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In this episode I am joined by my friends and colleagues, Stacey Davidson and Ru Clements of VetLed, to discuss the role of Quality Improvement (QI) in improving patient care.
We discuss what QI is and why you should be engaged with it. We also talk about the role of human factors and workplace culture in QI.
A description of many of the terms used in the episode can be found at the website here.
Apologies for the sometimes crackly sound quality on this episode.
VetLed Facebook page
Veterinary Human Factors private Facebook group started by VetLed
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This episode is focused on sepsis. I also talk about the relevance of the glycocalyx. And emphasise how much extrapolation there is from human medicine to veterinary practice.
Topics covered include:
Long-standing sepsis definitions and recently suggested updates History of sepsis management in human medicine; including early-goal directed therapy and Surviving Sepsis Campaign Recent large scale human trials: ProCESS (USA), ARISE (Australasia), ProMISe (UK) Key steps for managing the septic veterinary patient The glycocalyx: what it is, what it does, why it is relevant, implications for practiceClick Here For Your FREE Copy of a Transcript of This Episode
Click Here for Show Notes
To find out more about my Small Animal Emergency Medicine App (iOS, Android) click here. -
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Although feline hypertension may be a rare reason for emergency presentation, it is a condition that most small animal practitioners will have encountered both in routine practice and in critical care patients.
This episode is based on the 2017 ISFM* Consensus Guidelines on the Diagnosis and Management of Hypertension in Cats which were recently published in the Journal of Feline Medicine and Surgery. The episode discusses the following points:
Evidence base behind the Guidelines Secondary versus primary hypertension Target organ damage Monitoring and Underdiagnosis Which cats to monitor blood pressure in Importance of ensuring blood pressure is measured as accurately as possible with a reproducible technique White coat hypertension Defining normal blood pressure Criteria for therapeutic intervention and appropriate therapeutic targets What treatment to use Emergency treatment
[*International Society of Feline Medicine]The episode is based on:
ISFM Consensus Guidelines on the Diagnosis and Management of Hypertension in Cats. J Fel Med Surg 2017. 19:288–303.
Click Here For Your FREE Copy of a Transcript of This Episode
For show notes for this episode, click here.
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Hepatic encephalopathy is a relatively common condition in dogs and to a lesser extent in cats. It is a disorder that all clinical veterinary staff, and especially those working in Emergency and Critical Care, should be aware of.
This episode is based on a review article and covers the pathogenesis, clinical presentation, diagnosis, and management of hepatic encephalopathy in dogs and cats including comparisons with human medicine.
The episode is based on:
Lidbury JA, Cook AK, Steiner JM. Hepatic encephalopathy in dogs and cats. J Vet Emerg Crit Care 2016. 26 (4):471-487.
Click Here For Your FREE Copy of a Transcript of This Episode
For episode show notes click here.
For my Small Animal Emergency Medicine App on iOS click here. Android version coming out in early-mid 2017.
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Activated charcoal is a widely used therapy, especially in dogs, to facilitate gastrointestinal decontamination following toxin ingestion. Points covered in this episode include:
A reminder about what activated charcoal is and how it is meant to work Comments about the use of activated charcoal as a therapy contrasting human and veterinary medicine Contraindications and adverse effects Timing of administrationClick Here For Your FREE Copy of a Transcript of This Episode
Click Here For SHOW NOTES of This Episode
Click Here For Small Animal Emergency Medicine APP
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On this episode of the podcast I am joined by Kim Sheader (MSCP HCPC ACPAT Cat A, Chair ACPAT, RAMP), Chartered Veterinary and Human Physiotherapist, to discuss physiotherapy for the critical inpatient. Kim is a highly qualified and experienced physiotherapist and currently works with The Ralph Mobile Physiotherapy & Rehabilitation service.
I start by finding out about Kim’s background, training and experience in human and more recently veterinary physiotherapy. We then go on to discuss:
Physiotherapy for the critical patient with prolonged recumbency Physiotherapy for the dog with moderate-to-severe tetanus Respiratory physiotherapy, a subject about which Kim is especially passionateTo contact Kim please email her at [email protected] or message her via The Ralph MPRS website www.theralphphysio.vet.
