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No More Homeless Pets Forum
January 24, 2005 Emergency Care for Pets |
What should you do to help an animal who is injured? What should be done if an animal has eaten something toxic? How can you increase an animal's chance of survival in a crisis? Sharon Gwaltney-Brant, DVM, of the ASPCA Poison Control Center and Andrea Oncken, DVM, DACVECC, of Dove Lewis Emergency Animal Hospital will share basic emergency care procedures and tips for keeping pets safe and healthy.
Introduction from Sharon Gwaltney-Brant, DVM:
Animal Poison Safety Tips: Did you know that our furry and feathered companions could be at risk for accidental poisonings? Have you ever worried about what might happen and what you should do if your pet should ingest a plant, get into the trash or chew into a vial of medication? Dr. Sharon Gwaltney-Brant, board-certified veterinary toxicologist for the ASPCA Animal Poison Control Center, will answer your questions about what common household items can be toxic to pets, and how you can be prepared for, and even prevent, poison emergencies.Introduction from Andrea Oncken, DVM, DACVECC:
Would you know what to do if your animal had an emergency in the middle of the night? Are you comfortable with performing first aid and transporting your injured animal to the emergency room? Do you know what signs to look for to know if your animal's illness should be treated as an emergency? Do you want to know what's involved in a patient's stay at an animal intensive care unit? My specialty is in the area of emergency and critical care medicine. I work at a large animal hospital where we receive emergencies and perform 24-hour care and monitoring for critical patients. If you have questions about how to recognize an emergency or what you can do in a crisis, or if you're just curious about the emergency or critical care process please feel free to email me, and I'll do my best to shed light on these areas for you.Questions
Most important teachings in first aid
How poisonous is poisonous?
Poisonous mushrooms
What to do when an animal is hit by a car
How to help when someone has a pet in critical condition
Heroic surgery versus humane euthanasia
Treatment and prevention of pyometra, deadly uterine infection
Preventing accidental poisoning
How to tell if a problem can wait for the morning
The function and usefulness of IV catheterization
Most important teachings in first aid
Question from Becky:
I have just completed the American Red Cross Pet First Aid course and am preparing to teach it. Would you give me an idea of what you consider the most important thing to know in an emergency that I should pass on to my future students?Response from Sharon:
The most important thing to know in an emergency is how to keep your head and not panic. Beyond that, knowing the location of the nearest available veterinary emergency center (especially after hours) is also quite important.Response from Andrea:
All emergencies are different, so coming up with a single most important thing to know is difficult. However, the first thing for a person to remember is that the animal is often scared and may be in pain. The person needs to remember to protect him/herself. Even the kindest animals can bite in a situation involving fear or severe pain. The animal should be approached slowly, calmly, and carefully. Some sort of a muzzle should be used (nylons tied around the muzzle work well) if the animal is going to be moved. Also, if the animal is choking, or if there is something in its mouth, it is very easy to get severely bitten by sticking a hand down the throat. The same sort of caution should apply if the person is alone and is trying to drive the pet to the hospital. Care should be taken to secure the pet before starting the car, and the person should drive carefully at a steady pace, keeping their eyes on the road. If they need to check on the pet, they should pull over in a secure place first. It's more difficult to provide first aid to a pet if we get severely injured in the process!Another important point is that if the emergency is a traumatic incident (i.e. hit by car), and the animal is not able to walk, a board of some sort (flattened cardboard box, piece of plywood, etc.) should be used to carry the animal in a flat position in case it has a fractured spine. We can worsen the damage by twisting or bending the spine when lifting the animal and carrying it in our arms. And, last, persons who intend to learn first aid for pets needs to make sure that they are very sure of their ability to check for a heart rate and respirations. Starting CPR on an animal that still has a heartbeat can cause more harm than help. Make sure you are well practiced in listening and feeling for a pulse and for respirations.
How poisonous is poisonous?
