide- Animal mya be protected if acetamide is given prior to or simultaneously with compound 1080 (experimental)

Pentobarbitol- may protect against lethal dose (experimental)

Diazepam (Valium, Roche)

Protamine sulfate

Deferoxamine mesylate

• Calcium disodium edetate
• EDTA and dimercaprol (BAL)
• D-Penicillamine
• Thiamine hydrochloride

• Diazepam
• Triflupromazine
• Pentobarbitol

• ethanol
• 4-Methylpyrazole

Methylene blue

Naloxene chloride

calcium

• Methamphetamine hydrochloride
• Diphenhydramine hydrochloride

antitoxins not available commercially

Atropine sulfate, propranolol, potassium chloride

Antivenim

antivenin

• Antivenin
• Dantrolene sodium

• Calcium salts
• Ammonium chloride

• pentobarbitol
• Amobarbital
• Methocarbamol
• Glycerl guaiacolate
• diazepam

• Diphenylthiocarbazone
• Prussion blue
• Potassium chloride
• give simultaneously with thiocabazone or Prussian blue