Part 1 – First Aid - theveterinaryexpert.com fileillness occurring, putting some of these plans into action prior to getting the pet seen by a veterinary surgeon and, hopefully,

Copyright The Veterinary Expert 2014. All rights reserved

Part 1 – First Aid (Transcript)

Pet Lifesavers Part 1 - Transcript

Copyright 2014. All rights reserved 1

Welcome to everybody this evening and to this first presentation of the series on

Pet Lifesavers. This is really looking at first aid for dogs and cats. So, what can we

do for our pets if the worst should happen – if we are confronted with an

emergency?

What I wanted to start off with this evening was a brief chat about what we really

mean when we talk about first aid for our pets. What we are aiming to do is to

restrict the treatment we are giving. We are aiming, really, to save a life or reduce

pain and suffering in that animal. So, really, it is actions and it is steps that we

can take immediately following an accident or a sudden illness that we notice in our

pet. Legally, anyone can perform first aid. Anyone can help to ease suffering with

these pets. We are not aiming to make a specific diagnosis of exactly what injury

we’ve got or exactly what illness we are faced with. Again, in the UK, strictly by

law, the only people allowed to make a diagnosis in an animal would be a

veterinary surgeon. So what we are trying to do is to ease the suffering, help the

process.

The aim, as with human first aid, is that hopefully some of these actions may help

to save a life. Certainly, we can try to reduce pain and suffering until the animal is

transported to the vet’s. Some of the things we do in the early stages following an

accident, or the very early stages of an illness, can help the recovery of a patient

later on. Specifically, if we think about things like wounds, preventing them

getting contaminated or getting more dirt in them will certainly reduce the risk of

infection and speed up the healing process further down the line following an injury

like that.

What we are looking at is that short time-frame in between the accident or the

illness occurring, putting some of these plans into action prior to getting the pet

seen by a veterinary surgeon and, hopefully, going on to complete the job from

there.

If we’re talking about pets that have got problems, have got abnormal problems

going on, everyone is always told at veterinary school that it’s a lot easier to spot



what’s abnormal if we know what’s normal. It’s very helpful to the pet owner to

have certain information at a critical stage. In an emergency situation the pet

owner can pass on to the veterinary surgeon this information to help them do their

job. It is important to try to know what’s normal for your dog or cat. It can then

help us spot what’s going on or what, maybe, has gone wrong. We can spot if

things are abnormal and we can provide this information to the vet over the phone

if we are phoning up with an emergency.

So, certainly, something that it’s a good idea to get an idea of – and fairly easy to

do at home – is to know the normal heart-rate for your pet. In humans, heart

rates tend to all be about the same - round about 0-70 beats per minute at rest.

With our patients, because we’ve got such great variety in size, it’s going to vary

an awful lot for the individual. If we get an idea of what the heart-rate is at rest,

with the pet relaxed at home and, again, an idea after exercise – just the normal

routine exercise – when they come home, we can check from there. We’ve got a

good idea what that heart-rate should be normally and, in an emergency situation

when talking to the vet on the phone, we can check that heart-rate again and

provide some accurate information.

So, the top photograph we’ve got there is of a little dog, but it would equally be a

similar situation if we were looking at cats. What you can see with my hand there,

is that we’ve just got a thumb on the left-hand-side of the chest, just behind the

elbow of the dog, at the bottom of the chest. Fingers go on the other side of the

chest and we should be able to feel the heart-beat quite nicely just behind the

elbow. Just move your thumb up and down, backwards and forwards until you can

locate that heart-beat and then we can count how many beats is normal in a

minute for that animal. In the bottom picture on the screen, we’ve got the larger

animal, a bit more difficult to get a finger and thumb across the chest so, what

we’re doing with just three or four finger-tips is, again, putting them in a similar

position on the chest, just behind the elbow of the dog, just at the bottom of the

chest on the left-hand-side. Again, we should be able to feel the heart-beat quite

easily there and get an idea of what’s normal for our pet at that point.

Another sign we could be looking at if we were trying to assess the pet is roughly

what rate they breathe at. If we were concerned that the pet had breathing

problems or had been involved in an accident we could pass on to the vet what



rate the animal was breathing at and what changes we’ve got from normal. That is

certainly useful information.

