Vet Tech Journals: Emergency Shifts (long)

Very sorry about the length.... I know that many of you have had to
take your masters to the emergency clinic at some time, so here's a
view of what it's like to be on the tech staff.

As I said earlier, I worked two shifts at the emergency clinic this
weekend in addition to working two regualar shifts. They were tiring,
but quite satisfying.

Here there really isn't anyone to hold my hand. But as a relief tech i
still check with people on points of procedures so i do things they way
they want them. I get to really apply what i've learned, or at least
try to remember.

E-clinics can be EXTREMELY slow, which is a good thing and a bad thing.
It's good because it means that pets are safe and out of trouble, but
it's bad because it means sitting around for hours with nothing to do.

We'll see animals, some with non-emergency complaints, and give them
the care they need. Like we had two dogs that came in that had been
coughing. It's something that could have waited to be seen by a
regular vet, but the owner was quite concerned. Of course as an
e-clinic it's quite expensive, so sometimes mild concerns that could
easily be handled by a regular vet become 'emergencies' when a
concerned owner is involved. And the owner ends up paying for an
emergency visit.

But then there are times when suddenly the monotony is broken. I was
resting in a chair, debating whether to put up my throbbing feet, when
my coworker said we had a gentleman pull up with two dogs that had been
bitten by a rattlesnake.

Now then here's how we would handle it at the last clinic i worked at,
where rattlesnake bites were common: (this is a generalized thing,
since of course every case is different. Also bear in mind that there
are about four people, not including the doctor doing these things)

One person sometimes two, restrain the dog. Another person takes blood
and starts running labwork. Another immediately places an IV catheter,
while someone sets up the fluid bag and IV line. The doctor then talks
to the owner while the blood is being run, and the animal receives
fluids Then the doctor gives the antinvenom, checks the labwork, etc
etc, and the animal gets put into a cage and is hospitalized for a bit.


That's how a 'normal' clinic would usually handle it. Now lets see how
an e-clinic would handle it. Here there are only two technicians, the
doctor and receptionist(who's also a tech), that's it.

Any life threatening emergencies we have to make sure that hte owner
signs a release granting us to perform emergency treatment and do
whatever is necessary to STABILIZE the patient. STABLIZE only.
It'll have a few estimated numbers of what it could cost, but the owner
needs to sign it. Most of the time, at least from what i've seen, the
owner does sign it.

One dog was a large husky mix, and her face was quite swollen. My
coworkered tied her leash to the table, and using a tourniquet placed a
catheter. I had the other dog, an very old pit mix who had bad hips
and trouble walking. She just sort of collapsed and just laid there.
She was panting and her foot was swollen and bloody. The doctor held
off the vein and i placed the catheter.

So the catheters are in place, but we do NOT set up fluids. We do take
blood but do NOT run any labwork. Meanwhile the doctor and
receptionist are typing up an estimate for the owner to sign; listing
the estimated costs of treatment like; Antivenom, Pain meds,
antibiotics, labwork, IV fluids, hospitalization. All of it can be
quite costly. But we cannot initiate treatment UNTIL the owner has
signed the estimate AND left a deposit.

This is where working in an e-clinic becomes frustrating. It is here
where the owner's eyes pop out at the price listed on the estimate.
"What is this? Why should i pay for this? Does he really need this?"
etc etc etc and remember there were TWO dogs. (so double the price)
Meanwhile we techs in the back are waiting for our instructions.

Then the tech/recept comes back and says to the doctor. "The gentleman
is looking it over and trying to call his wife, but he's concerned
about the price" Not an unexpected reaction, but then she said "He
doesn't want to do any labwork."

Say what? The guy's dogs have been bitten by a rattler. Rattlesnake
venom is hemotoxic; destroying tissue, blood cells and disrupts blood
clotting. We NEED to run labwork to help monitor the dogs' health.
The tech and the doctor talk a bit and I kept an eye on the dogs who
were both just lying down.

Another 5-10 minutes go by and the doctor comes back and starts making
notes and calculations. Then the tech/recp comes back with a frown on
her face and hands me the clipboard with the signed estimate on it. I
thought things were fine until i read the estimate. The guy had only
approved for the dogs to receive fluids, pain meds and antibiotics, and
hospitalized stay. He had negated any labwork and no antivenom. lemme
repeat, NO ANTIVENOM.

The tech/recp continued, "I told the guy that the dog's chances of
survival are not good now and they could possibly crash (cease all
vital functions). And when i asked him about resuscitation the guy
said if the dogs do crash, to try to save the husky, since the other
dog was twelve years old."

I was about to say "Can i go out into the lobby and slug the guy?" but
i bit my lip.

Sooooooo, my coworker and i give both dogs some serious pain meds and
antibiotics and set them up in cages. And that's all we really could
do, except monitor their vital signs every hour. And so we did, for
the next five hours. When I left at midnight, both dogs were fine (as
they could be after everything)

In an e-clinic there's only so much you can do. The owner makes the
decisions and all we can do is advise what needs to be done. It does
come down to money and how much an owner is willing to do/pay to, if
necessary, dave the life of their companion.

Like I can tell you that in this case the estimate itself was in the
mid $2000s. How many people have that kind of money ready for things
like this? And how many people are willing to SPEND this amount at
such short notice? This e-clinic does not accept payments, so the
remaining balance MUST be paid in full when the animal is picked up. I
know of other clinics that use something called Care Credit, but i'm
not familiar with it.

