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Veterinary Hyperbaric Medicine Society

We would like to invite you to attend two seminars on the new, cutting edge therapy of veterinary hyperbaric medicine.

These seminars will occur on Thursday, September 18, 2008 during the International Veterinary Emergency and Critical Symposium, Phoenix AZ.

Hyperbaric Oxygen Therapy in the Emergent and Critical Small Animal Patient
Dr. Ronald Lyman DVM, Diplomat ACVIM
The Animal and Emergency and Referral Center
Ft. Pierce, Florida

Putting Pressure on Disease: An Overview of Large Animal Hyperbaric Therapy
Dr. Dennis R. Geiser DVM, Diplomat ABVP – Equine
Professor, Large Animal Clinical Sciences
College of Veterinary Medicine
University of Tennessee

Registration is open for the 2008 IVECC Symposium

We are excited to announce a new partnership between Veterinary Learning Systems and the Veterinary Emergency and Critical Care Society that will be of great benefit to our membership. Since 1999, Veterinary Learning Systems has published a monthly publication called Standards of Care in Emergency Medicine/Critical Care. Each issue provides two articles on current topics in EM/CC. The information is up to date, practical, and presented in an easy to use bulleted format. Beginning in 2008, the articles will be written exclusively by VECCS members and ACVECC Diplomates, and peer-reviewed by ACVECC members.

We are extremely pleased to announce the following special on-line and hard copy Standards of Care subscription rates exclusively for VECCS members:

• Online rate for VECCS subscribers (US and international, including Canada and Mexico): $29.00 (Non-VECCS subscribers: $60)

• Print and online rate for VECCS subscribers (US only): $49.00 (Non-VECCS subscribers: $90)

• Print and online subscription rate for international VECCS subscribers, including Canada and Mexico: $60.00 (Non-VECCS subscribers: $100)

This subscription fee not only includes current issues for 2008, but also allows the subscriber to access all past issues of Standards of Care since its inception in 1999. This online library will provide easy access to a wealth of practical and reliable information to our membership. As an added bonus, subscribers will also be able to access other publications on the vetlearn.com website, including Compendium, Veterinary Forum, Compendium Equine, Veterinary Therapeutics, and Veterinary Technician. You will receive more instructions but be assured there will soon be a link from our web site for to you subscribe.

Dr. Dougie Macintire, VECCS Past-President, will act as the Editor-in-Chief of the Standards of Care publication, and will serve as a liaison between the VECCS and VLS while facilitating topic selection, article solicitation, and peer review of submitted papers.

We are very excited to be able to offer this special subscription opportunity to our membership. We look forward to a rewarding partnership with Veterinary Learning Systems as they help VECCS fulfill our goal of “continuing to raise the level of patient care in seriously ill or injured animals” through quality education and communication programs. Check out the Veterinary Learning Systems website at www.vetlearn.com to see a sample of their publications, and then sign up for this great subscription offer! You will find that it is easy to search for topic areas, and you will have a wealth of information at your fingertips.

We are excited to announce that the International Sepsis Registry is now a live website! This web database enables you to enter information about your septic small animal patients on a case-by-case basis as well as any serial data or follow up. The data collected will help define sepsis in small animals and will be available for research purposes by application to the registry overseers through Dr. Cindy Otto cmotto@vet.upenn.edu.

Please feel free to begin entering data at any time using these instructions:

1. Enter this URL, http://www.vetsepsis.org/vision/, in your browser. If you have not seen or used the registry yet, please select “click here to register.” Otherwise enter your username and password.

2. Accept the Terms of Use to access the database.

3. The next page will offer you a list of studies for which you can register.

4. If you have not used the database in any capacity yet, you may find it helpful to run through the Demo Sepsis Registry first. Your data will NOT be captured from this site, it is for training purposes only. If you want to do the demonstration and register to enter real case data, select BOTH the Sepsis Registry and the Demo Sepsis Registry checkboxes.

5. Complete the Account Information form on the lower half of the page and select Submit.

6. When this form is submitted, it will be checked for omissions. If the information is complete, you will be sent to the logon page. Once logged on, if you have registered for more than one Registry, you will have a drop-down menu of choices at the top right. Otherwise you will default to the only registry you selected.

