EDUCATION“Education is what survives after what has been learned has been

forgotten.”- B.F. Skinner

Rare, life-threatening reactions to something injected or ingestedUntreated, it results in shock, resp/cardiac failure, and deathIgE Antibodies to allergen bind to mast cells; on subsequent exposure, the Ag-Ab

reaction causes massive release of histamine and other inflammatory mediators

Histamine → vasodilation → ↓BP• Initiating factors– Insects– Vaccines– Antibiotics– Certain hormones– Other medications– Foods

Anaphylaxis/Allergic reactions

• Signs– Sudden onset of vom/diarrhea– Shock• Gums are pale• Limbs are cold• HR rapid, weak

– Face scratching (early sign)– Respiratory distress– Collapse – Seizures– Coma– Death

Anaphylaxis/Allergic reactions

• Rx (this is an extreme emergency)– Eliminate cause– Epinephrine– H1 antihistamines (Diphenhydramine)– IV fluids– Corticosteroids – Oxygen

• Prevention– There is no way to predict what will bring on

an anaphylactic reaction the first time– Always inform vet if animal has had previous

reaction to vaccine• Owners should have an ‘epi-pen’ with them at all times

Anaphylaxis/Allergic reactions

Requires immediate treatmentDogs do not cool as well as humans (don’t sweat)• Causes– Left in hot car– Water deprivation– Obesity/older– Chained without shade in hot weather– Muzzled under a hot dryer– Short-nosed breed (esp Pug, Bulldog)/heavy coat– Heart/Resp disease or any condition that impairs

breathing or ability to cool body– Lack of acclimatization/exercise

Heat Stroke (Hyperthermia)

• Signs– Rapid, frantic, noisy breathing– Tongue/mm bright red, thick saliva– Vomiting/diarrhea—may be bloody– Rectal temp >105°– Unsteady/stagger– Coma/death

Heat Stroke

Prevention

• Complications– Multi-system organ failure– Denatures proteins– Hypotension– Lactic acidosis– Decreased oxygen delivery– Electrolyte abnormalities => cerebral edema and

death– Coagulopathies => DIC– If survives the first 24 hrs, prognosis is more favorable

Heat Stroke

• TREATMENT Mild cases: move dog to a/c building or car– Temp >104º, immerged in cool water, hose down– Temp >106º, cool water enema (cool to 103º)– Temp >109° leads to multiple organ failureSTOP COOLING EFFORTS AT 103º– IV fluids– Corticosteroids

Heat Stroke

Emergency Drugs in Cats

Emergency Drugs in Dogs

• Misconceptions about animal pain– Animals do not experience pain– Pain doesn’t really affect how animal responds to treatment– Signs of pain are too subjective to be assessed– Pain is good because it limits activity– Analgesia interferes with accurate assessment of treatment– Pain management not major concern in LA (except horses)– Pain shows weakness/fragility (Lab vs Collie)• Fresh ideas about animal pain – Analgesia increases chance of recovery in critically ill– Pain associated with diagnostic test should be minimized– Morally correct thing to do

Pain Management

• Signs– Vocalization– ↑HR– ↑RR– Restlessness, abnormal posturing, unwilling to move– ↑ Body temperature– ↑BP– Inappetence– Aggression– Facial expression, trembling– Depression, insomnia

Pain Management

• Sequelae to untreated pain– Neuroendocrine responses• Excessive release of pit, adr, panc hormones

– Cause immunosuppression and disturbances of growth, development, and healing

– Cardiovascular compromise• ↑BP, HR, intracranial pressure

– Coagulopathies• ↑platelet reactivity, DIC

– Long-term recumbency• Decubital ulcers

– Poor appetite/nutrition• Hypoproteinemia→slow healing

Pain Management

• Pain Relief– Nonpharmacologic interventions (differentiate

pain vs stress)• Give relief from:

– Boredom, Thirst, Anxiety, Need to urinate/defecate

• Clean bedding/padding• Reduce light/sound• Stroking pet, calming speech• Owner visits (±)• Minimize painful events (reduce #, improve skills in

injections, blood draw]

Pain Management

• Questions the Vet Tech must continually ask (you are in charge of pain meds)– Is patient at acceptable comfort level– Are there any contraindications to giving pain

meds– What is the appropriate (safe, effective) med for

this patient

Pain Management

• Drug Options– Nonsteroidal Antiinflammatory Drugs (NSAIDs)• Most widely used• Extremely effective for acute pain• Most effective when used preemptively (before tissue injury)• Usually not adequate to manage surgical pain• COX-2 NSAIDs do not cause damage to stomach lining

– Opioids• Most commonly used in critically injured animals

– Rapid onset of action; effective; safe• 4 types of receptors

– μ: analgesia, sedation, and resp depression– Κ: analgesia and sedation – Σ: depression, excitement, anxiety– Δ

• Side effects– Vomiting, constipation, excitement, bradycardia, panting

• Metabolized by liver; excreted by kidneys– Use caution with hepatic, renal disease

Pain Management

• Opioids – Morphine sulfate • Used for max analgesia/sedation• Inexpensive• Side-effects: systemic hypotension, vomiting• Cats particularly sensitive

– Oxymorphone• 10x potency of morphine• Much more expensive; less resp depression and GI stimulation• Side-effects: depression, sensory hypersensitivity

– Hydromorphone• Similar effects of Oxymorphone• More widely available, less expensive than Oxymorphone

Pain Management

• Opioids – Fentanyl citrate• Extremely potent• Rapid onset, short duration when administered IM or IV• Transdermal patch

– 3-day duration– Shave hair, apply to the skin

– Butorphanol Tartrate• Κ agonist; μ antagonist• Analgesic effect questionable (>1 h); good sedative (~2 h)

– More expensive than morphine– Less vomiting, resp. depression

– Buprenorphine• Partial mu agonist• 30x potency of morphine; longer duration• good absorption via buccal mucosa

Pain Management

• Opioids– Antagonists• Naloxone HCl

– Reversal occurs within 1-2 min– Can be used to reverse anesthesia (Inovar-Vet)

Pain Management