Your dog threw up twice in an hour. It's 10:47 PM. The regular vet closed five hours ago, and the emergency hospital is a 30-minute drive and at least $250 before anyone touches your dog. You're standing in the kitchen trying to decide whether this is the kind of thing you'll laugh about tomorrow or the kind of thing where every minute counts.
I triaged dogs at Angell for three years. The question that came through the door more than any other wasn't a clinical one. It was this: “Should I have come sooner?” Sometimes the answer was yes. More often, the answer was that they came at the right time, or that it could have waited until morning. The guilt runs in both directions, and neither version helps the dog.
What helps is a framework. Not a symptom list. A way to assess what you're seeing and decide what it means right now, in your kitchen, with the information you have.
The always-go-now list
These signs mean drive to the emergency hospital. Don't call first. Don't wait to see if it gets better. Don't finish reading this page.
Uncontrolled bleeding that doesn't slow with direct pressure after five minutes. Not a small cut on a paw pad. Bleeding that soaks through a towel.
Seizure lasting more than five minutes, or a second seizure within 24 hours of the first. A single short seizure (under two minutes) in an otherwise healthy dog is frightening but not always an emergency. Two in a day, or one that won't stop, is. The Merck Veterinary Manual, the reference textbook most clinicians keep on the shelf, flags prolonged seizures as a medical emergency because brain damage becomes a risk past the five-minute mark.
Bloat symptoms. A distended, tight abdomen with nonproductive retching. Your dog is trying to vomit and nothing comes up. Restlessness, panting, drooling. Gastric dilatation-volvulus (GDV), the condition this combination points to, can kill a dog within hours. Large breeds and deep-chested dogs are most at risk. Don't wait to see if the retching resolves.
Known toxin ingestion. Chocolate, xylitol (the sweetener in some peanut butters and sugar-free gum), grapes, raisins, antifreeze, rodent poison, human medications. If your dog ate something toxic, call the ASPCA Animal Poison Control Center at 888-426-4435 or the Pet Poison Helpline at 855-764-7661 while you're getting in the car. Treatment windows for toxin exposure are measured in minutes, not hours. Do not induce vomiting unless a toxicologist tells you to.
Inability to breathe. Gasping, blue or purple gums, exaggerated chest movement with little air moving. Choking on an object. Collapse with labored breathing.
Loss of consciousness. Your dog is unresponsive. Not sleeping. Not groggy. Not waking up when you say their name or touch them.
Hit by a car or a significant fall. Even if your dog gets up and walks. Internal injuries don't always show up immediately.
Inability to urinate. Straining repeatedly with no urine produced, especially in male dogs. A blocked urinary tract is a medical emergency.
The call-your-vet-in-the-morning list
These are real symptoms worth investigating. They aren't emergencies if your dog is otherwise alert, eating or drinking, and responsive.
A single vomiting episode with normal energy afterward. No blood, no repeated retching, no abdominal distension. A dog who throws up once and goes back to the couch is telling you something happened but probably not something urgent.
Mild limping without crying out. Weight still going on the leg. No visible deformity. No swelling. A dog who tweaked something on a walk but is still using the leg can see the vet tomorrow.
A small wound that isn't actively bleeding. Minor cuts, scrapes, a torn toenail that has stopped bleeding. Clean it gently if your dog will let you, and keep it covered overnight.
Soft stool or a single episode of diarrhea without blood. Watch for a second episode. If your dog is drinking water and acting normally, this can wait.
Ear shaking or scratching at one ear. Likely an ear infection. Uncomfortable, but not dangerous overnight.
A new lump you haven't seen before. Lumps don't become emergencies overnight. Note the size, take a photo, and bring it up at the next visit or call Monday morning.
The gray zone: how to assess what you're seeing
Most of the time, the question isn't whether your dog needs a vet. The question is whether your dog needs a vet right now. The gray zone is where the guilt lives, where the cost anxiety lives, and where most wrong calls happen in both directions.
Four things tell you more than the symptom itself.
