Emergency care begins with your call to the veterinarian. Be prepared to describe the emergency situation. Your veterinarian may instruct you on how to administer first aid and how to safely transport your pet. You may be able to identify life?threatening airway, breathing, and circulation problems with the help of a veterinary professional on the telephone. Follow instructions regarding immediate treatment and transport. Calling ahead also gives the veterinary staff some time to prepare for your arrival.
You can provide basic medical care at the scene of the injury. Remember that any animal that is injured or in pain may bite or scratch. Injured animals must be approached carefully, and you should first take precautions for your own safety. Using a muzzle is often a prudent safety measure; one can be easily made from a piece of cloth or a ready-made muzzle can be included in the first aid kit. Never muzzle a dog with chest injuries or a dog with a short nose (brachycephalic breeds like Pugs), and never leave a muzzled dog alone.
A temporary muzzle can be created from a strip of cloth. Find a cloth bandage, rope, or other long strip of fabric. Tie a knot in the center of the bandage. Make another loose knot several inches above the first knot. Slip the loop over the dog’s muzzle and gently pull the knot tight (Step 1). Cross the ends of the bandage under the dog’s jaw (Step 2). Firmly tie the crossed ends behind the dog’s neck (Step 3).
If your pet is not breathing, you may need to perform mouth-to-nose resuscitation and chest compressions. Request instructions from your veterinarian or pet emergency hotline. To perform mouth-to-nose resuscitation, close the animal’s mouth, place your lips over the animal’s nostrils, and initially give 3 to 4 strong breaths (see Emergency Care for Dogs and Cats : Cardiopulmonary-Cerebral Resuscitation). If the animal does not start breathing on its own, breathe for the animal 10 to 12 times per minute. If you cannot detect a heartbeat, perform 5 chest compressions to 1 quick breath. Continue this pattern until the animal starts breathing on its own, or you get to veterinary assistance. Of course, in this situation, someone else will have to drive during transport.
Bleeding requires immediate first aid. Press down firmly on the bleeding area with your fingers or the palm of your hand, and then apply a firm, but not tight, bandage. Any long pieces of fabric or gauze can be used. Often washcloths and hand towels are enough when applied with mild pressure. If the original bandage becomes soaked with blood, do not remove it; simply place additional material on top and continue to apply pressure. These bandages can be secured in place using duct or packaging tape.
Burns can be difficult to evaluate because the fur makes it hard to examine the injury. Large deep burns, chemical burns, and electrical burns need immediate attention, as do burns involving the airway or face. Use cold water on the affected area, and cover the burn with a nonstick dressing.
Dogs or cats that are choking may cough forcefully, drool, gag, or paw at their mouth. They may also hold their mouth open and show signs of agitation. If you think your pet is choking, do not stick your fingers in its mouth because you can easily be bitten or push the object further in. Instead, you can try to dislodge the object by thumping the animal between the shoulder blades or by applying several quick, squeezing compressions on both sides of the ribcage.
Do not remove foreign objects that have penetrated the skull, chest, or abdomen. Prevent the object from moving or penetrating further. If an arrow has penetrated the abdomen, do not let the shaft of the arrow move during transport. It may be necessary to stabilize the shaft of the arrow just outside the body and, holding it firmly, cut the shaft off.
Heat stroke is another emergency. Normal rectal temperature for cats and dogs is about 101.5°F to 102°F (38.6°C to 38.9°C). Signs of heat stroke include skin that is hot to the touch, vomiting, drooling, rapid panting, distress, loss of coordination, collapse, and unconsciousness. Remove the animal from the heat. Use cool water, ice packs, or wet towels to cool the head and body. Offer small amounts of water after the pet has begun to cool down. Do not immerse the animal in cold water.
Hypothermia (overexposure to cold) usually results when an animal has been lost or outside in very cold weather for a long time after another accident or injury, such as a car accident. Signs of hypothermia include slow pulse, shallow breathing, disorientation, collapse, and unconsciousness. Shivering is not a usual sign of hypothermia in pets. If the animal is wet, first dry it thoroughly, and then place wrapped warm (not hot) water bottles around the body. White, numb skin may be frozen or frostbitten. Thaw the area slowly; do not rub it or apply snow or warm water.
Dogs or cats that have neck or throat injuries caused by strangulation, such as hanging by their collar, should be taken to the veterinarian immediately. Remove the collar and use a makeshift harness from rope or an extra leash to control the animal.
