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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!