Textbook of Small Animal Emergency Medicine

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 Assistant Professor at the University of California Davis School of Veterinary Medicine in Davis, California, USA.

Elizabeth A. Rozanski, DVM, Diplomate ACVIM, Diplomate ACVECC, is Associate Professor at Tufts University Cummings School of Veterinary Medicine in North Grafton, Massachusetts, USA.

Deborah Silverstein, DVM, Diplomate ACVECC, is Associate Professor of Critical Care at the University of Pennsylvania School of Veterinary Medicine in Philadelphia, Pennsylvania, USA.

Contributors xiii


Preface xxix


About the Companion Website xxx


VOLUME 1


Section 1 Emergency Medicine Overview 1


1 Goals in Veterinary Emergency Medicine 3
Dustin Schmid and Bob Murtaugh


2 Triage 6
Nadja Sigrist


Section 2 Common Conditions in Emergency Medicine 11


3 Neurological Disorders 13
Daniel J. Fletcher


4 Respiratory Distress 18
Elizabeth Rozanski


5 Ventricular Ectopy 22
Lisa A. Murphy and Reid K. Nakamura


6 Acute Abdomen 26
Amy Koenigshof


7 The Collapsed Patient 31
Anna Gelzer and Marc S. Kraus


8 Global Approach to the Trauma Patient 39
Katie D. Mauro and Kenneth J. Drobatz


9 Reproductive Emergencies 44
Maureen McMichael


10 Anemia 48
Jillian DiFazio and Susan G. Hackner


11 Jaundice 55
Leo Londono and Michael Schaer


12 Ophthalmic Emergencies 60
Steven R. Hollingsworth


13 Vomiting, Regurgitation, and Diarrhea 66
Rebecca Flores and Deborah C. Mandell


14 Dysuria 72
Joseph Bartges


15 Dermatological and Ear Disease 76
Brian K. Roberts


16 Toxin Exposure 92
Tina A. Wismer


17 Epistaxis 97
Meghan E. Vaught and Elizabeth Rozanski


18 Fever 101
Melissa A. Claus


Section 3 Emergency Conditions by System 107
A. Neurological Disorders 109


19 Traumatic Brain Injury 111
Jillian DiFazio and Daniel J. Fletcher


20 Altered Mentation 118
Cassie Ostroski and Kenneth J. Drobatz


21 Seizures 124
Leontine Benedicenti and Evelyn M. Galban


22 Intracranial Disease 131
Kendra Mikoloski


23 Vestibular Disease 137
Laura Harvey


24 Spinal Trauma 146
Patrick J. Kenny


25 Intervertebral Disk Disease 154
Evelyn M. Galban and Jonathan H. Wood


26 Diskospondylitis 161
Sheila Carrera-Justiz


27 Lower Motor Neuron Disease 166
Dominic Barfield,Patrick J. Kenny, and Richard Malik


B. Respiratory Disease 177


28 Brachycephalic Syndrome 179
Guillaume L. Hoareau


29 Feline Upper Respiratory Complex 186
Alexandra Pfaff


30 Laryngeal Paralysis 193
Margo Mehl


31 Tracheobronchial Injury and Collapse 196
Dana Clarke


32 Acute Airway Obstruction 206
Dana Clarke


33 Exacerbations of Chronic Bronchitis 215
Lynelle R. Johnson


34 Feline Lower Airway Disease 220
Tekla Lee-Fowler


35 Puppy Pneumonia 225
Elizabeth Rozanski and Alex Lynch


36 Coughing and Hemoptysis 229
Geoff Heffner


37 Bronchopneumonia 234
Anthony L. Gonzalez and Lesley G. King


38 Cardiogenic Pulmonary Edema 242
Mark A. Oyama


39 Neurogenic Pulmonary Edema 247
Kenneth J. Drobatz


40 Submersion Injury 253
Nuno Felix and Isabelle Goy-Thollot


41 Pulmonary Hemorrhage 260
Soren Boysen


42 Pulmonary Thromboembolism 266
