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


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

Aug 01, 2008

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