first aid vn117. first aid & emergency care for small animals emergency: a set of circumstances...
TRANSCRIPT
First aid & emergency care for small animals
Emergency: A set of circumstances or a sudden unexpected event demands urgent action
First aid: The immediate treatment of injured animals or those suffering from sudden illness
3 aims & 4 rules
(An emergency in the absence of a vet is not a licence for the vet nurse doing first aid to practice veterinary medicine)
Aims◦Preserve life◦Prevent suffering◦Prevent the patient
deteriorating
Rules◦Stay calm◦Maintain the ABCs◦Control haemorrhage◦Contact the vet
The telephone
stay calm and non judgementalif asked for first aid advise, give clear
instructionsget accurate details (8 questions: Goodwin, J.(2003) First
aid. In D. Lane & B. Cooper (Eds.) Veterinary Nursing(3rd ed.)(p.102).
London: Butterworth-Heinemann)Find out who is the usual vet and who will
pay
The role of the NZ first aider
Triage-sort emergencies from non urgent situations
attend to life threatening injuries in the absence of the vet
Notify the vet asap
reduce suffering & promote healing
Classification of emergencies
Life threatening and serious emergencies
Lesser emergency
Dysentry, protracted vomiting or diarrhoea and significant depression and lethargy
Difficulty urinating but still passing urine
Collapse or unconsciousness Stings
Open fractures or those with wounds close to the broken ends
Small wounds or burns
Gaping wounds, severe haemorrhage or burns
abscess
Dystocia Weight bearing lameness
Serious emergencies require transport to the clinic without delay and may require life saving immediate actionMinor emergency may require immediate veterinary examination or a scheduled appointment
Initial action plan-DRABCS
Danger! begin scene assessment from a distance and think of safety issues- self, bystanders, animal
Response! level of consciousness-Alert or only responds to voice or pain, is it unconscious or dead? YELL FOR HELP
check Airway, Breathing, Circulation (15 sec)& Severe bleeding and treat any life threatening injuries (CPR etc start asap)
◦ ONCE LIFE THREATENING PROBLEMS ARE SORTED OUT
Tip of the nose to tip of the tail examination, Stabilisation of shock and other first aid conditions Transport to and contact the vet as soon as possible
Danger!
Animals in distress may react abnormally and bite
Muzzle may be required◦If airway or breathing are compromised the
animal is usually too distressed to attack effectively and a muzzle may be lifethreatening
Response
ResponseIs the animal alert? or responds only to voice or pain?Is the animal unconscious or dead?Call for help if not responsive
Background to changes in CPR protocol
Previous veterinary CPR protocols based on human advice
RECOVER initiative (Reassessment Campaign on Veterinary Resuscitation)is an evidence based review of veterinary literature
More information at www.acvecc-recover.orgComplete overview in the June 2012 issue of
Journal of Veterinary Emergency and Critical Care
The chain of survival
Early recognitionHigh quality CPRPost resuscitation care
Survival rates for animals in a clinic with anaesthetic emergency nearly 50%
Very, very poor survival rates without support facilities and medication
The Unresponsive patient
Assessment ABC: takes <15 seconds
Airway: is it patent? tongue, look, straighten Breathing: look, listen, feel Circulation: palpable femoral pulse/heartbeat?
(If no breathing and no pulse detected immediately move on. Take no more than15 sec for this whole assessment otherwise it has taken too long)
100% sure NOT in arrest: do a complete physical examination
Otherwise, start basic life support
Basic Life Support
Treatment: CABCompressionsAirwayBreathing
Main difference is compressions are the most important part of treatment. Start with these!Algorithm based on 2 minute cycles before checking for signs of life
Compressions
In general, done in right lateral recumbency
Rate is 100-120bpm irrespective of size/species
Compress 1/3 to ½ of chestAllow chest wall to recoil2 minute cycles of compressions and
rescue breathing without interruption
Compression techniques
Interlacing hands, heel over heel, locked elbows
Bend at the waist
Cats and small dogs: one hand cardiac pump
Medium to large DOGS: thoracic pump
B. Keel chested dogs: lateral, over the heart
C. Flat chested dogs: on back, compress sternum
A. Round chested dogs: lateral middle of chest
Airway - breathing
Ensure airway patent: open mouth, pull tongue out to the side, look and remove obvious blockage, straighten head and neck
Rescue breathing mouth to nose, entubate
and supply 100% oxygen asap
Inspiration, expiration pause
If on own do 30 compressions to 2 breaths
Breaths should be quick and completed within 5 seconds
Don’t stop compressions to breathe if 2 people working CPR
10 breaths per minute
Your turn!
