The use of the diaphragmatico-hepatic (DH) views of the abdominal and thoracic focused assessment with sonography for triage (AFAST/TFAST) examinations for the detection of pericardial effusion in 24 dogs (2011-2012)

Recasting the gold standard - part I of II: delineating healthcare options across a continuum of care

AIM

This is the first part of a two-part series on spectrum of care that encourages practitioners to embrace a non-binary approach to healthcare delivery. When care is not framed as all-or-none, either/or or best versus lesser, the provider and client can agree to diagnostic and/or treatment plans that individualize the practice of veterinary medicine. Care is tailored to the patient along a continuum of acceptable options. Care may also be intentionally incremental, with plans to reassess the patient and revise case management as needed.

RELEVANCE

Acknowledgment and ultimately acceptance that patient care journeys can be distinct, yet equitably appropriate, offers providers the flexibility to adapt case management competently and confidently to the patient based upon contextualized circumstances including client needs, wants and expectations for healthcare outcomes. Thinking outside the box to recast the historic gold standard with a continuum of care strategically offers feline practitioners a means by which they can overcome barriers to healthcare delivery.

SERIES OUTLINE

This first article introduces spectrum of care as an appropriate approach to case management and broadens its definition beyond cost of care. Part II explores communication strategies that enhance veterinary professionals' delivery of spectrum of care through open exchange of relationship-centered dialogue.

The Role of Point-of-Care Ultrasound in Managing Cardiac Emergencies

Point-of-care ultrasound (POCUS) is a useful imaging tool for the diagnosis and monitoring of cardiac emergencies. Unlike complete echocardiography, POCUS is a time-sensitive examination involving a subset of targeted thoracic ultrasound views to identify abnormalities of the heart, lungs, pleural space, and caudal vena cava. When integrated with other clinical information, POCUS can be helpful in the diagnosis of left-sided and right-sided congestive heart failure, pericardial effusion and tamponade, and severe pulmonary hypertension and can help clinicians monitor resolution or recurrence of these conditions.

Echocardiographic caudal vena cava measurements in healthy cats and in cats with congestive heart failure and non-cardiac causes of cavitary effusions

BACKGROUND

Echocardiographic indices of the inferior vena cava have been associated with elevated right atrial pressures in humans.

HYPOTHESIS/OBJECTIVES

Describe caudal vena caval (CVC) sonographic dimensions in healthy cats compared to cats with cardiogenic cavitary effusion (CCE), cardiogenic pulmonary edema (CPE), or non-cardiac causes of cavitary effusion (NCE).

ANIMALS

30 healthy control cats and 52 client-owned cats with CCE, CPE, or NCE examined at two university hospitals.

METHODS

Sagittal 2-dimensional (2D) and M-mode CVC dimensions were acquired from the subxiphoid view. Caudal vena cava collapsibility index (CVC-CI) was calculated. Variables were compared between study groups using Kruskal-Wallis and Dunn's Bonferroni testing. Receiver operating characteristic curves were used to assess sensitivity and specificity for diagnostic categories.

RESULTS

Healthy cats had sagittal 2D and M-mode (median, interquartile range) CVC maximal dimensions of 2.4 mm (1.3-4.0) and 3.4 mm (1.5-4.9) and CVC-CI of 52% (45.2-61.8) and 55% (47.8-61.3), respectively. The CVC maximal dimensions in healthy controls were smaller than in cats with cavitary effusions or pulmonary edema (all P<0.05). CVC-CI was different between CCE and NCE (P<0.0001) with cutoffs of CVC-CI ≤38% (2D) or ≤29% (M-mode) being 90.5% and 85.7% sensitive, and 94.4% and 100% specific for diagnosis of CCE, respectively.

CONCLUSIONS AND CLINICAL IMPORTANCE

Caudal vena cava measurements are larger in cats with cavitary effusions and cats with CPE than healthy cats. In cats with cavitary effusion, decreased CVC-CI, ≤38% (2D) or ≤29% (M-mode), was helpful in distinguishing between cardiogenic and noncardiogenic etiology.

N-terminal brain natriuretic peptide, cardiac troponin-I, and point-of-care ultrasound in dogs with cardiac and noncardiac causes of nonhemorrhagic ascites

BACKGROUND

Nonhemorrhagic ascites (NHA) can be caused by cardiac diseases (cNHA) and noncardiac diseases (ncNHA). N-terminal brain natriuretic peptide (NT-proBNP), cardiac troponin-I (cTnI), and point-of-care ultrasound (POCUS) may differentiate between cNHA and ncNHA.

