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Teaching GDV to Medics

GDV is a topic which is typically entirely new to medics since it is an extremely rare occurrence in the human population.

As this is targeted to veterinary professionals, we will not go into the full explanation of the topic here but rather focus on several of the key teaching points that are important to reinforce during skills sessions if questions come up.

  • We often use the word multi-factorial when discussing the causes, pointing out that GDV is not something we can induce and studied.
  • We also use the word considerations vs recommendations when describing potential actions that might help mitigate but won’t likely increase the risk of GDV, such as providing multiple meals through the day vs 1 and limiting strenuous activity for 2 hrs after meals.
  • We are strong proponents of preventative gastropexies and glad to see that the military and now more federal teams are adopting this as a standard procedure.
  • When teaching the concept of GDV, human medics are familiar with other reperfusion injuries, especially as it relates to disaster medicine and so this comparison helps students see the similarities.

Intervention

  • “Fluids First – Stomach Second”
    As students learn the nature of GDV, it is easy for them to get fixated on the decompression of the stomach.  It’s essential to drill the idea that this is a circulatory / reperfusion injury and that fluids are the first line of care, followed by decompression (and only when greater than 30min from care).  We continually reinforce this idea using the language “Fluids First – Stomach Second”. We also teach this phrase to K9 Handlers so they can act as advocates reminding medics of this sequencing.
  • The importance of using Tympany for decompression landmarks
    Since it is impossible to guarantee the degree of stomach rotation, we believe it is essential to assess for tympany vs using a predetermined landmark.  In fact, we also teach K9 Handlers this in their advocacy role, teaching them to only allow a medic to decompress if they have actually assessed for tympany vs doing an essentially blind decompression.  If a provider doesn’t have the ability to assess for tympany, then decompression should be considered above their scope of practice.

  • In terms of actual techniques, this is a fairly simple procedure.
    • When teaching this isolated skill we have the students verbalize “fluids first – stomach second” before performing the decompression skill.

    • Assess for the point of “greatest tympany” avoid using the words “highest tympany”.  Students sometimes mistake the word “highest” as a directional term.

    • Remind students they will need to initially keep the stylet in place (similar to chest decompression) since otherwise the high movement of the skin of the subQ space will kink the catheter.  Once most of the stomach is mostly deflated, they may remove the stylet to safely evacuate the last remaining air.

Sample Video