Wednesday, March 2, 2011

I like Urgent Care (but I'm really tired!)

My rotation this week is "Evening Urgent Care." From 5-8 pm, two of us juniors assist the seniors, nurses, and interns in handling cases that present to the VTH's urgent care department. At 8 pm, Urgent Care shuts down, so we head over to assist in CCU (Critical Care Unit) and also give the seniors a hand doing 10 pm walks and treatments for every other patient anywhere in the hospital.

Monday night, my first evening of the rotation, apparently happened to be the busiest night they've had in Urgent Care/CCU in a long time. The first hour was pretty slow, but starting around 6 pm, the proverbial poop hit the proverbial fan.

With the additional burden of a senior student scheduled to be on the overnight shift calling in sick because of intractable vomiting (yes, please don't come in!), I ended up staying until about 1 am (we juniors are supposed to be done around 11 pm).

Here are a few of the many cases I saw on Monday night:

-- A 2 year old Great Dane (whose owners drove him about 8 hours from Montana to get to our VTH) with a lengthy problem list, including joint effusion; lameness; caudal abdominal pain; an allergic reaction to penicillin given by the rDVM; severely ulcerated, itchy skin lesions on his paws, abdomen, chest, face, and ears; intractable fever ranging from 103-105 degrees for the last few days, despite being on enrofloxacin, amoxicillin, doxycycline, AND prednisone; concern about possible leptospirosis infection from the rDVM; and dehydration (and I'm sure I missed a few of his issues)

-- A chameleon that presented for "lethargy" (and I still haven't figured out how you tell that a chameleon is lethargic -- it was sitting in a Tupperware container!)

-- A young black lab who was hit by a car and had some minor abrasions on her limbs (and hopefully nothing else, like broken bones or a diaphragmatic hernia, because her owners couldn't afford more than basic bandaging and pain medication)

-- A blocked male Siamese cat who was slated for euthanasia until his owner was able to scrape together a $150 deposit to treat him

-- An old Pomeranian who had a "stroke" (probably granulomatous meningoencephalitis)

-- A middle-aged Boxer presented for vomiting, ataxia, and inappropriate mental status, who proceeded to go into supraventricular tachycardia repeatedly, which was treated until his heart rate was back into a normal range, and then he repeatedly got extremely bradycardic (heart rate 30-40 beats per minute), which was nonresponsive to drug correction -- fortunately he lived through the night and had a cardio consult on Tuesday

-- An old golden retriever who had had a laminectomy and meningioma resection earlier in the day, and wasn't feeling so great

-- A great Pyrenees recovering from a TPLO on Monday morning

-- A golden retriever with a heart mass who had had a huge volume of pericardial effusion drained a few hours earlier and was at risk of her heart sac filling up with blood again

And I'm sure I forgot a few!

Tuesday night was a little calmer. We had a few repeat patients (the Great Dane, the golden with pericardial effusion, the golden post-laminectomy, the Pomeranian, and the freshly-unblocked tom cat). Otherwise, it was basically much quieter. A few of the other patients we saw were:

-- A 10 year old small-breed mutt dog (we declared her a "ShitzaCockaPoo") whose owners thought she had something stuck in her throat. She looked great on presentation, wasn't coughing/gagging/retching, and nobody could see anything in her trachea or esophagus, as much as we looked. Her owners declined sedation for a closer look.

-- A wild bunny who was brought in by some Good Samaritans after being hit by a car (the bunny was HBC, not the Good Sams). Thank you, Rabbit & Rodent Medicine! Unfortunately, the fact that two random passersby could catch this wild rabbit and bring it to the hospital without much struggle was a sign that something bad was going on -- and indeed, the poor bunny had a broken spine with complete hindlimb paralysis, so was dispatched to Bunny Heaven shortly after presentation.

-- A 3 or 4 week old puppy fostered by a community member for the local humane society. Puppy presented nonresponsive with no heart beat, and although we tried resuscitating him with oxygen via ET tube, CPR drugs, and chest compressions, the puppy had already joined the bunny in heaven.

-- A young chihuahua/Dachshund mix (might have literally been the cutest dog I have ever seen) that came in for ataxia and disorientation. Physical exam revealed incoordination, altered mental status, dilated pupils, hyperreactivity to any type of stimulus, and bradycardia. Physical exam of the owners revealed altered mental status and serious odor of marijuana. Little dog likely just got into the pot stash and needed to sleep it off -- but ran a blood gas to look for signs of antifreeze poisoning since sometimes it can present similarly.

-- 3 dogs from 2 completely separate households that came in at the same time for ingesting unknown quantities of Rimadyl (a doggie version of Advil [which you can't give to dogs!]). Though the dogs were all sweet and came in happy and friendly, they looked quite miserable after we made them vomit and then force-fed them activated charcoal. Two of the dogs stayed the night for bloodwork and IV fluids.

In addition to new patients that came in, I got to help with "wards duty," which means taking care of all of the medicine, surgery, oncology, and community practice dogs and cats that are staying the night (usually pre-surgery or post-simple-surgery, or sometimes just staying for the owners' convenience). There were about 15 dogs and a handful of cats that needed to be watered, medicated, walked (dogs only), and generally checked for any signs of problems. Additionally, I had the chance to visit a bunny staying in the exotics ward after a spay earlier in the day. And I got to learn how to give a bunny oral liquid medication (which bunny did not appreciate), as well as an intramuscular injection of opioids in the epaxial muscles (which, again, bunny did not appreciate at first, but I'm sure she was happier when the drug high hit her). There were also 6 dogs and 1 cat from the humane society that had been spayed yesterday morning -- including 2 of the cutest chihuahuas I've ever met, and an adorable little Boston terrier/Beagle mix.

Since the night was slower, I got to leave at 11:45 pm instead of 1 am!

Here's hoping for a ton of interesting cases that come in tonight, but that are all pretty much resolved by 10:30 or 11 so I can go home and get some sleep...

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