HYPOTHESIS/OBJECTIVES

We compared NT-proBNP and cTnI concentrations as well as POCUS findings in dogs presented with cNHA and ncNHA.

ANIMALS

Dogs (n = 60) were enrolled based on identification of NHA with an effusion packed cell volume < 10%.

METHODS

Blood samples were collected and POCUS was performed on all dogs. Dogs were diagnosed with cNHA (n = 28) or ncNHA (n = 32) based on echocardiography. The cNHA group was subdivided into cardiac non-pericardial disease (n = 17) and pericardial disease (n = 11).

RESULTS

The NT-proBNP concentration (median; range pmol/L) was significantly higher in the cNHA group (4510; 250-10 000) compared to the ncNHA group (739.5; 250-10 000; P = .01), with a sensitivity of 53.8% and specificity of 85.7% using a cut-off of 4092 pmol/L. The NT-proBNP concentrations were significantly higher in the cardiac non-pericardial disease group (8339; 282-10 000) compared with the pericardial disease group (692.5; 250-4928; P = .002). A significant difference in cTnI concentration (median; range ng/L) between the cNHA group (300; 23-112 612) and ncNHA group (181; 17-37 549) was not detected (P = .41). A significantly higher number of dogs had hepatic venous and caudal vena cava distension in the cNHA group compared to the ncNHA group, respectively (18/28 vs 3/29, P < .0001 and 13/27 vs 2/29, P < .001). Gall bladder wall edema was not significantly different between groups (4/28 vs 3/29, P = .74).

CONCLUSIONS AND CLINICAL IMPORTANCE

NT-proBNP concentration and POCUS help distinguish between cNHA and ncNHA.

Focused cardiac ultrasound examination in the emergency and critical care equine patient: Training for non-specialist veterinarians and evaluation of proficiency

Background

Focused cardiac ultrasound examination (FoCUS) is rapidly emerging for point‐of‐care cardiac assessment using hand‐carried ultrasound (HCU) devices. A specific FoCUS protocol for horses and adequate training guidelines currently are not available.

Hypothesis

To gain knowledge about the training necessary to become proficient in performing FoCUS using a HCU device.

Animals

Three healthy Warmblood horses were used for practical training of veterinarians and veterinary students in equine focused cardiac ultrasound (eFoCUS).

Methods

Prospective educational study. An eFoCUS protocol and 1‐day training course were developed. Pre‐ and post‐course written tests were administered to participants to evaluate proficiency in knowledge of echocardiography and echocardiographic pathology. A post‐course practical examination involved performing eFoCUS and storage of representative images. Images were evaluated using an image quality score and compared between participants with some practical experience and participants with no practical experience.

Results

Participants' knowledge of echocardiography increased significantly. Recognition of echocardiographic pathology pre‐course ranged from 40% to 90% (mean score, 65.7%) and post‐course from 85% to 100% (mean score, 92%). Eighteen of 21 participants were proficient in performing eFoCUS with a median image quality score of 79% (range, 42%‐95%). Image quality did not differ between participants with some practical experience compared to participants with no experience.

Conclusions and Clinical Importance

Veterinarians and veterinary students independent of previous experience can become proficient in performing eFoCUS after completion of a 1‐day training course.

Right ventricular systolic and diastolic function assessed by two-dimensional speckle tracking echocardiography in dogs with myxomatous mitral valve disease

Pulmonary hypertension (PH) is a common comorbidity in dogs with myxomatous mitral valve disease (MMVD), and can induce various changes in the right heart, such as right ventricular (RV) hypertrophy, dilatation, and dysfunction. We hypothesized that RV function, not only systolic function but also diastolic function, could be worsened with PH progression. We aimed to compare RV systolic and diastolic function in dogs with MMVD. Twenty healthy dogs and sixty-eight dogs with MMVD were enrolled. Dogs with MMVD were classified into the probability of PH. Two-dimensional and Doppler echocardiographic indices for right heart and two-dimensional speckle tracking echocardiography indices were measured. The morphological indicators of the right heart were significantly higher only in the high probability of PH group. The RV strain, early-diastolic and systolic strain rates were significantly lower in the high probability of PH group than those in the low and intermediate probability of PH groups. Multivariate analysis showed that increased RV internal dimension normalized by body weight and RV myocardial performance index were significantly associated with the presence of right-sided congestive heart failure. Speckle tracking echocardiography-derived RV systolic and diastolic function were activated in the low and intermediate probability of PH groups. However, dogs with high probability of PH showed RV myocardial dysfunction and dilatation. Increased RV myocardial performance index and end-diastolic RV internal dimension normalized by body weight were significantly associated with the presence of right-sided congestive heart failure in dogs with MMVD.

