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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