A survey on workload and wellbeing
Burnout and poor mental health may be key factors linked to the current shortage of veterinarians; this paper presents the results of a recent survey that attempts to gauge the scale of the problems.
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Published 22/03/2021
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When should a cat be fed? Basically, as soon as possible. If anorexia is or may be present for more than 3 days. In kittens after a few hours of anorexia. As soon as cardiovascular and hemodynamic parameters are stable; major electrolyte abnormalities such as hyperkalemia should be corrected before feeding commences.
• Tasty food with a pleasant odor
• Consider starting with some “treats” to stimulate appetite
• A critical care diet with high energy and high protein content
• Food should be at room temperature
• Enteral if possible
• Partial parenteral if enteral nutrition does not provide adequate energy intake
• Parenteral nutrition if enteral nutrition is not possible
• Use highly palatable food
• Create a cat-friendly, calm environment with soft, warm bedding and a place to hide
• Make sure the cat is not in pain; administer analgesia as appropriate
• Give anti-emetics and gastric protectants if the cat appears nauseous
• Appetite in cats is stimulated by smell; clean the cat’s nose if obstructed with mucus or other material
• Offer fresh food at room temperature on a regular basis
• May be used if conventional techniques do not work
• Cyproheptadine is an H1-antihistaminic drug (1-4 mg/cat every 12-24h PO)
• Mirtazapine is a 5-HT3 antagonist (3-4 mg/cat every 3 days PO)
• Benzodiazepines (e.g., midazolam) may be used as a short-term option if other drugs fail. They may induce appetite at a very low dose (0.05 mg/kg IV) but may also cause sedation. However, hepatic failure has been described after giving diazepam to cats
• Careful force-feeding using a syringe may be carried out if other techniques fail. It may also be beneficial to put some food on the cat’s paws, as the cat may lick it off whilst trying to clean itself
• Feeding tubes should be used if enteral feeding is possible, but the energy requirements are not fulfilled by spontaneous food intake
• Easy to place without general anesthesia
• Can be removed whenever required
• Usable for three or more days
• Only suitable for liquid diets
• Feeding tube 4.5-6 FG
• Lidocaine-containing lubricant
• Suture material
• Needle holder
• Scissors
• Place some lubricant on the lower nasal meatus and at the tip of the tube (Figure 1)
• Measure tube length from the nose to the 8th intercostal space and mark with a permanent marker (Figure 2 and 3)
• Introduce the tube into the lower nasal meatus by directing the tube tip ventro-medially (Figure 4)
• Allow the cat to swallow the tube by flexing the neck slightly, and advance the tube until the mark reaches the nose (Figure 5)
• Suture the tube using a Chinese finger trap; a second suture should be placed at the level of the upper jaw or on the forehead (Figure 6)
• As an alternative to suturing, tissue glue may be used, but note that, when the tube is removed, some hair (and possibly skin) may be removed as well
• Check positioning with radiography
• Use food at room temperature
• Flush the tube before and after feeding with 2-3 mL of water
• Start with small boluses (1-2 mL/kg every 2-4 hours)
• Feed the cat 1/3 of its resting energy requirement* (RER) the first day, 2/3 RER the second and 3/3 RER the third day
• Increase bolus size stepwise up to 10 mL/kg (if tolerated by the cat)
• As an alternative to bolus feeding, a liquid diet can be given by constant rate infusion at a rate of 1-2 mL/kg/h. With this technique, the tube should be rinsed with water every 4-8 hours
*Daily RER can be calculated as follows: Kg0,75 x 70 = RER (kcal)
Rene Dorfelt
René Dörfelt, Ludwig Maximilian University, Munich, Germany Read more
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