Meghan T. Ramos VMD, Alexandra M. Hartzell VMD, Cynthia M. Otto DVM, PhD, DACVECC, DACVSMR
Objective
This retrospective study aimed to characterize and evaluate the emergency approach, diagnosis, management, treatment, and follow-up of nonspecific canine lameness cases.
Design
Retrospective case series from September 25, 2013 to September 25, 2014.
Setting
The study was conducted at an urban university teaching hospital.
Animals
A consecutive sample of dogs presenting to the emergency service with nonspecific lameness in the designated timeframe was used to identify 134 cases. Owners were contacted to participate in the follow-up survey; dogs that died prior to data collection were excluded from the survey. Medical records were reviewed for lameness localization, etiology of lameness, diagnostics obtained, medications prescribed, and owner recommendations.
Interventions
Based on review of the medical records, the lameness localization, presumptive source of lameness (joint, soft tissue, neurological, or bone), diagnostics obtained, medications prescribed, and owner recommendations were recorded. Survey data included duration of lameness, perceived response to treatment, and activity level.
Measurements and Main Results
Definitive diagnoses were not assigned in 88.8% of lameness cases. A presumptive diagnosis of soft tissue injury was assigned in 45.3% of cases. Single limb lameness was more prevalent than multiple limb lameness. Owners whose dogs were treated with medication were significantly more likely to report that the lameness resolved (P = 0.049). Dogs with injury localized to ≥1 of the joints were significantly less likely to have resolution of lameness (P = 0.037). Treatment recommendations were predominantly pain control and activity restriction.
Conclusions
Nonspecific lameness represents approximately 4% of canine urban emergency cases. Highlighting the points of clinical care considerations in understanding the etiology of lameness in dogs represents an opportunity for improved patient care and growth in emergency referral and follow-up.
{"title":"Retrospective evaluation and review of approaches for nonspecific lameness in dogs presented to an emergency service (2013–2014): 134 cases","authors":"Meghan T. Ramos VMD, Alexandra M. Hartzell VMD, Cynthia M. Otto DVM, PhD, DACVECC, DACVSMR","doi":"10.1111/vec.13344","DOIUrl":"10.1111/vec.13344","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This retrospective study aimed to characterize and evaluate the emergency approach, diagnosis, management, treatment, and follow-up of nonspecific canine lameness cases.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Retrospective case series from September 25, 2013 to September 25, 2014.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>The study was conducted at an urban university teaching hospital.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Animals</h3>\u0000 \u0000 <p>A consecutive sample of dogs presenting to the emergency service with nonspecific lameness in the designated timeframe was used to identify 134 cases. Owners were contacted to participate in the follow-up survey; dogs that died prior to data collection were excluded from the survey. Medical records were reviewed for lameness localization, etiology of lameness, diagnostics obtained, medications prescribed, and owner recommendations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Interventions</h3>\u0000 \u0000 <p>Based on review of the medical records, the lameness localization, presumptive source of lameness (joint, soft tissue, neurological, or bone), diagnostics obtained, medications prescribed, and owner recommendations were recorded. Survey data included duration of lameness, perceived response to treatment, and activity level.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Measurements and Main Results</h3>\u0000 \u0000 <p>Definitive diagnoses were not assigned in 88.8% of lameness cases. A presumptive diagnosis of soft tissue injury was assigned in 45.3% of cases. Single limb lameness was more prevalent than multiple limb lameness. Owners whose dogs were treated with medication were significantly more likely to report that the lameness resolved (<i>P</i> = 0.049). Dogs with injury localized to ≥1 of the joints were significantly less likely to have resolution of lameness (<i>P</i> = 0.037). Treatment recommendations were predominantly pain control and activity restriction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Nonspecific lameness represents approximately 4% of canine urban emergency cases. Highlighting the points of clinical care considerations in understanding the etiology of lameness in dogs represents an opportunity for improved patient care and growth in emergency referral and follow-up.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17603,"journal":{"name":"Journal of veterinary emergency and critical care","volume":"34 1","pages":"81-88"},"PeriodicalIF":1.3,"publicationDate":"2023-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138178128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"农林科学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Noa Berlin DVM, DACVECC, Alexandra Pfaff Med Vet, DACVECC, Elizabeth A. Rozanski DVM, DACVECC, DACVIM, Nolan V. Chalifoux DVM, DACVECC, Rebecka S. Hess DVM, MSCE, DACVIM, Michael W. Donnino MD, Deborah C. Silverstein DVM, DACVECC
Objective
To determine the normal reference interval (RI) for thiamine concentrations in healthy dogs and investigate the prevalence of thiamine deficiency in critically ill dogs with and without sepsis.
Design
Prospective, observational, multicenter study, conducted between 2019 and 2021.
Setting
Two veterinary university teaching hospitals.
Animals
A total of 109 dogs were enrolled into 3 groups: 40 healthy dogs, 33 dogs with suspected or confirmed sepsis and evidence of tissue hypoperfusion (Doppler blood pressure ≤90 mm Hg or plasma lactate ≥3 mmol/L), and 36 dogs with other critical illnesses and evidence of tissue hypoperfusion.
Interventions
For each dog, CBC, serum biochemistry, plasma lactate concentration, whole-blood thiamine concentration, blood pressure, vital parameters, Acute Patient Physiologic and Laboratory Evaluation (APPLE)fast score, and clinical outcomes were recorded, alongside basic patient parameters and dietary history. Whole-blood thiamine pyrophosphate (TPP) concentrations were measured using high-performance liquid chromatography.
Measurements and Main Results
The RI for whole-blood TPP in healthy dogs was 70.9–135.3 μg/L. Median TPP concentrations were significantly lower in septic dogs compared to healthy controls (P = 0.036). No significant difference in median TPP concentrations was found between septic dogs and nonseptic critically ill dogs, or between healthy dogs and nonseptic critically ill dogs. TPP concentrations were below the normal RI in 27.3% of septic dogs, compared to 19.4% of nonseptic critically ill dogs (P = 0.57). No correlations were found between TPP concentrations and lactate concentrations, age, body condition scores, time since last meal, RBC count, serum alanine aminotransferase, APPLEfast scores, or patient outcomes.
