Any suggestions why this cat crashed?

Re: Any suggestions why this cat crashed?

Julian Earl — Sat, 04 Aug 2012 09:00:05 GMT

Rotten when this dort of thing happens.

I (luckily) had a rescued but unowned six-months old cat in for castration a while ago. Everything was straightforward, kitten woke up and was walking around its' kennel afterwards, last noted about half an hour before the collection time. No problems - until the lady arrived to collect it and it was lying dead and cyanotic in the kennel. That's makes you scratch your head but honesty was the only option and admitting that nope I don't really have a clue at the moment about why it died - it might be this, it might be that, but actual cause? No clear idea.

I think the best you can hope for is an understanding owner and a good night's sleep for your self.

Re: Any suggestions why this cat crashed?

Nicola Lawlor — Fri, 03 Aug 2012 21:05:15 GMT

Thank you Emily - that is lovely to hear you say.

Re: Any suggestions why this cat crashed?

Emily Nightingale — Fri, 03 Aug 2012 20:32:35 GMT

Dear Nicola- Can't offer any vetty advice over and above the other suggestions already given, however just wanted to say I'm really sorry you have had a really rubbish day. Tomorrow will be much better and I hope that the whole experience hasnt rattled you too much. The fact that you are thinking so much about what went wrong/ if /how /when/ where etc etc shows a conscientious, caring and committed approach. Hope you get some respite this weekend and try and think of all the good/great cases you have helped along the way. I keep thank you cards and get them out when things don't go my way. As they say, a smooth sea never made a skilful mariner...

Re: Any suggestions why this cat crashed?

Nicola Lawlor — Fri, 03 Aug 2012 20:03:23 GMT

Thank you - the owner elected to euthanse last night after ongoing CNS issues. Not a wrong decision because they made an informed decision though I would have preferred to give the cat a bit more time having seen one cat take around 3 days to improve but then return to apparent normality after this.

I questioned the nurse more today and there was no difficulty placing the iv catheter and no jiggling of the stylette in the catheter that could have caused a bit to break off (another theory I came up with last night!). Drip was all run through so the worst bubbles that may have been run in would have been tiny so an unlikely cause.

Cat off colour for a few days = not eating well, pawing at mouth, pus from teeth etc.

Hopefully not to be repeated ever to anyone. Had another rubbish day today with some cases but that is another story! Next week...onwards and upwards.

Re: Any suggestions why this cat crashed?

Rajat — Fri, 03 Aug 2012 19:33:12 GMT

[quote user="Nicola Lawlor"]I hate days like this [/quote]

Me too!

[quote user="Nicola Lawlor"]As cat had been poorly for a few days[/quote]

What were the clinical signs , anything specific?

[quote user="Nicola Lawlor"]then the cat just keeled over. She rushed the cat back out to the table and at that point the cat barely had a heart beat which then stopped[/quote]

So basically the cat had a syncopal event..due to cardiac arrest. Not a CNS event leading to cardiac arrest.

Unsure what the cat vocalising loudly means other than potential distress....wouldn't read much into it.

It's virtually impossible from this info (not your fault) to tell what happened. It's worth performing an echocardiogram to check for underlying cardiac issues, getting an ECG trace -maybe hook upto a monitor for 5-10 minutes to evaluate if any arrhythmias, though these too may now be secondary to cardiac hypoxia and so on post arrest. The arrest could be primary cardiac or secondary. It may have some 'badness' lurking somewhere. Not heard of endocarditis in cats from dental disease, and it is a nebulous entity in dogs as well

Air embolism- well you have to have a HUGE pulmonary embolism to cause cardiac arrest...in the order of >60-70% occlusion of the PA circulation. So a large volume of air has to be run in ...so unless someone thought they had run the air out but didn't, this is unlikely to be a cause.

I hope you've got some better signs of CNS recovery now, I see blindness as the most common problem in these patients,I seem to remember something vaguely about the optic cortex being particularly vulnerable to hypoxia ...but this could be complete rubbish so best to look it up!

Good luck with the case

Raj

Re: Any suggestions why this cat crashed?

