 welcomes Anthony R. Coronado, DVM, to our show to discuss what is essential for a crash cart in emergency medicine cases. In this episode, Coronado and our host Adam Christman, DVM, MBA, discuss what items to stock for your crash cart, the importance of regular expiration date checks and training programs to ensure teams are ready for an emergency, common mistakes veterinary professionals make when it comes to emergency cases, and the pros and cons of what it is like to work in emergency medicine. 

Below is a partial transcript, edited lightly for clarity. 

 OK, so let's talk about the crash cart. This is so, so crucial. The reason why we're having this conversation is [because] we've been approached by listeners and learners about this, and...we're here to have you help guide us along the way. So let's talk about some of the nonnegotiables, if you will. What are some of the nonnegotiables that are in a crash card setup or a restock process?

I would say that every hospital is different in terms of what they prefer to have in their crash cart, so the main thing is being consistent in what you have in there. More importantly, though, regardless of what you keep in or on top of your crash cart, the most important thing is that it is stocked and it is secured so that people aren't using it for the day-to-day treatment of patients. Too many times, I see...somebody's using it for catheters [or] for grabbing a drug, and then when a crisis hits, that cart isn't ready for what it's designed for. So what you want to do is keep it stocked at all times. You've got a breakaway lock on there, and you want tape on there that says, "This was restocked at this time by this person," so that you know that it's ready to go and [it's] there when you need it. In terms of items, drugs are going to change...[and] things are on back order. Some require in-depth calculations that take a while, so they're not necessarily crash items. But you want to have chest tube placement kits, pericardiocentesis kits, thoracosynthesis kits, [and] unblocking kits ready for [blocked cats]. 

[You'll want] tracheal tubes of all sizes, if you have them, and you can get them for tracheostomy tubes, but you can also cut your own [tracheal] tube down in an emergency situation. [You also need] catheters of all sizes. In a shock situation, you want the bigger, the better. That is a common mistake. I see people put in tiny catheters [for] a giant dog, and you're just not able to deliver the fluids they need.... Then you might want to have central lines ready and [intraosseous] catheters with a driver so you can get fluids in those right away. And of course, you want the fluids that we just talked about handy, so your basic crystalloids...and hypertonic saline—[a] little controversial whether you want hetastarch or VetStarch, because of the concerns behind there, but go with those first few, and then epinephrine atropine. 

Now, whether you have access to pressors or not...those are one of the ones that have a lot of calculations go with them. But some people prefer to have those in the carts. I like to have insulin ready for those crashing blocked cats. I prefer calcium gluconate because I'm comfortable with it. To have that ready for those guys, too...can make a world of difference in a very short time.

Podcasts

Discover essential crash cart items for emergency medicine, including stocking tips, training advice, and common pitfalls to avoid.

ER medicine without the panic button

Harbor Point Animal Hospital in Mooresville, North Carolina, has been named the 2025 Accredited Practice of the Year (APOY) by the American Animal Hospital Association (AAHA). The award recognizes veterinary practices that set the standard for excellence in medicine, leadership, and client care, and it was presented to the honoree at AAHA Con 2025 in Chicago, Illinois.

AAHA is the only accrediting body for veterinary hospitals, requiring accredited hospitals to meet more than 900 rigorous standards across areas such as anesthesia, pain management, surgery, diagnostics, safety, and client communication. AAHA-accredited hospitals represent approximately 15% of all veterinary practices, according to a news release.

Harbor Point was chosen as the APOY from more than 4500 AAHA-accredited hospitals in the US and Canada.

 Other finalists included Stonebrook Family Pet Clinic in Frisco, Texas; North Shore Family Pet Hospital in Northbrook, Illinois; and Blue Springs Animal Hospital & Pet Resort in Blue Springs, Missouri.

“This award affirms the heart and passion behind everything we do,” Diane Vermillion, BS, RVT, VTS (ECC), practice operations coordinator at Harbor Point Animal Hospital, said in the release.

