Friday, July 20, 2012

Death By Accident

Yesterday our evening appointments were interrupted by a woman rushing into the clinc carrying in a white collie mix who was flat out. She was hysterical and her three young half-clothed boys followed like ducklings in tow.

When she erupted into the front doors her shrieking turned into a full exam room of screaming. The receptionists were frantically yelling, the waiting clients were awestruck, and then joined the bellowing, and even though I was only half-way through my examination with a client I too joined in on the hysteria. I literally dropped my papers, ditched the exam, and high tailed it (despite the receptionists screams to "RUN!") behind the congo line parade of delirium. It was pandemonium, and all the neighbors knew.

A very young, intact, long white haired Shepherd mix was placed on the surgery table. He was lifeless, but still breathing. He seemed to be entering a comatose state and I knew the minute that I saw his bright red-purple gums and the slightly watered down blood pouring from his rectum that he was a heat stroke victim. As I started to take his temperature the first number that flashed onto the digital read-out was 106. Within 2 seconds it beeped at its max read out of 108 degrees. I told the 3 techs scrambling for equipment that he was a hyperthermia and that he was likely going to die.

Terrible, cold, short, words to hear. But I knew that surviving 108 plus degrees internal body temp was physiologically impossible.

We immediately transferred him to the dental table so we could start hosing him off with water. I reminded the staff to use "cool" vs "cold" water because ice-cold water on an already way over heated animal causes the vasculature on the skin's surface to vaso-constrict and stop blood flow, therefore arresting the cooling process.

I then knew that I had to very quickly go out to talk to the family.

Three boys under age 10 flocked to me like I was some sort of relief aid worker. They were all in summer shorts, no shoes, and no shirts. It appeared that their dogs discovery had occurred mid- afternoon summer play time. Their mom, also in summer pool attire, was crying uncontrollably and kept asking me.

I asked the receptionist to sit in the exam room with the boys while I took mom across the hall to discuss Rudy's condition.

"How did this happen?" she asked.

As much as I didn't have a spare second to try to console her in her grief-ridden confusion I tried to explain hurriedly that Rudy was very hot, and that I needed to know if she wanted me to start emergency treatment measures on him.  although his internal core temperature was above what I could record and that I feared he was too hot to be saved.

She replied "Yes," in a momentary lapse of tears gurgling and incomprehensible babble.

She asked me, "What happened?" and I wanted to pick her up and shake her. It was my honest first response. How could she not know what happened? How did she expect me to know?

I replied back to her, "Ruby has gotten too hot. His internal body temperature does not even register. He is above 108 degrees and I am afraid he is going to die." I had no time for platitudes, and there were 3 techs in the back treatment area and her dying dog who needed me immediately.

She started to mutter something to the effect of "we only left him tied out for two hours..."

It was a 100 plus degrees outside and I was going to say things I would regret and Ruby was going to die if I didn't leave.

I ran to the back and we started to try to reverse the series of life-ending steps that his body had already started.

One tech was still hosing him down. To the touch he was almost completely soaked now.

The other two techs were trying to place peripheral i.v. catheters in his front leg.

I barked out orders as fast as I could. Ruby needed an i.v. catheter in each front leg and fluids as fast as we could deliver them.

My staff is incredibly competent and every technician in the building can place an i.v. catheter within seconds. Multiple attempts at light speed and they still didn't have one catheter in. They stopped their attempts and moved over so I could jump in.

He had no blood pressure, no palpable veins, and hence they had had no success in placing the catheter.

Because he was so hot his blood had already started to condense. They were expecting to see a "flashback" of blood when the catheter entered the vein, but he was too hot for the blood to "flash."  He was a patient with blood vessels like they hadn't seen before and their idea of normal was prohibiting them from believing that their catheters were in the vein. As I advanced the catheter there was only a teeny tiny drop of blood to flash. They were expecting his vein to be the normal tube like liquid-blood filled structure that healthy pets have. But he was no longer a normal healthy pet. I quickly taped the first i.v. in and moved to the other leg.

The other leg was so difficult that I had to do what we call a "cut-down." The vein was so small, so obscure, and so damaged that I had to cut through the skin to dissect the vein out so I could then try to place the i.v. catheter. It is a procedure we only do when everything else has failed and we are up against a wall. I placed the second i.v. and we started to push fluids as fast as we could.

"The fluids won't run," they reported to me as quickly as they started to squeeze the i.v. bags.

The veins were blowing because the "tube" of the vein had been heated up to a point where the tube broke down. Not only were the walls of the tubes breaking down, but the liquid-blood inside of them was no a jello-like consistency. He had essentially evaporated off the liquid and congealed his own blood. Both legs i.v. catheters were blown as quickly as we had started to push the i.v. fluids.

