Biomedical Engineering Reference
In-Depth Information
specialty. Several training programs have been created to
prepare veterinarians for board certification by the Amer-
ican College of Veterinary Emergency and Critical Care
(ACVECC).
Many of the essential diagnostics, patient monitoring
techniques, and therapies used in emergency medicine and
critical care in nonhuman primates are the same as or
similar to those used in companion animal species.
However, there are important differences between
nonhuman primates and other animal species that influence
diagnostic sampling, provision of treatment, and moni-
toring. Challenges for the veterinarian providing care to
critically ill nonhuman primate species include issues
related to biosafety, maintenance of access (chronic cath-
eterization), maintaining social contact, and the unanes-
thetized primate's ability to manipulate bandages,
catheters, and other medical devices. As prey species,
nonhuman primates have adapted responses to mask clin-
ical signs of pain, which may delay diagnosis until the
disease process has progressed significantly. Additionally,
the social needs of nonhuman primates and the conse-
quences of disrupting social bonds create additional
considerations
observed in nonhuman primates. Certain aspects of patient
assessment, technical description of some sample collec-
tion procedures, analgesic therapy, and diagnostic exercises
for specific disease states are discussed in more detail in
other chapters. The content of this chapter is devoted to
presenting an overview of these topics with detail focused
on emergency medicine and critical care.
Few of the drugs described in this chapter have widely
agreed upon recommended dose ranges in nonhuman
primates. Often, there are no recommendations for
addressing the possible variability in drug metabolism
between different species of nonhuman primates. Histori-
cally, nonhuman primate emergency drug doses have been
extrapolated from doses calculated for use in companion
animal and/or human medicine as a starting point, with
continued use based on their apparent clinical effective-
ness. Recommended doses on a weight basis for companion
animal and human patients are often close, if not identical,
for many emergency drugs. Unless doses have been
established in nonhuman primates for a particular
compound, commonly used doses in general veterinary
practice are referenced below as a starting point. The reader
is encouraged to refer to the literature to determine the most
current recommendations for drug dosages in nonhuman
primate species.
for
both
outdoor-housed
and
caged
individuals.
Nonhuman primates living in outdoor breeding colonies
often present with medical emergencies that are much
different than those of primates that are housed in indoor,
controlled environments. These differences are primarily
associated with the level of exposure to pathogenic agents,
physical hazards, environmental hazards, housing config-
uration, and social grouping. It is important that the initial
list of differential diagnoses be created with an eye toward
these differences. It may be necessary to use different
diagnostic
GENERAL
Initial Assessment and Diagnostic
Evaluation of the Critical Patient
The management of a critically ill laboratory nonhuman
primate begins with an initial assessment for life-threatening
conditions followed by a more thorough physical examina-
tion and consideration of the animal's medical history. This
section briefly describes the assessment process that is
commonly utilized in the early evaluation of critically ill
nonhuman primates.
The principles used during the initial assessment of
a critically ill nonhuman primate are similar to those that
would be used in the examination of a variety of laboratory
animals. A rapid primary survey of the animal includes
evaluation of the “A, B, C's,” which have expanded in
recent years to include airway, breathing, bleeding, circu-
lation, and consciousness (
Kirby, 2009
). If the patient is in
extremely critical condition at the time of presentation,
a full assessment might not be possible until the patient has
been stabilized. It is important to note that following the
primary survey,
and
treatment
strategies
for
these
two
populations.
It is impossible to adequately cover the entire specialty
of emergency medicine and critical care in a single chapter.
Based on this premise, the authors have included descrip-
tions of general approaches and techniques used in emer-
gency medicine and critical care and focused on common
emergency conditions seen in nonhuman primates. There is
a relative dearth of information in the literature addressing
emergency medicine and critical care in nonhuman primate
species. Keeping this reality in mind, in addition to the use
of nonhuman primate references, this chapter utilizes
references from companion animal and human medical
literature. The authors have also drawn extensively from
their personal experience and the experience of their
colleagues in treating critically ill nonhuman primates. The
chapter is structured into two major sections. The first part
of the chapter is focused on the technical aspects of
providing emergency medicine/critical care. The second
part of the chapter addresses the recognition and manage-
ment of commonly encountered emergency conditions
the most unstable system should be
addressed first.
In order to complete a thorough examination and collect
samples for diagnostic assays, decrease distress for the
patient, and increase safety for personnel, the initial eval-
uation of a critically ill nonhuman primate is often