7. You may now begin the demonstration or enter your case data.

If you have any questions or feedback regarding the registry, please do not hesitate to contact us via cmotto@vet.upenn.edu

We would like to thank our sponsors, The Barry & Savannah French-Poodle Memorial Fund, ACVECC, Pfizer Animal Health, and the University of Pennsylvania, School of Veterinary Medicine for their support of this endeavor.

On Thursday, September 27, 2007 a round table discussion convened at IVECCS in hopes of creating an awareness of the issues surrounding the dilemmas presented to the criticalists and emergency clinicians in every day practice. Moderating was Dr. Ira Zaslow; and panel members included Drs. Jennifer Devey, Karol Mathews, Dennis Burkett, Pam Wilkins, and critical care nurses Leslie Carter and Andrea Battaglia. An audience of approximately 15 doctors and technicians were also in attendance.

The two hour discussion focused on the theme question of "Is Critical Care Medicine Viable?” After a brief discussion of the history of critical care and emergency medicine in the veterinary profession, opening remarks included identifying the goals of critical care medicine, identifying who should be admitted to the ICU and defining considerations from which to focus the discussion. The list included:

First:
The Goals of Critical Care Medicine

- To provide specialized medical and nursing services
- To provide both routine and specialized therapy, care and treatment
- To continuously evaluate the physiological state of the patient by both routine monitoring and specialized techniques, and
- To provide resuscitative procedures

Secondly:
Who should be admitted to the ICU?

- Those patients with hematological disorders
- Those with renal insufficiency
- Those patents seizuring
- Those patients with metabolic and electrolyte imbalances
- Those patients subjected to poisonings
- Those patients with severe injuries and multiple fractures
- Those patients in respiratory insufficiency or distress
- Those patients with severe GI disturbances
- Those patients with cardiac dysfunctions
- Those patients with certain neurological disorders
- Those patients with insurmountable pain, and

Thirdly:
The Defining Considerations from Which to Focus the Discussions

- Cost
- Qualifying those patients for admittance
- Morbidity/mortality
- Euthanasia
- CPR vs DNR

The overall consensus was that the pursuit of excellence is the driving force behind emergency and critical care medicine and that this is a continually evolving process. Communication is the key and is essential to the process. The following summarizes the major issues and concerns that were identified in the discussion that followed:

- Defining the concept of informed consent under stress
- The need for an ethicist or an advocate presence in daily rounds
- A need to look at the cost-effectiveness ratio in treating low risk to high risk patients
- the need for developing a severity scoring system using evidence based medicine for admitting patients into the ICU
- Defining the use of prognostic indicators in evaluating and classifying patients
- Defining heroic measures in treating some patients
- Understanding the cost of treatment and quality of life in treating some patients
- When considering euthanasia, defining futile care, pain and suffering and the client's position in treating their pet.
- Defining the events of CPR vs DNR and the ethics of urgency vs the of ethics of common sense
- Defining what's humane and less intrusive
- Defining the need and role of a liaison person, an advocate or a triage nurse to improve doctor client relationships from the time of admittance to the time of finalization of the event.
- The need to create and utilize more support services (bereavement, hospice care/home assistant pet care support groups) for the client(s) and their pet(s) along with possible alternatives in palliative treatments.

I. M. Zaslow, DVM, Diplomate, ACVECC
Jennifer Devey, DVM, Diplomate, ACVECC

The Veterinary Emergency and Critical Care Foundation (VECCF) conducted an animal shelter support project in conjunction with IVECCS held this year in New Orleans. The symposium was September 26-30, 2007 and the support project was scheduled for September 25-26 immediately prior to IVECCS.

The St. Bernard Parish Animal Shelter in Chalmette, LA (east side of New Orleans) was identified as being most in need as very little had been done to repair or improve the facility since Hurricane Katrina two years ago. Dr Gary Stamp, VECCF Administrator, toured the shelter in May and again in August and met with shelter officials to validate the extreme need and willingness to accept volunteer support. At this time, it was learned that the LSU Veterinary School also was initiating a Shelter Outreach program for the New Orleans area and was going to focus first on the St Bernard Parish facility.