Some of you may remember that a few years ago, I rescued this cat after
it had been attacked by Rottweilers and took it to the e-clinic.
Ironically this is the very same e-clinic, and the estimate they gave
me was about $1100. That was for the exam, x-rays, pain meds, IV cath
and fluids, and hospitalization. And rememeber this wasn't my cat. To
keep a long story short, i put down a $200 deposit and was able to
contact the owner who paid the rest and paid me back. He was then able
to take his cat to a local vet and with the help of donations from
people on this newsgroup, was able to pay for the cat to have surgery.

Now what would have happened if I coudln't contact the owner? Or what
if the cat had been a stray? I would have had to pay the entire amount
JUST for the e-clinic. And even now, i can tell you i don't have that
kind of money. And everyone here knows how expensive vet bills can
get, and an e-clinic is even more expensive.

So on one hand it's can be seen as cruel to just approve basic care
when the dog's life is in danger, but on the other hand, it'd be
terrible to not be able to afford anything more than basic care.

I've only worked at that clinic 3 times, and hopefully will work more
as they need me. I'm on the relief staff so in cases when one of their
main staff is unavailable they call me. It was an interesting but
exhausting evening, and i learned a lot. Hopefully the next time they
call me, though, i won't have to work at my clinic AND theres in the
same day.

Take care,

Kristi

"Mischief" wrote:
The tech/recp continued, "I told the guy that the dog's chances of
survival are not good now and they could possibly crash (cease all
vital functions). And when i asked him about resuscitation the guy
said if the dogs do crash, to try to save the husky, since the other
dog was twelve years old."

I was about to say "Can i go out into the lobby and slug the guy?" but
i bit my lip.

It's hard, but you've learned so much. I really hope that the dogs
make it. If there was a happy ending, be sure to let us know.

On 2006-08-07, Mischief penned:
Any life threatening emergencies we have to make sure that hte owner
signs a release granting us to perform emergency treatment and do
whatever is necessary to STABILIZE the patient. STABLIZE only.
It'll have a few estimated numbers of what it could cost, but the
owner needs to sign it. Most of the time, at least from what i've
seen, the owner does sign it.

Yup. This is how they handled it when I brought Oscar to the
emergency clinic for her paw. They wanted to write up an estimate; I
kind of waved my hand and said, whatever, just do it. I still had to
sign the estimate *and* pay the low end of the estimate up front.

I lucked out because the original estimate was for surgery, and it
turned out that she didn't need surgery, so the final bill was much
lower than anticipated.

I'm just wondering how two dogs managed to get bitten in one go. Is
this common? Did they blunder into a nest?

Purrs for the dogs. It's hard to imagine the owner not authorizing
everything vetly possible, but I don't know his financial situation,
of course.

--
monique, who spoils Oscar unmercifully

pictures: http://www.bounceswoosh.org/rpca

I'm just wondering how two dogs managed to get bitten in one go. Is
this common? Did they blunder into a nest?

Probably not. Dogs are most commonly bit on the face because of their
curiosity. Although a bite on the leg can happen too if they are
walking by and don't see the rattler sleeping in the grass.

Since the older dog had a bloody foot, its possible that is what
happened. The foot was bleeding due to the hemolysis from the venom.
I bet then the other dog came in to see what was happening and got
tagged in the face, which then swelled up.

That's my best guess. Won't be able to really find out what happened
until i get called in again and can look up their file.

Kristi

On 2006-08-08, Mischief penned:

I'm just wondering how two dogs managed to get bitten in one go. Is
this common? Did they blunder into a nest?

Probably not. Dogs are most commonly bit on the face because of
their curiosity. Although a bite on the leg can happen too if they
are walking by and don't see the rattler sleeping in the grass.

Since the older dog had a bloody foot, its possible that is what
happened. The foot was bleeding due to the hemolysis from the
venom. I bet then the other dog came in to see what was happening
and got tagged in the face, which then swelled up.

That's my best guess. Won't be able to really find out what
happened until i get called in again and can look up their file.

Yeah, that makes sense. It's not exactly important for me to know,
either; I was just curious.

--
monique, who spoils Oscar unmercifully

pictures: http://www.bounceswoosh.org/rpca

Mischief wrote:

Very sorry about the length.... I know that many of you have had to
take your masters to the emergency clinic at some time, so here's a
view of what it's like to be on the tech staff.

As I said earlier, I worked two shifts at the emergency clinic this
weekend in addition to working two regualar shifts. They were tiring,
but quite satisfying.

Here there really isn't anyone to hold my hand. But as a relief tech i
still check with people on points of procedures so i do things they way
they want them. I get to really apply what i've learned, or at least
try to remember.

E-clinics can be EXTREMELY slow, which is a good thing and a bad thing.
It's good because it means that pets are safe and out of trouble, but
it's bad because it means sitting around for hours with nothing to do.

We'll see animals, some with non-emergency complaints, and give them
the care they need. Like we had two dogs that came in that had been
coughing. It's something that could have waited to be seen by a
regular vet, but the owner was quite concerned. Of course as an
e-clinic it's quite expensive, so sometimes mild concerns that could
easily be handled by a regular vet become 'emergencies' when a
concerned owner is involved. And the owner ends up paying for an
emergency visit.

But then there are times when suddenly the monotony is broken. I was
resting in a chair, debating whether to put up my throbbing feet, when
my coworker said we had a gentleman pull up with two dogs that had been
bitten by a rattlesnake.
snip
Take care,

Kristi

Poor doggies! I do hope that they recover.
We will be purring for them and we will send best wishes for their recovery,
Polonca and Soncek