This report highlights the complications associated with acromegalic patients in diabetic crisis, and suggests recommendations for the appropriate management and care. Outlined are the concepts of asymptomatic hypoglycaemia, the welfare implications of frequent pinna blood sampling and coma scale monitoring. It also discusses the benefit of using the nursing process for ongoing evaluation of the critical patient.
This study aimed to determine if dogs and cats presenting as an emergency had improved tolerance of intravenous catheterisation following the application of vapocoolant spray when compared to a saline control. Materials and MethOds:A randomised controlled trial of client-owned dogs and cats presenting as an emergency and requiring intravenous catheterisation was performed. Patient signalment and mentation score were recorded. All animals were restrained and had their fur clipped over the catheterisation site. They were then randomly allocated to either have a swab saturated with vapocoolant spray (treatment) or a swab saturated with saline (control) applied to the clipped area before intravenous catheterisation. The procedure was video recorded and a single blinded observer reviewed the recordings and assigned reaction scores (0 to 3) at four time points (initial restraint, limb handling, swab application and skin puncture).results: Between October 2020 and January 2021, a total of 100 patients (79 dogs, 21 cats) were enrolled, with 50 in each group. No significant difference in species, age, breed, sex or mentation score was detected between the two groups. There was no significant difference in reaction scores between the groups at any time point with the exception of a significantly increased swab application reaction score in the treatment group compared to the control group. clinical significance: The indirect application of vapocoolant spray via a swab before catheterisation does not significantly reduce the reaction of dogs and cats to intravenous catheterisation in an emergency setting.
Veterinary professionals in emergency and critical care see the sickest and most unstable patients, and it is understandable that nutrition is not at the forefront of their minds. This article demonstrates why nutrition is important in the most critical patients, and why studies show it is no longer advisable to delay assisted nutrition. Absence of nutrition in the critical patient leads to muscle catabolism, protein deficiencies and increased risk of sepsis. There are options for enteral or parenteral nutrition, and various feeding tubes that can be used depending on the status of the patient. Both underfeeding and overfeeding can be detrimental to the critical patient; requirements should be calculated for each patient on an individual basis, considering the dietary requirements and risks associated with each presentation and disease process. There are also changes that can be made in the hospital to encourage patients to eat voluntarily; it is important not to forget holistic care in the critical patient.
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