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Hospital for dogs and cats: what to expect and how to prepare a pet?

Hospitalization of the dog and cat - what to expect when your pet is in hospital?

Hospital for dog and cat

Hospitalization a beloved pet is always a difficult time for him, but also for his guardians.

Separation from your pet, uncertainty about his future, perhaps the burden of diagnosis is often a huge stress, which is additionally compounded by the limited awareness of what will happen to your beloved pet in a cold and strange hospital.

But is there really anything to fear??

Is that hospital it is not a place that is to serve primarily good, and all activities are aimed at helping the animal to recover as soon as possible?

Isn't that where miracles are often performed??

In this study, I would like to familiarize myself with the issue of hospitalization of a veterinary patient.

I know from experience that caregivers, hearing about the need to stop dog or cat in the hospital allow for a voice of various kinds of emotions that make it difficult to convey important information and recommendations.

These important issues are discussed in this article.

The reader will find there answers to many questions that bother owners of hospitalized animals, they will get acquainted with the general characteristics of diagnostic tests and activities carried out in patients in hospital and become familiar with the concept of intensive care.

As hospitalized patients often need to receive dietary support, there is also some information about the types and techniques of feeding sick animals.

However, at the very beginning I would like to answer the most common of all questions regarding hospitalization:

“Why does my pet have to stay in the hospital? "

Hospitalization of an animal may result from various reasons - most often it is a planned surgery, the need to administer drugs and fluids during the treatment of the current disease, but also various types of critical situations, during which the entire clinic staff is focused on saving the patient's life.

If your pet is injured or suddenly becomes ill with an acute, life-threatening disease, it will need immediate veterinary care.

In addition to the need for the initial emergency treatment, there are often many more days of treatment in hospital, before he recovers and the pet can go home.

During this time, it may be necessary to closely monitor and take measures to support vital functions in the veterinary intensive care unit.

  • Indications for hospitalization
  • How to prepare a dog / cat for hospital stay?
  • What gives a hospital stay?
  • What can I expect when my pet is hospitalized?
  • Veterinary hospital - intensive care
  • Patient Classification System (TRIAGE)
    • First patient assessment
    • Second Patient Assessment
    • Third patient assessment
  • Monitoring hospitalized critically ill patients
  • Pain assessment
    • Assessment of acute pain in dogs
    • Assessment of acute pain in cats
  • Basic physical examination
    • Body temperature
    • Heart rate and heart rate
    • Respiratory rate
    • Neurological assessment
    • Irrigation
    • Hematocrit and total protein
    • Blood glucose
    • Electrolytes
    • EKG
    • Blood pressure measurement
    • Pulse oximetry
    • Gasometry
    • Capnography
    • Quick ultrasound
    • Fluid analysis
    • Urine output
  • Feeding dogs and cats in the hospital
    • Enteral nutrition
    • Parenteral nutrition
  • Frequent questions asked by dog ​​and cat keepers
    • Will my dog ​​/ cat be safe??
    • Will my pet be under constant care at the veterinary hospital??
    • How long will my pet be hospitalized?
    • How can I find out about my dog ​​/ cat's well-being and treatment progress?
    • Will my pet be kept in a cage at all times??
    • Can I leave my favorite toy / blanket / scratching post?
    • Can I visit my dog ​​/ cat in the hospital?
    • What I need to know when my cat / dog is discharged from hospital?
  • How much is a dog and cat hospital?

Indications for hospitalization

Indications for hospitalization

Hospitalization is carried out in order to perform diagnostic tests, perform preventive treatments (eg. sterilization, castration) or treatment of the animal (including saving life).

The stay of the dog and cat in the hospital can take place in the following modes:

  • Hospitalization - the pet is admitted to veterinary hospital immediately if required by his state of health.
  • Planned hospitalization - the date of admitting the pet to the hospital is agreed with the owner in advance. Usually it concerns previously arranged treatments or diagnostic tests.
  • One-day hospitalization - it is most often used to administer drugs or drips (e.g. during chemotherapy). The patient arrives in the morning and is picked up by the caregiver in the afternoon or evening. Often, planned hospitalization lasts just one day.

The decision as to whether it is really necessary to detain a patient in a hospital is made on the basis of several key elements. These are:

Medical indications:

  • Preparing the patient for the procedure. Often, animals for which surgery is planned are admitted to the hospital in the morning - on the day of surgery or the day before, in order to perform the necessary qualifying tests and appropriate preparation of the patient (e.g. fasting, enema, etc.).
  • Surgical treatment sometimes entails keeping the dog or cat in the hospital for observation or continuation of treatment. This is especially true in situations where further steps are required, such as:
    • fluid therapy,
    • oxygen supply,
    • careful monitoring of the condition of a sick animal,
    • intravenous administration of drugs.
  • It is obvious that critically ill patients require hospitalization because they must be monitored and, if necessary, treatment is immediately modified. This group includes mainly:
    • major trauma patients, including those injured in car accidents, bites, shots, stabs or burns;
    • patients with severe bleeding (e.g. from the nose, mouth, ears, rectum, as well as from wounds);
    • any animal that has serious breathing problems;
    • any animal in shock (shock symptoms may include weakness, pale mucosa, cold extremities, abnormal heart rate);
    • animals with a life-threatening neurological disease such as coma or severe seizures that do not respond to treatment;
    • animals with heart failure or severe cardiac arrhythmias;
    • patients with sepsis;
    • dogs with acute dilation and torsion syndrome;
    • patients with advanced consequences of heat stroke;
  • Any seriously ill animal may be referred for hospitalization, and the most common are:
    • animals that require blood transfusions;
    • animals that have difficulty passing urine or do not produce urine;
    • dogs and cats that require specialized nutritional support because they do not want to or cannot eat on their own;
    • animals in which an abnormal heart rhythm is causing problems and at risk of developing cardiovascular failure;
    • patients who have undergone surgery and do not recover from anesthesia or have problems in the first days after surgery;
    • animals that ingested the poison (or were poisoned for other reasons, e.g. medications, the use of skin preparations not intended for a given species, etc.);
    • animals with acute kidney disease;
    • patients after bone fractures;
    • animals with severe vomiting or diarrhea;
    • patients with complications of systemic diseases such as diabetes;
    • animals with other disorders that may require hospitalization, e.g.:
      • paralysis;
      • breathing difficulties;
      • abdominal pain;
      • a snake or insect bite, threatening to develop an anaphylactic reaction;
      • overheating or stroke;
      • frostbite or exposure to cold;
      • acute ophthalmic conditions (e.g. glaucoma, eyeball prolapse);
      • prolonged labor or difficulties with childbirth;
      • prolapse of the rectum or uterus;
      • extreme apathy, lethargy, dementia.
  • Animals whose therapy requires periodic stay in a veterinary hospital, e.g. patients undergoing chemotherapy, radiotherapy, dialysis etc.

Logistic factors:

An extremely important issue in deciding whether or not to hospitalize a pet is whether it will be under close observation and whether it will receive appropriate treatment if it is delivered to the owner.

It happens that even dogs or cats that are not seriously ill, but require regular medication for a certain period of time, are left in the hospital.

What is a cause of it?

The guardian, for various reasons, is not able to regularly administer medications or monitor the recovery of the pet, so he decides to leave it in the hospital for a few days under the supervision of professional care.

This is a very good solution for people who cannot take care of their pet sufficiently.

Economic factors:

Often, when making a decision to hospitalize a patient, it is also necessary to take into account the economic factor, which may be a barrier element that prevents the use of this type of service.

  • If the owner cannot afford hospital treatment, consider the following options:
    • First of all - is there a chance to be treated at home without endangering the animal's life??
    • Second - is it possible to use financial support and help from family, relatives or various types of foundations?
    • Third, is the condition of the sick animal so severe that euthanasia should be considered??

After assessing the health of the animal, the veterinarian presents the caregiver with the treatment plan and estimated costs.

The decision to leave the pet in the hospital is made with the consent of the owner, and in the event of its absence - the above-mentioned options are discussed.

How to prepare a dog / cat for hospital stay?

How to prepare a dog / cat for hospital stay?

In the event of an elective hospitalization, your veterinarian will surely let you know in advance how to prepare your dog or cat.

It will not be very complicated, as it usually concerns such things as giving up food before the visit (eg. before blood sampling, imaging tests or surgery), refraining from walking or taking the cat's litter box 2 hours before the visit (before performing an ultrasound or urine collection).

Sometimes it is recommended that certain medications be given a few days before taking a specific diet or a special diet (especially if specific tests are to be performed).

In case of any doubts or questions, always consult a veterinarian in advance.

If your pet is admitted for surgery, it should be on an empty stomach (I wrote about preparing the patient for surgery here: // cowsiers.pl / treatment / # patient-dietary-preparation).

If, on the other hand, the pet is in a veterinary hospital due to illness, you can leave him some of his own food.

Thanks to this, the dog or cat will have a substitute for home, and it will also prevent gastric problems (sudden changes in food can cause stomach upset).

If we are already on the topic of leaving things in the hospital, ask the staff about the possibility of leaving your favorite toy, blanket or even a dog or cat's bed.

However, remember that they can become dirty, especially if your pet has diarrhea or is vomiting.

