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

Small Animal Emergency and Critical Care: Case Studies in Client Communication, Morbidity and Mortality......Page 5
Contents......Page 7
Contributor list......Page 13
Preface......Page 15
Part One: Medical and Treatment Errors......Page 17
1: Coming Up for Air: When equipment failure can be fatal......Page 19
2: Alistair and the UTI: Sometimes antibiotics ARE indicated!......Page 22
3: Double-Check the RX: How a simple math error cost a dog his life......Page 24
4:Holey Chest Tube!: How some inadvertent complications led to a change in s tandard operating procedure......Page 27
5: Count Your Sponges: A simple procedure can sometimes result in disaster......Page 30
6: First Off, Do No Harm: Always check tube placement, by many methods!......Page 33
7: Right Is Wrong: An example of at ragic outcome due to unmarked radiographs......Page 37
8: Sabrina the Good Witch: The importance of using the correct syringe......Page 41
9: Friends in High Places: An illustration of how imperative it is to correctly prepare and administer medications......Page 44
10: Midnight: A case describing the consequences of technical complications......Page 47
11: Sam and the Muscle Medicine: When you s hould listen to your gut and not your clients’ wishes......Page 51
12: A Shot in the Dark: The importance of discussing all potential complications prior to performing the procedure......Page 54
Part Two: Medical Judgment Errors......Page 59
13: Another Down Dog: Sometimes things are not as they seem!......Page 61
14: It HAS to Be Blasto!: Surprise endings......Page 63
15: Can You Tap That Cat for Me?: Complications of common procedures......Page 66
16: Chief’s Complaint: Entertain all differential diagnoses......Page 68
17: But He’s Been Fine!: The importance of assessing thoracic radiographs in patients experiencing blunt force trauma......Page 70
18: Would You Like Water with That? A Tale of Two Dogs: The dangers of hypernatremia!......Page 73
19: The Great Pretender: ALWAYS consider hypoadrenocorticism as a differential diagnosis in dogs with nonspecific symptoms......Page 76
20: A Lack of Concentration: Another example of how Addison’s disease can masquerade as a disease with a much worse prognosis......Page 79
21: Unlucky Lady: Remember to consider ALL possible differential diagnoses for your patient!......Page 83
22: But She Has Heart Disease!:All a spects of a patient’s history should be carefully considered when presenting for an illness......Page 85
22: Pennies from Heaven: ALWAYS perform abdominal radiographs in patients presenting with signs of intravascular immune-mediated hemolytic anemia!......Page 87
24: Seeing Red!: All ocular abnormalities should be examined promptly and completely, as irreversible disease may be present......Page 90
25: Sepsis the Next Day?: An illustration of the importance of a nalyzing effusions yourself if the results will not be reported the same day, and to ALWAYS look under the tongue of a vomiting cat!......Page 93
26: Anxious to Breathe: Care must be taken when performing diagnostics on brachycephalic, apprehensive dogs......Page 97
27: The Lost Acorn: A complicated case gets more perplexing!......Page 99
28: The Lost Puppies: How the inexperience of a junior veterinarian caused the demise of two puppies......Page 101
29: Don’t Be Too Cavalier: A full abdominal exploratory should always be performed during an abdominal surgical procedure......Page 104
30: Too Much Sugar: All causes, pulmonary and extrapulmonary, should be investigated in patients with respiratory distress......Page 106
31: Tyler: Dehiscence of enterotomy s ites should always be considered as a cause of illness in the 3–5 days following the operative procedure......Page 108
32: Whiskers: Immunosuppression from administered medications can result in the development of secondary infections......Page 110
33: Would You Like Some Salt?: The importance of monitoring fluid therapy......Page 112
34: Bambi?: Things to think about when coming into contact with wild animals......Page 116
35: The Big C: The dangers of making a pathologic diagnosis without obtaining a biopsy......Page 118
36: To Stent or Not to Stent?: New technology isn’t always the answer......Page 120
37: It Isn’t Asthma?: Noting when it is important to look past the suspected client situation and focus on the patient......Page 122
38: Hoping History Doesn’t Repeat: An illustration of the importance of good history taking......Page 124
Part Three: Lessons in Client Communication......Page 127
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......Page 129
40: Believing the Client: Listen to the client! They know their pets the best!......Page 132
41: But I Thought He Would Be Fine!: The importance of communication about prognosis and risk—junior clinician errors......Page 135
42: If It ’ s Not in the Medical Record, Did It Happen?: The importance of a medical director addressing any and all client concerns......Page 140
43: Hemangiosarcoma Is Bad: Failure to completely evaluate patients can result in a misdiagnosis......Page 146
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......Page 150
45: Is There Some “Wiggle” Room?: An illustration of how essential it is to offer a variety of options to clients......Page 154
46: But CPCR Was Successful!: Clear, timely communication about changes in patient status......Page 158
47: Rosie and the Platelets: Novel therapies require a firm discussion of risk and benefit......Page 160
48: The Receptionist’s Dog: Family and friends’ pets can be particularlys tressful for clinicians......Page 163
49: We’ll Take Good Care of Maxwell!: Unexpected deterioration of a pet after admission......Page 165
50: A Diagnosis to Stand By: A case highlighting why things are not always as they seem......Page 167
51: The Confused Setter: Making sure that all presenting clinical complaints are addressed......Page 170
52: Tasty Fungi: Working within financial constraints when the disease and prognosis are unknown......Page 173
53: Watch What You Write!: A lesson on how to always be professional......Page 176
54: But She Was Just Vomiting!: The importance of organization in the midst of chaos......Page 178
55: Peroxide Puppy: A case discussing the potential concerns of phone advice......Page 180
56: Too Tight!: An illustration of possible complications associated with bandage placement......Page 183
57: What Was That Popping Sound?: What to do when a routine procedure goes wrong......Page 185
Part Four: Communication Issues between Colleagues and Hospital Staff......Page 189
58: Bandit: A case documenting stresses around the holidays, and illustrating different clinical approaches......Page 191
59: Check the Medicines: A case describing a very busy day, with an inadvertent distribution of the wrong medications......Page 194
60: Cricket and the Insidious Radiograph: Understanding the right and wrong ways to teach and learn......Page 196
61: Go Team!: Highlighting the role of experienced technicians in management of cases......Page 199
62: Not Just Another Blocked Cat: Outlining conflict between client cost constraintsand clinician wishes......Page 202
63: Whose Fault?: Highlighting communication between a primary care hospital and an emergency clinic......Page 206
64: Shelby and the Needles: What to do when a situation has changed dramatically since the last physical examination......Page 209
65: Slow and Easy: The problems of “selling” an unfamiliar procedure to a client......Page 213
66: The Bandage: An example of noncollegial behavior......Page 216
67: We’ll See What the Blood Work Shows: The importance of timely client communication......Page 218
68: What Antibiotic Is Best?: Highlighting communication issues between senior veterinary clinicians......Page 220
69: Molly and the Chicken Bone: A case outlining the importance of reevaluating patients referred for a second opinion......Page 222
70: Know the Nodes: Why physical examination is so important......Page 224
71: Nancy’s Neck Pain: A case outlining why a specialist may be helpful......Page 226
Appendix: How to Set Up Your Own Morbidity and Mortality Conference......Page 231
Index......Page 233