Veterinary Critical Care

February 2017 Patient of the Month

Pilot's Story

January 13 2016 is a day that I will never forget, that was the day my boy was diagnosed with Immune Mediated Hemolytic Anemia-IMHA. When your dog has IMHA, it means his immune system destroys its own red blood cells. Your dog’s body still produces red blood cells in the bone marrow to replace the destroyed cells, but, once they are released the immune system mistakenly recognizes them as something foreign. Pilot is a 3 year old Schipperke male who came into my life on October 19th 2013. I show dogs and I waited a very long time, years in fact, to get a dog as special as he is. He was the most confident dog I have ever seen and I knew he was going to be a top show dog, he loves everyone he meets and everyone who meets him loves him, a dream come true but that was not to be. He rose to the top in a very short time, finished his championship in record speed before his first birthday, on his way to becoming a grand champion. I had HUGE goals for him and he certainly was the dog to do it all. But I noticed that he was starting to fade just after his second birthday, he would what I call pass out with exertion lost interest in eating and developed bloody stool. I rushed him to Stack Vet Hospital to see what was wrong they took a blood sample and said they would get back to me with results the next day.

Well I got the call from Dr. Stack and he asked me if I could come up that day to review the results, I knew right then and there it was not good. I called my husband Spencer and we met at home to take our boy for results. I was told that Pilot had IMHA and it was a life threatening illness, a normal RBC is 45 and above, he was at 15.5. We were in total shock, I had never heard of this disease. They started him on Prednisone which is the first line of treatment. A follow up appointment was made for the following week for a RBC count. I went home to do my research on this illness. I contacted some of my show friends and no one really knew or had seen this before.

When we went for his follow up appointment it was snowing and blowing out. Pilots RBC count was now 7.5! Dr. Stack said to me Pilot needs a blood transfusion or he will die. I chose to take him to the Emergency Room at the Veterinary Medical Center (VMC) and the arrangements were made.

Well, the staff at VMC were just incredible! I was an emotional wreck thinking the worst and in shock myself. I was treated with such compassion and a better knowledge of what was wrong with my dog. I left knowing he was in good hands. They kept in contact with me throughout the night and his RBC count went up to 19. He was hospitalized for two days and transferred to the Critical Care Service. I was told how serious this was that some dogs do well but it is a long battle, our goal is to get Pilot into remission.

Pilot still has a long way to go and is going to need frequent visits with the Internal Medicine Service at the VMC. The Internal Medicine Service is the greatest “team” ever to care for him. My husband, Pilot and I would like to personally thank Dr. Heather White, Dr. Cortright, Kim (vet tech) and Toby (vet tech), and Tracie receptionist who just love my boy, hard not to since he is very special. I can honestly say my dog would not be here if it weren’t for the love and devotion they have for him and for the emotional support they have given my husband and I. As long as Pilot is willing to fight so are we!!!

Thanks so much to everyone who has been there for Pilot!!!

Spencer, Sandi and Pilot Lovelace…

Albuterol toxicity in Pets: Where's your inhaler?

ventolin-inhaler-02-1 Millions of people in the United States suffer from asthma.  Many of these people have inhalers to use during an attack.   These inhalers are composed of a small pressurized canister that contains a solution of asthma medicine fitted into a plastic casing that releases a precise dose of the medicine in an aerosol form.  The medicine contained in many asthma inhalers is albuterol, a drug used to relax the muscles in the lungs and allow the air passages to open.

The size and (we think) the smell of the inhalers make them very attractive and interesting to our dogs.  Dogs are easily able to puncture the canister if they chew on it. Since the canister is pressurized, the entire contents are released instantly, resulting in almost certain overdose of the medication. In an overdose, these drugs affect both the muscles of the lungs as well as the muscles of the heart. The results are immediate, severe, and include the following:

  • Increased heart rate
  • Abnormal heart rhythms
  • Red gums
  • Increased respiratory rate / excessive panting
  • Abnormal behavior (restlessness/agitation, hiding, tremors, shaking, lethargy, weakness, collapse)
  • Low or high blood pressure
  • Vomiting
  • Severe changes in blood electrolytes (particularly potassium)
  • Seizures
  • Shock
  • Acute death

If you know that your pet has bitten into an inhaler, you should seek care at the nearest emergency veterinary facility.  Bring the inhaler and the original packaging if it is available, as well as any medications that your pet is currently taking. Do not induce vomiting at home.