 “Our mission has always been to change the way pets see the vet—by treating every client and patient like family, holding ourselves to the highest standards, and staying deeply connected to our community.”

Practices around the country are honored for hospital design

Harbor Point Animal Hospital is part of the Encore Vet Group network. Since opening in 2016, the practice has been recognized for its innovative approach to veterinary care, with a focus on reducing fear, anxiety, and stress in pets while delivering advanced, evidence-based medicine, according to the release. The practice is deeply rooted in the Mooresville community as partners with local rescue groups, supporting other small businesses and participating in regional events.

“We hold ourselves to a high standard because we believe our patients deserve the best medical care, every time. We’re passionate about being different in the best way—reducing fear, anxiety, and stress wherever we can while holding ourselves accountable to doing things the right way, not just the easy way,” Vermillion said in an interview with AAHA.

Its recently renovated facility, state-of-the-art equipment, and expanding client base from the thriving Lake Norman region position the practice for continued growth. As part of that growth, Harbor Point is welcoming applications from associate veterinarians, credentialed veterinary technicians, and veterinary assistants eager to join its award-winning team, according to the hospital.

Harbor Point Animal Hospital named AAHA’s Accredited Practice of the Year. News release. Harbor Point Animal Hospital. September 23, 2025. https://harborpointanimalhospital.com/harbor-point-animal-hospital-named-aahas-2025/ 

Dunwoodie C. Meet AAHA’s 2025 Accredited Practice of the Year. American Animal Hospital Association. September 16, 2025. Accessed September 23, 2025. 

https://www.aaha.org/trends-magazine/publications/meet-aahas-2025-accredited-practice-of-the-year-winner/

Articles

A veterinary hospital in North Carolina was selected from more than 4500 accredited practices in the US and Canada. 

AAHA honors the 2025 Accredited Practice of the Year 

Feline urethral obstruction remains a common and life-threatening emergency in veterinary practice. Most blockages occur at the distal penile urethra, where the lumen narrows to an average of 0.7 mm in diameter, in contrast to the wider proximal urethra (1.3–2.0 mm).

Traditional indwelling urinary catheters are sutured in place and extend into the bladder lumen. While effective at relieving obstruction, these designs may contribute to incomplete elimination of urinary crystals. Crystals tend to accumulate in the bladder neck during catheterization and often migrate into the urethra upon catheter removal, precipitating repeat obstruction.

The MILA Tomcat Catheter was developed to address these shortcomings. Designed at a shorter 5cm length, and available in a 4Fr size, the catheter resides in the membranous/pelvic urethra rather than extending into the bladder.

 This positioning allows urine suspension of struvite crystals, reduces bladder wall irritation, and facilitates more complete elimination. The present pilot study

evaluates the effectiveness of the MILA Tomcat Catheter in comparison with currently available commercial open-ended catheters.

Commercial catheter (top), MILA Tomcat Catheter (bottom). 

Radiographic measurements of feline urethral length and anatomical landmarks used to determine the 5cm MILA Tomcat Catheter Length.

Three groups of male cats were evaluated over 48 hours:

 Four non-diseased male cats with baseline urine samples collected via cystocentesis at day 0 and day 2. 

Obstructed male cats managed with the MILA 4 Fr catheter for 48 hours.

 Obstructed male cats managed with Argyle or Buster open-ended catheters for 48 hours. 

Day 0: Relief of obstruction and baseline urine collection (submitted to Texas A&M Veterinary Medical Diagnostic Laboratory).

Day 1: Medical management per clinician preference (fluids, antibiotics, analgesia, optional adjuncts).

Day 2: Repeat urine collection, catheter removal.
Samples were assessed for urine crystal concentration (intact struvite) at baseline and 48 hours.

 Healthy male cats showed minimal baseline crystalluria with an average concentration of 0.74 crystals per high-power field (hpf), decreasing to 0.20 crystals/hpf at 48 hours, confirming expected physiologic clearance (Figure 1a and 1b).