This means that they will end up in the hospital laundry, where they are sometimes difficult to find later.

What gives a hospital stay?

What gives hospitalization?

Everyone feels anxious when hospitalized.

This is perfectly understandable, but actually a bit irrational.

After all, a stay in a hospital is supposed to help you recover or even save your life.

The veterinary facility will never expose your ward to danger and will always make every effort to ensure that each patient has the greatest possible comfort.

While nothing can measure up to the comfort of your own home, here's what's on offer a veterinary hospital to help your dog or cat:

  • Preparation for the procedure. In a patient hospitalized due to a previously agreed procedure, all necessary examinations are performed, qualifying him for surgery. An intravenous entrance (the so-called. can also give fluids. Just before the procedure, the staff prepares the surgical field (i.e. shaves, washes and disinfects the area of ​​the patient's body, which is a surgical access).
  • Providing a quiet, clean, and peaceful environment when you wake up from surgery, and any supportive measures you will need to recover from surgery. Typically a short stay in hospital is recommended for these dogs and cats.
  • Caring for a patient whose condition is too serious to be at home.
  • Providing the following treatments:
    • Intravenous fluid therapy. Most sick pets do not eat or drink properly and may lose fluids from vomiting or diarrhea. Clinical examination can demonstrate that they are dehydrated. The intravenous administration of electrolyte fluids is the most effective way to solve this problem. This is necessary to aid recovery and improve patient comfort rapidly. Fluids are given into the vein through a cannula placed on the patient's paw, and sometimes - on the patient's neck. Most patients tolerate the catheter well, but the drip must be placed in a cage or immobilized for the duration of the drip so that they cannot withdraw the cannula. It also happens that a dog or cat is wearing an Elizabethan collar around its neck to prevent pulling out an intravenous line.
    • Drug application (intravenous, subcutaneous, intramuscular and oral). Some medications are best given directly into the bloodstream to increase their concentration in the blood and increase their speed of action. Venflon allows you to administer drugs frequently without having to enter a vein each time. Sometimes it is necessary to make intramuscular or intravenous injections or to administer tablets even every few hours. These types of treatments can be difficult or even impossible to perform at home, so hospitalization is necessary.
    • Nebulization, oxygen therapy. Patients with severe cough may require steam inhalation and / or nebulization therapy several times a day. The nebulizer produces a steam mist containing a strong antibiotic or bronchodilator drug that is delivered through the mask to deliver the medication deep into the bronchi or into the lungs. Animals with pneumonia or kennel cough can be cured in this way within 3-5 days, unlike an oral antibiotic, which is usually administered for 10-14 days. On the other hand, in the case of a patient with acute heart failure or respiratory failure, oxygen supply is necessary. This is done through tents or oxygen cages, less often through a mask. Only after the patient is stabilized, it will be possible to perform other diagnostic tests and introduce appropriate treatment.
    • Rehabilitation treatments (magnetotherapy, laser therapy, etc.). These techniques help relieve pain and speed up the healing of wounds and chronic inflammation.
    • Patient monitoring and ongoing diagnostic tests. Observation is usually necessary as patients undergo treatment. Blood morphological and biochemical parameters are monitored, in some patients it is necessary to X-ray or ultrasound control, monitoring of the heart rate.
    • Medical care. It is crucial in the whole assumption of hospitalization. It is necessary to monitor and adjust fluids, administer medications, change dressings, wash wounds. Bandages that come off or become dirty are replaced regularly. Sick animals may need to be fed with syringes or encouraged to eat. Catheter placement sites are also checked for displacement or infection. Physiotherapy may also be indicated to maintain range of motion, muscle tone, and blood flow. Dogs regularly go outside to urinate and defecate. Veterinary technicians keep the cage clean, sometimes they also need to wash or bathe the animal when it vomits or another problem occurs (e.g. diarrhea, urinating, etc.). Critically ill animals need qualified, competent, and attentive medical care. Animals that cannot walk should be turned from one side to the other approximately every 4 hours to prevent pressure ulcers, ulcers and other problems. If there is fluid accumulation in the limbs (edema), pressure compresses are used. All these activities and events are recorded and any problems reported to the doctor. Every animal with a critical illness should receive round-the-clock veterinary care.
  • Pain control. Symptoms of pain include a rapid heartbeat and pale mucous membranes that may resemble symptoms of shock. An animal with pain also has higher levels of stress hormones. However, patients may experience pain without any obvious symptoms. Medical treatment is always aimed at alleviating suffering. Even in situations where it is known that the animal is certainly experiencing a painful medical condition (e.g. inflammation of the pancreas) but it is not painful, you will be given painkillers. They make the patient more comfortable, but they can also reduce the signs of other conditions, possibly making diagnosis difficult.
  • Solitary. Some diseases are potentially contagious to other animals, so it may be advisable to keep the sick patient alone, away from other animals currently in the hospital room.

What can I expect when my pet is hospitalized?

What can I expect when my pet is hospitalized?

It all depends on the indications for hospitalization and its mode.

In scheduled receptions, everything usually takes place according to the appropriate schedule, so:

  • conducting a clinical examination of the patient,
  • performing the necessary research,
  • conversation with the guardian, etc.

In a situation where an animal in a critical condition comes to the doctor (e.g. after an accident) there is no time for some minor issues, and the most important thing is saving the patient.

In such situations, the patient most often stays in the intensive care unit or is referred to such a unit (after stabilizing the life functions at risk).

Upon arriving at veterinary hospital, the animal will be examined. During this time, you will also be asked to talk to the doctor, during which you will probably hear many questions about the current health condition of your pet and its habits.

The most important issues are:

  • Has the animal recently showed any disturbing symptoms that could indicate an illness?? If so, what kind? They have subsided or are still present?
  • Has the animal been diagnosed with any diseases before?? What? Was it treated and with what effect?
  • Has the patient been taking or is currently taking any medications? If so, what and in what doses?
  • Whether the animal has up-to-date vaccinations against infectious diseases?
  • If the patient is female, is the female / female in heat / heat?? When was the last heat / heat?
  • Is the patient fasting? When he had eaten his last meal?
  • Is the patient on a special diet? If so, what kind? How much and how often does he get meals?

Try to answer them as precisely as possible and truthfully of course.

Let the staff know about any special needs of your pet, as well as your concerns and concerns.

Be sure to clearly outline any feeding instructions for your dog or cat and any medications they take.

This is also the time when you can ask about the details of your pet's stay at the clinic. A technician or veterinarian will clarify any doubts, show the dog's whereabouts, and describe the routine management of hospitalized patients.

Then you will be asked to fill out a special form, which should include all the necessary contact details of the owner, a list of medications taken by the pet, food preferences of the dog or cat, diet composition and habits (e.g. the frequency of going for a walk, etc.).

If you think a detail is important, please mention it on the form as well. All this is to facilitate contact with you, but most of all it serves to create the most favorable conditions for your ward.

If a decision has been made to hospitalize your dog or cat, your veterinarian will provide you with a treatment plan which will include an estimate of the fees associated with the procedures, treatments, examinations and care for your dog or cat.

If the situation changes while you are there pet in the hospital and some additional tests, medications or treatments will be necessary, you will always be informed in advance.

All additional activities are carried out only with your consent.

After admission, the animal may be connected to a drip, receive medication or continue with diagnostics (e.g. taking blood for laboratory tests, etc.).

The patient is then placed in a safe cage.

It is good if hospital wards for dogs and cats are located separately, which significantly reduces the stress of the animal.

Cat cages contain litter boxes, beds or hiding houses and clean and warm bedding (blanket, pillow etc.).

Dog crates are adapted to the size of the dog, they are also equipped with warm blankets, and the pet regularly goes outside (unless, for various reasons, it cannot walk).

Each patient has an individual treatment and follow-up form for each day of stay.

Information on dosage and duration of medication, detailed comments on clinical trial results and other important information such as urination, faeces, temperature, appetite etc. are stored here.

At different times (depending on the facility - not all of them are open 24 hours a day), the night duty is taken over by a doctor and / or a veterinary technician. All recommendations for each patient are accurately communicated and each animal discussed.

In the evening, the staff administer medication (if necessary) and the animal is monitored during the night.

Dogs are taken outside regularly so that they can pass their faeces and urine naturally.

Cats are checked regularly and the cat litter in the litter box is changed. Technicians look after and care for patients and, if necessary, hand-feed or otherwise encourage them to eat.

In the morning, another shift is informed about events during the night.

Each animal is then examined by a doctor who updates the information, informs owners, recommends (possibly) diagnostic tests and medications.

Veterinary hospital - intensive care

How intensive therapy looks like?

All ICU patients have or are potentially at risk of at least one of their major systems (cardiovascular, nervous, or respiratory).

If these systems do not function properly, this condition can be fatal. Therefore, the goal of intensive care is to prevent, diagnose and treat failure of failure.

I will now explain when intensive patient care is required, what the emergency patient evaluation system looks like in the first minutes after arrival at the hospital, and how the patient is monitored for the so-called. ICU.

