Kristin Welch, DVM, DACVECC, discusses the importance of veterinary trauma care and immediate patient assessment

Trauma care assessment

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

, 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.

Welch discusses some immediate diagnostic techniques, one of the main focus areas of the lecture, in this video. She also shares a recent trauma case that demonstrated to attendees how ultrasound can quickly and easily aid in trauma diagnostics.

The following is a transcript of the video:

Trauma patients are always a big stressor. They give you a huge surge of adrenaline. And you sometimes only have minutes to make decisions that are critical in whether or not that patient lives. And, so, we focused a lot on the immediate diagnostic techniques that can be used to help save their lives. Cageside ultrasound, immediate diagnostic bloodwork, and how to put those little pieces of the puzzle together as part of your minimum database to make sure that you have a good idea of whether this patient has emergent injuries that need immediate surgical stabilization, whether a patient has emergent injuries that can be medically stabilized, or whether they have a combination of injuries, where those nonemergent injuries can be dealt with later, once you've focused on hemodynamic stabilization, fluid therapy, oxygen therapy, transfusion therapy.

One of the really neat moments during the talk was when we talked about who in the room has ultrasound that they can use, and almost everybody's hand went up. And the follow up question was ‘who uses ultrasound as part of their trauma triage diagnostics,’ and only about 40% of the room raised their hands. And I had a case, just this past week, it was a dog that had been hit by a car. And, so, I had some videos from just this past week, showing in real time, how quick it is and how easy it is for every doctor in that room to pick up their ultrasound and use it to do a global fast scan on these trauma patients. And after I showed all of those videos, I asked again, if this is something that everybody feels like they can start trying to do on every one of their patients. And everybody's hand went up.

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Videos

Kristin Welch, DVM, DACVECC, criticalist and founder of DVM STAT Consulting, discusses diagnostic techniques, one of the main focus areas of her lecture at Fetch Charlotte.

For any dermatology case, a comprehensive and thorough history is crucial to getting a complete picture of the patient and what might be going on. Joya Griffin, DVM, DACVD, star of television's "Pop Goes the Vet with Dr. Joya" on Nat Geo Wild, explained that these histories can take some time since they include several questions for the client. However, to free up some time for veterinarians and veterinary dermatologists, veterinary technicians can perform these tasks and allow the full team to be properly utilized. “These histories are really important in dermatology, and I think our histories are very specific,” Griffin stated during her session at the Fetch dvm360 conference in Charlotte, North Carolina.

Important questions to gather from dermatology histories:

When did it start? What is the age of onset?

Did the pet initially present with lesions or did pruritis precede the lesions and then from the pet itching, scratching, and biting, did the lesions develop and a secondary infection?

Are the medications that have been used that have worked or medications that haven't been tried yet?

Was there a particular seasonality of onset?

Griffin explained that technicians can take on this role of asking the client about the patient’s history, and then the veterinarian can come in to perform the complete body check and physical examination. Following the physical exam, Griffin said, “I'm going to do some cytology and collect my samples. Then, I'm going to look at them under the scope. You'll hear a dermatologist say over and over and over again, ‘cytology, cytology, cytology,’ it's easier said than done, for sure, and it takes a lot of time. Doing it to really feel confident and comfortable and knowing what you're seeing, I really recommend starting to get used to that. There's some ways that you can try to train your staff to help them do this for you and that'll speed things up as well.”

Griffen shared what her technicians are tasked with at the Animal Dermatology Clinic in Louisville, Kentucky. “They're collecting my histories, they're presenting estimates and discharges and they're going over those discharge statements at the end of the appointment. They're also assisting in our derm workups by collecting samples. Some of them are able to read cytology to some degree, and we're trying to empower them and teach them to do that,” she said. Along with discharge statements, Griffin explained that technicians are the leaders in client education in the clinic. They are experts who can reiterate what the veterinarian needs or recommended and technicians can also answer any questions clients may have about diagnostics or treatment needed to move forward.

Another way to save time is by being fully present in each appointment and giving each client and patient your full attention. To further explain this, Griffin shared a study that was done to measure client satisfaction with consultation appointment lengths.

 What was found is that clients preferred a shorter appointment that that felt more meaningful over a longer appointment in which clients felt they weren’t aware of what was going on. “If you asked me, I would assume the more time that my client has with me, the more satisfied they're going to be. But they actually found on the contrary to that. So, to clients it really wasn't the amount of time that they spent with you, but actually the quality of the appointment,” Griffin said.