Question from Clarisse:
I know a lot of plants and foods are listed as potentially poisonous. But I have known animals to eat a small amount of those poisonous substances, without seeming to suffer any ill effects. For example, my pets regularly nibble on geranium leaves, which are supposedly poisonous, and they seem to be fine. Are they doing themselves gradual damage, as with arsenic for humans? Are there some consistent warning signs to look for before panicking and rushing my friends to the animal hospital every time they get a taste of something potentially dangerous?Response from Sharon:
Actually, it may surprise you to know that some scientists think that arsenic may be an essential trace element. As with anything in toxicology, the dose is what determines the poison. Geraniums are not considered especially toxic, though they could cause some mild digestive upset (e.g. vomiting, diarrhea) if enough were eaten. When your pets eat something they shouldn't, it's always a good idea to check with your veterinarian as to whether that particular exposure is going to be a problem. There are also helpful hints on the web page of the ASPCA Animal Poison Control Center (www.apcc.aspca.org), as well as lists of toxic plants, non-toxic plants and an interactive tool to help you keep your pet safe from poisons in the home.Response from Andrea:
A certain amount of a substance has to be ingested in order for it to reach "toxic levels" in the body. For several toxins, this actual level has been quantified and even separated out into "minimal toxic dose", "lethal dose", and several doses of varying degrees in between these two extremes. Many toxins, however, appear to be more toxic to some individuals than to others, and often there is no way of knowing which animals will be affected until they ingest the toxin. Also many animals will have concurrent conditions that will predispose them to certain toxins more than "normal" animals (i.e. old age, young age, liver disease, kidney disease, gastrointestinal disease, etc.).Most toxins do not build up in the body after ingestion. They have a clearance rate, and, depending on how they are cleared from the body and the health of that animal, some are cleared more quickly than others. Therefore, if an animal ingests more of the same toxin before the previous ingested toxin is cleared, the levels may build up, bringing it closer to a "toxic level". However, if the toxin is fully cleared, repeated ingestions will not build up and cause later damage. The exception is if a sufficient level of a certain toxin is ingested to cause mild to moderate organ damage but not severe enough to cause clinical signs. If that toxin is again ingested in the future and that damage has not been repaired, chronic exposure can eventually lead to serious organ damage. This is a rare event and only holds true for a few toxins.
As for symptoms to watch for, since different toxins can cause extremely different symptoms, any "abnormal" behavior that follows possible ingestion of a toxin should be taken seriously. On the other hand, with the more deadly toxins, such as antifreeze, you should not wait to see if there are symptoms before taking you pet in to the veterinarian. My best advice is that if you are ever in doubt, call your local veterinarian or emergency hospital to seek advice on whether your pet should seek veterinary attention immediately.
Poisonous mushrooms
Question from Joan:
Last spring, my 40-pound dog and my sister's 90-pound dog ate mushrooms from the same yard (I don't know the amount). They were both vomiting a clear liquid the next morning and were taken to the vet, where he put them on IV fluids, charcoal, etc. They both died within 24 hours of massive hemorrhaging (ultimate liver failure). I was told by rural farmers that these mushrooms were called "death caps" or "angels of death", and could kill a cow within a day. Apparently the weather conditions have to be 'just right', wet, and then cold. The strangest part was none of the other three dogs, as well as our two babies who died, have ever shown any interest in eating anything in the yard. Have you ever heard of such poisoning?Response from Andrea:
So sorry to hear about the tragic loss of your two buddies. There are several different types of poisonous mushrooms in the Northwest region of America. Our moist, moderate environment is ideal for mushrooms to flourish! Each different type of toxic mushroom affects different organs and causes different clinical signs.The mushrooms that your dogs were exposed to are one of the most toxic and deadly varieties around. The Amanita species of mushroom's common names include death cap, death angel, and destroying angel. These mushrooms are relatively common in the Pacific Northwest and constitute approximately 50% of all human poisonings and approximately 95% of all human mushroom-related deaths. The organs most susceptible to the toxicity include the liver, kidney, and intestine. The toxins are rapidly absorbed from the gastrointestinal tract following ingestion, and clinical signs are often evident between 6-24 hours after eaten. The first phase involves gastrointestinal symptoms (vomiting, abdominal pain, fever, bloody diarrhea), lasting approximately 24 hours, followed by signs of liver and kidney dysfunction within 3 days of ingestion. Death often occurs between 3-7 days after ingestion, depending on amount ingested and type of mushroom ingested. Once severe liver damage has occurred, chance of survival is minimal. Treatment has to be aggressive and early, and there are antidotes that may help decrease the chances of death, but this is not one hundred percent. So, unfortunately, you are not alone in having lost animals to this toxin. There's no saying which dogs will eat which mushrooms, but sometimes the novelty of a new plant in the yard will attract some dogs to "taste" them. Dogs are definitely not known for their discriminating appetites!