Again, most pets with a fairly short coat, if they are not too shaggy and hairy, we

should be able to see the chest moving up and down and it would be quite easy to

count the respiratory rate or how often they are breathing. Again, we usually do

that over a period of a minute to get an idea of what’s normal for our pet. The

same as for us, that rate’s going to be quicker after exercise. So if we check that

again, after exercise, we know what’s normal from there. As for respiratory noise,

most cats and dogs don’t make any noise when breathing. There shouldn’t be a lot

of snoring or rattling noises unless we’ve got certain short-nosed breeds like

bulldogs. If we are beginning to notice changes in the breathing noises, that’s

useful information which we can pass on as well.

The second point on the screen is mucus membranes. When we talk about mucus

membranes, we are talking about areas of the body like the gums, really, where

we’ve got those pink, healthy, wet membranes. If we get an idea of what’s normal

for our pet, our dog, we can get variations. You can see from that picture with

pigment and colour what we’ve got going on there. If we get an idea what the

normal, healthy, pink colour is for our pet then, if the worst should happen, we will

get an idea whether our pet looks pale or if anything has changed from there. If

we don’t know what’s normal and you phone the vet, the vet may ask, “Does your

dog look pale?” and it is very difficult to then judge. So if we are looking at that

fairly regularly, we’ve got an idea of what’s normal.

Finally, body weight in kilograms. We usually use kilograms for working out doses

in the UK veterinary world. It sounds daft but if we know the body weight and we

have a problem such as poisoning or the animal has eaten a certain amount of

something, if we know the body weight, it is a lot easier for the vet over the phone

to try to work out doses or whether we’ve got potential problems. That’s

something we’ll talk a bit more about in the second presentation, when we deal

with poisonings.



So, really, we’re just gathering a bit of information about what is normal. It helps

us spot if we’ve got a problem, if we’ve got something abnormal and we can pass

that information on to the vet when we contact them.

The other thing we can do in terms of being prepared, the same as we tend to do

for humans around the house, is that we advise our clients to have a first aid kit

handy. It may not solve all the problems we’re going to encounter but certainly it

can help with the most common things that we tend to see. Usually, we would

have bandages, dressings that we could apply to a wound to try to stop bleeding

and apply pressure. We can see, in this picture, that we’ve got a foil blanket. So,

again, common in human first aid kits – you’ll often see people wrapped in them

after running marathons and other long-distance races. With this, we are trying to

conserve heat. If we’ve got a pet that’s been hit by a car or is collapsed then we

can wrap them in a blanket, try to conserve heat, try to prevent the animal going

into shock quite so quickly.

Other good ideas to have are a bottle of eye-wash, a saline wash for washing

splinters or debris or contamination out of eyes, tweezers for removing splinters or

wasp and bee stings. In the bottom picture, we are using an ear thermometer.

You can get them for young children and they use them in hospital for ourselves, if

we go in. You can get ones available for pets and we can just place that

thermometer in the ear, push the button and, again, we can get a temperature.

Again, it could be useful information that we can pass on to the vet if we are

concerned.

The third picture we have is a Buster collar, or an Elizabethan collar. It goes round

the head of the dog. It doesn’t sound like something you would need in an

emergency but it certainly can be very useful to prevent the dog rubbing or

scratching at their eyes if they have an eye infection or trauma to the eye. And

vice versa, really, it stops the dog reaching round to the rest of the body and

licking the coat. So if we had a wound that we didn’t want the dog to lick, if the

animal had walked in a chemical or paint and we didn’t want them to lick, we could

pop that Buster collar on, put the Elizabethan collar on the pet as we are

transporting it to the vet’s to try to prevent further problems occurring from there.

Sometimes it’s a handy item to have around.



So, if we’ve got the first aid kit, what are we going to do with it? Like I said, I tend

to have one around at home and it’s in the house. It’s there if you need it when

you come back from a walk or anything else. If you’re going out with your dog,

going for a drive in your car and a walk at the other end, then sometimes people

duplicate that first aid kit. They have a similar one in the car or take it with them

when they go. Certainly if you’re away on holiday and you’ve taken your pet with

you it’s a good idea to take that first aid kit with you and you can keep it in the car

or keep it wherever you’re staying.

