Boing… Boing… Boing… The white fluffy football bounces from hill to hill with bristly whiskers and that fluffy, cotton tail of course. Where is it going to go next? Only the limping lagomorph knows. It stops for only a second to smell a juicy, crunchy carrot, but it cannot take a nibble due to a throbbing, overgrown tooth. Not to mention, a fecal impaction. But it limps on, hobbling on three lucky feet, faster and faster until its heart beats out of control …
“Dr. Blom! Dr. Blom! We have a STAT triage!” I blink my eyes and abruptly stop thinking about that rabbit. Time to switch gears. In rushes my team of technicians, dressed in grey, pushing a clacking gurney that holds a very large Mastiff who is on his side, tongue out and covered in dirt. He’s non-responsive, his eyes are beet red and his tongue has an unhealthy, purplish hue. Even though he’s wet, he’s as hot as an oven.
At once, like a well-trained brigade, my team surrounds him. They apply an oxygen mask, work on an IV catheter and take his temperature: it’s 107.5 degrees Fahrenheit (a dog’s average temperature is around 101 degrees). I stand at the head of the ship and list my demands. “Jackie, get a blood glucose and lactate. Karen, start a liter LRS bolus at 999; better yet, grab a pressure bag. Annie, get some wet towels!”
There are items flying, used IV catheters, caps and syringe cases, along with the pungent smell of isopropyl alcohol splashing on his footpads. In the chaos, I focus on his overall condition; my mind is spinning: What’s his temp? What’s his blood glucose? Oh, it’s only 53. That’s his blood sugar and it’s 37 points too low (an average dog’s is between 90 and 120).
“Carrie, (let me think, he’s about 100lbs, that’s 3mL per 10lbs); give him 30mL 25 percent dextrose and spike his next bag with 2.5 percent.” What’s his ECG looking like? His heart is beating abnormally and way too fast. What is his coagulation status (ability to clot blood) and his renal function?
“Annie, grab coags and a CHEM 17 profile. Pete, grab me an ophthalmoscope.” The dog’s pupils are pinpoint; not good I think to myself, as this indicates brain swelling. Is that bruising on his abdomen? This hints at a problem with him being able to clot his blood. “Okay guys, keep cooling him slowly to 103.5 degrees Fahrenheit with wet towels, and then stop cooling efforts.” Where are his owners?
I leave the battlefield to speak with his equally red–eyed owner; she’s hysterical with guilt. She left him tied to a tree in the backyard after a bath and ran to the store. It was only 30 minutes … Well, five-year-old Duke was not clued into the plan; he proceeded to try and paw his way to China to get back inside for each of the 30 harrowing minutes, until he collapsed.
It’s Arizona. It’s July. It’s 6:05pm.
“I think he had a seizure on the way here.” Definitely not good.
I start to explain to the poor lady heat stroke, cerebral edema, DIC and multi-organ failure and all of the bad things that could happen to Duke in the next two to three days if he makes it until morning. Or even the next few hours for that matter. I’m an optimist at heart but I have to be a realist with this owner; even tipping the scales to pessimism. “He’s up against a lot,” I say. She replies, “He’s like my child, please save him.”
Then, I have to bring up the 500-pound gorilla in the room, the cost of treatment. “I will do everything I can. I need you to know that with the two-to-three day estimate to start, possible plasma transfusions, multiple blood panels, a urinary catheter and intensive care; it’s going to be around $4,000 to 5,000.” I hold my breath; I want her to say “yes” with every fragment of my being. She says, “Just do it.”
That’s all I needed to proceed. I jog back to the ICU. Duke’s temperature is 101.7 degrees Fahrenheit; his first liter of intravenous fluids is complete and his blood glucose is 78. I shout a few more orders, not realizing that I’m being a little pushy, but it’s no-holds-barred in the animal ER tonight. His blood pressure is a glorious 95 millimeters of mercury and his heart steadily thumps at 110 beats per minute. Whew. Take a swig of luke-warm coffee. It’s 7:40pm; it’s going to be a long night. We’ll check on Duke later.
As I glance at the triage board, the list is growing:
- Ginger, 3yo female spayed Havanese: vomiting
- Rocky, 11yo male castrated Shih Tzu: cough, congestive heart failure
- Lily, 16yo female spayed Domestic Shorthair: hematuria
Next up, triage for a canine as John radios, “I’m on my way.” Here comes John with a Goldendoodle in tow on a slip leash. “This is Pearl. She just ate a bag of dark chocolate Hershey’s Kisses. I got permission to induce vomiting.” I do a physical exam on the curly coated pup; boy, those dogs are cute, I think to myself. “Let’s give her 1.4mg Apo IV. Be sure to feed her a small can of dog food first, as this will help make her vomit more productively. In addition, please do not hover, as she will vomit more when she is not so nervous. Watch her from a distance.”
These pearls of wisdom are learned from years in the field, in the trenches. Twenty seconds later, out it comes, three large piles of chocolate dog food. The smell is not so sweet. Her treatment is not complete. If she ingested as much as the owner thinks, her night in the ER is only getting started.
I take a 20-second break to swig another sip of less-than-luke-warm coffee. I think back to the fluffy-tailed rabbit—maybe I’ll splint his bum leg so he can hop along much more efficiently, then I’ll dutifully follow him down the rabbit hole to our next adventure in Animal ER Wonderland …
Dr. Carly Blom is an emergency veterinarian in Phoenix, AZ. She has exclusively practiced small animal emergency medicine for 15 years. She currently practices at VETMED in Phoenix.