Monday, September 5, 2011

Holiday weekend

I'm back from a long (much needed) break!

The holiday weekend was an expectedly busy one.

Best save of the weekend -- a 9 year old 120# mastiff presented for collapse.  He had been outside with his family, playing on a nice summer day.  All of a sudden, he fell to the side, became unconscious, and foamed at the mouth.

His family, frightened, called us immediately.  They were on their way.

When "Rufus" arrived, he was unable to walk into the hospital on his own power, and was carried in on a gurney.  His physical exam was mostly unremarkable.  The only abnormal findings included an elevated heart rate, his inability or unwillingness to walk, and an ever-so-slight paleness to his gums.

The search for cause of his collapse was on.  His BP was normal, an electrolyte panel was normal.  A scan of his abdomen revealed no free fluid. He received a bolus of fluids, and improved slightly.  An ECG was normal.  His clients expressed their concerns to me that he had eaten a large amount of clay cat litter the previous weekend, and requested abdominal radiographs.  These too, were normal (no evidence of cat litter or anything else unusual).

I recommended an ultrasound of his heart, and the clients approved.  They wished to do whatever necessary to help their beloved Rufus, who had been normal the day prior.

The ultrasound of the heart revealed the cause of his collapse -- Rufus had pericardial effusion.  This means that an abnormal collection of fluid accumulates in the pericardial sac -- a fibrous sac surrounding the heart.  When fluid accumulates in this area, pressure becomes overwhelming and the heart becomes compressed, preventing the heart from being able to fill.  This results in pericardial tamponade, and explained Rufus' clinical signs.

The treatment of pericardial effusion is to remove the fluid from the space.  The area was prepared in a sterile manner, and I utilized a large bore needle to facilitate the removal of fluid from the space.  Rufus immediately felt relief.

The ultimate cause of Rufus' pericardial effusion is pending additional testing, but for now, he's home with his family.

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