DOCSLIB.ORG

Domestic Violence: the Shaken Adult Syndrome

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Domestic Violence: the Shaken Adult Syndrome 138 J Accid Emerg Med 2000;17:138–139 J Accid Emerg Med: first published as 10.1136/emj.17.2.139 on 1 March 2000. Downloaded from CASE REPORTS Domestic violence: the shaken adult syndrome T D Carrigan, E Walker, S Barnes Abstract Her initial blood pressure was 119/72 mm A case of domestic violence is reported. Hg, pulse 88 beats/min, her pupils were equal The patient presented with the triad of and reactive directly and consensually, and her injuries associated with the shaking of Glasgow coma score was 13/15 (she was infants: retinal haemorrhages, subdural confused and was opening her eyes to com- haematoma, and patterned bruising; this mand). Examination of the head showed bilat- has been described as the shaken adult eral periorbital ecchymoses, nasal bridge swell- syndrome. This case report reflects the ing and epistaxis, a right frontal abrasion, and diYculties in diagnosing domestic vio- an occipital scalp haematoma. Ecchymoses lence in the accident and emergency were also noted on her back and buttocks, setting. being linear in fashion on both upper arms, (J Accid Emerg Med 2000;17:138–139) and her underpants were torn. Initial skull and Keywords: domestic violence; women; assault facial x ray films were normal, and she was admitted under the care of A&E for neurologi- cal observations. Domestic violence is an under-reported and Over the next 24 hours, her Glasgow coma major public health problem that often first score improved to 15/15, but she had vomited presents to the accident and emergency (A&E) five times and complained that her vision department. It accounts for half of all violent remained blurred. Visual acuity was only hand crimes against women, and two deaths per movements in the right eye and finger counting week have been linked to domestic violence in in the left. Ophthalmological review confirmed Britain.1 Indeed, the Department of Health has both retinal and preretinal haemorrhages in the issued statements to ensure health profession- right eye and a retinal haemorrhage on the left. als are aware of domestic violence in this con- Both maculae were aVected by the haemor- text when patients present with consistent rhage (fig 1). Haematological investigations, http://emj.bmj.com/ traumatic injuries.2 including a full blood count and a clotting The following case report reflects the screen, were within normal parameters, and diYculties in diagnosing domestic violence in computed tomography of the head revealed a the A&E setting, and stresses the timely small left temporal subdural haemorrhage with referral of such patients to the relevant adjacent oedema. authorities. It was only after 48 hours and repeated advice that she should seek help and report the Case report injuries to the police, that she admitted that on September 30, 2021 by guest. Protected copyright. A 34 year old woman was brought to the A&E domestic violence had occurred. department by ambulance at 0400 hours with Ongoing police and consultant medical head injuries. When handed over from the review showed photographic evidence of pat- ambulance crew an assault was queried, terned bruising to the upper arms, and also although the patient later stated she had fallen several circular burns to the face and arm, down stairs after moderate alcohol ingestion. similar to the type caused by the deliberate Accident and Emergency Department, Dewsbury District Hospital, Dewsbury T D Carrigan E Walker S Barnes Correspondence to: Dr T D Carrigan, Specialist Registrar, Accident and Emergency Department, St James’s University Hospital, Beckett Street, Leeds LS9 7TF Accepted 28 September Figure 1 Photographs showing (A) retinal haemorrhage in the right eye and (B) retinal and preretinal haemorrhages in 1999 the left eye. Airbag associated fatal head injury 139 J Accid Emerg Med: first published as 10.1136/emj.17.2.139 on 1 March 2000. Downloaded from application of lit cigarettes. She suVered The diagnosis of “shaken adult syndrome” postconcussional symptoms for two weeks. was eventually made, supported by delayed Five weeks after the initial injury she diagnosis of some of the classical signs consist- reattended with persistent atypical chest pain. ent with non-accidental injury. Three months later her visual acuity had Domestic violence victims are often dis- improved on the left to 6/24, but remained charged home the same day, thus losing that unchanged on the right, and a vitrectomy was window of opportunity to allow for intrinsically contemplated for that side. motivated acceptance of help. Not all A&E departments have access to their own observa- Discussion tion beds, though many departments are now This patient had the diagnostic triad of retinal managing head injuries, especially now that haemorrhages, subdural haematoma, and pat- neurosurgical care has centralised to regional terned bruising that is associated with