“If my staff member goes in first, that client feels like they have been attended to on time. There's someone that has put them in a room and they're taking time with them…. I think that this helps to establish that client–tech relationship,” she added.

Overall, utilizing your technicians is important for making the whole veterinary team stay involved in the clinic, but in these cases, it can also save time and improve client satisfaction. Griffin concluded her session by also reminding attendees about the importance of team bonding to further improve teamwork flow in the veterinary clinic.

Griffin J. Leveraging and utilizing your staff for efficient dermatologic workups. Presented at: Fetch dvm360 conference; Charlotte, North Carolina; March 15-17, 2024.

Corah L, Mossop L, Dean R, Cobb K. Measuring satisfaction in the small animal consultation and its relationship to consult length. 

. 2020;187(11):446. doi:10.1136/vr.105910

Articles

Joya Griffin, DVM, DACVD, shared her tips for improving consultations and client satisfaction

Save time in dermatology appointments by utilizing your technicians

Temple Grandin, PhD, and Marty Becker, DVM, presented the keynote lecture on Day 3 on the morning of Day 3 at the 2024 Fetch dvm360 conference in Charlotte, North Carolina. 

Renowned animal behaviorist Temple Grandin, PhD, MS, shared the keynote stage with Marty Becker, DVM, founder of Fear Free, on Day 3 of the 

, North Carolina, to deliver a lecture on the emotional well-being of animals and mitigating fear in their patients. Both speakers arrived with a wealth of knowledge and decades of experience on these topics.

Grandin is a professor of livestock behavior at Colorado State University in Fort Collins and a designer of livestock handling facilities. Becker’s career includes volunteer work as a veterinarian with World Vets, an international veterinary aid organization, through which he has cared for refugee pets at the Ukraine borders in Romania and Moldova.

Their talk first addressed the importance of creating a practice environment where pets feel safe, and provided hospital design suggestions that can help mitigate patients’ fear. Grandin noted that what animals are seeing, hearing, and smelling all have an effect on their fear level and, ultimately, how the veterinary visit might proceed.

Rather than talking in an effort to calm down the patient, she said, veterinary professionals should instead address the situation from a sensory perspective. “Animals live in a sensory based world. Get away from language when you’re [handling] animals,” Grandin said. “If you get an animal completely upset, it’s going to take 20 minutes to calm it down.”

The speakers noted that small changes can have a big impact on animal behavior at a veterinary hospital. For example, laying inexpensive bath mats on the floor may alleviate animals’ fear. “Animals’ No. 1 fear, from birth, is the fear of falling,” Becker said.

From a patient’s perspective, he and Grandin agreed that shiny floors and surfaces that have a glare are viewed as hazards much like ice skating rinks. “I can’t emphasize enough [having a] nonslip floor. Animals panic when they start to slip and fall,” Grandin said.

Animals get scared on any surface that seems unstable, including sterile, raised tables, they continued. A warm, nonslip surface is preferred and can be achieved by lining a table with a mat. Visits can also be conducted on a floor with a comfortable surface, furniture that’s different from an exam table, such as an ottoman with a washable cover; or in a designated outdoor space.

During the talk, the speakers also suggested mitigating fear by not allowing animals to watch other patients being treated. Becker shared an experience of noticing caged patients sitting in self-protection poses while they intently watched a procedure being done by a veterinary team on another animal. To avoid generating anxiety and fear in their patients, the team hung a curtain that could be pulled around the treatment area, blocking it from view of other pets.

According to Grandin, a clinic’s décor can also trigger fear. “One thing I don’t want in [an exam room] is posters of dogs and cats with big eyes, because that is a threat [to patients]. It might be cute to us, but it’s not to them,” she said.

Becker noted that fear is caused by something painful or disturbing. He explained that notion with the example of an animal that feels pain from an injection and is later disturbed by the sight of a needle because of its association with pain. However, in the clinic or by clients at home, pets can be shown an object that elicits fear while being provided with a desirable treat. This can be done regularly as the animal becomes less stressed by the needle or other object.

In practice, animals also can be given treats while they are being given an injection or other treatment they may fear. Becker noted that his alma mater, Washington State University in Pullman, performs blood draws on grizzly bears. Medical care providers feed the bears honey water during the procedure to keep them calm and cooperative, he said.

Additionally, Grandin said she taught sheep how to cooperatively get on a typically feared tilt table through training with feed rewards. “When I did that in the 80s, that was real radical stuff,” she said.

