I wanted to elaborate on some thoughts that I put on Twitter earlier this week. First, here is the incident that prompted this:
I had an 8-month-old, roughly 30 pound dog come into the ER after she ate a lot of raisins about an hour and a half ago. Raisins are toxic to dogs – you can find out more about that over here.
This is a very common type of case for ER docs to see. But as with with many toxin ingestions, the client was told to call poison control. I don’t know who suggested this – sometimes the client is already aware of the service, sometimes our front desk staff tells them to call, or maybe the technician who initiates the triage will suggest it.
For most types of toxins, the standard approach is to induce vomiting for a recent ingestion. Then, other treatments may be performed depending on the dangers of the specific toxin. Often the ER doc will examine the pet, induce vomiting, and speak with the client all somewhat simultaneously.
With this dog, I had spoken with the client while a technician counted the raisins in the vomit. The clients had called poison control which then gives them a case number to relay to the ER vet. I called the hotline for current cases and waited to speak with someone.
And I kept waiting and waiting. After 30 minutes on hold I had to hang up – what a waste of time! I had other patients to attend to. And my raisin eater needed to get started on treatment.
So here’s the thing – poison control is a great resource. There are two places that we call: the ASPCA hotline or Pet Poison Helpline. But for the common toxins that ER vets see on a weekly (or sometimes daily) basis, I don’t need to talk to them. I *know* what raisin toxicity does. I already know the recommended treatment.
Even when my own cat chewed on a lily, I didn’t call poison control. There is a standard treatment for this and I’m quite familiar with it.
Once a poison control case number is generated though (and paid for by the client), I feel obligated to call and receive their guidance. So now I’m in a busy ER, often as the only doctor on, stuck on the phone for information that I don’t need. This just delays care and increases wait times.
Now there are times when I’ll have my technicians place the call and wait while I work on other things. But on many nights, they are just as busy as I am. While I wait, I might be able to do a little other work, like review bloodwork on other patients, type part of a record, or *gasp* eat something.
The situation that particularly irks me is when a client just “knows” their pet was poisoned and calls poison control. Poison control isn’t very helpful when you can’t tell them specifically what the pet ingested. Most of these cases aren’t poisoning and after an exam, this is clear.
When might poison control be helpful then? I think there are three situations when it’s great to call:
- Uncommon toxins – This is often human medication that we don’t use in dogs/cats, so the side effects and toxic doses aren’t well-known.
- High dose ingestions – If a pet eats something common and I know that this is a massively toxic dose and symptoms/side effects are almost certainly going to occur.
- Specific toxins – There are a few toxins where poison control may have detailed information that helps to calculate the dose ingested. The first one that comes to mind is xylitol. Poison control often knows how much is in specific products and can advise different levels of care based on that dose.
So please, please stop calling poison control reflexively for every single ingestion of something that isn’t food.
ER docs, have you had this problem? Or do you love poison control unconditionally? Let me know in the comments.