My Top 10 Veterinary Emergencies from a ER Veterinarian

Dr. Josh introduces himself as an emergency doctor at Nashville Veterinary Specialists with three years of experience. He shares his educational background from the University of Illinois, where he spent nine years for both undergraduate and veterinary school. Initially interested in surgery, Dr. Josh discovered his passion for emergency medicine through various assistant roles and an internship at VCA Aurora in 2015. He discusses the high volume of cases seen at Nashville, covering a range of emergency topics such as seizures, intervertebral disk disease, congestive heart failure, arrhythmias, and toxins, emphasizing the importance of a calm approach in emergency medicine.

Dr. Josh emphasizes the importance of staying calm in emergency medicine, as panic can be detrimental to patient care. He outlines the two main categories of seizures: generalized and focal, with subtypes such as tonic-clonic, myoclonic, and absence seizures. He explains the progression of seizures and the challenge of diagnosing them, especially in cases of late-onset idiopathic epilepsy. Dr. Josh also discusses the necessity of ruling out other causes of seizures through blood work, imaging, and other diagnostic methods, highlighting the importance of a thorough medical investigation.

This paragraph delves into the treatment protocols for seizures, including the use of medications like midazolam, diazepam, and levetiracetam (Keppra). Dr. Josh discusses the importance of understanding when to treat seizures, such as in cases of acute repetitive seizures or status epilepticus, and the steps to take when initiating treatment. He also covers the process of loading patients on medications to quickly reach a steady state, especially in cases of cluster seizures, and the preference for Keppra in such situations due to its rapid onset of action.

Dr. Josh discusses the management of seizures in dogs, including the decision-making process for hospitalization and the importance of accurate diagnosis and treatment adherence. He contrasts the treatment approaches for dogs and cats, noting that while some medications like phenobarbital are effective in both, cats may require different dosages or approaches. The paragraph also touches on the challenges of managing refractory seizures and the importance of communication with clients about treatment goals and expectations.

This paragraph focuses on intervertebral disc disease, particularly in breeds like dachshunds, beagles, and shih tzus. Dr. Josh describes the neuro localization process, the importance of history and progression of symptoms, and the differentiation between type 1 and type 2 herniation. He discusses the clinical signs to look for, the significance of pain assessment, and the importance of a thorough physical examination in determining the severity and localization of the lesion.

Dr. Josh outlines the medical management strategies for intervertebral disc disease, emphasizing the importance of pain control, muscle relaxants, and anti-inflammatory medications. He discusses the use of gabapentin for pain management and the preference for certain muscle relaxants depending on the location of the disc issue. The paragraph also covers the importance of strict rest as the primary treatment, with medications providing supportive care.

This paragraph addresses the challenging topic of congestive heart failure, explaining the pathophysiology behind the condition and its causes, such as DCM, mitral regurgitation, hypertension, and others. Dr. Josh discusses the clinical signs to watch for, such as cyanosis, coughing, tachycardia, and crackles, and the importance of a thorough physical examination. He also outlines the initial management steps for treating acute cases of congestive heart failure.

Dr. Josh delves into more advanced management techniques for congestive heart failure, including the use of furosemide CRI and nitroprusside patches for severe cases. He discusses the importance of sedation and intubation in the most critical patients and the considerations involved in such decisions. The paragraph also covers the potential complications of treatment and the importance of avoiding certain medications when congestive heart failure is suspected.

This paragraph focuses on the identification and treatment of arrhythmias, including the importance of examining P waves, PR intervals, and QRS complexes. Dr. Josh discusses different types of heart blocks and their implications, as well as the treatment options for various arrhythmias, such as the use of lidocaine for ventricular tachycardia and the considerations for using beta blockers in supraventricular tachycardia.

Dr. Josh discusses the emergency management of urethral obstruction in male cats, including the signs to look for, such as an over-distended bladder and changes in behavior. He outlines the diagnostic steps, the importance of blood work and urinalysis, and the treatment options, which may include fluid therapy, sedation, and catheterization. The paragraph also covers the use of medications like buprenorphine and prazosin in managing the condition.

This paragraph covers the essentials of toxicology in veterinary medicine, emphasizing the importance of contacting poison control for guidance. Dr. Josh discusses various toxins, their effects, and the general approach to treatment, which includes decontamination, inducing emesis, and the use of activated charcoal. He also provides specific examples of toxin ingestions, such as chocolate, grapes, and marijuana, and their respective treatments.

Dr. Josh provides a detailed overview of chocolate ingestion in pets, explaining the stages of toxicity and the corresponding clinical signs. He discusses the treatment protocols for mild, moderate, and severe cases, including the use of decontamination methods, fluid therapy, muscle relaxants, and anti-arrhythmics. The paragraph also highlights the importance of monitoring and symptomatic care in managing chocolate toxicity.

This paragraph addresses the issue of grape and raisin toxicity in pets, noting the unpredictable nature of the reaction and the potential for severe kidney damage. Dr. Josh discusses the importance of hospitalization for diuresis and monitoring, as well as the challenges in convincing owners of the seriousness of the situation. He outlines the treatment options, including activated charcoal, gastroprotectants, and the use of IV fluids.

Dr. Josh discusses the increasing prevalence of flea and tick toxicity in cats, which can present as tremors and seizures. He emphasizes the importance of accurate history-taking and the treatment options, which may include bathing the cat with a detergent, administering injectable medications for tremors or seizures, and monitoring electrolytes. The paragraph also mentions the use of intralipids for certain toxins and the need for supportive care.

This paragraph focuses on marijuana toxicity in dogs, which can cause hyperactivity, ataxia, and urinary incontinence. Dr. Josh outlines the treatment strategies, including emesis, activated charcoal, and the use of intralipids for severe cases. He also discusses the importance of monitoring clinical signs and providing supportive care, such as fluids and temperature support.

Dr. Josh addresses the serious and often fatal issue of lily toxicity in cats. He stresses the importance of immediate action if a cat ingests a lily, including emesis and IV fluids. The paragraph outlines the prognosis for cats that ingest lilies, noting that even with treatment, many cats may develop chronic renal failure. Dr. Josh advises caution and emphasizes the need to avoid lilies in homes with cats.

The final paragraph discusses the toxicity associated with anticoagulant rodenticides, highlighting the importance of knowing the specific type of rodenticide involved and consulting with poison control for treatment guidance. Dr. Josh emphasizes the need for accurate information and appropriate treatment.