Small Animal Emergency and Critical Care: Case Studies in Client Communication, Morbidity and Mortality

by Lisa Powell (University of Minnesota, College of Veterinary Medicine); Elizabeth A. Rozanski (Tufts University, Cummings School of Veterinary Medicine); John E. Rush (Tufts University, Cummings School of Veterinary Medicine)

• ISBN13: 9781444328646
• ISBN10: 1444328646
• Format: eBook
• Copyright: 2010-08-01
• Publisher: Wiley-Blackwell

Summary

Small Animal Emergency and Critical Care: Case Studies in Client Communication, Morbidity and Mortality provides a unique opportunity to learn from real case examples. Presented as a collection of short case studies, a wide range of situations likely to arise in emergency practice is examined.

The approach is modeled on the Morbidity and Mortality Conferences which were first established as a training and educational tool for medical doctors. They have now been successfully adopted in veterinary medicine as a forum for case review and learning opportunities, encouraging thorough review from different perspectives.

Each chapter presents a real case, and highlights the pitfalls that both novice and experienced veterinarians can encounter. A key theme of the book is on communication issues. Owner perspectives are discussed, and how communications between clinicians and owners can be optimized to allow veterinarians to better meet owner expectations.

The cases were provided by a variety of experienced veterinarians, primarily specialists in veterinary emergency and critical care, as well as other specialties, general practice, universities, and private institutions.

Highly readable, this book is suitable either to absorb from cover to cover, or for reference to a specific case or situation. It highlights a number of common clinical problems and communication issues that either did or may lead to difficulties in case management, helping you to avoid these situations.

Table of Contents

Contributor list

Preface

Medical and Treatment Errors

Coming Up for Air: When equipment failure can be fatal

Alistair and the UTI: Sometimes antibiotics ARE indicated!

Double-Check the RX: How a simple math error cost a dog his life

Holey Chest Tube!: How some inadvertent complications led to a change in standard operating procedure

Count Your Sponges: A simple procedure can sometimes result in disaster

First Off, Do No Harm: Always check tube placement, by many methods!

Right is Wrong: An example of a tragic outcome due to unmarked radiographs

Sabrina the Good Witch: The importance of using the correct syringe

Friends in High Places: An illustration of how imperative it is to correctly prepare and administer medications

Midnight: A case describing the consequences of technical complications

Sam and the Muscle Medicine: When you should listen to your gut and not your clients' wishes

A Shot in the Dark: The importance of discussing all potential complications prior to performing the procedure

Medical Judgment Errors

Another Down Dog: Sometimes things are not as they seem!

It HAS to Be Blasto!: Surprise endings

Can You Tap that Cat for Me?: Complications of common procedures

Chief's Complaint: Always suggest further diagnostics, and consider all differential diagnoses in a patient

But He's Been Fine!: The importance of assessing thoracic radiographs in patients experiencing blunt force trauma

Would You Like Water with That? A Tale of Two Dogs: The dangers of hypernatremia!

The Great Pretender: ALWAYS consider hypoadrenocorticism as a differential diagnosis in dogs with nonspecific symptoms

A Lack of Concentration: Another example of how Addison's disease can masquerade as a disease with a much worse prognosis

Unlucky Lady: Remember to consider ALL possible differentials for your patient!

But She Has Heart Disease!: All aspects of a patient's history should be carefully considered when presenting for an illness

Pennies From Heaven: ALWAYS perform abdominal radiographs in patients presenting with signs of immune-mediated hemolytic anemia!

Seeing Red!: All ocular abnormalities should be examined promptly and completely, as irreversible disease may be present

Sepsis the Next Day: An illustration of the importance of analyzing effusions yourself if the results will not be reported the same day, and to ALWAYS look under the tongue of a vomiting cat!

Anxious to Breathe: Care must be taken when performing diagnostics on brachycephalic, apprehensive dogs

The Lost Acorn: A complicated case gets more perplexing!

The Lost Puppies: How the inexperience of a junior veterinarian caused the demise of two puppies

Don't Be Too Cavalier: A full abdominal exploratory should always be performed during an abdominal surgical procedure

Too Much Sugar: All causes, pulmonary and extrapulmonary, should be investigated in patients with respiratory distress

Tyler: Dehiscence of enterotomy sites should always be considered as a cause of illness in the 3-5 days following the operative procedure

Whiskers: Immunosuppression from administered medications can result in the development of secondary infections

Would You Like Some Salt?: The importance of monitoring fluid therapy

Bambi?: Things to think about when coming into contact with wild animals

The Big C: The dangers of making a pathologic diagnosis without obtaining a biopsy

To Stent or Not to Stent: New technology isn't always the answer

It Isn't Asthma?: Noting when it is important to look past the suspected client situation and focus on the patient

Hoping History Doesn't Repeat: An Illustration of the importance of good history taking

Lessons in Client Communication

Not All Albumins are Equal: When transfusing nonautologous fluids, possible allergic reactions should always be considered and discussed with the client prior to administration

Believing the Client: Listen to the client! They know their pets the best!

But I Thought He Would Be Fine?: The importance of communication about prognosis and risk-junior clinician errors

If It's Not in the Medical Record, Did It Happen?: The importance of a medical director addressing any and all client concerns

Hemangiosarcoma is Bad: Failure to completely evaluate patients can result in a misdiagnosis

The Internet Can Be a Dangerous Thing: One must take into consideration the availability of information on the internet, whether it be true or not, when discussing disease diagnosis and treatment

Is there Some "Wiggle" Room?: An illustration of how essential it is to offer a variety of options to clients

But CPCR Was Successful!: Clear, timely communication about changes in patient status

Rosie and the Platelets: Novel therapies require a firm discussion of risk and benefit

The Receptionist's Dog: Family and friends' pets can be particularly stressful for clinicians

We'll Take Good Care of Maxwell!: Unexpected deterioration of a pet after admission

A Diagnosis to Stand By: A case highlighting why things are not always as they seem

The Confused Setter: Making sure that all presenting clinical complaints are addressed

Tasty Fungi: Working within financial constraints when the disease and prognosis are unknown

Watch What You Write!: A lesson on how to always be professional

But She was just Vomiting!: The importance of organization in the midst of chaos

Peroxide Puppy: A case discussing the potential concerns of phone advice

Too Tight!: An illustration of possible complications associated with bandage placement

What Was That Popping Sound?: What to do when a routine procedure goes wrong

Communication Issues between Colleagues and Hospital Staff

Bandit: A case documenting stresses around the holidays, and illustrating different clinical approaches

Check the Medicines: A case describing a very busy day, with an inadvertent distribution of the wrong medications

Cricket and the Insidious Radiograph: Understanding the right and wrong ways to teach and learn

Go Team!: Highlighting the role of experienced technicians in management of cases

Not Just Another Blocked Cat: Outlining conflict between client cost constraints and clinician wishes

Whose Fault?: Highlighting communication between a primary care hospital and an emergency clinic

Shelby and the Needles: What to do when a situation has changed dramatically since the last physical examination

Slow and Easy: The problems of "selling" an unfamiliar procedure to a client

The Bandage: An example of noncollegial behavior

We'll See What the Blood Work Shows: The importance of timely client communication

What Antibiotic is Best?: Highlighting communication issues between senior veterinary clinicians

Molly and the Chicken Bone: A case outlining the importance of reevaluating patients referred for a second opinion

Know the Nodes: Why physical examination is so important

Nancy's Neck Pain: A case outlining why a specialist may be helpful

Appendix: How to Set Up Your Own Morbidity and Mortality Conference

Index

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