Response from Sharon:
Only a small percentage of the thousands of species of mushrooms are toxic. Many people have the mistaken belief that animals instinctively know not to eat toxic mushrooms, but this is not the case. Mushroom poisonings in dogs, while uncommon, do occur. There are a variety of different types of poisonous mushrooms, but probably the most deadly are the ones that damage the liver (hepatotoxic mushrooms). Hepatotoxic mushrooms in the US are primarily of the genera Amanita, Galerina, and Lepiota. Amanita phalloides (death cap) and Amanita biosporigera (destroying angel) are two species that have been associated with liver failure in dogs. With the hepatotoxic mushrooms, there is often a lag time of several hours (up to 1-2 days) before any signs develop, and by then the damage has been done and treatment may be ineffective.Because mushroom identification requires skill and experience, it is not always easy to determine whether a wild mushroom that a dog has just eaten is going to cause a problem. Although there are far more non-toxic mushrooms than toxic ones, assuming that a given mushroom is non-toxic is like playing roulette with a dog's life. For this reason, we recommend that any witnessed exposure of pets to wild mushrooms be provided with veterinary care for decontamination and further treatment.
What to do when an animal is hit by a car
Question from Jose:
I work at a veterinary clinic. Several times a year, clients come rushing in with an animal who has been hit by a car. In fact, this happens so frequently that there's an industry abbreviation for the phenomenon, HBC.Can you detail which sorts of problems resulting from HBC can be addressed by a local clinic, and which ones will need to be addressed at a full service emergency hospital? I think that would be really helpful information for everyone to know.
Response from Sharon:
This is a difficult question to answer, as it will depend on the specific capabilities of the local clinic. While some local clinics may have the personnel and equipment to manage critical cases and perform emergency procedures, others might not. Cases that require constant monitoring to the point that they will tie up all of the time of the local clinic's personnel would likely be best referred to a facility that has a team dedicated to monitoring critical cases.Response from Andrea:
Unfortunately, animals are hit by cars much more frequently than we would like! It is the most common traumatic emergency seen at our 24-hour emergency and critical care hospital. We often receive HBC referrals from local veterinary clinics for continued care once initial care has been instituted. Depending on the location of the impact, the speed of the car, and other factors, several different injuries can occur when an animal is hit. If a hit by car patient presents to a local hospital, a quick examination should be undertaken to look for immediately life-threatening emergencies.Common life-threatening injuries include pneumothorax, or free air within the chest cavity; head trauma; severe hypovolemic shock; extensive blood loss; and hemorrhage into a body cavity. Often, if the injury is severe enough, these animals will not survive a trip to a critical care center, so the local veterinarian must be able to perform basic life-saving procedures. If pneumothorax is present, and the patient is struggling to breathe, a quick thoracocentesis (chest tap) should be performed. If the air builds back up immediately or cannot be fully evacuated with a thoracocentesis, a chest tube may need to be placed. This is often a procedure that is performed at a referral center, but many times a local veterinarian is faced with an emergency situation in which they may need to know how to place a chest tube before the animal can be transferred. If an animal is in hypovolemic shock, a local veterinarian may need to place an IV catheter and give quick boluses of sometimes large amounts of fluids in order to get oxygen to the vital organs. If ongoing hemorrhage is occurring, boluses should be given carefully in order to keep from increasing the bleeding. If the hemorrhage is external, a pressure bandage should be applied (NOT a tourniquet).
Bone fractures are also common injuries with HBC patients. The local veterinarian may want to apply a splint prior to transfer to prevent further damage to the limb. If the animal has fractured its spine, it should be immobilized on a flat board for transport. The most important therapy a local veterinarian can perform will be pain control. It should always be assumed that an animal that has been hit by a car will be in pain, and there is rarely a contraindication to giving pain medications.
If there is a pneumothorax present, hemorrhaging into body cavities, injuries to the lungs, head trauma, or severe shock, the patient will need 24-hour critical care monitoring and further intensive treatment. Once the patient is stable enough for transport, these animals should be sent to a critical care facility. Serial blood pressure monitoring, chest tube care, 24-hour oxygen supplementation, serial neurologic evaluations, and any necessary emergency surgical procedures can be undertaken at this facility.
