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

Objective: To retrospectively study the use of the human-based Trauma-Associated Severe Hemorrhage (TASH) score to predict transfusion needs and outcome in a population of traumatized dogs.

Measurements and main results: The TASH score (comprising sex, hemoglobin concentration, systolic blood pressure, abdominal effusion, heart rate, base excess [BE], and presence of pelvic/femoral fractures) was applied to 24 dogs presenting to a private veterinary hospital following trauma: 12 dogs that required transfusion of blood products and 12 age- and weight-matched controls that did not. Dogs that required transfusions demonstrated a significantly higher TASH score compared with dogs that did not (10.2 ± 2.0 vs 5.2 ± 1.1, respectively; P = 0.03). Univariate analyses of individual TASH score components demonstrated significant differences between animals that received a transfusion and those that did not in BE (median: -8.6 [range: -14.4 to 1.4] vs -4.5 [range: -15.4 to -0.4], respectively; P = 0.04) and positive abdominal fluid score (4/12 vs 0/12, respectively; P = 0.03). The Animal Trauma Triage scores (ATTSs) for dogs included in the study were also obtained from the Veterinary Committee on Trauma registry. The mean ATTS was significantly higher in dogs that received blood transfusions than those that did not (5.2 ± 0.78 vs 2.0 ± 0.5, respectively; P = 0.003).

Conclusions: The TASH score may be useful to predict transfusion needs in a larger population of traumatized canine patients.

Objective: To evaluate the feasibility of an improvised tamponade device allowing direct pressure to be applied to the canine nasopharynx.

Design: Proof-of-concept study using 8 canine cadavers.

Methods and results: A tamponade device was made by placing a condom over a nasogastric tube and suturing it to match the length of the nasopharynx. The device was placed in the nasopharynx of canine cadavers via the nares and filled with diluted ioversol. Placement was then confirmed with radiography or computed tomography. Concentrated ioversol was infused into the rostral nasal cavity to assess for a nasopharyngeal seal, defined as no ioversol passing the device seen on imaging. Subjective assessment of adequate nasopharyngeal compression via digital palpation of the soft palate agreed with imaging findings. Repositioning was required in several cases, but with digital palpation, initial placement was more accurate. Subsequent effective placement and a nasopharyngeal seal were achieved in all 8 cadavers.

Conclusion: This device can be placed in the canine nasopharynx, and an adequate nasopharyngeal seal can be achieved, allowing direct compression of the nasopharynx and filling of the nasal cavity with solution. Confirmation of placement was successful with digital palpation and imaging. Further studies are required to investigate the use of this device in live patients.

Objective: To describe the clinical presentation and diagnosis of bilateral diaphragmatic paralysis in a weanling miniature donkey jack.

Case summary: A 5-month-old miniature donkey jack presented to a tertiary care facility for fever, cough, and increased respiratory rate and effort initially unresponsive to treatment with antimicrobials and anti-inflammatories. Clinical and diagnostic evaluations found no evidence of upper respiratory obstruction or bacterial pneumonia. Serial arterial blood gas evaluations revealed hypercapnia and hypoxemia, and diagnostic imaging was consistent with bilateral diaphragmatic paralysis. The patient's nasal swab for equine influenza type A (subtype H3N8) was positive and had a mildly decreased whole blood selenium concentration. The donkey recovered after treatment with anti-inflammatories and supportive care.

New or unique information provided: This case documents the first report of diaphragmatic paralysis in a donkey, with concurrent equine influenza infection offering a possible causal factor. Bilateral diaphragmatic paralysis should be considered as a differential diagnosis for respiratory distress in donkeys, particularly when diagnostic testing or treatment trials do not support more common causes of respiratory disease in adult animals, such as infectious lower airway disease, asthma, and pulmonary fibrosis.

Background: There is little information on the prevalence of auscultatory abnormalities in anemic cats. This study aimed to describe the prevalence of cardiac murmurs and gallop sounds in a population of anemic and nonanemic cats presenting to an emergency room (ER) and to assess whether the prevalence of auscultatory abnormalities was influenced by the severity of anemia.

Key findings: Records of cats presenting to an ER between May 2021 and May 2022 or receiving a blood transfusion between September 2019 and January 2022 were retrospectively analyzed for presence of a murmur or gallop sound. Cats with known structural heart disease were excluded. A murmur was found in 56 of 185 (30%) anemic cats compared with 11 of 102 (11%) nonanemic cats (p < 0.001), with a higher proportion in cats with PCV <16% (p < 0.001). Twenty-five of 185 (14%) anemic cats had a gallop compared with 4 of 102 (4%) nonanemic cats (p = 0.009), with the highest proportion in cats with PCV 11%-20% (p < 0.001). Echocardiography was performed on 17 of 185 anemic cats; 8 had normal echocardiograms and 9 demonstrated evidence of chamber dilation without left ventricular wall thickening, consistent with anemia.

Conclusions: Abnormalities on auscultation are common in anemic cats presenting to the ER, with a higher prevalence in more severely anemic cats.

Objective: To describe a case of a suspected anaphylactoid reaction to mannitol in a dog.

