Kristin Welch, DVM, DACVECC, explains best practices for determining potential illness or injury and first steps in critical care of a patient.

How to triage in emergency veterinary medicine

Kristin Welch, DVM, DACVECC, criticalist and founder of DVM STAT Consulting, presented the lecture “Revolutionizing trauma care: advanced techniques for triage, severity assessment and stabilization” at the 2024 Fetch dvm360 Conference in Charlotte, North Carolina. In an interview with 

, she said the presentation was created to help veterinarians in a broad group of practices—from single-doctor general practices to emergency and urgent care practices—feel more comfortable assessing patients with trauma. 

In this video, Welch discusses the triage process in emergency veterinary care and how it is used to assess the physical condition of a patient with trauma. This process can determine immediate next steps.  

The following is a transcript of the video:

Triage is probably the most important single step that allows you to be able to stratify the severity of injuries in a trauma patient. And in smaller clinics, it's an ‘all hands on deck’ type process.

Part one is that you want to have a form that's preprinted, and maybe even laminated with a wipe off marker, where you can ask the client specific questions about when the injury happened. What did they witness? Has the patient walked since the injury? Has the patient urinated since the injury? Do they have any past medical history? Are they on any medications that might impact the treatment? And have they had any past transfusions? Having that [form] ready by your triage station is really helpful because a CSR (customer service representative) or a veterinary assistant can take that [completed form] and walk up front and talk to the client while the medical team is assessing the patient.

The triage process involves a physical exam, primarily. Your initial triage physical exam should be 2 to 3 minutes, an abbreviated version of what you do in a full-fledged physical, but with the goal of assessing level of consciousness. Is there any indication for traumatic brain injury strabismus and anisocoria? Does the patient have motor pain sensation? And do they have any pain or divots or irregularities on palpation of their spine? Do they have normal respiratory pattern? Lung sounds on all 4 quadrants to help rule out pneumothorax for pleural effusion. Is their respiratory rate normal or elevated? And all of the patients during triage should help flow by oxygen until proven otherwise because one of our triage goals is to maximize oxygenation and minimize hypoxia.Auscultation of the heart, while simultaneously feeling the pulses and having somebody look at the mucous membrane color and capillary refill time, will allow you to be able to determine whether this patient has signs of compensated or decompensated shock, which is a really important distinction when we're determining injury severity scoring.

Finally, [there is] looking at external wounds. Is there any evidence of severe bruising? And do you, on your physical exam, identify any indication of significant blood loss?

Those are abbreviated steps that are part of a comprehensive triage physical exam I would recommend that everybody get into the practice of doing in the same order every time on every patient so that you don't get that tunnel vision where you're looking at the obvious injury like, for instance, an open fracture on a pelvic limb that's bleeding significantly, but forget to notice that the patient has muffled lung sounds and has a pneumothorax and really pale gums with a delayed CRT (capillary refill time).

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Kristin Welch, DVM, DACVECC, criticalist and founder of DVM STAT Consulting, explains first steps of care for stratifying the severity of injuries in a patient with trauma.

Handling emergency triage in veterinary medicine

The San Diego Wildlife Alliance announced it welcomed Emaay, the 250th California condor chick at the San Diego Zoo Safari Park. Emaay’s name comes from the Kumeya word for sky. The mother is MexWe and the father is Xol-Xol, the first California condor brought into human care under the California Condor Recovery Program in 1982.

According to an organizational release, the egg was placed in an incubator before hatching to be monitored by the wildlife care team.

 The team began to suspect malposition and brought the egg to the Paul Hater Veterinary Medical Center for a CT, which determined the chick’s position was not a concern. The chick successfully pipped and was brought back to the parents for hatching. The nest for the family is equipped with an infrared camera so the team can monitor the hatching process 24/7. The San Diego Wildlife Alliance welcomed Emaay in the early hours of March 16, and their gender has not been determined yet. Emaay is doing well under the care of their very attentive parents, according to the release.

"Reaching this milestone feels incredible," said Nora Willis, senior wildlife care specialist, at San Diego Zoo Wildlife Alliance, in the release.

