Textbook of Small Animal Emergency Medicine

Contributors 
Preface 
About the Companion Website 

VOLUME 1

Section 1 Emergency Medicine Overview 1

1 Goals in Veterinary Emergency Medicine 3
Dustin Schmid and Bob Murtaugh

2 Triage 6
Nadja Sigrist

Section 2 Common Conditions in Emergency Medicine 11

3 Neurological Disorders 13
Daniel J. Fletcher

4 Respiratory Distress 18
Elizabeth Rozanski

5 Ventricular Ectopy 22
Lisa A. Murphy and Reid K. Nakamura

6 Acute Abdomen 26
Amy Koenigshof

7 The Collapsed Patient 31
Anna Gelzer and Marc S. Kraus

8 Global Approach to the Trauma Patient 39
Katie D. Mauro and Kenneth J. Drobatz

9 Reproductive Emergencies 44
Maureen McMichael

10 Anemia 48
Jillian DiFazio and Susan G. Hackner

11 Jaundice 55
Leo Londoño and Michael Schaer

12 Ophthalmic Emergencies 60
Steven R. Hollingsworth

13 Vomiting, Regurgitation, and Diarrhea 66
Rebecca Flores and Deborah C. Mandell

14 Dysuria 72
Joseph Bartges

15 Dermatological and Ear Disease 76
Brian K. Roberts

16 Toxin Exposure 92
Tina A. Wismer

17 Epistaxis 97
Meghan E. Vaught and Elizabeth Rozanski

18 Fever 101
Melissa A. Claus

Section 3 Emergency Conditions by System 107

A. Neurological Disorders 109

19 Traumatic Brain Injury 111
Jillian DiFazio and Daniel J. Fletcher

20 Altered Mentation 118
Cassie Ostroski and Kenneth J. Drobatz

21 Seizures 124
Leontine Benedicenti and Evelyn M. Galban

22 Intracranial Disease 131
Kendra Mikoloski

23 Vestibular Disease 137
Laura Harvey

24 Spinal Trauma 146
Patrick J. Kenny

25 Intervertebral Disk Disease 154
Evelyn M. Galban and Jonathan H. Wood

26 Diskospondylitis 161
Sheila Carrera-Justiz

27 Lower Motor Neuron Disease 166
Dominic Barfield,Patrick J. Kenny, and Richard Malik

B. Respiratory Disease 177

28 Brachycephalic Syndrome 179
Guillaume L. Hoareau

29 Feline Upper Respiratory Complex 186
Alexandra Pfaff

30 Laryngeal Paralysis 193
Margo Mehl

31 Tracheobronchial Injury and Collapse 196
Dana Clarke

32 Acute Airway Obstruction 206
Dana Clarke

33 Exacerbations of Chronic Bronchitis 215
Lynelle R. Johnson

34 Feline Lower Airway Disease 220
Tekla Lee-Fowler

35 Puppy Pneumonia 225
Elizabeth Rozanski and Alex Lynch

36 Coughing and Hemoptysis 229
Geoff Heffner

37 Bronchopneumonia 234
Anthony L. Gonzalez and Lesley G. King

38 Cardiogenic Pulmonary Edema 242
Mark A. Oyama

39 Neurogenic Pulmonary Edema 247
Kenneth J. Drobatz

40 Submersion Injury 253
Nuno Félix and Isabelle Goy-Thollot

41 Pulmonary Hemorrhage 260
Søren Boysen

42 Pulmonary Thromboembolism 266
Ronald Li and Joshua A. Stern

43 Primary and Metastatic Pulmonary Neoplasia 273
Erika L. Krick

44 Pneumothorax 278
Erin Mooney

45 Pleural Effusions 285
Lori Waddell

46 Pyothorax 291
Kate Farrell and Steven Epstein

47 Diaphragmatic Hernia 298
Cara A. Blake

48 Penetrating Thoracic Trauma 304
Ingrid M. Balsa, Guillaume L. Hoareau, and William T.N. Culp

49 Blunt Thoracic Trauma 309
Guillaume L. Hoareau, Ingrid M. Balsa, and William T. N. Culp

50 Look-Alike Causes of Respiratory Distress 316
Angela Borchers and Laura Cagle

C. Cardiovascular Disease 319

51 Mechanisms of Heart Failure 321
Mark A. Oyama

52 Congenital Cardiovascular Disease 325
Joshua A. Stern

53 Arrhythmias 329
Meg M. Sleeper

54 Pericardial Effusion 336
Sean B. Majoy

55 Dilated Cardiomyopathy 341
Suzanne M. Cunningham and Kursten V. Pierce

56 Feline Hypertrophic Cardiomyopathy 349
Lance C. Visser

57 Valvular Heart Disease 355
John MacGregor

58 Heartworm Disease 362
Marisa K. Ames

59 Pulmonary Hypertension 372
Rebecca Quinn

60 Bradyarrhythmias and Pacemakers 380
Lance C. Visser

61 Myocarditis 385
Lisa A. Murphy and Reid K. Nakamura

62 Thromboembolic Disease 388
Julien Guillaumin

63 Systemic Arterial Hypertension 397
Amanda E. Coleman

D. Hematological and Oncological Disorders 405

64 Leukocytosis and Leukopenia 407
Andrew G. Burton and Karl E. Jandrey

65 Non-Regenerative Anemia 413
Alex Lynch

66 Hemolytic Anemia 419
Megan Morgan and Susan G. Hackner

67 Thrombocytopenia 427
Maureen McMichael

68 Fibrinolysis and Antifibrinolytics 430
Jo-Annie Letendre and Robert Goggs

69 Congenital Coagulopathy 440
Elizabeth Rozanski and Armelle deLaforcade

70 Acquired Coagulopathy 444
Ronald Li

71 Antithrombotics in the Emergency Room 455
Armelle deLaforcade

72 Sick Oncology Patients in the Emergency Room 459
