Recognising emergencies Recognising emergencies 2 Differentiating emergencies 2 Emergency situations 3 and treatment of emergencies 4 1
Recognising emergencies After a client and patient have arrived for a consultation or admission for a surgical or medical procedure, the veterinarian involved needs to be informed of their arrival. This can be done either via a paging system or in person. Occasionally clients will arrive with animals that require urgent attention, with or without an appointment. As a veterinary nurse you ll need to be able to identify the various clinical signs that indicate an emergency, so that prompt treatment can be applied. If the client does not have an appointment or there are other clients already booked in, it will be necessary to explain the situation to the other waiting clients who may then be delayed. Differentiating emergencies This table outlines a range of conditions you may encounter Life threatening animal will die if not treated immediately unconscious conscious collapse with breathing trouble or cyanosis severe haemorrhage severe burns poisoning snake bite head injuries straining to urinate seizures Conditions requiring immediate attention conscious collapse difficulty breathing fractures/ dislocations haemorrhage gaping wounds difficulty giving birth prolapsed eye vomiting and diarrhoea Minor conditions insect stings minor wounds (where the bleeding is easily controlled by bandaging) minor burns (only slight discomfort) abscesses slight lameness hematuria aural hematoma Which category do you think this animal would fit into if it arrived without an appointment? 2
Emergency situations The table below lists veterinary emergencies that you may encounter in a clinic. Emergency situations must be reported to the veterinarian immediately when they present at the veterinary hospital. Many clinics will have a policies or procedure to follow when emergencies arrive. Patient details must be obtained from the owner and provided to the veterinarian either verbally, written or computer based. The patient must then be presented to the veterinarian in an ethical and humane manner. Veterinary emergencies hit by a car (70% of veterinary emergencies) ingestion of poisonous substance eg snail bait, rat poisons, caustic agents, aspirin, paracetamol, human heart drugs etc head trauma, falls etc straining to urinate unsuccessfully. dog administered DEC (daily heartworm preventative) that has not been blood tested beforehand and that is showing signs of dyspnoea or collapse animal left inside a car in the sun, or elsewhere in sun without water prolonged labour gunshot wounds burns dog attack snakebite, suspected or confirmed insect bite if has had a previous allergic reaction drug overdose eye injuries, prolapsed globe penetrating wounds or hernias to abdomen or thorax multiple fractures 3
and treatment of emergencies Broken bones Some bone breaks show obvious symptoms: twisted or distorted limbs, or in the case of a compound fracture, bone fragments sticking through the skin. Less apparent breaks cause great pain and discomfort. The animal will cry or bite when the affected area is touched; will lie around, often on the affected area; and will usually not walk, although in some cases it will walk despite the break, notably when the pelvis is broken. The fracture will not bear weight. Swelling of the affected area with 24 hours can be expected from any sort of fracture. of compound fractures by a veterinarian should be sought as soon as possible. Other breaks should be treated by a veterinarian within 24 hours. Apply an ice pack or cold wet compress to the affected area; change regularly. Protect the animal from further injury by confining it to a small room. Apply a temporary splint to broken limbs to avoid further dislocation. Burns All burns are painful to the touch. Electrical burns are the most serious and can cause heart attacks and death. The burned area will show seared flesh, reddened skin, lesions, and blisters. The animal may suffer respiratory distress; paleness or blueness, especially in lips, gums, and eyelid linings; rigidity in limbs; glassy stare; collapse; and shock. Thermal burns cause a singed or charred area; the exposed skin is reddened or inflamed; the wound is warm or hot to the touch. Friction burns are similar in appearance to thermal burns, but the skin is chafed or scraped and has bare spots; bare skin is rubbed raw, is reddish in colour, and is irritated or inflamed; the trauma causing the burn may leave cuts, lacerations, or embedded foreign matter. The animal should be taken to a veterinarian. 4