How to help when someone has a pet in critical condition
Question from Rose:
I'm wondering what I can do, as a virtual bystander, to help when an emergency situation happens with one of my friend's or colleague's animals. I would want to say or do something to comfort them, but I'm not sure what. I mean after they've gone to the animal hospital and their pet is probably out of immediate danger, but is still hospitalized. It seems like there are so many unknowns such as how critical the patient's condition is, how long the hospital stay will be, cost, and worst of all, if the pet might pass away without their person with them.Response from Andrea:
The emergency clinician will make a point to always keep the owners of critical patients informed of the animal's condition, the prognosis, and the financial situation. Certainly, the unexpected can always occur, and sometimes there is no way to predict when or what might happen.Again, there is generally always a doctor or medical professional present in any overnight care facility, and these professionals are trained to watch for symptoms of deteriorating conditions, changes in prognosis, or any other occurrence that the owner should be made aware of. We often tell owners to keep their phones on and near their beds, so that we can call at any time to inform them of changes.
As a friend of a person with an animal in the hospital, it is important to know that the owner is frightened and may be having trouble processing the information that has been given to them by the veterinarian. Or, they may not have felt comfortable or known how to word the right questions in order to get the information that they needed. My best advice would be to encourage them to feel comfortable asking the medical staff about anything that they don't understand. Even if they feel foolish asking questions or feel that they should understand things better, it is much more important that the owner have a full understanding of the entire process than to have them "appear" to understand everything when they don't.
Also, if an owner has a critically ill animal that is in danger of death, encourage them to take the necessary time to visit as often as possible. If the animal is in intensive care, it may be difficult to get the owner back to visit all the time, as necessary treatments must be performed, however the staff will let the owner know when it is a good time to visit and will encourage patient-owner interaction. Often owners may feel guilty about the animal's condition and may blame themselves. Let them know that the fact that they took on the responsibility to feed and care for a pet, and that they have been that pet's best friend during that time they were together shows that owner's selflessness and capacity for love and compassion.
Heroic surgery versus humane euthanasia
Question from LaRue:
We recently had a large, young, injured dog at our shelter, perhaps a Wolfhound mix. He had compound fractures of both front legs and a crushed pelvis. Some volunteers wanted to raise money and do a very heroic surgery.Could/should we have tried to get surgery for him? I wondered how you would rehab such a big dog. If only the front legs were injured you could lift by the rear but with the rear crushed too I just didn't see a good outcome for this dog. And there would have been so much pain management.
Response from Andrea:
Unfortunately, this is a very difficult question to answer and involves ethical beliefs and requires a bit more knowledge of the types of fractures and possible repair methods. Certainly, giant breed dogs create a serious rehabilitation dilemma. However, because there are so many out there, different techniques have been invented to help in this process. Canine rehabilitators use swimming pools, slings, and carts of different sizes to help maintain mobility during the healing process. Depending on the type of injuries, some animals are able to use their limbs quite quickly post-operatively.The type of injury will dictate whether there is nerve damage to any of the limbs, which will further limit the ability for the animal to be rehabilitated. And, of course, there is the question of how much pain the dog is in and will continue to be in post-operatively. This again becomes a question of judgment, and this is not a question I can answer without seeing the dog, looking at the injuries, and speaking to the surgeon involved.
So, to answer your question, that decision would need to be based on several discussions with orthopedic surgeons, rehabilitation specialists, and the people who would be responsible for maintaining his care post-operatively. He would definitely be facing a huge challenge, and his quality of life and comfort level would need to be taken into consideration, as well as the dedication of the people who would be taking on the task of rehabilitating him. Only with all of that information in hand could I make the decision on whether or not to proceed in this situation.
