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Emergency and Critical Care - Receptionist tips

Courtesy of Deb Stafford, CVT, VTS (ecc)

It is important for receptionists and support staff NOT to ATTEMPT TO DIAGNOSE.
ALWAYS OFFER AN EXAMINATION BY A VETERINARIAN.
Therefore, "Offer an examination" is not listed for each situation, however this should ALWAYS be your FIRST response.

This information is provided as assistance only.

Anorexia - Pet has not eaten for at least 24 hours, Kittens/Puppies have not eaten for at least 12 hours

  • Anorexia is a symptom of many conditions
    Questions to ask:
    • When is the last time the pet ate?
    • What did he/she eat?
    • How much?
    • Any vomiting?
    • Any diarrhea?
    • Is the pet lethargic?
    • Does the pet have any ongoing current illnesses or disease processes?
  • Possible complications without proper treatment
    • Hypoglycemia (low blood sugar)
      • Can be lethal
    • Dehydration
    • Weakness
    • Lethargy
    • Impaired function of any organ system

Antifreeze ingestion (Ethylene Glycol)

  • Questions to ask:
    • Did you see the pet ingest the ethylene glycol?
    • When?
      • Possibly induce vomiting if recent ingestion (less than 15 minutes) according to your clinics policy regarding authorizing induction of vomiting via the telephone.
      • Never induce vomiting in a pet that is seizing, comatose, or having difficulty breathing.
    • How much?
      • 1.5ml/kg minimal lethal to cats (about teaspoon per 2 lbs.)
      • 6.6ml/kg minimal lethal dose for canines (about 1 teaspoons per 2 lbs.)
      • All ingestion should be considered potentially lethal.
    • What species pet?
    • What size pet?
    • Need to examine the pet, even if vomiting is successful
  • Common symptoms of non-witnessed, possible ethylene glycol ingestion
    • Central nervous system depression (animal appears intoxicated)
    • Vomiting
    • Lethargy - (animal appears depressed, lazy, no energy)
    • Polydipsia - (increased drinking)
    • Polyuria - (increased urination)
    • Tachypnea - (abnormally fast breathing, may see panting)
    • Seizures
  • Possible complications without proper treatment
    • Kidney failure
    • Tachycardia (abnormally fast heart rate)
    • Coma
    • Seizures
    • Death
  • For more information on ethylene glycol ingestion and it's complications refer to Toxicology chapter

Chocolate ingestion

  • Questions to ask
    • Did you see the pet ingest the chocolate?
    • When did the ingestion occur?
      • Possibly induce vomiting if recent ingestion (less than 60 minutes) according to your clinics policy regarding authorizing induction of vomiting via the telephone.
      • Never induce vomiting in a pet that is seizing, comatose, or having difficulty breathing.
    • What type of chocolate?
      • Cocoa
      • Cocoa bean hulls (sometimes used as mulch by owners)
      • Unsweetened Baking
      • Dark chocolate
      • Milk chocolate
      • Semisweet
      • Sweetened cocoa powder (hot chocolate drink mix)
      • White chocolate
    • How much did the pet ingest?
    • What species of pet?
    • How much does the pet weigh?
  • Common symptoms of non-witnessed, possible chocolate ingestion
    • Hyperactivity
    • Vomiting
    • Diarrhea
    • Muscle tremors
    • Excess salivation (drooling)
    • Urinary incontinence (unable to "hold" urine)
    • Abdominal pain
    • Hematuria (bloody urine)
    • Cyanosis - (blue color to the gums)
    • Seizures
  • Possible complications without proper treatment
    • Seizures
    • Cardiac arrhythmia (abnormal heart beat)
    • Death
  • For more information regarding chocolate toxicity please refer to Toxicology Chapter

Coin ingestion

  • Questions to ask
    • Any breathing or swallowing difficulty
    • What type of coin
    • When was it ingested
    • If ingested within the last 10 minutes may induce vomiting per practice policy
    • Coin may pass on own
  • Possible complications without proper medical treatment
    • Lethargy
    • Vomiting
    • Intestinal blockage
    • Diarrhea
    • Anorexia
    • Metal toxicity

Diarrhea

  • Questions to ask
    • When did it start
    • How often
    • How much
    • Consistency
    • Blood present
    • Mucus present
    • Accompanied by any other problems
      • Lethargy
      • Vomiting
      • Anorexia
  • Possible complications without proper medical attention
    • Dehydration
    • Shock
    • Death

