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 […]
April 12, 2017

Making Sense of Effusions (Part 1)

  Is Your Patient Septic? Interpreting effusion samples can be confusing. Try to think of effusions as if you were collecting a blood sample. Many of your in-clinic diagnostic tests that apply to blood samples also apply to effusions, such as PCV/TP, smears, glucose, lactate, potassium, creatinine and bilirubin. It is not enough to only check the protein concentration of the effusion, then classify it as either a transudate, modified transudate or exudate and leave it at that. There is more information left to extract from that sample! Determining if an effusion is septic can be a challenge, here are […]
February 21, 2017

Pulse Oximetry! Know it’s Limitations.

Pulse oximetry is very useful diagnostic and monitoring tool that is now commonplace in veterinary clinics. It measures the percentage of hemoglobin that is saturated with oxygen, and is an indirect measure of arterial oxygen levels. However, here are several important points that can help you understand the limitations of pulse oximetry: Causes for false readings: Falsely low readings: Motion artefact Peripheral vasoconstriction/low tissue perfusion from hypothermia or shock Pigmentation of mucous membranes Thick hair coat Falsely high readings: Hemoglobin abnormalities (i.e. carboxyhemoglobin and methemoglobin) Pulse oximetry can give us a false sense of security: we hold on to the […]
January 16, 2017

Don’t Rush: A Systematic Approach To X-rays

  One of my responsibilities in our emergency hospital is the training and mentoring of veterinarians new to the field of emergency and critical care. A common area that I have found where clinicians request more training is radiographic interpretation. When I review radiographs and I find pathology that was missed it is more often due to a lack of systematic approach to reviewing a radiograph rather than experience or knowledge of that clinician. There is of course, no one set way you should go about interpreting a radiograph, whatever the method the entire radiograph should be assessed not just […]
December 30, 2016

The Dangers of Casts and Bandages

    Casts and bandages are frequently used to treat orthopaedic conditions, especially in situations where clients have financial constraints thus ruling out surgical treatment. However, these techniques have an extremely high probability of complications that include: Malunion, delayed or non-union. Fracture disease, which refers to joint stiffness, muscle atrophy, and disuse osteopenia associated with prolonged casting. And most commonly, soft tissue injury ranging in severity from mild dermatitis, pressure sores to sepsis and avascular necrosis of tissues. Although avoidance of using coaptation techniques is recommended, very stringent case selection may help to reduce the risk of complications occurring. If […]
December 12, 2016

Urinalysis – The Neglected Test.

Urinalysis is an important diagnostic tool in veterinary practice. It is indicated for any patient that presentations with polyuria or urinary tract signs, but also a necessary test to perform in conjunction with serum biochemistry. Why do some clinicians fail to perform urinalyses even when they are indicated? Some reasons include: Clinicians don’t see the importance of obtaining a urine sample. The difficulty in obtaining a sample in some situations. The patient may not want to void. No access to an ultrasound for a guided cystocentesis. Patients may not urinate upon bladder expression. However, it is important that clinicians make […]
December 12, 2016

Blood Smears – Make Them A Routine Test!

  Blood smear evaluation is an often overlooked but a very important aspect for in-house haematology. With the advancement in haematology analysers that can now detect reticulocytes and even band neutrophils, some practitioners are beginning to rely solely on the numerical data alone in evaluating the patient’s blood. The art of blood smear interpretation is on the decline. However, it is an extremely valuable skill that needs to be practiced and perfected and should be part of every in-house haematology. What are the benefits of understanding blood smears? Identifying of a regenerative response, looking for reticulocytes (polychromatophils) Looking for the […]
October 9, 2016

Dog Bite Wounds – The Tip of Iceberg!

