ISSN 2398-2942      

Kirby's rule of twenty



  • Checklist developed by Dr Rebecca Kirby, one of the founding members of the American College of Veterinary Emergency and Critical Care and founding member of the Veterinary Institute of Trauma, Emergency and Critical Care.
  • Checklist involves monitoring multiple organ systems in the most critically ill patients.
  • Aids in the integration of disease processes and possible interactions of drugs associated with therapy.


  • Mortality in patients who need Rule of Twenty monitoring is high, depending on primary disease state and response to aggressive therapy.



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Further Reading


Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Purvis D & Kirby R (1994) Systemic Inflammatory Response Syndrome: Septic Shock. Vet Clin North Amer Sm Anim Pract 24 (6), 1225-1247 PubMed.

Other sources of information

  • Rozanski E (2003) Approach to the trauma patient. A Bridge to the Future Veterinary Conference.
  • Kirby R (1995) Septic Shock. In: Kirk's Veterinary Therapy XII Small Animal Practice.Eds J D Bonagura and R W Kirk. W B Saunders, Philadelphia. pp 139 - 146.


Acid base imbalance

Acute prostatitis

Acute Respiratory Distress Syndrome (ARDS)

Adder bite poisoning

Analgesia: opioid

Analgesia: overview

Anemia: overview

Anemia: transfusion indications

Anesthetic monitoring: pulse oximetry

Anesthetic monitoring: respiratory system (capnograph)

Anesthetic ventilators: overview

Arterial blood gas sampling

Arterial blood pressure: oscillometric


Blood biochemistry: albumin

Blood biochemistry: bicarbonate

Blood biochemistry: creatinine

Blood biochemistry: glucose

Blood biochemistry: potassium

Blood biochemistry: sodium

Blood biochemistry: total calcium

Blood biochemistry: total globulin

Blood biochemistry: total protein

Blood biochemistry: urea

Blood pressure: direct measurement

Blood pressure: Doppler ultrasound

Blood smear preparation

Blood: transfusion

Brain: trauma

Buccal mucosa bleeding time

Cardiac arrest

Central venous pressure

Cephalic catheterization


Diabetes mellitus

Diabetic ketoacidosis

Disseminated intravascular coagulation



ECG: overview

ECG: principles of interpretation

Enteral nutritional support



Fibrin degradation products

Fluid therapy

Fluid therapy: acute circulatory collapse

Fluid therapy: for acid-base imbalance

Fluid therapy: for electrolyte abnormality

Gastrostomy: percutaneous tube 1 (endoscopic)

Heart: congestive heart failure

Heart: dysrhythmia

Heat stroke

Hematology: activated clotting time

Hematology: activated partial thromboplastin time (APTT)

Hematology: hemoglobin concentration

Hematology: leukocyte (WBC)

Hematology: neutrophil

Hematology: packed cell volume

Hematology: platelet count

Hematology: prothrombin time

Hospital-associated infections





Infusion: fluid pump

Infusion: syringe pump

Kidney: ischemia

Kidney: trauma

Lung: aspiration pneumonia

Lung: atelectasis

Lung: bacterial pneumonia


Multiple organ dysfunction syndrome (MODS)

Nasal oxygen administration

Nasoesophageal intubation


Pancreatitis: acute

Parvovirus disease associated with CPV-1

Parvovirus disease associated with CPV-2

Patient monitoring for critical care



Placing an arterial catheter



Pyrexia: overview

Radiography: thorax

Rattlesnake bite

Renal function assessment


Seldinger (over the wire) technique

Serum protein electrophoresis

Shock: septic

Skin: burn / scald

Skin: decubital ulcers

Skin: external parasite bite reaction

Small animal coma score

Smoke inhalation

Status epilepticus

Stomach: gastrotomy

Systemic inflammatory response syndrome (SIRS)

Therapeutics: antimicrobial drug

Therapeutics: gastrointestinal system

Therapeutics: nutrients

Ultrasonography: cardiac

Urethral catheterization: female

Urethral catheterization: male

Urinalysis: overview

Urinalysis: specific gravity

Urine collection: freeflow

Wound: bandage

Wound: drainage

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