The Homeless Parrot: OH DEAR LORD

Wednesday, June 10, 2009

OH DEAR LORD

my first night as an ER doctor was..........................

wait. there are no words. ok. there are some.

in 25 minutes, the following patients presented as "tech to the front" (meaning get yer ass up here stat and get this animal!!): a hit by car dog with pelvic fractures, a dog fight with puncture wounds all over his face, chest, and rear limbs, another hit by car with horrendous pelvic fractures and pulmonary contusions, an eclampsia dog, a cat that drank antifreeze, a gunshot wound through the chest, a dog with a possible torsed spleen (turned out to be splenic lymphoma), a cat with a waxing/waning fever, another dog attack that had been maced...and finally - the piece de resistance: the mother of all emergencies - yes, folks - on my FIRST night as the SOLE ER doctor - i had a GDV (gastric dilatation and volvulus). of course the owners were all "here's $3000, now go fix our dog immediately!

it is noon. my shift "ended" at 8am. i am just now getting home, and i feel like i've been repeatedly beaten with a cotton sledgehammer.

but i rocked it, folks. i really really did.

this morning, i was treated horrendously by a lunatic owner - my voice actually rose to a non-inside voice level...i'll be honest...

more details to come later. i must sleep.

1 comment:

Nicki said...: I think i'll keep to daytime practice. but way to go on handling all that!; June 10, 2009 at 9:30 PM

Subscribe to: Post Comments (Atom)

Medical terminology

Azotemia - elevation in kidney enzymes (BUN and creatinine) indicating dehydration, kidney failure, or urinary obstruction
Lactate - a salt/ester of lactic acid that is produced as energy for a cell when oxygen levels are low. In critically ill animals, elevated lactate can be an indicator of inadequate blood flow to organs (perfusion), decreased delivery of oxygen, and/or decreased oxygen uptake. Values > 6-7 are usually considered to be poor prognostic indicators for survival.
GI sloughing: when the cells lining the GI tract die (can be secondary to MANY things, including heatstroke) with resulting bloody diarrhea, bacterial translocation into the bloodstream and sepsis
TTJ: transfer to jesus: code for when an animal needs to be euthanized or die
DIC: disseminated intravascular coagulation: a very, very bad thing - when the hemostatic system gets out of whack, and clots start forming in the blood vessels until all clotting factors are wasted. once those are gone, internal hemorrhage ensues, followed by death, usually. also known as "death is coming"
Pleural effusion - fluid contained in the pleural space (chest) - this is not the same as fluid in the lungs (see pulm edema) - in cats can be caused by infection in the chest, heart failure, cancer, FIP, feline leukemia, FIV, and in some cases, the cause is never found (idiopathic)
Anisocoria - unequal pupil size (related to any number of causes including brain damage/head trauma)
Laterally recumbent - lying on side, unable to rise
Hyperglycemia - elevated blood glucose
Hyperkalemia: elevated blood potassium - a life-threatening condition related to several disorders (kidney failure, antifreeze toxicity, urethral obstruction...etc)
Sepsis - refers to a bacterial infection in the bloodstream or body tissues. This is a very broad term covering the presence of many types of microscopic disease-causing organisms.
Nephrectomy - kidney removal
Splenectomy - removal of spleen
Pulmonary edema - condition in which fluid accumulates in the lungs, usually because the heart's left ventricle does not pump adequately ( can be caused by heart failure, electrocution, drowning, too many IV fluids, to name a few)
Tick borne diseases - any of a myriad of diseases transmitted by ticks - including but not limited to Rocky Mtn Spotted fever, Lyme disease, Ehrlichia
Fine needle aspirate - A method of sampling in which a needle is used to suck in cells or tissue bits for diagnoses (good for diagnosing masses/lumps)
Blood glucose - The principal sugar produced by the body from food–especially carbohydrates, but also from proteins and fats; glucose is the body's major source of energy, is transported to cells via the circulation and used by cells in the presence of insulin (normal range in a dog/cat is 75-100)
PCV - packed cell volume - the volume of packed red cells in milliliters per 100 ml of blood (normal range 35-45)

Diseases I see/treat frequently

Dystocia - difficulty birthing. May be responsive to oxytocin administration (Pitocin, as in people) but may require c-section.
DKA - diabetic ketoacidosis: the extreme end of the diabetic scale. A patient that is diabetic can develop DKA when other diseases make the blood glucose hard to regulate. Other diseases that are commonly associated include urinary tract infection, pancreatitis, pyometra, skin infection, and cancer. In DKA, the body starts metabolizing fat and producing acids that cause a drop in blood pH, nausea, weakness, severe dehydration, electrolyte derangments, and death.
DCM - dilated cardiomyopathy: an idiopathic (cause unknown) cardiac disease in which the heart chambers become very thin/dilated, and cardiac output drops radically. Causes arrhythmias, tachycardia, and sudden death. Seen in large breed dogs like Dobermans, Great Danes, etc.
Lymphoma - cancer of the white blood cells, the most common and treatable form of cancer in dogs
Blocked cat - slang term for a male cat with a plug of mucus and crystals obstructing the urethra (fairly common in male cats) definitely a life-threatening because urine can't get out of the body! If present long enough, causes shock, acute renal failure, hyperkalemia (elevated potassium), coma, and death. Symptoms include straining in the litterbox, yowling while trying to urinate, producing small, bloody drops of urine (also symptoms of feline cystitis, a non-lethal condition)
GDV - stands for gastric-dilatation and volvulus - a condition of large breed, deep-chested dogs (usually) in which the stomach rotates 180 degrees on its axis and thus - nothing can enter or leave, considered the "mother of all emergencies" - it warrants immediate surgery and carries a guarded prognosis
IMHA - immune-mediated hemolytic anemia. A disease in which the immune system attacks the red blood cells and destroys them. It causes profound anemia and is life-threatening. Causes are primary (no known cause) and secondary ( tick borne disease, cancer, and heavy metal intoxication). Treatment is immunosuppression with drugs primarily. Prognosis is guarded at best.