Contributors: Elisa Mazzaferro, Joseph Harari, Andrew Gardiner
Species: Feline | Classification: Miscellaneous
- Arrest hemorrhage and restore blood pressure to maintain adequate vital tissue perfusion.
- Control external hemorrhage - ligation or compression bandage to all exposed bleeding tissue.
- Warmth, restrict movement.
- Analgesia Analgesia: overview - but avoid respiratory depressants.
An animal with chest pain (eg fractured ribs) will ventilate better with analgesia.
- Restore blood pressure with intravenous fluids Fluid therapy: overview:
- Consider need for emergency surgery if continued evidence of blood loss.
- Monitoring as above.
- Check blood supply to traumatized areas:
- Local CRT.
- Pressure bandage - check not restricting venous return.
- Maintain fluid balance IV or PO as necessary.
- Thorax - trauma Thorax: trauma.
- Severe or deteriorating respiratory rate and rhythm.
- Cyanosis (PaO2 < 50mmHg).
Significant hypoxia (PaO2 = 60-70mmHg) can be present when mucous membranes are still pink. Any form of stress causes rapid deterioration.
- Support treatment as soon as possible.
- Two views, plain films Radiography: thorax.
Use minimal restraint with patience and oxygenation.Consider horizontal beam if you cannot put the animal in a ventrodorsal position.
- Use sedation/general anesthetic if necessary to avoid struggling with animal in respiratory distress Anesthesia: in chest trauma:
- 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 ; thoracic wall for rib or spinal fractures.
- If outline obscured, do a coelogram and look for contrast medium in chest cavity .
Care should be taken not to produce respiratory compromise by excessive handling of patient.
- If ruptured Diaphragm: hernia with deteriorating respiratory condition → open surgical repair Diaphragm: repair of diaphragmatic defects using positive pressure ventilation (PPV) and ECG monitoring ECG: overview, Anesthetic monitoring: overview.
- If ruptured and respiratory condition is controlled, continue patient stabilization until can repair diaphragm electively (12-48 hours later).
- Hemothorax Hemothorax :
- Medical treatment is preferred as surgery unlikely to locate / control site of hemorrhage in good time: replace estimated blood loss Blood transfusion; check clotting time Hematology: activated clotting time; monitor PCV Hematology: packed cell volume; drainage of little value.
- Surgical treatment: identify site of hemorrhage on basis of radiograph and thoracocentesis ; ensure facilities prepared (PPV, suction, assistance, IV line).
- Pneumothorax Pneumothorax: drain via 3-way tap every 2 - 3 hours then several times daily, see treatment of pneumothorax Pneumothorax.
- Rib fracture : conservative management unless deep impaction on thoracic cavity or there is an open transcostal chest wound, then → surgical repair.
- 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 - guarded prognosis.
- Sub-dermal tissue substantially exposed.
- Aim to avoid fluid +/- heat loss from damaged tissue. Prevent further contamination and self-mutilation.
- If deep/contaminated, use antibiotic at outset Therapeutics: antimicrobial drug.
- Clip widely, prepare skin surface, generously flush wound with appropriate proprietary solutions, eg sterile saline; 0.05% chlorhexidine diacetate Chlorhexidine.
Dilute 1 part chlorhexidine stock solution with 40 parts sterile water (not saline due to precipitation).
- Premedication, sedation +/- general anesthesia or local anesthesia as required General anesthesia: overview Local anesthesia: overview.
- Laceration - suture subcutaneous layers and then skin layers, ensuring tension-free apposition.
- Skin deficit - use simple dermoplasty techniques or proprietary film dressings until elective surgery feasible.
- Burns Burns - film dressings supported with padded gauze.
- If extensive, may use aluminum foil as covering and plan early grafting Skin graft: free Skin graft: pedicle.
- Anti-inflammatory and shock therapy - corticosteroids (post-trauma inflammation and wound contracture in distal limbs may be potential complications).
- Antibiotics Therapeutics: antimicrobial drug: 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 Therapeutics: antimicrobial drug.
- Topical anti-inflammatories: primary burns and abrasions Therapeutics: skin.
- Fluid therapy: burns Fluid therapy: overview Fluid therapy: for burns.
- 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.
- Muscles, tendons, ligaments or compound fractures, treat as emergency:
- Replace as soon as possible to minimize peri-articular changes.
- Neurological examination Neurological examination to locate injury.
- Radiography: if spinal injury Spinal cord: concussion, do contrast myelogram Radiography: myelography , if patient stabilized, or clinical signs worsen, or surgery anticipated.
- Discuss prognosis with owner if there is para / tetraplegia.
- Treat with:
- 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 until eliminated possibility .
- Severe depression → suspect intracranial hemorrhage 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.
- Treat injuries urgently.
- See nerve trauma Peripheral nerve: trauma.
Depressed skull fractures endangering cranium
- Emergency surgical elevation and anchoring.
- Conscious, alert but concussed, with ataxia / paralysis → spine and neck radiography.