Conclusions
TPP concentrations were significantly lower in septic dogs compared to healthy controls, with an absolute thiamine deficiency found in 27.3% of septic dogs. The established TPP RI allows for further investigation of thiamine deficiency in critically ill dogs.
{"title":"Establishment of a reference interval for thiamine concentrations in healthy dogs and evaluation of the prevalence of absolute thiamine deficiency in critically ill dogs with and without sepsis using high-performance liquid chromatography","authors":"Noa Berlin DVM, DACVECC, Alexandra Pfaff Med Vet, DACVECC, Elizabeth A. Rozanski DVM, DACVECC, DACVIM, Nolan V. Chalifoux DVM, DACVECC, Rebecka S. Hess DVM, MSCE, DACVIM, Michael W. Donnino MD, Deborah C. Silverstein DVM, DACVECC","doi":"10.1111/vec.13341","DOIUrl":"10.1111/vec.13341","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To determine the normal reference interval (RI) for thiamine concentrations in healthy dogs and investigate the prevalence of thiamine deficiency in critically ill dogs with and without sepsis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Prospective, observational, multicenter study, conducted between 2019 and 2021.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Two veterinary university teaching hospitals.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Animals</h3>\u0000 \u0000 <p>A total of 109 dogs were enrolled into 3 groups: 40 healthy dogs, 33 dogs with suspected or confirmed sepsis and evidence of tissue hypoperfusion (Doppler blood pressure ≤90 mm Hg or plasma lactate ≥3 mmol/L), and 36 dogs with other critical illnesses and evidence of tissue hypoperfusion.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Interventions</h3>\u0000 \u0000 <p>For each dog, CBC, serum biochemistry, plasma lactate concentration, whole-blood thiamine concentration, blood pressure, vital parameters, Acute Patient Physiologic and Laboratory Evaluation (APPLE)<sub>fast</sub> score, and clinical outcomes were recorded, alongside basic patient parameters and dietary history. Whole-blood thiamine pyrophosphate (TPP) concentrations were measured using high-performance liquid chromatography.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Measurements and Main Results</h3>\u0000 \u0000 <p>The RI for whole-blood TPP in healthy dogs was 70.9–135.3 μg/L. Median TPP concentrations were significantly lower in septic dogs compared to healthy controls (<i>P</i> = 0.036). No significant difference in median TPP concentrations was found between septic dogs and nonseptic critically ill dogs, or between healthy dogs and nonseptic critically ill dogs. TPP concentrations were below the normal RI in 27.3% of septic dogs, compared to 19.4% of nonseptic critically ill dogs (<i>P</i> = 0.57). No correlations were found between TPP concentrations and lactate concentrations, age, body condition scores, time since last meal, RBC count, serum alanine aminotransferase, APPLE<sub>fast</sub> scores, or patient outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>TPP concentrations were significantly lower in septic dogs compared to healthy controls, with an absolute thiamine deficiency found in 27.3% of septic dogs. The established TPP RI allows for further investigation of thiamine deficiency in critically ill dogs.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17603,"journal":{"name":"Journal of veterinary emergency and critical care","volume":"34 1","pages":"49-56"},"PeriodicalIF":1.3,"publicationDate":"2023-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138178126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"农林科学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alicia Mastrocco DVM, DACVECC, Jennifer Prittie DVM, DACVIM, DACVECC, Chad West DVM, DACVIM, Melissa Clark DVM, PhD, DACVIM, DACVCP
Objective
To review and summarize the pharmacology of the antiepileptic drug (AED), levetiracetam (LEV), and to discuss its clinical utility in dogs and cats.
Data Sources
Veterinary and human peer-reviewed medical literature and the authors’ clinical experience.
Summary
LEV is an AED with mechanisms of action distinct from those of other AEDs. In people and small animals, LEV exhibits linear kinetics, excellent oral bioavailability, and minimal drug–drug interactions. Serious side effects are rarely reported in any species. LEV use is gaining favor for treating epilepsy in small animals and may have wider clinical applications in patients with portosystemic shunts, neuroglycopenia, and traumatic brain injury. In people, LEV may improve cognitive function in patients with dementia.
Conclusion
LEV is a well-tolerated AED with well-documented efficacy in human patients. Although its use is becoming more common in veterinary medicine, its role as a first-line monotherapy in small animal epileptics remains to be determined. This review of the human and animal literature regarding LEV describes its role in epileptic people and animals as well as in other disease states and provides recommendations for clinical usage.
