The Experts below are selected from a list of 126 Experts worldwide ranked by ideXlab platform
Dez Hughes - One of the best experts on this subject based on the ideXlab platform.
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Veterinary Critical Care
Critical care clinics, 2003Co-Authors: K. T. T. Corley, Karol A. Mathews, Kenneth J. Drobatz, Fairfield T Bain, Dez HughesAbstract:Veterinary species experience similar perturbations of their health to those of human patients. When the long-term prognosis is good and providing suffering can be minimized, animals stand to benefit greatly from recent advances in the field of emergency and Critical Care. Outcomes in many conditions in small and large animals have improved markedly in the last 15 years, as management has improved, making the financial and emotional investment in Critical Care worthwhile for many owners.
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The diagnosis and management of acute liver failure in dogs and cats.
The Veterinary clinics of North America. Small animal practice, 1995Co-Authors: Dez Hughes, Lesley G. KingAbstract:This article reviews the diagnostic evaluation and Critical Care management necessary to optimize outcome in cases of potentially reversible, acute liver failure in dogs and cats. A definitive histopathologic diagnosis should always be pursued to allow evaluation of the reversibility of the underlying condition. Treatment of acute liver failure in dogs and cats is largely supportive and requires specific attention to each functional derangement. With the current advances in Veterinary Critical Care, improved medical and technical management of the patient with acute liver should reduce both morbidity and mortality.
Kenneth J. Drobatz - One of the best experts on this subject based on the ideXlab platform.
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Veterinary Critical Care
Critical care clinics, 2003Co-Authors: K. T. T. Corley, Karol A. Mathews, Kenneth J. Drobatz, Fairfield T Bain, Dez HughesAbstract:Veterinary species experience similar perturbations of their health to those of human patients. When the long-term prognosis is good and providing suffering can be minimized, animals stand to benefit greatly from recent advances in the field of emergency and Critical Care. Outcomes in many conditions in small and large animals have improved markedly in the last 15 years, as management has improved, making the financial and emotional investment in Critical Care worthwhile for many owners.
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Canine gastric dilatation/volvulus syndrome in a Veterinary Critical Care unit: 295 cases (1986-1992).
Journal of the American Veterinary Medical Association, 1995Co-Authors: Daniel J. Brockman, Robert J. Washabau, Kenneth J. DrobatzAbstract:Two hundred ninety-five case records were included in an analysis of dogs treated by a standardized protocol for gastric dilatation/volvulus syndrome between 1986 and 1992. A breed predisposition was demonstrated for Great Danes, German Shepherd Dogs, large mixed-breed dogs, and Standard Poodles. One hundred and ninety-three dogs had gastric dilatation and volvulus (GDV) confirmed at surgery, 66 had simple gastric dilatation (GD), and 36 others had gastric dilatation but volvulus could not be proved or disproved (GD +/- V). Among dogs with GDV, the fatality rate was 15% (29/193). Twenty-six (13.5%) dogs with GDV underwent partial gastrectomy, and 8 (31%) died or were subsequently euthanatized. In comparing the group of dogs with GDV that survived to those that died, there were no statistical differences in the age of dog, time between onset of clinical signs and admission, time from admission to surgery, or duration of anesthesia. Cardiac arrhythmias were detected in 40% (78/193) of the dogs with GDV. There also was no statistical correlation between development of a cardiac arrhythmia and outcome in dogs with GDV. The causes of death in dogs with GDV were multiple and varied; presumed gastric necrosis was a common reason for intraoperative euthanasia (11 dogs). Among dogs with GD or GD +/- V, the fatality rate was 0.9% (1/102).
