Emergency and Critical Care
Emergency and Critical Care
This domain covers triage, cardiopulmonary resuscitation, shock, fluid resuscitation, and common emergencies. The primary survey always precedes a full history.
Core rules
- Triage uses the ABCs: airway, breathing, circulation. Patients are sorted into emergent, urgent, and non-urgent categories, and the emergent patient is treated before being fully examined.
- CPR (RECOVER guidelines): compressions at 100–120/min, 1/3 to 1/2 of chest depth, with full recoil; ventilate about 10 breaths/min once intubated; minimize interruptions.
- CPR drugs: epinephrine 0.01 mg/kg IV every 3–5 minutes, atropine 0.04 mg/kg, lidocaine 2 mg/kg in dogs.
- Shock is treated with an isotonic crystalloid bolus (e.g., 20 mL/kg in dogs, 10–15 mL/kg in cats), then reassess perfusion before repeating.
- Monitor blood pressure, mentation, lactate, urine output, and temperature.
Worked example
A 20 kg dog arrives in shock. Bolus = 20 kg × 20 mL/kg = 400 mL over 15–20 minutes. Recheck heart rate, mucous membrane color, and blood pressure; repeat only if perfusion is still poor. Boluses are cumulative and can cause volume overload.
Traps
- Giving a full shock bolus to a patient with cardiac disease or pulmonary contusions without reassessing.
- Using epinephrine at the high-dose range routinely; the standard dose is 0.01 mg/kg.
- Stopping compressions too long to place catheters or check a pulse.
- Missing the second patient in a multi-animal emergency.