UT-VMC emergency room tails: Just another Friday night

UTVMC COLUMN HEADER  2By Dr. Amanda Rainey

Friday nights seem to go one of two ways for our ER service.  Things will either be very quiet with few emergencies and phone calls or we will be very busy with many cases sent in from regular veterinarians and owners finishing a long week at work to discover that one of their pets is ill.

On a recent Friday evening we received a message from a vet office about an hour away that they were sending a dog that was hit by a car that afternoon.  With little information, we were unable to discern how stable or serious the dog’s condition would be, but we began to prepare immediately for her appearance.

When Charley entered our lobby in the arms of her owner, the front desk immediately recognized the severity of her status and a “Stat” call rang out over our intercom system.  She was rushed to our ICU, and the intern, myself and our emergency technician descended upon her.  

Charley was a cute Border Collie mix, around 35 pounds, and had been hit while running down the owner’s driveway.  We could tell without palpating her left hind limb that her femur was fractured, due to the swelling and abnormal position of the leg.  Her gums were frighteningly pale, and she was breathing rapidly with a very increased heart rate.  Charley’s temperature was also decreased along with her blood pressure, which signally cardiovascular shock.  Her chest seemed normal when we listened with our stethoscopes, but her abdomen was tense and taut, which made us concerned that she had suffered internal damage from the car’s impact.  Sensing she might be bleeding into her abdomen, we carefully inserted a needle into the cavity and confirmed this as blood filled the attached syringe.

During this time of assessment an intravenous catheter had been placed and we began giving Charley warm fluids to treat her shock, as well as opioid pain medication.  We also wrapped her in a warming blanket to address her low body temperature.  Despite our efforts, she seemed to worsen and her heart rate as well as respiratory rate continued to climb.  She looked up at me with kind brown eyes, and for a moment I felt very anxious that we were going to lose this sweet dog.  I pulled the intern aside for a quick consultation.

“We need to give her blood now or she isn’t going to make it.”  I told my young counterpart, feeling that we were unable to stabilize her because she was continuing to bleed into her abdomen.  She shook her head in agreement, but I could see this was a scary situation for a young doctor to face.  We administered the blood to Charley and an intense waiting period began while we determined if this truly would begin to turn the tide.  If not, the next step would be an emergent exploratory surgery to find the bleeding organ and try to staunch the flow, although she was a very poor candidate for anesthesia at the moment.

Fortunately, the transfusion seemed to be the answer, because Charley’s vitals began to stabilize.  She was kept through the weekend in ICU for supportive care and monitoring, and although she wasn’t out of the woods for at least 36 hours, by Monday morning she was doing fantastically and ready for surgery to repair her femur fracture.  A few days later she walked out of the hospital with her owners, tail wagging and already using her injured leg.  All the stress of Friday night was worth it to know we saved her.

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