Investigation of the influence of manual ventilation-controlled respiration on right ventricular pressure-volume loops and echocardiographic variables in healthy anesthetized dogs

OBJECTIVE

To evaluate the influence of manual ventilation-controlled respiration on right ventricular (RV) pressure-volume loop-derived and echocardiographic variables in dogs.

ANIMALS

8 healthy, anesthetized Beagles.

PROCEDURES

In a prospective experimental study, pressure-volume catheters were percutaneously inserted into the right ventricle of each dog, and manual ventilation was performed; RV pressure-volume loop (hemodynamic) data and conventional echocardiographic variables were assessed. Two-dimensional speckle tracking echocardiography-derived RV strain (RVS) and RV systolic strain rate (RVSR) were obtained with RV free wall-only analysis (free wall) and RV global analysis (RVGA; interventricular septum). Variables were compared between end-inspiratory and end-expiratory phases of respiration by statistical methods. Multiple regression analysis was used to assess associations between selected hemodynamic and echocardiographic variables.

RESULTS

The RV pressure significantly increased, and RV volume, stroke volume, tricuspid annular plane systolic excursion, RV fractional area change, peak myocardial systolic velocity of the lateral tricuspid annulus, and RV free wall only-assessed RVS and RVSR significantly decreased in the inspiratory phase, compared with the expiratory phase. There were no significant differences in end-systolic elastance or RVGA-assessed RVS or RVSR between respiratory phases. The RVGA-assessed RVSR was significantly associated with stroke volume and end-systolic elastance.

CONCLUSIONS AND CLINICAL RELEVANCE

Specific RV echocardiographic variables were significantly affected by respiration. In contrast, RVS and RVSR determined with RVGA were not affected by respiration and were associated with hemodynamic indicators of RV contractility.

TFAST Accurate Diagnosis of Pleural and Pericardial Effusion, Caudal Vena Cava in Dogs and Cats

TFAST, a standardized and validated thoracic point-of-care ultrasound examination, includes 5 acoustic windows: bilaterally applied chest tube site and pericardial site views plus diaphragmatico-hepatic view, also part of AFAST/ Vet BLUE. TFAST is used for rapid detection of pneumothorax and pleural and pericardial effusion. By following a set of TFAST rules, image interpretation errors are avoided, including mistaking cardiac chambers for effusion. Moreover, TFAST echocardiography is used as a screening test for chamber size and soft tissue abnormalities, volume status and contractility, and intracardiac abnormalities.

AFAST Target-Organ Approach and Fluid Scoring System in Dogs and Cats

Point-of-care ultrasonography as part of the physical examination is becoming considered a core skill. AFAST includes 5 acoustic windows over the abdomen and serves as a rapid screening test for free fluid (ascites, retroperitoneal, pleural and pericardial effusion) and soft tissue abnormalities (target-organ approach), and has an abdominal fluid scoring system (semiquantitating volume). Moreover, add-on skills are possible without additional views that include characterizing the caudal vena cava and hepatic veins (volume status), measuring the urinary bladder (volume estimation and urine output), screening for free air (pneumoperitoneum, pneumoretroperitoneum), and assessing gastrointestinal motility.

Lung Ultrasound Fundamentals, "Wet Versus Dry" Lung, Signs of Consolidation in Dogs and Cats

Vet BLUE, a standardized and validated rapid lung ultrasound examination, includes 9 acoustic windows: 4 transthoracic bilaterally applied named Caudodorsal, Perihilar, Middle, and Cranial Lung Regions plus the Diaphragmatico-Hepatic view of AFAST/TFAST. Moreover, Vet BLUE has a B-line scoring system (weak positives-1, 2, and 3 and strong positives->3 and infinite) that semiquantitate degree of alveolar-interstitial syndrome and a visual lung language for signs of consolidation (Shred Sign [air bronchogram], Tissue Sign [hepatization], Nodule Sign, and Wedge Sign [pulmonary infarction]). Using its regional, pattern-based approach, a respiratory working diagnosis may be rapidly developed point-of-care and followed serially.