While we’re at home and often in a panic if things do happen, it’s a good idea to

have your vet’s phone number written down. You can either keep that with your

first aid kit, written on top, or stored on your mobile phone so that you don’t have

to find it in a panic. It’s saving time for us if the worst should happen.

If you’re going on holiday and travelling decent distances away from where you

live, it’s a good idea to locate a vet that’s local, either from Tourist Information or

from internet searching. Make a note of the number, pop it in your mobile phone

at that stage at the beginning of the holiday. Again, if we run into any problems,

it’s going to be a lot easier. It’s going to save a lot of time rather than trying to

find the number in an emergency.

So just a little bit about being prepared. It’s the same with human first aid, saving

time saves lives.

Like we say, we want the number for the vets. Keep that number handy because

we might want to contact the vet if we do run into problems with emergencies. It’s

worth remembering, especially nowadays when it’s becoming more and more

common especially in the smaller practices such as the one where I work, the

smaller practices out of hours will tend to divert their phones to larger hospitals

which may be covering for them out of hours. Similarly, if your practice belongs to

a group of other practices, it may be that the branch you normally go to during the

day is shut of an evening and emergencies are seen at another branch. I always

say, if your pet has been in an accident, if it definitely needs veterinary care, still

phone ahead. You will want to know exactly where you are going to. It may not

be the place you are normally used to going to during the day. You can get



directions when you phone up from there. Also, very important, if you phone the

vet and let them know you’re on the way, it may only take you thirty seconds but if

your journey is fifteen minutes to get to that vet’s, then during that time the staff

can start to prepare and get things ready to deal with that emergency. This is

preferable to you turning up having not phoned them and then they waste time

getting things together while you’re at the surgery.

Occasionally, vets may not be at the surgery. They may have the phones diverted

to home so if you phone them it gives them a chance to get down there to meet

you and deal with the emergency. Often, in certain situations, if you phone the vet

before you go down they may be able to give you immediate advice, expand on

some of this first aid we’re going to talk about today. That should help you to help

your pet on the way there as well. In some situations, the last point we’ve got

down here, where it says phone the VPIS, that stands for the Veterinary Poisons

Information Service which is a very, very useful service that’s run from London

that has a lot of information on what can potentially cause problems and what can

be poisonous. If you phone your vet and let them know what’s going on, they

have a chance to call this service and to be armed with the kind of knowledge they

need to treat your pet when it arrives with them. If you’re on the way and your

pet looks shocked, looks thirsty, don’t give them anything to eat or drink at that

point. It may be that if the animal needs sedating or needs a general anaesthetic,

it’s going to cause problems if they’ve recently eaten or drank as well. So, it’s

best, if they may need sedation, not to offer them any food or drink.

The picture there shows our hospital at work and this was getting ready for a case

that was coming down. The owner had phoned ahead, we knew that the dog had

an obstruction. It had a tennis ball lodged in its throat. They had phoned ahead.

We knew they were coming which allowed us to get prepared. We could get

oxygen ready. We could get anaesthetic agents ready and surgical kits and

everything we needed could be at hand. We were stood there waiting for the dog

to turn up. The minute the dog walked through the door we could get to work on it

rather than having to wait and run around and find this sort of equipment. A bit of

warning saved an awful lot of time when we did see the patient.

We want to talk a bit about the kinds of scenarios we may be faced with with our

pets. One that we commonly see at our hospital is animals that have been



involved in road traffic accidents or trauma of other descriptions, like falls or bangs

or injuries from door-shutting and other things as well. Being hit by cars, road

traffic accidents, is the most common trauma we deal with. Often, if this happens,

it’s very difficult to be faced with your pet that has been through this sort of

trauma so we tend to say, especially if your animal is on the road or still at the

roadside, is try not to panic and remain safe yourself. There’s no point in you

running into the traffic and being involved in an accident where you can’t then help

your pet. Remain safe, think about what you’re doing, think about the

surroundings and try to assess the danger of what is going on. Try to assess the

traffic around you. Warning cones or warning signs that we carry in the boot of the

car for changing a wheel and things can be put out. Be aware of the surroundings.

Phone the vet as soon as possible to let them know the situation and let them

know you will be with them as soon as possible. They can start preparing and start

getting ready for your pet.

