Atari, canine, male entire, Cavalier King Charles Spaniel cross, 9 weeks, 3.7kg

Atari had been in ICU for multiple days with no significant improvement. He presented for vomiting and diarrhoea and parvovirus test was negative. He was currently being treated with buprenorphine, metronidazole, metoclopramide, maropitant and intravenous (IV) fluid therapy.

Regurgitation had started that morning and he was presented to the surgical department for exploration of abdominal cavity due to the suspicion of intussusception.

Atari was anaesthetised for an exploratory to source the issue of the patient’s anaemia, dull mentation and no improvement to medical treatment. There was suspicion of an intussusception.

Temperature (temp) 38.1 degrees celcius, heart rate (HR) 130bpm,respiratory rate (RR) 28bpm, mucous membranes (MM) pale, capillary refill time (CRT)<2 seconds, body condition score 4/9, pain score system Colorado State University: 20/24.

The biochemistry results were normal range, but the haematology and blood gas analysis showed anaemia, hypoproteinaemia as well as hypokalaemia and neutrophilia.

An Exlaparotomy advised by surgical and medical team.
During the surgical procedure blood pressure was a major issue at the beginning of surgery blood pressures systolic 70mmhg. A10ml/kg fluid bolus was given as the BP SAP was 70mmHg and a HR of 140bpm. The surgeon and I discussed that the patient was trying to compensate for the inadequate perfusion and blood flow. The SAP kept lowering to a systolic 60mmhg, Dopamine CRI was started but was ineffective at the highest dose rate and cardiac output was still an issue.

The surgeon identified a double intussusception where the entire section of the colon contained the distal small intestine within. A high morbidity rate and complication rate was advised. The patient was euthanized as the morbidity outcome would was too great.

If the patient had survived the surgery, noradrenaline CRI would be required and consistent monitoring by the ICU team.

Some things I may have considered:
Before surgery started, it would have been beneficial if the patient’s BP was checked to determine if a dopamine or noradrenaline CRI should have been started sooner. The surgeon discussed that paediatrics patients do not have the same ability to increase contractility and this was an indicator that a dopamine CRI would be ineffective. I discussed with the surgeon that a noradrenaline CRI would have been more effective for this procedure and case, but due to the double Intussusception, it may have been difficult to maintain.

Milo presented after a member of the public saw him fall from a third story balcony.

7yo MN Whippet presented with; High Rise Syndrome, Fractured L elbow, Pneumothorax, Pulmonary Contusions

• Triage QAR/NQR, pink tacky gums, HR – 200, bounding pulses. Temp 37.9.

•Physical findings - NWB LFL, dull lung sounds on L side. Falling over whilst standing, no deep pain in LFL

• Stabalisation
10ml/kg bolus of LRS, flow by O2 and fentanyl bolus followed by a combined drip of fentanyl, lignocaine and ketamine. Vasolamin 1.6mls slow IV q6h.

ICU, nasal prongs placed and RR and RE were checked ongoing. TFAST and AFASTS were done Q12 to monitor for lung deterioration/FAF
Rads take early hours of day 2 due to deterioration, pneumothorax discovered, thoracocentesis, 360mls air bilaterally. 1600 - O2 turned off, Milo remained off O2 for the remainder of his stay.

Marked bruising around the chest bilaterally, closely monitored over the following days.

He was fasted on and off for days and did not want to eat in hospital which led to a drop in his ALB and TP. Feeding plan made.

Once his elbow was repaired, he started physiotherapy

• Discussion:
Large comfortable bedding, turning once every 4 hours when first arrived to ensure that he didn’t develop atelectasis.

Thorough TPR’s were undertaken by ICU nurses. This alerted the vet to Milo’s initial deterioration. Pain relief was tapered down after the nurses mentioned that he seemed brighter on his short (30 minute) visit with his owner where he was off his FLK, he was opioid sensitive and was much brighter on the lower dose and also wanted to eat more after this.

