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00:00This program is brought to you by Open Paddock, a more open pet food company.
00:04Welcome to Ready Vet Go, the vet paramedics. Australia's veterinary paramedic service
00:10responding to critical pets at home, bringing pre-hospital care and emergency transport to
00:16pets and owners in crisis. Redefining the standard of care and bridging the gap between home and
00:22hospital, combining emergency vet medicine with the human ambulance, taking you where cameras
00:29have never been before. Into the complexity and the fight for survival, this is Ready Vet Go,
00:37the vet paramedics. Toby, a 14-year-old cavoodle with known heart failure, was stabilised at home
00:47by the vet paramedics. With this only being a temporary fix, his family must now make the
00:54decision to send Toby to hospital for treatment, or to make a decision that is much harder to face.
01:00I just wanted to touch base and figure out what you are and are not wanting to do going forward
01:07with Toby, if there are sort of lines in the sand that you guys have drawn with his treatment or not.
01:13The decision-making options for pets are much different than what they are with humans,
01:17particularly when there's a deterioration of a condition that isn't curable and that the family
01:23are aware of. It's a very clear-cut decision when it is a human and when they're in this situation,
01:29we would usually get a human to hospital. However, Toby's family actually do have the choice of end
01:35of life as a treatment option. We never want families to make these decisions under duress,
01:40which is why it's important that we stabilise Toby first to allow time for them to make these
01:46critical decisions. After having a very open discussion with Toby's family, they've decided
01:51to get Toby into hospital to see if he can get through this event. He's travelling really well
01:56up until now and he had a pretty severe episode like this when he was first diagnosed, so it's
02:01only reasonable that they would see if they can get him over this hurdle. This is an impossible
02:05decision for the family to make in a split moment. Toby is stable for now, but his condition
02:11is still critical. His family are out for celebrations with friends and then they get this call that
02:16their pet has deteriorated and they need to make a life or death decision in such a short period of time.
02:22We're glad that they've been able to make a decision that allows for that time to really grasp the situation
02:38and give Toby the best chance to get through this, but he needs an emergency hospital where they have
02:43the resources to manage this heart failure and give him round-the-clock care. With the emergency ambulance
02:49accepting Toby's critical case, the team prepare to transport Toby to hospital. With the family reassured
02:56and a clear plan to treat Toby in hospital, Nick and Paul prepare Toby for the move to the ambulance.
03:03Now that we've worked to get Toby stabilised, we're getting everything together to move him onto the
03:08emergency hospital. Toby likely has fluid on his lungs, so we do need to be mindful of any fluid that may
03:15disperse and shift even by simply picking him up and moving him into the van. The capacity of a veterinary
03:22hospital can change from time to time and it's important that we communicate with them to know
03:27that they're able to meet the needs of the patient when we're referring in, but also that they're prepared
03:32to care for the patient properly. Stabilising a critical patient is an ongoing task and a big part of
03:38this is maximising the amount of oxygen that Toby's getting to his vital organs. He's not loving the oxygen
03:43mask so we can put him into our oxygen box and still achieve the same goal. With every moment of
03:48this transport requiring precision, for Toby, oxygen is not just supportive, it is life-sustaining.
03:56Toby's heart isn't pumping blood as effectively as it should be, which means that less oxygen is
04:01reaching his organs. We decide that putting Toby in the oxygen box is the best option for him.
04:08He wasn't loving the oxygen mask, so this way, we're ensuring his blood has the oxygen
04:13it needs to support his body until we can get him to hospital while minimising his stress
04:18and discomfort.
04:18Most of my job at this stage is done. Toby is safely in the ambulance and now I just have
04:24to watch him and ensure that the numbers stay exactly where we need them to be.
04:27Much like the concerns of moving into the van, the transport itself poses the same concerns
04:34with the fluid on Toby's lungs.