When moving or transporting an injured animal, minimize motion of its head, neck, and spine. A flat, firm surface of wood, cardboard, or thick fabric can be used to provide support. If the animal acts confused or disoriented after trauma, keep the head level or slightly elevated during transport. Avoid any jerking or thrashing motions, and prevent anything from pushing on the neck or jugular veins. Placing cats in boxes can minimize stress during transport. The box should have holes large enough so that you can see the cat.
In emergency medicine, the most life-threatening problems are treated first. When you arrive at the veterinary hospital, the veterinary staff will make a rapid assessment of your pet’s physical condition and assign priority of care to each problem. They will ask about the current situation and probably for a brief medical history. Several observed problems or a history of problems may warrant immediate treatment regardless of physical findings. Trauma, shock, poisoning, severe burns, difficulty breathing, persistent seizures, abnormal heart rhythms, loss of consciousness, excessive bleeding, obstruction of the urethra, prolapsed organs, potential snake bite, heat stroke, open wounds exposing extensive soft tissue or bone, and difficult labor are usually treated immediately.
Common reasons for sudden death of an animal include airway blockage, breathing difficulty caused by buildup of air in the space around the lungs (called tension pneumothorax), fluid or blood in the lungs, severe narrowing of the airways (usually from an asthmatic or allergic reaction), cardiopulmonary arrest and loss of circulation, extremely slow or fast heart rate, or continued internal or external bleeding.
The veterinarian will evaluate your pet’s airway, breathing, and circulation, as well as its level of consciousness. After your pet has been stabilized and initial emergency treatment begun, the veterinary staff will ask you additional questions about the animal’s medical history and details of the current situation. Be prepared to provide information on your pet’s past medical problems, medications, drug and food sensitivities, date of last vaccinations, and any other pertinent details.
The veterinarian will perform a complete physical examination of the animal, including listening to your pet’s heart and lungs, checking the abdomen for pain, and examining the limbs and joints for pain or swelling. If abdominal pain is present, its source must be determined. Some signs, such as vomiting or diarrhea, can indicate which body systems may be involved. Samples of blood and urine may be collected for laboratory testing. All this information helps the veterinarian to identify specific problems and to determine a diagnosis, treatment, and monitoring plan.
Any obstruction of the airways can be life-threatening. If the large airways (the trachea, commonly called the windpipe, and its 2 main branches, called the bronchi) are completely obstructed, the animal is unable to breathe and will be unconscious. If the large airways are only partially obstructed, the animal’s breathing will be noisy. The animal may be fearful, and its skin may appear to have a bluish tinge due to lack of oxygen. Possible causes of large airway problems include foreign objects, swelling (perhaps because of an allergic reaction), paralysis of the larynx, collapse of the trachea, and a longer soft palate than is usual. A potentially very serious situation called aspiration refers to breathing in stomach contents that have been vomited. This can lead to respiratory problems such as pneumonia and is one of the reasons why animals must be fasted before anesthesia and surgery.
Animals with severe small airway obstruction have difficulty breathing. They may wheeze and push out their diaphragm when exhaling. They may be fearful or anxious, and their skin, eyes, nailbeds, and other tissues may appear bluish. The animal may be sedated and given medication to expand the airways and make breathing easier. Common causes include allergic reactions; asthma (cats); and fluid, blood, mucus, or foreign material in the lungs.
If an animal is unconscious and not breathing, a tube will be placed through the larynx into the trachea to help it breathe. This is called tracheal intubation. If the upper airway is obstructed, oxygen can be given through a tube inserted below the obstruction to open the airway. The veterinarian will listen to ensure that the air is reaching the animal’s lungs. Heart sounds and pulses are checked and when absent, cardiopulmonary-cerebral resuscitation is done.
If the large airways are only partially obstructed by a foreign object, the veterinarian will remove the object if possible. A tracheal tube may be placed to deliver oxygen. The animal may need to be sedated to relieve anxiety. When tracheal intubation is necessary, sedation, likely general anesthesia, will be needed.
When animals have difficulty breathing, they breathe faster and breathing takes more effort. The breathing pattern often changes, followed by changes in posture. For example, dogs may stand with the elbows spread out and the back arched. Cats may crouch on all 4 limbs and raise their chest slightly, or sit high on the rear haunches and extend their head and neck. Obvious labored, open-mouth breathing and a blue tinge to the skin due to lack of oxygen develop last. These signs indicate significant loss of respiratory function.
The veterinarian will carefully observe the breathing pattern and listen to the animal’s chest. X-rays or other tests may be necessary after the animal has been stabilized. Oxygen is administered by a tracheal tube, a mask, a hood, or other method. The animal may be sedated to relieve anxiety. After the animal has been stabilized, additional tests may be done.