Placement of nasal prongs, set up for thoracocentesis and assistance with the procedure a were the nurses responsibility.

Nurses were responsible for all physiotherapy and enrichment for Milo.

• Conclusion:
This case is all about triage and patient advocacy. First, we needed to stabilise pain and shock followed by assessment and intervention with his pneumothorax, close monitoring of bruising and pulmonary contusions and finally to treat the broken elbow. A lot of the patient advocacy is mentioned in 'discussion'

The nursing team had a major role in ensuring the Milo was surrendered to hospital instead of being euthanised half way though his stay after the owners decided they did not want to continue care. Milo is living a very happy life at my house.

I have chosen to do my presentation on a case that I have been involved in since the beginning and that is very close to my heart.

Storm is a 15-year-old, male-neutered Australian cattle dog that was diagnosed with hepatocellular carcinoma. There were multiple masses occupying approximately 80% of the liver parenchyma. There was one large mass and several smaller masses as well seen on CT within the liver. Complete surgical resection was not considered possible in Storm’s case. The option of a new procedure, transarterial chemoembolisation (TACE) was offered to and discussed with the owner and accepted.

The procedure involves a percutaneous access into the femoral artery (which is located under ultrasound guidance, without the need for surgical incisions) to insert a series of catheters. This is done via the Seldinger technique. Under fluoroscopic guidance using contrast, the catheters are fed into the femoral artery, aorta and then hepatic artery with super selective access into the artery supplying the tumour. When the correct artery is located, a chemotherapy drug mixed with a thick liquid called Lipiodol to embolise, is injected directly into the tumour. The Lipiodol is the major embolic agent used in this procedure.

Storm has undergone four TACE procedures in the past 18 months and his diagnostic imaging results have been extraordinary. His tumour has shrunk significantly over the time he has had the four procedures. He is a healthy and happy dog and his journey with this new and innovative procedure is remarkable for him and his family. The best part about this procedure is how well it is tolerated for an inoperable liver tumour.

My case study will follow his journey from diagnosis to his current state and will include diagnostics, procedural information, complications that have occurred and changes/improvements in this new procedure.

With Storm being one of the first patients undergoing this procedure in our hospital, this case has been an exciting one to be a part of.

Storm is a 2 year old MN mini lop rabbit who was presented to an exotics veterinary clinic in Perth with signs consistent with allergic alopecia after his carer noticed hair loss around his eyes, nose, lips and tail base. There are many causes for rabbits to develop alopecia, including mites, diet, ringworm and allergies. Despite the lack of literature, we trialed allergy immunotherapy, given the lack of published cases of desensitisation in rabbits we monitored closely for any adverse reactions or anaphylaxis during his treatment.

On the physical exam vitals were normal and there were no other findings or symptoms apart from his alopecia. Our nurses performed a skin scrape under the microscope, which was negative for mites, we trailed doramectin as a treatment trial. Nurses then advised a food trial to rule out any food allergies Storm may have had. Our veterinarian decided to reach out to The Perth Animal Dermatology Clinic for further testing and examination.

The nurses placed an intravenous catheter, monitored Storm manually with a stethoscope, checking mucous membrane colour, along with our surgivet, capnograph, pulse oximeter, temperature probe while he was sedated and maintaining on oxygen and isoflurane as the patient needs to be still while the allergens are injected subcutaneously. Close continuous monitoring was necessary throughout the procedure to ensure no negative reactions or anaphylaxis occurred and we could intervene promptly.

The dermatology nurse injected 68 allergens intradermally, the dermatologist then evaluated the skin for any reaction at the injection site, delivering an intravenous fluorescein stain the allergen injection sites were then graded.

Nurses recovered Storm in an ICU humidicrib to be warmed and closely monitored, having his vital signs taken i.e. heart rate, respiratory rate, temperature and mucous membrane colour, he recovered well eating as normal once he was alert. Storm’s results concluded he had severe allergies to oats, oaten hay, dust mites and several other allergens.

