Emergency Medicine and Critical Care
Triage and the primary survey
Triage sorts patients by urgency, not arrival order: airway, breathing, circulation, then disability and exposure. A patient with pale mucous membranes, prolonged capillary refill, tachycardia, weak pulses, and hypothermia is in shock and needs immediate vascular access. Recognize that cats in shock may be bradycardic and hypotensive rather than tachycardic.
Shock and resuscitation
Isotonic crystalloid boluses are typically 20–30 mL/kg in dogs and 10–15 mL/kg in cats, reassessing after each bolus. Hypertonic saline (about 4 mL/kg) and colloids are options for selected cases. CPR follows a structured approach: compressions at 100–120 per minute at one-third to one-half chest depth, minimal interruptions, ventilation, and drugs such as epinephrine at roughly 0.01 mg/kg IV every 3–5 minutes. Reversal agents include naloxone, atipamezole, and flumazenil.
High-yield emergencies
Gastric dilatation-volvulus requires decompression, fluids, and surgery. Urethral obstruction causes hyperkalemia with bradycardia and peaked T waves; treat with fluids, calcium gluconate, and relief of obstruction. Anaphylaxis calls for epinephrine and fluids. Toxicities, diabetic ketoacidosis, and severe hemorrhage round out the common scenarios.
Worked example
A 20 kg dog in shock receives 20 mL/kg of crystalloid = 400 mL over about 15–20 minutes, then reassess perfusion before repeating.
Traps
Giving a cat a dog-sized bolus, missing hyperkalemia on the ECG, and mixing calcium and bicarbonate in the same line.