Grandin emphasized animals’ need to explore new surroundings and objects. As an example, she shared an experience she had witnessing a dog resisting its’ handler’s attempt to board an escalator. Rather than reducing the dog’s fear of riding it, the handler immediately “yanked” the dog onto the moving staircase. “Now, [the dog] probably has a fear of escalators,” Grandin said.

She went on to explain that the handler should have allowed the dog some time to “explore” the escalator before getting on it. Through exploration, the dog could have quickly become comfortable with it.

Grandin also shared an example of exploration with cattle. She said cattle will walk up to a camera set up on tripod and explore it in a friendly manner. However, fear could set in when if a photographer abruptly puts a camera in a cow’s face, without allowing the animal a chance to examine it first.

According to Grandin, regularly and intentionally introducing a pet to unfamiliar individuals and places can train the animal not to fear the unknown by having them grow accustomed to new things. “A lot of dogs today are too sheltered,” she added.

Creating and maintaining a practice environment that feels safe and eases fear and anxiety in patients is a responsibility of the entire staff. Grandin explained that she has also witnessed care providers roughly handling their patients. “Animals feel pain,” she said.

Teams should be properly trained to mitigate fear and pain in patients, and how to gently handle them such as using gradient touch.

 “Practice management has to get behind it, totally,” Grandin said. She went on to explain that managers are often providing staff training and are tasked with hiring—and firing—employees.

Grandin and Becker agreed that a staff member who is not appropriate handling patients, should be let go from the practice. “Sometimes you have to change that person that’s holding the rest of the team back,” Becker said.

Becker M. Grandin T. If you’re not looking after the emotional wellbeing of animals, you’re not practicing best medicine. Presented at: Fetch dvm360 conference; Charlotte, North Carolina. March 15-17, 2024.

Grandin T. Becker M. Temple Grandin went into a typical companion animal practice and here’s what she saw. dvm360 Flex. Accessed March 17, 2024. 

https://ce.dvm360.com/learn/course/fetch-charlotte-2024-proceedings/proceeding/fetch-charlotte-2024-conference?page=15

Temple Grandin, PhD, MS, and Marty Becker, DVM, partnered to address fear and pain in animals with methods to help patients be more comfortable during veterinary care visits

Practicing with care for the emotional well-being of animals

Renee Schmid, DVM, DABT, DABVT, senior veterinary toxicologist and director, veterinary medicine, Pet Poison Helpline, discusses the danger of lilies to cats. 

The danger of lilies to pets

Renee Schmid, DVM, DABT, DABVT, senior veterinary toxicologist and director, veterinary medicine at Pet Poison Helpline, spoke about 

common household toxins, including pharmaceuticals

 in Orlando, Florida. In this segment, Schmid discusses the danger of lilies to cats.

], in particular, are a religious symbol of the Easter holiday and are traditionally popular in the spring. Pet owners should immediately call a veterinarian if a cat has, or may have, eaten an Easter lily leaf.

: So, the main lilies that we're concerned about concerned about are the renal toxic or the kidney toxic lilies. And those are the ones that are in the 

 [or daylily] as well. And so those are ones that we can see kidney failure developing in cats, and we often see them in fresh cut bouquets in the household. They also might be outside in landscaping, as well. 

All parts of the lily are considered to be toxic, including the pollen from that particular plant. And so, what we want to do is to make sure that those animals don't have any access. Ideally, No Lilies for Kitties is a [Pet Poison Helpline] campaign that we have. At noliliesforkitties.com, you can find different alternatives to plants, and different, safer plants for your pets in the home.

. University of Wisconsin-Madison, Horticulture-Extension. Accessed January 31, 2024. https://hort.extension.wisc.edu/articles/easter-lily-lilium-longiflorum/

Renee Schmid, DVM, DABT, DABVT, senior veterinary toxicologist and director, veterinary medicine at Pet Poison Helpline, discusses how a popular spring flower can be toxic to cats.

The danger of household lilies

Jb Minter, DVM, MS, DACZM, explains what makes zoo medicine challenging and how different species pose unique obstacles

The rewarding challenges of a zoo chief veterinarian

Jb Minter, DVM, MS, DACZM, director of Animal Health at the North Carolina Zoo, told 

 in an interview, about the most challenging species to work with and some of his favorites. He also explained how, as a director at the North Carolina Zoo, he can work in multiple areas of the profession.

