The use of a Foley balloon catheter to control junctional hemorrhage in a dog with severe vascular injury secondary to penetrating trauma.

INTRODUCTION: Penetrating trauma is commonly seen in dogs. The severity depends on the site of injury and tissue involved. Junctional hemorrhage can be especially challenging to control given the inaccessibility of the damaged vasculature. Methods described to control life-threatening hemorrhage in dogs include direct pressure, hemostatic gauze, hemostatic powder or granules, wound packing, tourniquets, and direct clamping of the vasculature. Foley balloon catheters (FBC) are commonly used to tamponade deep vascular hemorrhage in people, but the technique has not been previously described in the veterinary literature. OBJECTIVE: To present a case of penetrating trauma (bite wound) in a dog with a transected left femoral artery and vein in which the life-threatening hemorrhage was initially controlled with tamponade using an FBC. CASE: A 7-year-old neutered male Terrier mix presented in hemorrhagic shock with an Animal Trauma Triage (ATT) of 7 and modifed Glasgow coma scale (MGCS) of 17 forty-five minutes after being attacked by another dog. The dog had sustained a deep penetrating wound to the left groin. Direct pressure and gauze packing at the site of injury were not successful at slowing the hemorrhage. A 10-Fr, 55-cm Foley catheter with a 5-mL balloon was inserted into the wound tract, and the balloon was inflated with 7.5 mL of sterile saline. Hemorrhage was controlled after inflation of the Foley balloon. CBC, blood biochemistries, abdominal point-of-care ultrasound, radiographs, prothrombin time, partial thromboplastin time, and whole blood viscoelastic testing were performed. Stabilization included fluid resuscitation, analgesics, antimicrobials, and epsilon aminocaproic acid. The dog was then anesthetized to definitively identify and control the hemorrhage. Transection of the left femoral artery and vein where identified and ligated. The dog fully recovered and was discharged 32 hours later. NEW AND UNIQUE INFORMATION: FBCs may be useful as an alternative technique for temporary control of life-threatening hemorrhage secondary to penetrating injuries in both the emergency department and prehospital settings.

Successful cardiopulmonary resuscitation following cardiopulmonary arrest in a geriatric chinchilla.

OBJECTIVE: To describe the successful application of CPR in a geriatric chinchilla employing basic and advanced life support measures during cardiopulmonary arrest (CPA). CASE SUMMARY: A 13-year-old female intact chinchilla presented to a general and multispecialty referral hospital for a dental procedure. During recovery from anesthesia the patient suffered CPA and CPR was initiated. Noninvasive positive pressure mask ventilation was initiated and external chest compressions were performed. An 18-Ga needle was introduced into the medullary cavity of the right humerus as an intraosseous catheter and provided access for administration of drugs and fluids. After return of spontaneous circulation was noted mannitol was administered via the intraosseous catheter to alleviate suspected increased intracranial pressure. Clinical improvement was noted shortly after administration. Monitoring during the recovery period showed a normal sinus cardiac rhythm and a SpO2 of 100% while on supplemental oxygen. Neurologic function continued to improve over the following hours. Oxygen therapy was provided via an oxygen cage, and administration of antimicirobials, gastrointestinal protectants, and nutritional supplementation were part of the post resuscitation care. Oxygen therapy was discontinued after 24 hours, during which time normal behaviors were observed and neurologic status was considered appropriate. The patient was discharged 48 hours after CPA. NEW OR UNIQUE INFORMATION PROVIDED: Published reports from clinical practice on the outcomes of CPR for exotic small mammals are limited. This report details the successful outcome of the use of combined basic and advanced life support measures for the provision of CPR in a chinchilla. This report also highlights the utility of an intraosseous catheter for administration of drugs and fluids novel to this species during resuscitation and recovery. To the authors' knowledge this is the first published report of successful CPR following CPA in a geriatric chinchilla.

The ubiquitous role of zinc in health and disease.

