Intraobserver and interobserver reliability of standardized capillary refill time in dogs is high following observer training.

OBJECTIVE: To assess intraobserver and interobserver reliability of capillary refill time (CRT) measurement in dogs using a standardized technique after training. ANIMALS: 20 dogs presented to the emergency room. METHODS: Dogs presented to the emergency room were prospectively recruited. Using a timing device and standardized technique, CRT was measured at the oral mucosa of the inner lip. Measurements were performed by 2 emergency and critical care residents (observer 1 [Ob1] and observer 2 [Ob2]) and repeated 3 times by each observer for each dog. CRT values and signalment were recorded. Intraobserver and interobserver reliability were analyzed by calculation of the coefficient of variation (CV%), intraclass correlation coefficient (ICC), and minimal detectable difference. Reliability was considered high if CV% was lower than 10% and ICC was between 0.9 and 1. RESULTS: Median CRT for Ob1 was 1.22 seconds and for Ob2 was 1.19 seconds. Intraobserver reliability was high, evidenced by a median CV% of 6.2% (range, 1.0% to 18.6%) and 9.5% (range, 1.3% to 22.6%) and an ICC of 0.97 (95% CI, 0.94 to 0.99) and 0.95 (95% CI, 0.90 to 0.98) for Ob1 and Ob2, respectively. Between observers, the CV% was 4.4% (range, 0.8% to 17.5%) and the ICC was 0.98 (95% CI, 0.94 to 0.99), indicating high interobserver reliability. The minimal detectable differences for intraobserver and interobserver were 0.30 and 0.34 seconds, respectively. CLINICAL RELEVANCE: The reported high reliability of CRT despite its subjective nature enhances its usefulness in daily practice. However, further research on the validity of CRT is warranted.

Untargeted Analysis of Serum Metabolomes in Dogs with Exocrine Pancreatic Insufficiency.

Exocrine pancreatic insufficiency (EPI) is a malabsorptive syndrome resulting from insufficient secretion of pancreatic digestive enzymes. EPI is treated with pancreatic enzyme replacement therapy (PERT), but the persistence of clinical signs, especially diarrhea, is common after treatment. We used untargeted metabolomics of serum to identify metabolic disturbances associated with EPI and generate novel hypotheses related to its pathophysiology. Fasted serum samples were collected from dogs with EPI (n = 20) and healthy controls (n = 10), all receiving PERT. Serum metabolomes were generated using UPLC-MS/MS, and differences in relative metabolite abundances were compared between the groups. Of the 759 serum metabolites detected, 114 varied significantly (p < 0.05, q < 0.2) between dogs with EPI and healthy controls. Differences in amino acids (arginate, homoarginine, 2-oxoarginine, N-acetyl-cadaverine, and α-ketoglutaramate) and lipids (free fatty acids and docosahexaenoylcarnitine) were consistent with increased proteolysis and lipolysis, indicating a persistent catabolic state in dogs with EPI. Relative abundances of gut microbial metabolites (phenyllactate, 4-hydroxyphenylacetate, phenylacetyl-amino acids, catechol sulfates, and o-cresol-sulfate) were altered in dogs with EPI, consistent with disruptions in gut microbial communities. Increased kynurenine is consistent with the presence of intestinal inflammation in dogs with EPI. Whether these metabolic disturbances participate in the pathophysiology of EPI or contribute to the persistence of clinical signs after treatment is unknown, but they are targets for future investigations.

Veterinary Education's Role in the Opioid Epidemic: Integration of an Online Safe Opioid Prescribing Course into the Core Curriculum.

As the COVID-19 pandemic continues, the opioid epidemic has worsened. Opioid-related deaths continue to rise, and many of these deaths can be traced to a prescription opioid. Because veterinarians prescribe opioids, many organizations and federal agencies have called for increased veterinary education on the topic. In this teaching tip, we review the current literature surrounding the veterinary profession's link to the opioid epidemic and one potential way that educational institutions can successfully and efficiently incorporate safe opioid prescribing training into the curriculum using an online course.

Longitudinal analysis of the rectal microbiome in dogs with diabetes mellitus after initiation of insulin therapy.