04:35There is a bit of a misconception about the role of driving in an ambulance. This being that
04:42it's just about driving and getting to where we need to go. However, there is a lot of consideration
04:47of the medical presentation when it comes to things like the speed of the van and the force
04:51of movement. Any big pull of force from braking suddenly or any tight corners can actually shift
04:57the fluid in a way that compromises the delivery of oxygen to the blood. Likewise, if we do get
05:03an adrenaline spike and excite Toby to a point where he is excessively panting, we could potentially
05:09compromise the ability of him being able to move air in and out of the lungs.
05:13Having worked together for some time, we kind of instinctively know what the other person
05:17needs. I know that Nick has Toby's wellbeing in the forefront of his mind and it's my job
05:22to keep an eye on him and let Nick know up front if we need to alter the plan at any stage.
05:27I'm watching Toby closely and I can see that Toby's oxygen levels are exactly where we want
05:31them to be. He's looking much better and we are really happy that since we arrived, we've
05:37been able to improve his condition as this has been our number one focus.
05:41The goal of a pre-hospital or ambulance response is simple but crucial. That is, to stabilise
05:47a patient and, in Toby's case, interrupt a potentially fatal cascade of events. This allows the best
05:54chance of surviving this critical period and determining the most appropriate path forward. Arriving
06:01at Animal Emergency Services, the team quickly transfers Toby into the care of the hospital's
06:06advanced medical team.
06:08When you're dealing with cardiac failure, it's all about balancing time and care. If
06:13we had waited any longer or if Toby hadn't had oxygen during the transport, his condition
06:17could have worsened significantly before he even reached the hospital.
06:20Even though it is a relief to get Toby to the hospital safely, the hard part isn't over.
06:26Cases like Toby are a reminder of how critical every early intervention is in emergencies like
06:32this. You can never underestimate the importance of getting them to the right care the right
06:38way. Whatever the outcome is between the family's vast actions and the whole medical process,
06:44we've allowed time for Toby to try to get over this and for his family to make an informed
06:49decision for Toby's future, whilst ensuring that he's comfortable.
06:53For Toby and his family, the wait begins as the hospital team works to see if ongoing treatment
07:00will allow for Toby to make the recovery we are all hoping for.
07:07The Ready-Vet-Go team receive a call for Pusscat, a two-year-old Maine Coon who, for the past
07:17three days, has been vomiting, hasn't passed a stool and is off his food. The most concerning?
07:25Owner Angela reports that a piece of string is hanging from his back end.
07:29Hearing an owner call and complain that there's string hanging out of the back is never a good
07:34thing. Materials like string and ribbon are what we call a linear foreign object and unfortunately
07:40this can cause severe damage to the bowel if it becomes anchored in one place and then
07:45can saw nearly literally through the entire bunch of intestines. They can get sewn together
07:50so tightly that the intestines no longer get blood supply and they can create a life-threatening
07:55complication called septic peritonitis.
07:58First case scenario, the string will pass without any issue. Worst case is that it's still inside
08:04tangled in the bowel and from what we're hearing, I do have some concerns about what may be
08:10happening with Pusscat.
08:10But just as the team arrives, they walk in fearing the worst.
08:16On the way to any case, we try to get as much information as possible. That way we are ahead
08:21of the game when we arrive. And talking to the owner Ange, prior to the consult it was expressed
08:26that there's a limit to the intervention that she might be able to provide for Pusscat if it
08:30was a worst case scenario. If this is a true linear foreign body or an obstruction, this
08:36is a pretty costly intervention and it is really important that we know the limits that an owner
08:40can go to so that we can work within those means and still provide the best care for our patients.
08:46Although it's clear that this may be Ange's home, her pets are the ones who run the house.
08:52We walk in and there's a huge cat room full of apparatus and spaces to play. There's parrots
08:58out the back, kittens that she's just rescued today. Pet parents like Ange just fill our hearts
09:04with so much joy. They get fed cooked meals, they eat on the table.
