Introducing my girl crush
If any of you have had the opportunity to listen to Elizabeth Thornovsky present, you won’t be surprised to hear that there were very few spare seats left in the lecture theatre for her session on respiratory distress in cats and dogs. Elizabeth became my girl crush for several reasons: she is clearly a very clever person, is passionate about her subject and teaching, is super lovely and made me laugh. Elizabeth divided her respiratory distress presentation by determining if the patient had an upper or lower airway condition. Common causes of upper airway disease in cats include: nasopharyngeal masses or polyps, infections and laryngeal paralysis. The top differentials in dogs include BOAS (I guess increasingly so now that Frenchies are soon going to be the most popular UK dog breed), laryngeal paralysis and tracheal collapse. For upper airway presentations, Elizabeth introduced delegates to her mnemonic ‘NOSE’ where N: noisy breathing, O: oxygen, S: sedation and (for the sake of the mnemonic!) E: entubation! One of the differentials for lower airway disease is cardiogenic where initial treatment would include frusemide. If frusemide is administered initially and after further investigation, you identify that the cause isn’t cardiogenic, Elizabeth reassured attendees that it’s ok because frusemide is a bronchodilator, but to only give one dose because it can cause dehydration. I also attended Elizabeth’s session on CPR (another well-attended session!) where Elizabeth started by explaining that cats have a slightly better survival rate than dogs, 2-10% and 3-6% respectively but the survival rate improves significantly when patients are under anaesthesia (44% in cats and 47% in dogs).
Elizabeth’s presentation focused on the Reassessment Campaign on Veterinary Resuscitation (RECOVER) guidelines for CPR in small animals. According to these guidelines, there were five ‘links’ in the different stages of CPR. The first is early recognition and preparation. Equipment must be accessible, staff must have received CPR training and the team should have had a discussion about the team dynamic, for example, who will take the lead? Top tips from Elizabeth included drug dose charts and having ET tubes with ties already on (yes! Tying ET tubes in when confronted with a stressful event is surprisingly tricky so I fully appreciated this nugget of advice!). Basic life support was the next link which consists of breathing and beating. Whilst ventilating the patient, it’s important not to overinflate or provide too many breaths because thoracic pressure is increased and cardiac output is decreased. In terms of compressions, Elizabeth advised attendees to “channel John Travolta” to keep your patient ‘Staying Alive’ (I know the grammar is terrible but hopefully you’ll forgive me for the sake of the song title!). Next up was advanced cardiac life support which includes fluid therapy and assessing the patient’s heart rhythm.
Hypovolaemic patients should be given fluid boluses (a quarter of a 90ml/kg ‘shock’ volume) and fluids should not be given to normovolaemic patients except to flush drugs. The three arrest rhythms are: asystole, pulseless electrical activity (PEA) and ventricular fibrillation. Adrenaline is the first line drug used in CPR because it causes vasoconstriction and therefore moves blood back to the heart. Lidocaine can be used to treat ventricular tachycardia and can also be used to treat ventricular fibrillation, however, defibrillation is recommended as first line treatment for ventricular fibrillation. Elizabeth explained that atropine is currently contraindicated in human CPR, but in veterinary medicine the RECOVER guidelines suggest administering one dose of atropine for PEA and asystole.
Elizabeth’s advice was that if your patient vomited or passed diarrhoea before trying to die, this would suggest a vagal episode so consider providing one dose of atropine. Ensure that the crash cart is fully stocked with reversal agents for the anaesthetic drugs used in your practice. Link four was monitoring your patient other than ‘hands on’ monitoring, ECG, capnography, electrolyte monitoring and blood gas analysis. The final link was post-resuscitation care which was beyond the scope of the session and therefore wasn’t covered. I can safely say that Elizabeth’s lectures were definitely one of the highlights of my trip to NAVC. I think I’ll have the Bee Gee’s ‘Staying Alive’ earworm with me for the rest of the day!
Thanks for making it to this point!
This is definitely the longest blog I’ve ever written. I think a supersized blog is suitable for a supersized conference. Can you believe I flew all the way to Orlando to finally meet John Chitty? It was lovely to meet him in person at the RCVS drinks reception. I demonstrated the Hololens to him and his colleagues on the BSAVA stand the following day! I was concerned about looking like a bimbo with a gadget but the Hololens is really easy to use so I demonstrated it perfectly! Phew!
I hope that you’ve found my blog useful with some handy hints and tips. I have one more for the ladies but it won’t count as CPD. I had a free day before flying back to Manchester in the evening so I decided to have a wake-boarding lesson. I watched some YouTube videos the evening before in my hotel room so I had a vague idea about what to do! I managed to stand up first time!! Beginner’s luck or YouTube videos paying off? Who cares? My instructor said that I was amazing and I was really pleased with that! Here’s my top tip for the ladies; before you take your lifejacket off, make sure everything is present and correct BEFORE unzipping your lifejacket! Before you ask, the instructor said he thought I was amazing BEFORE that happened 😉
If you have any questions about any content in this blog, please don’t hesitate to contact me for further information and I’ll try my best to help!