Tuesday, March 22, 2011
It's like a real ER
Yesterday, we had one of the most critical patients I've ever seen arrive at our clinic.
An adult terrier mix had been attacked by a housemate. The victim had a gaping hole in his chest, and with each breath, air was flowing in to the wound. His mucous membranes were gray to purple, and he was gasping for air.
Open chest wounds are imminently life threatening, based upon the mechanics and physiology of breathing. The chest cavity maintains a pressure which is actually slightly lower than atmospheric pressure; therefore, breathing in is actually a passive process. If the chest wall integrity is lost (such as in a trauma case), the pressure equilibrates, and breathing in becomes a much more difficult task. In addition, if air is sucked into the chest cavity, the pressure inside the chest can actually become higher than the environment, resulting in what is called a tension pneumothorax. (If you've seen House, this is when he dramatically stabs someone's chest with a sharp, hollow object to relieve the pressure. DO NOT try that at home!). The ability to exchange oxygen and carbon dioxide in the lungs is one of the most critical processes in the body, and without this process, life ends within minutes.
Thankfully, both myself and the overnight doctor were in the building, as well as ample nursing staff. Immediately, we placed an IV catheter, provided him with oxygen supplementation, and covered the wound. A thoracocentesis was performed to remove excess air from his chest cavity (relieving the tension pneumothorax), and pain medications were given. Fluid support was initiated, a chest tube was inserted, and a technician focused on continuing to remove air from around his lungs. The other veterinarian and myself worked quickly to provide closure of the open chest wound, in an attempt to save the little dog's life. All of this happened in a matter of less than 15 minutes. The 10# dog had between 5-8 hands on him at any one time, trying to save his life.
We were successful in closing his wound, in providing him with rapid, life saving intervention, and although still critical and requiring much care, our little patient was in a bit of a better place.
Despite our best effort, effective teamwork, and our initial successes', the family ultimately decided that they couldn't continue treatment. He was euthanized, and passed peacefully with his family.