As veterinary professionals, we often encounter marijuana toxicosis in dogs. While lethargy, bradycardia and urinary incontinence are common, hyperesthesia can sometimes be overlooked. Here’s what to watch for:
🔹 Behavioral Changes: Sudden aggression, intense fear, or anxiety. These can be misinterpreted as behavioral disorders but may indicate hyperesthetic responses.
🔹 Increased Sensitivity to Touch: Dogs may react excessively to normal handling, grooming, or even petting. Owners might report their dog yelping or snapping without an apparent cause.
🔹 Visual and Auditory Sensitivity: Dogs may display heightened reactions to light or sound, including photophobia or phonophobia. They might seek dark, quiet areas or show distress in normally tolerated environments.
🔹 Mydriasis: Dilated pupils without exposure to bright light can be a sign. This often accompanies other neurologic signs but can stand out in cases of hyperesthesia.
Early recognition and intervention are key to managing these cases effectively. Stay vigilant and consider hyperesthesia in your differential diagnoses for toxicosis! 🩺🐾
#VeterinaryMedicine #Toxicosis #DogHealth #Hyperesthesia #VetLife #CriticalCareVeterinarian #VeterinaryEducation
🚨 Urethral Obstruction in Cats: The Power of a Urethral Lidocaine Block 🚨
🩺 When managing a feline patient with urethral obstruction, pain control and smooth catheterization are key. One effective technique (has NEVER failed me yet!) is the urethral lidocaine block.
🔬 Dosage: Use 0.5 ml/kg of lidocaine (2%), diluted 1:1 with sterile saline to achieve optimal results.
📋 Procedure:
1. Prepare: Calculate the correct dose based on the cat’s weight.
2. Administer: Gently instill the lidocaine into the urethra with a lubricated 24 G catheter
3. Wait: Allow a few minutes for the lidocaine to take effect.
4. Catheterize: Perform catheterization with reduced resistance and discomfort.
💡 Why it works:
- Pain Relief: Lidocaine effectively numbs the urethra, alleviating the cat’s pain.
- Ease of Catheterization: Reduces urethral spasms, making catheter insertion smoother.
🚑 This technique can significantly improve the comfort and outcomes for our feline patients.
This is my favorite best kept secret for UO management!
#VeterinaryMedicine #FelineCare #UrethralObstruction #LidocaineBlock #CriticalCareVeterinarian
Ultrasound is an invaluable, non-invasive tool for diagnosing metastatic lung disease in veterinary patients. Here are key signs to look for:
Nodule Sign: Hypoechoic or mixed echogenicity nodules visible against the normally anechoic lung field. Indicates focal lesions, often metastases.
B-Lines: Vertical, hyperechoic lines extending from the pleural line, moving with respiration. Suggests interstitial syndrome and may indicate early metastatic infiltration.
Shred Sign: Irregular, fragmented appearance of the pleural line with mixed echogenicity beneath. Represents lung consolidation and alveolar-interstitial syndrome, common in metastatic lesions.
Ultrasound provides real-time, bedside diagnostics without sedation, allowing for early detection and monitoring of metastatic disease. It’s a game-changer in veterinary oncology, enhancing our ability to manage and treat our patients effectively.
#VeterinaryUltrasound #LungDisease #UltrasoundDiagnosis #VetMed #CriticalCareVeterinarian
Ultrasound is an invaluable, non-invasive tool for diagnosing metastatic lung disease in veterinary patients. Here are key signs to look for:
Nodule Sign: Hypoechoic or mixed echogenicity nodules visible against the normally anechoic lung field. Indicates focal lesions, often metastases.
B-Lines: Vertical, hyperechoic lines extending from the pleural line, moving with respiration. Suggests interstitial syndrome and may indicate early metastatic infiltration.
Shred Sign: Irregular, fragmented appearance of the pleural line with mixed echogenicity beneath. Represents lung consolidation and alveolar-interstitial syndrome, common in metastatic lesions.
Ultrasound provides real-time, bedside diagnostics without sedation, allowing for early detection and monitoring of metastatic disease. It’s a game-changer in veterinary oncology, enhancing our ability to manage and treat our patients effectively.
