OBJECTIVE:To describe a dog with aspiration pneumonitis resulting from administration of polyethylene glycol (PEG) electrolyte and activated charcoal (AC) solution into the airway that was successfully treated using bronchoalveolar lavage and mechanical ventilation (MV). CASE SUMMARY:A young female Chihuahua-Pomeranian crossbreed initially presented with constipation to the primary care clinician. The dog was sedated for the placement of a nasoesophageal tube, after which the PEG and AC solution wer administered. The administration of this solution into the airways led to aspiration pneumonitis, causing respiratory distress and coughing. Initial treatment involved bronchoscopic suction and airway lavage and medical support, including an antimicrobial and a bronchodilator. Due to increasing respiratory effort and hypoxemia, MV was needed. Pressure-controlled synchronized intermittent mandatory ventilation mode, which allows spontaneous breathing and the administration of mandatory breaths, was initiated. Two complications occurred during MV. The first was hyperkalemia of unknown origin, which was treated with glucose, calcium gluconate, insulin, and terbutaline. The second complication involved severe clogging of the heat-moisture exchanger filters by the PEG and AC solution, resulting in hypercapnia. After 4 days, the dog was successfully weaned from the ventilator and eventually made a full recovery. NEW OR UNIQUE INFORMATION PROVIDED:To the authors' knowledge, this is the first report describing successful treatment of a dog using bronchoalveolar lavage and MV for the inadvertent administration of PEG electrolyte and AC solution into the airways.
OBJECTIVE:To report serum baclofen concentrations before, during, and after in-series carbon hemoperfusion (cHP) and hemodialysis (HD) in four dogs with severe baclofen toxicosis. SERIES SUMMARY:This series involves four dogs with serum samples collected before, during, and after in-series cHP/HD. The extraction ratio (ER, %) of cHP and HD, half-life during cHP/HD, and total extracorporeal elimination constant were calculated. Posttreatment samples were collected to determine endogenous half-life and intrinsic elimination constant. Two dogs received both cHP/HD and mechanical ventilation, while the other two received cHP/HD alone. The range of ingested dosages was 4-24 mg/kg. The median time from suspected ingestion to cHP/HD initiation was 7 h (range: 5-15 h). Extracorporeal therapy was performed using an intermittent hemodialysis platform in two cases and a continuous renal replacement therapy platform in two cases. The median duration of cHP/HD was 3 h (range: 2.2-4 h), with a median total blood volume processed of 1.3 L/kg (range: 1-1.5 L/kg), equating to 15 times (range: 12-18.2 times) the estimated blood volume (80 mL/kg) in dogs. Serum baclofen concentration was reduced during cHP/HD by a median 69% (range: 46%-80%). The median ER for cHP was 61% (range: 60%-81%) and for HD was 4% (range: -0.5% to 11.5%). The calculated half-life during cHP/HD was 1.9 h (range: 1.1-2.5 h), compared with 5.8 h (range: 3.1-13.6 h) after cHP/HD. The median extracorporeal elimination constant was 0.34 (range: 0.08-0.37), which was 2.8 times faster than the intrinsic elimination constant of 0.12 (range: 0.05-0.23). NEW OR UNIQUE INFORMATION PROVIDED:In-series cHP/HD reduced serum baclofen concentrations in this small series of dogs, highlighting its potential role in the treatment of severe baclofen intoxication.
OBJECTIVE:To describe the presentation and outcome of a case of suspected cholecalciferol rodenticide intoxication managed with both intralipid emulsion (ILE) and therapeutic plasma exchange (TPE). CASE SUMMARY:A 3-year-old, neutered female, crossbreed dog presented for acute-onset vomiting and lethargy after suspected exposure to cholecalciferol rodenticide. Severe hypercalcemia was observed without other identifiable causes found upon investigation. Standard therapy for hypercalcemia was initiated, but rebound hypercalcemia led to consideration of alternative management options. Although ILE therapy initially showed promise, rebound hypercalcemia persisted. Ultimately, TPE was performed as a novel therapy and successfully reduced serum concentrations of vitamin D metabolites. Normocalcemia was eventually maintained, though the dog developed endocarditis that progressed to congestive heart failure and death. Blood cultures revealed the growth of Serratia marcescens. NEW OR UNIQUE INFORMATION PROVIDED:To the authors' knowledge, this is the first report describing the use of both ILE and TPE in the management of cholecalciferol rodenticide intoxication in a dog. It is also the second reported case of S. marcescens causing endocarditis in a dog.
