Stabilization and resuscitation in acute abdomen cases (Proceedings) - Veterinary Healthcare
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Stabilization and resuscitation in acute abdomen cases (Proceedings)


CVC IN BALTIMORE PROCEEDINGS


Case Presentation

                - Signalment: 6 year old female Rottweiler, Miss Pooples, weighing 40 kg
                - Presenting complaint: Vomiting, collapse, acutely painful distended abdomen
                - Last normal: 1 week ago
                - Past Pertinent History: Increased urinations and water consumption for 1 week, vomiting for 3 days, complete anorexia for 24 hours. Acutely unwilling to rise this am.
                - Other medical conditions and pertinent history
                - Past UTI 1 year ago, responded to antibiotics, cranial cruciate rupture 2 years ago, 2 normal litters of puppies, last pregnancy 2.5 years ago, last estrus 1 month ago, vaccines current
                - Medications: glycoflex, glucosamine, Aspirin PRN last given 1 week ago
                - Systems review: no coughing, no sneezing, no diarrhea, no naso-ocular discharge, no seizures, vomiting and PU/PD present

Physical examination findings

                - Temperature: 105.5F,
                - Pulse: 180 bpm, pulses weak with occasional irregularity
                - Respirations: 50 bpm
                - Airway and Breathing: airway patent, breath sounds increased in all fields
                - Circulation: CRT 2.5 sec, mucous membranes pale and tacky, cardiac auscultation – no murmurs, limbs cold, 7% dehydrated
                - Neurologic: dull and depressed
                - Abdomen: distended, painful, tense, no obvious fluid wave
                - Urogenital: no vulvar discharge, mammary glands normal, unable to palpate bladder
                - Lymph nodes: within normal limits
                - EENT: no additional abnormalities
                - Musculoskeletal: nonambulatory, recumbent
                - Rectal examination: enlarged firm cervix, possible fluctuant uterine body

Initial therapeutic and diagnostic plan

                - Flow-by oxygen, IV catheter
                - ECG: tachycardia with occasional VPC
                - Blood pressure: mean 58 mm Hg 79/43
                - Pulse oximeter: 92%
                - IV fluids





Tissue oxygenation

The first question is whether defects in tissue oxygenation are a result of poor pulmonary function or poor oxygen delivery.

To determine pulmonary function in Miss Pooples calculate the A-a gradient:
                - Alveolar gas equation = Patm – PH2O (713mmHg) x FIO2 (.21) – PaCO2 (39 mmHg)/R (.8)
                - PAO2=150 – 49 = 101
                - PaO2 - PAO2 Gradient = 101 – 68 = gradient 33

      Plan: supplemental O2

                - Alveolar gas equation = Patm – PH2O (713mmHg) x FIO2 (.40) – PaCO2 (41 mmHg)/R (.8)
                - PAO2=236 – 51 = 185
                - a-A gradient = 185-171 = 14


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Source: CVC IN BALTIMORE PROCEEDINGS,
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