Journal of veterinary emergency and critical care (San Antonio, Tex. : 2001)最新文献

Objective: To evaluate the effectiveness of a standardized placement protocol in preventing inappropriate airway placement of nasogastric tubes (NGTs).

Design: Retrospective study.

Setting: University teaching hospital.

Animals: Five hundred eighty-two client-owned dogs and cats undergoing NGT placement between September 2021 and March 2023.

Methods: Medical records and digital radiographic records of all dogs and cats that were charged for NGT from September 1, 2021, to March 1, 2023, were reviewed. Data collected included patient species, breed, sedation protocol, proper or improper radiographic placement on thoracic inlet (TI) and last rib (LR) images, whether a stylet was used, and the number of attempts for successful placement in the stomach.

Results: A total of 582 NGT placement events were included, with 415 in dogs and 167 in cats. Airway positioning of the NGT was identified in the TI image in 57 events. Fifty-two of these were corrected immediately, and five were improperly advanced into the small airways due to operator misinterpretation of the TI image. Four small airway NGT misplacements were corrected and replaced prior to NGT use, with a total of 581 successful placement events. Median number of attempts for successful placement was 1 (range 1-9). Sedation was utilized in 515 of 582 placements and general anesthesia in 37 of 582. A stylet was used in 421 of 582 placement events. There was no association found between the use of sedation, anesthesia, or a stylet and airway positioning in the TI image.

Conclusions: The described protocol identified initial NGT placement into the trachea in 9.8% of cases. Prevention of inappropriate small airway placement requires both adherence to protocol and appropriate image interpretation.

Objective: To describe a case of successful CPR after prolonged cardiopulmonary arrest in a dog treated for refractory ventricular tachycardia (VT) with multiple antiarrhythmic medications and attempted electrical cardioversion, resulting in suspected lidocaine toxicosis necessitating intra-arrest IV lipid emulsion (ILE) administration.

Case summary: A 6-month-old male intact American Cocker Spaniel was presented for evaluation of VT found on routine physical examination. A dilated cardiomyopathy phenotype was identified on echocardiography. The arrhythmia was refractory to therapy with lidocaine, magnesium sulfate, procainamide, and amiodarone. Subsequently, the dog was anesthetized for electrical cardioversion. The dog then developed ventricular fibrillation (VF), and CPR was performed per the contemporaneous Reassessment Campaign on Veterinary Resuscitation guidelines. Once the duration of VF exceeded 10 min, CPR was adjusted with a longer period of chest compressions before defibrillation. ILE was administered due to a concern for concurrent lidocaine toxicosis and to bind some of the previously administered antiarrhythmic medications, which may have increased the defibrillation threshold (DFT). Return of spontaneous circulation was achieved after 16 min of CPR. After being discharged, the dog was treated with mexiletine and sotalol long term and continued to do well 12 months later despite persistent VT.

New or unique information provided: This report describes a case of CPA secondary to intractable VT refractory to both injectable antiarrhythmic medication and attempted electrical cardioversion. Evidence suggests that antiarrhythmic medications can have positive or negative effects on the DFT, which may affect the success of electrical cardioversion or defibrillation. ILE was administered to bind the lipophilic antiarrhythmic medications due to concern that they were increasing the DFT. In patients with malignant arrhythmias, use of antiarrhythmic medication is often essential; however, clinicians should consider its potential impact on the DFT during subsequent cardioversion or defibrillation.

Objective: To describe admission variables in dogs with bite wound trauma and to evaluate the relationship of these variables with the type of bite wound (penetrating, blunt, combination) and survival outcome.

Design: Retrospective evaluation of multi-institutional veterinary trauma registry data on dogs presenting with bite wound trauma.

Setting: Veterinary Committee on Trauma-identified Veterinary Trauma Centers (VTCs).

Animals: A total of 12,412 dogs with bite wound trauma presented to VTCs with data entered in the Veterinary Committee on Trauma registry from April 1, 2017, to December 31, 2021.

Interventions: None MEASUREMENTS AND MAIN RESULTS: Admission variables and outcome were evaluated for dogs suffering from penetrating bite trauma (10,942/12,412; 88.16%), blunt bite trauma (479/12,412; 3.86%), and a combination of these (991/12,412; 7.98%). Among all groups, 95.06% (11,799/12,412) survived to discharge, 1.01% (125/12,412) died, and 3.93% (488/12,412) were euthanized. Patient sex (p < 0.001), modified Glasgow Coma Scale score (p < 0.001), Animal Trauma Triage score (p < 0.001), lactate concentration (p < 0.001), base excess (p < 0.001), blood glucose concentration (p < 0.001), ionized calcium concentration (p < 0.001), and PCV/total plasma protein concentration (p < 0.001/p < 0.001) were each associated with survival outcome. Head injury (p < 0.001) or spinal trauma (p < 0.001) at time of admission, or the requirement for blood product transfusion (p < 0.001), was associated with a negative survival outcome. Treatment by a Doctor of Veterinary Medicine prior to arrival to VTC was associated with survival. In multivariate analysis, higher body weight and surgical intervention were associated with survival. Older age and glucose dysregulation were associated with a negative survival outcome.

