Capillary refill rate in animals. Dehydration in a cat: what to do at home: symptoms and treatment

Screening and initial management of children under 5 years of age

Clinical Guide

UK National Collaborating Center for Women's and Children's Health

Approved by the UK National Institute for Health and Clinical Excellence (NICE) May 2007

Fever in younger children usually indicates an underlying infection. Infectious diseases remain a leading cause of childhood morbidity and mortality in much of the world, and the need to improve recognition, assessment, and emergency management of febrile illnesses in children is clear.

Definitions
Various definitions of fever are used in the medical literature. Normal temperature body may vary depending on individual characteristics, measurement location and thermometer type. In this guide, fever is defined as an increase in body temperature above normal daily fluctuations.
Much of the guidance is devoted to recognizing children with severe illness, defined as an illness accompanied by fever that can lead to death or disability if diagnosis and treatment are delayed.

Clinical examination of a child with fever
When a child develops a fever, parents usually call for medical care.
The initial examination of a child with fever is of great importance. Most of these children have a self-limiting viral infection or an obvious cause of fever for which specific treatment can be given. In a minority of children, the cause of the fever cannot be immediately determined, and only a small number have severe illness.
In children aged 4 weeks to 5 years, the doctor should measure body temperature using one of the following methods:
electronic thermometer in armpit;
chemical point thermometer in the armpit;
infrared tympanic thermometer.
Feelings of fever in a child by his parents should be considered reliable and taken seriously.
Initial contact can be made remotely (for example, by telephone) or the child is sent to a medical facility where direct examination can be carried out. In any case, it is important to understand the meaning certain symptoms and signs.
A correct and comprehensive assessment implies that in most cases:
a child with a potentially serious illness is recognized and receives adequate care;
a child with a mild self-limiting illness is not burdened with unnecessary medical intervention, and parents receive instructions on how to help the child.

Priority tasks of the health service
1. Recognize any life-threatening signs.
2. Assess the likelihood of a child having a severe or self-limiting disease, without necessarily making a specific diagnosis.
3. Determine the etiology of the disease to prescribe specific treatment.
4. Make an appropriate decision on how to guide the child further, based on the results of the examination.

Life-threatening symptoms
First of all, the doctor must recognize any symptoms that directly threaten the child’s life (ABC): violations of the airways (A - airways), breathing (B - breathing) and blood circulation (C - circulation).

Assessing the risk of severe disease
After assessing the presence or absence of immediate life-threatening symptoms in a febrile child, the next task should be to further assess risk based on presenting symptoms and signs. Some may lead to a definitive diagnosis or site of infection, while others may be nonspecific but indicate severe disease.
Feverish children should be assessed for the presence or absence of symptoms and signs that can be used as predictors of risk of severe illness according to the proposed traffic light system (Table 1).

Children with fever and any signal in the red column are at high risk of severe illness; with any signal from the “yellow” column in the absence of all signals from the “red” column – medium risk; with signals from the “green” column in the absence of those from the “yellow” and “red” – low risk.

Clinical indicators with prognostic value for determining severe disease
Heart rate (HR) often considered as a useful marker of severe illness, including circulatory failure in shock. However, it should be remembered that heart rate is influenced by many factors (for example, age, activity, anxiety, fear, pain, body temperature).
To date, there is no evidence to establish normal heart rate values ​​in the population of children under 5 years of age. A study by Hanna & Greenes (2004) compared heart rate with body temperature in children under 1 year of age; with each increase in temperature by 1 °C, heart rate at rest increased by 9.6 beats/min (Fig.).
Capillary refill time (CRT). In a systematic review, Steiner et al. (2004) found that OBC has a sensitivity of 60% and specificity of 85% in detecting 5% dehydration, making OBC the most sensitive indicator of dehydration. There is no reliable association between a capillary refill time of 3 seconds with meningococcal infection, other significant bacterial infections and blood cell counts.
In the study by Leonard & Beattie (2004), prolongation of the OHL > 3 s was associated with the need for urgent care, fluid bolus administration and length of hospitalization. The highest predictive value of VNC was obtained for normal (≤1 s) and clearly pathological (≥4 s) values.
Wells et al. (2001) showed that in children with a petechial rash, a VLC of more than 3 s indicates a high probability of meningococcal infection (relative risk 29.4).
Blood pressure (BP) is not considered an independent risk factor for severe disease. Low blood pressure, along with a number of other factors, is a predictor of poor outcome in children with meningococcal infection.
According to the authors, blood pressure as a marker of adequacy of organ perfusion should be determined in children with fever and signs of severe illness. BP measurement may be useful in monitoring children with possible sepsis, although BP declines later in life septic shock.
Pathological respiratory rate (RR) is a nonspecific marker of severe illness and a specific sign of pneumonia, its determination is necessary when assessing dehydration.

The physician should measure and record body temperature, heart rate, respiratory rate, and capillary refill rate as part of the routine assessment of a child with a fever.
An elevated heart rate may be a sign of serious illness, particularly septic shock.
A capillary refill rate of 3 s or more is considered a marker of average risk of severe disease (“yellow” signal).
The doctor must measure arterial pressure in a child with fever in the presence of abnormal respiratory rates and capillary refill times.

Height and duration of fever and their prognostic value in determining severe illness
Body temperature should only be used in conjunction with other symptoms to identify children with severe illness. However, to the group high risk serious illnesses include:
children under 3 months of age with a temperature of 38 °C or higher;
children aged 3-6 months with a temperature of 39 °C and above.
Duration of fever is not a predictor of severe illness.

Dehydration assessment
Children with fever should be assessed for signs of dehydration, which include:
extended capillary refill time;
decreased skin turgor;
pathological breathing;
weak pulse;
cold extremities.

Symptoms and signs of specific severe diseases
The physician should look for the source of the fever and check for symptoms and signs associated with specific diseases (Table 2).

Management of children under 3 months
Children under 3 months with fever should be examined by a doctor to assess vital signs - body temperature, heart rate, respiratory rate.
Necessary clinical and instrumental studies:
general blood test with leukocytogram;
blood culture;
C-reactive protein;

x-ray of organs chest(if there are respiratory symptoms);
bacteriological examination of stool (for diarrhea).
Lumbar puncture is indicated (in the absence of contraindications):
children under 1 month;
all children aged 1-3 months who appear sick;
children aged 1-3 months with a blood leukocyte count below 5x10 9 /l or above 15x10 9 /l.
If indicated, lumbar puncture is performed without delay, if possible before antibiotics are prescribed.
Indications for parenteral antibiotics are the same as those for performing lumbar puncture. If a parenteral antibiotic is indicated for a child younger than 3 months, a third-generation cephalosporin (eg, cefotaxime or ceftriaxone) plus an antibiotic active against Listeria (eg, ampicillin or amoxicillin) should be given.

Management of children aged 3 months and older
"Red" group
Children with fever without obvious reason with one or more “red” signals, the following studies are carried out:

blood culture;
C-reactive protein;
urine test to check for urinary tract infection.
If there are indications, the following is carried out:
lumbar puncture in children of all ages (in the absence of contraindications);
X-ray of the chest organs, regardless of body temperature and the number of leukocytes in the blood;
determination of serum electrolytes and blood gases.

"Yellow" group
For children with fever without an obvious cause and one or more yellow lights, the following tests are performed:
urine test for urinary tract infection;
general blood test with leukocytogram;
blood culture;
C-reactive protein;
lumbar puncture in children under 1 year of age;
X-ray of the chest organs with fever above 39 ° C and leukocytosis more than 20x10 9 / l.

"Green" group
Children with fever without an obvious cause and without signs of severe illness have their urine tested for the presence of a urinary tract infection and assessed for symptoms of pneumonia. Routine blood tests and chest x-rays are not performed. Children in the “green” group can be taught at home, providing parents with the necessary instructions.

Viral coinfection
Children with fever and proven infection with respiratory syncytial virus or influenza virus should be assessed for signs of severe illness. A urine test is recommended to identify possible infection urinary tract.

Observation in the clinic
In children 3 months of age and older with fever of no apparent cause, a period of clinical observation (with or without testing) should be considered as part of the differential diagnosis between mild and severe illness.

Response to antipyretic therapy
If the child is receiving antipyretics:
- the doctor should not rely on a decrease or absence of a decrease in temperature after 1-2 hours for the differential diagnosis of mild and severe disease;
- the condition of children hospitalized with “yellow” or “red” signals is assessed every 1-2 hours.

Pediatric emergency care
Intravenous fluids
Children with fever and shock should immediately receive an intravenous bolus of fluid at a rate of 20 ml/kg; as a rule, at first it is 0.9% sodium chloride solution. Thereafter, active monitoring is carried out, repeating bolus fluid administration if necessary.
Antibiotics
Emergency parenteral antibiotics are given to febrile children who are in shock, unconscious, or have signs of meningococcal infection.
Parenteral antibiotics should also be considered in children with fever and decreased levels of consciousness. In these cases, the presence of symptoms of meningitis and herpes viral encephalitis is assessed.

When treating a child hospitalized with a fever suspected of having a bacterial infection requiring emergency treatment, antibiotics active against Neisseria meningitidis, Streptococcus pneumoniae, Escherichia coli, Staphylococcus aureus, and Haemophilus influnzae type b should be prescribed. When choosing an antibiotic, it is necessary to take into account regional data on the prevalence of antibiotic-resistant microorganisms.
If parenteral antibiotics are indicated, third generation cephalosporins are prescribed until culture results are available. Children under 3 months of age should additionally receive an antibiotic active against listeria.

Acyclovir
Children with fever and symptoms of herpes simplex virus encephalitis should receive acyclovir intravenously.

Oxygen
Oxygen is indicated for children with fever who have signs of shock or SpO 2 less than 92% when breathing air.
When SpO 2 is more than 92%, oxygen therapy is carried out according to clinical indications.

Hospitalization and discharge
When deciding on hospitalization, the doctor must take into account, in addition to clinical condition child the following factors:
social and family circumstances;
concomitant diseases in the child and relatives;
parents' concerns and intuitions;
contact with other persons with severe infectious diseases;
recent travel abroad to tropical/subtropical areas or areas with a high risk of endemic diseases;
repeated visit to the doctor with the same complaints;
recent serious illness or death in the family due to a febrile condition;
no obvious cause for fever that lasts longer than expected for self-limiting conditions.

