Small Animal Emergency and Critical Care: Case Studies in ClientCommunication, Morbidity and Mortality provides a uniqueopportunity to learn from real-life case examples. Presented as acollection of short case studies, the book examines a wide range ofsituations likely to arise in emergency practice.
The approach is modeled on the Morbidity and MortalityConferences which were first established as a training andeducational tool for medical doctors. They have now beensuccessfully adopted in veterinary medicine as a forum for casereview and learning opportunities, encouraging thorough review fromdifferent perspectives.
Each chapter presents a real case, and highlights the pitfallsthat both novice and experienced veterinarians can encounter. A keytheme of the book is on communication issues. Owner perspectivesare discussed, as well as how communications betweenclinicians and owners can be optimized to allow veterinarians tobetter meet owner expectations.
The cases were provided by a variety of experiencedveterinarians, primarily specialists in veterinary emergency andcritical care, as well as other specialties, general practice,universities, and private institutions.
This highly readable book is suitable either to absorb fromcover to cover, or for reference to a specific case or situation.It highlights a number of common clinical problems andcommunication issues that either did or may lead to difficulties incase management, helping you to avoid these situations.
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About the Author
Dr Lisa Powell is a clinical professor at the University ofMinnesota Veterinary Medical Center, US. Dr Elizabeth Rozanski andDr John Rush are clinical professors at Tufts University CummingsSchool of Veterinary Medicine, US. All three are board-certifiedDiplomates of the American College of Veterinary Emergency andCritical Care, and have 50 years of emergency and critical careexperience between them. The authors have practiced in institutionsthat provide advanced diagnostic techniques, 24-hour emergency andintensive care medicine, and training of both professionalveterinary students and post-doctorate veterinarians seekingspecialty certification in veterinary emergency and critical care.Dr Rush is also board-certified in veterinary cardiology, and DrRozanski is board-certified in veterinary internal medicine.
Table of Contents
Part One: Medical and Treatment Errors.
1. Coming Up for Air: When equipment failure can befatal.
2. Alistair and the UTI: Sometimes antibiotics AREindicated!
3. Double-Check the RX: How a simple math error cost a doghis life.
4. Holey Chest Tube!: How some inadvertent complications ledto a change in standard operating procedure.
5. Count Your Sponges: A simple procedure can sometimesresult in disaster.
6. First Off, Do No Harm: Always check tube placement, bymany methods!
7. Right is Wrong: An example of a tragic outcome due tounmarked radiographs.
8. Sabrina the Good Witch: The importance of using thecorrect syringe.
9. Friends in High Places: An illustration of how imperativeit is to correctly prepare and administer medications.
10. Midnight: A case describing the consequences of technicalcomplications.
11. Sam and the Muscle Medicine: When you should listen toyour gut and not your clients’ wishes.
12. A Shot in the Dark: The importance of discussing allpotential complications prior to performing the procedure.
Part Two: Medical Judgment Errors.
13. Another Down Dog: Sometimes things are not as theyseem!
14. It HAS to Be Blasto!: Surprise endings.
15. Can You Tap that Cat for Me?: Complications of commonprocedures.
16. Chief’s Complaint: Always suggest furtherdiagnostics, and consider all differential diagnoses in apatient.
17. But He’s Been Fine!: The importance of assessingthoracic radiographs in patients experiencing blunt forcetrauma.
18. Would You Like Water with That? A Tale of Two Dogs: Thedangers of hypernatremia!
19. The Great Pretender: ALWAYS consider hypoadrenocorticismas a differential diagnosis in dogs with nonspecificsymptoms
20. A Lack of Concentration: Another example of howAddison’s disease can masquerade as a disease with a muchworse prognosis.
21. Unlucky Lady: Remember to consider ALL possibledifferentials for your patient!
22. But She Has Heart Disease!: All aspects of apatient’s history should be carefully considered whenpresenting for an illness.
23. Pennies From Heaven: ALWAYS perform abdominal radiographsin patients presenting with signs of immune-mediated hemolyticanemia!
24. Seeing Red!: All ocular abnormalities should be examinedpromptly and completely, as irreversible disease may bepresent.
25. Sepsis the Next Day: An illustration of the importance ofanalyzing effusions yourself if the results will not be reportedthe same day, and to ALWAYS look under the tongue of a vomitingcat!