Dog bite wounds are one of the most common presentations both in general and emergency practice, and they can often be challenging cases. Once you have stabilised the patient, it is time to go speak to the client. Here is the most important point that you need address: The injuries you see are just the “Tip of the Iceberg’’. It can be helpful to draw pictures to let them know that a small penetrative puncture wound can often be masking a horrific injury underneath, especially in big dog on small dog bite wounds, where the small dog is often picked […]
September 26, 2016

Fluid Therapy: Twice Maintenance Just Isn’t Good Enough!

Fluid therapy is a topic that sometimes gets overlooked by veterinarians, partly because there is a misconception that developing fluid plans can be very difficult. However, if you keep it simple, you can develop a tailored fluid therapy plan for you patient that is much better than a blanket ‘twice maintenance’ rate. There are 4 basic components to a fluid therapy plan that you need to think about: Perfusion deficit Hydration deficit Maintenance requirements Ongoing losses Perfusion deficits need to be corrected immediately. Start with a 10mls/kg IV fluid bolus of buffered crystalloids and repeat as necessary to shock volumes […]
September 19, 2016

Anesthetic Risks: When Complacency Sets In!

Adverse events during anesthesia in otherwise young and healthy patients is a rare occurrence, however, with low incidence of adverse events could come an increased risk of complacency on the part of the veterinary team. Take the following case as an example: “Clicky” is a young and healthy cat that underwent a routine dental prophylaxis procedure. A few days after the procedure, she developed respiratory difficulties and presented to our emergency clinic. She was diagnosed as having severe subcutaneous emphysema, most likely from a tracheal wall compromise that would have occurred as an adverse event from tracheal intubation.  We need […]
July 29, 2016

The MiniVet Guide For Fundraising

Did you know the MiniVet Guide can help you raise funds for your student club, event or charity? I offer the MiniVet Guide to students to help them raise serious cash for their club, event or charity. I love this side of what I do, as it allows me to help students raise money for a good cause. I remember my time at University well and I was forever looking for new ways to raise money for a trips overseas, for a chosen charity or for an end of year dinner. How does it work? What I usually do if a club is […]
July 14, 2016

Dr Google Can Be Your Friend!

Technology has changed how we practice veterinary medicine. Gone are the days of the paternalistic relationship between vet and client where the client will simply go along with whatever the vet deems is necessary for the pet. Clients are becoming more knowledgeable and as vets, we are often faced with a situation where a client comes in armed with a ‘Dr Google’ diagnosis. As practitioners this can be challenging and confronting, maybe because our egos tell us that this is an insult to our hard earned years of training and experience. I think the perspective needs to change regarding this […]
May 24, 2016

Transition Into Clinical Practice

At the Animal Emergency Service, we have dozens of students every year coming through for practical rotations. Here are some of my tips to help your transition into practical placements. Top Tips Have a MiniVet Guide! This will give you a framework on which to approach any case that you see. Don’t be caught out not having a clue when asked by your supervisor what your take on a case is. Have your own stethoscope, pen, scissors and name badge. You don’t want to look like a pre-clinical student now do you? You’re not playing dress up anymore. For all […]
May 24, 2016

MiniVet Guide Interview

Que : What’s your background? I graduated from the University of Queensland in 2008. I started in a busy companion animal general practice then made the transition to the field of emergency and critical care. I am a director of a large emergency hospital in Brisbane called the Animal Emergency Service. I have a keen interest in the triage, stabilisation and management of critically ill patients, small animal ultrasound and radiology and emergency surgery. Que : Tell us what the MiniVet Guide is all about The MiniVet Guide is a pocket-sized quick reference booklet aimed at making the lives of […]
May 10, 2016

Life as an Emergency Veterinarian

I distinctly remember my first encounter with the world of emergency medicine. It was when I called the local emergency center for advice on how to manage a patient that was bitten by venomous snake. I was blown away by the calm, knowledgeable and reassuring voice on the other end of the phone. I put the phone down reassured and thought to myself that I would like to be that person someday. I was so grateful to that emergency clinician and little did I know that she was to become one of my mentors and have a huge impact on […]