An abdominal focused assessment with sonography for trauma ( AFAST ) was performed . This confirmed that there was no free fluid and the bladder was enlarged . Catheter placement was confirmed and there was evidence of abnormal material in the bladder , consistent with blood clots or uroliths .
The patient was placed in a warmed incubator in the treatment room with a multiparameter monitor connected , showing the electrocardiogram ( ECG ), non-invasive blood pressure , oxygen saturation ( SPO 2
), end-tidal carbon dioxide ( ETCO 2
) and temperature . The ECG trace had absent P waves , aberrant QRS complexes and tall , peaked T waves , consistent with prolonged hyperkalaemia ( Figure 1 ).
A bolus of glucose was given intravenously to the patient and the VS responsible for the case discussed the treatment options with the patient ' s owner . The patient was normotensive and had an SPO 2 of 97 % and ETCO 2 of 26 mmHg .
The patient was not intubated but , due to its mentation , capnography was facilitated with use of an intravenous ( IV ) catheter , with the stylet removed , attached to the capnograph and the open end inserted a few millimetres into the nasal cavity ( Figure 2 ).
This method is used when a patient ' s mentation is inappropriate – for example , stuporous or obtunded – but the patient is respiring nasally . It would not be suitable for use in a patient with compromised respiration or loss of pharyngeal reflex , which would instead be intubated , with or without mechanical ventilation .
Within 30 min of admission , the patient developed ventricular tachycardia . This can be distinguished from sinus tachycardia with wide QRS complexes (> 120 ms ) – which in this case could have been due to the hyperkalaemia – by the absence of P waves with persistent ventricular premature contractions [ 2 ] . If left untreated , ventricular tachycardia can lead to ventricular fibrillation , resulting in cardiac arrest [ 3 ] . Critical care was indicated in this case .
Figure 1 . Multiparameter monitor readings .
Figure 2 . Monitoring CO 2 levels via a nasal catheter .
42 Veterinary Nursing Journal