The Veterinary clinics of North America. Small animal practice
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Establishing and maintaining vascular access is often vital to the preoperative, intraoperative, and postoperative management of the small animal emergency surgical patient. Vascular access may be used for the delivery of crystalloids, colloids, blood components, medications, and anesthetic or sedative agents. ⋯ The small animal emergency and critical care veterinarian should have a thorough knowledge of vascular access techniques, including peripheral and central venous catheterization, intraosseous, and arterial access. Competence in percutaneous, percutaneous facilitative, and surgical cutdown approaches should ensure that vascular access can always be established in the critically ill patient.
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The goal of any method of fracture repair should be the early return of total limb function and the prevention of fracture disease. This can be accomplished through adhering to the basic principles of good patient and fracture assessment, choosing the correct method of fracture repair, and appropriate patient care. The complications of external coaptation can be minimized by appropriate patient and fracture assessment as well as correct cast and splint application. Choosing external coaptation as a method of fracture repair can be rewarding as long as the appropriate steps are taken to ensure success.
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Vet. Clin. North Am. Small Anim. Pract. · Sep 1999
ReviewExternal skeletal fixation. Linear fixators.
Linear external skeletal fixators offer some unique advantages over other fixation systems; they are biomechanically versatile, minimize surgical trauma to the fracture environment, and allow for simple staged disassembly to help promote bone healing. Historically, the use of linear external skeletal fixators has been reported to result in numerous complications, primarily related to the pin-bone interface. ⋯ Increased knowledge of proper pin insertion techniques and advancements in pin design have greatly enhanced the longevity of the pin-bone interface, resulting in fewer complications. This article reviews some of the potential advantages of linear external skeletal fixators and principles of application to help strengthen the pin-bone interface and minimize complications.
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A fluid therapy plan for a patient is developed prior to surgery and is designed to meet each patient's needs. The volume and type of fluid are dependent on the patient's physical status; the acid-base, fluid, and electrolyte status; the surgical procedure; and the expected losses occurring during the procedure. No one fluid regimen is ideal for all patients. ⋯ Balanced replacement fluids may be used to replace blood loss at a ratio of 3:1 and are added to maintenance and replacement requirements. Blood loss of 20% to 25% of the calculated blood volume or hematocrit values less than 20% are indications for colloids or blood replacement at a ratio of 1:1. The optimal fluid therapy regimen for a patient may involve a combination of crystalloids as well as natural and synthetic colloids, using each type of fluid to obtain and maintain perfusion and oxygenation to the tissues.
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There has been a substantial increase in the use of analgesics for pain management in the last 10 years. Traditionally, veterinarians have not been trained in the identification of or monitoring of patients that are in pain, even though an evaluation of pain is inherent in assessing improvement in many medical and surgical diseases. Until recently, the physiology and pharmacology of opioids, NSAIDs, local anesthetics, and alpha 2 agonists were taught, but the therapeutic role of these drugs was generally believed to be related to restraint, anesthesia, or control of inflammation rather than to pain management.