A 7 year-old spayed female miniature poodle was referred to a veterinary teaching hospital emergency service for further evaluation of severe thrombocytopenia due to a suspected immune-mediated thrombocytopenia with a platelet count of 12k/uL confirmed by a blood smear. Initial work-up included standard bloodwork, a tick-borne disease panel, thoracic and abdominal imaging. No apparent underlying causes of presumed ITP were identified. An initial physical examination showed moderate tachycardia with a HR of 150/min, strong femoral pulses, pale mucous membranes and multifocal cutaneous petechiation. The dog was eupneic and had normal bronchovesicular sounds. There was melena on rectal palpation. The patient’s PCV was 20% with TS of 5.5 g/dl.
Continue reading “TRALI or Pulmonary Hemorrhage?”Month: October 2019
Fluid responsiveness: is it that simple?
Fluid therapy is the most commonly used initial therapeutic intervention in treatment of shock states (e.g. hypovolemic and distributive shock). The approach to fluid resuscitation evolved over the last few decades. For instance, we no longer start with a full “shock dose” of fluids (60-90 ml/kg), and instead, an incremental 10-20 ml/kg boluses are preferred with frequent reassessment of the end-goal perfusion parameters. The standard therapeutic targets include improving heart rate, pulse quality, CRT, non-invasive or invasive blood pressure and mucous membrane colour.
Continue reading “Fluid responsiveness: is it that simple?”