Most inpatient veterinary patients, of course, do not require intensive care. The indications for it are the following disease processes and clinical symptoms:

  • serious pathological condition caused by trauma,
  • epileptic seizures,
  • dyspnoea,
  • serious diseases and clinical conditions, e.g. diabetic ketoacidosis, severe pancreatitis,
  • postoperative condition (e.g. after thoracotomy),
  • pronounced anemia,
  • Heart arythmia.

Given the nature of these diseases, owners of hospitalized pets should be made aware of the seriousness of the situation.

The veterinarian discusses with them the severity of the disease, the likely financial costs and the patient's condition, which in such situations can be very dynamic - with the possibility of quick twists and a variable recovery time.

Most likely, the topic of possible resuscitation will also be discussed, and often also - euthanasia.

Patient Classification System (TRIAGE)

"Triage " is a term which comes from the French word meaning "sort ". This method is used to classify the patient in terms of the urgency of providing medical care and enables the rapid diagnosis and treatment of life-threatening conditions.

Stable patients may await treatment, while critically ill patients are admitted promptly.

First patient assessment

Identification of life-threatening disorders

First, the patient's condition is identified. This should take place within 1 minute of the animal's arrival at the clinic / clinic and receiving information from the owner about the so-called. "Emergency ".

This term is most often used by caregivers for whom the sudden, sudden appearance of atypical clinical symptoms arouses anxiety and prompts them to visit the office immediately.

According to the caregiver's assessment, the pet's condition requires immediate medical intervention.

However, in reality, the "emergency" does not always mean a critically ill patient.

Therefore, the doctor or veterinary staff should verify the information heard by the owner as soon as possible.

The most important question in such a situation is:

What is the threat to the life of the animal? Once answered, the animal is classified (or not) as a life-threatening patient.

In order to quickly assess whether we are actually dealing with an animal in a life-threatening condition, three main elements are identified:

  • Determining the main ailment of the patient, thanks to which it can be included in the appropriate category, e.g.
    • respiratory system,
    • circulation,
    • uric,
    • injury.
  • Complete and Accurate Assessment of Vital Signs:
    • number of breaths and their nature,
    • number of heartbeats and rhythm,
    • heart rate number, rhythm and character,
    • exact body temperature, color of mucous membranes and capillary filling time.
  • Viewing, auscultation and palpation of the patient.

During the initial, rapid assessment of the patient, special attention is paid to the so-called AABCD scheme:

  • A - aware, awareness - reaction to a call, touch;
  • A - airway, airways - visual inspection of the nostrils and mouth area, compressing the chest several times to force air flow;
  • B - breathing, breathing - observation within 10 seconds of breathing movements and their character;
  • C - circulation, circulation - heartbeat, pulse quality, color of mucous membranes, capillary filling time (CRT);
  • D - disability - injuries - the presence of injuries and damage that may endanger life (eg. damage to large vessels - hemorrhages - hypotension, trauma to the chest wall - pneumothorax - respiratory failure).

On the basis of the information obtained, it is possible to make presumptions about the patient's condition and to classify him as one of several groups.

For example:

  • An adult, working hunting dog brought into hospital after a serious injury with a heart rate of 100 beats per minute is likely to experience shock, which may be due to a major haemorrhage.
  • The heart rate in such a dog should be 40-50 per minute.
  • In addition, a quick examination of the patient is helpful in determining the threat to life (it allows you to narrow down the area of ​​search; for example, is the disorder related to the upper respiratory or lower respiratory tract, or maybe the circulatory system).
  • Palpating the patient makes it possible to find sensitive areas as well as an approximate estimate of skin temperature, which helps to distinguish between vasoconstriction shock (e.g. in case of post-traumatic, hypovolemic, cardiogenic shock) and vasodilatation shock (septic, neurogenic, anaphylactic shock).
  • Auscultation makes it possible to distinguish whether the threat to life is caused by disorders of the lower respiratory tract (e.g. bronchospasm, pneumothorax) or circulation (mitral valve insufficiency, aortic stenosis).

When identifying the patient's emergency condition, the veterinarian focuses primarily on abnormalities that may pose a direct threat to life.

A life-threatening or critical condition is defined as any conditions and diseases that lead to failure of the most important systems, which is manifested by impaired gas exchange, disturbance of the cardiovascular function and tissue flow, or changes in the composition of body fluids.

Serious disturbance of these systems rapidly (within minutes) can kill the patient unless emergency measures are taken. Life-threatening abnormalities should be stabilized immediately.

Confirmation or exclusion of a life-threatening condition is a priority - if found, immediate intervention is required (often with resuscitation) and the patient achieves the status of a critical patient.

Disorders requiring immediate intervention

  • On the part of the cardiovascular system:
    • cardiac arrest (no pulse and no audible heartbeats),
    • pale mucous membranes,
    • extended capillary filling time (CRT> 2 sec),
    • low, threadlike, or no pulse,
    • haemorrhage,
    • brick-red mucous membranes, capillary filling time
    • tachycardia (dog> 180, cat> 250 beats / minute),
    • bradycardia (dog < 60, kot < 150),
    • heart rate missing, arrhythmia,
    • collapse.
  • On the part of the respiratory system:
    • fast and shallow breathing action,
    • obstruction of the upper respiratory tract,
    • difficulty breathing, gasping, mouth breathing,
    • cyanosis,
    • crackles or wheezes over the lung fields when auscultated,
    • chest injury - rib fracture, wounds penetrating the chest wall, flail chest.
  • On the part of the nervous system:
    • seizure attack or previous attacks,
    • stupor,
    • coma,
    • Head damage,
    • ingestion of poisonous substances,
    • acute paralysis, paresis.
  • On the part of the urinary system:
    • inability to urinate,
    • consumption of ethylene glycol,
    • large, painful bladder, found on palpation,
    • no palpable bladder in the patient after the accident.
  • Other disorders:
    • hyperthermia (temp. > 40.5 ° C, heat shock),
    • difficult childbirth, dystocia,
    • snake bite,
    • poisoning,
    • intense vomiting or diarrhea,
    • Burns,
    • fractures,
    • traffic injuries (being hit by a car),
    • fall from a great height,
    • dehiscence of the edges of the surgical wound after surgery,
    • frostbite,
    • inundation,
    • smoke poisoning,
    • electric shock,
    • prolapse of an internal organ,
    • gastric expansion,
    • ophthalmic emergencies (glaucoma, exophthalmos, eyeball prolapse),
    • recent ingestion of toxins.

During the initial qualification examination of the patient, the veterinarian or technician conducts a short interview with the animal's guardians, which is usually limited to the following issues:

  1. What is the main problem of the patient?
  2. When was the last time the animal behaved properly? How long the current symptoms last?
  3. Noticed symptoms and abnormalities (e.g. cough, wheezing, polyuria, faecal consistency).
  4. Whether similar symptoms were also noticed in other animals?
  5. Whether your pet is currently taking any medications or has any previous medical conditions?

After the exclusion of a critical condition or during resuscitation, the patient is checked again and basic laboratory tests are performed.

Second Patient Assessment

After stabilization of life-threatening disorders, a second, more detailed clinical examination is carried out together with laboratory tests.

  • Laboratory tests are performed urgently - while inserting an intravenous line (cannula), blood is taken for analysis in order to determine the following parameters:
    • Hematocrit value, total protein. In patients with pallor, these tests help distinguish anemia from insufficient perfusion and help assess the likelihood of haemorrhage or haemolysis. Baseline values ​​of these indicators are determined, which are necessary for further monitoring of the patient's condition. Initially, these tests are repeated every 20-30 minutes in shock or trauma patients receiving fluid therapy.
    • Lactate concentration. Index of the severity of anaerobic changes (assessment of perfusion and gas exchange disorders).
    • Urea nitrogen, glucose. They are helpful in identifying the causes of non-specific symptoms (e.g. anorexia, vomiting). They may indicate kidney failure, diabetes, and not a primary gastrointestinal disease. Hypoglycemia is sometimes a life-threatening disorder leading to coma and sometimes indicative of developing sepsis.

The purpose of the second assessment of the patient, which is performed over the next 3 minutes, is to confirm or rule out an emergency.

Urgency is a slightly different status (than critical) in which severe disruption of bodily functions is present, but does not yet exceed the organism's compensatory capacity.

This means that by activating and / or enhancing corrective and compensatory measures, the patient is able to "temporarily " maintain a certain relative state of homeostasis.

Such a state requires intensive therapy supporting disturbed body functions, because otherwise, side effects and disorders will intensify in a short time, which at some point exceeds the body's regulatory capacity, leading to organ failure, permanent organ damage, and even death.

In this case, it is necessary to eliminate the cause of the disorders, corrective and supportive measures, and stabilize the patient.

During this time, an assessment is also made of whether intensive therapy is necessary, or whether the patient is an internal medicine or a surgical case.

Intensive therapy supports the functions of the body's regulatory mechanisms, and sometimes it is necessary replacement therapy until activity returns (e.g. hemodialysis, controlled breathing, etc.).

Internal medicine case - disturbance of the body's functions without symptoms of failure of the homeostatic systems.

Surgical case - damage to the body's structures or dysfunction without symptoms of failure of homeostasis systems, requiring surgical intervention.

Third patient assessment

Extended assessment of activities along with the assessment of the integrity of the structures.

