Great Dane, 45 Minutes of Unproductive Retching
A 3-year-old male intact Great Dane weighing 58 kg is carried in at 22:40 after 45 minutes of unproductive retching. The abdomen is distended and tympanic; heart rate is 160 beats/min with weak femoral pulses, mucous membranes are pale, CRT is 2.5 seconds, respiratory rate is 40 and shallow, and rectal temperature is 38.1°C. The owner drove 40 minutes from a rural town. Two 18-gauge cephalic catheters have been placed. Available: lactated Ringer's solution, 6% hetastarch, 7.5% hypertonic saline, a small-animal gastric tube set, a 14-gauge over-the-needle catheter, lidocaine, and a portable ECG. The nearest 24-hour specialty center with a criticalist is 90 minutes away; this practice has a surgeon on call but no overnight ICU staff. The owner asks whether the dog "just needs to burp."
1. Outline the fluid resuscitation plan with volumes and the sequence of the first 30 minutes.
Read the worked answer
This dog is in hypovolemic shock with a gastric outflow obstruction, so the first 30 minutes belong to the vascular space, not the stomach.
Two 18-gauge catheters are marginal for a 58 kg dog - place at least one 14- or 16-gauge catheter, ideally a second large-bore line. Give a crystalloid bolus of 20 mL/kg (1,160 mL) of LRS over 15–20 minutes, then reassess perfusion (heart rate, pulse quality, mucous membrane color, CRT, mentation) and repeat up to a total of 60–90 mL/kg if needed. Hypertonic saline 7.5% at 4 mL/kg (about 230 mL) is a reasonable bridge when time is short, but it must be followed by crystalloid and is not a substitute for volume.
Give analgesia early - a full agonist opioid such as methadone or hydromorphone - because this is a painful condition and pain drives the tachycardia. Then decompress, then radiograph, then surgery. Give nothing orally and do not let the owner offer water. Do not delay for a full panel; PCV/TS, glucose, lactate, and an ECG are enough to start. Tell the owner plainly that "burping" will not correct the volvulus.
2. Compare orogastric intubation and trocarization for decompression here, including the specific risks of each.
Read the worked answer
Two options, and the choice depends on the dog and the equipment.
Orogastric tube: measure from the nose to the last rib, mark it, lubricate, and pass with the dog sitting or sternal, not lateral. If the tube stalls at the cardia, withdraw slightly, rotate, and try again with gentle pressure - never force it, because the esophagus is friable and perforation is fatal. Ideally intubate first to protect the airway, since a full stomach plus a struggling dog equals aspiration.
Trocarization: clip and aseptically prepare the left flank at the point of greatest tympany, caudal to the last rib, and insert a 14-gauge over-the-needle catheter; leave the catheter open to vent. It relieves pressure but does not empty the stomach, and the spleen sits directly there - a bloody tap means you hit it.
Either way, decompression is a stabilization step, not a treatment: it does not correct the volvulus, and this dog still needs surgery. Take a right lateral radiograph if the dog is stable enough, and keep the ECG running for arrhythmias.
3. Twelve hours postoperatively the ECG shows ventricular premature complexes. How do you decide whether to treat, and with what?
Read the worked answer
VPCs after GDV surgery are common and often peak 12–24 hours postoperatively. A single VPC is not an emergency, but the trend matters. Get a continuous ECG or at least a one-minute rhythm strip every hour, and record rate and VPC frequency so you are treating a trajectory rather than a snapshot.
Lidocaine is indicated when VPCs are frequent (roughly more than 15–20 per minute), multifocal, R-on-T, or causing hypotension: 2 mg/kg IV bolus, then a CRI of 25–50 µg/kg/min, titrated while watching for tremor or seizures.
Look for and correct the triggers - hypokalemia, hypomagnesemia, hypoxemia, hypotension, pain, and acid-base derangement - because lidocaine layered on uncorrected electrolytes is a losing game. This practice has no overnight ICU staff, which is a genuine limitation: either the surgeon stays, the dog is transferred to the center 90 minutes away once stable, or the owner is told honestly what unattended overnight care means. Document the strips and who was notified.