Sara Jackson

Replying to scott@vtx-cpd.com 21/02/2022 - 19:33

This is really great and I will take this and run with it 🙂

I wouldn’t induce emesis if the gag reflex is at all affected so any obvious reduced consciousness would stop me.

Sx

Hell, these make me nervous full stop.

Well, they did following a bad experience in a case at a previous job when, unfortunately, the FB was missed and the patient ended up with pressure necrosis o the esophagus and a pyothorax (and death).

Now I’d be excited to try to remove one with an endoscope with referral for sx if I couldn’t remove it. I guess the fistula would be a risk but how many cases actually develop one.

S

Congratulations Gail!!

I believe the atropine /alpha 2 is an American thing – a Facebook vet forum (the fount of all knowledge, yes?) had quite a few people posts about using atropine alongside an alpha 2 (plus other meds for trible/quad combo’s) to counteract the side effects of the alpha2. I’d go for atipamizole first, like you say. I’ve heard of some using it IV in an emergency.

Do you have any time of M&M rounds or team review/reflection where it could be discussed?

Pain scoring should be the 5th vital parameter. There has to be a recognition of strengths and weaknesses of pain scoring though – stoic patients, anxious patients etc. Also, most of the scoring validation is done on specific scenarios so doesn’t necessarily extrapolate as expected.

Still, scoring is vital and I try to always re-do it 15 to 30 min after analgesia is given to ensure it’s working.

Sometimes I also work on the principle if it’s a painful condition i.e. pancreatitis the patient is painful so, even if the score is lower than expected, give analgesia.

Now I’m on my soap box – it’s essential to understand the pathophysiology of pain and how pain meds works to ensure there’s good coverage with minimal side effects.

Could go on forever about this.

I was talking to an anesthesiologist and mentioned I don’t use alpha-2s in blocked cats – they told me about the potential reno-protective properties being mooted. When I think I have things sorted in my head….