forceful centres of excellence. and repeated shaking of infants. Such a triad The way forward should be a more struc- has previously been documented postmortem tured method of follow up of suspected victims in a Palestinian adult who died under interro- of domestic violence that is initiated in the gation by the Israeli security forces, and has A&E department. As it is in suspected paediat- been described as the shaken adult syndrome.3 ric non-accidental injury, so one can prevent Even when the presenting history is misguid- repeat episodes to not only the patient, but also ing, all injuries must be thoroughly docu- to their children and other family members. mented, and appropriate treatment instituted. The A&E department should grasp this initia- Management also involves guiding the patient tive. to autonomously decide whether to accept help and/or legal assistance. In most states of Contributors America, it is mandatory to report domestic Thomas Carrigan, guarantor of the case report, initiated and violence related injuries, though the American coordinated the collection of the clinical history, investigation confirmation, and writing of the abstract. College of Emergency Physicians oppose this, Ed Walker was involved with interpretation of the case, back- stating that reporting should be in accordance ground research, and writing of the report. Dr Barnes was 4 involved with the critical revision of the report, and with the with the patient’s wishes. Confidentiality was collation of photographic evidence of the patient. considered in this case, and gradual discussion broke down the barriers of denial. Eventual Conflict of interest: none. admission of domestic violence took three days Funding: none. though, a luxury not often available to 1 Hall C. One in four women face violence in the home. Daily emergency clinicians. Telegraph, 1 July 1998. Early detection and documentation of inju- 2 Department of Health NHS Executive. Domestic violence. London. Department of Health, 1997. ries consistent with domestic violence must be 3 Pounder D. Shaken adult syndrome. Am J Forensic Med attempted, and in this case, earlier documenta- Pathol 1997:18:321–4. 4 American College of Emergency Physicians. Mandatory tion of visual acuity would have facilitated an reporting of domestic violence to law enforcement and earlier diagnosis of retinal haemorrhage. criminal justice agencies. Ann Emerg Med 1997;30:561. http://emj.bmj.com/ Airbag associated fatal head injury: case report and review of the literature on airbag injuries on September 30, 2021 by guest. Protected copyright. K Cunningham, T D Brown, E Gradwell, P A Nee Abstract in a moderate impact frontal collision Airbags have been shown to significantly where such severe injury would not nor- Whiston Hospital, reduce mortality and morbidity in motor mally have been anticipated. The range of Prescot, Merseyside vehicle crashes. However, the airbag, like airbag associated injuries is described and L35 5DR: Department the seat belt, produces its own range of predisposing factors such as lack of seat of Accident and injuries. With the increasing use of air- belt usage, short stature, and proximity to Emergency Medicine K Cunningham bags in the UK, airbag associated injuries airbag housing are discussed. The par- T D Brown will be seen more often. These are usually ticular dangers airbags pose to children P A Nee minor, but in certain circumstances se- are also discussed. vere and fatal injuries result. Such inju- (J Accid Emerg Med 2000;17:139–142) Department of ries have been described before in the Pathology Keywords: airbags; head injury E Gradwell medical literature, but hitherto most reports have been from North America. Correspondence to: This is the first case report from the UK of The introduction of airbags has led to a signifi- Dr Cunningham (e-mail: serious injury due to airbag deployment [email protected]) cant reduction in morbidity and mortality from and describes the case of a driver who was road traYc accidents.12 However, the airbag Accepted 10 November 1999 fatally injured when her airbag deployed like the seat belt produces its own range of 140 Cunningham, Brown, Gradwell, et al J Accid Emerg Med: first published as 10.1136/emj.17.2.139 on 1 March 2000. Downloaded from injuries. In the case of the airbag this ranges at the base of the brain. The spinal column from relatively minor injuries, such as abra- and nerve cord were normal. The immediate sions and superficial burns to unexpected cause of death was deemed to have been a fatalities. Case reports of such fatalities have severe head injury. appeared in the North American literature The subject of this report was a middle since 1993,34 but hitherto none have been aged woman of stout build, height 5' 7", weight reported from the UK. 92 kg. Crash investigators have postulated that the unexpectedly severe injuries sustained Case report were caused by her sitting too far forward A 47 year old woman driving a 1997 registered when the airbag was deployed.