If it is decided that the child does not require hospitalization, but the diagnosis cannot be established, parents should be instructed, verbally or in writing, when to seek emergency medical attention (including how to recognize “yellow” and “red” signals).

Antipyretic treatment
Fever is an increase in temperature resulting from the action of substances known as pyrogens, produced under the control of the hypothalamus. The latter is sometimes compared to a thermostat, which stimulates the production or loss of heat to achieve an optimal set temperature.

It is important to distinguish between fever (regulated by the body) and hyperthermia (caused by external factors and not regulated by the hypothalamus).

Fever is a physiological response to infection and a number of other conditions. Despite this, some people, including many doctors, nurses, and parents, believe that fevers should be treated to bring the temperature down.
To reduce fever, there are a number of agents that can be used in monotherapy or in combination. Pharmacological treatment is fundamentally different from physical treatment, as it is aimed at reducing the temperature set by the hypothalamus, and not just cooling the body. If it is decided that fever control is necessary, the safest, most clinically and cost-effective treatment that is acceptable to the child should be used.
It is currently unknown whether antipyretic treatment should be used or whether it is beneficial. Also, the exact indications for the treatment of fever have not been determined. This leads to a wide variety of clinical approaches both in the application of treatment methods and in the goals of the latter. Some doctors aim to lower the temperature to a level they consider normal, while others simply lower the temperature. Although the conditions for which interventions are used may vary, it is important to understand the potential benefits and harms of fever treatment, including side effects.
An increase in body temperature occurs as a result of increased levels of prostaglandins in the hypothalamus. Paracetamol and non-steroidal anti-inflammatory drugs, such as ibuprofen, inhibit the action of cyclooxygenase, which is involved in the production of pro-inflammatory prostaglandins, which is the basis of the activity of these drugs. At the peripheral level, the production of pyrogenic cytokines is suppressed and the production of endogenous anti-inflammatory substances is stimulated.

Physical interventions
Physical treatment, such as sponging with cool water, cools the skin but does not reduce the concentration of prostaglandins, so the whole body temperature does not decrease. In addition, the hypothalamus still maintains temperature at elevated level, And physical treatment may cause shaking and other unwanted effects, since the body intends to maintain the temperature set by the hypothalamus.
In addition to wiping the body with a sponge soaked in cold or cool water, physical interventions also include undressing and blowing. All these methods use heat loss due to convection and evaporation, but do not eliminate the cause of fever, do not change the course of the disease and the temperature set by the hypothalamus. There are only a few well-designed studies examining the effectiveness of physical methods.
Wiping did not show any benefit compared with antipyretic drug alone. The addition of rubbing to pharmacotherapy did not lead to an additional decrease in temperature or the latter was short-term. Side effects of wiping in some children included crying and shaking. Undressing itself did not have a significant effect on body temperature. In a study by Lenhardt et al. (1999), in which fever was artificially induced in adult volunteers, active cooling of the body resulted in shivering and increased heat production and blood pressure. The most common side effect of wiping in children reported in studies was discomfort.
There is no evidence to date about the effect of opening windows and blowing air.
Due to the lack of evidence regarding clothing, children with fever should be dressed appropriately. environment to prevent overheating or hypothermia, primarily based on the child's comfort.

Sponge sponging with cold or cool water is not recommended for treating fever.
Children with a fever should not be undressed or re-dressed.

Drug therapy
The main way to control temperature is to prescribe antipyretic drugs such as paracetamol and ibuprofen. Unlike physical methods, these drugs change the temperature set by the hypothalamus, but they do not affect the original cause of the fever, such as an infectious process.
IN clinical studies paracetamol and ibuprofen were effective in reducing fever in children. Compared with paracetamol, ibuprofen showed a greater and/or longer-lasting effect on fever. However, in many comparative studies, paracetamol was prescribed at doses lower than those recommended today.
Despite the widespread use of paracetamol and ibuprofen in children with fever, the incidence side effects was low, and the safety profile of both drugs did not differ significantly. Today, there is more experience with the use of paracetamol, but at the same time there is an increase in the use of ibuprofen.

Antipyretic drugs should be considered in children with fever who appear distressed and unwell. Antipyretics should not be routinely prescribed for the sole purpose of reducing fever in febrile children without other bothersome symptoms. When making a decision, the views and wishes of the parents should be taken into account.

When treating children with fever, both doctors and parents often prescribe paracetamol and ibuprofen either sequentially or in combination. Determined that combination treatment doesn't give any additional benefits compared to monotherapy with one of these drugs and does not lead to a clinically significant additional decrease in body temperature. The safety of the combination of paracetamol and ibuprofen has not been confirmed. Anecdotal reports indicate the risk of potential drug interactions when coadministered.

Paracetamol and ibuprofen should not be given at the same time to children with fever.
An alternating treatment regimen (alternating between paracetamol and ibuprofen) should not be routinely used; however, if the child does not respond to one drug, another must be given.

Effects of lowering body temperature
In addition to the underlying disease, fever may be accompanied by a number of unpleasant symptoms, including pain, decreased appetite, drinking and activity. In some cases (for example, pain) these symptoms are a manifestation of the underlying disease, in others it is difficult to establish their exact cause.
Because fever is a normal response to infection, a number of studies have examined the effect of antipyretic treatment in specific conditions, including patients with malaria, chicken pox and various viral infections. Antipyretics have been found to slow down recovery and have an unreliable effect on well-being.
Parents are greatly concerned about the possibility of febrile seizures occurring against the background of fever. This symptom usually occurs in younger children and is very rarely associated with epilepsy and other problems in later life. Because antipyretics reduce body temperature, there is theoretical justification for their use in the prevention of febrile seizures. However, two currently available meta-analyses of studies of the use of paracetamol and ibuprofen for the prevention of febrile seizures in children with fever show that these antipyretics do not reduce the incidence of febrile seizures.

Antipyretics do not prevent febrile seizures and therefore should not be prescribed specifically for this purpose.

Memo to parents of children under 5 years of age discharged with fever
We believe that your child's condition allows him to be treated at home, but we ask you to consult a doctor if:
the child's health has deteriorated
Are you worried
Do you have questions about child care at home?
the child has seizures
the child has developed a rash that does not change color when pressed (see “glass test”)
fever lasts more than 5 days

Medical assistance telephone number_______________________________________________

OR take the child to ________________________________ as quickly as possible.

What to do if your child has a fever

Preventing dehydration
Offer your baby something to drink regularly (if your baby is breastfed, breast milk is the preferred drink).

Signs of dehydration:
sunken fontanelles (soft areas on the baby's head)
dry mouth
sunken eyes
no tears

If you notice signs of dehydration in your child, offer more fluids or, if concerned, seek medical attention.

Cloth
A child with a fever should not be completely undressed or re-wrapped. If your child is shaking or sweating a lot, change the amount of clothing they wear.

Medicines to reduce fever
It is not necessary to use medications (paracetamol or ibuprofen) to treat fever. However, if the child is very unwell, you can give him children's paracetamol or baby ibuprofen (read the instructions on the bottle first). Do not give your child these drugs at the same time. If he doesn't feel better after 2-3 hours, give him another drug.

Rubdown
DO NOT spray your child with water - this will not help reduce the fever.

Child monitoring
Check your child throughout the night to see if he or she develops a rash or gets worse. If a rash appears, do the glass test (see below). If your child does not get better, seek medical help. If a child has a fever, he should not attend kindergarten or school. Tell the nurse at these facilities about your child's illness.

Glass test
If your child has a rash, do the glass test. Press the glass beaker (the side) firmly against the area of ​​skin with the rash. If the rash is visible through glass and does not fade when pressed, consult a doctor immediately. The rash is harder to see on dark areas of the skin, so check light areas such as the palms, soles and abdomen.

Full text of the guide (in English): www.nice.org.uk/CG047

Prepared by Alexey Gladky

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Increased loss of water and beneficial microelements in the body is called dehydration. Unfortunately, this also often happens with our smaller brothers, in particular cats.

60% in the body healthy cat This is water!

A drop in water level of five percent or more is a sign of dehydration, a serious reason to consult a veterinarian. Any delay can end disastrously for your pet.

Three types of dehydration

There are three types of dehydration:

• weak - up to five percent;
• moderate - about five or ten;
• heavy - from ten and more.

Weak dehydration is practically asymptomatic. A slight weakness of the animal looks like simple fatigue after active games or hunting. Therefore, the onset of dehydration is almost impossible to notice.

Sticky saliva indicates moderate dehydration.

During moderate course the most striking and characteristic sign is the stickiness of saliva.

At severe course The cat is weak, constantly lies down, does not make contact, and refuses food and water. The doctor should determine the reasons. Finding out on your own will only delay time and aggravate the existing disease.

Symptoms of dehydration (tests)

Standard dehydration test.

Your home can help you check for dehydration. tests for skin elasticity and capillary refill time.

Skin elasticity checked by pulling back the skin on the nape of the neck. Normally, the skin should immediately return to its original position. A sick animal remains in a drawn-out state for some time. The time it takes for the skin to settle back to its original position indicates the severity of dehydration.

Capillary refill rate determined by pulling back the upper lip and pressing on the gum. Using a stopwatch, you can measure the time it takes for the area of ​​pressure to lose its whitish mark and return to its original appearance.

Normally, the return process takes up to two seconds. This test is performed to determine blood circulation, the presence of heart failure or shock.

Veterinarian examination

It is possible to determine the presence of dehydration by some visible signs.

Cannot go to the litter box for a long time, has difficulty emptying. If you listen, you can hear a rapid heartbeat.

Causes

If a cat stays outside for a long time and lacks fresh water, it can suffer from heatstroke and dehydration.

The causes of dehydration can be quite varied.

1. Diseases , which are characterized by such manifestations as: diseases digestive system, intoxication, infection with worms.
2. Pathologies in the animal’s body, in which frequent urination occurs - endocrine disorders: diabetes, .
3. Staying outside for a long time in extreme heat or in a stuffy enclosed room - heatstroke .
4. Inability to access fresh clean water .
5. Shock and stressful conditions : recent operations, medical painful events, moving in a confined space.
6. Pathologies or damage accompanied by heavy blood loss.
7. Feverish conditions .
8. In addition, any painful condition manifested by an increase in body temperature can provoke dehydration - injuries, inflammatory processes . The pet’s body is depressed in such cases and she refuses to take food and drink, which aggravates the course of the disease and general condition.

