November 15, 2017

PCV/TP – How To Get The Most Out of This Simple Test

The packed cell volume (PCV) and total protein (TP) is a simple yet informative laboratory test, but one that is often misinterpreted or under-utilised. It is important to remember that all test results need to be interpreted in the light of the patient’s history, presenting clinical signs and general physical examination findings. Below is a table of the various changes that can be found on a PCV/TP and the possible causes of these changes. Many of the differentials can be include or excluded based on the history, clinical signs and examination findings. I would like to highlight some common misconceptions […]
September 27, 2017

GDV: The Recovery

Postoperatively, gastric dilatation-volvulus (GDV) patients remain in our intensive care unit for at least two to three days. Monitoring includes standard general physical examination parameters, invasive arterial blood pressures, ECG, urine output via urinary catheter and pain scoring. I repeat PCV/total protein, lactate, blood gas and activated clotting times (ACT) immediately postoperatively and then every 8-12 hours, depending on abnormalities and patient progress. I always repeat these blood tests postoperatively, as IV fluids given during the resuscitation and intraoperative period often cause derangements. I use the results to guide my fluid therapy, but also take it with a grain of salt. […]
September 14, 2017

GDV: The Surgery

Part Three: Surgery Tips  Recently in my GDV blog series, I discussed releasing the pressure and decompression, this time I want to focus on surgery. Abdominal Incision: Make the abdominal incision large – from the xipoid to the pubis. You cannot perform a proper exploratory laparotomy without proper visualisation. Additionally, when it comes time to re-rotate the spleen, you will need all the space you can get. Remove the falciform fat to help improve exposure. Derotation: The degree of rotation is variable from 90 to 360 degrees, so not all GDV surgeries will be the same. If the omentum is […]
September 6, 2017

GDV: Releasing The Pressure

Part Three: Gastric Decompression  Last week we covered IV fluid resuscitation and pain relief. This week we will go into more detail about gastric decompression. There are two ways that gastric decompression can be achieved: 1) Trocarisation 2) Stomach tube (orogastric tube) placement The decision on which method to use depends on many factors: personal preferences, past experiences and clinical protocols to name a few. So, which one is the best? A recent retrospective analysis of 116 gastric dilatation and volvulus (GDV) patients by Goodrich et al. (2013) found that both methods of gastric decompression had low complication and high success […]
August 30, 2017

GDV: Resuscitation

Part Two: Resuscitation Recently we covered a bit of pathophysiology, presenting clinical signs and the radiographic diagnosis of gastric dilation and volvulus (GDV). Now we cover the three things you need to do as soon as a suspected patient is presented. As discussed, you can often make a presumptive diagnosis without radiographs based on supportive presenting clinical signs and signalment. IV fluid resuscitation Decompression the stomach Pain relief Depending on the number of staff you have available, all of these can be performed simultaneously. If not, follow the above order as shock is the most imminent problem. Fluid resuscitation is relatively […]
July 6, 2017

Temporary catheters in obstructed FLUTDs – Buying time with a blocked cat!

Obstructive feline lower urinary tract disease is a common presentation in both general practice and in an emergency setting. Every clinician has their own approach to treating and managing a cat with obstructive FLUTD signs. Working in an emergency setting, once I have confirmed an obstructed bladder via palpation, I focus on trying to relieve the obstruction as quickly as possible. The first step is obtaining consent from the client to administer pain relief (an opioid IV or IM), place an IV catheter, collect blood for biochemistry, electrolyte and blood gas analysis, and temporarily relieving the obstruction. At our hospital, […]
May 11, 2017

Euthanasia Part 2 – Caring for the Patient

  Last week we discussed the importance of caring for the client during the process of euthanasia of their much loved pet. This month, we focus on your patient. The goals of euthanasia are always to make it as painless, fearless and stress-free as possible for the patient. A vast majority of patients presented for euthanasia are either suffering from chronic, terminal or traumatic disease. The first thing I like to do is ensure the patient’s pain is managed. This usually means providing opioid pain relief. Methadone is my opioid of choice. Butorphanol provides minimal pain relief, but is excellent for […]
May 11, 2017

Euthanasia Part 1 – Caring for the Human

  Euthanasia is a big part of our work as veterinarians. It is something I have to face on every shift working in an emergency setting. It doesn’t get any easier no matter how many times I have to do it, but I have fine-tuned my approach over the years so that each euthanasia process runs as smoothly as possible and with minimal additional stress to patient and client. This week, I will talk about taking care of your client. The most important aspect of taking care of your client in this difficult time is to make sure you really […]
April 12, 2017

Effusion Analysis (Part 2)

  Effusion Evaluation: Last week we talked about how to determine if your effusion was septic. This week, let’s have a look into further evaluation of effusion samples. If the effusion is haemorrhagic, here are some things to look out for. Real or iatrogenic origin: Blood rapidly defibrinates in cavities so if it clots then it is iatrogenic If it swirls during collection it is more likely to be iatrogenic Is it acute or chronic? Compare PCV/TP to peripheral, if sample PCV/TP = peripheral blood PCV/TP then a recent bleed is most likely the cause Always run a PCV/TP on haemorrhagic […]