During this evaluation, which is carried out over the next 60 minutes, the patient is re-examined and further laboratory tests are ordered (if necessary).

  • Electrolytes (sodium, potassium, chlorine and calcium) detect life-threatening electrolyte disturbances (e.g. hyperkalemia, hypocalcemia, hypercalcemia and the sodium / potassium ratio in adrenal insufficiency). This marking allows you to determine the appropriate fluid therapy.
  • Blood gas analysis - enables the diagnosis of acid-base imbalances and their correction.
  • Blood smear - assessed for the presence of leukocytosis, leukopenia, estimated platelet count, presence of blood parasites, and abnormalities in red blood cell count.
  • Coagulation test for primary bleeding disorders such as disseminated intravascular coagulation syndrome (DIC) or poisoning with anticoagulant rodenticides.
  • Electrocardiogram - detects heart rhythm disturbances that can lead to a life-threatening condition.
  • Urine general examination. Strips and sediment tests allow the detection of rollers, signs of urinary tract infection, crystalluria, hematuria, glycosuria, ketonuria and proteinuria. The specific gravity assessment assesses a patient's ability to concentrate urine.
  • FAST ultrasound.
  • A neurological examination.
    • The patient is assessed for serious neurological disorders in the brain:
      • checking for signs of a head injury:
        • bleeding from the nasal cavity, blood or cerebrospinal fluid in the external ear canal,
        • head tilt, nystagmus, strabismus,
        • dementia, progressive decline in consciousness,
        • unevenly dilated pupils,
        • no or slower pupil response to light (pupillary reflex),
        • weakened or absent threat, eyelid, corneal or nasal reflexes;
      • assessment of the degree of consciousness:
        • A (alert) - the patient is conscious,
        • V (voice, visual) - reacts to sound or visual stimuli,
        • P (pain) - reacts only to pain stimuli,
        • U (unresponsive) - coma, does not respond to stimuli.
    • Patient evaluation for the presence of serious neurological disorders affecting the spinal cord and peripheral nerves.
  • Assessment of the abdominal cavity and urinary system:
    • Progressive enlargement of the outline of the abdominal integuments may indicate gastric dilatation syndrome or peritoneal haemorrhage.
    • Bladder rupture is suspected in patients with abdominal pain, abdominal contusion and vomiting 24-48 hours after the injury.
    • The rupture of the urethral wall usually leads to severe swelling and bruising of the pelvic limbs and pelvis.
    • Injury to the kidneys and ureters causes pain in the lumbar region, increased specific gravity of the fluid in the retroperitoneal space and azotaemia.
    • Palpate the bladder and monitor urine production:
      • Oliguria (
      • It is important to determine the root cause of oliguria by doing radiographs, contrast scans, ultrasound, as well as blood and urine tests, and measuring blood pressure.

Monitoring hospitalized critically ill patients

Monitoring of critically ill patients

ICU monitoring focuses on the main body systems:

  • cardiovascular,
  • neurological,
  • respiratory.

This allows the clinician to determine whether the patient's condition is stable, deteriorating, or improving.

Proper monitoring is adjusted individually to each case (in terms of what is monitored and how often) and focuses on the specific problems of individual patients and possible complications.

For example, a cat with pulmonary edema secondary to congestive heart failure that has just received furosemide may have its respiratory rate assessed every 20 minutes to evaluate the effectiveness of treatment.

A dog with ITP but no respiratory disturbance may require a respiratory rate check every 12 hours to confirm that there is no change in clinical status.

Therefore, in order to monitor each patient, it is necessary to check at least 2 times a day.

The following factors are always taken into account in the proper care of critically ill patients:

  • list of any patient problems,
  • any previous or current major system failure,
  • potential worsening or improvement of the patient's disease process,
  • potential disease complications that may develop,
  • possible side effects of therapy,
  • how to recognize improvement, worsening, complications and side effects.

This creates a suitable daily tracking sheet.

Patient inspection staff notify the physician if there are any alarming results, that is, signs of worsening of the underlying disease, complications, or side effects.

Veterinary hospitals providing intensive care services are constantly staffed to meet the high demands of patient monitoring and care. Thanks to this, all patients are under constant supervision.

Round-the-clock care ensures a quick response in the event of any change in the patient's condition (e.g. development of shortness of breath, the appearance of convulsions).

In such cases, abnormalities noticed are quickly noted, examined and treated, and a new monitoring plan is established for the animal.

Pain assessment

Pain assessment

While monitoring and trying to maintain the stability of major body systems is a key part of caring for critically ill patients, reducing pain is one of the veterinarian's most important responsibilities.

"Measuring " pain in a dog and a cat is very difficult in practice because it is a very individual experience.

Pain may be associated with symptoms such as increased heart rate, respiratory rate and blood pressure, but such changes can also be caused by a number of other factors, especially in ICU patients with serious underlying disease processes.

Pain can be subjectively assessed by observing body position, facial expressions and behavior, and prior knowledge of the patient can help diagnose pain.

It is clear that there is considerable variability between pain assessors.

Various schemes exist to objectify the assessment of pain.

One of them may be the pain assessment system based on observation of the patient in the hospital.

The system is divided into several sections and the results obtained from each section are added together.

A combined score of 6 or more suggests that additional analgesia is needed.

Assessment of acute pain in dogs

  • Section A - Watching the dog in the cage.
    • If the animal is:
      • silent - 0 points;
      • whines or squeaks - 1;
      • Moans - 2;
      • Shouts - 3.
    • Behavior of your dog in relation to a wound or painful area:
      • ignores them - 0 points;
      • looks at the wound or painful area - 1;
      • licks sore spots - 2;
      • rubs the wound or painful area - 3;
      • chews or bites a wound or painful area - 4.
  • Section B - watch the dog while it moves. The dog is taken for a short walk and watched as it stands up and moves. If the dog:
    • gets up and goes normally - 0 points;
    • limp - 1;
    • gets up and / or walks slowly or reluctantly - 2;
    • Walks stiffly - 3;
    • Refuses to move - 4;
    • This section is not performed for spine, pelvic or limb fractures or when assistance is required for mobility.
      In this situation, a total score of 5 or more suggests that additional analgesia is required.
  • Section C - reaction to palpation. If the dog has a wound or a sore spot, gentle pressure is applied within about 5 cm around the area. If the patient:
    • does nothing - 0 points;
    • looks around - 1;
    • shudders or recoils - 2;
    • growls or defends the area - 3;
    • snaps - 4;
    • cries, whines - 5.
  • Section D - assessment of the patient's well-being.
    • In general, if the dog is:
      • happy and comfortable - 0 points;
      • silent - 1;
      • indifferent or unresponsive to the environment - 2;
      • nervous, anxious, anxious or hunched over, tense - 3;
      • depressed, unresponsive or stiff - 4.

Assessment of acute pain in cats

The scores obtained from the scores for each section are added together to calculate the cat's pain score.

A combined score of 4 or more suggests that additional analgesia is required.

  • Section A - Cage Cat Observation.
    • If the cat:
      •  is quiet / purrs / meows or looks relaxed - 0 points;
      • cries / growls / groans or licks lips - 1;
      • restless, cowering in the back of the cage - 2;
      • tense, squatted - 3;
      • stiff, hunched - 4.
    • The cat's behavior in relation to a wound or painful area:
      • ignoring wounds or painful areas - 0 points;
      • paying attention to the wound - 1 point.
  • Section B - response to stimulation. Calling the cat by name, stroking it from head to tail:
    • the cat reacts to being stroked - 0 points;
    • unresponsive - 1;
    • he is aggressive - 2.
  • Section C - reaction to palpation. In the case of a wound or painful area, a gentle pressure is applied about 5 cm around the area. If the patient:
    • does nothing - 0 points;
    • wags his tail / puts his ears back - 1;
    • cries / hisses - 2;
    • growls - 3;
    • bites or hits with claws - 4.
  • Section D - assessment of the patient's well-being. Overall impression if the cat is:
    • satisfied and feeling comfortable - 0 points;
    • not interested in the surroundings / quiet - 1;
    • anxious / scared - 2;
    • apathetic / dull - 3;
    • depressed / grumpy - 4.

In assessing the presence and severity of pain an animal is experiencing, response to analgesic treatment is the gold standard.

Thus, if there are doubts as to whether the patient is in pain and requires anesthesia, or whether sufficient analgesia is provided, additional analgesia may be introduced (by increasing doses or administering a different or additional drug) and the patient is reassessed for symptoms. pain relief.

Basic physical examination

Basic physical examination

Patients in the intensive care unit undergo a thorough physical examination at least once a day.

This is to assess the progression of the primary disease process and to identify complications.

Common complications include:

  • corneal ulcer,
  • the formation of puffiness,
  • burns from urine and faeces,
  • wound infection and inflammation,
  • thrombophlebitis,
  • nosocomial infections, including aspiration pneumonia and urinary tract infections.

Each disease process has some specific complications, such as e.g. ventricular arrhythmias in dogs after gastric dilatation and torsion or thromboembolism in patients with immune haemolytic anemia.

Patient temperature, pulse rate, and respiratory rate assessments are usually performed more than once a day.

