Small Animal Emergency and Critical Care: Case Studies in Client Communication, Morbidity and Mortality


Small Animal Emergency and Critical Care: Case Studies in Client Communication, Morbidity and Mortality provides a unique opportunity to learn from real case examples. Presented as a collection of short case-studies, a wide-range of situations likely to arise in emergency practice is examined. The approach is modeled on the Morbidity and Mortality Conferences which were first established as a training and educational tool for medical doctors. They have now been successfully adopted in veterinary medicine as a ...

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Small Animal Emergency and Critical Care: Case Studies in Client Communication, Morbidity and Mortality

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Small Animal Emergency and Critical Care: Case Studies in Client Communication, Morbidity and Mortality provides a unique opportunity to learn from real case examples. Presented as a collection of short case-studies, a wide-range of situations likely to arise in emergency practice is examined. The approach is modeled on the Morbidity and Mortality Conferences which were first established as a training and educational tool for medical doctors. They have now been successfully adopted in veterinary medicine as a forum for case review and learning opportunities, encouraging thorough review from different perspectives. Each chapter presents a real case, and highlights the pitfalls that both novice and experienced veterinarians can encounter. A key theme of the book is on communication issues. Owner perspectives are discussed, and how communications between clinicians and owners can be optimized to allow veterinarians to better meet owner expectations. The cases were provided by a variety of experienced veterinarians, primarily specialists in veterinary emergency and critical care, as well as other specialties, general practice, universities, and private institutions. Highly readable, this book is suitable either to absorb from cover to cover, or for reference to a specific case or situation. It highlights a number of common clinical problems and communication issues that either did or may lead to difficulties in case management, helping you to avoid these situations.

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Editorial Reviews

Doody's Review Service
Reviewer: Mauria O'Brien, DVM, DACVECC (University of Illinois College of Veterinary Medicine)
Description: In this compilation, the authors share their small animal emergency and critical care cases with a focus on potential complications, medical errors, and client communication issues. The book is divided into four parts. Part one focuses on treatment errors, part two on medical judgment errors, and parts three and four on client and staff communication issues.
Purpose: The purpose is to provide case examples from a variety of experienced veterinarians with the goal of highlighting a number of common clinical difficulties in case management. The authors meet their objectives by sharing their cases and giving suggestions on how to appropriately diagnose and treat specific conditions. Because every pet is accompanied by an owner, adding to the complexity of each case, the book provides excellent information on how to deal with client communication difficulties.
Audience: This is an important addition to any emergency clinician's library. It is useful for veterinary emergency room physicians, interns, and residents. The authors are mostly specialists with a vast amount of experience in the fields of emergency and critical care as well as internal medicine.
Features: This book is divided into four sections. Section one is dedicated to cases involving diagnostic and treatment errors, and covers special diagnostic procedures, drug selection, and surgical intervention. Section two covers medical judgment errors involving the physical exam, interpretation of diagnostic test results, and misinterpretation. Section three involves lessons learned from client communication issues, and section four is an extensive example list of communication issues between doctors and hospital staff. This book is unique in that it presents the perspective of veterinary specialists dealing with real cases and the lessons to be learned from mistakes. Each case has key take home points.
Assessment: This is a great book for veterinarians in general practice as well as those in training. No other book (to my knowledge) in veterinary medicine addresses medical errors and communication issues from the point of view of a specialist. This book is extremely useful and provides great learning material based on past experiences in order to prevent future errors.
From the Publisher
“I can strongly recommend this book to everyone involved in small animal emergencies.” (Veterinary Times, 9 April 2012)

"This is a great book for veterinarians in general practice as well as those in training. No other book (to my knowledge) in veterinary medicine addresses medical errors and communication issues from the point of view of a specialist. This book is extremely useful and provides great learning material based on past experiences in order to prevent future errors." (Doody's, 29 July 2011)

"Worth reading several times... This book is an easy and interesting read and is very accessible... it is a book that I believe is useful for both experienced and newly-graduated vets and also nurses, as not only are clinical aspects broached, there is also a large focus on communication." (Veterinary Practice, May 2011)

"In my opinion, most cases in this book would make a great discussion starter for staff meetings / clinical audit meetings. The book should be required reading for all interns and residents in the relevant fields. It is an excellent resource for anyone who deals with emergency or critically ill patients, filling a particular need that is not met by other textbooks." (Veterinary Record, April 2011)

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Product Details

  • ISBN-13: 9781405167529
  • Publisher: Wiley
  • Publication date: 10/26/2010
  • Edition number: 1
  • Pages: 232
  • Product dimensions: 6.70 (w) x 9.50 (h) x 0.60 (d)

Meet the Author

Dr Lisa Powell is a clinical professor at the University of Minnesota Veterinary Medical Center, US. Dr Elizabeth Rozanski and Dr John Rush are clinical professors at Tufts University Cummings School of Veterinary Medicine, US. All three are board-certified Diplomates of the American College of Veterinary Emergency and Critical Care, and have 50 years of emergency and critical care experience between them. The authors have practiced in institutions that provide advanced diagnostic techniques, 24-hour emergency and intensive care medicine, and training of both professional veterinary students and post-doctorate veterinarians seeking specialty certification in veterinary emergency and critical care. Dr Rush is also board-certified in veterinary cardiology, and Dr Rozanski is board-certified in veterinary internal medicine.