Global FAST for Patient Monitoring and Staging in Dogs and Cats

Please verify if FAST should be expanded at first use - "focused assessment with sonography for trauma"?: Global FAST consists of abdominal FAST, thoracic FAST, and Vet BLUE combined as a single point-of-care ultrasound examination used as an extension of the physical examination. By applying its unbiased set of 15 data imaging points, information is gained while avoiding image interpretation errors, such as satisfaction of search error and confirmation bias error, through selective POCUS imaging. Moreover, Global FAST is used for integrating information from both cavities, rapidly screening for the Hs and Ts of cardiopulmonary resuscitation, and staging localized versus disseminated disease, helpful diagnostically and prognostically for patient work-up. By seeing a problem list, patient care is improved.

Focused Canine Cardiac Ultrasound

Focused cardiac ultrasound (FCU) is a useful point-of-care imaging tool to assess cardiovascular status in symptomatic dogs in the acute care setting. Unlike complete echocardiography, FCU is a time-sensitive examination involving a subset of targeted ultrasound views to identify severe cardiac abnormalities and is performed as part of an integrated thoracic ultrasound including interrogation of the pleural space and lungs. When integrated with other clinical information, FCU can be helpful in the diagnosis of left-sided and right-sided congestive heart failure, pericardial effusion and tamponade, and severe pulmonary hypertension, and can provide estimates of fluid responsiveness in hypotensive dogs.

Thirteen dogs and a cat with ultrasonographically detected gallbladder wall edema associated with cardiac disease

Background

Ultrasonographically detected gallbladder wall edema (GBWE) is a marker for anaphylaxis in dogs. Cardiac disease can cause GBWE with similar signs and should be included as a differential diagnosis to prevent interpretation errors.

Hypothesis/Objectives

Document GBWE associated with cardiac disease.

Animals

Fourteen client‐owned animals.

Methods

Prospective case series with abdominal focused assessment with abdominal sonography in trauma, triage and tracking (AFAST), and thoracic focused assessment with abdominal sonography in trauma, triage, and tracking (TFAST) performed at triage. Animals with GBWE and cardiac disease were enrolled. A board‐certified radiologist reviewed images to confirm cardiac disease, GBWE, and characterize the caudal vena cava (CVC) and hepatic veins.

Results

Thirteen dogs and 1 cat had GBWE associated with cardiac disease. Gallbladder findings included mural thickness ranging from 3 to 5 mm, mild to moderate sludge (n = 3), and mild to moderate luminal distension (n = 6). CVC and hepatic venous distension were found in 5/6. Cardiac diagnoses in dogs included 11 with pericardial effusion (PCE) and 1 each with dilated cardiomyopathy and right‐sided myocardial failure. Severity of PCE was rated as mild (n = 1), moderate (n = 6), or severe (n = 4). Seven of 11 had pericardiocentesis performed. Nine of 13 had ascites with 4 having abdominal fluid scores of 1 (n = 2), 2 (n = 2), 3 (n = 1), and 4 (n = 0). Lung ultrasound findings were as follows: dry lung (n = 6), B‐lines (n = 4), and nodules (n = 1). The cat had moderate PCE, ascites scored as 1, and severe right‐sided ventricular enlargement associated with a ventricular septal defect. Primary presenting complaints included acute weakness (n = 9), acute collapse (n = 5), gastrointestinal signs (n = 3), respiratory distress (n = 2), and need for cardiopulmonary resuscitation (n = 1).

Conclusions and Clinical Importance

Ultrasonographically detected GBWE was associated with PCE in this small cohort of cases.

Utility of tricuspid annular plane systolic excursion normalized by right ventricular size indices in dogs with postcapillary pulmonary hypertension

Background

Tricuspid annular plane systolic excursion (TAPSE) is a common right ventricular (RV) function indicator. However, TAPSE was not decreased in dogs with myxomatous mitral valve disease (MMVD) and postcapillary pulmonary hypertension (PH) because of its load, angle, and body weight dependency, and TAPSE was considered a preload‐dependent index.

Objectives

To evaluate the utility of TAPSE normalized by RV size in dogs with postcapillary PH.

