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Группа авторов. Small Animal Surgical Emergencies
Table of Contents
List of Tables
List of Illustrations
Guide
Pages
Small Animal Surgical Emergencies
Contributors
Preface
Acknowledgements
About the Companion Website
Daisy’s Story
1 Triage and Initial Stabilization of the Emergency Small Animal Surgical Patient
Introduction
Triage and Initial Assessment
Respiratory Assessment
Hypoxemic Shock
Box 1.1 Formula Used for A–a Gradient Calculation
Example Blood Gas
Cardiovascular Assessment
Hypovolemic Shock and Fluid Therapy
Cardiogenic Shock
Distributive/Septic Shock
Metabolic Shock
Dehydration
Box 1.2 Fluid Therapy Prescription Formula
Example Fluid Prescription Calculation
Neurologic Assessment
Urinary Assessment
Vascular Access
Analgesia, Sedation and Anxiolytics
2 Operating Room Nursing Tips for Emergency Surgical Procedures
Gastrointestinal System
Esophageal Surgery
Gastrointestinal Foreign Bodies
Rectal Prolapse
Hemoabdomen
Box 2.1 Routine Soft Tissue Instrument Set
Box 2.2 Instruments for Gastrointestinal Surgery
Biliary Emergencies
Liver Lobectomy
Box 2.3 Instruments for Biliary Surgery
Urinary System. Ureteral Surgery
Urethral Surgery. Perineal Urethrostomy in Cats: Patient Positioning
Box 2.4 Instrumentation for Hepatic Surgery
Box 2.5 Instrumentation for Ureteral Surgery
Retrograde Hydropulsion in Dogs
Urethrostomy and Urethrotomy in Dogs: Patient Positioning
Contrast Studies
Respiratory System. Temporary Tracheostomy
Brachycephalic Upper Airway Surgery: Patient Positioning
Arytenoid Lateralization (Laryngeal Tie‐Back Procedure): Patient Positioning
Lateral Thoracotomy for the Treatment of Pleural Space Disease
Sternotomy for the Treatment of Pleural Space Disease
Cardiovascular System. Pacemaker Placement
Box 2.6 Instrumentation for Perineal Urethrostomy
Box 2.7 Instruments for Retrograde Hydropulsion
Box 2.8 Instruments for Urethrostomy and Urethrotomy in Dogs
Pericardiocentesis for Pericardial Effusion
Box 2.9 Instruments for Contrast Studies
Box 2.10 Instruments for Temporary Tracheostomy Tube Placement
Box 2.11 Instrumentation Recommended for Arytenoid Cartilage Lateralization
Box 2.12 Instruments for a Lateral Thoracotomy
Pericardiectomy
Box 2.13 Instrumentation to Perform a Sternotomy
Box 2.14 Instruments for Pericardiocentesis
Reproductive System. Cesarean Section
Box 2.15 Instruments Recommended for a Pericardiectomy
Neonatal Care
Box 2.16 Instruments and Supplies for Cesarean Section
Pyometra
Penile Emergencies
Prostatic Abscessation
Vaginal Prolapse
Box 2.17 Neonatal Supply Box
Box 2.18 Instruments for Pyometra Surgery
Wound Management
Box 2.19 Instruments and Supplies for Penile Surgery
Box 2.20 Instruments and Supplies for Prostatic Surgery
Box 2.21 Instruments and Supplies for Vaginal Prolapse
Ocular Emergencies. Standard Surgical Preparation Protocol
Surgical Supplies
Box 2.22 Instruments and Supplies for Initial Wound Management
Box 2.23 Preoperative Periocular Surgical Preparation
Box 2.24 Final Sterile Periocular Surgical Preparation
Box 2.25 Intraocular Instrument Set
Box 2.26 Extraocular Instrument Set
Box 2.27 Enucleation Instrument Set
Box 2.28 Eye Utility Instrument Set
Instrument Sterilization
Intraocular Surgery
Box 2.29 Instrumentation and Supplies for Intraocular Surgery
Extraocular Surgery
Box 2.30 Instruments and Supplies for Temporary Tarsorrhaphy
Box 2.31 Instruments and Supplies for Eyelid Laceration Repair
Box 2.32 Instruments and Supplies for Nictitating Membrane Laceration
Enucleation
Oral Emergencies. Nursing Responsibilities
Box 2.33 Instruments and Supplies for Enucleation Procedure
Safety Requirements. Surgical Environment
Personal Protective Equipment
Standard Oral Surgical Preparation Protocol
Patient Positioning
Surgical Supplies
Instrument Sterilization
