Contributors: Elisa Mazzaferro

 Species: Canine   |   Classification: Miscellaneous

Cardiovascular system

Emergency

Aim

  • Arrest hemorrhage and restore blood pressure to maintain adequate vital tissue perfusion.

Procedure

  • Control external hemorrhage - ligation or compression bandage to all exposed bleeding tissue.
  • Warmth, restrict movement.
  • Analgesia - but avoid respiratory depressants.
    An animal with chest pain (eg fractured ribs) will ventilate better with analgesia.
  • Restore fluid pressure with (shock doses) intravenous fluids Fluid therapy :
    • Blood - crossmatched if possible Blood: transfusion.
    • Plasma.
    • Plasma expanders.
    • Electrolyte solutions.
  • Consider need for emergency surgery if continued evidence of blood loss.
  • Assess:

Follow-up

  • Monitoring as above.
  • Check blood supply to traumatized areas:
    • Edema.
    • Pulse.
    • Warmth.
    • Local capillary refil time (CRT).
    • Pressure bandage - check not restricting venous return.
  • Maintain fluid balance IV or PO as necessary.
Follow the diagnostic tree for Vehicular trauma.

Respiratory system

Emergency

Criteria

  • Severe or deteriorating respiratory rate and rhythm.
  • Cyanosis (PaO2 < 50 mmHg).
    Significant hypoxia (PaO2 = 60-70 mm Hg) can e present when mucous membranes are still pink. Any form of stress causes rapid deterioration.

Aim

  • Support treatment as soon as possible.

Procedure
Radiography

  • Two thoracic views, plain films Radiography: thorax.
    Use minimal restraint.Consider horizontal beam if you cannot put the animal in a ventrodorsal position
  • Use sedation/general anesthetic if necessary to avoid respiratory distress Anesthesia: in respiratory emergencies :
    • Check upper airway for obstruction.
    • If blood in pharynx identify if source is cranial or caudal to larynx.
    • Intubate and prepare to provide ventilatory support.
  • Check outlines of lungs, heart and diaphragm; thoracic cavity for hemo-/pneumothorax; thoraxic wall for rib or spinal fractures.

Diaphragm

  • If outline obscured, do a coelogram and look for contrast medium in thoracic cavity Thorax ruptured diaphragm - radiograph DV.
    Care should be taken not to produce respiratory compromise by excessive handling of patient.
  • If ruptured Diaphragm: traumatic hernia with deteriorating respiratory condition → open surgical repair using positive pressure ventilation (PPV) Anesthetic ventilators: overview and ECG monitoring ECG: overview.
  • If ruptured and respiratory condition is controlled, continue patient stabilization till you can repair diaphragm Diaphragm: repair of diaphragmatic defects electively (12-48 hours later).

Thoracic cavity

  • Hemothorax Hemothorax :
    • Medical treatment is preferred as surgery unlikely to locate/control site of hemorrhage in good time: replace estimated blood loss; check clotting time; monitor PCV; drainage of little value.
    • Surgical treatment: identify side of hemorrhage on basis of radiograph and thoracocentesis Thoracocentesis ; ensure facilities prepared (PPV, suction, assistance, IV line).
  • Pneumothorax Thorax pneumothorax - radiograph lateral : drain via 3-way tap every 2-3 hours then several times daily, see treatment of pneumothorax Pneumothorax.
  • Rib fracture Thorax rib fracture - radiograph lateral :
    • Conservative management unless deep impaction on thoracic cavity or there is an open transcostal chest wound, then → surgical repair Thorax rib fracture - radiograph lateral.

Follow-up

  • Monitor respiratory rate and rhythm.
  • Maintain chest drains until no gas or fluid is withdrawn and inspiratory radiographs show expansion of lung.
  • Monitor for pulmonary edema Lung: pulmonary edema - acute development suggests embolism Lung: pulmonary thromboembolism - guarded prognosis.

