Impact of a Dexmedetomidine Intravenous Infusion in Septic Dogs: Preliminary Study.

The purpose of this study was to determine if a continuous rate infusion (CRI) of dexmedetomidine decreases vasopressor requirements in septic dogs undergoing surgery. Vital parameters, sequential organ failure assessment (SOFA) score, vasopressor requirement, and 28-day mortality were recorded. Dogs were randomly divided into two groups: a dexmedetomidine (DEX) (1 mcg/kg/h) group and a control group (NaCl), which received an equivalent CRI of NaCl. Dogs were premedicated with fentanyl 5 mcg/kg IV, induced with propofol, and maintained with sevoflurane and a variable rate fentanyl infusion. DEX or NaCl infusions were started 10 min prior to induction. Fluid-responsive hypotensive patients received repeated Ringer's lactate boluses (2 mL/kg) until stable or they were no longer fluid-responsive. Patients that remained hypotensive following fluid boluses received norepinephrine at a starting dose of 0.05 mcg/kg/min, with increases of 0.05 mcg/kg/min. Rescue adrenaline boluses were administered (0.001 mg/kg) if normotension was not achieved within 30 min of starting norepinephrine. The NaCl group received a significantly higher dose of norepinephrine (0.8, 0.4-2 mcg/kg/min) than the DEX group (0.12, 0-0.86 mcg/kg/min). Mortality was statistically lower in the DEX group (1/10) vs. the NaCl group (5/6). Results of this study suggest that a 1 mcg/kg/h CRI of dexmedetomidine decreases the demand for intraoperative vasopressors and may improve survival in septic dogs.

Evaluation of B-lines with 2 point-of-care lung ultrasound protocols in cats with radiographically normal lungs.

OBJECTIVE: To compare 2 point-of-care lung ultrasound (LUS) protocols for quantification of B-lines in cats without evidence of respiratory disease based on history, physical examination, and thoracic radiography. DESIGN: Prospective observational study. SETTING: Single center, veterinary teaching hospital. ANIMALS: Fifty-seven cats without respiratory disease based on history, physical examination, and thoracic radiographs. INTERVENTIONS: All cats had 2 point-of-care LUS protocols performed bilaterally: a regional protocol (veterinary bedside lung ultrasound evaluation [VetBLUE]) and a more comprehensive vertical sweeping (VS) protocol. The total number of B-lines per cat, number of sites with B-lines, and maximal number of B-lines at each site were recorded and compared. MEASUREMENTS AND MAIN RESULTS: Ten cats (18%) had at least 1 B-line identified with VetBLUE, versus 29 (51%) with VS. Comparing protocols, VS had a statistically higher total number of B-lines per cat, higher number of sites with B-lines, and higher maximal number of B-lines per site. B-lines that were too numerous to count were identified at a single location in 1 cat with VetBLUE and 2 cats with VS. A maximum of 3 B-lines were identified at all other positive sites regardless of the protocol used. On average, it took 1.79 times longer to complete VS bilaterally compared to VetBLUE (median [interquartile range]: 140 [33] and 78 [14] s, respectively) (P = 0.001). CONCLUSIONS: This study demonstrates it is not uncommon to identify a single or even multiple B-lines in 1 or several sites on LUS in cats deemed to be clinically free of respiratory pathology-essential knowledge when using LUS as a screening test and to monitor intrathoracic lesions. In cats asymptomatic for respiratory disease, VS generally identifies more B-lines than VetBLUE, likely because it assesses a larger lung surface area. The sonographic identification of B-lines should be interpreted considering the LUS protocol used, history, and other diagnostics to determine their clinical significance.

Case report: Application of color Doppler sonography for the assessment of pulmonary consolidations in a dog.

A 1,5-year-old male Maltipoo was presented to the emergency service for dyspnea, weakness, and cough. An echocardiographic examination showed evidence of pulmonary hypertension with a McConnell sign. Lung ultrasound, including color Doppler, was performed and identified two distinct populations of lung consolidation. Color Doppler analysis of the first type of consolidation showed the absence of blood flow within regions of the consolidation and flow amputation. These findings were consistent with the "vascular sign" reported in human medicine and prompted consideration of pulmonary thromboembolism as a differential diagnosis. In the second type of consolidation, color Doppler identified blood flow within the pulmonary vessels of the consolidated lung, forming a "branching tree-like" pattern that followed the anatomical course of the pulmonary vasculature. These findings suggested that blood flow was preserved within the pulmonary vasculature of the consolidated lung and prompted consideration of inflammatory causes of pulmonary pathology. On recheck 6 days later, recanalization of the first type of consolidation was identified with color Doppler. The case was followed serially once a month for 5 months with LUS, which showed continued improvement. Based on a positive fecal Baermann test, a final diagnosis of Angiostrongylus vasorum was made. New or Unique information Provided-this is the first report of color Doppler LUS being used to characterize and help differentiate the cause of lung consolidation in dogs.