Comment from Amy:
I would like to comment on the heroic surgery question. Less than a year ago, our humane society received a call about a dog who had been hit by a train. The person who rescued her couldn't care for her so my husband and I took her into our home. We knew the dog had an eye injury and broken pelvis and broken leg from the initial vet visit. When we took her to our vet, we asked about euthanasia, because we knew the expense would be great. We also learned that she had a fractured vertebrae and a tiny fracture to a hind leg. After viewing the dog's successful effort to stand and defecate, our vet said that this dog had a tremendous will to live and spirit. She was taken to a vet school for surgery on both sides of the pelvis. We carried her up and down stairs to get her outside and gave her physical therapy. Now Angel's as normal as a 2-year old Lab mix can be. She's the happiest girl, always has a toy in her mouth and her tail wagging. We did newspaper, TV, and radio interviews to raise funds to cover her surgery costs. Now we use her as the poster child for our organization's emergency fund.Treatment and prevention of pyometra, deadly uterine infection
Question from Kristin:
I'd like to learn more about pyometra. I know it's a sometimes deadly uterine infection that can quickly and quietly kill intact females. Does it ever go away on its own? What is the infection rate for unspayed females? What I mean is, over the course of her life, what are the chances she'll develop pyometra at some point, if she never gets fixed? I think it usually occurs in dogs after they've been in heat and/or have been bred, is it the same for cats? What's the usual treatment, and how effective is that at saving the patient's life?Response from Sharon:
Pyometra is most commonly seen in intact females that have not been bred (pregnancy seems to have a protective effect). It is unlikely that pyometra will resolve on its own. The usual treatment for pyometra is surgical removal of the uterus; in uncomplicated cases, complete recovery can be expected. However, because early detection of pyometra may be difficult, affected animals may not be presented for surgery before they have significant systemic illness, which increases the risk for serious complications or death.Response from Andrea:
Pyometra is a secondary infection of the uterus following an exaggerated response of the uterine tissues to the hormone progesterone. Progesterone is normally secreted during the heat cycle in sexually intact female dogs and cats. Pyometra is generally seen in older, intact females and usually occurs approximately 6 weeks following a heat cycle. The incidence in dogs appears to be approximately 15-20% of sexually intact females. The incidence in cats is much lower but certainly does occur.There are two forms of pyometra, an open form and a closed form. Both are serious and will lead to death if untreated, but the closed form presents a more critical emergency. In the open form, the cervix remains open, so the infection is able to drain from the uterus. These animals often have a malodorous vaginal discharge that can be easily spotted by their owners. In the closed form, the cervix is closed, so there is nowhere for the infected fluid in the uterus to drain. This leads to uterine distension, which can eventually lead to uterine rupture if allowed to progress.
In both situations, these dogs often present with a fever, they're often vomiting, they're depressed, and have abdominal pain. The veterinarian can diagnose this condition using a combination of clinical signs, blood tests, x-rays of the abdomen and possibly abdominal ultrasound.
Once the infection has set in, this condition does not clear up on its own. The most reliable and recommended therapy is a surgical ovariohysterectomy. For closed pyometras, this is the only therapy. However, in the case of open pyometras, these will sometimes respond to prostaglandin therapy (usually a series of injections over 3-5 days). Although this therapy is often effective, the chance for recurrence is very high, and the animal will have to be bred on the next heat cycle. Therefore, surgery is always the best option for this disease. However, surgery alone will not be sufficient, as these animals are often very sick and sometimes in shock. They will sometimes require multiple days of hospitalization with fluid therapy, antibiotics, and special monitoring. With aggressive, early treatment, the prognosis is generally good.
Preventing accidental poisoning
Question from Lois:
What can I do to make my home and yard as safe as possible for my dog, cats, and cockatiel? They've never shown any interest in the cupboard under the sink where I keep household cleaners, but the story earlier this week about the two dogs poisoned by mushrooms they'd never eaten before has me worried (my condolences to that person)! Should I have those cupboard doors child-proofed?Response from Andrea:
Generally I do not think it is necessary to childproof your cupboard doors, as it would be rare for a dog or a cat to open a cupboard, pull out cleaners, and chew through the packaging to get inside. For the most part, just keeping your cleaning agents tightly capped and stored away should be sufficient. As for the rest of your house, the most important thing to keep in mind is to place all highly toxic substances in an area or container to which the animals do not have access.The most common and deadliest toxin is antifreeze. Generally, if antifreeze is in a container, animals will leave it alone. The most common toxicities occur when antifreeze is spilled on the ground (radiator leak, etc.) or left in a bucket after a fluid change.
Other potentially toxic household products include lead-based paint (often found in older homes), medications, and some plants. Dogs will often eat pills or tablets spilled on the ground and will sometimes chew through a pill bottle and eat the contents. Medications should be kept out of reach and in closed cupboards. Most household plants only cause mild toxicities, but lilies can cause severe kidney disease if ingested by cats, so if you have curious cats, you probably don't want to have lilies. Some human foods can also be toxic to animals, such as chocolate, grapes, and raisins. It is best to keep these types of food out of reach, as animals often find them hard to resist!
Cockatiels often chew on things, and lead-based paint can create a problem, as can Teflon-coated pans in the kitchen. The best thing to do with birds is to keep them locked up unless they can be closely supervised. Their cage should not be near the kitchen, as heated Teflon can send out toxic fumes to birds.
