Our Process

We conduct a primary survey, investigation; and take general stabilization measures of the patient. Rapid identification allows us to prioritize and immediately stabilize life-threatening problems. We administer any life-saving emergency procedures, address minor injuries and symptoms immediately, and return the patient home for monitoring.

We follow and comply with the ABCD (Airway, Breathing, Circulation, Disabilities) method in all kinds of emergencies which help us concentrate on less distinct but potentially life-threatening problems while decreasing the risk of focusing on non-lethal injuries.

We obtain further information by means of targeted diagnostic tests such as on-site imaging, blood work and urine/fecal testing.

We conduct the initial management of an acute neurological patient presenting altered consciousness, posture, and body position; abnormal movements, ambulation and gait with the DAMNIT-V approach to detect and understand sudden neurologic symptoms:

Degenerative (spinal disease, slipped disc, muscle storage)

Anomalous (by birth)

Metabolic (neurologic symptoms from diabetes, low blood sugar, high/low cortisol and sodium; and chronic liver disease)

Neoplasia (cancer) of the primary nervous system or metastatic (spreading cancer)

Infectious/Inflammatory

Toxin (rat/mice poison, pesticides, over the counter flea and tick products) Trauma (skull fractures, vertebral fractures and dislocations, bruising, blood clots and water in the brain)

Vascular (blood clot and hemorrhage)

We address respiratory distress of the upper and lower airways, lung tissue, or inner chest space caused by airway structural issues, airway collapse, cardiac and non-cardiac watered lungs, infections, inflammation, and trauma.

We deploy tactical imaging and guided sampling such as ultrasound, radiology, and CT scan; or bedside point-of-care ultrasound which is very useful in the evaluation of distressed inner chest space, cardiac structure and function, and lung tissues to detect the sources and causes of respiratory distress so we can address them in a timely manner.

We address arrhythmias of both cardiac and non-cardiac origins. We deploy synchronized and simultaneous screen display of the point-of-care ultrasound and electrocardiogram so we can readily detect, characterize, and address the source of arrhythmias sources effectively. Patients experiencing ventricular arrhythmias can present without symptoms, or with symptoms such as weakness, lethargy, collapsing, or in apparent seizure activity.

We place incoming respiratory distressed patients on oxygen support in the parking areas, lobby, and triage rooms utilizing ceiling dropped oxygen until they arrive in the ICU space. Our ICU is equipped with climate-controlled oxygen cage/incubator units to make respiratory distressed and oxygen deprived patients more comfortable. Intubation and positive pressure ventilation are also deployed in unconscious and respiratory distressed patients.

When detected, we address incoming acute abdomen patients with rapid volume resuscitation and physiological target monitoring. Patients with acute abdomen issues such as ongoing bowel losses, stomach torsion, pancreatic disease, or internal bleeding, come with challenging and life-threatening low volume septic/distributive shock and respiratory disorders as a result of concurrent chest and lung diseases. We deploy tactical imaging and guided sampling such as ultrasound, radiology, and CT scan or bedside point-of-care ultrasound to detect the sources of abdomen distress early on so we can address it in a timely and effective manner.

All of our imaging modality (point-of-care ultrasound, radiology, ER video, and CT scan) renditions are received and reviewed by expert imaging teams via expedited telemedicine response, to provide the most in depth and specialized imaging interpretations to ensure we address the sources of the patient’s discomfort in a timely and effective manner.

Falling over, sudden weakness, or syncope (temporary loss of consciousness due to low blood flow to the brain characterized by rapid onset, short duration), seizures, low blood glucose, and certain metabolic diseases which can also result in temporary loss of blood flow to the brain.

We can address syncope caused by:

 – Cardiac arrhythmia (first and most common cause of syncope)

 – Low heart rate and low blood pressure

 – Structural heart diseases that reduce cardiac output and brain blood flow

 – Impending congestive heart failure; and excess fluids in the heart sac

 – Intense activity, excitement, coughing, urination or vomiting/gagging (situational syncope which is the second most common cause of syncope in veterinary medicine)

Our risk stratification system during triage helps determine if the cause of syncope is life threatening (arrhythmia) and can provide timely treatment when needed. Non-life-threatening causes of syncope, such as coughing or medication overdose, once recognized as lower risk, allows for the patient to be safely discharged from the emergency room for monitoring and a scheduled diagnostics work up.

We adopt the risk stratification system used in human patients using the following criteria (CHESS):

– Congestive heart failure history

 –Hematocrit (packed cell volume) <30%

– Electrocardiogram (ECG)

– Shortness of breath

– Systolic blood pressure <90mmHG or >200mmHG

We bring our mobile ECG straight to the patient during triage, which can provide a definitive diagnosis of syncope with any of the following:

 – Persistently low heart rate <50 bpm in patients with advanced atrial-ventricular block

– Atrial standstill

– Sinus pauses > 6–8 seconds.