 "Seeing the success that the San Diego Zoo Safari Park has had—and the success of the California Condor Recovery Program as a whole—is inspiring. There's still a long way to go but being part of this and helping the species recover is life-changing."

The California condor egg receiving a CT at the Paul Hater Veterinary Medical Center (Image courtesy of San Diego Zoo Safari Park)

Xol-Xol was rescued from the Sespe Condor Sanctuary at 3 months old after being neglected by his parents. He was then brought to the San Diego Zoo Safari Park, making him the first California condor to be brought into human care under the California Condor Recovery Program in 1982. Now, Xol-Xol fathered 41 chicks in 1993 and many have been reintroduced into their native habitat. In 2025, Emaay is expected to join the native population.

The San Diego Zoo has a long history of helping the California condor. In 1929, the zoo received its first California condor after a couple found it with a damaged wing in Ventura, California.

 Although the bird had to have its wing amputated, it has been active and healthy for over 10 years The US Fish and Wild Service and the California Department of Fish and Game gave the San Diego Wildlife Alliance permission to begin the first zoological propagation program for these birds when there was only 22 left in the world.

In 1983, the San Diego Zoo received its first condor egg after it was moved from the wilderness into human care for artificial incubation. Sisquoc was then the first California Condor to ever hatch in a zoo on March 30, 1983.

 Now at least 50 California condors have rejoined their native habitat with 12-15 condors hatched in the habitat every year. The condors hatched in human care are reintroduced in the United States across 5 reintroduction sites: 1 in northern Arizona at the Vermillion Cliffs and 4 in California, including Ventana Wilderness in Big Sur, Pinnacles National Monument, Yurok Ancestral Territory, and Redwood National Park, and the Bitter Creek National Wildlife Refuge in the Los Padres National Forest.

San Diego Zoo Safari Park welcomes 250th California Condor Chick, a significant milestone for the critically endangered species. News release. San Diego Zoo Wildlife Alliance. April 11, 2024. Accessed April 16, 2024. 

https://prnmedia.prnewswire.com/news-releases/san-diego-zoo-safari-park-welcomes-250th-california-condor-chick-a-significant-milestone-for-the-critically-endangered-species-302114577.html

San Diego Zoo. California Condor. San Diego Zoo Animals & Plants. Sandiegozoo.org. Published 2011. https://animals.sandiegozoo.org/animals/california-condor

The birth of this chick is a huge milestone for this critically endangered species

San Diego Zoo Safari Park welcomes 250th California condor chick 

Petszel is a new online platform for the postadoption journey. It connects shelters and owners for a seamless communication experience, and it supplies information about nearby veterinary services in the user’s area. Users can review medical records from animal shelters, schedule appointments, get pet care advice, access breed- and age-specific resources, and more. Petszel is specially designed for shelters and is free for animal welfare organizations.

Radimal connects directly to a practice’s x-ray machine, and information is sent through artificial intelligence (AI) to conduct a preliminary analysis. A live radiologist reviews the case and consults the AI findings, using them to validate their observations and guide their examination. The report includes the case history, patient images, an easily interpretable visual representation of the examined systems and findings, and clinical notes. Average return times are 4 minutes for AI assessments, 40 minutes for 1-hour STAT consultations, and 3.5 hours for 48-hour standard consultations.

Pet Honesty has unveiled a new skin care line, Restore + Soothe, aimed at promoting healthier skin and preventing itch and irritation. The product line includes the Restore + Soothe 2 in 1 shampoo and conditioner, body spray, and ear cleaning solution. What sets this skin care line apart from others is its MicroSilver ingredient, which has been shown to eliminate bad bacteria without harming the essential good bacteria beneath.

Dental Delights by Stella & Chewy’s are dental hygiene treats for dogs, specially designed to roll and flip for extra stimulation. Each treat includes ridges and nubs for flossing and scraping, helping prevent plaque and tartar buildup. Dental Delights features peppermint and parsley flakes for fresh breath and cage-free freeze-dried chicken for flavor.

