Contributors: Elisa Mazzaferro, Joseph Harari, Andrew Gardiner

 Species: Feline   |   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 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.
  • Assess:

Follow-up

  • Monitoring as above.
  • Check blood supply to traumatized areas:
    • Edema.
    • Pulse.
    • Warmth.
    • Local CRT.
    • Pressure bandage - check not restricting venous return.
  • Maintain fluid balance IV or PO as necessary.

Respiratory system

Emergency

Criteria

  • 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.

Aim

  • Support treatment as soon as possible.

Procedure

Radiography
  • 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.
Diaphragm
  • If outline obscured, do a coelogram and look for contrast medium in chest cavity  Thorax: ruptured diaphragm - radiograph lateral  Thorax: ruptured diaphragm - radiograph DV .
    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).
Thoracic cavity
  • Hemothorax Hemothorax  Thorax: pleural effusion 01 - radiograph lateral  Thorax: pleural effusion - radiograph DV :
    • 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  Thorax: rib fracture - radiograph lateral: conservative management unless deep impaction on thoracic cavity or there is an open transcostal chest wound, then   →   surgical repair.

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 - 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

Clean area
  • 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).
Restraint
Repair
  • 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.
Dressings

Medication

Follow up

  • Coat: use solvents to remove greases; clean coat of dirt.
  • Wounds: prevent patient interference - sedation, analgesia, physical means (Elizabethan collar Cat with nasogastric tube and 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.

Musculoskeletal system

Emergency

Open wounds
  • Muscles, tendons, ligaments or compound fractures, treat as emergency:
    • Decontaminate wounds with copious lavage Wound: lavage and debride Wound: debridement  necrotic tissue.
    • 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
  • Replace as soon as possible to minimize peri-articular changes.
Fractures

Neurological system

Paralysis

  • Neurological examination Neurological examination to locate injury.
  • Radiography: if spinal injury Spinal cord: concussion, do contrast myelogram Radiography: myelography  Spine: cervical cord compression - myelogram , if patient stabilized, or clinical signs worsen, or surgery anticipated.
  • Discuss prognosis with owner if there is para / tetraplegia.
  • Treat with:
    • Corticosteroids - prednisolone Prednisolone, dexamethasone Digoxin, betamethasone Betamethasone if within 8 hours of injury, however use is controversial.
    • IV fluids/analgesics.
    • Surgery - acute procedure where spinal compression present, otherwise stabilize first.

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 until eliminated possibility .
  • Severe depression   →   suspect intracranial hemorrhage Intracranial hemorrhage.

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 Epilepsy: traumatic - diazepam Diazepam.