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Dogs suffering from albuterol toxicity will typically need to stay in the hospital for 12 - 48 hours.  Treatment will include sedation, aggressive IV fluids, blood work (to monitor the electrolyte levels), drugs to slow the heart rate down, and heart and blood pressure monitoring. With prompt and appropriate treatment, albuterol toxicity is rarely fatal, although pets with heart conditions and pets on medications that interact poorly with albuterol are at higher risk for serious complications.

Veterinary Medical Center of CNY's Emergency veterinarians are available 24/7/365 to help you and your pet through these types of emergencies, but we will be just as happy if you can avoid them!  Keep these and all other medications out of reach of your pets.  Also avoid disposing of used canisters in trash cans that are accessible to pets. Used inhalers can still contain enough medication to be dangerous.

VMC's November Patient of the Month

Simba's Story

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Simba had no history of any physical ailments. He was on a routine walk one afternoon when another dog got away from its owner and ran toward Simba. Simba turned his body and his neck quickly to move away from the other dog, and suddenly dropped to the ground. All four legs were stiff, he was breathing very heavily, panting hard, and his eyes were looking around panicked. He wouldn’t move, and then his tongue started to swell and turn purple. I quickly got him into the car and rushed to my vet, Lyncourt Veterinary Hospital.

There, Simba was given oxygen and examined for the cause of the problem. He still wasn’t moving, and was still very panicked. Simba couldn’t understand what was happening. In fact, he was so scared that he put himself into cardiac arrest and was not breathing at all for several minutes. The vet administered several shots of epinephrine in order to revive him, at which point he was transferred directly to the Veterinary Medical Center.

Dr. Luschini was able to stabilize Simba, although his heart rate was still very high and he still wasn’t moving at all. He couldn’t move his limbs or his tail, and he couldn’t even bark. But he was alive and breathing. He was placed into one of the beds at the Veterinary Medical Center, connected to an IV and a urinary catheter, and kept overnight for observation. Still not moving the next day, Dr. Fleckenstein evaluated Simba and began acupuncture treatment, while Lis Conarton assessed him and began physical therapy. Because Simba couldn’t move or stand on his own, Lis started him in a “cart” with harnesses that held him up in a standing position and moved on wheels to start exercising his legs. We also did “range of motion” exercises to prevent atrophy in his muscles.

After 3 days of stabilization at VMC, and still unsure of the exact cause of this ailment, we transferred Simba to Cornell University’s School of Veterinary Medicine for an MRI.   The MRI revealed that Simba had a disc degenerating in his spine in his neck, and a small piece of cartilage had likely broken off when he turn his neck away from the other dog.  This had  punctured his spinal cord – impacting his entire central nervous system and paralyzing him. No doctor could give us a clear prognosis for his recovery.

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Simba returned to the Veterinary Medical Center the next day, and remained hospitalized for nearly two weeks. It was days before he could eat on his own, and a week before he was able to urinate on his own. But he still couldn’t stand. All of the doctors and technicians continued their work and exercises with him multiple times throughout each day.

 

When Simba finally came home, we still had a lot of work to do. We purchased a “Help ‘Em Up” full-body harness that has handles at either end to help us lift Simba, so that we could carry him outside to go to the bathroom, and help him to get up and moving around for his at-home physical therapy exercises. We also brought him in to the VMC multiple times for acupuncture, PT with Lis, and evaluations by the doctors. Over the next three months, Simba slowly made progress.

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Simba is now miraculously up and walking, even running, and nearly 100% back to his old self. Throughout the entire experience, our family had to make tough decisions – but the team and support at VMC saved our dog’s life. ~Simba’s Family

Simba: 5 year old golden retriever mix

Diagnosis Spinal cord damage & temporary paralysis

Treatments Hospitalization MRI Acupuncture Laser Therapy Underwater Treadmill Home Exercise Program Pain Management Medications

VMC's April 2015 Patient of the Month

Conoco Conoco spent some time with our Emergency and Surgery services, and we all loved him!

