Large Animal Emergency Large Animal Emergency and Critical Care serviceand Critical Care service

LA ECC- HistoryLA ECC- History

• In 2002, a plan was developed by the In 2002, a plan was developed by the equine sections to establish an equine sections to establish an independent service dedicated to independent service dedicated to Equine Emergency and Critical CareEquine Emergency and Critical Care– Faculty dedicated to ECC- interest and Faculty dedicated to ECC- interest and

expertiseexpertise– Alleviate schedule disruptionAlleviate schedule disruption– Improve student teachingImprove student teaching– Improve student scheduleImprove student schedule– Decrease faculty after hours time Decrease faculty after hours time

commitment commitment

LA ECC- HistoryLA ECC- History

• GoalGoal– 3 faculty positions3 faculty positions

•1 Medicine1 Medicine•2 Surgery2 Surgery

– 3 lecturer position3 lecturer position•1 medicine1 medicine•2 surgery2 surgery

To allow full 24/7 coverage by To allow full 24/7 coverage by senior faculty dedicated to ECCsenior faculty dedicated to ECC

LA ECC- Current statusLA ECC- Current status• 3 faculty positions3 faculty positions

• Residents/interns Residents/interns from other from other services(3 for each services(3 for each after hour shift)after hour shift)

LA ECC- Dedicated LA ECC- Dedicated techniciantechnician

The faculty and staff of the college The faculty and staff of the college are committed to exceptional are committed to exceptional teaching, research and patient teaching, research and patient care ……care ……

Large Animal Emergency

and Critical Care

Clinical Service Teaching Research

LA ECC- Clinical ServiceLA ECC- Clinical Service

Emergency triage

Stabilization and transfer

Immediate care and transfer

Immediate and ongoing care

Caseload-Types of casesCaseload-Types of cases

Colic 262

Laceration 68

Orthopedic 68

Foal 67

Respiratory 42

Diarrhea 25

Eye 20

Choke 19

Neurologic 17

Reproductive 15

Dystocia 8

Other 114

Grand Total 725

725 cases- 10.5 months725 cases- 10.5 months

Type of cases 11/17/04 to 10/01/05

0

50

100

150

200

250

300

Co

lic

Lac

erat

ion

Ort

ho

ped

ic

Fo

al

Res

pir

ato

ry

Dia

rrh

ea Eye

Ch

oke

Neu

rolo

gic

Rep

rod

uct

ive

Dys

toci

a

Oth

er

36%

9%

3%

9%

6%

9%

2%3%3% 2% 1%

16%

Caseload- SurgicalCaseload- Surgical

0

50

100

150

200

250

300

Co

lic

Lac

erat

ion

Ort

ho

ped

ic

Fo

al

Res

pir

ato

ry

Dia

rrh

ea Eye

Ch

oke

Neu

rolo

gic

Rep

rod

uct

ive

Dys

toci

a

Oth

er

Surgery

No surgery

32%

15%12%

14%

16%37%34%

13%5% 0% 38%

18%

181/725

Caseload- Management

0

50

100

150

200

250

300

Co

lic

Lac

erat

ion

Ort

ho

ped

ic

Fo

al

Res

pir

ato

ry

Dia

rrh

ea Eye

Ch

oke

Neu

rolo

gic

Rep

rod

uct

ive

Dys

toci

a

Oth

er

Type of cases

Nu

mb

er o

f ca

ses

ICU care

No ICU70%

25%

7% 12% 64%

29%

80% 10% 26% 47% 60% 38%

LA ECC- Importance of LA ECC- Importance of “satellite services”“satellite services”

Theriogenology

ICU

Radiology

Ultrasound

Anesthesia

Clinical patholog

y

LA Emergenc

y and Critical

Care

ICU ServiceICU Service

-”Open” ICU : technicians offer ICU -”Open” ICU : technicians offer ICU services to usersservices to users

-Under ICU technician supervisor: -Under ICU technician supervisor: Mr Vidal Villareal (“V”)Mr Vidal Villareal (“V”)

-Overseen by ICU committee-Overseen by ICU committee

“V”

ICU facilityICU facility

LA ECC- TeachingLA ECC- Teaching

LA ECC- TeachingLA ECC- Teaching

• Separate student rotation Separate student rotation instituted for the class of 2003instituted for the class of 2003

• Within each rotation: 2 groupsWithin each rotation: 2 groups• Day studentsDay students• Night studentsNight students

• Overlap at 4:00pm for roundsOverlap at 4:00pm for rounds

LA ECC -TeachingLA ECC -Teaching

• CurriculumCurriculum– Participate in core curriculum Participate in core curriculum

teachingteaching– Currently offer elective classesCurrently offer elective classes

•NeonatalogyNeonatalogy

•Colic teamColic team

– Goal: core course to integrate Goal: core course to integrate lectures related to ECC, both LA and lectures related to ECC, both LA and SASA

