On-Call Emergency Guide – McCurtain Pet Clinic

ON-CALL EMERGENCY GUIDE
As of April 3, 2018

While on call, you will receive additional pay for the week.

After-hours, always let the on-call phone go to voicemail. If the caller leaves a message, the phone will vibrate. If the caller does not leave a voicemail, do not call back. You can also ignore all texts, too. This policy helps to weed out non-emergencies and non-client calls.

If the caller has left a COMPLETE voicemail that includes the Owner’s:

name,
a return phone number,
the name of the pet, and
the type of emergency,

then call the client back for more information.
(Remember, the PIN to access voicemail is the same as the security PIN.)

If you’re not sure of the caller’s status, you can confirm that the caller is a client by asking when on the phone with them, or, preferably, by checking NEO beforehand.

When talking to the client, explain the Emergency fee ($125) and ask if they want to be seen by the doctor as an emergency visit. If yes, use the questions below to get further information about the pet. While different scenarios are listed below, the client’s emergency may not be listed. Use the information provided as a guide in all other situations.

After getting more information about the pet and situation, call Dr. Hoskins to update her and to find a time to meet at the clinic. If you are not able to get in touch with Dr. Hoskins after 30 minutes, let the client know that Dr. Hoskins could not be reached, and they should proceed to the nearest emergency room — usually East Texas Pet ER in Longview. Alternative after-hour options are provided below and on our website.

If meeting the client at the clinic, and there is time before they get there, you can start a consult and prepare any additional equipment you think may be necessary (start the x-ray computer, etc.). Add these additional charges to the invoice, too.

If during the initial client call, the client decides not to come in, DO NOT call Dr. Hoskins. Answer any questions the client may have as well as you can, and document the call in NEO.

COMMON EMERGENCY SCENARIOS

It is important that you DO NOT attempt to diagnose the pet.
ALWAYS OFFER AN EXAMINATION BY A VETERINARIAN.

This information is provided as assistance only.

Anorexia – Pet has not eaten for at least 24 hours, Kittens/Puppies have not eaten for at least 12 hours

Anorexia is a symptom of many conditions
Questions to ask:
- When is the last time the pet ate?
- What did he/she eat?
- How much?
- Any vomiting?
- Any diarrhea?
- Is the pet lethargic?
- Does the pet have any ongoing current illnesses or disease processes?
Possible complications without proper treatment
- Hypoglycemia (low blood sugar)
  - Can be lethal – esp. for puppies and small breeds (chihuahua/yorkie/pom/maltese)
- Dehydration
- Weakness
- Lethargy
- Impaired function of any organ system

Antifreeze ingestion (Ethylene Glycol)

Questions to ask:
- Did you see the pet ingest the ethylene glycol?
- When?
  - Possibly induce vomiting if recent ingestion (less than 15 minutes) according to your clinics policy regarding authorizing induction of vomiting via the telephone.
  - Never induce vomiting in a pet that is seizing, comatose, or having difficulty breathing.
- How much?
  - 1.5ml/kg minimal lethal to cats (about ¼ teaspoon per 2 lbs.)
  - 6.6ml/kg minimal lethal dose for canines (about 1 ¼ teaspoons per 2 lbs.)
  - All ingestion should be considered potentially lethal.
- What species pet?
- What size pet?
- Need to examine the pet, even if vomiting is successful
Common symptoms of non-witnessed, possible ethylene glycol ingestion
- Central nervous system depression (animal appears intoxicated)
- Vomiting
- Lethargy – (animal appears depressed, lazy, no energy)
- Polydipsia – (increased drinking)
- Polyuria – (increased urination)
- Tachypnea – (abnormally fast breathing, may see panting)
- Seizures
Possible complications without proper treatment
- Kidney failure
- Tachycardia (abnormally fast heart rate)
- Coma
- Seizures
- Death
For more information on ethylene glycol ingestion and it’s complications refer to Toxicology chapter