{"title":"A review of the pharmacology and clinical applications of levetiracetam in dogs and cats","authors":"Alicia Mastrocco DVM, DACVECC, Jennifer Prittie DVM, DACVIM, DACVECC, Chad West DVM, DACVIM, Melissa Clark DVM, PhD, DACVIM, DACVCP","doi":"10.1111/vec.13355","DOIUrl":"10.1111/vec.13355","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To review and summarize the pharmacology of the antiepileptic drug (AED), levetiracetam (LEV), and to discuss its clinical utility in dogs and cats.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Data Sources</h3>\u0000 \u0000 <p>Veterinary and human peer-reviewed medical literature and the authors’ clinical experience.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Summary</h3>\u0000 \u0000 <p>LEV is an AED with mechanisms of action distinct from those of other AEDs. In people and small animals, LEV exhibits linear kinetics, excellent oral bioavailability, and minimal drug–drug interactions. Serious side effects are rarely reported in any species. LEV use is gaining favor for treating epilepsy in small animals and may have wider clinical applications in patients with portosystemic shunts, neuroglycopenia, and traumatic brain injury. In people, LEV may improve cognitive function in patients with dementia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>LEV is a well-tolerated AED with well-documented efficacy in human patients. Although its use is becoming more common in veterinary medicine, its role as a first-line monotherapy in small animal epileptics remains to be determined. This review of the human and animal literature regarding LEV describes its role in epileptic people and animals as well as in other disease states and provides recommendations for clinical usage.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17603,"journal":{"name":"Journal of veterinary emergency and critical care","volume":"34 1","pages":"9-22"},"PeriodicalIF":1.3,"publicationDate":"2023-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138178124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"农林科学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<div> <section> <h3> Objective</h3> <p>Describe the use of fixed-rate intravenous insulin infusions (FRIs) in cats and dogs with diabetic ketoacidosis (DKA) and determine if this is associated with faster resolution of ketosis compared to variable-rate intravenous insulin infusions (VRIs). Secondary objectives were to evaluate complication rates, length of hospitalization (LOH), and survival to discharge (STD).</p> </section> <section> <h3> Design</h3> <p>Randomized clinical trial (January 2019 to July 2020).</p> </section> <section> <h3> Setting</h3> <p>University veterinary teaching hospital and private referral hospital.</p> </section> <section> <h3> Animals</h3> <p>Dogs and cats with DKA and venous pH <7.3, blood glucose concentration >11 mmol/L (198 mg/dL), and β-hydroxybutyrate (BHB) concentration >3 mmol/L were eligible for inclusion. Patients were randomly assigned to receive either FRI or VRI.</p> </section> <section> <h3> Interventions</h3> <p>Neutral (regular) insulin was administered IV as an FRI or VRI. For FRI, the rate was maintained at 0.01 IU/kg/h. For VRI, the dose was adjusted according to blood glucose concentration.</p> </section> <section> <h3> Measurements and Results</h3> <p>Sixteen cats and 20 dogs were enrolled. Population characteristics, mean insulin infusion rate, time to resolution of ketosis (BHB <0.6 mmol/L), complications, LOH, and STD were evaluated. In cats, overall resolution of ketosis was low (9/16 [56.3%]), limiting comparison of protocols. In dogs, resolution of ketosis was high (19/20 dogs [95.0%]) but the time to resolution in the FRI group was not different than that in the VRI group (<i>P</i> = 0.89), despite a 25% higher average insulin infusion rate in the FRI group (<i>P</i> = 0.04). The incidence of complications was low and did not differ between protocols. In cats, LOH and STD did not differ between protocols. All cats that died (5/16) did so within 78 hours and none had resolution of ketosis. Dogs receiving FRI had a shorter LOH (<i>P</i> = 0.01) but STD did not differ between protocols. Six dogs (30.0%) did not survive to hospital discharge but all had resolution of ketosis.</p> </section> <section> <h3> Conclusions</h3> <p>FRIs can be used in veterinary species but may not hasten reso
{"title":"Comparison of insulin infusion protocols for management of canine and feline diabetic ketoacidosis","authors":"Poppy Gant BVSc, MVetMed, DACVECC, DECVECC, Dominic Barfield BSc, BVSc, MVetMed, DACVECC, DECVECC, Jessica Florey BVM&S, MVetMed, DACVIM, DECVIM","doi":"10.1111/vec.13354","DOIUrl":"10.1111/vec.13354","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Describe the use of fixed-rate intravenous insulin infusions (FRIs) in cats and dogs with diabetic ketoacidosis (DKA) and determine if this is associated with faster resolution of ketosis compared to variable-rate intravenous insulin infusions (VRIs). Secondary objectives were to evaluate complication rates, length of hospitalization (LOH), and survival to discharge (STD).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Randomized clinical trial (January 2019 to July 2020).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>University veterinary teaching hospital and private referral hospital.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Animals</h3>\u0000 \u0000 <p>Dogs and cats with DKA and venous pH <7.3, blood glucose concentration >11 mmol/L (198 mg/dL), and β-hydroxybutyrate (BHB) concentration >3 mmol/L were eligible for inclusion. Patients were randomly assigned to receive either FRI or VRI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Interventions</h3>\u0000 \u0000 <p>Neutral (regular) insulin was administered IV as an FRI or VRI. For FRI, the rate was maintained at 0.01 IU/kg/h. For VRI, the dose was adjusted according to blood glucose concentration.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Measurements and Results</h3>\u0000 \u0000 <p>Sixteen cats and 20 dogs were enrolled. Population characteristics, mean insulin infusion rate, time to resolution of ketosis (BHB <0.6 mmol/L), complications, LOH, and STD were evaluated. In cats, overall resolution of ketosis was low (9/16 [56.3%]), limiting comparison of protocols. In dogs, resolution of ketosis was high (19/20 dogs [95.0%]) but the time to resolution in the FRI group was not different than that in the VRI group (<i>P</i> = 0.89), despite a 25% higher average insulin infusion rate in the FRI group (<i>P</i> = 0.04). The incidence of complications was low and did not differ between protocols. In cats, LOH and STD did not differ between protocols. All cats that died (5/16) did so within 78 hours and none had resolution of ketosis. Dogs receiving FRI had a shorter LOH (<i>P</i> = 0.01) but STD did not differ between protocols. Six dogs (30.0%) did not survive to hospital discharge but all had resolution of ketosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>FRIs can be used in veterinary species but may not hasten reso","PeriodicalId":17603,"journal":{"name":"Journal of veterinary emergency and critical care","volume":"34 1","pages":"23-30"},"PeriodicalIF":1.3,"publicationDate":"2023-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/vec.13354","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138178125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"农林科学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alice Le Gal DVM, MVetMed, DACVECC, DECVECC, Dominic Martin Barfield BSc, BVSc, MVetMed, DACVECC, DECVECC, Roseanne Helen Wignall RVN, Simon David Cook BSc, BVSc, MVetMed, DACVECC, DECVECC
