October 25, 2018

Perfusion Deficits and Fluid Resuscitation: A More In-depth Look

Previously we discussed the four basic components of a fluid therapy plan – perfusion deficit, hydration deficit, maintenance requirements and ongoing losses. Let’s consider perfusion deficits. As an emergency clinician, correcting perfusion deficits is a crucial part of stabilising a patient. So what is a perfusion deficit? It either refers to a real or relative loss of intravascular fluid volume, or low blood pressure, leading to a decrease in perfusion of tissues and, ultimately, decreased oxygen delivery – ie, shock. What does this look like clinically?                 Clinical signs of perfusion deficits include: pale gums […]
June 20, 2018

Five Things I Wish I Could Tell Myself When Starting Uni

We all sometimes wish we could go back in time or have a do-over on some situations, University is such an important time in our lives, and often when we look back with hindsight and more life experience we wish we could have done things a little differently, or perhaps focused our time and energy in a better way. I have been reflecting recently as my career has progressed, and whilst I am incredibly proud of what I have achieved and where my journey has bought me, if I could say 5 things to the Gerardo Poli about start University, […]
January 31, 2018

Intoxications: Phone Conversations Part 2

Building on from last week’s blog on telephone advise, this is what I advise that owners can do at home if they have been exposed to a toxin. The main routes of exposure are ocular, dermal and gastrointestinal. Ocular Acids and alkalis cause the most severe effects as they can cause ongoing damage sometime after initial contact. Eye irrigation (avoid contact lens solution as this can cause further irritation) Tepid water, saline or distilled water 20 to 30 minutes (ideally) Rinse from medial to lateral to avoid contamination of the other eye Once the eye(s) have been flushed, then recommend […]
January 25, 2018

Intoxications: Phone Conversations

We frequently field phone calls from owners who are concerned about their pets being intoxicated or having access to a toxic compound. These are the list of questions I ask always owners: What is your pet doing? The main reason I ask this question first is to determine if the pets life is in danger. If the pet is seizing, collapsed, neurological, bleeding or having difficulty breathing then they need to come down immediately. What lead to the suspicion of toxic exposure? This can help provide useful background information. What is the product? In some situations owners can tell you […]
December 12, 2017

Christmas Dangers!

Christmas can be a very busy time for veterinary clinics; here are a list of common intoxications and conditions to keep an eye out on during this festive period. Chocolate There are numerous online calculators to determine whether a toxic dose has been consumed – they are a great place to start I always perform emesis in patients that have ingested chocolate even hours after ingestion as often large amounts can reside in the stomach Remember that cardiac arrhythmias can also occur in clinically normal looking patients so perform an ECG The toxic components can be reabsorbed through the bladder […]
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 […]
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 […]
April 7, 2017

Vet Surgery – Open chest surgery

Bronx: Open Chest Surgery Bronx was playing in the back yard when he became impaled on a large stick – the wound looked small from the outside, however, what we found after further investigation was beyond anything we had ever seen before. Watch one of the most challenging surgeries we have faced to date and Bronx’s truly heroic recovery. I couldn’t be more proud of the AES team for their hard work and commitment during this long, complex procedure.
April 7, 2017

Vet surgery – foreign body

Meet Tia, a 2 year old German Short Haired Pointer. Take a look at what we found stuck in her small intestine
April 7, 2017

Stuck Puppy

Stuck Puppy – A Helping Hand One of the greatest joys of being an emergency veterinarian is that we get to be a part of the miracle of birth. We often have patients bought in to see us because they are having a difficult labour, but luckily we are always there to lend a helping hand!