Box 2.34 Large Dental Surgery Set
Box 2.35 Periodontal Extraction Cassette
Box 2.36 Orthodontic Supplies
Box 2.37 Instruments and Supplies for Pulpectomy
Box 2.38 Supplies for Specific Oral Surgical Emergencies
Specific Oral Surgical Emergencies
Orthopedic Emergencies. Joint Irrigation and Drainage with Hypodermic Needles
Arthroscopy
Box 2.39 Instruments and Supplies for Joint Irrigation
Arthrotomy
Open Fracture
Box 2.40 Arthroscopy Tower Set‐Up
Box 2.41 Instruments and Supplies for Arthroscopy
Box 2.42 Instruments and Supplies for Arthrotomy
Box 2.43 Supplies for a Robert Jones Bandage
Standard Surgical Preparation Protocol
Bone Plates and Screws
Box 2.44 Types of Plates
Box 2.45 Instruments and Supplies for Fracture Repair
Box 2.46 String of Pearls Instruments and Supplies
Box 2.47 Instruments and Supplies to Insert an Interlocking Nail
Box 2.48 Instruments and Supplies for the SK External Skeletal Fixation System
3 Emergency Stabilization of the Acute Abdomen Patient
Introduction
Pathophysiology of Acute Abdomen
Differential Diagnoses
Primary Assessment
Systematic Approach to Initial Stabilization: Cardiovascular System
Resuscitation and Management of Cardiovascular Abnormalities
Monitoring Response to Treatment
Systematic Approach to Initial Stabilization: Respiratory System
Systematic Approach to Initial Stabilization: Central Nervous System
Abdominal Examination
Minimum Database Interpretation and Management
Peritoneal Fluid Analysis and Indications for Emergency Laparotomy
Diagnostic Imaging for the Acute Abdomen
Conclusion
4 Esophageal Foreign Bodies
Introduction
Anatomy
Pathophysiology of Esophageal Injury (Figure 4.3)
Presentation
Emergency Stabilization
Diagnostics. Radiography
Computed Tomography
Endoscopy
Non‐surgical Treatment. Esophageal Forceps
Endoscopic Technique
Fluoroscopic Technique [9]
Rigid Endoscope Technique
Advancement into the Stomach
Surgical Treatment
Cervical Esophagotomy
Transthoracic Esophagotomy
Case Report 4.1
Postoperative Care
Complications
Prognosis for Esophageal Bone Foreign Bodies
Fishhooks and Needles
Fishhooks
Needles
Esophageal Stick Injuries
5 Gastrointestinal Foreign Bodies
Introduction
Classification of Foreign Bodies
Pathophysiology
Signalment, History, and Physical Examination
Laboratory Findings
Imaging. Radiographs
Ultrasound
Computed Tomography
Surgical Techniques
Stomach
Small Intestine. Anatomy
Discrete Foreign Body
Linear Foreign Body
Postoperative Care
Long‐Term Postoperative Complications
Prognosis
6 Intussusception
Introduction
Clinical Presentation
Diagnosis
Initial Stabilization
Surgical Management
Postoperative Care and Complications
Prognosis
7 Rectal Prolapse
Etiology
Clinical Evaluation
Treatment
Box 7.1 Conditions Associated with Rectal Prolapse in Small Animals
Reduction of Prolapse
Surgical Intervention
8 Gastric Dilatation and Volvulus
Introduction
Pathogenesis
Risk Factors
Pathophysiology
Local Effects
Systemic Effects
Clinical Presentation
Stabilization and Diagnostic Evaluation
Operative Techniques
Goals of Surgery
Repositioning of the Stomach
Assessment of Gastric Viability
Gastric Necrosis
Gastric Resection
Open Resection
Stapled Resection
Gastric Invagination
Splenectomy
Gastropexy
Gastropexy Techniques
Incisional Gastropexy
Belt‐Loop Gastropexy
Tube Gastropexy
Circumcostal Gastropexy
Other Techniques
Postoperative Care
Complications
Postoperative Arrhythmias
Gastric Necrosis, Ulceration or Dehiscence
Recurrent Gastric Dilatation
Ileus
Acute Kidney Injury
Systemic Inflammatory Response Syndrome and Disseminated Intravascular Coagulation
Outcome and Prognosis
9 Intestinal Volvulus
Definition and Pathophysiology
Presentation
Diagnostics
Case Report 9.1
Treatment. Preoperative Treatment
Surgical Treatment
Postoperative Treatment
Complications and their Management
Ischemic Necrosis