BACKGROUND:To assess the viability of canine and feline plasma for the purpose of transfusion therapy after freezer malfunction and inadvertent thawing of numerous fresh frozen plasma (FFP) units resulted in prolonged exposure to room temperature. KEY FINDINGS:After a plasma freezer alarm malfunction, numerous units of canine and feline FFP thawed over a period of approximately 10 h. Hemostatic capacity was assessed with measurement of prothrombin time (PT), partial thromboplastin time (PTT), and coagulation factor analysis on a representative unit of canine and of feline FFP. Analysis of samples demonstrated normal PT and PTT, with all coagulation factor activities exceeding 70% of reference interval standards. No bacterial growth was noted after this duration of time. SIGNIFICANCE:Hemostatic capacity of representative canine and feline FFP units appeared to remain normal and may be considered a viable transfusion product after exposure to room temperature for up to 10 h and within the circumstances described in this report.
OBJECTIVE:To decribe the indications, complications, and outcomes of companion animals treated with extracorporeal therapy (ECT). DESIGN:Retrospective case series from November 2023 to December 2024, with a 1-month follow-up. SETTING:Single-center study at a veterinary university teaching hospital. ANIMALS:Forty-one client-owned animals (37 dogs, four cats) treated with ECT for endogenous substance accumulation (ESA [n = 28], including acute kidney injury [AKI; n = 27] or post-attenuation neurologic signs [PANS; n = 1]), immune-mediated disease (IMD; n = 3), or intoxication (n = 10). MEASUREMENTS AND MAIN RESULTS:Data collected included signalment, indication, ECT type (hemodialysis [HD], hemoperfusion [HP], or therapeutic plasma exchange [TPE]), complications, and outcome. A total of 103 ECT sessions were performed. Session complications were frequent (HD: 27%, HP: 71%, TPE: 64%), most commonly circuit clotting (15/103), hypocalcemia (10/103), bleeding (9/103), and hemodynamic instability (9/103); none were fatal. Assessment of specific complication risks by ECT type was limited by sample size, but the complication rate of HD was lower compared with other modalities (p = 0.012). Overall, 25 of 41 animals were discharged, and 20 of 25 survived 1 month. Survival in dogs differed by indication: 100% (10/10) for intoxication, 57% (13/23) for AKI, and 33% (1/3) for IMD (p = 0.006). Among dogs with AKI, those with probable or confirmed leptospirosis had higher 1-month survival (9/19) compared with other causes of AKI (1/4) (p = 0.014). CONCLUSIONS:ECT is associated with a moderate to high complication rate, but most complications were mild and transient. Intoxicated patients receiving ECT had an excellent prognosis, while dogs with AKI and confirmed or probable leptospirosis showed better survival than those dogs with AKI unlikely to be due to leptospirosis.
OBJECTIVE:To investigate the correlation between arterial and venous concentrations of lactate and glucose and to explore the relationship between hyperlactatemia and hyperglycemia in critically ill dogs. DESIGN:Prospective clinical study. SETTING:University veterinary teaching hospital. ANIMALS:Ninety client-owned dogs presenting for emergency surgery between June 2015 and March 2024. INTERVENTIONS:None. MEASUREMENTS AND MAIN RESULTS:Arterial and venous blood samples were collected from the dorsal pedal artery and jugular vein, respectively, ≤5 min apart to measure lactate and glucose concentrations with portable devices. Dogs with known diabetes mellitus were excluded. Based on arterial blood, 35 of 90 dogs (38.9%) were hyperlactatemic, 49 (54.4%) were hyperglycemic, and 9 (10.0%) were hypoglycemic. Based on venous blood, 41 of 90 dogs (45.6%) were hyperlactatemic, 46 (51.1%) were hyperglycemic, and 8 (8.9%) were hypoglycemic. A very strong correlation was found between arterial and venous lactate and glucose concentrations (ρ = 0.850; 95% confidence interval [CI]: 0.766-0.905; p < 0.001 and ρ = 0.970; 95% CI: 0.950-0.982; p < 0.001, respectively). In dogs with arterial hyperlactatemia, a very strong correlation was found between arterial and venous samples (ρ = 0.835; 95% CI: 0.683-0.918; p < 0.001), whereas the correlation was fair in normolactatemic dogs (ρ = 0.488; 95% CI: 0.224-0.685; p < 0.001). The sensitivity and specificity of venous lactate to detect arterial hyperlactatemia were 81.8% and 88.6%, respectively. No correlation was found between arterial lactate and glucose concentrations (ρ = -0.57; 95% CI: -0.261 to -0.152; p = 0.593). CONCLUSIONS:Venous lactate and glucose concentrations correlated well with arterial values; however, hyperlactatemia was not correlated with hyperglycemia. Venous blood sampling offers a practical and reliable method for assessing lactate and glucose concentrations in critically ill dogs, reducing the need for arterial sampling in emergency situations.