 Cats treated with the MILA Tomcat Catheter demonstrated a substantial reduction in crystalluria. Average baseline concentration was 13.86 crystals/hpf, falling to 2.12 crystals/hpf after 48 hours. Several cases demonstrated near-complete clearance, with no re-obstruction observed during hospitalization (Figure 2a and 2b).

 Cats treated with Argyle or Buster catheters showed less effective crystal clearance. Average baseline concentration of 4.55 crystals/hpf rose to 10.4 crystals/hpf after 48 hours, reflecting persistent or worsening crystalluria. In several cases, recurrent obstruction occurred within hours of catheter removal (Figure 3a and 3b).

 When groups were compared, the MILA Catheter group showed markedly superior outcomes, with an average 85% reduction in urine crystal concentration compared to baseline, versus a +128% increase in the commercial catheter group (Figure 4a and 4b).

These findings support the hypothesis that catheter design significantly impacts clinical outcomes in feline urethral obstruction. Traditional catheters extending into the bladder body do not effectively address crystals pooling in the bladder neck, leading to residual crystalluria and frequent re-blockage. The MILA Tomcat Catheter’s shorter length and placement within the proximal urethra leverage feline urethral anatomy to maximize clearance of suspended crystals.
Additional clinical advantages include:

Reduced bladder wall trauma due to shorter indwelling length.

Maintenance of urethral sphincter function, lowering risk of incontinence.

Improved patient comfort with reduced irritation and inflammation.

The pilot study results align with anecdotal feedback from practitioners reporting fewer recurrent blockages and faster recovery times. Limitations include small sample size, variability in concurrent medical management, and potential dilutional effects in certain cases. Larger, multicenter trials with standardized protocols are recommended.

The MILA Tomcat Catheter represents a promising advancement in the management of feline urethral obstruction. By aligning with the anatomic advantages of the proximal urethra, it provides superior clearance of urinary crystals compared to Argyle and Buster catheters. These findings suggest a potential for improved patient outcomes, reduced recurrence, and a meaningful shift in how blocked tomcats are medically managed.

 2nd ed. Philadelphia, PA: Saunders; 1986

Texas A&M Veterinary Medical Diagnostic Laboratory. Urinalysis reports. 2024.

Besançon M. MILA Tomcat Catheter Pilot Study. Internal data. 2024.

The author gratefully acknowledges the collaboration of MILA International, Inc., participating veterinary clinics, and the Texas A&M Veterinary Medical Diagnostic Laboratory for analytical support. Special thanks to veterinary technicians and colleagues who assisted with patient monitoring, catheter placement, and sample collection.

Results found the MILA Tomcat Catheter improves crystal clearance in obstructed male cats.

Pilot study results of novel catheter design for managing feline urethral obstruction

Melissa Evans, CVT, LVT, VTS (ECC), describes how some members of the veterinary team actively participate in caring for patients with this serious condition. 

Understanding the technician's role in a diabetic emergency case

What is the veterinary technician’s role in caring for patients with diabetic emergencies? Melissa Evans, CVT, LVT, VTS (ECC), owner of Melissa Evans, VTS (ECC): Veterinary Nurse Consulting, discussed the hands on work required of technicians in a 

interview at the 2025 Fetch dvm360 Conference in Kansas City, Missouri.

Evans is an experienced emergency, intensive care unit, and critical care technician with additional experience in shelter, wildlife, and disaster medicine. She is a RECOVER CPR–certified instructor who has worked in referral and specialty hospitals in New Jersey and New York. Evans is also a relief technician for specialty hospitals throughout New York, New York.

At the Fetch conference, Evans presented a series of continuing education sessions, including on focused on diabetic emergencies. In the session, she discussed 

 and the role of veterinary technicians in providing nursing care. In this video, she describes the tasks that technicians are responsible for in these cases.

The following is a transcript of the video:

: We do so much of the hands on work with these patients and the ones that need to be hospitalized are often hospitalized for an extended period of time. So once they are stabilized, we are the ones monitoring them, making sure that their blood glucose stays within the range that it's supposed to, making sure that if it's not, we are changing the dosage of their insulin [constant rate infusions] (CRIs) or their dextrose CRIs, adding any supplementation. They sometimes have electrolyte abnormalities that need to be dealt with, so we're adjusting that supplementation as well doing all the hands on work that the doctor has put on their treatment sheet and just the general tender loving care, nursing care that they need.