Kim Slensky and Craig A. Clifford

73 Paraneoplastic Syndromes 467
Alycen P. Lundberg and Laura D. Garrett

E. Esophageal and Abdominal Disease 473

74 Vomiting and Regurgitation 475
Jayme E. Hoffberg

75 Esophageal Foreign Bodies 481
Mark P. Rondeau

76 Diarrhea 485
Marko Pipan

77 Hematemesis and Gastrointestinal Hemorrhage 490
Kayla Hanson and Elke Rudloff

78 Parvovirus Enteritis 496
Raegan J. Wells and Sullivan Lauren

79 Hemorrhagic Gastroenteritis 501
Erica L. Reineke

80 Protein-Losing Enteropathy 506
Rachel E. Smith and Robert J. Washabau

81 Gastrointestinal Obstruction 511
Chap Pratt

82 Gastric Dilation-Volvulus 520
Elke Rudloff

83 Mesenteric Torsion 524
Fabio Vigano

84 Hemoperitoneum 528
S. Anna Pesillo-Crosby

85 Splenic Disease 535
Alex Lynch and Therese O’Toole

86 Pancreatitis 541
Erica Tinson and Elise Boller

87 Peritonitis 550
Medora Pashmakova and James Barr

88 Postoperative Complications Presenting to the Emergency Service 556
Therese O’Toole

89 Biliary Disease 561
Amanda K. Boag and Steve J. Mehler

90 Acute Liver Failure 566
Deborah C. Mandell

91 Feeding Tube Complications 578
Daniel L. Chan

92 Anorectal Disease 582
David E. Holt

93 Constipation 587
Mark P. Rondeau

VOLUME 2

F. Urogenital Disorders 593

94 Acute Azotemia 595
Carrie Palmr

95.Oliguria 601
J.D. Foster

96 Urinary Tract Infections 606
Reid Groman

97 Urolithiasis 620
Joseph Bartges

98 Feline Ureteral Obstruction: Diagnosis and Management 627
Allyson Berent

99 Feline Lower Urinary Tract Obstruction 634
Edward Cooper

100 Urethral Trauma 641
Elena S. Addison and Donald A. Yool

101 Lyme Nephritis 646
Meryl P. Littman

102 Chronic Kidney Disease 653
Melisa Gunsel Rosenthal and Mary A. LabatoI

103 Uroabdomen 659
Saya Press and Anusha Balakrishnan

104 Urethral Prolapse 665
Jennifer Carr

105 Discolored Urine 667
Julie M. Walker

106 Urinary Diversion in the Emergency Room 673
Cassie Ostroski and Dana Clarke

107 Acid–Base Disorders 680
Kate Hopper

108 Sodium and Water Balance 687
Yu Ueda and Kate Hopper

109 Potassium Disorders 697
Sabrina Hoehne and Matthew Mellema

110 Calcium, Magnesium, and Phosphorus Disorders 706
Matthew Mellema

111 Hypoglycemia 716
Anthony L. Gonzalez and Deborah C. Silverstein

112 Hyperglycemia 723
Gideon Daniel and Alex Lynch

113 Complicated Diabetes Mellitus 726
Amie Koenig

114 Adrenal Gland Disorders 733
Jonathan D. Dear and Guillaume L. Hoareau

115 Hypoadrenocorticism 739
Soren Boysen

116 Thyroid Disorders 749
Jonathan D. Dear

117 Diabetes Insipidus 754
Jamie M. Burkitt Creedon

G. Reproductive Disorders 759

118 Dystocia 761
Liam Donaldson and Philip Thomas

119 Eclampsia 767
Michelle A. Kutzler

120 Neonatal Resuscitation 771
Carol A. Margolis and Margret L. Casal

121 Diseases of the Neonate 775
Andrea Hesser and Autumn P. Davidson

122 Metritis and Mastitis 787
Sophie A. Grundy

123 Pyometra 791
Grayson B. Wallace and Margret L. Casal

124 Prostatic Disease 798
Autumn P. Davidson

125 Uterine and Vaginal Prolapse 803
Michelle A. Kutzler

126 Penile, Preputial, and Testicular Disease 808
James Lavely and Autumn P. Davidson

H. Common Toxins 815

127 Decontamination and Toxicological Analyses of the Poisoned Patient 817
Justine A. Lee

128 Lipid “Rescue” Therapy 827
Kathryn Benavides and Jonathan Babyak

129 Blood Purification Techniques for Intoxications 831
Carrie Palm

130 Rodenticide Toxicity 837
Jesse Bullock and Alex Lynch

131 Ethylene Glycol Intoxication 842
Rachel B. Davy and Leo Londoño

132 Acetaminophen Intoxication 847
Amanda Thomer and Lesley G. King

133 Non-Steroidal Anti-Inflammatory Drug Intoxications 852
Angela Borchers

134 Grape, Raisin, and Lily Ingestion 858
J.D. Foster

135 Recreational Drug Intoxications 862
Melissa Bucknoff

136 Household Toxins 867
Lindsey Nielsen

I. Skin and Soft Tissue Disease 871

137 Life-Threatening Dermatological Emergencies 873
Brian K. Roberts

138 Severe Soft Tissue Infections 888
Melissa Clark and Yekaterina Buriko

J. Environmental Emergencies 893

139 Smoke Inhalation Toxicity 895
Erin McGowan and Kenneth J. Drobatz

140 Porcupine Quilling 901
Elizabeth Rozanski

141 Crotalinae Snake Envenomation 904
Raegan J. Wells

142 Elapid Snake Envenomation: American Coral Snakes and Australian Elapids (Tiger Snakes, Brown Snakes, Taipans, Death Adders and Black Snakes) 910
Katrin Swindells and Michael Schaer