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Table of Contents

Contributor list


Part One Medical and Treatment Errors 1

1 Coming Up for Air: When equipment failure can be fatal 3

2 Alistair and the UTI: Sometimes antibiotics ARE indicated! 6

3 Double-Check the RX: How a simple math error cost a dog his life 8

4 Holey Chest Tube!: How some inadvertent complications led to a change in standard operating procedure 11

5 Count Your Sponges: A simple procedure can sometimes result in disaster 14

6 First Off, Do No Harm: Always check tube placement, by many methods! 17

7 Right is Wrong: An example of a tragic outcome due to unmarked radiographs 21

8 Sabrina the Good Witch: The importance of using the correct syringe 25

9 Friends in High Places: An illustration of how imperative it is to correctly prepare and administer medications 28

10 Midnight: A case describing the consequences of technical complications 31

11 Sam and the Muscle Medicine: When you should listen to your gut and not your clients' wishes 35

12 A Shot in the Dark: The importance of discussing all potential complications prior to performing the procedure 38

Part Two Medical Judgment Errors 43

13 Another Down Dog: Sometimes things are not as they seem! 45

14 It HAS to Be Blasto!: Surprise endings 47

15 Can You Tap That Cat for Me?: Complications of common procedures 50

16 Chief's Complaint: Entertain all differential diagnoses 52

17 But He's Been Fine!: The importance of assessing thoracic radiographs in patients experiencing blunt force trauma 54

18 Would You Like Water with That? A Tale of Two Dogs: The dangers of hypernatremia! 57

19 The Great Pretender: Always consider hypoadrenocorticism as a differential diagnosis in dogs with nonspecific symptoms 60

20 A Lack of Concentration: Another example of how Addison's disease can masquerade as a disease with a much worse prognosis 63

21 Unlucky Lady: Remember to consider All possible differential diagnoses for your patient! 67

22 But She Has Heart Disease!: All aspects of a patient's history should be carefully considered when presenting for an illness 69

23 Pennies from Heaven: Always perform abdominal radiographs in patients presenting with signs of intravascular immune-mediated hemolytic anemia! 71

24 Seeing Red!: All ocular abnormalities should be examined promptly and completely, as irreversible disease may be present 74

25 Sepsis the Next Day?: An illustration of the importance of analyzing effusions yourself if the results will not be reported the same day, and to Always look under the tongue of vomiting cat! 77

26 Anxious to Breathe: Care must be taken when performing diagnostics on brachycephalic, apprehensive dogs 81

27 The Lost Acorn: A complicated case gets more perplexing! 83

28 The Lost Puppies: How the inexperience of a junior veterinarian caused the demise of two puppies 85

29 Don't Be Too Cavalier: A full abdominal exploratory should always be performed during an abdominal surgical procedure 88

30 Too Much Sugar: All causes, pulmonary and extrapulmonary, should be investigated in patients with respiratory distress 90

31 Tyler: Dehiscence of enterotomy sites should always be considered as a cause of illness in the 3-5 days following the operative procedure 92

32 Whiskers: Immunosuppression from administered medications can result in the development of secondary infections 94

33 Would You Like Some Salt?: The importance of monitoring fluid therapy 96

34 Bambi?: Things to think about when coming into contact with wild animals 100

35 The Big C: The dangers of making a pathologic diagnosis without obtaining a biopsy 102

36 To Stent or Not to Stent?: New technology isn't always the answer 104

37 It Isn't Asthma?: Noting when it is important to look past the suspected client situation and focus on the patient 106

38 Hoping History Doesn't Repeat: An illustration of the importance of good history taking 108

Part Three Lessons in Client Communication 111

39 Not All Albumins Are Equal: When transfusing nonautologous fluids, possible allergic reactions should always be considered and discussed with the client prior to administration 113

40 Believing the Client: Listen to the client! They know their pets the best! 116

41 But I Thought He Would Be Fine?: The importance of communication about prognosis and risk---junior clinician errors 119

42 If It's Not in the Medical Record, Did It Happen?: The importance of a medical director addressing any and all client concerns 124

43 Hemangiosarcoma Is Bad: Failure to completely evaluate patients can result in a misdiagnosis 130

44 The Internet Can Be a Dangerous Thing: One must take into consideration the availability of information on the Internet, whether it be true or not, when discussing disease diagnosis and treatment 134

