Emergency Animal and Pet Care - Hopkins Emergency Response ...

Emergency Animal and Pet Care - Hopkins Emergency Response ...

EMERGENCY ANIMAL AND PET CARE ConEds 2017 Background In humans, unintentional injuries are one of the leading causes of death in ages 1-44. Similarly, traumatic injuries to animals are a leading cause of death in animals of all ages. The origins of prehospital emergency veterinary care began with the implementation of Tactical Emergency Casualty Care (TECC) for K9s used in battlefield and police environments.

There is now a committee called K9-TECC that has established guidelines for K9 casualty care. The American College of Veterinary Emergency and Critical Care Veterinary Committee on Trauma has established best practice guidelines for prehospital emergency veterinary care DOGGOS Legal Standing Currently, only Colorado and Ohio have adopted statewide legislation authorizing EMS providers to preform emergency veterinary care

Emergency veterinary care may not be covered by good Samaritan laws this is essentially an untested legal field If you decide to render care to an animal, do so within these guidelines and if possible contact medical direction General Approach to Prehospital Care Scene size-up Patient

assessment Primary assessment Vital parameters Secondary (Head-to-Tail) assessment Complete history On-scene medical care Packaging, transport, and care en-route Reassessment

Communication and documentation Scene Size Up The same rules apply as with humans- do not approach an unsafe scene TAKE BSI zoonosis is rare but still possible Number Need of patients

for additional resources Determine MOI/NOI Especially consider toxic hazards to the animal Primary Assessment Form a general impression- age, anxiety level, and body positioning Anxiety is an important vital sign in animals

AVPU Address life threats based on the MOI/NOI In the following situations, expedite transport: penetrating injuries above the knees or elbows, chest wall instability, two or more proximal long bone fractures, crushed, degloved, or mangled extremity, amputation proximal to the carpals or tarsals, pelvic fracture, open or depressed skull fracture, fall from 2-3 times height, MVC with intrusion >12 inches ABCD A The

airway is patent in a barking or meowing animal, animal alert and breathing comfortably, panting but not in respiratory distress Unconscious animals extend the head and neck into an in-line position, manually open the mouth (try to avoid putting your fingers in the mouth), grasp the tongue and extend it out over the bottom jaw, remove and visible foreign objects (DO NOT DO A BLIND FINGER SWEEP B Look, listen, and feel for breathing Normal

respiratory rate for both cats and dogs is between 6-30 breaths/min C Assess for external hemorrhage Palpate a femoral pulse A normal rate is Dog: <20 kg 100-160 bpm, 20-40 kg 60-120 bpm, >40 kg 50-80 bom Cat: 180-240 bpm

Warm the patient Spinal Protection Spinal protection should be implemented in the following scenarios Fall associated with loss of consciousness or altered mental status Falls from height in which the animal has fallen on their head or back Falls from 2-3 time their height or 15 feet High velocity impacts Distracting injuries (tail pull injury in cats) Implement

present spinal precautions if the following signs and symptoms are Obvious injury to the back Pain/tenderness to palpation of the midline spine Weakness or paralysis Lack of recognition of stimulus in limbs Loss of control of bladder Vitals Place a BP cuff between the elbow and wrist on the forelimb, knee

and ankle on hind limb, or most proximal tail if necessary. Secondary Assessment Literally human Dont just a head to tail physical exactly like you would do in a forget to Check pupils

Auscultate lung sounds Palpate the abdomen Assess all four extremities History If possible, ascertain a SAMPLE history from the animals handler/owner OPQRST can be used on animals! How do you rate the severity of the pain? You judge it similar to the FACES scale again ask someone familiar with the animal, they will

know best CATS SPECIFIC EMERGENCIES External Hemorrhage Immediately apply firm direct pressure with a gloved hand, followed by gauze (if available with hemostatic agent), and finally with pressure dressing Consider occlusive dressings for wounds to head and neck If your pressure dressing becomes soaked through, do not remove the original dressing, add more dressing If a limb is involved, elevate the limb