The Chronic Pain Educational Toolkit from the American Association of Feline Practitioners (AAFP) gives veterinary professionals insights and resources to effectively address chronic pain in feline patients. The toolkit offers a deep dive into the pathology, types, and prevalence of chronic pain in feline patients and can help veterinary professionals explore various assessment methods. AAFP provides effective therapy goals with practical applications, incorporating pharmaceuticals, environmental modifications, and nutrition.

PetPace 2.0 is a dog collar powered by artificial intelligence (AI) that displays continuous, real-time medical insights. The collected data can be used for early detection, treatment, monitoring, and GPS tracking. The smart collar measures all major vital signs and health- related biometrics, including temperature, pulse, respiratory rate, heart rate, sleep quality, activity (calories burned), and more.

Here's our regular rundown of new and notable veterinary products

dvm360® product report: AI radiology, plus feline pain toolkit, and more

Azalia Boyd, DVM, always dreamed of becoming a doctor. She started out as a biology major but soon switched to studying animal and poultry science after hearing her college roommate talk about giving a cow a pregnancy test in one of her courses. While attending Tuskegee University in Alabama, Boyd joined the pre-vet club and started volunteering at the university’s veterinary school. “I am super proud to be a graduate of the only HBCU [historically black college and university] that houses a veterinary school,” Boyd told 

Boyd is currently the chief veterinary medical officer (CVMO), for Companions and Animals for Reform and Equity’s (CARE) Urban Community Animal CARE Division and serves as the chair of CARE’s veterinary advisory board. CARE is an animal welfare organization aimed at amplifying Black, Indigenous, and people of color, and other marginalized voices using narratives, research, and community-centered investments
to protect pets and the people who love them within underrepresented
communities.

“Since childhood, I always had a deep love for science and math, which led me to pursue a career in veterinary medicine. I grew up in a Caribbean household, so my parents weren’t really keen on having a pet, but I always found ways to bring them home. In fact, I performed my first surgery on a squirrel in our yard using my mom’s sewing kit, somewhere between the ages of 7 and 9. I think it’s always been in me, and maybe that’s why my surgery skills are so great right now,” she said laughing.

After graduating with her DVM degree, Boyd decided to travel and learn more about different countries and how each culture approaches animal companionship and veterinary care. “I’ve also discovered that I have a passion for connecting with people.... Veterinary medicine is not just about treating animals, it’s also about helping and supporting their owners,” Boyd said. “I went to places in Africa, South America, the Caribbean islands, [and] Europe. I found out there’s an actual term for what I was doing: ethnographic research. I was just going to places and studying how people were interacting with their pets. [Sometimes] I would be brave enough to ask people questions about how they felt about their pet. I wanted to learn so much more about the cultural aspect and the difference from what we have in the Western world. That became intriguing to me. That journey really enriched my understanding of the human–animal bond from a cultural standpoint.”

Following her travels, Boyd served as an associate and medical director for hospitals in the metro Atlanta area before joining the CARE team. “We’re dedicated to rethinking and rebuilding animal welfare and animal protection. Our primary goal is to do that in a manner that respects and reflects the well-being of all individuals with a specific influence on the human-animal bond and human-animal well-being,” Boyd explained. Boyd noted that CARE places a focus on including the pet owner in its initiatives. “Far too often, the people within these communities are left out of the solution. CARE believes that the genius and solutions to community problems are found from the people within.”

As CVMO of the urban CAC program, Boyd explained that her tasks include “understanding what the barriers are for access to care and helping implement strategies to reduce those barriers.”

“My work isn’t as hands-on as it typically has been in clinical settings, but it’s really in helping to build sustainable processes for marginalized communities in regards to access to care.... My particular strategy, and our focus for preventative care, is going to be with heartworm disease and parvovirus in both rural and urban communities.” Heartworm disease and parvovirus are both preventable diseases, Boyd noted, adding, “We know that, in part, people aren’t getting the information that they need or they don’t trust where the information is coming from. So I help outline best medical practices from the lens of improving the spectrum of care.”