Treatment of dehydration

The principle of treating dehydration at home is to immediately replenish lost fluid.

Add canned cat juice to the water!

The animal should be placed in a cool, dark room and provided with sufficient water. It is sometimes recommended to supplement the drink with liquid from canned food, flavored water with the smell of meat and the presence of electrolytes.

If the pet refuses to take water on its own, you should force it to drink using a syringe.

Injecting fluid under the skin

Injection of liquid under the skin is also indicated. To do this, take a syringe with a needle and Ringer's solution. The animal's skin is lifted in the area of ​​the withers and the solution is injected. The dose of the administered solution is determined by the veterinarian.

If your pet does not refuse food, it is worth replacing dry and solid food with liquid food. Indicated with glucose solution.

Drug treatment for dehydration in cats

Drug treatment is prescribed by the doctor, based on the results of the examination and the identified pathologies that caused dehydration. You should not hesitate if such dangerous symptoms as occur. You should contact the clinic immediately.

Prevention

Make sure the water in your cat's bowl is always fresh.

For preventive purposes, it is necessary to control your pet’s access to water.

Frequent outdoor exercise in summer should be provided with a small shelter for the animal. If the cat has chronic diseases or genetic pathologies, you should carefully monitor her condition, changes in mood, behavior, changes in habits.

The diet must be balanced, contain sufficient quantity liquids. The room where the pet is kept should not be stuffy.

Assessment of the circulatory system

The initial assessment of the circulatory system is carried out on the basis of an analysis of the characteristics of the pulse, arterial and central venous pressure, the state of the myocardium - using electrocardioscopy or electrocardiography.

Heart rate. Normal heart rate is about 60-80 beats per minute. Its deviation in one direction or another in critically ill patients should be considered an unfavorable sign.

A significant decrease or increase in heart rate can cause cardiac output to fall to the point of hemodynamic instability. Tachycardia (more than 90-100 beats per minute) leads to an increase in the work of the heart and an increase in its need for oxygen.

At sinus rhythm The maximum tolerated heart rate (that is, maintaining adequate blood circulation) can be calculated using the formula:

Heart rate max = 220 - age.

Exceeding this frequency can cause a decrease in cardiac output and myocardial perfusion even in healthy people. When coronary insufficiency and other pathological conditions, cardiac output may decrease with more moderate tachycardia.

It should be borne in mind that sinus tachycardia during hypovolemia is an adequate physiological response. Therefore, hypotension in this condition should be accompanied by compensatory tachycardia.

The development of bradycardia (less than 50 beats per minute) can lead to circulatory hypoxia, as well as a critical decrease in coronary blood flow and the development of myocardial ischemia.

The main causes of severe bradycardia in emergency medicine are hypoxemia, increased tone vagus and high degree cardiac conduction block.

Normally, a healthy heart adapts to physiological or pathological depressions in heart rate through the Starling mechanism. A well-trained athlete can have a resting heart rate of less than 40 beats per minute without any negative effects. In patients with impaired myocardial contractility or distensibility, bradycardia less than 60 beats per minute may be accompanied by a significant decrease in cardiac output and systemic blood pressure.

In case of rhythm disturbances, pulse waves may follow at unequal intervals of time, the pulse becomes arrhythmic (extrasystole, atrial fibrillation, etc.). The number of heartbeats and pulse waves may not match. The difference between them is called heart rate deficit. The presence of heart rhythm disturbances can significantly worsen the patient’s condition and is subject to corrective therapy.

Measuring blood pressure provides valuable information about the overall hemodynamic status. The simplest way to measure blood pressure is to palpate the pulse on the radial artery using a sphygmomanometer cuff. The method is convenient in emergency situations, but is not very accurate in cases of low blood pressure or in the presence of vasoconstriction. In addition, only systolic blood pressure can be determined in this way.

More accurate, but requiring more time and the use of a phonendoscope, is measurement by auscultation of Korotkoff sounds over the arteries in the cubital fossa.

Currently, indirect blood pressure measurement using automated oscillometry is becoming increasingly popular.

The accuracy of the various electronic devices for non-invasive blood pressure measurement currently available is no better, and sometimes even worse, than with standard methods. Most models are not accurate at systolic pressures below 60 mmHg. Art. In addition, there is an underestimation of high blood pressure. Blood pressure readings may not be possible during episodes of arrhythmia, and oscillometers may not be able to detect sudden changes in blood pressure.

In patients with shock, invasive methods of measuring blood pressure are preferred, but they are currently of limited use. prehospital stage(although technically these methods do not present much difficulty).

Systolic blood pressure is within 80-90 mmHg. Art. indicates a deterioration that is dangerous but compatible with maintaining basic vital functions. Systolic pressure is below 80 mm Hg. Art. indicates the development of a life-threatening condition requiring immediate emergency measures. Diastolic pressure over 80 mm Hg. Art. indicates an increase in vascular tone, and pulse pressure (the difference between systolic and diastolic pressure is normally 25-40 mm Hg) is less than 20 mm Hg. Art. - about a decrease in stroke volume of the heart.

The value of blood pressure indirectly characterizes cerebral and coronary blood flow. Autoregulation of cerebral blood flow maintains the constancy of cerebral blood flow during changes in mean arterial pressure from 60 to 160 mmHg. Art. by regulating the diameter of the supply arteries.

When the limits of autoregulation are reached, the relationship between mean arterial pressure and volumetric blood flow becomes linear. When systolic blood pressure is below 60 mm Hg. Art. reflation of cerebral vessels is disrupted, as a result of which the volume of cerebral blood flow begins to passively follow the level of blood pressure (with arterial hypotension brain perfusion decreases sharply). But it should be remembered that blood pressure does not reflect the state of organ and tissue blood flow in other parts of the body (except the brain and heart).

The relative stability of blood pressure in a patient with shock does not always indicate the preservation of the normal physiological optimum of the body, since its stability can be achieved by several mechanisms.

Arterial pressure depends on cardiac output and general vascular resistance. The relationship between the level of systolic and diastolic blood pressure can be considered as the relationship between stroke volume and minute volume of blood circulation on the one hand and the resistance (tone) of peripheral vessels on the other. Maximum pressure mainly reflects the volume of blood ejected into the vascular bed at the time of cardiac systole, since it is determined mainly by the minute volume of blood circulation and stroke volume. Blood pressure may change as a result of changes in vascular tone of peripheral vessels. An increase in vascular resistance with a constant minute volume of blood circulation leads to a predominant increase in diastolic pressure with a decrease in pulse pressure.

Mean arterial pressure (MAP) is normally 60-100 mm Hg. Art. In clinical practice, mean arterial pressure is calculated using the formulas:

SBP = BP diast + (BP syst - BP dist)/3 or SBP = (BP syst + 2A D diast)/3.

Normally, in a supine patient, the mean arterial pressure is the same in all major arterial vessels. There is usually a small pressure gradient between the aorta and the radial vessels. The resistance of the vascular bed has a significant impact on the supply of blood to the body's tissues.

The average arterial pressure is 60 mm Hg. Art. can cause abundant blood flow through a significantly dilated vascular bed, while a mean arterial pressure of 100 mm Hg. Art., may be inadequate during malignant hypertension.

Errors in measuring blood pressure. The pressure determined by sphygmomanometry is characterized by inaccuracy when the cuff width is less than 2/3 of the arm circumference. The measurement may show increased blood pressure if the cuff is too narrow, or if there is severe atherosclerosis that prevents pressure from compressing the brachial artery. In many patients with hypotension and low cardiac output, the points of muffling and disappearance of sounds during determination of diastolic pressure are poorly distinguishable. During shock, all Korotkoff sounds may be lost. In this situation, Doppler ultrasound cardiography helps to detect systolic pressures below the threshold of audibility.

The state of central hemodynamics can be quickly assessed by the ratio of pulse rate and magnitude systolic pressure. To determine the severity of the condition and the need for emergency measures, the following nomogram is convenient.

Normally, the systolic pressure value is twice the pulse rate (respectively 120 mm Hg and 60 beats per minute). When these indicators are equalized (tachycardia up to 100 per minute and a decrease in systolic pressure to 100 mm Hg), then we can talk about the development of a threatening condition. A further decrease in systolic blood pressure (80 mm Hg and below) against the background of tachycardia or bradycardia indicates the development of a shock state. Central venous pressure serves as a valuable, but very rough indicator for assessing the state of central hemodynamics. It represents the gradient between intrapleural pressure and pressure in the right atrium. Measuring central venous pressure allows us to indirectly assess venous return and the state of contractile function of the right ventricular myocardium.

Central venous pressure is determined using a catheter inserted into the superior vena cava through the subclavian or jugular vein. A Walkhchan device for measuring central venous pressure is connected to the catheter. The zero mark of its scale is set at the level of the midaxillary line. Central venous pressure characterizes venous return, mainly dependent on the volume of circulating blood, and the ability of the myocardium to cope with this return.

Normally, the central venous pressure is 60-120 mmH2O. Art. Its decrease is less than 20 mm of water. Art. serves as a sign of hypovolemia, while an increase of more than 140 mm of water. Art. caused by inhibition of the pumping function of the myocardium, hypervolemia, increased venous tone or obstruction to blood flow (cardiac tamponade, pulmonary embolism, etc.). That is, hypovolemic and distributive shocks cause a decrease in central pressure, and cardiogenic and obstructive shocks cause an increase.

Increase in central venous pressure above 180 mmH2O. Art. indicates cardiac decompensation and the need to stop or limit the volume of infusion therapy.

With central venous pressure in the range of 120-180 mm water. Art. You can use a trial jet infusion of 200-300 ml of liquid into a vein. If there is no additional rise or it is eliminated within 15-20 minutes, then the infusion can be continued by reducing the infusion rate and monitoring venous pressure. The level of central venous pressure is below 40-50 mmH2O. Art. should be regarded as evidence of hypovolemia requiring compensation.

This test serves as a key test for determining hemodynamic reserve. Improving cardiac output and normalizing systemic blood pressure without developing symptoms of excessive cardiac filling pressure makes it possible to adjust infusion and drug therapy.

Capillary refill rate. When assessing circulatory status, it is useful to check the refilling of the pulse and the rate of refilling of the capillaries of the nail bed (spot sign). The duration of filling of the capillaries of the nail bed after pressure is normally no more than 1-2 seconds, with shock it exceeds 2 seconds. This test is extremely simple, but not very popular in clinical practice, since it is difficult to accurately determine the moment and time of disappearance of a pale spot on the skin after pressure.