We deploy real time point-of-care ultrasounds to evaluate excess fluid within the heart sac, enlarged atria (heart chamber), or inadequate cardiac filling in patients suspected of having a cardiac cause of collapse/syncope. Excess fluid within the heart sac, severe aortic or pulmonic stenosis, very high pulmonary artery pressure, obstructive tumors or clots may be evident upon examination.

We utilize information from our full in-house blood work serum biochemistry to detect electrolyte abnormalities associated with deteriorating endocrine disease in dogs, high potassium associated with low heart rate, or low thyroid associated with arrhythmias in cats. Cardiac biomarkers can now detect heart muscle cell changes in early heart disease much sooner than imaging can detect.

Many blunt impact and bite wound patients sustain minor injuries such as road rash, puncture wounds, and small lacerations with light discomfort, which at Pet ER we address immediately. Most often, we can discharge the patient shortly after evaluation and treatment if they are stable, to be monitored at home with pain control and rest.

Our emergency team is prepared to receive trauma patients with minor to major lacerations, fractures, burns, or blunt trauma with acute cavitary mechanisms (chest and abdomen). We also address polytrauma involving multiple organ systems and multiple injury mechanisms as a result of motor vehicle accidents, a fall from a height, animal-to-animal interactions, human-to-animal interactions or fire exposure.

We know trauma patients are in a dynamic state and therefore we closely monitor trends and anticipate complications before they get worse. We look for clinical signs indicating inadequate oxygen delivery or depressed mentation so we can devise optimization tools of oxygen delivery, and as such curb/end organ compromise. This allows us to establish a baseline from which to evaluate progression and therapy.

Pet ER 24/7 and emergency personnel are prepared to receive, evaluate, and administer timely and emergency treatments for the trauma patient. We bring supplemental oxygen to the parking lot and triage area until the injured patient is hosted in the ICU. We establish vein access and volume resuscitation upon arrival. We complete cavitary imaging early on (radiographs and bedside point-of-care ultrasound) so we may characterize and understand inner chest space, lung, and inner belly injury mechanisms that may place the trauma patient at an oxygen disadvantage.

Impaired trauma patients often have low tissue blood flow which can result in loss and/or hemorrhaging. We therefore obtain instant venous access and blood sampling to assess blood gas, blood thickness levels, total protein (TP), lactate, blood glucose, and electrolytes so we may detect and understand life threatening shifts early on and devise effective fluid therapy to restore circulation volume. Potential sites of sustained hemorrhage include the inner belly, retroperitoneal space, inner chest space, and external hemorrhaging can occur around long bones.

In patients with traumatic brain or spine injury, altered mentation can occur as a result of direct tissue damage, hemorrhage, clot formation, watered brain, poor oxygen supply to the brain, high pressure on the brain within the skull, or spinal compression. Our ICU brings robust bedside oxygen supply and climate control, novel cooling, strategic imaging (largely CT focused), and delicate slow drip intravenous therapy to stabilize those patients early in the aftermath of head or spinal injury.

Trauma patients may also sustain serious urinary system damage from either impaired kidney blood flow or direct urinary system damage. Our early detection laboratory diagnostics, contrast (dye) imaging and intervention allows us to address such occurrences in a timely and optimal manner.

Limb injuries are very common emergencies and account for 53% of ER patients.  Pelvic canal fractures and instability are also causes for limping or impaired ambulation in many trauma patients. At Pet ER we assess a patient’s ability to ambulate early on, devise pain control and sedation protocols, and survey imaging to detect and characterize fractures accurately for surgical planning so we may address fracture emergencies in a timely and effective manner.

Tactical and staged imaging in injured patients is imperative but never therapeutic and is deployed to complement a thorough physical examination with the ER veterinarian and nurse to stabilize the patient quickly. 

Table/bedside ultrasound is at our fingertips and helps us improve the initial assessment of the trauma patient. We deploy an abdominal/thoracic (belly/chest) focused assessment with sonography for trauma (aFAST/tFAST) to evaluate a patient for chest and inner belly space disease or injury. Chest injuries resulting in trapped air in the chest and loss of negative pressure, bruising, or herniated diaphragm occur in approximately 72% of trauma patients and can be readily detected with ultrasound shortly. Inner belly injuries occur in 12–50% of trauma patients and can be qualified by evaluation of free fluid within the four quadrants of the belly based on the location of the free fluid.

Chest radiographs should be evaluated in every trauma patient to further assess the severity of lung injury, rib fractures, and other inner chest space diseases not readily identified on physical examination or ultrasound. Radiographs of the belly and appendicular skeleton are planned based on emergency physical examination findings.

