Emergency and critical care veterinarian
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Dr Philomena Kwong BVSc (Hons)
*Emergency and Critical Care
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*My Background
*Veterinary nurse at WAEC 2006-2008
*Graduation 2008
*Rotating internship in emergency medicine, critical care, internal medicine and surgery at Queensland Veterinary Specialists in 2009
*Animal Emergency Service 2010 til now
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*So what is it like to work as an Emergency
vet?
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Emergency
*Shift time: 8pm-8am*
*Break when it’s quiet between consults
*No vaccinations, worming etc
*Emergency surgeries only (no orthopaedic surgery expect for spinal surgeries) as soon as the patient is stablised.
*No long term client & patient relationship.
*Taking on referral cases
*Going home not having to stress about cases.
General Practice
*8am-5pm
*Standard lunch hours
*Vaccinations, worming
*Routine surgeries at scheduled time of day.
*Ongoing client & patient relationship.
*Referral of complicated cases
*Worrying about cases that are still in hospital as no one is there to look after them.
*+/- on calls at night
*Emergency VS General Practice
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*The Good…
*The challenge
*The instant satisfaction
*Touches on all the different disciplines of veterinary medicine
*Constantly learning
*The flexibility
*Full time = 3-4days a week
*Enjoy the day instead of working through it
*Is encouraged to sleep when work isn’t busy! (there’s usually a bed at the clinic)
*Make independent decisions
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*The Bad…
*Long hours
*Unset finishing time
*Abnormal sleep pattern
*Working graveyard shifts
*Working most weekends
*Days off don’t coincide with people who work normal hours
*Working by yourself at night- consulting + procedures + looking after hospital patients
*Stress with unfamiliar cases or rare cases
*Angry clients due to waiting time (not uncommon in an emergency center)
*Talking about money to extremely distressed and emotional clients
*Abuse- mostly verbal but occasionally physical
*Higher incidences of litigation
*Miscommunication more likely when clients are distressed
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2009 @ Pet ER 2011 @ AES
*Still doing Emergency
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*2012
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*So what cases do we commonly
see?
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*The Common Cases
*Vomiting and Diarrhoea
*Lethargy/ Unwell
*Inappetence
*Itchy ears
*Urticaria
*Seizures
*Lameness
*Tick Paralysis
*Cane toad intoxications
*Coughing
*HGE
*HBC
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*The real emergencies
*Peritonitis
*Haemoabdomen
*Pleural effusion
*Dog attacks
*Diabetic Ketoacidosis
*Congestive heart failure
*Heat strokes
*Addisonian crisis
*Oesophageal foreign body
*Fulminant hepatic failure
*Tetanus
*Ethylene glycol toxicity
*Intestinal foreign bodies
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*The much hated emergencies
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Gruesome photos
*Some interesting cases
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*Chemical Burn
My presentation at Science Week during my internship year
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*What is your diagnosis?
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*Clinical Signs
*Lethargy
*Somnolence
*Paresis
*Ataxia
*Hyper-reaction to stimulus
*URINARY INCONTINENCE*****
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*MARIJUANA TOXICITY!
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*Treatment
*1. Induce emesis (patients that are awake) or gastric lavage
*2. Activated charcoal 0.5g-1g/kg PO **not in dogs that have severe somnolence
*3. Induce diuresis (fluids @ 2 x maintenance)
*4. Place urinary catheter
*5. Monitor pCO2 (blood gas) for hypoventilation
*6. +/- Ventilation
*Discharge once mentation returns to normal and urinary incontinence has resolved.
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*Estimation of costs
Disease 1st 24 hours Per 24hrs there after
GDV $5,000- $10,000 (by the time of discharge)
Diabetic ketoacidosis
$1,500- $2,000 $800-1000
Dog fight (simple) $500-1000
Dog fight (severe) $5,000- $10,0000 (may require multiple Sx)
Caesarean $2,800- $4,000
Intestinal FB $2,000- $3,000
Oesophageal FB $1,500- $2,000 $400- $1200
Spinal Surgery $4,000- $5,000 (by the time of discharge)
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*Tick Paralysis1st 12 hrs Per 24hrs
Initial setup and treatment
$600- $1,200 *size dependent*
Fluids & monitoring $300-400
Oxygen dependent $600-800
Intubation $1,500- $17,000
Ventilation $2,400- $2,600
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*COMMUNICATION
* THE MOST IMPORTANT ASPECT IN VETERNARY MEDICINE
*Establish trust
*Emergency treatments usually $$$$ TREATMENT VS EUTHANASIA
*New grads: 1/10 GDVs will go to surgery
*Senior vets: 9/10 will go to surgery
*Complaints & Litigation
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*Salary
*Every emergency clinic is different
*Average $400-500/shift
*Some have floor salary/ commission and is paid based on whichever one is the higher value
*Commission based only
*** Note when on commission based- over treatment (i.e. doing things that could have waited to be done by regular veterinarian)/ unjustifiable treatments or diagnostics will result in termination.
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*How to become an emergency veterinarian
*Direct
*Requires previous emergency work experience- veterinary nursing
*Internship
*focusing on emergency medicine
*Must have consulting experience
*GP to gain experience ER
*GP doing work experience at ER clinics ER vet
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*ComparisonRoute Pros Cons
Direct - Usually same clinic so easier to adapt especially as new grad
- Already has good communication skills
- Have only ever seen things done one way
- Nursing very different to being a vet- requires sudden change of mindset.
Internship - Exposure to various discipline before deciding whether emergency is suitable
- Supervision & backup for 1 year
- Advice from specialists- High case exposure
- Treating complicated cases with limited knowledge
- Stressful having high workload- may make emergency seem off putting.
GP 1st - Surgical, client communication experience
- Knowledge outside emergency
- Already know areas that need improvement
- Certain about being an emergency veterinarian
- Sometimes requiring re-education
- Change of ways to do things
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*ADVICE
*Veterinary nursing
*Volunteer/ work experience
*Hands on experience is by far the easiest way to learn.
*No matter what field you will be in the future:
*YOU MUST HAVE INCOME PROTECTION !!!
* YOU MUST HAVE INDEMNITY INSURANCE !!!
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*The books that will save your life
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*Other books of interest
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*If you’re still really stuck
*Referral
*If referral is not an option then call the specialists or emergency centers for advice
*Small Animal Critical Care Medicine
*VIN
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My little stray 10 weeks later
*ANY QUESTIONS?