Lecture 26

Question 1

Which problems in small mammals are more urgent than in other species?

Answer 1

*small volumes of hemorrhage
-significant due to small size

*open-mouth breathing
-always an emergency in rabbits and rodents

*short term anorexia or lack of defecation
-emergency in hindgut fermenters

*diarrhea
-can indicate life-threatening dysbiosis in hind gut fermenters

Question 2

Which subtle signs in ferrets can indicate severe disease?

Answer 2

-pawing at the face can indicate insulinoma
-licking at the abdomen in males can indicate urinary obstruction

Question 3

Which subtle sign in rabbits can indicate severe disease?

Answer 3

bilateral exophthalmia can indicate thymoma

Question 4

Why is it important to consider that most small mammals are prey species?

Answer 4

-may mask disease and appear more stable than they truly are
-emergency presentation is often due to decompensation following long-standing chronic disease
-err on the side of caution when triaging

Question 5

What are the basics of small mammal CPR training for staff?

Answer 5

-use same concepts as RECOVER for dogs and cats
-have refresher courses
-run occasional drills
-have visual aids and drug doses readily available

Question 6

Which ventilation materials should be available in the crash cart for small mammals?

Answer 6

-ET tubes in sizes 2.0, 2.5, and 3.0; both cuffed and uncuffed
-IV catheters to serve as ET tubes with appropriate connector
-tight-fitting face masks
-syringe cases that can be modified into face masks for animals with long noses

Question 7

Which equipment should be in the crash cart for monitoring of small mammals?

Answer 7

-stethoscope
-thermometer
-pulse ox
-ECG
-doppler
-ETCO2

Question 8

Which supplies are useful for obtaining vascular access in small mammals?

Answer 8

-small-sized IV catheters
-spinal needles with stylets for IO catheters

Question 9

Which emergency drugs should be in the crash cart?

Answer 9

-epinephrine +/- vasopressin
-atropine
-glycopyrrolate for rabbits
-naloxone
-flumazenil
-atipamazole

Question 10

Which aspects of history are important for triaging small mammals?

Answer 10

-signalment
-reason for seeking medical care
-concurrent medical conditions
-husbandry

Question 11

What are the characteristics of the primary survey in small mammal emergencies?

Answer 11

-do a hands off, observation exam first
-hands on exam should last less than 2 minutes
-be prepared with all equipment before handling
-provide animal breaks as needed
-maintain stress free environment when not handling
-consider flow-by during exam and oxygen cage before and after exam
-consider sedatives and/or analgesics
-be aware that animal may appear more stable than they are

Question 12

Which systems are assessed during the primary survey?

Answer 12

-respiratory
-cardiovascular
-neurologic
-urogenital
-possibly GI

Question 13

Which other conditions should be assessed during the primary survey?

Answer 13

-toxicity
-hypo- or hyperthermia
-severe pain
-trauma
-active bleeding
-open wounds
-fractures
-burns
-organ prolapse

Question 14

What are the expected temperatures in various small mammal species?

Answer 14

*rabbit:
-100.5 to 104

*chinchilla:
-94.8 to 100.2

*sugar glider:
-97.3 rectal
-89.6 cloacal

*hedgehog:
-95.7 to 98.6

Question 15

What are the components of the respiratory primary survey?

Answer 15

-assess for presence or absence of hypoxemia or hypoventilation
-assess upper airway first
-assess rate and effort
-assess mucous membrane color
-auscult sinuses, trachea, and lungs
-consider pulse ox and arterial blood gas analysis

Question 16

What are the components of the cardiovascular primary survey?

Answer 16

-assess for poor tissue perfusion and decreased tissue oxygen delivery
-capillary refill time
-heart rate and pulse quality
-cardiac auscultation
-dull mentation, quiet heart sounds, low body temp., and/or cool extremities are worrying
-consider ECG, non-invasive BP, lactate measurement, and/or thoracic POCUS

Question 17

What is thoracic Point of Care UltraSound (POCUS) used to assess?

Answer 17

-cardiac contractility
-pleural or pericardial effusion
-large thoracic masses

Question 18

What are the components of the neuro primary survey?

Answer 18

-treat seizures immediately
-consider increased cranial pressure in cases of stupor or coma
-minimize further movement in cases of severe acute paralysis and suspected spinal trauma

Question 19

Which conditions are important to consider in animals presenting for emergency?

Answer 19

-toxicity
-gastric dilatation in rabbits
-GDV in guinea pigs

Question 20

What are the phases of fluid therapy?

Answer 20

-resuscitation
-rehydration
-maintenance

Question 21

What are the clinical markers that indicate fluid therapy success?

Answer 21

-mentation
-mucous membrane color
-CRT
-heart rate
-normothermia
-normovolemia
-weight

Question 22

What are the characteristics of resuscitation fluids in small mammals?

Answer 22

-can be IV or IO
-want to give crystalloid boluses of 10 to 15 ml/kg
-can use colloids or hypertonic saline in moribund or decompensated shock patients
-non-responsive shock if no response after 3-4 crystalloid boluses and colloid admin.

Question 23

What are the differentials for non-responsive shock?

Answer 23

-excessive vasodilation/vasoconstriction
-hypoglycemia
-electrolyte imbalances and/or acid-base disorders
-cardiac dysfunction
-hypoxemia

Question 24

Which treatments should be considered in cases of non-responsive shock?

Answer 24

-additional diagnostics
-vasopressor or inotrope
-blood transfusion

Question 25

What is the equation for rehydration?

Answer 25

rehydration in mL = % dehydration x weight in kg x 1000

Question 26

How should different losses be accounted for with fluids?

Answer 26

*acute losses: -less than 24 hours -unstable CV status -replace over 4 to 6 hours *chronic losses: -greater than 24 hours -stable CV status -replace over 12 to 24 hours *maintenance: -approx. 3 to 4 ml/kg/hr *account for ongoing losses