Reperfusion Injury
Short Bowel Syndrome
Prognosis
10 Colonic Torsion
Introduction
Pertinent Anatomy
Signalment and Clinical Presentation
Diagnostics
Emergency Stabilization
Surgical Management
Postoperative Care and Prognosis
11 Peritonitis
Anatomy
Etiology
Diagnosis. Abdominal Imaging
Collection of Peritoneal Effusion
Analysis of Peritoneal Effusion
Considerations for Patient Care
Box 11.1 Components of Medical Therapy for Septic Peritonitis
Case Report 11.1. Signalment
History
Physical Exam
Initial Diagnostic Evaluation
Initial Medical Therapy
Surgical Therapy
Postoperative Monitoring
Postoperative Care
Discussion
Antibiotic Therapy
Hypotension
Hypoalbuminemia
Alterations in Coagulation
Anesthetic Planning
Surgical Therapy
Box 11.2 Components of Surgical Therapy for Septic Peritonitis
Source Control and Ancillary Procedures
Lavage
Drainage
Primary Abdominal Closure without Drainage
Open Peritoneal Drainage
Vacuum‐Assisted Closure
Closed‐Suction Drainage
Surgical Complications
Prognosis
Summary
12 Surgical Intervention Post‐Celiotomy
Introduction
Secondary Septic Peritonitis
Postoperative Hemoabdomen
Portal Hypertension
13 Biliary Emergencies
Anatomy
Physiology
Etiology
Disease Processes that Cause Biliary Obstruction or Rupture. Cholelithiasis/Choledocholithiasis
Cholecystitis/Cholangitis
Gallbladder Mucocele
Pancreatitis/Abscess/Pseudocyst
Neoplasia
Diagnosis. Clinical Signs
Laboratory Abnormalities
Abdominocentesis
Case Report 13.1 Ruptured Gallbladder Mucocele with Localized Peritonitis
Imaging. Radiography
Abdominal Ultrasonography
Computed Tomography and Magnetic Resonance Imaging
Hepatobiliary Scintigraphy
Surgery
Preoperative Planning
Anesthetic Considerations
Surgery of the Gallbladder. Cholecystotomy
Cholecystectomy
Tube Cholecystostomy
Cholecystoenterostomy
Surgery of the Bile Duct. Choledochotomy
Choledochoduodenostomy
Choledochal Stenting
Surgery for Traumatic Injury of the Gallbladder, Hepatic Ducts, and Common Bile Duct
Surgical Treatment of Bile Peritonitis
Postoperative Monitoring and Treatment
Prognosis
14 Hemoperitoneum
Introduction
History and Clinical Signs
Physical Examination
Emergency Stabilization
Maintaining Oxygenation
Fluid Resuscitation. Crystalloids and Colloids
Blood Product Transfusions
Diagnostics. Blood Tests
Diagnostic Imaging
Medical Management
Surgical Management
Hemostatic Techniques
Traumatic Hemoperitoneum
Spontaneous Hemoperitoneum
Liver
Surgical Hemostasis
Surgical Procedures
Spleen
Splenic Neoplasia
Surgical Procedures
Other Sources of Hemorrhage. Adrenal Gland
Kidney
Postoperative Care
Complications. General
Cardiac Arrhythmias
Coagulopathy
Prognosis
15 True Abdominal Hernias
Introduction
Umbilical Hernias
Clinical Signs
Diagnosis
Treatment
Case Report 15.1 Incarcerated Umbilical Hernia
Aftercare
Complications and Prognosis
Inguinal/Scrotal Hernias
Anatomy
Clinical Signs
Diagnosis
Treatment. Inguinal Hernias
Scrotal Hernias
Aftercare and Complications
Prognosis
16 Traumatic and Incisional Hernias
Anatomy
Traumatic Hernias
Clinical Signs
Diagnosis
Treatment
Prognosis
Complications
Incisional Hernias
Clinical Signs
Diagnosis
Treatment
Prognosis
17 Perineal Hernias
Anatomy
Etiology of Perineal Hernias
History and Signalment
Physical Examination Findings
Treatment of Uncomplicated Perineal Hernia
Preoperative Preparation
Surgical Approach
Traditional Herniorrhaphy
Internal Obturator Muscle Transposition
Semitendinosus Muscle Transposition
Superficial Gluteal Muscle Transposition
Grafts and Mesh
Adjuncts to Herniorrhaphy
Colopexy
Cystopexy
Ductus Deferens Fixation
Emergency Presentations
Urinary Tract Obstruction
Case Report 17.1
Uroabdomen
Small Intestine Obstruction, Ischemia, or Rupture
Rectal Perforation
Rectal Prolapse
18 Pancreatic Abscessation
Introduction
Anatomy
Clinical Presentation
Emergency Stabilization