OBJECTIVE:To determine whether a lower cost (LC) outpatient wound management protocol for dogs could achieve equivalent rates of wound healing complications with fewer veterinary visits and less impact on fecal microbiota diversity compared with the gold standard (GS) treatment. DESIGN:Pragmatic noninferiority randomized controlled trial. SETTING:Veterinary teaching hospital. ANIMALS:Convenience sample of 58 dogs. INTERVENTIONS:Dogs were quasi-randomized by admission date into GS (n = 33) or LC (n = 25) bundled interventions. The GS group comprised use of sterile surgical gloves, sterile saline at 8 psi, hair clipped with a No. 40 blade, nylon used with an interrupted pattern for skin closure, and a 7-day course of potentiated amoxicillin. The LC group used clean examination gloves, a tap water gravity lavage, a No. 10 blade for clipping the hair, poliglecaprone-25 in a continuous pattern for skin closure, and a 3-day course of potentiated amoxicillin. Outcomes were assessed by follow-up with blinded owners and primary veterinarians. MEASUREMENTS AND MAIN RESULTS:Wound complications in the LC group prompted interim analysis, and the trial was stopped early. Ten of 25 wounds (40%) in the LC group became infected compared with 4 of 32 (12.5%) in the GS group, corresponding to a risk difference of 27.5% (95% CI, 5.1-49.8; p = 0.03) and a risk ratio of 3.20 (95% CI, 1.14-9.01; p = 0.03). Follow-up veterinary visits were similar between the two groups (p = 0.3). Reduced treatment impact on fecal microbiota diversity was seen in nine dogs in the LC group (delta Shannon diversity index: 1.16 ± 0.28) compared with 16 dogs in the GS group (delta Shannon diversity index: 0.76 ± 0.27) (p = 0.002). CONCLUSIONS:The bundled, LC wound management protocol described in this study is not recommended for outpatient management of superficial wounds in dogs.
OBJECTIVE:To investigate and compare the enantiomer-specific nephrotoxicity of tartaric acid (TTA) in Madin-Darby canine kidney (MDCK) cells and human kidney (HK-2) cells. Secondary aims were to determine the enantiomeric-specific TTA accumulation to induce these effects through distinct influx and efflux pathways via organic anion transporter (OAT)-1 and OAT-4. Subsequently, a critical objective was to determine the mitochondrial mechanisms of toxicity via citrate synthase inhibition and assess supplemental substrate mitigation within this reaction. DESIGN:In vitro concentration-response experiments and transporter transfection studies using racemic and enantiomeric forms of TTA in canine and human immortalized renal cell lines over a 48-h exposure period. SETTING:School of Pharmacy biomedical research laboratory and tissue culture facility. ANIMALS/SAMPLES:Immortalized MDCK and HK-2 proximal tubule epithelial cell lines. INTERVENTIONS:MDCK and HK-2 cells were treated with 5-50 mmol/L of racemic or enantiomeric TTA for 48 h. Cotreatment of 0.08 mmol/L oxaloacetate (OAA) was used to assess the mitigation of citrate synthase inhibition. Additional transporter transfection experiments were conducted using probenecid (PBD) as a cotreatment to gain a greater understanding of TTA accumulation and toxicity prevention. MEASUREMENTS AND MAIN RESULTS:Cellular ATP levels and citrate synthase activity were measured. L-Tartaric acid (L-TTA) caused significant ATP depletion (8.5%-24.8%) and citrate synthase inhibition (36.5%-45.0%) in MDCK cells but not in HK-2 cells, suggesting species-specific toxicity. OAT-4 transfection reduced ATP loss by 8.0%-11.2% after L-TTA exposure. Cotreatment with PBD reduced cytotoxic L-TTA effects by 11.7%, suggesting that OAT-1 uptake and insufficient OAT-4 efflux are central to TTA accumulation. Cotreatment with OAA rescued ATP loss by 15.6%. CONCLUSIONS:L-TTA is a species- and enantiomer-specific nephrotoxicant in dogs resulting from a lack of transporter-mediated efflux and subsequent citrate synthase inhibition. OAT-1 inhibition or OAT-4 transfection mitigates toxicity, supporting a transporter-driven mechanism for TTA accumulation.
