Sunday, 28 July 2013

Nothing you could have done.......

How certain cases hit you really hard!

My latest happened during one of the busiest set of nights I've had for quite some time! A cute Labrador was in the walk in kennel when I started my first night of four. He was recovering from a foreign body surgery from the previous night, they removed a corn of the cob from his small intestine. The surgery had gone well, but his recovery hadn't been that great all day. He also suffered from very bad hips & elbows so it was felt that when he did he did go out for toilet walks etc the pain & stiffness was due to this.

So after the handover of all the inpatients from day to night staff I began my rounds checking on each animal in turn. This particular dog was on Methadone every 4 hrs for the pain but he wasn't due one for another hour so I decided to get him up for a toilet walk. This took a lot of coaxing and if I didn't know his age would have placed him more like 10 yrs than his 18mths! He really struggled to get up although he was very eager to, I helped him with his rear legs until he got his balance and then happily trotted outside. It was on the return to his kennel that I noticed a few spots of bloody mucous coming from his nose, to which I alerted the vet to the problem. He was on two drips one to help with his stomach and the other to not only replace his fluids but it was also spiked with a local anaesthetic to assist with pain & potassium as his was low.

As the night went on we had to go to surgery with another foreign body cat, and had numerous consults to see to. It was rather a busy night, but every hour or so I managed to get him up and assist him outside, to also ensure he wasn't laying on one side for to long. Towards the middle of the night we both felt he was improving and it was decided that we would let the Methadone go for another hour so that we could assess his true pain and also we felt it would make him less flat to hold off. We retook some bloods from him to check his levels and they all showed that he was improving.

My vet then had to disappear to the other branch surgery as some emergencies had rocked up there, I have to be honest this always makes me a bit nervous being left. But we agreed everybody was stable. I was going to get up every 45mins to an 1hr to check especially on the Labrador in case I felt he needed Methadone. At 1:30ish I heard his drip go off, so went into the ward to check on him, I reset the drip but noticed that his resps had gone up quite high & he was open mouth breathing. I phoned the vet and asked if I could administer some further meds to which she told me yes. After giving the meds I noted that his resps had returned to normal & he seemed a lot calmer, however he had passed some runny D+. So I went to get some replacement blankets with a view to get him out of his kennel.

However when I entered the kennel I noticed that his muscles had gone quite rigid, his breathing was shallow and his eyes where rolling in the top of his skull. I immediately knew that he was 'crashing' adrenaline kicked in & I dragged him for the rear of the kennel with one hand out to the front. I ran to the phone and telephoned the vet whilst with the other hand cracking open a vial of adrenaline. I told the vet what had happened and asked to administer adrenaline, she told me she would race back. I ran to the dog who now had pure blood pouring out of his nose and mouth. I gave some adrenaline IV and then finally Intra-cardiac whilst starting compressions. However with every compression I performed more blood poured out of him, I soon realised that there was no hope and after listening to him he was gone. I stopped, partly in shock myself and sat with the dog until the vet arrived to break the news to her.

We discussed into the early hours what could have happened, even debating a post mortem x-ray but we both agreed we would probably never know. We both questioned if there was something we could have done but in conclusion we think he had something going on in his thoracic cavity possibly a tumour or possibly aspiration pneumonia. This case hit us both really hard, however from my point of view I felt rotten for being there by myself during that time and the period after until the vet came, its a very eerie experience.

1 comment:

  1. What an awful situation for you to be in! Sounds like not much could have been done though :(

    By the way, I very much enjoy reading your blog - nice to hear about other nursing experiences :)