In this episode I am joined by my friends and colleagues, Stacey Davidson and Ru Clements of VetLed, to discuss the role of Quality Improvement (QI) in improving patient care. We discuss what QI is and why you should be engaged with it. We also talk about the role of human factors and workplace culture in QI. A description of many of the terms used in the episode can be found at the website here. Apologies for the sometimes crackly sound quality on this episode. VetLed Facebook page ...

This episode is focused on sepsis. I also talk about the relevance of the glycocalyx. And emphasise how much extrapolation there is from human medicine to veterinary practice. Topics covered include: Long-standing sepsis definitions and recently suggested updates History of sepsis management in human medicine; including early-goal directed therapy and Surviving Sepsis Campaign Recent large scale human trials: ProCESS (USA), ARISE (Australasia), ProMISe (UK) Key steps for managing the...

Although feline hypertension may be a rare reason for emergency presentation, it is a condition that most small animal practitioners will have encountered both in routine practice and in critical care patients. This episode is based on the 2017 ISFM* Consensus Guidelines on the Diagnosis and Management of Hypertension in Cats which were recently published in the Journal of Feline Medicine and Surgery. The episode discusses the following points: [*International Society of Feline Medicine] ...

Hepatic encephalopathy is a relatively common condition in dogs and to a lesser extent in cats. It is a disorder that all clinical veterinary staff, and especially those working in Emergency and Critical Care, should be aware of. This episode is based on a review article and covers the pathogenesis, clinical presentation, diagnosis, and management of hepatic encephalopathy in dogs and cats including comparisons with human medicine. The episode is based on: Lidbury JA, Cook AK, Steiner JM....

Activated charcoal is a widely used therapy, especially in dogs, to facilitate gastrointestinal decontamination following toxin ingestion. Points covered in this episode include: A reminder about what activated charcoal is and how it is meant to work Comments about the use of activated charcoal as a therapy contrasting human and veterinary medicine Contraindications and adverse effects Timing of administration Click Here For Your FREE Copy of a Transcript of This Episode Click Here For...

On this episode of the podcast I am joined by Kim Sheader (MSCP HCPC ACPAT Cat A, Chair ACPAT, RAMP), Chartered Veterinary and Human Physiotherapist, to discuss physiotherapy for the critical inpatient. Kim is a highly qualified and experienced physiotherapist and currently works with The Ralph Mobile Physiotherapy & Rehabilitation service. I start by finding out about Kim’s background, training and experience in human and more recently veterinary physiotherapy. We then go on to...

On this episode of the podcast I am joined by Rene Agredano and Jim Nelson of Tripawds, “the world's largest support community for animal amputees”, to discuss how we as veterinary staff can be better prepared to help clients with dogs and cats that are either facing or have had a limb amputation. After some background discussion of the Tripawds resource, we discuss: Ethical and moral considerations carers may have around amputation Steps carers can take to prepare for their amputee dog or...

Anaemia in critically ill cats; severe anaemia in blocked tomcats; spinal shock in dogs; haemorrhagic GI disease in veterinary ICUs. In this episode of the podcast I discuss a few papers from the latest issue of the Journal of Veterinary Emergency and Critical Care (JVECC) that especially caught my eye, in particular as they relate to primary care practice and not just referral centres. The four papers in question are: Balakrishnan A, Drobatz KJ, Reineke EL. Development of anemia,...

Antimicrobial resistance is said to be one of the greatest challenges currently facing small animal veterinary medicine. How can we become part of the solution rather than part of the problem? In this episode of the podcast I start by providing a brief refresher of bacteriology and antibacterials before going on to discuss antimicrobial stewardship in an episode that is derived from this review article: Guardabassi L, Prescott JF. Antimicrobial Stewardship in Small Animal Veterinary...

In this episode of the podcast I am joined by Enid Traisman M.S.W., CT, CFS to discuss issues around emotional well-being in veterinary practice. Enid is the Director of Pet Loss Support Services at Dove Lewis, a non-profit emergency animal hospital in Portland, Oregon in the USA. Topics that we discuss in this episode include the following; where appropriate we talk about prevention, recognition and coping strategies: Pet loss grief When veterinary staff have to deal with loss of their...

In this episode of the podcast I take a look at magnesium and its role in clinical practice, something which many people may not be very familiar with. The episode is based on the following article: Humphrey S, Kirby R, Rudloff E. Magnesium physiology and clinical therapy in veterinary critical care. J Vet Emerg Crit Care 2015. Areas covered include: Background theory Measuring magnesium Magnesium disorders Treatment Click Here For Your FREE Copy of a Transcript of This Episode For SHOW...

HORMONAL SEIZURES, IV POTASSIUM SUPPLEMENTATION, ICU SOUND LEVELS, BRAIN TUMOURS AND IMHA! In this episode of the podcast I discuss some of the papers that were published in the Journal of Veterinary Internal Medicine during 2015. Remember that this journal is now freely available via open online access. The papers I mention are as follows: Van Meervenne SAE, Volk HA, Van Ham ML. Association between Estrus and Onset of Seizures in Dogs with Idiopathic Epilepsy. J Vet Int Med 2015....