Kate Richardson — Fri, 03 Aug 2012 18:20:22 GMT

[quote user="Martin Atkinson"]

[quote user="Kate Richardson"]Otherwise I would be thinking thrombembolus as well especially as you say the cat miaowed- a lot of cats prior to an aortic TE will miaow loudly, not sure if this is due to the very early stage of a clot blocking a vessel/pain, but it is something I have seen or heard of quite regularly.[/quote] I know cats sometimes give a very stressed miaow as some serious event is about to occur but Christ alive, if we think every time a cat gives a loud call its having a brain haemorrhage or ATE we'd be stressed out of our skins.

[/quote]

Having a bad day? That's hardly what I suggested. This cat did have some kind of CNS event, so all I was suggesting was in the context of what happened, this may have fit the picture. Jeez

Re: Any suggestions why this cat crashed?

Martin Atkinson — Fri, 03 Aug 2012 17:52:39 GMT

Re: Any suggestions why this cat crashed?

Mark Hedberg — Thu, 02 Aug 2012 21:33:53 GMT

I had a cat who had knocked a canine out 90%, painful enough that you couldn't just grab it. Faintest of premeds (this thing was loose, wobbling and out of the socket, a faint premed and he held still and i pulled it. ( couldn't get it un pre meded). Got it, and 5 seconds later the cat drops like a rock. Cat survived and made a perfect recovery but i swear this took 5 years off my life. I can look back and grin but there for the grace of God go I...

Re: Any suggestions why this cat crashed?

Nicola Lawlor — Thu, 02 Aug 2012 20:47:57 GMT

No blood pressure check prior to this no, so BP could be a factor. Assuming it makes it overnight I will check that tomorrow and make sure we address any issues there. I guess we will have to have a longer chat with the owner about a possible thromboembolism too. Will update more tomorrow.

Thanks all

Re: Any suggestions why this cat crashed?

Kate Richardson — Thu, 02 Aug 2012 16:34:07 GMT

Did the cat have a blood pressure checked at any point prior to the procedure? As a CNS bleed would be something to consider. Although it is good that it appeared a non stressful event to place the iv line, there will be some stress involved (we cannot eliminate it all), and I'm not sure we all fully appreciate this. Just cos the cat stays still it doesn't mean its not stressed, and if it was already hypertensive then a small amount of extra stress could just cause that BP to go up a bit more and that vessel that had already become weakened just couldn't take that rise. if that's the case, it was an accident waiting to happen, but at least BP is something you can still assess now and treat if necessary.

Otherwise I would be thinking thrombembolus as well especially as you say the cat miaowed- a lot of cats prior to an aortic TE will miaow loudly, not sure if this is due to the very early stage of a clot blocking a vessel/pain, but it is something I have seen or heard of quite regularly.

[quote user="Nicola Lawlor"]The cat had miowed a couple of times (and I had laughed to the nurse who was holding that her miaow was in good form!) but no hissing, struggling etc and certainly a non stress procedure as these things go. [/quote]

Sympathies though, its horrible when these things happen

Re: Any suggestions why this cat crashed?

James Laidlaw — Thu, 02 Aug 2012 16:14:34 GMT

If long term dental disease - could have had something cardiac (endocarditis?) that may have been triggered from even a relatively stress free procedure. Or emboli as others have mentioned.

Anything else illness wise in the previous history?

I imagine we've all had things just die on us and without a PM you'll never know, even with a PM you may not get an answer. Hope the rest of your day has been better!

Re: Any suggestions why this cat crashed?

Mark Lowrie — Thu, 02 Aug 2012 15:16:12 GMT

Apologies Nicola, I have re-read it and I see that is exactly what you meant. Very puzzling...

Re: Any suggestions why this cat crashed?

Nicola Lawlor — Thu, 02 Aug 2012 15:14:20 GMT

The drip was basically started and the cat taken straight back to the kennel from what I understand, so yes was really within moments of starting the fluids. The only other thing I came up with on Dr Google is the possibility of a patent foramen ovale in the heart and a small air embolus then crossing to the left side and into the coronary arteries.

Sorry to hear about the puppy Utlendigur. That is rough too.

Handling I know was fine. I was in the theatre next to the prep room while they were putting the cat on a drip. The cat had miowed a couple of times (and I had laughed to the nurse who was holding that her miaow was in good form!) but no hissing, struggling etc and certainly a non stress procedure as these things go.

Mark thank you for the info - I will read and digest in due course but in this case we hadn't got as far as the dental. We were putting fluids on prior to a premed somewhere further down the line, just to be set up and ensure that sufficient fluids was given through the day as to be worthwhile. Needless to say the dental will not be happening at least for now, possibly ever though that will remain to be discussed.

