Veterinary Vertex
Veterinary Vertex is a weekly podcast that takes you behind the scenes of the clinical and research discoveries published in the Journal of the American Veterinary Medical Association (JAVMA) and the American Journal of Veterinary Research (AJVR). Tune in to learn about cutting-edge veterinary research and gain in-depth insights you won’t find anywhere else. Come away with knowledge you can put to use in your own practice – along with a healthy dose of inspiration to remind you what you love about veterinary medicine.
Veterinary Vertex
Increasing the Frequency of Successful Emesis Induction in Dogs
Discover how to improve the success rate of inducing vomiting in dogs with our guest, Dr. Trevor Chan. Trevor shares how the combination of abdominal thrusts and apomorphine that achieved a 100% success rate, an improvement from the 76.5% success rate with apomorphine alone. Trevor also discusses the consistent time to onset of vomiting and why larger dogs may be more responsive to this life-saving intervention. This episode is packed with crucial insights that can transform emergency veterinary practices.
Trevor also shares essential considerations for veterinarians when advising clients on emesis induction. We explore the potential risks and side effects, particularly for at-risk breeds, and why attempting this procedure at home is not advised. Trevor emphasizes the importance of immediate veterinary care when dogs ingest harmful substances. Tune in for an episode filled with practical advice and captivating discoveries.
JAVMA article: https://doi.org/10.2460/javma.23.12.0681
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Speaker 3:I want Dogs should be tested for existing heartworm infection prior to starting a preventive. To learn more, visit nextguardpluscliniccom. You're listening to Veterinary Vertex, a podcast of the APMA Journals. In this episode we chat about how the use of abdominal thrusts is associated with improved rate of successful emesis induction in dogs with our guest, trevor Chan Trevor, thank you so much for being here today.
Speaker 2:Hi, thanks for having me.
Speaker 3:All right, let's dive right in. So your JABMA article discusses how the use of abdominal thrust is associated with improved rates of successful MSS induction in dogs. Please share with our listeners the background on this study of successful emesis induction in dogs.
Speaker 2:Please share with our listeners the background on this study. Yeah, so clinically we use apomorphine in dogs to induce emesis. Normally that's either because they've eaten something that is poisonous and we want to try to retrieve as much as possible before they can absorb that and get the systemic effects of it, or if they've eaten something that's inedible that we think is going to eventually get stuck in the GI tract. We'd love to try to relieve that obstruction before we have to do anything more invasive. The success of that emesis really depends on a couple of factors, but also eventually it leads to major changes in how we treat our patients after that. A successful emesis in some of our patients means that they can go home within an hour. Our owners can relax and breathe a sigh of relief. Sometimes it is moderately successful and they might need some supportive care that might need to stay for observation. But at the worst case scenario, if we can't actually get the form material, then sometimes that even leads to things like a stint with general anesthesia to endoscopically retrieve that foreign material or even need to take them to surgery to remove that foreign material itself. And so some people, because of how important that emesis is, they've been performing things outside of just giving the apomorphine intravenously, and that's been kind of passed down from person to person, from hospital to hospital now, where we try to do other things to try to make them more successful.
Speaker 2:More successful Things like what we studied in this paper itself, where we applied external abdominal force, trying to jostle them around and try to get them to become more nauseous and have our MSS more successful. Some people will run dogs up and down the hallway. Some people even put cats in a chair or in their carrier and spin them. We're trying that with small dogs as well, sometimes Basically, anything we can do to further support the apomorphine. That being said, no one's ever actually studied is this successful? Is this helpful? Is it harmful? Is it neutral? Should we be doing this and focusing our efforts with this in a very busy ER setting, having someone do these things when they could do something else for another patient? It's important to know. You know how are we best utilizing our team and focusing our efforts for our patients? So that's why we wanted to do this study.
Speaker 3:Very well said. Having worked in a small animal ER background myself, I can definitely say I've seen and performed all those maneuvers that you just covered. So it's nice to see some evidence behind doing that, like you said, to justify the time it takes to to do these extra procedures sometimes. And what were some of the pivotal findings from the study?
Speaker 2:So the big thing that we found was that performing these abdominal thrusts was associated with increased rates of success, and so in this study we had 100% success rate when we were applying the external abdominal thrusts. All of our patients that received that extra intervention, they actually tolerated it really well, meaning that they didn't try to bite the person trying to actually perform the thrusts, they didn't run away, they just they. They were very compliant with that extra intervention. We found that when we gave the apomorphine and they were left alone as a control, we had a success rate of about 76 and a half percent. So definitely a bit of a change in there.