Conoco's Story:

Conoco developed lower urinary tract signs in January, which prompted evaluation and treatment at another clinic. At that time he was hospitalized and treated with a urinary catheter, IV fluids and medications. He has since been monitored and further treated by his primary care veterinarian Dr. Ryan at Beaver Lake Animal Hospital where dietary management was instituted. He re-presented on February 23 for similar signs but was able to pass urine; his medications were restarted. On February 26 he presented to Dr. Ryan where a mucus plug was dislodged from his urethra and he was able to urinate. He was restarted on prednisone, prazosin and started on amitryptiline. This morning, however, he was growling and straining to urinate with no urination possible. He was then referred by Dr. Ryan to the Veterinary Medical Center for a Perineal Urethrostomy with Dr. Robinson who is a board certified surgeon. Conoco recovered well from surgery and was hospitalized for four days. I want to sincerely thank Dr. Robinson and all the numerous staff for wonderful care and respect to our needs during Conoco’s “ordeal”! What a top notch facility and the staff was extraordinary! What spoke volumes to me was Conoco was not used to strangers yet he gradually offered his belly to the staff that took such amazing care of him. Your care went beyond medicine it included love and kindness which I know had a hand in our being able to have more time with our beloved Conoco. I know that you can’t save the world however, sometimes you can save someone’s world.. ~Conoco’s Family

Conoco's Problems: Repeated Urethral Obstruction Secondary to Feline Lower Urinary Tract Disease

Conoco's Treatment: Board Certified Surgical Intervention Perineal Urethrostomy

Conoco and friend

We love happy endings!

 

Handling a Pet Toxin or Poisoning Emergency

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My pet just got into something he shouldn’t have. What should I do?

 

This could be the shortest blog post ever.  The answer:

1) Call your veterinarian or the nearest emergency veterinary hospital.

2) If #1 is not possible, call Poison Control.     ASPCA Animal Poison Control (888) 426-4435

Perhaps you’ve been through a similar situation in the past. Perhaps your sister has. Perhaps your neighbor’s son’s friend worked in a veterinary practice for a few months three years ago. This is what we’ll tell you: Unless the advice you are given is the two steps above -- DON’T USE IT.

What your pet ate may be fine, and we get plenty of false alarms here. A call will never hurt, and is certainly quicker and more accurate than getting several dozen opinions from your friends, family, neighbors, and Dr. Google.

When you call, your vet (or Poison Control) will need to know:

• the name of the substance • the strength of the product if known (medication, chemical, etc.) • how much was consumed • how long since you think the consumption occurred • age, breed, and approximate weight of your pet

Can’t I just make my pet vomit?

No.

Do not give your pet any ‘antidotes’ unless instructed to do so by your veterinarian or poison control. Some substances will cause even more harm if you make your pet vomit. Some have even more risk if your pet inhales some of the substance while vomiting. Once, memorably, we encountered a substance that, when mixed with the stomach acid of the dog, could potentially have created a gas that was extremely dangerous to all of us in the hospital if we had released the gas by making the dog vomit. Some substances will need to be neutralized with specific antidotes that a veterinary hospital will have access and the tools to administer.

Here at VMC, poisonings and toxicities are what we deal with day in and day out. We are very comfortable handling these cases and are easily able to properly guide a pet owner through this process. While some cases are very routine and we know exactly what to do immediately, we commonly utilize the resources of Animal Poison Control. New products, drugs, and chemicals are created all the time, and so the potential toxins and combinations of toxins in common household items can change so rapidly. So can the antidotes and treatments. The ASCPA Animal Poison Control service stays current with the newest information that can make all the difference in saving a pet’s life.

WORTH REPEATING ONE MORE TIME: DO NOT MAKE YOUR PET VOMIT UNLESS YOU HAVE EXPLICIT INSTRUCTIONS FROM YOUR VETERINARIAN OR POISON CONTROL.

