RECOVER Guidelines: First Aid. Evidence, Treatment Recommendations, Knowledge Gap Analysis, and Clinical Guidelines for Acute Allergy and Anaphylaxis in Dogs and Cats
JVECC. Open access
https://onlinelibrary.wiley.
These guidelines have asked questions such as: when prescribing epinephrine for anaphylaxis in hospital would an IV or IM protocol be better, concluding that IM would be advised in moderate anaphylaxis (i.e. not collapsed/hypotensive) and an IV continuous rate infusion would be advised in severe anaphylaxis (i.e. in the collapsed/hypotensive patient). Definitions provided.
Also acknowledged was the recent study we discussed, feasible adverse events with IV epinephrine protocols (extrapolated from people), and the Mink 2004 study which is a staple if you are interested in this topic. Funnily enough that Mink 2004 study was one of the first I was exposed to as an intern when my anaesthesia supervisor was teaching me his DIY epinephrine CRI recipe that I would say has saved numerous cases in our hospital. It’s still top of my “quick reference” notes.
Plenty more is covered such as options for dispensing epinephrine for prehospital IM administration when a prior anaphylaxis event has occurred (recognising that auto-injectors containing 0.15 mg epinephrine provide the IM dose of 0.01 mg/kg for a 15kg dog and the 0.3 mg pens contain the 0.01 mg/kg dose for a 30kg dog).
Carbon hemoperfusion markedly reduces serum meloxicam concentrations in dogs with meloxicam toxicosis
AJVR. Open access
https://avmajournals.avma.org/
Hemoperfusion has the wind in its sails at the moment, with one attraction being the (relative) simplicity compared to other extracorporeal techniques. Hemoperfusion enables toxin removal by adsorption as blood passes through a cartridge, without so many prescriptive changes to blood components as would happen in plasma exchange or dialytic therapies.
You can read more about hemoperfusion for toxicities in the International renal interest society best practices consensus guidelines
Assessment of Wound Healing Complications With a Lower Cost Outpatient Wound Management Protocol: A Pragmatic Randomized Clinical Trial in Dogs
JVECC
https://onlinelibrary.wiley.
This intrigued me because we were recently discussing our approaches to bite wound trauma, specifically the cases doing just fine without the extensive management that one might describe as “gold standard”. How you identify those cases is the question. I digress…
This study randomised dogs with wounds amenable to outpatient management to have two different management techniques: one with sterile gloves, no. 40 clipper blades, sterile saline, non-absorbable sutures, interrupted suture patterns and longer antimicrobial courses, or the other (low-cost) version with non-sterile gloves, no. 10 clipper blades, tap water, absorbable sutures, continuous suture patterns and shorter antimicrobial courses.
Although the infection rates (higher in the low-cost group) were the concern in this study, there were multiple ways in which the management was different between groups and I am still personally quite interested in the cases that did just fine… I’d love to read more on wound management from centres where the ‘low cost’ equivalent is simply the norm and I’m certain there is some fascinating data to be captured or highlighted.
Evaluation of Fibrinolysis by Thromboelastography in Dogs With Hemorrhagic Pericardial Effusion
JVECC
https://onlinelibrary.wiley.
This study describes hyperfibrinolysis in dogs with haemorrhagic pericardial effusions, often with hemangiosarcoma. Timescales to recurrence of pericardial effusion are highly variable but there is some data to suggest that a relevant proportion (feasibly around 20%) can re-effuse in the same hospital visit, so possibly it’s that population which is of most interest here.
RECOVER Guidelines: First Aid for Dogs and Cats. Clinical Guidelines
JVECC. Open access
https://onlinelibrary.wiley.
Some practical recommendations useful for multiple parties here. From pre-hospital advice calls, to your local dog show organisers or lay-person interest groups looking for recommendations – send them here.
Evidence and consensus-based guidelines for first aid in dogs and cats i.e. in the pre-hospital setting, including:
- Recommendations for pre-hospital cooling in heat related illness
- 20 mins of cool running water in pre-hospital management of thermal burns
- Prehospital irrigation with running water with caustic substance exposures to skin
- Back blows in suspected choking events
- Naloxone IM/IN for suspected opioid overdose
- Tourniquets when direct pressure is insufficient
And this is how the guidelines were created:
Investigation of Tartaric Acid Enantiomer-Specific Nephrotoxicity and Citrate Synthase Inhibition in Madin–Darby Canine Kidney Cells In Vitro
JVECC.
https://onlinelibrary.wiley.
For a dose of basic science with tangible clinical relevance, I can recommend this study. I will openly admit these articles take me longer to read than many, but you get a satisfying fix of biochemistry that you did learn way back when 😉 and the accomplishment of understanding it, too.
A few background points to augment your reading and interpretation:
- Tartaric acid (TTA) exists as L- and D- enantiomers but only L-TTA occurs in grapes.
- Uptake of tartaric acid from the blood into renal tubular cells might occur via OAT-1 transporters, and egress would occur via OAT-4 transporters if you were a person. Dogs don’t seem to have OAT-4 mediated efflux.
- L-TTA and oxaloacetate (a substrate in the first step of the TCA cycle…) are structurally similar and it is proposed that impaired ATP production is a mechanism of TTA-induced kidney injury in dogs as L-TTA outcompetes oxaloacetate.
- Probenecid impairs OAT-1 and could feasibly be a treatment option for tartaric acid toxicity.
- Providing the OAT-4 transporters to dog kidney cells limited the ATP depletion induced by tartaric acid.