Gum color. Lift your dog's upper lip. Healthy gums are pink. Press a finger to the gum for two seconds and release. The color should return in under two seconds. That's capillary refill time (CRT). The Merck Veterinary Manual lists a normal CRT as under two seconds. Pale, white, gray, blue, or bright-red gums are all reasons to go now. This one check tells you more about your dog's circulation than anything else you can do at home.
Breathing rate at rest. Watch your dog's chest. Count the rises for 30 seconds and multiply by two. A normal resting rate is 10 to 30 breaths per minute for most adult dogs. Puppies and small breeds run higher. Over 40 at rest with no obvious cause (no recent exercise, no heat, no excitement) is a flag. Labored breathing where the belly pumps or the neck extends is more urgent than fast breathing alone.
Responsiveness. Is your dog tracking you with their eyes? Responding to their name? Getting up to follow you? A dog who is lethargic but responds when you speak is different from a dog whose eyes are open but who doesn't seem to register that you're there. The second is a reason to drive.
Timeline. When did this start? Getting worse, staying the same, or improving? A symptom that appeared two hours ago and is holding steady is different from one that appeared two hours ago and is getting worse every 30 minutes. Trajectory matters more than severity in the gray zone.
What to document before you go
The ER vet is meeting your dog for the first time. Everything you bring shortens the gap between arrival and treatment.
Write down the symptom timeline. When did it start, what happened first, what changed. “Threw up at 9, again at 9:45, now panting and won't lie down” is more useful than “he's been sick.”
Take a photo or a short video. A 15-second clip of labored breathing tells the ER vet more than a description ever will. If your dog had a seizure, note the time it started and the time it stopped. A seizure that felt like five minutes to you might have been 45 seconds. The clock matters.
Know what medications your dog is on, with doses. Know the last time your dog ate and drank. If your dog got into something, bring the packaging. The emergency vet guide has a printable checklist for what to bring. The triage guide walks through how to read what your dog's body is telling you.
About cost
Emergency vet visits are expensive. That's a fact, not a judgment. An exam alone runs $150 to $300, and that's before bloodwork, imaging, or treatment. After-hours surcharges add more. A night in the ER with IV fluids and monitoring can reach $1,500 to $3,000.
Cost shapes the decision whether people admit it or not. I watched families in the Angell lobby weigh the numbers against what they were seeing. There is no version of this conversation that isn't hard. What I can tell you is this: if the symptom is on the always-go list, go. Work out the payment after. Most emergency hospitals offer payment plans, accept CareCredit, or will work with you. The conversation about cost is easier from the waiting room than from the other side of a decision you can't take back.
For everything in the gray zone, a phone call costs nothing. Call the ER front desk. Describe what you're seeing. They will tell you whether to come in. That call exists for exactly this moment.
Four questions, in order
When you're standing in the kitchen at 10:47 PM, run these in order. They take 90 seconds.
1. Is this on the always-go list? Uncontrolled bleeding, prolonged seizure, bloat signs, toxin ingestion, can't breathe, unresponsive, hit by a car, can't urinate. If yes, go. Stop here.
2. What do the gums look like? Pink and refilling in under two seconds is reassuring. Anything else, go.
3. Is it getting worse? Check twice in 30 minutes. If the symptom is stable or improving, you can probably wait and call in the morning. If it's getting worse, go.
4. When in doubt, call. The ER front desk answers the phone specifically so you don't have to decide alone.
The AVMA's emergency care guidance covers similar ground from the veterinary side. The four questions above are the owner-side version of what triage techs run through when you walk in. The same assessment, done at home, 30 minutes earlier.
A complete symptom timeline, a medication list, and a 15-second video are worth more to the ER vet than an hour of worrying. Veta's pet health passport keeps your dog's full history, medication list, and symptom log in one place. When the ER vet asks what your dog is on and when the last bloodwork was done, the answer is already there. The page on observing your pet covers how to build the habit of noticing what's normal so you can spot what isn't.
Questions about emergency vet visits
How much does an emergency vet visit cost?
