confused about basic things!

Re: confused about basic things!

scatty — Mon, 07 Jul 2014 21:37:11 GMT

Thanks all of you for these responses - very good to hear your thoughts and I think I understand what I am saying a lot more now.

Re: confused about basic things!

Rory Bell — Sun, 06 Jul 2014 20:55:49 GMT

A somewhat rhetorical question; would you, or did you (in this case) use CRT to distinguish between peripheral underperfusion and haemolytic anaemia? I'll bet you didn't and that's why you're struggling to retrospectively make things fit. You know that CRT is notoriously non-specific and inaccurate as a diagnostic test; it's possible to elicit a CRT <2seconds in a (recently) deceased dog! The problem with CRT is not just that it's inaccurate to begin with, but that inaccuracy gets multiplied when you try to perform it on a dog with pale mucous membranes. I've suggested some alterations to your statement, but might it be worthwhile just mentioning that you perhaps found it difficult to accurately interpret a prolonged CRT in a patient with mucous membrane pallor? I absolutely don't want to place words in your mouth though, so please just treat this only as a suggestion.

'Mucosal pallor could be due to anaemia or decreased peripheral perfusion which has a number of causes (hypovolaemia, reduced cardiac output and shock or severe hypothermia which I assume you'd already excluded). Tachycardia and tachypnoea could also fit with shock or congestive heart failure. The change in peripheral circulation in these situations tends to result in mucosal pallor and delayed CRT (contrasting with anaemia which would cause pallor but not necessarily (if not accompanied by hypovolemia) prolong CRT)

Feel free to get in touch if you've any questions

cheers

rory

Re: confused about basic things!

Claire Fisher — Sun, 06 Jul 2014 20:14:47 GMT

I think what you've written sounds good.

I always ended up with long complicated sentences explaining these parts of my case reports so after a couple I opted for bullet points which the assessors seemed quite happy with.

Re: confused about basic things!

Michael Woodhouse — Sun, 06 Jul 2014 17:35:05 GMT

I agree with what you have written.

Re: confused about basic things!

Suzanne Kelly — Sun, 06 Jul 2014 17:35:05 GMT

Anaemia secondary to a bleed will cause an > CRT. So acute haemorrhage eg ruptured splenic mass, RTA with a bleed, bleeding post surgery, these are all things that will cause anaemia and an >CRT. CRT is an indicator of tissue perfusion.

If an animal is dehdydrated but not anaemic it will have a prolonged CRT, but the mms will be pink,

I hope I haven't made you more confused!