You can also learn more and register for the 2026 Fetch dvm360 Conference in Kansas City

Evans M, Crossley KC. Identifying diabetic emergencies. 

. September 3, 2025. Accessed September 23, 2025. 

https://www.dvm360.com/view/identifying-diabetic-emergencies

Videos

The FDA has approved an updated US label for ilunocitinib tablets (Zenrelia; Elanco Animal Health Incorporated), removing language about the risk of fatal vaccine-induced disease associated with the medication from modified live virus vaccines. The revision to the label comes after the federal agency reviewed additionally submitted data, according to an announcement by Elanco.

The immunosuppressant, first approved in September 2024, is a nonselective Janus kinase inhibitor administered once a day for the control of pruritus associated with allergic dermatitis and the control of atopic dermatitis in dogs of at least 12 months of age.

When the medication was first launched, the US label contained language based on lab study results in unvaccinated dogs given 3 times the approved dose of Zenrelia. According to Elanco, an outbreak of concurrent diseases occurred during the study, “complicating interpretation of the results.”

In the study, one treated dog developed fatal vaccine-induced adenoviral hepatitis and pancreatitis, and another developed infectious enteritis, according to the FDA's initial 2024 approval summary.

 Other dogs failed to mount an adequate response to rabies and distemper vaccines, as Zenrelia works partially by suppressing the immune system.

Still, in its initial approval last year, the FDA noted that “Zenrelia is safe and effective when used according to the label."

Having evaluated additionally submitted data, the FDA now states that “the totality of evidence supports removal of the risk of fatal vaccine-induced disease from modified live virus vaccines from the labeling.”

However, a boxed warning on the label advising “discontinuation of Zenrelia for at least 28 days to 3 months prior to vaccination and withholding Zenrelia for at least 28 days after vaccination due to the risk of inadequate immune response to vaccines” still remains.

“When initiating treatment with Zenrelia, refer to label directions. Zenrelia should only be used in dogs that are up to date on vaccinations, at least 12 months old, and free from serious infection,” Elanco stated.

Dogs on Zenrelia should also be monitored for infections, as the medication increases the chances of developing an infection. During clinical studies, researchers observed benign and malignant neoplastic conditions in dogs. Common adverse effects associated with the medication include vomiting, diarrhea, and tiredness.

The medication has not been tested in breeding, pregnant, or lactating dogs or alongside other immunosuppressive therapies such as glucocorticoids or cyclosporine.

"We appreciate the FDA's commitment to reviewing the latest submitted scientific data to ensure that the label is reflective of the totality of evidence," Ellen de Brabander, PhD, executive vice president of research, development, and regulatory affairs at Elanco, said in Elanco’s announcement.

In addition to the US, the drug has also become available in the European Union, Great Britain, Brazil, Canada, and Japan. According to Elanco, more than half a million dogs globally have been treated with Zenrelia.

Elanco announces FDA approves improved Zenrelia (ilunocitinib tablets) label, removing vaccine-induced disease language. News release. Elanco. September 23, 2025. Accessed September 23, 2025. 

https://www.prnewswire.com/news-releases/elanco-announces-fda-approves-improved-zenrelia-ilunocitinib-tablets-label-removing-vaccine-induced-disease-language-302564189.html

FDA approves new treatment for allergic skin conditions in dogs. News release. FDA. September 19, 2024. Accessed September 23, 2025. 

https://www.fda.gov/animal-veterinary/cvm-updates/fda-approves-new-treatment-allergic-skin-conditions-dogs

The revision removes language about fatal vaccine-induced disease from the skin allergy drug's label.