OBJECTIVE:To characterize acid-base disorders in dogs with hyperlactatemia via traditional and semiquantitative approaches, and to investigate the mechanisms of hyperlactatemia and the prognostic significance of metabolic acidosis in these patients. DESIGN:Retrospective study. SETTING:University teaching hospital. ANIMALS:A total of 3866 dogs with various diseases and a plasma lactate concentration >2 mmol/L at any timepoint during hospitalization underwent traditional acid-base analysis. Among these patients, 1755 dogs had data available for semiquantitative acid-base evaluation. MEASUREMENTS AND MAIN RESULTS:The most common disease associated with hyperlactatemia was gastrointestinal disorders in 1232 of 3866 dogs (29.3%), and the most common mechanism of hyperlactatemia was circulatory shock in 741 (19.1%). The traditional approach identified acid-base abnormalities in 2586 dogs (66.9%), with the most common being primary respiratory acidosis in 609 (15.7%). When considering both primary and mixed disorders, metabolic acidosis was present in 1452 patients (37.5%). When excluding the lactate effect, the semiquantitative approach identified concurrent acidifying and alkalinizing effects in 1241 of 1755 dogs (70.7%). Unmeasured anions, determined via semiquantitative analysis, were the most frequent acidifying effect in 775 dogs (44.1%). Metabolic acidosis, whether primary or as part of a mixed disorder, was associated with increased mortality (682/1452 [46.9%]) compared with patients without metabolic acidosis (479/2414 [19.8%]) (p < 0.001). Similarly, type A hyperlactatemia was associated with higher mortality (374/717 [52.5%]) than type B (227/746 [30.4%]) (p < 0.001). CONCLUSIONS:Acid-base disorders in dogs with hyperlactatemia were frequent and complex, with both acidifying and alkalizing processes often occurring simultaneously. The semiquantitative approach might be a valuable tool to improve our understanding of the underlying mechanisms of metabolic acid-base disorders in these patients. The presence of metabolic acidosis was most frequent in dogs with type A hyperlactatemia and was associated with higher mortality.
OBJECTIVE:To evaluate how environmental and other risk factors are associated with the prevalence of corneal ulceration in horses presenting to equine emergency veterinarians in the Western United States. DESIGN:Retrospective study conducted from May 2020 to November 2023. SETTING:Equine field and hospital practice in the Western United States. ANIMALS:Four hundred twenty horses with corneal ulceration, confirmed by clinical examination and fluorescein staining, of any underlying cause. INTERVENTIONS:None. MEASUREMENTS AND MAIN RESULTS:The primary study outcomes were the association between environmental factors (wind speed, temperature, dew point) and corneal ulceration, as well as factors associated with the need for enucleation. Using a Poisson regression model, increased average wind speed (p < 0.01) and increased average temperature (p = 0.08) were associated with higher rates of corneal ulceration. Male horses were more likely to develop ulcers (p = 0.004) compared with females. Older age (p < 0.0001), deeper ulcers (p < 0.0001), and involvement of the left eye (p < 0.05) were associated with an increased risk for enucleation. The presence of uveitis was also associated with the need for enucleation (p = 0.002). CONCLUSIONS:Equine emergency veterinarians should be aware that both wind speed and increasing temperatures are associated with corneal ulceration in the Western United States. Enucleation in horses with corneal ulcers is associated with increasing age, uveitis, and increasing depth of the ulcer.
