Emergency Rotation
I have finished my mandatory emergency rotation and have just slept for about 14 hours after coming off of the night shift. My hours have been crazy inconsistent lately, with me working anywhere from 3p-12a, to 3p – 4a. I was only required to keep accepting new patients until midnight, but when you admit a patient at 11:45 p and have a procedure to do, it’s hard to walk away, especially when it’s a procedure I am unfamiliar with.
If a patient comes in with a complaint of seizures, the first thing you should do is bust out that glucometer. Dextrose is a lot easier to administer than doing a whole seizure work-up.
Human beings seem to fail to understand that seizures can have many causes…
Free fluid in the abdominal/thoracic cavities looks like little triangles of black
Ultrasonography is a skill that I need a lot more practice with. I pride myself on being able to consistently find spleen, bladder, liver, and kidney. Intestines I can find, but follow them I cannot.
A yowling cat in the waiting room is always cause for concern. There’s a certain sound those poor urethral obstruction and aortic thromboembolism cats make.
Feline heart disease is some of the trickiest shit without an ultrasound of the heart. Their rads are never consistent, they typically don’t get cardiomegaly, and they do not cough like dogs do.
A tiny, white, fluffy dog with a cough better start your brain thinking of mitral valve disease
Feline pyometra never seems to present like I think it should.
Our feline owning clients seem to not realize that cats cough with their mouths closed – maybe part of why our asthma patients do not present until later in life? I keep getting told their cat has hairballs and tries to puke them up despite the owner having never seen an actual hairball from their cat. Then we go to a Youtube example and it turns out their cat is coughing.
I love explaining that vomiting can be caused by a long list of differentials and people being offended that I want to rule out the life-threatening ones. Sorry your dog ate razor blades, but I did not put them in there.
Always check under a cat’s tongue if they present for vomiting. Linear (String) foreign bodies like to get caught around the base of the tongue and stick around to cause chronic symptoms with minimal diagnostic imaging detection.
I like sedating cats because they all come to the emergency room quite stressed and unable to chill
Cats like to get offended when assessing femoral pulses
Cats get these magnificently disgusting abscesses which are sort of fascinating to lance
If you open glove for a procedure and wear them long enough, the ink labels indicating the size of the glove are imprinted on your skin for a while.
Please vaccinate your pets for rabies. This helps your pets, you, and your vet staff.
Stop blaming opossums for your dog’s bite wounds. They might have beady little eyes, but they would rather lie down and urinate on themselves before fighting your dog. It was more likely a raccoon, coyote, or woodchuck.
Reptiles and mammals should not be in contact with one another. Cats especially have very dangerous bacteria in their mouth. Your cat playfully grabs your reptile? Well, now your beardie is septic and has a poor prognosis for survival.
Vaccination ≠ immunization. I know it’s a hard to accept, but there are some (very few) individuals who do not have appropriate immune responses to vaccination, meaning they are not immunized against the antigens we presented them with. We know the vast majority of our patients have protective immunity, but we are unable to predict those individuals that fail to mount an appropriate immune response.
I have reservations about raw, homemade diets because the increased bacterial load and correct balancing of a diet is incredibly tricky and can be fatal if done improperly
There are ophthalmology emergencies. The aqueous humor of the eye should not be on the cornea.
Pleural effusion (free fluid in the thoracic cavity) never has good differentials…
I have also learned that clients can be the most challenging part of this rotation. I got called heartless, stupid, just in it for the money on this rotation. I even had one client yelling and cursing at me. It can really make a great day into a bad one, but I was lucky to have a team of clinicians who supported me and made sure to communicate to those clients that if they cannot be civil, we can decline services to them. I am well aware that these are stressful and emotional times for clients, but we have to recommend the best care and try to rule out the most life-threatening causes for your pet’s problems. It’s your right to decline those things, but yelling at me will not change anything. So, please, treat your vet staff the way you would like to be treated. We’re all trying to accomplish the same thing: getting your pet the care they need.
It’s been a fun, stressful rotation and I started this one with a great deal of anxiety. I surprised myself in emergent situations: my hands may have been shaking but I saved lives. I even brought one dog back from the dead and they eventually made it to discharge! I learned a lot of clinical skills from clinicians/veterinary nurses and got to teach some Fear Free restraint methods to some of the ICU staff.
My next rotation is an emergency externship that sees wildlife, exotics, cats, and dogs. I am hoping to see some bunnies this go around and maybe overcome my fear of handling birds.