Speaker 2:Other things that we found was that performing the abdominal thrusts wasn't actually associated with a faster time to onset for emesis, meaning that the ones that will vomit are going to do it within a similar time frame, whether or not we perform the thrusts. That part I thought was a little bit interesting. I was expecting them to be a bit faster, but we are suspecting that it's probably because of all of these the neural signaling, the reaction patterns, all the reflexes together it's something that is not facilitated. You can't expedite that. The other thing that we found was that larger dogs in the study were more likely to have a successful emesis. But we need to investigate that a bit further to be able to speak a bit more intelligently about why. But that's just a finding that we had so far.
Speaker 3:Well, it sounds like another great project, so we look forward to hopefully seeing another manuscript from you Now. What sparked your research interest in inducing MSS in dogs and cats?
Speaker 2:I was in vet school and then now, being an ECC resident, you know I've been working in emergency rooms for my rotating as well as in my residency, and so working in all of these different ERs, working with a bunch of different people bringing in different experiences, everyone seems to have some sort of belief or a trick that they want to try with apomorphine and trying to make their MSs more successful, and so I've been seeing it for years now and I was really wondering you know, what are we doing here? Is it helpful? Am I doing the right thing for my patient?
Speaker 3:We always strive for an evidence, not eminence-based approach. So again, thank you for that. Now this next question is a little bit self-serving, but why did you choose to submit this manuscript to JABMA?
Speaker 2:Yeah, I love JABMA. I've been reading it for years, obviously, but also I felt like this topic I was hoping to reach a lot of general practitioners ER doctors reach a lot of general practitioners, er doctors, as well as people in specialty medicine. So I feel like JAMA is one of the best ones, one of the widest reaching journals, to submit to. So I was happy to try to submit to JAMA.
Speaker 3:We're very thankful that you did and I did promote your manuscript on social media this week too, so that also helped to increase its reach as well.
Speaker 2:That'd be great, thank you.
Speaker 3:Of course. So what was the most surprising finding from the study? We talked about some of the most important ones, but was there anything like wow, I didn't expect to find that.
Speaker 2:Yeah, all of the investigators not just me but both of my seniors in my residency we're all thinking that the time to onset to emesis was going to be different. If someone is bothering you when you're nauseous, we were really expecting a faster time to emesis, and the fact that they just hadn't it could either speak to that we either had a too small of a sample size to detect that, or it's just something that you can't really expedite and they're going to um, they're going to be successful, uh other on at their own pace and other ones being yeah, definitely surprising.
Speaker 3:I mean it makes sense what you're saying, so very, very interesting. Now, do you see a role for AI in clinical medicine around emesis and dogs?
Speaker 2:Yeah, so I I thought about this a little bit and I'm not quite sure about research aspect on that side of it.
Speaker 2:I think I need to be a bit more.
Speaker 2:I think I need to educate myself a bit more about AI for research purposes there, but I think that there could be a role for it on the clinical aspect side. A bunch of the pet poison hotlines that we think about that we encourage our owners to call. They are getting inundated with how many more pets there are now after the pandemic and time really is of the essence with a lot of the toxins as well as with foreign material. And so if there could be something with AI in terms of collecting that patient information a bit more in terms of like their weight when they actually induced or ate something, trying to get a bit more of that information to be able to screen for the veterinarians on the phone call side saying, yes, you should probably go see a vet or that's probably okay to wait and see, that could probably help both our wait times in the emergency room as well as with the pet poison hotlines or HPCA hotlines and things like that trying to help expedite that. That could be pretty helpful I think.
Speaker 3:Yeah, that'd be super interesting and definitely helps with the workload too. Hopefully, like the ER clinics are even saying go to ER, go to urgent care. You know, some of those places are popping up. So yeah, and for those of you just joining us, we're discussing how the use of abdominal thrusts is associated with improved rates of successful emesis induction and dogs, with our guest, trevor Chan. So you talked about your ECC residency. How has your training prepared you to write this?
