The Veterinary clinics of North America. Equine practice
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Several combination therapies have been described throughout this article: in all likelihood, it is combination therapy that will allow improved survival of ARDS patients. As medicine moves into the future, clinical trials evaluating the efficacy of therapies for ARDS will be performed. In human critical care medicine, a large forward step was taken when ALI and ARDS were clearly defined. ⋯ If anything, ALI and ARDS are clinical diagnoses. It is time for veterinarians to reach a consensus on the definition for ALI and ARDS in our patients. Only when we have a consensus of definition can rational prospective clinical trials of therapies be designed.
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Vet. Clin. North Am. Equine Pract. · Apr 2004
ReviewBrain injury after head trauma: pathophysiology, diagnosis, and treatment.
Brain injury after impact to the head is due to both immediate mechanical effects and delayed responses of neural tissues. In horses, traumatic brain injury occurs in three main settings: (1) poll impact in horses that flip over backwards; (2) frontal/parietal impact in horses that run into a fixed object, and (3) injury to the vestibular apparatus secondary to temporohyoid osteoarthropathy. Distinct forebrain, vestibular, midbrain, hindbrain, or multifocal syndromes may be encountered in horses with traumatic brain injury. ⋯ Pain must be controlled and brain swelling may be treated with infusions of hypertonic saline or mannitol. Surgical procedures, including unilateral hyoid bone transaction or elevation of skull fracture fragments, are indicated in selected cases. Optional additional treatments include use of anti-oxidants, conventional doses of corticosteroids, magnesium sulfate and drainage of CSE There is no indication for the use of massive doses of methyl prednisolone sodium succinate.
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Vet. Clin. North Am. Equine Pract. · Apr 2004
ReviewInotropes and vasopressors in adults and foals.
Successful treatment with inotropes and vasopressors depends on an understanding of the interplay of flow, pressure, and resistance in the cardiovascular system and an appreciation of the pathophysiologic mechanisms leading to inadequate tissue perfusion. Any treatment strategy is necessarily a compromise between the requirements of different vascular beds. Furthermore. the underlying hemodynamic derangements can change rapidly. Therefore. inotropes and vasopressors should be titrated to measures of improved hemodynamic status, and the treatments should be frequently reviewed.
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Vet. Clin. North Am. Equine Pract. · Apr 2004
ReviewFluid therapy in the neonate: not your mother's fluid space.
Fluid therapy is a universally used therapeutic modality in critical care patients. To effectively deliver fluids to neonates., an understanding of their fluid physiology is necessary. Neonates, as they make the transition from fetal physiology, have increased capillary filtration and a compliant interstitium producing a large ISF reserve. ⋯ The neonate's unique sodium handling must also be recognized. Many critical neonates benefit from sodium restriction, whereas others may have high ongoing losses and require careful sodium replacement therapy. Careful attention to fluid therapy formulation ensures positive fluid support without adding to the physiologic stress of the critical neonate.
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Measurements of physiologic parameters, such as blood pressure or lactate concentration, are useful to detect occult derangements, such as tissue hypoxia and dysoxia. These tools are also useful in determining the effects of therapy. ⋯ The goal of increased monitoring is to improve the level of care in the ICU; L ultimately. increased survival of critical patients is the motivation behind enhanced monitoring of physiology, with particular attention being paid to trends or alterations over time. This review highlights practical and informative monitoring tools and techniques and provides normal reference values from the literature.