143 Spider and Scorpion Envenomation 917
Kate Hopper

144 Bufo Toad Toxicosis 922
Leo Londoño and Gareth Buckley

145 Hymenoptera Envenomation 926
Rebecca Flores and Vincent Thawley

146 Hypersensitivity and Anaphylaxis 932
Sabrina Hoehne and Kate Hopper

147 Canine Heat Stroke 938
Yaron Bruchim and Efrat Kelmer

148 Cold Exposure 946
Karol A. Mathews

149 Electrical and Lightning Injuries 952
F.A. (Tony) Mann

Section 4 Trauma and Resuscitation 959

A. Cardiopulmonary Resuscitation 961

150 Cardiopulmonary Resuscitation in the Emergency Room 963
Daniel J. Fletcher and Manuel Boller

151 Small Animal Cardiopulmonary Resuscitation Initiatives 970
Manuel Boller and Daniel J. Fletcher

B. Circulatory Shock 975

152 Pathophysiology of Shock 977
Edward Cooper

153 Hypovolemic Shock 982
Corrin Boyd and Lisa Smart

154 Cardiogenic Shock 989
Luiz Bolfer and Meg M. Sleeper

155 Additional Mechanisms of Shock 996
Sean Smarick and Iain Keir

156 Lactate Monitoring 1001
Casey Kohen and Kate Hopper

157 Emerging Monitoring Techniques 1007
Rodrigo C. Rabelo

158 Ischemia-Reperfusion Injury 1015
Josh Smith and Robert Goggs

159 Systemic Inflammatory Response Syndrome, Sepsis, and Multiple Organ Dysfunction Syndrome 1026
Claire R. Sharp

C. Trauma 1035

160 Trauma Overview 1037
Erica L. Reineke

161 Trauma Center Registry 1048
Kelly Hall

162 High-Rise Syndrome 1050
Yekaterina Buriko

163 Trauma-Associated Coagulopathy 1056
Alex Lynch and Robert Goggs

164 Metabolic Consequences of Trauma 1064
Leo Roa and Elizabeth M. Streeter

165 Traumatic Orthopedic Emergencies 1068
Spencer A. Johnston and Marian E. Benitez

166 Wound Management Principles 1075
F.A. (Tony) Mann

Section 5 Fluid and Blood Product Therapy 1085

167 Crystalloid Fluid Therapy 1087
Deborah C. Silverstein and Samantha Hart

168 Colloid Fluid Therapy 1093
Marie K. Holowaychuk

169 Crystalloids versus Colloids 1099
Jennifer Prittie and Dava Cazzolli

170 Management of Hemorrhagic Shock 1111
Andrew Linklater

171 Management of Dehydration 1122
Ashley E. Allen-Durrance and Samantha Campos

172 Maintenance Fluid Therapy 1128
Travis Lanaux

173 Potassium Supplementation 1132
Jillian DiFazio

174 Administration of Sodium Bicarbonate 1136
Jennifer E. Waldrop

175 Continuous-Rate Infusion 1143
Andrea M. Steele and Karol A. Mathews

176 Transfusion of Red Blood Cells and Plasma 1147
Raegan J. Wells and Brandi L. Mattison

177 Massive Transfusion 1152
Kari Santoro Beer and Amanda Thomer

Section 6 Emergency Room Procedures 1157

178 Vascular Access 1159
Matthew W. Beal

179 Intraosseous Catheters 1165
Alison Allukian and Amanda Abelson

180 Airway Management 1169
Elizabeth Rozanski

181 Oxygen Therapy 1173
Christine L. Guenther

182 Sonography in the Emergency Room 1179
Gregory R. Lisciandro

183 Thoracocentesis 1191
Melissa Bucknoff and Meghan Respess

184 Thoracostomy Tube Placement 1195
Samantha Campos and Alex Lynch

185 Pericardiocentesis 1198
Kursten Roderick and John E. Rush

186 Abdominocentesis 1202
Karl E. Jandrey

