Vetemcrit

11/07/2023

Assessment of the intravascular volume status is a critical skill for emergency veterinarians. Point-of-care ultrasonography (POCUS) is emerging as a valuable, noninvasive, cage-side diagnostic tool for objective evaluation of physiologic and hemodynamic parameters related to volume status, fluid tolerance, and responsiveness. Rapid cage-side sonographic evaluation can obtain qualitative data on cardiac function even when performed by non-cardiologists. POCUS involves answering focused clinical questions using cage-side ultrasonography and increases the sensitivity of the conventional physical examination.

In this blog post, I will describe the most commonly used views to assess volume status in dogs and cats: focused sonographic assessment of the heart (cardiac POCUS) and caudal vena cava (CVC POCUS):

Assessment of the intravascular volume status is a critical skill for emergency veterinarians. Point-of-care ultrasonography (POCUS) is emerging as a valuable, noninvasive, cage-side diagnostic too…

10/06/2023

Refeeding syndrome refers to a potentially fatal constellation of metabolic derangements that occur upon refeeding a patient with an extended period of complete anorexia or severe malnutrition (Crook 2001; Kraft 2005). These metabolic derangements include severe hypophosphatemia, hypomagnesemia, hypokalemia, hyponatremia, hypocalcemia and vitamin deficiencies (Skipper 2012).

If you want to learn more about refeeding syndrome, watch the short video below:

Refeeding syndrome refers to a potentially fatal constellation of metabolic derangements that occur upon refeeding a patient with an extended period of compl...

13/05/2023

A lot of clinicians continue to believe that impaired tissue oxygenation is the main cause of increased blood lactate, and lactate itself results in metabolic acidosis. This biochemical understanding has persisted for long time, but there are some good reasons to challenge these traditional views on the 'bad' lactate.

After its production by anaerobic glycolysis lactate is re-used in the liver and the kidneys, and it may be converted back to glucose. The important point though is that lactate is also produced via aerobic glycolysis as a response to catecholamine release and stress. This may happen in septic patients, albuterol toxicity, trauma and other critical illnesses. In these clinical scenarios, the trigger for lactate production is adrenergic stimulation and NOT lack of oxygen.

If you want to learn more about lactate metabolism, watch the short video below:

In this video, I will discuss the physiology of lactate metabolism in dogs and cats, and will explain why lactate is not always a bad thing in your patient.

27/03/2023

VetEmCRIT has published a new article and video on a clinical diagnosis of shock in dogs and cats. “Shock” is one of the most frequently used words in a small animal emergency room and ICU. The circulatory shock is the category of shock that is most commonly referred to as “shock” in daily small animal clinical practice. It is important to understand that circulatory shock is a clinical diagnosis, and there is no perfect test that can be run to definitively rule it in. It is a common misconception that low arterial blood pressure (arterial hypotension) is always present in patients with shock. In reality, canine and feline patients in shock may have low, normal or even transiently elevated blood pressure during the early compensated stage of circulatory shock (Porter et al. JVECC 2013). If you want to read a full article and watch the video, click the link below:
https://youtu.be/aHRSu2kWeS8

FREE Diagnosis of Shock Checklist can be downloaded here: https://dedicated-creator-5292.ck.page/shock_checklist

In this video, we will talk about the clinical diagnosis of shock in dogs and cats. “Shock” is one of the most frequently used words in a small animal emerge...

01/03/2023

VetEmCRIT has published a new blog article and YouTube video on our website.

Those of you who have ever participated in canine blood donation might have encountered a situation when the blood flow through a sampling line has significantly slowed down or even completely stopped, and despite your best efforts, you had to abort the mission. As a result, the blood bag may end up being half full and contain only 200-250 ml of blood. Since the majority of commercially available donor bags contain 63-70 ml of citrate-based anticoagulant, they are designed to be filled up with 400-450 ml of donor blood to maintain a 1:7 - 1:9 citrate-to-blood ratio. If not, the citrate-to-blood ratio goes up, which creates a risk for citrate toxicity during a blood transfusion. In this situation, a clinician or technician may elect to waste this blood product and send this donor home since collecting another full bag of blood will not be safe for the donor animal. On the other hand, there is an extreme shortage of blood products in veterinary medicine, and, if possible, any waste should be avoided. In this blog post and video, I will give you a tool that may help you decide on whether a blood product with a high citrate-to-blood ratio should be discarded or safely given to a prospective recipient.

You can read the full article by clicking on the link below:

​https://vetemcrit.com/citrate-toxicity-calculator-for-dogs/

VIDEO:

This video is about citrate toxicity in canine patients. I will also demonstrate a tool that may help veterinarians and veterinary technicians (especially, t...