Left atrial measurement in lateral versus sternal recumbency in cats undergoing focused cardiac ultrasound examination.

Objective: To compare left atrial measurements carried out by an emergency and critical care (ECC) clinician on cats in lateral and sternal recumbency. Animals and procedures: A prospective observational study was conducted between December 2019 and January 2021 at the university teaching hospital at University of Liège. One hundred and two hospitalized cats were enrolled. Focused cardiac ultrasound (FOCUS) was performed in right lateral and sternal recumbency by a single FOCUS-trained ECC resident. Standard right parasternal long- and short-axis views were recorded. After randomization of the cineloops, the same blinded resident measured maximal left atrial dimension (LAD) and the ratio of left atrial to aortic diameter (LA:Ao). Reproducibility was assessed using the Bland-Altman method. Results: The LA:Ao and LAD measurements in lateral (LA:Ao median: 1.37, range: 1.02 to 3.22; LAD median: 13.25, range: 7.90 to 32.90) and sternal (LA:Ao median: 1.38, range: 1.06 to 3.22; LAD median: 13.00, range: 8.00 to 32.90) recumbency were not significantly different (bias: -0.003, CI -0.014, 0.007; and bias: -0.101, CI -0.231, 0.029, respectively). Conclusions and clinical relevance: The FOCUS technique was successfully applied in sternal recumbency in almost all cats. The LAD and LA:Ao measured in sternal and lateral recumbency were not significantly different. Cardiac left atrial measurements obtained using FOCUS can be reliably assessed in sternal recumbency in hospitalized, stable cats.

Mesure de l'oreillette gauche en décubitus latéral versus sternal chez les chats soumis à une échographie cardiaque focalisée. Objectif: Comparer les mesures de l'oreillette gauche effectuées par un clinicien des urgences et soins intensifs (ECC) sur des chats en décubitus latéral et sternal. Animaux et procédures: Une étude observationnelle prospective a été menée entre décembre 2019 et janvier 2021 au CHU de l'Université de Liège. Cent deux chats hospitalisés ont été enrôlés. L'échographie cardiaque focalisée (FOCUS) a été réalisée en décubitus latéral droit et sternal par un seul résident ECC formé au FOCUS. Des vues parasternales droites grand et petit axe standards ont été enregistrées. Après randomisation des cineloops, le même résident en aveugle a mesuré la dimension auriculaire gauche maximale (LAD) et le rapport entre le diamètre de l'oreillette gauche et celui de l'aorte (LA:Ao). La reproductibilité a été évaluée à l'aide de la méthode de Bland-Altman. Résultats: Les mesures LA:Ao et LAD en décubitus latéral (LA:Ao médian : 1,37, intervalle : 1,02 à 3,22; LAD médian : 13,25, intervalle : 7,90 à 32,90) et sternal (LA:Ao médian : 1,38, intervalle : 1,06 à 3,22; médiane LAD : 13,00, intervalle : 8,00 à 32,90) n'étaient pas significativement différents (biais : −0,003, IC −0,014, 0,007; et biais : −0,101, IC −0,231, 0,029, respectivement). Conclusions et pertinence clinique: La technique FOCUS a été appliquée avec succès en décubitus sternal chez presque tous les chats. Le LAD et LA:Ao mesurés en décubitus sternal et latéral n'étaient pas significativement différents. Les mesures de l'oreillette cardiaque gauche obtenues à l'aide de FOCUS peuvent être évaluées de manière fiable en décubitus sternal chez les chats hospitalisés et stables.(Traduit par Dr Serge Messier).

Markers of tissue perfusion and their relation to mortality in dogs with blunt trauma.