Emergency exam fees typically run $150 to $300 before any diagnostics or treatment. After-hours surcharges add $50 to $150 on top. Bloodwork, imaging, or overnight observation can push the total to $1,000 or more depending on what your dog needs. Cost is real and it matters, but the signs in the always-go list above don’t negotiate. If your dog is in that category, go. Work out payment with the clinic after. Many emergency hospitals offer payment plans or accept CareCredit.
Can I call my regular vet instead of going to the ER?
During business hours, yes. Call the clinic first. They can often triage over the phone and tell you whether to come in or head to the ER. After hours, most clinics have a voicemail message with the name and number of the nearest emergency hospital. If you can’t reach anyone and the symptom is in the gray zone, call the emergency hospital directly. Most ER front desks will answer questions over the phone and help you decide.
What should I bring to the emergency vet?
Your dog’s medication list with doses, the timeline of what happened (when the symptom started, what changed, what you tried), any substance your dog may have eaten (bring the packaging if it was a toxin), and your regular vet’s name and number. If your dog vomited, take a photo. If there was a seizure, note how long it lasted. The ER vet is meeting your dog cold. Everything you bring shortens the time between arrival and treatment.
My dog threw up once but seems fine now. Should I go to the emergency vet?
A single vomit episode in a dog who is otherwise alert, drinking water, and acting normally is almost never an emergency. Watch for a second episode within 6 hours, any blood in the vomit, lethargy, refusal to eat at the next meal, or a bloated or tense abdomen. If none of those appear, call your regular vet in the morning. If your dog vomited after eating something it shouldn’t have, that changes the calculus. Call the ASPCA Animal Poison Control Center at 888-426-4435 for guidance.
How do I check my dog’s gum color?
Lift your dog’s upper lip and look at the gums above the canine teeth. Healthy gums are pink, like the inside of your wrist. Press a fingertip against the gum for two seconds and release. The color should return within two seconds. That’s capillary refill time. Pale white or gray gums suggest shock or blood loss. Blue or purple gums mean the dog isn’t getting enough oxygen. Bright red gums can indicate heatstroke or toxin exposure. Yellow gums point to liver involvement. Any of those warrant an ER visit.
Is limping a reason to go to the emergency vet?
Limping by itself is rarely an emergency. If your dog is putting some weight on the leg, isn’t crying, and is otherwise eating and alert, this can wait until morning. What changes that: a visibly deformed limb (possible fracture), a limb that’s swollen and hot to the touch, a dog that can’t stand on three legs, or a sudden onset of dragging a hind leg with no use at all (possible disc issue). The last one has a time-sensitive surgical window, so don’t wait on that.
Should I induce vomiting if my dog ate something toxic?
Do not induce vomiting without calling a poison control line first. Some substances cause more damage coming back up than they did going down. The ASPCA Animal Poison Control Center (888-426-4435) and the Pet Poison Helpline (855-764-7661) both have veterinary toxicologists who will tell you exactly what to do for the specific substance your dog ate, including whether vomiting is safe and how soon you need to reach a clinic.
My dog is breathing fast but otherwise seems okay. Is that an emergency?
Context matters. If your dog just exercised, is in a hot room, or is panting from excitement, fast breathing is normal. If your dog is breathing rapidly at rest with no obvious cause, count the breaths. Watch the chest rise and count for 30 seconds, then multiply by two. A resting rate over 30 breaths per minute in a dog who hasn’t been active is worth a call to the vet. A resting rate over 40, or breathing that sounds labored or wet, warrants a same-day visit or ER trip. The Merck Veterinary Manual lists 10 to 30 breaths per minute as normal for resting dogs.
Join the Veta waitlist
When Veta opens for iOS, we'll tell you first. No spam, no roadmap emails. One note when the app is ready to download.
Rachel Howland, CVT (ret.), spent a decade in clinic: seven years in a mixed practice in upstate New York, then three on the internal-medicine floor at Angell Animal Medical Center in Boston. She left practice in 2017 and has written about small-animal health since. She does not diagnose or prescribe; she explains what your vet's records are telling you and what questions are fair to ask.