In patients with severe polytrauma, a full body computed tomography (CT) scan may provide a more accurate assessment of all injuries. This modality is ideal for patients that may require emergency and staged surgery.

Reproductive emergencies occur during and after heat and during pregnancy. It is imperative that we recognize life-threatening complications and treat them accordingly. Reproductive disorders can be life-threatening and should be considered when evaluating the systemically ill, intact female.

Pallor is the hallmark sign of anemia. Red blood cell consuming disease processes (anemia) are common in small animals, and in most forms of anemia, the patient is unable to regenerate red blood cells. Bone marrow disorders are also common. Other causes are blood loss due to trauma, surgery bleeding disorders, immune disease, heavy metal toxicity, and red blood cell parasites. Young animals are more likely to have congenital disease or blood loss due to parasites, whereas older animals are at greater risk of malignancies.

An in-house laboratory assessment can elucidate a definitive cause of anemia, and in some cases, the diagnosis is within minutes. More common laboratory assessments can determine the mechanism of the anemia and consolidate a finite list of differential causes, guiding focused diagnostic testing. History is crucial in triage to inform the veterinarian about current medications taken by the patient, diet, travel, and past illnesses. Some current medical therapies may predispose to immune disease, bone marrow suppression, or low platelets.

Signs of bleeding may include dark tarry stools, blood-tinged urine, nose bleeds, as well as any prior bleeding incidents. Viral diseases are common in anemic cats, so exposure and onset of clinical signs details are crucial.

Fever may result from inflammation, infectious disease, malignancy, or acute immune-mediated red blood cell disintegration. At Pet ER 24/7 we actively seek evidence of malignancy, infectious disease or immune-mediated disease (arthritis, eye or skin lesions) by deploying automated hematology instruments, blood smear examinations, and complete blood and reticulocyte (immature red blood cells) counts produced in the bone marrow and released into the peripheral blood.  This, along with fast ultrasound imaging, can detect significant blood loss or red blood cell disintegration/destruction.

Significant blood loss can occur externally or internally into the chest or abdominal space. Pallor, weak pulse, high heart rate, prolonged capillary refill time, and low blood pressure can be detected early in triage. Hemorrhagic shock constitutes a life-threatening emergency.

At Pet ER 24/7 we are able to receive and address eye emergencies such as corneal lacerations, deep corneal ulcers, primary glaucoma, acute anterior uveitis, anterior lens luxation, acute blindness. Fast eye ultrasound, tonometry, corneal staining are some of the diagnostic tools we deploy upon initial evaluation to detect sources of eye distress early on and address them effectively until later review by the veterinary Ophthalmologist for ongoing monitoring and on a referral basis. Eyelid laceration or other traumatic eye injuries such as proptosis (forward displacement of the eye globe to the extent that the eyelids are trapped behind the globe equator), those are addressed at Pet ER 24/7 as surgical emergencies and immediately. 

Vomiting, regurgitation and diarrhea are associated with both gastrointestinal. 

Extragastrointestinal sources. At Pet ER 24/7 we conduct a thorough search for causes starting with history of evaluation of the patient’s vital parameters and visible symptoms, a complete blood count and serum chemistry are also completed when symptoms are significant enough to deter a patient’s energy level and demeanor. Tactical and thorough abdominal imaging is also completed (radiographs, abdominal ultrasound, endoscopy or combined modalities) to flesh out difficulties in detecting obvious sources of symptoms, or to determine the presence of a surgical problem. At Pet ER 24/7 a fast abdominal ultrasound upon evaluation along with radiographs are usually the first-line diagnostic imaging  and are useful in detecting acute and obvious abdominal sources of symptoms and distress. Chest radiographs are also utilized to detect vomiting and regurgitation associated with chest disease such as esophageal disease, chest mass, or pneumonia.

Diarrhea can lead to severe abnormalities in nutrient, acid–base, fluid, and electrolyte balance and may be associated with patient discomfort, local dermatitis, and potentially bacterial translocation in small and large bowel. Viral infections such as canine parvovirus and feline panleukopenia, fungal and other l infections also cause diarrhea.

Other causes of acute and distressed abdomen are hemorrhagic gastroenteritis,  Inflammatory bowel disease, Protein-losing bowel disease, alimentary malignancies such lymphosarcoma, liver/gallbladder disease, pancreatic disease, renal disease, endocrine disease, congestive heart failure (particularly right-sided)  which usually results in free belly fluid. At Pet ER 24/7 we lead a structured and early detection approach to curb sources of patient’s distress early on in the process, utilizing physical examination information and symptoms obtained as we meet patients in urgent need for medical attention, along with lean diagnostic imaging tools and bloods to maximize findings early on, detect  issues and address them in a timely and effective fashion. 

