Textbook of Small Animal Emergency Medicine

The Editors Kenneth J. Drobatz, DVM, MSCE, Diplomate ACVIM, Diplomate ACVECC, is Professor of Critical Care and Director of Emergency Services at the University of Pennsylvania School of Veterinary Medicine in Philadelphia, Pennsylvania, USA. Kate Hopper, BVSc, PhD, Diplomate ACVECC, is Associate Professor at the University of California Davis School of Veterinary Medicine in Davis, California, USA. Elizabeth Rozanski, DVM, Diplomate ACVIM, Diplomate ACVECC, is Associate Professor at Tufts University Cummings School of Veterinary Medicine in North Grafton, Massachusetts, USA. Deborah C. Silverstein, DVM, Diplomate ACVECC, is Professor of Critical Care at the University of Pennsylvania School of Veterinary Medicine in Philadelphia, Pennsylvania, USA.

• Contributors xiiiPreface xxixAbout the Companion Website xxxVOLUME 1 Section 1 Emergency Medicine Overview 11 Goals in Veterinary Emergency Medicine 3Dustin Schmid and Bob Murtaugh2 Triage 6Nadja SigristSection 2 Common Conditions in Emergency Medicine 113 Neurological Disorders 13Daniel J. Fletcher4 Respiratory Distress 18Elizabeth Rozanski5 Ventricular Ectopy 22Lisa A. Murphy and Reid K. Nakamura6 Acute Abdomen 26Amy Koenigshof7 The Collapsed Patient 31Anna R. Gelzer and Marc S. Kraus8 Global Approach to the Trauma Patient 39Katie D. Mauro and Kenneth J. Drobatz9 Reproductive Emergencies 44Maureen McMichael10 Anemia 48Jillian DiFazio and Susan G. Hackner11 Jaundice 55Leo Londoño and Michael Schaer12 Ophthalmic Emergencies 60Steven R. Hollingsworth13 Vomiting, Regurgitation, and Diarrhea 66Rebecca Flores and Deborah C. Mandell14 Dysuria 72Joseph Bartges15 Dermatological and Ear Disease 76Brian K. Roberts16 Toxin Exposure 92Tina A. Wismer17 Epistaxis 97Meghan E. Vaught and Elizabeth Rozanski18 Fever 101Melissa A. ClausSection 3 Emergency Conditions by System 107A. Neurological Disorders 10919 Traumatic Brain Injury 111Jillian DiFazio and Daniel J. Fletcher20 Altered Mentation 118Cassie Ostroski and Kenneth J. Drobatz21 Seizures 124Leontine Benedicenti and Evelyn M. Galban22 Intracranial Disease 131Kendra Mikoloski23 Vestibular Disease 137Laura Harvey24 Spinal Trauma 146Patrick J. Kenny25 Intervertebral Disk Disease 154Evelyn M. Galban and Jonathan H. Wood26 Diskospondylitis 161Sheila Carrera-Justiz27 Lower Motor Neuron Disease 166Patrick J. Kenny, Dominic Barfield, and Richard MalikB. Respiratory Disease 17728 Brachycephalic Syndrome 179Guillaume L. Hoareau29 Feline Upper Respiratory Complex 186Alexandra Pfaff30 Laryngeal Paralysis 193Margo Mehl31 Tracheobronchial Injury and Collapse 196Dana L. Clarke32 Acute Airway Obstruction 206Dana L. Clarke33 Exacerbations of Chronic Bronchitis 215Lynelle R. Johnson34 Feline Lower Airway Disease 220Tekla Lee-Fowler35 Puppy Pneumonia 225Elizabeth Rozanski and Alex Lynch36 Coughing and Hemoptysis 229Geoff Heffner37 Bronchopneumonia 234Anthony L. Gonzalez and Lesley G. King38 Cardiogenic Pulmonary Edema 242Mark A. Oyama39 Neurogenic Pulmonary Edema 247Kenneth J. Drobatz40 Submersion Injury 253Nuno Félix and Isabelle Goy-Thollot41 Pulmonary Hemorrhage 260Søren Boysen42 Pulmonary Thromboembolism 266Ronald Li and Joshua A. Stern43 Primary and Metastatic Pulmonary Neoplasia 273Erika L. Krick44 Pneumothorax 278Erin Mooney45 Pleural Effusion 285Lori Waddell46 Pyothorax 291Kate Farrell and Steven Epstein47 