OBJECTIVE: To evaluate admission Animal Trauma Triage (ATT) score, shock index (SI), and markers of perfusion, including base excess (BE), plasma lactate, and lactate clearance in dogs with blunt trauma. DESIGN: Prospective observational clinical study from 2013 to 2015. SETTING: Private veterinary referral and emergency center. ANIMALS: Forty-four client-owned dogs hospitalized following blunt trauma. INTERVENTION: Within 1 hour of presentation and prior to fluid administration an initial hematocrit, total plasma protein, blood glucose, plasma lactate, blood gas, and electrolytes were obtained for analysis. Plasma lactate concentrations were also measured 4 and 8 hours following initial measurement, and a 4-hour lactate clearance was calculated if patients had an increased admission plasma lactate. ATT score and SI were calculated for each patient based on admission data. Outcome was defined as survival to hospital discharge. MEASUREMENTS AND MAIN RESULTS: Twenty-nine dogs survived, 14 were euthanized, and 1 died. Nonsurviving dogs had a lower mean pH (7.28 ± 0.03 vs 7.36 ± 0.01, P = 0.006), lower median HCO3 (15.7 vs 18.8 mmol/L, P = 0.004), lower median admission BE (-11.0 vs -7.0 mmol/L, P = 0.004), and higher median admission lactate (3.1 vs 2.4 mmol/L, P = 0.036) than those who survived. Median ATT was significantly higher in nonsurvivors (5 vsF 2, P < 0.001). The SI was not significantly different between survivors and nonsurvivors (P = 0.41). There was no difference in median 4-hour lactate (P = 0.34), median 8-hour lactate (P = 0.19), or 4-hour lactate clearance (P = 0.83) in survivors compared to nonsurvivors. No other statistically significant differences were noted between groups. CONCLUSION: Dogs hospitalized following blunt trauma with a lower admission pH, HCO3 , and BE and a higher admission plasma lactate were less likely to survive to hospital discharge. Median ATT score was also significantly higher in nonsurvivors. Although lactate clearance was not predictive of survival, the sample size was small, and additional studies with a larger study population are warranted.

Comparison of transrectal and transabdominal transducers for use in fast localized abdominal sonography of horses presenting with colic.

Abdominal ultrasonography is valuable in the diagnosis of equine colic. Fast localized abdominal sonography of horses (FLASH) enables practitioners with limited experience to perform ultrasonography in emergency settings. However, many practitioners only possess rectal format linear array transducers (RFLT). The hypotheses are: (a) A low frequency curvilinear transducer (LFCT) and RFLT will detect free abdominal fluid and abnormal small intestinal loops with similar frequency during FLASH, and (b) there will be a difference between the transducers for detection of gastric abnormalities and nephrosplenic entrapment. The objective is to compare transcutaneous abdominal ultrasonographic detection of abnormalities in horses presenting with colic using a LFCT and RFLT. Twenty-four horses requiring FLASH for investigation of colic were enrolled. Horses that were too painful to undergo transcutaneous abdominal ultrasonographic examination were excluded. A single investigator performed FLASH on all horses using a RFLT, while one of three other clinicians simultaneously performed FLASH using a LFCT. Comparison of abnormal findings between the two transducers was performed using Chi square, Fisher's exact or Wilcoxon tests. The incidence of identification of abnormal findings was similar between the two transducers for all comparisons except the visibility of the left kidney and stomach (kidney LFCT 81.25% vs. RFLT 22.92%, stomach LFCT 87.5% vs. RFLT 62.5%). While there are limitations to using a RFLT to identify nephrosplenic entrapment of the colon and detection of the stomach, it reliably detects other common abnormalities, including peritoneal effusion, lesions of the small intestine, and changes to the wall of the large colon and cecum.

Comparison of four different hematocrit assays and the effect of albumin on their measurements.

Clinical decisions are influenced by hematocrit values. Centrifugation (reference standard), conductivity, optical and impedance methods are often used interchangeably to measure hematocrit. The effects of albumin, which are known to affect conductivity methods, have not been evaluated for limits of agreement (LOA) between hematocrit assays in small animals. Canine venous blood was collected from 74 clinical cases and measured by centrifugation (n = 72), conductivity (n = 73), impedance (n = 24) and optical (n = 50) methods. Bland-Altman analysis determined bias (± SD) and 95% LOA between methods. There was a statistically significant difference between centrifugation hematocrit values and values obtained via conductivity (p < 0.0001), optical (p < 0.0001), and impedance (p = 0.0082) methods. The conductivity method underestimated hematocrit by 2.1 ± 2.9% (95% LOA -3.54 to 7.88), the optical method by 3.1 ± 3.6% (95% LOA -4.0 to 10.2), and the impedance method by 2.3 ± 3.7% (95% LOA -5 to 9.6) when compared to centrifuged hematocrit values. The hematocrit difference between conductivity and centrifugation methods was statistically different for low (4%, 0-5%), within reference limits (3%, -5 to 8%), and high (2%, -2 to 5%) albumin values, respectively (p = 0.02), with post-hoc analysis demonstrating that the difference occurred between the low and high albumin groups. This study confirms that albumin values outside reference limits can affect the conductivity method and that hematocrit values obtained via conductivity, optical and impedance methods underestimate values obtained via centrifugation. Therefore, the hematocrit methods cannot be used interchangeably. The wide limits of agreement also demonstrates that care must be taken when making clinical decisions with different hematocrit methodologies.

