Читать книгу Small Animal Surgical Emergencies - Группа авторов - Страница 243

Initial therapy is aimed at stabilizing the patient in hypovolemic shock, with emphasis placed on preparing the patient for correction of the intestinal and vascular anatomic abnormalities as promptly as possible. Fluid resuscitation is vital and should be among the first steps in treating patients; it should not be sacrificed in the pursuit of diagnostics. While septic and toxic shock will not resolve without management of the underlying cause, resuscitative efforts are employed to optimize patient status in preparation for anesthesia and surgery (see Chapter 1). Colloids or hypertonic crystalloids are used as necessary to correct hypotension. Once the patient is as stable as possible and a high index of suspicion for intestinal volvulus has been reached, abdominal exploration should not be delayed. Timeliness in correcting the volvulus is critical in influencing patient outcome [9, 20]. Anesthesia should be planned carefully as patients often remain critical at the time of surgery and may decompensate rapidly secondary to reperfusion injury or uncorrected acid–base abnormalities. Vasopressor therapy may be required to maintain normotension and protect renal function. If the patient is not responding to typical resuscitative efforts, and the index of suspicion for intestinal volvulus is high, rapid diagnostic and therapeutic decision making is critical. Typically, abdominal radiographs lead most efficiently to the diagnosis, however, to prevent further patient decompensation, clinical judgment must be exercised when deciding to take the time to obtain radiographs.