By: Julien Guillaumin, Docteur Vétérinaire, Diplomate ACVECC, Diplomate ECVECC

Description:
There is limited literature in septic shock in dogs and cats, although plenty of evidence-based practices from human medicine. With a mortality rate around 15-20% in dogs, it is very important that septic shock is quickly suspected, appropriately diagnosed and treated. Both the veterinary definitions and the human Sepsis 3 definitions aligned for septic shock, which avoids confusion of having 2 sets of definitions for SIRS, sepsis and MODS. Treatment of septic shock includes rapid source identification and control, and a bundle of treatments. This bundle includes early and judicious fluid therapy, rapid administration of broad spectrum antibiotics, sometimes with higher doses or prolonged infusion, and finally rapid administration of vasopressors. Specific triggers and timing of decision-making processes regarding use of those therapies, especially antibiotics and pressors, are important. Finally, ancillary treatment such as monitoring, nutrition and specific organ dysfunction treatments are important to understand the management of this complex syndrome.

Course Objectives:

1. Understand the timing of antibiotic and vasopressor administration in septic shock
2. Recall the veterinary and human sepsis 3 definitions of septic shock
3. Apply a specific bundle of treatment to the management of septic shock in dogs and cats

Speaker Info:
Dr Guillaumin is currently an Associate Professor in Emergency and Critical Care at Colorado State University. After graduating from the Ecole Nationale Veterinaire de Nantes, France, Dr Guillaumin pursued a small animal rotating internship at the Ecole Nationale Veterinaire d’Alfort, France. After graduation, he worked in both private practice emergency settings and academia, serving as a clinical instructor in Emergency and Critical Care at the Ecole Nationale Veterinaire de Lyon (now VetAgroSup). Dr Guillaumin continued his advanced training in Emergency and Critical Care by moving to the US in 2005, working as a clinical instructor at Cornell University and then completed his ACVECC residency at the University of California, Davis in 2009.

For 10 years, Dr Guillaumin was a clinician, teacher and researcher as a clinical track Assistant, then Associate Professor at the Ohio State University. He also acted as the Blood Bank Director. In 2015, Dr Guillaumin was recognized as an invited diplomate of the European College of Veterinary Emergency and Critical Care. In 2019, Dr Guillaumin took a tenure-track position at Colorado State University. His clinical and research interests include thrombosis and thrombolysis, hemostasis, blood banking, transfusion medicine, sepsis and septic shock.

Dr Guillaumin is a former Chair of the ACVECC residency training committee and currently serves as a Chair of the Joint Committee which oversees the work of the 3 major ACVECC Committees as well as a member of the ECVECC Education Committee. Dr Guillaumin has trained over 150 interns and ECC residents and has over 200 invited lectures and scholarly publications.

By: Dr Sheilah A Robertson BVMS (Hons), PhD, DACVAA, DECVAA, DACAW, DECAWBM (WSEL), CVA, MRCVS

Description:
In this session tips on how to start the difficult conversation about euthanasia will be discussed; this includes verbal priming, supporting the owner / family, understanding the difference between empathy and sympathy, focusing on the pet’s needs and being non-judgmental. Owners have four main budgets when making euthanasia decisions (financial, emotional, physical and time) and all must be considered. Setting the scene for success includes small but powerful ‘little things’ such as never separating the patient from the owner once the decision has been made, quickly creating a less clinical setting (blankets, cushions, dimming lights). How and when to ask for payment will be discussed.

Course Objectives:

1. Attendees will feel confident initiating difficult conversations about euthanasia by learning key words and phrases that are patient centric.
2. Attendees will understand why pre-euthanasia sedation is important for the whole veterinary team, patient and owner.
3. If intravenous access is not possible attendees will be confident with using alternate routes for administration of euthanasia solutions.
4. Attendees will perform their next euthanasia with confidence, calmness and a feeling of control form start to finish.

Speaker Info:
Dr. Sheilah Robertson graduated from the University of Glasgow in Scotland. Following time in private practice and a surgery internship she undertook specialized training in anesthesia and completed her PhD at the University of Bristol. She is board certified in anesthesia and in animal welfare by the respective American and European Colleges and holds a certificate in small animal acupuncture. In 2019 she received her certification as a Traditional Chinese Veterinary Medicine Palliative and End-of-Life practitioner by the Chi Institute of Chinese Medicine. She has published widely on the recognition and alleviation of acute pain. Currently she is the senior medical director of Lap of Love Veterinary Hospice, a large network of veterinarians dedicated to end-of-life care and in-home euthanasia throughout the USA. Dr Robertson is also a courtesy Professor in the Department of Small Animal Clinical Sciences, University of Florida, Gainesville, Florida.