26. Anxious to Breathe: Care must be taken when performingdiagnostics on brachycephalic, apprehensive dogs.
27. The Lost Acorn: A complicated case gets moreperplexing!
28. The Lost Puppies: How the inexperience of a juniorveterinarian caused the demise of two puppies.
29. Don’t Be Too Cavalier: A full abdominal exploratoryshould always be performed during an abdominal surgicalprocedure.
30. Too Much Sugar: All causes, pulmonary and extrapulmonary,should be investigated in patients with respiratorydistress.
31. Tyler: Dehiscence of enterotomy sites should always beconsidered as a cause of illness in the 3–5 days followingthe operative procedure.
32. Whiskers: Immunosuppression from administered medicationscan result in the development of secondary infections.
33. Would You Like Some Salt?: The importance of monitoringfluid therapy.
34. Bambi?: Things to think about when coming into contactwith wild animals.
35. The Big C: The dangers of making a pathologic diagnosiswithout obtaining a biopsy.
36. To Stent or Not to Stent: New technology isn’talways the answer.
37. It Isn’t Asthma?: Noting when it is important tolook past the suspected client situation and focus on thepatient.
38. Hoping History Doesn’t Repeat: An Illustration ofthe importance of good history taking.
Part Three: Lessons in Client Communication.
39. Not All Albumins are Equal: When transfusingnonautologous fluids, possible allergic reactions should always beconsidered and discussed with the client prior toadministration.
40. Believing the Client: Listen to the client! They knowtheir pets the best!
41. But I Thought He Would Be Fine?: The importance ofcommunication about prognosis and risk—junior clinicianerrors.
42. If It’s Not in the Medical Record, Did It Happen?:The importance of a medical director addressing any and allclient concerns.
43. Hemangiosarcoma is Bad: Failure to completely evaluatepatients can result in a misdiagnosis.
44. The Internet Can Be a Dangerous Thing: One must take intoconsideration the availability of information on the internet,whether it be true or not, when discussing disease diagnosis andtreatment.
45. Is there Some “Wiggle” Room?: An illustrationof how essential it is to offer a variety of options toclients.
46. But CPCR Was Successful!: Clear, timely communicationabout changes in patient status.
47. Rosie and the Platelets: Novel therapies require a firmdiscussion of risk and benefit.
48. The Receptionist’s Dog: Family and friends’pets can be particularly stressful for clinicians.
49. We’ll Take Good Care of Maxwell!: Unexpecteddeterioration of a pet after admission.
50. A Diagnosis to Stand By: A case highlighting why thingsare not always as they seem.
51. The Confused Setter: Making sure that all presentingclinical complaints are addressed.
52. Tasty Fungi: Working within financial constraints whenthe disease and prognosis are unknown.
53. Watch What You Write!: A lesson on how to always beprofessional
54. But She was just Vomiting!: The importance oforganization in the midst of chaos.
55. Peroxide Puppy: A case discussing the potential concernsof phone advice.
56. Too Tight!: An illustration of possible complicationsassociated with bandage placement.
57. What Was That Popping Sound?: What to do when a routineprocedure goes wrong.
Part Four: Communication Issues between Colleagues andHospital Staff.
58. Bandit: A case documenting stresses around the holidays,and illustrating different clinical approaches.
59. Check the Medicines: A case describing a very busy day,with an inadvertent distribution of the wrong medications.
60. Cricket and the Insidious Radiograph: Understanding theright and wrong ways to teach and learn.
61. Go Team!: Highlighting the role of experiencedtechnicians in management of cases.
62. Not Just Another Blocked Cat: Outlining conflict betweenclient cost constraints and clinician wishes.
63. Whose Fault?: Highlighting communication between aprimary care hospital and an emergency clinic.
64. Shelby and the Needles: What to do when a situation haschanged dramatically since the last physical examination.
65. Slow and Easy: The problems of “selling” anunfamiliar procedure to a client.
66. The Bandage: An example of noncollegial behavior.
67. We’ll See What the Blood Work Shows: The importanceof timely client communication.
68. What Antibiotic is Best?: Highlighting communicationissues between senior veterinary clinicians.
69. Molly and the Chicken Bone: A case outlining theimportance of reevaluating patients referred for a secondopinion.
70. Know the Nodes: Why physical examination is soimportant.
71. Nancy’s Neck Pain: A case outlining why aspecialist may be helpful.
Appendix: How to Set Up Your Own Morbidity and MortalityConference.
Most Helpful Customer Reviews
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.