Chocolate ingestion

Questions to ask
- Did you see the pet ingest the chocolate?
- When did the ingestion occur?
  - Possibly induce vomiting if recent ingestion (less than 60 minutes) according to your clinics policy regarding authorizing induction of vomiting via the telephone.
  - Never induce vomiting in a pet that is seizing, comatose, or having difficulty breathing.
- What type of chocolate?
  - Cocoa
  - Cocoa bean hulls (sometimes used as mulch by owners)
  - Unsweetened Baking
  - Dark chocolate
  - Milk chocolate
  - Semisweet
  - Sweetened cocoa powder (hot chocolate drink mix)
  - White chocolate
- How much did the pet ingest?
- What species of pet?
- How much does the pet weigh?
Common symptoms of non-witnessed, possible chocolate ingestion
- Hyperactivity
- Vomiting
- Diarrhea
- Muscle tremors
- Excess salivation (drooling)
- Urinary incontinence (unable to “hold” urine)
- Abdominal pain
- Hematuria (bloody urine)
- Cyanosis – (blue color to the gums)
- Seizures
Possible complications without proper treatment
- Seizures
- Cardiac arrhythmia (abnormal heart beat)
- Death
For more information regarding chocolate toxicity please refer to Toxicology Chapter

Coin ingestion

Questions to ask
- - Any breathing or swallowing difficulty
  - What type of coin
  - When was it ingested
  - If ingested within the last 10 minutes may induce vomiting per practice policy
- Coin may pass on own
Possible complications without proper medical treatment
- Lethargy
- Vomiting
- Intestinal blockage
- Diarrhea
- Anorexia
- Metal toxicity

Diarrhea

Questions to ask
- When did it start
- How often
- How much
- Consistency
- Blood present
- Mucus present
- Accompanied by any other problems
  - Lethargy
  - Vomiting
  - Anorexia
Possible complications without proper medical attention
- Dehydration
- Shock
- Death

Facial swelling

Many causes
- Allergic reactions
- Trauma
- Witness an insect bite
Questions to ask
- Difficulty breathing (See Respiratory Difficulty below for more information. )
- How long
- Recent vaccinations/medications
Possible complications without proper medical treatment
- Airway obstruction
- Respiratory distress
- Respiratory failure
- Lack of oxygen effects all tissues
- Death

Respiratory Difficulty

Questions to ask
- Any breathing
- Choking
- Open mouth
  - Cats with any open mouth breathing – transport immediately
- Making sounds
No breathing
- Talk through CPR
Choking
- Heimlich
- Quick thrusting compression on chest
- Do not place the animal upside down
- Do not reach in the pets mouth
Difficulty
- Allow patient to remain in comfortable position
- Transport immediately
Possible complications without proper medical exam
- Respiratory arrest
- Cardiac arrest
- Death

Seizure

Questions to ask
- Any previous history of seizures
- Any known toxin exposure
- Any known head trauma
- How long
- How many
Precautions
- Stay away from the pets face
- May bite involuntarily
- Quiet the room
- Turn down lights
- Transport post seizure
- Quiet in vehicle
- If seizure continues over 60 seconds transport immediately
Information for emergency team
- Previous seizures
- Known trauma
- Known ingestions
- Size, species and age of pet
- How many seizures in what time period
- Length of seizures
Possible complications without treatment
- Brain damage
- Continued seizures
- Death

Swollen Abdomen

Questions to ask
- When did first notice
- Species
- Vomiting
- Retching
- Lethargy
- Anorexic
- Uncomfortable
- Restless
- Painful
Possible causes
- Gastric Dilatation
- Gastric Dilitation Volvulus
- Ruptured bladder
- Liver disease
- Heart failure
Possible complications without proper medical treatment
- Death

Torn toe nail / bleeding toe nail – not anemergency, but needs treatment to prevent infection