Ronald Li and Joshua A. Stern


43 Primary and Metastatic Pulmonary Neoplasia 273
Erika L. Krick


44 Pneumothorax 278
Erin Mooney


45 Pleural Effusions 285
Lori Waddell


46 Pyothorax 291
Kate Farrell and Steven Epstein


47 Diaphragmatic Hernia 298
Cara A. Blake


48 Penetrating Thoracic Trauma 304
Ingrid M. Balsa, Guillaume L. Hoareau, and William T.N. Culp


49 Blunt Thoracic Trauma 309
Guillaume L. Hoareau, Ingrid M. Balsa, and William T. N. Culp


50 Look-Alike Causes of Respiratory Distress 316
Angela Borchers and Laura Cagle


C. Cardiovascular Disease 319


51 Mechanisms of Heart Failure 321
Mark A. Oyama


52 Congenital Cardiovascular Disease 325
Joshua A. Stern


53 Arrhythmias 329
Meg M. Sleeper


54 Pericardial Effusion 336
Sean B. Majoy


55 Dilated Cardiomyopathy 341
Suzanne M. Cunningham and Kursten V. Pierce


56 Feline Hypertrophic Cardiomyopathy 349
Lance C. Visser


57 Valvular Heart Disease 355
John MacGregor


58 Heartworm Disease 362
Marisa K. Ames


59 Pulmonary Hypertension 372
Rebecca Quinn


60 Bradyarrhythmias and Pacemakers 380
Lance C. Visser


61 Myocarditis 385
Lisa A. Murphy and Reid K. Nakamura


62 Thromboembolic Disease 388
Julien Guillaumin



63 Systemic Arterial Hypertension 397
Amanda E. Coleman

D. Hematological and Oncological Disorders 405


64 Leukocytosis and Leukopenia 407
Andrew G. Burton and Karl E. Jandrey


65 Non-Regenerative Anemia 413
Alex Lynch


66 Hemolytic Anemia 419
Megan Morgan and Susan G. Hackner


67 Thrombocytopenia 427
Maureen McMichael


68 Fibrinolysis and Antifibrinolytics 430
Jo-Annie Letendre and Robert Goggs


69 Congenital Coagulopathy 440
Elizabeth Rozanski and Armelle deLaforcade


70 Acquired Coagulopathy 444
Ronald Li


71 Antithrombotics in the Emergency Room 455
Armelle deLaforcade


72 Sick Oncology Patients in the Emergency Room 459
Kim Slensky and Craig A. Clifford


73 Paraneoplastic Syndromes 467
Alycen P. Lundberg and Laura D. Garrett


E. Esophageal and Abdominal Disease 473


74 Vomiting and Regurgitation 475
Jayme E. Hoffberg


75 Esophageal Foreign Bodies 481
Mark P. Rondeau


76 Diarrhea 485
Marko Pipan


77 Hematemesis and Gastrointestinal Hemorrhage 490
Kayla Hanson and Elke Rudloff


78 Parvovirus Enteritis 496
Raegan J. Wells and Sullivan Lauren


79 Hemorrhagic Gastroenteritis 501
Erica L. Reineke


80 Protein-Losing Enteropathy 506
Rachel E. Smith and Robert J. Washabau


81 Gastrointestinal Obstruction 511
Chap Pratt


82 Gastric Dilation-Volvulus 520
Elke Rudloff


83 Mesenteric Torsion 524
Fabio Vigano


84 Hemoperitoneum 528
S. Anna Pesillo-Crosby


85 Splenic Disease 535
Alex Lynch and Therese O Toole


86 Pancreatitis 541
Erica Tinson and Elise Boller


87 Peritonitis 550
Medora Pashmakova and James Barr


88 Postoperative Complications Presenting to the Emergency Service 556
Therese O Toole


89 Biliary Disease 561
Amanda K. Boag and Steve J. Mehler


90 Acute Liver Failure 566
Deborah C. Mandell


91 Feeding Tube Complications 578
Daniel L. Chan


92 Anorectal Disease 582
David E. Holt


93 Constipation 587
Mark P. Rondeau


VOLUME 2


F. Urogenital Disorders 593


94 Acute Azotemia 595
