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STAT! Tips for treating and transferring emergency cases in general practice

Are you a general practitioner who gets stressed by emergency cases? Here are some tips to refresh your confidence—and an invitation to reach out to your colleagues at your local ER.

Published Dec 4, 2023

By Emily Singler

Some veterinary professionals thrive under pressure. They love the really sick critical care cases and get genuinely excited when a true emergency comes in the door. If you’re anything like me, however, you are the exact opposite. Your stress level shoots way up and your anxiety goes into overdrive. You’d rather spend 45 minutes discussing the ins and outs of heartworm prevention with a cynical client than try to stabilize a patient who is trying their hardest to die.

Like it or not, however, emergency cases are part of most general practice positions. Some practices may be fortunate enough to have a 24-hour emergency hospital in close enough proximity with availability to take all their urgent and critical cases. For the rest of us, we need to know how to at least stabilize emergent cases, even if they will later be referred.

Hurdles to treating ER cases in GP

I asked Elizabeth Chosa, DVM, a former general practice owner and current ER relief vet, for her insight. She identified some reasons why general practice veterinarians may not always be comfortable treating emergency cases.

“I think confidence is the biggest hurdle for veterinarians in most general practices,” she said. This can come from a lack of regular practice. Veterinarians may also fear negative feedback (such as a lawsuit, a board complaint, an online smear campaign, or even physical violence) if a patient does not respond well to treatment, and they may also worry about being judged by those to whom they refer their patients for their diagnostic and treatment decisions.

I also spoke with Kate Boatright, VMD, who has worked in both general and ER practice and regularly writes and speaks on these topics. She said time constraints are one of the main hurdles. “You don’t want to delay your already-busy schedule and keep clients waiting,” she said.

Other barriers to providing emergency care in general practice can include a lack of appropriate equipment such as an ultrasound, point-of-care bloodwork testing capabilities, and medications. Practices that are short-staffed can have a much harder time providing the intensive care needed to manage some emergency cases.

Top tips for treating common ER cases in GP

Chosa and Boatright said the most common emergent cases they see in general practice include respiratory distress, blocked cats, and trauma of various kinds. Here are some quick tips for managing these types of emergencies from Dr. Boatright.

Please note: These tips are meant as inspiration only and should not be construed as dictating an exclusive protocol, course of treatment, or procedure.

Respiratory distress

“Look and listen!”

Look at your patient’s breathing patten and listen to their lungs to try to localize the source of their distress.
Handle patients minimally.
Give oxygen and sedation (if needed) and do not rush into radiology.
It is OK to tap the chest or give medication such as furosemide based on clinical suspicion

Blocked cats

“Give them fluids and pain medication.”

Try to unblock your patient before transferring them (if applicable), paying close attention to their heart rates.
If you have to transfer them before unblocking them, consider performing a decompressive cystocentesis.

Trauma

“Stabilize the respiratory and cardiovascular systems first.”

Don’t forget to check blood pressure.
Resuscitate hypotensive patients, being careful to aim for a lower blood pressure that maintains perfusion to vital organs but won’t disrupt a clot.

Tips for preparing ER cases for transfer

For the cases that start in general practice but will then be transferred to an emergency, Chosa has some recommendations that come from her experience as both an ER vet and a GP vet.

Placing an IV catheter, giving a fluid bolus and/or pain medication (if indicated) before transfer can often make a huge difference. “This could make a difference in patient outcomes and will make them more comfortable during transport to the ER,” Chosa said.
Provide a list of medications and fluids given (along with their doses and administration times).
Provide copies of any diagnostic test results.
Even if the whole medical record isn’t complete, a short note with the most important information can save time and prevent clients from spending more money to repeat testing unnecessarily in the ER.

Communicate (with everyone)

Chosa recommends not relying on the client to relay pertinent information to the ER vet. “A short phone call can make a huge difference in understanding what everyone expects and getting on the same page,” she said.

Boatright adds some important reminders: “Don’t be afraid to phone a friend at the local ER and ask for advice before transferring the patient.” It’s also critical to be honest with the client about their pet’s prognosis, the potential cost of further care, she adds. “They may not always hear you, but have the conversation.”

For the times when transfer or referral is not an option, Chosa has some encouraging advice for general practitioners. “You know more than you think,” she reminds us. “Every time you say yes to an emergency, it helps the pet but also helps build your skill set and confidence for the next one.”