15/01/2023

In this video, I will talk about Chronic Intestinal Pseudo-Obstruction (CIPO) in canine patients. This is a syndrome reported in dogs where impaired intestinal motility results in clinical signs of obstruction without mechanical occlusion of the intestinal lumen. This syndrome is rare, and small animal practitioners should bear it in mind. Medium to large breed dogs may be overrepresented. CT scan could be used as an adjunctive imaging modality in dogs with suspected CIPO or equivocal abdominal ultrasound results. Gastrointestinal biopsies should be strongly considered in all cases of negative exploratory laparotomies due to suspected mechanical GI obstruction.

In this video, I will talk about Chronic Intestinal Pseudo-Obstruction (CIPO) in canine patients. This is a syndrome reported in dogs where impaired intestin...

08/01/2023

VetEmCRIT has published a new blog article on our website.

A 2-year-old spayed female standard poodle was referred to a specialty private practice for evaluation of a suspected small intestinal mechanical obstruction. Two weeks prior, the dog started vomiting and stopped eating. The initial diagnostic work-up performed by her primary veterinarian showed normal bloodwork, and the dog received regular supportive care on an outpatient basis. Due to the presence of persistent vomiting and inappetence, the abdominal survey radiographs were performed, and they were consistent with the gastrointestinal obstruction as it was interpreted by a board-certified radiologist.

You can read the rest of the article here:

A 2-year-old spayed female standard poodle was referred to a specialty private practice for evaluation of a suspected small intestinal mechanical obstruction. Two weeks prior, the dog started vomit…

06/12/2022

VetEmCRIT has published a new blog article and YouTube video on our website. Check it out!

https://vetemcrit.com/do-all-cats-with-hcm-have-hcm/

https://youtu.be/-cZhmrBNxK0

In this video, I will talk about a "transient myocardial thickening" in feline patients that may mimic a true feline hypertrophic cardiomyopathy and may lead...

21/11/2022

VetEmCRIT has published a new blog post on radiographic confirmation of NG/NE tube placement in dogs and cats. Check it out!

Nasogastric and nasoesophageal tubes are commonly used in small animal practice for short-term enteral nutrition. They are easy to place without general anesthesia, inexpensive and can be used for …

19/10/2022

Vetemcrit has published a new online course on management of sodium derangements in dogs and cats. Check it out:
https://www.udemy.com/course/sodium_disorders_veterinary/?referralCode=6E2166814E673A332349

This course will cover basic and advanced aspects of sodium and water balance physiology, incidence and mortality associated with low and elevated plasma sodium concentration as well as treatment of hypo- and hypernatremia in stable and critically-ill feline and canine patients. It will provide a step-by-step approach to diagnosis and treatment of sodium disorders. The instructor will discuss in detail how to make a contrived solution that is necessary when resuscitating patients with very low or high plasma sodium. Each module contains real clinical examples and post-lesson quizzes that are intended to re-enforce your learning and give you an opportunity to practice your recently acquired skills. Participants are expected to progress through the course materials at their own pace.

All recommendations are based on current human and veterinary research as well as the author’s experience working in emergency and critical care field for over 10 years. This course will consist of videos and post-lesson assignments highlighting the most important take-away messages.

This course includes 10 video lectures and 10 quizzes.

10/10/2021

VetEmCRIT has published a new video on obtaining an accurate fetal heart rate by using the M-mode. Check it out!
http://www.vetemcrit.com/fetal-heart-rate-in-m-mode/
https://www.youtube.com/watch?v=ZkSYHJFDF3c&t=29s

In this video, I will teach you how to obtain an accurate fetal heart rate by using the M-mode (point-of-care ultrasound).

25/07/2021

VetEmCRIT has published a new post on coagulopathy associated with pulmonary hypertension. Check it out!

http://www.vetemcrit.com/ph-induced-coagulopathy/ -1116

A 12-year-old female spayed Chihuahua was presented to the emergency service for evaluation of respiratory distress that had started acutely several hours prior to presentation. The dog began cough…

18/04/2021

Drs. Laura Cole and Rachael Birkbeck recorded VetEmCRIT Rounds on fibrinolysis in dogs and cats. During these rounds, they talk about physiology and pathophysiology of fibrinolysis as well as DIC, viscoelastic testing and the reasons why hemorrhagic cavitary effusions do not clot.

http://www.vetemcrit.com/vetemcrit-rounds-a-chat-about-fibrinolysis/

During these rounds, two Diplomates of American College of Veterinary Emergency and Critical Care (Laura Cole and Rachael Birkbeck) are discussing a post-operative bleeding in a dog that underwent …

04/04/2021

VetEmCRIT has published a new post on understanding medical statistics when reading a scientific paper. Check it out!

http://www.vetemcrit.com/understanding-stats-when-reading-a-scientific-paper/ -1084

07/03/2021

VetEmCRIT has published a new post. Check it out!

