On the #RVN
as reached #1
on us apple music
Can’t wait to travel again in January! 😎🤗 This picture was taken in Africa 2013 when I performed my very first injection, and to my favourite antelope #Sable
💜 I was apprehensive and it was tricky to hit that tiny little ear vein! Now I administer injections every day like second nature, bonkers! 😂🙈 #veterinary
🌟 Hyperthyroidism 🌟
Feline hyperthyroidism is a multisystemic disorder resulting from excessive production/secretion of T4 and T3. It affects middle aged to older cats and has no gender predisposition, though Siamese and Himalayan breeds have fewer reported incidences than other breeds.
In 97-99% of cases, it is caused by a benign adenomatous hyperplasia or multinodular adenoma. The remaining 1-3% of cases have malignant thyroid carcinoma. The majority of cats (70%) have bilateral disease, with the majority of cats having asymmetrical disease.
The most classic clinical signs are weight loss and polyphagia – as the high levels of circulating thyroid hormones cause a hypermetabolic state, resulting in the cat not being able to consume enough calories to compensate for the speed at which they are being burned off. In some cases, cachexia can result. Other signs include gastrointestinal disease, PU/PD, hyperactivity and behavioural changes such as vocalisation, irritability or increased socialisation.
The condition is generally diagnosed through clinical history, physical examination and laboratory results. On physical exam, tachycardia >220bpm, systolic heart murmurs, arrhythmias, weight loss and poor muscle mass and coat quality are often seen. Thyroid nodules (goitres) may also be palpable when running a finger and thumb down either side of the trachea.
Elevated total T4 is the most reliable laboratory result used to diagnose the condition. Other abnormalities include elevated ALP and ALT, erythrocytosis, neutrophilia and lymphocytosis.
The condition is managed medically, surgically or using radioactive iodine therapy. Medical management is administered, either systemically or topically (topical gels are typically applied to the ear pinna). These medications inhibit the synthesis of thyroid hormones, but do not prevent the tumour from growing, so dose adjustments may be required in the future
In patients who will not tolerate or respond well to medication, surgical or radioactive iodine therapy may be considered.
Thyroidectomy is performed commonly in the UK; this removes the thyroid gland(s), however, many cats are found to have ectopic thyroid tissue
💉Central Venous Catheters 💉
Central lines are catheters placed in the jugular vein. They have many advantages in high-dependency patients, or patients requiring frequent blood sampling (e.g. a patient with diabetic ketoacidosis). These advantages include: ✅ Being able to collect blood samples from the catheter without repeated venipuncture
✅ Being able to administer multiple fluid types, including blood products, and IV medications simultaneously through the multi-lumen catheter
✅ Being able to administer osmolar solutions which would not be suitable for peripheral administration, due to phlebitis - such as parenteral nutrition, and more concentrated glucose solutions
✅ Being able to measure central venous pressure.
CVCs do have some specific considerations:
⚠️ Introducing infection into a central vein carries more risk than a peripheral vein - so strict aseptic technique must be adhered to when handling the line. Gloves should be worn, the ports disinfected with isopropyl alcohol prior to connection of fluid lines/syringes, and the catheter should be unbandaged, cleaned and re-bandaged at least once daily. Needle-free ports should be used to prevent contamination associated with needle use.
⚠️ The catheter ports should be regularly flushed to prevent thrombus formation blocking the catheter, or to prevent thrombi entering the central circulation.
👩🏻⚕️Our 🌟hands on monitoring🌟 skills are super important - and nothing more so than peripheral pulse palpation and assessment.
Assessing a patients peripheral pulses is an efficient and quick way of assessing their cardiovascular system & blood pressure.
If a patients pulse is strong, and not easy to occlude then it is thought that theoretically their blood pressure should be adequate. However this should always be interpreted alongside other diagnostics and monitoring methods such as NIBP or IBP monitoring.
Although the femoral pulse is often super easy to locate and accessible it is classified as a ‘central' pulse rather than peripheral pulse. It will often remain relatively easy to feel even when a patient may have poor perfusion & absent peripheral pulses. Therefore I would encourage you to always go for the peripheral pulses when performing your assessment - it is a better reflection of what their blood pressure is likely to be.....! Remember certain anaesthetic drugs will change the patients systemic vascular resistance (how vasodilated or vasoconstricted they are!). This can really effect how easy it is assess their pulse quality. Alpha 2's such as dexmedetomidine will cause vasoconstriction (albeit transient) whereas other drugs such as acepromazine cause vasodilation. We must remember what clinical effects these drugs will have on our patients and interpret our pulse quality accordingly alongside other monitoring techniques. 🧐Finally always make sure you palpate your peripheral pulse concurrently with cardiac auscultation so that you can check for pulse deficits.
Here are some recent articles on interpretation of the above; 📚 https://www.ncbi.nlm.nih.gov/pubmed/26588058 📚 https://onlinelibrary.wiley.com/doi/full/10.1111/vec.12718