Within minutes of cool water cooling his temperature registered at 106.5. It was better than >108, but he was failing, and all of our attempts to save him were too.

He then started to seize. I tried to give an emergency valium dose to stop the seizure but seconds after the seizure started his heart started to beat irregularly.

At this point I looked at my staff. They were begging me to save him, and gazing at me as if I had some magical powers to stop and reverse time.

I said to them again "I am sorry, I think he is going to die."

I looked at Ruby and I said, "I am sorry."

His heart changed from too slow, during his seizure, to wildly erratically irregularly fast. He was in atrial fibrillation now. I grabbed for more drugs. His eyes opened, his head flew back, the pupils went fixed and dilated, and his mouth gaped open as if to release a harboring demon.

The techs begged me to put him down. One grabbed for the euthanasia solution as I wrapped my hand around the area of his chest where I could feel his dying bewildered heart take its last few beats.

As he took his last breath I pierced his heart with the pink fluid to relieve his struggle. He died before the fluid could assist him.

It had been less than 20 minutes and we had all witnessed what we all collectively agreed was the most excruciatingly horrible death.

I returned to the family to notify them of Ruby's passing. The boys, who had not seemed upset before, now screamed in a charged guttural grief stricken cry. Their mom held them and tried to comfort them. I could tell that she wasn't going to let herself cry while she stayed strong for her children.

The rest of the family arrived a little while later. I spoke to all of the adults together.

They didn't understand that 2 hours was likely an hour and 50 minutes longer than any dog could tolerate in 100 plus degree very high humidity heat. They told me that they never tie him up, but because the kids were out playing, and because Ruby was trying to corral them up, they had tied him to a bush. He had been jumping and barking and when they found him he was collapsed under the bush.

I tried to explain that dogs are about 2 degrees warmer than humans are, they wear a fur coat all year around, and that they have a very limited ability to sweat.

Ruby's death was a terrible tragic accident and my only hope is that his story will save other pets out there somewhere.

Please never leave your pets outside in hot weather. NEVER EVER leave them in a car. And if they start to pant its time to get them wet and cool them off.

Any pet over 103 degrees needs to go to a vet immediately!

My thoughts and prayers are with Rudy's family.



I saw this online recently. It is a petition at change.org.

It’s a sight that makes Dorothy Hearst desperately worried every summer: a car parked at a shopping center, a dog looking anxiously out the window, and no owner in sight.
Dorothy never leaves Emmi, a 3-year-old Labrador whom she adores, in her Subaru -- as a lifelong dog lover, she knows that in the few minutes it takes to run an errand, the temperature in a car can soar to almost 110 degrees. But many people don’t realize that even a 15 minute errand can be fatal for their beloved pets.
For Dorothy, it’s heartbreaking. And what’s worse is knowing it can happen to even the most loving owners -- people simply don’t realize the danger. Dorothy knows that educating people would save the lives of countless dogs. That’s why she’s started a petition asking Subaru, which prides itself on its dog-friendly image, to make an ad warning drivers not to leave their dogs in the car during the summer.
As a Subaru driver, Dorothy appreciates all the ways the company has already shown it cares about dogs -- and she loves its popular "Dog Tested, Dog Approved" ads showing dogs test driving its cars with hilarious results. This summer, she thinks Subaru can use these creative ads to send an important message about the dangers of hot cars -- and save the lives of hundreds of dogs.
Subaru says 70% of its customers are pet owners, and Dorothy thinks this makes them the ideal voice for such an important, dog-friendly message. She's convinced that Subaru will jump at the chance to appeal not only to its own customers, but to dog lovers everywhere -- and she knows that this is one of the most powerful ways to make sure this summer, more dogs don’t die needlessly.** ask Subaru to save dogs’ lives by making an ad warning owners not to leave their dogs in the car this summer.
Thanks for being a change-maker, via Change.org see Dorothies petition.


The signing period for this petition has closed. You can notify Subaru yourself via their link at  https://www.subaru.com/shopping-tools/contact-us.html. Wouldn't it be nice if there was a way for automobiles to detect if a pet or person was in the car? It will happen someday.


For more information on the dangers of pets in cars see; http://www.petmd.com/dog/emergency/common-emergencies/e_dg_heat_stroke

4 comments :

  1. Replies
    1. It was a terrible day for everyone. I will never forget it.

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  2. Thank you for this post! You put a 'human' face on this tragedy that a 'sound byte' or 'heat chart' just can't do.

    It felt real, in fact I felt like I was there in the treatment room with your techs...high anxiety and a sad ending. But if your post (and I shared it on both my FB pages, our hospital FB page and Tweeted it, too) can save one pet, it will have been a good day for that pet and that family!

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