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Critical Care

Overview

The Critical Care service at CVRC works to stabilize and treat critically ill patients requiring ICU level care. This team is responsible for managing the sickest patients in the hospital.

CVRC’s Critical Care team does not see routinely-scheduled appointments but instead works very closely with the Emergency and other Speciality services to ensure that the highest level of care is provided from the moment any patient presents to CVRC.

The Critical Care service is in the hospital providing care every day, including weekends and holidays.

What is a veterinary Criticalist?

A Criticalist has obtained intensive additional training for specialization in Emergency and Critical Care medicine. The advanced training and education includes a veterinary degree (3 to 5 years of undergraduate university, followed by 4 years of veterinary school), a rotating internship (1 year), and an ECC residency (3 years), followed by a series of rigorous examinations covering all aspects of emergency and critical care medicine for completion of certification by the American College of Veterinary Emergency and Critical Care (DACVECC).

What conditions does the Critical Care service manage?

The Critical Care service works closely in cooperation and conjunction with all other services in the hospital to provide support for a well-rounded approach to management of any patient in need of intensive care or monitoring. This most often means that a Criticalist is involved in the acute or life-threatening period of your pet’s illness in hospital, and then will work with other specialists or your primary care veterinarian to establish a plan for long-term care and management. Criticalists participate in management of a wide variety of illnesses, including but not limited to:

Traumatic injuries
Complex post-operative patients
Sepsis (life-threatening infection)
- Abdominal infection (peritonitis)
- Blood stream infection
- Severe pneumonia
Thoracic and respiratory disorders
- Pneumonia (aspiration pneumonia, contagious
- Congestive heart failure, pericardial effusion (fluid around the heart)
- Noncardiogenic pulmonary edema
- Pleural effusion and pneumothorax (fluid and air around lungs)
- Acute respiratory distress syndrome (ARDS) and acute lung injury (ALI)
- Feline asthma
- Pulmonary thromboembolism
- Acute exacerbations of chronic lung or airway conditions (bronchitis, tracheal collapse)
Abdominal disorders
- Severe gastrointestinal upset (either entirely acute or exacerbation of chronic digestive disorders)
- Intestinal obstructions
- Gastric foreign bodies (and esophageal foreign bodies)
- Pancreatitis
- Urinary tract obstruction
- Kidney dysfunction (both acute kidney injuries and exacerbations of chronic kidney disease)
- Urogenital conditions (pyometra, prostatitis)
- Liver diseases (infections, toxins, exacerbation of chronic liver disorders)
Blood disorders
- Anemia from bleeding, hemolysis (red blood cell destruction), or decreased red blood cell production
- Low platelets (thrombocytopenia)
- Blood clotting abnormalities (both excessive and inadequate clotting)
Endocrine (hormone) crises
- Diabetic ketoacidosis
- Hypoglycemia
- Addison’s disease (hypoadrenocorticism)
- Hypercalcemia
Immune-mediated diseases
- Hemolytic anemia, thrombocytopenia
- Polyarthritis
- Neurological conditions
Symptoms of infectious diseases
- Viral infections
  - Canine Parvovirus, Distemper, Feline Immunodeficiency Virus (FIV), Feline Leukemia Virus (FeLV), Feline Herpesvirus and Calicivirus
- Vector-borne (flea, tick, and mosquito) infections
  - Lyme, Ehrlichia, Heartworm Disease, Bartonella
- Contagious respiratory infections
  - Mycoplasma, Bordetella, Parainfluenza, Influenza
- Significant symptoms caused by parasites
  - Diarrhea or anemia from intestinal parasites

What diagnostics does the Critical Care service utilize?

Similar to CVRC’s other services, the Critical Care service utilizes our comprehensive in-house diagnostic capabilities, including:

Serial physical examinations
Comprehensive in-house laboratory essentials
- Hematology
- Blood chemistry
- Urinalysis
- Coagulation profile
- Cytology
Extensive diagnostic imaging
- Digital radiography
- Abdominal ultrasound
- Echocardiography (in conjunction with Cardiology)
- Advanced imaging
  - CT scan
  - MRI (in conjunction with Neurology)
  - Fluoroscopy for dynamic imaging
Emergency endoscopy
- Esophageal and gastric foreign bodies
- Esophageal dysfunction, inflammation, or strictures
- Gastrointestinal disorders (in conjunction with Internal Medicine)
Fine-needle aspirates, ultrasound-guided aspirates
Bone marrow aspirates and biopsies
Utilization of external laboratories for advanced diagnostics
- Infectious disease testing (cultures, serology, PCRs)
- Cytology, fluid analyses
- Histopathology (biopsies)

What treatments does the Critical Care service provide?

CVRC’s most critical patients are housed in our dedicated Intensive Care Unit (ICU) with round-the-clock monitoring and care by an Emergency & Critical Care doctor and nursing team 24 hours a day. The Critical Care service and all patients in ICU have access to:

Comprehensive in-house pharmacy with full complement of oral and injectable medications and therapeutics
Attentive fluid therapy and electrolyte supplementation
Continuous patient monitoring
- ECG, telemetry
- Blood pressure (indirect and arterial)
- Oxygenation
- Temperature
- Capnography (CO2 monitoring)
Intensive respiratory support
- Oxygen supplementation (kennels, nasal oxygen)
- High-flow oxygen therapy
- Endotracheal intubation
- Tracheostomy management
- Mechanical ventilation
Multimodal pain management
Transfusion medicine
- Blood typing and cross matching
- Blood transfusions with in-house Blood Bank and Donor Program
  - Whole blood
  - Packed red blood cells
  - Fresh frozen plasma, frozen plasma
  - Specialized products (cryoprecipitate, platelet-rich plasma)
Nutrition support
- Prescription diets
- Feeding tubes
- Intravenous nutritional therapy