***PLEASE NOTICE – NEW SCHEDULE FORMAT***
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.
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.
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.
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.
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.
This conference has covered a range of in-depth topics meant to enhance your clinical practice. 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.