Small Animal Emergency and Critical Care: Case Studies in Client Communication, Morbidity and Mortality

Preface.

Part One: Medical and Treatment Errors.

1. Coming Up for Air: When equipment failure can be fatal.

2. Alistair and the UTI: Sometimes antibiotics ARE indicated!

3. Double-Check the RX: How a simple math error cost a dog his life.

4. Holey Chest Tube!: How some inadvertent complications led to a change in standard operating procedure.

5. Count Your Sponges: A simple procedure can sometimes result in disaster.

6. First Off, Do No Harm: Always check tube placement, by many methods!

7. Right is Wrong: An example of a tragic outcome due to unmarked radiographs.

8. Sabrina the Good Witch: The importance of using the correct syringe.

9. Friends in High Places: An illustration of how imperative it is to correctly prepare and administer medications.

10. Midnight: A case describing the consequences of technical complications.

11. Sam and the Muscle Medicine: When you should listen to your gut and not your clients’ wishes.

12. A Shot in the Dark: The importance of discussing all potential complications prior to performing the procedure.

Part Two: Medical Judgment Errors.

13. Another Down Dog: Sometimes things are not as they seem!

14. It HAS to Be Blasto!: Surprise endings.

15. Can You Tap that Cat for Me?: Complications of common procedures.

16. Chief’s Complaint: Always suggest further diagnostics, and consider all differential diagnoses in a patient.

17. But He’s Been Fine!: The importance of assessing thoracic radiographs in patients experiencing blunt force trauma.

18. Would You Like Water with That? A Tale of Two Dogs: The dangers of hypernatremia!

19. The Great Pretender: ALWAYS consider hypoadrenocorticism as a differential diagnosis in dogs with nonspecific symptoms

20. A Lack of Concentration: Another example of how Addison’s disease can masquerade as a disease with a much worse prognosis.

21. Unlucky Lady: Remember to consider ALL possible differentials for your patient!

22. But She Has Heart Disease!: All aspects of a patient’s history should be carefully considered when presenting for an illness.

23. Pennies From Heaven: ALWAYS perform abdominal radiographs in patients presenting with signs of immune-mediated hemolytic anemia!

24. Seeing Red!: All ocular abnormalities should be examined promptly and completely, as irreversible disease may be present.

25. Sepsis the Next Day: An illustration of the importance of analyzing effusions yourself if the results will not be reported the same day, and to ALWAYS look under the tongue of a vomiting cat!

26. Anxious to Breathe: Care must be taken when performing diagnostics on brachycephalic, apprehensive dogs.

27. The Lost Acorn: A complicated case gets more perplexing!

28. The Lost Puppies: How the inexperience of a junior veterinarian caused the demise of two puppies.

29. Don’t Be Too Cavalier: A full abdominal exploratory should always be performed during an abdominal surgical procedure.

30. Too Much Sugar: All causes, pulmonary and extrapulmonary, should be investigated in patients with respiratory distress.

31. Tyler: Dehiscence of enterotomy sites should always be considered as a cause of illness in the 3–5 days following the operative procedure.

32. Whiskers: Immunosuppression from administered medications can result in the development of secondary infections.

33. Would You Like Some Salt?: The importance of monitoring fluid therapy.

34. Bambi?: Things to think about when coming into contact with wild animals.

35. The Big C: The dangers of making a pathologic diagnosis without obtaining a biopsy.

36. To Stent or Not to Stent: New technology isn’t always the answer.

37. It Isn’t Asthma?: Noting when it is important to look past the suspected client situation and focus on the patient.

38. Hoping History Doesn’t Repeat: An Illustration of the importance of good history taking.

Part Three: Lessons in Client Communication.

39. Not All Albumins are Equal: When transfusing nonautologous fluids, possible allergic reactions should always be considered and discussed with the client prior to administration.

40. Believing the Client: Listen to the client! They know their pets the best!

41. But I Thought He Would Be Fine?: The importance of communication about prognosis and risk—junior clinician errors.

42. If It’s Not in the Medical Record, Did It Happen?: The importance of a medical director addressing any and all client concerns.

43. Hemangiosarcoma is Bad: Failure to completely evaluate patients can result in a misdiagnosis.

44. The Internet Can Be a Dangerous Thing: One must take into consideration the availability of information on the internet, whether it be true or not, when discussing disease diagnosis and treatment.

45. Is there Some “Wiggle” Room?: An illustration of how essential it is to offer a variety of options to clients.

46. But CPCR Was Successful!: Clear, timely communication about changes in patient status.

47. Rosie and the Platelets: Novel therapies require a firm discussion of risk and benefit.

48. The Receptionist’s Dog: Family and friends’ pets can be particularly stressful for clinicians.

49. We’ll Take Good Care of Maxwell!: Unexpected deterioration of a pet after admission.

50. A Diagnosis to Stand By: A case highlighting why things are not always as they seem.

51. The Confused Setter: Making sure that all presenting clinical complaints are addressed.

52. Tasty Fungi: Working within financial constraints when the disease and prognosis are unknown.

53. Watch What You Write!: A lesson on how to always be professional

54. But She was just Vomiting!: The importance of organization in the midst of chaos.

55. Peroxide Puppy: A case discussing the potential concerns of phone advice.

56. Too Tight!: An illustration of possible complications associated with bandage placement.

57. What Was That Popping Sound?: What to do when a routine procedure goes wrong.

Part Four: Communication Issues between Colleagues and Hospital Staff.

58. Bandit: A case documenting stresses around the holidays, and illustrating different clinical approaches.

59. Check the Medicines: A case describing a very busy day, with an inadvertent distribution of the wrong medications.

60. Cricket and the Insidious Radiograph: Understanding the right and wrong ways to teach and learn.

61. Go Team!: Highlighting the role of experienced technicians in management of cases.

62. Not Just Another Blocked Cat: Outlining conflict between client cost constraints and clinician wishes.

63. Whose Fault?: Highlighting communication between a primary care hospital and an emergency clinic.

64. Shelby and the Needles: What to do when a situation has changed dramatically since the last physical examination.

65. Slow and Easy: The problems of “selling” an unfamiliar procedure to a client.

66. The Bandage: An example of noncollegial behavior.

67. We’ll See What the Blood Work Shows: The importance of timely client communication.

68. What Antibiotic is Best?: Highlighting communication issues between senior veterinary clinicians.

69. Molly and the Chicken Bone: A case outlining the importance of reevaluating patients referred for a second opinion.

70. Know the Nodes: Why physical examination is so important.

71. Nancy’s Neck Pain: A case outlining why a specialist may be helpful.

Appendix: How to Set Up Your Own Morbidity and Mortality Conference.

Index.