Respiratory emergencies Q&A with Ken Yagi, MS, RVT, VTS (ECC), (SAIM)

Can you give me a little bit of background about yourself?

I’m a veterinary technician specialist in Emergency and Critical Care as well as Small Animal Internal medicine with 24 years of experience, starting as a veterinary assistant and growing up in a 24/7 general/emergency practice. Today, I am the chief veterinary nursing officer at VEG overseeing over 2100 veterinary nurses and assistants in 88 hospitals.

What are the key clinical signs that indicate a patient is in the early stages of shock?

The early stages of shock, known as compensatory shock, are characterized by:

• Increased heart rate (tachycardia): The heart pumps faster to maintain cardiac output.
• Bounding pulses: A stronger pulse due to increased stroke volume.
• Normal to slightly elevated blood pressure: Blood pressure may still be maintained despite underlying issues.
• Pale or normal mucous membranes: Vasoconstriction causes less visible blood flow, but in some cases, color remains normal.
• Prolonged capillary refill time (CRT): Vasoconstriction makes it take longer for blood to return to the capillaries.
• Cool extremities: Peripheral vasoconstriction shunts blood to vital organs, making extremities feel cooler.

These signs indicate the body's compensatory mechanisms are active, maintaining vital organ perfusion despite underlying problems.

Kenichiro Yagi, MS, RVT, VTS (ECC), (SAIM), chief veterinary nursing officer for Veterinary Emergency Group (Image courtesy of Veterinary Emergency Group)

What are some of the most common causes of shock?

The common causes of circulatory shock are:

1. Hypovolemic Shock: Due to significant fluid or blood loss (e.g., hemorrhage, severe vomiting or diarrhea, polyuria) leading to loss of intravascular volume.
2. Cardiogenic Shock: Caused by heart dysfunction (e.g., dilated cardiomyopathy, hypertrophic cardiomyopathy, or pericardial effusion) reducing forward flow of blood.
3. Distributive Shock: Results from altered blood flow distribution (e.g., anaphylaxis, sepsis, systemic inflammatory response syndrome) which leads to relative hypovolemia and poor perfusion.

What are some of the challenges in assessing shock in animals, especially in high-stress emergency situations?

Assessing shock in animals during emergencies is a race against time, requiring the ability to quickly and confidently evaluate the patient and determine the type of shock involved. The initial challenge is recognizing the signs accurately and rapidly deciding on a treatment approach when every second counts. Once the diagnosis is made, success hinges on swift, decisive action and the coordinated efforts of a well-trained team. Effective management demands more than individual expertise. It requires seamless teamwork, strong communication, and clinical proficiency to implement interventions that stabilize the patient and prevent further deterioration.

How important is teamwork and communication in managing a shock patient during an emergency?

Managing shock patients effectively relies heavily on strong teamwork and communication. Rapid identification and prompt treatment are key, and these depend on having a team that can respond quickly and work together seamlessly. Shock cases often require multiple actions happening at once (placing IV lines, administering fluids, monitoring the patient, while setting up for necessary procedures) making coordination essential. Clear communication keeps everyone on the same page regarding the treatment plan and any changes in the patient’s condition.

It’s also important that each person understands their role to prevent delays or confusion. Safety is a top priority, especially when handling complex treatments, and having a well-organized team reduces the risk of mistakes. In emergency situations, solid teamwork can make all the difference in achieving a good outcome for the patient.