Facial swelling

  • Many causes
    • Allergic reactions
    • Trauma
    • Witness an insect bite
  • Questions to ask
    • Difficulty breathing
    • How long
    • Recent vaccinations/medications
  • Possible complications without proper medical treatment
    • Airway obstruction
    • Respiratory distress
    • Respiratory failure
    • Lack of oxygen effects all tissues
    • Death

Respiratory Difficulty

  • Questions to ask
    • Any breathing
    • Choking
    • Open mouth
      • Cats with any open mouth breathing - transport immediately
    • Making sounds
  • No breathing
    • Talk through CPR
  • Choking
    • Heimlich
    • Quick thrusting compression on chest
    • Do not place the animal upside down
    • Do not reach in the pets mouth
  • Difficulty
    • Allow patient to remain in comfortable position
    • Transport immediately
  • Possible complications without proper medical exam
    • Respiratory arrest
    • Cardiac arrest
    • Death

Seizure

  • Questions to ask
    • Any previous history of seizures
    • Any known toxin exposure
    • Any known head trauma
    • How long
    • How many
  • Precautions
    • Stay away from the pets face
    • May bite involuntarily
    • Quiet the room
    • Turn down lights
    • Transport post seizure
    • Quiet in vehicle
    • If seizure continues over 60 seconds transport immediately
  • Information for emergency team
    • Previous seizures
    • Known trauma
    • Known ingestions
    • Size, species and age of pet
    • How many seizures in what time period
    • Length of seizures
  • Possible complications without treatment
    • Brain damage
    • Continued seizures
    • Death

Swollen Abdomen

  • Questions to ask
    • When did first notice
    • Species
    • Vomiting
    • Retching
    • Lethargy
    • Anorexic
    • Uncomfortable
    • Restless
    • Painful
  • Possible causes
    • Gastric Dilatation
    • Gastric Dilitation Volvulus
    • Ruptured bladder
    • Liver disease
    • Heart failure
  • Possible complications without proper medical treatment
    • Death

Torn toe nail / bleeding toe nail

  • Questions to ask
    • Traumatic
    • Nail trim
    • Still bleeding
  • Bleeding due to nail clipping
    • Apply styptic powder
    • Flour
    • Cornstarch
  • Due to trauma
    • Still bleeding
      • Cover with sock
      • Apply pressure - use caution
      • Bandage with fabric (towel/washcloth etc and tape) - exam
  • Possible complications without proper medical treatment
    • Infection
    • Continued bleeding
    • Additional undiagnosed trauma

Trauma

  • Questions to ask
  • Open airway
  • Breathing
  • Bleeding
  • Conscious
  • Pulse present
  • Gum color
  • What type of trauma
  • External wounds
  • How long ago
  • Species, age, size of pet
    • Used to help trauma team prepare

*** May recommend the following and/or transport - re-contact in route with cell-phone

  • Precautions
    • Approach gently and quietly
    • Even normally good pets may bite
      • Cats
        • Towel over
        • Blanket over
        • Scoop up
      • Dogs
        • Quick muzzle
          • Shoe lace
          • Belt
          • String
          • Pantyhose
  • Not breathing
    • Transport immediately and
      • Hold muzzle shut
      • Blow into nostrils
      • Every 2 seconds
      • Use extreme caution near the face of an injured animal
  • No pulse
    • Transport immediately and
      • Chest compressions
      • Middle of the rib cage
      • 1/3 depression (only depress the chest 1/3)
      • Excessive pressure may fracture ribs
      • Fractured ribs may lacerate lungs and heart
      • Assist breathing as above
  • Unconscious
    • Transport immediately
    • Check pulses - none present - see above
    • Check breathing - none present - see above
  • Immobilization
    • Small dog and cat
      • Cardboard
    • Large dog
      • Wood
    • Extremity
      • Sticks
      • Broom handle
      • Rolled newspapers
      • Rolled magazine
      • Wrap in towel
      • Apply tape to the support to hold in place
  • Bleeding
    • Towels
    • Direct Pressure
    • Sheets
    • Socks
  • Penetrating wound
    • Do not remove object
    • If penetration to the chest and object has been removed
      • Wrap in entire chest and wound in saran wrap
    • If penetration to abdomen and object has been removed
      • Cover in towel

Urinary difficulty

  • Questions to ask
    • Able to urinate at all
      • If no
        • Immediate medical attention needed
    • When did you notice last urination
    • Sex, species and breed of patient
    • Blood
    • Seem painful
    • Amount last urinated
    • How often is the pet urinating
    • Urinating in inappropriate area
    • Cats
      • History of any urinary problems
  • Possible complications without proper medical attention
    • Severe infection
    • Increased or decrease urination may signal many serious conditions
      • Diabetes
      • Heart disease
      • Kidney disease
      • Bladder stones
        • Especially consider Dalmatians, Schnauzers
      • Bladder infections
      • Urinary tract infections
      • Urethral blockages
        • Due to stones
        • Cats - especially male
    • Total urinary blockage
    • Bladder rupture
    • Death