Frequent measurement of these basic parameters is essential in unstable patients.

More detailed monitoring (e.g. cardiovascular system) is highly desirable, but may not be possible due to the risk of worsening of the condition when the patient is manipulated.

If the animal is more stable, regular auscultation of the lungs is useful, together with the measurement of respiratory rate, especially if there is a risk of:

  • pneumothorax,
  • pleural fluid,
  • pulmonary edema,
  • pneumonia.

Body temperature

Measurement of body temperature makes it possible to recognize the development of a fever or to monitor the fever that is already present.

In general, it is not necessary to take measurements more than twice a day as most patients do not like the use of rectal thermometers.

More frequent monitoring may be required in patients with hypothermia (e.g. recovering from general anesthesia, in pediatric patients or small-breed dogs) or in patients who are hyperthermic or at risk of hyperthermia (e.g. dogs with obstruction of the upper respiratory tract, e.g. brachycephalic breeds, patients with laryngeal paralysis).

Heart rate and heart rate

Assessment of the heart rate and pulse rate as well as pulse quality are a very useful indicator of a patient's cardiovascular fitness.

Frequent (at least hourly) monitoring of these parameters is performed in every patient with cardiovascular insufficiency, especially if specific treatment is being administered such as intravenous fluids in hypovolemic animals.

Tachycardia is common in dogs and cats in shock, but cats may also develop relative bradycardia (heart rate 140-160 bpm) with a low heart rate.

The joint assessment of the frequency and quality of the pulse enables different causes of tachycardia, such as pain and excitement (in which case the pulse quality should be good), to be distinguished from shock and anemia (the heart rate is hyperdynamic or weak).

If a heartbeat irregularity (other than a dog's sinus arrhythmia) or a heart rate deficit (audible heartbeat with no palpable pulse wave) is noticed, an electrocardiogram (EKG) assessment is performed.

Respiratory rate

Respiratory rate monitoring is an essential part of managing any patient with an impaired respiratory system.

During the observation of the patient, the respiratory effort, sounds of the upper respiratory tract, taking a relief position to facilitate breathing, paradoxical abdominal movement and the presence of cyanosis are assessed.

These assessments can be made remotely, so there is no need to manipulate patients, which is beneficial as dyspnoea patients (especially cats) can deteriorate rapidly due to increased stress-related oxygen demand.

It also allows you to monitor the patient in an oxygen cage that maintains a high concentration of oxygen in the air.

Neurological assessment

Patients with neurological disorders including seizures, traumatic brain injury and inflammatory disease of the central nervous system require close monitoring as they can worsen rapidly.

Monitoring may only be observation at a distance, but in demented or coma patients it is important to regularly assess pupil response, pupil size and cranial nerve reflexes.

Irrigation

Hydration status is generally monitored once or twice a day as it does not change as quickly.

Assessments based on the results of a physical examination, such as skin tightness and viscosity of the mucous membranes, are quite subjective.

However, body weight is also used to assess dehydration, if it is known how much the patient weighed when he was healthy.

In all cases, scales can be used to monitor the patient's rehydration effectiveness as weight gain can be expected.

In patients at risk of volume overload (e.g. patients with acute kidney injury and oliguria or anuria) regular weight checks 2-3 times a day, can make it possible to recognize fluid retention and overload when body weight increases.

This is especially useful when you cannot place a catheter in your bladder and you cannot accurately quantify your urine output.

Hematocrit and total protein

Monitoring a patient's hematocrit can be very useful, especially in patients who are anemic or at risk of blood loss, e.g. in surgical or coagulopathic patients.

In combination with a total protein test, the hematocrit value is used to assess hydration status; however, given the prevalence of hypoproteinaemia and anemia in ICU patients, interpretation may be difficult.

Unless rapid blood loss is suspected, monitoring of hematocrit and total protein once daily is generally adequate.

This allows clinicians to judge whether hydration is adequate and whether the patient requires a blood product.

Blood glucose

Both hyper- and hypoglycaemia are common in ICU patients.

The former can occur as a result of stress, severe trauma, and parenteral nutrition.

Hypoglycaemia can occur in patients with sepsis, miniature breeds and very young animals, in patients on insulin, and in those with certain cancers, endocrinopathies, liver failure or ingestion of toxins.

Patients with hypoglycaemia must be monitored frequently to see if the condition has resolved after initiation of treatment, and if the underlying cause is not promptly resolved, further frequent monitoring is required to see if the condition has recovered.

Anyone at risk of hypoglycaemia should have their blood glucose levels checked, especially if they are dull or develop more advanced neurological symptoms.

Electrolytes

Electrolyte abnormalities are common in ICU patients.

Once an actual or potential electrolyte disturbance has been identified, monitoring can be quite costly, so your veterinarian will carefully consider how often such monitoring is required.

Taking into account the possible cause of the abnormality, the severity of clinical symptoms, aggressive corrective therapy, and concerns about overdose (e.g. conversion of a hypokalemic patient to a hyperkalemic patient) or too rapid correction (e.g. hyponatraemia), an appropriate monitoring frequency can be determined.

For relatively stable cases with intravenous fluid therapy, monitoring only once a day is sufficient, but for patients with dynamic disorders, monitoring may even be needed every hour for a short time.

EKG

ECG monitoring should be considered in patients with significant cardiac dysfunction (dogs: above 180 bpm or below 50 bpm, cats: above 240 bpm or below 140 bpm) or rhythm to further characterize the disorder.

Continuous monitoring with a multi-parameter monitor is a useful tool in patients with current or recent cardiovascular instability to ensure a response to treatment and detect any deterioration promptly.

Determining the patient's heart rate is an important part of advanced life support during cardiopulmonary resuscitation (CPR) to determine whether drug therapy or defibrillation is indicated.

Bradyarrhythmia is defined as a heart rate below 60 bpm in dogs and 100 bpm in cats with associated clinical signs.

Sinus bradycardia is common in critically ill patients secondary to underlying disease, but ECG evaluation is required to distinguish it from more serious conduction abnormalities such as AV block or sick sinus syndrome.

Bradycardia can also result from severe electrolyte disturbances (such as hyperkalemia) or neurological disorders. Therefore, a careful analysis of the electrocardiogram may be justified.

Tachycardia is also very common in ICU patients.

Most often it is sinus in origin and is often associated with shock.

There may also be tachyarrhythmias (both regular and irregular) of cardiac origin requiring ECG interpretation to differentiate between supraventricular and ventricular rhythms and to choose the most appropriate treatment.

Blood pressure measurement

Blood pressure can be measured indirectly using Doppler or oscillometric techniques or directly by placing an arterial catheter.

Most patients in the ICU have blood pressure measured at least once a day and the result is assessed in conjunction with other perfusion parameters and the patient's overall condition.

In patients with severe haemodynamic impairment, continuous direct blood pressure measurement is indicated from time to time to assess the response to treatment and monitor for worsening.

Blood pressure is maintained by the interplay of heart rate, stroke volume, and vascular resistance.

Hypotension is common in critically ill patients and may occur when any of these components are abnormal, leading to impaired tissue perfusion.

Doppler pressures less than 90 mmHg or mean oscillometric arterial pressures less than 60 mmHg are considered diagnostic hypotension.

Treatment is aimed at removing the underlying cause through fluid therapy, pulse control, administration of vasopressors or inotropics.

Hypertension is less common in critically ill patients, but is no less important.

Blood pressure above 180 mmHg puts the patient at high risk of damage to target organs such as the central nervous system, eyes, heart and kidneys, and should be treated if believed to be genuine and permanent.

True high blood pressure is often associated with kidney or adrenal disease, but this should be distinguished from more transient blood pressure that may be caused by pain or a response to stress or excitement.

Pulse oximetry

Pulse oximetry is a non-invasive way to measure a patient's oxygenation and can be used to monitor respiratory failure.

The pulse oximeter measures the oxygen saturation of arterial blood as a percentage, using the difference in the absorption of red and infrared light by oxygenated and deoxygenated blood.

An oximeter reading greater than 95% for the animal breathing room air is considered normal.

Values ​​less than 95% (corresponding to the partial pressure of oxygen [PaO2 below 80 mmHg) are associated with hypoxemia, and those less than 90% (corresponding to a PaO2 below 60 mmHg) are very worrying and correspond to severe hypoxemia.

Pulse oximetry can be used to evaluate patients with respiratory distress to determine the presence and severity of any deterioration in oxygenation, although it is relatively insensitive.

When used continuously in ICU patients, it can also be used as a perfusion marker.

Typical locations for the placement of the pulse oximetry probe include the tongue (in anesthetized patients) or any hairless area of ​​minimally pigmented skin (e.g. auricle, lip, foreskin, vulva or interdigital space).

The machine can display the result as a single number or it can display the waveform or a pile of bars as a pulse quality marker.

The measured heart rate should be in line with the patient's heart rate to ensure an accurate result.

False or inaccurate readings are common with patient movement (including tremors), poor perfusion, anemia, skin pigmentation, electrical interference, or hemoglobinopathy such as carbon dioxide toxicity.

Gasometry

Abnormalities in the acid-base balance are often observed in patients requiring intensive care.

