Like in any other part of the medical field, we have acronyms to describe common problems: BDLD (big dog/little dog, referring to a dog fight), PTS (put to sleep), ADR (ain't doin' right, often used as a collective term for vague symptoms that could be anything, including the owner's Munchausen's), V+/D+ (vomiting & diarrhea), and HBC.
HBC = hit by car. This is one of those acronyms that carries with it all sorts of suspense and dread because you really never know in what condition these patients are going to arrive. We've had HBC dogs come into the lobby bouncing at the end of their leash with a tiny scrape on an elbow, while we've had others that we've had to wheel into the hospital on a gurney at a dead run so we can immediately initiate CPR. (Yup, just like something out of a Grey's Anatomy episode. We do that too.)
The worst ones are the ones that arrive bouncing at the end of that leash, high on adrenaline, and then wind up crashing 30 minutes later when the adrenaline wears off and they go into shock. For example, the spleen is a wonderful organ. When there is acute (sudden) hemorrhage somewhere in the body, the spleen will contract in an effort to grab as much blood as it can to protect the body. It can only do this for so long. If the hemorrhage continues, the spleen has to let go of the blood it has been holding, and that's when the patient will start to really show he's in trouble as his blood volume continues to drop.
Sometimes the triage tech will catch these kinds of cases in time: on presentation they will have something like an inordinately high heart rate or increased respiratory effort or rapidly paling gums. But sometimes even on physical exam they will seem normal initially, before their body starts to decompensate. Sometimes the patient looks so stable that the client declines diagnostics and takes the dog home, only to bring it back a week later half dead from sepsis.
You really never know what to expect.
Thus, when "HBC" gets written on our board, we prepare for the worst: the crash cart is moved over next to the ER table, we'll set up for an IV catheter placement, and have fluids ready to go.
|Typical veterinary ER/ICU chaos during a busy shift|
(not my hospital)
This reminded me of another case that I participated in many, many moons ago, back when I was just starting tech school.
It was the first 24-hour specialty hospital I'd ever worked at. During the week, I worked a mid-shift or "swing shift" similar to what I work now - going into work in the afternoon and leaving between midnight and 2:00 am - which was perfect for my class schedule, and pulling an additional full overnight shift on Saturday evenings. That overnight was a killer, but it was also the shift where I learned the most and where we saw the most interesting cases.
On one of these Saturdays in the middle of the night, we had a client bring in their bull terrier. He had escaped his collar and run into the street, where he'd been hit by a car.
You know the Tonka trucks?
In the '80's they had a popular commercial where they showed a full-size truck falling down a rocky cliff and breaking into smithereens at the bottom. They then showed the Tonka truck falling down the same cliff and making it in one piece. Like most little boys (and some girls - I was one of them...) growing up in the '80's, Charles had one of these trucks. He saw that commercial (you can watch it here!) and decided to test it out.
He dropped the truck from the balcony of his parents' 10th floor apartment.
The truck landed on the sidewalk below.
The thing actually survived the impact. (Thankfully, no one was walking by at that point, or they certainly would not have survived the plummeting metal toy truck!)
The commercials were true. Those trucks really were indestructible.
Well, bull terriers are the Tonka trucks of the canine world.
|"I am indestructible!"|
That dog, whom I shall call Buddy, strutted into our ER wagging his tail, completely calm and relaxed, with some dirt and black scuff marks on his white fur. One of his ears had been partially torn off at the base but other than that, he was unscathed. Radiographs of his chest and abdomen were clean, and his bloodwork was completely normal. It was nothing short of a miracle.
All we had to do was fix his ear.
His dad had been able to do all of the recommended diagnostics to make sure that his dog was okay. However, by the time all was said and done, he could not afford much else. He wanted Buddy's ear repaired, but he asked that it be done without sedation or a local anesthetic to save money. I winced when the intern in charge of his case told me what we were going to do. Guess who would be holding the bull terrier for this procedure? Moi, of course.
The laceration was about 2" long, a clean, straight cut partially severing the ear from the bull terrier's head. Buddy had been absolutely fantastic for everything we'd done so far, but what we were about to do next was going to be painful. We muzzled him for our own protection, just in case; we couldn't foresee how much or how little this would hurt. We clipped and cleaned the area round the laceration to remove all the hair and dry blood prior to repairing it. Buddy was absolutely fine with all of this, requiring no restraint whatsoever.
The intern chose surgical staples to re-attach the lacerated portion of ear. Much quicker than sutures.
I held Buddy by hugging him to steady his head so the intern could do her job.
That dog didn't even flinch throughout the whole procedure! We promptly removed his muzzle as soon as that last staple was in, and he received tons of pets and "Good boy"s from our team for being such a brave man. He grinned and happily wagged his tail at us.
He was the first bull terrier patient I'd ever worked with. Afterwards, the other more experienced techs on our team were commenting on the stoic, solid nature of bull terriers. Katie, our senior tech, said, "They are like tanks! I'm sure the car that hit Buddy sustained a lot more damage than Buddy himself. That car probably has a big ole dent in the front."
We imagined the car being taken to the mechanic the next day. Problem? "HBD"
Hit by dog!