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In Good Hands



Veterinarian

The Foster Hospital for Small Animals stands at the forefront of battling infection and bringing other advances in the ICU.

First-year resident Dr. Amy Trow, V04, was on duty in internal medicine in the Foster Hospital for Small Animals at the Tufts Cummings School of Veterinary Medicine—one of her rare shifts outside Emergency and Critical Care—when she got the page. She answered it matter-of-factly, assuming it was just routine, but soon learned differently: it was her own dog, Siler ("Si Si") that had been seriously injured and was on his way to the emergency room.

The Tufts project was the first to study risk factors for hospital-acquired infection in veterinary patients to the same extent as has been done for humans.

Si Si, with two other dogs at the house where Trow and her housemates lived, had bolted from the yard after a section of fence was toppled by a stiff wind. His bad fortune was to dash into the path of an oncoming car. His good fortune was that members of the Tufts community happened to come onto the scene just moments after the accident occurred. One of them, Dr. April Paul, a resident in emergency and critical care at TuftsVETS emergency clinic in Walpole, was walking her dog Savannah when she saw Si Si lying in the road with the driver of the car cradling his head. She immediately recognized the dog as Trow's and started examining his injuries. Among other things, he was having a great deal of trouble breathing.

Paula McCarthy, a former veterinary nurse and the wife of Dr. Robert McCarthy, V83, clinical associate professor, was driving by and stopped to help. Paul placed the injured dog into McCarthy's car. As they headed for the Foster Hospital ER, she called ahead to alert them that she was bringing in Si Si and that he would need a chest tube. So by the time they arrived, a whole battery of people—including Dr. Armelle de Laforcade, V97, assistant professor of clinical sciences, three residents, and several students—was ready for him. They quickly intubated him to relieve his breathing, inserted a urinary catheter, placed a central line in his neck to receive blood (Savannah was a donor), took chest x-rays, and brought him into the intensive care unit (ICU) to stabilize him.

'It was scary'

Among the residents on duty was Dr. Catherine Rogers, V04, a classmate of Trow's. She recalls, "When Siler first came in, it was scary since he was definitely having trouble breathing. But he was lucky that he was found by people who knew him—and who let us know he was coming in—so that things could happen so quickly." They confirmed that severe pulmonary contusions, or bruised lungs, were causing the breathing problem. He needed to be sedated so he could be placed on a ventilator.

Foster Hospital for Small Animals ICU

A flurry of activity takes place in the ICU at the Foster Hospital for Small Animals.

As distressed as she was about Si Si, a mixed breed she'd rescued from a North Carolina animal shelter, Trow wisely stepped back and let others treat him. "I was incredibly upset that he had life-threatening injuries, so because he's my own personal pet I really had to distance myself from what was happening," she says. "I visited him in the ICU during his stay, but I made a significant effort not to spend too much time there, since I also had to make sure to take good care of all of my own patients."

She was confident that he was in the best of hands. But her training in the ICU had made her acutely aware that Si Si and his caregivers would be battling more than his injuries: his severely weakened condition put him at an increased risk for acquiring an infection while in the ICU. She also knew that every catheter, venous line, or breathing tube inserted—and Si Si had a whole assortment of those—is a breach in the body's natural barriers to infection. And she was aware that infections acquired in both human and animal hospitals can be fatal, particularly in critical cases, because they are so resistant to antibiotics.

A leadership role

It's been the mission of Dr. Scott Shaw, V98, assistant professor of clinical sciences, to identify and manage risk factors for hospital-acquired infection (HAI), particularly in emergency and critical care. Together with Dr. Elizabeth Rozanski, assistant professor of Clinical Sciences, and Dr. Paul, Shaw conducted a 14-month study of 307 dogs admitted to the ICU for a stay of 24 hours or longer. (continued)

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