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Dr Philomena KwongBVSc (Hons) Emergency and Critical Care
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
So what is it like to work as  an Emergency vet?
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
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…
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
2011 @ AES 2009 @ Pet ER Still doing Emergency 
2012
So what cases do we commonly see?
Vomiting and Diarrhoea Lethargy/ Unwell Inappetence Itchy ears Urticaria Seizures Lameness Tick Paralysis Cane toad intoxications  Coughing HGE HBC The Common Cases
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
The much hated emergencies
Gruesome photos Some interesting cases
Chemical Burn My presentation at Science Week during my internship year
What is your diagnosis?
Clinical Signs Lethargy Somnolence Paresis Ataxia Hyper-reaction to stimulus URINARY INCONTINENCE*****
MARIJUANA TOXICITY!
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.
Estimation of costs
Tick Paralysis
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
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.
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
Comparison
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 !!!
The books that will save your life
Other books of interest
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
My little stray 10 weeks later ANY QUESTIONS?

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Emergency and critical care veterinarian

  • 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 
  • 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
  • 14.
  • 15.
  • 16.
  • 17.
  • 18.
  • 19.
  • 20.
  • 21.
  • 22.
  • 23.
  • 24.
  • 25.
  • 26. Chemical Burn My presentation at Science Week during my internship year
  • 27.
  • 28. What is your diagnosis?
  • 29. Clinical Signs Lethargy Somnolence Paresis Ataxia Hyper-reaction to stimulus URINARY INCONTINENCE*****
  • 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.
  • 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
  • 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?

Editor's Notes

  1. I started nursing in third year after finishing my pre-clinical prac work. I initially did work experience at WAEC where I eventually was offered a job. It was the only job that I could fit in before and after class and on the weekends. I worked all the 3-8am shifts so I could make it to the 8am lectures. I graduated at the end of 2008 and started Pet ER’s rotating internship. Who doesn’t know what an internship is? Ok so an internship is a one year supervised experience where you get to rotate through various disciplines like medicine, surgery, oncology, dermatology, ophthalmology etc. We did focus mainly on doing emergencies so on my first day I had around 16 consults in 5 hours. Doesn’t sound like much but it was quite scary. After that I continued working in emergency at Animal Emergency Service, first at the Cararra clinic and now at Underwood.
  2. Anything an owner perceives as an emergency IS an emergency. But sometimes owners will decide to bring their dogs in that has vomited for 4 days.. Hasn’t eaten for 7 days on a Sunday night at 3am… beats us.
  3. Newbies get all the awesome exotic animals because the people who graduated before you will always claim that they haven’t learnt enough and that their knowledge is outdated.