Speaker 2:manuscript. Yeah, so I think in my residency we do journal clubs a lot, so we're reading a lot of papers, analyzing them, evaluating them. So seeing how people phrase things, how people talk about things, how people set up the papers in general, reading all these materials and methods and their discussions and things like that. It's really helpful for me to understand the verbiage, how to actually design a paper and a study itself. So that kind of thing has been really helpful. And then, even without the formal journal clubs that we do, we also are always trying to read papers, understand what's the literature behind one of my patients that I have in hospital right now. All those kinds of things we try to apply to the patients that we're seeing in hospital at the time.
Speaker 3:Next set of questions is going to be really important for our listeners. What is one piece of information the veterinarian should know before discussing emesis induction in dogs with the client?
Speaker 2:I think talking about the possible side effects and the risk factors for inducing emesis is really important. I know that we have to be okay with those risk factors because ultimately, decontaminating our patient or retrieving the form material is going to be most likely in their best interest, depending on the patient, especially if theyexposed to the patient by having it come back up Aspiration, pneumonia, all those things, especially in more of our at-risk breeds. I think about rachycephalics, I think about dogs with laryngeal paralysis, dogs that can't protect their airways as well. Knowing that it's while universally, I think we can say that it's most likely going to be helpful knowing that you know there's definitely specific patient variation that we need to consider and also the owners need to be aware of that as well. Knock on wood, hopefully they don't incur any of those risks as well, but every time we do MSS I know that we're getting very comfortable with it or we do it on a regularity. But just being comfortable and aware of those specific differences for your patient when they come in would be my push for them.
Speaker 3:And on the other side of the relationship, what's one thing clients should consider around emesis induction in dogs?
Speaker 2:Yeah, I think the big thing for me is I'm finding that some clients want to delay coming to the veterinarian, either because of the wait times or finances, or they want to try to do something at home. Ultimately, there's nothing that is over the counter or at home that is safe and that we'd recommend to try to induce emesis at home. It's something that, like we said, there are risk factors associated with it too should be performed by a veterinarian, and anything that you have that's at home or over the counter is probably riskier than something that we have available in the emergency clinic or at urgent care. So I'd say that if you think that there's a chance that your pet has ingested something that they shouldn't have, time is of the essence. I wouldn't try to do anything at home.
Speaker 2:I bring them into that, at the very least out of emergency service. They'll be triaged, they'll be have, get a once over, make sure that they're stable, get an understanding of why you guys are here. If it is something like a toxin or foreign body, things like that, normally I know that there are wait times, but we do prioritize based on severity of things and because toxins are time dependent, we want to make sure that we can get them decontaminated before they can absorb any of that. You normally would get seen a bit sooner, and we would definitely try to address something like that sooner rather than later, for sure. So don't wait, please come to the vet. We're not as scary as we think.
Speaker 3:Very well said again, so thank you very much. Now my favorite question what is your favorite animal fact?
Speaker 2:My favorite animal facts.
Speaker 2:I actually read a little article at npr earlier this month.
Speaker 2:There's an orangutan, um uh, who was seen to get in a fight with a rival male and he had a gash on his face. And they uh, the researchers there um, they found that he found this specific uh tree I think was like a liana vine grabbed some of of the leaves, started chewing it the leaves themselves and parts of the plants. They're known to be pain relieving, anti-inflammatory as well, and so this was the first time that they've been able to document and witness that an orangutan is actually going out, finding a leaf that has medicinal properties and is treating himself. So he both ate some of the leaves themselves as well, as he chewed up some more to get the sap and put it within the wound itself. He applied a bandage when flies were over it, and so after five days they found that it was pretty well healed. So see that there are those kinds of tools and plant knowledge and you know, being his own nurse and his own doctor, it was pretty cool to see. I think that was like one of my new favorite ones, for sure.
Speaker 3:That's so cool. Non-human primates are amazing and also everyone's favorite fact is always around zoo animals, which, selfishly, I love. So I always learn something new every episode. So thank you again, trevor. I just really appreciate your time today for you submitting your manuscript to JAVMA.
Speaker 2:Thank you so much for having me today. This was fun.
Speaker 3:And to our listeners. You can read Trevor's article and print JAVMA or online using your favorite search engine. I'm Sarah Wright and I want to thank each of you for joining us on this episode of the Veterinary Vertex podcast. We love sharing veterinary research with you and we want to hear from you. Be sure to leave us a rating and review on Apple Podcasts or whatever platform you listen to.
