This tiny Yorkie presented for acute onset of neuro signs. The patient had eaten a bag of Taki Fuego chips earlier in the day, there was no access to drugs or medications, nor any history of trauma. She presented severely bradycardic at 62 bpm, ECG showed a sinus bradycardia, blood pressure was 90 mmHg. Point of care ultrasound showed good systolic function and normal cardiac volume, no pericardial or pleural effusion, no abdominal effusion, no b-lines. Neuro exam showed obtunded mentation, severe ataxia, slow pupillary light response, absent withdrawals x 4, normal patellar reflexes, absent postural reactions x 4, head swaying and no pain elicited on neck or spinal palpation.
A urine drug test was negative for cocaine, marijuana, PCP, amphetamines, opiates, benzodiazepines, barbiturates, methadone, propoxyophene and quaaludes. PCV/TS and ammonium was within normal limits and Na was elevated at 161 mmol/L. She was diagnosed with salt toxicosis from Taki chip ingestion. Taki chips have 420 mg per 1 ounce serving, she ingested a 3.25 oz bag, meaning she ingested a total of 1365 mg of Na.
Acute hypernatremia can cause fluid to move from the intracellular space to the extracellular spaces, causing a decrease in the volume of cells in the brain (cerebral edema), brain hemorrhage, neurological damage, coma, or death.
For Acute (<48h) hypernatremia:
- If clinical signs are present: Calculate the free water deficit: Free water deficit (L) = 0.6 x lean body weight (kg) x [(patient serum Na/140 )– 1], this will give you the amount of free water to be replaced, then administer D5W (free water) at a rate of 7–10 mL/kg/h at a correction rate of 2–3 mEq/L/h for the initial 2–3 h or until the neurological signs are resolved
- If no clinical signs are present: Administer D5W at a rate of 3–6mL/kg/h at a correction rate of 1–2 mEq/L/h
- Correct hypernatremia within 24 h of initial therapy
- Recheck electrolytes within 30 min to an hour, and every 4–8 h until hyper
Coxofemoral luxation occurs when the head of the femur becomes luxated (dislocated) from the acetabulum. Typically this is due to trauma but may severe hip disease may also cause this. The hip will most commonly luxate craniodorsally (up and forward) but can also luxate caudoventrally (down and backward).
Closed reduction can be performed if there are no concurrent injuries in the acetabulum, femoral head and the hip conformation is normal. The patient is placed under general anesthesia; a towel is placed under the affected leg to apply counter traction. For a craniodorsal luxation, the limb is externally rotated to move the femoral head away from the lium. Distocaudal traction is applied to move the femoral head into proximity with the acetabulum. With pressure applied to the greater trochanter and internal rotation of the limb, one attempts to reduce the femoral head. Once the femoral head is reduced, move the limb through a range of motion to feel for crepitus (undiagnosed fracture) and to unseat soft tissues from the acetabulum. An Ehmer sling should be placed to maintain internal rotation of the femoral head for the next 2 weeks to allow the soft tissues to heal. I would recommend an additional 4 weeks of strict confinement to reduce reluxation. Unfortunately, 50% of patients will reluxate with closed reduction of a craniodorsal coxofemoral luxation.
For a caudoventral luxation, a towel is placed under the affected leg to apply counter traction. Distal traction is applied to the limb to free the femoral head from the obturator foramen. Once the femoral head is free, it is rotated laterally and cranially to seat in the acetabulum. Once the femoral head is reduced, move the limb through a range of motion to feel for crepitus (undiagnosed fracture) and to unseat soft tissues from the acetabulum. Hobbles should be placed above the tarsus to prevent abduction of the pelvic limbs. The skin around the hobbles should be evaluated weekly for 6 weeks and changed as
It’s been a few weeks after IVECCS (International Veterinary Emergency and Critical Care Symposium), and I can’t help but relive some key moments that I’m sure will live in heart for ever.
It’s no surprise to anyone that knows me in person or through social media that I’m a proud Latina. But I’m also acutely aware of the challenges that I have faced BECAUSE of that fact as well. My ethnicity has nothing to do with my intellect, my empathy or potential and yet I’ve felt the weight that people put on this unchangeable part of me. I’ve been INCREDIBLY privileged as a Latinx immigrant woman in vet med.
1. I’m an American citizen
2. I speak English fluently without an accent
3. I’m able bodied and healthy
4. I was raised in a middle-class home and never experience hunger or the lack of a roof over my head
5. I’ve gotten opportunities that an incredibly small % of people get
6. The list goes on and on…
I KNOW that I’ve worked incredibly hard and sacrificed tons to get here, I’m not minimizing my work. But there are sooo many more smart, hard-working, capable people out there that may never get a chance. I strongly feel this responsibility to do everything in my power to make those opportunities more accesible.
This year we had a Spanish track at IVECCS for the first time! 6 Spanish lectures on advanced critical care, all taught by amazing Latinx speakers (honored beyond words to be one of them).
The response… blew me away. People approached us IN TEARS! Latinx veterinary technicians and doctors hearing a Spanish lecture for the first time in their lives, truly impacted them and us.
