Call the Ambulance!

November 26, 2012

Whenever I meet a new client at our animal hospital, I like to give them a brief rundown of our hospital’s hours, policies and procedures. We do see emergencies whenever our hospital’s doors are open. However, it is important clients know that our hospital is closed overnight, and that we do not take overnight emergency call. Fortunately, there are several wonderful 24-hour emergency and speciality facilities nearby to help our clients and patients in the middle of the night, when we are not available. A question clients often ask is “What constitutes a pet emergency?” Below is a list of some of the signs and symptoms that your pet may be experiencing a medical emergency and needs urgent care. This entire post, of course, is intended to be a very basic guide for pet owners. If you are unsure whether your pet’s condition is an emergency, please have him evaluated! It is much better to be safe than sorry.

1.) Respiratory distress

This is defined as labored breathing, excessive panting, increased respiratory rate, increased respiratory effort, wheezing and, for cats, open-mouth breathing. While dogs pant, cats do not. Any time a cat is breathing with her mouth open, this is considered a bona fide emergency and she should be immediately rushed to the veterinary hospital. If your pet seems to have a blue discoloration to his tongue, or a very pale tongue and gums, this is further indication to have him evaluated right away. A blue tongue can indicate hypoxia, or a lack of circulating oxygen to the body’s tissues. Pale/white gums can indicate severe anemia or shock. A physiology professor at my alma mater, Penn Vet, used to say “No breathe, no live.” Any hint of respiratory trouble is truly the definition of a medical emergency!

2.) Inability to walk or stand

If your pet suddenly seems to be weak or paralyzed in the hind legs, or is unable to stand or walk without assistance, this requires urgent evaluation. In dogs, intervertebral disc disease (IVDD) is a common cause of acute weakness in the limbs, and may be permanent without emergency surgery. In cats, aortic thromboembolism, or a clot in the main artery leaving the heart, is the most common cause of acute paralysis of the hind legs. Of course, there are a variety of other conditions that can result in limb weakness but the majority of them are considered emergencies.

3.) Hit by car

This may be a no-brainer for pet owners, but a surprising number of pet owners bring their animals in days or weeks after being hit by a car. While some injuries resulting from vehicular trauma (wounds, broken limbs) may be immediately obvious to pet owners, a lot of trauma (pulmonary contusions, intra-abdominal bleeding, ruptured bladder) may not be, and these are life-threatening conditions.

4.) Altered mentation

If Fluffy or Fido seems unconscious, minimally responsive to you, or mentally inappropriate (stumbling, confused, acutely blind), these neurologic symptoms require urgent evaluation. Toxin ingestion, trauma, retinal detachment, infection and a host of other diseases can result in these symptoms.

5.) Seizures (caveat: only if lasting more than 5 minutes, or if multiple seizures occur within a short time period)

While alarming to watch, seizures are often not a medical emergency. The reality is, by the time owners bring their seizing pet to us, the seizure is finished and the animal appears perfectly normal. If an animal is actively exhibiting seizure activity for more than five minutes (check your watch, because any seizure can feel like an eternity when you’re forced to watch it) or if your pet has multiple seizures in quick succession, this constitutes an emergency. If your pet has a seizure, make sure he’s in a place where he can’t hurt himself, and stand back. Many pet owners have been inadvertently bitten by their seizing pet. It is a fallacy that dogs and cats (and humans) can swallow their tongue while having a seizure, so please do not put your hand in Fido’s mouth. If you’re unsure whether or not your pet’s seizure is an emergency, please call your veterinarian for guidance. All pets having a seizure for the first time should be examined, and probably have bloodwork to rule out metabolic diseases; however, this can often be done as a routine appointment during regular office hours.

