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حمل من هنــــــــــــــــــــــــــا
حمل من هنــــــــــــــــــــــــــا
حمل من هنــــــــــــــــــــــــــا
حمل من هنــــــــــــــــــــــــــا
حمل من هنــــــــــــــــــــــــــا
حمل من هنــــــــــــــــــــــــــا
حمل من هنــــــــــــــــــــــــــا
حمل من هنــــــــــــــــــــــــــا
حمل من هنــــــــــــــــــــــــــا
حمل من هنــــــــــــــــــــــــــا
حمل من هنــــــــــــــــــــــــــا
حمل من هنــــــــــــــــــــــــــا
حمل من هنــــــــــــــــــــــــــا
حمل من هنــــــــــــــــــــــــــا
حمل من هنــــــــــــــــــــــــــا
حمل من هنــــــــــــــــــــــــــا
حمل من هنــــــــــــــــــــــــــا
حمل من هنــــــــــــــــــــــــــا
حمل من هنــــــــــــــــــــــــــا
حمل من هنــــــــــــــــــــــــــا
حمل من هنــــــــــــــــــــــــــا
حمل من هنــــــــــــــــــــــــــا
حمل من هنــــــــــــــــــــــــــا
حمل من هنــــــــــــــــــــــــــا
حمل من هنــــــــــــــــــــــــــا
حمل من هنــــــــــــــــــــــــــا
حمل من هنــــــــــــــــــــــــــا
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حمل من هنــــــــــــــــــــــــــا

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    • 1. Large Animal EmergencyLarge Animal Emergency and Critical Care serviceand Critical Care service
    • 2. LA ECC- HistoryLA ECC- History • In 2002, a plan was developed by theIn 2002, a plan was developed by the equine sections to establish anequine sections to establish an independent service dedicated to Equineindependent service dedicated to Equine Emergency and Critical CareEmergency and Critical Care – Faculty dedicated to ECC- interest andFaculty 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 timeDecrease faculty after hours time commitmentcommitment
    • 3. 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 seniorTo allow full 24/7 coverage by senior faculty dedicated to ECCfaculty dedicated to ECC
    • 4. LA ECC- Current statusLA ECC- Current status • 3 faculty positions3 faculty positions • Residents/interns fromResidents/interns from other services(3 forother services(3 for each after hour shift)each after hour shift)
    • 5. LA ECC- Dedicated technicianLA ECC- Dedicated technician
    • 6. The faculty and staff of the collegeThe faculty and staff of the college are committed to exceptionalare committed to exceptional teaching, research and patient careteaching, research and patient care ………… Large Animal Emergency and Critical Care Clinical Service Teaching Research
    • 7. LA ECC- Clinical ServiceLA ECC- Clinical Service Emergency triage Stabilization and transfer Immediate care and transfer Immediate and ongoing care
    • 8. 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 Colic Laceration Orthopedic Foal Respiratory Diarrhea Eye Choke Neurologic Reproductive Dystocia Other 36% 9% 3% 9% 6% 9% 2%3%3% 2% 1% 16%
    • 9. Caseload- SurgicalCaseload- Surgical 0 50 100 150 200 250 300 Colic Laceration Orthopedic Foal Respiratory Diarrhea Eye Choke Neurologic Reproductive Dystocia Other Surgery No surgery 32% 15%12% 14% 16%37%34% 13%5% 0% 38% 18% 181/725
    • 10. Caseload- Management 0 50 100 150 200 250 300 Colic Laceration Orthopedic Foal Respiratory Diarrhea Eye Choke Neurologic Reproductive Dystocia Other Type of cases Numberofcases ICU care No ICU 70% 25% 7% 12% 64% 29% 80% 10% 26% 47% 60% 38%
    • 11. LA ECC- Importance ofLA ECC- Importance of “satellite services”“satellite services” Theriogenology ICU Radiology Ultrasound Anesthesia Clinical pathology LA Emergency and Critical Care
    • 12. ICU ServiceICU Service -”Open” ICU : technicians offer ICU-”Open” ICU : technicians offer ICU services to usersservices to users -Under ICU technician supervisor: Mr-Under ICU technician supervisor: Mr Vidal Villareal (“V”)Vidal Villareal (“V”) -Overseen by ICU committee-Overseen by ICU committee “V”
    • 13. ICU facilityICU facility
    • 14. LA ECC- TeachingLA ECC- Teaching
    • 15. LA ECC- TeachingLA ECC- Teaching • Separate student rotation institutedSeparate student rotation instituted for the class of 2003for 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
