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extracellular space into the intracellular space causing volume expansion. It is most commonly used in cases of hypovolaemic shock (decreased circulating volume) as it creates rapid volume expansion. It must always be followed by crystalloid fluid administration to restore equilibrium of the extracellular and intracellular fluid. An example of hypertonic saline is Dextrans. Mannitol is another fluid that may be used in the emergency situation. Mannitol is an osmotic diuretic and is used
and the force of contractions of the heart. It is most commonly administered intravenously but can also
be given intratracheal through a feeding tube placed down the endotracheal tube. The dose rate does need to be doubled by this route and may already be made up as a 1:10000 solution (9mls of saline to 1ml of 1:1000 adrenalin). Lower doses are recommended to start with as high does may cause ventricular fibrillation. It’s effect is immediate if given intravenously.
Vasopressin
Dose rate of 0.3 micrograms/kg (1ml/25kg) IV given instead of Adrenalin for the first one or two doses then administer Adrenalin for subsequent doses. May be given Intra-tracheal at a dose rate 5 times the IV dose. Vasopressin is a nonadrenergic vasopresser that causes peripheral, coronary and renal vasoconstriction. This
in turn increase cerebral and coronary blood flow and can be used instead of Adrenalin to similar effects. Current studies in human medicine do not find that Vasopressin is superior to use of Adrenalin however some studies have shown that it may be more effective in animals particularly those with severe hypovolaemia. The RECOVER guidelines recommend that Vasopressin is used for only the first or second doses and that Adrenalin is used thereafter.
Atropine Sulphate 0.6mg/ml
Dose rate of 0.02 – 0.05mg per kg intravenously, intramuscularly or
sub-cutaneously. Used in cases of bradycardia. It will increase the cardiac output and heart rate by blocking vagal stimulation in the heart. It is also used as an antidote in cases of organophosphate poisoning. Care must be taken not to overdose as this can cause sinus tachycardia. Its effect is at its peak 3 – 4 minutes after intravenous administration. Can be given intratracheal again at double the dose rate intravenously and should be followed with a few short breaths to enhance delivery into the patients system.
Lignocaine 2% 20mg/ml
Dose rate of 2 – 6 mg per kg equating to 1ml/10kg intravenously. Used in cases of severe tachycardia and ventricular fibrillation. It is a local anaesthetic and therefore suppresses the ventricular electrical activity of the heart. It can be given intratracheal at double the intravenous dose rate.
Frusemide (Furosemide) 50mg/ml
Dose rate of 2- 4 mg per kg in dogs and 1 – 2 mg per
kg in cats intravenously or intramuscular. Used to treat cerebral and pulmonary oedema. It is a diuretic and hence helps to remove fluid. Care must be taken that the patient does not dehydrate and develop an electrolyte imbalance.
to treat cerebral oedema. It draws fluid from the extracellular space as hypertonic saline does. It helps by increasing cerebral blood flow and decreasing fluid and swelling of the brain therefore decreasing intracranial pressure. 50% Glucose should also be included in the Emergency cart for use in cases of Hypoglycaemia where the glucose level of the patient is extremely
low. The rate of fluid administration will depend on
the condition of the patient. In CPR fluid overload has been found to be a problem when there is circulatory compromise and the use of fluids will depend on the individual case. As a general guide slightly higher
than maintenance rates at 5 – 10ml/kg/hr can be used however only if the patient is hypovolemic. Fluid may
be given as a bolus in severe cases to rapidly restore circulating volume.
Therefore the crash cart should contain both 500ml and 1000ml bags of Hartman’s, 0.9% Sodium Chloride and if possible Haemaccel or 5% Dextrose. Hypertonic saline, Mannitol and 50% Glucose in 500ml bags are required also. Infusion sets of 20 drops/ml and paediatric giving sets should also be included.
Emergency Drugs
Recommended route of administration for most emergency drugs is Intravenous (I/V) or Intra-Osseous for the fastest absorption rate however if these routes are not possible the Intra-Tracheal route can be used however there is not any evidence on optimal dose, volume or diluents. Any drugs administered during CPR via the IV route must be followed by a saline bolus of 20 – 30mls
to ensure the full effect. The following drugs, doses
and routes of administrations are guides only and your Veterinarian will decide on what may or may not be used and the dose and route of administration for each case.
Adrenalin 1:1000 1mg/ml
Dose rate of 0.01mg/kg intravenously or double dose rate if given intratracheal for two doses on every other cycle of basic life support. If further doses are required then the dose is increased to 0.1mg/kg. Administer on every other cycle of basic life support. Used in cases of Ventricular Asystole (No electrical activity present
in the heart) and also in cases of severe bradycardia (slow heart rate). Adrenalin causes vasoconstriction and improves coronary and cerebral blood flow and venous return to the heart. It increases the heart rate
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