Comparison of lung ultrasound, chest radiographs, C-reactive protein, and clinical findings in dogs treated for aspiration pneumonia.

BACKGROUND: Comparison of clinical findings, chest radiographs (CXR), lung ultrasound (LUS) findings, and C-reactive protein (CRP) concentrations at admission and serial follow-up in dogs with aspiration pneumonia (AP) is lacking. HYPOTHESIS: Lung ultrasound lesions in dogs with AP are similar to those described in humans with community-acquired pneumonia (comAP); the severity of CXR and LUS lesions are similar; normalization of CRP concentration precedes resolution of imaging abnormalities and more closely reflects the clinical improvement of dogs. ANIMALS: Seventeen dogs with AP. METHODS: Prospective observational study. Clinical examination, CXR, LUS, and CRP measurements performed at admission (n = 17), 2 weeks (n = 13), and 1 month after diagnosis (n = 6). All dogs received antimicrobial therapy. Lung ultrasound and CXR canine aspiration scoring systems used to compare abnormalities. RESULTS: B-lines and shred signs with or without bronchograms were identified on LUS in 14 of 17 and 16 of 17, at admission. Chest radiographs and LUS scores differed significantly using both canine AP scoring systems at each time point (18 regions per dog, P < .001). Clinical and CRP normalization occurred in all dogs during follow up. Shred signs disappeared on LUS in all but 1 of 6 dogs at 1 month follow-up, while B-lines and CXR abnormalities persisted in 4 of 6 and all dogs, respectively. CONCLUSION AND CLINICAL IMPORTANCE: Lung ultrasound findings resemble those of humans with comAP and differ from CXR findings. Shred signs and high CRP concentrations better reflect clinical findings during serial evaluation of dogs.

Incidence of superficial abdominal organ identification is similar using high-frequency linear (transrectal) and low-frequency curvilinear (abdominal) transducers in clinically healthy horses: A pilot study.

Abdominal organ displacement is a potentially life-threatening condition in horses. Primary care veterinarians commonly make referral decisions based on a combination of clinical and ultrasonographic findings. However, published studies describing the effects of transducer on identifying abdominal organ locations in horses are currently lacking. The objective of this prospective, methods comparison, pilot study was to compare organ identification using a high-frequency linear (transrectal) transducer and a low-frequency curvilinear (abdominal) transducer for transcutaneous abdominal ultrasonography of healthy horses. Twelve clinically normal adult horses owned by the University of Calgary were enrolled in the study. Abdominal ultrasonography was performed by four practitioners, each randomly assigned to an alternating rotation of transrectal or abdominal transducer and left or right side of a horse. Using a Chi square test or Fisher's exact test, the frequency of identification for each organ was compared between both transducers. There was no significant difference in organ identification on the right side of the abdomen. On the left side, the stomach, liver, and kidney were less likely to be detected with the transrectal transducer. Compared with a low-frequency abdominal transducer, a high-frequency linear transrectal transducer delivers images that allow for organ identification in transcutaneous ultrasonography of the equine abdomen except for the left kidney, left liver, and stomach.

Ultrasonographically derived caudal vena cava parameters acquired in a standing position and lateral recumbency in healthy, lightly sedated cats: a pilot study.

