This document summarizes the background and experience of Dr. Philomena Kwong, an emergency and critical care veterinarian. It discusses her training and career path, including veterinary nursing, internships focusing on emergency medicine, and current work as an emergency vet since 2010. It then compares and contrasts the differences between emergency veterinary work and general practice, covering topics like hours, responsibilities, stress levels, and relationships with clients and patients.

1. Dr Philomena KwongBVSc (Hons) Emergency and Critical Care

2. My Background Veterinary nurse at WAEC 2006-2008 Graduation 2008 Rotating internship in emergency medicine, critical care, internal medicine and surgery at Queensland Veterinary Specialists in 2009 Animal Emergency Service 2010 til now

3. So what is it like to work as an Emergency vet?

4. Emergency General Practice Shift time: 8pm-8am* Break when it’s quiet between consults No vaccinations, worming etc Emergency surgeries only (no orthopaedic surgery expect for spinal surgeries) as soon as the patient is stablised. No long term client & patient relationship. Taking on referral cases Going home not having to stress about cases. 8am-5pm Standard lunch hours Vaccinations, worming Routine surgeries at scheduled time of day. Ongoing client & patient relationship. Referral of complicated cases Worrying about cases that are still in hospital as no one is there to look after them. +/- on calls at night Emergency VS General Practice

5. The challenge The instant satisfaction Touches on all the different disciplines of veterinary medicine Constantly learning The flexibility Full time = 3-4days a week Enjoy the day instead of working through it Is encouraged to sleep when work isn’t busy! (there’s usually a bed at the clinic) Make independent decisions The Good…

6. The Bad… Stress with unfamiliar cases or rare cases Angry clients due to waiting time (not uncommon in an emergency center) Talking about money to extremely distressed and emotional clients Abuse- mostly verbal but occasionally physical Higher incidences of litigation Miscommunication more likely when clients are distressed Long hours Unset finishing time Abnormal sleep pattern Working graveyard shifts Working most weekends Days off don’t coincide with people who work normal hours Working by yourself at night- consulting + procedures + looking after hospital patients

7. 2011 @ AES 2009 @ Pet ER Still doing Emergency 

8. 2012

9. So what cases do we commonly see?

10. Vomiting and Diarrhoea Lethargy/ Unwell Inappetence Itchy ears Urticaria Seizures Lameness Tick Paralysis Cane toad intoxications Coughing HGE HBC The Common Cases

11. The real emergencies Peritonitis Haemoabdomen Pleural effusion Dog attacks Diabetic Ketoacidosis Congestive heart failure Heat strokes Addisonian crisis Oesophageal foreign body Fulminant hepatic failure Tetanus Ethylene glycol toxicity Intestinal foreign bodies

12. The much hated emergencies

13. Gruesome photos Some interesting cases

26. Chemical Burn My presentation at Science Week during my internship year

28. What is your diagnosis?

29. Clinical Signs Lethargy Somnolence Paresis Ataxia Hyper-reaction to stimulus URINARY INCONTINENCE*****

30. MARIJUANA TOXICITY!

31. Treatment 1. Induce emesis (patients that are awake) or gastric lavage 2. Activated charcoal 0.5g-1g/kg PO **not in dogs that have severe somnolence 3. Induce diuresis (fluids @ 2 x maintenance) 4. Place urinary catheter 5. Monitor pCO2 (blood gas) for hypoventilation 6. +/- Ventilation Discharge once mentation returns to normal and urinary incontinence has resolved.

32. Estimation of costs

33. Tick Paralysis

34. COMMUNICATION THE MOST IMPORTANT ASPECT IN VETERNARY MEDICINE Establish trust Emergency treatments usually $$$$  TREATMENT VS EUTHANASIA New grads: 1/10 GDVs will go to surgery Senior vets: 9/10 will go to surgery Complaints & Litigation

35. Salary Every emergency clinic is different Average $400-500/shift Some have floor salary/ commission and is paid based on whichever one is the higher value Commission based only ** Note when on commission based- over treatment (i.e. doing things that could have waited to be done by regular veterinarian)/ unjustifiable treatments or diagnostics will result in termination.

36. How to become an emergency veterinarian Direct Requires previous emergency work experience- veterinary nursing Internship focusing on emergency medicine Must have consulting experience GP to gain experience  ER GP doing work experience at ER clinics  ER vet

37. Comparison

38. ADVICE Veterinary nursing Volunteer/ work experience Hands on experience is by far the easiest way to learn. No matter what field you will be in the future: YOU MUST HAVE INCOME PROTECTION !!! YOU MUST HAVE INDEMNITY INSURANCE !!!

39. The books that will save your life

40. Other books of interest

41. Referral If referral is not an option then call the specialists or emergency centers for advice Small Animal Critical Care Medicine VIN If you’re still really stuck

42. My little stray 10 weeks later ANY QUESTIONS?