Sunday, June 5, 2011

Borrowed time

My best save of the week was a 10 year old, female calico kitty.  She presented in severe respiratory distress, with purple mucous membranes, gasping for air, and minutes from death.  Her heart at triage was 100 beats per minute -- far to low for a cat, and as I listened, the rate was dropping dramatically.  She was dying, NOW.  Auscultation of her chest and her respiratory pattern were classic for pleural effusion, or fluid around the lungs.  Fluid filling up in this space results in inability of the lungs to expand, and decreased area for gas exchange.  When severe, as in this kitty, pleural effusion is essentially like drowning in the body's own fluid.

We provided her flow by oxygen and I shaved hair on the side of her chest.  I inserted a butterfly needle into her chest and began to remove slightly white, milky fluid from her pleural space.  150ml was removed, a VERY large amount for a cat of her size (about 6#).  She immediately began to breathe easier.  We placed her in oxygen to let her rest, and moved on to the next case.  A radiograph revealed that more fluid remained, however she was stabilized and would have to wait until the next critical patient was stable for further testing.

The next patient who had just arrived was a 15 pound beagle mix who had just been hit by a car.  Her family immediately authorized any care necessary to improve her condition.  An IV catheter was placed, and a fluid bolus initiated to improve her low blood pressure.  Hydromorphone, a morphine derivative, was given for pain.  "Suzie" was excruciatingly painful over her pelvis.  

Radiographs were taken, and revealed 5 fractures in Suzie's pelvis, as well as a dislocated hip.  Ultrasound and chest radiographs were clear, with no other injuries present.  Her blood pressure had improved.  I updated the family to the good news, and although Suzie would require surgery to repair her pelvis, she would likely survive.  They were ecstatic, and hugged me and Suzie, as they left her for the evening.

Several outpatients later, I returned my attention to the kitty.  Ultrasound of her chest revealed a moderate amount of fluid remaining, and I removed an additional 120ml.  Chest radiographs and ultrasound revealed an enlarged heart, but Suzie was now breathing comfortably without oxygen, eating, grooming, and purring when we pet her.  I saved her life, and she narrowly escaped death - a good feeling.

Suzie transferred to a surgical facility, where she did very well and went home 48 hours later.  Her family called me a week later to thank me for saving their dog, for making a stressful evening a little easier, and for being compassionate.

These two cases felt really, really good.  Like my header above says, it's not always this happy, as you've seen on my previous blogs, but I really love having the opportunity, knowledge, and ability to intervene and save furry, innocent lives.

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