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canine gastric dilatation volvulus syndrome in a Veterinary Critical Care unit 295 cases 1986 1992
Javma-journal of The American Veterinary Medical Association, 1995Co-Authors: Daniel J. Brockman, Robert J. Washabau, Kenneth J. DrobatzAbstract:Two hundred ninety-five case records were included in an analysis of dogs treated by a standardized protocol for gastric dilatation/volvulus syndrome between 1986 and 1992. A breed predisposition was demonstrated for Great Danes, German Shepherd Dogs, large mixed-breed dogs, and Standard Poodles. One hundred and ninety-three dogs had gastric dilatation and volvulus (GDV) confirmed at surgery, 66 had simple gastric dilatation (GD), and 36 others had gastric dilatation but volvulus could not be proved or disproved (GD +/- V). Among dogs with GDV, the fatality rate was 15% (29/193). Twenty-six (13.5%) dogs with GDV underwent partial gastrectomy, and 8 (31%) died or were subsequently euthanatized. In comparing the group of dogs with GDV that survived to those that died, there were no statistical differences in the age of dog, time between onset of clinical signs and admission, time from admission to surgery, or duration of anesthesia. Cardiac arrhythmias were detected in 40% (78/193) of the dogs with GDV. There also was no statistical correlation between development of a cardiac arrhythmia and outcome in dogs with GDV. The causes of death in dogs with GDV were multiple and varied; presumed gastric necrosis was a common reason for intraoperative euthanasia (11 dogs). Among dogs with GD or GD +/- V, the fatality rate was 0.9% (1/102).
Timothy B. Hackett - One of the best experts on this subject based on the ideXlab platform.
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Lactate Kinetics in Veterinary Critical Care: A Review
Journal of Veterinary Emergency and Critical Care, 1996Co-Authors: Michael S. Lagutchik, Gregory K. Ogilvie, Wayne E. Wingfield, Timothy B. HackettAbstract:Summary Elevation in blood lactate concentration, with or without accompanying metabolic acidosis, is a hallmark finding in patients with circulatory compromise, and is also consistently noted in other conditions affecting Critically ill or injured individuals. Little is reported in a Veterinary literature regarding lactate measurement in the emergency and Critical Care setting, despite impressive reports of the clinical usefulness of lactate measurement in people. The purpose of this article is to review lactate kinetics and the clinical utility of lactate measurement. Limitations to lactate evaluation will also be discussed.
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Magnesium in the 1990's: Implications for Veterinary Critical Care
Journal of Veterinary Emergency and Critical Care, 1993Co-Authors: Linda G. Martin, Wayne E. Wingfield, Deborah R. Van Pelt, Timothy B. HackettAbstract:Summary Magnesium is the second most abundant intracelular cation, exceeded only by potassium. The majority of magnesium is found in bone and muscle. This cation is required for many metabolic functions, most notably as a coenzyme for the sodium-potassium ATPase pump. Magnesium functions to maintain the electrolyte gradient across all membranes. Interference with this gradient may result in changes in the resting membrane potential and disturbances in repolarization, resulting in cardiovascular and neuromuscular abnormalities. Hypomagnesemia may be the most underdiagnosed electrolyte disorder. Incidence rates greater than 50 percent have been reported in Critically ill human patients. Currently there is little or no information available regarding the incidence and significance of hypomagnesemia in hospitalized animals. Causes of magnesium deficiency can be divided into four general categories: gastrointestinal, renal, endocrine and miscellaneous. The diagnosis of magnesium depletion can be difficult since less than one percent of total body magnesium is located in serum. Alternative methods of evaluating magnesium status include determining ultrafilterable magnesium levels, mononuclear blood cell magnesium levels or by quantifying magnesium retention of an administered loading dose.
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Application of Airway Pressure Therapy in Veterinary Critical Care: Part II: Airway Pressure Therapy
Journal of Veterinary Emergency and Critical Care, 1993Co-Authors: Deborah R. Van Pelt, Wayne E. Wingfield, Timothy B. Hackett, Linda G. MartinAbstract:Summary As the specialties of emergency medicine and Critical Care have grown and evolved in both human and Veterinary medicine, so has the need for more advanced Care of patients with primary lung disease. Treatment of acute respiratory failure has been the focus of several articles in the human medical literature of the past few years.1,8 This paper deals with airway pressure therapy and its application in cases of acute respiratory failure in Veterinary medicine. The reader is referred to part I of this paper for a reveiw of respiratory mechanics and hypoxemia as they apply to respiratory therapy.
