kasey (allthingsshiny) wrote,

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taffy the spaniel

I had an interesting gomer last night.

Taffy, a ten year old cocker spaniel, post-op diaphragmatic hernia with entrapment of parts of the liver, spleen, and bowel. Cancerous nodules were apparent on the liver during repair. A real winner from the start. Blood transfusions immediately after surgery, arrythmias even before the procedure and much more pronounced after it.

She looked horrible saturday night, but wasn't my patient. Last night, she looked worse and i had her all to myself. She had a regular IV catheter, a central line in the rear leg, and a double lumen (two port) central in her neck, one for measuring blood pressure and one for the TPN we anticipated her needing in the future. She also had a chest tube in place (to aspirate fluid and air from her chest) and a urinary catheter in.

Taffy had four lines going into her: a dopamine drip for her blood pressure, a crystalloid solution with dextrose, a CRI of mannitol (a diuretic), and Hetastarch (colloid blood volume expander). Coming from her, she had the line to measure her central venous blood pressure, the ECG leads, and the line from her urinary catheter. Six tubes and three electrode lines. I labeled all of them and tried to keep them organized. Every time she moved or had to be turned, they would tangle.

Every hour, i drained her chest tube. Every other hour, i took her blood pressure and measured her oxygenation levels. Every four, i measured her urine and turned her. Every six, I obtained a full set of vitals and some bloodwork. She got all sorts of medications through the night, something else every hour. I didn't work on many other patients, because there was always something to be done for taffy.

We couldn't keep her blood pressure up, and without good blood pressure, the kidneys fail. When the kidneys fail, the body can't rid itself of waste and fluids. The heart can't process the extra fluid, and it ends up in the lungs. When it the lungs are full of fluid, the whole body is deprived of oxygen and dies. Taffy was on her way there when the owner finally decided to euthanize.

All in all, it was an interesting case. I was kinda proud to realize that the doctor I was working with would give me orders like "give her 50mg/kg of *drug* in a CRI over 24 hours" and trust that i would be able to calculate everything out properly. It's not all that complicated, but drug calculations are rarely left up to technicians. I also got the central venous pressure machine set up on my own, and that is a messy piece of equipment. No one wanted to do it - i asked a few techs if they knew anything about it, and they all ran the other way. it involves hanging a bag of fluids pressurized to a certain level, opening certain valves and closing other ones, getting the adapter positioned so that it is at the exact level of the heart, and also finding the damn adapter. But now i can do it, and without help.

I wasn't sad when they put her to sleep. I was sad when I had to 'second' the phone authorization for euthanasia - to ask a sobbing old woman to confirm that yes, she does wish to euthanize taffy - that's not easy.
Tags: work

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