187 Urethral Catheterization (Including Urohydropulsion) 1206
Sean Smarick

188 Mechanical Ventilation in the Emergency Room 1212
Lisa L. Powell

189 Damage Control Surgery 1215
Steve J. Mehler

Section 7 Anesthesia and Analgesia for the Emergency Room Patient 1219

190 Anesthesia and Analgesia in the Emergency Room: An Overview 1221
Lisa J. Bazzle and Benjamin M. Brainard

191 Anesthetic Concerns and Protocols for Common Conditions 1227
Becca Reader and Amanda Abelson

192 Sedation for the Emergency Room Patient 1235
Stephanie R. Krein

193 Pain Management in Critical Patients 1241
Alicia Z. Karas

194 Opioids 1246
Lois A. Wetmore

195 Alpha-2 Adrenergic Agonists 1251
Katherine A. Cummings

196 Non-Steroidal Anti-Inflammatory Drugs 1254
Christopher L. Norkus

197 Regional Anesthesia Techniques 1259
Marlis L. de Rezende

198 Go Home Analgesics 1265
Ashley Wiese

199 Approach to the Aggressive or Fearful Emergency Room Patient 1272
Selena L. Lane and Benjamin M. Brainard

Section 8 Unique Emergency Medicine Topics 1279

200 Antimicrobial Therapy in the Emergency Patient 1281
Steven Epstein

201 Disaster Medicine 1288
Lee Palmer

202 Working Dogs in the Emergency Room 1294
Cynthia M. Otto

203 Approach to Unowned and Shelter/Rescue Animals in the Emergency Room 1299
April Paul

204 Euthanasia Considerations 1302
Katherine J. Goldberg

205 Emergency Room Design and Staffing Models 1309
Jan P. Kovacic

206 Conflict in the Emergency Room 1318
Jim Wohl

207 Maximizing Communication 1323
Laura D. Garrett

208 Basics of Clinical Study Design 1327
Kenneth J. Drobatz

209 Designing and Participating in Clinical Trials 1331
Dorothy Cimino Brown

Textbook of Small Animal Emergency Medicine offers an in-depth understanding of emergency disease processes and the underlying rationale for the diagnosis, treatment, monitoring, and prognosis for these conditions in small animals.

• A comprehensive reference on a major topic in veterinary medicine
• The only book in this discipline to cover the pathophysiology of disease in depth
• Edited by four respected experts in veterinary emergency medicine
• A core text for those studying for specialty examinations
• Includes access to a website with video clips, additional figures, and the figures from the book in PowerPoint

Kenneth J. Drobatz, DVM, MSCE, Diplomate ACVIM, Diplomate ACVECC, is Professor of Critical Care and Director of Emergency Services at the University of Pennsylvania School of Veterinary Medicine in Philadelphia, Pennsylvania, USA.

Kate Hopper, BVSc, PhD, Diplomate ACVECC, is Assistant Professor at the University of California Davis School of Veterinary Medicine in Davis, California, USA.

Elizabeth A. Rozanski, DVM, Diplomate ACVIM, Diplomate ACVECC, is Associate Professor at Tufts University Cummings School of Veterinary Medicine in North Grafton, Massachusetts, USA.

Deborah Silverstein, DVM, Diplomate ACVECC, is Associate Professor of Critical Care at the University of Pennsylvania School of Veterinary Medicine in Philadelphia, Pennsylvania, USA.