6.) Collapsing or fainting episodes

It can be very difficult for owners (and sometimes veterinarians) to determine when a pet’s “episode” is a seizure or a fainting spell (called syncope). If Fluffy or Fido collapses, or appears to faint, then rouses immediately, this is not likely to be a seizure. Seizures have a post-ictal period, where it can take an animal many minutes to hours to completely revert back to normal. Syncopal episodes can result from an arrhythmia (irregular heart beat), acute blood loss, toxin ingestion, choking, etc. These generally are considered emergencies and your pet should be evaluated promptly.

7.) Known ingestion of a medication, toxic substance or foreign object

Time is of the essence when Fido has eaten a bottle of Advil, a box of chocolate or your child’s mitten! If we see patients shortly after they have ingested an inappropriate substance, we can quickly induce vomiting and bring up the offending item. This could prevent an intestinal obstruction, or systemic toxicity. Your pet can then also be given activated charcoal, to prevent intestinal absorption of a toxic substance. Do not delay if you know that Fido or Fluffy has eaten something inappropriate! This is truly a situation where, the sooner we address the problem, the better the outcome is likely to be.

8.) Excessive vomiting or severe liquid/bloody diarrhea

This is a tricky area, because we see so many appointments with pets who have gastrointestinal symptoms. In my mind, one or two episodes of vomiting or diarrhea in a pet that is eating and acting normally is not considered an emergency. I rarely consider diarrhea an emergency at all, unless your pet is having copious, liquid diarrhea and losing large volumes of fluid, or if the diarrhea appears to be very bloody liquid. Vomiting is often more of a concern than diarrhea, particularly if there are many vomiting episodes in a short time, if your pet is unable to hold down any food or water, or if the vomiting is accompanied by lethargy and/or anorexia. When in doubt, call your vet for further guidance!

9.) Bleeding wounds, lacerations, bite wounds, and abscesses

If Fluffy has a gaping wound that is bleeding heavily, this obviously should be seen promptly. Wounds are much easier to close when they are fresh, and they have better healing potential than a wound that is several days old. In many cases, we elect not to close older wounds at all since they may be infected.

10.) Severe, non-weight bearing lameness

When Fido is holding up one of her legs, and unable to walk on it, or if one of her limbs seems to be swollen, this is an emergency. Fido should be examined to ascertain that she didn’t break a bone, or that she doesn’t have a systemic infection like Lyme disease. A minor limp, where Fido is still bearing weight, particularly if it’s not acute, does not constitute an emergency and can be evaluated during normal office hours.

11.) Straining to urinate, decreased urine production and/or bloody urine

Particularly in young, male cats, it is essential to ensure that they do not have a urinary tract obstruction if they are exhibiting the above behaviors. This is a life-threatening condition where a plug of mucous or grit blocks the urethra, obstructing outflow of urine. Male dogs can also have urinary obstructions, but they are far less common than in male cats. Female pets generally do not experience this condition, due to a much wider urethra. If Fluffy or Fido is unproductively straining to urinate, or if you are seeing bloody urine, this requires immediate evaluation.

12.) A swollen, red, bulging eye

Most ocular symptoms are minor in cats and dogs, but an enlarged, bulging, red eye can indicate glaucoma. If diagnosed and treated promptly, vision in the glaucomatous eye can be preserved. WIthout prompt diagnosis and treatment, permanent blindness can result. A swollen, red eye can also be signs of a corneal scratch or ulcer, which in some cases can result in perforation of the eye. This can also be successfully treated with prompt diagnosis and medical therapy.

What does not constitute an emergency:

Most dermatologic problems (itching, ear infections, hot spots, fleas, and ticks); urinating in the house without symptoms of straining, particularly if a longstanding problem; increased appetite; concerns about anxiety, aggression or other behavioral issues; worms in the stool; sneezing; arthritis; questions about housebreaking a puppy; concerns that “Fluffy is looking at me funny” (I’ve heard this one a few times over the years!)

Again, when in doubt, call your veterinarian for advice. We can help guide you as to whether your pet needs to be seen on an urgent basis. Never delay if you suspect an emergency!