Animals

Twenty healthy dogs and 71 MMVD dogs with or without PH.

Methods

In this prospective observational study, end‐diastolic RV internal dimension (RVIDd), end‐diastolic and end‐systolic RV area, and end‐diastolic RV wall thickness were measured as RV size indices. The TAPSE was measured using B‐mode and M‐mode methods. Normalized TAPSE was calculated by dividing TAPSE by each RV size index. The RV strain was obtained as the detailed RV function using 2‐dimensional speckle tracking echocardiography. All indices were compared among the PH severity groups and in the presence of right‐sided congestive heart failure (R‐CHF).

Results

Although nonnormalized TAPSE was higher with PH severity progression, each normalized TAPSE showed a significant decrease in the severe PH group (P < .05). The TAPSE_B‐mode/RVIDd ratio had high area under the curve to predict R‐CHF and had moderate correlation with RV strain (P < .05). The TAPSE_B‐mode/RVIDd and left atrial‐to‐aortic diameter ratios were independent predictors for R‐CHF.

Conclusions and Clinical Importance

Normalized TAPSE could reflect RV systolic dysfunction in dogs with severe PH, which could not be detected by nonnormalized TAPSE. The TAPSE_B‐mode/RVIDd ratio might predict R‐CHF with high sensitivity and reproducibility.

Mixed methods investigation of the use of telephone triage within UK veterinary practices for horses with abdominal pain: A Participatory action research study

BACKGROUND

Telephone triage is an integral part of modern patient care systems in human medicine, and a key component of veterinary practice care systems. There is currently no published research on telephone triage within the veterinary profession.

OBJECTIVE

To investigate current approaches to telephone triage of horses with abdominal pain (colic) in veterinary practice and develop new resources to support decision-making.

STUDY DESIGN

Participatory action research using mixed-methods approach.

METHODS

An online survey assessed current approaches to telephone triage of horses with colic in UK veterinary practices. Structured group and individual interviews were conducted with four equine client care (reception) teams on their experiences around telephone triage of colic. Evidence-based resources, including an information pack, decision flow chart and recording form, were developed and implemented within the practices. Participant feedback was obtained through interviews six months after implementation of the resources.

RESULTS

There were 116 participants in the online survey. Management and client care staff (53/116) felt less confident giving owner advice (p<0.01) and recognising critical indicators (p = 0.03) compared to veterinary surgeons and nurses (63/116). Thirteen themes were identified in the survey relating to owner advice; exercise and owner safety were most frequently mentioned, but conflicting guidance was often given. Fourteen client care staff were interviewed. They were confident recognising colic during a telephone conversation with an owner and identified the most common signs of critical cases as sweating and recumbency. The new resources received positive feedback; the decision flow chart and information on critical indicators were identified as most useful. After resource implementation, there was an increase in confidence in recognising critical cases and giving owners advice.

MAIN LIMITATIONS

Limited sample population.

CONCLUSIONS

This study described existing approaches to telephone triage, identified variations in advice given, and worked with client care teams to develop new resources to aid decision-making.

Cageside Ultrasonography in the Emergency Room and Intensive Care Unit

Global Focused Assessment with Sonography for Trauma (FAST) and point-of-care ultrasonography carry the potential to screen for and monitor conditions rather than traditional means without ultrasonography. Advantages include being point of care, cageside, low impact, rapid, safe, and radiation sparing, and requiring no shaving and/or minimal patient restraint. Moreover, information is real time for free fluid and soft tissue abnormalities of the abdomen, heart, and lung, which are missed or only suspected by physical examination, basic blood and urine testing, and radiography. A standardized approach with recording of patient data is integral to a successful Global FAST program.

The use of focused cardiac ultrasound to screen for occult heart disease in asymptomatic cats

Background

Focused cardiac ultrasound (FCU) helps detect occult heart disease in human patients.

Hypothesis

Focused cardiac ultrasound by a nonspecialist practitioner (NSP) will increase the detection of occult heart disease in asymptomatic cats compared with physical examination and ECG.

Animals

Three hundred forty‐three client‐owned cats: 54 excluded and 289 analyzed.

Methods

Multicenter prospective cohort study. Twenty‐two NSPs were trained to perform FCU. Cats without clinical signs of heart disease were recruited, and NSPs performed the following in sequential order: physical examination, ECG, FCU, and point‐of‐care N‐terminal pro‐B‐type natriuretic peptide assay (POC‐BNP). After each step, NSPs indicated yes, no, or equivocal as to whether they believed heart disease was present. The level of agreement between the NSP diagnosis and a blinded cardiologist's diagnosis after echocardiogram was evaluated using Cohen's kappa test.

