24/7 Emergency
You’ve brought your dog or cat to the emergency room, often without knowing what’s wrong. Your pet has gone back to be examined, and while the doctors and technicians work out of sight, questions run around your brain. What goes on during that first hour in a veterinary ER? How will doctors identify the problem and start fixing it? This article will help to answer some of those questions.
Gathering Preliminary Details
Even before the doctor sees your pet, vet techs do initial triage. They’ll decide whether your animal should wait a bit for an assessment or be treated immediately for a life-threatening condition. If it’s not life-or-death, they’ll note the patient’s medical history and vaccinations and ask about diet and medications.
First Steps in the ER
As part of the first hour in a veterinary ER, technicians will obtain vital signs right away: temperature, heart rate, respiratory rate, gum color and capillary refill time (a measure of blood circulation). If your pet is stable and the doctor isn’t available, the technician may begin approved diagnostics. These could include radiographs (X-rays) or bloodwork.
The Veterinarian Exam
The veterinarian will do a full body exam. Initial assessment will be general, noting the way your pet is breathing and holding their body and the way your pet is interacting with the world around them. A closer look at each body part is then performed, starting at the head and working towards the tail. She starts with the gums and mouth, checks to see if the pupils are normal or she finds nasal discharge, looks at the symmetry of the head for trauma, swelling or muscle wasting.
The vet then moves to the lungs and heart. Is the dog breathing normally or using belly muscles to help the animal breathe, perhaps sticking out its neck for that purpose? A stethoscope helps to reveal a heart murmur or abnormal rhythm. It also helps to find crackles or wheezes in the lungs.
Is the abdomen normal or distended? Does the pet feel pain when organs are palpated through the fur? A vet can actually feel the kidneys and part of the liver and intestines with her fingers in a cat or very small dog. The doctor checks the way the animal moves and holds its body: Does it bear weight evenly on all four legs?
A quick neurological exam shows whether the pet is anxious or calm, aware of what’s going on around it or non-responsive. Proprioception is how an animal knows where its paws are and can walk without seeing them; a vet flips paws over to see if the pet rights them automatically.
Remarkably, this preliminary check usually takes only about five minutes.
More Sophisticated Exams
Vets don’t rely only on what owners tell them in the first hour in a veterinary ER. Instead, they check the whole animal. For instance, a dog hit by a car might obviously have a broken leg. But it could also have a ruptured urinary bladder or contusions in the lungs. The next step is often a POCUS scan (Point of Care UltraSound)—an ultrasound machine searches for fluid where it ought not to be, especially in the abdomen or chest.
What If My Pet Has a More Severe or Critical Condition?
An animal in pain will usually get pain relief quickly, often during initial triage. Pain medications need time to take effect before ER doctors manipulate an animal for X-rays. Veterinarians use a lot of opiates because they’re safe for short-term use and aren’t likely to worsen heart disease or interact with other medications.
When a pet breathes poorly during the ER exam, a technician may hold flow-by oxygen up to its face; in some cases, ICU nurses put pets in enclosed kennels with a high level of oxygen flowing to ease breathing. After 15 or 20 minutes, that animal may be ready for chest X-rays.
An unstable patient may get immediate attention from many technicians at once. One installs an IV catheter; one gives oxygen; a third prepares IV fluids, should the animal go into shock and have a blood pressure plunge. A condition that serious may prompt doctors to request advance consent from the owner to perform CPR if needed.
Some Common Situations After the First Hour in a Veterinary ER?
Vets frequently see dogs in respiratory distress and suspect congestive heart failure. Those animals get oxygen and medication to remove fluid from the lungs. Then X-rays and blood samples confirm the condition.
For a cat, failure to urinate is life-threatening. Technicians will palpate the bladder and have a doctor give a mild sedative, hoping it relaxes the cat enough to urinate. If not, a doctor applies heavy sedation and inserts a catheter.
A couple of common situations require immediate surgical attention. Bloat in dogs, also called gastric dilatation and volvulus, requires the vet to get fluids into the animal immediately, decompress the stomach by sticking a giant catheter into it to relieve pressure, then do an operation to untwist the stomach.
Another common straight-to-surgery issue occurs when a tumor on the spleen ruptures. If the ultrasound shows fluid in the abdomen, vets take a quick sample to see if that fluid contains blood, which suggests the tumor is bleeding. Then doctors check for tumors spreading before going to surgery. In some cases, the blood from the abdomen can be removed and given back to the animal through an IV catheter.
And the Good News Is…
In the first hour in a veterinary ER, even if you don’t see your pet, they are being closely monitored. This includes an ER technician, ICU technician and a doctor at the very minimum. And if you’re waiting up front for a long time, that means your animal is stable and has less need to be treated immediately.
If the patient’s really stable, and it’ll be a while before the doctor can thoroughly check it out, a technician may bring it back to wait with you in the lobby. Owners prefer that, and pets do, too.
You can think of Charlotte Animal Referral and Emergency (CARE) as the animal equivalent of a medical center for people. It operates 24 hours a day, 365 days a year, and offers a wide range of treatments. You can expect not only emergency room care but board-certified work by specialists once you obtain a referral from your primary care veterinarian. Please check out the practice at carecharlotte.com/tour.