Blood gas analysis can provide useful information about the disease process, its severity and response to treatment.

Results are obtained quickly and can detect life-threatening abnormalities within minutes.

This analysis can be performed on venous or arterial blood; venous samples only provide information on acid-base disorders and ventilation, while arterial blood provides additional information on oxygenation.

Any peripheral artery can be used to collect blood for testing, although the dorsal artery of the foot is the most commonly used for this purpose.

PaO2 should be approximately five times higher than the oxygen concentration in the inhaled air: for example, a patient breathing room air (containing 21% oxygen) should have PaO2 = 5 × 21 = 105 mmHg.

Blood pH is usually tightly regulated to avoid tissue damage and organ dysfunction.

Any abnormality in blood pH warrants further evaluation.

Common acid-base disorders:

  • Respiratory acidosis in which blood pH is lowered due to increased PCO2 in the blood. It usually occurs due to hypoventilation (e.g. with obstruction of the upper respiratory tract, anesthetic drugs or neuromuscular diseases).
  • Respiratory alkalosis - increase in blood pH as a result of lowering PCO2 in the blood. Usually accompanied by hyperventilation (fear, pain, hypoxemia, anemia).
  • Metabolic acidosis - lowering HCO3- or excess of bases, e.g.:
    • lactic acidosis,
    • ketoacidosis,
    • uremic acidosis,
    • toxins such as:
      • ethylene glycol,
      • metaldehyde,
      • salicylates, etc.
  • Metabolic Alkalosis - Increase in HCO3- or excess of bases. Observed during prolonged and / or intense vomiting or during treatment with diuretics.

In most cases, treatment of the underlying cause is indicated to correct any acid-base disturbance.

Capnography

End tidal carbon dioxide (Et-CO2) can be measured non-invasively in a patient with an endotracheal tube using a capnograph.

The normal level of Et-CO2 in dogs and cats is approximately 35-45 mmHg.

The normal gradient between Et-CO2 and the arterial partial pressure of carbon dioxide (PaCO2) is usually less than 5 mmHg in small animals; therefore, capnography can be used to assess the patient's ventilation function.

Capnography has many additional uses for a patient in the ICU, including the ability to confirm correct placement of an endotracheal tube or nasogastric feeding tube and to monitor the effectiveness of heart compressions during CPR (where the goal is to achieve a minimum of 15 mmHg to maximize the chance of spontaneous circulation return).

A sharp drop in measured Et-CO2 values ​​to (close to) zero suggests equipment displacement or cardiac arrest and should prompt immediate patient evaluation.

The most common causes of increased Et-CO2 in ICU patients:

  • hypoventilation due to painkillers or anesthetics,
  • obstruction of the upper respiratory tract,
  • neurological disorders,
  • atelectasis after prolonged lying position.

Et-CO2 may also increase secondary to an increase in carbon dioxide production as a result of:

  • pain,
  • anxiety,
  • chills,
  • seizures,
  • hyperthermia.

Quick ultrasound

Unlike the more formal, extensive patient ultrasound that assesses all internal organs, rapid focused ultrasound is usually performed in ICU patients.

These tests do not require specialized training, can be done quickly, and can provide valuable information about the nature of the patient's underlying disease.

This test is called the FAST scan (. focused assessment with sonography for trauma, triage or tracking (targeted assessment with sonography for trauma, segregation or tracking) and can be used for both abdominal (AFAST) and thoracic (TFAST) assessments.

The primary purpose of the AFAST scan is to detect free peritoneal fluid that can occur secondarily to many disease processes seen in ICU patients.

This is achieved by placing the ultrasound probe over four sites (right and left side surfaces, midline above the bladder and below the xiphoid process of the sternum).

Serial AFAST scans can detect fluid build-up over time and can be used to check the progress of the disorder.

TFAST can be used to detect pericardial, pleural and pneumothorax fluid.

The ultrasound probe is placed at five standard locations above the chest to detect the presence of free air or fluid.

TFAST is especially useful in patients with respiratory failure that are too unstable to allow more definitive diagnosis, e.g. x-ray.

The short term nature of the TFAST study can provide valuable information in unstable patients.

FAST can also be used to assess the ratio of the left atrium to aorta (it is a marker of left atrial enlargement).

A subjective assessment of ventricular filling and cardiac contractility can also be made, and this may be useful in the treatment of patients with cardiovascular instability.

Fluid analysis

Some patients in the intensive care unit may have drains attached.

Proper management of these tubes is imperative to prevent additional patient morbidity.

Thoracostomy tubes are placed to assist in the treatment of pleural diseases, including persistent pneumothorax, chylothorax, tumor exudate, and pyothorax.

Abdominal drains are often placed after abdominal surgery to help resolve the underlying disease process and facilitate fluid therapy decisions.

The total volume of air or fluid produced can be estimated and the cytological nature of any fluid can be estimated and is expected to improve with disease resolution.

For example, in the case of postoperative septic peritonitis:

  • The volume of drained fluid should decrease significantly over time.
  • The number of cells should decline and consist mainly of non-degenerate neutrophils.
  • There should be no bacteria (although bacterial contamination of the drain may occur, meaning bacteria are present in the fluid but not necessarily septic peritonitis).

The drain is kept as long as it is productive (meaning that more than 5-10 ml / kg m.c. every 24 hours) and is then removed to reduce the risk of nosocomial infection.

Urine output

Urine output is a useful parameter for monitoring renal function in ICU patients.

Normal urine output in a properly hydrated patient with normal blood flow is usually 1-2 ml / kg / hour.

Urine output may be below this value in hypoperfusion (reduced flow) as a normal physiological response to preserve body fluids, or pathologically in cases of acute kidney injury.

Patients requiring intensive care are often at high risk of developing acute kidney injury, which may be multifactorial in origin.

Possible reasons include:

  • previous episodes of hypotension secondary to shock or hypotension,
  • administration of nephrotoxic drugs as part of patient therapy,
  • systemic inflammation,
  • other systemic underlying diseases.

Early diagnosis of altered urine output can speed up the accurate assessment of a patient for ongoing hypoperfusion or kidney damage, allowing for aggressive management of.

Urine output can sometimes be increased above normal levels. The reasons for this include:

  • iatrogenic volume overload (fluid overload),
  • cats with post-structural diuresis after resolving urinary obstruction,
  • patients with polyuric acute kidney injury or spinal rinsing after prolonged fluid therapy.

The diagnosis of pathological polyuria is important to guide fluid therapy and prevent unintentional dehydration.

Urine output can be measured by placing a urinary catheter on a permanent basis and a closed collection system.

Other techniques include the direct measurement of naturally excreted urine or weighing of a hygienic liner in hospitalized patients.

The patient's body weight can also be used as a marker of altered urine output.

Urine sampling and analysis are also indicated in patients who are suspected of having a urinary tract infection or develop a fever during hospitalization.

In the past few decades, great strides have been made in veterinary medicine to effectively treat critically ill patients.

Intensive care dogs and cats have serious disease processes, but with proper monitoring, effective treatment, and the financial and emotional commitment of their handlers, many of these animals can do very well.

Feeding dogs and cats in the hospital

Nutrition of patients in the hospital

Adequate nutrition of sick animals has a positive effect on strengthening the body's defenses, repairing wounds, responding to treatment, recovery time and overall survival.

However, the nutritional needs of sick animals or critically ill patients are often ignored due to the intense emphasis on "more serious", often life-threatening medical and surgical problems.

After an injury, under stress, or in the course of certain diseases, there is a change in metabolism, which is mainly characterized by an increased caloric demand.

Patients suffering from severe burns and severe head injuries experience the greatest increase in caloric requirements.

In such situations, there is a marked increase in the level of catecholamines, glucocorticoids and glucagon and an increase in peripheral insulin resistance, which results in an increase in the metabolic rate and leads to a rapid mobilization of energy from tissues.

If the damage or disease persists and is accompanied by malnutrition, immunosuppression, increased bacterial growth (with an increased risk of sepsis), delayed wound healing can occur, all of which lead to longer hospitalization and delayed recovery.

The goal of nutritional support is to provide energy and nutrients in proportions that can be used by the patient with maximum efficiency.

Nutritional support provides substrates for gluconeogenesis and protein synthesis, and provides the energy needed to meet the additional requirements of host defense, wound repair, and cell division and growth.

Indications for nutritional support

  • In general, nutritional support is recommended for animals that have not eaten for more than 5 days or have lost more than 10% of their body weight.
  • Patients with hypoalbuminaemia or suffering from medical conditions that require an increased demand for nutrients, such as extensive trauma or burns.
  • Patients with conditions causing increased loss of nutrients (excessive loss of protein in the digestive tract or kidneys).

Enteral nutrition

Oral or enteral administration is the preferred route of nutrient administration.

Enteral nutrition is the safest, simplest, cheapest and most physiological route and should be used whenever possible.

In animals that are partially or fully anorexic, enteral nutrition can be achieved by one of several techniques: stimulation of the appetite, force-feeding, and tube feeding.