**Apologies for the less than optimal sound quality of this episode and the non-stereo recording!** Dog bite injuries are a relatively common problem to be faced with in small animal practice. In this episode of the podcast I am joined by Nicola Kulendra, a European specialist in small animal surgery, to discuss their management. Some of the points we discuss include: Adhering to standard ECC principles in terms of initial stabilisation and analgesia The mechanics of dog bites and the ‘tip...

In this episode I am joined by Liz Hughston and Charlotte Rosenthal, both specialist ECC nurses from the USA, to discuss patient handovers/rounds. We start with a brief introduction to both my guests and then go on to discuss questions such as: What is the basic purpose of handover? Separate rounds for nurses and vets, or combined? Strategies for doing an efficient and effective handover Keys bits of information to communicate This is the first episode in this podcast series to feature...

Dogs and cats with acute liver failure may present as emergencies and be critically ill. In this episode of the podcast I discuss this condition based on a recent review article from the Journal of Veterinary Emergency and Critical Care*. (*Weingarten MA, Sande AA. Acute liver failure in dogs and cats. J Vet Emerg Crit Care 2015. 25(4):455-473.) Topics covered include: Injury versus failure Causes Clinical findings Diagnosis Treatment including managing complications Prognosis Click Here...

Traumatic brain injury (closed head trauma) is relatively common in dogs and especially cats, often following motor vehicle collision. A rational approach to management is essential to try and maximise the chances of a successful outcome. In this episode of the podcast I discuss traumatic brain injury focusing on key aspects of management and touching on some potentially contentious issues. Areas covered include: The need to prioritise potentially life-threatening problems that may be...

In this episode of the podcast I discuss an approach to the early management of dyspnoeic cats that is predicated on ‘first do no harm’ and thinking risk-benefit at all times. The main take-home messages from the episode are: Appreciate that dyspnoeic cats can be very vulnerable and easily tipped over the cliff edge. Even more so than normal, pay acute attention to the risk-benefit assessment at all times. Understand that each cat is clearly going to be an individual patient with their own...

In this episode of the podcast I discuss two papers from the Journal of the American Veterinary Medical Association in 2015. The first is on post-operative regurgitation and vomiting (PORV) in dogs and the second is on lactate in cats. To end the podcast I mention a letter-to-the-editor case report from Veterinary Anaesthesia and Analgesia, also in 2015, which describes a complication of oesophagostomy tube placement in a cat with a cuffed endotracheal tube. For abstracts and references,...

Critically ill patients almost by definition have a number of different problems and management considerations. They can be high maintenance requiring intensive care and it is easy to accidentally overlook different aspects of their care; this is especially the case when you are looking after more than one critically ill patient and/or working in an otherwise busy practice environment.  Using some form of checklist on a daily basis is a quick and easy way of being reminded of all the...

The shock index is equal to heart rate divided by systolic arterial blood pressure. It has received a fair amount of attention in the human medicine literature being evaluated for example in haemorrhagic hypovolaemic shock, especially post-traumatic, sepsis and obstetric patients, and for correlation for example to length of hospital stay and mortality. There is very little clinical veterinary information on the shock index. In this episode I discuss what the shock index is, the parameters...

Whether or not steroids should be used in shock has been an on-going debate for many years. In this episode I discuss some of the literature, in particular relating to the use of steroids in septic shock, and the concept of ‘relative adrenal insufficiency’ – more recently referred to as ‘critical illness-related corticosteroid insufficiency’ (CIRCI). An episode summary is as follows: Use of steroids in shock in general is not recommended unless that patient happens to have a...

This is the second of a two-part mini-series on canine haemoabdomen loosely based around the following review article: Herold LV, Devey J, Kirby R, Rudloff E. Clinical evaluation and management of hemoperitoneum in dogs. J Vet Emerg Crit Care 2008. 18(1):40-53. If you have not yet listened to Part 1, please do before listening to this episode! Points discussed in this episode include: Improving and maintaining oxygen-carrying capacity Arresting haemorrhage Autologous transfusion (cell...

In a recent Facebook survey 80% of 150 respondents mentioned haemoabdomen, especially due to splenic rupture, as a top cause of collapse in dogs. This is the first of a two-part mini-series on canine haemoabdomen loosely based around the following review article: Herold LV, Devey J, Kirby R, Rudloff E. Clinical evaluation and management of hemoperitoneum in dogs. J Vet Emerg Crit Care 2008. 18(1):40-53. Points discussed in this episode include: Causes of canine haemoabdomen Canine...

Ketamine is a drug with complex pharmacology and a number of potential clinical effects and uses including a dose-dependent central nervous system continuum from analgesia through to sedation, partial dissociation and complete dissociation. In this episode I discuss this drug based around the following points: How does ketamine work? What does it do? Continuum of central nervous system effects Is ketamine contraindicated with raised intracranial pressure? Ketamine is sympathomimetic What...