Veterinary Emergency Medicine Research Articles

Use of an Escape Room Experience in Emergency Veterinary Medicine Education.

Escape room experiences have been used as an educational tool in several health professions, and to the authors' knowledge, it is not yet documented in veterinary medicine. They are an example of gamification in a simulated environment where course objectives guide puzzle development. Veterinary emergency medicine can be very stressful as veterinarians often have to make quick decisions. The element of a time limit adds stress to the experience as learners must complete the puzzles within a specified time to successfully escape the room. This article describes the development and delivery of an escape room experience in emergency veterinary medicine to third year students at the Western College of Veterinary Medicine at the University of Saskatchewan. In a survey following the experience, learners indicated they enjoyed participating in the learning activity. They felt it encouraged the use of communication, collaboration, and leadership skills which have been identified as core competencies in veterinary education. While on average learners would disagree with the experience being stressful, several commented that it was a "good stress". This indicates that the experience may have been considered challenging to learners, which in simulation, supports a positive way to achieving learning objectives that may not overstress participants.

252: ECONOMIC EUTHANASIA IN DOGS REQUIRING EMERGENCY SURGERY INCREASED DURING THE COVID-19 PANDEMIC

Introduction: ‘Economic euthanasia’, defined as euthanasia of pets due to financial constraints despite treatable illness, is common in veterinary emergency medicine. Gastric dilatation-volvulus (GDV) in dogs is inexpensive to diagnose and has a high survival rate with corrective, but costly, surgery. Without surgery, GDV is lethal. The proportion of dogs with GDV euthanized pre-surgery emerged as a reliable metric of economic euthanasia. If the COVID-19 pandemic aggravated economic distress in dog owners compromising their ability to afford pet healthcare, an increase in pre-surgical euthanasia in dogs with GDV would be expected. We hypothesized that in dogs with GDV, the risk of pre-surgical euthanasia during the COVID-19 pandemic increased compared to such risk before the pandemic. Methods: In this case-control study, we included non-referred dogs with GDV that presented to 11 US veterinary hospitals. Dogs were cases if they were euthanized pre-surgery, and controls if they underwent surgical treatment. Exposure positive dogs were those presenting during the initial surge of unemployment due to COVID-19 (March 16 - July 5 2020), exposure negative dogs were those during the same period in 2019. Univariate analyses and binary logistic regression models were developed to quantify the association between COVID-19 status (present, absent) and euthanasia risk, adjusting for the effect of known confounders. The significance level was set at p < 0.05. Results: We recorded 118 dogs with GDV over the 2 time periods, with 30% of non-exposed and 52% of exposed pets being euthanized pre-surgery (OR, 2.6; 95% CI, 1.2-5.4). After adjusting for age, breed, comorbidities and recumbency, the odds of euthanasia for dogs presenting during COVID-19 were 2.7 (95% CI 1.1 to 6.3) times those of dogs presented in 2019. Old age (OR, 2.6; 95% CI, 1.1 to 6.1), but no other explanatory variables, were associated with pre-surgical euthanasia. Conclusions: Our findings show that in this study population, dogs with GDV presented in the period March 16 to July 5 2020 had a greater risk of euthanasia compared with dogs presented in the same period the year before. It is our inference that economic consequences arising from the COVID-19 pandemic directly impacted on the level of veterinary care owners were able to provide for their pets.

Aspectos epidemiológicos de 306 casos emergenciais em pequenos animais atendidos em um Hospital Escola Veterinário

The deficiencies in the screening protocols and the paucity of epidemiological studies aimed at emergency care contribute to a generalist emergency approach, without focusing on the most common causes and injuries of emergency admissions in veterinary practice. Thus, we aimed to retrospectively study the epidemiological aspects of emergency cases in dogs and cats under routine care at a veterinary school hospital at University X over 24 months (June 2012–June 2014). During this period, 328 cases were considered as emergencies, of which 306 were included in the study. The main causes of emergency admissions in both species were trauma, followed by hypovolemic shock. The third cause differed between species, the most common being neurological emergencies in dogs and urinary emergencies in cats. Knowledge of emergency epidemiological data in the pet clinic is essential for clinical surveillance, case screening, early diagnosis, rapid therapeutic intervention, and avoiding losses in the waiting rooms of veterinary emergency medicine.

The Effect of Pet Insurance on Presurgical Euthanasia of Dogs With Gastric Dilatation-Volvulus: A Novel Approach to Quantifying Economic Euthanasia in Veterinary Emergency Medicine.

