First aidvn117

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

CPR protocolRecent changes Assessment: ABCTreatment: CAB

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

Choke

What can be done if a dog is choking?Why does it happen?What are the signs?

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

Step 4: CPR

The dog is likely to become unconsciousBegin CPRContinue CPR in transit to the vet

finally

Even if the dog seems to have recovered a vet check for throat trauma that may lead to complications is advised

Severe bleeding and wounds

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

Bandaging technique

Limb and foot bandage

Ear bandage

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 3

A Lab is having a grand mal fit. It has never had one before.

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

Scenario 6

The dog has just been run over and is lying in the road whining. It is lifting its head and scrabbling with its front paws but its hind end is not moving.