Tuesday, April 6, 2010

What they say is true.

Duct tape does fix everything.

At least, temporarily.

This was evidenced by the poor patient I saw this morning around 4am. Said patient was a large, mixed breed dog of approximately 70 pounds. He'd been running outside the previous evening and cut his foot badly. He starting bleeding, and it had continued unabated for 3 hours. According to the "owner" (more on that later), it was massive volumes of blood. The "owner's" boyfriend (actually the dog's true owner) had fashioned a tourniquet of his own for the foot.

The tourniquet consisted of an elastic hair tie double-wrapped around mid-forearm, pillow material ripped into shreds wrapped around the wound, and a forearm to just-above-the-paw "cast" of duct tape. This was placed at 11pm and left until I saw the dog at 4am. Actually, had this been placed as a temporary measure (say: 1 hour or less), it would have been pretty good!

By the time I saw the poor dog, the paw was 5 times the size of the normal foot. Circulation was beyond cut off. The dog wouldn't even put his foot down. His femoral pulses were rip-roaring bounding (likely a combination of pain and blood loss), his color was poor, his blood pressure was none-too great (systolic BP 85, should be around 95-100), and his heart rate was a whopping 250 beats per minute (normal for a dog his size should have been around 90-120). He was NOT bleeding anymore, however.

I went to talk to the "owner." Turns out this was the owner's (barely 18 years old) girlfriend. The boyfriend (he the fashioner of the duct tape bandage) had placed the bandage and gone to bed. When the GF got up and saw the swelling around 4am, she was so horrified, that she woke her BF and demanded a trip to the vet. He refused to get up, so she dragged the dog in. This was no mean feat, considering she weighed all of 100lbs.

I gave her my recommendations - sedation, pain medication, acepromazine to help with hemorrhage control, wound care, check PCV/TS to assess blood loss, possibly clotting times, possibly a packed red blood cell transfusion. She had $150, given to her by the BF's father.

She didn't whine, she didn't complain, she acquiesced to the treatment she could afford (sedation, removal of tourniquet for examination of the wound, placement of a proper bandage) and thanked us for our care. She didn't ask for a payment option or expect special treatment.

When I removed the duct tape bandage, nothing happened for about 3 minutes. I was able to examine the wound. It was about nickel sized and located just below the carpal pad - circular and rather unremarkable. It took all of those 3 minutes for circulation to return to the arm. When it did - WHOO-WHEE! The severed artery started pumping like mad! We quickly placed a stack of guaze over the wound and re-wrapped it with cast padding and VetWrap.

The owner's girlfriend was stuck in an unfortunate situation - trying to care for - let's admit, if you won't get out of bed to care for your hemorrhaging dog because you want to sleep, you're a douchebag- a douchebag's dog. I felt for her, and she expected no charity.

I placed a 16 guage catheter in the back leg - no tape, no nothing, and ran a liter of fluids into the dog to boost the blood pressure and help improve perfusion. I checked a PCV/TS (measure of anemia/hemorrhage) and found it wasn't that bad. I also checked a blood pressure. All for no charge.

It was my good deed for the week. When they left, it was 5:45am. Their general practitioner opened in less than 2 hours. I told her I thought the dog would make it till then, but that he still needed treatment and monitoring. I'm sure she'll get it for him.

Must be the spring fever that's making me a giver this week...


Elizabeth said...

Maybe it is spring fever but maybe it was because she didn't whine, complain or otherwise try to make you feel guilty and was trying to do the best she could in the situation and you saw that.. and I bet she expressed her appreciation for all you did.

Nicki said...

I put a splint on a broken leg once for a puppy. The owner's had the usual strict instructions about care. Came back in for a recheck-with a new homemade splint of a t-shirt, cardboard, and duct tape. Why do we bother?