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.