The VECCF and LSU group, led by Dr Susan Eddlestone (DACVIM, Assistant Professor) decided to collaborate efforts on the facility. It was determined that the initial project would be to establish a surgery room at the shelter so that veterinary students from LSU Veterinary School could perform spays and neuters at the facility. This would give the students valuable training experience plus make the animals more adoptable. The shelter in its present condition was overflowing with animals but had no capacity to test for any diseases or have a spay/neuter program. Thus, an adoption program was non-existent. The VECCF put out a call for volunteers July 21st targeting veterinarians and technicians planning to attend IVECCS. Over 50 individuals responded.

Dr. William Smith, President of the Veterinary Emergency & Critical Care Foundation, was placed in charge of the project and did a preliminary site visit in early September to estimate the work needed and equipment required to accomplish the mission. On Tuesday, September 25th, Drs Smith and Eddlestone, along with 18 volunteers who had registered to attend IVECCS, performed a thorough cleaning of the facility; they scraped, sanded, painted, and installed new ceilings. On Wednesday, September 26th, thirty IVECCS volunteers assisted with painting, cleaning, and socializing dogs and cats. Thursday through Saturday, Dr. Smith and several volunteers continued work by installing doors, cabinets, and wet tables. The plumbing and electrical connections were made and the major portion of the project was completed at midnight on Saturday night. Final cleanup was conducted on Sunday afternoon, September 30th, and a functional surgery room with an additional treatment/exam room were ready.

When the volunteers arrived on Tuesday the 24th, they found deplorable conditions in a facility that been devastated by Katrina two years earlier. There had been minimal repairs made on the shelter and only in late summer had permanent power and hot water been restored. As Dr Cindy Otto commented, “I was devastated by the state of affairs as I passed through the 9th Ward and St. Bernard Parrish. Arriving at the Animal Shelter, it was clear that it too had suffered, but unlike the overwhelming sense of gloom elsewhere, here was hope and promise. The energy of the staff and the volunteers made all things seem possible. The commitment from LSU to continue to collaborate with the shelter to provide care for the animals, while a teaching opportunity for the students instilled a confidence in me that the work we were doing was going to have a lasting effect. In the brief time that we spent there, the transformation of the physical space was amazing, but it was hope and promise that painted the walls not just bright colors.”

In a few days the volunteer veterinarians, technicians and students who came from all over the U.S. worked with the shelter staff to transform the facility. They created surgery and exam rooms out of overrun animal holding rooms that had no ceilings. Most of all, however, the volunteers brought hope and encouragement.

The below account of the situation by Rene Scalf, RVT, VECCF Secretary and volunteer says it well.
“My post Katrina animal relief experiences really were a driving factor for my involvement with the Veterinary Emergency and Critical Care Foundation. This is the true meaning of life. It is all about making the effort to make a positive difference in other people’s lives. This shelter still has a tough road ahead as it still takes money and people to keep it running, but at least there is a clean working space now to allow for spay/neuter and simple procedures for the animals. Hopefully, ongoing donations can help ease the strain and pain of the extreme loss that the shelter faced two years ago.”

Industry representatives were contacted in late July to donate supplies and equipment as part of the support project and over 20 companies responded very generously. Equipment and supply items were also donated on site by exhibitors at the Veterinary Emergency and Critical Care Symposium. This included surgery instruments, stainless steel wet tables, surgery lights, ophthalmoscope/otoscope combinations, stethoscopes and a gas anesthesia machine. Other equipment items were sold to the VECCF at significant discounts. Supplies such as vaccines, flea & tick products, antibiotics, diagnostic tests, needles, syringes, bandaging materials, etc were donated and shipped by several industry partners.

The VECCF was officially founded in August 2003 as a sister organization to the VECCS. It became active during the hurricane season of 2005. The organizational objectives and missions of the VECCF are to: a) Provide support to disaster response operations; b) Fund emergency and critical care related research; c) Fund post-graduate training and continuing education programs. The Foundation is an IRS category 501(c)(3) charitable organization and is actively seeking donations to meet the above mentioned missions. Contact the website linked through: www.veccf.org or call 210-698-5575 for more information.