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Some general tips:

Be Honest. We know what a dog that ate marijuana looks like and acts like. We can run a whole bunch of tests that will tell us what we already suspect (and waste time and cost you money you don’t really need to spend), or you can just tell us the truth. It’s OK. We won’t judge. We just want to help your pet, and the sooner we can do that the better. And no, it is not, not, NOT OK to intentionally “share” with your pet. They do not react the same way to recreational drugs, and it is cruel to do that on purpose. Not funny. Not ever.

Drugs and Chemicals (rodent poisons, insecticides, antifreeze, recreational drugs, human pharmaceuticals) are potentially the most harmful poisons as they are often in a very concentrated form. Your pet may only need to consume a small amount for it to have a significant effect.

Cats tend to be more susceptible to poisons than dogs. Fortunately, cats are normally less likely to eat something unfamiliar. If toxic exposure does occur, cats may be more at risk, as their metabolism is less able to process many toxins (acetaminophen, permethrin, and plant poisons) that are somewhat less dangerous for dogs. Be aware that cats are at high risk for ingesting contaminants on their fur, however, due to their grooming habits.

The most common sources of toxins for pets, according to the ASPCA are: prescription and over-the-counter drugs (both human and pet drugs), insecticides and insect baits, common household plants, rodenticides and baits, and common household cleaners including bleach, detergents, and disinfectants. We see all of those problems at VMC, and would also add chocolate, xylitol, and recreational drugs to the list.

What should I include specifically for this in my pet's first-aid kit?

The ASPCA Animal Poison Control Center experts recommend the following to keep on hand in case of toxins:

• Fresh bottle of hydrogen peroxide, 3 percent USP (to induce vomiting) • Turkey baster, bulb syringe or large medicine syringe (to administer peroxide) • Saline eye solution • Artificial tear gel (to lubricate eyes after flushing) • Mild grease-cutting dishwashing liquid (for bathing an animal after skin contamination) • Forceps (to remove stingers) • Muzzle (to protect against fear- or excitement-induced biting) • Can of your pet's favorite wet food • Pet carrier

Always consult a veterinarian or the APCC for directions on how and when to use any emergency first-aid item. We also suggest that you keep the telephone number of the ASPCA Animal Poison Control Center—(888) 426-4435—as well as that of your local veterinarian in a prominent location.

VMC's Blood Hounds Canine Blood Donor Program

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BloodHounds LogoYour dog can help save lives!

Did you know that dogs need blood transfusions to help treat serious illnesses, just like people?  Dogs need blood transfusions for many of the same reasons that people do, such as recovery from blood loss during trauma or some surgeries, to recover from some serious illnesses, and for acute issues such as heat stroke.

Your pet can help save lives by becoming a VMC Blood Hound!

Listed below are the requirements for canine blood donors:

• Your dog weighs at least 50lbs • Your dog is between the ages of 1 – 7 years of age. • Your dog is in good health • Your dog is easy going and easy to handle at a veterinary office • Your dog is current on Canine Rabies and Distemper/Parvo Vaccinations (vaccine records must be provided) • Your dog is not receiving any medications • Your dog receives yearly flea and tick preventative • Your dog is spayed or neutered

If your dog meets these requirements, your dog can potentially be a VMC Blood Hound!

As a VMC Blood Hound Donor, your dog (and you!) will receive as a thank you:

  • Annual blood testing performed at NO CHARGE, including blood typing, blood Chemistry profile, Complete Blood Count (CBC), thyroid testing, and tests for infectious diseases.  This more than a $350 value performed yearly for as long as the donor is in the program and donating on a regular basis.
  • One unit of blood or plasma for every unit of blood donated free of charge should illness or injury ever warrant its use (although we hope that our donors stay healthy and don't need this!)
  • A VMC Blood Hound leash and other bonus goodies at the time of enrollment.
  • A bio and picture on our VMC Blood Hound Facebook and/or webpage.
  • A post celebrating your pet’s help in caring for a critically ill pet will be posted on our Facebook page after every donation.

