Cardiac or respiratory?? Definitely an emergency!!

It’s 5pm on a Friday afternoon. Primary care clinics are well into the afternoon consultation period and everything is going well. Voilà – the scene is set for a feline cardiorespiratory emergency.

We often receive calls late in the day, typically towards closing time, from referring vets wishing to have a feline patient seen at short notice for specialist consultation by the Cardiorespiratory Department at SARC.

Under non-emergency circumstances appointments are booked well in advance and owners make their way in an orderly manner to SARC for cardiac or respiratory workup. However, a dyspnoeic cat seen at 5pm on a Friday afternoon may not have the luxury of waiting until the next available appointment on Monday. Primary care vets are wanting both (non specialist) emergency stabilisation and specialist cardiorespiratory workup at what is well known to be the worst possible time of the week.

It is under these circumstances that the integration between the Emergency and Critical Care Department and the Cardiorespiratory Department at SARC comes to the fore.

We see a great number of cases in need of a ‘two speed’ service; firstly the hurried transfer and emergency stabilisation (inevitably during primary care consulting times or nearer to closing time), followed by the required specialist cardiorespiratory workup recommended by the primary care vet and expected by the owner.

Rather than offering either one or the other, with neither individual service being sufficient, we are able to provide a service where the Emergency and Critical Care Department can stabilise and undertake basic diagnostics (if not already performed by the referring vet) followed by a specialist workup soon after or early the next morning, depending on the condition of the patient.

Thus both problems can be solved under this difficult circumstance, giving primary care vets the best of both worlds. The types of cases we see under this circumstance include presentations of effusions, pulmonary oedema, pneumonia, ascites, general dysponea, collapse and more.

Cases are typically stabilised as best as possible for transfer at the primary care veterinary clinic or sent direct to the Emergency and Critical Care Department at SARC. If fit to travel, cases are then transferred and admitted for continuing stabilisation. If not fit for transfer, we are happy to discuss the case over the phone to assist in improving the outcome.

A varying range of diagnostics is typically completed at the primary care practice, and patients often arrive with basic screening, bloodwork and imaging already complete, though we are obviously happy to accept cases at any stage of workup.

Once patients are admitted, further emergency treatment can continue while the Emergency and Cardiorespiratory teams formulate a further diagnostic and treatment plan. This often involves telemedicine to view radiographs or blood results if specialist cardiologist Richard Woolley is not already on-site. Consultation during this stabilisation and preparation period means that when specialist cardiologist Richard Woolley is on-site he is often fully apprised of all important details.

If owners are present they are welcome to attend during further cardiac workup, including specialist cardiac ultrasound, meaning that there is a seamless transition between emergency care and further specialist cardiac workup. Once workup is complete, further emergency and critical care can then proceed, again in a seamless transition back to the Emergency and Critical Care team.

During this process owners communicate with the same staff in the same facility; all of whom have access to the same medical records and are pursuing the same treatment plan. This simplifies the communication and decision making process for owners, who can concentrate on key decisions in what is already a difficult and fast-changing situation.

If you have questions about advice or referral for urgent cardiorespiratory cases, please feel free to contact us at any time.

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