Case summary: A 1-year-old, neutered female French Bulldog was anesthetized for a T12-T13 dorsal laminectomy surgery for a previously diagnosed spinal arachnoid diverticulum. Perioperatively, the spinal cord appeared grossly edematous, and IV mannitol administration was elected. Midway through administration of mannitol, peracute erythema and angioedema were noted around the patient's tongue, muzzle, and paws. The dog's tongue grew to approximately twice its normal size. All vital parameters remained within normal limits. The dog was treated intravenously with dexamethasone and intramuscularly with mepyramine maleate. The remainder of the anesthetization was uneventful. The swelling completely resolved during the 2-hour recovery period, but careful management of the enlarged tongue was required to prevent airway occlusion.

New or unique information provided: This is the first reported case of a suspected anaphylactoid reaction to IV administration of mannitol in a dog.

Objective: To compare glucose measurements from capillary and venous blood samples using a point-of-care (POC) glucometer with a standard laboratory (colorimetric, glucose oxidase) assay (LABGLU) in a population of hospitalized, neonatal foals.

Design: Multicenter, prospective, experimental study, conducted between March 2019 and June 2020.

Setting: Four university teaching hospitals and 1 private referral hospital.

Animals: Fifty-four hospitalized neonatal (≤30 days of age) foals.

Interventions: Simultaneous capillary (muzzle, POCMUZ) and venous (jugular, POCJUG) blood samples were obtained to determine POC glucose concentrations. Venous samples were also analyzed by LABGLU. Each foal was sampled at the time of enrollment or admission to the hospital and at 1 subsequent point during hospitalization. Indirect mean arterial pressure and hematocrit were concurrently recorded.

Measurements and main results: Bland-Altman analysis showed a mean bias (95% limits of agreement) of -28.0 (-88.6 to 32.6) mg/dL for comparison of POCJUG with LABGLU, -8.2 (-94.3 to 78.0) mg/dL for POCMUZ and LABGLU, and 18.8 (-44.4 to 82.0) mg/dL for POCMUZ and POCJUG. A total of 63.5% of the POCJUG and 45.2% of the POCMUZ samples exceeded the reference value by ±15 mg/dL (for LABGLU samples <75 mg/dL) or ±15% (for LABGLU samples ≥75mg/dL). Concordance correlation coefficient (95% confidence interval [CI]) indicated a fair agreement between POCJUG and LABGLU (0.75, 95% CI: 0.66-0.82) and between POCMUZ and LABGLU (0.71, 95% CI: 0.58-0.80). Fifty percent (14/28) of hypoglycemic foals on the reference method were incorrectly classified as euglycemic by POCJUG, and 5 of 28 were incorrectly classified by POCMUZ.

Conclusions: In the sampled population, the chosen POC glucometer lacked agreement with the standard laboratory measurement. Limits of agreement were wide for both POCJUG and POCMUZ. Inaccuracies in POC results could impact decision-making in the clinical management of glycemic control in hospitalized neonatal foals and, importantly, increase the risk of hypoglycemic events being underdiagnosed in critical patients.

Objective: To quantify and characterize plasma cannabinoid concentrations in cases of suspected cannabis toxicity in dogs, identify potential correlations between clinical signs and plasma concentrations, and assess the specificity of cannabis toxicity diagnosis based on clinical signs alone.

Design: Observational study.

Setting: Veterinary teaching hospital.

Animals: Thirty-eight client-owned animals.

Interventions: Blood was collected from dogs presenting to the emergency room for suspected cannabinoid intoxication based on history or physical examination findings. Samples were analyzed using a validated liquid chromatography-tandem mass spectrometry method for the cannabinoids Δ⁹-tetrahydrocannabinol (THC), cannabidiol (CBD), and their active metabolites.

Measurements and main results: The most common abnormality observed was ataxia (35/38 dogs), with urinary incontinence, lethargy, and hyperesthesia also commonly noted. Cannabinoids were quantifiable in 37 of 38 plasma samples (97.4%), with THC the predominant cannabinoid (range: 1.99-2748 ng/mL). Lower concentrations of CBD (up to 115.3 ng/mL) and cannabinoid metabolites were detected. Of the clinical signs recorded, only abnormal reflexes were statistically correlated with the THC concentration at the time of sampling (P = 0.01).

Conclusions: A diagnosis of suspected cannabinoid toxicity based on case history and clinical presentation was confirmed via quantifiable plasma concentrations in nearly all cases. Although the range of plasma cannabinoid concentrations was broad, the clinical signs observed were generally similar. Other than the presence of abnormal reflexes, clinical signs were not associated with plasma THC concentrations. Subsequent confirmation of cannabinoids in plasma indicates that cannabis toxicity in dogs can be diagnosed with high specificity by veterinarians based only on history and clinical abnormalities.

Objective: To evaluate the safety of repeated administration of a lyophilized canine-specific albumin (CSA) product and to quantify its effect on serum albumin concentrations and colloid osmotic pressure (COP) in healthy dogs.

Design: Prospective study.

Setting: University research facility.

Animals: Six healthy, adult, purpose-bred Beagles.

