Veterinary ECC Small Talk – Details, episodes & analysis

In this episode I am joined by my friends and colleagues, Stacey Davidson and Ru Clements of VetLed, to discuss the role of Quality Improvement (QI) in improving patient care.

We discuss what QI is and why you should be engaged with it. We also talk about the role of human factors and workplace culture in QI.

A description of many of the terms used in the episode can be found at the website here.

Apologies for the sometimes crackly sound quality on this episode.

VetLed Facebook page

Veterinary Human Factors private Facebook group started by VetLed

This episode is focused on sepsis. I also talk about the relevance of the glycocalyx. And emphasise how much extrapolation there is from human medicine to veterinary practice.

Topics covered include:

• Long-standing sepsis definitions and recently suggested updates
• History of sepsis management in human medicine; including early-goal directed therapy and Surviving Sepsis Campaign
• Recent large scale human trials: ProCESS (USA), ARISE (Australasia), ProMISe (UK)
• Key steps for managing the septic veterinary patient
• The glycocalyx: what it is, what it does, why it is relevant, implications for practice

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Click Here for Show Notes

To find out more about my Small Animal Emergency Medicine App (iOS, Android) click here.

In this episode of the podcast I take a look at magnesium and its role in clinical practice, something which many people may not be very familiar with. The episode is based on the following article:

Humphrey S, Kirby R, Rudloff E. Magnesium physiology and clinical therapy in veterinary critical care. J Vet Emerg Crit Care 2015.

• Areas covered include:
• Background theory
• Measuring magnesium
• Magnesium disorders
• Treatment

Click Here For Your FREE Copy of a Transcript of This Episode

For SHOW NOTES for this episode see Here.

And don't forget to check out my Small Animal Emergency Medicine App - currently for iPhone and iPad; Android version out soon!

HORMONAL SEIZURES, IV POTASSIUM SUPPLEMENTATION, ICU SOUND LEVELS, BRAIN TUMOURS AND IMHA!

In this episode of the podcast I discuss some of the papers that were published in the Journal of Veterinary Internal Medicine during 2015. Remember that this journal is now freely available via open online access.

The papers I mention are as follows:

Van Meervenne SAE, Volk HA, Van Ham ML. Association between Estrus and Onset of Seizures in Dogs with Idiopathic Epilepsy. J Vet Int Med 2015. 29(1):251-253.

Hoehne SN, Hopper K, Epstein SE. Accuracy of Potassium Supplementation of Fluids Administered Intravenously. J Vet Int Med 2015. 29(3):834-839.

Fullagar B, Boysen SR, Toy M, et al. Sound Pressure Levels in 2 Veterinary Intensive Care Units. J Vet Int Med 2015. 29(4):1013-1021.

Hu H, Barker A, Harcourt-Brown T, Jeffery N. Systematic Review of Brain Tumor Treatment in Dogs. J Vet Int Med 2015. 29(6):1456-1463.

Goggs R, Dennis SG, Di Bella A, et al. Predicting Outcome in dogs with Primary Immune-Mediated Hemolytic Anemia: Results of a Multicenter Case Registry. J Vet Int Med 2015. 29(6):1603-1610.

...and don't forget my SMALL ANIMAL EMERGENCY MEDICINE APP FOR IPHONE AND IPAD - Android version in development!

**Apologies for the less than optimal sound quality of this episode and the non-stereo recording!**

Dog bite injuries are a relatively common problem to be faced with in small animal practice. In this episode of the podcast I am joined by Nicola Kulendra, a European specialist in small animal surgery, to discuss their management. Some of the points we discuss include:

• Adhering to standard ECC principles in terms of initial stabilisation and analgesia
• The mechanics of dog bites and the ‘tip of the iceberg’ concept
• Exploring bite injuries to uncover their true extent; the role of diagnostic imaging
• The importance of wound drainage
• Bacterial involvement and the use of antimicrobials
• The ‘two hit theory’ in cats with moderate-to-severe dog bite injuries
• The ‘big dog, little dog’ phenomenon

iPhone/iPad users see HERE for my Small Animal Emergency Medicine app for iOS; Android version is in development.

[This podcast is closely aligned with the MedEdLIFE Research Collaborative’s Quality Checklist for Podcasts.]

In this episode I am joined by Liz Hughston and Charlotte Rosenthal, both specialist ECC nurses from the USA, to discuss patient handovers/rounds.

We start with a brief introduction to both my guests and then go on to discuss questions such as:

• What is the basic purpose of handover?
• Separate rounds for nurses and vets, or combined?
• Strategies for doing an efficient and effective handover
• Keys bits of information to communicate

This is the first episode in this podcast series to feature guests - please let me know what you think!

Twitter: @VetEmCC

Dogs and cats with acute liver failure may present as emergencies and be critically ill. In this episode of the podcast I discuss this condition based on a recent review article from the Journal of Veterinary Emergency and Critical Care*.

(*Weingarten MA, Sande AA. Acute liver failure in dogs and cats. J Vet Emerg Crit Care 2015. 25(4):455-473.)

Topics covered include:

• Injury versus failure
• Causes
• Clinical findings
• Diagnosis
• Treatment including managing complications
• Prognosis

Click Here For Your FREE Copy of a Transcript of This Episode

For SHOW NOTES visit the website HERE.

Traumatic brain injury (closed head trauma) is relatively common in dogs and especially cats, often following motor vehicle collision. A rational approach to management is essential to try and maximise the chances of a successful outcome.

In this episode of the podcast I discuss traumatic brain injury focusing on key aspects of management and touching on some potentially contentious issues. Areas covered include:

• The need to prioritise potentially life-threatening problems that may be extra-cranial
• Primary (already happened) versus secondary (aim to minimise) brain injury
• Ensuring adequate oxygenation and ventilation
• Ensuring adequate cerebral perfusion
• Addressing raised intracranial pressure including hypertonic saline vs. mannitol; furosemide?
• The importance of analgesia
• Steroids?
• Relevance of hyperglycaemia?
• Prognostication

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For show notes for this episode go to the website HERE.

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In this episode of the podcast I discuss an approach to the early management of dyspnoeic cats that is predicated on ‘first do no harm’ and thinking risk-benefit at all times. The main take-home messages from the episode are:

• Appreciate that dyspnoeic cats can be very vulnerable and easily tipped over the cliff edge.
• Even more so than normal, pay acute attention to the risk-benefit assessment at all times.
• Understand that each cat is clearly going to be an individual patient with their own set of circumstances and behaviour, but that a hands-off, slow, staged approach is likely to be the least risky and most beneficial in most cases.
• Continue to improve your ability and confidence in examining these cases paying attention to trying to anatomically localise the cause of the dyspnoea; this will allow you to make the most sensible decisions in terms of how to help the patient.
• Don’t be in a hurry to x-ray dyspnoeic cats until and unless you feel like you have done all you can to make them as stable as possible beforehand.
• And, lastly engage more with POCUS, point-of-care ultrasound, if you are not already.

Click Here For Your FREE Copy of a Transcript of This Episode

For SHOW NOTES for this episode click HERE.

In this episode of the podcast I discuss two papers from the Journal of the American Veterinary Medical Association in 2015. The first is on post-operative regurgitation and vomiting (PORV) in dogs and the second is on lactate in cats. To end the podcast I mention a letter-to-the-editor case report from Veterinary Anaesthesia and Analgesia, also in 2015, which describes a complication of oesophagostomy tube placement in a cat with a cuffed endotracheal tube.

For abstracts and references, visit the website HERE.

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