Pennsylvania Ag Connection - Penn Veterinarians Save Blue, a Hero Dog

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Penn Veterinarians Save Blue, a Hero Dog
Pennsylvania Ag Connection - 03/27/2017

Having one's home broken into is bad enough, but imagine the fear aroused by having an armed assailant invade your house while you're there.

One February morning at the home of Nina Teller and Leroy Buchanan in West Philadelphia, Teller answered a knock at the door. As she spoke with the man, another man pushed past them into the house.

Thankfully they had Blue, their loyal eight-year-old pit bull, to defend them. Buchanan was in the kitchen making breakfast when the invasion occurred. "I told Blue to get after the guy," said Buchanan. "He locked onto the guy's leg and that's when he fired his gun." Both men then ran off.

Blue was hit.

"It was pretty scary and I was shaken up," said Teller. "But I was worried about Blue. He was bleeding a lot. We were scared for him."

When the police arrived, Teller stayed to give her statement while Blue and Buchanan were rushed to Penn Vet in a cop car.

Erica Reineke, Associate Professor of Emergency and Critical Care, recalls Blue looking stable when he first arrived at Ryan Hospital's Emergency Service.

"My first instinct was that the shoulder wound was an entry and the sternum was the exit wound," said Reineke. "We knew the wounds were close to his thorax or in his thorax, and he had some air under his skin. So the first thing I was concerned about was thoracic trauma and bleeding from the bullet."

Dr. Erica Reineke and Emergency Service staff work to stabilize Blue's breathingBlue was not Reineke's first patient with bullet wounds. As the only urban veterinary school in the country, Penn Vet sees more cases of this nature than most vet schools. And, as a Level I facility and verified Veterinary Trauma Center, Ryan Hospital's Emergency Service is fully equipped to handle them.

According to Reineke, Blue looked stable from a cardiovascular standpoint, though he was a little pale. His heart rate was not alarming and his pulse quality was good.

Initially, Blue's breathing was stable as well, but he soon started to have some difficulty breathing. The Emergency Service team was concerned he had pneumothorax, or air in his chest cavity, so they inserted a needle into the left side of his chest to remove any air, a procedure called needle thoracocentesis, or 'tapping.'

"At that point, Blue initially stabilized, said Reineke. "But his condition rapidly declined, so we started tapping his right side. Suddenly he decompensated from a respiratory standpoint and turned very gray. We weren't getting negative pressure, and the air just kept coming through his chest."

Blue did not improve, so clinicians intubated him and continued tapping his chest. Though Blue's wounds were on his left side, there was a continuous leak to his right side through the mediastinum, which connects both sides of the chest.

In order to remove air from his chest and allow the lungs to expand more normally, a chest tube was placed and Blue was connected to continuous suction.

Once stabilized, he was transferred to Radiology.

Surgery resident Dr. Brian Brophy was Blue's lead surgeon. He followed Blue to Radiology to view the x-rays that would help him plan the surgery.

"The radiographs clarified a few things," said Brophy. "Initially, we weren't sure how many points of entry we were dealing with, but when we saw the imaging it did look consistent with one through-and-through wound. We had a wound over the shoulder and a wound on the sternum."

Dr. Brian Brophy points out the exit wound on Blue's x-ray to third-year student Therese Miranda

The radiographs also showed that Blue had a moderate amount of bruising on his lungs secondary to the trauma.

Abdominal radiographs were taken to rule out any penetrating trauma to the abdominal cavity. As Blue was seen limping earlier in the day, radiographs also were taken of the humerus and shoulder to ensure that the bullet had not fractured the bone upon entry, which it hadn't.

With a better idea of what to expect inside, Blue was taken to surgery.

Blue was anesthetized and an exploratory surgery of his chest was performed via median sternotomy, where surgeons saw through the bones of the sternum.

"With gunshot wounds, sometimes multiple injuries can happen because it's such a high-energy trauma," said Dr. Michael Mison, Clinical Associate Professor of Surgery, who assisted with Blue's surgery. Luckily for Blue, that was not the case.

Inside, the surgeons found that the left cranial lung lobe was punctured by the bullet. That damage had caused air to leak into the chest, so the lobe was removed. There were no other signs of damage.

"It is not uncommon for us to remove lung lobes," said Brophy. "This was a relatively manageable issue to deal with. Removing that portion of the lung will not compromise Blue's long-term function. And the damage was in line with the trajectory of the wounds."

"Given that we had to open the chest, dogs do recover surprisingly well," added Mison. "Pit bulls definitely have a will to live. They're hearty, and so they tend to bounce back really well."

All told, surgery only took about an hour.

Blue's owners were anxiously awaiting news. "We felt a lot better after the surgery," said Buchanan.

At left, Dr. Brophy opens up Blue's chest; at right, Dr. Michael Mison instructs Miranda

All clinical cases at Ryan Hospital present teaching opportunities for students, interns, and residents. Blue's case, in particular, was a memorable learning experience for third-year student Therese Miranda. When Blue arrived, Miranda was beginning her first day of a soft-tissue surgery rotation. The wounded pit bull would become her first-ever surgical case. She followed Blue from the Emergency Service to surgery to his discharge.

"Starting my first day with my first thoracotomy was an amazing experience," said Miranda. "The doctors were so composed and confident while I was giddy with excitement as they opened the chest and I saw Blue's beating heart. It was wonderful to watch him go from barely breathing to jumping on his owners when it was time to return home!"

"Therese was scared but thrilled at the same time," remarked Mison. "For an educator, it's fun to watch that, as the experience is still kind of novel to them. This is going to stay with her for a long time. It's going to be one of her stories, her 'very first case.'"

Following surgery, Blue recovered slowly from anesthesia and was directly transferred to the Intensive Care Unit (ICU) for close monitoring. The ICU staff's primary goals were to make sure Blue did not have excessive amounts of fluid or air leaking into his chest, to watch his wounds for any negative changes, and to make sure, most of all, that he was comfortable.

"Sometimes we need to give them potent pain medications to keep them comfortable," said Dr. Deborah Silverstein, Associate Professor of Critical Care. "We don't want patients jumping around right after surgery and potentially disrupting the surgical sites, causing further problems."

In addition to pain management, the ICU staff monitored Blue's oxygenation, breathing effort, and blood pressure, giving lots of supportive care and fluid therapy. It was important to make sure all of his organs stayed as oxygenated and perfused as possible during his recovery.

Blue experienced a relatively quick recovery in the Intensive Care UnitBlue was up and moving around 24 hours after surgery. He regained his appetite quite quickly. There were no complications from the procedures, his wounds were healing nicely, and he did not develop any severe infections from the wounds.

"Everything looked really great," recalled Silverstein. "As far as penetrating chest wounds go, Blue was as lucky as he could get. Having the genetic makeup of a pit bull definitely helped."

Teller and Buchanan visited Blue every day and were delighted to take him home just four days after being shot and having major surgery.

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