By: Dr Sheilah A Robertson BVMS (Hons), PhD, DACVAA, DECVAA, DACAW, DECAWBM (WSEL), CVA, MRCVS

Description:
In this session the value of pre-euthanasia sedation or anesthesia and which drugs to choose will be discussed. Tips for intravenous access (have you tried dorsal pedal vein?) will be covered along with what to do if IV access is not possible. Non-intravenous techniques for dogs and cats will be covered. If things do not go as planned, we will discuss how to explain this to owners and how to deal with unexpected adverse effects. What we do after the euthanasia has an impact on the owner. This includes a discussion on body care, providing mementos, giving them time alone, and follow up within a few days.

Course Objectives:

1. Attendees will feel confident initiating difficult conversations about euthanasia by learning key words and phrases that are patient centric.
2. Attendees will understand why pre-euthanasia sedation is important for the whole veterinary team, patient and owner.
3. If intravenous access is not possible attendees will be confident with using alternate routes for administration of euthanasia solutions.
4. Attendees will perform their next euthanasia with confidence, calmness and a feeling of control form start to finish.

Speaker Info:
Dr. Sheilah Robertson graduated from the University of Glasgow in Scotland. Following time in private practice and a surgery internship she undertook specialized training in anesthesia and completed her PhD at the University of Bristol. She is board certified in anesthesia and in animal welfare by the respective American and European Colleges and holds a certificate in small animal acupuncture. In 2019 she received her certification as a Traditional Chinese Veterinary Medicine Palliative and End-of-Life practitioner by the Chi Institute of Chinese Medicine. She has published widely on the recognition and alleviation of acute pain. Currently she is the senior medical director of Lap of Love Veterinary Hospice, a large network of veterinarians dedicated to end-of-life care and in-home euthanasia throughout the USA. Dr Robertson is also a courtesy Professor in the Department of Small Animal Clinical Sciences, University of Florida, Gainesville, Florida.

By: Kate Hopper BVSc, PhD, DACVECC

Description:
Envenomation by a poisonous animal can be a challenging emergency case to manage and the severity of potential injury varies between regions. This presentation will review key diagnostic and management aspects of snake and spider envenomation with guidelines for rational clinical decision making.

Course Objectives:

1. Review the main venomous snakes and spiders in North America
2. Understand the common presenting signs of pit viper envenomation
3. Review the key aspects to management of snake envenomation
4. Outline how venomous spider bites could present and the management approach to these cases

Speaker Info:
Kate is a Professor of Small Animal Emergency and Critical Care at the University of California, Davis. She graduated from the University of Melbourne and completed residencies in emergency and critical care at both the University of Melbourne and UC Davis. Kate also completed a PhD in acid base physiology at UC Davis. Her current research interests include cardiopulmonary resuscitation, clinical acid base and electrolyte disorders and mechanical ventilation. Kate is a co-editor of the textbooks Small Animal Critical Care Medicine and Small Animal Emergency Medicine.

By: Sarah Musulin, DVM, DACVECC

Description:
Maximizing safety and efficacy is paramount when transfusing a patient.  This lecture will provide information on when and how to perform precompatibility testing.  A brief discussion of canine and feline blood types and blood typing will be followed by indications for crossmatching.  The remainder of the lecture will incorporate available literature and provide an understanding about crossmatching methods.

Course Objectives:

1. When is blood typing indicated prior to transfusing cats and dogs?
2. When is crossmatching indicated prior to transfusing cats and dogs?
3. What point-of-care crossmatching tests are available and what are some of the limitations?

Speaker Info:
Sarah Musulin, DVM, DACVECC
Clinical Associate Professor, Emergency & Critical Care, NC State
ER Director, Blood Bank Director, NC State

Dr. Sarah Musulin received her veterinary degree from Auburn University (2004).  She completed a small animal rotating internship at University of Florida (2005) and her residency training in Emergency and Critical Care at North Carolina State University (2010).  Dr. Musulin achieved her Diplomate status in 2010.  Dr. Musulin is a Clinical Associate Professor at NC State, the Director of Emergency Services and the Blood Bank Director.  She is a current board member and past president (2016 – 2020) of the Association of Veterinary Hematology and Transfusion Medicine.  Dr. Musulin’s teaching and research interests are in transfusion medicine and blood banking.