Veterinary Emergency and Critical Care Society (VECCS)
VECCS board of directors met and addressed:
• Formalizing vision and mission statements
• Accreditation of emergency practices in conjunction with ACVECC
• Spring Break meeting at the St. Kitts Marriott Resort, April 2-7, 2008
• IVECCS ‘08 will be at the JW Marriott Desert Ridge, Phoenix, AZ, Sept. 17- 21
• The Society currently has 3600 members which is approximately 250 more than in 2006.
The General Membership meeting was held Saturday evening, September 29, to review the yearly activities and financial status of the society.
Officials: Dr. Susan M. Barnes, Leesburg VA., president; Harold Davis Jr., Sacramento CA, president-elect; Dr. Robert Messenger, Charlotte NC, treasurer; Dr. Dennis E. Burkett, Newtown PA., immediate past president; Sally Powell, West Chester PA., recorder; and Dr. Gary L. Stamp, San Antonio TX, executive director

American College of Veterinary Emergency and Critical Care (ACVECC)
The ACVECC certification exam was given to 56 candidates over three days, September 23-25. The Board of Regents, Residency Training Committee and the Exam Committee held meetings and an Information Session to discuss the new training guidelines was conducted Wednesday evening. The annual business meeting of College and a reception was held Saturday, Sept. 29, and new officers were installed. Receptions included an exam candidates reception Tuesday evening and a Diplomate Dinner Friday evening at the Royal Sonesta Hotel.
2007-009 Officials: Drs Jan Kovacic, Lafayette CA, president; Dennis Burkett, Newtown PA president-elect; Elizabeth Rozanski, North Grafton MA, vice president; Scott Shaw, North Grafton MA, treasurer; and Tony Mann, Columbia MO, immediate past president. Regents – Drs Elisa Mazzaferro, Denver CO; Minneapolis MN; Marc Raffe, Minneapolis MN; Jim Wohl, Auburn AL; Pam Wilkins, New Bolton PA. Executive Secretary - Armelle de Laforcade

Academy of Veterinary Emergency and Critical Care Technicians (AVECCT)
The certification examination was conducted with 38 technicians sitting for the exam. This year AVECCT hosted a reception for all VTS members and exam candidates on Tuesday, September 25. The academy also held a pinning ceremony and reception for the AVECCT class of 2006.

Academy of Veterinary Technician Anesthetists (AVTA)
The AVTA VTS certification examination was conducted for 21 candidates and a special lecture track was presented as part of the technician program.
Officers: Larry Nann, president; Sharon Johnston, president elect; Deb Coleman, immediate past president; Sharon Kaiser-Klingler, treasurer.

Ira M Zaslow Distinguished Service Award
VECCS highest award was presented to Dr Kenneth Drobatz, University of Pennsylvania, for his many contributions to the society and the specialty through his teaching, training, mentorship and the several leadership positions he held.

Hill’s Dr Jack Mara ACVECC Achievement Award
This award is given annually by ACVECC to a veterinarian(s) in recognition of his/her exceptional contribution in a particular specialty area. The 2007 award for outstanding achievement in the area of Infectious Disease in the Critically Ill was presented to Dr. Douglas Macintire, Auburn, University. (Award sponsored by Hill’s).

Resident Small Animal Abstract Award
Sponsored jointly by VECCS/ACVECC and Boehringer Ingelheim, was presented to Dr Michael Ethier from the Ontario Veterinary College. His paper was “Evaluation of the safety and efficacy of two sedative/analgesic protocols for assisted ventilation in healthy dogs”. His abstract was part of the ACVECC Residents Forum on September 27th and a $500 stipend from Boehringer Ingelheim accompanied the award.

Large Animal Resident Abstract Award
Awarded to Dr Anna Hollis from the New Bolton Center in Pennsylvania. Dr Hollis’ abstract was entitled “Comparison of point-of-care, blood gas and laboratory methods of glucose measurement in equine emergency patients”. Mila International provided a $500 cash stipend as part of the award.

ACVA Abstract Award
Presented to three individuals: (1st place) Dr Chaira Valtolina for "Dexmedetomidine constant rate infusion for post-operative pain management in dogs"; (2nd place) Dr Jusmeen Dhanjal for "Effects of Tramadol in horses"; and (3rd place) Dr Andrew Claude for "A comparison using an electrocardiograph technique with a blind technique for central venous catheter placement in the dog". These awards were sponsored by Smiths Medical/Surgivet.

