Page 156 - Basic Monitoring in Canine and Feline Emergency Patients

Table 7.5. Indications for VetBLUE.

VetBooks.ir Indication Comment
Rapid determination of the likelihood of
Achieved via semi- quantitative assessment of the presence or
absence of ultrasound B-lines (see Fig. 7.6).
interstitial lung edema (dry versus wet
lungs) ≥3 B-lines is consistent with a ‘wet’ lung (interstitial disease)
Perform within minutes of triage assessment and either before or
after interventional procedures
Presence and distribution of B- lines may Changes potentially identified before clinical signs are appreciated
help predict early signs of left-sided Changes detected with US before pulmonary edema evident on
CHF, fluid overload, and lung injury in radiographs
at risk patients
Identify lung patterns consistent with Limited to disease located at the periphery of the lungs
pulmonary contusions or acute B-lines consistent with ‘wet’ lungs
lung injury in a dyspneic patient too
unstable for thoracic radiography
Increase or decrease clinical suspicion Lung patterns narrow down likely disease etiologies. For example:
for primary respiratory processes Aspiration pneumonia → B-lines likely appreciated in region of
such as asthma, aspiration right middle lung lobe
pneumonia, neoplasia, or pulmonary Asthma → dry lungs in all fields
thromboembolism in dyspneic patients Neoplasia → identify nodule sign or tissue sign in the affected lung
too unstable for thoracic radiography (peripheral regions)
PTE → peripheral parenchymal consolidations visible (shred or
tissue sign)
Semi-quantification of the severity of Number and distribution of B-lines at baseline and serially
pulmonary contusions
Trend in respiratory distress patients’ Serial examinations and recording the number and distribution of
response to therapy B-lines can provide tangible evidence of disease progression
Identify lung consolidation and degree of Observation of shred and tissue signs (both number and location)
consolidation allows for semi-quantification of degree of lung consolidation
Identify possible nodules Quantify and record location of nodule sign in peripheral lung
tissue
CHF, congestive heart failure; PTE, pulmonary thromboembolism; US, ultrasound; VetBLUE, veterinary beside lung ultrasound
examination.

TFAST /VetBLUE
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● ● In severely dehydrated and hypotensive patients,
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AFAST may be falsely negative. Serial AFAST While TFAST and VetBLUE are a valuable asset
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examinations are important, especially after fluid to supplement physical examination findings and
resuscitation. Typically, reassessment is recom- serially monitor pleural and pericardial space dis-
mended within four hours of fluid resuscitation, ease, there are a number of limitations. These limita-
but fluid can accumulate sooner or later than the tions include but are not limited to the following:
initial reassessment.
● ● An AFAST examination cannot reliably predict ● ● TFAST is unable to characterize the type of
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the degree of anemia in cats with blunt trauma. effusion present in either pleural or pericardial
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● ● The AFAST is less sensitive for effusion detec- effusion. Either US-guided thoracentesis or peri-
tion in penetrating trauma as compared to blunt cardiocentesis is needed to sample the fluid
trauma. found on TFAST . Samples can be analyzed
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● ● As with any US imaging, there can be artifacts cytologically and/or submitted for culture and
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during AFAST which can limited the interpreta- biochemical testing to further characterize the
tion of AFAST . See Table 7.1 for the various effusion. The reader is referred to the Further
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artifacts related to AFAST . Reading section for more information.
148 D.M. Hundley