Diaphragmatic Hernia 298Cara A. Blake48 Penetrating Thoracic Trauma 304Ingrid M. Balsa, Guillaume L. Hoareau, and William T.N. Culp49 Blunt Thoracic Trauma 309Guillaume L. Hoareau, Ingrid M. Balsa, and William T. N. Culp50 Look-Alike Causes of Respiratory Distress 316Angela Borchers and Laura CagleC. Cardiovascular Disease 31951 Mechanisms of Heart Failure 321Mark A. Oyama52 Congenital Cardiovascular Disease 325Joshua A. Stern53 Arrhythmias 329Meg M. Sleeper54 Pericardial Effusion 336Sean B. Majoy55 Dilated Cardiomyopathy 341Suzanne M. Cunningham and Kursten V. Pierce56 Feline Hypertrophic Cardiomyopathy 349Lance C. Visser57 Valvular Heart Disease 355John MacGregor58 Heartworm Disease 362Marisa K. Ames59 Pulmonary Hypertension 372Rebecca Quinn60 Bradyarrhythmias and Pacemakers 380Lance C. Visser61 Myocarditis 385Lisa A. Murphy and Reid K. Nakamura62 Thromboembolic Disease 388Julien Guillaumin63 Systemic Arterial Hypertension 397Amanda E. ColemanD. Hematological and Oncological Disorders 40564 Leukocytosis and Leukopenia 407Andrew G. Burton and Karl E. Jandrey65 Non-Regenerative Anemia 413Alex Lynch66 Hemolytic Anemia 419Megan Morgan and Susan G. Hackner67 Thrombocytopenia 427Maureen McMichael68 Fibrinolysis and Antifibrinolytics 430Jo-Annie Letendre and Robert Goggs69 Congenital Coagulopathy 440Elizabeth Rozanski and Armelle de Laforcade70 Acquired Coagulopathy 444Ronald Li71 Antithrombotics in the Emergency Room 455Armelle de Laforcade72 Sick Oncology Patients in the Emergency Room 459Kim Slensky and Craig A. Clifford73 Paraneoplastic Syndromes 467Alycen P. Lundberg and Laura D. GarrettE. Esophageal and Abdominal Disease 47374 Vomiting and Regurgitation 475Jayme E. Hoffberg75 Esophageal Foreign Bodies 481Mark P. Rondeau76 Diarrhea 485Marko Pipan77 Hematemesis and Gastrointestinal Hemorrhage 490Kayla Hanson and Elke Rudloff78 Parvovirus Enteritis 496Raegan J. Wells and Lauren A. Sullivan79 Hemorrhagic Gastroenteritis 501Erica L. Reineke80 Protein-Losing Enteropathy 506Rachel E. Smith and Robert J. Washabau81 Gastrointestinal Obstruction 511Chap Pratt82 Gastric Dilation-Volvulus 520Elke Rudloff83 Mesenteric Torsion 524Fabio Vigano’84 Hemoperitoneum 528S. Anna Pesillo-Crosby85 Splenic Disease 535Alex Lynch and Therese E. O’Toole86 Pancreatitis 541Erica Tinson and Elise Boller87 Peritonitis 550Medora Pashmakova and James Barr88 Postoperative Complications Presenting to the Emergency Service 556Therese E. O’Toole89 Biliary Disease 561Amanda K. Boag and Steve J. Mehler90 Acute Liver Failure 566Deborah C. Mandell91 Feeding Tube Complications 578Daniel L. Chan92 Anorectal Disease 582David E. Holt93 Constipation 587Mark P. RondeauIndex i1VOLUME 2F. Urogenital Disorders 59394 Acute Azotemia 595Carrie Palm95 Oliguria 601J.D. Foster96 Urinary Tract Infections 606Reid Groman97 Urolithiasis 620Joseph Bartges98 Feline Ureteral Obstruction: Diagnosis and Management 627Allyson Berent99 Feline Lower Urinary Tract Obstruction 634Edward Cooper100 Urethral Trauma 641Elena S. Addison and Donald A. Yool101 Lyme Nephritis 646Meryl P. Littman102 Chronic Kidney Disease 653Melisa G. Rosenthal and Mary A. Labato103 Uroabdomen 659Saya Press and Anusha Balakrishnan104 Urethral Prolapse 665Jennifer Carr105 Discolored Urine 667Julie M. Walker106 Urinary Diversion in the Emergency Room 673Cassie Ostroski and Dana L. ClarkeG. Acid-base, Electrolyte and Endocrine Disorders 