Thursday, November 28, 2013

A passion for emergency and critical care: SAT interviews Garret Pachtinger

Dr Garret Pachtinger with a patient.
Garret Pachtinger is a boarded emergency and critical care specialist and COO of VetGirl. SAT reviewed his webinar on haemoabdomen, which was fantastic. We wanted to ask him more about careers in emergency medicine.

Who are you, where did you graduate from and what do you do?

I am a 2005 graduate of the University of Pennsylvania College of Veterinary Medicine.  Following veterinary school, I completed a small animal rotating internship in medicine and surgery, an emergency and critical care fellowship, and an emergency and critical care residency at University of Pennsylvania (UPENN).  I became a board-certified emergency and critical care specialist (Diplomate of the American College of Veterinary Emergency and Critical Care – DACVECC) in 2010.  I’m the COO of VetGirl, a subscription-based podcast service offering RACE-approved veterinary continuing education (CE). I’m teamed up with my UPENN colleague, Dr. Justine Lee, DACVECC, DABT, CEO, VetGirl.  I’m also in full-time clinical practice, where I’m an associate criticalist at the Veterinary Specialty and Emergency Center (VSEC) in Levittown, Pennsylvania. I’m also the VSEC intern director.

What attracted you to emergency medicine?

The variety of the patient presentations, the pace of the environment, and high expectations that force you to step up as a leader each and every day.  I’m a type A personality and live for the adrenaline rush of a new case and emergent nature.  The diversity of the cases I see forces me to continue learning each and every day.

As an emergency and critical care board certified specialist, what emergencies do you find the most rewarding to work on?

My special case interests include trauma, severe metabolic disease, acid-base disturbances, and management of critically ill small animal patients with an emphasis on fluid therapy.  In reality, in the emergency room, we expect everything.  We see the itchy dog, the ear infection, the limping dog, the renal failure patient, the massive trauma, to the septic patient. You have to be ready to see everything that walks in the door without warning.

What kind of emergencies do even ER specialists find challenging?

As an ECC specialist in a multi-specialty referral hospital, what I find challenging is attempting to provide a rapid assessment to a patient with numerous, chronic diseases. The thick medical record can be challenging to decipher in a timely manner.  While pediatric patients can be rewarding, pediatric cases can also be challenging.  Frequent testing such as hematology and chemistry is often difficult due to a low blood volume, vascular access is often limited, they can worsen just as quickly as they can improve, and ultimately they often demand intensive monitoring.

Off the top of your head, what are five drugs you'd always have in your crash cart and why?

The top 5 drugs I choose are epinephrine, atropine, calcium gluconate, vasopressin, and diazepam.

There are formularies for a reason, notably because it is difficult to remember every single drug dose for all the medications out there.  With that said, there are certain medications you should have a dose or a body weight shortcut memorized for rapid delivery of your critically ill and crashing patient. Along with the 5 medications listed above, honorable mention would also go out to naloxone, 50% dextrose, and lidocaine.

You're the COO of VetGirl. Hang on a mo, you're a dude! Tell us a bit about VetGirl. Is it exclusively for chicks?

Absolutely not! VetGirl is designed for any veterinarian, veterinary student, or veterinary technician who wants to learn “on the run.” I don’t know many people in the veterinary community that work 20 hours a week and feel they have enough time to stay up to date on the veterinary literature while enjoying their family life as well as an active social life. Most veterinarians have time poverty, working 80-hour weeks and trying to balance a family and social life. With VetGirl, it provides a great option to learn on the run on their schedule – all they need is a smart phone with internet access!  There are two subscription plans:

VetGirl STANDARD: This provides over 50-60 podcasts (ranging from 3-5 minutes, on average) per year, focusing on what you need to know to stay on top of the field! These include clinical vignettes with topics ranging from ‘How to unblock a cat” to “Treating the po’: parvovirus” to “Phenobarbital or potassium bromide: which one’s better?”  ($99/year)

VetGirl ELITE: Not only do you get the 50-60 podcasts, but with
VetGirl ELITE, you get 12 hours of veterinary CE webinars that you can watch from the comfort of your own home! Check out our 2013 and 2014 topics here! ($199/year).

The benefit of subscribing to VetGirl? It also can help save yourself the expense of travel, conference fees, and even having to hire someone at your clinic to cover you while you are away!

You've lectured around the world and published in books like The Five Minute Veterinary Consult Clinical Companion: Small Animal Toxicology  and Feline Emergency and Critical Care Medicine. Do you think you will ever stop learning?

Absolutely not.  When my drive to continue learning is no longer there, that will be time for me to leave medicine.  I love the daily challenge of critical cases, I love teaching, and I love learning.  It is part of my DNA. 

Do you share your life with any non-human companions? If so can you tell us who they are and how you met. 

I currently share my life with a cat named Joie.  She is a Siamese-mix that I adopted when I was an intern at UPenn.  I am sure we all understand that there is very little chance you leave your veterinary training without rescuing something!  I diagnosed her with panleukopenia while on the emergency service rotation and adopted her understanding the risks of this serious and potentially fatal disease.  Fortunately, she was a fighter and 7 years later is still a ball of personality!

Emergency medicine is notoriously stressful. Can you give us an example illustrating why this is and how do you wind down?

Emergency medicine can be extremely stressful.  No matter the severity of the patient’s situation, the owners present in a panic.  Without an “appointment” in the ER, the wait time in the ER can be long and this can be exacerbated by the unexpected and unplanned costs associated with a visit to the emergency room. Complicating matters, there is often no previous relationship with the emergency veterinarian, often described as lacking an “emotional bank” that the owner can fall back on when a veterinarian is delivering information.  When you add all of these concerns together, along with having to deliver unexpected news, the situation can be stressful for both the pet owners and the emergency room veterinarian.

With experience, I have learned to handle these situations better.  One of the most common misconceptions that people have is that veterinarians just deal with the pets, and unlike human medicine they do not need to deal with people.  I emphatically disagree.  I would consider a pediatrician a close comparison in that like pets, often children cannot communicate their symptoms or concerns and we are forced to actually deal with the parents even more.  This is why someone who can communicate well with owners will continue to be a commodity in veterinary medicine.

Dr Pachtinger examines a patient.
To wind down, I typically resort to spending time at the gym or preparing for events such as the Tough Mudder. I also have two active kids that tend to take some of my remaining energy too!

Any advice for aspiring ER vets, and veterinary students?

My advice is to follow your passion and follow your dream.  I love to go into work every day knowing I am going to make a difference, not only to the pet, but the owners as well. Yes, like most veterinarians out there, I have some debt.  That is what is plastered all over the news these days.  But the bottom line is that I love to teach, learn, and practice medicine.  I wouldn’t trade my job for anything, certainly not sitting behind a desk!