The Seventh International Veterinary Emergency and Critical Care Symposium was held on September 6-10, 200 in Orlando, Florida on the grounds of Walt Disney World.  Being a young emergency and critical care veterinarian, I found it a unique opportunity to continue my education in a most fascinating field.  And, frankly, I also wanted to revisit the hallowed ground of my younger days.

I have to admit, The Magic Kingdom can still grab and hold me.  Perhaps to today's child who is used to all modern conveniences and amusement parks galore, the Magic Kingdom may be a disappointment.  But to the triumphant return of the once child and the imagination replete, I found it … energizing.  There was a spring in my step as I hurried to rides.  I found myself humming tunes.  In short, I was corny personified.
Anyhow, back in the real world, the IVECCS lectures were very thorough and nuggets of insight were gleaned when I wasn't day dreaming of Splash Mountain.  I will try to compact this knowledge into a succinct, yet useful, packet:

Feline Pancreatitis Update:  Overall prognosis--fair to poor.  Do Not Fast These Cats!  By the time you see a cat with pancreatitis it has already NPOed itself for 24 hours or more.  These cats need nutrition and quickly.  Feeding tube of choice:  Jejunostomy tube, but Dr. Simpson at Cornell Uni

versity has had luck with gastric feeding.  Oral and esophageal alimentation should be avoided when possible.  Diagnostic Tests: Amylase and Lipase--Worthless.  TLI--better than Amylase and Lipase, but still not a good test. (High TLI's found in cats with IBD, intestinal lymphoma, and hepatic disease.)  Ultrasound--better than TLI, but the worst cases of necrotizing pancreatitis have looked normal ultrasonographically.  Best diagnostic:  Biopsy of pancreas during exploratory laparotomy.  Bottom Line:  These are critical cases that need immediate attention and 24-hour care.

Options for Prokinetic Therapy:  Reglan (metoclopramide) - old standard for prokinetic/antiemetic therapy.  Good effect on proximal GI tract, no effect on distal GI tract, has centrally mediated antiemetic properties.  Can be used as a constant rate infusion (1-2 mg/kg/24 hours).  Side effects:  hyperactivity and dystonic reactions.  Propulside (cisapride) - enhances small intestinal and colonic motor activity.  Relevant for treatment of idiopathic constipation in cats, esophageal reflux disease, post-operative ileus, and in some cases of canine megaesophagus.  Cisapride has been found to cause cardiac arryhthmias in people and the manufacturer has discontinued production.  Veterinarians may be able to obtain this drug from other sources.  Newer Options:  Low dose erythromycin--0.5-1 mg/kg TID.  Induces antral

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the object.
· An old dog arrives in status epilepiticus and cannot be reversed with the routine medicine. A constant rate infusion of propofol is begun and the neurologist is consulted as to whether an emergency MRI is needed.

• An internist is called in to consult on a critically ill older patient with multiple problems belonging to an owner concerned not only with their pet's immediate care, but with the "big picture:" The prognosis and required follow up the owner must provide.
  
• An unstable patient is admitted with a mass or unexplained body cavity effusion. The patient needs an ultrasound examination that day and can't wait for the scheduled consultation with the radiologist or internist elsewhere. The scan gets done that day by a specialist, providing timely and critical information for the attending doctor.
  

· The holistic doctor is consulted on very difficult cases to search for alternative approaches or to treat patients with acupuncture who are having surgery for intervertebral disc herniation.
· One of the National Zoo veterinarians calls; they need
help with a complicated surgery, an endoscopy on a

cheetah or a myelogram on a tiger.  "How soon can you come?" is always the question.

While the treatment of patients is occurring, our administration staff is arranging for the SouthPaws staff to attend and financially support Dog Walks, Canine Games, Bark Ball, etc. We also sponsor a soccer team called the SouthPaws Yankees and a little league team, the Blue Jays, who were the 1999 A.N.S.L.L. "AA" Champions.

We get phone calls from local veterinary organizations requesting speakers for CE and from examination committees for specialty colleges like oncology.

As the day winds down, each doctor rounds with the overnight staff doctors about their patients in the hospital to ensure continuity and quality of care throughout the night. The SouthPaws surgery staff is available round the clock for emergency surgeries and many other departments are available should the overnight staff doctors need to talk about newly admitted patients or our in-house patients.

At 8am the next morning, we begin again!