Foreword

The editor has asked me to write the foreword for the second edition of Veterinary Technician's Manual for Small Animal Emergency and Critical Care, focusing on changes in the veterinary profession, veterinary technician specialization, and the future of the profession. I am honored and humbled to be given this opportunity.

My career has spanned over 40 years focusing on veterinary emergency medicine and critical care nursing. I have certainly seen many changes in our profession over that period, in technology, knowledge base, and veterinary technician specialization. In the field of veterinary emergency medicine and critical care, we have first made great strides on the technological front. Early in my career, in-hospital lab tests were conducted to some degree: leukocyte counts were obtained using a hemocytometer and Unopette system; few practices had electronic cell counters; and dipstick or test strip methods were used to assess glucose or blood urea nitrogen levels. Again, few practices had blood chemistry capabilities. Chemistry analyzers included liquid reagent instrument-based units which used the principles of photometry to perform the analysis. Today, dry chemistry units are common. In addition, the measurement of electrolytes, pH, and blood gas analysis is now commonplace. Today's analyzers are user friendly, low maintenance, and economical.

I have seen our intravenous anesthetic options change from short-acting and ultrashort-acting barbiturates, ketamine used in combination with diazepam, acepromazine, xylazine, and the combination of fentanyl and droperidol (Innovar-Vet). Today, propofol, etomidate, and alfaxalone have replaced the ultrashort-acting barbiturates (pentothal, sodium thiamylal). Now we have more options, including opioids, alpha-2-agonists, and benzodiazepines. Analgesic options previously included (assuming they were given) morphine, meperidine (Demerol), and pentazocine (Talwin). Methoxyflurane and halothane have come and gone as inhalational agents. Today's options for inhalational anesthetics include isoflurane, sevoflurane, and desflurane, with the future suggesting exciting options such as xenon. Anesthetic monitoring once focused primarily on physical parameters (heart and respiratory rate, mucous membrane color, capillary refill time, pulse quality, etc.).

Central venous pressure and blood pressure (direct and indirect) were measured primarily in university teaching hospitals. When we measured direct blood pressure, we used very expensive non-disposable transducers. Dopplers were used to measure indirect blood pressure. Now, it is common practice to measure blood pressure in the exam room, ER/ICU, and operating room. We still measure direct and indirect blood pressure but now have disposable transducers and have added high-definition oscillometric blood pressure analyzers to the mix. Capnography, pulse oximetry, electrocardiography, arterial blood gas measurements, gas agent monitors, and thermistor temperature probes are also commonplace now. CVP is not measured as frequently as it once was. With the advent of multiparameter patient monitors, many of the previously mentioned parameters can be measured by one unit.

At one time, imaging was mostly limited to radiography and fluoroscopy. Today, our options include ultrasonography, CT, MRI, flexible and rigid endoscopy, and laparoscopy. When it comes to processing radiographs, I can remember the excitement of moving away from hand processing films (dipping films in chemicals in the dark room) to automatic processors. Now we have digital imaging; what a difference!

Beyond the changes in technology I have seen, one of the biggest changes in the profession is in veterinary technician specialization. This has only helped to enhance the delivery of patient care. While the technology is important, there is no substitute for a well-trained, critical thinking, credentialed veterinary technician. Although we still see the same types of medical conditions today that we saw back when I started, our understanding of the disease processes has advanced. To be an effective member of the veterinary healthcare team, our knowledge of disease processes and nursing care must also advance. This carries over into how we think about and provide nursing care to our patients. It is important for veterinary technicians to have critical thinking skills as well as hands-on technical skills. Critical thinking is not innate but fortunately, it is now being emphasized in veterinary technology curricula.

I was perhaps one of the first to talk about the "nursing process" in veterinary medicine. The nursing process is a five-part systematic decision-making method focusing on identifying and treating responses of patients to actual or potential alterations in health. This is something that has been taught to human nursing students for years. It relies heavily on the use of critical thinking in nursing practice. I am pleased to see that this too is now taught both in veterinary technician programs and at national continuing education conferences. More and more veterinary technicians have adopted the use of the nursing process, ultimately enhancing the delivery of patient care.

It wasn't until the early 1990s that we thought of the possibility of veterinary technician specialization. We felt that the timing was right to form a specialty academy in emergency and critical care. Veterinary medicine had seen a rapid growth in knowledge and technology. The thought was that veterinary technicians who worked with veterinarian specialists found themselves being channeled into those areaa of specialization. It only seemed natural to recognize those veterinary technicians who acquired a broad base of knowledge and skill in emergency and critical care nursing.

In 1994, the North American Veterinary Technician Association (NAVTA - now the National Association of Veterinary Technicians in America) created the Committee on Veterinary Technician Specialties (CVTS) which was charged with overseeing the development of specialty academies. While we had the support of the Veterinary Emergency and Critical Care Society and the American College of Veterinary Emergency and Critical Care, there was a bit of pushback from the veterinary community; some asked why would any general practice want a technician who is advance trained in fluid therapy, anesthesia, or clinical pathology? It was felt those were the domains of the veterinarian. However, the first technician academy was ultimately recognized. I am proud of the fact that I was one of three founding members of the first recognized veterinary technician specialty academy, the Academy of Veterinary Emergency and Critical Care Technicians (AVECCT), which is a large audience for this book. We worked closely with NAVTA's CVTS to develop the process of specialty certification and recognition. Our academy has laid the foundation for many other veterinary technician specialty academies. We received provisional recognition from NAVTA in 1996 and in 2016 we celebrated our 20th anniversary! Today, AVECCT is over 400 members strong and growing and there are more than a dozen NAVTA-recognized veterinary technician specialties.

I believe the future for the profession and the specialty is bright. The reality is that we are still a relatively young profession, at approximately 56 years of age. We have come a long way in a short time although we still have some growing to do. There is talk of a national name change from veterinary technician to veterinary nurse. Thus, to support this effort, the editor has elected to use the term veterinary nurse rather than veterinary technician throughout this book. The profession is also looking at a national credentialing process with some rumblings of an advanced level veterinary technician on a par with a physician's assistant. Can you imagine an advanced level veterinary nurse in emergency medicine and critical care? I have no doubt that with collegial discussion, willingness to find common ground, thoughtful planning, and teamwork, we can achieve it.

For several years, there were just a handful of books (four to be exact) that focused on veterinary trauma, emergency medicine, and critical care. Today, there is a plethora of books available to veterinary technicians and veterinarians on those subjects. However, there are only a few books edited by veterinary technicians for veterinary technicians. Veterinary Technician's Manual for Small Animal Emergency and Critical Care is one of those texts. When Christopher Norkus edited the first edition of this text, he was a certified veterinary technician and veterinary technician specialist in both emergency and critical care and anesthesia. He has subsequently become a veterinarian, finished an internship, completed a residency, became specialty board certified in anesthesia and analgesia, and is now nearing completion of a second residency and board certification in emergency and critical care! But despite his extensive training as a veterinarian, I am sure he would tell you that he is still a veterinary technician at heart. Given his diverse background on both sides of the aisle (nurse and doctor), he can give us a unique perspective.

I am excited about the changes in the second edition of this book. There is more of an emphasis on evidence-based medicine and references. Information on the anatomy and physiology of the major body systems has been added. There are also several new chapters, including mechanical ventilation, dialysis, and pain management. The international panel of contributors includes individuals in...