Re: Any suggestions why this cat crashed?

Utlendigur — Thu, 02 Aug 2012 15:11:51 GMT

[quote user="Mark Lowrie"]

Hi Nicola, I couldn’t quite work out from your post, did this cat have a GA and dental procedure? If so, try this link:

[/quote]

I read it that the cat had just been put on iv fluids prior to GA but hadn't got to the GA stage

Re: Any suggestions why this cat crashed?

Bob Russell — Thu, 02 Aug 2012 15:07:51 GMT

12 years ago I had a cat arrive in evening surgery. The whole family was there, all very worried because the cat had a lump on its side. I was very reassuring and told the young child that it was only an abscess and as it was about to point I told him not to worry and I would lance it and all would be fine!

Little handling stress and almost no reaction when I lanced the abscess. Within a minute it keeled over in a similar way and was dead within minutes despite all the efforts we took to recover the situation.

Imagine the time I had explaining this to the family!

I have always believed this was an embolism but it was not possible to do a PM and I probably would not have found it if it was there. As already said 'Shit happens'!

There was a case of an air embolism documented in the VR a number of years ago. This was a patient being treated by a student.

I learnt not to be quite so confident and cavalier in front of an owner until the procedure is completed but otherwise have continued to do things the same way (uneventfully).

Re: Any suggestions why this cat crashed?

Mark Holmes — Thu, 02 Aug 2012 15:07:30 GMT

We had something similarly off a few months ago, dog out for a walk came into the clinic for a hedgehog chew, owner walked out of the clinic around the corner and the dog dropped stone dead. Only 18 months old and was apparantly very well in the clinc. Jumping around and yipping for chew. Shit does happen although I would look again at handling, if there had been any restraint at all it could be implicated. I am very very cautious about restraint of elderly cats and will sedate anything which doesn't pretty much bleed and drip itself.

Re: Any suggestions why this cat crashed?

Mark Lowrie — Thu, 02 Aug 2012 15:03:57 GMT

Hi Nicola, I couldn’t quite work out from your post, did this cat have a GA and dental procedure? If so, try this link:

http://www.remedicajournals.com/Companion-Animals/BrowseIssues/Volume-1-Issue-3/Article-Analgesia-and-Anaesthesia

And scroll down to article on “Post-anesthetic cortical blindness in cats: twenty cases”

We get a surprising number of advice calls from vets that have performed anaesthetics (usually for dentals) in cats that have either had an unexpected arrest or seemingly uneventful GA followed by severe neurological signs ranging from coma, blindness to seizures.

I would recommend you assess the menace response in your cat to see if it responds. A positive PLR with negative menace response would fit this cortical or ‘central’ blindness.

Prognosis is guarded but we do see some recover as the paper suggests just with time and nursing alone (no other treatment options). It also gives some information as to the possible causes.

Were you measuring blood pressure during the GA? This study suggests that routine blood pressure measurement during cat dentals is a good idea.

Re: Any suggestions why this cat crashed?

Utlendigur — Thu, 02 Aug 2012 15:00:36 GMT

Or possible CVA?? eg thromboembolic disease - some cats can have clots rattling round in the ventricle just waiting to cause problems. How long between starting drip and crash - I'd have thought onset of an air embolism would have been very quick ie not much more than the time for what was in the drip line to run in.

Also having similar day - client phoned with 4mnth old puppy that had been "bouncing around" earlier in the morning then "vomited" a few times and seemed lethargic - told to come straight down but dog was DOA 15minutes after call (massive spontaneous pneumothorax from a pulmonary bulla). Husband had taken apparently normal pup out for an hour then had to phone the family and say he was dead

Re: Any suggestions why this cat crashed?

Martin Atkinson — Thu, 02 Aug 2012 14:42:01 GMT

Can't help on the why apart from anything you would reasonably have thought of but can be a bit encouraging as we had one similar a couple of months ago while a new grad. was doing a routine dental and it made a full recovery by the evening. Equally sadly I've had those that didn't. Main thing is, if there is nothing you would have done differently that you haven't done a thousand times before, then as I told my distraught young vet: don't blame yourself - shit happens.

PS as far as I'm aware air embolisms only occur in divers and hospital dramas!