Interventions: Dogs received 1 g/kg of 16% CSA intravenously on days 1, 2, and 14 and were observed, with serial measurement of vital parameters during and for 2 hours after each infusion, to monitor for adverse events or evidence of a hypersensitivity reaction. Serum albumin concentration and COP were measured at predetermined time points before and after each infusion.

Results: One dog experienced a single episode of vomiting approximately 1 hour after completion of the second infusion. No other adverse reactions were observed during the 28-day study period. Serum albumin concentration was increased by a mean of 0.57 g/dL (5.7 g/L) (P = 0.003) when measured 2 hours after the first CSA infusion, and albumin concentration remained significantly higher than baseline at 24 hours after infusion, with a mean difference of 0.42 g/dL (4.2 g/dL) (P < 0.001). The second and third CSA infusions similarly increased serum albumin concentration at 2 hours (P = 0.001 and P = 0.001, respectively) and 24 hours (P = 0.012 and P = 0.007, respectively) after infusion. COP increased by a mean of 2.03 mm Hg at 2 hours after the first infusion (P = 0.013) and remained significantly higher than baseline at 24 hours after infusion, with a mean difference of 1.52 mm Hg (P = 0.002). The second CSA infusion similarly increased COP at 2 hours (P < 0.001) and 24 hours (P = 0.017) after infusion. The third CSA infusion increased COP at 2 hours after infusion (P = 0.004) but did not achieve statistical significance at 24 hours after infusion (P = 0.053).

Conclusions: A 1-g/kg dose of lyophilized CSA was effective at increasing serum albumin concentration and COP. Repeated infusions of CSA appear safe in healthy dogs.

Objective: To determine and compare the efficacy of intranasal (IN) atomization, IN drops, and IM injection of atipamezole for reversal of medetomidine-induced sedation in healthy dogs.

Design: Prospective, randomized, blinded study.

Setting: University teaching hospital.

Animals: Forty mixed-breed, shelter-owned dogs with an average weight of 29.9 ± 5.6 kg (mean ± SD) that required sedation for minor diagnostic or therapeutic procedures.

Interventions: Atipamezole was administered by a dog handler at 200 µg/kg via IN atomization (ATI-IN_A, n = 10), IN drops (ATI-IN_D, n = 10), or IM injection (ATI-IM, n = 10) 20 minutes following medetomidine administration (40 µg/kg). A control group (n = 10) received no atipamezole.

Measurements and main results: Ease of atipamezole administration was evaluated. Sedation score, heart rate (HR), respiratory rate (RR), and blood pressure (BP) were recorded pre-medetomidine administration (T0), pre-atipamezole administration (T20), and at multiple intervals following atipamezole administration. ATI-IM resulted in the fastest recovery, followed by ATI-IN_A, with ATI-IN_D being the slowest. The adverse cardiovascular impacts of medetomidine were not completely mitigated. ATI-IM showed initial HR restoration followed by a decline. HR in both IN groups showed a slower increase compared to ATI-IM, but no subsequent decline was observed. ATI-IM resulted in a transient decrease in BP, though dogs remained normotensive. A gradual reduction in BP was noted in the IN groups. At T50, RR of all atipamezole groups differed from control, and a significant increase in RR was observed in ATI-IM dogs compared to pre-atipamezole value. No adverse effects were observed.

Conclusions: All routes for atipamezole administration effectively reversed medetomidine-induced sedation, with ATI-IM being fastest. IN routes were easy for the dog handler to administer, making them viable alternatives in cases of accidental drug exposure, particularly outside a hospital setting.

Objective: To establish reference intervals using a new point-of-care thromboelastometry device in dogs for the extrinsically activated test (EX-test), intrinsically activated test (IN-test), fibrin polymerization test (FIB-test), ecarin test (ECA-test), and tissue plasminogen activator test (TPA-test) and to investigate the effects of storage time on the results.

Design: Prospective clinical study in 2022.

Setting: University teaching hospital.

Animals: Forty-eight healthy privately or university-owned dogs were prospectively enrolled and included on the basis of normal physical examination and normal baseline laboratory results (CBC, biochemistry profile, prothrombin time, and activated partial thromboplastin time [aPTT]).

Interventions: After a 30-minute storage time, the EX-test, IN-test, FIB-test, ECA-test, and TPA-test were performed on citrated blood samples. To determine the effect of storage time, 11 samples had the EX-test, FIB-test, and IN-test repeated 90 and 150 minutes after sample collection.

Measurements and main results: Ten thromboelastometry parameters were evaluated for each test. Reference intervals were calculated using the robust method for parametric data, and the robust Box-Cox transformed or nonparametric methods were used for nonparametric data. Increasing storage time resulted in more hypocoagulable tracings. A correlation was found between the IN-test and aPTT (r = 0.62, P < 0.0001). Other weak to moderate correlations were seen between thromboelastometry parameters and platelet count and hematocrit.

Conclusions and clinical importance: The development of reference intervals for the thromboelastometry device allows for the clinical use of this technology. Analyzing samples after a prolonged storage time of more than 30 minutes may result in erroneous results. Results may also be affected by an abnormal hematocrit or platelet count.