Page 160 - Basic Monitoring in Canine and Feline Emergency Patients

3
A repeat AFAST in 2 hours shows accumulation of
SR view 0/4 fluid within the DH view. An US-guided abdomino-
VetBooks.ir HR 3 0/4 centesis yields fluid that is submitted for a fluid
0/4
CC view
analysis, a total bilirubin level, and cytology. The
TFAST /
VetBLUE Right Left cytology shows biliary crystals and degenerate neu-
trophils. Abdominal total bilirubin is 35 mg/dL
CTS Glide sign + Glide sign + (normal 0.1–0.8 mg/dL). Given the bile crystals
<3 B-lines <3 B-lines and the comparative abdominal:serum total biliru-
Pericardial site No evidence of No evidence of bin ratio of >2, the peritoneal effusion is consistent
pericardial pericardial with bile peritonitis. As her hemodynamic status is
effusion effusion stable, Brindy undergoes an abdominal exploratory
Symmetrical surgery and cholecystectom. She is treated aggres-
atrial sizes. sively within the intensive care unit for three days
An estimated prior to dismissal to her family.
LA:Ao ratio is 1
DH As above in AFAST 3
Caudodorsal Glide sign + Glide sign + 7.6 Summary
lung lobe <3 B-lines <3 B-lines Ultrasound has many applications for veterinary
region emergency and critical care cases. Through ade-
Perihilar lung Glide sign + Glide sign + quate training and consistent applications of
lobe region <3 B-lines <3 B-lines AFAST , TFAST , and VetBLUE, a non-radiologist
3
3
Middle lung lobe Glide sign + Glide sign + clinician can gather information to help diagnose
region <3 B-lines <3 B-lines and treat his patients. Clinicians also have the
Cranial lung lobe Glide sign + Glide sign + potential to serially track changes that can increase
region <3 B-lines <3 B-lines sensitivity for detecting dynamic changes in the
critically ill patient.
+, positive; AFAST , abdominal focal assessment
3
sonographically for trauma/triage/tracking; CC, cystocolic; CTS,
chest tube sites; DH, diaphragmaticohepatic; HR, hepatorenal;
3
SR, splenorenal; TFAST , thoracic focal assessment Abbreviations
sonographically for trauma/triage/tracking; US, ultrasound.
3
AFAST , abdominal focal assessment sonographi-
cally for trauma/triage/tracking; CC, cystocolic
Brindy’s blood pressure improves to a systolic view; COAST , cage-side organ assessments for
3
pressure of 95 mmHg on Doppler and her tempera- trauma triage and tracking; CTS, chest tube site;
ture improves to 98.7ºF (37.06ºC). Her blood glu- CVC, central venous catheter; DH, diaphragmatico-
cose improves to 90 mg/dL. At that time, her hepatic view; HR, hepatorenal view; PCS, pericar-
remaining dehydration deficit is corrected over 12 dial site; SR, splenorenal view; TFAST , thoracic
3
hours with a 2.5% dextrose continuous rate infu- focal assessment sonographically for trauma/triage/
sion. Her vitals are closely monitored for decline. tracking; US; ultrasound; UST, ultrasound-guided
Blood work returns and Brindy has an inflamma- technique; VetBLUE, veterinary beside lung ultra-
tory leukogram with a degenerate left shift, she is sound examination.
hemoconcentrated, and has a thrombocytosis. Her
PT/aPTT are within normal limits and the ammo-
nia is normal. She has a severe cholestatic pattern Further Reading
with a total bilirubin of 13, is mildly azotemic,
hypoglycemic, and has a 13 mg/dL (normal 0.1–08 Campbell, M.T., Macintire, DK. (2012) Catheterization of
mg/dL) mildly elevated albumin. These findings are the venous compartment. In: Burkitt Creedon, J.M.,
suggestive for possible peritonitis. At this time there Davis, H. (eds) Advanced Monitoring and Procedures
is no free fluid to corroborate this suspicion. for Small Animal Emergency and Critical Care. WB
Saunders Co, Chichester, UK, pp. 51–68.
She is admitted to the ICU with serial vital moni- DeFrancesco, T. (2014) Focused or COAST-ECHO(Heart).
toring, frequent weights, and urine collection and In: Lisciandro, G. (ed.) Focused Ultrasound
quantification. She is started on pain medications, Techniques for the Small Animal Practitioner. Wiley
broad spectrum antimicrobials, and anti-emetics. and Sons, Ames, Iowa, USA, pp. 40–164.

152 D.M. Hundley