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On this episode of the podcast I am joined by Rene Agredano and Jim Nelson of Tripawds, “the world's largest support community for animal amputees”, to discuss how we as veterinary staff can be better prepared to help clients with dogs and cats that are either facing or have had a limb amputation.
After some background discussion of the Tripawds resource, we discuss:
Ethical and moral considerations carers may have around amputation Steps carers can take to prepare for their amputee dog or cat returning home for the first time Client concerns about when their pet will be normal again, pain management, and the surgical incisionThe following links were mentioned in the episode:
Tripawds - Help For Three Legged Dogs And Cats
The Tripawds charitable foundation
Tripawds on YouTube
Tripawds Downloads
The PBS Show that Rene mentions, “Why we love dogs and cats”
The Tripawds blog by an ECC vet: Hank the Tank
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Anaemia in critically ill cats; severe anaemia in blocked tomcats; spinal shock in dogs; haemorrhagic GI disease in veterinary ICUs. In this episode of the podcast I discuss a few papers from the latest issue of the Journal of Veterinary Emergency and Critical Care (JVECC) that especially caught my eye, in particular as they relate to primary care practice and not just referral centres.
The four papers in question are:
Balakrishnan A, Drobatz KJ, Reineke EL. Development of anemia, phlebotomy practices, and blood transfusion requirements in 45 critically ill cats (2009–2011). J Vet Emerg Crit Care 2016. 26(3):406-411. Beer KS, Drobatz KJ. Severe anemia in cats with urethral obstruction: 17 cases (2002–2011). J Vet Emerg Crit Care 2016. 26(3):393-397. Full AM, Barnes Heller HL, Mercier M. Prevalence, clinical presentation, prognosis, and outcome of 17 dogs with spinal shock and acute thoracolumbar spinal cord disease. J Vet Emerg Crit Care 2016. 26(3): 412–418. Swann JW, Maunder CL, Roberts E, et al. Prevalence and risk factors for development of hemorrhagic gastro-intestinal disease in veterinary intensive care units in the United Kingdom. J Vet Emerg Crit Care 2016. 26(3): 419–427.Remember as always that what I don’t tend to do in these podcasts is to provide an in-depth evidence-based appraisal of the papers I mention. So I continue to encourage you to get in touch for copies of the papers if you do not have access to JVECC and to read and critique the papers yourself. Don’t just take what the abstract says or indeed what I say here at face value!
Click Here For Your FREE Copy of a Transcript of This Episode
For SHOW NOTES for this episode click here.
And be sure to check out the Veterinary Small Animal Emergency Medicine App. -
Antimicrobial resistance is said to be one of the greatest challenges currently facing small animal veterinary medicine. How can we become part of the solution rather than part of the problem?
In this episode of the podcast I start by providing a brief refresher of bacteriology and antibacterials before going on to discuss antimicrobial stewardship in an episode that is derived from this review article:
Guardabassi L, Prescott JF. Antimicrobial Stewardship in Small Animal Veterinary Practice: From Theory to Practice. Vet Clin N Am – Sm Anim Prac 2015. 45(2):361–376.
Areas covered include:
Defining the problemWhat is antimicrobial stewardship?Antimicrobial stewardship strategiesDeveloping and implementing guidelinesGeneral (generic) guidelines for rational antibiotic useRole of the microbiology laboratory
Click here for SHOW NOTES for this episode.Click Here For Your FREE Copy of a Transcript of This Episode
And be sure to check out the Veterinary Small Animal Emergency Medicine App.
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In this episode of the podcast I am joined by Enid Traisman M.S.W., CT, CFS to discuss issues around emotional well-being in veterinary practice.
Enid is the Director of Pet Loss Support Services at Dove Lewis, a non-profit emergency animal hospital in Portland, Oregon in the USA.
Topics that we discuss in this episode include the following; where appropriate we talk about prevention, recognition and coping strategies:
Pet loss griefWhen veterinary staff have to deal with loss of their own companion animalsCompassion fatigue and burnoutWorkplace stress and emotional challenges of the veterinary professionDuring the episode Enid mentions creating a memorial table at work when a staff member loses a pet. You can find Enid’s overview of the pet memorial table concept and a list of other REALLY USEFUL RESOURCES, both provided by Enid and some others, HERE.