Euthanasia of companion animals in veterinary emergency medicine is a common cause of death. Euthanasia is economic when it is the consequence of the pet owner's inability to afford essential treatment while a viable medical alternative to euthanasia exists. Gastric dilatation-volvulus (GDV) is an acute life-threatening emergency condition of dogs; if left untreated, rapid death is highly likely. Surgical treatment leads to survival of around 80-90% of dogs; however, such treatment is costly. Therefore, pre-surgical euthanasia may be largely economically motivated. Having pet insurance, a financial instrument to reduce the burden of unforeseen veterinary medical costs on pet owners, would be expected to abolish the risk for pre-surgical economic euthanasia. We therefore aimed to determine whether pet insurance attenuates the risk of pre-surgical economic euthanasia in dogs with GDV. Non-referred dogs (n = 260) with GDV and known insurance status seen at 24 emergency clinics over a 2-year period were included. Relevant data (e.g., insurance status, age, comorbidities, outcome) were retrospectively extracted from a pet insurer's claim records (insured animals) or from electronic medical records of participating hospitals (non-insured animals). Forty-one percent of dogs (106 of 260 dogs) did not survive to hospital discharge; 82 (77%) of non-survivors died before surgery, all through euthanasia. The pre-surgical euthanasia rate was 10% in insured and 37% in non-insured dogs (p < 0.001). When adjusted for the effect of age, deposit size, comorbidities, and blood lactate concentration, the absence of insurance increased the odds of pre-surgical euthanasia by a factor of 7.4 (95% CI 2.0 to 37; p = 0.002). Of dogs undergoing surgery, 86% survived to hospital discharge. Overall, 80% of insured animals and 53% of non-insured animals survived to hospital discharge (p < 0.001). Thus, insurance was associated with a marked decrease in risk of pre-surgical euthanasia indicating that the cause of pre-surgical euthanasia of dogs with GDV is predominantly economic in nature. The rate of pre-surgical euthanasia in dogs with GDV may emerge as a suitable marker to quantify economic decision making of pet owners and to measure the impact of financial interventions aimed at mitigating economic duress associated with cost of veterinary emergency care.

Chloride:Sodium Ratio May Accurately Predict Corrected Chloride Disorders and the Presence of Unmeasured Anions in Dogs and Cats.

Disorders of chloride and mixed acid–base disturbances are common in veterinary emergency medicine. Rapid identification of these alterations and the presence of unmeasured anions aid prompt patient assessment and management. This study aimed to determine in dogs and cats if site-specific reference values for [Cl−]:[Na+] ratio and [Na+] − [Cl−] difference accurately identify corrected chloride abnormalities and to evaluate the predictive ability of the [Cl−]:[Na+] ratio for the identification of unmeasured anions. A database containing 33,117 canine, and 7,604 feline blood gas and electrolyte profiles was generated. Institution reference intervals were used to calculate site-specific reference values for the [Cl−]:[Na+] ratio and the [Na+] − [Cl−] difference. Contingency tables were used to assess the ability of these values to correctly identify corrected chloride disorders. Unmeasured anions were estimated by calculating strong ion gap (SIG). Continuous variables were compared using the Mann–Whitney U test. Correlations between continuous variables were assessed using Spearman’s rho (rs). In dogs, site-specific reference values for the [Cl−]:[Na+] ratio correctly identified 94.6% of profiles as hyper-, normo-, or hypochloremic. For dogs with normal sodium concentrations, site-specific reference values for the [Na+] − [Cl−] difference correctly identified 97.0% of profiles. In dogs with metabolic acidosis (base deficit > 4.0), [Cl−]:[Na+] ratio and SIG were moderately but significantly negatively correlated (rs −0.592, P < 0.0001). SIG was significantly greater in dogs with metabolic acidosis and hypochloremia compared to those without hypochloremia (P < 0.0001). In cats, site-specific reference values for the [Cl−]:[Na+] ratio correctly identified 93.3% of profiles as hyper-, normo-, or hypochloremic, while site-specific reference values for [Na+] − [Cl−] difference correctly identified 95.1% of profiles. In cats with metabolic acidosis [Cl−]:[Na+] ratio and SIG were moderately significantly negatively correlated (rs −0.730, P < 0.0001). SIG was significantly greater in cats with metabolic acidosis and hypochloremia compared to those without hypochloremia (P < 0.0001). Site-specific values for [Cl−]:[Na+] ratio and [Na+] − [Cl−] difference accurately identify corrected chloride disorders in both dogs and cats and may aid identification of the presence of unmeasured anions.

Infectious agent screening in canine blood donors in the United Kingdom

Transfusion of blood products is an important component of veterinary emergency medicine. Donors must be carefully selected to minimise risk of transmission of blood-borne infectious agents. This study was devised to assess the prevalence of such agents in healthy, non-travelled UK dogs screened as prospective donors. Ethylenediaminetetraacetic acid blood samples from dogs donating blood between August 2007 and January 2012 were screened by polymerase chain reaction for haemotropic mycoplasmas, Bartonella, Babesia, Leishmania, Ehrlichia and Anaplasma spp. Dogs with positive or inconclusive results underwent repeat polymerase chain reaction testing. Four of 262 dogs had positive or inconclusive results at initial screening. Repeat polymerase chain reaction testing in each dog was negative, and none of the dogs developed clinical signs of disease. The positive results on initial screening may have represented false positives from sample contamination or amplification of non-target DNA. It is also possible that dogs were infected at initial sampling but successfully cleared infection before repeat testing. The low number of positive results obtained suggests that prevalence of these agents in a population of healthy UK dogs is low and that use of blood products is unlikely to represent a significant risk of transmission of these diseases.

The Use of IV Lipid Emulsion for Lipophilic Drug Toxicities

IV lipid emulsion (ILE) therapy is emerging as a potential antidote for lipophilic drug toxicities in both human and veterinary medicine. ILE has already gained acceptance in human medicine as a treatment of local anesthetic systemic toxicity, but its mechanism of action, safety margins, and standardized dosing information remains undetermined at this time. Experimental and anecdotal use of ILE in the human and veterinary literature, theorized mechanisms of action, current dosing recommendations, potential adverse effects, and indications for use in human and veterinary emergency medicine are reviewed herein.

Emergency management of the acute abdomen in dogs and cats

MANAGEMENT of an animal with an acute abdomen presents one of the greatest challenges in veterinary emergency medicine. This clinical syndrome has a large number of possible causes, many of...