To then win the CPR battle for LAVECCS! (LatinAmerican VECCS), this is a fun and friendly competition. But to see Latinx people surround us and cheer for us, see them stick out their chest in pride and watch their eyes twinkle with emotion… I cannot express what it meant to me… it was more than just a friendly competition.
It was a statement!
We
As my time comes to an end @veterinary_emergency_group, I look back at the most amazing year!
Not only did I become a better doctor, having learned surgery, endoscopy and the VEG way. But I also experienced first hand the magic of an open floor concept and integrating the clients into a team that heals their pet.
I met brilliant, kind, inspiring co-workers that I hope have become life- long friends. I worked with NERDs (New ER Doctors) and was able to teach some of my team and many of you know that’s what makes me happy at the end of the day!
Thank you for letting me into your family, thank you for letting me teach you and thank you for teaching me so much!
I love you and VEG will always feel like another home!
#VEG #VEGGIEforlife #veterinaryemergencygroup
Make sure to include looking under the tongue as part of your kitty physical exam!
#string #tongue #cat #kitty #veterinarian #veterinarymedicine #vetmed #emergencymedicine #criticalcareveterinarian
This 4 month old female pit bull was rescued the previous day with nystagmus. The breeder had noted the puppy had nystagmus for a very long time.
General physical exam was unremarkable, neuro exam revealed the following:
🧠 Mentation: normal
🧠 Gait: normal, no ataxia noted
🧠 Cranial nerves: pendulous nystagmus, intact PLR, delayed menace, intact palpebrals, intact facial sensation, intact gag reflex, absent dazzle
🧠 Postural reactions: normal placement in all 4 limbs, intact hopping in all 4 limbs
🧠 Spinal reflexes: intact withdrawals in all 4 limbs, intact patellar in both hind limbs, intact cutaneous trunci, Intact anal tone
🧠 Nociception: no pain noted on spinal and head palpation
We suspect that she has congenital pendulous nystagmus. This is typically caused by a congenital abnormality in the visual pathway. This is frequently seen in blue-eyed puppies that are visually impaired. In these dogs, they may have abnormalities of their optic chiasm causing congenital blindness or significantly impaired vision. The abnormal eye movement may be due to the brain constantly searching for visual input so the eyes keep going back-and-forth trying to find something. Usually, no other neurologic signs are present, and the condition may be non-progressive and of no clinical significance.
Additionally, this could be due to developmental problems of the cerebellum. Finally, infectious diseases such as neospora, toxoplasma, and cryptococcus may also be a cause of vestibular signs.
A definitive answer may be obtained with an MRI and CSF tap.
Given that bloodwork and physical exam was normal and vision was impaired noted by a decreased menace and dazzle, our top differential was congenital pendular nystagmus from visual pathway abnormalities.
This kitty came in for a history of vomiting twice and diarrhea for the past 5 days. Mom came in with theories of what was going on…. She had a recent cockroach infection and thought maybe that was causing the diarrhea… she asked me if I had heard of that before…. I said NOPE! But it doesn’t mean it may not be true… Physical exam was unremarkable, and bloodwork showed a significant eosinophilia of 3.2…
So obviously I googled “cockroach parasites cat”…. And well… why be grossed out by yourself when you can share your disgust with all of social media! 🤢
Cockroaches have been recognized as mechanical vectors of pathogens that can infest humans or animals. They frequently feed on human faeces, garbage, and sewage!
They are nocturnal and have filthy habits which coupled with their feeding mechanisms make them efficient vectors of pathogens like:
- Bacteria (Klebsiella pneumonia, Enterobacter cloacae, Enterobacter aerogenes, Salmonella spp., Shigella sonnei, Vibrio cholerae, Citrobacter freundii )
- Viruses (Poliomyelitis)
- Protozoa (Isospora belli, Cryptosporidium parvum, Cyclospora cayetanensis, cysts of Entamoeba histolytica, Balantidium coli, and Giardia lamblia)
- Fungi (Candida sp., Rhizopus sp., Aspergillus sp., Mucor sp.)
- Pathogenic intestinal worms (Ascaris lumbricoides, Trichuris trichiura, Hookworm, Enterobius vermicularis, Hymenolepis nana, Toxocara canis, and Strongyloides stercoralis larvae)
Cockroaches not only contaminate food or water bowls with their droppings or by pathogens but they also cause food poisoning.
In one study evaluating over 800 house cockroaches, these were found to have numerous intestinal parasites. These were Ascaris (33.76%), Trichuris (11.97%), Capillaria (6.16%), Toxocara (4.86%), Hook Worm (4.86%), and Eimeria (2.73%). The parasites were more commonly found on the external surface (54.27%) of cockroaches than in the internally (38.51%).
So…. I told the Lerner she was lucky spot on and sent it h
Dynamic air bronchogram in a dog
The management of acute respiratory distress requieres quick stabilization and may necessitate hospitalization. Differential diagnosis can be based on the results of the patient’s medical history, clinical examination, laboratory tests and conventional radiology. Traditionally, the first approach to dyspnea has been radiology in both lateral recumbencies, followed, when possible, by dorsoventral (DV) or ventrodorsal (VD) recumbency. This may be risky in unstable respiratory patients which may delay a diagnosis and subsequent treatment until the patient is stable enough for radiographs.
