I'll grab some off the tip of my memory and update later (coming off a long string of tough days and I'm SUPER tired). Some are some weird tidbits that I've picked up unique to where I've worked but may help you in some weird/unique situations along the way that others may not tell you...
1. Kitten maintenance rates are higher than expected - 120 ml/kg/day up to 4-5 months. I've packed kittens with panleuk upwards of 260 ml/kg/day if they've needed it (if they can't handle it, something's usually wrong congenitally, usually. Technically, you can fluid overload a kitten, but it's realllly hard).
2. Rib fractures RARELY occur in motor vehicle accidents. Especially rib fractures at different stages of healing...think non-accidental injury. If you are suspicious of NAI, come up with a reason to take CXR, you'd be surprised how often you'll find rib fx and you have reason, then, to report animal abuse.
3. Don't try to solve all of an animal's problems on ER (still struggling with this one). If an animal comes in in CHF, it's really less of a concern to fix the pododermatitis (maybe at a follow up with the rDVM).
4. Cats can get pyometras. Keep it on your differential list. (This may be a 'duh,' but I was burned my first few times with cat pyos because really, who is silly enough to have an intact female cat in their house?
5. Don't be stingy on the fluids with UOs. Post-obstructive diuresis is a thing.
6. I've gone faster to recommending PUs because of $$ (faster than the theoretical 3 strike rule). If an owner can only afford a one time UO then it will be euthanasia if they obstruct the second time, better to give the cat a chance with a UO --> PU then UO --> UO/euth.
7. Don't judge owners (also struggle with this one, though to a much lesser degree). I have an internmate who not uncommonly tells owners: "we could have saved Fluffy if you brought him/her sooner." NOT COOL, and not the time/place. Sure, if they're bringing in a stable pyo, say "hey next time, spaying will prevent MGTs/pyos/overpopulation, but I am not of the opinion that an appropriate time to do this is when the animal comes in with a BCS 1/9, a sobbing owner, and a creat of 14.5.
8. Learn from EVERYONE. Techs, specialists, assistants, staff doctors. Be humble. Everyone has something to teach you. There's one doctor here who writes horrific SOAPs. We all dread picking up her cases the next day because we don't understand her plan or what was discussed. She knows what she's doing and is incredibly intelligent. But I've learned that I don't want to write my SOAPs like her (ie, SWO - "UO - very sick, may die" is paraphrasing.
9. In our experience, doxycycline IV causes a nasty cellulitis when it extravasates. We love it for our URI kitties, but will only give it PO, or diluted and given over 4 hours.
10. If something's dead, you can't make it deader. Most things will either 1) die or 2) recover without our intervention. It's most important to MAKE A DECISION (learned this the hard way when I ran a code by myself at 1 am).
11. There are certain drug dosages you need to know by heart. These include: valium and calcium gluconate. Others, you have time to look up (and will remember with repeated usages). Know what drug reverses what sedative.
12. Know your shock doses. And get comfortable guesstimating an animal's weight in your head (and confirming with others - ha! Do you guys think this dog looks about 40 lbs? Yeah? Okay, give a bolus...)
13. Stress is a big killer of cats. If a cat can't breathe - hands off. Throw it in oxygen +/- drugs. Agree with someone above that everything should be able to handle one dose of lasix. I like torb as my first go to.
14. Don't be lazy. You're there to learn, and you're only there for a year - make the most of it.
15. The stress of internship isn't that bad, it's all the personal stuff that creeps up during the year that makes it unbearable at times. Have good coping mechanisms in place. You'll need them.
That's all for now. Hope some of this was helpful!!
~N