Diagnostics
Surgical Management
Case Report 18.1
Postoperative Care
Postoperative Complications
Prognosis
Alternative Approaches
19 Hepatic Emergencies
Anatomy
Physiology
Regulation of Splanchnic Blood Flow in Health and Critical Illness
Preoperative Diagnostics and Treatment for Suspected Liver Diseases
Surgical Techniques
Liver Biopsy
Liver Lobectomy
Methods of Hemostasis
Postoperative Complications and Management
Specific Liver Diseases. Hepatic Neoplasia
Hepatic Trauma
Liver Lobe Torsion
Hepatic Abscess
Conclusion
20 Bleeding Gastrointestinal Ulcers
Introduction
Etiology
History and Clinical Signs
Physical Examination
Diagnostics. Clinicopathological Testing
Fecal Tests
Imaging. Radiography
Ultrasonography
Computed Tomography
Abdominocentesis
Endoscopy
Case Report 20.1
History
Physical examination
Diagnostics
Problem list
Diagnostics
Final diagnosis
Discussion
Medical Management. Cardiovascular Stabilization
Treatment of Underlying Disease
Specific Therapy for Ulceration
Gastric Acid Reducers
Mucosal Binding Agents
Prostaglandin Analogues
Additional Therapy
Surgical Management
Additional Treatments
Prognosis
21 Enteral Feeding Tubes
Introduction
Increasing Voluntary Consumption
Enhancing Palatability of Foods
Improving Hospital Environment
Appetite Stimulants
Force Feeding
Indications for Enteral Assisted Feeding
Parenteral or Enteral Nutrition
Contraindications to Enteral Nutrition
Timing of Intervention
Assisted Enteral Feeding Tubes
Nasoesophageal or Nasogastric
Esophagostomy
Gastrostomy
Jejunostomy
Nasojejunal, Esophagojejunostomy and Gastrojejunostomy
Types of Enteral Diets
Human Liquid Enteral Formulas
Veterinary Liquid Enteral Formulas
Commercial Veterinary Therapeutic Dry and Canned Diets
Delivery of Enteral Tube Feeds
Monitoring of Enteral Tube Feeds. Clinical Signs
Physical Examination
Case Report 21.1 Using a Commercial Therapeutic Dry Food Diet to Feed as a Slurry Via an Esophagostomy Feeding Tube
Laboratory Parameters
Enteral Tube Related Complications
Mechanical
Gastrointestinal
Infectious
Metabolic
Summary
22 Stabilization of the Uremic Patient
Introduction
Diagnosis of Acute Uremia
Complications of Acute Uremia
Initial Assessment of the Uremic Patient
Case Report 22.1 Urethral obstruction in a cat
Case Report 22.2 Ruptured urinary bladder in a dog
Monitoring the Uremic Patient
Urinary Catheterization
Box 22.1 Techniques for Urinary Catheter Placement
Central Venous Pressure Monitoring
Electrocardiogram
Treatment of Uremia
Fluid Therapy
Diuretics
Novel Therapies
Renal Replacement Therapy
23 Renal and Ureteral Injury
Anatomy
Renal Trauma
Treatment of Renal Injury
Vascular Injury to the Kidney
Ureteral Trauma
Treatment of Ureteral Injury
24 Approach to the Uroabdomen
Introduction
History and Clinical Signs
Initial Evaluation
Patient Stabilization
Metabolic Acidosis
Hyperkalemia
Urinary Diversion
Diagnosis of Uroabdomen
Focused Assessment with Sonography for Trauma
Abdominocentesis and Diagnostic Peritoneal Lavage
Peritoneal Fluid Evaluation
Diagnostic Imaging
Case Report 24.1
Surgical Treatment
Complications and Prognosis
25 Urethral Injury
Initial Assessment
Patient Stabilization
Case Report 25.1
Diagnosis
Treatment
Principles of Urethral Surgery
Urinary Diversion
Cystostomy Tube‐Standard Surgical Approach
Cystostomy Tube via a Minimally Invasive Inguinal Approach
Conservative Management
Surgical Management. Primary Surgical Repair
Case Report 25.2
Urethrostomy
Penile Amputation
Permanent Cystostomy Tube
26 Ureteral Obstruction
Introduction
Case Report 26.1
Diagnostic Evaluation
Medical Therapy
Instrumentation for Ureteral Surgery
Microsurgical Instruments. Jeweler's Forceps
Pierce Tissue Forceps
Vessel Dilators
Needle Holders
Dennis Blade and Blade Holder
Dissecting Scissors
Adventitial Scissors
Approximating Clamps
Preoperative Preparation
