Specialist: Dr Adam Mugford BVetMed MVetMed DACVECC MRCVS, Board-Certified Emergency and Critical Care Specialist
Gypsy was referred to London Vet Specialists from a practice in Kent, having returned home with multiple lacerations and bite wounds.There was evidence of a body wall rupture without penetration of bite wounds to the abdomen. She was stable on admission and surgical repair was successful.
Post-operatively she developed severe hypotension that was unresponsive to fluid therapy. This rapidly-developing septic shock required vasopressor support in the form of a norepinephrine continuous rate infusion for 5 days with noninvasive blood pressure measurement required every 30 minutes to hourly. Blood glucose supplementation and monitoring was also needed as well as serial electrolyte and lactate measurement to guide therapy, with placement of a peripherally-inserted central venous catheter.
Gypsy also was developing severe anaemia, coagulopathy, evidence of acute kidney injury and icterus with elevations in ALT and GGT indicative of acute hepatic injury. Supportive measures required a fresh whole blood transfusion and oesophageal tube feeding. Antibiotic coverage was extended with administration of intravenous marbofloxacin and clindamycin.
Further wound management allowed early detection of ongoing infection and follow up management of large fat necrosis. Wet to dry dressings were used and surgical debridement with active suction drain placement allowed full resolution of Gypsy’s injuries.
After 8 days of intensive care and a total of 6 weeks of management she returned to the care of her primary practice.
Dysfunction of 4 body systems with sepsis has been reported to carry a survival rate of only 9% in veterinary patients . This case demonstrates the importance of high levels of round-the-clock intensive care nursing and specialist supervision. Here, the involvement of a board-certified ECVS surgical diplomate, working closely in co-operation with Critical Care Specialist, Dr Mugford, meant that the management of Gypsy’s condition could be seamless, which led to an outstanding outcome.