ACVECC cheat sheet

Perfusion assessment: mentation, mucous membrane color, CRT (<2 s normal), extremity temperature, pulse quality, and lactate trend; hypotension = systolic <90 mmHg or MAP <60 mmHg in dogs.

Fluid resuscitation: isotonic crystalloid bolus 10-20 mL/kg in dogs and 5-10 mL/kg in cats, reassess after each bolus; synthetic colloid 3-5 mL/kg bolus if crystalloid-refractory; avoid hetastarch in cats and in sepsis with coagulopathy.

Shock endpoints: MAP 65-80 mmHg, lactate clearance >10-20% per hour of resuscitation, improved mentation and pulse quality; persistent hyperlactatemia (>2.5 mmol/L) predicts mortality.

Transfusion triggers: PCV <18-20% with clinical signs or <12-15% perioperatively; platelet transfusion rarely effective due to short lifespan; fresh frozen plasma for coagulopathy at 10-15 mL/kg.

CPR (RECOVER): compression rate 100-120/min, depth one-third to one-half chest width, compression:ventilation 30:2 without advanced airway (10 breaths/min with intubation), rotate compressor every 2 min.

Arrhythmia therapy: vagal maneuvers/atropine 0.02-0.04 mg/kg IV for hemodynamically significant bradycardia; lidocaine 2 mg/kg IV bolus for ventricular tachyarrhythmias, then 25-50 mcg/kg/min CRI.

Emergency drugs: epinephrine 0.01 mg/kg IV (low dose) or 0.1 mg/kg (high dose) in arrest; naloxone 0.04 mg/kg for opioid reversal; dextrose 0.5-1 g/kg diluted for hypoglycemia; calcium gluconate 10% 0.5-1 mL/kg slow IV for hypocalcemia.

Sepsis: SIRS criteria (≥2 of temperature, heart rate, respiratory rate, WBC abnormalities) plus infection source; treat with broad-spectrum antibiotics within 1 hour, source control, and goal-directed fluids.

Anesthesia monitoring in critical patients: capnography (EtCO2 35-45 mmHg), pulse oximetry (SpO2 >95%), direct or oscillometric blood pressure, and ECG; hypotension under anesthesia treated with fluid bolus, vasopressor, or inotrope.

Drug dosing conversions: 1 kg = 2.2 lb; 1 mg/kg = 1 mL/kg of a 0.1% solution; percent solution = g/100 mL, so 5% = 50 mg/mL; CRI mL/hr = (dose mcg/kg/min × weight kg × 60) / concentration mcg/mL.

Antibiotic selection principles: culture and susceptibility when possible; empiric first-line for skin/soft tissue is a beta-lactam (cephalexin 22 mg/kg PO q8-12h); avoid fluoroquinolones in growing animals (cartilage) and enrofloxacin in cats >5 mg/kg/day (retinal toxicity).

NSAID caution: avoid in dehydration, renal disease, GI ulceration, and concurrent corticosteroid use; COX-2 preferential drugs (meloxicam, carprofen) still carry renal and GI risk; washout 3-5 days between NSAID and steroid.

Surgical wound closure: debride nonviable tissue, lavage with 0.9% saline at 5-10 psi, close clean wounds primarily; contaminated or infected wounds managed open with wet-to-dry or vacuum-assisted closure and delayed primary closure.

Anesthetic premedication: opioid (hydromorphone 0.05-0.1 mg/kg or methadone 0.2-0.5 mg/kg) plus a sedative (acepromazine 0.01-0.05 mg/kg or dexmedetomidine 1-5 mcg/kg); avoid acepromazine in patients with seizure history, hepatic disease, or hypovolemia.

Fluid maintenance: 2-3 mL/kg/hr isotonic crystalloid (approx 50-60 mL/kg/day) for adult dogs and cats; add deficit (dehydration % × body weight kg × 1000 mL) and ongoing losses.

Common toxicities: chocolate (theobromine >20 mg/kg causes GI signs, >40-50 mg/kg cardiac, >60 mg/kg seizures), grapes/raisins (acute kidney injury), xylitol (hypoglycemia, hepatic failure at >0.1 g/kg), and lilies (cats: acute kidney injury).

Electrolyte correction: sodium correction rate ≤0.5 mEq/L/hr (10-12 mEq/L/day) to avoid cerebral edema; potassium supplementation ≤0.5 mEq/kg/hr peripherally; add 20-30 mEq KCl per liter of fluids for hypokalemia.

Vaccination and preventive care: core canine vaccines (distemper, adenovirus-2, parvovirus, rabies) and feline (panleukopenia, herpesvirus-1, calicivirus, rabies); rabies is required by law in most US states.