Maltese Only News
February 2002

One of the most difficult decisions facing both the dog owner and the veterinarian is what constitutes a bona fide emergency. This is not a problem when the patient is in the office, but faced with a call from a distraught client, the veterinarian is forced to make a judgment call and, if the condition is not clear-cut, an assumption of emergency is usually made. Fortunately, there are guidelines for determining an emergency and arranging for medical care, so pre­planning for problems can often save time and grief.

First, what constitutes an emergen­cy? There are many situations that are clear-cut to both the owner and the veterinarian, and these require no questions of judgment.

• Traumatic injury is always an emergency. Even accidents in which the patient does not appear to be hurt should receive immediate atten­tion. The patient may seem to be alert, yet go into shock hours later. And despite having no visible frac­tures or lacerations, there may be internal injuries, slow bleeding or a ruptured bladder that becomes obvi­ous only as time goes by. Automobile accidents are the most common type of trauma, but falls from heights (sometimes even minor falls), gunshot wounds and being struck by stones, balls and falling objects are also examples of traumat­ic emergencies.
• Hemorrhage is another obvious emergency. Every attempt should be made to find the source of bleeding, and a compression bandage applied to prevent severe blood loss. If a tourniquet is applied, remember to release it every 15 to 20 minutes to avoid loss of circulation to that part of the body. The accidental swallowing of poi­son, lye, insecticides, antifreeze and other known toxic substances must receive immediate attention. Read the package label carefully and follow the instructions for accidental poi­soning. Then rush to the doctor. Periodically inspect your contain­ers, and if the label is missing from any of them or the directions are hard to read, discard the container before there is a problem. It also is a good idea to keep a package of acti­vated charcoal on hand, as this is an excellent emergency antidote for cer­tain poisons. The dose is one to eight grams mixed in water, or enough to make a few ounces of a mixture hav­ing a creamy consistency. Antifreeze, in particular, is a deadly poison, causing liver and kidney dam­age from which few patients ever recover.
• Sudden collapse, loss of con­sciousness, cyanosis (a bluish col­oration of the tongue or other mem­branes indicating an insufficient oxygen supply to the red blood cells), paralysis and similar problems con­stitute real emergencies. They can be caused by many things and require a quick and thorough work-up to pre­vent further deterioration.
• Foreign objects mayor may not be an acute emergency. Objects that are inhaled into the windpipe, bron­chial tubes or lungs are always an emergency. Foreign objects that are swallowed are an emergency if they are sharp-razors, sharp bone frag­ments, pins and glass-or if they are very large. Small objects-small bones, coins, marbles and small stones-may pass through the intes­tine and, although it may not neces­sarily be an emergency, the pet must be monitored carefully. In such cases, it is important to call the veterinarian so that he or she knows what has happened and can advise you as to what to do.
• Sudden vomiting and diarrhea, as with foreign objects, mayor may not be a medical emergency. Pets can vomit for many reasons, not all of them serious. Continued vomiting is cause for concern, however, and if it continues for more than a few hours, it should receive attention. The same is true for diarrhea. A few soft move­ments in a relatively normal animal is nothing to be concerned about. How­ever, if either the vomiting or diar­rhea is projectile, as though shot out of a hose, or if it contains pools of blood, seek veterinary advice imme­diately.

A pet owner should always ask about provisions for emergen­cy care before establishing a relationship with a veterinarian. To wait until an emergency exists is too late. If the practice has not arranged for 24-hour emergency service, it is best to go elsewhere. This does not mean that a veterinarian must be available personally at all times of the day or night; it does mean that the veterinarian is part of a rotating pool that provides the service, that in a multi-veterinarian practice the staff rotates being on duty or that the practice has made arrangements with an emergency clinic. This is the vet­erinarian's responsibility to the client.

The client also has a responsibility to the veterinarian. It is eminently unfair to know that a pet has been sick all day long (or for several days) and start to worry about it after the practice has closed for the evening.It is also unfair to watch a pet dete­riorate on "home treatment," only to rush in when the pet is near death and expect a miracle-and when the miracle doesn't happen, to blame the veterinarian.

The proper procedure is to call the veterinarian immediately and let the receptionist know that you have an emergency. In such situations min­utes can save lives, and you should spend no more time on the telephone than necessary. Answer questions as concisely as possible, and let the office tell you how to proceed.

Once the examination has started, answer all of the veterinarian's ques­tions, but don't ask a million ques­tions of your own. Emergencies are tense situations, requiring intense concentration on the part of the doc­tor, and at that stage he or she really may not know what the cause is, how serious it is and whether the pet will live. It is best to let the doctor con­centrate on the patient, even if it means you must stay in the waiting room.

When a diagnosis has been made, or an evaluation com­pleted, the veterinarian will explain the problem and outline a proposed course of treatment and alternatives, if there are any. If the emergency treatment has been given by an emergency clinic or by a doctor you don't know, and you would be happier having the case treated by your own doctor, you have the right to transfer the case as soon as the pet can be moved safely.

The most important thing to know about emergencies is how they are handled. Find out who covers emer­gencies when your regular veterinari­an is away. Find out if you call the regular office number when the office is closed or if there is a special emer­gency number to call.

Ask about follow-up care and, if surgery is needed or the treatment period is prolonged, whether the emergency doctor will care for your pet or refer it back to your regular veterinarian. Then you will know what to expect and, should an emer­gency arise, care and treatment can proceed smoothly and in the best interests of the patient.