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Too hot to handle

Gavin’s attention drifted somewhat as a shard of Spring sunshine refracted through the tiny consulting room window, an architect’s lamentable nod to allowing a token shaft of natural light into the otherwise dingy and unimaginative room. Mr Stacey’s soft tones were somewhat soporific as he wittered on about his French Bulldog, Mildred’s recent malaise in excruciating and, on the whole, irrelevant detail. As he dragged his thoughts away from a sudden but longing desire to take up a career in market gardening, Gavin had to concede Mildred did appear to be a little out of sorts. With the chaff chopped from Mr Stacey’s somewhat Tolstoyesque history telling, Mildred’s lack of appetite, increased thirst and slightly distended abdomen prompted Gavin to recall the many years of prevarication he had endured with her fretful owner around the pros and cons of neutering.

After finally establishing when Mildred had her last season, as opposed to her last cough, sneeze, breaking of wind or odd expression last Tuesday afternoon, Gavin prised Mildred from the arms of her doting owner. An abdominal ultrasound confirmed his provisional diagnosis and, with consent obtained, she was popped onto fluids with a plan made to rid her of her troublesome uterus.

"When seen five days later however, Mr Stacey expressed his concern over some exudate and crusting on Mildred’s side."

Once she was stable, Gavin cracked on with Mildred’s surgery and whilst it was relatively uneventful, he was a little concerned about the florid appearance of her uterus and the hint of turbid fluid floating around her abdominal cavity. As he reached for the five litre bags, the nurses simultaneously grabbing as many clean towels they could lay their hands on, he muttered to himself the old adage “dilution is the solution to pollution”, before flooding the abdomen with gay abandon, risking as he did the wrath of the theatre nurse as the resultant tsunami cascaded onto the floor, missing all but one corner of a single towel.

Mildred, now resembling a drowned rat, had been placed on a heat pad throughout the surgery however since her rectal temperature had dropped a little, additional heat sources were used during her recovery; both ‘hot hands’ and a microwaveable bean bag being put to good use.

All appeared tickety-boo at first; Mildred recovered well and was discharged the following day already showing a glimmer of her old self. When seen five days later however, Mr Stacey expressed his concern over some exudate and crusting on Mildred’s side. Gavin was not too worried at first; however, over the following few days a relatively large area of skin blackened and developed a consistency akin to a pig’s ear once dried and packaged up as a canine delicacy.

As the lesion grew Mr Stacey became more perturbed. Mildred having, apparently, been lined up for a latent career in canine modelling, indeed a show dog of some future renown. Unnerved by Mildred’s rocketing potential value, Gavin considered referral but not before calling the Society. The Claims Consultant reassured him that the VDS handles claims relating to thermal burns on a not too infrequent basis and they can be challenging, as the lesions can become quite disfiguring and naturally upsetting to some owners. He also explained the common denominator was often either a microwaveable source or ‘hot hands’, whilst judiciously avoiding the term 'spawned by the Devil' for the former, particularly when used in recumbent patients during recovery.

The Society took up the cudgels with Mr Stacey, Mildred was duly referred and a large eschar was removed, allowing granulation and gradual epithelialisation over the next few weeks with a little help from the Mānuka tree and a hive of diligent bees. Mildred seemed unphased by her newly acquired bald patch; however, its appearance continued to cause rancour with Mr Stacey.

Eventually, he capitulated once the Claims Consultant set him the task of providing some proof Mildred was on the verge of stardom. Whilst she may have missed out on a career on the catwalk, Mildred remained more than capable of enjoying a dog walk and the claim was eventually settled for the cost of the referral fees.

Thermal burn injuries are undoubtedly an acknowledged complication of keeping a patient warm during anaesthesia, although idiosyncratic reactions and medical co-morbidities can also play a part. Patients most at risk appear to be those with prolonged recoveries where they lie against a heat source without moving and when sources with potential ‘hot spots’ are used. Occasionally, a faulty heat pad is the culprit and checking these on a regular basis, particularly when in use, is always worthwhile. Very few, if any, claims have arisen following the use of warm air blankets (no product placement here! – Ed) and finally, (look away now anaesthetists – Ed) the Society has never, to its knowledge, received a claim as a direct result of a patient becoming too cold during surgery.

Read our VDS Advice Note on 'Preventing Thermal Burns in Small Animal Practice' (log in required).

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