As for your yard, periodically walking through and checking for any new items, such as mushrooms or items thrown or blown into the yard, and removing them is probably enough. The fact is animals are like children (especially dogs!), and keeping them completely risk free is nearly impossible.
My best advice for you is to be aware of the potential dangers, supervise your animals well (keep dogs on leash, keep cats indoors, keep birds caged when not supervised), and call your veterinarian if you ever have any questions about the potential dangers to which your animals may be exposed.
Response from Sharon:
Pets can be curious about their environment and their curiosity can get them into trouble. Pet-proofing your home should be considered, especially if your pets are left unconfined and unsupervised for any length of time. Hints on poison-proofing your home can be found on the website of the ASPCA Animal Poison Control Center (www.apcc.aspca.org). There's also a link to a fun interactive game on making your pet's home poison-safe, and what to do for a poisoned animal.How to tell if a problem can wait for the morning
Question from Nancy:
A lot of us who subscribe to this forum probably know how to tell if an animal is really sick or injured. I'm wondering if your veterinarians could give us some tips for deciding whether we need to get help on an emergency basis, or if the situation can wait for regular clinic hours.In my community there is one after hours emergency hospital, and they are all about the money. If it is necessary we will take an animal there, but for a lot of reasons (NOT just the money), it is better to go to our local docs whenever possible.
Response from Sharon:
Unfortunately, it is difficult to make one statement that will cover all situations adequately. The age and general prior health of the pet should be taken into account. Very young or old animals should probably be evaluated by a veterinarian if more than mild clinical signs are shown. Obviously, animals that are having seizures, bleeding, having difficulty breathing, are poorly or non-responsive, or having severe or protracted signs should be seen as quickly as possible.Less severe signs may be more difficult to assess, especially in animals that have no history of health issues. Remember, too, that in some cases prompt treatment may prevent the development of more severe signs that may require much more extensive (and expensive) veterinary care.
Response from Andrea:
The scope of this question is a bit too broad to answer in this forum. My general answer would be, if you're worried, it's worth the peace of mind to take your animal in to the emergency hospital. Unfortunately, it is true that emergency hospitals can be more expensive than day clinics.On the other hand, emergency medicine is not usually a big profit-making venture. Rarely do people go into emergency medicine or start an emergency hospital to get rich. However, the equipment required to stabilize critical animals, the number and high quality of staff necessary to handle the most critical patients and who are willing to give up their nights, weekends, and holidays, and the overhead involved in keeping a building up and running throughout the night can all make expenses add up quickly.
Emergency veterinary hospitals were started because so many animals were facing crises in the middle of the night or on weekends. The veterinary community needed a resource of highly trained people who could handle these crises and who would be available when the day practitioners weren't. Their job is to assess and stabilize animals who either would not have survived the night or who needed medical care sooner rather than later.
Again, it's impossible to list all of the situations when it's better to take your pet to the emergency room rather than waiting. A short list would include bleeding that doesn't stop after a few minutes, vomiting or diarrhea that is protracted or contains blood, a change in the mental status of your pet, seizures, choking, ongoing coughing, any animal that is hit by a car or fallen from a height, any animal that has ingested a potential toxin, any difficulty breathing, weakness or severe lethargy, fractures, head trauma, abdominal pain or a distended abdomen; pale, yellow, or white gums; unexplained pain, sudden weakness, and the list goes on. The best advice I can give would be to call your local emergency room and explain the symptoms. Keep in mind that they are unable to see your pet, so they will not be able to say for sure that your pet will be stable through the night, and they won't be able to give medical advice over the phone. However, they may be able to assess the immediacy of the problem and give you an idea of what signs to watch for that can indicate a worsening of the condition. Then again, they may have to give you the same advice that I gave at the beginning... if you're worried, it's worth your peace of mind to have your animal seen.
Comment from Jeannette:
It's worth it for the animal's sake to always get a professional assessment. As a nurse and an animal rescuer, I know from experience that you cannot count on verbal assessments given by caregivers. Even as a nurse, if something isn't right, it's usually off to the doctor, since I know that I am a nurse, and not a doctor.A caregiver usually isn't knowledgeable enough to give an accurate assessment. Emotional involvement and other factors can often cloud people's judgment. These and many other factors usually result in assessments by nonprofessional caregivers turning out to be totally different when seen first hand by a professional.
