Читать книгу Small Animal Surgical Emergencies - Группа авторов - Страница 151

A suspicion of an esophageal foreign body demands prompt intervention. Fluid and electrolyte imbalances are identified based on a thorough physical examination and bloodwork. Physical examination should assess mucous membrane moisture and color, capillary refill time, skin turgor, heart rate, pulse quality, body temperature, serial measurements of body weight and blood pressure. Bloodwork should evaluate for any electrolyte and acid–base abnormalities as well as the degree of dehydration based on packed cell volume and total solids. Even though animals with esophageal foreign bodies are seldom markedly hypovolemic, any imbalances should be corrected. Losses often relate to reduced water intake. An isotonic crystalloid, such as isotonic saline solution (0.9% NaCl), lactated Ringer's solution, Plasma‐Lyte 148, or Normosol‐R, can replace both vascular and interstitial volume deficits and maintain hydration. Because isotonic saline solution contains a higher concentration of sodium and chloride and may cause an increase in serum sodium and chloride, patient electrolytes should be monitored regularly and fluid therapy adjusted appropriately. Blood glucose concentration should be monitored and supplemented as needed. A constant rate infusion of 2.5–5% dextrose can be administered (appropriate amount of 50% dextrose can be added to the isotonic crystalloid therapy) until resolution of the hypoglycemia occurs. For patients that present in shock, shock fluid doses can be administered. If isotonic crystalloids are used, the total dose for dogs and cats is 80 and 50 ml/kg, respectively. Shock fluid therapy should be given in increments monitoring the patient's individual response. Synthetic colloids (hydroxyethyl starch, dextrans, and gelatins) can also be administered incrementally in dogs (10–20 ml/kg) and cats (5–10 ml/kg). Broad‐spectrum intravenous antibiotics (e.g., cefuroxime 10–15 mg/kg every 8–12 hours) should be considered, particularly if there is concern regarding esophageal perforation. In addition, pain medication such as an opioid analgesic (e.g., methadone: dogs 0.1–0.5 mg/kg every 4–6 hours intravenously, IV; cats 0.05–0.25 mg/kg IV every 4–6 hours) can be administered. If there is any suspicion of respiratory embarrassment secondary to pleural effusion or aspiration pneumonia, an arterial blood gas should be performed and thoracic radiographs taken once the patient is stabilized. If physical examination reveals muffled heart sounds and there is concern that pleural effusion is present, thoracocentesis should be performed before taking thoracic radiographs. If dyspneic, supplemental oxygen is administered via nasal prongs or oxygen mask. Gastric protectants such as omeprazole (0.5–1.5 mg/kg IV every 24 hours) help to limit the development of esophagitis. Ranitidine (2 mg/kg slow IV every 8–12 hours) is an alternative for dogs and is indicated for cats, for which omeprazole is not licensed for intravenous use.

Figure 4.3 Pathophysiology of esophageal injury.