How to know if you need to visit the vet ER

My best friend made a suggestion for this post, and I thought it was a GREAT idea.

So, we've all been faced with the question: Do I take Fluffy to the ER, or can I wait until tomorrow? Here are some reasons why you should go, as well as some reasons that can wait.

1) Allergic reaction to shots (or other causes): these occur fairly frequently, especially in small breed dogs like Boston Terriers, dachshunds, chihuahuas, and the like. The most common reaction is swelling around the eyes, lips, and muzzles (urticaria). Hives all over the body might also be present. They can be very subtle or extremely severe. Your dog will likely itch all over and frantically rub him/herself all over the carpet, walls, and scratch vigorously. The reaction is called a hypersensitivity type I reaction. If your dog is suffering from hives, itching, and swelling, a trip to the ER is NOT necessary. Benadryl can combat the effects. I usually use 1-2mg per pound (so for a 25 pound dog, one adult Benadryl-25mg should be sufficient - up to 50mg if needed). Make sure that the Benadryl has no other ingredients in it other than diphenhydramine. Pseudephedrine, etc can kill dogs!

On the flip side, dogs can develop anaphylaxis - a life-threatening manifestation of a type I hypersensitivity. This is typified by very sudden onset of vomiting, diarrhea/defecation, collapse, pale gums, and labored breathing. Immediate treatment is warranted for this type of allergic reaction, as it can cause swelling shut of the airways.

Rarely do both occur together. Dogs suffering cutaneous (skin) hypersensitivity reactions rarely have any problems. Dogs suffering anaphylaxis rarely have any skin manifestation.

2) Ingestion of chocolate, antifreeze, rat bait, sugar-free gums containing xylitol, raisins, grapes, any over the counter medications such as ibuprofen, tylenol, aspirin, or prescribed medications: these do necessitate a trip to the ER. Many owners try to induce vomiting at home with hydrogen peroxide. That stuff is incredibly caustic and can cause esophageal and stomach burns/ulcers. If your pet has eaten something it should not have, the safest route is to have a veterinarian induce vomiting with an injectable drug called apomorphine. Afterwards, activated charcoal is often administered to coat the stomach and prevent further toxin absorption.

A sidenote about rat poison: most of them (with the exception of bromethalin) are drugs that inhibit clotting in the body. It takes a minimum of 48 hours for those drugs to take effect (usually closer to 72 hours). So, if your pet ingests rat poison in the wee hours of the morning, or you can't get to the ER vet immediately, as long as you see a vet within 24-36 hours, you're fine. It's ideal to get there sooner, so that vomiting can be induced, but it's not going to kill your pet if you have to wait a bit.

Also a note about bones: bones will digest in stomach acid. However, I do not recommend feeding them, because large bones can become lodged in the pylorus of the stomach, causing pain and/or damage to that area. I recently had to take the eye of round bone out of dog's stomach. Also, sometimes bone dissolve so slowly that they wind up in the colon, causing massive discomfort and very bloody diarrhea.

Another important thing: moldy food. It often contains mycotoxins - which lead to tremoring. This can be very mild or so severe as to be life-threatening.

3) Limping: this can be very hard to sort out. A good general rule of thumb is this: if the pet REFUSES to put the leg down AT ALL, it is likely broken and should be addressed. If a patient will walk on the leg occasionally but prefers to hold it up, a muscle sprain or other soft tissue damage is much more likely. Obviously, if the leg is dangling/limp or there is any blood involved, it should be seen immediately.

4) Vomiting and diarrhea: not every case of v/d is an emergency. I tell owners to apply common sense to this. How many times have you personally been to an ER for v/d? I can answer that question with a never. If your pet is vomiting or having diarrhea, but otherwise seems bright, alert, and happy, take up his/her food for 12 hours. Offer nothing by mouth (even water) for that period. After 12 hours, you can offer very bland food such as unseasoned white chicken (boiled) and white rice. If the vomiting continues, it would be a good idea at that point to have your pet checked.

Continuous vomiting that goes on for more than an hour or having the knowledge that your pet likes to chew/eat things such as socks, towels, or toys necessitates a trip to the ER.

As for diarrhea, it just depends. If the pet is otherwise happy, eating, and drinking, it can wait. A little bit of blood in the stool is not necessarily an emergency. If your pet is lethargic, passing LARGE amounts of blood in the stool, or has other systemic signs (vomiting, weakness, etc), he/she should be seen. If the pet is a puppy (<1 year old), has vomiting and bloody diarrhea, parvo needs to be ruled out.

5) Broken toenails: these are very rarely emergencies. Corn starch applied to the tip of the nail, along with light pressure for 5-10 minutes can usually stop even the nasty broken toenails. I hate wasting $92+ of someone's money to apply Kwik-Stop to a toenail.

6) Difficulty breathing: this is always an emergency. If your pet is having trouble breathing (coughing, rasping, wheezing), he/she should be seen. Questions your vet needs to know the answers to: up to date on heartworm preventative? history of a heart murmur or other known cardiac disease? any other pets in the household affected? history of coughing over the last few weeks/months?

7) Lacerations: if your pet has sustained an injury or a cut, they should be seen. If a wound can be addressed, cleaned, and sutured closed within 8 hours, you can prevent bacterial proliferation to the point of infection. Don't wait until the cut is dirty!

8) If you have a male cat that is suddenly lethargic, vomiting, straining in the litterbox, yowling while using the litterbox, or collapsed - to the ER immediately. Male cats frequently suffer urethral obstruction - the formation of small, crystalline plugs that block the urethra and make urinating impossible. This can be rapidly fatal due to the rising level of potassium in the body, as well as the acute renal failure that occurs due to back pressure on the kidneys.

9) Anything to do with the eye should be addressed. While fairly tough structures, any damage to the eye (scratches, trauma, etc) should be looked at immediately. Even if there is no blood, if your pet is squinting, has excessive discharge from one or both eyes, or significant redness/swelling, the eye should be checked.

10) Sneezing/ropy nasal discharge/lethargy in cats: this is not usually an emergency. Cats (esp outdoor) are very prone to picking up upper respiratory tract infections. These URIs are 99% of the time a virus (either herpes or Calicivirus). Thus, antibiotics are not warranted. Cats will feel very lethargic, may feel hot, and refuse to eat. You can care for them at home by cleaning their noses and eyes frequently, humidifying the bathroom with the shower and putting them in there for 10 minutes 4-6 times a day, offering wet, smelly, foul cat foods (like Friskies, etc), and monitoring to make sure that in 3-4 days, they feel better. Rarely, these cats will be very, very sick and require hospitalization and a feeding tube, but this is very uncommon.

For now, those are the most common things I can think of. What do you guys think? Do you have questions about things you've encountered and been unsure about?