VECCSpert level- audience is advanced clinician who like some physiology-pathophysiology-
new information mixed in with practical information
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?
Define a fluid bolus and what an expected physiologic clinical response to a fluid bolus is.
Discuss more recent strategies regarding fluid therapy including the 4D’s and the ROSE principle.
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.
Discuss the physiology behind fluid responsiveness vs fluid intolerance
Discuss the limitations of currently used clinical parameters when it comes to predicting volume status and response to fluid therapy.
Compare are contrast static vs. dynamic markers of IV volume status and fluid responsiveness
Describe additional techniques that can be used to help predict volume status and 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.
Discuss options for rapid alternative techniques to peripheral IV catheters in situations of difficult IV access
Describe how to perform placement of intraosseous catheters, ultrasound guided IV access, and venous cutdowns.
Describe advantages and disadvantages of alternative techniques for different situations
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.
Understand the indications of ABT
Be able to perform collection and administration of ABT
Understand possible risks of ABT
DESCRIPTION: “For many of us, working in veterinary medicine doesn’t just feel like a full-time job. It feels like a job we never leave. Our sense of obligation, strong desire to help, and struggles with letting go can contribute to us feeling like we are ‘always on’. No wonder so many of us burn out! It need not be that way. In this session you will learn evidence-based tools and practices for setting healthy boundaries, saying no, and integrating both work and life in a way that contributes to your well-being.”
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.
Understand the difference between whole blood and component transfusion therapy
Apply this information to better address a patient’s transfusion needs
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.
To review the studies published during the last year pertinent to small animal transfusion medicine.
To deduce what changes might be made to clinical practice based on study findings and consensus among the relevant literature.
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.
Understand the technology and advancements of CGMs and be familiar with at least one model
Know indications for placement and be able to place a CGM
Be comfortable with reviewing and interpreting the data that is collected
DESCRIPTION: “Scrolling through social media, reading reviews, watching ads on TV or YouTube or absorbing articles with titles that read like, “The 10 Ways You’re Not Good Enough”, we feel it every day – the Cult of Happiness. This pursuit of happiness feels baked into the foundation of our society and can overwhelm us with an unending desire to feel good all the time. But our brains aren’t built that way – psychologically and physiologically we can’t be happy all the time. And the desire to buck that nature is harming us in immense ways. In this session you’ll learn about the Cult of Happiness and explore a healthier, evidence-based approach for a sustainable, thriving career.”
DESCRIPTION: “As a veterinary leader, you don’t wake up in the morning looking forward to ruining the day for the people you lead. Quite the contrary, fulfillment for you comes from knowing you’ve supported your team in being the best they can be. Rarely do we find bad people leading in veterinary medicine. Often, we find good people leading badly. In this session you’ll learn about an evidence-based framework for unleashing the Positive Leadership superpowers within you.”
DESCRIPTION: “Good, worthwhile work, can be hard work and working in veterinary medicine is no exception. Sometimes the difference between burning out and burning bright is less about our talents and more about our ability to persevere, bounce back, and learn from challenges and adversities. Psychologists call those abilities “resilience factors” and it turns out, just like skills such as venipuncture or soft tissue surgery they can be learned, honed, and mastered. In this session we’ll explore the various types of resilience factors and learn about evidence-based practices for growing our resources within each type. Attendees will leave empowered with a research-backed plan for cultivating heightened resilience both professionally and personally.”
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.
Discuss advancements in abdominal veterinary point of care ultrasound beyond the original A-FAST study
Define and describe the detection of ileus using original A-FAST sites
Discuss the significance of detecting gall bladder wall edema (halo sign)
Describe simple sonographic findings suggestive of pneumoperitoneum
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.
Discuss the limitations and the accuracy of detecting pleural space disease based on recent veterinary literature.
Review current sonographic findings (lines and signs) to assess, rule out and confirm pneumothorax and pleural effusion.
Describe advances and modifications to the original 2008 T-FAST protocol that may increase the accuracy of detecting pleural pathology, including probe orientation and abnormal curtain signs.
No CE Credit
Have you ever struggled to place an IV catheter in a patient’s 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.
Build a simple chicken breast IV catheter training model for ultrasound guided placement of IV catheters.
Place IV catheters, including central guide wire catheters, using both in and out of plane ultrasound techniques.
Use ultrasound guidance to sample smaller vessels for blood gas collection
DESCRIPTION: “From upset clients to underperforming employees difficult conversations are more the norm than the exception in a veterinary career. How many of us were taught the skills to approach and handle these conversations in productive ways? The good news is, there are skills that can help and all of us can learn and hone them. In this session we’ll explore the makings of common difficult conversations and learn about tools for a measured, effective communication approach.”
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.
Become familiar with new viscoelastic technology
Understand how this test can be integrated into practice
Understand what categories of disease can be identified with viscoelastic testing
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.
Understand hyperfibrinolysis and how to identify patients at risk
Understand how hyperfibrinolysis can be diagnosed in the clinical setting
Be able to treat hyperfibrinolysis
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.
Identify how the ER practitioner can use ultrasound examinations in practice.
Work through problem cases in transfusion medicine and fluid therapy, such as my Type-B cat needs blood….but I don’t have a Type-B donor.
Identify and apply techniques for enhancing your enjoyment of your chosen profession, and maybe explore the questions: “should I stay or leave”, “how do I find a mental health provider?”, and “how do I deal with a bullying colleague.”