Questions to ask
- Traumatic
- Nail trim
- Still bleeding
Bleeding due to nail clipping
- Apply styptic powder
- Flour – at home
- Cornstarch – at home
Due to trauma
- Still bleeding
  - Cover with sock
  - Apply pressure – use caution
  - Bandage with fabric (towel/washcloth etc and tape) – exam
Possible complications without proper medical treatment
- Infection
- Continued bleeding
- Additional undiagnosed trauma

Trauma

Questions to ask
- Open airway
- Breathing
- Bleeding
- Conscious
- Pulse present
- Gum color
- What type of trauma
- External wounds
- How long ago
- Species, age, size of pet
  - Used to help trauma team prepare

*** May recommend the following and/or transport – re-contact in route with cell-phone

Precautions
- Approach gently and quietly
- Even normally good pets may bite
  - Cats
    - Towel over
    - Blanket over
    - Scoop up
  - Dogs
    - Quick muzzle
    - Shoe lace
    - Belt
    - String
    - Pantyhose
Not breathing
- Transport immediately and
  - Hold muzzle shut
  - Blow into nostrils
  - Every 2 seconds
  - Use extreme caution near the face of an injured animal
No pulse
- Transport immediately and
  - Chest compressions
  - Middle of the rib cage
  - 1/3 depression (only depress the chest 1/3)
  - Excessive pressure may fracture ribs
  - Fractured ribs may lacerate lungs and heart
  - Assist breathing as above
Unconscious
- Transport immediately
- Check pulses – none present – see above
- Check breathing – none present – see above
Immobilization
- Small dog and cat
  - Cardboard
- Large dog
  - Wood
- Extremity
  - Sticks
  - Broom handle
  - Rolled newspapers
  - Rolled magazine
  - Wrap in towel
  - Apply tape to the support to hold in place
Bleeding
- Towels
- Direct Pressure
- Sheets
- Socks
Penetrating wound
- Do not remove object
- If penetration to the chest and object has been removed
  - Wrap in entire chest and wound in saran wrap
- If penetration to abdomen and object has been removed
  - Cover in towel

Urinary difficulty

Questions to ask
- Able to urinate at all
  - If answer is “no” – Immediate medical attention needed
- When did you notice last urination
- Sex, species and breed of patient
- Blood
- Seem painful
- Amount last urinated
- How often is the pet urinating
- Urinating in inappropriate area
- Cats
  - History of any urinary problems
Possible complications without proper medical attention
- Severe infection
- Increased or decrease urination may signal many serious conditions
  - Diabetes
  - Heart disease
  - Kidney disease
  - Bladder stones
    - Especially consider Dalmatians, Schnauzers
  - Bladder infections
  - Urinary tract infections
  - Urethral blockages
    - Due to stones
    - Cats – especially male
- Total urinary blockage
- Bladder rupture
- Death

Vomiting

Generalized, vague symptom

Numerous causes – minor to lethal

Never authorize or recommend any medications be given without prior approval from a DVM

Questions to ask
- How long
- How much
- Consistency
- How often
- Blood
- Know foreign body ingestion
- Known dietary indiscretion
- What size pet
- Any current diagnosed illnesses
- Age of pet
- Species of pet
- Any changes in diet
- Any “human” foods fed
Possible complications without proper medical attention
- Dehydration
- Esophageal irritation
- Death to intestinal tissue
- Leakage of intestinal contents into abdomen
- Possible GDV – see swollen abdomen
- Electrolyte imbalance – improper function of all organ systems
Common “bland” diet if recommended by DVM
- Withhold all food 12 hours
  - If any vomiting occurs during this 12 hour period – Must examine
- Small amounts of water after 6 hours
  - 2 Tablespoons per 10 pounds
  - Measure the water
  - Offer every ½ hour
- Gradually introduce bland diet
  - Boil chicken or beef until cooked through (cottage cheese may be substituted for meat)
  - Rinse well
  - Mix 1 part meat to 3 parts white rice
  - Feed 1 Tablespoon per 10 pounds hourly
  - After completing this for 12 hours gradually return to normal diet
    - Day 1 ¾ rice/meat mixture, ¼ regular diet
    - Day 2and 3: ½ rice/meat mixture, ½ regular diet
    - Day 4 and 5 ¼ rice/meat mixture, ¾ regular food
    - Day 100% regular food
    - Any recurrence of vomiting – need exam