Conclusion: Dogs sustaining bite wound trauma have an excellent prognosis for survival. These findings may help guide discussion with caregivers regarding patient care, resource requirements, and prognosis.

Objectives: To evaluate the association between the percentage of pulmonary contusion volume (PPCV) found on computed tomography (CT) and survival to discharge or implementation of mechanical ventilation (MV) in a cohort of dogs with thoracic trauma.

Design: Retrospective multicenter study (March 2019 to April 2023).

Setting: Two veterinary teaching hospitals and one diagnostic imaging telemedicine service.

Animals: Twenty-seven client-owned dogs with thoracic trauma and CT findings compatible with pulmonary contusions.

Interventions: None.

Measurements and main results: Medical records were retrospectively searched for dogs with thoracic trauma and CT findings compatible with pulmonary contusions. Demographic parameters, PPCV, presence of pneumothorax or pleural effusion, number of fractured ribs, provision of MV, and outcome were recorded. CT studies were reviewed, and PPCV was calculated using commercial software following a standardized protocol. Nonsurvivors had a higher PPCV (median, 49.6% [range, 4.2-81.3]) than survivors (median, 6.5% [range, 0.1-52.9]; p = 0.005). Dogs that received MV also had a higher PPCV (median, 41.4% [range, 4.2-81.3]) compared with dogs that did not (median, 7.5% [range, 0.1-66.7]; p = 0.015).

Conclusions: In this population of dogs with thoracic trauma, nonsurvivors and dogs that received MV had a higher PPCV, as evidenced by CT.

Objective: To (1) establish whether the erythrocyte sedimentation rate (ESR) at admission is related to mortality in dogs hospitalized in the ICU; (2) observe and evaluate the ESR trend during 48-72 h of hospitalization and determine how it relates to mortality; and (3) test whether ESR is a marker of sepsis.

Design: Prospective study using residual K3-EDTA blood samples of hospitalized dogs.

Setting: ICU of a university teaching hospital.

Animals: A total of 124 hospitalized dogs were included in the study. Sixty of the 124 dogs were used to test whether ESR is a marker of sepsis.

Measurements and main results: The ESR was measured on residual EDTA blood samples collected from hospitalized dogs as part of clinical evaluation. A total of 32 dogs died during hospitalization, while 92 were discharged. The ESR at admission (T0) was significantly higher in nonsurvivors (28 mm/h) compared with survivors (11 mm/h) (p = 0.03). Forty-one dogs had ESR monitored at T1 (24 h postadmission) and T2 (48-72 h postadmission). An increase in the ESR from T0 to T2 was seen in nonsurvivors (p < 0.01; medians: T0, 22 mm/h, T1, 37 mm/h, T2, 42 mm/h). Survivors showed a decrease in the ESR from T0 to T2 (p < 0.01; medians: T0, 12 mm/h, T1, 14 mm/h, T2, 5 mm/h). Twenty-eight dogs were diagnosed with sepsis and had a higher ESR than nonseptic dogs (35 vs. 10 mm/h; p < 0.0001). A cutoff of 22 mm/h may differentiate septic dogs from nonseptic dogs, with a sensitivity of 76% and a specificity of 81% (area under the curve = 0.8; p < 0.0001).

Conclusions: The ESR at admission can predict the mortality of hospitalized dogs. Its monitoring during hospitalization may add prognostic information. Given the challenges involved in screening septic patients, point-of-care testing may easily evaluate the ESR when used alongside other indicators.

Objective: To assess the efficacy of a new equine F[ab']₂ antivenom (US Department of Agriculture code 6101.05) in removing serum venom and lowering the snakebite severity score (SSS) in animals suffering from naturally occurring viperid envenomation.

Design: Retrospective study, April 2020 to October 2021.

Setting: Veterinary hospitals across four North American regions.

Animals: Twenty-two dogs, one cat, and one horse.

Interventions: All patients received the new antivenom intravenously and were assessed for clinical response. Most dogs required one vial for clinical control of signs.

Measurements and main results: Among the dogs and cats with detectable initial serum venom, 94.4% showed a strong response to antivenom administration, with a reduction in serum venom ranging from 94% to >99% at 2 h. Animals that experienced a 90% reduction of serum venom within 2 h greatly exceeded the 0% expected of an ineffective antivenom. The canine and feline SSS improved relative to the initial SSS at 2, 6, and 12 h in 57.9%, 77.8%, and 90.9% of cases, respectively. A favorable reduction in SSS was also appreciated in the single horse in the study.

Conclusions: In the canine, feline, and equine cases of North American viperid envenomation studied, antivenom 6101.05 adequately removed serum venom and lowered the SSS.

Objective: To report the use of cryosupernatant (CS) transfusion for the treatment of suspected vitamin K antagonist rodenticide (VKAR)-associated coagulopathy in dogs and its impact on coagulation times.

Design: Retrospective case series (2000-2017).

Setting: University teaching hospital.

Animals: Seven dogs with hemorrhage associated with suspected VKAR intoxication treated with CS transfusion.

Interventions: CS transfusion.

