When I came across this true-story by Dr. Kiah Hann, I immediately thought that I MUST share it with you guys!
So here it is:
I present to you another true-life case.
It is, like my others, written in the order in which I received the information and in which events happened to provide a more realistic explanation and thought process.
It is, from memory, a day in March, although warm for the time of year at 20°C. My colleagues and I are buzzing about in prep getting things done, finishing up procedures and tidying, it must have been coming towards lunchtime. I’ll point out at this stage that I have a background in advanced human first aid, some things come more naturally to me than to others.
A receptionist comes through, “A dog walker called, they have a dog struggling to breathe, I’ve told them to come straight in, couldn’t get more details they were panicking.”
Brain-working overdrive. “Okay, get all staff who are not immediately busy with clients to attend prep immediately. We need a few circuits, let’s get some endotracheal (ET) tube sizes ready, let’s get bits ready for an IV have fluids out ready, emergency drugs ready (this was before we had the crash cart, it was previously just a box), make sure the X-ray machine is on, someone get a notepad and paper to record what we do”
My brain is at this time trying to turn the bread and butter of my human first aid into things we can do to prepare.
AIRWAY- okay get tubes ready, make sure we have circuits, the oxygen is already on at the cylinder.
BREATHING- circuits we can IPPV with are chosen.
CIRCULATION- we have stuff ready to place an IV and start fluids if needed. Medicines- I think of diuretics incase of fluids, sedatives incase of respiratory distress and we need to make it sleep, anti-allergic treatment in case breathing problems were triggered by allergies. These thoughts are happening whilst I am actively working with my colleagues to set up.
Less than 5 minutes later the patient arrives.
We are presented with a male husky who is thrashing in panic and is cyanotic in the most awful way. He’s purple. This is bad. He’s placed on the prep table and I grab an ET tube, slightly smaller than I estimate he needs, but I need to oxygenate this dog, now, otherwise it’s not likely to survive. The dog is semi-conscious and still trying to thrash but we manage to get the mouth open and intubate it. During that intubation I mentally noted his tongue felt hot. Real. Hot.
“Rectal temperature please”
My mind is putting the pieces together, its only 20°C outside. But he’s a husky, and a week ago it was 5°C, dogs take time to adjust. He was brought in by a dog walker, he’s been exercising.
Colleague- “he’s 42.9°C”
Me- "shit, okay guys, tub table, now, we need to cool him”
So we all grab a bit and the circuit and swap him to the tub table. The pieces have connected. This is severe heatstroke. Right now his internal cells and enzymes are being cooked. This is extremely time critical.
“Okay, start cool hosing please, all over, make sure you rub it in, he’s double coated. Could you (points at a colleague) please get all the spare ice packs from the freezer and grab some small towels to wrap them on the way back? You could (Gestures to another colleague) please start running those iv fluids through? Could you (another colleague) please rectal temp every 2 minutes and record that and what else we are doing? Could you (another colleague) go and speak to the dog walker and get some more history for us etc and let them know what we are doing and that the dog is critical right now but we are doing everything we can?”
Whilst I make these requests and receive nods back, I have also been placing a tourniquet and placing a pink cannula. Once I’ve taped it, I do a quick mental calculation based on estimated weight of the patient from looking at them and draw up enough propofol to cover and more. I give it to effect. The logic here is- patients under general anaesthesia (GA) lose heat quickly, that’s what we need here! Patients under GA are not trying to fight out attempts to save them (safety, but also because patients fighting us are making themselves warmer) and are usually not doing rapid shallow breathing, so we can ensure this dog gets adequate breaths and oxygenation, although the ET tube placement has improved the colour of the dog and demeanour and it looked more ‘alive’ prior to the GA.
The fluids are hooked up, then when the icepacks arrive we wrap the fluid bag in icepacks in towels (aim to cool the fluids, not freeze them). We placed wrapped ice packs in the inguinal and axilla area, again to cool but not so much to get vasoconstriction which would slow our efforts. Every few minutes a temperature is called out.
Within 12 minutes of arrival the dog’s temp is down to 39.8. Still a bit high, but not going-to-cook-your-internal-organs level hot. At this point I tell them to stop hosing the dog, remove the icepacks from the dog and the fluids and start waking the dog up. I know logically this dog will lose another degree or more waking up and drying off, I don’t want to end up with a hypothermic dog if I can help it.
Ideally, we would have kept the dog overnight for observations and done some bloods then and 48- 72 hours later to check for organ dysfunction, but these were declined by the owner.
As it was, it was extremely rewarding for the whole staff to see that dog walk out the kennel wagging his tail later that afternoon and head home. He had been just a few minutes from death and thanks very much to the whole team effort absolutely no time was wasted in treating him. We had no real idea it would be a heatstroke when we got the call, but with emergencies, you must be able to respond quickly to the unexpected.
After this incident I pushed for a crash cart, and I started running emergency training sessions for staff both clinical and non-clinical to empower them that whenever their role in the team, they could very much still be a vital cog in saving a life.
This dog survived because he had a team of 3 vets, 3 nurses, 2 patient care assistants, a vet student and 2 receptionists trying with everything they had to save him. This time we succeeded. Many times we may not, but we know if we are prepared, if we train for emergencies, if we have good protocols and the suchlike we give our patients the very best chance.
True story by: Dr. Kiah Hann
This story made me feel super
terrified excited to start as a vet next month. It also reignited my fire and made me think, wow, being a vet like Kiah is so cool!
One life thing:
I came across this podcast
which mentioned the Regret Minimization Framework, basically a way to help you make those big decisions, eg. Should I move to a different city, should I take on this project, Should I be in this relationship…
When making these decisions, a simple question to ask yourself is this
“20 years from now, would my future self regret not making this decision?”
The idea is to think about how your ‘future self’ would feel about this if you made that decision. In the short term, we like feeling safe so we tend to make safe choices, but that slows down our progress. So by asking that question we force ourselves to think long term.
On that note, that’s it for this week’s newsletter.
PS: all the best to students getting their A-level results today! No matter what, you’ve done amazingly to make it through stressful exams and the pandemic, so please be proud of how far you’ve come!
Take care my lovelies,