Ureterotomy
Ureteral Anastomosis
Neoureterocystostomy
Intravesicular Technique
Extravesicular Technique
Complications
Ureteral Stenting
Antegrade Approach
Retrograde Approach
Complications
Subcutaneous Ureteral Bypass System
Complications
Postoperative Care
Choosing the Appropriate Ureteral Intervention
27 Urethral Obstruction
Introduction
Anatomy. Canine
Feline
Signalment and Presenting Complaint
Initial Diagnostics and Stabilization
Physical Examination Findings
Clinicopathologic Evaluation
Temporary Urinary Diversion Techniques
Tube Cystostomy
Minimally Invasive Percutaneous Cystostomy Tube Placement
Low‐Profile Gastrostomy Tubes
Complications of Tube Cystostomy
Urethral Catheterization
Retrograde Catheterization
Antegrade Catheterization
Complications of Catheterization
Definitive Surgical Techniques for Treatment of Urethral Obstruction in the Emergent Patient. Cystotomy
Cystoscopy
Transvesicular Percutaneous Cystolithotomy
Laser Lithotripsy
Urethrotomy
Permanent Urethrostomy
Scrotal Urethrostomy
Perineal Urethrostomy
Transpelvic Urethrostomy
Prepubic Urethrostomy
Urethral Anastomosis
Urethral Stenting
28 Stabilization Techniques for Patients with an Upper Respiratory Obstruction
Introduction
Clinical Evaluation
Emergency Stabilization
Oxygen Therapy
Sedative Therapy
Anti‐inflammatory Therapy
Cooling Measures
Intubation
Alternative Intubation Techniques and Verification
Blind Intubation
Retrograde Intubation
Nasopharyngeal Intubation
Diagnostics
Oxygenation and Ventilation
Imaging
Sedated Oral Examination
Endoscopy
Echolaryngography
Advanced Imaging
Additional Considerations. Anesthetic Recommendations
Antimicrobial Therapy
Airway Maintenance
Summary
29 Tracheostomy
Introduction
Temporary Tracheostomy
Permanent Tracheostomy
Equipment
Box 29.1 Essential Equipment to Perform a Temporary Tracheostomy
Anatomy
Surgical Approach
Temporary Tracheostomy
Permanent Tracheostomy
Temporary Percutaneous Dilatational Tracheostomy
Aftercare and Management
Temporary Tracheostomy Tube Removal
Complications of Temporary Tracheostomy
Accidental Extubation
Tube Occlusion
Airway Colonization
Injury to the Trachea and Recurrent Laryngeal Nerve
Subcutaneous Emphysema
Increased Intracranial Pressure
Complications of Permanent Tracheostomy
Other Complications
Prognosis
30 Brachycephalic Airway Syndrome
Anatomy and Pathophysiology
Presentation
Emergency Stabilization
Diagnostics
Surgical Therapy and Operative Technique. Staphylectomy
Laryngeal Sacculectomy
Stenotic Nares
Stage II/III Laryngeal Collapse
Turbinectomy
Temporary Tracheostomy
Postoperative Care
Surgical Complications and Management
31 Laryngeal Paralysis
Introduction
Anatomy
Physiology and Pathophysiology
Clinical Presentation
Diagnostics
Laryngeal Exam
Diagnostic Imaging
Laboratory Tests
Emergency Treatment
Medical Management
Surgical Management
Arytenoid Cartilage Lateralization
Aftercare
Complications
Prognosis
32 Laryngeal Trauma
Introduction
Clinical Signs and Diagnosis
Imaging
Emergency Management of Laryngeal Trauma
Surgical Treatment
33 Tracheal Collapse
Etiology and Signalment
Clinical Signs and Physical Examination
Diagnostics
Treatment Options
Medical Management
Surgical Treatment
Interventional Treatment
Instrumentation
Tracheal Stent Placement Using Radiography/Fluoroscopy
Tracheal Stent Placement Using Bronchoscopy
Postprocedural Complications and Outcome
34 Stabilization Techniques for Patients with Pleural Space Disease
Introduction
Clinical Signs
Patient Stabilization and Diagnostic Evaluation
Imaging. Point of Care Ultrasonography
Thoracic Radiography
Additional Imaging
Pleural Fluid Evaluation
Specific Causes of Pleural Space Disease
Hemothorax
Pyothorax
Pneumothorax
Diaphragmatic Hernia
Stabilization Techniques. Thoracocentesis
Directions for Thoracocentesis [57]
Standard Thoracostomy Tube Placement
