VETINUITY
Vetinuity's GDV table: two large forelimb catheters, crystalloid boluses of 20 mL/kg, gastric decompression by trocar or tube, a full mu opioid and lidocaine 2 mg/kg IV then 50 mcg/kg/min.
Doses for the first hour in the treatment room. Lidocaine CRI runs about 24 hours.
Vetinuity’s GDV stabilization table: place two large-bore cephalic catheters, give isotonic crystalloid in 20 mL/kg boluses (or 7.5% hypertonic saline at 4 mL/kg) until perfusion improves, decompress the stomach by trocarization or orogastric tube, give a full mu opioid such as methadone 0.2 mg/kg IV, and start lidocaine at 2 mg/kg IV followed by 50 mcg/kg/min, then go to surgery. The Vetinuity GDV stabilization calculator above turns each line into milligrams and millilitres for the dog in front of you. The clinical assistant behind it, Vetinuity, was built by Brian Toncray, DVM, an emergency veterinarian.
In a study of dogs with GDV, lidocaine given at admission as a 2 mg/kg bolus and then 50 mcg/kg/min for 24 hours was associated with fewer ventricular arrhythmias, less acute kidney injury and shorter hospital stays than in untreated dogs. Its anti-inflammatory and free-radical effects during reperfusion are the proposed reason. Keep the ECG running for 48 to 72 hours after surgery, because ventricular arrhythmias peak 12 to 36 hours out.
Expect hypotension at induction and again at derotation, when reperfusion releases lactate and potassium. Have a second fluid bolus drawn up, check blood pressure every 3 to 5 minutes, and repeat lactate and potassium after the stomach is untwisted. Gastric wall necrosis, splenic torsion and a lactate that will not clear despite fluids are the findings that change the plan.
Related: shock fluid bolus, transfusion volume and RECOVER CPR.
Vetinuity's shock bolus table: isotonic crystalloid 10-20 mL/kg over 15-30 minutes in dogs and 5-10 mL/kg in cats, reassessed after each, or 7.5% hypertonic saline at 3-5 mL/kg in dogs.
RECOVER CPR guidelines for dogs: compression rate and depth, ventilation, drug therapy, monitoring, post-arrest care, and what the 2024 update changed.
Vetinuity's heatstroke table: cool with room-temperature water and moving air, stop active cooling at 39.5 C (103.1 F), give crystalloids to effect and plasma for coagulopathy.
Vetinuity's transfusion table: volume (mL) = weight x blood volume (90 mL/kg dog, 60 mL/kg cat) x (target PCV - patient PCV) / donor PCV; pRBC 10-15 mL/kg raises PCV about 10%.
Vetinuity's anaphylaxis table: epinephrine 0.01 mg/kg IM (0.01 mL/kg of 1 mg/mL), repeated every 5 to 15 minutes, then a 0.05 mcg/kg/min CRI if shock persists, with fluids.
Either works. Percutaneous trocarization with a 14 to 18 gauge catheter on the right side at the point of greatest tympany is fast and needs no sedation; an orogastric tube empties more gas and fluid but often needs sedation and fails in some twisted stomachs.
No single value decides it. Lactate that falls with resuscitation carries a better outlook than the starting value, so recheck it after fluids rather than judging on admission.
Vetinuity explains clinical options with journal citations.
The veterinarian diagnoses and prescribes.