28. Pathology of the cardiovascular system: main heart diseases, their causes, prevention.

Diseases of the cardiovascular system include atherosclerosis, hypertension, coronary heart disease (CHD), rheumatic diseases, inflammatory heart diseases and defects, as well as congenital and acquired vascular diseases. The morbidity and mortality rate of the population around the world from these diseases is the highest. Atherosclerosis, hypertension and ischemic heart disease are considered among the main diseases of the 20th and 21st centuries.

Their significance became clear only at the beginning of the twentieth century. Thus, myocardial infarction was first described in detail by V.P. Obraztsov and N.D. Strazhesko in 1909. The term “atherosclerosis” was proposed by Marchand in 1904, and how independent disease atherosclerosis was isolated by N.N. Anichkov and S.S. Khalatov in 1913. Hypertension as a nosological form was described in 1922 by G.F. Lang. I.V. Davydovsky called these diseases “diseases of civilization,” considering them an expression of a person’s inability to adapt to rapidly progressing urbanization, civilization, and the associated change in lifestyle, constant stress, violation of environmental conditions and other features of the so-called civilized society.

In the etiology, pathogenesis and morphogenesis of atherosclerosis and hypertension much in common. IHD is essentially a cardiac form of atherosclerosis and hypertension. However, despite the fact that these are different diseases, they are characterized by atherosclerotic damage to large and medium arteries. Vascular atherosclerosis also develops in a number of other diseases, especially endocrine and viral ones. Atherosclerosis is not only an independent nosological form, but also the body’s response to changes in various types of metabolism in combination with damage to the inner lining of the arteries. The causes of these disorders are different, which is probably why it is so difficult to determine the etiology of atherosclerosis.

Atherosclerosis is just a type of arteriosclerosis, that is, hardening of the artery walls as a result of various reasons, developing through a variety of mechanisms. There are several types of arteriosclerosis:

∨ metabolic arteriosclerosis, or atherosclerosis;

∨ arteriolosclerosis, or hyalinosis (with hypertension);

∨ inflammatory arteriosclerosis (with syphilis, tuberculosis, etc.);

∨ allergic arteriosclerosis (polyarteritis nodosa);

∨ toxic arteriosclerosis (for example, adrenal);

∨ primary calcification of the medial tunic of arteries (Mönckeberg mediacalcinosis);

∨ age-related (senile) arteriosclerosis.

ATHEROSCLEROSIS

Atherosclerosis (from the Greek atheros - mush and sclerosis - compaction) - chronic illness arteries of the elastic and muscular-elastic type, caused by disorders of fat and protein metabolism. Characterized by focal deposits in the inner lining of blood vessels of proteins and lipids, followed by the growth of connective tissue around them.

Atherosclerosis affects the majority of the world's population, but the disease is especially widespread in Europe and North America. It affects people starting from 25-30 years old; in this age group, men are affected 5 times more often than women, although after 45-50 years these differences are less pronounced, and after 70 years atherosclerosis is expressed equally in men and women. Complications of atherosclerosis, regardless of gender, are the main cause of mortality in the world.

The etiology of atherosclerosis has not been fully established, although it is recognized that this polyetiological disease is caused by a combination of changes in fat and protein metabolism with damage to the arterial endothelium.

Risk factors for the development of atherosclerosis: age, gender, heredity, hyperlipidemia, arterial hypertension, smoking, hormonal factors, stressful situations, obesity, physical inactivity, viruses.

Hyperlipidemia (hypercholesterolemia) is a major risk factor caused by an imbalance in the blood ratio of low and very low density lipoproteins (LDL and VLDL) with high and very high density lipoproteins (HDL and VLDL). This ratio in atherosclerosis is 5:1 or more (normally 4:1). It has been established that 65% of cases of atherosclerosis are associated with an increase in the content of LDL and VLDL in the blood, and about 35% - with a decrease HDL level. This risk factor also includes triglyceridemia.

Hyperlipidemia is often associated with hereditary factors and dietary habits. Therefore, to a certain extent, it explains geographical and ethnic differences in the incidence of atherosclerosis.

Age. The undoubted increase in the frequency and severity of atherosclerosis with age allows a number of authors to consider atherosclerosis not as a disease, but as a natural problem of age.

Floor. Men begin to suffer from atherosclerosis earlier than women, and their disease is more severe. Therefore, complications of atherosclerosis in men are more frequent.

Heredity plays an important role in the development of atherosclerosis, since the existence of genetic forms of the disease associated with mutations or defects of certain genes has been proven. Often, but not always, it is accompanied by other genetically determined risk factors - diabetes mellitus, arterial hypertension, etc.

Hypertension. An increase in blood pressure of any origin leads to an increase in the permeability of vascular walls, including for lipoprotein complexes, which contributes to endothelial damage. Hypertension is associated with the appearance of atherosclerotic plaques in vessels atypical for atherosclerosis - in the pulmonary artery with hypertension of the pulmonary circulation, in the portal vein with portal hypertension.

Smoking. Atherosclerosis of the coronary arteries and aorta is 2 times more pronounced in smokers, it is diagnosed 2 times more often than in non-smokers. Therefore, myocardial infarction, as well as other complications of atherosclerosis, occurs much more often in smokers than in non-smokers.

Hormonal factors. Most hormones, to one degree or another, affect disorders of fat and protein metabolism. Particularly important risk factors are diabetes mellitus and hypothyroidism. Atherosclerosis (macroangiopathy) in these diseases is associated with severe hyperlipidemia and a significant increase in LDL in the blood (see Chapter 18). This risk factor contributes to the development of atherosclerotic vascular occlusion.

Taking oral contraceptives for more than 5 years is close to hormonal risk factors; it increases the risk and intensity of early development of atherosclerosis in women.

Stressful situations are a clear risk factor. They lead to psycho-emotional stress, causing disturbances in the neuroendocrine regulation of fat-protein metabolism and vasomotor disorders.

Obesity and physical inactivity contribute to disruption of fat-protein metabolism and accumulation of LDL and VLDL in the blood.

Viruses are also likely to be a risk factor, especially Herpes simplex. Viruses that infect endothelial cells can enhance their procoagulant activity, endothelial destruction, and platelet adhesion.

HYPERLIPIDEMIAS

All risk factors disrupt fat-protein metabolism, causing hyperlipidemia, hypercholesterolemia, a significant progressive increase LDL level and VLDL, the appearance of modified apo-β-lipoproteins. The mechanisms of these metabolic disorders are different, although they can complement each other in the pathogenesis of atherosclerosis.

A combination of hyperlipidemia and hypercholesterolemia is required, and disorders of fat-protein metabolism obviously begin with changes in cholesterol metabolism. Cholesterol imbalance is possible due to excess intake of cholesterol from food, excess synthesis, or disruption of its removal from the body. In any case, dislipoproteinemia occurs, i.e. disturbance of the content of lipoproteins in the blood plasma and changes in the ratio of their fractions. Depending on the cause, hyperlipidemia is divided into genetic (primary), secondary and nutritional (related to dietary habits).

Genetic hyperlipidemia and hypercholesterolemia are caused by hereditary disorders of lipid metabolism. Their frequency in the population is from 1 to 2000 per 1 million, which is associated with mutations of certain genes encoding the synthesis and function of LDL receptors cell membranes(Goldstein-Brown theory of atherosclerosis), as well as other reactions in the process of lipoprotein metabolism. Genetic hyperlipoproteinemias are manifested by pronounced early atherosclerosis, primarily of the coronary arteries. The following types of genetic hyperlipidemia are known.

◊ Familial hypercholesterolemia, when genetic changes occur that lead to a deficiency of cellular LDL receptors.

◊ Familial hypo-α-lipoproteinemia is caused by a genetic defect in apolipoproteins A-I and A-II, which leads to a decrease in HDL levels, blockade of reverse cholesterol transport and, as a result, dyslipoproteinemia and hypercholesterolemia.

◊ Cholesteryl ester storage disease in young people is associated with a genetic defect in lysosomal lipase and, accordingly, impaired cholesterol catabolism.

◊ Familial combined hyperlipidemia.

◊ Familial triglyceridemia.

The genetic defect causing the latter two diseases is unknown, but both are characterized by hereditary hyperlipidemia and dyslipoproteinemia.

Secondary hyperlipidemias (with diabetes mellitus, hypothyroidism, nephrotic syndrome and other diseases) are described in Chapter 18.

Nutritional hyperlipidemias are associated with dietary habits.

PATHOGENESIS OF ATHEROSCLEROSIS

The role of LDL receptors of cell membranes in the development of atherosclerosis is apparently universal, but in hereditary disorders of lipid metabolism, deficiency of LDL receptors of cytomembranes is primary, and in secondary or alimentary hyperlipoproteinemia and hypercholesterolemia it is secondary and serves as the most important link in the pathogenesis of atherosclerosis. Thus, hyperlipidemia may be associated with infiltration of the inner lining of the arteries with exogenous or endogenous cholesterol. The mechanism of infiltration is blockade of LDL receptors in the membranes of liver cells, adrenal glands, fibroblasts, lymphocytes, endothelial cells by an excessive amount of LDL, VLDL, modified apo-β-lipoproteins, inhibition of regulated lipoprotein metabolism. Under these conditions, cells of the macrophage system - monocytes, macrophages, endothelial cells and others, which have receptors for LDL and modified lipoproteins ("scavenger receptors"), as well as receptors for Fc fragments of immune complexes, carry out unregulated (unsaturated) lipoprotein metabolism. Cholesterol from various types of lipoproteins enters the lysosomes of macrophages, and its excess must be removed by HDL. With hyperlipidemia, the cholesterol elimination system is insufficient; it accumulates in macrophages and smooth muscle cells of the vascular walls, resulting in foamy or xanthoma cells. Thus, in atherosclerosis, the unregulated metabolism of lipoproteins prevails over the regulated exchange of LDL and VLDL.

In the pathogenesis of atherosclerosis, hyperlipidemia and dyslipoproteinemia are combined with endothelial damage, which leads to the onset of atherosclerotic plaque formation. Possible damaging factors:

∨ hyperlipidemia;

∨ hypercatecholaminemia;

∨ immune complexes and other components immune system;

∨ toxins, viruses;

∨ hemodynamic effects (hypertension, vascular spasms and paresis, rheological disorders, etc.).