To the tune of Staying Alive
(or ‘Another One Bites the Dust)
Signs of effective CPR
Early signs ◦Palpable pulse during
CPR◦Constriction of the
pupil◦Ventromedial rotation
of the eyeball◦MM colour improves◦ECG changes
Late signs◦Lacrimation◦Cranial nerve reflexes
return (blink gag cough)
◦Spontaneous breathing
If in a veterinary clinic
CPR performed in a clinic may involve the use of more resources than available elsewhere
After checking ABC, perform CAB
If no signs of life in the first 2 minutes
DEF (administer Drugs, Electrodefibrillation, and Follow up with post crisis stabilisation of compromised body systems)
https://www.youtube.com/watch?v=Gl11AOLliXE
Follow up: After the event
The animals body systems will be seriously out of balance even if the CPR has “saved” the animal’s life
Seek veterinary assistance but get advice before moving the animal. The stimulus of movement may cause a set back.
chokingIf the animal is seen choking and is initially still conscious the protocol for first aid focuses on airway management until the animal becomes unconscious and unresponsive
First step
Initially, if your dog is capable of coughing, wait a few moments to see if your dog can manage to cough up the obstruction on his own
If the problem continues, try to look in the dogs mouth and remove the blockage◦Restrain the dog and open its mouth using the dogs own lips to
protect your fingers use a piece of cloth to help grab the tongue and move it out to the side
◦ If you see the object and it is easy to grasp and pull it is preferable to use a blunt spoon end or round ended pliers to dislodge it than your fingers
◦Do not blindly sweep or reach down the throat
Second step
If the airway blockage remainsTilt the dog or try chest compressions
Third step: The heimlich manoever
Small dog ◦Position: kneel behind
or hold against your stomach
◦Use the one or two knuckles
Medium and large dog◦Position: stand behind◦Use one fist
finally
Even if the dog seems to have recovered a vet check for throat trauma that may lead to complications is advised
Priorities of wound care
Bleeding stopped with pressure Direct pressure Bandage or improvised If bandage soaks through add another on top
Do not remove penetrating foreign objects cut them short and ring bandage
Protect exposed tissues from further contamination
Cover wound surface with commercial sterile dressing and bandage or clean, non stick, non fluff material
Assess and treat shock◦Wrapt
Handling and transport
Use least restraint possible & a quiet assertive approach-ensure airway not compromised (consider human safety)
If ambulatory allow self movement
Non-ambulatory carry in arms or …and ensure injuries supported
Allow animal to lie in position it finds most comfortable
Restrain and monitor in the vehicle
Ensure safe procedures carpark to vet clinic
If there will be a delay before the vet can attend
allow patient to lie/sit in whatever position is most comfortable in a warm comfortable kennel
clean wounds, apply dressings and splints if possible without patient showing distress
prepare drips, instruments, theatre etc for the vet
Monitor vital signs and level of consciousness
intervene to prevent death or major complications
Shock – multisystemic response to inadequate tissue energy production
Signs◦Tachycardia◦Weak rapid pulse◦Vasoconstriction of
peripheral vessels◦Slow CRT◦Cold extremities
Treatment◦ Keep warm, stress free
and rested◦ O2 ◦ Fluid therapy◦ Pain relief
Scenario tasks
With a group brainstorm your response to your scenario. Record your decisions and actions for others to share.
Ensure you cover the following◦classification of your emergency-explain why◦Initial action plan◦(Assume a full body examination found no
other issues than those noted)◦First aid stabilisation of shock and injuries◦Positioning and transport issues
Scenario 1
A dog has been just been hit by a car and skidded across the gravel to the road edge. It hopped slowly towards you, and is now sitting with its mouth wide open and breathing hard. He has a skinned and lacerated paw that is bleeding, but not profusely
Scenario 2
First thing in the morning a huntaway is found with a bloated abdomen and having difficulty breathing.
Scenario 4
A dog has been chasing sticks and it is suddenly distressed, pawing at its mouth, coughing and retching
Scenario 5
A crossbred dog has had itchy ears. It has been shaking its head and now one of its ears is very swollen