Veterinary Emergency & Critical Care

VECCS=Veterinary Emergency and Critical Care Society; VECC=Veterinary Emergency & Critical Care. Core objective: rapid stabilization, resuscitation, and monitoring of life-threatening conditions in animals. ABCs of triage: Airway, Breathing, Circulation. Triage protocols: VECCS 4-tier system (1=immediate, 4=non-urgent). Primary survey: assess mentation, mucous membrane (MM) color, capillary refill time (CRT), heart rate (HR), respiratory rate/effort (RR/RE), temperature, pulse quality. Shock states: hypovolemic (most common), distributive (e.g., septic, anaphylactic), cardiogenic, obstructive (e.g., pericardial effusion, GDV), and relative (e.g., anemia). Shock indicators: tachycardia, prolonged CRT (>2 sec), hypotension (MAP <60 mmHg), cool extremities, altered mentation. Fluid therapy: crystalloids (e.g., LRS, 0.9% NaCl) first-line; colloids (e.g., Hetastarch, Voluven) for refractory hypotension. Fluid rates: shock doses (dogs: 80–90 mL/kg/hr; cats: 50–60 mL/kg/hr), titrate to response. Use of CVP (central venous pressure) and lactate clearance to guide resuscitation. Vasopressors: dopamine, norepinephrine, epinephrine for septic/cardiogenic shock. Inotropes: dobutamine for low cardiac output. Oxygen supplementation: NC (nasal cannula), flow-by, O2 cage, VNI (ventilatory non-invasive support), intubation + MV (mechanical ventilation). Indications for intubation: apnea, GCS<8 (modified), severe hypoxemia, airway obstruction. ET tube size: (age/2)+30 for dogs, 3.0–3.5 Fr for cats. Monitoring: ECG, NIBP (non-invasive BP), IBP (invasive BP), SpO2, ETCO2, BG (blood glucose), lactate, electrolytes, PCV/TS, ABG/VBG. Common emergencies: GDV (gastric dilatation-volvulus), acute abdomen, trauma (RTC, falls), toxin ingestion (NSAIDs, xylitol, rodenticides), status epilepticus, urethral obstruction (FLUTD in cats), DKA (diabetic ketoacidosis), anaphylaxis, cardiopulmonary arrest. GDV: medical stabilization (decompress via trocar/NG tube, IVF, pain control), surgical correction. Trauma: AFAST (abdominal FAST), TFAST (thoracic), CT preferred for CNS injury. Neurologic emergencies: elevated ICP managed with mannitol (0.5–1 g/kg IV), hypertonic saline, SIB (sedation, intubation, ventilation). Status epilepticus: diazepam (0.5 mg/kg IV), levetiracetam, phenobarbital, midazolam CRI. UTI/obstruction: urethral catheterization (8–12 Fr tomcat), analgesia (buprenorphine), SPC (suprapubic cystostomy) if refractory. DKA: IVF (0.9% NaCl), insulin (regular, 0.1 U/kg/hr CRI), K+ supplementation, monitor BG, anion gap, ketones. Anaphylaxis: epinephrine (0.01 mg/kg IM), diphenhydramine, fluids, oxygen. CPR: RECOVER Initiative guidelines. Basic life support: C-A-B (Compressions-Airway-Breathing). Compression depth: 1/3–1/2 thoracic width; rate: 100–120/min. IV/IO access, epinephrine (0.01 mg/kg IV/IO q3–5min), vasopressin alternative. Post-ROSC care: optimize CPP (cerebral perfusion pressure), avoid hyperoxia/hypoglycemia, therapeutic hypothermia (controversial). Nutrition in ICU: early enteral feeding (within 24–48 hr) via NG, NE, or PEG tube; parenteral nutrition if GI contraindicated. Analgesia: multimodal—opioids (fentanyl, methadone), NSAIDs (if renal perfusion adequate), local blocks, ketamine CRI. Sepsis: qSOFA analogs under study; treat with source control, broad-spectrum ABX (e.g., piperacillin-tazobactam, amikacin), immunomodulation. ICU-acquired weakness: minimize sedation, physical therapy. Prognostic indicators: lactate >5 mmol/L, base deficit <−10, prolonged hypotension, multiorgan dysfunction. Point-of-care tools: POC lactate, blood gas, glucose, coagulation (TEG/ROTEM). Transfusion medicine: PCV <20% or clinical signs of anemia; FFP for coagulopathy, cryoprecipitate for hypofibrinogenemia. Ethical considerations: DNR orders, client communication during crises, resource allocation. Current SoA: goal-directed therapy, lung-protective ventilation (6–10 mL/kg tidal volume), conservative fluid strategies post-resuscitation, use of biomarkers (e.g., procalcitonin, NT-proBNP). Pitfalls: delayed triage, fluid overload (esp. in cats), misinterpreting CRT in anemic patients, inadequate pain control, premature extubation, poor glucose monitoring in DKA, underestimating sepsis severity. Emerging: ECMO (limited centers), tele-ICU, AI-driven predictive analytics for deterioration. Species-specific nuances: feline sensitivity to fluids and drugs (e.g., acetaminophen), brachycephalic airway emergencies, reptile/amphibian critical care requiring temp/humidity control.