Last night was an awesome reminder of why I do ER medicine. We've been slow lately, and frankly, I've been a bit bored at work. Most people are financially strapped in our area, and they can't afford work-ups for illness. If I see a seriously injured or critically ill pet, euthanasia is highly likely. While these are important parts of my job, it gets old when all I feel like I'm doing is shotgun medicine and euthanizing things.
Last night, the night got off to a rollicking start. There were 3 rooms waiting to be seen simultaneously. In one of them were 2 dogs, both bitten by a rattlesnake several hours before. I was initially skeptical - rattler bites in this area are much, much less common than copperheads. The owners had brought the snake with them, and sure enough, it was a rattler. Not only was it a rattler, it was a very young one. This is, probably surprisingly, worse than an adult. Young snakes cannot control the amount of venom they inject and usually inject it all at once.
One patient was a 7.5# dog named Sunny. She sustained a bite to the inside of her mouth, in a highly vascular area. When she presented, she was laterally recumbent, oozing pure blood from her rectum, had a very low blood pressure, and blood sugar. Her condition was terrible. Her housemate, a 70# dog, sustained a bite to the leg. While swollen, Lena was in much better condition. It appeared that the baby snake had likely expended all his venom on Sunny.
I expected to be euthanizing Sunny, as her care with antivenin (which she needed), would run in the high $1800-2000 range. Add in hospitalization and monitoring for Lena, and the bill would likely be around $3000 just for the night.
To my enormous delight, the owner consented to treatment. I was able to give anti-venin. My patient went from laterally recumbent and shocky to responsive and able to walk outside this morning. Her blood glucose and blood pressure stabilized, and she looked 1000 times better this morning when she transferred.
In the midst of dealing with an extremely unstable Sunny, the doors opened to allow in a dog thats foot had just been almost completely severed by a lawnmower. Shortly behind came a Great Dane with a suspected GDV, a dog with a vaccine reaction, and the like. We had to call in an extra technician to help us with the craziness - as we had one dog bleeding all over our ICU, Sunny trying to die after being bitten, a Great Dane with a distended abdomen, and all kinds of other fun stuff.
It was a great, great night. Does that make me twisted?
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