OBJECTIVE: To review zinc physiology and pathophysiology and the importance of zinc toxicity and deficiency in veterinary patients. DATA SOURCES: A review of human and veterinary medical literature. HUMAN DATA SYNTHESIS: There is a significant amount of original research in humans and animals on the role of zinc in multiple organ systems. There is also significant data available on human patients with zinc abnormalities. VETERINARY DATA SYNTHESIS: Zinc deficiency has been studied in dogs with genetic disease and dietary deficiency leading to dermatological disease and immune deficiency. Zinc toxicity has been described after ingestion of metallic foreign bodies containing zinc. CONCLUSIONS: Historically, the role of zinc in health and disease has been studied through patients with toxicity or severe deficiency with obvious clinical signs. As the ubiquitous contribution of zinc to structure and function in biological systems was discovered, clinically significant but subtle deficiency states have been revealed. In human medicine, mild zinc deficiencies are currently thought to cause chronic metabolic derangement leading to or exacerbating immune deficiency, gastrointestinal problems, endocrine disorders, neurologic dysfunction, cancer, accelerated aging, degenerative disease, and more. Determining the causal relationships between mild zinc deficiency and concurrent disease is complicated by the lack of sensitive or specific tests for zinc deficiency. The prevalence of zinc deficiency and its contribution to disease in veterinary patients is not well known. Continued research is warranted to develop more sensitive and specific tests to assess zinc status, to determine which patients are at risk for deficiency, and to optimize supplementation in health and disease.

Thrombin physiology and pathophysiology.

OBJECTIVES: To review the role of thrombin in physiology and clinical disease and to discuss the pharmacology of antithrombosis. DATA SOURCES: Original research articles, scientific reviews, textbooks. HUMAN DATA SYNTHESIS: Thrombin and thrombin receptors are involved in a variety of physiologic and pathologic processes resulting in a great deal of interest in thrombin-related pharmacologic intervention. VETERINARY DATA SYNTHESIS: Although there is little clinical research data available on thrombin specifically in veterinary patients, some of the original research on protease activated receptors was performed at veterinary institutions and many of the human molecular biology studies have been done on animals including dogs. CONCLUSION: Thrombin plays a significant role in coagulation, anticoagulation, and fibrinolysis. Antithrombotic treatment is focused on preventing thrombosis while maintaining hemostasis. Pharmaceutical agents are selected for the specific component of the coagulation pathway associated with a specific disease process, for a proven prophylactic benefit with procedures that carry a risk of thromboembolism, for rapidity of onset and ease of reversibility, for limited monitoring requirements, and for oral formulation and bioavailablity. Recent insight into other aspects of thrombin physiology presents an opportunity for pharmacologic intervention in a variety of other processes such as inflammation and sepsis, peripheral blood cell activation and chemotaxis, vascular endothelial and smooth muscle activity, cellular development and tissue repair, mitogenesis, neoplasia, and the function of nervous tissue following injury.

Histamine: metabolism, physiology, and pathophysiology with applications in veterinary medicine.

OBJECTIVE: To review the human and veterinary literature on histamine physiology and pathophysiology and potential applications for clinical use in veterinary critical care. DATA SOURCES: Human and veterinary clinical studies, reviews, texts, and recent research in histamine receptor and antagonist therapy. HUMAN DATA SYNTHESIS: Recent progress in molecular biology has led to a more complete understanding of the enzymes involved in histamine metabolism and histamine receptor physiology. The past decade of research has confirmed the role of histamine in the classical functions (contraction of smooth muscle, increase in vascular permeability, and stimulation of gastric acid secretion) and has also elucidated newer ones that are now under investigation. Data on the roles of histamine in angiogenesis, circadian rhythm, bone marrow regeneration, bacterial eradication, and cancer are emerging in the literature. Newer histamine antagonists are currently in drug trials and are expected to advance the clinical field in treatment of allergic, gastrointestinal, and cognitive disorders. VETERINARY DATA SYNTHESIS: Veterinary histamine research is directed at identifying the effects of certain pharmacological agents on blood histamine concentrations and establishing the relevance in clinical disease states. Research demonstrates important species differences in regards to histamine receptor physiology and tissue response. Studies in the area of trauma, sepsis, anaphylaxis, allergy, and gastrointestinal disorders have direct applications to clinical veterinary medicine. CONCLUSIONS: Histamine plays a key role in the morbidity and mortality associated with allergy, asthma, gastric ulcers, anaphylaxis, sepsis, hemorrhagic shock, anesthesia, surgery, cardiovascular disease, cancer, CNS disorders, and immune-mediated disease. Histamine antagonism has been in common use to block its adverse effects. With recent advances in the understanding of histamine receptor physiology, pharmaceutical agents targeting these receptors have increased the therapeutic options.