Last night was a potent reminder of why I love my job.
At around 7pm, we were presented with a beautiful, sweet large breed dog named Jet. He'd been outside, come back in, and the owner noticed that he was drooling heavily and had a massively swollen face. When I examined him, I saw two puncture marks on his muzzle, consistent with a snakebite. Everything else was pretty normal on him - normal bloodwork, normal blood pressure, and an unremarkable physical exam. I recommended standard snakebite treatment - hospitalization for pain medications, antibiotics for necrosis of the skin around the wound, and monitoring of blood pressure and neurological status. Everything seemed 5 by 5. The owner had no financial concerns and agreed to everything I recommended.
We placed Jet on the table for his IV catheter, and he laid on his side. Suddenly and completely without warning, he began to gasp, and his gums turned purple. We grabbed the oxygen while I quickly explored inside his mouth. Imagine my surprise (and terror) when I saw the enormous, necrotic swollen soft palate. The snake had also bitten him IN the mouth, and now his airway was rapidly swelling shut. Before it was completely shut, I was able to intubate him, which was a huge relief.
I called his owner to the ICU and informed her that given the degree of swelling and the intra-oral snakebite, Jet was going to need an emergency tracheostomy and 3-4 days in the hospital. She never hestitated.
20 minutes later, I was placing my first tracheostomy tube. It went as perfectly as can be imagined and Jet has been doing great ever since. He was transferred to our local, 24 hour emergency and specialty clinic at 7:30am, where he will remain until his trach tube can be pulled.
As I was working on him, a dog that had been hit by a car was wheeled to the back. My technician began triaging her (Sylvia) for me. She seemed stable enough, but her front leg looked broken.
After attending to Jet, I did my physical and realized that her leg was not broken. Her elbow was dislocated. I felt a cold thread of fear, as I have never reduced a dislocated elbow in a big dog. Still, that's my job, right?
Sylvia's owner also agreed to whatever I recommended. After several hours of fluids, monitoring, and stabilization, we lightly anesthetized Sylvia. After 5 minutes of sweating and pulling and twisting, the elbow suddenly and easily snapped back into place. I had done it! Xrays confirmed that her elbow was now normal again.
She also did well and went to her veterinarian this morning.
It was a fun night in the ER!