Constipation The animal struggles or strains during a bowel movement without passing a stool; avoids food; becomes nervous or irritated. Diarrhoea The animal passes liquid stool during bowel movement; there may be abnormal coloration of the stool. Prolonged diarrhoea can lead to severe dehydration and should be treated as an emergency if persist for more than 24 hours, or if blood is present. Respiratory infections and conditions Sneezing, coughing, runny eyes, swollen glands, difficulty swallowing, laboured breathing, fever. If symptoms such as sneezing, coughing, and runny eyes are present but the animal remains active and eats normally, the condition is probably not as serious. A veterinarian should examine the animal if symptoms continue for a while; if the animal becomes lethargic and loses appetite; if there are discharges of pus from its nose; if congestion becomes heavy or laboured breathing is continued; or if fever of more than 40 degrees is present. Skin problems Localized skin conditions cause inflammation or irritation and may cause bald spots of red, raw, or discoloured skin. More serious disorders such as moist eczema, wet dermatitis, or acute pruritus cause raw, oozing bald spots that may be damp to the touch or oozing pus. A lump on the animal's skin that does not go away within a few days may be a tumour. Other skin problems can cause dry, flaky skin, or an oily coat, and constant biting, licking, or scratching. Symmetrical skin disorders affect both sides of an animal's body equally; a generalized condition affects the animal's whole body. Generally not an emergency unless the animal has caused or inflicted self trauma. Bald patches of red or raw skin and damp, oozing hot areas should be treated by a veterinarian. 5
Any skin condition that does not go away or that reappears after treatment should be treated by a veterinarian. Sprains Sprains usually occur in the joints of an animal's limbs, causing rapid swelling. The affected area will be hot to the touch. The animal will not walk normally, if it walks at all. Apply cold compresses or ice packs gently to the swollen area; removing the compress or ice every 20 minutes. Wrap the affected area snugly with cloth, gauze, or athletic bandages; secure the wrapping to be sure the animal does not scratch or bite it off. Keep the animal quiet; discourage activity; avoid stairs. See a veterinarian. Wounds Cuts can be recognized by the presence of smoothly separated tissue and possible bleeding. Lacerations result in jaggedly torn skin, bleeding, swelling, irritation, and black or blue discoloration of the skin. Abrasions rub or scrape away the outer layers of skin, causing pain, swelling, redness, and heat. Bruises or contusions leave black-and-blue tissue and swelling. Any serious wound should be treated by a veterinarian especially if bleeding will not stop, if blood is gushing out or if shock is present. These are emergency situations- seek veterinary advice right away. Cuts that are bleeding can be dealt with by applying a pressure bandage (clean gauze or cloth wrapped around some non stick padding) pressed firmly but gently against the wound and an ice bag, pressed firmly but gently on the area. After the bleeding has been controlled, clean the wound and then dry it; keep skin from wrinkling or bunching, then apply an antiseptic or antibiotic to gauze square and wrap snugly in place; change the dressing daily and keep the animal from removing it. Lacerations can be treated in the same way as cuts, but an ice bag must be used to reduce swelling and prevent further inflammation. Abrasions require the application of a soothing cream, ointment, or lotion; a bandage is not recommended, but the animal must be kept from licking the treated area. Bruises and contusions are best treated with 6
cold compresses or ice packs. Bite wounds Wounds caused by another dog or cat can be very serious. Puncture wounds are often deeper than they appear. Fight wounds also tend to become infected easily. Seek Veterinary advice as soon as possible after a fight wound has been sustained by your pet. Antibiotics are often prescribed to prevent the formation of an abscess. An abscess is best described as a pocket of pus. They cause the abscessed area to become very enlarged, hot and painful to touch. Abscesses may cause your pet to become dull and go off their food. They can also cause a raging fever. Some pets become so sick with an abscess that they can die from associated blood poisoning. /action Approach the pet carefully to avoid getting bitten. Muzzle the animal. Check the wound for contamination or debris. If significant debris is present, then clean the wound with large amounts of saline. Wrap large open wounds to keep them clean. Apply pressure to profusely bleeding wounds. Do not use tourniquets. Bite wounds often become infected and need professional care. Wear gloves when possible. Breathing stops /action Check to see if the animal is choking on a foreign object. If an animal is not breathing, place it on a firm surface with its left side up. Check for a heartbeat by listening at the area where the elbow touches the chest. If you find no heartbeat and no breathing, commence CPR. If there is a heartbeat, but not respiration, commence breathing for the animal and continue to check for heartbeat. Please note: Even in the hands of well-trained veterinary health professionals, success of resuscitation is very low overall. Success may be slightly higher in the cases of drowning or electrical shock. Call veterinarian immediately. This is a major veterinary emergency! 7
