What happened to Peggy the Pitbull?

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When it comes to clients and patients, emergency veterinary clinics never know what is going to come through the door. To help veterinary professionals be prepared for what kinds of cases can come into the clinic, the Directions in Veterinary Medicine (DIVM) faculty in Arlington, Virginia—led by Adam Christman, DVM, MBA, chief veterinary officer at dvm360® and Fred Wininger, VMD, MS, DACVIM (Neurology)—put together a make-believe scenario about a Pitbull brought into an imaginary clinic.

Along with DIVM faculty Steven Berkowitz, DVM, DACVECC; Erica Brandt, CVT, VTS(ECC); S. Bryce Dooley, DVM, MS, DACVAA; Justin Gangei, DVM, DACVS-SA; Shadi Ireifej, DVM, DACVS; and Adesola Obunayo, DVM, MS, DACVECC, these continuing education presenters led discussions about possible causes that brought Peggy the Pitbull to the emergency room on day 1 of the symposium, and how to move forward now that she is in the door.

Presentation and discussion

For Peggy and Christman, it was a normal day at Starbucks until the Pitbull suddenly callasped. Christman then rushed her to their local veterinary emergency clinic to get help for his beloved pet. Once admitted and upon further testing, Peggy’s initial assessment was as follows:

• Temperature: 99.2 F
• Pulse: 156 beats per minute
• Respiratory rate: 24 breaths per minute
• Pulse quality: thready
• Mucus membrane: pale with capillary refill time >2 sec
• Abdominal palpitation: doughy and distended
• Blood Pressure: Doppler 70 cm H20

After receiving fluids, Peggy began to stabilize. Continuing with the evaluation and presenting the initial assessment, Wininger asked attendees what kinds of shock they thought Peggy could be suffering from. Once the room had time discuss, the faculty began to explain the shocks this patient could be suffering from.

After speaking to attendees, Odunayo gave them a little more insight on the differences between types of shock, specifically between sepsis and distributive shock. “The issue with sepsis, [it’s like an] unstoppable infection…the animal just has a really profound vasodilation the blood vessels, which get dilated for a lot of reasons, but it can be caused by like noninfectious things like kidney tightness, so an animal who has severe trauma, why they might not necessarily be an infectious agent kind of thing,” explained Odunayo.

A key point Berkowitz wanted attendees to take away from the review of the initial assessment is that veterinary professionals must get their hands on the patient. Although running tests and labs is important, putting your hands on the patient to feel and see if anything else is happening can be crucial to the treatment of the patient.

Final steps

With the initial assessments completed, the attendees ruled out certain types of issues, such an allergic reaction, and the faculty and attendees began to discuss the different diagnostics that could be done on Peggy. After presenting more of the case and the findings to the audience, it was determined that this Pitbull’s white blood count was high.

“I don't like that it’s so high… So that automatically makes me start getting a little fancy of what actually is causing as well. I think what's happening in my patient may not be as acute as we think it is. Neutrophils are not going to get that high because you were just hit by a car or stung by 1000 bees. Obviously, chemotherapy admin came to mind because you saw the patient that was in shock and it had anemia,” explained Berkowitz.

With all the information presented to them, the question came on whether it was time for the team to call in the veterinary surgeon or not. Ireifej explained that realistically, it depends on the team because once you do everything, you may need to rush into surgery but on the other hand, there may be certain situations or scenarios where surgery is not an option at the time.

“It really depends on your mission, civilization parameters, and then what the response is… it may be that we have to stabilize the patient on the way to the operating room, which is waking me up, let's get it going. Otherwise, the patient doesn't get stabilized pretty well and you can hold and maintain, and then the next day, maybe you have all the diagnostics you need,” explained Ireifej.