  • Appetite stimulants. They are mainly used in cats with partial anorexia. Commonly used drugs are diazepam, cyproheptadine and mirtazapine. Diazepam should be avoided in cats with liver disease as it may induce liver necrosis.
  • Forced feeding. This technique has limited benefit and is stressful for the cats and dogs in which it is performed. In addition, force-feeding can create a conditioned aversion to food and should therefore be abandoned in favor of tube-feeding techniques if voluntary food intake does not meet the patient's caloric requirements.
  • Enteral nutrition apparatus.

Naso-esophageal tube

Simple and effective choice of short-term (less than 10 days) nutritional support for most anorexic, hospitalized patients with normal nasal cavity, throat, esophagus and abdomen.

Naso-oesophageal tube feeding is contraindicated in vomiting, coma or non-gag feeding animals.

The most common complications associated with the use of a naso-oesophageal tube include:

  • epistaxis,
  • inflammation of the lacrimal sac,
  • rhinitis,
  • tracheal intubation (incorrect tube placement in the trachea instead of in the esophagus),
  • secondary pneumonia or vomiting.

Pneumothorax and esophagitis are less common.

The main disadvantage of naso-esophageal tubes is their small diameter, which requires the use of liquid enteral preparations (canned food diluted with water often clogs the tubes).

Most human and veterinary liquid enteral formulations have a caloric density of between 1.0-1.5 kcal / ml.

Pharyngostomy

The probe is inserted into the throat through an opening in the neck (during a short surgical procedure).

Requires general anesthesia and meticulous care during placement to avoid obstruction of epiglotting movement and partial laryngeal obstruction.

Esophagostomy

A technique of surgical insertion of an esophagostomy tube into the esophagus of dogs or cats.

The technique has been refined to avoid complications due to content aspiration or laryngeal obstruction that can occur with pharyngostomy and nasophageal tube placement.

The tubes are relatively easy to insert and insertion requires only light general anesthesia or strong sedation.

The only serious complication with an esophageal tube is infection of the wound at the site of the stoma where the tube exits the skin.

Meticulous daily care for the stoma site can be effective in preventing infection.

Gastrostomy

Requires general anesthesia.

This procedure allows for the placement of relatively large diameter catheters into the patient's stomach.

Surgical (open) jejunostomy

The probe is inserted into the proximal part of the jejunum.

The type of diet used to feed the patient depends on the route of feeding chosen, the functional state of the gastrointestinal tract and the nutritional requirements of the patient.

Other factors such as cost, availability, and ease of use can also be important.

In patients fed via naso-oesophageal or herunostomy tubes, feeding options are limited to administration of liquid enteral preparations.

Most commercially available liquid diets have a caloric density of around 1 kcal / ml.

The most important factor in an intestinal nutritional product is its protein content, type (intact protein, peptides, and amino acids), and quality.

Protein quality depends on the protein digestibility, absorption and its amino acid composition. The whole egg has the highest biological value, followed by cow's milk, lactalbumin, beef, soy and casein.

Most human liquid recipes contain less than 20% calories of protein origin, precluding their use for long-term (more than 3 weeks) feeding of cats.

Blends with a lower protein content should be supplemented with special protein formulas.

Almost all human enteral formulations do not contain taurine, an essential amino acid in cats, which requires supplementation.

Commercial blended dog and cat food is used for gastric feeding via pharyngostomy, esophagostomy or gastrostomy.

In selected cases, the use of a liquid enteral preparation may be indicated.

There are many complete and balanced veterinary enteral formulations available that contain adequate amounts of protein, taurine and micronutrients, eliminating the need for supplementation in most cases.

Feeding is started 24 hours after insertion of the gastrostomy tube to allow gastric motility to return and to form a fibrin seal.

Jejnunostomy feeding can begin approximately 6 hours after insertion, if peristalsis is present.

Food administration can be carried out by cyclical bolus administration (appropriately calculated volume of food administered at a given time) or by continuous infusion (e.g. via an infusion pump).

To avoid abdominal cramps and diarrhea associated with bolus feeding, continuous feeding at an initial infusion rate of 1 ml / kg / hour is used in jejunostomy, which is gradually increased over 48 hours until the total daily volume can be administered over a period of 12-18 hours.

During gastrostomy tube feeding, the diet can be given as a bolus or continuous infusion.

If continuous feeding is used, it is interrupted every 8 hours and the so-called residual volume is determined (by applying a suction to the feeding tube).

If the residual volume is more than twice the volume administered in 1 hour, feeding is stopped for 2 hours and the infusion rate is then reduced by 25% to prevent vomiting.

Metoclopramide is used at a dose of 1-2 mg / kg / 24 hours as a continuous infusion to increase gastric emptying and prevent vomiting.

When administered as a bolus, the required daily amount of food is divided into 4-6 meals.

Patients are typically fed around 25% of their caloric needs on the first day of feeding, with a gradual increase of 0 to 25% of their caloric needs per day.

Most patients achieve their energy requirements by the fourth or fifth day of feeding.

The food is warmed to room temperature and fed slowly through the tube (to avoid vomiting).

It is always better for your pet to eat on its own or at least take food orally. In general, small volumes of the liquid diet can be given orally, but when the pet refuses to eat, enteral nutrition may be used.

In the rare cases when food cannot be given through the gastrointestinal tract, nutrition is provided by the so-called. parenteral nutrition.

Parenteral nutrition

Total parenteral nutrition is the administration of full energy and protein by intravenous infusion.

The specific indications for the use of parenteral nutrition include:

  • enteral nutrition intolerance manifested by vomiting or diarrhea,
  • severe malabsorption,
  • severe pancreatitis,
  • risk of aspiration of food contents if the patient is fed through the gastrointestinal tract.

The basic ingredients of parenteral nutrition are amino acid solutions, lipid emulsions and dextrose.

Amino acids

Amino acid solutions serve as a protein source for parenteral nutrition.

Lipid emulsions

They are a source of calories and essential fatty acids.

Fat is the densest caloric substrate available, more than twice as dense in calories as carbohydrates and proteins, providing about 9 kcal / g.

Fat emulsions usually consist of vegetable oils, phospholipids and glycerol.

Different amounts of linoleic and linolenic acid are provided as a source of essential fatty acids.

Cats cannot convert linoleic acid to arachidonic acid and should therefore be supplemented with a source of animal fat if parenteral nutrition is longer than 2 weeks.

Lipid emulsions are approximately isotonic.

Dextrose solutions

Dextrose is used almost exclusively in parenteral solutions as a caloric source of carbohydrate origin.

It is an inexpensive and readily available source of energy that is used to provide 40-60% of the patient's caloric intake.

Providing carbohydrate calories has been shown to inhibit amino acid gluconeogenesis and therefore conserve protein.

Vitamin supplementation

Vitamins act primarily as coenzymes for energy nutrients, as well as cofactors in energy storage and use.

The requirement for parenteral vitamins is generally much lower than the dietary requirement because the parenteral route bypasses the digestive and absorption functions of the gastrointestinal tract.

Electrolytes are usually delivered as part of intravenous fluid therapy.

Close observation of changes in the patient's weight, current losses (diarrhea, vomiting, exudative wounds) and physical examination results (depletion of subcutaneous fat, muscle wasting, presence of edema or ascites) will help determine whether to increase or decrease the patient's caloric intake.

Frequent questions asked by dog ​​and cat keepers

Frequent questions asked by dog ​​and cat keepers

Will my dog ​​/ cat be safe??

Each veterinary practice has its own policies and standard arrangements for managing inpatients.

However, despite the different needs of patients and different circumstances, there are some common areas, important both in a small veterinary office and in a large clinic.

  • First of all, the transfer of information between individual team members. Staff responsible for taking care of hospitalized patients have all the necessary information and this information is provided during daytime changes or outside normal working hours.
  • Monitoring and monitoring of patients is carried out in detail and with an appropriate, individually adjusted frequency. Staff are aware of any recommendations on what to check and monitor, and how often. The following are routinely checked for: temperature, heart rate and respiration rates, signs of post-operative pain, appetite and water intake, urine and faeces excretion, and any changes in condition or status to watch for. Drug administration guidelines and any special care requirements are met in detail.
  • Patient care personnel have clear responsibilities and are aware of both legal and professional limitations of what they can do. For example, a veterinary technician cannot decide on the prescription of drugs on his own, but, on the explicit recommendation of a veterinarian, he will administer drugs to patients according to the prescribed doses and frequency.
  • It happens that the patient's condition or the specificity of his disease require specialized equipment, round-the-clock care or treatment options that are not available to a given office, which is why patients are often referred to other, specialized clinics or clinics. If the veterinarian is unable to provide adequate care or medical attention for various reasons (e.g. due to the unavailability of appropriate equipment, personnel, or outside working hours), and the animal requires significant and immediate care, the staff will prepare the patient and his caregiver to carry out the procedure in another office, where this care can be provided.
  • If a period of veterinary care is expected to involve a change of personnel or even a change of practice (e.g. transfer to an out-of-hours specialist or to another facility) the veterinarian develops a plan that includes:
    • provision of relevant clinical information,
    • availability of the necessary personnel, equipment and medicines,
    • the method of transport and any necessary ancillary considerations (e.g. oxygen therapy, continuous fluid administration, pain relief, presence of professional staff),
    • the animal will be subjected to a minimum number of transfers appropriate for the animal and its owner.
  • Informed consent of the owner from the outset should include the arrangements to be made if the animal needs to be hospitalized. The guardian needs to be clear about the level of supervision and possible transfer arrangements.
  • Throughout the stay in hospital, animal welfare is a top priority.