When you are approaching the pet, whether it’s your pet or another animal that

has been involved in this accident, the thing to remember is that, even if you know

the animal, an animal in pain can be very unpredictable. They don’t know what’s

going on. They don’t understand what’s going on. There’s a lot of adrenaline

pumping through the system so they can react in ways you wouldn’t expect. Being

bitten by injured animals is very common.

A couple of points to try to help avoid that happening is to always approach the pet

from the front so that they can see you coming. Make nice, calm, steady

movements towards them. Speak quietly, speak gently so that they can see you,

they can hear you, they are aware of your presence before touching them or

holding on to them or anything. It gives a bit of warning about what’s coming

along and, hopefully, helps them to settle a little from there.

The pictures we’ve got are of a dog that was unfortunately involved in a road traffic

accident fairly recently. The dog sustained some very nasty injuries from contact

with the road and contact with the wheels and tyres of the car as well. We will talk

about wounds a little bit later in a couple of slides. We want to cover the wounds

as soon as we can with whatever is to hand, with a clean cloth or clean material.

We want to cover it to prevent further contamination getting onto bones or getting

into joints. That’s going to help in the longer run in terms of speeding up healing.



A lot of human first aid and veterinary first aid going back ten or twenty years or

so used to talk about splinting broken limbs and trying to stabilise things from

there. We absolutely advise against trying to splint broken limbs. You are likely to

hurt the animal. You are likely to get bitten or hurt yourself. It just delays things

and slows down time at the scene. It’s much better to bring the animal and

transport it as quickly as possible, rather than carrying out a splinting procedure.

This brings us to the question of how to get the pet to your vet’s and how to

transport them to somewhere they can be helped further. If large dogs can walk

following a trauma or a road traffic accident, get a lead on them or a belt or a tie

or something else and just try and gently coax them towards the car. We may

need to help them to step into the car but, if they can walk, we can try to gently

coax them from there. If they can’t walk or we are suspicious that they have got

an injury to the spine and we are concerned about things, same as us really, we

need to try to carry them on a stretcher of some description. We’ve got a nice

photo there of a proper animal stretcher with Velcro straps being used in our

hospital, but often we’re not going to have that available to us in the trauma/road

traffic accident situation. Usually we are looking at trying to improvise something

to carry the animal on. The ideal is something that’s going to remain flat and rigid.

Something like a board or plank is usually pretty difficult to find in an emergency

situation. We’ve seen some animals brought in on things which I’ve found pretty

impressive, in that the owners have improvised. If you’ve got a hatchback car and

the parcel shelf lifts off and comes out the back, that’s nice and light. It remains

rigid. We can roll the animal onto there and lift them with the parcel shelf. Other

things we’ve seen would be plastic bread crates, ironing boards. We are looking

for a flat, light, rigid surface that we can get the animal on and lift them from

there. If it’s not available, we don’t want to waste a lot of time searching around

for this kind of thing. We can use a blanket and slide that under the dog and lift

them into the car. In preference, though, if we thought we had a spinal injury, a

flat surface is better. Speed is often of the essence though so if we do have to use

a blanket, we can do that to get the animal into the car.

If it is a cat or a small dog that’s been injured, I would always advise clients to get

that cat into a cat-carrier or a cage or cardboard box of some description so that its

not being carried loose in the car on the way to the vets. We have had a couple of

incidents where cats have got free, got under brake pedals, accelerator pedals, and



caused another accident as well. They are in pain, they are unpredictable so it’s

safer for the cat and safer for yourself to confine them.

If it is a small dog, as in the bottom picture, it is picking up and scooping up a

small dog. We’ve got one arm that goes in front of the neck, in front of the fore-

limbs. The other hand goes behind the back limbs and scoops the dog up behind

their back legs. We haven’t got a hand between their legs pushing on a painful

abdomen or pushing on a painful chest and we can scoop the dog up and carry

them into the car that way.

We’ve already mentioned that the animal is scared and we have a lot of defence

mechanisms kicking in. We’ve got adrenaline coursing through the bloodstream.

