SCENE: It's like 10PM on July 4th. Our reception had stepped out and the phone rang back - all the techs had hands on animals, so I grabbed the phone and introduced myself as
firstname like I always do to stay ~ninja~.
There's a vet on the line, calling about a possible transfer.
firstname asks for a bit more information, and then I drop the ruse to introduce myself as the doctor and chat.
I am the
SEVENTH hospital she has called. She has a HBC (scared by fireworks into the street) dog with some pelvic fractures and a pneumothorax she's had to tap once, but she's at a nights and weekend-y ER that closes in the morning... so she's trying to get the dog somewhere to both monitor the respiratory stuff and then fix the fractures eventually.
My hospital is honestly fairly full, but if she's calling to where I work, you're pretty much talking... 2.5-3+ hours out if I say no to get to another 24/7 hospital. I think she almost cried when I said I'd take the dog. Asked please to make sure he's as stable as he can be before getting on the road, then send him over.
He comes in a touch tachypneic and I tap like a liter of air off his chest. It's been at least four or five hours since the first tap at this point, though, and he's also got some contusion, so I just talk to the owner about potentially needing a chest tube if it recurs again and start him on O2/pain meds/resp watch.
The night was busy, but like four hours later he's doing fine, I'm writing records in the doctors office and I hear faintly
"Dr. Trilt~!"
Okay, my staff do not yell for me instead of calling me unless something is actively dying so I HUSTLE over to ICU and that dog is PURPLE. He is orthopneic, he is struggling, and my (very good) ICU tech is like "I SWEAR I JUST LOOKED AT HIM a second ago!"
Very VERY quickly tapped ~2.5L of air off his chest with a butterfly, and in the time it takes me to gather the supplies to slap a chest tube in... the dog is visibly dyspneic again. Placed the chest tube the fastest I ever have and started pulling air and... after 6 liters we're still not getting negative pressure.
Definitely a
"****, did I stab this dog in the lungs?" moment, lol.
Took a placement rad and it's beautiful (
phew) beyond a moderate pneumothorax (
boo), then tap another half liter off immediately after the rad.
Five minutes later, almost another liter.
The owners are, of course, not answering their phones because it's like 4AM in the morning. Try multiple times over the next hour, while I literally just have an assistant with a syringe tapping every two minutes because we don't have continuous suction. I didn't record it to the mL, but we pull well over 10 liters off the dog's chest in this time frame.
After an hour with no response, I say screw it and do a blood pleurodesis on the dog - for people who aren't familiar, this is a super slick (but not always successful) technique where you pull blood from the patient, and then instill it back into their own pleural space to allow the blood it to form a clot and hopefully patch up the area that is actively leaking air.
here's a link for more info.
I dumped the blood in the chest, rolled the dog around a little bit to hopefully distribute it, and held my breath...
...and he was totally fine for about an hour, then got a titch tachypneic again. Pulled like ~700mLs of air off the chest. Eventually the owners call back and ok transfer to a hospital with continuous suction (because of course NOW they can take him, lol, not before he tried to die).
In the six hours while we worked out transfer, we only pulled like ~1.5Ls of air off his chest. In the two hours prior to blood patching him, we'd pulled over TWENTY LITERS. So cool.
And the dog did great, which is the best part. He was on continuous suction with pretty minimal quantities at the vet school for two days, got a CT scan (bulla/pneumatocele that resolved with time), they fixed the pelvic fractures, then they eventually pulled the chest tube and sent him home.
This was like ~1.5y into working ER after my swap from GP and I was like... "yeaahhhh I think I count as an ER vet now I guess" haha