Vomiting

Generalized, vague symptom
Numerous causes minor to lethal
Never authorize or recommend any medications be given without prior approval from a DVM

  • Questions to ask
    • How long
    • How much
    • Consistency
    • How often
    • Blood
    • Know foreign body ingestion
    • Known dietary indiscretion
    • What size pet
    • Any current diagnosed illnesses
    • Age of pet
    • Species of pet
    • Any changes in diet
    • Any "human" foods fed
  • Possible complications without proper medical attention
    • Dehydration
    • Esophageal irritation
    • Death to intestinal tissue
    • Leakage of intestinal contents into abdomen
    • Possible GDV - see swollen abdomen
    • Electrolyte imbalance - improper function of all organ systems
  • Common "bland" diet if recommended by DVM
    • Withhold all food 12 hours
      • If any vomiting occurs during this 12 hour period Must examine
    • Small amounts of water after 6 hours
      • 2 Tablespoons per 10 pounds
      • Measure the water
      • Offer every hour
    • Gradually introduce bland diet
      • Boil chicken or beef until cooked through (cottage cheese may be substituted for meat)
      • Rinse well
      • Mix 1 part meat to 3 parts white rice
      • Feed 1 Tablespoon per 10 pounds hourly
      • After completing this for 12 hours gradually return to normal diet
        • Day 1 rice/meat mixture, regular diet
        • Day 2and 3: rice/meat mixture, regular diet
        • Day 4 and 5 rice/meat mixture, regular food
        • Day 100% regular food
        • Any recurrence of vomiting - need exam

Whelping

Normal gestation for dogs is 62-66 days
Temperature of bitch will drop to 99 F - rectal

  • Common signs of impending whelping
    • Temperature drop
    • Restless
    • Anorexic
    • Nesting behavior
  • Normal presentation of puppies
    • Head first
    • Head located between front limbs
  • Questions to ask
    • When was she bred
    • What breed of dog
    • Any puppies successfully delivered
    • Any puppies visible in vulva area
    • Has she ever whelped before
    • How old is the bitch
    • Currently having contractions
      • How often
      • How long have contractions been occurring
      • How forceful are the contractions
      • Any discharge present
        • What does the discharge look like
  • General guidelines for whelping
    • Non-forceful contractions
      • May have for 6-12 hours prior to delivery
      • Can barely see, similar to slight abdominal tensing
    • Forceful contractions
      • Should produce a puppy in 15-30 minutes
    • Between puppies
      • Up to 4 hours
      • No forceful contractions during this time
    • Emergency situations
      • Forceful contractions
        • Over 30 minutes - no puppy
        • Puppy stuck in birth canal
        • Weak intermittent contractions that do not produce a puppy in 2 hours
        • Bloody discharge (small amount of blood normal after delivery of puppy)
        • Malodorous discharge (bad odor)
        • Green colored discharge
        • Obvious difficulty passing puppy
        • Prolonged pregnancy (over 65-68 days)
  • Abandoned puppy post delivery
    • Remove sac - do not sever the umbilical cord yet
    • Wipe mucus from nostrils and mouth
    • Stimulate (rub with moderate pressure) the puppy to breath
    • When puppy breathing well proceed
    • Tie off the umbilical cord (thread, string) about -1 inch away from the puppy
      • Tie snuggly
      • Repeat immediately adjacent to first tie
      • Cut umbilical cord (about inch away from tie and body of puppy)
    • Encourage to nurse
    • Continue to ensure breathing and nursing
    • If no nursing
      • Must supplement with milk replacer (available at pet shops)
      • Do not give cows milk straight
      • Emergency formula (do not feed over 24 hours)

Courtesy of Deb Stafford, CVT, VTS (ecc)

The Nerd Book
The VSPN Nerdbook was created by veterinary technicians and veterinary support staff for their colleagues. The Nerdbook provides information that veterinary technicians and support staff need in practice, but is not meant to contain everything. Procedures and policies vary among practices, so feel free to modify your Nerdbook fit your facility.
Volume One
Contributors
Introduction
Clinical Pathology
Critical Care - Triage
You are hereEmergency-Receptionist tips
Medical Calculations
Medical Records
Medical Terminology
Pharmacology
Physical Exam
Preventative Health
Radiology

Address (URL): http://www.vspn.org/Library/Misc/VSPN_M02367.htm

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