Pub Date : 2020-06-03DOI: 10.1201/9780138719128-40
Sheila McCullough
causing hemodilution and possible hyponatremia and hypokalemia. The resultant change in plasma tonicity and electrolyte abnormalities can lead to secondary red cell hemolysis. This hemolysis by itself can impair oxygen delivery to the tissues. Fresh water, in addition to the hemodilution, also inactivates the surfactant within the alveoli. This alters alveolar surface tension and can result in alveolar collapse and pulmonary atelectasis. The ventilation/perfusion mismatch caused by perfused but unventilated lung regions causes hypoxemia, which can be severe. This can be potentiated by the mere presence of water in the alveoli and interstitium, acting as a diffusion barrier. This intrapulmonary shunting and barrier to oxygenation of the blood further hampers oxygenation of the tissues. In contrast, salt water pulls fluid into the alveoli because of its hypertonicity. This fluid comes from the vasculature, and if significant enough, it can cause a depletion of the intravascular fluid volume. Hypovolemia, hemoconcentration, and hypotension may result. This, in turn, can lead to decreased tissue perfusion and tissue hypoxia. Salt water does not inactivate the surfactant, so atelectasis is not typically a component of this syndrome. The electrolyte abnormalities involved in salt water aspiration are primarily hypernatremia, with a possible increase in serum calcium and magnesium based on the mineral content of the water. Despite the initiating physiology, the end pathology Peer Reviewed
{"title":"Near Drowning","authors":"Sheila McCullough","doi":"10.1201/9780138719128-40","DOIUrl":"https://doi.org/10.1201/9780138719128-40","url":null,"abstract":"causing hemodilution and possible hyponatremia and hypokalemia. The resultant change in plasma tonicity and electrolyte abnormalities can lead to secondary red cell hemolysis. This hemolysis by itself can impair oxygen delivery to the tissues. Fresh water, in addition to the hemodilution, also inactivates the surfactant within the alveoli. This alters alveolar surface tension and can result in alveolar collapse and pulmonary atelectasis. The ventilation/perfusion mismatch caused by perfused but unventilated lung regions causes hypoxemia, which can be severe. This can be potentiated by the mere presence of water in the alveoli and interstitium, acting as a diffusion barrier. This intrapulmonary shunting and barrier to oxygenation of the blood further hampers oxygenation of the tissues. In contrast, salt water pulls fluid into the alveoli because of its hypertonicity. This fluid comes from the vasculature, and if significant enough, it can cause a depletion of the intravascular fluid volume. Hypovolemia, hemoconcentration, and hypotension may result. This, in turn, can lead to decreased tissue perfusion and tissue hypoxia. Salt water does not inactivate the surfactant, so atelectasis is not typically a component of this syndrome. The electrolyte abnormalities involved in salt water aspiration are primarily hypernatremia, with a possible increase in serum calcium and magnesium based on the mineral content of the water. Despite the initiating physiology, the end pathology Peer Reviewed","PeriodicalId":335807,"journal":{"name":"The Veterinary ICU Book","volume":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127678017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-06-03DOI: 10.1201/9780138719128-25
S. Ross, C. Osborne, J. Lulich, D. Polzin
We have found colonoscopic polypectomy to be a safe and efficient procedure. It is well tolerated, even by elderly, high-risk patients. The procedure at times is diicult and time-consuming. We would advise, therefore, that only those who have had gastrointestinal endoscopy experience should undertake it. Our findings are similar to those reported by other investigators as to size, location, pathologic features, complications and incidence of malignancy in colonic polyps." It is too early to ascertain whether complete removal of malignant adenomatous polyps by colonoscopic cautery snare will prove to be a curative procedure. At present we would advise that patients with malignant changes be treated by laparotomy and segmental resection. Longterm follow-up of a significant number of cases is needed to show whether we are removing these lesions completely enough and, therefore, whether localized carcinoma in pedunculated adenomatous polyps can be cured without operation. Colonoscopic polypectomy, as a non-invasive procedure, has major advantages over laparotomy, colotomy and polypectomy. The average length of time spent in hospital in our series was 36 hours and the average time lost from work was 48 hours. The patient usually is able to return to regular activity in 72 hours. A normal diet is resumed on the first day after polypectomy and the cost to the patient or the insurance carrier is reduced by approximately 75 percent.
{"title":"Acute Renal Failure","authors":"S. Ross, C. Osborne, J. Lulich, D. Polzin","doi":"10.1201/9780138719128-25","DOIUrl":"https://doi.org/10.1201/9780138719128-25","url":null,"abstract":"We have found colonoscopic polypectomy to be a safe and efficient procedure. It is well tolerated, even by elderly, high-risk patients. The procedure at times is diicult and time-consuming. We would advise, therefore, that only those who have had gastrointestinal endoscopy experience should undertake it. Our findings are similar to those reported by other investigators as to size, location, pathologic features, complications and incidence of malignancy in colonic polyps.\" It is too early to ascertain whether complete removal of malignant adenomatous polyps by colonoscopic cautery snare will prove to be a curative procedure. At present we would advise that patients with malignant changes be treated by laparotomy and segmental resection. Longterm follow-up of a significant number of cases is needed to show whether we are removing these lesions completely enough and, therefore, whether localized carcinoma in pedunculated adenomatous polyps can be cured without operation. Colonoscopic polypectomy, as a non-invasive procedure, has major advantages over laparotomy, colotomy and polypectomy. The average length of time spent in hospital in our series was 36 hours and the average time lost from work was 48 hours. The patient usually is able to return to regular activity in 72 hours. A normal diet is resumed on the first day after polypectomy and the cost to the patient or the insurance carrier is reduced by approximately 75 percent.","PeriodicalId":335807,"journal":{"name":"The Veterinary ICU Book","volume":"107 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129066832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-06-03DOI: 10.1201/9780138719128-89
D. Boothe
{"title":"Changes in Drug Disposition and Drug Interaction","authors":"D. Boothe","doi":"10.1201/9780138719128-89","DOIUrl":"https://doi.org/10.1201/9780138719128-89","url":null,"abstract":"","PeriodicalId":335807,"journal":{"name":"The Veterinary ICU Book","volume":"345 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122836742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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