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Application of Airway Pressure Therapy in Veterinary Critical Care: Part I: Respiratory Mechanics and Hypoxemia
Journal of Veterinary Emergency and Critical Care, 1993Co-Authors: Deborah R. Van Pelt, Wayne E. Wingfield, Timothy B. Hackett, G LindaAbstract:Summary Over the past several decades, recognition of acute respiratory failure as the cause of death in patients suffering from various clinical conditions has prompted aggressiv investigation into the area of respiratory physiology and supportive respiratory Care. With the evolution of emergency medicine and Critical Care services in both human and Veterinary medicine, many patients previously considered unsalvageable due to the severity of their underlying disease are now being resuscitated and successfully supported, creating a new population of Critically ill patients. Where only a decade ago these patients would have succumbed to their underlying disease, they now survive long enough to manifest the complications of shock and tissue injury in the form of acute respiratory failure. Investigation into the pathophysiology and treatment of this acute respiratory distress syndrom (ARDS) has facilitated increased clinical application of respiratory theerapy and machanical ventilation.1 The purpose of this paper is to provide a basic review of respiratory mechanics and the pathophysiology of hypoxemia as they relate to airway pressure therapy in Veterinary patients and to review the use of airway pressure therapy in Veterinary patients This paper is divided into two parts; part I reviews respiratory mechanics and hypoxemia as they apply to respiratory therapy, while part II deals specifically with airway pressure therapy andits use in clinical cases.
Elizabeth A Rozanski - One of the best experts on this subject based on the ideXlab platform.
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clinical application of the american college of Veterinary emergency and Critical Care acvecc consensus on the rational use of antithrombotics in Veterinary Critical Care curative guidelines to small animal cases
Journal of Veterinary Emergency and Critical Care, 2019Co-Authors: Claire R Sharp, Robert Goggs, Marieclaude Blais, Benjamin M Brainard, Daniel L Chan, Armelle M Delaforcade, Elizabeth A RozanskiAbstract:Objective To illustrate the application of the Consensus on the Rational Use of Antithrombotics in Veterinary Critical Care (CURATIVE) guidelines to the management of dogs and cats at risk of developing thrombosis using a case‐based approach. Etiology Dogs and cats become at risk of developing thrombosis from a wide range of conditions. These conditions often involve a specific insult followed by an inflammatory response and when combined with other contributing factors (eg, hypercoagulability, vascular endothelial injury, hemodynamic changes) create favorable conditions for thrombosis. Diagnosis Development of thrombosis in small animals remains challenging to demonstrate. Compatible clinical signs, the presence of known risk factors, and supporting diagnostic tests may be highly suggestive of the development of thrombosis. Therapy Therapeutic recommendations in accordance with the CURATIVE guidelines for dogs and cats are described in specific case vignettes presented. Discussion is centered on antithrombotic drug choices and dosing protocols, as outlined in Domains 2 and 3 of the CURATIVE guidelines. Where appropriate, guidelines related to therapeutic monitoring (Domain 4) and discontinuation of antithrombotics (Domain 5) were included. Prognosis In small animals at risk of developing thrombosis, overall prognosis may be improved by following consensus‐based recommendations on the use of antithrombotics as outlined in the CURATIVE guidelines. Whether such interventions have any impact on outcome requires further investigation.
