Colic: The deciding factors – from referral to surgery (Proceedings)

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Colic: The deciding factors – from referral to surgery (Proceedings)

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Aug 01, 2008
1234Next All colics are not created equal • Thorough and timely assessment play a significant role in successful treatment of the critical colic • Making a decision for referral early can significantly influence the outcome • Survival is directly correlated to early diagnosis and treatment Field diagnostics • Components of the colic examination o Physical exam o Rectal o Abdominocentesis (belly tap) o Ultrasound o Nasogastric intubation • Physical exam o Pain status o Heart rate • Normal = 36-44 o Temperature • Normal = 99.5-101 o Respiratory rate • Normal = 12-16 o Mucous membranes o Normal = pink, moist, CRT <2 sec o Gastro-intestinal sounds • Present? Not present? Increased? Decreased? Gas? o Evidence of pain o Abdominal distention • Examination per rectum o Slow initial entry into rectum o Left dorsal quadrant to find the spleen o Clockwise examination o Detect all fixed structures o Buscopan (0.3 mg/kg) can facilitate rectal • Rectal examination o What you are feeling for: • Abnormal distention. • Abnormal position. • Abnormal mass. • Abnormal peritoneal surface. • Abdominal ultrasound o Can be performed in the field o Preferable a 5-10 MHz microconvex probe or 2.5-5 MHz sector scanner o Can sometimes use linear probe percutaneously if it is at lease a 5 MHz, but is more difficult o Can use reproduction probe transrectally sometimes to evaluate SI distention and motility palpated rectally o Abdominal ultrasound • The sweet spots: • Inguinal region • Just abaxial to midline • Identify position of spleen and locate left kidney (for nephrosplenic rule-out) • Abdominocentesis o Can be performed in the field • Teat cannula or 18 gauge – 1.5" needle • Aseptic prep • At most dependent portion of the abdomen • Just abaxial to midline • Gross analysis of fluid – serosanguinous or not? o Can carry refractometer – evaluate protein (normal = < 1.0 g/dl) o Nasogastric intubation o Reflux and gastric lavage o Fluid obtained should be less than 2 L o Perform lavage if significant feed material obtained – gastric impaction?? o If > 2 L net back – do not give oil, H2O or electrolytes 1234Next