Fluid Therapy and Heat Injuries in Multi Purpose Canines (MPC) PFN: SOMVML0R Hours: Instructor: Slide 1 Terminal Learning Objective Action: Communicate knowledge of fluid therapy and heat injuries in Multi Purpose Canines (MPC) Conditions: Given a lecture and practical exercise in a classroom environment Standards: Received a minimum score of 75% on a written exam IAW course standards Slide 2 References The Veterinary Merck Manual 9 th edition, published 2005 Birchard, Stephen J. Saunders Manual of Small Animal Practice. W.B. Saunders, 2000 TMEPS Slide 3 1
Reason As a Special Operations Combat Medic, you are responsible to provide emergency medical care to a government owned animal in the absence of veterinary assets. Slide 4 Agenda Identify the anatomical locations for fluid administration in the MPC Identify the clinical presentation and prevention of dehydration in the MPC Identify the clinical presentation and management of heat injuries in the MPC Calculate fluid replacement therapy for the MPC Slide 5 Anatomical Locations for Fluid Administration in the MPC Slide 6 2
Subcutaneous Injections Amount 500 1000 ml Sites Shoulders Pelvis Slide 7 Intravenous Injections Sites Cephalic Saphenous Jugular Slide 8 Intraosseous Injections Sites Head of the humerus Tibial tuberosity Greater trochanter of the femur Sedation required for placement Excellent in patients suffering from severe dehydration or hypovolemia Slide 9 3
Intraosseous Injections Site Anatomy Slide 10 Clinical Presentation of Dehydration in the MPC Slide 11 Dehydration Refresher Skin turgor Skin between the shoulder blades Tent skin and release, skin should return to position within 1 second Capillary refill time Oral mucosa Press on the gums above the teeth, color should return within 2 seconds Slide 12 4
Dehydration Assessment Signs and symptoms of dehydrationª <5% No significant findings on physical exam 6 8% Mild to moderate decreased skin turgor, dry mucous membranes, slight tachycardia 10 12% Marked degree of decreased skin turgor, dry mucous membranes, weak and rapid pulse, slow capillary refill time, moderate to marked mental depression ªPlunket, S. Emergency Procedures for Small Animal Veterinarians, 2 nd ed. W.B. Saunders 2001 Slide 13 Dehydration Prevention Subcutaneous fluids prior to work NS or LR s Adequate accessibility to water Allow the animal work/rest cycles with access to water Slide 14 Clinical Presentation and Management of Heat Injuries in the MPC Slide 15 5
Signs and symptoms Heavy panting Irregular heart rate Lethargy Sudden collapse Treatment Heat Exhaustion Move animal to cooler environment Small amounts of water Wet the fur with cool (not cold) water DO NOT SUBMERGE in an Ice Bath Slide 16 Heat Stroke Signs and Symptoms Rapid erratic heart rate Heavy panting or gasping for air Lack of coordination or staggering Excessive body temperature (> 106 ) Excessive drooling or frothing at the mouth Dark red gums Pale gums with shock Seizures Vomiting and/or diarrhea Confusion or blank stare/ lack of responsiveness to commands Slide 17 Heat Stroke Treatment Same as heat exhaustion Initiate fluid therapy (discussed in next section) Discontinue cooling at 103 F Immediate evacuation to a Veterinarian Lack of treatment can cause multiple organ failure and death Slide 18 6
Fluid Replacement Therapy for the MPC Slide 19 Fluid Replacement First 24 hours Hydration deficitª (replacement requirement) Calculated by multiplying the % of dehydration (as a decimal) by the body weight (kg) which equals the deficit in liters Next 24 hours Maintenance Requirement ª(40 60 ml/kg per day) Sensible losses (urine output): 27 40 ml/kg per day Insensible losses (fecal, cutaneous, respiratory): 13 20 ml/kg per day ªPlunket, S. Emergency Procedures for Small Animal Veterinarians, 2 nd ed. W.B. Saunders 2001 Slide 20 Fluid Replacement Example for first 24 hours: A 75 lb (34 kg) dog is assessed to be 7% What volume of fluid deficit should be given during the first 24 hours? Hydration deficit volume (L) % dehydration x body weight (kg) = deficit in liters Hydration deficit volume (L) = 0.07 x 34 kg ~ 2.4 L Slide 21 7
Fluid Replacement Example for next 24 hours: A 75 lb (34 kg) dog is assessed to be 7% dehydrated and has been vomiting. How much fluid should be given during the next 24 hours? Volume (L of fluid required) = deficit volume + maintenance volume = [0.07 x 34 kg] + [50 ml x 34 kg] = [2.4] + [1.7] = 4.1 L Maintenance fluid volumes for the dog. Recommended volumes are calculated from the formula (40 60 ml X BW Kg per day). Slide 22 Practical Exercise on Fluid Replacement Calculations for the MPC Slide 23 Practical Exercise would be given in the first 24 hours. A 84 lb (38 kg) dog is assessed to be 9% Answer: 0.09 x 38 kg = 3.42 L Slide 24 8
Practical Exercise would be given in the first 24 hours. A 66 lb (30 kg) dog is assessed to be 6% Answer: 0.06x 30 kg = 1.8 L Slide 25 Practical Exercise would be given in the first 24 hours. A 92 lb (42 kg) dog is assessed to be 11% Answer: 0.11x 42 kg = 4.62 L Slide 26 Practical Exercise would be given in the second 24 hours. (for practical purposes use 50ml/kg maintenance dose) A 71 lb (32 kg) dog is assessed to be 8% Answer: [0.08x 32 kg] + [50ml x 32kg] [2.56] + [1.6 L] = 4.16L Slide 27 9
Practical Exercise would be given in the second 24 hours. (for practical purposes use 50ml/kg maintenance dose) A 77 lb (35 kg) dog is assessed to be 5% Answer: [0.05x 35 kg] + [50ml x 35kg] [1.75] + [1.75 L] = 3.5 L Slide 28 Practical Exercise would be given in the second 24 hours. (for practical purposes use 50ml/kg maintenance dose) A 97 lb (44 kg) dog is assessed to be 7% Answer: [0.07x 44 kg] + [50ml x 44 kg] [3.08] + [2.2 L] = 5.28 L Slide 29 Questions? Slide 30 10
Terminal Learning Objective Action: Communicate knowledge of fluid therapy and heat injuries in Multi Purpose Canines (MPC) Conditions: Given a lecture and practical exercise in a classroom environment Standards: Received a minimum score of 75% on a written exam IAW course standards Slide 31 Agenda Identify the anatomical locations for fluid administration in the MPC Identify the clinical presentation and management of dehydration in the MPC Identify the clinical presentation and management of heat injuries in the MPC Calculate fluid replacement therapy for the MPC Slide 32 Reason As a Special Operations Combat Medic, you are responsible to provide emergency medical care to a government owned animal in the absence of veterinary assets. Slide 33 11