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

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 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.

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 traumatic endocardial rupture, without obvious clinical signs of cardiac injury, resulting in acute thrombosis of the forelimbs in a dog.

Case summary: A young adult male German Shepherd Dog presented with vehicular polytrauma. The dog was diagnosed with hypovolemic shock and traumatic pneumothorax and was stabilized, having displayed no clinical indicators of cardiac dysfunction. For 10 days, the dog was treated with no complications in the hospital for wounds but presented again shortly after discharge with bilateral forelimb paraparesis determined likely to be due to thrombosis. The dog was euthanized, and the body was submitted for necropsy. A diagnosis was made of left atrial endocardial rupture with thrombosis, multifocal pulmonary bullae and contusions, and cutaneous abrasions, all secondary to trauma. Based on the dog's physical examination on secondary presentation and the necropsy findings of a thrombus adherent to a left atrial tear, it was suspected that one or more thrombus fragments dislodged and occluded the major supplying vessels of the forelimbs.

New or unique information provided: Blunt cardiac injury may occur without overt clinical manifestations of dysfunction and may lead to thrombosis and associated complications.

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 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 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 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 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 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.