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consensus on the rational use of antithrombotics in Veterinary Critical Care curative domain 1 defining populations at risk
Journal of Veterinary Emergency and Critical Care, 2019Co-Authors: Armelle M Delaforcade, Robert Goggs, Marieclaude Blais, Lenore M Bacek, Alex M Lynch, Elizabeth A RozanskiAbstract:Objectives Thrombosis is a well-recognized phenomenon in dogs and cats with a significant impact on morbidity and mortality. Despite growing awareness of thrombosis and increased use of antithrombotic therapy, there is little information in the Veterinary literature to guide the use of anticoagulant and antiplatelet medications. The goal of Domain 1 was to explore the association between disease and thrombosis in a number of conditions identified as potential risk factors in the current Veterinary literature, to provide the basis for prescribing recommendations. Design A population exposure comparison outcome format was used to represent patient, exposure, comparison, and outcome. Population Exposure Comparison Outcome questions were distributed to worksheet authors who performed comprehensive searches, summarized the evidence, and created guideline recommendations that were reviewed by domain chairs. Revised guidelines then underwent the Delphi survey process to reach consensus on the final guidelines. Diseases evaluated included immune-mediated hemolytic anemia, protein-losing nephropathy, pancreatitis, glucocorticoid therapy, hyperadrenocorticism, neoplasia, sepsis, cerebrovascular disease, and cardiac disease. Settings Academic and referral Veterinary medical centers. Results Of the diseases evaluated, a high risk for thrombosis was defined as dogs with immune-mediated hemolytic anemia or protein-losing nephropathy, cats with cardiomyopathy and associated risk factors, or dogs/cats with >1 disease or risk factor for thrombosis. Low or moderate risk for thrombosis was defined as dogs or cats with a single risk factor or disease, or dogs or cats with known risk factor conditions that are likely to resolve in days to weeks following treatment. Conclusions Documented disease associations with thrombosis provide the basis for recommendations on prescribing provided in subsequent domains. Numerous knowledge gaps were identified that represent opportunities for future study.
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consensus on the rational use of antithrombotics in Veterinary Critical Care curative domain 5 discontinuation of anticoagulant therapy in small animals
Journal of Veterinary Emergency and Critical Care, 2019Co-Authors: Benjamin M Brainard, Yekaterina Buriko, Jennifer Good, Alan Ralph, Elizabeth A RozanskiAbstract:Objectives To systematically evaluate the evidence supporting the timing and mechanisms of permanent or temporary discontinuation of antiplatelet or anticoagulant medications in small animals DESIGN: Standardized, systematic evaluation of the literature, categorization of relevant articles according to level of evidence and quality (poor, fair, or good), and development of consensus on conclusions via a Delphi-style survey for application of the concepts to clinical practice. Settings Academic and referral Veterinary medical centers. Results Databases searched included Medline via PubMed and CAB abstracts. Two specific courses of inquiry were pursued, one focused on appropriate approaches to use for small animal patients receiving antiplatelet or anticoagulant drugs and requiring temporary discontinuation of this therapy for the purposes of invasive procedures (eg, surgery), and the other aimed at decision-making for the complete discontinuation of anticoagulant medications. In addition, the most appropriate methodology for discontinuation of heparins was addressed. Conclusions To better define specific patient groups, a risk stratification characterization was developed. It is recommended to continue anticoagulant therapy through invasive procedures in patients at high risk for thrombosis that are receiving anticoagulant therapy, while consideration for discontinuation in patients with low to moderate risk of thrombosis is reasonable. In patients with thrombosis in whom the underlying cause for thrombosis has resolved, indefinite treatment with anticoagulant medication is not recommended. If the underlying cause is unknown or untreatable, anticoagulant medication should be continued indefinitely. Unfractionated heparin therapy should be slowly tapered rather than discontinued abruptly.
