From the very first time I was faced with the responsibility of possibly having to respond to an emergency when I was a young
boy scout (at age 11) to just yesterday when I was an emergency clinician at the Pet Emergency Clinic, the immediate goal
was "to make everything ready". A pioneer in emergency care that coined the term "the Golden Hour." Dr. RA Cowley was emphatic
on the carrying out of this goal because time is one of the things that can be manipulated and saved when faced with emergencies.
It is a savings of time that can make a difference between life and death. The information presented here on practical readiness
is provided to help clinicians and staff manage patients in the most efficient way possible. Some of the recommendations come
from my experience and training as a surgeon and emergency and critical care specialist as well as a fireman and medic on
the front lines...being the one to have to provide the initial care to critical patients whether 2 or 4 legged.
Readiness is also centered on being ready to perform those techniques that must be done immediately when critical patients
are first seen
Readiness also involves the need to perform emergency procedures that one might not do very often when the crisis even occurs.
The crisis can occur even during during "routine procedures" such as the adverse drug reaction leading to anaphylactic shock
in which a tracheostomy may have to be performed prevent airway obstruction from the edema produced, to a rapid thoracotomy,
aortic cross clamping, and cardiac massage, for the patient experiencing a sudden cardiac arrest secondary to a vasovagal
response from moving the patient while under anesthesia. So the bottom line is that we must all be ready for critical life-and-death
emergencies, all the time, even during a "routine" day.
Readiness involves being ready within the facility regarding equipment and supplies/drugs as well as knowing how to perform
emergency procedures, operative techniques, and having the memorized knowledge of protocols that will need to be followed
for the successful management of common emergency conditions
These include: patients presented with difficult breathing, collapse, severe hemorrhage, an acute abdomen, parvovirus like
syndrome with diarrhea and dehydration/vomiting, gastric dilation-volvulus, acute poisoning, snake bite and spider bite-toxic
envenomation, seizures, heat stroke, severe hypothermia or hyperthermia, severe sepsis, severe burns, acute paraparesis –
paralysis, anaphylactic shock, aortic thromboembolism, severe hemorrhage, severe pancreatitis, peritonitis, severe wounds
and fractures, and urethral obstruction, severe arrhythmias, head and spinal cord trauma, cardiac or near cardiac arrest from
many causes and many others that may occur as a "routine" case in general practice and the procedures necessary to prevent
a catastrophic even from occurring.
Those steps necessary in the anticipation that something could go wrong are also important to do in readiness. An example
is the older patient with dental disease that has renal and cardiac compromise that requires anesthesia for dental prophylaxis
and the removal of a suspected tooth root abscess. The placement of an intravenous catheter while the patient is receiving
blow-by oxygen and the injection of a "chemical courage" drug cocktail of ketamine, butorphanol and acepromazine are performed.
These steps help preoxygenate the patient and decrease the patient's stress levels and provides a gentle and cardiovascular
and renal protective strategy as a preanesthesia and the patient will accept, stress free, a mask for the delivery of 100%
oxygen and assist ventilation with the BM (bag-valve) and reservoir attached.
Isoflurane is then added for induction after continuous arterial blood flow Doppler monitoring is added. This is accomplished
by clipping the hair over the palmar arterial arch and adding ultrasonic jelly onto the ultrasound flat probe and the probe
fixed in place tightly with adhesive tape on the central portion of the metacarpal skin above the metacarpal pad. This may
sound complicated but is very easy to achieve.