We had a couple of really rewarding cases in the ER this weekend (and it was a busy weekend, YAY). The first was a little dog that we originally saw on Friday morning, about an hour prior to closing. She presented with severely hemorrhagic diarrhea, vomiting, incredible dehydration, and a slight drop in her white blood cell count. Bloodwork was non-specific for anything, and we assumed a nasty hemorrhagic gastroenteritis. We stabilized "Angel" and sent her to her veterinarian for the day.
He monitored her through the day, and her white blood cell count continued to drop. Oddly, he decided to discharge her home, assuring the owners that she would "likely be ok." She presented to me Friday evening, flat out, with a blood pressure of 30 (normal 100!), a blood sugar of 33 (normal 80-100), terrible gum color, significant abdominal pain, and a low white blood cell count. She was suffering severe sepsis.
We started aggressive fluid therapy to get her blood pressure up, intra-nasal oxygentation to help with possible imminent ARDS (acute respiratory distress syndrome, often seen concurrently with sepsis), placed a urinary catheter to measure her urine output, started treating her with broad spectrum antibiotics, dextrose supplementation, aggressive pain medications (a fentanyl/lidocaine/ketamine CRI), and placed a nasoesophageal feeding tube so that we could start trickle feeding her.
For the first 12 hours, she stubbornly circled the drain. Her blood sugar refused to come up, her blood pressure hovered around 80 (better but not great), and she just looked bad. I gave the owners a guarded to grave prognosis, but we continued on.
Then, over the course of 72 hours, she went from flat out to sitting up to responding to us. Her WBC count started to rise. She started to show an interest in food. Her diarrhea slowed down, and she became more social, coming to the front of her cage and looking out. Her blood pressure held steady on its own, and her blood sugar came up enough to discontinue her dextrose.
This morning, I sent her for one more day of hospitalization. When her owners arrived, this previously near death dog stood up on her hind legs and danced for her owners. It was like night and day.
I was really proud of the care we provided this little dog. Without it, she would have died without a doubt. Now, because of my team, their hardwork and dedication, she lives to fight another day!
As to the other rewarding case, I'll save that for tomorrow. Technically, today is the first day of my 9 day off stint, but I am working relief at the 24 hour specialty/ER hospital tonight, so I need some sleep.
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