Imaging the ECC patient

Question 1

ECC Patient safety considerations when imaging (2)

Answer 1

Positioning
- Cardiovascular compromise
- Respiratory compromise
- Neurological compromise
Species

Question 2

Situational considerations when imaging ECC patient

Answer 2

Speed of answers/logistics
Diagnostic utility
Availability

Question 3

Usefulness of CT in ECC patient

Answer 3

Higher sensitivity and specificity than Ultrasound/radiography for detection of free fluid or gas, as well as organomegaly.
Quick to obtain the images once in the machine – full body CT <1 minute followed by processing time.
Slow to prep the patient (sedation/GA required) and can be very slow to obtain a final report from a radiologist.
Considered gold standard diagnostically in many human emergency departments, however, due to slow turnaround time utility is limited.
Availability is limited in veterinary practice.

Question 4

Usefulness of MRI in ECC patient

Answer 4

Excellent for diagnosis of intracranial lesions and spinal lesions.
Excellent in equine for distal limb lameness – can image bone, tendon, ligament, joint capsule, etc.
Poor for both speed, utility and availability

Question 5

Usefulness of radiography in ECC patient

Answer 5

Often requires restraint/sedation/specific positioning which can be dangerous to the unstable patient
Good sensitivity and specificity for free gas e.g. pneumothorax
Moderate sensitivity and specificity for free fluid e.g. pleural, abdominal, pericardial
Allows limited assessment of thoracic and abdominal organs, more useful for lung pathology or mediastinal pathology and organ size, but less so parenchymal appearance.
Obstructive GIT and urinary disease in small animals.
Good for orthopaedic emergencies e.g. especially in equine where decisions must be made quickly vs orthopaedic injuries in small animals where an immediate decision is less important.
Widely available and relatively cheap
Easy to perform though interpretation does require some experience

Question 6

Usefulness of endoscopy in ECC patient

Answer 6

Excellent for upper respiratory distress in equine patients
Less useful in small animals due to the need for anaesthesia in unstable patients
Can be used for curative intervention

Question 7

Usefulness of ultrasound in ECC patient

Answer 7

PREFERRED
This can safely be performed in unstable patients with minimal restraint.
Non-invasive, rapid, easy to interpret with minimal training when doing standardised protocols:
– AFAST/TFAST/VetBLUE/VPOCUS/GFAST in small animals.
– FLASH in Equine.
Allows for abdominal organ assessment – parenchyma and size.
Allows for surface lung assessment.
Allows for cardiac assessment including volume status.
Good sensitivity and specificity for free fluid.
Moderate sensitivity and specificity for free gas.
Can be used for other soft tissue structures e.g. ligaments/tendons in equine.
Allows for interventions e.g. ultrasound guided centesis, or arterial blood sampling.
Does not allow assessment of deep thoracic structures unless major pathology.
Does not allow assessment of airways.