By: Marc Seitz, DVM, DACVR, DABVP

Description:
Is surgery indicated?  Few questions cause an emergency clinician’s stomach to tie up in knots!  This session will use radiographs from real cases to discuss interpretation strategies for diagnosing mechanical gastrointestinal obstructions.   Alternative radiographic imaging techniques available to most emergency clinicians will also be discussed.

Course Objectives:

1. By the end of the session, the attendee will be able to diagnose the three main types of mechanical gastrointestinal obstructions with radiography: pyloric outflow obstruction, small intestinal mechanical obstruction, and linear foreign body.
2. The attendee will be able to utilize the following to increase the diagnostic yield of radiography for diagnosing mechanical gastrointestinal obstructions: left lateral projection, objective criteria for small intestinal dilation, negative contrast gastrography using soda, pneumocolonogram, and compression radiography.
3. The attendee will be able to recognize free gas and decreased serosal detail in cases of gastrointestinal rupture and presumed septic peritonitis.

Speaker Info:
Marc Seitz, DVM, DACVR, DABVP

Dr. Seitz is an Assistant Clinical Professor of Diagnostic Imaging at Mississippi State University (MSU).  He earned both his B.S. in biochemistry and his DVM from MSU.  After graduation, he spent eight years in private practice as both a general practitioner and emergency clinician prior to returning to MSU as an emergency faculty member.  In 2014, he earned Diplomate status with the American Board of Veterinary Practitioners (Canine and Feline).  Due to his interest in performing and teaching ultrasound, in 2018 he began working towards a second specialty in diagnostic imaging and is now a full-time board-certified radiologist.  In addition to clinical practice, he thoroughly enjoys teaching, with the ultimate goal of translating sound medical practices and current veterinary literature into useful clinical skills for both general practitioners and emergency clinicians.  His passion for teaching has been recognized through the Zoetis Distinguished Veterinary Teaching Award (2016).

By: Amanda Cavanagh, DVM, DACVECC

Description:
In this 1-hour presentation, learners will first dive into the challenges of accurate volume assessment in dogs and cats presenting with emergent conditions or hospitalized with critically illness. The challenges and limitations of various invasive techniques for volume assessment will be briefly reviewed. Point of care ultrasound is a non-invasive, inexpensive, easily learned tool that can be used to assess volume status and urine output in dogs and cats. Learners will be introduced to ultrasound techniques that indirectly assess volume by imaging the heart and caudal vena cava. Techniques will be applied to clinical scenarios. Learners will also be introduced to bladder measurements as a noninvasive method of assessing urine output to aid in volume assessment.

Course Objectives:

1. Understand the challenges of volume assessment in critically ill patients
2. Describe the technique for imaging the caudal vena cava, left ventricle, and bladder to approximate blood and urine volume
3. Interpret caudal vena cava images and left ventricular end diastolic diameter measurements to determine volume status in a patient
4. Describe changes in imaging and measurements in response to fluid boluses

Speaker Info:
Amanda Cavanagh, DVM, DACVECC
Service Leader, Small Animal Urgent Care
Assistant Professor, Emergency and Critical Care
CSU College of Veterinary Medicine

Amanda Cavanagh, DVM, DACVECC is an Assistant Professor of Small Animal Emergency and Critical Care at Colorado State University and is the section head of the Urgent Care Service. She received her DVM from Auburn University in 2011 and acquired ACVECC board certification after completing a residency at North Carolina State University in 2015. Dr. Cavanagh has specific interests in point of care ultrasound, traumatology, and toxicology.

By: Steven Epstein, DVM, DACVECC

Description:
This lecture will review how intravenous lipid emulsions (ILE) work for treating lipophilic intoxications and provide a framework for decision making for the rationale use of ILE in various toxins.