Usually the influence of several damaging factors.

Combinations of changes various parameters blood with damage to the inner lining of the arteries underlie most theories of atherosclerosis, confirmed clinically.

Infiltration theory of atherosclerosis N.N. Anichkova and S.S. Khalatova emphasizes the importance of exogenous hypercholesterolemia and hyperlipidemia as the causes of the development of this disease.

Neuro-metabolic theory of A.L. Myasnikova assigns the main role in the development of the disease to repeated stressful situations, causing psycho-emotional stress. This leads to a disorder in the neuroendocrine regulation of fat-protein metabolism and vasomotor disorders. The resulting hyperlipidemia in combination with hypercatecholaminemia and vasomotor reactions causes damage to the vascular endothelium.

Immunological theory of A.N. Klimov and V.A. Nagorneva considers atherosclerosis as an immune inflammation. Proof of this is characteristic changes in the immune system, the presence of autoimmune complexes and immunocompetent cells in the vascular wall, progression of the disease when using immunosuppressants in the case of organ transplantation, etc.

The Goldstein-Brown receptor theory explains well the reasons for the development of hereditary forms of atherosclerosis and, probably, the features of secondary and nutritional hyperlipidemias.

The monoclonal (neoplastic) theory is based on the assumption that atherogenesis is based on a mutation in one or more genes that regulate the cell cycle, which leads to the proliferation of smooth muscle cells vascular wall. These altered cells trigger the atherosclerotic process.

Duguede's thrombogenic theory identifies the causes of the formation of flat parietal thrombi with their subsequent organization in the aorta and other arteries, which is often the case with atherosclerosis.

The viral theory of the disease has been confirmed mainly experimentally.

Obviously, all these mechanisms leading to damage to the endothelium, its desquamation, increased permeability of the inner lining of the arteries, and disorders of fat-protein metabolism in one or another combination are involved in the multifactorial pathogenesis of atherosclerosis.

MAIN STAGES OF PATHOGENESIS OF ATHEROSCLEROSIS

Before the appearance of morphological changes in the inner lining of the arteries, atherogenic dislipoproteinemia, hypercholesterolemia with cholesterol levels above 250-300 mg% occurs. Modified lipoproteins appear and are intensively captured by VLDL receptors and scavenger receptors of endothelial cells.

The beginning of the formation of an atherosclerotic plaque and atherosclerosis as a disease is damage to the endothelium and an increase in its permeability. As a result, a large amount of lipoproteins and other components of blood plasma penetrate into the inner lining of the arteries. Subendothelial mucoid edema develops. After exfoliation of some of the damaged endothelial cells, contact of platelets with the basement membrane of the inner membrane is possible, and some of the endothelial cells lose their anticoagulant properties.

Damaged endothelial cells release adhesion molecules (ICAM-1, VCAM-1, LFA-1), which leads to the adhesion of platelets, monocytes, and lymphocytes to the endothelium. Platelets secrete transforming growth factor (TGF). Monocytes penetrate into the subendothelial space and turn into macrophages that synthesize cytokines (IL-1, TNF, TGF, fibroblast growth factor, etc.). The latter cause chemotaxis and cell proliferation. Lymphocyte cytokines also mediate chemotaxis of cells involved in immune inflammation.

Macrophages, platelets, and damaged endothelium release TGF, which stimulates the smooth muscle cells of the arterial wall. Smooth muscle cells migrate to the inner membrane, where they begin to synthesize proteoglycans, collagen, and elastin, necessary for the construction of collagen and elastic fibers. At the same time, the synthesized types of collagen ensure the affinity of lipoproteins for accumulations of smooth muscle cells, which also contributes to the accumulation of lipids.

In the inner lining of the arteries, peroxidation of lipoproteins occurs under the influence of macrophage cytokines. Complexes of lipoproteins with proteoglycans arise, and the latter are captured by macrophages and smooth muscle cells. At the same time, unregulated absorption of modified VLDL is possible in myocytes. In macrophages and smooth muscle cells, the recycling system, primarily lysosomes, is depleted. When the cytoplasm is loaded with lipids, xanthoma cells arise. Subsequently, macrophages, smooth muscle and xanthoma cells are destroyed, which contributes to the accumulation of extracellular lipids.

As the disease progresses, vessels form in the atherosclerotic plaque, the processes of sclerosis and hyalinosis increase, necrosis of the center of the plaque and its calcification occur (Fig. 10-1).

Rice. 10-1. Pathogenesis of atherosclerosis. Abbreviations: GF - growth factor, TrGF - platelet-derived growth factor, SMC - smooth muscle cell.

Nobody wants to be considered a suspicious eccentric. So we wait, sometimes until we are told reproachfully: “Where were you before?!” But there are situations when you can’t hesitate, when you count not by hours, but by minutes and even seconds. Moreover, unfortunately, illnesses and accidents can sometimes strike your pets in the field, where immediate veterinary care is difficult.

So, it is important not only not to get confused, to adequately assess the situation, to provide first aid before visiting a doctor, but also to use the means at hand to save your dog’s life. The purpose of this article is to consider various emergency conditions, to help master skills first aid, which will help you gain time before visiting the veterinary clinic, and possibly save your pet’s life.

Please note that this guide is not a substitute for visiting your doctor. In many cases, additional diagnostics are required (X-rays, ultrasound, blood tests, etc.), which is only possible in a clinical setting, as well as hospitalization and subsequent treatment.

What situation should be considered an emergency?

Most owners see their pets as members of their family. Therefore, they care about the well-being of their charges and show special observation in everything related to health.

The owner must be able to assess whether his pet needs the help of a doctor when he sees signs of ill health. Of course, experienced specialists will provide your dog with professional help, but only if you, the owner, are able to recognize the signs of the disease.

It is quite difficult to formulate a clear definition of an emergency situation. The basic rule is: if you think your pet needs veterinary care, seek it.

The dogs' vital signs are normal. Undoubtedly, every owner should have an idea of ​​the normal vital parameters of their pet. With this knowledge, you will be able to notice deviations in early stage. Deviation of any indicator from the norm may constitute an emergency situation.

Behavior and mental activity are normal. Every owner is familiar with their dog's normal activity level and behavioral patterns. Any deviations from the norm may indicate an emergency.

Airway patency. At rest, healthy dogs breathe with their mouths closed, making no noise. Dogs with a flattened muzzle (brachycephalic breeds such as English bulldogs, pugs, and Pekingese) typically wheeze or make “snorting” sounds when breathing, especially while sleeping.

Breath

Normally, an animal's breathing does not require much effort.

The normal resting respiratory rate depends on the size of the animal:

For small breeds (Chihuahua, Yorkshire Terrier) this figure is breaths per minute;

For medium breeds (Australian Shepherd, Boxer): breaths per minute;

For large breeds (Labrador, German Shepherd): breaths per minute;

For giant breeds (Great Dane, Malamute, Irish Wolfhound): 8-20 breaths per minute;

In hot weather or during physical activity, a healthy dog's breathing rate can increase to 200 breaths per minute. Puppies aged 8-10 weeks breathe at rest at a rate of breaths per minute.

Heart rate. In order to count the number of heartbeats (HR), you need to place your palms on the animal’s chest on both sides (for dogs of medium or large breeds), or clasp the chest from below with one palm (for dogs of small breeds) placing the palm immediately behind the elbows joints.

For small and dwarf breeds(poodle, chihuahua, yorkshire terrier) beats per minute;

For medium breeds (Australian Shepherd, Boxer) beats per minute;

For large breeds (Labrador Retriever, German Shepherd, Golden Retriever) beats per minute;

For giant breeds (Great Dane, Irish Wolfhound, Malamute) beats per minute.

In athletic dogs, the heart rate may be slightly lower than indicated. In puppies up to 8-10 weeks of age, the heart beats at a rate of beats per minute.

Pulse rate

It is most convenient to count the pulse by feeling it on the femoral artery. It is located on the inner surface of the hind limb, closer to the abdomen. Grasp the front of the animal's left hind limb with the palm of your left hand, placing your thumb on the outside and the other four fingers on the inside of the thigh. The same procedure can be done with the right hand, checking the pulse on the right hind limb. Carefully feel the pulse (pulsation of the artery) with the tips of the index, middle and ring finger, placing them in a row.

Coherence of heart contractions and pulse.

Normally, the pulse rate is equal to the heart rate.

Color of mucous membranes and.

The mucous membranes are rich in blood vessels. The color of the mucous membranes will give you an idea of ​​the quality of their blood supply. The easiest way to assess the color of the mucous membranes is by examining the gums and the inner surface of the eyelids. In healthy dogs, the color of the mucous membrane is pale pink. For some dogs, black pigmentation on the gums and inner lips is normal. In this case, assessing blood supply is difficult.

Body temperature. In dogs, temperature is measured rectally using an electronic or mercury thermometer.

Lubricate the end of the thermometer with Vaseline and carefully insert it into the animal's rectum approximately 2.5 cm. Assess the result after 1-3 minutes.

Normal temperature in dogs ranges from 37.8 to 39.2 C.

Emergency criteria

Deviation in behavior and activity.

First of all, you may notice deviations in the general condition of your pet, in the form of decreased activity (depression, lethargy) or unusual behavior. The most common symptom in an emergency situation is general depression, fast fatiguability after light or moderate physical activity, reluctant movement. The head is lowered, the tail is tucked. Instead of oppression there can be excitement. Aggression or fear often indicates that the animal is in pain.

Airway obstruction.

In dogs that are not brachycephalic breeds (those with a “flattened muzzle”), breathing should not be noisy, either with the mouth open or closed.

If you hear your pet breathing, it is possible that he has an obstructed upper airway, for example due to a foreign body blockage, a pathological mass (such as a tumor), or swelling of the pharynx or larynx.

Visible effort during inhalation and/or exhalation indicates an emergency condition, especially if the animal is breathing with its mouth open.

Breathing disorders due to diseases of the respiratory system may be less obvious. For example, you may only notice rapid breathing, not accompanied by any special effort.

Any circulatory disorders are usually accompanied by changes in several parameters of the body. For example, changes in the color of mucous membranes, pulse, heart rate and capillary refill rate can be simultaneously observed.

Heartbeats may be excessively frequent or, conversely, rare. You can determine if there are any abnormalities only by knowing your pet's normal heart rate. In most cases, acceleration or deceleration of heartbeats is combined with a change general condition animal, color of mucous membranes and capillary refill time.

