What do we really know about bolus fluid therapy? Is it possible to define a fluid bolus we can all agree on? What about agreeing to what constitutes a patient’s response to a fluid bolus? What clinical markers are available to help us determine if a patient is in fluid overload and what fluid strategy techniques are currently recommended to help balance the need to improve perfusion vs. the risk of fluid overload?
Predicting IV volume status (hypo- and hyper-volemia), and which patients receiving fluids are volume responders and fluid tolerant vs. intolerant is extremely challenging. We all rely on physical exam findings to estimate a patient’s volume status, but how accurate are clinical findings at predicting IV volume and fluid responsiveness? How well do static measures of fluid volume and response hold up? What about less invasive dynamic measures of volume and fluid response? These two lectures (Part 1 and Part 2) will overlap and build on each other. Together they will discuss some of the physiology behind the administration of an IV fluid bolus and the techniques (static vs. dynamic) used to predict volume status and fluid responsiveness.
In veterinary patients requiring rapid fluid resuscitation, airway management, or medication administration, the placement of one or more IV devices is essential. In the vast majority of patients, simple landmark-based blind placement of peripheral IV catheters is sufficient. However, most of us have encountered situations where this may be difficult or impossible to achieve, due to thrombosis, edema, obesity and limited viable peripheral veins in the cardiovascularly stable hospitalized ICU patient, or due to marked peripheral vasoconstriction and vascular collapse in the unstable or arrested patient. Being familiar with ultrasound guided vascular access, automated intraosseous catheter placement and venous cutdown techniques is invaluable in these patients.
This lecture covers in detail the advantages and disadvantages of autologous blood transfusions (ABT), including videos that demonstrate step-by-step instructions on how to perform ABTs, as well as indications and complications associated with ABT. Relevant literature on the topic will also be reviewed.
Veterinarians commonly struggle with strategies to “stay sane” and maintain work-life balance. This session will provide the tools necessary to foster wellness and resilience by preserving time for self-care and non-veterinary-related activities. Practical strategies for setting boundaries, saying no, and work-life separation will be discussed, and examples shared.
Transfusion medicine has evolved over many years, and current practice focuses on collection, storage and administration of component parts of whole blood, specifically, red blood cells, plasma and platelets. These components are administered individually as indicated to minimize unnecessary complications in our most critically ill patients. However, new evidence supports the use of whole blood therapy for patients suffering hemorrhage from trauma or surgery.
Transfusion medicine is a fast-growing field with new studies being published monthly pertaining to clinical practice. This session will review studies pertinent to small animal transfusion medicine published during the last year. Recommendations for changes to clinical practice will be made based on the study findings and literature consensus.
Treatment and monitoring of patients with glucose disorders is advancing rapidly. Many improvements have originated primarily due to shared diseases with humans (diabetes mellitus), and the veterinary industry has a great opportunity to take advantage of these for our own patients. Compared to traditional in-hospital glucose curves, continuous glucose monitors (CGMs) provide substantially more information and have nearly eliminated concerns about multiple blood draws, patient discomfort and inaccuracies due to patient stress. CGMs have become miniaturized, are easy to use, intuitive, and compatible with common technology.
Communication breakdown in the ER can lead to client dissatisfaction and psychological distress among team members. This session will review helpful strategies for conversations with clients regarding money, euthanasia, and delivery of bad news, as well as how to effectively approach angry clients and handle emotional situations.
Burnout is highest among human emergency care providers but has not previously been studied among veterinary emergency care teams. This session will review the results of a large web-based survey intended to compare burnout scores among veterinary emergency care givers and investigate demographic or work-related factors that may be associated.
Burnout is a growing concern among veterinary emergency care providers and may be contributing to shortages of veterinarians and technicians in the ER and ICU setting. This session will explain the factors that contribute to burnout, as well as the signs of burnout among care providers, so that steps can be taken to mitigate this concerning syndrome.
Shift work and on-call are realities of 24-hour veterinary practice but can have detrimental effects on physical and mental well-being. This session will provide evidence-based information regarding the impact of shift work and on-call on health and wellness. Discussion of ways to decrease sleep deprivation and maintain longevity as a shift worker will be included.
Since the first landmark small animal veterinary point of care ultrasound (VPOCUS) study published out of Tufts in 2004, the applications for VPOCUS in small animal emergency and critical care have grown rapidly. Although the first clinical small animal veterinary study was limited to detecting trauma-induced abdominal fluid, the role of abdominal VPOCUS has expanded well beyond trauma. The application of abdominal VPOCUS beyond the simple detection of free abdominal fluid will be presented.
Despite the wide acceptance of veterinary point of care ultrasound to assess the pleural space and lung, recent evidence suggests the detection of pleural space disease is not easily mastered and the correlation of detecting pleural space pathology (effusion and pneumothorax) is poor to moderate at best. Modifying currently existing protocols to try and answer clinically relevant and focused (often binary) questions and looking for new ways to identify pathology may improve emergency room detection of pleural effusion and pneumothorax.
Have you ever struggled to place an IV catheter in patients that are dehydrated, have hematomas, thick skin or edema? Ultrasound can help! Vascular access techniques are commonly used in human medicine when blind percutaneous catheter attempts fail, and evidence suggests they can be used in small animals. With the use of phantom models (which we will build in the lab so you can train others), in and out of plane ultrasound guided catheter placement, including the Seldinger techniques, will be practiced.
Mindfulness, or maintaining awareness in the present moment, has dramatic benefits for physical and mental wellbeing. Find out why celebrities like Katy Perry and 50 Cent, professional sports teams, and millions of other people are adopting daily meditation and mindfulness practices. This session will include the scientific evidence behind mindfulness and meditation and give practical ways to start a personal practice.
Conflict among team members is a huge work-related stressor experienced by veterinarians. This session will clarify the different types of conflict experienced and offer practical strategies for conflict resolution with examples of effective verbal and non-verbal skills.
Advancements in viscoelastic technology and its availability and affordability for the veterinary field have improved dramatically in the last 2 years. A new system allows viscoelastic assessment of coagulation in veterinary patients in a way that was never possible, minimizing many of the common downfalls of traditional thromboelastography. A new benchtop analyzer is simple to use, compact and affordable and can provide valuable insight not only about patients that are hypocoagulable due to primary or secondary hemostatic disorders, but also due to hyperfibrinolysis. It can also provide awareness of a patient’s risk for thrombosis and may be useful for therapeutic monitoring.
Our understanding of clinical coagulation in veterinary medicine has improved dramatically. It is essential for the clinician to look beyond hypocoagulation as the cause of bleeding disorders and be able to differentiate among lookalikes. Hyperfibrinolysis is one such condition that is likely underdiagnosed and therefore mismanaged. This lecture will introduce hyperfibrinolysis to the VECCSpert and provide information about convenient and affordable bedside testing as well as appropriate approaches to treatment.
This session applies those topics to clinical cases with the experts putting them to practice. This open forum session allows spontaneous discussion between panel members and audience for the purpose of debate and creating a consensus.