09:09Speaking of the table, Ange gives the team an update. The string was passed on the table
09:15and is nowhere to be seen in Pusscat at all. Angie thankfully didn't remove the string but it did
09:23come out before we got there. If the string was tugged out at all, we would likely see a deterioration
09:29in Pusscat's vital signs pretty quickly. Ideally we would have liked to see the string and the bowel
09:34movement but unfortunately it was thrown out. Angie thinks that it might have been a worm but what she
09:40is describing doesn't quite fit with that typical presentation. Based on the reports that it was
09:45hanging out, I don't feel any more comfortable and we still need to check Pusscat over. Now with the
09:51string being out, we need to check for signs of a bowel obstruction or tear. Having gathered as much
09:57information as possible, Dr Paul commences the consult right away. Any medical consultation can be
10:04clouded with a range of information that might seem important to the owner at the time and does form
10:09part of the overall history. However, in situations where we have real concerns, it's important that
10:14we get directly to assessing Pusscat immediately so that we can start figuring out exactly what he needs.
10:20Pusscat isn't happy but his body language tells the team that this may not be a scenario that Pusscat
10:27willingly participates in.
10:32There's no kitty minutes? No, that's all right. I'll tell you what we're going to do. We're going to get a kitty
10:37muscle out and we're just going to be able to finish this exam.
10:42If Pusscat is about to start being really unhappy with us, this will only delay getting him the
10:48intervention that he needs and sometimes time isn't a luxury that we have.
10:52In order to do an assessment right, we need to go at a pace that Pusscat is willing to partake in.
10:57He's certainly not going to love it, but sometimes taking the time to build up trust actually gets
11:02us to the answers sooner. With not knowing exactly what's going on with Pusscat, we do need to tread
11:08carefully. If he's really unwell, increasing his stress could be the point where everything tips over
11:15the edge. If that were to happen, then we are in a really scary place.
11:20It is also imperative that Paul and Nick remain vigilant with Pusscat's behaviour
11:26so that they stay safe.
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11:53Two-year-old Maine Coon Pusscat was seen to have a piece of string hanging from his bottom
11:59and had been vomiting and off his food. While the string that was there is now gone,
12:04the team have serious concerns Pusscat is not out of the woods yet and his reluctance to allow for a
12:11thorough assessment may delay being able to find out the extent of the issue.
12:17It goes without saying that Pusscat can't understand our language or understand that these
12:22strangers aren't trying to cause more pain. We would ideally have time to build up his trust completely,
12:27but we need to assess him sooner rather than later. If he were to lash out, that's only because he
12:33doesn't understand what we're doing. All he knows is that he is in pain when we're doing our examination,
12:38but if we get injured, that may quickly end our ability to see if he's okay.
12:42When I'm holding a pet for an examination, a lot of it is also about looking for indications that the
12:48pet is becoming less tolerant of the assessment and holding them in a way that means if there is a
12:53lash out, that my partner isn't going to get hurt. Pusscat isn't loving what we're doing,
12:59but he isn't escalating his communication with us. With the team being able to find a compromise with
13:05Pusscat... Uh, I don't necessarily think he saw this as a compromise. The assessment is nearly complete.
13:13Yeah, very angry, sorry. I know.
13:19When I have a feel of his abdomen, I can feel that he is tensing up,
13:22meaning that he is having some discomfort there. This isn't surprising considering the
13:27symptoms that Angie's described to us. One thing that owners are often surprised about is when we
13:32advise that there's pain despite an animal not yelling out. Pets respond to pain in various ways,
13:39depending on the stage of pain that they're experiencing. Even though the history of the
13:43string being present is concerning, it's important that the team keep an open mind about what else could
13:49be the cause of Pusscat's presentation. With long-haired cats, there's always the possibility
13:55that a hairball obstruction could be the cause of this. Or is this a simple gastro? After completing
14:01the exam, I'm feeling a little more confident that we can trial some at-home treatments for Pusscat,
14:07with some very strict escalation points for Angie. With no signs of a blockage and the string no longer
14:13present, the team discuss the next steps. Our first recommendation to Angie is always going to be to
14:20rule out any damage to the bowel. Despite this, his vital signs are looking good. He has some mild
14:25dehydration, but we will try some anti-nausea meds and pain relief, which will hopefully promote him to
14:30eat and drink again. If he doesn't get his appetite back or if he vomits with this medication on board,
14:36Angie needs to call us straight back or head right into hospital. Normally, we would probably approach a
14:41cat like this a little more cautiously, but he's given us consistent signals that his growling
14:47is more of a warning sign. If I don't push the love from here, I should be able to get this medication
14:52into him safely. We can work with this cautiously, but I wouldn't recommend doing this at home by
14:57yourself. Thankfully, all I need to do is get the medication into the side of his gums.