They may not recognise you even if they’re your pet. They may try to bite as a

natural reaction because they do not understand what’s going on with the pain that

they are in and everything. Certainly, with dogs, it’s possible to improvise a tape

muzzle which we show on the next slide. That’s me placing one on my dog. You

can see that it occurs again and again on these slides. It’s made with a bit of

bandage that we’ve got there but, again, we can improvise it with a piece of tape

or ribbon or a tie that is taken off and used on there. What we’re doing is trying to

stop the animal biting so that we can tend to them, we can help them and we can

transport them somewhere as well. We’re not trying to hurt them. We are just

trying to make the situation safer for everybody involved. Again, if it’s an animal

that has been involved in a road traffic accident, if they’ve any sign of breathing

difficulties or panting, we wouldn’t do this. We don’t want to close their mouth or

make their breathing worse. In an injured dog that’s in pain it’s a very helpful

technique. If we’ve not got something like that and if it’s a fairly small dog, we can

put a towel over their head and scoop them up and get them into the car and again

a cat is best transported in a cage where they can’t cause any harm or get into any

difficulties themselves.

This is just step by step how we put that tape muzzle on as a useful technique. We

are just approaching the dog and all we’ve done is tied half a knot. We’ve just tied

this piece of bandage over itself and through. We’ve got a nice big circle that we

can hold in front of the animal. What we’re going to do is to pull that back over

the dog so that the loop is sitting over the muzzle. As you can see, if you look at

the second picture, if we pull on both ends it just pulls that knot down. It doesn’t



have to be really tight but you can see that it sits snug against the nose and you

just pull that half a knot snug against the top of the muzzle.

What we then do, you can see on the third picture, is that we bring both ends of

that bandage down and we do the same underneath the muzzle. We just tie half a

knot again, pulling the two ends tight so that it just sits snugly beneath the muzzle

and then we’ve got it wrapped twice around the muzzle from there. What we are

doing on the final picture is that we bring the two loose ends below the ears around

to the back of the head. We can then tie that bandage or tie or whatever we’ve

got to hand, in a bow at the back of the head. We’ve then got the animal

restrained. It’s unable to bite. It’s not going to be quite so panicky and, hopefully,

that aids us in transporting that animal a bit more quickly and a bit more

efficiently.

Commonly following from traumas, the accidents that these animals are involved

in, we’re going to have wounds of some description. It’s very common for us to be

presented with wounds out of hours at our practice. A couple of things we should

be doing with wounds are, if they are contaminated, if we can see a lot of mud or

dirt in them, we can wash them. That can be with clean water, if we have got

sterile saline, like an eyewas,h we can use that, but certainly with tap water, that

is perfectly adequate for the clean up of a wound like that. As you can see on

these two pictures on the right, we want to cover that wound as soon as we can to

stop further contamination to stop the animal licking or bothering at the wound. If

we can stop the contamination at this point it makes infection a lot less likely in the

next day or two.

We can try to stop any bleeding that we’ve got from that wound by direct pressure.

As we are doing in this bottom slide we’ve got a clean tea-towel which is folded

into quarters. We are pushing down onto the wound to stop any bleeding and the

whole thing is that way. That’s the most effective way to stop a wound bleeding.

On this top slide you can see that we’ve done that and then we’ve just wrapped the

bandage that we’ve got from our first aid kit around the limb. It’s just going to

hold that dressing in place. It’s going to stop contamination, stop the bleeding and

then we can transport the animal to go and get that wound assessed.



In an emergency situation, if we’ve not got a dressing or something to go on the

wound then really what we’re looking for is something that’s clean and something

that’s highly absorbent. In emergency situations we can use things like disposable

nappies and sanitary towels. They are very absorbent. They are going to be clean.

They are individually wrapped. We can put those against the wound and apply

pressure in that way. As we mentioned before, with the plastic collars and

everything, it’s very important that we prevent dogs and cats licking at these

wounds. It’s a bit of an old wives’ tale that licking wounds helps to heal them.

Dogs and cats’ mouths have got some fairly nasty bacteria and we don’t want that

getting into our wounds and causing problems.

That’s what we want to do with wounds. Here are a few things that we don’t want

to do with wounds. These are things we certainly want to avoid. We want to avoid

putting wound powders or disinfectants onto wounds. Applying disinfectants to

wounds will hurt the animal and some disinfectants are actually toxic to our

patients. Products such as TCP, Savlon, if they contain certain chemicals, if they

contain phenols, then they can actually be toxic to cats. As we’ve mentioned

before, if we’re going to clean that wound, just use clean water or clean saline

which is salty water. If we’re going to use anything, the only thing we would use

on a wound would be diluted chlorhexidine solution, which is a solution which is

used in the veterinary and the human world for cleaning skin prior to surgery. The

trade name is Hibiscrub, which is a nice pink-coloured solution, and that is safe to

use on wounds. Anything else is potentially harmful.