Will my pet be under constant care at the veterinary hospital??

When an animal is admitted to hospital, it is under the care of support staff and a veterinarian.

Many veterinary facilities are not open 24 hours a day, so at the end of the working day there are no people in the facility from closing until staff return the next morning.

Before staff leave the clinic, each animal is fed, medication is given, dogs are taken for a short walk, and then placed in cages.

Pets are usually used to sleeping at night, so when the lights go out, they calm down immediately.

Other facilities offer 24-hour care.

In these situations, staff are available 24/7 to look around and check patients and administer medications, similar to human hospitals.

Before admitting your pet to hospital, your doctor will discuss the care with you and let you know about any restrictions.

Patients who require 24/7 care are never left alone.

In such situations, many offices arrange an additional duty or redirect the patient to another facility that provides 24-hour services.

How long will my pet be hospitalized?

On admission, the doctor makes an initial assessment and tries to predict the likely course of events and possible complications.

This is important not only from a medical point of view, but also in order to obtain the informed consent of the animal caregiver to carry out diagnostic and treatment activities, as well as to estimate the costs.

The physician should therefore determine approximately how long the animal is likely to have to remain under veterinary care, at what intensity level and should consider where this will be provided (whether the facility is able to meet the patient's diagnostic, therapeutic and care requirements, or whether the patient should be referred to another clinic / clinic).

As a rule, planned hospitalization, i.e. related to a specific procedure, diagnostic tests or administration of drugs, lasts a short time (from one to several days).

In patients hospitalized due to serious illness, the appearance of serious complications or those in a serious condition, the hospitalization period may last longer and depends mainly on the dynamics of the disease process and the response to the treatment applied.

How can I find out about my dog ​​/ cat's well-being and treatment progress?

When you are admitted to hospital, your veterinarian will discuss any hospitalization arrangements with you and outline the treatment recommended.

Clients are also informed about the costs of hospital care.

If the dog or cat is in the hospital for more than 24 hours, the veterinarian will contact the owner daily with a full medical report and discuss treatment progress.

If any significant changes occur while your dog or cat is in the hospital, your doctor will contact you immediately (regardless of the time of day or night).

You can also call the facility to check the general condition of your pet during your stay.

Will my pet be kept in a cage at all times??

Yes, patients are placed in special cages during hospitalization.

They restrict the animal's movement, allow the administration of drugs and intravenous fluids, provide safety and, in a sense, force the patient to rest.

Most animals adapt very quickly to the cage, especially if they are sick - then all they need is a good night's sleep.

Hospitals provide warm, clean blankets, lairs, cats also get litter boxes and sometimes even covered booths.

If the patient develops problems that may contaminate the cage (e.g. vomiting, diarrhea, urinary incontinence, etc.), the bottom of the cage is additionally lined with hygienic pads, which are regularly checked and replaced.

Can I leave my favorite toy / blanket / scratching post?

There are plenty of clean, cozy blankets, towels and pillows in clinics that your pet can use while in hospital.

The possibility of leaving the patient's personal belongings depends on the policy of the veterinary facility:

some agree to leave a blanket, toys or lairs without any problems, while others suggest leaving these items at home.

This is because:

many things get dirty, lost or even destroyed by their owner.

It is best to take the leash home - all hospitals have their own, but leave the collar or harness with the animal.

Can I visit my dog ​​/ cat in the hospital?

Visiting hours are primarily for pets hospitalized for intensive care.

There are times when interaction with family is an essential component of recovery.

Visits can be an ideal way to deal with your pet's hospitalization, however frequent visits are not recommended.

Patients' acclimatization in the hospital environment takes some time and the visit may break this process.

Pets can be overstimulated and excited during family visits, and stress levels can increase when you go out.

Your veterinarian will tell you what is best for your pet. Anesthetized animals should be allowed time to recover fully prior to the visit.

As a rule, visits take place at specific, scheduled times and last from several to several dozen minutes.

If the owner's visit does not hinder the administration of medications or procedures and does not affect the general routine of the facility, the doctor may consent to the owner's staying with the animal also outside visiting hours, but as a common sense - the patient needs rest, and the stress associated with the visit may disturb regeneration process.

Remember not to give your pet anything to eat or drink (especially if you are being treated for nausea and vomiting), unless your doctor agrees.

Every caring pet caregiver wants to be with the pet and support him during his stay in the hospital, which is completely understandable.

Owners often worry that the pet will be anxious.

However, before you decide to visit your sick dog or cat, carefully consider whether such a visit is really advisable.

There are some important things to consider that apply to both your pet and you.

  • Your dog's / cat's personality. This is one of the most important factors influencing whether our visit will be helpful and will really lift our animal's "spirit", or on the contrary - it will only provoke sadness, strengthen longing, and after our departure it will only cause disappointment and stress. Some animals suffer from severe separation anxiety, which can make the dog or cat feel an emotional roller coaster with each subsequent visit. This is very stressful for the patient and stress is bad for recovery. However, most animals do not belong to this group. Many patients who are hospitalized for long periods may experience a gradual withdrawal, as if losing hope when the caregiver does not show up. Cats appear to be more likely to suffer from this form of stress. For such pets, periodic, regular visits can be beneficial and improve mood.
  • A degree of awareness. How aware is your hospitalized pet? This is important because if the animal is lying down and reacts poorly, visits are unlikely to make it anxious or upset. However, you need to prepare yourself emotionally when you see an unconscious, beloved pet.
  • Your personality. Be honest with yourself: when you see your ailing pet, you will break into pieces? Remember that animals perfectly read our emotions; I will say more - usually our stress, nervousness or fear "passes " to the ward. Therefore, one should keep one's distance and tame emotions. Concerning a frightened, weak, often sore pet that longs for its family will not bring any benefit, and will only reinforce anxiety and stress. If you are unable to tame these kinds of emotions, seriously consider visiting your pet - for its sake.
  • Hospital policy. It happens that the clinic does not allow visiting patients in the hours that the latter prefer. Hospital rules must be followed, as unannounced visits may adversely affect the routine activities performed in the hospital, cause unnecessary confusion and disorganization at work.
  • A sick animal needs a calm and quiet place, with a limited amount of external stimuli. If there are more animals in the hospital, the visit of the caretakers of the "neighbor" can be very stressful for them. So let's not forget about other patients for whom strangers are another stressor.

What I need to know when my cat / dog is discharged from hospital?

When it is time to take the patient home, make sure you fully understand all care instructions.

Often you will need to restrict your pet's activity for a while, especially after surgery or after fractures.

You may be instructed to restrict movement by placing your pet in a small room or even a cage, walking on a leash, or even prohibiting your dog from walking to prevent it from running or jumping.

Cats can be kept in a small room where they will not be tempted to jump on furniture or countertops.

When discharging dogs and cats from hospital:

  • The veterinarian will agree with the owner in advance a realistic, projected date and time for discharge.
    As circumstances may change and evolve until the patient is discharged from the hospital, recommendations and plans are constantly updated and communicated to the caregiver.
  • When it is necessary to involve a different veterinary practice, it is helpful to provide clinical information and study results in advance (indirectly or through the client).
  • The facility staff always make sure that the owner has received all the necessary information about the discharge.
    These include: care plan and patient management instructions, symptoms to look for, clarification of any surgical or medical complications, restrictions on physical activity, contact numbers for emergency services, details of follow-up visits, and medication administration recommendations.
  • The physician also ensures that owners are provided with all required medications or materials (collars, bandages) and decides that the animal is clinically fit to discharge.

Medicines should be administered as instructed and strictly follow any advice given by your veterinarian.

Likewise, changing bandages and dressings should follow staff directions, and wounds or sutures should be regularly checked for swelling, redness, or discharge, indicating infection.

Avoid bathing your pet until the sutures are removed (for non-absorbable sutures) or for 10-14 days (for absorbable sutures).

Your vet will arrange a follow-up visit to check your pet's recovery.

In the meantime, give us a call if any problems arise or you have questions about your care.

How much is a dog and cat hospital?

How much is a dog and cat hospital?

It is extremely difficult to estimate the overall costs of hospitalization as they are case-by-case.

The service itself is valued by various institutions at the level of PLN 30-50 / day, however, the costs of any other procedures, diagnostic tests, materials and medicines should be added to this amount.

A day of intensive treatment can be as long as PLN 200-400.

Sick animals need as much care and love as humans. The difference is that the dog or cat will not tell us when it is in pain or needs something.

We learn about his suffering, hunger, painful condition or other abnormalities by observing his behavior, attitude and analyzing the results of various studies.

A hospital is a place where qualified technicians and veterinarians do everything to, firstly - to read precisely all signals transmitted by the organism of a sick pet, and secondly - to implement appropriate procedures as soon as possible to improve the comfort and health of the patient.

So if we are still unable to look more favorably at the fact of the pet's hospitalization, then let's try to treat it not as a necessary evil, but rather as an opportunity for quick help and care for our beloved protégé.

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