Results

Cardiologist diagnoses included 148 normal cats, 102 with heart disease, and 39 equivocal ones. Agreement between NSP and cardiologist was slight after physical examination (kappa 0.253 [95% CI, 0.172‐0.340]), did not increase after ECG (0.256 [0.161‐0.345]; P = .96), increased after FCU (0.468 [0.376‐0.558]; P = .002), and the level of agreement was similar after POC‐BNP (0.498 [0.419‐0.580]; P = .67). In cats with mild, moderate, and marked occult heart disease, the proportion of cats having a NSP diagnosis of heart disease after FCU was 45.6%, 93.1%, and 100%, respectively.

Conclusions and Clinical Importance

Focused cardiac ultrasound performed by NSPs increased the detection of occult heart disease, especially in cats with moderate to marked disease. Focused cardiac ultrasound appears to be a feasible and useful tool to assist NSPs in the detection of heart disease in cats.

The utility of point-of-care ultrasound right-sided cardiac markers as a screening test for moderate to severe pulmonary hypertension in dogs

Dogs with respiratory disease can develop pulmonary hypertension (PH), a comorbid condition that can impact therapy and prognosis. Without confirmation using the criterion standard of echocardiography, this complication may be missed. Point-of-care ultrasound (POCUS) is a simple, non-invasive screening test that may suggest PH. It was hypothesized that in dogs POCUS right-sided cardiac markers (R-SCM) at the subxiphoid view would predict moderate to severe PH confirmed by echocardiography. Forty-three client-owned dogs that underwent respiratory evaluation with POCUS and echocardiography were included. POCUS R-SCM evaluated in the subxiphoid view included subjective caudal vena cava distention (CVC_sx), CVC_sx >1cm, gallbladder wall edema and ascites. PH was defined by tricuspid regurgitation pressure gradient (TRPG) as mild (30-49.9mmHg), moderate (50-74.9mmHg) or severe (>75mmHg). POCUS subxiphoid views were blindly evaluated post hoc and compared to echocardiography. Chi square test and one-way ANOVA were used to evaluate correlations between POCUS R-SCM and echocardiographic diagnosis of moderate to severe PH. Twenty-six dogs with PH, and 17 dogs without PH, were enrolled. There was no significant difference in the presence or absence of any R-SCM between dogs with and without PH. When dogs with no PH and mild PH were grouped and compared to dogs with moderate to severe PH (i.e., dogs for which treatment for PH would be recommended), no significant differences in R-SCM were noted. POCUS R-SCM using the CVC_sx view was not a sensitive screening test to identify dogs with PH in this study population.

Veterinary-focused assessment with sonography for trauma-airway, breathing, circulation, disability and exposure: a prospective observational study in 64 canine trauma patients

OBJECTIVE

To describe the technique and findings of the 'veterinary focused assessment with sonography for trauma-airway, breathing, circulation, disability and exposure' protocol in dogs suffering from trauma.

MATERIALS AND METHODS

Prospective observational study on a new point-of-care ultrasound protocol on 64 dogs suffering from trauma and comparison of findings with radiology.

RESULTS

Comparison of the results of this new ultrasound protocol for trauma patients with radiography findings for pneumothorax, pleural effusion, alveolar-interstitial syndrome and abdominal effusion revealed positive agreement of 89, 83, 100 and 87% and negative agreement of 76, 83, 76 and 92%, respectively. Novel findings of the 'veterinary focused assessment with sonography for trauma-airway, breathing, circulation, disability and exposure' exam, which were not previously reported for dogs undergoing focused assessment with sonography for trauma, included alveolar-interstitial syndrome (suggestive of pulmonary contusions), diaphragmatic hernia, retroperitoneal effusion and tracheal injury. Our new technique may also help identify increased intracranial pressure via changes in optic nerve sheath diameter and haemodynamic instability through the evaluation of the caudal vena cava and cardiac function.

CLINICAL SIGNIFICANCE

The described ultrasound examination protocol can be rapidly performed on dogs suffering from trauma during resuscitation and it may detect injuries previously undetectable using other veterinary point-of-care ultrasound protocols.