Monitoring critically ill patients can be a daunting task even for experienced clinicians. Goal-directed therapy is a technique involving intensive monitoring and aggressive management of hemodynamics in patients with high risk of morbidity and mortality. The aim of goal-directed therapy is to ensure adequate tissue oxygenation and survival. This article reviews commonly used diagnostics in critical care medicine and what the information gathered signifies and discusses clinical decision making on the basis of diagnostic test results. One example is early goal-directed therapy for severe sepsis and septic shock. The components and application of goals in early goal-directed therapy are discussed.
Since 1999, when the author first described the research and potential applications of minimally invasive gastrointestinal surgery in animals, veterinarians have begun to apply some of these techniques in treating client owned animals. Minimally invasive surgery is advocated with diagnostic, prophylactic, and therapeutic intent. There has been a transition from a minimally invasive caseload toward the expansion of diagnostic procedures, adoption of prophylactic procedures (such as lap-assisted gastropexy), and performing more difficult therapeutic procedures. Small animal patients benefit from reduced tissue trauma and experience a rapid recovery. In this article, current research and minimally invasive gastrointestinal procedures in animals are discussed.
Article Outline
Some gastrointestinal (GI) problems (e.g., vomiting, diar- rhea, weight loss, anorexia, icterus, hepatomegaly, abnor- mal behavior associated with eating, abdominal pain) typically necessitate laboratory testing. On the other hand, dysphagia, regurgitation, ptyalism, halitosis, con- stipation, mucoid stools, hematochezia, and melena are usually best approached initially by other means (e.g., physical examination, radiology, ultrasonography, endos- copy, laparotomy, and/or biopsy).
FIGURE 9-3. A, A canine rectal scraping showing a macrophage with numerous engulfed yeasts. These are Histoplasma capsulatum. B, A canine rectal scraping that shows inflammatory cells and spherical organisms with a clear halo. The organisms are Prototheca.
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