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

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.

Objective: To report a case of inadvertent epidural injection of cefazolin in a dog.

Case summary: A 5-year-old neutered male mixed-breed dog weighing 37.2 kg was presented to The Ohio State University Veterinary Medical Center's emergency room after the inadvertent epidural administration of cefazolin. The dog was referred from a primary care veterinarian, where it was being prepared for routine lateral suture cranial cruciate ligament repair. After premedication and induction, 800 mg of cefazolin (volume 8 mL) was inadvertently administered into the epidural space. Recovery from anesthesia was uneventful, with the dog showing no immediate adverse effects or seizure activity. The dog's vitals remained stable until transfer to the tertiary facility, where it exhibited signs of residual sedation that resolved appropriately over time with naloxone. The dog was monitored overnight and discharged the next day without complications observed.

New or unique information provided: Recognizing that drug and communication errors are the most common errors in medicine is a critical first step toward implementing interventions aimed at enhancing patient safety and outcomes. Although inadvertent caudal epidural injections of cefazolin have been documented in people, this case appears to be the first report in veterinary medicine.

Objective: To determine the effect of operator experience on the adverse events associated with pericardiocentesis. A secondary objective was to determine whether adverse events with inexperienced operators were less common in the presence of an experienced supervisor.

Design: Prospective observational clinical study.

Setting: Private practice specialty teaching hospital.

Animals: Forty-five client-owned dogs with pericardial effusion undergoing pericardiocentesis.

Interventions: Pericardial effusion was identified via point-of-care ultrasound (POCUS). Pericardiocentesis was performed according to standard protocol, with the operator chosen based on availability. An ECG was recorded before, during, and after pericardiocentesis, with optional postprocedural telemetry monitoring. POCUS was repeated to monitor for recurrent effusion. Operators completed a questionnaire to report their experience level and adverse events associated with pericardiocentesis. Medical records were reviewed to verify diagnostic results and adverse event occurrence.

Measurements and main results: Forty-five dogs undergoing pericardiocentesis were prospectively enrolled. Seventeen (37.8%) cases experienced adverse events, with 16 of 45 (35.6%) experiencing an arrhythmia requiring antiarrhythmic therapy during or after pericardiocentesis. There was one case of documented cardiocentesis. No spontaneous death occurred within 48 h. Adverse event occurrence did not differ based on the operator's role (intern, resident, or staff doctor) or the number of pericardiocenteses previously performed by the operator. Supervising operators were present during all pericardiocenteses performed by an intern or an operator who had never performed pericardiocentesis. Neoplasia was documented in 73.3% of cases. Adverse event occurrence was not associated with plasma lactate concentration at presentation or with the presence of neoplasia.

Conclusions: Operator experience level was not associated with adverse event occurrence related to pericardiocentesis. Adverse events were more common than previously reported in the veterinary literature.

Objective: The goal of this study was to describe the use of and complications associated with the administration of lyophilized platelets (LPs) in dogs with thrombocytopenia-associated hemorrhage and those with nonthrombocytopenia-associated hemorrhage. Secondary objectives were to report pretransfusion and posttransfusion values, including PCV, total plasma protein concentration, platelet count, blood product administration, and overall survival.

Design: Retrospective study between 2018 and 2022.

Setting: Two university veterinary teaching hospitals.

Animals: Sixty-eight dogs that received LPs.

Measurements and main results: Thirty-five dogs received LPs due to thrombocytopenia-associated hemorrhage, and 33 dogs received LPs due to nonthrombocytopenia-associated hemorrhage. The platelet count was lower in dogs with thrombocytopenia-associated hemorrhage, both before (p < 0.001) and after LP administration (p < 0.001), compared with dogs with nonthrombocytopenia-associated hemorrhage. Dogs with thrombocytopenia-associated hemorrhage had lower PCV values before LP administration (p = 0.007), but no difference was noted at 6-12 or 12-24 h after LP administration. There was no difference in the transfusion of other blood products (p = 0.620) or in survival to discharge (p = 1.000). Potential complications were noted in 6% of dogs.

Conclusions: LP administration may be considered for a variety of conditions, including both thrombocytopenia-associated hemorrhage and nonthrombocytopenia-associated hemorrhage.

Objective: In people, severe Hymenoptera stings can lead to systemic allergic reactions, acute kidney injury, rhabdomyolysis, hemolysis, shock, and even death. Hemolytic anemia as a result of multiple honeybee stings has been reported in dogs; however, there are no prior reports of hemolytic anemia due to wasp stings in the dog. In this report, we present a case of a dog that developed hemolytic anemia after a single wasp sting. We also report the vulnerability of RBCs to the wasp venom using an in vitro hemolysis assay.

Case summary: A 3-year-old neutered male Yorkshire Terrier presented with hemoglobinuria 4 h after a suspected single wasp sting and achieved complete remission after a short course of treatment with glucocorticoids and IV infusion, without long-term sequelae. An in vitro hemolysis assay using mastoparan, a major wasp venom constituent, was performed to test our hypothesis that increased sensitivity of the RBC membrane to wasp venom would lead to hemolysis after exposure to a small amount of venom by a single sting. Although no difference in the amount of mastoparan leading to hemolysis in 50% of the RBCs (HC₅₀) was seen between the patient and two healthy controls, the HC₅₀ was higher in whole blood samples.

