Fluid responsiveness: is it that simple?

Fluid therapy is the most commonly used initial therapeutic intervention in treatment of shock states (e.g. in hypovolemic and distributive types of 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, capillary refill time (CRT), non-invasive or invasive blood pressure and mucous membrane color. 

But, how reliable is this approach in assessment of fluid responsiveness? Today, I will explore available evidence and diagnostic tools that can be utilized in evaluation of fluid responsiveness in veterinary and human patients. 

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Should you recommend euthanizing canine patients with spontaneous hemoperitoneum based on CT results alone?

As emergency veterinarians, one of the most critical decisions we face is whether to recommend humane euthanasia in canine patients with spontaneous (non-coagulopathic) hemoperitoneum based solely on CT results. A recent study shed light on the limitations of CT imaging in distinguishing between benign and malignant lesions in such cases (Parry et al. JVECC 2023). Understanding the study’s findings is crucial for making well-informed decisions and providing optimal care for our canine patients. In this blog post, we will explore the study’s results, particularly the concerning frequency of benign lesions being misinterpreted as malignant, and discuss the implications for our decision-making process.

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Assessment of the intravascular volume status with point-of-care ultrasound

Assessment of the intravascular volume status is a critical skill for emergency veterinarians. Point-of-care ultrasonography (POCUS) is emerging as a valuable, noninvasive, cage-side diagnostic tool for objective evaluation of physiologic and hemodynamic parameters related to volume status, fluid tolerance, and responsiveness. Rapid cage-side sonographic evaluation can obtain qualitative data on cardiac function even when performed by non-cardiologists. POCUS involves answering focused clinical questions using cage-side ultrasonography and increases the sensitivity of the conventional physical examination.

That said, POCUS findings should be interpreted in conjunction with other clinical parameters—such as conventional perfusion parameters (heart rate, mentation, body temperature, mucous membrane color, CRT, pulse quality), urine output, blood pressure, and body weight —and not viewed as an alternative to physical examination or standard imaging studies.

In this blog post, I will describe the most commonly used views to assess volume status in dogs and cats: focused sonographic assessment of the heart (cardiac POCUS) and caudal vena cava (CVC POCUS).

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Pulmonary thromboembolism in dogs and cats: to lyse or not to lyse? 

An 8-year-old neutered male dachshund was presented to the emergency department for evaluation of respiratory distress. The dog was previously diagnosed with a heartworm disease and was currently undergoing treatment with a “slow kill” method. Physical examination revealed tachycardia at 160/min, right-sided pulmonary crackles, and tachypnea with increased respiratory effort. The point-of-care blood work showed hyperlactatemia at 4.5 mmol/L, PCV/TS of 53%/7.8 g/dl, mild metabolic acidosis, normal electrolytes and renal values. The arterial blood pressure (Doppler) was at 130 mm Hg. 

As the dog was getting flow-by oxygen, an abbreviated thoracic point-of-care ultrasound (T-POCUS) was performed (see below). 

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How to teach veterinary students to diagnose shock?

“Shock” is one of the most frequently used words in a small animal emergency room and ICU. Despite this fact, a lot of veterinary students and new graduates have only superficial understanding of this term. This lack of understanding may lead to inaccurate diagnosis and mismanagement of patients in shock. 

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