- 4 weeks ago
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00:00This program is brought to you by Open Paddock, a more open pet food company.
00:04Welcome to ReadyVetGo, the vet paramedics, Australia's veterinary paramedic service
00:10responding to critical pets at home, bringing pre-hospital care and emergency transport
00:16to pets and owners in crisis. Redefining the standard of care and bridging the gap between
00:22home and hospital, combining emergency vet medicine with the human ambulance,
00:27taking you where cameras have never been before, into the complexity and the fight for survival.
00:34This is ReadyVetGo, the vet paramedics.
00:41The ReadyVetGo team have received their first call for the day.
00:46Four-year-old Pebbles has presented to the Animal Emergency Centre with suspected cardiac failure.
00:52Pebbles is in need of an emergency appointment with vet cardiologist, Dr. Richard Woolley, as soon as possible.
01:00She's got a heart murmur, crackles in her lungs, and they've been treating her in oxygen, with diuretics, sedation.
01:09Any pet that presents with suspected cardiac failure is always at a high risk for deterioration, even in a hospital setting.
01:15The hospital has managed Pebbles' symptoms amazingly, but this is only a temporary fix.
01:21Pebbles needs an urgent review from a cardiologist for a proper diagnosis.
01:25Only then will we know exactly what's going on with Pebbles.
01:28To get Pebbles safely to the cardiologist, Paul and Nick must continue the care Pebbles is receiving in the hospital in the vet ambulance.
01:37Keeping Pebbles on oxygen and monitoring for signs of a deterioration is going to be vital in achieving this.
01:45But the team face another challenge with Pebbles.
01:48Any ambulance transport that we do needs careful consideration and planning.
01:54The nature of a cat's personality is that they're at a high risk of getting stressed in different environments with new people around, loud noises.
02:01Because any or all of these factors can actually increase their heart rate and their oxygen requirements, which means that their heart works harder and faster.
02:12For a cat in Pebbles' condition, this increased stress means that her heart could get so overworked that it actually stops working altogether.
02:20Paul and Nick assess the best way to minimise the risk of stress for Pebbles as much as possible during the hour-long drive to the cardiologist.
02:29What we'll do is we'll get her in the ambulance loaded.
02:33My vet assistant, Nick, has got an oxygen box like this set up.
02:36So we're just getting that flooded with oxygen.
02:38We'll get her moved to Frankston.
02:40We'll ring them when we're about to arrive.
02:42And then we'll ring them as well whenever.
02:44We'll ring you and let you know once she's safely in their hands.
02:47We'll give a handover from our team to theirs.
02:50We need to ensure that we are continuing the care provided in hospital and monitor for any increases in heart rate or breathing.
02:56To not only keep Pebbles comfortable, but to reduce any progression of the condition or damage to other vital organs that can occur when a pet's not getting enough oxygen delivered through their bloodstream.
03:06An ambulance service isn't just about putting a vet team in a van and driving away.
03:10A key component is coordinating logistics of each transfer.
03:14So this includes how we move our patients, even if it is only from the hospital to the ambulance.
03:21We need to plan for any foreseeable risks before even getting Pebbles into the ambulance at all.
03:27Inside the Animal Emergency Centre, the ReadyVet Go team discuss what medications may benefit Pebbles
03:34to make sure this is as comfortable as possible while also managing the suspected heart condition.
03:41The anti-nausea meds, that's all right.
03:44We'll probably give her a bit of metamine when we get her in the van just before transport.
03:48We never go into any transport as if we've done this before.
03:51This is not our first cardiac and respiratory transfer, but it is the first time that we've transported Pebbles.
03:58Knowing Pebbles' temperament, particularly in the context of cardiac failure, is crucial for her surviving this transport.
04:03We only have one chance to get this right.
04:07And we know the time constraints, but the decision that we make now can determine whether she survives or not.
04:13Dr. Woolley is the only cardiologist in this state, and if we miss this opportunity, that could be fatal for Pebbles as well.
04:20With the stakes this high, the team only have minutes to plan their strategy before making the move to the ambulance.
04:33Pebbles' critical condition posed a challenge for the team, with the risk of increasing Pebbles' stress, causing further damage to her heart.
04:43The team inside opt to give medication to help keep Pebbles calm during the transport, as well as medication to reduce her risk of vomiting.
04:53Planning for a transport that is as least stressful as possible is not only the kindest thing for Pebbles, but it also makes the transport much safer for her.
