Dr Philomena Kwong BVSc (Hons)

*Emergency and Critical Care

*My Background

*Veterinary nurse at WAEC 2006-2008

*Graduation 2008

*Rotating internship in emergency medicine, critical care, internal medicine and surgery at Queensland Veterinary Specialists in 2009

*Animal Emergency Service 2010 til now

*So what is it like to work as an Emergency

vet?

Emergency

*Shift time: 8pm-8am*

*Break when it’s quiet between consults

*No vaccinations, worming etc

*Emergency surgeries only (no orthopaedic surgery expect for spinal surgeries) as soon as the patient is stablised.

*No long term client & patient relationship.

*Taking on referral cases

*Going home not having to stress about cases.

General Practice

*8am-5pm

*Standard lunch hours

*Vaccinations, worming

*Routine surgeries at scheduled time of day.

*Ongoing client & patient relationship.

*Referral of complicated cases

*Worrying about cases that are still in hospital as no one is there to look after them.

*+/- on calls at night

*Emergency VS General Practice

*The Good…

*The challenge

*The instant satisfaction

*Touches on all the different disciplines of veterinary medicine

*Constantly learning

*The flexibility

*Full time = 3-4days a week

*Enjoy the day instead of working through it

*Is encouraged to sleep when work isn’t busy! (there’s usually a bed at the clinic)

*Make independent decisions

*The Bad…

*Long hours

*Unset finishing time

*Abnormal sleep pattern

*Working graveyard shifts

*Working most weekends

*Days off don’t coincide with people who work normal hours

*Working by yourself at night- consulting + procedures + looking after hospital patients

*Stress with unfamiliar cases or rare cases

*Angry clients due to waiting time (not uncommon in an emergency center)

*Talking about money to extremely distressed and emotional clients

*Abuse- mostly verbal but occasionally physical

*Higher incidences of litigation

*Miscommunication more likely when clients are distressed

2009 @ Pet ER 2011 @ AES

*Still doing Emergency

*2012

*So what cases do we commonly

see?

*The Common Cases

*Vomiting and Diarrhoea

*Lethargy/ Unwell

*Inappetence

*Itchy ears

*Urticaria

*Seizures

*Lameness

*Tick Paralysis

*Cane toad intoxications

*Coughing

*HGE

*HBC

*The real emergencies

*Peritonitis

*Haemoabdomen

*Pleural effusion

*Dog attacks

*Diabetic Ketoacidosis

*Congestive heart failure

*Heat strokes

*Addisonian crisis

*Oesophageal foreign body

*Fulminant hepatic failure

*Tetanus

*Ethylene glycol toxicity

*Intestinal foreign bodies

*The much hated emergencies

Gruesome photos

*Some interesting cases

*Chemical Burn

My presentation at Science Week during my internship year

*What is your diagnosis?

*Clinical Signs

*Lethargy

*Somnolence

*Paresis

*Ataxia

*Hyper-reaction to stimulus

*URINARY INCONTINENCE*****

*MARIJUANA TOXICITY!

*Treatment

*1. Induce emesis (patients that are awake) or gastric lavage

*2. Activated charcoal 0.5g-1g/kg PO **not in dogs that have severe somnolence

*3. Induce diuresis (fluids @ 2 x maintenance)

*4. Place urinary catheter

*5. Monitor pCO2 (blood gas) for hypoventilation

*6. +/- Ventilation

*Discharge once mentation returns to normal and urinary incontinence has resolved.

*Estimation of costs

Disease 1st 24 hours Per 24hrs there after

GDV $5,000- $10,000 (by the time of discharge)

Diabetic ketoacidosis

$1,500- $2,000 $800-1000

Dog fight (simple) $500-1000

Dog fight (severe) $5,000- $10,0000 (may require multiple Sx)

Caesarean $2,800- $4,000

Intestinal FB $2,000- $3,000

Oesophageal FB $1,500- $2,000 $400- $1200

Spinal Surgery $4,000- $5,000 (by the time of discharge)

*Tick Paralysis1st 12 hrs Per 24hrs

Initial setup and treatment

$600- $1,200 *size dependent*

Fluids & monitoring $300-400

Oxygen dependent $600-800

Intubation $1,500- $17,000

Ventilation $2,400- $2,600

*COMMUNICATION

* THE MOST IMPORTANT ASPECT IN VETERNARY MEDICINE

*Establish trust

*Emergency treatments usually $$$$ TREATMENT VS EUTHANASIA

*New grads: 1/10 GDVs will go to surgery

*Senior vets: 9/10 will go to surgery

*Complaints & Litigation

*Salary

*Every emergency clinic is different

*Average $400-500/shift

*Some have floor salary/ commission and is paid based on whichever one is the higher value

*Commission based only

*** Note when on commission based- over treatment (i.e. doing things that could have waited to be done by regular veterinarian)/ unjustifiable treatments or diagnostics will result in termination.

*How to become an emergency veterinarian

*Direct

*Requires previous emergency work experience- veterinary nursing

*Internship

*focusing on emergency medicine

*Must have consulting experience

*GP to gain experience ER

*GP doing work experience at ER clinics ER vet

*ComparisonRoute Pros Cons

Direct - Usually same clinic so easier to adapt especially as new grad

- Already has good communication skills

- Have only ever seen things done one way

- Nursing very different to being a vet- requires sudden change of mindset.

Internship - Exposure to various discipline before deciding whether emergency is suitable

- Supervision & backup for 1 year

- Advice from specialists- High case exposure

- Treating complicated cases with limited knowledge

- Stressful having high workload- may make emergency seem off putting.

GP 1st - Surgical, client communication experience

- Knowledge outside emergency

- Already know areas that need improvement

- Certain about being an emergency veterinarian

- Sometimes requiring re-education

- Change of ways to do things

*ADVICE

*Veterinary nursing

*Volunteer/ work experience

*Hands on experience is by far the easiest way to learn.

*No matter what field you will be in the future:

*YOU MUST HAVE INCOME PROTECTION !!!

* YOU MUST HAVE INDEMNITY INSURANCE !!!

*The books that will save your life

*Other books of interest

*If you’re still really stuck

*Referral

*If referral is not an option then call the specialists or emergency centers for advice

*Small Animal Critical Care Medicine

*VIN

My little stray 10 weeks later

*ANY QUESTIONS?