If bleeding is not controlled consider a tourniquet Most human tourniquets will not work on most animals. The ideal tourniquet is a pediatric blood pressure cuff or improvised cloth/cravat tourniquet Keep the patient warm and provide supplemental oxygen Medics may provide fluid resuscitation and anti-fibrinolytic agents Respiratory Distress Place

the animal on its belly, upright In animals, work of breathing generates lots of heat. If necessary, consider cooling if temperature exceeds 105 F Always by administer oxygen. Flow-by oxygen can be accomplished Placing simple oxygen tubing 2 cm from the nostril at 2-3 Lpm, FiO2 is 25-40%. Flow may be increased to 8-10 Lpm but may not be tolerated well. Place the most appropriately sized nonrebreather, remove one or both

diaphragms if possible to prevent CO2 buildup. Flow of 8-12 Lpm can provide FiO2 of 50-60% BVMs may be used in animals Respiratory Distress Signs of a foreign object include pawing at the mouth, gagging, excessive drooling, frequent swallowing, and extended head and neck. Importantly, stridor is heard. If a complete airway obstruction is present, perform the Heimlich maneuver place the animal on its side and apply a thrusting force to the ribs, this works for most animals. For dogs only, you may place the dog upright and attempt abdominal thrusts below the sternum.

If not breathing, provide mouth to snout rescue breaths at 10 breaths per minute Dogs- close the mouth and place your mouth over the nose. Cats- Place your mouth over both the mouth and nose. Respiratory Distress Auscultate the lungs If crackles are heard, consider contusions, pneumothorax, non cardiogenic or cardiogenic edema. Provide oxygen. If expiratory wheeze is heard, in dogs consider toxic inhalants dogs rarely get asthma. Asthma is possible in cats, for a wheeze consider administration of 1-2 puffs of albuterol MDI every 15 minutes for a

maximum 3 doses. Decreased lung sounds, consider pneumothorax or hemothorax and evaluate for tension pneumothorax Medics may attempt needle thoracentesis if orthopnea is noted, inserting the needle between the 7th and 9th ribs (to palpate the ribs, it is easiest to count backwards from the 13th rib) Cardiac Arrest If animal is unresponsive, check for respirations, if respirations are not present position airway, check pulse. Perform

chest compressions place the animal on their side on a hard surface. Compress the ribs at a rate of 100-120 compressions per minute to between 1/3 and the chest depth. In large animals, perform CPR as in humans with the hand over hand technique In smaller animals, consider an infant approach with a one handed squeezing motion of the ribs or two hands encircling, compressing with thumbs Compressions should be over the heart landmark for the heart is at the point of the elbow when the limb is flexed For For a single rescuer, perform 30 compressions to 2 breaths two rescuers, rotate compressors every two minutes and provide ventilations at a rate of 10 breaths per minute while compressions are ongoing

ALS Cardiac Arrest Medics may place an ETT tube (RSI is achieved with ketamine and diazepam or midazolam) Medics may establish IV access with lactated Ringers Place an ECG by placing ECG pads on animals foot pads. Broadly, the same criteria as humans may be applied to determine shockable vs. nonshockable rhythm. For a shockable rhythm in small dogs and cats, administer 30J, medium dogs administer 60 J, for large dogs administer 100J

Place defibrillator paddles overlying the heart on opposite sides of the chest An AED may be used on large dogs (>30 kg). Fur will have to be removed from the animal. Take care to avoid pads are well spaced. https://youtu.be/kaBNhX7dj_w Analgesia Never give any oral pain medications Animals will tolerate a variety of IV pain medications including ketamine, fentanyl, tramadol etc.

Head and Spinal Trauma If indicated, place the animal on a rigid board (backboard) and secure by placing straps or tape. To move the animal onto the backboard, scruff the animal behind the neck and near the rump. To protect the c-spine, place padding under the animals neck such that it is in a neutral inline position avoid hyperextension. Penetrating Trauma Place in position of comfort Provide

oxygen Immediately cover open or sucking chest wounds with a gloved hand. If available, place a commercial chest seal such as a tegaderm. Otherwise place an occlusive dressing taped on all 4 sides. Fur poses a problem if it can be quickly removed, do so. If it cannot, consider placing a water based lubricant on the underside of the seal to provide a more airtight seal. Monitor for tension pneumothorax. If signs of tension PTX develop, burp the chest seal. Do For

not remove impaled objects evisceration, wash gross contamination with crystalloid solution or sterile water, cover with moistened sterile gauze, cover to keep warm. Fracture/Dislocation Transfer patient to rigid board for transport to minimize movement If transport times are less than 20 minutes, it may be best to avoid splinting Clean large wounds or open fractures