OBJECTIVE:To evaluate the clinical characteristics, underlying diseases, organ dysfunctions, and survival of dogs with systemic inflammatory response syndrome (SIRS) or sepsis. DESIGN:Prospective observational study from January to December, 2023. SETTING:Single-center, veterinary university teaching hospital. ANIMALS:One hundred sixty-six dogs; six dogs with distinct cases of SIRS were included twice (172 cases). INTERVENTIONS:None. MEASUREMENTS AND MAIN RESULTS:Dogs were included if they met two or more of the four SIRS criteria (hypothermia or fever; tachycardia; tachypnea; leukocytosis, leukopenia, or left shift) and had a disease causing systemic inflammation. Cases were categorized into groups (G) "nonseptic SIRS" (G1: n = 73), "sepsis" (G2: n = 92), "sepsis without organ dysfunction" (G2a: n = 25), "severe sepsis" (G2b: n = 59; dysfunction of one or more organ systems), "septic shock" (G2c: n = 8; hypotension despite adequate fluid resuscitation), and "SIRS of unclear origin" (G3: n = 7). The most common causes of SIRS/sepsis were gastrointestinal diseases (n = 61 [35.5%]), vector-borne diseases (n = 28 [16.3%]), and neoplasia (n = 22 [12.8%]). There was dysfunction of one or more organs in 114 cases (66.3%). The coagulation system was most frequently affected (n = 78 [45.3%]), followed by the cardiovascular system (n = 47 [27.3%]), respiratory tract (n = 14 [8.1%]), kidney (n = 13 [7.6%]), and liver (n = 6 [3.5%]). Overall, 128 of 165 cases (77.6%) survived until discharge (short-term), and 116 of 159 (73%) survived ≥4 weeks after discharge (long-term). Differences in outcome were found between G1 and G2 (short-term: p = 0.046, long-term: p = 0.015), with dogs in G2 having better survival. Short-term mortality was higher in cases with one or more organ dysfunctions than in cases without (p = 0.031). CONCLUSIONS:SIRS can be triggered by a variety of diseases in dogs. Strict and regular monitoring is important for early detection of organ dysfunction.
OBJECTIVE:To characterize clot waveform analysis (CWA) parameters (delta and derivative values), alongside standard coagulation parameters (prothrombin time [PT], activated partial thromboplastin time [aPTT], and fibrinogen) in dogs diagnosed with immune-mediated hemolytic anemia (IMHA) using a turbidimetric optical clot detection-based analyzer. DESIGN:Retrospective study from January 2018 to October 2022. SETTING:University teaching hospital. ANIMALS:Thirty-five client-owned dogs diagnosed with IMHA. MEASUREMENTS AND MAIN RESULTS:CWA parameters were characterized by an increased PT delta in 35 of 35 dogs with IMHA (100%) and an increased PT first derivative, aPTT delta, and aPTT second derivative in 34 of 35 (97.1%). Compared with healthy controls, the PT was prolonged and the fibrinogen concentration was increased in most of the IMHA cohort, while the aPTT fell within the reference interval. Of the 18 patients that had D-dimers performed, 17 (94.4%) measured above the reference interval. CONCLUSIONS:CWA of patients with IMHA revealed increased parameters compared with the reference intervals, consistent with a hypercoagulable state. This measurement may be helpful in identifying patients that may benefit from antithrombotic therapy.
OBJECTIVE:To evaluate dogs presenting with hemorrhagic pericardial effusion (PCE) for the presence of hyperfibrinolysis. DESIGN:Prospective observational study. SETTING:Single veterinary teaching hospital. MEASUREMENTS AND MAIN RESULTS:Dogs with PCE had blood samples collected before pericardiocentesis for PCV, total plasma protein and blood lactate concentrations, venous blood gas, and thromboelastography modified with tissue plasminogen activator (tPA-TEG). Fibrinolysis was assessed on tPA-TEG using the percentage of clot lysis at 30 min (LY30) after maximum clot strength (MA). Hyperfibrinolysis was defined as an LY30 of ≥20%. LY30 values were compared with values from a cohort of healthy dogs. Most dogs with PCE (14/16 [87.5%]) were hyperfibrinolytic, whereas no control dogs had hyperfibrinolysis. The median LY30 for dogs with PCE (51.5%, range: 3.0%-77.6%) was significantly higher than that of control dogs (1.3%, range: 0.0%-5.8%; p < 0.001). CONCLUSIONS:Compared with dogs that are healthy, dogs with hemorrhagic PCE are hyperfibrinolytic as assessed by LY30 on tPA-TEG. Given that dogs with hemorrhagic PCE may experience ongoing hemorrhage after pericardiocentesis, further investigation into the use of antifibrinolytic medications in these patients is warranted.
