Tails and Triage - ER shift 🚨

September 27, 2025, 7 AM - 5 PM.

I started my day bright and early in the Emergency Department at VMCLI. I spent my shift with Kaleen, one of the LVTs and also the shift leader. She manages the floor with such confidence and precision - it was inspiring to watch how she kept everything running smoothly while still teaching me along the way. Her technical skills and assertiveness definitely made an impression on me, and I hope to bring that same level of professionalism into my own career someday.

We began the morning with rounds, checking on the patients who stayed overnight in her section.

Isabella – DKA and Critical Care

Our first patient on rounds was Isabella, a 14-year-old spayed Female Morkie mix. She was newly diagnosed with diabetes and suspected of being in diabetic ketoacidosis (DKA). In DKA, the body can't properly use glucose for energy because of insufficient insulin. Instead, fat is broken down, producing ketones that cause metabolic acidosis. Symptoms include lethargy, vomiting, PU/PD, dehydration, and sometimes collapse.

On top of this, Bella also had a newly detected heart murmur, which meant we had to be cautious with her fluid therapy. To stabilize her, she was on a CRI (constant rate infusion) with a cocktail of fluids and medications:

• KCl (potassium chloride): replaces potassium lost through osmotic diuresis.

• Insulin CRI: helps reduce dangerously high blood glucose levels slowly and safely.

• Phosphorus supplementation: added for hypophosphatemia, since low phosphorus can cause muscle weakness, hemolysis, and respiratory compromise.

Since Bella also had a new heart murmur, she was started on a double-strength insulin CRI, carefully titrated to prevent fluid overload.

Kaleen and I began by checking her CRI calculations to make sure the rates from last night were accurate. At 8 AM, we ran a blood glucose (BG) curve - her BG was 473mg/dL, which improved from the 700s the day before. Based on the protocol chart, we adjusted her CRIs: increasing the fluid rate by 1mL/hr and decreasing the insulin rate by 1mL/hr. We planned to repeat BG in two hours to monitor her response.

Kaleen also showed me Bella's IV setup. She had a cephalic IV catheter, but also an intracatheter (a 22G cath placed in the lateral saphenous or jugular vein). This allows for quick access to blood draws and medications in emergencies, leaving some limbs free in case they need another vein. To prevent anemia from frequent blood sampling, they use a "dirty sample" system: draw back 1-2mLs of blood (to clear any residual meds), then collect a "clean" sample for testing, and return that "dirty" sample back to the patient. This way, Bella's blood could be monitored closely without causing iatrogenic anemia.

By the end of my shift, Isabella's BG was in the low 200s - stable enough that her doctor planned to discharge her the next day.

Mo – The Parrot with Personality 🦜

Next up was Mo, a feisty but adorable 10-year-old Quaker parrot who had flown into a wall at home. Her owner was worried about a possible head injury since she showed some neurological signs at home. Fortunately, once she arrived at VMCLI's Exotics department, Mo appeared bright, alert, and stable.

Mo had an old injury that left the top of her beak broken with part of her tongue exposed, but she ate and drank without difficulty. Since she wasn't showing clinical issues, the team decided no medications or diagnostics were needed in order not to stress Mo out - just hourly vital checks. At 7:30 AM, her HR was appropriately in the 280-300 bpm range, and she was doing just fine. She also did a little dance for us.

Luna the Boston Terrier

Our major patient was Luna, a 10-year-old spayed female Boston Terrier who presented in respiratory distress. She was placed in the Snyder oxygen unit and was receiving a CRI of dexmedetomidine (1:9 dilution), a sedative to help calm her, since stress can worsen breathing issues. Since Bostons are predisposed to spinal issues like IVDD (intervertebral disc disease), which can sometimes affect breathing, sedation was particularly helpful.

Kaleen asked me to calculate Luna's CRI dosage. Using Luna's weight, prescribed dose, and drug concentration, I worked through the math - and got it right! It felt great to apply what I've been learning in Pharmacology. Later, I helped Kaleen's assistant, Amelia, collect Luna's vitals, including an uncomfortable rectal temperature.

Remy the Maltipoo

Suddenly, alarms went off - Remy, a young neutered male Maltipoo, presented with hematochezia (bright red bloody diarrhea). His workup included a CBC/chemistry panel, an EPOC (another in-depth in-house panel), and a PCT/TS (packed cell volume/total solids) test. I helped interpret the PCV with Kaleen and then gave the results to the doctor. Since his values looked stable, he was discharged after receiving fluids SQ, and went home with antibiotics and a probiotic.

Gigi the Terrier Mix

Next, Gigi, an 8-year-old spayed terrier mix, presented for icterus. Suspecting liver disease, the team quickly ran some bloodwork, which revealed elevated liver enzymes, so she was started on fluids with KCl supplementation. Her mom came to visit, which seemed to boost her spirits. Last I heard, she was staying overnight with supportive care.

Tucker

Tucker, a 4-year-old neutered DSH, had been hospitalized for an unknown origin fever and lethargy. His bloodwork came back all within normal limits, but his temperature still would not go down. His temperature was still high at 104.8°F (normal is up to ~102.5°F). We offered him Hill's K/D Food, which he happily ate, while we continued supportive care until his unknown origin fever was diagnosed.

Doug - Labrador Behaviors

Doug, an 8-month-old neutered Labrador, came in for eating his bedding. Ultrasound and X-rays confirmed a foreign body obstruction. He received a fentanyl CRI for pain (which I helped calculate) and was rushed to surgery. Two hours later, he was resting comfortably with his foreign body successfully removed.

The Reality of ER - CPR Case

After lunch, an older dog came in with respiratory distress and was placed in the Snyder oxygen tank immediately. Sadly, he went into cardiac arrest minutes after his owner visited him. The team immediately performed CPR, including intracardiac epinephrine. Despite efforts, he only had agonal breathing and did not recover. His owner was brought back to say goodbye and chose humane euthanasia. Witnessing this was heartbreaking but also a reminder of the fragility of life and the emotional side of ER veterinary medicine.

Two Feline "Blocked" Cases

Later, two male cats presented for possible urinary blockage.

• The first had urine in his carrier—unusual for a true obstruction. He was only 2 years old and was diagnosed with a UTI, not a blockage.

• The second underwent a cystocentesis for urinalysis, which confirmed UTI without obstruction. Both were treated with meds and discharged home.

Discharge of Luna

Our final task was discharging Luna, the Boston Terrier. She had improved enough to be weaned off her dexmedetomidine CRI. To make her trip home easier, she received a bolus of dexmed and was sent home with gabapentin and trazodone for pain and anxiety. She was thrilled to go home to her family after a long day of pokes and prods.

Reflection 🐾

This week in the ER was a whirlwind of emergencies, routine checks, and life-or-death moments. From managing complex cases like Isabella’s DKA to something as simple (yet scary to owners) as bloody stool, I saw firsthand how quickly things change in emergency medicine. I admired how Kaleen orchestrated the floor—delegating, staying calm, and keeping the team running smoothly. The emotional ups and downs of the day, especially the CPR case, really highlighted how precious every moment is with our pets. Working in the ER reminded me that while medicine is about calculations, procedures, and protocols, it is equally about compassion, communication, and appreciating the bond people share with their animals. It really hits home the reality of the ER and how precious life is. That we should appreciate and love our pets, giving them a fulfilling life...as they only have one, just like us.