The pulse can also be rapid or too rare. In addition, it can be consistently weak, or vary in the filling of blood vessels.

In circulatory disorders, the pulse beats usually lag behind the heart beats, which can be determined by simultaneously monitoring the pulse and heartbeats.

An increase in capillary refill time indicates deterioration of blood flow. If the capillary refill time exceeds 2 seconds, the animal should be shown to a veterinarian. An indicator of less than 1 second in dogs with intensely pink mucous membranes may also indicate a pathology that requires examination.

Typically, an increase in capillary refill time is combined with a rapid or slow heartbeat.

If the animal's mucous membranes are too pale or white look The animal needs to be shown to a veterinarian.

An animal with any disturbances in activity, breathing or circulation needs immediate first aid and transportation to a veterinarian.

Categories of severity of general condition

In emergency situations, there is a so-called triage of patients based on the severity of their condition.

Safety precautions

When providing first aid to an animal, your first priority is to ensure your own safety. A sick animal can behave unpredictably even towards a person trying to help it. Keep in mind that if you are bitten or severely scratched, you will not be able to help an animal in need. Remember: “safety is the key to success.”

Restrain the animal carefully. In an emergency, your goal is to provide help without causing harm. Incorrect or rough manipulations can harm the animal. Do not give any medications before consulting with your veterinarian.

Transportation of the victim

The best thing you can do for a sick and, in particular, injured animal is to take it to a veterinary clinic.

Give the victim maximum peace and comfort. Transport stray dogs with extreme caution. Such animals, as a rule, are not accustomed to people; when you approach, all of them, and especially the injured ones, will experience severe fear. You can use plywood or other hard material as a stretcher. Secure your dog to the stretcher using rope or duct tape. Small dogs can be transported in boxes lined with fabric.

Clinical death

The basis for performing cardiopulmonary resuscitation is the presence of obvious signs clinical death(this is the name given to the visible cessation of vital body functions).

The onset of clinical death is determined by one or more of the following signs:

Complete cessation of breathing

Undetectable heartbeats and pulse

Mucous membranes remain blue

Persistent loss of consciousness

There are situations when the animal’s breathing, heartbeat and pulse are present, but the patient is unconscious. If you try to perform cardiopulmonary resuscitation on him, and at that moment the animal suddenly regains consciousness, you risk serious bites!

Respiratory arrest/cardiac arrest

Primary resuscitation measures should be started when the animal is unconscious. Artificial respiration is the most important technique for maintaining life, since the most common cause of death in animals is respiratory arrest.

Make sure the animal's airway is clear;

Use one hand to squeeze the dog's mouth to prevent air leakage during forced inhalation. With your other hand, lightly squeeze both sides of the trachea to prevent air from entering the stomach instead of the lungs;

Gently blow air into the animal’s nostrils (for 1-1.5 seconds at a time);

The smaller the dog, the less force the air should be blown into;

Artificial respiration should be performed at a rate of breaths per minute.

Circulatory support

During cardiopulmonary resuscitation, circulation is maintained by rhythmic chest compressions, also known as indirect massage hearts.

Animals with obvious chest injuries should not undergo chest compressions.

Your goal is to ensure sufficient blood flow to the heart and brain to support their activity. The choice of massage technique depends on the number of people providing assistance and the size of the animal.

Maintaining blood circulation should be combined with artificial respiration:

When providing assistance alone, alternate two consecutive breaths with five chest compressions

If two people perform resuscitation, one person only performs artificial respiration(15-20 breaths per minute). The second performs chest massage as described below:

Small dogs (100 clicks per minute):

One or both palms clasp the chest from below or above, while the animal should lie on its side

The chest is compressed in the center, not necessarily above the heart

Concentrate pressure on one point. Rough pressure can break ribs. Be careful not to compress your chest too much due to anxiety.

Medium to large dogs (100 strokes per minute):

Lay the animal on its side and stand behind it. During the massage, you can press the animal with your leg or thigh to ensure its immobility.

Straighten your arms, clasp the fingers of both palms and place your palms on your chest. Remember, pressing on the chest near the heart is not as effective as squeezing the chest where it is widest;

Start the massage at a pace of 100 compressions per minute;

Do not squeeze the cell more than half its volume. Ribs can be broken!

Basic resuscitation techniques should be performed on the way to the veterinary clinic, because further special resuscitation measures and supportive treatment will be required, which are possible only in a clinic setting.

It should be understood that even in cases where resuscitation is carried out on time and correctly, it happens that its techniques are not enough to maintain brain life and prevent death, even if it is possible to restore cardiac and respiratory activity.

Diseases of the upper respiratory tract, larynx, trachea

Symptoms of diseases of the upper respiratory tract, larynx and trachea differ from diseases of other parts of the respiratory system due to noisy breathing. Mainly while inhaling.

During inhalation, the muscles of the chest and abdomen in such patients work hard to draw air into the lungs. When expanded, the chest noticeably increases in volume, and the walls abdominal cavity"fall inside."

While inhaling, the dog may open its mouth and experience obvious difficulty breathing. The animal looks restless. There may be an increase in temperature as a result of impaired thermoregulation. An increase in temperature, in turn, worsens shortness of breath. Gums are pale, white or bluish.

Foreign body in the upper respiratory tract, pharynx or trachea.

Dogs love to play with foreign objects that are convenient to hold in their mouths. During play, such an object can slip into the throat and block its lumen. This condition is life-threatening. Emergency assistance required.

If a foreign body is visible in the lumen of the pharynx:

Do not try to remove the item with your fingers;

It is necessary to apply the Heimlich maneuver:

If the dog is conscious: from the animal’s back, put your arms around its waist. Make a fist with one hand and place your thumb on your stomach, in the middle, just above your navel. With your other hand, clasp your fist tightly with your hand. Next, with sharp jerking movements of both hands, you need to press on the abdominal area several times in a row. If the technique is effective and the foreign body has advanced into oral cavity, you will hear a deep breath and a convulsive cough.

Please note that the Heimlich maneuver should only be used when the foreign body is visible;

The use of this method in case of other causes of difficulty breathing may harm the animal;

Improper execution can harm the dog;

After removing a foreign body using this method, it is necessary to show the animal to a doctor.

If the efforts do not lead to success, the animal loses consciousness, the mucous membranes begin to turn blue, it is necessary to immediately turn the animal over a bent knee, head down on its stomach, and hit the interscapular area with the palm of the hand several times. If a foreign object then moves into the oral cavity, remove it (provided you can see it!)

While providing assistance, you must call veterinarian or go to the veterinary clinic.

Laryngeal paralysis

This condition is common in older dogs of large breeds (such as Labradors, golden retrievers). The essence of the disease is that the lumen of the larynx, which is located behind the pharynx and in front of the trachea, loses its ability to expand during inhalation. The larynx stops opening and the flow of air cannot penetrate the windpipe.

An early sign of the disease is a change in the timbre of barking; in some cases, the dog completely loses the ability to bark. Breathing becomes difficult and very noisy.

Laryngeal paralysis is often found in animals experiencing difficulty breathing after active or moderate load. Sometimes paralysis manifests itself more clearly when the weather changes (warming), which makes it possible to establish a diagnosis. Severe respiratory distress in overweight dogs in hot, humid weather is also typical of this disease.

It is important to exclude symptoms of rabies when such complaints occur. This disease is deadly for people and animals.

Has the animal been vaccinated against rabies no more than 12 months ago?

Has your dog been bitten by other animals for at least 2 months?

Is the animal kept in areas where rabies has occurred?

At the slightest suspicion of rabies, you must contact your local state veterinary clinic! First aid for difficulty breathing due to paralysis:

Wet your dog's chest and belly with cool or cold water;

Minimize exposure to stress factors;

Do not try to insert your hands or any tools into the dog's mouth unless you can see the dog's throat. foreign object when she breathes with her mouth open;

Take your dog to the clinic immediately.

Tracheal collapse

Tracheal collapse ( windpipe) is a common disease characteristic of older dogs of small and toy breeds ( pomeranian spitz, poodle, Yorkshire terrier, Maltese).

With age, the soft tissues of the windpipe lose their elasticity, as a result of which the walls of the trachea collapse, and hence the narrowing of its lumen during the inhalation stage.

Most cases of tracheal collapse occur in obese dogs. Subcutaneous fat deposits in the throat and neck area aggravate the problem. When the trachea collapses, attacks of a loud, dry cough, reminiscent of a “goose cry,” are observed. Difficulty breathing usually leads to an increase in body temperature.

First aid for tracheal collapse:

Wet your dog's chest and belly with cool or cold water;

Minimize your exposure to stressors.

Take the animal to a veterinarian as soon as possible.

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/ ACUTE VASCULAR INSUFFICIENCY. EDUCATIONAL MANUAL

Shock develops as a result of intravascular volume deficiency, disturbance of its distribution and due to damage to myocardial function. At various stages, septic shock is similar to hypovolemic, distributive and cardiogenic types of shock. Characteristic is early disruption of cellular metabolism followed by the development of circulatory failure. Tissue damage in septic shock results from the direct effect of pathogens, the response to endotoxin, and the consequences of the immune system response. All these mechanisms lead to peripheral vasodilation and a decrease in peripheral vascular resistance, which is an integral and early component of the septic shock reaction.

The compensated stage of septic shock is characterized by a decrease in vascular resistance, a compensatory increase in cardiac output, tachycardia, warm extremities and adequate urine production. In the stage of decompensation, the decrease in intravascular volume continues and the inhibition of myocardial contractility progresses. Clinically, this is manifested by lethargy, decreased body temperature, anuria, and respiratory distress. Vascular resistance increases sharply and cardiac output decreases. Clinical picture progresses and irreversible shock occurs, in which deep myocardial damage occurs.

Clinically, peripheral hypoperfusion, which occurs in response to a reduction in intravascular volume, is manifested by a decrease in body temperature (cold extremities) and capillary refill rate (acrocyanosis), renal hypoperfusion (oliguria), and decreased perfusion of the central nervous system (impaired consciousness). The severity of hypovolemia is indicated by signs of dehydration. An early symptom of shock is tachycardia. In children of the first years of life, an increase in heart rate precedes changes in blood pressure. Decreased blood pressure is a late manifestation of hypovolemia in children. The level of systolic pressure slowly falls, the increase in arteriolar tone maintains diastolic pressure. At the same time, pulse pressure and venous return decrease and stroke volume is secondarily impaired. Eventually, decompensated arterial hypotension (systolic and diastolic) develops. This stage indicates a significant impairment of hemodynamics. Signs of primary acidosis are detected early.