Surface wounds

Emergency care

  • Sub-dermal tissue substantially exposed.
  • Aim to avoid fluid +/- heat loss from damaged tissue. Prevent further contamination and self-mutilation.

Procedure

  • If deep/contaminated, use systemic broad spectrum antibiotic at outset.

Clean area

  • Clip, prepare skin surface, flush wound with isotonic saline (0.9%) or 0.05% chlorhexidine diacetate Chlorhexidine.
    Dilute 1 part chlorhexidine stock solution with 40 parts sterile water (not saline due to precipitation).

Restraint

Repair

  • Laceration - suture subcutaneous levels and then skin layers, ensuring tension-free apposition.
  • Skin deficit - use simple dermoplasty techniques or proprietary film dressings until elective surgery feasible.

Dressings

  • Burns - film dressings supported with padded gauze.
  • If extensive, may use aluminium foil as covering and plan early grafting Skin: free grafting.

Medication

  • Anti-inflammatory and shock therapy - corticosteroids (post-trauma inflammation and wound contracture in distal limbs maybe potential complications).
  • Antibiotics: not substitute for wound preparation, but to reduce complications arising from infection in deep or contaminated wounds; use before surgery (IM or IV) to ensure good tissue levels at surgical sites.
  • Topical anti-inflammatories: primary burns Skin: burn / scald and abrasions.
  • Fluid therapy: burns Fluid therapy: for burns.

Follow-up

  • Coat: use solvents to remove greases; clean coat of dirt.
  • Wounds: prevent patient interference - sedation, analgesia, physical means (Elizabethan collar or dressings); maintain medication.

Road traffic and other traumatic accidents

Examine all cases thoroughly on presentation and treat accordingly. Advise owners of possible sequelae, eg myocardial contusions.

  • Give a guarded prognosis.
  • If there is any doubt about the patient's condition, hospitalize, or give owner strict instructions on home nursing and make a follow-up visit or call the next day.
  • If hospitalized, keep owner well-informed of progress.
  • Discuss, perform and record more thorough investigations as necessary.
    Avoid initial over-optimistic prognosis, tell owner that some injuries may not be immediately evident.

Musculo-skeletal system

Emergency

Open wounds

  • Muscles, tendons, ligaments or compound fractures, treat as emergency:
    • Decontaminate wounds with copious lavage Wound: lavage and debride necrotic tissue Wound: debridement.
    • Repair tendons and muscles if animal stable; otherwise use sterile dressings until anesthesia/surgery can be performed.
    • Relocate bones and fragments (swab exposed bone for bacteriology)

Luxations/dislocation

  • Replace as soon as possible to minimize peri-articular changes.

Fractures

  • Must stabilize patient if prolonged procedure anticipated.
  • Select appropriate procedure Fracture: overview.

Neurological system

Paralysis

Emergency
Criteria

  • Collapse, ataxia +/- unconsciousness without identifiable cardiovascular or musculoskeletal cause.
  • Suspect spinal fracture Spine: fracture / luxation if patterns of spastic paralysis or opisthotonus - handle patient very carefully till eliminated possibility.
  • Severe depression → increased intracranial pressure Intracranial pressure measurement.

Procedure
Intracranial hemorrhage

  • Surgical - decompression if site identified and reasonable access.
  • Medical - preferred, as for spinal paralysis, plus raise head and neck 25 degrees; hypotensive sedation; check for obvious trauma.
    Avoid morphine analgesia.

Eye

  • Treat injuries urgently.

Peripheral paralysis

Depressed skull fractures endangering cranium

  • Emergency surgical elevation and anchoring.

Concussion

  • Conscious, alert but concussed, with ataxia/paralysis → spine and neck radiography.

Follow-up

  • Treatment of periorbital damage and superficial depressed skull fractures.
  • Maintain supportive therapy.
  • Nursing support as required.
  • Convulsions - diazepam.