Whelping

Normal gestation for dogs is 62-66 days

Temperature of bitch will drop to 99° F – rectal

Common signs of impending whelping
- Temperature drop
- Restless
- Anorexic
- Nesting behavior
Normal presentation of puppies
- Head first
- Head located between front limbs
Questions to ask
- When was she bred
- What breed of dog
- Any puppies successfully delivered
- Any puppies visible in vulva area
- Has she ever whelped before
- How old is the bitch
- Currently having contractions
  - How often
  - How long have contractions been occurring
  - How forceful are the contractions
  - Any discharge present
    - What does the discharge look like
General guidelines for whelping
- Non-forceful contractions
  - May have for 6-12 hours prior to delivery
  - Can barely see, similar to slight abdominal tensing
- Forceful contractions
  - Should produce a puppy in 15-30 minutes
- Between puppies
  - Up to 4 hours
  - No forceful contractions during this time
- Emergency situations
  - Forceful contractions
    - Over 30 minutes – no puppy
    - Puppy stuck in birth canal
    - Weak intermittent contractions that do not produce a puppy in 3-4 hours
    - Bloody discharge (small amount of blood normal after delivery of puppy)
    - Malodorous discharge (bad odor)
    - Green colored discharge
    - Obvious difficulty passing puppy
    - Prolonged pregnancy (over 65-68 days)
Abandoned puppy post delivery
- Remove sac – do not sever the umbilical cord yet
- Wipe mucus from nostrils and mouth
- Stimulate (rub with moderate pressure) the puppy to breath
- When puppy breathing well proceed
- Tie off the umbilical cord (thread, string) about ½-1 inch away from the puppy
  - Tie snuggly
  - Repeat immediately adjacent to first tie
  - Cut umbilical cord (about ¼ inch away from tie and body of puppy)
- Encourage to nurse
- Continue to ensure breathing and nursing
- If no nursing
  - Must supplement with milk replacer (available at pet shops)
  - Do not give cows milk straight
  - Emergency formula (do not feed over 24 hours)

Courtesy of Deb Stafford, CVT, VTS (ecc)
More information can be found at VSPN: www.vspn.org/Library/Misc/VSPN_M02367.htm

AFTER-HOUR EMERGENCY SERVICES

The Vet

Veterinary clinic in Texarkana open 10am to 7pm Wednesday through Saturday and Sunday open 1pm to 4pm.

3504 Robin Lane
Texarkana, TX 75503
903-280-7570

Oklahoma State University Boren Veterinary Medical Hospital

After regular office hours and on holidays, emergencies are accepted 24/7/365. Your call, to the appropriate clinic before you arrive, will help expedite preparation for handling the case.

2065 W. Farm Road
Stillwater, Oklahoma 74078
405-744-7000
CALL Before you Come!

Animal Emergency Clinic

After-hours emergency facility also offering intensive care and hospitalization services.

2419 Line Ave.
Shreveport, LA
318-227-7234

East Texas Pet ER
(Kilgore Small Animal Hospital)

Small animal hospital featuring 24-hour service.

812 Gilmer Rd.
Longview, TX
903-759-8545

Grayson County Animal ER Clinic

Veterinary emergency clinic open nights, weekends and holidays.

3301 Woodlawn Blvd.
Denison, TX
903-337-0898

ASPCA Animal Poison Control Center

The ASPCA Animal Poison Control Center (APCC) is your best resource for any animal poison-related emergency, 24 hours a day, 365 days a year. If you think your pet may have ingested a potentially poisonous substance, call 888-426-4435. A $65 consultation fee may be applied to your credit card. 888-426-4435