 Some of the ones that are a little bit the most complicated are actually some of the the either the largest or the smallest. So when I got a 2g dart frog—so this is something that's about the size of your little pinky finger—and you're trying to do a workup on that, that's extremely difficult because a lot of the diagnostic tools that we would have don't work. I can barely get a blood sample from a 2g dart frog without exsanguinating it. So those little, subtle differences make those animals very complicated. The same thing goes true if we start bringing the size of the animal up. So, if I start working with an elephant diagnostically, I can't do a lot. I mean, they're well-trained, we can get, obviously, get a blood sample from an elephant, and you can usually do that with the animal wake. But radiographs really don't work. You can potentially get some radiographs of the distal periphery, so limbs, toes, things like that. But if you wanted to get a full chest radiograph, it doesn't work. You can't. There's no radiograph machine that can go that far, or shoot through that much tissue.

Obviously, I practice medicine, I'm a veterinarian, but on the flip side of that, some of the other things that we do really depends on the size of the zoo that you're working in, where you may wear different hats. And some of those may be still within the medicine aspect; we act as a nutritionist. But some of the things that stepped outside of the field that most people don't do is I helped with exhibit design. Obviously, I'm a big teacher. I work in West Africa, probably about 2 to 3 months out of the year working with elephants in West Africa. So those are the big aspects of the reason that this job to me is I mean, I can't complain. I love my job. It's one of the greatest jobs in the world.

Management of allergy-associated skin conditions can include topical therapy as an adjunctive treatment in a multimodal care plan. Utilizing topical therapies may decrease medication dependency, while also increasing their efficacy, according to Julia Miller, DVM, DACVD, associate professor of dermatology at Cornell University College of Veterinary Medicine in Ithaca, New York, and dermatologist at Animal Dermatology Group in Louisville, Kentucky.

In her lecture on topical therapies for veterinary dermatology at the 

2024 Fetch dvm360 conference in Charlotte

, North Carolina, Miller provided an overview of the variety of options for treating skin conditions in pets with allergies. However, one of the key things to consider when choosing a topical product is the client’s ability to afford the treatment and their willingness to adhere to the prescribed care plan.

Miller suggested having an open and honest conversation with the client to ascertain the best topical therapy for their pet and their adherence ability before providing a recommendation or prescription.

 “Whenever you’re choosing a product, there’s never one perfect product. You always want to think about the animal’s needs and the client's needs,” she said.

Miller’s lecture, sponsored by Zarasyl­, presented a variety of topical formulations such as shampoos, rinses, spot-ons, mousses, sprays, wipes, creams, ointments, gels and powders. She noted that the surface area being treated, the amount of hair in that area, and the pet’s type of lesion should all be considered when deciding which topical product to use.

Product ingredients should also be considered for effectiveness in treating the pet’s condition as well as potential adverse effects. These ingredients may include glucocorticoids for inflammation and lipids for epidermal barrier support in allergy cases, as well as antimicrobials for bacterial or fungal skin infections.

To treat and prevent inflammation, for example, Miller noted that topical therapies may be applied daily. However, she cautioned that higher steroid potency can be a problem and encouraged attendees to seek out products that contain active ingredients at safer levels such as a sprays with 1% hydrocortisone.

Attendees were reminded that a product that works well for one pet may not be suitable for another animal, even if both are being treated for the same condition. One example shared by Miller was about a dog whose skin  became dried out when a certain topical therapy was applied. However, most other patients she has treated with the same product have showed success without experiencing excessive dry skin.

In concluding her talk, Miller emphasized choosing products for each patient that the owner will actively use.

 “Try to get the most value for your buck if you can. So, for example, a lot of shampoos have antimicrobial AND epidermal barrier. A lot of mousses and sprays are the same way,” Miller said.“Try to make things as easy as you possibly can.”

While consulting with clients, veterinary professionals should educate pet owners about the administration routine that best works for them and their animal. “Physically show them [how a treatment is administered],” she said. Miller also encouraged attendees to treat the pet more often if lesions develop, but also provide prevention treatment to limit the need for rechecks.

Miller J. Spray, slather, dab or dip? Topical management tips to improve your skin successes. Presented at: Fetch dvm360 Conference; Charlotte, North Carolina; March 15-17, 2024.

Miller J. Guidelines for topical therapy in allergic dogs and cats. dvm360 Flex. Accessed March 15, 2024. 

https://ce.dvm360.com/learn/course/fetch-charlotte-2024-proceedings/proceeding/fetch-charlotte-2024-conference?page=28

When choosing a product for treating skin conditions caused by allergies, there are a variety of available options and some key considerations