When I don’t handle a case as well as I think I should have,
I try to go back and do some research so that I will do a better job next
time. The frustrating (or
encouraging?) thing is that I DO come up with a better plan, just a day or two
later. Here are some recent cases:
1. Indoor/outdoor cat with presenting complaint of
inappetance and lethargy for several days; had a fever on physical exam. The client
couldn’t afford both diagnostics and treatment. I wanted to use a broad-spectrum
antibiotic – possibly something like Baytril because I’d seen it work well on
cats with fevers. We had no Baytril. I panicked. I prescribed Clavamox. Later
that night once I got home I realized we had Orbax available (in the same drug
class as Baytril) and smacked myself on the forehead.
2. First thing on a Sunday morning a puppy was
presented for suspected intoxication. The clients didn’t know which drug (an
opioid or an antibiotic – they were taking both) or how much was ingested. The puppy was obtunded, bradycardic,
and pale. I strongly recommended that the puppy go 2 blocks down the street to
the emergency clinic because all I could think of to do was make the puppy
vomit (possibly a questionable choice if he was obtunded) and bolus IV fluids.
The next day I remembered that we had naloxone and I could have tried a small
dose of that IV to reverse the opioid (which is what I suspected it had
ingested.)
To be fair, I don’t feel like I royally screwed up either
case. Clavamox is a valid choice for case #1. Case #2 would have needed
intensive nursing and monitoring (maybe even a ventilator) which I could not
provide, and the puppy was stable enough to make the 5-minute drive to the
e-clinic. I just wish I had thought of those extra ideas a little earlier,
that’s all. These are the times where it would be really nice to work with even one other doctor to bounce ideas off of!
p.s. Given the number of crazy emergencies that presented to
me yesterday, I REALLY should just throw in the towel and go work at an e-clinic.
Seriously.
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