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Head trauma is a common cause of significant morbidity and mortality in dogs and cats. Traumatic brain injury may occur after head trauma. Understanding the pathophysiology of primary and secondary injury after head trauma is essential for management. This article reviews the pathophysiology of head trauma, patient assessment and diagnostics, and treatment recommendations., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Anesthesia can lead to pathophysiologic changes that dramatically alter the fluid balance of the body compartments and the intravascular space. Fluid administration can be monitored and evaluated using static and dynamic indexes. Guidelines for fluid rates during anesthesia begin with 3 mL/kg/h in cats and 5 mL/kg/h in dogs. If at all possible, patients should be stabilized and electrolyte disturbances should be corrected before general anesthesia., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Administration of appropriate types and volumes of parenteral fluids is of paramount importance when treating sick and debilitated patients, especially those fighting critical illness. Fluid selection and accurate calculations must be performed logically and accurately to maximize positive outcomes. Knowledge of fluid types, as well as the complex relationship of the body's fluid compartments, helps clinicians develop rational fluid therapy plans for their patients., (Copyright © 2016 Elsevier Inc. All rights reserved.)

The incidence of respiratory acid-base abnormalities in the critical care unit (CCU) is unknown, although respiratory alkalosis is suspected to be common in this population. Abnormal carbon dioxide tension can have many physiologic effects, and changes in Pco 2 may have a significant impact on outcome. Monitoring Pco 2 in CCU patients is an important aspect of critical patient assessment, and identification of respiratory acid-base abnormalities can be valuable as a diagnostic tool. Treatment of respiratory acid-base disorders is largely focused on resolution of the primary disease, although mechanical ventilation may be indicated in cases with severe respiratory acidosis., (Published by Elsevier Inc.)

This article describes the calculation of the alveolar-arterial gas gradient and its clinical application in determining the cause of hypoxemia. It also outlines the analysis of arterial blood gases and the clinical approach toward diagnosis and treatment of respiratory disease., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Perioperative patients can be highly dynamic and have various metabolic, physiologic, and organ system derangements that necessitate smart monitoring strategies and careful fluid therapy. The interplay between changing patient status, therapeutic interventions, and patient response makes effective monitoring crucial to successful treatment. Monitoring the perioperative patient and an approach to fluid therapy are discussed in this text., (Copyright © 2015 Elsevier Inc. All rights reserved.)

This article reviews management of the acutely poisoned veterinary patient, including initial telephone triage, appropriate communication and history gathering from the pet owner, decontamination methods (including the use of appropriate emetic agents and dosing of activated charcoal), and general treatment of the poisoned patient. Symptomatic and supportive care of the poisoned patient includes the use of fluid therapy, gastrointestinal support (eg, antacids), central nervous system support (eg, muscle relaxants, anticonvulsants), sedatives/reversal agents (eg, phenothiazines, naloxone, flumazenil), hepatoprotectants, and miscellaneous antidotal therapy., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Monitoring of the emergent patient can be one of the most challenging aspects in veterinary medicine, but can also be one of the most rewarding. Careful monitoring of the emergent patient is crucial in assessment and treatment of potentially life-threatening conditions. While advanced monitoring equipment is becoming increasingly available, triage evaluation and serial assessment can recognize patient changes before clinical deterioration. In addition to hands-on serial patient assessment, valuable monitoring tools include pulse oximetry, blood pressure monitoring, urine output, electrocardiography monitoring, and central venous pressure monitoring., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Continuous renal replacement therapy (CRRT) is a relatively new extracorporeal blood purification modality that is rapidly gaining acceptance for the treatment of acute kidney injury in cats and dogs. The author has used CRRT for the treatment of leptospirosis, tumor lysis syndrome, heatstroke, pre- and postsurgical support of ureteral obstructions, as well as aminoglycoside and melamine toxicities. As the name implies, CRRT is a slow gradual process, and once treatment begins, patients continue therapy until their renal function returns, they are transitioned to intermittent hemodialysis (IHD), or they are euthanized. Unlike IHD, which is a primarily diffusive therapy, CRRT uses diffusion as well as convection. Because of its efficient use of fluids, CRRT units use prepackaged fluids, eliminating the need for costly water purification systems that are needed for IHD., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Because of the role of the kidneys in maintaining homeostasis in the body, kidney failure leads to derangements of fluid, electrolyte, and acid-base balance. The most effective therapy of a uremic crisis is careful management of fluid balance, which involves thoughtful assessment of hydration, a fluid treatment plan personalized for the specific patient, repeated and frequent reassessment of fluid and electrolyte balance, and appropriate changes in the treatment plan in response to the rapidly changing clinical situation of the patient that has renal failure. Disorders of sodium, chloride, potassium, calcium, and phosphorus are commonly encountered in renal failure and may be life threatening. Treatment of metabolic acidosis and nutritional support are frequently needed.

