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Small Animal Emergency and Critical Care Medicine: Self-Assessment Color Review, Second Edition, Q&A 17 (view source)
Revision as of 17:55, 6 November 2018
, 17:55, 6 November 2018Created page with "{{CRC Press}} {{Student tip |X = an approach to pain relief showing how to perform an epidural. }} <br><br><br> File:Small Animal Emergency and Critical Care Medicine 2E Q17..."
{{CRC Press}}
{{Student tip
|X = an approach to pain relief showing how to perform an epidural.
}}
<br><br><br>
[[File:Small Animal Emergency and Critical Care Medicine 2E Q17.png|centre]]
<br>
'''A 5-year-old Beagle-cross is hospitalized with a working diagnosis of acute severe pancreatitis (144). During the morning rounds: T = 39.4°C (103°F); HR = 140 bpm; RR = 20 bpm; CRT = 2 sec; MM pale pink and moist. The dog is anorexic and showing signs of nausea and severe abdominal pain. The dog is currently receiving fentanyl (5 μg/kg/min CRI IV) for analgesia but does not appear to be receiving adequate pain control.'''
<br>
<FlashCard questions="4">
|q1= What additional options for pain control may be used in this dog?
|a1= In order of preference: (a) increasing the fentanyl infusion dose (up to 10 μg/kg/min); (b) additional analgesic infusions (e.g. ketamine [0.1–1 mg/kg/hr], lidocaine [25–80 μg/kg/min] and/or dexmedetomidine [1–5 μg/kg/min]) to the fenta-nyl; (c) change the opioid (e.g. hydromorphine, methadone); (d) epidural local analgesia (0.5–2.0 mg/kg of 7.5% bupivacaine); (e) peritoneal lavage and infusion of local anesthetic. NSAIDs are rarely used in animals with pancreatitis.
|l1= Replace text with name and subsection of relevant WikiVet page if in existence eg. Feather - Anatomy & Physiology#Structure & Function
|q2= Describe how to perform an epidural injection.
|a2= Need heavy sedation or GA. Sternal or lateral recumbency with hindlimbs ex-tended cranially. Clip and scrub the region over spinal processes of L6–S2. Ensure midline entry of needle by palpating wings of ilium; locate the space between L7 and S1. Insert a 20 or 22 gauge spinal needle directly on the midline, caudal to the dorsal process of L7, perpendicular to the spinal column. Several small ‘pops’ are felt passing through the ligamentum flavum, and a more pronounced ‘pop’ through the interarcuate ligament. Inject the drug without resistance and over 1–5 minutes.
|l2= Replace text with name and subsection of relevant WikiVet page if in existence eg. Feather - Anatomy & Physiology#Structure & Function
|q3= What medications are commonly administered in the epidural space for pain relief?
|a3= Local anesthetics (lidocaine 2% or bupivacaine 0.5% and preservative-free morphine (0.1–0.4 mg/kg; drug volume should not exceed 6 ml).
|l3= Replace text with name and subsection of relevant WikiVet page if in existence eg. Feather - Anatomy & Physiology#Structure & Function
|q4= What are some possible causes of the worsened nausea and abdominal pain in this dog?
|a4= Include: increasing pancreatic inflammation, peritonitis from ruptured pancreatic abscess or other cause, GI ulceration, organ torsion, dilation or ischemia, severe ileus, gallbladder distension or rupture, insufficient analgesia.
|l4= Replace text with name and subsection of relevant WikiVet page if in existence eg. Feather - Anatomy & Physiology#Structure & Function
</FlashCard>
[[Category:CRC Press flashcards]]
To purchase the full text with your 20% off discount code, go to the [https://www.crcpress.com/9781482225921 CRC Press] Veterinary website.
{{#tag:imagemap|Image:Next Question CRC Press.png{{!}}center{{!}}200px
rect 0 0 860 850 [[Small Animal Emergency and Critical Care Medicine: Self-Assessment Color Review, Second Edition, 2nd Edition Q&A 18|Next question]]
desc none}}
{{Student tip
|X = an approach to pain relief showing how to perform an epidural.
}}
<br><br><br>
[[File:Small Animal Emergency and Critical Care Medicine 2E Q17.png|centre]]
<br>
'''A 5-year-old Beagle-cross is hospitalized with a working diagnosis of acute severe pancreatitis (144). During the morning rounds: T = 39.4°C (103°F); HR = 140 bpm; RR = 20 bpm; CRT = 2 sec; MM pale pink and moist. The dog is anorexic and showing signs of nausea and severe abdominal pain. The dog is currently receiving fentanyl (5 μg/kg/min CRI IV) for analgesia but does not appear to be receiving adequate pain control.'''
<br>
<FlashCard questions="4">
|q1= What additional options for pain control may be used in this dog?
|a1= In order of preference: (a) increasing the fentanyl infusion dose (up to 10 μg/kg/min); (b) additional analgesic infusions (e.g. ketamine [0.1–1 mg/kg/hr], lidocaine [25–80 μg/kg/min] and/or dexmedetomidine [1–5 μg/kg/min]) to the fenta-nyl; (c) change the opioid (e.g. hydromorphine, methadone); (d) epidural local analgesia (0.5–2.0 mg/kg of 7.5% bupivacaine); (e) peritoneal lavage and infusion of local anesthetic. NSAIDs are rarely used in animals with pancreatitis.
|l1= Replace text with name and subsection of relevant WikiVet page if in existence eg. Feather - Anatomy & Physiology#Structure & Function
|q2= Describe how to perform an epidural injection.
|a2= Need heavy sedation or GA. Sternal or lateral recumbency with hindlimbs ex-tended cranially. Clip and scrub the region over spinal processes of L6–S2. Ensure midline entry of needle by palpating wings of ilium; locate the space between L7 and S1. Insert a 20 or 22 gauge spinal needle directly on the midline, caudal to the dorsal process of L7, perpendicular to the spinal column. Several small ‘pops’ are felt passing through the ligamentum flavum, and a more pronounced ‘pop’ through the interarcuate ligament. Inject the drug without resistance and over 1–5 minutes.
|l2= Replace text with name and subsection of relevant WikiVet page if in existence eg. Feather - Anatomy & Physiology#Structure & Function
|q3= What medications are commonly administered in the epidural space for pain relief?
|a3= Local anesthetics (lidocaine 2% or bupivacaine 0.5% and preservative-free morphine (0.1–0.4 mg/kg; drug volume should not exceed 6 ml).
|l3= Replace text with name and subsection of relevant WikiVet page if in existence eg. Feather - Anatomy & Physiology#Structure & Function
|q4= What are some possible causes of the worsened nausea and abdominal pain in this dog?
|a4= Include: increasing pancreatic inflammation, peritonitis from ruptured pancreatic abscess or other cause, GI ulceration, organ torsion, dilation or ischemia, severe ileus, gallbladder distension or rupture, insufficient analgesia.
|l4= Replace text with name and subsection of relevant WikiVet page if in existence eg. Feather - Anatomy & Physiology#Structure & Function
</FlashCard>
[[Category:CRC Press flashcards]]
To purchase the full text with your 20% off discount code, go to the [https://www.crcpress.com/9781482225921 CRC Press] Veterinary website.
{{#tag:imagemap|Image:Next Question CRC Press.png{{!}}center{{!}}200px
rect 0 0 860 850 [[Small Animal Emergency and Critical Care Medicine: Self-Assessment Color Review, Second Edition, 2nd Edition Q&A 18|Next question]]
desc none}}