If distal limb pulses are absent, attempt to realign to a neutral position. Do not use excessive force and stop if significant resistance is met. Splint in position found. If unsure of pulse (most likely) splint in position found Splinting of fracture is best accomplished with SAMM splint Gastric Dilation with Volvulus This

is a life threatening condition specific to dogs known as bloat, where the stomach rotates and causes gas and fluid buildup which results in increased pressure that decreases venous return to the heart and global hypoxia. Look for distention of the abdomen especially outward (left-right) distention, general discomfort and agitation, retching and attempting to vomit with no vomitus, tachycardia, decreased femoral pulses, pale mucous membranes, rapid breathing Transport Needle rapidly gastric decompression (trocarization) may be attempted.

Percuss the abdomen while listening with stethoscope. Choose the location just behind the ribs that is most hyper-resonant. Remove fur and clean area with skin disinfectant. Place large bore (14-16 Ga) over needle catheter (or 18 Ga needle if catheter not available) perpendicular to the body wall at the chosen site. Remove the catheter when abdomen is decompressed. Heat Emergency Recognize the following behaviors of heat emergency shade seeking, flattening of tongue or dangling of tongue, less direct return to handler, squinty eyes, excessive panting (retractions at corners of mouth, smiling) If rectal temperature is available and above 106 F take cooling

measures, otherwise utilize clinical judgement Immerse young healthy patients in cool water, do not immerse the head Dousing with water if immersion is not possible is also appropriate Older animals with comorbidities may have cold packs places in axilla and groin, spray skin with room temperature water and fan If shivering occurs, vigorously rub the animal or slightly warm until shivering stops If seizure occurs, consider hypoglycemia and give corn syrup

Burns Cool wound with copious amounts of tepid water Remove Apply any items that may cause constriction such as leashes, clothes etc dry, nonadherent sterile dressing Elevate burned extremities Protect

from hypothermia burns over 20% of BSA easily will result in hypothermia BSA Each rear limb is 18% Each forelimb is 9% Each hemithorax is 9% Each hemiabdomen is 9% The head is 9% The neck is 1% Smoke Inhalation Very common

Administer oxygen! Up to 100% FiO2 can be administered but pulse oximetry should be utilized if possible, titrate to above 94% If wheezing or stridor is heard, consider administration of albuterol MDI https://

social.newsinc.com/media/json/690 17/27676711/singleVideoOG.html? type=VideoPlayer/Single&widgetId =2&trackingGroup=69017&videoId =27676711 Anaphylaxis In dogs, cutaneous signs such as erythema, urticarial, pruritus, angioedema likely present with cardiovascular, gastrointestinal, and respiratory signs including tachycardia, weak pulses, change in color of mucous membranes, urinating, vomiting, hemorrhagic diarrhea, increased respiratory effort, wheezes and crackles. Cats most often present with GI symptoms including nausea, diarrhea and

may also present with head pruritus, followed by dyspnea, salivation, vomiting, incoordination, and collapse. For respiratory, CV, and GI symptoms, administer epinephrine. Administer .15 mg epinephrine (EpiPen Jr) in patients <20 kg, administer .3 mg epinephrine (EpiPen) in patients > 20 kg. Repeat dosing every 5-15 minutes if anaphylaxis persists. For respiratory symptoms, also administer albuterol MDI. Poisoning Provide supportive care

Contact ASPCA Animal Poison Control Center at (888) 426-4435 and follow their directions Activated charcoal may be administered at 1-4 g/kg with consultation from poison control AMINALS More Information For complete guidelines, see Best practice recommendations for prehospital veterinary care of dogs and cats, Journal of Veterinary

Emergency and Critical Care 26(2) 2016, pp 166233 doi: 10.1111/ vec.12455 http://time.com/4712367/santa-monica-firefighter-dog-cpr/? xid=time_socialflow_facebook http:// prehospitalwisdom.blogspot.com/2016/08/dogs-part-1-hurt-dogs.ht ml http://www.k9tecc.org/

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