OBJECTIVES: The aim of this study was to determine the feasibility of ultrasonographically measuring the caudal vena cava (CVC) at the subxiphoid view of healthy, lightly sedated cats in a standing position and lateral recumbency. METHODS: This was a prospective, observational, experimental single-centre study. Twenty healthy research-purposed cats were enrolled. Two trained operators scanned each cat in two positions - standing and lateral recumbency - in a randomised order. CVC diameter was measured at the narrowest diameter during inspiration and at the widest diameter during expiration, at two anatomical locations along the CVC - where the CVC crosses the diaphragm (base) and 2 mm caudal to the diaphragm. The CVC collapsibility index (CVC-CI) was calculated for each site. Normalcy was assessed with a Shapiro-Wilk test. A one-way ANOVA with post-hoc Tukey's test was used to compare inspiratory with expiratory values within and between groups. A paired t-test compared the CVC-CI between groups (P ⩽0.05 indicated statistical significance). Spearman's correlation and Bland-Altman analysis assessed inter-operator variability. RESULTS: All ultrasonographic data passed normalcy and were reported as mean ± SD. When compared with each other, inspiratory and expiratory values were statistically different for position, location and operator (all P <0.0001). There was no statistically significant difference between lateral recumbency or standing position for inspiratory, expiratory and CVC-CI values. Inter-operator variability was substantial, with operator 2 consistently obtaining smaller measurements than operator 1. The mean CVC-CI in lateral recumbency at the base was 24% for operator 1 and 37% for operator 2. For the same site in standing position, CVC-CI was 27% and 41% for operators 1 and 2, respectively. CONCLUSIONS AND RELEVANCE: This pilot study demonstrates that it is possible to ultrasonographically measure the CVC diameter in both lateral recumbency and a standing position in healthy, lightly sedated cats. However, measurements obtained are operator dependent with variability between individuals. Further studies are needed to determine if ultrasonographic CVC assessment will prove helpful in estimating intravascular volume status in cats.

Lung Ultrasonography for Pneumothorax in Dogs and Cats.

A sonographic diagnosis of pneumothorax (PTX) traditionally relies on excluding the presence of lung sliding, lung pulse, and/or B lines/lung consolidations, and identifying the lung point. However, these criteria can be difficult to identify, particularly in critically ill patients with respiratory disorders, and the lung point is infrequently used. Newer sonographic findings, such as mirrored ribs, reverse lung sliding, and abnormal curtain signs, have been identified to try to increase the accuracy of diagnosing PTX. This article describes and discusses the lung ultrasonography criteria used to diagnose PTX in both human and small animal patients.

Assessment of Volume Status and Fluid Responsiveness in Small Animals.

Intravenous fluids are an essential component of shock management in human and veterinary emergency and critical care to increase cardiac output and improve tissue perfusion. Unfortunately, there are very few evidence-based guidelines to help direct fluid therapy in the clinical setting. Giving insufficient fluids and/or administering fluids too slowly to hypotensive patients with hypovolemia can contribute to continued hypoperfusion and increased morbidity and mortality. Similarly, giving excessive fluids to a volume unresponsive patient can contribute to volume overload and can equally increase morbidity and mortality. Therefore, assessing a patient's volume status and fluid responsiveness, and monitoring patient's response to fluid administration is critical in maintaining the balance between meeting a patient's fluid needs vs. contributing to complications of volume overload. This article will focus on the physiology behind fluid responsiveness and the methodologies used to estimate volume status and fluid responsiveness in the clinical setting.

Evaluation of intramuscular sodium nitroprusside injection to improve oxygenation in white-tailed deer (Odocoileus virginianus) anesthetized with medetomidine-alfaxalone-azaperone.

OBJECTIVE: In ungulates, α2-adrenergic agonists can decrease oxygenation possibly through alteration of pulmonary perfusion. Sodium nitroprusside can decrease pulmonary vascular resistance (PVR) and increase cardiac output (Q˙t) through vasodilation. The objective was to determine if sodium nitroprusside would improve pulmonary perfusion and attenuate the increased alveolar-arterial (a-a) gradient resulting from medetomidine-azaperone-alfaxalone (MAA) administration. STUDY DESIGN: Prospective, randomized, crossover study with a 2 week rest period. ANIMALS: A group of eight adult female captive white-tailed deer (Odocoileus virginianus). METHODS: Deer were administered MAA intramuscularly (IM), and auricular artery and pulmonary artery balloon catheters were placed. Deer spontaneously breathed air. Saline or sodium nitroprusside (0.07 mg kg-1) were administered IM 40 minutes after MAA injection. Heart rate (HR), mean arterial pressure (MAP), mean pulmonary arterial pressure (MPAP), pulmonary artery occlusion pressure (PAOP), right atrial pressure (RAP), Q˙t, arterial pH, PaCO2 and PaO2 were obtained immediately before nitroprusside injection (baseline) and 5, 10 and 15 minutes afterwards. Mixed venous blood samples were obtained at baseline and at 5 minutes. Systemic vascular resistance (SVR), PVR, intrapulmonary shunt fraction (Q˙s/Q˙t), a-a gradient, oxygen delivery (D˙O2) and oxygen extraction ratio (O2ER) were calculated. Statistical analysis was performed with repeated measures analysis of variance with correction factors. A p value < 0.05 was considered significant. RESULTS: With nitroprusside, MAP, MPAP, PAOP, RAP, SVR and O2ER significantly decreased and HR, Q˙t and D˙O2 increased compared with baseline and between treatments. There was a significant decrease in PVR and a-a gradient and increase in PaO2 compared with baseline and saline treatment. Changes were not sustained. CONCLUSIONS AND CLINICAL RELEVANCE: Nitroprusside temporarily changed hemodynamic variables, increased PaO2 and decreased a-a gradient. Nitroprusside possibly led to better pulmonary perfusion of ventilated alveoli. However, IM nitroprusside at this dose is not recommended because of severe systemic hypotension and short action.

