Presenting Complaint
On Sunday, September 13, 2009, “Churchill”, a 2 year old male intact Bulldog, was a presented to the AER with 2nd and 3rd degree burns. “Churchill” was surrendered to and presented by Animal Care Services (ACS) utilizing the AER for after-hours emergency care.
History
Reports indicated that cologne was spilled on the patient and he was then ignited.
Assessment
“Churchill” was presented in such great pain, he was too defensive to remove from the ACS vehicle and/or handle. His injuries consisted of burns, reportedly caused by an accelerant
Diagnostics
Diagnostics were an important part of “Churchill’s” treatment and recovery used to evaluate both declines and progressions. We repeatedly utilized hematology analysis, complete serum chemistry analysis, electrolyte analysis, blood gas analysis, and clotting profiles.
Treatment
Upon presentation to shift veterinarian Dr. Alicia Gonzalez, aggressive pain killers were administered for pain control and sedation. Upon examination, “Churchill” had singed hair over 85% of his body with burns over 50% of his body, with 10-20% of the burns assessed as 3rd degree. Dr. Gonzalez proceeded to stabilize “Churchill” with pain control, NSAIDs, IV fluid therapy, prophylactic antibiotics, and aggressive wound care. Frequent reassessment was necessary to reevaluate the severity of the dermal damage which would not become fully apparent for several days. “Churchill” was also monitored for smoke inhalation, sepsis, pneumonia, anemia, hypo-albuminemia, DIC, and multi-organ failure
By day 2-3, “Churchill’s” blood work was showing multiple organ failure and pain control was increased to a constant rate of infusion (CRI). Physically, “Churchill’s” condition was largely unchanged, and the patient’s guarded prognosis and treatment plan were discussed with the ACS veterinary staff, the acting guardian of the patient. The owners were presented with a recommended treatment plan for intensive care, as well as the expenses for prolonged care, a list of potential complications, and or considerations for the general welfare of the patient, which included a guarded prognosis. In a severely burned dog, these factors (in addition to the lack of a guarantee for survival) will often lead owners to humanely euthanize a pet rather than risk failure of treatment; however, thanks to an outpouring of community support and donations, a “shelter discount” from AER, and the caring of some key people involved in the case, the decision was made to pursue treatment.
By day 4, Churchill's condition continued to decline with the presence of bleeding issues and nutrition issues. In addition, wound care was upgraded from topical application to twice daily sedation and deep skin scrubbing using a combination of Technical surgical scrub and Malaseb Shampoo.
Over the next 3 weeks, “Churchill” remained at AER for 24-hour intensive care, continuing to receive daily wound care (initially twice daily with sedation until the level of debridement was minimal as he was gradually transitioned to once daily without sedation) and general supportive care. Early in his treatment, he developed acute renal failure and liver dysfunction, but it was caught early and managed aggressively to achieve resolution by the end of the third week.
Day 9 of treatment marked several milestones in “Churchill’s” treatment. The patient began eating on his own which eventually allowed the discontinuation of IV feeding. In addition, day 9 marked the end of aggressive wound care that required general anesthesia and we began the gradual process of weaning him off the CRI pain medication administration. His dermal wounds were healing appropriately, and surgical resection was not needed.
After 24 days of treatment, “Churchill” was ready to leave the intensive care environment; however, still in need of daily wound care and the management of multiple topical and oral medications. Ultimately, he was fostered by two AER employees who had the expertise and skill to care for him while living in a home environment.
At this point, “Churchill” resided under the foster care of Karen, an AER employee; however, a short time later Karen adopted Churchill. Remarkably, the burns have healed with no excessive scarring or cheloid formation and “Churchill” continues to return to life as a happy and healthy young dog with no apparent long-term effects.
A thank you goes out to Karen as well for continuing to provide Churchill
with the loving home he deserves.