There have been numerous studies in humans and rodents substantiating the role of the gastrointestinal microbiome in the pathogenesis and progression of both type 1 and type 2 diabetes mellitus. Diabetes mellitus is a common endocrinopathy in dogs; however, little is known about the composition of the gut microbiome during the development and treatment of diabetes in this species. The objective of this pilot study was to characterize the gastrointestinal microbiome of dogs with diabetes mellitus at the time of diagnosis and over the first 12 weeks of insulin therapy and identify associations with glycemic control. Rectal swabs and serum for fructosamine measurement were collected from 6 newly diagnosed diabetic dogs at 2-week intervals for 12 weeks. Rectal samples were sequenced using 16S, ITS, and archaeal primers. Measures of alpha and beta diversity were assessed for changes over time; associations between absolute sequence variant (ASV) relative abundances and time and fructosamine concentration were identified using a microbiome-specific, multivariate linear effects model. No statistically significant changes over time were noted in alpha diversity and samples significantly grouped by dog rather than by time in the beta diversity analysis. However, multiple ASVs were negatively (Clostridium sensu stricto 1, Romboutsia, Collinsella) and positively (Streptococcus, Bacteroides, Ruminococcus gauveauii, Peptoclostridium) associated with time and two ASVs were positively associated with fructosamine (Enterococcus, Escherichia-Shigella). These changes in gastrointestinal microbial composition warrant further investigation of how they may relate to diabetes mellitus progression or control in dogs.

Toxidromes for Working Dogs.

Terrorist attacks with biological and chemical warfare agents are increasing in frequency worldwide. Additionally, hazardous chemical accidents, illicit drug laboratories and intentional poisonings are potential sites for exposure to working dogs. Working dogs play a crucial role in law enforcement, military and search and rescue teams. Their intelligence, agility and strength make them ideal partners to be deployed to these natural disaster sites, terrorist attacks and industrial accidents. This, unfortunately, leads to increasing exposure to chemical and biological weapons and other hazardous substances. First responders have little to no training in emergency care of working dogs and veterinarians have very little training on recognition of the clinical signs of many of these agents. In order to ensure a rapid medical response at the scene first responders and veterinarians need a primer on these agents. Identifying a specific agent amidst the chaos of a mass casualty event is challenging. Toxidromes are a constellation of clinical and/or laboratory findings that allow for rapid identification of the clinical signs associated with a class of toxin and have been helpful in human medical triage. Focusing on a class of agents rather than on each individual toxin, allows for more expedient administration of antidotes and appropriate supportive care. This article reviews toxidromes for the most common chemical weapons with a special emphasis on clinical signs that are specific (and different) for canines as well as appropriate antidotes for working canines. To our knowledge, there are no publications describing toxidromes for working dogs.

Case Report: Successful Intravenous Lipid Emulsion Therapy for Canine Amphetamine Toxicosis.

A 4-year-old, female-spayed, mixed breed dog, weighing 24.2 kg, was presented for acute ingestion of ~12.3 mg/kg of Adderall XRⓇ, an extended-release amphetamine medication. In dogs, the oral median lethal dose for amphetamines ranges anywhere from 9-11 mg/kg to 20-27 mg/kg. On presentation, the patient was agitated, tachycardic and hypertensive. Initial treatment was instituted with intravenous lipid emulsion (IVLE) therapy, and baseline and post-treatment amphetamine concentrations were quantified in serum and plasma. In both serum and plasma, post-IVLE concentrations of amphetamine were lower 1 h after treatment and IVLE was the only treatment instituted during this time. The dog improved significantly while in hospital and was discharged <24 h after presentation. This is the first known reported use of IVLE for treatment of amphetamine toxicosis with documented decreases in both serum and plasma amphetamine levels shortly after administration of IVLE.

Resolution of Severe Neurologic Signs Following Intravenous Lipid Emulsion Therapy in a Young Dog With a Portosystemic Shunt: Case Report.

A 5-month-old male intact Great Pyrenees was presented for an acute onset of severe neurologic signs (stupor, absent menace, intermittent head turn to the left). The patient's history included possible naproxen ingestion with a maximum ingested dose of 59 mg/kg, exceeding the reported dose of >50 mg/kg known to cause neurologic signs. Blood sampling for baseline bloodwork was performed, and intravenous lipid emulsion (ILE) was subsequently administered, for treatment of the suspected toxicosis. Due to severe and life-threatening neurologic signs, other methods of decontamination were contraindicated and unlikely to be effective; extracorporeal therapy was also unavailable. Complete resolution of neurologic signs occurred 30 min after completion of ILE therapy. At this time, the owners found the missing naproxen tablets after returning home and the bloodwork results returned revealing findings consistent with hepatic encephalopathy. The fasted blood ammonia concentration immediately prior to ILE administration was 702.1 µg/dL (reference interval, RI: 24-36 µg/dL) and decreased to 194.1 µg/dL 24 h later. In the first 24 h, the patient also received three doses of lactulose, N-acetylcysteine, and intravenous fluids. The patient was subsequently diagnosed with a single, large intrahepatic portosystemic shunt via computed tomography and underwent an endovascular coil embolization procedure. Given the rapid and dramatic improvement in severe neurologic signs after ILE therapy alone, it is strongly suspected that this treatment resulted in improvement of hepatic encephalopathy.

Current Rules and Regulations for Dogs Working in Assistance, Service, and Support Roles.