The use of veterinary point-of-care ultrasound by veterinarians: A nationwide Canadian survey.

This survey assessed how veterinary point-of-care ultrasound (VPOCUS), including abdominal and thoracic focused assessment with sonography for trauma (AFAST, TFAST), is used across Canada. Seventy-four veterinarians completed an online survey; 88% (65/74) used ultrasound, 94% (61/65) performed AFAST, and 69% (45/65) performed TFAST. Reasons for not performing VPOCUS included no machine/poor quality machine, lack of experience/confidence, and lack of training/education. Abdominal effusion, and pleural and pericardial effusion were the most frequently diagnosed AFAST and TFAST pathologies, respectively. Lung and cardiovascular ultrasound examinations were infrequently performed. Subpleural consolidation was rarely included in VPOCUS. Most respondents performed VPOCUS, with AFAST being more frequently and confidently preformed than TFAST. More training, education, and standardization of techniques appear to be key elements to help build confidence and experience, particularly with regard to TFAST applications and diagnosis.

Utilisation de l'échographie au lieu d'intervention par les vétérinaires : une enquête pancanadienne. Cette enquête visait à évaluer comment l'échographie au lieu d'intervention vétérinaire (VPOCUS), incluant l'évaluation abdominale et thoracique avec l'échographe pour un trauma (AFAST, TFAST), est utilisée à travers le Canada. Soixante-quatorze vétérinaires ont complété une enquête en ligne; 88 % (65/74) utilisait l'échographie, 94 % (61/65) effectuaient AFAST et 69 % (45/65) effectuaient TFAST. Les raisons invoquées pour ne pas effectuer VPOCUS incluaient aucun appareil/équipement de pauvre qualité, manque d'expérience/confiance et manque de pratique/formation. Les effusions abdominales de même que les effusions pleurales et péricardiques étaient les pathologies AFAST et TFAST les plus fréquemment diagnostiquées, respectivement. Les examens échographiques pulmonaires et cardiovasculaires étaient effectués peu fréquemment. La consolidation sub-pleurale était rarement incluse dans les VPOCUS. La plupart des répondants réalisaient VPOCUS, avec AFAST effectué plus fréquemment et avec plus de confiance que TFAST. Plus de pratique, de formation et de standardisation des techniques semblent des éléments clés pour aider à bâtir la confiance et l'expérience, particulièrement en ce qui concerne les applications et le diagnostic des TFAST.(Traduit par Dr Serge Messier).

Intraosseous Catheter Flow Rates and Ease of Placement at Various Sites in Canine Cadavers.

Objective: To compare intraosseous catheter placement difficulty, success rates, and flow rates at four different locations in canine cadavers. Design: Prospective study. Setting: Private referral center. Animals: Eleven fresh canine cadavers. Interventions: With owner consent, animals presenting for euthanasia were recruited. Animals received heparin (1,000 IU/kg IV) at least 5 min prior to euthanasia. After euthanasia, EZIO intraosseous catheters were placed into the ilial wing, proximal medial tibia, proximal lateral humerus, and distal lateral femur on one side of the animal. Time to catheter placement and catheter difficulty were scored for each placement site. Sterile saline was infused into each location simultaneously over 5 min, first via gravity then using 300 mmHg pressure. Animals were repositioned onto the contra-lateral side and the experiment repeated. Measurements and Main Results: Placement was successful in 16/22 ilial, 18/22 tibial, and 22/22 femoral and humoral attempts. A post-hoc analysis revealed the ileum had a significantly greater difficulty score when compared to the femur and humerus (p ≤ 0.0001). The femur had a statistically significant faster placement time when compared to the ileum (p ≤ 0.05). Gravity infusion rates were statistically lower in the tibia when compared to humerus (p ≤ 0.01) and between the tibia when compared to the femur (p ≤0.001). Additionally, pressurized infusion rates were statistically lower in the tibia compared to the humerus (p ≤ 0.0001), the femur (p ≤ 0.0001), and the ileum (p ≤ 0.01). Conclusions: The femur and humerus had high success rate for IO catheter placement and low placement time and difficulty scores. Pressurized intraosseous flow rates were highest in the humerus and femur. Contrary to human literature, success rates for catheter placement in the humerus and femur were higher than at other sites, suggesting the humerus and femur may be preferred sites for intraosseous catheter placement in the dog. Further investigation through a larger sample size is required to confirm these findings.