Measurements and main results: The median age was 3.0 years, with a median weight of 17.7 kg. Initial coagulation testing revealed median one-stage prothrombin time and activated partial thromboplastin time of 697% and 393%, respectively, above control/average of the reference range (CARR). The median dose of CS was 11.0 mL/kg. One-stage prothrombin time decreased (p = 0.043) after CS transfusion to a median of 98% of CARR. Activated partial thromboplastin time (n = 3) decreased to 114% of CARR (sample size precluded statistical analysis) upon recheck. All dogs received vitamin K supplementation, with an initial median subcutaneous dose of 4.11 mg/kg. Initial median PCV and total plasma protein concentration were 27.0% and 4.5 g/dL (45 g/L), respectively, with posttransfusion PCV and total plasma protein concentration of 22.0% and 4.9 g/dL, respectively. Six dogs showed resolution of observed clinical hemorrhage and were discharged. One dog was euthanized due to multi-organ dysfunction. No transfusion reactions were reported.

Conclusions: Dogs with suspected VKAR intoxication showed resolution of clinical hemorrhage after CS transfusion. Compared with fresh frozen plasma, CS is an option for treating VKAR-associated coagulopathy, despite lower factor IX activity.

Objective: To describe two rabbits with iatrogenic venous vascular air embolism (VAE) confirmed with computed tomography (CT), their management, and the possible risk factors for air embolism specific to hospitalized rabbits.

Series summary: Iatrogenic VAE is a risk to human and veterinary patients who undergo multiple procedures, including routine IV catheter placement. Review of past experimental studies suggests that rabbits may be especially susceptible to the harmful effects of air emboli, attributed to both their small relative body size and their unique systemic sensitivity. Two rabbits at a tertiary referral hospital were diagnosed with VAE using CT. The air was presumably introduced through their IV catheters. One rabbit experienced immediate cardiopulmonary arrest and died, while early detection and intervention resulted in the survival of the other rabbit.

New or unique information provided: This case series is the first to describe CT-confirmed air embolism in rabbits and the first report of successful management of a VAE in this species with long-term survival.

Objective: To determine the incidence of, and characterize the clinical signs associated with, apparent type I hypersensitivity (HS) reactions due to administration of a new formulation of IV amoxicillin-clavulanate (AC).

Design: Observational retrospective study.

Setting: Two private specialty hospitals in New South Wales, Australia.

Animals: One thousand six hundred seventy-two dogs and cats administered a new formulation of IV AC.

Measurements and main results: Between September 2018 and May 2022, patients were identified that received chlorpheniramine or dexamethasone within 6 h of receiving the new formulation of IV AC, had an allergy alert to the new formulation noted in the medical record, or had an allergy or suspected reaction to the new formulation described in the medical record. Patients were included if the new formulation was administered, if they had evidence of a type I HS reaction within 6 h of injection, and if they were administered treatment for a type I HS reaction. Eleven dogs (and no cats) had an apparent type I HS reaction (incidence 0.81% for dogs). Cases were clustered between November 2021 and May 2022 (n = 10), with an incidence of 2.13% for dogs. Dermatologic signs were recorded for all cases (n = 11), with some showing cardiovascular (n = 2) or gastrointestinal signs (n = 1). All cases survived.

Conclusions: The incidence of a type I HS reaction to the new formulation of IV AC in dogs was low, and the outcome was excellent. No reactions in cats were identified. A cause for clustering of cases within a 6-month period was not elucidated.

Objective: To compare conventional (C) and point-of-care ultrasound (POCUS)-guided (P) peripheral catheterization by a single clinician in dogs presenting to the emergency department. The dogs randomly received a peripheral C or P catheter in the cephalic or lateral saphenous vein. The P placement was further randomized to be performed in or out of plane. The success rate, time taken to obtain vascular access, weight, body condition score (BCS), age, shock index (SI), vein catheterized, and technique used were recorded.

Design: Randomized, controlled, prospective clinical study conducted from January to August, 2022.

Setting: University teaching hospital.

Animals: A total of 102 dogs presenting to an emergency department.

Measurements and main results: The dogs were of various breeds, 5.9 ± 4.3 years old, weighed 21.9 ± 12.5 kg, with BCS 5.4 ± 1.4. The mean SI was 1.01 ± 0.47. The success rates of catheterizations C (84.6%) and P (73.1%) did not differ (p = 0.15). The median catheter placement time was shorter for C (65 s [43-122]) than for P (96 s [42-180]) (p < 0.001). In smaller dogs (5-15 kg), C had a higher success rate than P (88.0% vs. 61.1%, p = 0.049), but not in larger dogs (>15 kg; C 81.5% and P 79.4%, p = 0.84). BCS and SI did not affect the success rates. The out-of-plane (76.9%) and in-plane (69.2%) success rates did not differ (p = 0.53). After additional P catheterization, a positive slope was identified for the success rate (mean increase of 0.48%, p < 0.0001), suggesting a learning effect, which was confirmed for the out-of-plane technique (average 1.4% increase per placement, p < 0.0001).

Conclusion: P and C catheter placement had similar success despite the suggested learning curve for the out-of-plane technique.