OBJECTIVE:To describe systemic protothecosis as a novel differential for hypoadrenocorticism-like clinicopathologic findings. CASE SUMMARY:A 3-year-old neutered female Labrador Retriever was evaluated for an episode of acute lethargy, hyporexia, and ataxia. The dog had a prior history of chronic gastrointestinal signs with no underlying cause determined. On presentation, the dog had several clinicopathologic changes similar to those seen in cases of hypoadrenocorticism, most notably a severe hyperkalemia and hyponatremia, with a sodium-to-potassium ratio of <14:1. A diagnosis of Prototheca bovis infection was made based on the histopathology of endoscopic biopsies and confirmatory polymerase chain reaction. The dog initially had a positive response to treatment with oral antifungals but was later euthanized due to the progression of ophthalmologic and neurologic signs. NEW OR UNIQUE INFORMATION PROVIDED:Based on a literature search and to the authors' knowledge, this is the first time canine protothecosis has been associated with severe hyperkalemia and one of only a few reports of gastrointestinal disease resulting in severe hyperkalemia.
OBJECTIVE:To investigate and describe the therapeutic potential of manual plasma exchange for controlling seizures and neurologic dysfunction in a dog with postattenuation neurologic signs (PANS). CASE SUMMARY:A 4-year-old neutered female Yorkshire Terrier was initially diagnosed using computed tomography with a congenital extrahepatic portosystemic shunt involving the left gastric and azygos veins. After diagnosis, surgical correction of the anomaly was performed without complications, and the patient was discharged. However, within 48 h of surgery, the dog developed a neurologic condition characterized by generalized tonic-clonic seizures that were poorly responsive to medical treatment. Given the timing and progression of clinical signs despite medical therapy, and after ruling out hepatic encephalopathy as a likely cause, a presumptive diagnosis of PANS was established. A modified, manual therapeutic plasma exchange (MTPE) technique was successfully performed over an 8-h period with minimal complications. After the procedure, marked clinical improvement was observed, with resolution of neurologic signs, and the patient was discharged without further procedure-related complications. NEW OR UNIQUE INFORMATION PROVIDED:PANS has been described in veterinary medicine in both dogs and cats, although its etiology and treatment remain poorly understood. This report describes the use of MTPE as a therapeutic approach, yielding promising results. To the authors' knowledge, this is the first documented use of MTPE for this condition in dogs, with previous reports limited to a single case in a cat.
OBJECTIVE:To describe the clinical presentation of presumptive acute post-hypoxic myoclonus in a cat and a dog after cardiopulmonary arrest (CPA). In people, acute post-hypoxic myoclonus is a transient focal, multifocal, or generalized rhythmic myoclonus that results from global hypoxic-ischemic brain injury and may be cortical or subcortical in origin, specifically brainstem-generated. Post-hypoxic myoclonus typically presents within 48 h of CPA while the patient is still comatose. Although this neurologic sign has historically been associated with a poorer prognosis, recent studies suggest that evaluation of its clinical characterization in conjunction with electroencephalographic features should be considered. CASE SERIES SUMMARY:We describe the cases of one cat and one dog that suffered CPA, underwent CPR, and experienced return of spontaneous circulation. Both cases developed presumed acute post-hypoxic myoclonus within 24 h of resuscitation, did not respond to antiseizure and sedative drugs, and were subsequently euthanized. NEW OR UNIQUE INFORMATION PROVIDED:Acute post-hypoxic myoclonus can occur in cats and dogs after CPA and successful resuscitation.