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american college of Veterinary emergency and Critical Care acvecc consensus on the rational use of antithrombotics in Veterinary Critical Care curative guidelines small animal
Journal of Veterinary Emergency and Critical Care, 2019Co-Authors: Robert Goggs, Marieclaude Blais, Benjamin M Brainard, Daniel L Chan, Armelle M Delaforcade, Elizabeth A Rozanski, Claire R SharpAbstract:Objectives To systematically review available evidence and establish guidelines related to the risk of developing thrombosis and the management of small animals with antithrombotics. Design Standardized, systematic evaluation of the literature (identified by searching Medline via PubMed and CAB abstracts) was carried out in 5 domains (Defining populations at risk; Defining rational therapeutic use; Defining evidence‐based protocols; Refining and monitoring antithrombotic therapies; and Discontinuing antithrombotic therapies). Evidence evaluation was carried out using Population, Intervention, Comparison, Outcome generated within each domain questions to address specific aims. This was followed by categorization of relevant articles according to level of evidence and quality (Good, Fair, or Poor). Synthesis of these data led to the development of a series of statements. Consensus on the final guidelines was achieved via Delphi‐style surveys. Draft recommendations were presented at 2 international Veterinary conferences and made available for community assessment, review, and comment prior to final revisions and publication. Settings Academic and referral Veterinary medical centers. Results Over 500 studies were reviewed in detail. Worksheets from all 5 domains generated 59 statements with 83 guideline recommendations that were refined during 3 rounds of Delphi surveys. A high degree of consensus was reached across all guideline recommendations. Conclusions Overall, systematic evidence evaluations yielded more than 80 recommendations for the treatment of small animals with or at risk of developing thrombosis. Numerous significant knowledge gaps were highlighted by the evidence reviews undertaken, indicating the need for substantial additional research in this field.
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Multiple organ dysfunction syndrome in humans and dogs
Journal of Veterinary Emergency and Critical Care, 2004Co-Authors: Valerie Johnson, Daniel L Chan, Alison Gaynor, Elizabeth A RozanskiAbstract:Objective: To describe the clinical appearance and theories on the pathogenesis of multiple organ dysfunction syndrome (MODS) in humans, and to review the evidence suggesting that a similar syndrome occurs in Critically ill dogs. Human-based studies: Currently, there are a multitude of publications describing the pathogenesis and clinical course of MODS in humans. Providing much of the basis for on-going research and the development of clinical applications, a consensus statement made by the American College of Chest Physicians and Society of Critical Care Medicine defined parameters that had guided and shaped much of what is known about MODS. Veterinary-based studies: To date, there are few publications describing MODS in dogs and much of what is known has been derived from case reports and reviews of various Critical illnesses in dogs. While a similar syndrome of multiple organ dysfunction likely exists in dogs, a consensus statement defining clinical parameters has not been made. Data sources: Veterinary and human literature review. Conclusions: The development of MODS in human Critical illness is widely recognized and major strides have been made in the understanding of this complex syndrome. Scoring schemes applied to human MODS patients have established that with increasing numbers of failing organs, there is a worse prognosis. As a similar finding likely exists in dogs, an awareness of MODS is vital to Veterinary Critical Care clinicians and a consensus definition of MODS in dogs is warranted.
Wayne E. Wingfield - One of the best experts on this subject based on the ideXlab platform.
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Lactate Kinetics in Veterinary Critical Care: A Review
Journal of Veterinary Emergency and Critical Care, 1996Co-Authors: Michael S. Lagutchik, Gregory K. Ogilvie, Wayne E. Wingfield, Timothy B. HackettAbstract:Summary Elevation in blood lactate concentration, with or without accompanying metabolic acidosis, is a hallmark finding in patients with circulatory compromise, and is also consistently noted in other conditions affecting Critically ill or injured individuals. Little is reported in a Veterinary literature regarding lactate measurement in the emergency and Critical Care setting, despite impressive reports of the clinical usefulness of lactate measurement in people. The purpose of this article is to review lactate kinetics and the clinical utility of lactate measurement. Limitations to lactate evaluation will also be discussed.