Many patients presented to the emergency veterinarian are suffering from global or local tissue hypoperfusion. Global or systemic hypoperfusion can occur secondary to a reduction in the effective circulating intravascular volume (hypovolemic shock) or reduced ability of the heart to pump blood around the body secondary to reduced cardiac function (cardiogenic shock),obstruction to blood flow (obstructive shock), or maldistribution of the circulating intravascular volume (distributive shock). Initial assessment involving physical examination supplemented by measurement of hemodynamic and metabolic parameters allows the clinician to recognize and treat patients with severe global hypoperfusion. Use of techniques like sublingual capnometry and measurement of central venous oxygen saturation may aid recognition and evaluation of early hypoperfusion. Treatment decisions are made based on an assessment of the severity of the hypoperfusion and its probable underlying cause. Early effective treatment of hypoperfusion is likely to lead to a better outcome for the patient.

There has been a substantial increase in the use of analgesics for pain management in the last 10 years. Traditionally, veterinarians have not been trained in the identification of or monitoring of patients that are in pain, even though an evaluation of pain is inherent in assessing improvement in many medical and surgical diseases. Until recently, the physiology and pharmacology of opioids, NSAIDs, local anesthetics, and alpha 2 agonists were taught, but the therapeutic role of these drugs was generally believed to be related to restraint, anesthesia, or control of inflammation rather than to pain management.

No definitive, clinically proven drug therapy currently exists for reversal or amelioration of the injurious cellular events initiated by head trauma. The patient's physiologic status should therefore be monitored and managed as best as possible bearing in mind all the factors that can aggravate intracranial abnormalities. All treatment options have positive and negative aspects that should be considered and balanced on an individual patient basis. A major concern in the management of head-injured patients is the avoidance or treatment of intracranial hypertension. This may be achieved largely through medical means and accurate efforts can only be made if intracranial pressure and the variables that influence it are monitored directly. A definite place exists for surgery in the management of head-injured patients, though such a decision is best guided by objective evaluation of the intracranial vault.

Monitoring is the key to a successful critical care endeavor. It is the only way in which we know if we did a good thing and if we did enough of it (or too much). Oftentimes, the decision to treat or not to treat is made difficult by the paucity of information available. The secret is to make an intuitive decision and then monitor the patient to see if it was the right or the wrong decision. Most wrong decisions can be caught and corrected long before the patient has suffered the consequences. Go forth, and monitor!

Malnutrition has a direct relationship to complications associated with ineffective wound and fracture healing, inadequate immune responses, decreased tolerance to cancer therapy, muscle weakness, and certain organ dysfunctions (heart and liver). Malnutrition combined with disease, injury, or stress increases the metabolic rate in patients above that of resting. These patients are undergoing an accelerated form of starvation, which is more common than presently recognized in veterinary medicine and may be responsible for the less than optimal responses to proper therapies. Diseased or injured patients unable to digest or absorb nutrients from the gastrointestinal tract require additional medical support in the form of parenteral nutrition. Advances in parenteral solutions, products, and delivery systems make parenteral nutritional support possible in veterinary medicine, although not possible in all small animal practices. Proper patient selection, well-informed clients, dedicated technicians, and knowledgeable veterinarians are all essential in the successful implementation of parenteral nutritional support.