Carrie Palmr


95.Oliguria 601
J.D. Foster


96 Urinary Tract Infections 606
Reid Groman


97 Urolithiasis 620
Joseph Bartges


98 Feline Ureteral Obstruction: Diagnosis and Management 627
Allyson Berent


99 Feline Lower Urinary Tract Obstruction 634
Edward Cooper


100 Urethral Trauma 641
Elena S. Addison and Donald A. Yool


101 Lyme Nephritis 646
Meryl P. Littman


102 Chronic Kidney Disease 653
Melisa Gunsel Rosenthal and Mary A. LabatoI


103 Uroabdomen 659
Saya Press and Anusha Balakrishnan


104 Urethral Prolapse 665
Jennifer Carr


105 Discolored Urine 667
Julie M. Walker


106 Urinary Diversion in the Emergency Room 673
Cassie Ostroski and Dana Clarke


107 Acid Base Disorders 680
Kate Hopper


108 Sodium and Water Balance 687
Yu Ueda and Kate Hopper


109 Potassium Disorders 697
Sabrina Hoehne and Matthew Mellema


110 Calcium, Magnesium, and Phosphorus Disorders 706
Matthew Mellema


111 Hypoglycemia 716
Anthony L. Gonzalez and Deborah C. Silverstein


112 Hyperglycemia 723
Gideon Daniel and Alex Lynch


113 Complicated Diabetes Mellitus 726
Amie Koenig


114 Adrenal Gland Disorders 733
Jonathan D. Dear and Guillaume L. Hoareau


115 Hypoadrenocorticism 739
Soren Boysen


116 Thyroid Disorders 749
Jonathan D. Dear


117 Diabetes Insipidus 754
Jamie M. Burkitt Creedon


G. Reproductive Disorders 759


118 Dystocia 761
Liam Donaldson and Philip Thomas


119 Eclampsia 767
Michelle A. Kutzler


120 Neonatal Resuscitation 771
Carol A. Margolis and Margret L. Casal


121 Diseases of the Neonate 775
Andrea Hesser and Autumn P. Davidson


122 Metritis and Mastitis 787
Sophie A. Grundy


123 Pyometra 791
Grayson B. Wallace and Margret L. Casal


124 Prostatic Disease 798
Autumn P. Davidson


125 Uterine and Vaginal Prolapse 803
Michelle A. Kutzler


126 Penile, Preputial, and Testicular Disease 808
James Lavely and Autumn P. Davidson


H. Common Toxins 815


127 Decontamination and Toxicological Analyses of the Poisoned Patient 817
Justine A. Lee


128 Lipid Rescue Therapy 827
Kathryn Benavides and Jonathan Babyak


129 Blood Purification Techniques for Intoxications 831
Carrie Palm


130 Rodenticide Toxicity 837
Jesse Bullock and Alex Lynch


131 Ethylene Glycol Intoxication 842
Rachel B. Davy and Leo Londono


132 Acetaminophen Intoxication 847
Amanda Thomer and Lesley G. King


133 Non-Steroidal Anti-Inflammatory Drug Intoxications 852
Angela Borchers


134 Grape, Raisin, and Lily Ingestion 858
J.D. Foster


135 Recreational Drug Intoxications 862
Melissa Bucknoff


136 Household Toxins 867
Lindsey Nielsen


I. Skin and Soft Tissue Disease 871


137 Life-Threatening Dermatological Emergencies 873
Brian K. Roberts


138 Severe Soft Tissue Infections 888
Melissa Clark and Yekaterina Buriko


J. Environmental Emergencies 893


139 Smoke Inhalation Toxicity 895
Erin McGowan and Kenneth J. Drobatz


140 Porcupine Quilling 901
Elizabeth Rozanski


141 Crotalinae Snake Envenomation 904
Raegan J. Wells


142 Elapid Snake Envenomation: American Coral Snakes and Australian Elapids (Tiger Snakes, Brown Snakes, Taipans, Death Adders and Black Snakes) 910
Katrin Swindells and Michael Schaer