<div> <section> <h3> Objective</h3> <p>To determine whether emergency staff and students can predict patient outcome within 24 hours of admission, comparing the accuracy of clinician prognostication with outcome prediction by Acute Patient Physiologic and Laboratory Evaluation (APPLE)<sub>fast</sub> scoring and identifying whether experience or mood would be associated with accuracy.</p> </section> <section> <h3> Design</h3> <p>Prospective observational study between April 2020 and March 2021.</p> </section> <section> <h3> Setting</h3> <p>University teaching hospital.</p> </section> <section> <h3> Animals</h3> <p>One hundred and sixty-one dogs admitted through an Emergency Service were assessed. Where data were available, an APPLE<sub>fast</sub> score was calculated per patient. An APPLE<sub>fast</sub> score of >25 was deemed a predictor for mortality.</p> </section> <section> <h3> Interventions</h3> <p>None.</p> </section> <section> <h3> Measurements and Main Results</h3> <p>Emergency staff and students were asked to complete surveys about dogs admitted to the emergency room. All clinicopathological data were available for review, and the animals were available for examination. Data collected included opinions on whether the patient would be discharged from hospital, a mood score, position, and experience in Emergency and Critical Care. One-hundred and twenty-five dogs (77.6%) were discharged; 36 dogs (22.4%) died or were euthanized. Two hundred and sixty-six responses were obtained; 202 responses (75.9%) predicted the correct outcome. Students, interns, residents, faculty, and nurses predicted the correct outcome in 81.4%, 58.3%, 83.3%, 82.1%, and 65.5% of cases, respectively. Of 64 incorrect predictions, 43 (67.2%) predicted death in hospital. APPLE<sub>fast</sub> scores were obtained in 121 cases, predicting the correct outcome in 83 cases (68.6%). Of 38 cases in which APPLE<sub>fast</sub> was incorrect, 27 (71.1%) were dogs surviving to discharge. Mean APPLE<sub>fast</sub> score was 22.9 (± 6.2). There was no difference in outcome prediction accuracy between staff and APPLE<sub>fast</sub> scores (<i>P</i> = 0.13). Neither experience nor mood score was associated with outcome prediction ability (<i>P</i> = 0.55 and <i>P</i> = 0.74, respectively).</p> </section> <section>
{"title":"Outcome prediction in dogs admitted through the emergency room: Accuracy of staff prediction and comparison with an illness severity stratification system for hospitalized dogs","authors":"Alice Le Gal DVM, MVetMed, DACVECC, DECVECC, Dominic Martin Barfield BSc, BVSc, MVetMed, DACVECC, DECVECC, Roseanne Helen Wignall RVN, Simon David Cook BSc, BVSc, MVetMed, DACVECC, DECVECC","doi":"10.1111/vec.13350","DOIUrl":"10.1111/vec.13350","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To determine whether emergency staff and students can predict patient outcome within 24 hours of admission, comparing the accuracy of clinician prognostication with outcome prediction by Acute Patient Physiologic and Laboratory Evaluation (APPLE)<sub>fast</sub> scoring and identifying whether experience or mood would be associated with accuracy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Prospective observational study between April 2020 and March 2021.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>University teaching hospital.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Animals</h3>\u0000 \u0000 <p>One hundred and sixty-one dogs admitted through an Emergency Service were assessed. Where data were available, an APPLE<sub>fast</sub> score was calculated per patient. An APPLE<sub>fast</sub> score of >25 was deemed a predictor for mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Interventions</h3>\u0000 \u0000 <p>None.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Measurements and Main Results</h3>\u0000 \u0000 <p>Emergency staff and students were asked to complete surveys about dogs admitted to the emergency room. All clinicopathological data were available for review, and the animals were available for examination. Data collected included opinions on whether the patient would be discharged from hospital, a mood score, position, and experience in Emergency and Critical Care. One-hundred and twenty-five dogs (77.6%) were discharged; 36 dogs (22.4%) died or were euthanized. Two hundred and sixty-six responses were obtained; 202 responses (75.9%) predicted the correct outcome. Students, interns, residents, faculty, and nurses predicted the correct outcome in 81.4%, 58.3%, 83.3%, 82.1%, and 65.5% of cases, respectively. Of 64 incorrect predictions, 43 (67.2%) predicted death in hospital. APPLE<sub>fast</sub> scores were obtained in 121 cases, predicting the correct outcome in 83 cases (68.6%). Of 38 cases in which APPLE<sub>fast</sub> was incorrect, 27 (71.1%) were dogs surviving to discharge. Mean APPLE<sub>fast</sub> score was 22.9 (± 6.2). There was no difference in outcome prediction accuracy between staff and APPLE<sub>fast</sub> scores (<i>P</i> = 0.13). Neither experience nor mood score was associated with outcome prediction ability (<i>P</i> = 0.55 and <i>P</i> = 0.74, respectively).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 ","PeriodicalId":17603,"journal":{"name":"Journal of veterinary emergency and critical care","volume":"34 1","pages":"69-75"},"PeriodicalIF":1.3,"publicationDate":"2023-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/vec.13350","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138178127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"农林科学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Thomas H. Edwards DVM, MS, DACVECC, Michael A. Meledeo PhD, Grantham C. Peltier MS, Alice F. Henderson, Luis A. Pompa, James A. Bynum PhD
Objective
To determine the characteristics of canine freeze-dried plasma (cFDP) as it is serially diluted with sterile water.
Design
In vitro experimental study.
Setting
Government blood and coagulation research laboratory.
Animals
cFDP from a commercial manufacturer.
Interventions
Ten units of cFDP were reconstituted to 100%, 90%, 80%, 70%, 60%, 50%, and 40% of the recommended volume with sterile water. The resultant solutions were analyzed for coagulation factor activity (factors II, V, VII, VIII, IX, X, and XII as well as antithrombin), fibrinogen concentration, prothrombin time, activated partial thromboplastin time, viscosity, osmolality, and kaolin-activated thromboelastography.
Measurements and Main Results
Viscosity, osmolality, and turbidity properties of plasma were increased in a reconstitution volume-dependent manner, with the 40% suggested volume generating approximately 2-fold increases in each. Similarly, factor activity levels and fibrinogen concentration increased by approximately 2-fold over this range in a concentration-dependent manner. Prothrombin time declined from 11.4 seconds at 100% volume to 10.9 seconds at 70% before increasing to 11.9 seconds at 40%. Activated partial thromboplastin time increased exponentially from 21.8 seconds at 100% rehydration to 100.0 seconds at 40%. R-time on TEG increased from 3.1 to 13.9 minutes at 50% rehydration, while alpha angle declined from 61.3° to 24.7° over the same range, and the maximum amplitude initially increased from 13.2 mm at 100% water to 18.6 mm at 70% water before dropping back down to 14.6 mm at 50% water. No clotting was observed with 40% rehydration.