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Magnesium in the 1990's: Implications for Veterinary Critical Care
Journal of Veterinary Emergency and Critical Care, 1993Co-Authors: Linda G. Martin, Wayne E. Wingfield, Deborah R. Van Pelt, Timothy B. HackettAbstract:Summary Magnesium is the second most abundant intracelular cation, exceeded only by potassium. The majority of magnesium is found in bone and muscle. This cation is required for many metabolic functions, most notably as a coenzyme for the sodium-potassium ATPase pump. Magnesium functions to maintain the electrolyte gradient across all membranes. Interference with this gradient may result in changes in the resting membrane potential and disturbances in repolarization, resulting in cardiovascular and neuromuscular abnormalities. Hypomagnesemia may be the most underdiagnosed electrolyte disorder. Incidence rates greater than 50 percent have been reported in Critically ill human patients. Currently there is little or no information available regarding the incidence and significance of hypomagnesemia in hospitalized animals. Causes of magnesium deficiency can be divided into four general categories: gastrointestinal, renal, endocrine and miscellaneous. The diagnosis of magnesium depletion can be difficult since less than one percent of total body magnesium is located in serum. Alternative methods of evaluating magnesium status include determining ultrafilterable magnesium levels, mononuclear blood cell magnesium levels or by quantifying magnesium retention of an administered loading dose.
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Application of Airway Pressure Therapy in Veterinary Critical Care: Part II: Airway Pressure Therapy
Journal of Veterinary Emergency and Critical Care, 1993Co-Authors: Deborah R. Van Pelt, Wayne E. Wingfield, Timothy B. Hackett, Linda G. MartinAbstract:Summary As the specialties of emergency medicine and Critical Care have grown and evolved in both human and Veterinary medicine, so has the need for more advanced Care of patients with primary lung disease. Treatment of acute respiratory failure has been the focus of several articles in the human medical literature of the past few years.1,8 This paper deals with airway pressure therapy and its application in cases of acute respiratory failure in Veterinary medicine. The reader is referred to part I of this paper for a reveiw of respiratory mechanics and hypoxemia as they apply to respiratory therapy.
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Application of Airway Pressure Therapy in Veterinary Critical Care: Part I: Respiratory Mechanics and Hypoxemia
Journal of Veterinary Emergency and Critical Care, 1993Co-Authors: Deborah R. Van Pelt, Wayne E. Wingfield, Timothy B. Hackett, G LindaAbstract:Summary Over the past several decades, recognition of acute respiratory failure as the cause of death in patients suffering from various clinical conditions has prompted aggressiv investigation into the area of respiratory physiology and supportive respiratory Care. With the evolution of emergency medicine and Critical Care services in both human and Veterinary medicine, many patients previously considered unsalvageable due to the severity of their underlying disease are now being resuscitated and successfully supported, creating a new population of Critically ill patients. Where only a decade ago these patients would have succumbed to their underlying disease, they now survive long enough to manifest the complications of shock and tissue injury in the form of acute respiratory failure. Investigation into the pathophysiology and treatment of this acute respiratory distress syndrom (ARDS) has facilitated increased clinical application of respiratory theerapy and machanical ventilation.1 The purpose of this paper is to provide a basic review of respiratory mechanics and the pathophysiology of hypoxemia as they relate to airway pressure therapy in Veterinary patients and to review the use of airway pressure therapy in Veterinary patients This paper is divided into two parts; part I reviews respiratory mechanics and hypoxemia as they apply to respiratory therapy, while part II deals specifically with airway pressure therapy andits use in clinical cases.
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Respiratory and cardiopulmonary arrest in dogs and cats: 265 cases (1986-1991).
Journal of the American Veterinary Medical Association, 1992Co-Authors: Wayne E. Wingfield, D. R. Van PeltAbstract:Outcomes of cardiopulmonary arrest and resuscitation in clinically affected dogs and cats have not been adequately studied. We examined the records from 200 dogs and 65 cats that had received cardiopulmonary resuscitation for respiratory or cardiopulmonary arrest; none of the animals had been anesthetized or intubated at the time of arrest, and all had been hospitalized in a Veterinary Critical Care facility. Cardiopulmonary arrest was found to be more common than respiratory arrest in dogs and cats. Hospital discharge rates for animals with cardiopulmonary arrest ranged from 4.1% for dogs to 9.6% for cats, and were consistent with those reported from studies of human beings with cardiopulmonary arrest. Hospital discharge rates for dogs and cats with respiratory arrest were 28% and 58.3%, respectively.
