Thursday, 28 February 2013

Emotional day......Veterinary Nursing

Now, I'm in my 8th year of nursing and although not immune to emotion it's rare that I get teary (unless it's a case that I've had a lot of input in, or the owners are old - they always get to me) but there are still the odd few that even take me by surprise.


CPR is hard work, it's unpredictable and the outcome I'm afraid is not always the best.



So lets set the scene. I was the kennel nurse on this day. One nurse was already down in x-ray with the permanent vet. Which left a trainee nurse in the practice and a foreign locum vet on his second day at the practice (it goes like this here, lots of new faces!).
As the others were getting on with x-rays and I had completed my morning rounds, it seemed I thought the opportune time to make a cup of tea! As is always the way I had just brewed it, sat down and was about to take my first sip when the receptionist rushes in saying the consulting vet needs a hand with a resus! The first thought that entered my head was ****, down goes my tea - maybe I will see you again! I jog (I like to say jog but it was a bit more abrupt) into the consult room, there I find the locum vet performing heart compressions on a small Yorkshire terrier whilst the bewildered 'owner' looks on with tears flooding down her face.........

Ok lets take control here. 'Lets get the dog out the back and on some oxygen....now!'
At this point everything seems to take on a different speed almost in slow motion, when I explain it now it seems very undramatic but I can only attempt to install into you readers how when the adrenaline's pumping, you gain a certain frantic energy. Some people thrive in this environment others unfortunately flounder, but the next time they may thrive.
I grab the small dog bed and all and rush into the prep area, where we have oxygen and the equipment we need, from here I leave the vet and run into theatre to grab a circuit (A modified Ayre's T-piece to be precise) and whilst running back to the vet who is still performing heart compressions I shout for extra help, and 'I NEED AN OXYGEN KEY PLEASE'

Lets slow it down - The poor little dog is at this point looking very lifeless, cold, gums are pale somewhat cyanotic (blue) eyes are up & look fixed, no blink & I cannot feel a pulse.

Sped back up - 'Tube it guys whilst I draw up some adrenaline' - I draw up a ml but when I turn around I see them struggling the vet cannot grab the tongue (the dog has started to stiffen his jaw and is hyper salivating creating quite a problem with excess fluid in his mouth) ok think think, A SWAB! I grab a swab, take one look at the vet who looks a bit lost and tell him to keep compressing the heart. Whilst the trainee holds up the head, I using the swab and taking several attempts manage to grab the tongue which the dog is trying to pull back on during a moment of gag reflex.

Slow down - At this point I think well this isn't a bad sign the dog is fighting against my attempts to pull his tongue down. However tubing a 'crashed' animal is notoriously hard due to the airway not opening because they have ceased breathing, everything stiffens, jaws locks etc.

Sped back up - I grab the tube, locate the epiglottis, push down on it and see the vocal cords, I take a breath and feed the tube into the trachea - I did it phew. As the trainee is about to connect the circuit and provide oxygen I ask her to wait a second and I fire 1ml of adrenaline down the endotracheal tube (this after giving a rescue breath is absorbed through the lungs, crosses and acts on the heart - it was a tip I picked up on an emergency CPD) I connect the circuit and proceed to give IPPV* every 10-15 secs whilst instructing the trainee to listen for a heartbeat or feel for a pulse. The dogs eyes at this point roll downwards very slightly, but still no pulse. At this point I instruct/suggest that the vet gives the remainder of the adrenaline intra-cardiac (this is basically a last ditch attempt to revive the animal). I continue IPPV and notice the dogs mucous membrane colour turn a hint of pink. 'The dog just took a breath!' I feel for a blink reflex and his eyelid flutters! I listen for the heart, 'HE HAS A HEART BEAT' - I shout! It's faint and thready and only about 24bpm, but its there.

Slow down - At this point you have to question whether the dog has brain damage, I instruct the vet to run for a light source, we throw the lights and check for a pupil reflex................

There is none, the eye is up central and the pupil is fixed :(, although we managed to revive the dog it's been starved of oxygen for too long. The owners, were away on a cruise and the dog was in the care of their local kennels. We had to take the ethical decision to euthanase the dog.....it was only 18mths old. We couldn't tell what caused it without further tests, at a guess a heart defect...?

That little dog made me cry that day........



*IPPV - Intermittent positive pressure ventilation

4 comments:

  1. I am currently training to be a veterinary nurse and I am in my 2nd year at university.
    We had a similar case with a cat last time I was placement, unfortunately the outcome was not good. I thought your tip about the adrenaline down the ET tube was brilliant!

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  2. Thanks for your comments Beth & hopefully the tip will help you in the future. Good luck with your studies :)

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  3. I would love to visit this blog in future.

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