Their stimulation causes tachypnea, hyperpnea and hyperventilation, leading to respiratory alkalosis. The oxygen content and carbon dioxide tension in arterial blood help assess the adequacy of pulmonary ventilation.

The classification of shock by degree, proposed by the American College of Surgeons (Rogers M., Helfair M.), can be used to select therapy, assess severity and standardize various shock conditions (Table 2).

Children at risk of shock should be monitored to assess physiological status and the outcome of therapeutic interventions. In case of shock, it is absolutely necessary to monitor changes in: peripheral perfusion, skin and mucous membrane color, prevalence and nature of cyanosis, pulse rate and pulse wave, blood pressure, respiratory parameters, level of consciousness.

Monitoring includes: ECG, pulse oximetry, body temperature measurement, blood pressure measurement (invasive for high degrees of shock), recording fluid intake and output with urine output recording. Diuresis below 1 ml/kg/h indicates renal hypoperfusion and activation of homeostatic mechanisms for conserving water and sodium during a state of shock. Oliguria in a state of shock usually manifests itself early, even before a decrease in blood pressure or the development of significant tachycardia.

Treatment of shock conditions in children is aimed at ensuring adequate coronary, cerebral and renal blood flow, preventing or correcting the metabolic consequences of cell hypoperfusion. Resuscitation measures are carried out aimed at ensuring the patency of the airways and access to the venous bed, correcting hypoxemia by ensuring adequate ventilation and oxygenation, and ensuring adequate hemodynamics. Correction of hemodynamic disorders includes measures aimed at increasing preload, increasing myocardial contractility and reducing afterload.

Increasing preload and replenishing intravascular volume in most cases normalizes blood pressure and peripheral perfusion in children with shock. Infusion therapy produced on the basis of ml/kg per day. Volume replacement is carried out with careful consideration of fluid intake and output. Combinations of crystalloids, blood products (to maintain hemoglobin levels and clotting factors) and colloids - albumin and hydroxystarch (to maintain colloid oncotic pressure) are used.

Correction of acid-base imbalances can improve the function of both the myocardium and other cells, reduce systemic and pulmonary vascular resistance and reduce the need for respiratory compensation of metabolic acidosis. To correct metabolic acidosis, sodium bicarbonate is used. The drug is administered slowly intravenously as a repeated bolus at a dose of 1-2 mmol/kg. In newborns, use a solution at a concentration of 0.5 mmol/ml (1.3%) to avoid acute changes in blood osmolarity, which may be complicated by intraventricular hemorrhage in the brain. If the administration of sodium bicarbonate does not correct the acidosis, then peritoneal dialysis is necessary to remove excess acids, lactates, phosphates and protons, to treat hypernatremia and allow further administration of bicarbonate.

Increased by 10-20%

More than 150 beats/min

More than 150 beats/min

Capillary refill rate

Reduced systolic and pulse pressure; orthostatic hypertension more than mmHg. Art.

Reduced systolic and pulse pressure; orthostatic hypertension more than mmHg. Art.

Lethargy, cold and moist skin of the extremities, vomiting

Myocardial contractility is increased with the help of catecholamine drugs. The most commonly used are dopamine and dobutamine. The use of epinephrine and norepinephrine is limited due to the large number of side effects. The use of one of these drugs is necessary for cardiogenic shock, as well as in the stage of decompensation of other types of shock, when there are signs of damage to the heart muscle, manifested by a decrease in cardiac output and a drop in blood pressure.

Dopamine is the drug most often used in the treatment of shock. Dopamine stimulates alpha, beta and dopaminergic sympathetic receptors and has varied dose-dependent effects. In small doses - 0.5-4.0 mcg/kg/min, it primarily causes dilatation of the blood vessels of the kidneys and other internal organs, thus working as a diuretic and protecting renal perfusion. At a dose of 4-10 mcg/kg/min, its inotropic effect is manifested with an increase in stroke volume and cardiac output.

Dobutamine is a catecholaminergic drug with pronounced inotropic effects without the adverse effects of isadrin. It increases stroke and cardiac output, reduces total peripheral and pulmonary vascular resistance, reduces ventricular filling pressure, increases coronary blood flow and improves oxygen supply to the myocardium. Also, when using dobutamine, renal perfusion improves and sodium and water excretion increases. The speed and duration of drug administration are set individually and adjusted taking into account the patient’s response and the dynamics of hemodynamic parameters. The infusion rate required to increase cardiac output is 2.5-10 mcg/kg/min. It is possible to increase the rate of administration to 20 mcg/kg/min. In rare cases, infusion rates of up to 40 mcg/kg/min are used.

A relatively new drug for inotropic and chronotropic support is amrinone. Amrinon is a type III phosphodiesterase inhibitor that slows down the degradation of myocardial cyclic adenosine monophosphate (cAMP). This increases myocardial contractility and cardiac output, reduces left ventricular end-diastolic pressure and pulmonary capillary wedge pressure. Amrinone also causes relaxation of vascular smooth muscles. Since its mechanism of action differs from the action of catecholamines, amrinon can be used in combination with them. To further increase cardiac output and reduce afterload.

Reducing afterload is of great importance in children with cardiogenic shock in the postoperative period, with myocarditis or ischemic disease hearts. Late stages septic shock, high systemic vascular resistance, poor peripheral perfusion, and reduced sulfur output can also be compensated by reducing afterload. Drugs used to reduce afterload include nitroprusside and nitroglycerin. They stimulate the formation of the endothelium relaxing factor - nitric oxide (NO).

Sodium nitroprusside acts on both arteries and veins to reduce total peripheral resistance and venous return to the heart. Increases cardiac output, reduces pre- and afterload and myocardial oxygen demand. In some cases it causes reflex tachycardia. The hypotensive effect after intravenous administration develops in the first 2- 5 minutes, and 5-15 minutes after the end of the administration, blood pressure returns to the original level. Administer intravenously at a rate of 1-1.5 mcg/kg/min; if necessary, the rate of administration is gradually increased to 8 mcg/kg/min. For short-term infusion, the dose should not exceed 3.5 mg/kg.

For all forms of shock, etiotropic therapy is mandatory. Bleeding, external or internal, must be stopped and blood loss replaced. Shown if necessary surgical treatment. If the cause of shock is sepsis, then the identification and destruction of the etiologically significant microorganism becomes essential.

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Diagnosis of circulatory failure

Hemodynamic status and heart rate

Normal heart rate (HR) in children is presented in Table 7.2. Heart rate increases during shock, which is caused by the release of cytokines and is aimed at compensating for the reduced stroke volume of the heart. Heart rate in children, especially infants, can increase significantly (more than 220 per minute).

Table 7.2. Heart rate in children of different ages

Heart rate, beats/min

A decrease in heart rate of less than 60 per minute or a rapid drop in heart rate, accompanied by impaired systemic perfusion, is regarded as bradycardia. This is a pregonal symptom.

Pulse filling

Because blood pressure is maintained at normal levels until shock becomes severe, perfusion can be assessed by comparing central and peripheral arterial pulses. Weakening of the pulse in the central vessels and absence in the peripheral ones is a serious symptom of progressive shock and always indicates the presence of arterial hypotension. A rising or hyperfilling pulse occurs with increased cardiac output (eg, sepsis), arteriovenous shunting (eg, patent ductus arteriosus), or hypercapnia.

Capillary refill time

The capillary refill time is checked by pressing on the skin in the central part of the sternum for 5 seconds and then assessing the time it takes for the color of the pale spot to return. Normally, the capillary refill time is 2-3 s. A slower recovery of skin color after pressure indicates reduced tissue perfusion. This is important diagnostic sign in the early stages of septic shock, when appearance The baby is not disturbed and his limbs are warm.

Hyperthermia in patients with hypovolemia does not impair the sensitivity of this symptom, i.e. prolongation of capillary refill time, as opposed to cooling, which prolongs capillary refill time, so this symptom should be interpreted with caution in cooled patients with traumatic injuries. Prolongation of capillary refill time and changes in pulse filling are not specific and sensitive criteria for shock in infants and children, but in combination with other described symptoms they are important clinical signs shock. Each of these symptoms alone should not be used as a criterion for shock or as a sign by which response to therapy can be assessed.

In children with pigmented skin, assessing capillary refill time is difficult. In this case, the symptom is determined on the nail beds or in small children on the sole.

Arterial pressure

Normal blood pressure values ​​in children are presented in Table 7.3. The expected level of systolic blood pressure in a child can be calculated using the formula: blood pressure = 80 + (age in 2 years). Reliable determination of blood pressure levels is only possible when using a tonometer cuff that is appropriate for the child’s age. This applies to both auscultatory and oscillometric devices. The width of the cuff should be more than 80% of the shoulder length, and the width of the air chamber should be more than 40% of the shoulder circumference.

Table 7.3. Blood pressure in children of different ages

Systolic pressure, mm Hg.

Arterial hypotension is a late and preagonal symptom of circulatory failure. Once a child's blood pressure drops, cardiac arrest becomes imminent. Hypertension may be a cause or consequence of coma or intracranial hypertension.

Effect of circulatory failure on other organs

Tachypnea with an increase in tidal volume, but without retraction of the chest wall, occurs as a consequence of metabolic acidosis secondary to circulatory failure.

Cool, pale, and mottled skin is an indicator of impaired tissue perfusion. As circulatory failure progresses, more and more central areas of the body surface become cool to the touch.

A characteristic symptom of circulatory failure is agitation, which, as it progresses, gives way to drowsiness and depression of consciousness. This is due to a decrease in cerebral perfusion. A small child may look, in the words of his parents, “not himself.”

Urine output less than 1 ml/kg/h in children and less than 2 ml/kg/h in infants indicates decreased renal perfusion due to shock. It is necessary to evaluate whether the child has oliguria or anuria.

The following symptoms may indicate cardiac causes of respiratory failure:

1. Cyanosis that does not disappear with oxygen therapy
2. Tachycardia inappropriate to the severity of respiratory failure
3. Increased venous pressure in the jugular vein
4. Gallop rhythm or noise
5. Liver enlargement
6. Absence of pulse in the femoral arteries

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Capillary refill rate is normal

If, after lifting the animal's lip, you lightly press on the gum with your finger, it will temporarily turn pale.

