Heart Failure

Well, didn' have such a bad night...it was busy but not overwhelming. Saw a Fox Terrier with an intestinal mass...had been vomiting for 3 weeks...found mass on ultrasound...placed nasogastric tube, gave anzemet (dolasetron), and scheduled for surgery today. Saw a cat with IBD and possible intestinal lymphoma...vomiting...placed on fluids, anzemet, famotidine, prednisone...will get abdominal ultrasond today. Saw a dog in for an ultrasound-guided liver biopsy...completely healthy aside from elevated liver values found on routine geriatric blood work at rDVM...kept him over night to monitor PCV/TS (monitors for bleeding from liver biopsy site)...sent in liver histopathology, anaerobic cultures, and leptospirosis titers...dog is a freak and has never stayed in a hospital so had to tranquilize him with Acepromazine throughout entire night...no evidence of bleeding...sent home today on liver protectants (Denamarin and Ursodiol)...pending results. Saw a dog with a cut above his toe, bandaged it and sent him out door on pain meds (tramadol) and clavamox antibiotics. Saw my little Puggle puppy with the pneumonia that I endotracheal washed the night before...he was doing a little coughing and owners thought he felt warm...otherwise doing great at home, eating well, good activity...PE was completely normal, no fever, harsh lung sounds still but we know he had pneumonia...they are a very young couple...high school I think...so just over-worried, assured them that he is fine and he will do some coughing, maybe for the rest of his life if it is kennel cough...so told them to continue with antibiotics, continue to nebulization, and showed them how to take a temperature. Then saw a dog came in cyanotic (blue gums), trouble breathing, lungs very wet sounding, 4/6 left systolic apical heart murmur (uh oh)...gave flow-by oxygen and he pinked up some...went out to talk with owners about treatment options which at that time included catheter placement and trying to get thoracic rads...discussed that we may need to take over airway if she goes into respiratory distress....owners agree. We start to get catheter in, dog falls on side and goes cyanotic again..I run out to owners to get ok to intubate and breath for her...woman is a mess, crying...finally get an answer...go back, sedate with Etomidate, intubate, begin manual ventilation, administer furosemide, start to think about Nitroprusside dosages...go back out to discuss heart failure with the owners and tell them we have to treat and try to pull all the fluid from the lungs as well as make it easier for the heart to pump blood through..because it is a small dog with a L systolic apical heart murmur...yep mitral valve insufficiency is what I am thinking too. So we are thinking about radiographs, Mom and Dad have left and are on their way home...then dog arrests...EKG flatlines for about 3 minutes, we are thinking she is gone (he is a no code), then all of a sudden heart starts back up again...she continued to do these cycles despite atropine...so finally called owners and said that her heart is giving out and we need to help him along..get the ok for euthanasia...very sad...owner is devastated....problem is, dog started having cough a week ago...probably had started to go into failure at that point...but we all do it, oh lets wait and see if the cough gets better before bringing in to doctor...sometimes that is our demise. Got out at about 5a last night, was done at 3:30a but had to wait around to round to other clinicians....that made me mad!! Now, I am getting ready to head back in again. I have today and Friday and then I have Sat/Sun off. I might go to Zoo on Saturday...I am excited I haven't been there in about 7 years!! Ok, well..gonna go read for a bit prior to heading back in...Thursday so I am expecting a very busy night...darn it!!!!