Course Objectives:

1. Understand the differing mechanisms of how intravenous lipid emulsions act as an antidote
2. Recognize which toxins intravenous lipid emulsions are useful for treatment
3. Understand the limitations of intravenous lipid emulsion therapy
4. Recognize adverse effects of intravenous lipid emulsions

Speaker Info:
Dr. Steven Epstein attended University of California at Davis for his Doctorate of Veterinary Medicine.  He then went on to complete an internship in anesthesiology at Kansas State University and then completed a three-year residency in veterinary emergency and critical care at UC Davis.  Dr. Epstein is now Professor of Clinical Small Animal Emergency and Critical Care. His research interests include CPR, diagnostic testing in the emergency room, and antimicrobial resistance patterns.

By: Tiffany Jagodich, DVM, DVSc. DACVECC

Description:
Course description: High flow nasal oxygen is a novel modality of respiratory support in animals. It has been used widely in neonatal and pediatric children as well as adult humans. It’s use in dogs at this point, has been limited to acute hypoxemic failure but, evidence may lead us to investigate new perspectives for use of this device in other conditions. In this lecture, we will discuss the use of HFNC in people, in hypoxemic failure of companion animals, and further considerations for our brachycephalic patients.

Course Objectives:

1. Understand the mechanisms of action and indications supported by the literature for use of HFNC in respiratory disease.
2. Describe the safety considerations for use of HFNC as related to the patient population and disease process.
3. Discuss when success or failure of HFNC is observed, and consideration when discussing outcomes with veterinary patient owners.

Speaker Info:
Dr. Jagodich completed her veterinary degree at the University of Guelph, Ontario Veterinary College. She subsequently completed a rotating internship at Tufts University and then returned to the University of Guelph for her residency in emergency and critical care; as well as a graduate degree focussing on respiratory physiology and high flow nasal cannula oxygen therapy in dogs. She is currently the  founding criticalist for a private practice in British Columbia, Canada and trauma medical director for her hospital. Her areas of interest include respiratory medicine, mechanical ventilation, trauma and much more.

By: Erin Mays, DVM

Description:
Coagulation dysfunction in trauma has been a topic of debate for the past 20 years. Over the past decade, our understanding of the mechanisms behind trauma induced coagulopathy have improved significantly, though some concepts remain unclear.  Specifically: why do some patients develop coagulopathy and others do not?  This question holds true in veterinary trauma medicine as well- for we have yet to consistently identify such a coagulopathy in veterinary trauma studies, though many case reports exist. In this session, we will explore our understanding (as well as lack of understanding) of the mechanisms of coagulopathy in trauma and will delve into the recommended diagnostic treatment approach for cases in which coagulopathy is suspected or confirmed.  We will explore what is on the horizon to improve our understanding of coagulopathy in trauma and how we can harness what we know about the phenomenon to improve outcomes, even when advanced coagulation diagnostics are not available.

Course Objectives:

1. Understand the clinical and diagnostic features of coagulopathic trauma patients
2. Understand mechanisms driving coagulation dysfunction in trauma
3. Understand the pertinent literature surrounding trauma and coagulopathy in both human and veterinary medicine
4. Understand how to apply our knowledge of coagulopathy to optimally treat trauma patients, even in resource-limited settings

Speaker Info:
Dr. Mays is a Diplomate of the American College of Veterinary Emergency and Critical Care and has special clinical and research interest in trauma resuscitation, transfusion therapy, and disorders of coagulation. Following graduation from University of Illinois in 2008, she was commissioned as an Officer in the U.S. Army Veterinary Corps. Following her active duty service, Dr. Mays pursued her passion for critical care medicine at NC State University where she completed specialty internship and residency in emergency and critical care. She works both in private practice and industry and has ongoing clinical research in the area of trauma hemostasis and development of novel transfusion products and strategies. Dr. Mays continues her military service in the Army Reserves.