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15:13as the number one ingredient, every pouch delivers the mouth-watering taste that cats crave. Plus,
15:20the moisture-rich broth supports healthy hydration, helping your cat thrive. With the team outlining the
15:25plan to Angie and what to look out for at home, they will check in to see how Pusscat is managing at home
15:32tomorrow.
15:40Hi, I'm Marianne, founder of All 4 Paws Dog Rescue. It's great to see Nick and Paul back here again
15:45this week checking in on all of our fosters. We're here to help out with Divetilact for the puppies and
15:51the mother's nutrition, some Nature's Miracle products and also, of course, open paddock food for
15:57all the nutrition that they need. Divetilact provides essential protein, fats, folates and nutrients to
16:03support healthy foetal development during pregnancy while maintaining her strength in preparation for
16:08birth. Nature's Miracle doesn't just clean, it discourages re-soiling by removing the scent completely,
16:14even from the most stubborn messes. With an odour control formula and a fresh scent,
16:19it's safe to use on carpets, hard floors, furniture, fabrics and more.
16:24We've been called to Max, a 15-year-old French Bulldog who is requiring vet transport from St Kilda
16:30Vet Clinic to Southpaws Hospital in Malvern. He's had significant complications after waking from a
16:35routine dental procedure requiring anaesthetic. His oxygen saturations have been sitting around 74%
16:42on room air when they try to wean him off of oxygen. Post-procedural complications are a risk with
16:47any anaesthesia, no matter what the age. Getting handover from the team at Max's clinic, it's clear
16:53they have done everything right, but sometimes these complications still occur. The St Kilda Vet Clinic team
17:00know that without continued support and treatment to the 24-hour emergency hospital, the transfer to
17:06hospital could be a fatal one. Max's presentation could be for a number of reasons. He could have
17:12difficulty moving air in and out of his airway, if there's swelling or possible fluid build-up in the
17:17air sacs in his lungs. Knowing the oxygen levels in the blood are crucial because they show how well the
17:23body is getting the oxygen that it needs. The oxygen levels that Max is reaching when he's not being
17:29administered oxygen are dangerously low. At the moment, the receptors in Max's brain are detecting
17:35those low levels of oxygen and it tells him to breathe harder and faster. For Max, this puts a lot
17:42of pressure on his narrow airways when they pant for a long period of time, which only makes the situation
17:48worse. As a human nurse, I've seen people in this situation and the feelings that they describe to me
17:54is that they feel like they're suffocating, which is a terrifying thing to feel. It may only be a 15
18:01minute trip to hospital, but that 15 minutes with oxygen levels that low can be the difference as to
18:06whether Max survives or not. Paul and Nick need to plan carefully for an ambulance transfer for Max,
18:14with every step being vital to keeping him stabilised. These post anaesthetic issues are
18:20complicated at the best of times, particularly in an older boy like Max. The move is always to be
18:26planned very carefully. We don't know exactly what the cause of his presentation may be, which means
18:31that being cautious is our best option here. While Nick prepares the ambulance for Max's transfer,
18:37Paul gets handover about Max's current presentation. We're looking at a dog who is relying entirely on
18:43supplemental oxygen. His levels drop to a critically low 74% when we try to wean him. And as a French
18:50bulldog, his airway is easily compromised with swelling. So in planning the transfer to the ambulance,
18:56we need Max to be full of oxygen and we need to reduce as much stress as possible. One of our
19:01fundamental rules when transporting is to provide anti-nausea medications beforehand. Max still has some
19:08anaesthetic on board and with the medication that he's had, that's a high risk of occurring.
