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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Nov 01, 2009
1234Next 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 1234Next