Load more

Recommended publications
  • Management of Airway Obstruction and Stridor in Pediatric Patients
    November 2017 Management of Airway Volume 14, Number 11 Obstruction and Stridor in Authors Ashley Marchese, MD Department of Pediatrics, Yale-New Haven Hospital, New Haven, CT Pediatric Patients Melissa L. Langhan, MD, MHS Associate Professor of Pediatrics and Emergency Medicine; Fellowship Director, Director of Education, Pediatric Emergency Abstract Medicine, Yale University School of Medicine, New Haven, CT Peer Reviewers Stridor is a result of turbulent air-flow through the trachea from Steven S. Bin, MD upper airway obstruction, and although in children it is often Associate Clinical Professor of Emergency Medicine and Pediatrics; Medical Director, Emergency Department, UCSF School of Medicine, due to croup, it can also be caused by noninfectious and/or con- Benioff Children’s Hospital, San Francisco, CA genital conditions as well as life-threatening etiologies. The his- Alexander Toledo, DO, PharmD, FAAEM, FAAP tory and physical examination guide initial management, which Chief, Section of Pediatric Emergency Medicine; Director, Pediatric Emergency Department, Arizona Children’s Center at Maricopa includes reduction of airway inflammation, treatment of bacterial Medical Center, Phoenix, AZ infection, and, less often, imaging, emergent airway stabilization, Prior to beginning this activity, see “Physician CME Information” or surgical management. This issue discusses the most common on the back page. as well as the life-threatening etiologies of acute and chronic stridor and its management in the emergency department. Editor-in-Chief
    [Show full text]
  • Stridor in the Newborn
    Stridor in the Newborn Andrew E. Bluher, MD, David H. Darrow, MD, DDS* KEYWORDS Stridor Newborn Neonate Neonatal Laryngomalacia Larynx Trachea KEY POINTS Stridor originates from laryngeal subsites (supraglottis, glottis, subglottis) or the trachea; a snoring sound originating from the pharynx is more appropriately considered stertor. Stridor is characterized by its volume, pitch, presence on inspiration or expiration, and severity with change in state (awake vs asleep) and position (prone vs supine). Laryngomalacia is the most common cause of neonatal stridor, and most cases can be managed conservatively provided the diagnosis is made with certainty. Premature babies, especially those with a history of intubation, are at risk for subglottic pathologic condition, Changes in voice associated with stridor suggest glottic pathologic condition and a need for otolaryngology referral. INTRODUCTION Families and practitioners alike may understandably be alarmed by stridor occurring in a newborn. An understanding of the presentation and differential diagnosis of neonatal stridor is vital in determining whether to manage the child with further observation in the primary care setting, specialist referral, or urgent inpatient care. In most cases, the management of neonatal stridor is outside the purview of the pediatric primary care provider. The goal of this review is not, therefore, to present an exhaustive review of causes of neonatal stridor, but rather to provide an approach to the stridulous newborn that can be used effectively in the assessment and triage of such patients. Definitions The neonatal period is defined by the World Health Organization as the first 28 days of age. For the purposes of this discussion, the newborn period includes the first 3 months of age.
    [Show full text]
  • Snoring and Stertor Are Associated with More Sleep Disturbance Than Apneas and Hypopneas in Pediatric SDB
    Sleep and Breathing (2019) 23:1245–1254 https://doi.org/10.1007/s11325-019-01809-3 SLEEP BREATHING PHYSIOLOGY AND DISORDERS • ORIGINAL ARTICLE Snoring and stertor are associated with more sleep disturbance than apneas and hypopneas in pediatric SDB Mark B. Norman1 & Henley C. Harrison2 & Karen A. Waters1,3 & Colin E. Sullivan1,3 Received: 2 November 2018 /Revised: 26 January 2019 /Accepted: 19 February 2019 /Published online: 1 March 2019 # The Author(s) 2019 Abstract Purpose Polysomnography is not recommended for children at home and does not adequately capture partial upper airway obstruction (snoring and stertor), the dominant pathology in pediatric sleep-disordered breathing. New methods are required for assessment. Aims were to assess sleep disruption linked to partial upper airway obstruction and to evaluate unattended Sonomat use in a large group of children at home. Methods Children with suspected obstructive sleep apnea (OSA) had a single home-based Sonomat recording (n = 231). Quantification of breath sound recordings allowed identification of snoring, stertor, and apneas/hypopneas. Movement signals were used to measure quiescent (sleep) time and sleep disruption. Results Successful recordings occurred in 213 (92%) and 113 (53%) had no OSA whereas only 11 (5%) had no partial obstruc- tion. Snore/stertor occurred more frequently (15.3 [5.4, 30.1] events/h) and for a longer total duration (69.9 min [15.7, 140.9]) than obstructive/mixed apneas and hypopneas (0.8 [0.0, 4.7] events/h, 1.2 min [0.0, 8.5]); both p < 0.0001. Many non-OSA children had more partial obstruction than those with OSA.