OBJECTIVE:To determine whether the regular use of structured communication tools is associated with greater communication openness among small animal specialty practitioners and emergency providers. DESIGN:A cross-sectional, anonymous, and voluntary survey of veterinary providers. PARTICIPANTS:Two hundred forty-seven survey responses were received across three specialty veterinary college email listservs, including the American College of Veterinary Surgeons, the American College of Veterinary Internal Medicine, and the American College of Veterinary Emergency and Critical Care. MEASUREMENTS AND MAIN RESULTS:Descriptive statistics were used to determine respondents' awareness and use of communication tools, as well as perceptions of team communication openness. Most respondents (n = 201 [85.9%]) were unaware of Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS). Less than one-third (n = 72 [30.8%]) reported that they or one of their colleagues had undergone formal training to enhance teamwork and communication in the hospital. Despite not being aware of specific TeamSTEPPS communication tools when referred to by name, many reported the use of communication tools when descriptions were provided. The call out, Situation-Background-Assessment-Response (or similar method), and handoff were the most commonly used communication tools. The debrief and huddle were the least frequently used at a regular interval. The check back and brief were variable in their frequency of use. Multivariable ordinal logistic regression analysis of communication tool utilization and communication openness found that frequent use of structured communication tools was associated with respondents reporting greater team communication openness. CONCLUSIONS:Awareness of specific TeamSTEPPS communication tools was low among specialty and emergency veterinarian respondents; however, many respondents reported consistent use of analogous structured communication techniques. Frequent use of structured communication tools was associated with communication openness.
Background Rhodococcus equi-specific hyperimmune plasma (Re-HIP) is routinely administered to neonatal foals to help prevent rhodococcal pneumonia. In addition to pathogen-specific immunoglobulins, frozen plasma products (FPPs) contain electrolytes that may exceed concentrations found in neonatal foal plasma. Because FPPs are also used to treat failure of passive transfer and sepsis, understanding their effects on neonate homeostasis is crucial. This study evaluated the effects of administration of Re-HIP on the serum concentrations of Na+, Cl-, K+, albumin, and globulin of healthy neonatal foals.Key Findings The concentration of Na+ was high in Re-HIP when compared with normal plasma values. Administration of Re-HIP resulted in an increase in serum Na+, Cl-, albumin, and globulin concentrations in neonatal foals.Significance The serum electrolyte changes seen after Re-HIP administration were likely of no clinical significance in healthy foals. However, the administration of hypernatremic plasma to septic or dehydrated foals could exacerbate electrolyte imbalances. These results suggest that caution and close monitoring are warranted when administering FPPs to critically ill foals.
OBJECTIVE:To evaluate the effectiveness of teaching novice learners the competency of small-bore wire-guided thoracostomy tube (SBWGTT) placement using point-of-care ultrasound (POCUS)-guided and blind, landmark-guided techniques and assess the complications associated with each technique. DESIGN:Crossover randomized study. SETTING:Clinical skills teaching of second-, third-, and fourth-year veterinary students. ANIMALS:Sixteen canine cadavers of various breeds, ages, and sexes. INTERVENTIONS:Thirty second, third and fourth-year DVM students were enrolled. Online and in-person training was completed before collection of cadaver data. Each student was randomized into two of four cadaver groups: POCUS-guided (U) and landmark-guided (L) protocols for either pleural effusion (PE) or pneumothorax (PN). Students placed SBWGTTs into canine cadavers with iatrogenic pleural space pathology (10 mL/kg of air and 10 mL/kg of fluid infused into each hemithorax); results were recorded. MEASUREMENTS AND MAIN RESULTS:Placement time, confidence in SBWGTT placement and ease of placement (using weighted scales), and complications (determined by necropsy) were recorded. Data were parametric. One SBWGTT was missing at necropsy. LPE SBWGTT placement (mean ± SD: 5.2 ± 1.1 min) was faster than UPE (7.9 ± 2.8 min, p = 0.0083) and UPN placement (9.0 ± 2.7 min, p = 0.0001). LPN placement (4.6 ± 1.6 min) was faster than UPN (p < 0.0001) and UPE placement (p = 0.0009). Eleven SBWGTTs were placed extrapleurally with no difference among groups. Four UPE SBWGTTs had intrathoracic complications, which were not different between groups (p > 0.05). Novices felt more confident that SBWGTTs were within the pleural space when using POCUS: UPN (mean ± SD: 7.2 ± 2.4) versus LPN (4.4 ± 2.6, p = 0.0232); LPE (4.6 ± 2.68) versus UPE (7.1 ± 2.9, p = 0.0326). CONCLUSIONS:POCUS-guided SBWGTT placement performed by novices was slower with similar complication rates and higher confidence scores.