Conclusions
The creation of hyperosmotic plasma from cFDP appears feasible with preservation of concentrated coagulation factors, although there are some unexplained effects that happen to coagulation functions at the highest concentrations tested using only 40%–50% of recommended rehydration volume. Further studies are needed to evaluate the hyperosmotic product in vivo.
{"title":"In vitro evaluation of hyperosmotic canine plasma suitable for infusion","authors":"Thomas H. Edwards DVM, MS, DACVECC, Michael A. Meledeo PhD, Grantham C. Peltier MS, Alice F. Henderson, Luis A. Pompa, James A. Bynum PhD","doi":"10.1111/vec.13353","DOIUrl":"10.1111/vec.13353","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To determine the characteristics of canine freeze-dried plasma (cFDP) as it is serially diluted with sterile water.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>In vitro experimental study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Government blood and coagulation research laboratory.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Animals</h3>\u0000 \u0000 <p>cFDP from a commercial manufacturer.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Interventions</h3>\u0000 \u0000 <p>Ten units of cFDP were reconstituted to 100%, 90%, 80%, 70%, 60%, 50%, and 40% of the recommended volume with sterile water. The resultant solutions were analyzed for coagulation factor activity (factors II, V, VII, VIII, IX, X, and XII as well as antithrombin), fibrinogen concentration, prothrombin time, activated partial thromboplastin time, viscosity, osmolality, and kaolin-activated thromboelastography.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Measurements and Main Results</h3>\u0000 \u0000 <p>Viscosity, osmolality, and turbidity properties of plasma were increased in a reconstitution volume-dependent manner, with the 40% suggested volume generating approximately 2-fold increases in each. Similarly, factor activity levels and fibrinogen concentration increased by approximately 2-fold over this range in a concentration-dependent manner. Prothrombin time declined from 11.4 seconds at 100% volume to 10.9 seconds at 70% before increasing to 11.9 seconds at 40%. Activated partial thromboplastin time increased exponentially from 21.8 seconds at 100% rehydration to 100.0 seconds at 40%. R-time on TEG increased from 3.1 to 13.9 minutes at 50% rehydration, while alpha angle declined from 61.3° to 24.7° over the same range, and the maximum amplitude initially increased from 13.2 mm at 100% water to 18.6 mm at 70% water before dropping back down to 14.6 mm at 50% water. No clotting was observed with 40% rehydration.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The creation of hyperosmotic plasma from cFDP appears feasible with preservation of concentrated coagulation factors, although there are some unexplained effects that happen to coagulation functions at the highest concentrations tested using only 40%–50% of recommended rehydration volume. Further studies are needed to evaluate the hyperosmotic product in vivo.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17603,"journal":{"name":"Journal of veterinary emergency and critical care","volume":"34 1","pages":"63-68"},"PeriodicalIF":1.3,"publicationDate":"2023-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"107592959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"农林科学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Ryan Smith DVM, DACVECC, Virginie A. Wurlod MS, Dr vet med, DACVECC, DECVECC, Chin-Chi Liu MS, MApStat, PhD
Objective
To describe hemostatic derangements associated with canine anaphylaxis and to assess for association with syndrome severity.
Design
Prospective observational study.
Setting
University teaching hospital.
Animals
Twenty-seven client-owned dogs, recruited from November 2018 to January 2022, diagnosed with anaphylaxis of varying severity were included. Study inclusion required presentation <6 hours after initiation of clinical signs, no medications or history of illness within the prior 2 weeks, lack of comorbidities expected to affect hemostasis, and lack of a disease state that could alternatively explain the clinical presentation.
Interventions
Blood samples were collected within the first hour of presentation for CBC, serum biochemistry, prothrombin time (PT), activated partial thromboplastin time (aPTT), and viscoelastic coagulation testing for use with a cartridge-based point-of-care device.
Measurements and main results
Clotting time and clot formation time were prolonged, alpha angle and maximum clot firmness were decreased, PT and aPTT were prolonged, and platelet counts were lower in severe cases compared to mild and moderate cases. There were no differences for any parameter between mild and moderate cases. The presence or absence of abdominal effusion was not associated with hemostatic status.
Conclusions
Global hemostatic derangements consistent with hypocoagulability are a prominent feature of severe anaphylaxis in dogs and should be considered for routine evaluation.
{"title":"Evaluation of hemostatic derangements associated with canine anaphylaxis and the relationship to syndrome severity","authors":"M. Ryan Smith DVM, DACVECC, Virginie A. Wurlod MS, Dr vet med, DACVECC, DECVECC, Chin-Chi Liu MS, MApStat, PhD","doi":"10.1111/vec.13345","DOIUrl":"10.1111/vec.13345","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To describe hemostatic derangements associated with canine anaphylaxis and to assess for association with syndrome severity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Prospective observational study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>University teaching hospital.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Animals</h3>\u0000 \u0000 <p>Twenty-seven client-owned dogs, recruited from November 2018 to January 2022, diagnosed with anaphylaxis of varying severity were included. Study inclusion required presentation <6 hours after initiation of clinical signs, no medications or history of illness within the prior 2 weeks, lack of comorbidities expected to affect hemostasis, and lack of a disease state that could alternatively explain the clinical presentation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Interventions</h3>\u0000 \u0000 <p>Blood samples were collected within the first hour of presentation for CBC, serum biochemistry, prothrombin time (PT), activated partial thromboplastin time (aPTT), and viscoelastic coagulation testing for use with a cartridge-based point-of-care device.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Measurements and main results</h3>\u0000 \u0000 <p>Clotting time and clot formation time were prolonged, alpha angle and maximum clot firmness were decreased, PT and aPTT were prolonged, and platelet counts were lower in severe cases compared to mild and moderate cases. There were no differences for any parameter between mild and moderate cases. The presence or absence of abdominal effusion was not associated with hemostatic status.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Global hemostatic derangements consistent with hypocoagulability are a prominent feature of severe anaphylaxis in dogs and should be considered for routine evaluation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17603,"journal":{"name":"Journal of veterinary emergency and critical care","volume":"33 6","pages":"648-655"},"PeriodicalIF":1.3,"publicationDate":"2023-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/vec.13345","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"92158044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"农林科学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Miranda Buseman DVM, April E. Blong DVM, DACVECC, Lingnan Yuan, Jonathan P. Mochel DVM, MSc, PhD, DECVPT, Rebecca A. L. Walton DVM, DACVECC
Objective
To evaluate the association of admission total plasma protein (TPP) and the administration of red blood cell transfusions in dogs with diagnosed hemoabdomen. To secondarily evaluate additional point-of-care parameters associated with red blood cell transfusion administration.
