Haemothorax – an emergency

Well Bob caused utter chaos in our little practice in Kinnegad yesterday! Of course I’m away in New York.. and one year old Bob; a golden retriever, presents in a critical condition with severe breathing difficulties. My team were doing a brilliant job diagnosing him when I called from the High Line walk in NYC to see how things were going. They were worried; so we did a triage conference over phone and what’s app. There were flurries of messages.

Bob’s gums were very pale. He had a massive lump on his side. His thoracic X-ray was shocking. His lungs were compressed and unable to expand due to free fluid in his chest. Our team immediately placed an intravenous cannula started oxygen therapy whilst they worked on him to save his life.

I was thinking on my feet whilst trying not to be distracted by the New York skyline!! My team needed my help to devise a way to save him.

We made a plan to save his life. He was really suffering and things were not looking good.

First- we list possible causes. Our number one was a haemhorrage or bleeding disorder. We ran bloods and performed a thoracocentesis which involves sterile prep and passing a needle through the chest wall into the chest cavity.

The guys drew back blood from his chest. A lot of blood. He was actively bleeding into his thorax (haemothorax). His blood was not clotting. He was dangerously anemic. The most likely cause was rodenticide poisoning causing a bleeding crisis. This can happen over a number of days; and can be unnoticeable until things are advanced. The other possibilities are haemophilia or lungworm infection.

We often can’t pinpoint a diagnosis; especially on a Friday; because external laboratories are closed. We don’t have the luxury of phlebotomists; haematologist and internal medicine specialists; unlike doctors working in the fully staffed hospitals with teams of people with specialist skills.

We have to think on our feet; and use all of our experience in cases like these. We need every bit of our excellent equipment we keep in our private hospitals to diagnose and treat our cases. We have in-house haematology and radiography and ultrasound; which gives us a lot of information.Vets are all running animal A and E’s alongside our routine work.

There were difficult conversations. But we had a plan. I discussed it with my team. I warned them it was risky; and that Bob could die.

We drained the blood from his chest using a wide bore needle; into a blood donation bag with coagulant; and we autotransfused him. This means we gave his own blood back to him through a blood transfusion. He had vitamin K and other treatments; like tranexamic acid to help stop the bleeding. He remained in ICU until he stabilized.

It worked! We relieved the pressure on his lungs; allowing them to expand; and his breathing settled almost immediately. His heart was racing; but we kept an eye on that. He started to recover within a few hours and by midnight he was out of the woods.

This morning he is charging around the ward with a normal PCV.

My team saved the day; and I couldn’t be prouder of them. I was happy to be on the phone making the treatment plan; but I was worried for them with me being away! They smashed it! Well done to Mariana, Avril, Katie, Orlaith and our animal care student Kelly. We’ll continue to monitor Bob; and he’ll need six weeks of medications until he has fully recovered.

Driving past our little clinic; you’d never know the dramas that could be going on behind the scenes! 😉

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