Abdominal and thoracic focused assessment with sonography for trauma, triage, and monitoring in small animals

Gregory R. Lisciandro, DVM, DABVP, DACVECC
Journal of Veterinary Emergency and Critical Care 21(2) 
2011. 

Objectives – To review the nonradiologist use of ultrasound (US) in the setting of emergency and critical care, the development, clinical applications, and standardization of veterinary abdominal and thoracic focused assessment with sonography for trauma (FAST) techniques.

Etiology – Since the 1990s, the 4-point FAST US technique has been used for injury surveillance in people with blunt and penetrating trauma. FAST screens for free fluid in the abdominal, pleural, and pericardial cavities with high sensitivity and specificity. More recently, an extended FAST scan was developed for the rapid detection of pneumothorax. These techniques and newly created scans have been applied to other critically ill, nontraumatized, subsets of human patients. As a result, the terminology related to this field, eg, extended FAST, HHFAST, FFAST, FAFF, BOAST, SLOH, bedside US, ‘$ Approach,’ protocols, and objectives have become convoluted despite having similar goals.

Diagnosis – The importance of US in the setting of emergency medicine is highlighted by the fact that this diagnostic modality has become an integral part of the core curriculum for nonradiologists including the American College of Surgeons, American College of Emergency Physicians, American Board of Emergency Medicine, Society of Academic Emergency Medicine, and all United States Accreditation Council for Graduate Medical Education Emergency Medicine residency programs.

Therapy – Veterinary applications of FAST techniques include an abdominal FAST technique with an abdominal FAST applied fluid scoring system, and a thoracic FAST technique. In an attempt to avoid the creation of numerous acronyms, veterinarians would be well served by making the ‘T’ in ‘FAST’ stand for ‘Trauma,’ ‘Triage,’ and ‘Tracking.’ Prognosis – These veterinary FAST techniques provide an extension of the physical examination for the emergency and critical care veterinarian potentially expediting diagnosis, prompting life-saving maneuvers, and guiding patient management. Further clinical research to determine sensitivity, specificity, and accuracy for specific conditions is warranted.

Dystocia

Sergio Serrano, LV, DVM, DACVECC 
Matthew McMillan, BVM&S, MRCVS
Standars of Care of Compendium 

February of 2009

Dystocia is a relatively common emergency presentation. It occurs in 3.3% to 5.8% of all feline pregnancies; in dogs, the overall rate is around 5%. However, dystocia rates are breed specific: only 0.8% to 2.3% of pregnancies in cats with a normal conformation result in dystocia, whereas in some large-headed and achondroplastic dog breeds, the rate can approach 100%.

Pulmonary tromboembolism

Heidi New, DVM, Christopher G. Byers, 
DVM, DACVECC, DACVIM (SAIM)
Compendium, 2011

Pulmonary thromboembolism (PTE) has been associated with many diseases. Clot formation is a consequence of hypercoagulability, blood stasis, and damage to the endothelium of blood vessels, a set of changes known as the Virchow triad. Diagnosing PTE may be difficult because common clinical signs, including tachypnea, dyspnea, and hypoxemia, are not pathognomonic for the disease. The initial workup for PTE should include arterial blood gas analysis and thoracic radiography. If there is a strong clinical suspicion for PTE, further tests are indicated, such as D-dimer measurement, thromboelastography, and advanced imaging..

Acute respiratory distress syndrome in dogs and cats - a review of clinical findings and pathophysiology

Amy E. DeClue, DVM, MS, DACVIM
Leah A. Cohn, DVM, PhD, DACVIM
Journal of Veterinary Emergency and Critical Care 
17(4) 2007, pp 340–347

Unfortunately, current mortality rates for ARDS in small animals are close to 100%. As our capability to treat patients with advanced life-threatening disease increases, it is vital that we develop a familiarity with the pathogenesis of ARDS. Understanding the complex inflammatory interactions is essential for determining effective preventative and management strategies as well as designing novel therapies for veterinary patients.

Feline Pyothorax

Tonya E. Boyle, DVM 
Eleanor C. Hawkins, DVM, DACVIM
Standars of Care
August 2005

Pyothorax is the presence of a suppurative, septic effusion within the pleural space. It is typically easy to diagnose via cytologic analysis of fluid obtained by thoracentesis. The fluid obtained may be very turbid and can range in color from white to brown or red. Pyothorax is characterized as an exudate with protein above 3.5 g/dl, total nucleated cell count exceeding 7,000/μl of mostly degenerative neutrophils, pH below 6.9, and glucose concentration less than 10 mg/dl. Generally, extracellular and intracellular bacterial organisms are present on cytologic examination if the patient has not received antibiotic therapy before thoracentesis is performed. Because many cats with pyothorax present in respiratory distress, initial thoracentesis can be both a stabilizing, therapeutic measure as well as a definitive diagnostic test.

The Kidney in Critically ill Small Animals

Katharine F. Lunn, BVMS, MS, PhD, MRCVS
Vet Clin Small Anim 41 (2011) 727–744

This article discusses kidney disease in critically ill small animal patients. Critically ill patients may present to the clinician with kidney disease as the primary complaint, or kidney damage or dysfunction may arise as a complication or consequence of other illness. In the latter scenario, the clinician must carefully monitor parameters that assess renal function and be prepared to intervene to prevent irreversible injury.

Pneumothorax - A Review

Danielle R. Pawloski, Kristyn D. Broaddus
J Am Anim Hosp Assoc 
46:385-397.

2010

Pneumothorax is a pathological condition in which air accumulates within the thoracic cavity.Pneumothorax affects animals without sex or age predilections; however, it has been suggested that the Siberian husky breed of dog has a predisposition for spontaneous pneumothorax. Pneumothorax occurs as the result of trauma or underlying disease and can present a clinical challenge with regard to diagnostic and therapeutic techniques. Topics reviewed include normal lung physiology; the pathogenesis, diagnosis, treatment, complications, and prognosis of pneumothorax; and current techniques in animals and humans..

Heatstroke

Carl Gorman BVSc MRCVS
Companion Animal Vol 16
June 2011

Heatstroke is one of the genuine emergencies seen in practice. The recognition, assessment and initial treatment of the condition is vitally important to improve survival rates. Studies suggest that 25-50% of severe cases may not survive. Patients that survive the initial 24 hours, however, will usually go on to recover. This article summarises the risk factors and physiological processes involved in heatstroke, and recommends monitoring and therapy to improve survival rates