19:13If Max were to vomit during this transport whilst in the middle of having increased anxiety,
19:18that could be catastrophic. We know that Max has been anxious in the vet clinic leading up to our
19:23arrival. Our preference would always be to monitor his cardiac function with this type of transfer.
19:29However, it's a catch 22 with Max. We want to reduce any risk of anxiety and introducing monitoring
19:36wires and leads may mean that we're doing more harm than good potentially. With the decision to forgo the
19:42monitoring equipment, Paul has to rely on his extensive experience in emergency medicine to monitor
19:49Max's condition. I'm confident that promoting the environment of least stress is the safer option
19:54here. But believe me, I'm watching Max like a hawk. With medications to reduce stress and the risk
20:01of vomiting, the team buckle in to begin the transport to Southpaw's hospital. Even 15 minutes without
20:07administering oxygen to Max can make his condition so much worse. This would be the equivalent of Max
20:14feeling like he's suffocating. Not only this, but the effect that this has on his vet team only adds to the
20:20overall stress that the team faces. As Max's journey continues, the team focus on keeping
20:27him calm so that his work of breathing doesn't compromise his airway further. As we go around
20:33every turn and bump, I'm just holding my breath, hoping that he stays calm long enough to get to the
20:37hospital. Presentations like Max's are often about holding the fort and giving him time to properly
20:43recover. A recovery is simply not possible if we're unable to medically support him in a time of being
20:49critically unwell. We've done a very small but important part in getting Max to hospital safely.
20:54It's up to the team here to take over and we just hope to hear back from Max's family soon that he's
20:59doing a lot better and back at home with them. Vet clinic teams like the team at St. Kilda Vet Clinic
21:05work tirelessly to stabilize patients when things don't go to plan, often under enormous pressure along
21:11with their routine consultations still coming in. Without vet ambulances, not only does the patient
21:16suffer without them. This impacts the mental health of the staff, just hoping that the patient will
21:21make it and a lot of the time they don't or they are worse off without the ambulance. One of the best
21:26parts of what we do is getting to work with incredible veterinary teams across Melbourne. The Southpaws
21:32team for example are the kind of team you'd want looking after your own pet in a situation like Max's.
21:38What makes the veterinary ambulance so unique is how it connects clinics and hospitals and this is
21:44something that we need in our industry right now. In an industry currently facing a staffing crisis
21:50and with mental health at an all-time low, even small things like reducing the stress for clinics
21:55and hospitals can make a big difference. It's not just about the patient, it's about the people too.
22:02Every time we do a transfer like this, it's a reminder of how much teamwork matters. Whether it's
22:07the clinic, the hospital or us and the ambulance, we're all working toward the same goal which is giving
22:12pets like Max the best possible chance of survival.
22:42Three days later, Puskat is back to his usual self. Despite some initial protests,
22:51he eventually agreed to take his medication on his own terms of course.
22:55If you at home have ever seen any material like string hanging from your pet's mouth or their back
23:01end, please do not pull it out. Call your vet straight away or attend your nearest emergency hospital
23:07to ensure that the removal is done in the safest way possible. We've waited eagerly to hear back on
23:13how Max has been doing and we finally get the correspondence back from Southpaws. Unfortunately,
23:18the reason for Max's breathing difficulty was likely due to a pneumonia caused by breathing in some of his fluid.
23:32This could have been a very different outcome. This is exactly why we do this.
23:48People cutting me off, not a problem.
23:52We've just... We've just given her some... Can't quite...
23:56Get to finishing the sentence. This is honestly just the best result and
24:02I'm ecstatic to see her doing so well.
24:07Oh, wow. Yep.
24:09Duty call. Duty.
24:11The biggest role you have is to not be manipulated by him, which is...
24:17Yeah, are you waking me down now? Did you win?
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