    [Show full text]
  • INITIAL APPROACH to the EMERGENT RESPIRATORY PATIENT Vince Thawley, VMD, DACVECC University of Pennsylvania, Philadelphia, PA
    INITIAL APPROACH TO THE EMERGENT RESPIRATORY PATIENT Vince Thawley, VMD, DACVECC University of Pennsylvania, Philadelphia, PA Introduction Respiratory distress is a commonly encountered, and truly life-threatening, emergency presentation. Successful management of the emergent respiratory patient is contingent upon rapid assessment and stabilization, and action taken during the first minutes to hours often has a major impact on patient outcome. While diagnostic imaging is undoubtedly a crucial part of the workup, patients at presentation may be too unstable to safely achieve imaging and clinicians may be called upon to institute empiric therapy based primarily on history, physical exam and limited diagnostics. This lecture will cover the initial evaluation and stabilization of the emergent respiratory patient, with a particular emphasis on clues from the physical exam that may help localize the cause of respiratory distress. Additionally, we will discuss ‘cage-side’ diagnostics, including ultrasound and cardiac biomarkers, which may be useful in the working up these patients. Establishing an airway The first priority in the dyspneic patient is ensuring a patent airway. Signs of an obstructed airway can include stertorous or stridorous breathing or increased respiratory effort with minimal air movement heard when auscultating over the trachea. If an airway obstruction is present efforts should be made to either remove or bypass the obstruction. Clinicians should be prepared to anesthetize and intubate patients if necessary to provide a patent airway. Supplies to have on hand for difficult intubations include a variety of endotracheal tube sizes, stylets for small endotracheal tubes, a laryngoscope with both small and large blades, and instruments for suctioning the oropharynx.
    [Show full text]
  • Severe Peri-Ictal Respiratory Dysfunction Is Common in Dravet Syndrome
    The Journal of Clinical Investigation RESEARCH ARTICLE Severe peri-ictal respiratory dysfunction is common in Dravet syndrome YuJaung Kim,1,2 Eduardo Bravo,1 Caitlin K. Thirnbeck,1 Lori A. Smith-Mellecker,1 Se Hee Kim,3 Brian K. Gehlbach,4 Linda C. Laux,3 Xiuqiong Zhou,1 Douglas R. Nordli Jr.,3 and George B. Richerson1,5,6 1Department of Neurology and 2Department of Biomedical Engineering, University of Iowa, Iowa City, Iowa, USA. 3Division of Pediatric Neurology, Northwestern University, Chicago, Illinois, USA. 4Department of Internal Medicine and 5Department of Molecular Physiology and Biophysics, University of Iowa, Iowa City, Iowa, USA. 6Neurology Service, Veterans Affairs Medical Center, Iowa City, Iowa, USA. Dravet syndrome (DS) is a severe childhood-onset epilepsy commonly due to mutations of the sodium channel gene SCN1A. Patients with DS have a high risk of sudden unexplained death in epilepsy (SUDEP), widely believed to be due to cardiac mechanisms. Here we show that patients with DS commonly have peri-ictal respiratory dysfunction. One patient had severe and prolonged postictal hypoventilation during video EEG monitoring and died later of SUDEP. Mice with an Scn1aR1407X/+ loss- of-function mutation were monitored and died after spontaneous and heat-induced seizures due to central apnea followed by progressive bradycardia. Death could be prevented with mechanical ventilation after seizures were induced by hyperthermia or maximal electroshock. Muscarinic receptor antagonists did not prevent bradycardia or death when given at doses selective for peripheral parasympathetic blockade, whereas apnea, bradycardia, and death were prevented by the same drugs given at doses high enough to cross the blood-brain barrier.