New and unique information: This is the first report demonstrating that even a single wasp sting can cause hemolysis in dogs. In addition, based on our in vitro hemolysis assay, plasma may have an inhibitory effect on mastoparan-induced hemolysis.

Objective: To describe the use and feasibility of high-velocity nasal insufflation (HVNI) in cats.

Design: Retrospective descriptive study from 2019 to 2022.

Setting: University teaching hospital.

Animals: Eight cats that failed traditional oxygen therapy and, based on clinical evaluation, required more aggressive oxygen supplementation.

Measurements and main results: Eight cats had HVNI instituted between 2019 and 2022. Four cats received HVNI for primary pulmonary disease, including two with severe nodular pulmonary patterns, one with acute respiratory distress syndrome secondary to septic shock, and one with diffuse hepatization of multiple lung lobes. Two cats received HVNI for airway disease, including one with feline asthma and one with chronic bronchiolar injury. One cat received HVNI due to pleural space disease secondary to failed herniorrhaphy repair for a peritoneal-pericardial diaphragmatic hernia, and one had an unknown cause of respiratory distress. No cat received HVNI due to cardiac disease. The median time spent on HVNI was 17 h (range, 2-76 h). The median flow rate was 1 L/kg (range, 0.612-2.68 L/kg). The median highest FiO₂ recorded was 100% (range, 50%-100%), and the median lowest was 52.5% (range, 40%-100%). Three cats had HVNI successfully discontinued, and two cats survived to discharge. All cats tolerated HVNI with no reported complications.

Conclusions: This is the first report to evaluate the use of HVNI for respiratory support in cats, demonstrating that HVNI is a feasible option in cats requiring more aggressive respiratory support than traditional oxygen therapy.

Objective: To report the use of high-flow nasal cannula oxygen therapy (HFNOT) in three dogs with carbon monoxide poisoning resulting from smoke inhalation.

Series summary: Three dogs were presented to the emergency room with carbon monoxide poisoning associated with house fires. Blood CO-oximetry at the time of presentation confirmed markedly increased carboxyhemoglobin levels. The dogs were treated with 4-7 h of HFNOT to eliminate carboxyhemoglobin. The calculated half-lives of carboxyhemoglobin during HFNOT for Dogs 1, 2, and 3 were 79, 86, and 77 min, respectively. All three dogs survived to discharge, and no delayed complications of carbon monoxide poisoning were reported.

New or unique information provided: To the authors' knowledge, this is the first case series of dogs treated with HFNOT for carbon monoxide poisoning. HFNOT was shown to be effective at removing carbon monoxide, reducing the half-life of carboxyhemoglobin from 77 to 86 min. The half-life of carboxyhemoglobin and the effectiveness of HFNOT should be further investigated in a larger sample of dogs.

Objective: To evaluate the concentration versus time course profiles of urinary tissue inhibitor of metalloproteinase-2 (TIMP-2), insulin-like growth factor-binding protein-7 (IGFBP-7), and kidney injury molecule-1 (KIM-1) during repeated administrations of meloxicam, and determine whether these profiles differ from saline-treated cats.

Design: Placebo-controlled experimental design performed in 2017.

Animals: Twelve healthy, adult, purpose-bred female cats.

Interventions: Cats were randomly allocated to control and treatment groups. Cats in the treatment group (n = 6) received meloxicam 0.3 mg/kg subcutaneously every 24 h for 31 days. Cats in the control group (n = 6) received saline (0.1 mL/kg subcutaneously).

Measurements and main results: Urinary TIMP-2, IGFBP-7, KIM-1, and creatinine were measured every 4-6 days for 31 days, along with serum creatinine. In the treatment group, cats were determined to have renal injury if at least one kidney had histopathological evidence of tubular damage, basement membrane damage, and/or interstitial inflammation. The urinary biomarker concentrations between control and renal injury groups were compared by calculating the area under the curve (AUC) for each biomarker normalized for urine creatinine (UC) concentration versus time course profile and reported as mean ± SE. The AUC values for the two groups were compared statistically using an unpaired, two-tailed t-test. The AUC for urinary IGFBP-7/UC was higher (p = 0.0152) in the treatment group (0.042 ± 0.0062) compared to the control group (0.02676 ± 0.0018). The AUC for urinary KIM-1/UC was higher (p = 0.0083) in the treatment group (0.034 ± 0.0055) compared to the control group (0.019 ± 0.0022). An increase in urinary TIMP-2 was detected in only 50% of the treatment group.

Conclusions: Urinary IGFBP-7 and KIM-1 increase in cats that develop acute kidney injury after repeated meloxicam administration. Further studies are needed before the clinical utility of these molecules as biomarkers for early acute kidney injury detection in cats can be determined.