One cause of breathing problems is pleural space disease. The pleural space is the area between the membrane covering the lungs and the membrane lining the chest cavity. In this condition, air, fluid, or abdominal contents are in the pleural space. The veterinarian will hear muffled lung sounds over the affected regions. Treatment of pleural space disease begins with the veterinarian using a needle or catheter to remove the air or fluid that is free in the chest cavity. This procedure relieves the tension within the chest, allowing the heart to beat and the lungs to expand. A chest tube is then placed to continue to relieve the pressure.
Several indicators are used to determine how well the animal’s circulatory system is functioning. These include heart rate, mucous membrane color, capillary refill time, and pulse intensity. Listening to the animal’s heart and breath sounds will help the veterinarian determine what circulatory problems may exist.
Shock is the medical term for changes that develop when the body attempts to compensate for limited heart function, blood volume, or circulation. Shock can develop in many emergency situations, including head trauma, excessive blood or fluid loss, and severe infection. Signs of shock include a rapid heart rate, pale mucous membrane color, very low blood pressure, very little urinary output, and weak pulses. As shock progresses, delivery of oxygen and other nutrients to the tissues drops, eventually leading to organ failure and ultimately death.
Recognizing the type and stage of shock early is vital to treatment. Shock is typically classified into 3 categories: hypovolemic, cardiogenic, and distributive. Hypovolemic shock develops when blood volume is low, usually from loss of blood due to traumatic injury or loss of fluid through metabolic processes. Cardiogenic shock results when the heart fails, no longer pumping blood to the lungs or the rest of the body. Distributive shock is caused by blood flow being directed away from the central circulation because of a problem with peripheral blood vessels and is usually associated with serious widespread infections.
The goal of treatment for shock is to deliver blood to the tissues, bringing oxygen and other nutrients. Oxygen can be administered by a mask, bag, nasal or tracheal tube, or another method. Bleeding must be controlled. However, internal bleeding may not be evident until blood pressure and circulation are restored. Fluids and blood products will be given intravenously as needed to replace what has been lost. Abdominal counterpressure may be used to reduce abdominal bleeding, when present.
Medication to relieve pain is usually provided quickly. Narcotics or local anesthetics can be used. Your veterinarian may use other medications as well.
In an emergency, after your pet has been stabilized the veterinarian will ask you for a more complete history, conduct a more systematic physical examination, and begin specific diagnostic and treatment procedures.
Accidents, falls, and fights with other animals may result in different types of trauma. In blunt trauma, the animal has been struck by an object (such as a car) but the skin was not penetrated. Blunt trauma is commonly associated with internal bleeding, organ rupture, fractures, and head injuries. In penetrating trauma, a sharp object, such as an arrow or bullet, pierces the skin, and injuries are related to the path of the penetrating object. Falling from a height can cause multiple bone fractures, as well as injuries to the chest and organs. A dog bitten by another larger dog can have deep penetrating bite wounds and will frequently have spinal injuries and tracheal rupture from the thrashing motions experienced during the attack.
For all types of trauma, airway, breathing, and circulation are evaluated and stabilized as described above. Control of bleeding, oxygen if needed, and pain relief are also given immediate attention. After stabilization, the nervous system, chest, abdomen, and bones are carefully evaluated. Blood tests, urine tests, and x-rays may be performed as needed. Trauma to the eye is also a common emergency (see Eye Emergencies).
Animals that have suffered a trauma often have multiple injuries, some of which may not be immediately obvious. Whenever the animal is moved or being examined, the neck and spine should be kept still in case there are spinal fractures or other problems that cannot be readily seen. Broken legs may be wrapped with bandages or splinted. Because many problems are not apparent for 12 to 24 hours after trauma occurs, your pet needs careful monitoring in the veterinary hospital.
Some traumatic injuries to the chest are potentially life-threatening. Bruising of the lungs, air in the space around the lungs (called pneumothorax), heart rhythm problems, internal bleeding, and rib fractures are emergencies that may result from blunt trauma.
Tests to help determine the extent and severity of the problems include chest x?rays, blood tests, and an electrocardiogram (ECG). A procedure called centesis, in which a needle is inserted into the chest or abdomen of the animal to remove fluid or air, may also be performed. Laboratory examination of any fluid removed can help with diagnosis.
