Small Animal Surgical Emergencies

Small Animal Surgical Emergencies
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Small Animal Surgical Emergencies <p><b>A comprehensive and up-to-date guide in emergency surgical intervention for veterinary professionals </b> <p><i>Small Animal Surgical Emergencies, Second Edition</i> continues to be an important resource focusing on surgical emergencies, combining the work of surgical specialists and critical care specialists, and filling a void in educating and informing veterinarians. <p>The new edition of this book provides updated information on an array of topics such as preoperative stabilization, new and innovative treatment options, and aftercare. Each chapter covers step-by-step information on emergency stabilization, diagnostic approach, operative techniques, postoperative care, common complications encountered in each case, and how to troubleshoot any such complication should they occur. It also offers simplified surgical techniques to ensure success and describes new and novel procedures throughout. <p>The Second Edition of <i>Small Animal Surgical Emergencies</i> features: <ul><li>Nine new chapters covering operating room nursing tips, rectal prolapse, colonic torsion, surgical intervention post celiotomy, assisted enteral feeding tubes, open chest CPR, managing complications of skin flaps and grafts, incisional infection, and joint luxations</li> <li>Many chapters are written in collaboration by experts in small animal surgery and critical care, combining these practices in one important resource</li> <li>Relevant anatomy, imaging, and full-color illustrations and drawings incorporated into each chapter</li> <li>Inclusion of case presentations, when relevant</li></ul> <p>An important tool for small animal general practitioners, veterinary surgeons, critical care specialists, as well as veterinary nurses and operating room technicians, <i>Small Animal Surgical Emergencies, Second Edition</i> is a crucial resource for this constantly evolving branch of veterinary medicine.

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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

WILEY END USER LICENSE AGREEMENT

Отрывок из книги

Second Edition

.....

Jennifer Savini DVM DACVECC Emergency and Critical Care Specialist VRC Specialty Hospital Malvern, PA, USA

Mike Schlicksup DVM DACVS Columbia Veterinary Emergency Trauma and Specialty Columbia, SC, USA

.....

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