Tijdschr Diergeneesk
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Tijdschr Diergeneesk · Feb 1989
Review[Medical hemostasis. II. Systemic hemostatics, a critical evaluation].
The control of spontaneous and traumatic haemorrhage is a matter of constant concern to veterinary practitioners. In some instances, the control of bleeding may be relatively simple using some topical therapeutic procedure, but when haemostatic defects are present, treatment with topical agents alone might not be sufficient, and more radical and life-saving procedures are indicated: replacement therapy with blood or blood products. As this is not easy to perform in most veterinary clinical situations, any therapeutic agent, which facilitates control of haemorrhage is a welcome addition to the therapeutic armament. ⋯ Double-blind prospective trials with quantitation of loss of blood showed that antifibrinolytic agents such as tranexamic acid are clinically effective in certain conditions in humans. Because of their mode of action, it might reasonably be expected that these drugs might have positive results in veterinary medicine. Therefore, clinical trials with antifibrinolytic agents are urgently indicated to evaluate the effectiveness and side-effects of these drugs in animals showing severe bleeding or in the prevention of peroperative haemorrhage.
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In Part II of this review, recent aspects in shock therapy are discussed. Treatment of an animal in a state of shock is not an easy task, it is time-consuming and expensive. The basic aims of shock therapy are to remove the inciting cause (wherever possible), to increase the circulating blood volume in order to stimulate the cardiac output and tissue perfusion (by infusion of fluids and eventually vasoactive substances), and to reduce or correct the injurious effects of shock (oxygenation, corticosteroids, antibiotics, energy or substrates, vasoactive substances, diuretics, regulation of the acid-base balance, stimulation of RES, and treatment of DIC).
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Cyanide is a potent and rapidly-acting asphyxiant which prevents tissue utilization of oxygen by inhibition of the cellular respiratory enzyme, cytochrome oxidase. Inhalation or ingestion of cyanide produces reactions within a few seconds and death within minutes. ⋯ Biological detoxification of cyanide is available through several routes, and the application of sodium nitrite with sodium thiosulfate or administration of methylene blue are effective treatment procedure. The environmental availability of cyanide in its various forms necessitates an understanding of its pathophysiology and responsible management of hazardous situations.