681107 Acid–Base Disorders 683Kate Hopper108 Sodium and Water Balance 690Yu Ueda and Kate Hopper109 Potassium Disorders 700Sabrina N. Hoehne and Matthew Mellema110 Calcium, Magnesium, and Phosphorus Disorders 709Matthew Mellema111 Hypoglycemia 719Anthony L. Gonzalez and Deborah C. Silverstein112 Hyperglycemia 726Gideon Daniel and Alex Lynch113 Complicated Diabetes Mellitus 729Amie Koenig114 Adrenal Gland Disorders 736Jonathan D. Dear and Guillaume L. Hoareau115 Hypoadrenocorticism 742Søren Boysen116 Thyroid Disorders 752Jonathan D. Dear117 Diabetes Insipidus 757Jamie M. Burkitt CreedonH. Reproductive Disorders 763118 Dystocia 765Liam Donaldson and Philip Thomas119 Eclampsia 771Michelle A. Kutzler120 Neonatal Resuscitation 775Carol A. Margolis and Margret L. Casal121 Diseases of the Neonate 779Andrea Hesser and Autumn P. Davidson122 Metritis and Mastitis 791Sophie A. Grundy123 Pyometra 795Grayson B. Wallace and Margret L. Casal124 Prostatic Disease 802Autumn P. Davidson125 Uterine and Vaginal Prolapse 807Michelle A. Kutzler126 Penile, Preputial, and Testicular Disease 812James Lavely and Autumn P. DavidsonI. Common Toxins 819127 Decontamination and Toxicological Analyses of the Poisoned Patient 821Justine A. Lee128 Lipid “Rescue” Therapy 831Kathryn Benavides and Jonathan Babyak129 Blood Purification Techniques for Intoxications 835Carrie Palm130 Rodenticide Toxicity 841Jesse Bullock and Alex Lynch131 Ethylene Glycol Intoxication 846Rachel B. Davy-Moyle and Leo Londoño132 Acetaminophen Intoxication 851Amanda Thomer and Lesley G. King133 Non-Steroidal Anti-Inflammatory Drug Intoxications 856Angela Borchers134 Grape, Raisin, and Lily Ingestion 862J.D. Foster135 Recreational Drug Intoxications 866Melissa Bucknoff136 Household Toxins 871Lindsey NielsenJ. Skin and Soft Tissue Disease 875137 Life-Threatening Dermatological Emergencies 877Brian K. Roberts138 Severe Soft Tissue Infections 892Melissa Clark and Yekaterina BurikoK. Environmental Emergencies 897139 Smoke Inhalation Toxicity 899Erin McGowan and Kenneth J. Drobatz140 Porcupine Quilling 905Elizabeth Rozanski141 Crotalinae Snake Envenomation 909Raegan J. Wells142 Elapid Snake Envenomation: North American Coral Snakes and Australian Elapids (Tiger Snakes, Brown Snakes, Taipans, Death Adders, and Black Snakes) 914Katrin Swindells and Michael Schaer143 Spider and Scorpion Envenomation 921Kate Hopper144 Bufo Toad Toxicosis 926Leo Londoño and Gareth Buckley145 Hymenoptera Envenomation 930Rebecca Flores and Vincent Thawley146 Hypersensitivity and Anaphylaxis 936Sabrina N. Hoehne and Kate Hopper147 Canine Heat Stroke 942Yaron Bruchim and Efrat Kelmer148 Cold Exposure 950Karol A. Mathews149 Electrical and Lightning Injuries 956F.A. (Tony) MannSection 4 Trauma and Resuscitation 963A. Cardiopulmonary Resuscitation 965150 Cardiopulmonary Resuscitation in the Emergency Room 967Daniel J. Fletcher and Manuel Boller151 Small Animal Cardiopulmonary Resuscitation Initiatives 974Manuel Boller and Daniel J. FletcherB. Circulatory Shock 979152 Pathophysiology of Shock 981Edward Cooper153 Hypovolemic Shock 986Corrin Boyd and Lisa Smart154 Cardiogenic Shock 993Luiz Bolfer and Meg M. Sleeper155 Additional Mechanisms of Shock 1000Sean Smarick and Iain Keir156 Lactate Monitoring 1005Casey Kohen and Kate Hopper157 Emerging Monitoring Techniques 1011Rodrigo C. Rabelo158 Ischemia-Reperfusion Injury 1019Josh Smith