Find contact details for Enid here on the Dove Lewis website.And don’t forget to check out the Small Animal Emergency Medicine app for iOS devices here. Android version to follow soon!
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In this episode of the podcast I take a look at magnesium and its role in clinical practice, something which many people may not be very familiar with. The episode is based on the following article:
Humphrey S, Kirby R, Rudloff E. Magnesium physiology and clinical therapy in veterinary critical care. J Vet Emerg Crit Care 2015.
Areas covered include:Background theoryMeasuring magnesiumMagnesium disordersTreatmentClick Here For Your FREE Copy of a Transcript of This Episode
For SHOW NOTES for this episode see Here.
And don't forget to check out my Small Animal Emergency Medicine App - currently for iPhone and iPad; Android version out soon!
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HORMONAL SEIZURES, IV POTASSIUM SUPPLEMENTATION, ICU SOUND LEVELS, BRAIN TUMOURS AND IMHA!
In this episode of the podcast I discuss some of the papers that were published in the Journal of Veterinary Internal Medicine during 2015. Remember that this journal is now freely available via open online access.
The papers I mention are as follows:
Van Meervenne SAE, Volk HA, Van Ham ML. Association between Estrus and Onset of Seizures in Dogs with Idiopathic Epilepsy. J Vet Int Med 2015. 29(1):251-253.
Hoehne SN, Hopper K, Epstein SE. Accuracy of Potassium Supplementation of Fluids Administered Intravenously. J Vet Int Med 2015. 29(3):834-839.
Fullagar B, Boysen SR, Toy M, et al. Sound Pressure Levels in 2 Veterinary Intensive Care Units. J Vet Int Med 2015. 29(4):1013-1021.
Hu H, Barker A, Harcourt-Brown T, Jeffery N. Systematic Review of Brain Tumor Treatment in Dogs. J Vet Int Med 2015. 29(6):1456-1463.
Goggs R, Dennis SG, Di Bella A, et al. Predicting Outcome in dogs with Primary Immune-Mediated Hemolytic Anemia: Results of a Multicenter Case Registry. J Vet Int Med 2015. 29(6):1603-1610.
...and don't forget my SMALL ANIMAL EMERGENCY MEDICINE APP FOR IPHONE AND IPAD - Android version in development!
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**Apologies for the less than optimal sound quality of this episode and the non-stereo recording!**
Dog bite injuries are a relatively common problem to be faced with in small animal practice. In this episode of the podcast I am joined by Nicola Kulendra, a European specialist in small animal surgery, to discuss their management. Some of the points we discuss include:
Adhering to standard ECC principles in terms of initial stabilisation and analgesiaThe mechanics of dog bites and the ‘tip of the iceberg’ conceptExploring bite injuries to uncover their true extent; the role of diagnostic imagingThe importance of wound drainageBacterial involvement and the use of antimicrobialsThe ‘two hit theory’ in cats with moderate-to-severe dog bite injuriesThe ‘big dog, little dog’ phenomenoniPhone/iPad users see HERE for my Small Animal Emergency Medicine app for iOS; Android version is in development.
[This podcast is closely aligned with the MedEdLIFE Research Collaborative’s Quality Checklist for Podcasts.]
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In this episode I am joined by Liz Hughston and Charlotte Rosenthal, both specialist ECC nurses from the USA, to discuss patient handovers/rounds.
We start with a brief introduction to both my guests and then go on to discuss questions such as:
What is the basic purpose of handover?Separate rounds for nurses and vets, or combined?Strategies for doing an efficient and effective handoverKeys bits of information to communicateThis is the first episode in this podcast series to feature guests - please let me know what you think!
Twitter: @VetEmCC
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Dogs and cats with acute liver failure may present as emergencies and be critically ill. In this episode of the podcast I discuss this condition based on a recent review article from the Journal of Veterinary Emergency and Critical Care*.
(*Weingarten MA, Sande AA. Acute liver failure in dogs and cats. J Vet Emerg Crit Care 2015. 25(4):455-473.)
Topics covered include:
Injury versus failureCausesClinical findingsDiagnosisTreatment including managing complicationsPrognosisClick Here For Your FREE Copy of a Transcript of This Episode
For SHOW NOTES visit the website HERE.