Abnormal Curtain Signs Identified With a Novel Lung Ultrasound Protocol in Six Dogs With Pneumothorax.

Pneumothorax is typically ruled out sonographically by detecting a glide sign, lung pulse, and/or B lines, and ruled in by detecting the return of a glide sign and/or presence of a lung point. This case series describes novel lung ultrasound findings (abnormal curtain signs) in dogs with naturally-occurring pneumothorax. This case series also describes a novel lung ultrasound protocol that involves evaluating the curtain sign along the entire thoracoabdominal border and evaluating the ventral pleural space with the probe parallel to the ribs. Six dogs with pneumothorax (three traumatic pneumothorax and three spontaneous pneumothorax) had lung ultrasound performed. All dogs had normal synchronous curtain signs in the caudal mid-to-ventral region of the thorax and abnormal curtain signs in the caudal mid-to-dorsal thoracic regions. Five dogs had bilateral pneumothorax; four had a lung point and absence of a glide sign bilaterally, and one had a lung point identified unilaterally (a lung point was not visible on the opposite side and the glide sign was equivocal bilaterally). One dog had a unilateral pneumothorax, in which a lung point and absence of a glide sign were identified. With the probe parallel to the ribs in the ventral thorax, a small volume pleural effusion was also identified in two dogs. All dogs had mild to moderate quantities of pleural air removed via thoracentesis or chest tubes following lung ultrasound. Two distinct types of abnormal curtain sign were observed, referred to as the asynchronous curtain sign and the double curtain sign. The authors hypothesize that these abnormal curtain signs are caused by the presence of free air within and/or cranial to the costophrenic recess. To the authors' knowledge, this is the first description of pneumothorax-induced abnormal curtain signs, and the first report of evaluating the curtain sign to diagnose pneumothorax in any species. Further research is required to determine the sensitivity and specificity of asynchronous and double curtain signs in diagnosing pneumothorax, and to investigate whether probe orientation parallel to the ribs in the ventral thorax will improve detection of pleural effusion.

Interobserver agreement between non-cardiologist veterinarians and a cardiologist after a 6-hour training course for echographic evaluation of basic echocardiographic parameters and caudal vena cava diameter in 15 healthy Beagles.

OBJECTIVE: To evaluate cardiovascular focused assessment with sonography for trauma and triage (CV-FAST) interobserver agreement for echocardiographic parameters and caudal vena cava (CVC) diameter measurement, between a cardiologist and 2 non-cardiologists after a 6-hour training course. SETTING: University veterinary teaching hospital. ANIMALS: Fifteen healthy Beagle dogs. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Echocardiography parameters were assessed via standardized views. Caudal vena cava was assessed via a subxiphoid window (CVC-SubX) using 3 measurements (minimal and maximal CVC diameter, and collapsibility index) and via a dorsolateral window (CVC-DL) using 1 measurement (CVC diameter). Bland-Altman analysis assessed agreement of each non-cardiologist with the cardiologist; coefficients of variation (CoV) quantified variability between observers. The 95% limits of agreement (LOA) and CoVs were considered acceptable for left atrial diameter, left atrium to aortic ratio, normalized left ventricle diameter in diastole and systole but non-acceptable for fractional shortening and pulmonary vein to pulmonary artery ratio. For CVC-SubX, the 95% LOA for maximum CVC diameter were acceptable, while minimum CVC diameter and CVC collapsibility index were non-acceptable. The CoVs were good for maximum and minimum CVC (7%) and poor for collapsibility index (37%). For CVC-DL, the 95% LOA were non-acceptable, although the CoV was considered good (11%). CONCLUSIONS: A 6-hour training course in echocardiography allows non-cardiologists to assess left atrial diameter, left atrium to aortic ratio, normalized left ventricle diameter in diastole and systole, and CVCmax of the CV-FAST exam in healthy Beagles. Standardization of the CVC-SubX technique and assessment of the impact of the respiratory phase on CVC diameter in dogs is needed. Further studies are required to determine whether interobserver agreement remains acceptable when including different breeds. Assessment of basic echocardiographic parameters and the CVC to estimate volume status in small animal medicine merits further clinical evaluation.