Steps for Cardiopulmonary Resuscitation (CPR) Check airway 1. Carefully pull the tongue out of the animal's mouth. WARNING: even an unresponsive dog may bite by instinct!! 2. Make sure that the neck is reasonably straight; try to bring the head in-line with the neck. WARNING: Do not hyperextend in cases where neck trauma exists 3. Attempt two rescue breaths, by closing the mouth, and performing mouth-to-nose ventilations. If they go in with no problems continue to steps for Breathing. Breathing 4. Reposition the neck and try step three again. 5. Visibly inspect the airway by looking into the mouth, and down the throat for foreign objects occluding the airway. Unlike CPR for humans, rescuers may reach into the airway and remove foreign objects that are visible 6. After achieving a patent airway, one must determine whether the animal is breathing, and whether this breathing is effective: 7. Carefully pull the tongue out of the animal s mouth. WARNING: even an unresponsive dog may bite by instinct!! 8. Make sure that the neck is reasonably straight; try to bring the head in-line with the neck. WARNING: Do not hyperextend in cases where neck trauma exists 9. Ventilate the animal by closing the mouth, and performing mouth-tonose ventilations. If they do not go in with ease go to A-Airway. 10. Ventilate at 20 breaths per minute If supplemental Oxygen is available, and the animal is breathing on its own, use a high-flow blowby. WARNING: Do not attempt to intubate the animal, without prior training, and properly sized ET tubes. 11. Proceed to C-Circulation, while continuing respiratory support as necessary Circulation 12. This is the final step of CPR and should only be initiated after the airway and breathing steps have been completed: 13. Make sure that there are no major pooling/spurting blood points of bleeding. Control as necessary. 14. Lay the animal on its right side. 8
15. Locate your hands where its left elbow touches the chest. Approximately the middle of the rib-cage 16. Compress the chest 15 times followed by two rescue breaths (three compressions every two seconds) Compress a.1/2" - small dogs b.1" - medium dogs < c. 1.5" - large dogs 17. Repeat as necessary Choking /action Difficulty breathing, excessive pawing at the mouth, blue lips and tongue. Be sure to protect yourself as well since the pet will likely be frantic and may be more likely to bite. If the pet can still partially breathe, it's best to keep the animal calm and get to a veterinarian as quickly as possible. If possible, look into the mouth to see if foreign object in throat is visible. To avoid being bitten, use the handle of a screw driver to wedge between the molar teeth on one side of the mouth so the pet can not close its mouth. Use your fingers to perform a finger sweep at the opening of the throat. If you can, clear the airway by removing the object with your fingers, being careful not to push it farther down the throat. If possible, encourage the pet to cough by gently rubbing at the throat area or using a gentle tinkling motion at the throat area while the pets head is slightly extended back. If it is lodged too deep or if the pet collapses, then place your hands on both sides of the animal's rib cage and apply firm, quick pressure. Or place the animal on its side and strike the side of the rib cage firmly with the palm of your hand three or four times. Repeat this 9
procedure until the object is dislodged or you arrive at the veterinarian's office. Call veterinarian immediately. Warning- there is a structure deep in the throat (the Adams Apple ) that feels like a smooth bone. DO NOT pull at this structure!! Heatstroke /action Rapid or difficulty breathing, vomiting, high body temperature, collapse. Place animal in a tub and run cool water over it. Or, gently soak animal with a garden hose or wrap in a cool, wet towel. Do not overcool the animal. Stop cooling when rectal temperature reaches 39 degrees. Call veterinary immediately. Seizures /action Salivation, loss of control of urine or stool, violent muscle twitching, loss of consciousness Move pet away from any objects that could be harmful. Use a blanket for padding and protection. Do not put yourself at risk by restraining the pet during the seizure. Time the seizure. They usually last only 2 to 3 minutes. Afterwards, keep the animal calm and quiet. Call veterinarian immediately. Shock Early stages of shock Bright red gums Very rapid capillary refill time (CRT) (1-2 seconds) The pet may be either excited or subdued Rapid heart rate Pulse not difficult to find Middle stages of shock Gums appear pale or muddy Abnormally long CRT (2-3 seconds) 10
The heart rate is frequently above normal The pulse weakens and is often difficult to find The pet will most likely be subdued and weak. Respiration is often shallow and rapid (but may be normal still) Rectal temperature is often below normal Late stages of shock Gums are extremely pale or show signs of a blue discolouration CRT is often quite long (3-4 seconds +) Heart rate is elevated and irregular. If very severe shock however, heart rate may be slowing as the heart muscles begin to fail. The pulse is very weak and difficult to locate Respiration may be slow and rapid, shallow or deep (but not normal!) The eyes may take on a glazed appearance and appear not to focus normally. Mental condition deteriorates from subdued to stupor or even coma. Rectal temperature is below normal- often critically so. /action Successful treatment of a patient with shock involves prompt recognition of the signs, immediate initiation of first aid procedures and safe, rapid transport to a veterinary facility for definitive treatment. First aid includes: providing adequate breathing stopping blood loss protecting obvious fractures from further injury preventing loss of body heat by covering the patient with blankets or clothing immediately transporting the patient to a veterinary facility. 11