FDA approves updated US label for Zenrelia

Gallant, an animal health biotechnology company working on ready-to-use stem cell therapies for pets, announced the FDA’s Center for Veterinary Medicine (FDA-CVM) issued a complete letter for the Reasonable Expectation of Effectiveness technical section to support conditional approval of its ready-to-use stem cell therapy for refractory feline chronic gingivostomatitis (FCGS).

"This milestone represents a major leap forward in our mission to make stem cell therapies accessible to every pet in need," said Linda Black, DVM, PhD, CEO of Gallant, in an organizational release.

 "We're pioneering FDA-approved regenerative therapies designed to be practical and transformative—readily available, delivered through a simple intravenous injection, and aimed at treating the root cause rather than just the symptoms. We are entering the regenerative medicine era—and proud to be leading the way."

According to the release, the product under review is Gallant’s investigational new animal drug (INAD), sonruvetcel suspension for injection. This is potentially a first-in-class, uterine-derived allogeneic mesenchymal stromal cell therapy that is developed specifically for feline patients with refractory FCGs.

 Feline patients with refractory FCGS suffer from severe oral pain as well as a reduced quality of life, but there are currently no therapeutic options available. Because of this, many of these cats are then euthanized.

Gallant’s cells are sourced from a healthy, specific-pathogen free, FDA-qualified feline donors and then manufactured under current Good Manufacturing Practice conditions. Gallant disclosed that the conditional approval of the product is targeted for early 2026, and if given the conditional approval, this could be the first FDA-conditionally approved and ready to use stem cell therapy in veterinary medicine.

"Completion of the RXE technical section marks a foundational milestone for Gallant's uterine-derived platform of allogeneic mesenchymal stromal cell therapies—and the potential first ready-to-use stem cell therapy in veterinary medicine," said Valentine Williams, DVM, MS, DACVS (Equine), senior vice president of clinical development and strategy at Gallant, in the release.

"For many of us at Gallant, pioneering a gold-standard regenerative medicine platform has been a career-long ambition, serving beloved pets and enriching the lives of those who care for them. This success not only validates that vision but also demonstrates our ability to navigate the regulatory pathway for a pipeline of products that are leading the industry into the regenerative medicine era—an era focused on more than just managing clinical symptoms."

This therapy is in currently being reviewed for conditional approval and if granted, veterinarians will be able to begin prescribing and using the product in everyday practice for this ‘undeserved population of cats.’

In July of this year, Gallant raised $18 million in a Series B funding round to help develop and potentially commercialize its off the shelf stem cell therapies, including this one. Additional products in this new line of therapies include treatments for feline and canine osteoarthritis, canine atopic dermatitis, and feline chronic kidney disease, each of which will continue to be developed with funding.

A survey Gallant conducted with over 800 veterinarians in the US found that of those surveyed, 56% are satisfied with the current therapies out there for canine osteoarthritis, with most agreeing that current treatments focus on managing symptoms instead of addressing the underlying disease.

 Of those surveyed, only 8% showed satisfaction in the current treatments out there for FCGS. 

Gallant Achieves FDA "Technical Section Complete" for Reasonable Expectation of Effectiveness, Advancing First Ready-to-Use Stem Cell Therapy. News release. Gallant. September 23, 2025. Accessed September 23, 2025. https://prnmedia.prnewswire.com/news-releases/gallant-achieves-fda-technical-section-complete-for-reasonable-expectation-of-effectiveness-advancing-first-ready-to-use-stem-cell-therapy-302563870.html

2.Windsor R. Busting myths around stem cell therapy. DVM 360. Published July 31, 2025. Accessed September 23, 2025. https://www.dvm360.com/view/busting-myths-around-stem-cell-therapy

Bautista-Alejandre A. Veterinary stem cell therapy advances toward FDA approval with $18M in funding. dvm360. Published July 8, 2025. Accessed September 23, 2025. https://www.dvm360.com/view/veterinary-stem-cell-therapy-advances-toward-fda-approval-with-18m-in-funding

Veterinarians agree: Current treatments manage symptoms; anticipate regenerative options—Gallant study.

The agency found that Gallant’s data provides reasonable expectation of effectiveness. 