Boyd’s work also includes bringing resources and learning opportunities veterinary professionals who might not have easy access to these assets through a certification program called VetREDI. “VetREDI was designed to educate veterinary professionals on aspects that will help reduce barriers to accessing veterinary care—like cultural competency, the importance of racial equity, and even topics like microaggressions, privilege, and spectrum of care. And even better, all proceeds of VetREDI help to support people and their pets.” These certification programs and other resources can be found on the CARE website at https://careawo. org/ and any additional information can be found on the organization’s social media accounts on LinkedIn by the business name and on Instagram at @CAREforequity.

Overall, Boyd works to positively impact the lives of those in her community and to boost the veterinary profession. “For the future of veterinary medicine, I hope to see a culture shift toward being more supportive, inclusive, and nurturing,” she said. “In an ideal world, veterinarians would remain trusted profes- sionals for all communities. Additionally, I hope to see a more diverse veterinary staff reflecting the diverse world of pet families. It’s disheartening for me to be the only doctor of color in many practices, if not all of them, that I’ve been in. I believe that a more diverse veterinary workforce could benefit both professionals and pet owners alike.”

One way to kickstart this change is through leadership. “It’s about leading by example. It’s about paving a way for others to follow. It’s recognizing that leadership isn’t always about receiving acknowledgment or even having everyone agree with you,” she said. “What’s most important to me as a leader is really making a lasting impact and a difference in people’s lives during my time in any leadership role that I’m in.”

A closer look at Azalia Boyd, DVM, and the work she doing to progress the veterinary profession

Striving for equity in veterinary medicine

This article was updated on April 22, 2024. 

Zoetis is standing by its osteoarthritis (OA) therapies for dogs and cats in the wake of a published report questioning the safety of the company’s bedinvetmab injection (Librela) and frunevetmab injection (Solensia) products. In a 

 article published on April 12, 2024, pet owners claimed their animals were sickened by these drugs rather than seeing the medications' intended improvement of the animals' conditions.

In one case, according to the news article, a 12-year-old dog was reportedly euthanized within 2 months after an initial dose of bedinvetmab for treatment of a stiff hip. The dog demonstrated a decrease in mobility and appetite, became lethargic and lost kidney function before dying. Similar cases with another dog and a 16-year-old cat that used either bedinvetmab or frunevetmab, respectively, were also documented.

 Since publication, the report has received increased attention on social media platforms.

, representatives of Zoetis acknowledged adverse effects have been reported in a small number of patients using these drugs. However, they noted that an “overwhelming majority” of patients using bedinvetmab injection and frunevetmab injection have benefitted from them. “There are rare adverse events, like any other medication,” said Richard Goldstein, DVM, DACVIM, DECVIM-CA, global chief medical officer for Zoetis. “We are very confident in the safety and efficacy of Librela and Solensia. We are very confident with the fact that [Librela] is efficacious, that it's helping thousands of dogs worldwide. But [we are] also aware that a small percentage of cases, just like any other drug, have potential side effects.”

Bedinvetmab injection was approved by FDA officials

 in May 2023, becoming the first monoclonal antibody for dogs suffering from osteoarthritis pain. Bedinvetmab injection is only available by prescription from a licensed veterinarian to ensure the drug is given and monitored for safety and the treatment of any adverse effects.

 These adverse effects include blood urea nitrogen, urinary tract infection, dermatitis, erythema, pain at the injection site, vomiting, weight loss, etc. The drug works by binding to and inhibiting the biological activity of canine nerve growth factor (NGF).

, the first monoclonal antibody drug for use in any animal species, in January 2022 to treat felines with OA. Frunevetmab injection, a cat-specific monoclonal antibody, also targets NGF, which is elevated in cats suffering from OA and involved in the regulation of pain. The drug works by binding to and inhibiting the biological activity of NGF. Adverse effects include diarrhea, vomiting, injection site pain, scabbing on the head and neck, dermatitis, and pruritus. At the time of the FDA approval, reports on the adverse effects were relatively mild and did not require stopping the injections.

Duncan Lascelles, BSc, BVSc, PhD, FRCVS, CertVA, DSAS(ST), DECVS, DACVS, professor and director of the Comparative Pain Research and Education Centre, NC State College of Veterinary Medicine, and a Zoetis partner, said that from his perspective, cases of severe adverse reactions being shared on social media are “a small minority” of patient experiences with these drugs. “It's a few instances that, unfortunately, are really blown out of proportion. It doesn't represent this therapeutic, its value, its efficacy, its contribution to veterinary medicine, and certainly is not representative of the risks associated with it,” he said in the interview.

