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


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

Nov 01, 2009

All colics are not created equal

• Thorough and timely assessment play a significant role in successful treatment of the critical colic
• Making an 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
           • 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
      o Gross analysis of fluid – serosanguinous or not?
      o Can carry refractometer – evaluate protein (normal = < 1.0 g/dl)
• 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