45 Is there Some "Wiggle" Room?: An illustration of how essential it is to offer a variety of options to clients 138

46 But CPCR Was Successful!: Clear, timely communication about changes in patient status 142

47 Rosie and the Platelets: Novel therapies require a firm discussion of risk and benefit 144

48 The Receptionst's Dog: Family and friends' pets can be particularly stressful for clinicians 147

49 We'll Take Good Care of Maxwell!: Unexpected deterioration of a pet after admission 149

50 A Diagnosis to Stand By: A case highlighting why things are not always as they seem 151

51 The Confused Setter: Making sure that all presenting clinical complaints are addressed 154

52 Tasty Fungi: Working within financial constrainsts when the disease and prognosis are unknown 157

53 Watch What You Write!: A lesson on how to always be professional 160

54 But She Was Just Vomiting!: The importance of organization in the midst of chaos 162

55 Peroxide Puppy: A case discussing the potential concerns of phone advice 164

56 Too Tight!: An illustration of possible complications associated with bandage placement 167

57 What Was That Popping Sound?: What to do when a routine procedure goes wrong 169

Part Four Communication Issues between Colleagues and Hospital Staff 173

58 Bandit: A case documenting stresses around the holidays, and illustrating different clinical approaches 175

59 Check the Medicines: A case describing a very busy day, with an inadvertent distribution of the wrong medications 178

60 Cricket and the Insidious Radiograph: Understanding the right and wrong ways to teach and learn 180

61 Go Team!: Highlighting the role of experienced technicians in management of cases 183

62 Not Just Another Blocked Cat: Outlining conflict between client cost constraints and clinician wishes 186

63 Whose Fault?: Highlighting communication between a primary care hospital and an emergency clinic 190

64 Shelby and the Needles: What to do when a situation has changed dramatically since the last physical examination 193

65 Slow and Easy: The problems of "selling" an unfamiliar procedure to a client 197

66 The Bandage: An example of noncollegial behavior 200

67 We'll See What the Blood Work Shows: The importance of timely client communication 202

68 What Antibiotic Is Best?: Highlighting communication issues between senior veterinary clinicians 204

69 Molly and the Chicken Bone: A case outlining the importance of reevaluating patients referred for a second opinion 206

70 Know the Nodes: Why physical examination is so important 208

71 Nancy's Neck Pain: A case outlining why a specialist may be helpful 210

Appendix: How to Set Up Your Own Morbidity and Mortality Conference 215

Index 217

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  • Posted January 15, 2011

    Highly Recommended for vets and technicians alike!

    I would like to thank Wiley-Blackwell for giving me this opportunity to review this book. Their offer of a review copy was most generous.

    This book is being marketed to veterinarians but can be utilized by technicians as well. All 71 case studies teach a lesson, whether it be to double check your medicine calculation before administration, the importance of taking a proper and thorough history, to the necessity of complete and accurate communication between and among hospital personnel.

    The contents are broken down into four parts: medical treatment errors, medical judgment errors, lessons in client communication, and communication issues between colleagues and hospital staff. Each case summary is only about 2-4 pages long, so each lesson can be taken in quickly. At the end of each case is a "Key Points" block which further highlights where things went wrong, how the error could have been prevented, and steps to take to avoid this happening in the future. All cases are factual, taken from morbidity and mortality rounds from animal hospitals throughout the U.S. The names have been changed to protect doctor-patient-owner confidentiality.

    The case studies are presented in a way that both veterinarians and technicians will be able to understand. Treatment histories are clear, with patient stats and lab results included. Some cases are further illustrated by actual patient radiographs or ECG tracings.
    As I read each case, I was amazed at the number of preventable complications described. It may be very easy for the reader to say that it would "never happen in MY hospital", but the sad case is, that is not true. Mistakes can be made by anyone, regardless of their experience or level of education.

    Some of the cases that made me cringe:
    . The dog with neoplasia that had the wrong leg amputated
    . The dog that died because it was given 15 mL instead of 1.5 mL of neostigmine
    . The diabetic cat that could have died because the catheter was not checked and her dextrose extravasated into her SQ space
    . Two patients being discharged at the same time, receiving each other's medications
    . Arguments and attitude between either RDVMs, or between an RDVM and a specialist, with the patient's illness seemingly forgotten
    . The dog that underwent an abdominal explore needlessly, due to the fact that a proper history was not taken upon presentation to the hospital
    . The blocked cat whose bladder ruptured and the owner sued because the intern did not cover all the possible complications of the unblocking procedure

    I strongly recommend this book by read by all veterinary personnel, whether you are a general practice doctor; a surgeon; or a technician who works either in the patient wards, takes radiographs, or simply takes a history. Each case will make you stop and think, and if you are truly dedicated to patient care, vow to work hard to NEVER make these mistakes on your watch.

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