Nicole Martell-Moran, DVM, MPH, DABVP (Feline Practice),a feline specialist, said her practice has “given almost 1000 injections [of frunevetmab] since it was launched in the United States” and has had no reports of death. “Adverse reactions we have seen include face and body itching, loss of appetite for 24 hours post-injection, and self-limiting head tremors.All resolved without complications,” she continued.

According to Martell-Moran, making a claim of injury is difficult with cats being treated for painful arthritis, most likely, at the end of their lives. “There are a lot of diseases processes that can occur suddenly that cause death or there may be many comorbidities that gradually progress, and the end result is death, especially in a senior cat,” she said, in an interview with 

. “As with any medication or intervention, there is the potential for side effects. We have to keep an open mind as this is a new drug and the more we administer it, the more experience we will have to report. I have seen it greatly improve the quality of life in my patients and will not stop recommending it but will continue to monitor reports of adverse events to help our clients make an informed decision.”

Educating pet owners can help, Goldstein said. “I think the first thing that’s important to understand is [pet owners] are hurt for a reason. It's very difficult to lose a pet, a family member, and people often want to find a reason to blame. ‘Ever since my dog fell down the stairs, it had this big tumor in his liver.’ And so, falling down the stairs caused him to have a tumor in their liver. People feel the need to find a reason for things that happen. I understand that piece of it…I understand their desire to find a reason for when bad things happen. But we’re treating dogs that have recurrent disease or older dogs, that there's a reasonable chance that something else will happen to that dog, unrelated to whatever treatment or medication we gave. That's hard sometimes to explain, but we need to explain that. And we need to arm the veterinarians who are in contact with the pet owners with the facts so they can help explain to the pet owner, what happened,” he added.

Both Goldstein and Lascelles said they stand by study findings that support the safety of bedinvetmab injection and frunevetmab injection. A clinical trial

 examined 287 dogs given bedinvetmab injection monthly and found that the animals experienced less pain from OA compared with dogs who received a placebo. By alleviating pain, the study found improved mobility and overall quality of life for those using bedinvetmab injection. Although the full effectiveness may not be noticeable until after the second dose of bedinvetmab, some dogs might feel less pain as soon as 7 days after the initial injection. The study also indicated that dogs treated with bedinvetmab injection consistently experienced relief from OA pain with monthly injections.

According to Goldstein, Zoetis is continuing to investigate the safety and efficacy of these drugs. Continued study is not only required by the FDA, but he said, too, that Zoetis takes seriously its responsibility to patient safety. Goldstein also encouraged veterinarians to contact Zoetis with any questions or needed support. “Anything we could possibly do to make sure that we're all working together to alleviate pain,” he added.

Goldstein also encouraged veterinary professionals to report any patient adverse effects to Zoetis. “We will investigate, and we will do whatever we can to make sure that the drug is used appropriately. Pharmacovigilance is an ongoing, tremendous effort,” he said.

"The death of a pet is heartrending. I feel nothing but sympathy for the loss of these 2 pets. But unfounded accusations and fear mongering does nothing to help, and may hinder the ability of people with pets in pain from OA to seek treatment to attain a better quality-of-life," explained 

"As a practitioner who has been treating animals in pain for 44 years, and yes, before the advent of drugs like Rimadyl (carprofen) were introduced back in 1996, I saw many animals suffer needlessly as well as euthanized before their time due to lack of sufficient pain control," he continued.

For Zoetis product support, veterinarians in the US can contact the company’s Veterinary Medical Information Support Team at 1-888-963-8471.