Design
Retrospective study between 2009 and 2019.
Setting
University veterinary teaching hospital.
Animals
Ninety dogs admitted to a university veterinary teaching hospital after a diagnosis of traumatic or nontraumatic hemoabdomen (NTH).
Measurements and Main Results
Medical records were retrospectively reviewed; signalment, point-of-care diagnostics, and transfusion administration information was recorded. A total of 47 dogs (traumatic hemoabdomen 11/26; NTH 36/64) received packed red blood cell transfusions. For each 1 g/dL unit decrease in TPP, dogs had an increased odds ratio (OR) of 2.14 (95% confidence interval [CI]: 1.44–3.40, P < 0.001) of receiving a red blood cell transfusion. Dogs diagnosed with NTH were more likely to receive a red blood cell transfusion than dogs with a traumatic hemoabdomen (OR: 2.78, 95% CI: 1.11–7.141, P = 0.03). Lower PCV values (OR: 1.08, 95% CI: 1.04–1.12, P < 0.001), bicarbonate values (OR: 1.3, 95% CI: 1.09–1.56, P = 0.003), and base excess (OR: 1.27, 95% CI: 1.1–1.49, P = 0.003) were associated with a higher likelihood of red blood cell transfusion. Additionally, higher lactate (OR: 1.35, 95% CI: 1.16–1.63, P < 0.001) and Acute Patient Physiologic and Laboratory Evaluation (APPLE)fast scores (OR: 1.10, 95% CI: 1.04–1.17, P < 0.001) were associated with increased red blood cell transfusion administration.
Conclusions
Low admission TPP, independent of low PCV, was associated with red blood cell transfusions regardless of underlying cause. For each 1 g/dL unit decrease in TPP on presentation, dogs were approximately 2 times more likely to receive a red blood cell transfusion during hospitalization. Other factors that were associated with increased transfusion administration included presenting PCV, PCV/TPP ratio, bicarbonate, base excess, lactate, and APPLEfast scores.
{"title":"Retrospective evaluation of admission total plasma protein as a predictor of red blood cell transfusion requirement in dogs diagnosed with traumatic and nontraumatic hemoabdomen: 90 dogs (2009–2019)","authors":"Miranda Buseman DVM, April E. Blong DVM, DACVECC, Lingnan Yuan, Jonathan P. Mochel DVM, MSc, PhD, DECVPT, Rebecca A. L. Walton DVM, DACVECC","doi":"10.1111/vec.13343","DOIUrl":"10.1111/vec.13343","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To evaluate the association of admission total plasma protein (TPP) and the administration of red blood cell transfusions in dogs with diagnosed hemoabdomen. To secondarily evaluate additional point-of-care parameters associated with red blood cell transfusion administration.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Retrospective study between 2009 and 2019.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>University veterinary teaching hospital.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Animals</h3>\u0000 \u0000 <p>Ninety dogs admitted to a university veterinary teaching hospital after a diagnosis of traumatic or nontraumatic hemoabdomen (NTH).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Measurements and Main Results</h3>\u0000 \u0000 <p>Medical records were retrospectively reviewed; signalment, point-of-care diagnostics, and transfusion administration information was recorded. A total of 47 dogs (traumatic hemoabdomen 11/26; NTH 36/64) received packed red blood cell transfusions. For each 1 g/dL unit decrease in TPP, dogs had an increased odds ratio (OR) of 2.14 (95% confidence interval [CI]: 1.44–3.40, <i>P</i> < 0.001) of receiving a red blood cell transfusion. Dogs diagnosed with NTH were more likely to receive a red blood cell transfusion than dogs with a traumatic hemoabdomen (OR: 2.78, 95% CI: 1.11–7.141, <i>P</i> = 0.03). Lower PCV values (OR: 1.08, 95% CI: 1.04–1.12, <i>P</i> < 0.001), bicarbonate values (OR: 1.3, 95% CI: 1.09–1.56, <i>P</i> = 0.003), and base excess (OR: 1.27, 95% CI: 1.1–1.49, <i>P</i> = 0.003) were associated with a higher likelihood of red blood cell transfusion. Additionally, higher lactate (OR: 1.35, 95% CI: 1.16–1.63, <i>P</i> < 0.001) and Acute Patient Physiologic and Laboratory Evaluation (APPLE)<sub>fast</sub> scores (OR: 1.10, 95% CI: 1.04–1.17, <i>P</i> < 0.001) were associated with increased red blood cell transfusion administration.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Low admission TPP, independent of low PCV, was associated with red blood cell transfusions regardless of underlying cause. For each 1 g/dL unit decrease in TPP on presentation, dogs were approximately 2 times more likely to receive a red blood cell transfusion during hospitalization. Other factors that were associated with increased transfusion administration included presenting PCV, PCV/TPP ratio, bicarbonate, base excess, lactate, and APPLE<sub>fast</sub> scores.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17603,"journal":{"name":"Journal of veterinary emergency and critical care","volume":"34 1","pages":"76-80"},"PeriodicalIF":1.3,"publicationDate":"2023-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"92158045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"农林科学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jasper E. Burke VMD, DACVECC, Rebecka S. Hess DVM, MSCE, DACVIM, Elisa P. McEntee DVM, DACVIM, Maureen A. Griffin DVM, DACVS, Selimah M. Harmon DVM, Deborah C. Silverstein DVM, DACVECC