The legal landscape for dogs working in assistance, service, and support roles is complicated and contradictory. Regulations permit access to public places, allow subsets of dogs' emergency transport and treatment, provide elevated protections for K-9s and assistance animals from criminal acts, and make it a crime to fraudulently represent a service animal. Federal and state agencies provide different regulations for dogs to access public places. Identification and verification of the working animal are not standardized. Working dog legislation is a changing landscape that requires veterinarians to be up to date on laws and regulatory guidance.

Assistance, Service, Emotional Support, and Therapy Dogs.

This article focuses on the areas where harnessing the canine's trainability, mobility, and sociability enables their use for aiding and augmenting humans. This area, which is rapidly expanding, has provided life-changing solutions for persons affected by various impairments and disabilities (eg, visual, hearing, physical, mental).

EMS Safety and Prehospital Emergency Care of Animals.

Emergency Medical Services (EMS) personnel frequently encounter animals in situations ranging from injured law enforcement canines (LEK9s) to pets with smoke inhalation injury. In recent years, several US states have enacted laws that legally allow EMS personnel to provide basic emergency care to certain animals. Currently, nine states allow some type of emergency medical treatment and/or ambulance transport of animals by EMS, and five states limit liability for vehicle damage resulting from rescuing animals trapped inside. Despite this expanding body of legislation encouraging EMS to assist animals, EMS personnel are not typically trained in the safe handling or medical treatment of animals. Interaction with veterinary patients can pose serious injury and infectious disease risks to untrained EMS personnel. Furthermore, relationships with veterinarians must be built and treatment and transport protocols must be developed for EMS agencies to appropriately care for these animals. This report serves as an initial framework from the veterinary perspective for EMS consideration regarding current legislation, safety concerns, transport protocols, and common life-saving treatments in the prehospital emergency care of animals. Increased collaboration between EMS personnel and veterinary professionals provides an opportunity to develop quality training programs for EMS and to improve disaster preparedness of the whole community.

Use of a Multimodal, Peer-to-Peer Learning Management System for Introduction of Critical Clinical Thinking to First-Year Veterinary Students.

Veterinary medical students need multiple thinking strategies, particularly critical thinking. We used a multimedia, peer review learning management system (CGScholar) to introduce a series of complex, realistic, case-based e-learning modules to help introduce critical thinking to 422 first-year veterinary students through instructor-designed clinical cases. Students developed and published on the CGScholar platform an analysis of a case and conducted anonymous peer reviews of each other's drafts. Instructors selected desirable characteristics of a student's activity to track and provide automatic feedback to students via an analytics dashboard and aster plot that allowed visualization of progress. The dashboard also enabled instructors to view the entire class's performance, highlighting students whose performance was lagging. Online interactions were supplemented by case-specific face-to-face workshop sessions. Our goal was to address the following questions: Does the addition of multimedia to a work (one's own or others') enhance people's ability to understand and convey the material? Does peer review (of one's own and others' work) lead to improvements in the writer's own work? Does the peer review process enhance the writer's understanding of what constitutes high-quality literature evidence? An anonymous student survey showed that experience was significantly more positive in the second and third year of implementation after inclusion of explicit guidance on the use of the rubric for peer review. Overall, 67% of students thought inclusion of multimedia enhanced their ability to communicate and 52% agreed multimedia enhanced their ability to understand their peers' analyses, but students were split on benefits to their understanding of high-quality literature.

Small Animal Transfusion Medicine.

Transfusion medicine can be a lifesaving intervention. Component therapy has expanded the availability and blood products available. Patient safety and minimizing risk is important and can be accomplished through proper donor screening, collection, storage, compatibility testing, administration, and monitoring. The pros and cons of available products must be considered and tailored to each individual patient. Recent discoveries include new antigens and blood types, microbial effects on blood type, and the association between blood type and disease prevalence.

Development of a Training Program for Law Enforcement K9 Handlers to Administer Naloxone.

As the opioid epidemic continues across the United States, law enforcement K9s (LEK9s) are at increased risk of accidental exposure and overdose. This study evaluated a novel training program teaching handlers to administer naloxone to their LEK9 in the event of an overdose. Seventy-five LEK9 handlers from a governmental agency attended a naloxone training session. A presurvey given to the handlers evaluated their knowledge of opioid overdose in LEK9s and their confidence administering naloxone. Officers were educated via a PowerPoint presentation about naloxone and how to administer it to their LEK9. A postsurvey evaluated changes in their knowledge and confidence as a result of the presentation. Sixty-two presurveys and 47 postsurveys were completed. Nearly all handlers had never given their LEK9 an intramuscular or intranasal injection. Most handlers were not comfortable monitoring their LEK9's vital signs for an opioid overdose. After the training, handlers demonstrated a mild increase in comfort level administering intramuscular and intranasal naloxone (15 and 14% increase, respectively). Comfort level monitoring vital signs and symptoms of an opioid overdose increased 38 and 32%, respectively. Handlers may not be fully prepared to assess and treat their LEK9 and may benefit from a targeted training program teaching them to administer naloxone.

