Options for imaging the ECC patient

Question 1

What are the patient considerations when deciding on the method of imagery for an emergency?

Answer 1

Patient safety:
- positioning (cardiovascular, respiratory, neurological compromise)
- species

Question 2

What situational considerations must be made when deciding on the method of imagery in an emergency?

Answer 2

Speed of answers/logistics
Diagnostic utility
Availability

Question 3

Describe the pros and cons of using CT in an emergency

Answer 3

Pros:
- higher sensitivity and specificity for detection of free fluid or gas and organomegaly
- quick to obtain images once in machine
Cons:
- slow prep time (sedation/GA needed)
- can be slow to obtain final report
- limited availability

Question 4

What are the pros and cons of MRI in emergency situations?

Answer 4

Pros:
- good for diagnosing intracranial and spinal lesions
- good in equine distal lameness
Cons:
- poor speed
- poor utility
- poor availability

Question 5

Describe the pros and cons of radiography in an emergency

Answer 5

Pros:
- good sensitivity and specificity for free gas and fluid
- good for obstructive GI and urinary disease
- good for orthopaedic emergencies
- widely available and relatively cheap
- easy to perform
- useful for lung or mediastinal pathology
Cons:
- requires restraint/sedation/specific positioning which can be dangerous to unstable patient
- limited access to thoracic and abdominal organs

Question 6

Describe the pros and cons of endoscopy in emergencies

Answer 6

Pros:
- excellent for upper respiratory distress in horses
- can be used for curative intervention
Cons:
- less useful in small animals due to need for anaesthesia in unstable patients

Question 7

Describe the pros and cons of ultrasound in emergencies

Answer 7

Pros:
- can be performed safely with minimal restraint
- non-invasive
- rapid
- easy to interpret
- allows for abdominal organ assessment
- allows for surface lung assessment
- allows for cardiac assessment including volume status
- good sensitivity and specificity for free fluid and gas
- can be used for other soft tissue structures e.g., ligaments
- allows for interventions e.g., ultrasound guided centesis
Cons:
- Does not allow assessment of deep thoracic structures unless major pathology.
- Does not allow assessment of airways.