143 Spider and Scorpion Envenomation 917
Kate Hopper


144 Bufo Toad Toxicosis 922
Leo Londono and Gareth Buckley


145 Hymenoptera Envenomation 926
Rebecca Flores and Vincent Thawley


146 Hypersensitivity and Anaphylaxis 932
Sabrina Hoehne and Kate Hopper


147 Canine Heat Stroke 938
Yaron Bruchim and Efrat Kelmer


148 Cold Exposure 946
Karol A. Mathews


149 Electrical and Lightning Injuries 952
F.A. (Tony) Mann


Section 4 Trauma and Resuscitation 959


A. Cardiopulmonary Resuscitation 961


150 Cardiopulmonary Resuscitation in the Emergency Room 963
Daniel J. Fletcher and Manuel Boller


151 Small Animal Cardiopulmonary Resuscitation Initiatives 970
Manuel Boller and Daniel J. Fletcher


B. Circulatory Shock 975


152 Pathophysiology of Shock 977
Edward Cooper


153 Hypovolemic Shock 982
Corrin Boyd and Lisa Smart


154 Cardiogenic Shock 989
Luiz Bolfer and Meg M. Sleeper


155 Additional Mechanisms of Shock 996
Sean Smarick and Iain Keir


156 Lactate Monitoring 1001
Casey Kohen and Kate Hopper


157 Emerging Monitoring Techniques 1007
Rodrigo C. Rabelo


158 Ischemia-Reperfusion Injury 1015
Josh Smith and Robert Goggs


159 Systemic Inflammatory Response Syndrome, Sepsis, and Multiple Organ Dysfunction Syndrome 1026
Claire R. Sharp


C. Trauma 1035


160 Trauma Overview 1037
Erica L. Reineke


161 Trauma Center Registry 1048
Kelly Hall


162 High-Rise Syndrome 1050
Yekaterina Buriko


163 Trauma-Associated Coagulopathy 1056
Alex Lynch and Robert Goggs


164 Metabolic Consequences of Trauma 1064
Leo Roa and Elizabeth M. Streeter


165 Traumatic Orthopedic Emergencies 1068
Spencer A. Johnston and Marian E. Benitez


166 Wound Management Principles 1075
F.A. (Tony) Mann


Section 5 Fluid and Blood Product Therapy 1085


167 Crystalloid Fluid Therapy 1087
Deborah C. Silverstein and Samantha Hart


168 Colloid Fluid Therapy 1093
Marie K. Holowaychuk


169 Crystalloids versus Colloids 1099
Jennifer Prittie and Dava Cazzolli


170 Management of Hemorrhagic Shock 1111
Andrew Linklater


171 Management of Dehydration 1122
Ashley E. Allen-Durrance and Samantha Campos


172 Maintenance Fluid Therapy 1128
Travis Lanaux


173 Potassium Supplementation 1132
Jillian DiFazio


174 Administration of Sodium Bicarbonate 1136
Jennifer E. Waldrop


175 Continuous-Rate Infusion 1143
Andrea M. Steele and Karol A. Mathews


176 Transfusion of Red Blood Cells and Plasma 1147
Raegan J. Wells and Brandi L. Mattison


177 Massive Transfusion 1152
Kari Santoro Beer and Amanda Thomer


Section 6 Emergency Room Procedures 1157


178 Vascular Access 1159
Matthew W. Beal


179 Intraosseous Catheters 1165
Alison Allukian and Amanda Abelson


180 Airway Management 1169
Elizabeth Rozanski


181 Oxygen Therapy 1173


Christine L. Guenther


182 Sonography in the Emergency Room 1179


Gregory R. Lisciandro


183 Thoracocentesis 1191


Melissa Bucknoff and Meghan Respess


184 Thoracostomy Tube Placement 1195


Samantha Campos and Alex Lynch


185 Pericardiocentesis 1198


Kursten Roderick and John E. Rush


186 Abdominocentesis 1202
Karl E. Jandrey


187 Urethral Catheterization (Including Urohydropulsion) 1206
Sean Smarick


188 Mechanical Ventilation in the Emergency Room 1212
Lisa L. Powell


189 Damage Control Surgery 1215
Steve J. Mehler


Section 7 Anesthesia and Analgesia for the Emergency Room Patient 1219


190 Anesthesia and Analgesia in the Emergency Room: An Overview 1221
Lisa J. Bazzle and Benjamin M. Brainard


191 Anesthetic Concerns and Protocols for Common Conditions 1227
Becca Reader and Amanda Abelson


192 Sedation for the Emergency Room Patient 1235
Stephanie R. Krein


193 Pain Management in Critical Patients 1241
Alicia Z. Karas


194 Opioids 1246
Lois A. Wetmore


195 Alpha-2 Adrenergic Agonists 1251
Katherine A. Cummings


196 Non-Steroidal Anti-Inflammatory Drugs 1254
Christopher L. Norkus


197 Regional Anesthesia Techniques 1259
Marlis L. de Rezende


198 Go Home Analgesics 1265
Ashley Wiese


199 Approach to the Aggressive or Fearful Emergency Room Patient 1272
Selena L. Lane and Benjamin M. Brainard


Section 8 Unique Emergency Medicine Topics 1279


200 Antimicrobial Therapy in the Emergency Patient 1281
Steven Epstein


201 Disaster Medicine 1288
Lee Palmer


202 Working Dogs in the Emergency Room 1294
Cynthia M. Otto


203 Approach to Unowned and Shelter/Rescue Animals in the Emergency Room 1299
April Paul


204 Euthanasia Considerations 1302
Katherine J. Goldberg


205 Emergency Room Design and Staffing Models 1309
Jan P. Kovacic


206 Conflict in the Emergency Room 1318
Jim Wohl


207 Maximizing Communication 1323
Laura D. Garrett


208 Basics of Clinical Study Design 1327
Kenneth J. Drobatz


209 Designing and Participating in Clinical Trials 1331
Dorothy Cimino Brown