05:02When a pet is stressed, their heart rate can increase, and that's only more oxygen the heart muscle needs.
05:07A slower heart rate allows for more time for the chambers of the heart to fill, to allow for as much oxygenation as possible, reducing the workload of the heart and helping support the body.
05:16Pebbles has had a lot of medications on board, and that can cause nausea and vomiting.
05:21If we add in an hour-long car ride to this, that's an even bigger risk.
05:26We don't want her having a big vomit while she's sedated and breathing that into her lungs.
05:31With the meds settled and administered, Pebbles is comfortable enough to also tolerate the monitoring leads, a vital tool to see if there is any change to Pebbles' condition.
05:41This is just as well, because soon enough, Dr. Paul notices a change in Pebbles' heart rhythm.
05:48As I'm watching the monitor, I notice an abnormality in the heart rhythm, something called premature ventricular contractions.
05:55This means the bottom chambers of the heart are contracting too early, and during those beats, only a small amount of blood and oxygen is being delivered.
06:02If these abnormal heartbeats become more frequent, then I may have to intervene with medications that we would ideally be using in a hospital setting with more hands on deck.
06:11So it means that we need to get to the hospital as soon as possible.
06:19Oh, hi, Chelsea. It's Nick here from Ready to Go. How are you?
06:25Good, thanks, thank you. Not too bad. We are probably about 30 minutes away, and our ETA is 327, so we should be there right on time.
06:34All right, I'll lift them. Sorry, next update.
06:37Cheers. Thanks, Chelsea. Bye.
06:38And also on cue, the team hit peak hour traffic.
06:44All of a sudden, I look up and the traffic slows right down.
06:53Knowing that there's been a change in the cardiac rhythm and then seeing this come up ahead just makes my stomach turn.
07:02And we are really pushing it with this one.
07:05Despite the traffic concerns, there is finally a break in the flow.
07:09The team arrive with one minute to spare for Pebble's appointment.
07:14Let's get this girl in for her appointment.
07:16So we've got RVG one, Melbourne traffic zero.
07:19Inside the Animal Emergency Centre in Frankston, Dr. Paul has transferred Pebble's into her appointment with Dr. Richard Woolley, a veterinary cardiologist.
07:30There's a few changes that we're seeing into Pebble's heart, and they're not very typical ones.
07:36We thought initially she might have hypertrophy or thickening of her heart muscle, which there might be some slight evidence of that.
07:43But there's a wall of her heart muscle where it looks like it's a lost blood supply.
07:46Maybe there's been a blood clot that's been thrown there.
07:48And that likely has contributed to her heart muscle not pumping the way that it should, and her becoming sick, developing left-sided heart failure, is what we call it.
07:58We're also concerned that that might be the reason why she could have thrown a blood clot to one of her back legs and has now lost blood supply to the arteries that give blood to that back right leg.
08:08It's causing her some pain and some dysfunction as well.
08:11So while Pebble's isn't out of the woods just yet, we know that she's in good hands here with the team.
08:15She's getting the treatments that she needs.
08:17We know that the medications she's receiving are helping her breathe more comfortably, and we'll certainly be following her story and seeing how things turn out for Pebble's and when we can get her back home.
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08:47It's a 38-degree day in Melbourne, and pet owner Samantha has called with concerns that six-year-old bull terrier, Peggy, has become lethargic after several days of vomiting and diarrhoea.
09:03She's been unable to keep down any food or water for almost 24 hours.
09:08Samantha reported to the team that a family member had witnessed blood in her faeces, sparking concern for the RVG team.
09:16Gastroenteritis is probably one of the more silent killers in the pet world, particularly on a scorching day like today.
09:23When we receive a call about a pet that has had vomiting or diarrhoea for a number of days, as well as becoming lethargic, we get concerned that we're about to attend something potentially very sinister.
09:33Peggy's owners have described that they are now seeing blood in her stools, so we need to get there as soon as possible.
09:39The longer a pet has gastro symptoms, the more likely that we are turning up to a severely dehydrated pet, or worse, that this is a precursor to a hemorrhagic gastro.
09:49With hemorrhagic gastro being a life-threatening condition, the team attend to Peggy within 20 minutes of receiving the call.
09:58When the RVG team arrive, Dr Paul and Nick start to gather further information about Peggy's presentation.
10:05I've never seen her react that way. She was pacing, and she was staring, and she was just, it took probably five and a half hours for her to sort of come out, like go to sleep.
