CSGTR Flat Cat

Question 1

A 1 year old MN silver tabby is presented after having been missing for 6 hours.

Forumalte a triage plan, start at the point of opening the cardboard box that the cat has been transported in. Describe primary and secondary survey.

Answer 1

• Airway: Check mouth for obsturction. Resp effort. Patency of airway. Auscultate trachea and lung fields.
• Circulation:
• circulation
• heart sounds
• pulses
• capillary refill time
• Respiratory:
• respiratory sounds
• bruising
• external wounds to chest
• Abdomen:
• palpation
• bruising
• external wounds
• fast ultrasound:
• abdomen:
• free fluid (diaphragmatic-hepatic site, splenorenal site, cysto-colic site, hepatorenal site)
• bladder integrity
• thorax (do this at the same time as assessing the abdominal cavity):
• ensure you do both left and right sides
• chest tube site
• pericardial site
• wet/dry/third space
• Spine and tail:
• gait and posture
• pain sensation
• crepitus
• Head:
• mentation
• cognitive function
• cranial nerves
• external wounds/bruising
• eyes – including symmetry, third eyelids, eye position, haemorrhage and detailed ophthalmological examination
• ears
• nose
• Pelvis: wounds, bruising, pain, crepitus, perineum, external genitalia
• Limbs: deformities, fractures, pain, bruising, wounds, weight bearing vs non-weight bearing
• Arteries: All accessible superficial arteries – pulses and pressure
• Nerves: mentation, cranial nerves, conscious proprioception, postural reflexes, peripheral spinal reflexes, withdrawal reflexes, deep pain, cutaneous trunci reflex, anal tone

Question 2

You decide to radiograph the cat, the cat will require some chemical restraint to allow thoracic/ and abdominal/pelvic radiographs to be taken

Suggest a combination of drugs that would provide moderate sedation and a degree of analgesia (use supplied pdf as a guide), how can you improve the sedation if it doesn’t work?

Answer 2

• Come up with a sensible combination of drugs to adequately sedate the cat
• Start with methadone: 0.2mg/kg, 10mg/ml à 0.02ml/kg (full agonist, faster onset of action), add ketamine 0.3ml/kg if sedation not adequate (Doesn’t cause as much CRS depression)

But there isnt one right answer!

Question 3

What premedicants are licensed in cats?

What premed should we avoid in this cat?

Answer 3

• What is licensed in cats? NB cascade
• Pethidine (opioid)
• Buprenorphine (vetergesic)
• Medathone (comfortan)
• Ketamine (vetoquinol, ketavet)
• Diazepam (Ziapam)
• (Morphine isn’t licensed)
• Avoid acepromazine and medetomidine/dexmedetomidine, but sometimes microdoses of these drugs are used if the cat is very wriggly

Question 4

Following sedation, the cat is quiet enough to position for radiographs and ultrasound.

Bladder ultrasound is possible, and confirms an intact bladder

What other tests could you do to check integrity of the bladder (contrast studies, u/s)

Answer 4

• Retrograde cystogram
• Abdominocentesis and ultrasound looking for urine in abdomen

Question 5

What is wrong with this cats radiograph?

Answer 5

• From a lateral and VD view you diagnose a right sacroiliac luxation and a short oblique fracture of the left ilial shaft, as well as an acetabular fracture on the left.
• There is a mild degree of pelvic canal narrowing and rectal examination (after sedation and analgesia) confirms only mild narrowing

Question 6

You opt for surgical repair of the fracture.

What will you warn the owner about?

Answer 6

• Infection
• Anaesthesia complications
• Death
• Osteoarthiritis later
• Long recovery
• Cage rest
• Hospitalisation costs
• Neurological issues
• May become incontinent
• Regular check ups
• How much are they insured for?

Question 7

Surgery will give a more predictable outcome and will help control pain

It is invasive and more costly

What are some disadvantages are those related to fracture repair?

Answer 7

• Orthopaedic infections
• Possibility of failure of repair
• Nerve damage – Neuro defecits
• Assistance for moving – Slings etc
• Cost
• Rehab (nt always covered by insurance)
• Long GA – Higher risk of infection and GA

Question 8

If the owner didn’t have the financial means to allow surgical repair could you offer conservative management? Why?

Answer 8

Conservative treatment is cheap and non-invasive. Cats are often very painful and the outcome may be less predictable. In this case, both left and right hind limbs are affected, so the cat has lost both weight-bearing axes and therefore conservative management is not a good option

In addition, if there is pelvic narrowing, the cat may have long term problems with constipation and require further and repeated treatment for this

Question 9

You decide to operate later on the same day

What will you do for the cat in the meantime?

Can you give this cat a NSAID?

Answer 9

NO – Hypovolaemic so opioids are a better choice

Question 10

The cat recovers well from the fracture repair and is discharged 4 days later

Formulate a rehabilitation plan for a cat recovering from this pelvic fracture

Answer 10

• Regualar check ups: a few days after
• Pain relief : Give regularly
• Pain scoring at home
• Away from other pets
• Re-Xray
• Physiotherapy – massage
• Cage rest – as little movement as possible
• Come back and see:
  
  • Smelling
  • Discharge
  • No urination
  • Lack of appetite
  • Constipation
  • Tell owner to check legs below dressing for circulation (too tight)