Usually associated with alteration in volume or frequency of urination, decreased size of urine stream and alteration in urine consistency. Discolored urine is among other clinical findings that may be associated with lower urinary tract disease including infections. At Pet ER 24/7 we utilize radiographs and fast ultrasound captures to visualize and detect urinary tract sources of distress and symptoms, contrast study of the urinary tract is also useful at Pet ER 24/7 to help us detect structural issues with the urinary tract or growing masses. Ultrasound guided tap of urinary bladder is also useful in collecting sterile urine samples for more in depth urinalysis and culture so we may adequately characterize lower urinary tract infections. 

Skin emergencies such as hair loss, intense itch, and ear discomfort and infections are in the top five reasons why dog owners visit the veterinarian. Allergies and autoimmune skin disease are the two most common skin disorders affecting cats. Acute moist dermatitis (Hot Spot), skin infection due to penetrating trauma, self-inflicted hair loss and skin redness, rash and hemorrhage from eroding a wart blood vessel are also common skin emergencies we address at Pet ER 24/7 at any time of the day or night.

Most intoxications are accidental (dropped pill, animal given wrong medication, etc.). At Pet ER 24/7 we evaluate patients for immediate life-threatening problems associated with intoxications. We follow the ABCs (airway, breathing, circulation) of emergency medicine and address seizures, hemorrhage, and high body temperature to ensure patient survival when presented with a pet in active seizures, or life-threatening cardiac arrhythmias. The mainstay of treatment includes maintaining hydration, ensuring adequate urine output, monitoring of respiratory, cardiac, and neurological status, and managing clinical signs as they develop. At Pet ER 24/7 decontamination is always considered and completed when needed by way of inducing vomiting or stomach lavage under sedation. 

Acetaminophen and cold medications can have blood levels within 10 min, grain-based rodenticides (mice and rat poison) will stay in the stomach for up to 4 hours. Chocolate increases the pyloric sphincter (far third part of stomach) tone and can be recovered with emesis up to 8 hours later. Emetics (substances we use to induce vomiting) generally empty 40–60% of the stomach contents.

ASPCA Animal Poison Control Center is available for toxicology consultations 24 hours a day, 365 days a year. They can be contacted at 888-426-4435.

Nose bleeding is a common presenting complaint. Systemic disease is significantly less common as a cause of nasal bleeding than local nasal causes. At Pet ER 24/7 controlling the hemorrhage and secondly, determining the underlying cause of the bleeding is our mainstay approach to bleeding. Potential for trauma or bleeding tendency such as presence of bruising (purple skin patches or discoloration), or blood in urine are identified early on to make sure we activate a system focused diagnostic plan and identify the source and cause of acute bleeding. 

Gastrointestinal bleeding is also a cause for concern in the pet population such as vomiting blood, blood-tinged stomach liquid or dark tarry stools.

At Pet ER 24/7 we conduct in-house baseline laboratory testing initially which includes a complete blood count, chemistry profile, and urinalysis. Nasal imaging and sampling are also completed to characterize the nature of nose bleeding and address it early in the onset. Volume depletion from bleeding regardless of the source is also addressed early on with volume replacement/resuscitation. 

In acute hemorrhage in dogs, the packed red blood cell volume may be deceivingly normal due to loss of whole blood and concurrent spleen contraction. At Pet ER 24/7 we may address blood loss with whole blood transfusion to restore adequate blood volume. Concurrent crystalloids (fluids) are also used. 

Fever can be caused by viral, bacterial, fungal, and protozoal infections as well as a variety of non-infectious inflammatory diseases including sterile tissue inflammation, tissue necrosis, immune-mediated diseases, and malignancies.

Initial diagnostics at Pet ER 24/7 are generally focused on ruling out infectious causes for fever. Early tests include complete blood count, biochemistry, cultures of blood and urine, thoracic radiographs, and brief ultrasonographic assessment of body cavities for the presence of free fluid. Later tests may include advanced diagnostic imaging (such as CT or MRI), evaluation for specific infectious diseases, tissue biopsies, cerebral spinal fluid analysis, and joint fluid analysis. Diagnostic tests are based on the patient’s breed and age, history, physical examination findings, and results of previous tests performed. It is important to note that sepsis is a life-threatening condition, and appropriate antimicrobial therapy is imperative.  

A complete blood count can be used to determine if there are significant alterations in white blood cells, red blood cells, or platelet counts. A markedly low white blood cell count prompts commencement of broad-spectrum antimicrobial therapy, regardless of underlying cause for neutropenia. A blood smear can be evaluated for the presence of infectious organisms or cellular changes that can occur with different diseases.  A biochemistry profile can help determine if there is evidence of organ dysfunction from sepsis or other inflammatory disease. Chest radiographs

Point-of-care ultrasound is used at Pet ER 24/7 to detect free cavitary fluids or overt abnormalities that may be causing the fever.  Cultures of blood, urine, and other relevant fluids or tissues.