A pilot study comparing bone marrow aspirates and venous blood for emergency point-of-care blood parameters in healthy dogs.

OBJECTIVE: To compare intravenous and intraosseous blood aspirates using point-of-care diagnostic equipment available in veterinary hospitals. DESIGN: Prospective study. SETTING: Private referral hospital. ANIMALS: Dogs undergoing a tibial plateau leveling osteotomy or extracapsular anterior cruciate ligament stabilization procedure were enrolled. METHODS: Under general anesthesia, simultaneous 0.5 mL intravenous and intraosseous blood samples were collected from the jugular vein and proximal tibia, respectively. Samples were evaluated in duplicate within 10 minutes of collection and averaged for each of the following parameters: blood urea nitrogen (BUN), glucose, packed cell volume, total plasma protein (TPP), plasma lactate, sodium, potassium, chloride, urea, glucose, pH, anion gap, pO2, and pCO2 . Normalcy was tested with Kolmogorov-Smirnov test. A Student's t-test and Bland-Altman plot were used to compare intravenous and intraosseous samples. RESULTS: Twelve dogs were recruited into the study. There were statistically significant differences between intravenous and intraosseous samples for sodium (P = 0.0216), chloride (P = 0.0225), BUN (P = 0.014), and potassium (P < 0.0001), respectively. No significant differences were detected for the other parameters evaluated. DISCUSSION: The intraosseous space provides an easily accessible, noncollapsible alternative for assessing blood parameters. Omitting potassium, the statistically significant differences noted between sites was not felt to be clinically significant. Although statistically insignificant, the large difference in hematocrit values indicates that the samples should not be used interchangeably. CONCLUSION: Intraosseous aspirates, excluding potassium and hematocrit, appear to be a reliable alternative for assessing most point-of-care analytes in healthy dogs, although a larger sample size should be investigated. The application of these data in shock patients is unknown.

Assessing the Efficacy of Ventilation of Anesthetized Neonatal Calves Using a Laryngeal Mask Airway or Mask Resuscitator.

Calves that have undergone a dystocia are often hypoxic and acidemic, which can result in reduced vigor and subsequent mortality. Methods of field resuscitation of apneic newborn calves are often ineffective and therefore underutilized. This proof-of-concept study aimed to determine the efficacy of the laryngeal mask airway (LMA) as well as the current industry standard method of ventilation, the McCulloch Calf Aspirator/ Resuscitator (MMR) for positive pressure ventilation of neonatal calves. Five LMA models of various sizes were first tested in cadaver heads to assess anatomical fit. Three LMA models in two sizes each were then tested in two anesthetized calves to determine the model best suited to ventilate calves. Next, the selected LMA and the MMR were both assessed for efficacy of ventilation. Six anesthetized calves had hypoventilation induced by administering alfaxalone intravenously. Calves were ventilated for 3 min with the LMA, allowed a brief washout period, then given a second administration of alfaxalone prior to ventilation with the MMR. Serial arterial blood gas analyses were performed prior to ventilation (baseline), at 1, 2, and 3 min during ventilation, and 1 min after ventilation had ceased. Success of ventilation was assessed by monitoring partial pressure of oxygen (PaO2), partial pressure of carbon dioxide (PaCO2), bicarbonate ( HCO 3 - ), pH, L-lactate, and hemoglobin saturation (SaO2) in arterial blood. A one-way ANOVA for repeated measures with Bonferroni correction was used to assess the efficacy of ventilation of each device compared to baseline. For the LMA, PaO2, SaO2, and pH were significantly higher than baseline throughout ventilation and PaCO2 was significantly lower than baseline at 1 min of ventilation. For the MMR, PaO2 and SaO2 were significantly higher and PaCO2 and HCO 3 - were significantly lower than baseline for 1 to 2 min of ventilation. This proof-of-concept study showed the LMA is an effective means of ventilating neonatal calves, as was the MMR.