Directions for Thoracostomy Tube Placement
Thoracostomy Tube Placement Using the Seldinger Technique
35 Diaphragmatic Hernia
Pathophysiology
Etiology
Anatomy
Signalment
Clinical Signs
Physical Examination
Diagnostic Testing
Treatment. Initial Stabilization
Surgical Treatment
Postoperative Care
Complications
36 Pyothorax
Etiology and Pathophysiology
Presentation
Emergency Stabilization
Diagnostics. Cytology
Diagnostic Imaging
Laboratory Findings
Medical Management
Surgical Treatment
Operative Procedures
Case Report 36.1
Postoperative Care
Prognosis
37 Hemothorax
Introduction [1, 2]
Anatomy
Etiology. Traumatic Hemothorax. Blunt Trauma
Penetrating Trauma
Operative Trauma
Non‐traumatic Hemothorax. Neoplasia
Infection
Coagulopathies (Toxic, Acquired, Congenital)
Other Causes
Diagnosis. Clinical Signs
Therapy. Medical Management
Surgery
38 Pneumothorax
Etiology
Pathophysiology
Presentation
Emergency Stabilization
Diagnostics
Diagnostic Imaging
Pulse Oximetry
Additional Diagnostics
Medical Management. Traumatic Pneumothorax – Closed
Traumatic Pneumothorax – Open
Iatrogenic Pneumothorax
Spontaneous Pneumothorax
Surgical Management. Traumatic Pneumothorax
Spontaneous Pneumothorax
Case Report 38.1
Postoperative Care
Prognosis
39 Lung Lobe Torsion
Anatomy
Etiology and Pathophysiology
Presentation
Emergency Stabilization
Diagnostics. Clinicopathological Evaluation
Radiography
Ultrasound
Bronchoscopy
Computed Tomography
Cytology
Operative Technique
Complete Lung Lobectomy
Intraoperative Complications
Postoperative Care
Postoperative Complications
Case Report 39.1
Comparative Medicine. Detorsion with Pneumopexy
Video‐Assisted Thoracic Surgery
40 Surgical Approach to the Thoracic Cavity
Introduction
Lateral Thoracotomy
Rib Pivot Thoracotomy
Median Sternotomy
Thoracoscopy/Video‐Assisted Thoracic Surgery
Lung Lobectomy Techniques
Partial Lobectomy
Complete Lobectomy
41 Stabilization Techniques for Patients with Chest Wall Disease
Introduction
General Stabilization Approach
Nonpenetrating Wounds. Rib Fractures and Flail Chest
Penetrating Wounds
Case Report 41.1 Thoracic trauma in a cat secondary to a dog attack
Conclusion
42 Pectus Excavatum
Introduction
Etiology
Clinical Signs and Physical Examination
Emergency Stabilization
Diagnostics
Severity of Deformity
Treatment Options. Conservative Management
Surgical Treatment
External Splint Placement
Anesthetic Considerations
Perioperative and Postoperative Complications
Postoperative Care
Prognosis
43 Flail Chest
Introduction
Clinical Signs and Diagnosis
Treatment. Medical Management
Surgical Management
44 Pacemaker Therapy
Introduction
Indications for Pacemaker Therapy
Sinus Bradycardia
Sinus Node Dysfunction
Atrioventricular Block
Persistent Atrial Standstill
Patient Evaluation
Transcutaneous Pacing
Transvenous and Epicardial Pacemaker Components
Pacing Basics
Temporary Transvenous Pacemakers
Permanent Transvenous Pacemakers
Epicardial Pacemakers
Programming
Rate
Amplitude
Sensitivity
Pacemaker Complications
Lead Dislodgement
Generator Failure
Thrombosis
Infection
Seroma Formation
Lead Failure
Loss of Capture
Pacemaker Syndrome
Pneumothorax
Dehiscence
45 Pericardial Effusion
Introduction
Anatomy and Physiology
Etiology and Signalment
Neoplastic Conditions
Idiopathic Conditions
Diagnosis of Pericardial Effusion
Physical Examination and Hematologic Testing
Radiography
Cardiac Diagnostics
Cytology and Fluid Analysis
Biomarkers
Emergency Stabilization. Fluid Administration
Pericardiocentesis
Complications of Pericardiocentesis
Surgery
Thoracotomy
Additional Surgical Procedures
Case Report 45.1
Complications
Thoracoscopy
Medical Treatment
Other Treatments
Prognosis
Conclusion
46 Open‐Chest Cardiopulmonary Resuscitation
Introduction
Reasons for Cardiopulmonary Arrest
Recognition of Cardiopulmonary Arrest
