Page 75 - WSAVA2017
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WSVA7-0490
EMERGENCY/CRITICAL CARE (VECCS)
THE FIRST 5 MINUTES-YOU TOO CAN SAVE A LIFE!
E. Rudloff1
1Lakeshore Veterinary Specialists, Emergency and Critical Care, Glendale, USA
THE FIRST 5 MINUTES: You too can save a life!
Elke Rudloff, DVM, DACVECC
Lakeshore Veterinary Specialists, Glendale, WI USA erudloff@lakeshorevetspecialists.com
Hospital Readiness
Along with the first responders, the veterinary team plays an integral role in initial evaluation and stabilization of the emergent and critical patient. Increased public demand for state-of-the-art emergency care obligates the veterinary team to provide quality care or make a direct referral to an emergency facility. By practicing organized team work and hospital readiness, the veterinary team can provide successful resuscitation and stabilization of the emergent patient.
By pre-assigning roles and practicing responses to various life-threatening situations, valuable time is saved, and patient morbidity is decreased. In-hospital training and practice sessions with animal models help the team respond as an effective unit. Online training
in BLS, certified by the American College of Veterinary Emergency and Critical Care and based on the findings of RECOVER, is available online (www.ecornell.com/ certificates/veterinary-medicine). CPR drug dosing charts, as well as CPR updates can be obtained through continuing education courses sponsored by the Veterinary Emergency and Critical Care Society (www.veccs.org).
Veterinary hospital readiness consists of providing a place for receiving, assessment of and treatment of the emergent patient. The area should be free of obstacles, and transport of the animal to the area should be uncomplicated. The area should have basic equipment and drugs required for resuscitation of the most life- threatening conditions. Hair clippers should be in the ready area for intravenous (IV) catheter placement. Isotonic crystalloid fluids with attached intravenous administration sets can be hanging ready to use in the receiving area. Synthetic colloid fluids should be kept nearby. Supplemental oxygen and suction units as well as small and large ambu bags and oxygen administration sets are in near proximity of the resuscitation area.
For those practices that see a large volume of emergencies, setting up a large mobile cart housing the instruments and equipment is of great value. Otherwise, maintaining a tackle box with emergency equipment and drugs can be an inexpensive way to provide emergency care. Having a clipboard with a CPR record and an attached CPR dose schedule. Equipment and drugs should be inspected daily, and following resuscitation,
to ensure that the ready area is set up for the next emergency. Marking a check-off list, which itemizes the contents, allows anyone to perform the inspection. The equipment and drugs should be rotated with the hospital supply monthly to avoid waste due to expiration.
Additional preparations can be made as incoming
calls are taken and information gathered. Once it has been determined that a patient with a potentially life- threatening problem is due to arrive, the treatment staff should be notified verbally. A dry erase board can be placed in the general treatment area and all animals listed that are due to arrive, with their estimated time
of arrival and presenting complaint noted. This allows the treatment staff to plan their time and procedures efficiently.
Common complaints that indicate life-threatening problems, and motivate the team to be as ready as possible ahead of time include:
hit by car, dog fight, falling from height, gunshot, stabbing, potential toxicity, inability to urinate, abdominal distension, labored breathing, seizures, collapse, altered consciousness, profuse bleeding, dystocia, snake bite, prolapsed organs, heat stroke, severe cold exposure, electrocution, and burns.
The nursing staff should have an idea of the usual procedures and equipment required for the critical presenting complaints. The equipment that is usually needed is laid out ahead of time, so that any patient needing life-saving intervention, time is not wasted searching for materials. There should be a list complied by the nurses, under the supervision of the veterinarians, of the equipment, drugs and materials needed, termed "set- ups". There will be different set-ups for different problems.
Once the patient arrives at the clinic, the person taking the call will notify the nurse or clinician that a triage (with or without a gurney) is required. A quick statement identifying the presenting complaint and an indication
of the urgency (whether "stat" or not) completes the immediate information.
An Urban Experience
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