Storm was prescribed antihistamines and started his Rush immunotherapy, receiving multiple injections subcutaneously of the allergen throughout the day nurses closely monitored for any adverse reaction or anaphylaxis by checking his vitals continuously, after completing this we continued weekly injections as maintenance. The nurses made a food plan for Storm making sure no oats were in his diet and he has made some improvement since starting the desensitisation and we hope to see further improvement in the future.

Surgical removal of a pulmonary bullae in an anxious geriatric golden retriever. 10yo FS Golden Retriever.

Originally presented due to abnormal behavior at home. Computed tomography performed, pulmonary bullae was an incidental finding along with a right adrenal mass suspected to be a pheochromocytoma (to be surgically removed at a later date).

Patient required a thoracotomy, therefore a tailored anaesthesia and analgesia plan was derived which included mechanical ventilation. In-depth nursing care was required, ensuring the patient remained stable throughout the anaesthetic and had a good recovery. Post-operative care involved close monitoring with the emergency & critical care team. This included appropriate analgesia intervention, chest drain care, respiratory and oxygen saturation monitoring.

Patient recovered well and was discharged the following day.

This presentation offers a case study of a canine patient with Immune-Mediated Haemolytic Anaemia (IMHA), a life-threatening autoimmune disorder. Therapeutic Plasma Exchange (TPE) was employed as a vital intervention. This presentation will examine the case and the critical factors that led to the adoption of TPE as part of the treatment protocol.

Exploration of the TPE procedure, its rationale, and its impact on the patient's condition will be provided, along with insights into monitoring and aftercare. This case study exemplifies the potential of TPE as a life-saving modality in managing IMHA in dogs, showcasing the significance of individualized treatment plans in complex autoimmune disorders.

By delving into this case study, attendees will gain a deeper understanding of the role of TPE in its use for IMHA patients.

My abstract is to discuss the key roles in nursing for cats in kidney failure that have been admitted to hospital. This can be very intense cases for vets as there is a lot of information to digest for the owners and decisions for treatment. As nurses, it is beneficial to know what basic treatments the vet will require, important symptoms to monitor closely at and to inform the vet on and beneficial ways to keep these patients as comfortable as possible. There is a lot that can be discussed about theses cases but I would like to provide nurses with important information that I have found most beneficial with a case.

Amniotic membrane has been used as a graft or as a dressing in different surgical subspecialities to promote healing of persistent epithelial defects for some time. Amniotic membrane is a rich source of biologically active factors and as such, promotes healing and acts as an effective material for wound dressing. It supports epithelialisation and exhibits anti-fibrotic, anti-inflammatory, anti-angiogenic and anti-microbial features. In equine ophthalmology, it is increasingly being used for the treatment of persistent epithelial defects and non-healing corneal ulcers in conjunction with a range of techniques to facilitate this process including, inlays, overlays or patch techniques and in combination with a conjunctival graft to preserve the integrity of the globe. It is also a helpful to minimise scarring and optimise visual outcome for athletic horses in disciplines where this is paramount.

Placentas' utilised in the preparation of amniotic membrane are retrieved from a healthy mare and foal undergoing an uncomplicated birth or ideally from caesarean section to avoid contamination. The amnion is prepared and washed a number of times under aseptic conditions and soaked overnight in a solution of phosphate buffered saline, benzylpenicillin, neomycin and amphotericin B. The washing process is repeated with the addition of EDTA prior to separating the amnion from the chorion. Once separated, the amnion is placed stromal side down on to nitrocellulose membrane and cryopreserved in solution until it is needed.

The use of amniotic membrane transplant in the healing of ocular surface defects is undeniable and is expanding in the human and veterinary ophthalmology arenas. There are a number preparation techniques that vary slightly however the technique described above is derived from Dennis Brooks at the University of Florida.