    [Show full text]
  • Proceedings from the 2011 Annual Meeting of the American College of Physicians, Wisconsin Chapter
    PROCEEDINGS Proceedings from the 2011 Annual Meeting of the American College of Physicians, Wisconsin Chapter The Wisconsin Chapter of the American College of Physicians held its annual meeting in evaluate the temporal relationship between Wisconsin Dells, September 9-11, 2011. Internal medicine residents from each of Wisconsin’s 5 onset of atopic dermatitis (AD) and EE residency programs presented their research and/or unusual clinical experiences via posters diagnosis. and vignettes. Methods: A retrospective cohort study was conducted in a population-based cohort. PRESENTED POSTERS ger length of hospitalization (OR, 0.72, Esophageal biopsy reports from 1995- Effect of Hyperglycemia on Outcomes 95% CI, 0.54-0.96, P = 0.03). Forty-one 1997 and 2005-2007 were screened using in Acute Exacerbations of Chronic patients (19%) were readmitted to the SNOMED (Systematized Nomenclature Obstructive Pulmonary Disease hospital within 30 days of discharge from of Medicine) to identify patients with Narendranath Epperla, MD, Yusuf Kasirye, index hospitalization. Adjusting for previ- pathologic confirmed or suspected EE. MD, Melissa Simpson, PhD, Hong Liang, PhD, ous covariates and length of hospitalization, Histopathology reports in which EE could Chaitanya Mamillapalli, MD, Steven Yale, MD; BG was not associated with 30-day hospital not be excluded and those with features sug- Departments of Internal Medicine, Biostatistics, readmission (OR, 0.82, 95% CI, 0.54-1.22, and Clinical Research and Marshfield Clinic gestive of EE were reviewed. Cases of esoph- Research Foundation; Marshfield Clinic, P = 0.32). Nine patients (4%) died within agitis due to chemicals, drugs, infections, Marshfield, Wis 90 days of their index hospitalization.
    [Show full text]
  • Diagnostic and Therapeutic Approach to Upper Airway Obstructions
    Diagnostic and therapeutic approach to upper airway obstructions Gerhard Oechtering University of Leipzig, Veterinary Faculty, Small Animal Department, ENT-Unit Leipzig, Germany Overview of the Issue The diagnostic approach to obstructions of the upper airways bases on both a thorough anamnesis (including among other things questions on breathing at rest, after exercise, during sleep, through mouth or nose) and a careful adspection and listening to breathing sounds and possible stridores. Distinguishing stenoses of the oro-laryngeal airway from those of the nasal and nasopharyngeal airway is a primary goal and can be very helpful for planning subsequent examinations. If an obstruction of the nasal and or nasopharyngeal airway is suspected, usually an examination under anesthesia is necessary. These passageways are not accessible for the naked eye and we need diagnostic aids like endoscopy and/or computed tomography. Plain radiographs of this region can be helpful but usually are clearly inferior to CT information. Key Clinical Diagnostic Points In dogs and cats, endoscopic examination of the upper respiratory tract from the nares down to the carina is done primarily with ridging endoscopes. Several factors determine the quality of the results. 1. Quality of endoscopes, light source, camera and documentation unit 2. Endoscopic experience and technique of the examiner 3. The examiners anatomic knowledge of the specific region 4. Patient preparation and positioning 5. Anesthesia and ventilatory support 6. Variety of supporting equipment Endoscopes for anterior and posterior rhinoscopy differ in size and angle of view. Common types are: 1. Diameter: Ø 2.7 mm (most dog breeds) and 1.9 mm (small dogs and cats) 2.