The Morel-Lavallée lesion in a dog

http://www.vetemcrit.com/the-morel-lavallee-lesion-in-a-dog/ -1044

24/12/2020

http://www.vetemcrit.com/approach-to-hyponatremia-in-dogs-and-cats/?fbclid=IwAR0IOfkKDAxxD9dOGArsnYzg3W9SxIDL9bim8iO0vSaZItoM0pkdAgkkEiA -1009

This post presents diagnostic and therapeutic approaches to canine and feline patients with hyponatremia. As we all remember, the plasma sodium concentration represents a ratio of plasma sodium con…

25/10/2020

A new post has been published on VetEmCRIT. Check it out!
http://www.vetemcrit.com/approach-to-hypernatremia-in-dogs-and-cats/

Hypernatremia is defined as a serum sodium level above the reference range. It is a relatively infrequently encountered electrolyte disturbance in dogs and cats. In one retrospective study (Ueda et…

15/09/2020

Dr. Laura Cole has published a new post on VetEmCRIT. Check it out!
http://www.vetemcrit.com/trauma-acute-kidney-injury-and-mannitol/

Traumatic injury is a risk factor for acute kidney injury (AKI). The cause of AKI is likely multifactorial and may include renal hypoperfusion and renal hypoxia secondary to hypovolemic shock and/o…

26/07/2020

VetEmCRIT has published a new post! Check it out!

http://www.vetemcrit.com/approach-to-hypokalemia-diagnosis-and-treatment/ -947

05/07/2020

VetEmCRIT has published a new post. Check it out!
http://www.vetemcrit.com/a-tricky-enterococcus/ -913

Enterococci are commensal bacteria inhabiting GI tract of animals and humans. It typically emerges in debilitated patients exposed to broad-spectrum antibiotics and as part of polymicrobial infecti…

21/06/2020

VetEmCRIT has published a new post. Check it out!

http://www.vetemcrit.com/approach-to-hyperkalemia-diagnosis-and-treatment/ -888

This blog post commences a series of articles on diagnostic and therapeutic approaches to potassium and sodium derangements. This is meant to be a quick reference/guideline for emergency veterinari…

10/06/2020

Laura Cole has published a new post on VetEmCRIT. Check it out!

http://www.vetemcrit.com/wide-complex-tachycardia-more-complex-than-first-thought/ -858

A 7 year-old male neutered domestic shorthaired 5 kg cat is currently hospitalized for management of an aortic thromboembolism. The cat was diagnosed with hypertrophic cardiomyopathy, left sided co…

24/05/2020

VetEmCRIT has published a new post. Check it out!

http://www.vetemcrit.com/dysnatremias-the-role-of-urine-sodium-and-osmolality/ -837

All living organisms originated in the sea. A constant salt concentration was important to maintain their vital functions. To overcome their dependency on sea environment, a sophisticated renal sys…

08/05/2020

A new post has been published on VetEmCRIT. Check it out!

http://www.vetemcrit.com/why-i-dont-use-artificial-colloids/

Currently, veterinary emergency and critical care practitioners (diplomates, residents and emergency veterinarians) are divided into two camps: those that don’t use artificial colloids and those th…

21/04/2020

Furosemide use in management of acute kidney injury: magic bullet or fatal blow? Furosemide is the most commonly used diuretic in critical care and is frequently used in the management of acute kidney injury (AKI). However, the benefits of furosemide administration in AKI has long been questioned an...

21/04/2020

A new blog post has been published by Dr. Laura Cole!

We are delighted to announce that two insanely smart emergency and critical care specialists, Dr. Alex Lynch from North Carolina State University and Dr. Laura Cole from Royal Veterinary College, have joined the VetEmCRIT team as co-authors.

http://vetemcrit.com/furosemide-use-in-management-of-acute-kidney-injury-magic-bullet-or-fatal-blow/ -710

Furosemide use in management of acute kidney injury: magic bullet or fatal blow? Furosemide is the most commonly used diuretic in critical care and is frequently used in the management of acute kidney injury (AKI). However, the benefits of furosemide administration in AKI has long been questioned an...

18/04/2020

A new educational video has been published on VetEmCRIT.com
http://vetemcrit.com/a-practical-approach-to-mechanical-ventilation-in-small-animals/

A Practical Approach to Mechanical Ventilation in Small Animals Author: Igor Yankin Igor is the creator of VetEmCRIT.com. He is a clinical assistant professor of Veterinary Emergency and Critical Care Medicine at the Texas A&M University. View all posts by Igor Yankin Author Igor YankinPosted on Apr...

15/04/2020