Venous pCO2 in Shock

A 3 year-old neutered male domestic shorthaired cat was rolled out of an OR after the chylothorax surgery (cysterna chyli ablation, pericardiectomy, and thoracic duct ligation) as well as the surgical correction of congenital peritoneopericardial diaphragmatic hernia (PPDH). An extensive pleural fibrosis was noted during surgery due to the suspected chronicity of the chylous effusion. A unilateral small-bore chest tube was placed into one of the hemithoraces at the conclusion of the surgical procedure. The intraoperative anesthesia monitoring was complicated by the inability to obtain indirect blood pressure measurements during the second half of the procedure despite the presence of otherwise stable monitoring parameters including end-tidal CO2. No significant blood loss was noted during the surgery.

Continue reading “Venous pCO2 in Shock”

Ugly Twins: Combined HHS + DKA

A 13 year-old castrated male domestic shorthaired cat (2.72 kg) was presented to the veterinary teaching hospital emergency department for worsening lethargy and weakness. He had been recently diagnosed with diabetes mellitus and started on PZI insulin at 1 unit twice a day.  Historically, the cat was diagnosed with ocular histoplasmosis that was in remission on fluconazole treatment. 

Continue reading “Ugly Twins: Combined HHS + DKA”

TRALI or Pulmonary Hemorrhage?

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?”

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?”