#VeterinaryUltrasound #LungDisease #UltrasoundDiagnosis #VetMed #CriticalCareVeterinarian
Heatstroke in dogs is defined as a nonpyrogenic increased body temperature above 104°F (40°C), with a spectrum of systemic signs.
Types of Heat Stroke:
🥵Exertional Heatstroke
Occurs during exercise, common in dogs that have not been acclimated to their environment
🥵Nonexertional Heatstroke
Occurs from exposure to high environmental temp without means of cooling
Acute-Phase Response:
This is a coordinated cellular response, stimulated to protect tissues from excessive heat.
🥵Negative acute-phase proteins: Albumin decreases by 25%
🥵Positive acute-phase proteins: increase by 25%, such as C-reactive protein, Serum amyloid A, Haptoglobin, Ceruloplasmin and Fibrinogen
🥵Heat shock proteins: protect against protein denaturation
What to AVOID During Treatment
🥵Ice and cold water: causes peripheral vasoconstriction, preventing cooling of blood via shunting to the periphery
🥵 Alcohol on pads: it doesn’t work, it’s a waste of alcohol and may be absorbed through the vasodilated skin, just DON’T
🥵Cold towels: these warm up quickly and then retain body heat, delaying cooling
The most important treatment in heat stroke is active cooling, the goal is to normalize body temperature ASAP, while avoiding further organ damage. An effective cooling method is directing a fan and applying cool or tepid water to the skin. Monitor the temperature every 5 minutes and stop once you reach 103.5°F (39.7°C), discontinue active cooling in order to avoid rebound hypothermia.
The effects of heat stroke produce varied clinical signs (see chart attached). Quick stabilization and diagnostics will make the difference between life and death. Remember not to rule out patients with normal or low temp, that have been actively cooled before, since the organ damage has still ocurred and needs to be addressed.
Treat aggressively with buffered isotonic fluids, broad spectrum antibiotics for bacterial translocation, gastric protectants, analgesia, liver protectants.
Heatstroke in dogs is defined as a nonpyrogenic increased body temperature above 104°F (40°C), with a spectrum of systemic signs.
Types of Heat Stroke:
🥵Exertional Heatstroke
Occurs during exercise, common in dogs that have not been acclimated to their environment
🥵Nonexertional Heatstroke
Occurs from exposure to high environmental temp without means of cooling
Acute-Phase Response:
This is a coordinated cellular response, stimulated to protect tissues from excessive heat.
🥵Negative acute-phase proteins: Albumin decreases by 25%
🥵Positive acute-phase proteins: increase by 25%, such as C-reactive protein, Serum amyloid A, Haptoglobin, Ceruloplasmin and Fibrinogen
🥵Heat shock proteins: protect against protein denaturation
What to AVOID During Treatment
🥵Ice and cold water: causes peripheral vasoconstriction, preventing cooling of blood via shunting to the periphery
🥵 Alcohol on pads: it doesn’t work, it’s a waste of alcohol and may be absorbed through the vasodilated skin, just DON’T
🥵Cold towels: these warm up quickly and then retain body heat, delaying cooling
The most important treatment in heat stroke is active cooling, the goal is to normalize body temperature ASAP, while avoiding further organ damage. An effective cooling method is directing a fan and applying cool or tepid water to the skin. Monitor the temperature every 5 minutes and stop once you reach 103.5°F (39.7°C), discontinue active cooling in order to avoid rebound hypothermia.
The effects of heat stroke produce varied clinical signs (see chart attached). Quick stabilization and diagnostics will make the difference between life and death. Remember not to rule out patients with normal or low temp, that have been actively cooled before, since the organ damage has still ocurred and needs to be addressed.
Treat aggressively with buffered isotonic fluids, broad spectrum antibiotics for bacterial translocation, gastric protectants, analgesia, liver protectants.
Myasis is a condition where flies lay eggs in a living animal’s skin or cavities and the hatching larvae eat the surrounding dead skin. The larvae can be two types: maggots or bots. Maggots are long and slender and associated with wound myasis. Bots are large and rotund (ie., Cuterebra) and produce furuncular and migratory myiasis.
