Clinical Tidbits (August 2018)

“Don't be afraid of fluids,” says Deborah Silverstein, DVM, DACVECC, associate professor of critical care at the University of Pennsylvania School of Veterinary Medicine. “They are your friend. But they can also lead to adverse effects.”

It shouldn’t be a scary process to administer fluids, Dr. Silverstein says, but carefully evaluating the patient’s initial presentation in terms of cardiovascular stability and hydration status is important, and don’t forget you have to repeatedly reevaluate those to avoid any adverse effects.

“Trying not to give too much fluid is probably the most important consideration,” Dr. Silverstein says. “But at the same time you need to be sure perfusion is adequate so the organs don’t suffer from oxygen deficits and subsequent injury.”

All in all, she recommends that veterinarians be “cautiously judicious” in their choices of fluids and monitor patients frequently for any changes or potential complications.

Dealing With Collapse in Dogs

“Collapse in dogs is one of the most frustrating things we see in the emergency room,” says Liz Rozanski, DVM, associate professor of emergency and critical care at the Cummings School of Veterinary Medicine at Tufts University. “And collapse is, unfortunately, common.”

The primary factor in helping these pets is to have owners bring them to the hospital as soon as possible, because time is of the essence. “Most cases of collapse respond well to therapy,” Dr. Rozanski says. “We just have to figure out what we’re dealing with.” She advises veterinarians to consider whether the pet may have gotten into a poison, is bleeding internally, has pericardial effusion, is suffering from heat stroke, or has hypertension or hypotension. “Check the major body systems—the heart, brain, and lungs—and see if there’s an abnormality there,” she says. “Then start thinking about how you can correct that abnormality by giving fluids, oxygen, or a blood transfusion or by removing fluids.”

Generally speaking, says Vickie Byard, CVT, VTS (Dentistry), dentistry specialist at PetED Veterinary Education and Training Resources, most dogs and cats should receive annual dental examinations. “I like to tailor it according to how much oral care the pet owner is able to do at home,” Byard says.

Larger-breed dogs can wait a bit longer between dental exams, she notes, while smaller breeds should probably come in every 6 to 9 months, “especially if they’re high strung and their owners can’t do any home care.”

Fear Free for Cats: Simple Strategies

Lisa Radosta, DVM, DACVB, owner of Florida Veterinary Behavior Service in West Palm Beach, offers a few easy and inexpensive suggestions for practices that want to start implementing feline Fear Free tactics. “The first thing is to use pheromone diffusers and sprays,” she says. “Will they work on every cat? No, but they will help many cats to be calmer in the practice.”

Second, she advocates minimizing or eliminating the amount of time that stressed cats spend in the waiting room. “Having a separate cat waiting room is fantastic, but we can’t all do that,” Dr. Radosta acknowledges. Instead, she suggests that practices have cats and their owners wait in the car until an exam room becomes available.

“Finally,” she says, “I know we’re all running 24/7, but what we can do as doctors is take a deep breath and consider examining our stressed feline patients in their carriers or sitting on the floor and putting that cat on our lap.” By simply rethinking how you examine stressed feline patients, you are implementing a Fear Free technique.

“Issues can turn south in eyeballs really, really quickly,” says Jennifer Welser, DVM, DACVO, chief medical officer of BluePearl Veterinary Partners, “so rapid intervention is key.”

When it comes to eyes, several diseases require immediate attention, Dr. Welser explains. It is much better to act too quickly and too aggressively than to miss the boat, because these animals can lose vision or the eyes themselves. “Even if you’re wrong,” she says, “you can always justify the fact that you treated it aggressively.”

And while it might sound simple to get clients to understand that, Dr. Welser says it can be tricky sometimes to get clients to come in to the practice when there is a problem with their pet’s eye.

Making the Most of Electrocardiograms in Anesthesia Monitoring

Basic monitoring for every veterinary patient under anesthesia includes an electrocardiogram (ECG). But while they give us a lot of information, Gregg M. Griffenhagen, DVM, MS, DACVAA, anesthesiologist and clinical instructor at Colorado State University, says we start to ignore them over time. He offers a simple 3-step approach to better understand an ECG:

• Look at the P waves.
• Look at the QRS complexes.
• Ask: Are they associated? Are they wide?

With monitoring today providing so much data, it becomes imperative to be able to determine quickly what is important and what needs to be done. “[This approach to the ECG] gives you the basic information to very easily look and say, ‘Here’s what I see, here’s what I think should treat it,’ and then move on,” he says.