Calfas J. What killed their pets? Owners blame meds, but vets aren’t sure. Wall Street Journal. April 12, 2024. Accessed April 15, 2024. 

https://www.wsj.com/health/pharma/dog-cat-arthritis-drugs-bcdddea6?st=nqd8io6pc74r71z&reflink=desktopwebshare_permalink

Coppock K. FDA approves first monoclonal antibody for dogs with osteoarthritis pain. News release. FDA. May 5, 2023. Accessed April 15, 2024. 

https://www.fda.gov/animal-veterinary/cvm-updates/fda-approves-first-monoclonal-antibody-dogs-osteoarthritis-pain?utm_medium=email&utm_source=govdelivery

FDA Approves Novel Treatment to Control Pain in Cats with Osteoarthritis, First Monoclonal Antibody Drug for Use in Any Animal Species. News release. FDA. January 13, 2022. Accessed April 15, 2024. 

https://www.fda.gov/news-events/press-announcements/fda-approves-novel-treatment-control-pain-cats-osteoarthritis-first-monoclonal-antibody-drug-use-any

Corral MJ, Moyaert H, Fernandes T, et al. A prospective, randomized, blinded, placebo-controlled multisite clinical study of bedinvetmab, a canine monoclonal antibody targeting nerve growth factor, in dogs with osteoarthritis. 

. 2021;48(6):943-955. doi:10.1016/j.vaa.2021.08.001

This update comes after some pet owners publicly claim bedinvetmab injection (Librela) and frunevetmab injection (Solensia) have worsened their pets’ condition

Animal health company assures veterinarians that OA drugs are safe

Equine multinodular pulmonary fibrosis (EMPF) is a lung condition in horses in which scar tissue forms throughout the lungs, creating diffuse miliaries or nodular pulmonary patterns on radiographic imaging. Experts believe that equine herpesvirus-5 (EHV-5) could also be associated with EMPF because similar viruses have been known to cause lung issues in humans and mice. However, not all cases of EMPF are caused by EHV-5, as some horses with EMPF-like symptoms don't test positive for the virus.

 researched EMPF and specifically the prognostic indicators for the disease since current clinical literature is limited.. The horses involved in this study consisted of 24 (52%) mares, 21 (46%) geldings, and 1 (2%) stallion, totaling to 46 horses. The median age was 15 years from a range of 5-26 years and horses came from 9 different clinics spanning across the United States, Canada, Spain, Switzerland, and the Netherlands.

Prior to the study each horse was diagnosed with EMPF by a diplomate of the American College of Veterinary Internal Medicine or the European College of Equine Internal Medicine, all specializing in large animal medicine.

 Researchers on the clinical study confirmed the diagnosis in 34 out of 46 cases by examining lung tissue either from biopsies or autopsies. In 12 other cases, lung tissue could not be examined directly, so researchers relied on clinical symptoms, like respiratory disease and abnormalities seen on lung scans, while also ruling out bacterial infections.

Overall the study found that diagnostic factors of EMPF in these participants were weight loss (36/46, 78%), difficulty breathing (33/46, 72%), rapid breathing (32/46, 70%), and fever (18/46, 39%), however researchers indicated that fever is not a reliable sign of EMPF.

 Researchers also found that more horses with EMPF had abnormal cells in their respiratory fluid compared to horses with asthma.

Prognostic outcomes remain poor for this disease. During hospitalization, 19 out of 46 horses (41%) were either euthanized or died. The main reason for euthanasia was a poor prognosis (10/46, 22%), followed by the disease getting worse despite treatment (4/46, 9%). Two horses (4%) had complications such as colic, diarrhea, and laminitis, leading to euthanasia. One horse suffered from acute respiratory distress and died, while another owner declined treatment and requested euthanasia. One additional case did not provide a reason for euthanasia.

Among the 27 horses that survived in the short term, 1 was lost to follow-up within 3 months. Eleven out of 45 horses (24%) survived for at least 3 months. Additionally, 15 out of 45 horses (33%) either died or were euthanized within 3 months after leaving the hospital.

In conclusion, the researchers aimed to provide further insight into the prognosis of this disease, maintaining its poor outlook. Furthermore, corticosteroid treatment does not improve the 3-month survival time seen in most participants.

Craven A, Todd-Donato A, Stokol T, et al. Clinical findings and outcome predictors for multinodular pulmonary fibrosis in horses: 46 cases (2009-2019). 

. Published online April 15, 2024. doi:10.1111/jvim.17084

Researchers looked at the diagnostic traits and prognostic outcomes of this disease