10:20Yeah, sure, sure.
10:21And that sort of freaked me out a bit because I've never seen her do that before.
10:25Yeah.
10:25There's no doubt that Peggy is obviously unwell, but the assessment findings are going to be the information we need to determine if Peggy has crossed a barrier where we need to potentially get her into hospital, or if she can be safely managed at home.
10:37And how many vomiting episodes has she had, and when did it start?
10:41So she had breakfast, absolutely fine. About 12, I would say probably about 11, 30, 12, she did a big vomit. I'm like, I'm amazed if there's anything left.
10:50When inflammation of the gastrointestinal system is so severe, there can be a sudden onset of bleeding within the intestinal tract.
10:58Samantha has been really diligent in monitoring Peggy since she became unwell.
11:03She's done all of the right things by keeping her cool in this heat.
11:08She's been trying to keep up with the fluid that Peggy's been losing, but it seems to be a losing battle in itself.
11:14Most importantly, she sought help early, which can mean the difference between life and death for these guys.
11:21In order to understand the severity of Peggy's illness, the team need more, well, finer details.
11:30And you said that there was a bit of pink, sort of...
11:33Yeah, or both sort of...
11:35Last time she went, it was about an hour ago, and there was a lot of...
11:39Pink girl.
11:41Yes.
11:42Yeah, and that was a vomit.
11:44Uh, no.
11:46No, that was a diarrhoea.
11:48Ah, right, diarrhoea.
11:49OK.
11:49There it is.
11:51Poo talk.
11:52Stools.
11:52In the yard.
11:54Yeah.
11:54Oh, me.
11:55And it was quite warm.
11:56Diarrhoea.
11:57Yeah, it's OK.
11:58Lots, lots, lots.
11:59A girl.
12:00Yeah, dry heat again.
12:02Wait, where were we?
12:04I get my channel from bleeding within the intestinal tract.
12:07Ugh.
12:08Which can mean the difference between life and death for these guys.
12:11Right.
12:11Um, well, then, get back to it.
12:14No, the blood pressure's good.
12:16Oh, yeah.
12:16Um, slightly, slightly higher, but it might be just because we've got people coming in.
12:21Yeah.
12:21A pre-hospital assessment with paramedics isn't about solving all of the problems at that very
12:26moment, but it's more about seeing what is happening in the moment instead.
12:31We are really happy to see that Peggy's numbers look good, and despite feeling pretty ordinary
12:36at this time, we don't need to be rushing Peggy to the emergency room.
12:41But we are there to guide the family in their decision-making about what to do next.
12:45Look, my usual recommendations in situations like this is we break it down into talking
12:52about what pets absolutely need and what they could benefit from, right?
12:56So, I don't think she's in dire danger.
13:01I think that she will benefit from whatever, you know, whatever attention we provide.
13:06Paul's giving some great advice about how to look after Peggy at home, when to escalate
13:11concerns and all those important things, but I just can't help looking at him as he's sitting
13:17on this couch with no cushions.
13:19Bad, bad bloody diarrhea if the vomiting is continuing.
13:22Probably not the focus at this point, though.
13:24No, I wouldn't have thought so.
13:27With the team outlining the points of escalation for Samantha and her family, they feel confident
13:33in keeping Peggy in the comfort of her own home for now.
13:43Toby, a 14-year-old Cavoodle has been living with cardiac failure since his diagnosis earlier
13:49this year.
13:50The Ready Vet Go team have treated Toby before and have received a phone call from
13:56his owner, Rick, informing them that Toby has had an increase in his work of breathing.
14:02We've treated Toby before during his cardiac diagnosis.
14:05He is a fighter and his family have followed the cardiologist's instructions to a tee.
14:11The cardiac failure in a dog, his age is always concerning and things can change at any moment.
14:16Getting a call that his breathing has changed is really worrying and thankfully, we're only
14:21about 10 minutes away from Toby and sometimes even that amount of time is just not fast enough.
14:27It's important when we get a triage call that we determine the safest intervention for the
14:31pet based on the circumstances provided to us.
14:34If we're an hour away, it may be best that Toby's family take him directly into hospital.
14:39However, that stress alone could mean the difference between getting there alive or something catastrophic
14:44happening on the way.
14:45The best thing to do in this situation is to stabilise Toby, start immediate treatment and
14:50figure out where we go from here.