<div> <section> <h3> Objective</h3> <p>To investigate the clinical findings, treatment strategies, and outcomes in dogs with confirmed hepatic abscessation.</p> </section> <section> <h3> Design</h3> <p>Retrospective cohort study from 2010 to 2019.</p> </section> <section> <h3> Setting</h3> <p>Multicenter study.</p> </section> <section> <h3> Animals</h3> <p>Fifty-six client-owned dogs with hepatic abscessation confirmed by culture, cytology, or histopathology.</p> </section> <section> <h3> Measurements and Main Results</h3> <p>Dogs were presented for lethargy (39/56), hyporexia (31/56), and vomiting (26/56). Abnormal physical examination findings included increased temperature (41/56) and abdominal pain (22/54). CBCs revealed neutrophilia (31/49), toxic changes (25/49), anemia (28/49), and thrombocytopenia (23/49). Biochemical analyses revealed increased alkaline phosphatase (45/50), increased alanine aminotransferase (40/50), hypoalbuminemia (25/48), and hyperbilirubinemia (19/49). Hypoglycemia was found in 13 of 49 dogs. Hepatic abscesses ranging from 0.5 to 15 cm in diameter were identified ultrasonographically in 37 of 48 dogs; 19 of 37 had solitary abscesses, and 18 of 37 had multifocal abscessation. Escherichia coli was the most commonly cultured organism, isolated in 18 of 42 cases. Histopathology revealed underlying hepatic neoplasia in 10 of 47 dogs. Surgical management was performed in 41 of 49 dogs, and 35 of 41 survived to discharge. Medical management was performed in 8 of 49 dogs, and 5 of 8 survived to discharge. With univariate analysis, hypoglycemia and multifocal abscessation were associated with decreased odds of survival (odds ratio [OR]: 0.2, 95% confidence interval [CI]: 0.03–0.9, <i>P</i> = 0.04; OR: 0.07, 95% CI: 0.01–0.6, <i>P</i> = 0.02, respectively). With multivariate analysis, only multifocal abscessation was associated with decreased odds of survival (OR: 0.09, 95% CI: 0.01–0.87, <i>P</i> = 0.04).</p> </section> <section> <h3> Conclusions</h3> <p>Hepatic abscessation, although rare, should remain a differential diagnosis for dogs presenting with nonspecific clinical signs and increase liver enzyme activities, especially with concurrent increased temperature and neutrophilia. Rate of survival to discharge for dogs in this study was consistent with previously reported survival rates, with 40 of 56 (71%) of the total population surviving to discharge. No variables assessed were able to predict survival to discharge; however, hypoglycemia and mult
{"title":"Hepatic abscessation in dogs: A multicenter study of 56 cases (2010–2019)","authors":"Jasper E. Burke VMD, DACVECC, Rebecka S. Hess DVM, MSCE, DACVIM, Elisa P. McEntee DVM, DACVIM, Maureen A. Griffin DVM, DACVS, Selimah M. Harmon DVM, Deborah C. Silverstein DVM, DACVECC","doi":"10.1111/vec.13340","DOIUrl":"10.1111/vec.13340","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To investigate the clinical findings, treatment strategies, and outcomes in dogs with confirmed hepatic abscessation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Retrospective cohort study from 2010 to 2019.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Multicenter study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Animals</h3>\u0000 \u0000 <p>Fifty-six client-owned dogs with hepatic abscessation confirmed by culture, cytology, or histopathology.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Measurements and Main Results</h3>\u0000 \u0000 <p>Dogs were presented for lethargy (39/56), hyporexia (31/56), and vomiting (26/56). Abnormal physical examination findings included increased temperature (41/56) and abdominal pain (22/54). CBCs revealed neutrophilia (31/49), toxic changes (25/49), anemia (28/49), and thrombocytopenia (23/49). Biochemical analyses revealed increased alkaline phosphatase (45/50), increased alanine aminotransferase (40/50), hypoalbuminemia (25/48), and hyperbilirubinemia (19/49). Hypoglycemia was found in 13 of 49 dogs. Hepatic abscesses ranging from 0.5 to 15 cm in diameter were identified ultrasonographically in 37 of 48 dogs; 19 of 37 had solitary abscesses, and 18 of 37 had multifocal abscessation. Escherichia coli was the most commonly cultured organism, isolated in 18 of 42 cases. Histopathology revealed underlying hepatic neoplasia in 10 of 47 dogs. Surgical management was performed in 41 of 49 dogs, and 35 of 41 survived to discharge. Medical management was performed in 8 of 49 dogs, and 5 of 8 survived to discharge. With univariate analysis, hypoglycemia and multifocal abscessation were associated with decreased odds of survival (odds ratio [OR]: 0.2, 95% confidence interval [CI]: 0.03–0.9, <i>P</i> = 0.04; OR: 0.07, 95% CI: 0.01–0.6, <i>P</i> = 0.02, respectively). With multivariate analysis, only multifocal abscessation was associated with decreased odds of survival (OR: 0.09, 95% CI: 0.01–0.87, <i>P</i> = 0.04).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Hepatic abscessation, although rare, should remain a differential diagnosis for dogs presenting with nonspecific clinical signs and increase liver enzyme activities, especially with concurrent increased temperature and neutrophilia. Rate of survival to discharge for dogs in this study was consistent with previously reported survival rates, with 40 of 56 (71%) of the total population surviving to discharge. No variables assessed were able to predict survival to discharge; however, hypoglycemia and mult","PeriodicalId":17603,"journal":{"name":"Journal of veterinary emergency and critical care","volume":"33 6","pages":"665-675"},"PeriodicalIF":1.3,"publicationDate":"2023-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71523725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"农林科学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ashley Genetti BVM&S, Efa A. Llewellyn BVetMed, DACVECC, DECVECC, FHEA