    [Show full text]
  • Respiratory Distress in the Newborn
    Respiratory Distress in the Newborn Suzanne Reuter, MD,* Chuanpit Moser, MD,† Michelle Baack, MD*‡ *Department of Neonatal-Perinatal Medicine, Sanford School of Medicine–University of South Dakota, Sanford Children’s Specialty Clinic, Sioux Falls, SD. †Department of Pediatric Pulmonology, Sanford School of Medicine–University of South Dakota, Sanford Children’s Specialty Clinic, Sioux Falls, SD. ‡Sanford Children’s Health Research Center, Sioux Falls, SD. Educational Gap Respiratory distress is common, affecting up to 7% of all term newborns, (1) and is increasingly common in even modest prematurity. Preventive and therapeutic measures for some of the most common underlying causes are well studied and when implemented can reduce the burden of disease. (2)(3)(4)(5)(6)(7)(8) Failure to readily recognize symptoms and treat the underlying cause of respiratory distress in the newborn can lead to short- and long-term complications, including chronic lung disease, respiratory failure, and even death. Objectives After completing this article, the reader should be able to: 1. Use a physiologic approach to understand and differentially diagnose the most common causes of respiratory distress in the newborn infant. 2. Distinguish pulmonary disease from airway, cardiovascular, and other systemic causes of respiratory distress in the newborn. 3. Appreciate the risks associated with late preterm (34–36 weeks’ gestation) and early term (37–38 weeks’ gestation) deliveries, especially AUTHOR DISCLOSURES Drs Reuter, Moser, by caesarean section. and Baack have disclosed no financial 4. Recognize clinical symptoms and radiographic patterns that reflect relationships relevant to this article. This commentary does not contain information transient tachypnea of the newborn (TTN), neonatal pneumonia, about unapproved/investigative commercial respiratory distress syndrome (RDS), and meconium aspiration products or devices.
    [Show full text]
  • Evaluation of Pediatric Upper Airway
    Evaluation of pediatric upper airway C. Gysin ORL-Unit University Children’s Hospital Zurich SSORL-Ecole d’été – SGORL-Sommerschule 2019 Pediatric airway – anatomy • large head • short neck • small nares • small mandible • pliable trachea and chest wall • immature alveolae • gastric dilatation, reflux • high metabolic rate • friable mucosa Pediatric airway – anatomy • high larynx • cricoid cartilage = C4 • long epiglottis • lies against the soft palate • long uvula • neonate obligate nasal breather Pediatric airway – anatomy prominent cuneiform cartilages short aryepiglottic folds tendency to collapse during inspiration epiglottis omega-shaped glottic length 50% ligamentous – 50% cartilaginous (adults 80-20) Pediatric airway – anatomy • subglottis: – from conus elasticus to inferior part of cricoid cartilage – only complete ring of the larynx and trachea – narrowest region of the pediatric airway • subglottic diameter at birth: – cricoid cartilage: 5.5mm – full-term baby: 4.5-5.5mm – premature baby: 3.5mm Pediatric airway – anatomy ↓ diameter 1mm = ↓ surface 50% ⇒ resistance R = 8µL/πr4 Pediatric airway – anatomy Newborn Child Adult Normal subglottic diameter (mm) 4 8 14 subglottic radius (mm) 2 4 7 subglottic surface (mm2) 12 6 12 1mm edema subglottic diameter (mm) 2 6 12 subglottic radius (mm) 1 3 6 subglottic surface (mm2) 3 27 108 Diminution of subglottic surface 75% 44% 27% Clinical approach 1. age of onset of respiratory symptoms? 2. level of obstruction? 3. investigations? 4. what is the lesion? Pediatric airway obstruction acquired congenital tumor foreign body infection trauma • newborn = congenital • 1-3 years = acquired more likely • >3 years = acquired likely (congenital highly unlikely) Diagnosis and age of onset of respiratory symptoms . since birth: . bilateral vocal cord paralysis .
