Monday, May 9, 2011

People are so different....

Two cases, two clients.  Two extreme examples of people which illustrate one of the many factors that makes the ER an interesting and difficult place.

Client #1:

The phone rings.  My technician answers with the standard greeting, and before he can get the words out, the client is screaming. 

The staff member urges the client, Sandra, a 40-something married lady traveling with her husband and adult children, to calm down and speak clearly so he can assist her.  It finally becomes clear that her dog, "Sissy" a 2 year old miniature pincher, is panting in the car.  Sandra let her dog outside at rest stop, and Sissy urinated and appeared normal.  When they got back in the car, the panting resumed.  Sandra is beside herself with emotion, fear, and on the phone is inconsolable.  She's on her way, and she'll be here within minutes.

Client 2:

The phone rings.  My technician answers with the standard greeting.  The client, Beth, very calmly states that her puppy was in a little dog fight, and has a few bite wounds.  She'll be on her way shortly. 

What do you think is wrong with each pet?  Which one is more critical? 

It's not what you'd think.

Client 1 arrives, and after triage, appears normal.  Due to Sissy's normal appearance and lack of panting in our office, the clients were given the opportunity to leave, before paying for an exam, and monitor for any change in symptoms.  The clients, hysterical by this time, elected to proceed with an exam, despite the cost, as they were fully convinced their dog was dying in front of them.  (Keep in mind, this young dog is bouncing around the lobby, looking for anything he can eat, sniffing, and acting like a totally normal dog).  A full physical exam is normal.  Panting comes and goes, but there is NO evidence of respiratory difficulty. "Sissy" is eating and drinking normally, and has pink, moist mucous membranes.  She urinated normally at the rest stop, and defecated normally outside our office. No other symptoms are present.  The clients express their new concern -- Sissy was "jumping up and down from the back seat to the floor more than usual."

It literally took me an hour to convince Sandra that Sissy's physical exam was normal.  I tried to explain that while I understood their concerns, she was absolutely not having difficulty breathing, and that "jumping up and down from the back seat" was not a sign or symptom of a specific disease.  I offered, to further prove her normal status, that we could pursue further diagnostics, if the client wished.....

Client 2 arrives, carrying a laterally recumbent 5 month old puppy.  The puppy, "Sid"  had gray mucous membranes, shallow respirations, and very poor pulses.  Immediately, the receptionist recognized that this was NOT a "few lacerations" and that this dog was much, much sicker than the clients led us to believe.  The clients described that they had returned home to find Sid in this condition; he was with 3 other dogs and they had never had any problems previously, however today obviously was a different story.

An IV catheter was placed, oxygen was provided, antibiotics and pain medications were given.  Severe bite wounds were present over the throat and neck, involving the trachea and larnyx.  Sid also had multiple bite wounds over his hind legs and groin.  Clearly, he had been viciously attacked by a group of dogs, and was suffering from severe shock.  Sid required emergency action to prevent his imminent death.  We worked quickly, however after radigoraphs and initial stabilization it became clear that Sid's chances of recovery were quite poor.  The family elected euthanasia due to concern for suffering.

This is why I can't tell you what's going on over the phone.  I have countless examples of this, however these two occurred in rapid succession and illustrate the point perfectly.  I can't see your pet, I have no idea how good you are at describing the situation, and most importantly you aren't trained to diagnose -- that's my job, and I need my eyes, hands, and ears to do it properly.

1 comment:

  1. I was wracking my brains trying to come up with a post topic. So desperate that I went back and re-read old cases on VIN (of mine) - and I still couldn't come up with jack squat. This is unusual for me...then I thought, shamelessly abuse your friends. Why not? That's what they're there for, right? :)