Best Case Report Award
Dr Jamie Peyton, Davis, California, was selected as the winner of the case report presentation. Title of her case report was “Another Cup of Coffee?” Dr Peyton received a stipend of $300 from Boehringer Ingelheim for the winning case report.

Best Technician Case Report Award
Ms DeeDee Schumacher, Des Moines, Iowa, was recognized by an AVECCT Panel for presenting the most outstanding technician case report. Her case was entitled “The Unusual Tube Gastropexy Complication”. Pfizer provided a stipend of $300 from for the winning case report.

2007 ACVECC Research Grant
The 2007 grant was awarded to three outstanding individuals: (1) Dr Elizabeth Armitae-Chan, Royal Veterinary College, UK, for “Investigation of the role of regulatory T cells in the immunoparalysis evoked by naturally occurring sepsis in dogs; (2) Dr. Gary Magdesian, University California, Davis for “Fluid volume distribution in the neonatal foal: Evaluation of an isotonic fluid challenge using bioelectrical impedance analysis and indicator dilution”; and (3) Sophie Adamantos, Royal Veterinary College, UK for “Prevalence and risk factors associated with colonization with multi drug resistant E.coli on admission to a veterinary Intensive Care Unit”.

The 13th International Veterinary Emergency and Critical Care Symposium as held Sept. 26-30, 2007, New Orleans and drew a record attendance of nearly 3150 total registrants.
IVECCS again was held jointly by the Veterinary Emergency & Critical Care Society (VECCS), American College of Veterinary Emergency and Critical Care (ACVECC), and the Academy of Veterinary Emergency and Critical Care Technicians (AVECCT). This record attendance reflected 200 more veterinarians and technicians than in 2006.

Registration Data
Veterinarians: 1514 (residents & interns 178)
Technicians: 845
Students: 85
Exhibitor personnel: 393 (131 exhibits)
Job Fair Exhibitors: 38
Guests & Press: 270

Total: 3145

(Includes 194 International registrants from 27 countries)

The focus of IVECCS ‘07 was “critical pharmacology.” More than 450 hours of continuing education were offered. The symposium combined lectures, laboratories and small group seminars; additionally there were five 7:00 am “Daybreak” sessions and a poster session. Over 45 of the sessions were Limited Enrollment Session wet labs, dry labs and workshops. IVECCS ‘07 was the venue for the annual meetings of the VECCS, ACVECC and AVECCT as well as the Academy of Veterinary Technician Anesthetists (AVTA) and the American Association of Veterinary Blood Banks. This year for the first time, the American College of Veterinary Anesthesiologists met at IVECCS and conducted two full tracks of Abstracts on Thursday, September 27, along with their business meeting and the certification exam.

Other Program Highlights
• Drs Dawn Boothe and Mark Papich combined to deliver the Robert P. Knowles memorial keynote lecture on the role of Clinical Pharmacology in emergency and critical care.
• Dr Ben deBoiseblanc (MD) gave a special presentation on “Post Katrina Humanism,” an emotional presentation which described how he and his staff responded and managed the ICU patients of New Orleans’ largest hospital without power for days following the hurricane.
• 49 Limited Enrollment Sessions (Labs, workshops, etc) were presented and 80% were sold out.
• A full day of Technician Multidisciplinary Review was presented this year
• Camelid lectures were included on the large animal program
• A “Management 101” workshop was offered for new practice managers
• New information on head trauma
• Disaster medicine program included presentations by veterinarians, technicians and shelter workers involved in Hurricane Katrina.
• Exotics animal handling lab was held at Audubon Zoo
• Numerous lectures and LES’s focused on clinical pharmacology issues including drug interactions, advanced drug regimens for heart failure, GI emergencies, and appropriate and inappropriate antibiotic use.
• A special lunchtime roundtable discussion was held Thursday to explore “Ethical Issues in Critical Care.” Watch for more on this topic in future JVECC publications and at IVECCS ‘08.

First Annual Job Fair
Thirty-two practices participated in IVECCS’ first annual Job Fair on Wednesday, September 26. Overflow crowds visited the practices which were from all across the US and one from the UK. The net proceeds from the Job Fair were donated to the VECCF Shelter Support program.