Please follow the steps below if you are interested in having your pet become a blood donor:

 

Step 1: Complete Application Forms

  1. Contact us at VMCBloodHounds@vmccny.com and request the Donor Registration and Health History form.
  2. Complete the Donor Registration and Health History form and return to VMCBloodHounds@vmccny.com
  3. Send us a copy of your pet’s recent vaccination records to VMCBloodHounds@vmccny.com

Step 2: Temperament Screening

Eligible dogs will be invited to VMC by appointment for an initial assessment regarding ease of handling/temperament of the dog.

Step 3: Free Physical Exam and Blood Tests

1. Dogs from families who are dedicated to fulfilling the donation commitments and meet all the VMC Blood Hound requirements will have a complimentary physical examination. 2. If the dog is noted to be in good health, they will have their blood drawn for further blood testing. These tests will include a blood type, tests to look for underlying infection or organ disease, and tests for infections that can be transmitted through blood transfusions. 3. Owners will be notified of their dog’s blood work results and status as donor dogs.

Step 4: Donations Dogs that pass all the requirements and are selected for the program will be invited to become a VMC Blood Hound. Most donations will need to be made on an Emergency basis and can be as often as every 2-3 months. We will do our best to contact you in a timely manner. However, since emergency need of blood transfusions cannot be predicted, we may ask you to come in to have donations done on nights, weekends, and holidays.

Izzy's Story

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Izzy was referred to the Veterinary Medical Center of Central New York by her family veterinarian.  Izzy, a 3 year old otherwise healthy Yorkshire Terrier, had collapsed and was non-responsive by the time she arrived at her family veterinarian.   She was not breathing well, and her veterinarian quickly responded by placing a breathing tube and beginning assisted breathing with an ambu-bag.  Izzy’s heart rate was abnormally fast, and so IV fluids were also administered.  Because her family veterinarian knew Izzy needed specialty care, she was transferred to the Critical Care Service at the Veterinary Medical Center of CNY.  Izzy’s owners drove her here (an approximately 45 minute drive) with a tube in her airway.  Izzy was comatose and they were not sure that she would even survive the drive.

On arrival to the Veterinary Medical Center’s Critical Care Service, Izzy was immediately rushed to the ICU for evaluation and treatment.  She remained in a coma, with a fast heart rate and low blood pressure.  Her oxygen level was low, so she was given supplemental oxygen while a technician gave her breaths through an ambu-bag.  Tests were performed immediately while additional treatments were provided in order to improve Izzy’s condition.  An EKG showed a fast heart rate.  Blood pressure and oxygen levels were low.  Emergency blood work showed a low red blood cell level as well as a low protein level.  Izzy continued to receive IV fluids while her parameters were continuously monitored.  During this time a large swelling was noted on Izzy’s neck.  Further inspection of this swelling showed it was due to bleeding under the skin.  Izzy had also bled heavily from her IV catheter sites.  An ultrasound showed she was bleeding around her lungs, causing her lungs and airways to collapse.  This was deemed the cause of her difficulty breathing.

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Based on these findings she was immediately screened for anticoagulant rat poison toxicity, a toxin which causes life-threatening internal and external bleeding.  Her test results were highly suggestive of rat poison toxicity.  Izzy’s owners were informed of this and realized that there had been the potential for exposure to rat poison a few days prior to this incident.   Izzy immediately received treatment for this condition, which included a red blood cell transfusion, a plasma transfusion and Vitamin K injection.  She continued to be continuously monitored while a Critical Care specialist and a team of licensed veterinary technicians stood constantly by her side.  Over the next hour Izzy became responsive and able to breathe well on her own.  The breathing tube was removed, and her heart rate and blood pressure normalized.  Within 2 hours of treatment Izzy was up and going outside for walks!

Izzy remained hospitalized in the ICU for 48 hours to be closely monitored and receive supportive care.  During this time she made a steady recovery.   For the first 24 hours she remained in an oxygen cage to help support her breathing. Her heart rate, breathing rate, temperature, blood pressure and EKG were closely monitored.  Recheck blood work was performed to monitor her for internal bleeding.  She was eating and drinking well, and she was bright and alert (especially when her family came by for visits!).  Izzy was discharged 48 hours after presenting to the Veterinary Medical Center.  She was sent home with a 4 week course of treatment with Vitamin K.  A recheck evaluation performed 1 month later showed that Izzy made a complete recover and no further treatment was necessary.