<div> <section> <h3> Objective</h3> <p>To assess compression rate accuracy among veterinarians and registered veterinary nurses (RVNs) without and with an audible aid.</p> </section> <section> <h3> Design</h3> <p>Prospective study with use of a canine CPR manikin.</p> </section> <section> <h3> Setting</h3> <p>Small animal teaching hospital.</p> </section> <section> <h3> Subjects</h3> <p>Thirty-six participants (20 veterinarians and 16 RVNs).</p> </section> <section> <h3> Interventions</h3> <p>Each participant completed the first 2-minute cycle of chest compressions without an auditory aid on a canine CPR manikin. Each participant was then randomized to 1 of 3 auditory aid groups (Group B: Bee Gees “Stayin’ Alive”; Group Q: Queen “Another One Bites the Dust”; or Group M: traditional metronome) and then completed a second 2-minute cycle of chest compressions with the instruction to synchronize their compression rate with the beat of the auditory aid. An accurate chest compression rate was defined as obtaining a rate between 100 and 120 compressions per minute (cpm).</p> </section> <section> <h3> Measurements and Main Results</h3> <p>Median number of compressions administered by participants during Cycle 1 for the first minute was 111 (range 88–140) and for the second minute was 107 (range 80–151), with 25 of 36 (69%) participants obtaining an accurate chest compression rate. Median number of compressions administered during Cycle 2 for the first minute was 110 (range 76–125) and for the second minute was 110 (range 72–125), with 34 of 36 participants (94%) obtaining an accurate chest compression rate. Participants were more likely to obtain an accurate chest compression rate when an auditory aid was present compared to without (McNemar's test; <i>P</i> = 0.013). Subgroup analysis suggested the auditory aid was beneficial in Groups Q and M but not Group B (Kruskal–Wallis with Dunn's post hoc testing; <i>P</i> = 0.014, <i>P</i> = 0.0455, and <i>P</i> = 0.5637, respectively).</p> </section> <section> <h3> Conclusions</h3> <p>An auditory aid was associated with improved chest compression rate accuracy. However, as the auditory aid was not beneficial for Group B participants, our findings suggest that some auditory aids are more helpful than others.</p>
目的：评估无助听器和有助听器的兽医和注册兽医护士（RVN）压缩率的准确性。设计：使用犬心肺复苏模型进行前瞻性研究。设置：小动物教学医院。受试者：36名参与者（20名兽医和16名RVN）。干预措施：每个参与者在没有助听器的情况下，在犬心肺复苏假人上完成了第一个2分钟的胸外按压周期。然后，每个参与者被随机分为3个助听器组中的1个（B组：Bee Gees“Stayin‘Alive”；Q组：Queen“Another One Bites the Dust”；或M组：传统节拍器），然后完成第二个2分钟的胸外按压周期，并指示其压缩率与助听器的节拍同步。准确的胸部按压率被定义为获得每分钟100到120次按压（cpm）之间的速率。测量和主要结果：在第1周期中，参与者第一分钟的按压次数中位数为111次（范围88-140），第二分钟为107次（范围80-151），36名参与者中有25名（69%）获得了准确的胸部按压率。在第2周期中，第一分钟的按压次数中位数为110次（范围76-125），第二分钟的按压数量中位数为110（范围72-125），36名参与者中的34名（94%）获得了准确的胸部按压率。与没有助听器相比，有助听器的参与者更有可能获得准确的胸部压迫率（McNemar检验；P=0.013）。亚组分析表明，助听器在Q组和M组是有益的，但在B组不是有益的（Kruskal-Wallis与Dunn的事后检验；分别为P=0.014、P=0.0455和P=0.5637）。结论：助听器可提高胸部按压率的准确性。然而，由于助听器对B组参与者没有益处，我们的研究结果表明，一些助听器比其他助听器更有帮助。
{"title":"Usefulness of an auditory aid to improve chest compression rate accuracy during cardiopulmonary resuscitation","authors":"Ashley Genetti BVM&S, Efa A. Llewellyn BVetMed, DACVECC, DECVECC, FHEA","doi":"10.1111/vec.13351","DOIUrl":"10.1111/vec.13351","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To assess compression rate accuracy among veterinarians and registered veterinary nurses (RVNs) without and with an audible aid.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Prospective study with use of a canine CPR manikin.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Small animal teaching hospital.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Subjects</h3>\u0000 \u0000 <p>Thirty-six participants (20 veterinarians and 16 RVNs).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Interventions</h3>\u0000 \u0000 <p>Each participant completed the first 2-minute cycle of chest compressions without an auditory aid on a canine CPR manikin. Each participant was then randomized to 1 of 3 auditory aid groups (Group B: Bee Gees “Stayin’ Alive”; Group Q: Queen “Another One Bites the Dust”; or Group M: traditional metronome) and then completed a second 2-minute cycle of chest compressions with the instruction to synchronize their compression rate with the beat of the auditory aid. An accurate chest compression rate was defined as obtaining a rate between 100 and 120 compressions per minute (cpm).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Measurements and Main Results</h3>\u0000 \u0000 <p>Median number of compressions administered by participants during Cycle 1 for the first minute was 111 (range 88–140) and for the second minute was 107 (range 80–151), with 25 of 36 (69%) participants obtaining an accurate chest compression rate. Median number of compressions administered during Cycle 2 for the first minute was 110 (range 76–125) and for the second minute was 110 (range 72–125), with 34 of 36 participants (94%) obtaining an accurate chest compression rate. Participants were more likely to obtain an accurate chest compression rate when an auditory aid was present compared to without (McNemar's test; <i>P</i> = 0.013). Subgroup analysis suggested the auditory aid was beneficial in Groups Q and M but not Group B (Kruskal–Wallis with Dunn's post hoc testing; <i>P</i> = 0.014, <i>P</i> = 0.0455, and <i>P</i> = 0.5637, respectively).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>An auditory aid was associated with improved chest compression rate accuracy. However, as the auditory aid was not beneficial for Group B participants, our findings suggest that some auditory aids are more helpful than others.</p>\u0000 ","PeriodicalId":17603,"journal":{"name":"Journal of veterinary emergency and critical care","volume":"33 6","pages":"639-647"},"PeriodicalIF":1.3,"publicationDate":"2023-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/vec.13351","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71523755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"农林科学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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