Open‐Chest Cardiopulmonary Resuscitation. Indications
Contraindications
Benefits
Requirements
Box 46.1 Materials Requested and Recommended to Perform Open‐Chest Cardiopulmonary Resuscitation Outside the Operating Room
Performing Open‐Chest Cardiopulmonary Resuscitation. Outside the Operating Room
Inside the Operating Room
Monitoring
Post‐Arrest Care
Prognosis
47 Cesarean Section
Patient Presentation
Emergency Stabilization and Diagnostic Evaluation
Anesthetic Considerations
Box 47.1 Guidelines for Cesarean Section as Treatment for Dystocia in Dogs and Cats. Dam and Queen‐Related Factors
Fetus‐related Factors
Regional Anesthesia
Regional Analgesia
General Anesthesia
Box 47.2 Example of General Anesthesia Protocols for Cesarean Section. Protocol 1
Protocol 2
Protocol 3
Operative Technique
Postoperative Care
Surgical Complications
48 Pyometra
Introduction
Signalment and Presenting Complaints
Diagnosis
Imaging
Clinical Pathological Evaluation
Urinalysis and Urine Culture
Resuscitation and Medical or Surgical Management
Preoperative Consideration
Surgical Approach
Intraoperative and Postoperative Care
Prognostic Indicators
49 Penile and Testicular Emergencies
Introduction
Anatomy
Emergency Conditions of the Penis and Prepuce
Penile Trauma
Approach and Stabilization
Conservative Management
Surgical Wound Repair
Os Penis Fracture
Strangulation
Paraphimosis
Priapism
Other Conditions
Surgical Procedures of the Penis. Partial Penile Amputation
Subtotal Penile Amputation with Scrotal Urethrostomy (Dog)
Subtotal Penile Amputation with Perineal Urethrostomy (Cat)
Testicular Emergencies
Trauma
Testicular Torsion
Orchitis, Epididymitis and Scrotal Infection
Surgical Procedures of the Testicles
Conclusion
50 Prostatic Abscessation
Introduction
Anatomy
Physiology
Pathophysiology
Diagnosis
Management
Non‐surgical Approach to the Prostate
Surgical Approach to the Prostate
Preparation
Laparotomy
Exploration and Drainage of the Abscess Cavities
Surgical Options for Prostatic Abscesses
Marsupialization
Drainage
Partial Prostatectomy
Omentalization
Infected Cysts
Postoperative Care
Marsupialization
Drainage
Prostatectomy
Omentalization
Castration
Prognosis
51 Uterine and Vaginal Prolapse
Anatomy of the Uterus and Vagina
Uterine Prolapse
Clinical Presentation and Diagnosis
Treatment
Complications
Vaginal Prolapse
Clinical Presentation and Diagnosis
Treatment
Medical Management
Surgical Management
Prognosis
52 Bite Wounds
Introduction
Local Tissue Injury
Systemic Effects of Bite Wounds
Initial Evaluation and Stabilization
Injury Assessment
Limb Wounds
Head and Neck Wounds
Thoracic and Abdominal Wounds
Perineal Wounds
Treatment
Wound Exploration, Debridement and Lavage
Fracture, Body Wall Repair
Wound Repair
Antibiotic Use in Patients with Bite Wounds
Postoperative Management and Complications
Infectious Disease
53 Burn Injury
Presentation
Pathophysiology and Healing
Initial Stabilization and Treatment of Burn Wound Patients
Cold Water Irrigation
Pain Management
Topical Antimicrobials
Treatment Methods
Autolytic Debridement
Enzymatic and Mechanical Debridement
Surgical Debridement
Coverage of Burn Wounds
Negative‐Pressure Wound Therapy and Burn Wounds
Postoperative Care
Surgical Complications
Chemical Burns
Electrical Burns
Case Report 53.1
Frostbite
Conclusion
54 Penetrating Injury in the Dog and Cat
Introduction
Ballistics in Veterinary Medicine
Ammunition
Velocity
Case Report 54.1
Local Tissue Effects
Systemic Effects
Triage and Stabilization
Surgery
Porcupine Quill Injury
Case Report 54.2
Impalement Injuries
Antibiotic Use in Penetrating Wounds
Postoperative Care
55 Necrotizing Fasciitis
Introduction
Risk Factors
Microbiology
Pathophysiology
Initial Evaluation and Diagnosis
Case Report 55.1
Stabilization
Analgesia
Antimicrobial Therapy
Diagnostic Imaging
Imaging Details of Non‐Necrotizing Fasciitis