Severe bruising of the lungs causes labored breathing and lack of oxygen to the tissues. Oxygen treatment may require sedation and tracheal intubation, in which a tube is inserted into the trachea to help the animal breathe. When bruising is severe, ventilation (in which air is forced mechanically in and out of the lungs) may be required to provide the best chances for survival.
If air or fluid is trapped inside the animal’s chest cavity, a tube may be inserted through an incision in the chest to drain the air or fluid. Surgery may be recommended either immediately or after several days if the animal does not improve.
A condition called flail chest may be caused by blunt trauma that breaks 3 or more ribs. The portions of ribs that have broken off, called flail segments, may be stabilized by using an external frame of metal rods or cast material that is formed to the shape of the chest. The animal must generally be anesthetized, and surgery is usually necessary.
Bite wounds over the chest must be cleaned and drained. The puncture holes seen on the skin from the bite are only a small portion of the significant damage that may have occurred to the muscles and tissues underneath the skin. Surgery may be required if the wound is penetrating or if there is significant bruising or swelling.
Heart rhythm abnormalities, particularly fast heart rhythms, are often seen after trauma. A sedative may be used to relieve anxiety and slow the animal’s heart rate. The animal should be treated aggressively for shock, and an electrocardiogram should be done to look for primary heart rhythm problems.
The extent and severity of abdominal injuries are not always obvious immediately. If the abdominal wall is torn open, the injury is clearly serious. Bruising, road burns, cuts, scrapes, swelling, a change in the shape of the abdomen, or pain may indicate internal injuries. If your pet appears to have abdominal pain and is in shock, internal bleeding may be present. The spleen, liver, or kidneys may be injured. All abdominal organs have blood vessels that can be injured by blunt trauma.
It may take several hours for specific signs of an injury to an abdominal organ to appear. Your veterinarian will watch closely for sharp abdominal pain. Abdominal x-rays or ultrasonography may show the location of injury. If fluid is present in the abdomen, a needle may be inserted into various locations to remove it. The fluid is then examined for any evidence of infection, rupture of an organ, cancer, or other problems.
Sometimes, a catheter is placed through an incision in the animal’s abdomen, and warm saline solution is flowed into the abdomen. The fluid is left in the abdomen for several minutes and then drained. This process is called peritoneal lavage. If the fluid is clear, significant internal abdominal bleeding is unlikely. Some blood in the fluid indicates mild bleeding. More blood in the fluid indicates significant abdominal bleeding that warrants careful monitoring and may require surgery. However, bleeding may be present even if the peritoneal lavage shows little or no blood in the fluid. Pelvic fractures in particular may cause complications, including bleeding, that often are not found by peritoneal lavage.
If internal bleeding or other serious internal problem is found, emergency surgery may be needed.
Cardiac arrest occurs when there is no heartbeat and breathing stops. The purpose of cardiopulmonary-cerebral resuscitation (CPCR) is to replace the work that the lungs and heart are not performing on their own. The success of CPCR efforts depends on the underlying cause of the cardiac arrest as well as on the speed and effectiveness of the treatment. The initial steps of CPCR are meant to get the needed oxygen and blood to the animal’s tissues. CPCR progresses with advanced life support measures. Heart rhythms are monitored, drugs are administered, and the heart is defibrillated when necessary.
Defibrillation is a process of shocking the heart in a specific way to restore a coordinated heart beat and a pulse. Often, immediate defibrillation offers the best chance of recovery after cardiac arrest. Defibrillation is considered the best treatment for one of the most common arrest arrhythmias, ventricular fibrillation. Other heart rhythm problems are generally thought not to be made any worse by the procedure.
Mouth-to-nose resuscitation is the first step of CPCR. This continues until the veterinary staff can insert a tube to deliver oxygen and help the animal breathe with mechanical ventilation. Chest compressions are used to promote circulation when no pulse is present. The animal is positioned on its back or its side (depending on size) and supported as needed while compressions are performed over the area of the heart. The goal is to improve the return of the blood to the heart between beats.
Constant monitoring is important during basic life support procedures. If circulation continues to fail, additional procedures or drugs may be necessary.
In advanced life support, heart rhythms are monitored by electrocardiogram, and drugs or defibrillation may be used. The purpose is to reestablish the heartbeat.
Fluids are administered, usually intravenously (IV), to promote circulation. Sometimes, blood products are also given.