Lung ultrasound is an excellent and under-utilized tool to assess pulmonary parenchyma. Studying intrathoracic structures can be difficult due to the air content of the lungs and by the bones of the rib cage which block the ultrasound beam and cause artifacts. However, this technique does not require placing the patient in recumbency and is quick providing extremely valuable and sensitive information. This may aid in obtaining a quicker diagnosis and hence delivery of treatment.
Multiple signs have been described to facilitate the diagnosis of pneumonia on ultrasound:
🫁 air bronchograms
🫁 b-lines
🫁 subpleural consolidations
🫁 pleural line abnormalities
🫁 pleural effusions
The most specific sign for the diagnosis of pneumonia is the presence of air bronchograms, which are hyperechoic lines and dots within a hypoechoic area (trapped air in airways).
These can be dynamic or static.
Dynamic air bronchograms are thought to be pathognomonic for pneumonia.
Static air bronchograms are immobile and may be both atelectasia or pneumonia.
In this video you can see a dynamic air bronchogram identified as a moving “worm” like structure through the lung. We diagnosed aspiration pneumonia and started broad spectrum antibiotics immediately.
#lungultrasound #airbronchogram #dynamicairbronchogram #pneumonia #POCUS #tfast #vetmed #veterinarymedicine #criticalcare
I mean… Do you want to create SUPERBUGS?
This cat presented with respiratory distress and open mouth breathing. He was stabilized with oxygen and sedation and tFAST revealed a pneumothorax as well as a large volume pleural effusion on the opposite side. An emergency thoracocentesis was performed and the patient improved enough to safely take thoracic radiographs. Thoracic radiographs showed mild pleural effusion, mild pneumothorax on the other side, a bronchiolar pattern consistent with asthma and a mediastinal mass. Although we had removed a large amount of air, he soon destabilized again as he had filled up with air again. We placed a chest tube to continuously suction the air abs keep him comfortable abs stable until the owners arrived to say goodbye as they were concerned about his quality of life.
Pneumothorax is an accumulation of air in the pleural space surrounding the lungs. The extra air doesn’t allow the lungs to inflate normally, causing a collapse of the lungs producing difficulty breathing, tachypnea, shallow breathing, exercise intolerance, cyanosis, collapse, etc. If severe cases are left untreated, a pneumothorax can be fatal.
Pneumothorax may result from chest trauma, excessive pressure on the lungs, or underlying lung disease (asthma, chronic obstructive pulmonary disease, etc.). In some cases, the cause is never discovered.
Types of pneumothorax:
💨Closed pneumothorax: air is leaking from a defect in a lung cyst, bronchus, trachea, esophagus, or lung tissue into the chest cavity.
💨Open pneumothorax: air is entering the chest cavity via an open wound in the chest wall (animal bites, gunshot wounds, puncture wounds, vehicular trauma)
💨Iatrogenic pneumothorax: air entered the chest cavity during lung surgery or procedures.
💨Spontaneous pneumothorax: (no known cause for the air in the chest cavity).
💨Tension pneumothorax: A tear in the pleura that acts like a one-way valve (lets air in, but doesn’t let it exit), causing progressive collapse of the lung.
#pneumotho
Emergencies WILL happen, and when that moment comes please be prepared. Pet insurance can help you do that. If you are buying a pure breed pet, please do your research on what diseases they are predisposed to, what additional médica expenses you will have.
Some examples:
1. Brachycephalic dogs (French and English bulldogs, boxers, Pekingese, etc) WILL have difficulty breathing, some may require surgery to correct, some may be more predisposed to vomiting and regurgitation, some may develop heat stroke because they can’t release heat well…
2. Large, deep chested dogs may be predisposed to gastric volvulus and dilatation, prevention involves surgery with a gastropexy, of not GDV is an emergency surgery
3. Dachshunds will very likely develop back problems, they may even become paralyzed and require neurosurgery
4. Sweet loyal Golden retrievers and labradors develop CANCER, all types… be prepared
5. King Charles Cavaliers may (likely will) develop heart disease
These are just a few examples of many other issues that some of these breeds may have, and that doesn’t account for accidents and trauma.
Have savings or get pet insurance (even better, do both!), because when that moment come, you will want to have the peace of mind of being able to do everything your pet needs.
Veterinarians many times have emotional burdens that stem from clients putting pressure on them (moral blackmail) to discount services or be blamed for “being in it only for the money”
Please remember that your veterinarian deeply cares and has studied at minimum 8-10 years (more if specialists) and deserves to be paid for their services.
We want to focus on your pets health, none of us WANT to have money being a limiting factor in your pets care. So please prepare well for unexpected health issues so that we can focus only on what’s the best plan for your pet is.
Please share ❤️
#nomv #trupanion #pethealthinsurance #moralblackmail #beprepared #bekindtoyourvet