    [Show full text]
  • Dealing with the Trauma Patient Louise O'dwyer
    Dealing with the Trauma Patient Louise O’Dwyer MBA BSc(Hons) VTS (Anesthesia & ECC) DipAVN(Medical & Surgical) RVN Clinical Support Manager, VetsNow, UK Trauma is a common cause of emergency presentations in small animal practice. Due to our patients small size the potential for multi-system damage is high and their injuries need to be approached in a systematic manner to ensure than no life threatening abnormalities are missed. Appropriate management in the first few hours is vital for success. Many patients benefit from a multi-modal approach in the successive days, concentrating on careful nursing, nutrition and pain relief. Primary assessment A major body system assessment approach should be used to rapidly identify the life threatening problems and initiate life-saving treatment. The major body systems are: • Cardiovascular • Respiratory • Neurological Cardiovascular Cardiovascular assessment is aimed at identification of hypoperfusion as a result of hypovolaemia. Significant blood loss can occur into body cavities and fracture sites without visible haemorrhage. This is especially true in cats. The response to hypovolaemia is initially tachycardia, vasoconstriction and increased myocardial contractility as a result of adrenergic stimulation. With continued blood loss these compensatory measures fail to maintain tissue perfusion and signs of decompensated hypovolaemic shock ensue. The response of dogs to blood loss is predictable and the degree of hypoperfusion can be estimated from the severity of their clinical signs (see table below). Cats are less predictable and more difficult to assess. Their higher resting heart rate also means there is less room for an increase in heart rate. We are therefore more reliant on palpation of pulse quality for assessment in these patients.
    [Show full text]
  • Stridor/Snoring/OSAS
    Stridor/Snoring/OSAS AdriaanAdriaan PentzPentz Division of Otorhinolaryngology University of Stellenbosch and Tygerberg Hospital Stridor/Stertor • Noisy breathing = airway obstruction • ALWAYS THINK WHAT’S CAUSING IT! Introduction • Stertor=Snoring – Caused by obstruction of airway above the larynx – Vibration in tissues of nasopharynx, oropharynx or soft palate – Rough, unmusical • Stridor – Due to obstruction in the larynx, trachea or bronchi Stridor: • Harsh, high-pitched, crowing noise during inspiration- larynx/ supraglottis obstruction • Stridor of lower pitch with snoring + excessive secretions- pharynx/ nasopharynx • Inspiratory+ expiratory stridor with prolonged low-pitched expiration- trachea/ brongi Grading of Stridor: • Grade I : Inspiratory stridor • Grade II : Expiratory stridor • Grade III : Inspiratory + expiratory stridor with pulsus paradoxsis • Grade IV : Respiratory arrest Associated signs and symptoms • Dyspnoea – Severity of one reflects severity of the other – Signs of respiratory embarrassment • Nasal flaring • Accessory muscles • Cyanosis • Indrawing of soft tissues • Tracheal tug – Beware of signs in neonate and small infant Associated signs and symptoms (continued) • Cough – Harsh and barking – Subglottic inflammation/tracheal compression • Hoarseness – Speech or crying – Vocal cord pathology Associated signs and symptoms (continued) • Deglutition and respiration – Share common pathway: oropharynx – Disorders of the one may interfere with the other – Stridor/Stertor often increase during feeding – Infants often
    [Show full text]
  • Lord October 2020
    Edinburgh Research Explorer Severe hypercapnia associated with a chemodectoma causing profound tracheal narrowing in a cat Citation for published version: Lord, S, Gozalo Marcilla, M, Bavcar, S & Lodzinska, J 2020, 'Severe hypercapnia associated with a chemodectoma causing profound tracheal narrowing in a cat', Vet Record Case Reports. https://doi.org/10.1136/vetreccr-2020-001232 Digital Object Identifier (DOI): 10.1136/vetreccr-2020-001232 Link: Link to publication record in Edinburgh Research Explorer Document Version: Peer reviewed version Published In: Vet Record Case Reports General rights Copyright for the publications made accessible via the Edinburgh Research Explorer is retained by the author(s) and / or other copyright owners and it is a condition of accessing these publications that users recognise and abide by the legal requirements associated with these rights. Take down policy The University of Edinburgh has made every reasonable effort to ensure that Edinburgh Research Explorer content complies with UK legislation. If you believe that the public display of this file breaches copyright please contact [email protected] providing details, and we will remove access to the work immediately and investigate your claim. Download date: 25. Sep. 2021 Submission template for full cases All case reports MUST be submitted online using this Word template. Please refer to the Hints and Tips template so you know what to include in each section o http://mc.manuscriptcentral.com/vetreccr o You will be asked for more detailed information on submission where you can also upload images, multimedia files, etc o Further details are available in the Instructions for authors For studies using client-owned animals the article must demonstrate a high standard (best practice) of veterinary care and have informed client consent You, your practice or institution must be a subscriber to Veterinary Record Case Reports in order to submit.
    [Show full text]