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Emergency Response Learner’s Guide
©2014. Veterinary Nurse Solutions Pty Ltd. Version 1.0 Page 6 of 71 This publication is subject to copyright and may not be made available to any other person, other than the registered student.
bleeding dog fight wound, we can advise the owner to cover the wound with a damp clean dressing and apply pressure to help stop the bleeding before heading into the clinic for a proper assessment and consultation with the vet. Other conditions where first aid advice is essential is emergent
situations like near drowning and choking.
It is also important to advise on how best to handle a pet that could be in pain or disorientated, for example applying a makeshift muzzle with pantyhose to avoid being bitten when shifting an animal that has been hit by a car.
It is also useful to inform owners about the cost of an emergency visit and explain that additional costs may apply should treatment be necessary, and any details of your clinic’s payment policy. If the emergency is lifethreatening, it may be more prudent to skip this part of the converation and get them straight into the clinic for immediate care and stabilisation, then go through expected costs once a full examination has been undertaken.
When dealing with owners on the phone, it is important to obtain an estimated time of arrival to allow the staff to prepare. Always confirm that the owners know where they are going so they do not turn up at the wrong clinic. Provide geographical landmarks when explaining your location, as well as the actual address. This makes it easier to find
the clinic, especially if the owners are distressed.
Some problems that require immediate veterinary attention
→ Respiratory distress
→ Bleeding from bodily orifices
→ Pale mucous membranes
→ Weakness
→ Neurological abnormalities
→ Rapid abdominal distension
→ Protracted vomiting
→ Inability to urinate
→ Severe coughing
→ Ingestion of toxins
→ Known or suspected trauma
→ Dystocia
→ Burns
→ Prolapsed organs
→ Snake bites
→ Collapse or sudden inability to stand especially if extremities are cold
→ Coma
→ Eye injuries
→ Severe pain
→ Seizures if prolonged or recurrent within 24 hours
→ Severe distress or pain
→ Blue tongue/gums (unless chow breed)
Image: Applying a makeshift gauze muzzle.
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Emergency Response Learner’s Guide
©2014. Veterinary Nurse Solutions. Version 1.0 Page 12 of 71 This publication is subject to copyright and may not be made available to any other person, other than the registered student.
→ Has a bite wound disrupted the larynx or trachea? → Is subcutaneous emphysema present? → What is the colour of the mucous membranes? → Does the dyspnoea get worse with positional changes of the patient? → Is there evidence of thoracic penetration or is there a flail chest?
Any abnormalities or problems detected in the assessment of the airway and breathing must be addressed immmediately before moving on with the next step in the primary survey process. For example, ff the patient is a cat and it is breathing but his having breathing difficulties at this point, the cat should be placed in an oxygen cage unless it can be handled with mask O2/flowpast without any distress.
C – Cardiovascular System
The cardiovascular system, or Circulation, is assessed by visualisation, palpation, and auscultation of several vital signs.
Mucous Membranes
Mucous membrane (MM) colour may vary with circulatory related problems. It may be pale or white due to blood loss, anaemia or vasoconstriction. Brick red coloured MM is a result of vasodilation and can be seen with hyperthermia or sepsis. Grey MM is seen with stagnation of the blood. Blue MM is associated with cyanosis, and this can be seen with hypoxia or methaemoglobinaemia (with paracetamol toxicity). Note in anaemic animals there may be insufficient red cells to detect cyanosis even though the patient is hypoxemic.
Capillary Refill Time
The capillary refill time (CRT) should be less than two seconds. Prolonged capillary refill time (over two seconds) is also a result of peripheral vasoconstriction and causes decreased peripheral perfusion.
Peripheral Perfusion
Cool extremities are also seen as a result of vasoconstriction and decreased peripheral perfusion. Touch the digits/distal limbs to compare their temperature to the main body trunk. Remember animals have a higher body temperature than humans and therefore when healthy their feet, ears and extremities should always feel warm to us (unless exposed to very cold environmental temperatures).
Pulses
Palpation of the artery provides information about the animal's heart rate and rhythm. In addition, pulse quality is an indicator of stroke volume, the amount of blood pumped out of the heart with each beat. Ideally, the pulse should be full, regular and strong. Absent pulses should also be noted (e.g. with feline aortic thromboembolism you would not feel the caudal pulses but would feel the cranial pulses).
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Emergency Response Learner’s Guide
©2014. Veterinary Nurse Solutions. Version 1.0 Page 51 of 71 This publication is subject to copyright and may not be made available to any other person, other than the registered student.
Oxygen
Oxygen (Fi02 40% or greater) should be administered quickly. Intubation is the most effective method to deliver a high concentration of oxygen. If intubation cannot be performed and breathing has ceased, then mouth-‐to-‐snout should be attempted. While the AHA recommends the use of oxygen they do not have a position on whether it is more effective than mouth-‐to-‐mouth room air resuscitation in people. Currently there is no data to support a better outcome during CPR if room air is used versus oxygen. The RECOVER campaign recommends: "In the absence of arterial blood gas data, the risks of hypoxaemia likely outweigh the risks of hyperoxaemia, and the use of a FiO2 of 100% is reasonable."
In order for CPR to be effective both the heart and brain must remain appropriately oxygenated. Myocardial oxygen delivery is dependent upon myocardial blood flow and arterial oxygen content (CaO2). Cerebral perfusion depends on cardiac output and cerebral vascular resistance. Therefore oxygen should be a benefit and should be able to help with CPR. Unfortunately some studies have shown that excessive oxygen may predispose patients to increased concentrations of reactive oxygen species during states of CPA, worsening tissue damage during CPR. How effective oxygen actually is remains unknown.
Drug Administration
Atropine
Atropine is a prototype antimuscarinic drug meaning it has the ability to block muscarinic receptors. Muscarinic receptors are a type of acetylcholine receptors found in all effector cells (cells of muscles, glands or organs that are capable of responding to a nerve impulse) of the parasympathetic nervous system. The heart is supplied with both parasympathetic and sympathetic nerves. The parasympathetic nerves (also known as the vagi) are mainly attached to the sinus and A-‐V nodes of the heart. When the vagi are stimulated they release acetylcholine at their vagal ending. Acetylcholine causes a decrease in the rate of the sinus node and it also decreases the excitability of the A-‐V junctional fibres thus decreasing the cardiac impulse to the ventricles. This is also known as a vagal response. Vagal stimulation slows the heart beat and excessive stimulation can stop it entirely. Atropine inhibits acetylcholine at postganglionic parasympathetic neuroeffector sites which helps to stop this effect.
Atropine is given when vagal responses are thought to have occurred. Most bradycardia is responsive to atropine. The AHA has not taken any stance on administering atropine during asystole. They state “No prospective controlled studies support the use of atropine in asystole or slow pulseless electrical activity arrest.” Atropine falls under their class of indeterminate drugs meaning there appears to be no harm in giving it, but it also does not appear beneficial during asystole. The well-‐known side effect of atropine is that it can induce a severe sinus tachycardia. During an arrest hypoxia has generally occurred. There is some theory that sinus tachycardia caused by atropine can cause increase oxygen demands to the myocardium which predispose the myocardium to fibrillate.
Doses vary and atropine can be used both IV and intratracheally (IT). For patients just suffering respiratory arrest a small dose of 0.004-‐0.01 mg/kg can be given IV. For severe bradycardia or
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