14:52At home with only the family's son, Toby's condition appears to have worsened drastically
14:58since this morning.
14:59For Paul and Nick, even a few minutes of delayed action could be dangerous.
15:04Paul and Nick attended Toby immediately and although this is an emergency, it's important
15:10that the stakes of the situation are handled and communicated calmly.
15:15Going into a critical situation doesn't help if we're stressed.
15:18Believe it or not, pets are intelligent beings.
15:21If everyone around them is calmer, then that is a really good thing for their heart rate
15:25and their breathing.
15:27And with Toby's situation, we need everything we can get on our side to manage this situation.
15:32Within a few moments of stepping into Toby's home and having a look at him, we know that
15:36things aren't great.
15:37His oxygen levels are really low.
15:39He's looking blue in his tongue and gums.
15:41And the first point of stabilising Toby is about maximising the amount of oxygen that he'll
15:46be able to get into his bloodstream.
15:47Listening to Toby's chest, I can hear some fluid on his lungs, crackles that are throughout
15:52his chest and we know that he is reducing the amount of oxygen that he's getting into his
15:56bloodstream.
15:57With Toby's breathing becoming more laboured by the minute, the team makes the decision
16:03to administer oxygen immediately.
16:05The less oxygen that Toby's able to get in only increases his work of breathing and the
16:11workload on his heart.
16:12This is a cascade and it's a fast one.
16:16Whilst the oxygen is buying more time, Dr. Paul performs a mobile ultrasound on Toby's chest.
16:22What Dr. Paul finds on the ultrasound only confirms his suspicions.
16:27His left side of his heart, as we would expect, is really just very enlarged.
16:32That's part of why he's got this breathing issue, fluid build-up.
16:36Looking at the ultrasound, I'm not surprised by what I'm seeing.
16:41But it's certainly not what I was hoping for.
16:45G'day, Rick.
16:45I'm good, thanks.
16:47Yeah, look, he's not fabulous.
16:50His work of breathing is quite...
16:53He's got a lot of effort behind it.
16:56Paul's had a listen to his chest.
16:57It does sound quite wet on the left side.
17:01So it could indicate that he's got some fluid if that's...
17:06Yeah, if he's having a bit of an episode at the minute.
17:09Listening to Toby's chest and seeing his oxygen readings, my suspicion is that there is a
17:13considerable amount of fluid on his lungs that is caused by a backflow of fluid from heart failure.
17:19I was hoping to some degree that there would be some fluid that we would be able to drain
17:23in the chest cavity.
17:25However, the ultrasound shows that the area of his heart that delivers blood to the rest
17:28of his body is quite enlarged.
17:30So I'm not surprised by the way that he's acting today.
17:34We're giving a diuretic to try and remove the fluid build-up from around his lungs.
17:38Hopefully, this will take some of the pressure off of his heart, and he will start to breathe
17:43a lot easier.
17:44With the oxygen and the diuretic on board, Toby begins to show small signs of improvement.
17:50But it's clear that this is not a condition they can manage at home.
17:54Toby's presentation is the perfect example of why we need an ambulance response for pets.
18:00Our decision-making options for pets are different to humans, particularly when there's a deterioration
18:05for a condition that isn't curable.
18:08Stabilising Toby not only provides him with comfort, but it allows us some time to discuss
18:13the situation with the family in an environment that is calm and clear.
18:17We're at a fork in the road here, and although we've stabilised Toby, the family needs to make
18:22some tough decisions at this point.
18:24He's been managed really well until now, and even though his family have done everything
18:28right, this condition is progressive and fatal.
18:30With the severity of Toby's condition clear, Paul and Nick must now wait for the family's
18:36decision that immediate transport to a hospital is the only option to see if this event is
18:42something that Toby can come back from.
18:45If we're treating this heart failure, we need to treat it now.
18:48Time is not on Toby's side, and the sooner we get him into hospital, the better his chances
18:52of making the best recovery he can.
18:53We'll see you next time.
19:23We're touching base with Mary-Anne from All4Paws.
19:53where she's actually just received a litter of kittens and a litter of puppies.
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20:44Next week on the season finale of Ready Vet Go. With Toby's condition stabilized,
20:53his family decides whether Toby is transported into hospital for his cardiac failure.
20:58The team determine if Puss Cat's gastro symptoms are signs of a bowel obstruction and 17-year-old Max's
21:06routine dental procedure leaves him fighting for life.
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