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Recently the Veterinary Medical Center received these pictures of Izzy running through her yard, happy and healthy.  We are so grateful that Izzy has made a full recovery, and we wish her all the best!  Izzy is a very special patient of the CriticalCare Service, and she will never be forgotten!

So what made Izzy’s case so successful?  Not only did Izzy receive immediate care and treatment by her primary care veterinarian, but Izzy’s transfer to the Veterinary Medical Center (VMC) was an important step in her treatment.  At the VMC Izzy was directly cared for by board-certified specialists in Emergency and Critical Care.  The VMC is the only private hospital in central New York to have not only one, but two full-time Emergency and Critical Care Specialists, Dr. Maureen Luschini and Dr. Elise Craft.  Please refer to "What is Veterinary Critical Care"  or our website for more information.

Thanks to our Medical Director, Dr. Maureen Luschini, for summarizing Izzy's case for this post and some very special thanks to Izzy's family for allowing us to share her story!

What is Veterinary Critical Care?

The Veterinary Medical Center of CNY is the only private hospital in Central New York to have not only one, but two, full-time Emergency and Critical Care Specialists.

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The following information provided by the American College of Veterinary Emergency and Critical Care helps address many questions pet owners have about veterinary Emergency and Critical Care specialists (information obtained from http://acvecc.org/): What is a specialist in Veterinary Emergency and Critical Care? A specialist in emergency and critical care is a specially trained veterinarian who is dedicated to treating life-threatening conditions. Yes, they do have additional training! They must first be a graduate of a recognized veterinary school, then receive a minimum (or equivalent) of 3 additional years of intense training in emergency, surgery and critical care through completion of an American College of Veterinary Emergency and Critical Care (ACVECC)-approved training program. This intense program is referred to as a “residency” in emergency and critical care and focuses on the most up-to-date techniques for diagnosis and treatment of life-threatening disease processes in an emergency, and for the critical time while the animal is recovering. The emergency and critical care residency is supervised by mentors who have been through similar training programs and are themselves board-certified Diplomates of the American College of Veterinary Emergency and Critical Care (DACVECC).

Once the veterinarian has completed these years of specialty residency training, the individual must then pass a tough board -certification examination given by the ACVECC. Upon successful completion of the training and passing of the examination, the veterinarian is a Diplomate of the ACVECC, is termed a “specialist”, and is board-certified in veterinary emergency and critical care.

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How do I know if a veterinarian is a specialist in emergency and critical care? There are several ways for you to find an ACVECC Diplomate in your area. First, you may consult the ACVECC web site (http://acvecc.org/), where Diplomates are listed according to geographical location. Second, you may ask your veterinarian if the emergency practice in your area is led by a veterinarian that is an ACVECC Diplomate. Third, if your veterinarian refers your pet to a specialty practice for non-routine surgery, medical care or diagnostics, you can inquire whether there is an ICU with a life support team headed by a specialist in emergency and critical care, should your pet require intensive care and life support.

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How can I find a specialist in veterinary emergency and critical care for my pet? First, ask your veterinarian. Any pet that is seriously ill might benefit from this type of care. Animals that have sustained trauma or bite wounds are an obvious example, but a number of other problems are commonly treated. The following is a sampling of the type of patients that routinely benefit from care by an ACVECC Diplomate: • Trauma patients, including those hit by cars, bite, bullet, knife or burn injuries • Any animal that is having trouble breathing • Animals that need a blood transfusion • Any patient that is in shock (signs of shock can include weakness, pale mucous membranes in their mouth, cold extremities, and an abnormal heart rate) • Animals that are having trouble urinating, or are not producing urine • Dogs and cats that need specialized nutritional support because they are unwilling or unable to eat on their own • Animals in which an abnormal heart rhythm is causing problems • Animals with life-threatening neurologic disease such as coma or severe seizures that are not responding to medications • Patients that have had surgery and are not recovering well from anesthesia or are having trouble in the first few post-operative days