The treatment of myiasis is based on the manual removal of the larvae, blocking the respiration (occlusion) of the larva (especially in furuncular myiasis), and/or using larvicidal antiparasitics. The damaged area is then cleansed and necrotic tissue Proper wound management and antibiotics are necessary. Larvicidal antiparasitics may be used to kill the possible existing larvae and to discourage further myiasis, crushed Capstar (nitenpyram) or even isoflurane (yep, the gas anesthetic!) can be used. In a small area you may soak a cotton ball or gauze in isoflurane and place it over the maggots or you can take an appropriate sized anesthetic mask that will cover the wound area, without the black rubber cover. Cover the connection end with tape, and then stuff a piece of cotton soaked with liquid isoflurane in the “top” (taped connector end) while placing the bell end over the wound. The maggots will squirm around and then drop asleep (or dead?). Wipe them off and dispose of them. This also reaches many hidden or buried maggots and makes them crawl out.
To ensure prevention, environmental conditions of the pet should be clean and dry. Any damaged skin should be treated carefully and weak animals kept indoors.
What emergency disgusts you the most?
#maggots #infested #wound #dog #myasis #isoflurane #emergencyvet #ER #ew #gross
Hypertension is a critical issue that demands swift recognition and action.
🚨 Hypertensive Emergency: Immediate intervention is needed due to severe blood pressure spikes causing acute organ damage. Signs include seizures, sudden blindness, and kidney failure. Fast-acting IV meds are essential to prevent further damage.
⏰ Hypertensive Urgency: High blood pressure without immediate organ damage. The approach is more gradual, aiming to normalize pressure with oral meds over time, avoiding rapid changes that could harm the patient.
Spotting the Signs: Look out for blindness, disorientation, excessive drinking/urinating (kidney signs), and any neurological oddities. These could indicate hypertension’s toll on the body.
🔍 Initial assessment should:
Identify any contributing conditions.
Assess for target-organ damage.
Check for complicating factors like heart or kidney disease.
Treatment should start when systolic BP exceeds 160 mmHg or diastolic BP exceeds 100 mmHg, especially if there’s evidence of organ damage.
📉 The goal is a 10% reduction in systolic BP in the first hour, followed by 15% over the next few hours, avoiding sudden drops that could lead to organ hypoperfusion. This controlled decrease is key, especially in chronic hypertension cases where organs have adapted to higher pressures.
💉For acute management, parenteral treatments that can be precisely dosed are crucial. Fenoldopam, a dopamine-1-receptor agonist, stands out for its renal benefits and safety in acute situations, starting at 0.1 μg/kg/min and adjusting as needed. Other options include labetalol, hydralazine, and nitroprusside, chosen based on their action and anecdotal veterinary success.
💊 Transition to oral meds like amlodipine or hydralazine once stable for 12-24 hours, carefully reducing IV meds as oral effects kick in. For patients with severe hypertension but no acute organ damage, oral medications offer a quick, effective BP decrease.
Initial monitoring ma
Dr. Caroline Bogle was able to perform a lung aspirate on one of many lung nodules on this young cat. I was able to walk her through this procedure and we were able to get good diagnostics samples for an owner that had limited finances.
Always push yourself out of your comfort zone, especially when you have the safety net of a criticalist with you 😊
This dog came in for acting weird all of a sudden, after some investigation the owners realized he had eaten half a bar of a chocolate psilocybin bar. He was TRIPPIN!
Magic mushrooms (psilocybin) have a sour or bitter taste, so they may be dipped in chocolate or alcohol, added to a chili, or even made into a tea. Although psilocybin is similar to other classical psychedelics, such as LSD and ayahuasca, it is relatively safe in comparison with them and according to available evidence will not cause neurophysiological deficits or organ damages.
Psilocin (active metabolite). has a fast absorption and is mostly eliminated in urine. Psilocin and similar hallucinogens behave as non-specifics serotonin receptor agonists. Clinical signs in dogs include vocalization, mydriasis, nystagmus, ataxia, tachycardia, disorientation, hyperthermia and anxiety. Rarely tremors and seizures have been reported. Although clinical signs usually occur within 0.5–1 hour.
Treatment is symptomatic, and controlling tachycardia and agitation will likely be a mainstay of treatment. Prognosis is generally good.
Don’t you wish you knew what they were thinking?
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
Board Certified Emergency and Critical Care Veterinary Specialist Her dedication to teaching is not just a profession; it's a calling.