This effect is explained by the fact that as a result of pressure, blood is pushed out of small vessels called capillaries.

1-2 seconds after you remove your finger, the pale area should regain its original color.

This period is called the capillary refill rate.

The capillary refill time can be used to judge how successfully the heart and blood vessels supply blood to the body tissues.

Measuring the rate of filling of the vessels of the nail bed 4 seconds. The measurement of the nail plate is 2 centimeters. Determine the time it takes for the nail bed vessel to fill.

Answers and explanations

Laboratory work No. 11.

Determination of blood supply to the capillaries of the nail bed

Laboratory work No. 7.3. Measuring the speed of blood flow in the vessels of the nail bed.

The vessels of the nail bed include not only capillaries, but also tiny arteries called arterioles. To determine the speed of blood flow in these vessels, it is necessary to find out the length of the path - 5, which the blood will travel from the root of the nail to its top, and the time - t, which it will take for this. Then, using the formula V = S/t, we can find out the average speed of blood flow in the vessels of the nail bed.

Let's measure the length of the nail from the base to the top, excluding the transparent part of the nail, which is usually cut off: there are no vessels under it.

Let's determine the time it takes for blood to cover this distance. For this index finger press on the nail plate of the thumb so that it turns white. In this case, the blood will be forced out of the vessels of the nail bed. Now you can find out the time of blood filling of the vessels. We release the compressed thumbnail and measure the time it takes for it to turn red. This moment will tell us the time during which the blood has made its way to the end.

After this, we calculate the blood flow speed using the formula. Compare the obtained data with the speed of blood flow in the aorta.

Assignment: Explain in writing the difference you identified.

Dehydration in a cat: what to do at home: symptoms and treatment

Increased loss of water and beneficial microelements in the body is called dehydration. Unfortunately, this also often happens with our smaller brothers, in particular cats.

Normal water content in a cat's body

60% of a healthy cat's body is water!

A drop in water level of five percent or more is a sign of dehydration, a serious reason to consult a veterinarian. Any delay can end disastrously for your pet.

Three types of dehydration

There are three types of dehydration:

• weak - up to five percent;
• moderate - about five or ten;
• heavy - from ten and more.

Mild dehydration is almost asymptomatic. A slight weakness of the animal looks like simple fatigue after active games or hunting. Therefore, the onset of dehydration is almost impossible to notice.

Sticky saliva indicates moderate dehydration.

During a moderate course, the most striking and characteristic sign is the stickiness of saliva.

In severe cases, the cat is weak, constantly lies down, does not make contact, and refuses food and water. The doctor should determine the reasons. Finding out on your own will only delay time and aggravate the existing disease.

Symptoms of dehydration (tests)

Standard dehydration test.

Home tests for skin elasticity and capillary refill time will help you verify the presence of dehydration.

The elasticity of the skin is checked by pulling the skin at the nape of the neck. Normally, the skin should immediately return to its original position. A sick animal remains in a drawn-out state for some time. The time it takes for the skin to settle back to its original position indicates the severity of dehydration.

Capillary refill rate

The rate of capillary refill is determined by retracting the upper lip and pressing on the gum. Using a stopwatch, you can measure the time it takes for the area of ​​pressure to lose its whitish mark and return to its original appearance.

Normally, the return process takes up to two seconds. This test is performed to determine blood circulation, the presence of heart failure or shock.

Veterinarian examination

A biochemical blood test can tell you a lot about your cat's health.

In addition to home tests, you should take your cat to a doctor. The clinic will host the following events:

The most significant tests are hematocrit and blood protein levels.

With an increased hematocrit and the presence of protein in the body, almost one hundred percent dehydration is established.

Visual signs of dehydration in a cat

Dehydration in a cat

It is possible to determine the presence of dehydration by some visible signs.

The cat is lethargic, looks tired, moves its paws with difficulty. The gums feel dry and sticky to the touch, the eyes are sunken.

Cannot go to the litter box for a long time, has difficulty emptying, and is constipated. If you listen, you can hear a rapid heartbeat.

Causes

If a cat stays outside for a long time and lacks fresh water, it can suffer from heatstroke and dehydration.

The causes of dehydration can be quite varied.

1. Diseases that are characterized by such manifestations as diarrhea and vomiting: diseases of the digestive system, intoxication, infection with worms.
2. Pathologies in the animal’s body that cause frequent urination - endocrine disorders: diabetes mellitus, kidney failure.
3. Staying outside for a long time in extreme heat or in a stuffy, enclosed room is a heat stroke.
4. Inability to access fresh, clean water.
5. Shock and stress conditions: recent operations, painful medical events, moving in a confined space.
6. Pathologies or injuries accompanied by heavy blood loss.
7. Feverish conditions.
8. In addition, any painful condition manifested by an increase in body temperature - injuries, inflammatory processes - can provoke dehydration. The pet’s body is depressed in such cases and she refuses to take food and drink, which aggravates the course of the disease and general condition.

Treatment of dehydration

The principle of treating dehydration at home is to immediately replenish lost fluid.

Add canned cat juice to the water!

The animal should be placed in a cool, dark room and provided with sufficient water. It is sometimes recommended to supplement the drink with liquid from canned food, flavored water with the smell of meat and the presence of electrolytes.

If the pet refuses to take water on its own, you should force it to drink using a syringe.

Injecting fluid under the skin

Injection of liquid under the skin is also indicated. To do this, take a syringe with a needle and Ringer's solution. The animal's skin is lifted in the area of ​​the withers and the solution is injected. The dose of the administered solution is determined by the veterinarian.

If your pet does not refuse food, it is worth replacing dry and solid food with liquid food. Droppers with glucose solution are indicated for use.

Drug treatment for dehydration in cats

Drug treatment is prescribed by the doctor, based on the results of the examination and the identified pathologies that caused dehydration. You should not hesitate if dangerous symptoms such as diarrhea and vomiting occur. You should contact the clinic immediately.

Prevention

Make sure the water in your cat's bowl is always fresh.

For preventive purposes, it is necessary to control your pet’s access to water.

Frequent outdoor exercise in summer should be provided with a small shelter for the animal. If a cat has chronic diseases or genetic pathologies, you should carefully monitor its condition, changes in mood, behavior, and changes in habits.

The diet must be balanced and contain sufficient fluid. The room where the pet is kept should not be stuffy.

My cat used to forget to drink water all the time, so he suffered from constipation. Now I have bowls of fresh water all over my apartment so that when playing, the cat will bump into them and drink water. This method really works, the cat began to drink a lot more.

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Cats and dogs rule

Initial assessment of blood circulation in critical conditions in children

Diagnosis of circulatory failure

Hemodynamic status and heart rate

Normal heart rate (HR) in children is presented in Table 7.2. Heart rate increases during shock, which is caused by the release of cytokines and is aimed at reducing the stroke volume of the heart. Heart rate in children, especially infants, can increase significantly (more than 220 per minute).

Table 7.2. Heart rate in children of different ages

A decrease in heart rate of less than 60 per minute or a rapid drop in heart rate, accompanied by impaired systemic perfusion, is regarded as bradycardia. This is a pregonal symptom.

Pulse filling

Because blood pressure is maintained at normal levels until shock becomes severe, perfusion can be assessed by comparing central and peripheral arterial pulses. Weakening of the pulse in the central vessels and absence in the peripheral ones is a serious symptom of progressive shock and always indicates the presence of arterial hypotension. A rising or hyperfilling pulse occurs with increased cardiac output (eg, sepsis), arteriovenous shunting (eg, patent ductus arteriosus), or hypercapnia.

Capillary refill time

The capillary refill time is checked by pressing on the skin in the central part of the sternum for 5 seconds and then assessing the time it takes for the color of the pale spot to return. Normally, the capillary refill time is 2-3 s. A slower recovery of skin color after pressure indicates reduced tissue perfusion. This is an important diagnostic sign in the early stages of septic shock, when the child's appearance is intact and his limbs are warm.

Hyperthermia in patients with hypovolemia does not impair the sensitivity of this symptom, i.e. prolongation of capillary refill time, as opposed to cooling, which prolongs capillary refill time, so this symptom should be interpreted with caution in cooled patients with traumatic injuries. Prolongation of capillary refill time and changes in pulse filling are not specific and sensitive criteria for shock in infants and children, but together with other described symptoms they are important clinical signs of shock. Each of these symptoms alone should not be used as a criterion for shock or as a sign by which response to therapy can be assessed.

In children with pigmented skin, assessing capillary refill time is difficult. In this case, the symptom is determined on the nail beds or in small children on the sole.

Arterial pressure

Normal blood pressure values ​​in children are presented in Table 7.3. The expected level of systolic blood pressure in a child can be calculated using the formula: blood pressure = 80 + (age in 2 years). Reliable determination of blood pressure levels is only possible when using a tonometer cuff that is appropriate for the child’s age. This applies to both auscultatory and oscillometric devices. The width of the cuff should be more than 80% of the shoulder length, and the width of the air chamber should be more than 40% of the shoulder circumference.

Table 7.3. Blood pressure in children of different ages

Arterial hypotension is a late and preagonal symptom of circulatory failure. Once a child's blood pressure drops, cardiac arrest becomes imminent. Hypertension may be a cause or consequence of coma or intracranial hypertension.

Effect of circulatory failure on other organs

Respiratory system

Tachypnea with an increase in tidal volume, but without retraction of the chest wall, occurs as a consequence of metabolic acidosis secondary to circulatory failure.

Leather

Cool, pale, and mottled skin is an indicator of impaired tissue perfusion. As circulatory failure progresses, more and more central areas of the body surface become cool to the touch.

Level of consciousness

A characteristic symptom of circulatory failure is agitation, which, as it progresses, gives way to drowsiness and depression of consciousness. This is due to a decrease in cerebral perfusion. A small child may look, in the words of his parents, “not himself.”

Diuresis

Urine output less than 1 ml/kg/h in children and less than 2 ml/kg/h in infants indicates decreased renal perfusion due to shock. It is necessary to evaluate whether the child has oliguria or anuria.

Heart failure

The following symptoms may indicate cardiac causes of respiratory failure:

1. Cyanosis that does not disappear with oxygen therapy
2. Tachycardia inappropriate to the severity of respiratory failure
3. Increased venous pressure in the jugular vein
4. Gallop rhythm or noise
5. Liver enlargement
6. Absence of pulse in the femoral arteries