Noise-Induced Hearing Loss in 3 Working Dogs.

Three working dogs were diagnosed with noise-induced hearing loss following exposure to loud noise. Physical and neurologic examinations in each case revealed no significant findings. Brainstem auditory evoked response (BAER) demonstrated bilateral sensorineural deafness. One dog did not regain hearing but continued working with adjusted protocols utilizing hand signals. One dog was lost to follow-up. The last dog was treated with oral Vitamin B complex (daily), Vitamin E (400 IU daily), and N-acetyl-cystine (600 mg daily) and regained hearing 2 months later, based on repeat BAER testing.

Development and validation of a multivariate predictive model to estimate serum ionized calcium concentration from serum biochemical profile results in cats.

BACKGROUND: Measurement of serum ionized calcium is not always available in practice. Total calcium (tCa) might not be reliable for determination of calcium status in cats. OBJECTIVES: To predict serum ionized calcium concentration from signalment, biochemistry profile and T4, and compare predicted ionized calcium (piCa) to tCa. ANIMALS: A total of 1701 cats from two hospitals. METHODS: Cross-sectional study. Cats with serum ionized calcium, biochemistry profile and T4 available were screened over 6 years and included in the training set (569 cats) to create a multivariate adaptive regression splines model to calculate piCa. Diagnostic performances of tCa and piCa and its prediction interval (PI) were compared in 652 cats from the same institution (test set) and 480 cats from a different hospital (external set). RESULTS: The final model included tCa, chloride, albumin, cholesterol, creatinine, BUN, body condition score, GGT, age, and potassium. For hypercalcemia, piCa was highly specific (test set: 99.8%; confidence interval [CI]: 99.5-100; external set: 97%; CI: 95.3-98.7) but poorly sensitive (test set: 30.4%; CI: 18.3-42.4; external set: 42.5%; CI: 31.7-53.3). For hypocalcemia, piCa was also highly specific (test set: 81.6%; CI: 78-85; external set: 99.6%; CI: 99-100) but poorly sensitive (test set: 57.6%; CI: 50.6-64.6; external set: 0%). These diagnostic performances were comparable to those of tCa. The upper and lower limits of piCa PI had high sensitivity for detecting ionized hypercalcemia and hypocalcemia, respectively. CONCLUSIONS AND CLINICAL IMPORTANCE: Predicted ionized calcium is useful to confirm suspected hypercalcemia in cats and screen for hypercalcemia and hypocalcemia.

The Carle-Illinois (Urbana, Illinois USA) Transport Protocol for LEK9s: Guidelines for Emergency Medical Service Providers.

Three states and one county now allow Emergency Medical Services (EMS) providers to transport injured law enforcement K9s (LEK9s) as long as no human needs the ambulance at the time. Several other states either have pending legislation or are in discussions about this topic. As additional states ponder these laws, it is likely that the EMS transport of LEK9s will become legal in many states. In the wake of this legislation, a significant void was created. Currently, there are no published protocols for the safe transport of LEK9s by EMS providers. Additionally, the transport destination for these LEK9s is unlikely to be programmed into vehicle Global Positioning Systems. The authors of this report convened a Joint Task Force on Working Dog Care, consisting of veterinarians, EMS directors, EMS physicians, and LEK9 handlers, who met to develop a protocol for LEK9s being transported to a veterinary facility. The protocol covers the logistics of getting the LEK9 into the ambulance (eg, when the handler is or is not available), appropriate restraint, and the importance of prior arrangements with a veterinary emergency facility. A LEK9 hand-off form and a Transport Policy Form are provided, downloadable, and customizable for each EMS provider. This protocol provides essential information on safety and transport logistics for injured LEK9s. The hope is that this protocol will assist EMS providers to streamline the transport of an injured LEK9 to an appropriate veterinary facility.

The Carle-Illinois (Urbana, Illinois USA) Treatment Protocol for Law Enforcement K9s: Guidelines for Emergency Medical Services.

This document is a resource for Emergency Medical Services (EMS) treating an injured law enforcement K9 (LEK9) in the field and/or during transport by ambulance to a veterinary hospital. A Joint Task Force on Working Dog Care was created, which included veterinarians, EMS directors, EMS physicians, and canine handlers, who met to develop a treatment protocol for injured LEK9s. The protocol covers many major life-threatening injuries that LEK9s may sustain in the line of duty, and also discusses personnel safety and necessary equipment. This protocol may help train EMS providers to save the life of an injured LEK9.