LA ECC- TeachingLA ECC- Teaching

• Interns and residentsInterns and residents

• Residents: ACVIM, ACVSResidents: ACVIM, ACVS

Dr Leslie Easterwood

ACVIM

Dr Meghan Gilhooly

Dr Jared JankeACVIM

Dr Jason MezACVS

Dr Catherine Mohr

Dr Berkeley ChesenACVS

Dr Tracy Norman

ACVIM

Dr Amy Plummer

ACVS

LA ECC-ResearchLA ECC-Research

• Through Link GI group: Drs Cohen and Through Link GI group: Drs Cohen and RousselRoussel– 1: Cohen ND, Lester GD, Sanchez LC, Merritt AM, 1: Cohen ND, Lester GD, Sanchez LC, Merritt AM,

Roussel AJ Jr. Evaluation of risk factors associated Roussel AJ Jr. Evaluation of risk factors associated with development of postoperative ileus in with development of postoperative ileus in horses. J Am Vet Med Assoc. 2004 Oct horses. J Am Vet Med Assoc. 2004 Oct 1;225(7):1070-8. 1;225(7):1070-8.

– 2: Roussel AJ Jr, Cohen ND, Hooper RN, Rakestraw 2: Roussel AJ Jr, Cohen ND, Hooper RN, Rakestraw PC. Risk factors associated with development of PC. Risk factors associated with development of postoperative ileus in horses. J Am Vet Med Assoc. postoperative ileus in horses. J Am Vet Med Assoc. 2001 Jul 1;219(1):72-8. Erratum in: J Am Vet Med 2001 Jul 1;219(1):72-8. Erratum in: J Am Vet Med Assoc 2001 Sep 15;219(6):800. Assoc 2001 Sep 15;219(6):800.

LA ECC- ResearchLA ECC- Research

• Clinical researchClinical research– Comparison of different analyzers Comparison of different analyzers

for lactate measurement in normal for lactate measurement in normal horses (Marsh)horses (Marsh)

– Retrospective evaluation of cecal Retrospective evaluation of cecal impactions in horses (Plummer, impactions in horses (Plummer, Rakestraw, Hardy) Rakestraw, Hardy)

LA ECC-ResearchLA ECC-Research

• Collaborative studies Collaborative studies – Intraoperative lidocaine (Dr Chris Intraoperative lidocaine (Dr Chris

Sanchez)Sanchez)– Risk factors for duodenitis-proximal Risk factors for duodenitis-proximal

jejunitis (Dr Noah Cohen)jejunitis (Dr Noah Cohen)

LA ECC -ResearchLA ECC -Research

• Inter-department collaborationInter-department collaboration– Mechanisms of edema resolution: Mechanisms of edema resolution:

implications for treatment of implications for treatment of cardiovascular disease. Glen Laine, cardiovascular disease. Glen Laine, Principal Investigator. Program of Principal Investigator. Program of Excellence in Life Sciences, Texas Excellence in Life Sciences, Texas A&M University (Hardy)A&M University (Hardy)

LA ECC- Organizations LA ECC- Organizations and Collegeand College

• Veterinary Emergency and Veterinary Emergency and Critical Care Society (VECCS)Critical Care Society (VECCS)– American College of Veterinary American College of Veterinary

Emergency and Critical CareEmergency and Critical Care– Academy of Veterinary Emergency Academy of Veterinary Emergency

and Critical Care techniciansand Critical Care technicians– Student chapter of VECCSStudent chapter of VECCS

American College of American College of Veterinary Emergency and Veterinary Emergency and

Critical Care-ACVECCCritical Care-ACVECC

• Recognized by the AVMA in 1989• Currently 136 Diplomates• New college for equine diplomates (1999)• Currently only ≈14 equine Diplomates• Increase training/expertise in ECC• Participation in the college; training and

examination

LA ECC- Future directionLA ECC- Future direction

• Continue to strive to improve Continue to strive to improve teachingteaching– ACVECC residency trainingACVECC residency training

• Continue to strive to improve Continue to strive to improve service to clients and service to clients and veterinariansveterinarians

• Continue research effortsContinue research efforts

LA ECC- Importance to the LA ECC- Importance to the communitycommunity

• After hours emergencies less After hours emergencies less desirable for practitionersdesirable for practitioners

• After hours expertise remains criticalAfter hours expertise remains critical

• Close monitoring and intensive care Close monitoring and intensive care may be difficult to achievemay be difficult to achieve

• ECC may serve as primary, secondary ECC may serve as primary, secondary or even tertiary referral centeror even tertiary referral center

Outreach-Outreach-Disaster preparednessDisaster preparedness

Technical Large Animal Emergency Technical Large Animal Emergency RescueRescue

Drs. Tomas & Rebecca GimenezDrs. Tomas & Rebecca Gimenez

THANK YOU!THANK YOU!