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Traumatic brain injury (closed head trauma) is relatively common in dogs and especially cats, often following motor vehicle collision. A rational approach to management is essential to try and maximise the chances of a successful outcome.
In this episode of the podcast I discuss traumatic brain injury focusing on key aspects of management and touching on some potentially contentious issues. Areas covered include:
The need to prioritise potentially life-threatening problems that may be extra-cranialPrimary (already happened) versus secondary (aim to minimise) brain injuryEnsuring adequate oxygenation and ventilationEnsuring adequate cerebral perfusionAddressing raised intracranial pressure including hypertonic saline vs. mannitol; furosemide?The importance of analgesiaSteroids?Relevance of hyperglycaemia?PrognosticationClick Here For Your FREE Copy of a Transcript of This Episode
For show notes for this episode go to the website HERE.
Get your FREE one page summary of TBI management
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In this episode of the podcast I discuss an approach to the early management of dyspnoeic cats that is predicated on ‘first do no harm’ and thinking risk-benefit at all times. The main take-home messages from the episode are:
Appreciate that dyspnoeic cats can be very vulnerable and easily tipped over the cliff edge.Even more so than normal, pay acute attention to the risk-benefit assessment at all times.Understand that each cat is clearly going to be an individual patient with their own set of circumstances and behaviour, but that a hands-off, slow, staged approach is likely to be the least risky and most beneficial in most cases.Continue to improve your ability and confidence in examining these cases paying attention to trying to anatomically localise the cause of the dyspnoea; this will allow you to make the most sensible decisions in terms of how to help the patient.Don’t be in a hurry to x-ray dyspnoeic cats until and unless you feel like you have done all you can to make them as stable as possible beforehand.And, lastly engage more with POCUS, point-of-care ultrasound, if you are not already.Click Here For Your FREE Copy of a Transcript of This Episode
For SHOW NOTES for this episode click HERE.
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In this episode of the podcast I discuss two papers from the Journal of the American Veterinary Medical Association in 2015. The first is on post-operative regurgitation and vomiting (PORV) in dogs and the second is on lactate in cats. To end the podcast I mention a letter-to-the-editor case report from Veterinary Anaesthesia and Analgesia, also in 2015, which describes a complication of oesophagostomy tube placement in a cat with a cuffed endotracheal tube.
For abstracts and references, visit the website HERE.
Click Here For Your FREE Copy of a Transcript of This Episode
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Critically ill patients almost by definition have a number of different problems and management considerations. They can be high maintenance requiring intensive care and it is easy to accidentally overlook different aspects of their care; this is especially the case when you are looking after more than one critically ill patient and/or working in an otherwise busy practice environment.
Using some form of checklist on a daily basis is a quick and easy way of being reminded of all the different aspects of the care of critically ill patients and hopefully minimises how often treatment considerations are overlooked and sub-optimal care provided.
In this episode I discuss my version of a daily checklist for critically ill patients including aspects such as monitoring, analgesia, nursing care and non-clinical considerations.
To download a COPY OF THE CHECKLIST for free and a TRANSCRIPT of the episode. visit the website HERE.
You can also get a copy of the checklist by directly going to this link.
Click Here For Your FREE Copy of a Transcript of This Episode
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The shock index is equal to heart rate divided by systolic arterial blood pressure. It has received a fair amount of attention in the human medicine literature being evaluated for example in haemorrhagic hypovolaemic shock, especially post-traumatic, sepsis and obstetric patients, and for correlation for example to length of hospital stay and mortality. There is very little clinical veterinary information on the shock index.
In this episode I discuss what the shock index is, the parameters that are included in the shock index, the potential value of the shock index, some of the human medicine studies, and the following two canine studies:
Porter A, Rozanski E, Sharp C, et al. Evaluation of the shock index in dogs presenting as emergencies. J Vet Emerg Crit Care 2013. 23(5):538–544.
Peterson KL, Hardy BT, Hall K. Assessment of shock index in healthy dogs and dogs in hemorrhagic shock. J Vet Emerg Crit Care 2013. 23(5):545-550.
For show notes for this episode and a full list of all papers that informed or were mentioned in this episode, see HERE.
Click Here For Your FREE Copy of a Transcript of This Episode
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