If basic life support has not been successful, meaning that the animal does not begin to breathe on its own or have a normal heartbeat after 5 to 10 minutes, open-chest cardiopulmonary resuscitation (CPR, see Emergency Care for Dogs and Cats : Open-chest Cardiopulmonary Resuscitation (Emergency Thoracotomy)) may be started. Sometimes open-chest CPR is begun earlier. In severe trauma with blood loss, the chest may be opened to assess the injury as well as to perform CPR. In a large dog, external compressions may not generate enough blood flow. You should make your wishes known to the veterinary team as quickly as possible regarding your permission for open-chest CPR. This technique can be life-saving, but it carries additional expense and requires surgery to close the chest.
When chest compressions are not successful in restoring the heartbeat, the chest may need to be opened to allow access to the heart. If blood has pooled around the heart in the tissue sac called the pericardium, the pressure from this fluid can be relieved by opening the sac. If the heart is not beating, the veterinarian grasps the heart with one or both hands and compresses it. The compression is then released to allow the heart chambers to refill with blood. If blood loss is severe or poor circulation has been prolonged, certain blood vessels may be clamped to direct blood flow to the brain. This is a temporary measure, usually up to 10 minutes.
If the heart begins to beat again, the open chest is rinsed with sterile, warm salt water, and a chest tube is placed before the chest is closed. Treatment continues while the underlying cause of the arrest is determined.
Maintaining volume in the blood vessels and the tissues of the emergency patient is vital. Signs of dehydration (fluid loss in the tissues) include dry skin that does not “smooth” back into its normal position after being pinched, dry mucous membranes, and sunken eyes. When fluid is given, it is distributed evenly throughout the body. This rehydrates a dehydrated animal. However, excessive water volume can cause swelling, called edema. Specific types of fluids are given to injured animals to meet their specific bodily needs.
Critically ill animals must be monitored closely in the veterinary hospital for a period of time depending on the severity of the illness or injury. Close attention helps the veterinarian determine whether treatment is effective, or whether other treatments may be needed. Often, secondary problems become evident or develop during treatment.
Several parameters are generally evaluated daily or more often while the animal is hospitalized. These include the balance of fluids in the body, glucose (blood sugar) levels, electrolytes, oxygen levels, level of consciousness, blood pressure, heart rate and rhythm, coagulation of blood, red blood cell count and hemoglobin (a protein that carries oxygen) level, gastrointestinal function, kidney function, and effects of medications.
It is always preferable if an animal will eat on its own or at least take food orally. Small amounts of a liquid diet can generally be given orally. When the pet refuses oral feeding, a tube can be placed to provide nutrition through the gastrointestinal tract. In the rare event that nutrition cannot be given through the gastrointestinal tract, then nutrition is usually provided through specific intravenous fluids.
Signs of pain include fast heart rate and pale mucous membranes. These can mimic signs of shock. An animal in pain also has higher levels of stress hormones. However, animals may be in pain without showing obvious signs. In these cases, if the animal has a known painful condition, pain medication is generally administered. Pain medication makes the animal more comfortable but can also reduce signs of other conditions, possibly making diagnosis more difficult.
Critically ill animals need skilled, knowledgeable, attentive nursing care. Animals that are unable to walk should be turned from one side to the other, every 4 hours if possible, to prevent ulcers and other problems. Physical therapy to maintain range of motion, muscle tone, and blood flow may be a part of nursing care. Catheter sites should be inspected frequently for signs of infection or displacement. Bandages that become soiled or wet should be changed. If fluid collects in limbs, light compression wraps may be used. These should be changed every day. Any animal with a critical illness should have 24-hour nursing care.
If your pet needs to stay in the veterinary hospital, ask about the visitation policy. Many veterinary hospitals encourage owner visits and have daily visiting hours. Talking to your pet and maintaining contact when possible can help reduce your pet’s stress and anxiety (as well as your own).
When it is time to bring your pet home, make sure that you completely understand all care instructions. Often, you will be required to restrict an animal’s activity for a certain period of time, particularly after surgery or if your pet has fractured a bone. Dogs can be crated or restrained in a small room; when taken outside, they should remain on a leash to prevent running or jumping. Cats can be kept in a small room where they will not be tempted to jump onto furniture or counters.
Medication should be given according to instructions, and all label directions followed closely. Tips on administering medications are given in the Dog Basics and Cat Basics chapters ( Routine Health Care of Dogs : Giving Medication and Routine Health Care of Cats : Giving Medication). Bandages should be changed as directed, and wounds or sutures (stitches) checked for any swelling, redness, or discharge that might indicate infection. You will probably be advised to avoid bathing your pet until any sutures are removed.
Your veterinarian will usually schedule a followup appointment to check on your pet’s recovery. In the meantime, call if any problems arise or if you have any questions about care.