Emergency Situations, Support, and Surgery (Other Than Acute Abdomen)

Any patient that requires acute / emergent surgery will require stabilization, perhaps save the acutely paraplegic Dachshund with intervertebral disc extrusion. Care should be taken to rapidly evaluate, treat, and diagnose the cardiopulmonary systems. initial fluid therapy with crystalloids usually effectively treats alterations in hydration and per- fusion (shock). failure for a patient’s physical examination or diagnostic testing (blood pressure) to respond should prompt alteration of therapy. Hypertonic saline may be used; however, if available, synthetic colloids may be a better alternative. the synthetic colloids (Hetastarch, Dextrans) are often required for the septic patient or the patient with SirS. Keep in mind the possibility of coagulation alterations due to synthetic col- loids in those patients with signs of a coagulopathy, but still the administration may be necessary for stabilization. further therapy with plasma may be initiated if the coagu- lopathy is confirmed – surgical causes of coagulopathies usually respond well to the cornerstone of treatment, which is removal of the primary cause. alterations in cardiac rhythm associated with surgical cases are usually ventricular in origin and respond to standard lidocaine therapy. Specific therapy of electrolyte abnormalities are rarely required if standard fluid therapy and surgical repair can be done acutely. once excep- tion, however, is the severely azotemic patient with hyperkalemia. Significant altera- tions in Bun, creatinine, and potassium may be treated with rehydration, diuresis, and if necessary, specific therapy (dextrose, insulin). fluid therapy alone can restore the values to normal if urine can be removed from the body. procedures required include nephros- tomy tube placement, peritoneal drain placement, tube cystostomy, and urethral cathe- terization. any of these surgeries can be done quickly and safely with sedation and local anesthetic and perhaps light, general anesthesia. Establishing urine flow from the body allows for significant headway to be made in restoring normal values and makes the patient safe for definitive repair of the cause of urinary obstruction or leakage. Each procedure will be described in the seminar.

Nephrostomy tube placement can be done with ultrasound and fluoroscopic guidance if the renal pelvis is sufficiently dilated (1 cm). percutaneous placement will only be temporary and risks tube dislodgement. Significant ureteral obstruction may be temporarily diverted with surgically placed nephrostomy tube(s) with concurrent nephropexy around the exit site. the patient must be kept from bothering the tubes which must be secured with a bandage and connected to individual closed collection systems. this allows urine volume measurement and proper fluid therapy. Early dislodgement may require definitive surgery to be done sooner, but the tubes (if in place) can also be used for injection of contrast to define the anatomy of each ureter for surgical planning. [...]