    • 16. LA ECC -TeachingLA ECC -Teaching • CurriculumCurriculum – Participate in core curriculum teachingParticipate in core curriculum teaching – Currently offer elective classesCurrently offer elective classes • NeonatalogyNeonatalogy • Colic teamColic team – Goal: core course to integrate lecturesGoal: core course to integrate lectures related to ECC, both LA and SArelated to ECC, both LA and SA
    • 17. LA ECC- TeachingLA ECC- Teaching • Interns and residentsInterns and residents • Residents: ACVIM, ACVSResidents: ACVIM, ACVS Dr Leslie Easterwood ACVIM Dr Meghan Gilhooly Dr Jared Janke ACVIM Dr Jason Mez ACVS Dr Catherine Mohr Dr Berkeley Chesen ACVS Dr Tracy Norman ACVIM Dr Amy Plummer ACVS
    • 18. LA ECC-ResearchLA ECC-Research • Through Link GI group: Drs Cohen and RousselThrough Link GI group: Drs Cohen and Roussel – 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 associatedRoussel AJ Jr. Evaluation of risk factors associated with development of postoperative ileus in horses. Jwith development of postoperative ileus in horses. J Am Vet Med Assoc. 2004 Oct 1;225(7):1070-8.Am Vet Med Assoc. 2004 Oct 1;225(7):1070-8. – 2: Roussel AJ Jr, Cohen ND, Hooper RN, Rakestraw2: Roussel AJ Jr, Cohen ND, Hooper RN, Rakestraw PC. Risk factors associated with development ofPC. 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 Med2001 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.
    • 19. LA ECC- ResearchLA ECC- Research • Clinical researchClinical research – Comparison of different analyzers forComparison of different analyzers for lactate measurement in normal horseslactate measurement in normal horses (Marsh)(Marsh) – Retrospective evaluation of cecalRetrospective evaluation of cecal impactions in horses (Plummer,impactions in horses (Plummer, Rakestraw, Hardy)Rakestraw, Hardy)
    • 20. LA ECC-ResearchLA ECC-Research • Collaborative studiesCollaborative studies – Intraoperative lidocaine (Dr ChrisIntraoperative lidocaine (Dr Chris Sanchez)Sanchez) – Risk factors for duodenitis-proximalRisk factors for duodenitis-proximal jejunitis (Dr Noah Cohen)jejunitis (Dr Noah Cohen)
    • 21. LA ECC -ResearchLA ECC -Research • Inter-department collaborationInter-department collaboration – Mechanisms of edema resolution:Mechanisms of edema resolution: implications for treatment ofimplications for treatment of cardiovascular disease. Glen Laine,cardiovascular disease. Glen Laine, Principal Investigator. Program ofPrincipal Investigator. Program of Excellence in Life Sciences, TexasExcellence in Life Sciences, Texas A&M University (Hardy)A&M University (Hardy)
    • 22. LA ECC- OrganizationsLA ECC- Organizations and Collegeand College • Veterinary Emergency and CriticalVeterinary Emergency and Critical Care Society (VECCS)Care Society (VECCS) – American College of VeterinaryAmerican College of Veterinary Emergency and Critical CareEmergency and Critical Care – Academy of Veterinary Emergency andAcademy of Veterinary Emergency and Critical Care techniciansCritical Care technicians – Student chapter of VECCSStudent chapter of VECCS
    • 23. American College ofAmerican College of Veterinary Emergency andVeterinary 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
    • 24. LA ECC- Future directionLA ECC- Future direction • Continue to strive to improveContinue to strive to improve teachingteaching – ACVECC residency trainingACVECC residency training • Continue to strive to improveContinue to strive to improve service to clients and veterinariansservice to clients and veterinarians • Continue research effortsContinue research efforts
    • 25. LA ECC- Importance to theLA ECC- Importance to the communitycommunity • After hours emergencies lessAfter hours emergencies less desirable for practitionersdesirable for practitioners • After hours expertise remainsAfter hours expertise remains criticalcritical • Close monitoring and intensive careClose monitoring and intensive care may be difficult to achievemay be difficult to achieve • ECC may serve as primary,ECC may serve as primary, secondary or even tertiary referralsecondary or even tertiary referral centercenter
    • 26. Outreach-Outreach- Disaster preparednessDisaster preparedness Technical Large Animal EmergencyTechnical Large Animal Emergency RescueRescue Drs. Tomas & Rebecca GimenezDrs. Tomas & Rebecca Gimenez
    • 27. THANK YOU!THANK YOU!

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