No photos tonight. I was too busy playing ER doc to be a photographer. I spent 4 years in an emergency practice (nights, weekends, holidays) where I got a wealth of experience and lived for the adrenaline rush. In my calm, orderly, daytime world, I seldom experience the hectic pace of that old life (and don't really miss it) but it's nice to know I can still "kick it" when I have to.
It was just 6pm and we were closing up after a fairly slow day. My technician was discharging the last patient and I was writing up my charts while the kennel assistant waited for her chance to mop the front floors. Suddenly I heard, "Doc, we have an emergency up front!"
I ran to the front to find a man struggling to get a German Shepherd through the door. She had collapsed literally on our doorstep. I helped him into an exam room and asked "What's the problem?" She was wet, and I was guessing that she must have had a heat stroke (It was over 95 today) and they had wet her down before bringing her in. Wrong. Turns out they had been bathing her outside by their back fence when she was attacked by a swarm of yellow jackets.
I started my assessment immediately - gum color, capillary refill time, heart rate - all within normal range. Respirations - a little rapid, OK. She was recumbent and not very responsive, which worried me. But, my biggest concern --- she was covered in yellow jackets. Several had flown off when she entered the building and were buzzing around my reception area, causing the two young boys of the family to scream and cry. I killed 4 that were in her ear, and many more from her body. All told, we removed close to 2 dozen yellow jackets in the office, and I don't have a clue how many stings she must have had - dozens for sure, maybe hundreds. Who had time to count?
My tech followed me into the room and we completed our triage and had an IV catheter going within 5 minutes of the dog entering the building. Intravenous steroids and antihistamines, plus shock rate IV fluids soon had her coming around - sitting up on her chest and looking more alert. I didn't feel it was necessary to give her epinephrine, as she was responding so well, but I advised the owner that we weren't out of the woods yet.
Yellow jackets aren't like bees, which die after stinging once. They are able to keep on stinging, and part of treatment is to try to find and remove every last insect. Tough to do in a thick coated dog, with two worried adults and two freaked-out children to deal with. My emergency drugs were keeping the worst of the reaction away, but I knew they would wear off soon, and that the dog needed additional treatment and continued monitoring. We got the dog stable and sent her on to the local 24 hour emergency service for intensive overnight care. I hope she does well: The last dog I saw that was this badly affected died despite our best care.
This story emphasizes the benefit of overnight and 24 hour veterinary ER's. In the old days, I would have stabilized the dog, left her on IV fluids overnight, and prayed that she would be alive in the morning. Now, I consider "emergency care" that consists of the vet coming in, hospitalizing the pet and going home to bed as tantamount to malpractice. I know there are areas of the country that don't have 24 hour facilities readily available (I have lived and practiced in several such areas) and I know that vets do the best they can. I personally have made many late night trips to check on critically ill pets or napped on the floor near unstable patients in the past. I also know that I don't miss the lack of sleep, the worry wondering if there was something else I could have done, or the sick feeling of coming in to work the next morning to find a pet "dead in cage."
Two lessons from tonight's event: 1) Yellow jackets can cause life-threatening toxicities and 2) When your vet refers you to an overnight or 24 hour emergency service, it is because s/he has your pet's best interests at heart.
Update, Thursday, 5pm: Tia is doing well. Although I was off today, I couldn't wait to hear about her and called the emergency practice at 8am. She lived through the night, and was expected to be discharged today. Hip, hip, hooray! A "save" always makes me feel good.