By: Lee Palmer, DVM, MS, DACVECC, NRP, EMT-T, WEMT, CCRP, TP-C

Description:
Operational K9s (OpK9s) deployed in a tactical or high threat environment remain at high risk for suffering preventable deaths. Despite their invaluable contribution in safeguarding our society’s freedoms, prehospital trauma care for these OpK9s remains lacking. Factors hindering the availability and provision of such care include lack of: a) Veterinary Emergency Medical Service (VEMS) support b) Nationally accepted “standards of care” for Veterinary Prehospital Care, and c) standardized VEMS training courses and certifications. Veterinary professionals are increasingly requested to teach non-veterinary first responder’s canine field care. Attempts to provide or develop standardized veterinary prehospital courses are hampered by the interpretation of current state laws governing practice of veterinary medicine. As such, not only would such acts be considered out of the scope of practice of an EMSP, but also in violation of the state’s Veterinary Practice Act / Legislative Code which subjects the EMSP to legal reprisal.  The National Association of Veterinary EMS (NAVEMS) is a not-for-profit association with the mission to advocate preveterinary care legislation and to serve providers of veterinary prehospital care with the knowledge, information, and inspiration to enable them to be the best in their profession. NAVEMS is the first multidisciplinary association of veterinary professionals, EMS practitioners and K9 Handlers with a united front of delivering focused educational programs and building strong networks to enable a collaboration between Veterinary and EMS professionals to develop a National Standard for Veterinary Prehospital Care.

Course Objectives:

1. Discuss lessons learned needed for States to pursue the development of Preveterinary Care Legislation to legally allow EMS providers the ability to legally render emergency life-saving care to Operational K9s injured in the Line of Duty.
2. Discuss key points EMS agencies need to consider before providing preveterinary care to an injured OpK9 to include development of: a VEMS training program for their EMS providers, a working relationship with a regional veterinary treatment facility for provision of veterinary oversight, training, and Online Veterinary Medical Control support, and more.
3. Discuss the tenets of developing a training program for various audiences (EMS, K9 handlers). This requires veterinary personnel to have a general understanding of each audience’s scope of practice, training knowledge, available resources, and operations

Speaker Info:
Dr. Palmer is a Diplomat of the American College of Veterinary Emergency and Critical Care and Certified Canine Rehabilitation Practitioner (CCRP) that possesses over 20 years of military, tactical and operational medicine experience. He has served in the military since 1996, currently assigned as the Group Veterinarian for the 20th Special Forces Group, Alabama Army National Guard. Dr. Palmer also serves as the Veterinarian for the 24^th Special Operations Wing and Operational K9 consultant for various federal Law Enforcement agencies. He has and continues to provide training and consultation in the field of K9 Tactical and Prehospital Care nationally and internationally, at various venues and for various military, Law Enforcement, Search and Rescue, and Tactical EMS communities. Dr. Palmer is the lead and founder of the K9 Tactical Emergency Casualty Care (K9 TECC) working group, Medical Education Director for PennVet’s Working Dog Practitioner program, Veterinary Medical Director for National Association of Veterinary EMS (NAVEMS), and active working group member for the Defense Committee on Trauma’s (DCoT) Canine Combat Casualty Care Committee. Additionally, he serves as a Reserve Deputy Sheriff and certified Tactical Paramedic for the Lee County Sheriff’s Office.

By: Scott P Shaw, DVM, DACVECC

Description:
Patient Safety Science is well established in human medicine; a strong movement originated in the early 2000’s and now is ubiquitous in human healthcare. In this lecture we will review patient safety science, current patient safety data and statistics and cover why errors happen when delivering medical care. We will explore the many opportunities to apply Patient Safety Science to veterinary medicine in order to keep our patients safer from medical error. We will discuss how errors impact our teams. Errors hurt not only our patients, but us as their caregivers. This is called the second victim phenomenon, and it contributes to the stress and burnout common in our profession. We will discuss the importance of a strong patient safety culture, and how one can be established and fostered in our clinics and hospitals.

Course Objectives:

1. Develop a basic understanding patient safety science
2. Be able to describe why errors happen and their impact on health care profession
3. Be able to perform a Root Cause Analysis to help us dissect and learn from events

Speaker Info:
Dr. Shaw 1998 graduate of the Tufts Cummings School of Veterinary Medicine and completed a rotating internship at the Veterinary Referral and Emergency Center in Norwalk CT before returning to Tufts to complete a residency in Emergency and Critical Care Medicine.  After completing his residency in 2002, Dr. Shaw joined the faculty at Tufts.  He spent the next 10 years as a faculty member at Tufts.  In 2012, Dr. Shaw left Tufts to help open New England Veterinary Center & Cancer Care in Windsor, CT. In 2014 he became the Regional Medical Director for the VCA Specialty Hospitals in the Northeast.  In 2017 he became the Regional Vice-President of VCA’s Northeast Specialty Hospitals. Dr. Shaw lives in Woodstock, CT with his wife and son.  They breed and show Labrador retrievers and standard dachshunds and have 3 mini donkeys.