and Robert Goggs159 Systemic Inflammatory Response Syndrome, Sepsis, and Multiple Organ Dysfunction Syndrome 1030Claire R. SharpC. Trauma 1039160 Trauma Overview 1041Erica L. Reineke161 Trauma Center Registry 1052Kelly Hall162 High-Rise Syndrome 1056Yekaterina Buriko163 Trauma-Associated Coagulopathy 1060Alex Lynch and Robert Goggs164 Metabolic Consequences of Trauma 1068Leo Roa and Elizabeth M. Streeter165 Traumatic Orthopedic Emergencies 1072Marian E. Benitez and Spencer A. Johnston166 Wound Management Principles 1079F.A. (Tony) MannSection 5 Fluid and Blood Product Therapy 1089167 Crystalloid Fluid Therapy 1091Deborah C. Silverstein and Samantha Hart168 Colloid Fluid Therapy 1097Marie K. Holowaychuk169 Crystalloids Versus Colloids 1103Jennifer Prittie and Dava Cazzolli170 Management of Hemorrhagic Shock 1115Andrew Linklater171 Management of Dehydration 1126Ashley E. Allen-Durrance and Samantha Campos172 Maintenance Fluid Therapy 1132Travis Lanaux173 Potassium Supplementation 1136Jillian DiFazio174 Administration of Sodium Bicarbonate 1140Jennifer E. Waldrop175 Continuous-Rate Infusion 1147Andrea M. Steele176 Transfusion of Red Blood Cells and Plasma 1151Raegan J. Wells and Brandi L. Mattison177 Massive Transfusion 1156Kari Santoro Beer and Amanda ThomerSection 6 Emergency Room Procedures 1161178 Vascular Access 1163Matthew W. Beal179 Intraosseous Catheters 1169Alison Allukian and Amanda Abelson180 Airway Management 1173Elizabeth Rozanski181 Oxygen Therapy 1177Christine L. Guenther182 Sonography in the Emergency Room 1183Gregory R. Lisciandro183 Thoracocentesis 1195Melissa Bucknoff and Meghan Respess184 Thoracostomy Tube Placement 1199Alex Lynch and Samantha Campos185 Pericardiocentesis 1202Kursten V. Pierce and John E. Rush186 Abdominocentesis 1206Karl E. Jandrey187 Urethral Catheterization (Including Urohydropulsion) 1210Sean Smarick188 Mechanical Ventilation in the Emergency Room 1216Lisa L. Powell189 Damage Control Surgery 1219Steve J. MehlerSection 7 Anesthesia and Analgesia for the Emergency Room Patient 1223190 Anesthesia and Analgesia in the Emergency Room: An Overview 1225Lisa J. Bazzle and Benjamin M. Brainard191 Anesthetic Concerns and Protocols for Common Conditions 1231Becca Reader and Amanda Abelson192 Sedation for the Emergency Room Patient 1239Stephanie R. Krein193 Pain Management in Critical Patients 1245Alicia Z. Karas194 Opioids 1250Lois A. Wetmore195 Alpha-2 Adrenergic Agonists 1255Katherine A. Cummings196 Non-Steroidal Anti-Inflammatory Drugs 1259Christopher L. Norkus197 Regional Anesthesia Techniques 1263Marlis L. de Rezende198 Go Home Analgesics 1269Ashley Wiese199 Approach to the Aggressive or Fearful Emergency Room Patient 1276Selena L. Lane and Benjamin M. BrainardSection 8 Unique Emergency Medicine Topics 1283200 Antimicrobial Therapy in the Emergency Patient 1285Steven Epstein201 Disaster Medicine 1292Lee Palmer202 Working Dogs in the Emergency Room 1298Cynthia M. Otto203 Approach to Unowned and Shelter/Rescue Animals in the Emergency Room 1303April Paul204 Euthanasia Considerations 1306Katherine J. Goldberg205 Emergency Room Design and Staffing Models 1313Jan P. Kovacic206 Conflict in the Emergency Room 1322Jim Wohl207 Maximizing Communication 1327Laura D. Garrett208 Basics of Clinical Study Design 1331Kenneth J. Drobatz209 Designing and Participating in Clinical Trials 1335Dorothy Cimino BrownIndex i1