Surgical Management
Postoperative Wound Management. Sugar and Honey
Sugar
Honey
Silver Sulfadiazine
Hyperbaric Oxygen Therapy and Vacuum‐Assisted Wound Closure
Physical Therapy
Conclusion
56 Degloving and Shear Injuries
Introduction
Anatomy
Wound Healing
Inflammatory Phase
Proliferative Phase
Maturation Phase
Cat and Dog Wound Healing Differences
Degloving and Shear Injuries
Immediate Response to Degloving and Shear Injury. Assessment and Prioritization
Prevent Further Damage
Know Mechanism of Injury and Full History
Analgesia
Managing Degloving and Shear Injuries
Tenet 1: Clip and Cleanse
Tenet 2: Debridement
Tenet 3: Lavage
Tenet 4: Dress and Drain
Contact Layer Dressings for the Inflammatory Phase
Contact Layer Dressings for the Proliferative Phase
Intermediate and Outer Layers of the Bandage
Antibiotics
Topical Medications
Complications
Delayed Wound Healing
Summary
57 Skin Flaps and Grafts : Managing Complications
Introduction
Skin Flaps and Grafts
Basic Reconstructive Surgery Principles
Complications and Management of Skin Flaps
Box 57.1 Halsted's Principles of Surgery
Infection
Seroma and Hematoma
Skin Edge Dehiscence
Self‐Trauma/Mutilation
Distal Flap Necrosis
Case Report 57.1
Free Skin Graft Failure
Conclusion
58 Incisional Infections
Introduction
Defining Surgical Site or Incisional Infections
Epidemiology of Incisional Infections
The Agent
The Host
The Environment
Managing Risks Associated with Incisional Infections
Device‐Associate Events
Procedure‐Associated Events
Compliance‐Associated Events
Etiology‐Associated Events
Prevention of Incisional Site Infections
Adherence to Aseptic Principles
Judicious Use of Antimicrobial Drugs
Identification of High‐Risk Patients
Incisional Infection Surveillance Activities
Treatment of Incisional Infections
Conclusion
59 Ocular Emergencies
Introduction
Initial Stabilization
Ocular Examination
Surgical Supplies (see also Chapter 2)
Surgical Preparation
Draping, Patient Positioning and Globe Fixation
Anatomy
Proptosis
Tarsorrhaphy
Enucleation
Eyelid Laceration
Nictitating Membrane Lacerations
Corneal Trauma
Corneal Foreign Bodies
Corneal Laceration
Conjunctival Grafting
Surgical Techniques
60 Oral Surgical Emergencies
Introduction
Oral Inflammation
Tooth Fractures
Oral and Maxillofacial Swellings
Tooth Displacement Injuries
Palate Defects
Surgical Technique
Jaw Fractures
Tape Muzzling
Case Report 60.1 Dog with Mandibular Fracture
Labial Sutures Through Buttons
Circumferential Wiring
Temporomandibular Joint Luxation
Open‐Mouth Jaw Locking
Temporomandibular Joint Ankylosis
Masticatory Muscle Myositis
Bite Wounds
Foreign Bodies
Projectile Injuries
Burns
Lip Avulsion
Oral Bleeding
61 Approach to the Septic Joint
Importance
Diagnosis. Signalment and History
Gait Analysis and Physical Examination
Radiographic Examination
Diagnostic Arthrocentesis
Case Report 61.1 Signalment and History
Treatment Options. Medical Treatment
Emergency Interventional Treatment
Joint Irrigation and Drainage with Hypodermic Needles
Additional Emergency Treatments
Arthroscopy and Arthrotomy
Local and Regional Antibiotic Application
Choosing a Treatment Protocol
Prognosis
62 Surgical Management of Open Fractures
Introduction
Patient Evaluation
Fracture Classification
Radiographic Examination
Initial Wound Management
Antimicrobial Therapy
Definitive Surgical Treatment
Fracture Fixation
Bone Grafting
Wound Closure
Results and Complications
63 Traumatic Joint Luxation and Reduction
General
Scapula
Shoulder
Closed Reduction Technique
Prognosis
Elbow
Closed Reduction Technique
Prognosis
Carpus
Metaphalangeal and Interphalangeal Joints
Hip
Closed Reduction Technique
Craniodorsal Luxation
Caudoventral Luxation
Stifle
Tarsus
Index. a
b
c
d
e
f
g
h
i
j
k
l
m
n
o
p
r
s
t
u
v
w
x
y
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