Re: Emergency calls

katsutton — Mon, 05 May 2014 19:37:57 GMT

Nice explanation! I'm just moving into a job with sole night duties so this is really helpful :)

Re: Emergency calls

Cloudy Weather — Mon, 05 May 2014 06:50:23 GMT

Wow- thank you for taking the time to write this reply :) This is very helpful! I think its just a case of getting a list of good questions to ask in my head. In theory its easier but when that phone rings and you're on the spot I find it hard to process everything. This defientely helps and I will certainly jot your questions down in a little notebookto help prompt me in future:)

Re: Emergency calls

Angiy Michael — Mon, 05 May 2014 03:02:02 GMT

It helps to use the good old ABC in your head ..airway , breathing , circulation as a starting point..If they can't breathe or something is affecting their breathing it's curtains pretty quickly if they receive no interventions . ..if they are haemorrhaging somewhere on a significant level it's curtains..just more time to work with ..So any dyspnoea , get them in , any airway obstruction get them in , any haemorrhage that is not minor ..get them in . Any notable abdominal bloating get them in .

Some of the most common ones tend to be ;

Toxicities

Bite wounds

RTA's

GDV

Splenic bleed/Ruptured spleen

Bladder obstruction

Heat stroke

Decompensated congestive heart failure ( frequently untreated/undiagnosed and have been compensating for a while..often worsened by heat waves etc.,)

ATE in cats

Undiagnosed Pyo

HGE

Dystocia

Allergic reaction

Anorexia

To be honest if there is ANY doubt get them in ..and it usually best policy to always offer that at all junctures anyway . I

It's good to familiarise yourself with some of the most common toxins and symptoms ..also be aware of seasonal ones so that you are looking out for those symptoms in a telephone triage situation ..ie antifreeze (cold snaps and at the change of seasons) , chocolate toxicity,. lillies ( Easter & Mother's Day week especially) ..etc., and this often helps guide your questioning although with some owners you have to develop an "ear" and hunt for clues

In the main veterinary emergency practice tends to break down in to three categories

Trauma & Urgent Care scenarios ( RTA/Major bite wounds/Toxicities/Heat strokes etc.,)

Chronic or undiagnosed illnesses that decompensate or become uncontrolled ( Chronic heart failure/Cluster seizures etc.,)

Emergencies caused by secondary complications of underlying conditions ( Obstruction due to FUS, anorexia & vomiting due to renal problems, ruptured spleen due to haemangioarcoma etc.,)

For seizuring pets first thing I ask them to do is reduce stimulus in the room and make sure environment is safe..so move any dangerous objects, turn down lights, turn off tv, ask people to keep their voices down etc.

Next thing is ask are they known epileptic and then to ask is this the first seizure that day and approximately how long it has been going on for . Is the pet having cluster seizures ..one in rapid succession after another ? Have they consumed any toxins that are known ?

As a general rule it is not advisable to move a seizuring animal , however the exceptions would be for cluster seizures or if the seizure continues for longer than 5- 10 mins . Basically the core aim is to avoid any damage to the brain and other organ systems . So continued seizuring that is uncontrolled or prolonged or clusters are likely to require urgent treatment to break the cycle . If no history of epilepy, underlying medical conditions or toxins it can be useful to note the age in dogs, as the average age for the onset of idiopathic epilepy is approx 18 months to 2 years ..also breed may factor in ..border collies particularly .

If it is a one off short seizure the owner generally should follow your instructions re environment and then observe their pet to ensure they make a full recovery..they are often dazed for an hour or so post ictally but should return to normal . It's generally sensible to have a general health check in the 24 hours proceeding a seizure if they have no history of epilepsy ..although if it is the onset of idiopathic epilepy there are no standard diagnostic tests as you know ..but good practice to have a check over so nothing else is missed . However, the advice you offer will need to be according to your practice policy, the indiviidual situation and obviously all clients should be offered the option to attend OOH.

For potential dystocia my first questions are always age, breed , due date if known and is it a first litter. Then rough time of onset of labour signs and what are they doing now ? You often have to help the client out with explaining what sort of things they might need to be looking for and when you mention certain signs they often confirm which they have seen and when . If the client is moderately sensible and can describe things and can positively describe abdominal pushing then you want to know have they produced any young ? how many ? and how long between ? If they have been actively pushing for 1 - 2 hours without producing anything or actively pushed for this long and then have given up I tend to advise them to come down ...again always offering the option anyway . If the pet is calm and actively pushing and the owner is prescise and it has been 1- 2 hours you can potentially allow them to opt to observe for a further hour ..but again get their no and call them back if they don't call you More oftne than not you will get the two extremes..someone who calls before anything whatsoever has happened and the pet is not even actively pushing yet just nesting..and then the other end of the spectrum where they have been labourisng for hours..or in some cases days ..or have a puppy hanging out and it been there for 24 + hours ....worst case I had was 3 days hanging there and they had had various friends "who knew about these things" to come round and try and pull it out ..awful .

My argument with coughing is that ..apart from kennel cough or an environmetnal cause , the majority of things that cause dogs or cats to cough aren't good..it just depend how unwell the pet is as to the urgency ..basically it's back to protecting that airway and what's happening with their breathing . So it's mostly a case of establishing a history and the severity . Is the pet breathing normally ? Open mouth breathing /panting ? Some sensible owners can give you a rough resp rate. How old is the pet ? Any known heart or resp conditions ? How long has it been going on for ? Is it a cough or a retch ? With dogs - do they play with sticks ? get fed bones ? are they wormed reguarly for lung worm ? Do they go out ? With cats are they sneezing ? ( grass blades) etc.,

Hope some of this is useful and it's not just all long winded waffle from me :-D XX