I always strongly advise people never to try to practice medicine without a license, including administering over the counter medications, unless instructed to do so by a licensed physician or veterinarian, and to never advise others to do anything or to administer any medication, even if a licensed doctor instructed you to do so. There are too many different variances for situations, conditions, medications, reactions, and more. Everyone is unique and should be treated as such. What is benign, compatible or works for one could be disastrous or even lethal for another.
I believe in giving the patient a chance and letting the professionals care for them, and that if there is ever enough cause for concern, there is usually also enough cause to seek professional help.
Don't risk waiting to see if it goes away or gets better. I've seen too many cases where there was no time to 'wait and see' and 'tomorrow' never came.
The function and usefulness of IV catheterization
Question from Sharon:
I show longhaired dogs and over the years there have been several occasions where an emergency clinic has wanted to shave the hair on one of my dog's legs in order to insert an IV catheter. I am usually reluctant to comply unless absolutely necessary, because it can take 6 months or more for the hair to grow back, which hurts their show career. Can the doctors please explain what the advantages are to automatically inserting a catheter in a patient when they are brought into an emergency facility? In what sorts of instances is IV therapy truly vital to a patient's recovery?Response from Sharon:
Being able to provide fluid support and an established venous access is fundamental in the treatment of any life-threatening emergency (and many non-life-threatening emergencies). In emergency medicine, having quick access to the bloodstream can often mean the difference between life and death, as it allows for the administration of medication, fluids or blood as well as access to blood for diagnostic testing. Institution of intravenous fluid therapy provides essential cardiovascular support for animals suffering from trauma, shock, hemorrhage, dehydration, electrolyte disorders, metabolic diseases, etc. Additionally, fluids are important in providing support and protection of kidney function in cases of poisonings, low blood pressure, administration of certain medications, etc.Some suggestions to minimize the impact of IV catheter placement on the dog's show career (which obviously comes in a distant second to saving the dog's life) include discussing with the veterinary staff and asking if a smaller area of skin could be shaved, or perhaps using a vein in an area where longer hair can be later brushed over the bare spot (e.g. saphenous vein on rear leg for breeds with "britches"). How much a shaved area impacts a dog's show career could be arguable -- in 1989 CH Tudor's Wild as the Wind CD, a Doberman Pinscher, won Best in Show at the Westminster Kennel Club show just days after being treated for gastric dilitation (bloat), and she had a small shaved area on her from her veterinary treatment.
Response from Andrea:
The reasons that we would want to automatically insert an IV catheter into our patients when they come in to the emergency room include the following: the patient has lost a lot of blood or is anemic for another reason and needs fluids or blood products to replace the loss, the patient is moderately to severely dehydrated and needs fluid therapy (especially if it has had ongoing vomiting or diarrhea and is unlikely to hold down water and is likely to continue to lose fluids), the patient is in shock and needs IV fluids and/or drugs to help restore circulation, the animal needs or is in danger of needing immediate intravenous drugs (i.e. it is having seizures, is in heart failure, is hypoglycemic, is struggling to breathe for any reason, has serious electrolyte imbalances, has cardiac arrhythmias, or has been involved in a traumatic incident and is in danger of hemorrhage or shock), the animal requires sedation or anesthesia for a procedure, the patient is about to undergo a procedure that may involve some risk; the animal has diabetes or a history of heart disease, kidney disease, or other endocrine disease and is having complications; the animal has or the owner strongly suspects it has ingested a serious toxin and diuresis or antidote therapy may be necessary, the animal has had a sudden change in mental status or has become acutely lethargic and there is danger that the condition may deteriorate, and many reasons that I haven't listed.In essence, there are multiple very serious reasons for emergency clinicians to want quick IV access. If any patient deteriorates, it is an unnecessary waste of precious time to try and get access to a vein to deliver life-saving fluids, blood, or drugs. Too many of us have lost patients because we were unable to get to a vein in time to save them. For this reason, although I certainly respect your right to ask questions and make sure that all procedures being done are necessary, I also recommend that if an emergency clinician truly thinks that IV access is necessary it's in your best interest to comply. Even if it turns out to be unnecessary, the possibility of its being necessary, but not available, is too great of a risk. Most of us who have worked on show dogs are aware of this dilemma, and whenever possible, if we're informed that it is a show dog, we will do everything in our power to avoid shaving when not necessary. However, the animal must be shaved to aseptically place a catheter or to have any surgical procedures, so there are many times when it is absolutely necessary.
