Page 158 - Basic Monitoring in Canine and Feline Emergency Patients

sal and middle lung lobes which could be sugges-
AFAST 3 tive of pulmonary bleeding or other pulmonary
VetBooks.ir DH view 0/4 within the abdominal cavity interstitial disease. Additionally, the irregular hypo-
echoic changes in the pleural spaces are consistent
Positive race-track sign is seen
and there appears to be
cardial effusion without evidence of tamponade.
irregular triangles of anechoic with pleural effusion and he has evidence of peri-
fluid within the pleural Given that he is showing signs of active hemor-
space rhage, is clinical for his anemia, and has altered
SR view 0/4 secondary hemostasis, he is a good candidate for
CC view 0/4 fluids and a whole blood transfusion.
HR view 0/4 Cash receives a whole blood transfusion. At
TFAST /VetBLUE Right Left completion of the transfusion, a US-guided thora-
3
centesis is performed and is consistent with hemor-
CTS Glide sign + Glide sign + rhage. Based on these findings, Cash likely
<3 B-lines <3 B-lines
consumed vitamin K antagonist (anticoagulant)
Pericardial site Pericardial Pericardial rodenticide and has subsequent pulmonary paren-
effusion without effusion chymal, pleural space and pericardial space hemor-
diastolic Pleural rhage. He is started on vitamin K. Cash continues
compression of effusion to improve after his transfusion and within 36
the right atrium
hours is discharged to the care of his family.
DH As above in AFAST
Caudodorsal lung >3 B-lines >3 B-lines Case study 2: AFAST/TFAST/VetBLUE
lobe region bilaterally bilaterally
applications in an acutely
Perihilar lung lobe Glide sign + Glide sign + dyspneic patient
region <3 B-lines <3 B-lines
Middle lung lobe >3 B-lines >3 B-lines Indy, a 5-year-old male domestic shorthair cat, was
region presented to the emergency department for evalua-
Cranial lung lobe >3 B-lines >3 B-lines tion of changes in breathing character at home.
region Small amount of Small amount Indy is an indoor only cat and has 12 housemates
pleural effusion of pleural that are up to date on vaccines and preventative
effusion medications. Over the last month his owner has
been diffusing the house with cinnamon essential
3
+, positive; AFAST , abdominal focal assessment
sonographically for trauma/triage/tracking; CC, cystocolic; CTS, oils daily and has historically smoked within the
chest tube sites; DH, diaphragmaticohepatic; HR, hepatorenal; home throughout Indy’s life. His owner has noted
SR, splenorenal; TFAST , thoracic focal assessment that Indy has had a rapid respiratory rate over the
3
sonographically for trauma/triage/tracking; US, ultrasound. last 24 hours; he became worse acutely this evening
when she attempted to nebulize Indy with the cin-
3
3
At completion of the AFAST /TFAST /VetBLUE namon essential oils.
assessment, results of the PCV/TS/lactate and PT/ On examination, Indy is open mouth breathing
aPTT have arrived. The results are 14% / 3.0 mg/ with a respiratory rate of 90 bpm. He has signifi-
dL / 5.0 mmol/L (normal values 35–45% / cant expiratory effort and his breathing is shallow.
4.5–6 mg/dL / <2.0 mmol/L) for PCV/TS/lactate, With exertion a dry cough is seen. His mucous
respectively. Both the PT and aPTT are prolonged. membranes are pale and auscultation is difficult as
Cash is showing signs of active hemorrhage due to he is vocalizing and thrashing.
his low total protein and PCV. His elevated lactate Indy is placed into oxygen with an FiO of 40% and
2
3
shows that he is currently undergoing anaerobic a bit later is able to tolerate a TFAST /VetBLUE assess-
3
metabolism. This is likely due to a combination of ment. Below is his TFAST /VetBLUE assessment:
hypovolemic and hypoxemic shock resulting in
inadequate oxygen delivery to his tissues. He is TFAST /VetBLUE Right Left
3
showing evidence of secondary hemostasis abnor-
malities with his prolonged PT and aPTT values. CTS Glide sign + Glide sign +
He has evidence of wet lungs within his caudodor- <3 B-lines <3 B-lines

150 D.M. Hundley