If we place the dressing onto the wound and we are placing pressure on and trying

to stop it bleeding, if we start to see blood soak through that dressing, don’t

remove the dressing and use a fresh one because we will disturb any clots. We will

disturb the process that’s going on, trying to clot and cause the healing there. So,

if you see anything coming through the dressing, add another layer on top and

apply pressure to that rather than removing and starting again.

The use of tourniquets, where we put a tight rope or a tight belt further up the

limb, has certainly gone out of favour and is potentially harmful. Most bleeding,

we should be able to control just by applying direct pressure and that’s a lot safer

way to do it on the limb with the animal.



The pictures we’ve got there are really just to illustrate the final point that we’ve

got there. If you see a wound on an animal, if it’s a small puncture wound, never

assume that that’s a minor injury. The size of the skin wound can be out of all

proportion to the damage that’s been done beneath. This is especially true with

bite wounds or gun-shot, air-gun pellet wounds as well. That little dog that we’ve

got there on the left of the screen has been bitten by a larger dog. The skin

wounds themselves don’t look that large. There are several of them but they’re

quite small, but most of those bite wounds have actually penetrated through to the

abdomen and caused quite a lot of harm that took us quite a few hours of

abdominal surgery to put things right. If the owner hadn’t presented that to us

straightaway we would definitely have been in problems with peritonitis and

infection within that abdomen. So, just because a skin wound is small doesn’t

mean that there’s not a lot more damage beneath the surface.

Another common presentation that is certainly very worrying for owners to be

presented with is if we’ve got an animal that is having a fit or seizures. Seizure is

just a word for having a fit really. The most common reasons we are going to see

for animals having fits is certainly, top three, epilepsy, which is a lot more common

than it is in humans. Certain poisons, certain toxins, can cause fits. In older

animals, it may be that something has happened to the brain, like a stroke or a

tumour or something putting pressure on the brain that can cause a seizure as

well.

When we see a seizure, the kinds of things we can expect is for the animal usually

to fall over and lay on their side. We see a lot of paddling with the front and back

legs. It will look like they’re running and the legs will be bent back and forwards

and scrabbling back and forward. You may see some chomping of the jaws and

the jaws will go up and down and snap. You will certainly see a lot of salivating

and often the animal will lose control of their bladder and urinate at the same time.

So it’s worth observing that so you can explain to the vet on the phone exactly

what you’ve seen and what’s gone on and try to get a rough idea of the duration,

how long it has actually lasted for. It seems an awful long time when you’re

watching your pet go through this but it’s just worth either checking your watch or

checking a clock to see how long things are going on for. It’s worth describing

what you’ve seen to your own vet, because it’s a very different set of symptoms



we see to if an animal were fainting or collapsing, which is common due to heart

problems or breathing problems, where we would expect the animal to fall over,

stay very still and then slowly regain consciousness. So, it’s worth just observing

what’s going on as you’re phoning the vet.

So, what to do if it does happen? Basically, we don’t want to hold or comfort or

cuddle the animal. Any stimulation we give will prolong the fit and make it longer

and therefore make it potentially dangerous from there. We want to reduce all the

stimulation going on around the animal so that it can calm down and hopefully the

seizure will finish. We want to stop any noise, turn off the telly, turn off any noise

around the animal in the room. Dim the lights so there is less stimulation coming

through the eyes. If you can remove any furniture from around the pet or remove

any obstacles, then do it. Otherwise, as you can see there, we’ve just put a

cushion against the fireplace, a cushion against the table leg. If the animal does

move, he’s not going to harm himself or knock or bang anything around from

there. Do not handle the dog’s head or put your fingers in their mouth or try to

pull their tongue out. People commonly do this with humans who are having fits

because they are concerned about swallowing the tongue. It doesn’t tend to

happen in dogs or cats. If you put your fingers in their mouth, you’re going to get

your fingers bitten. You’re going to be in a worse position and you’re not going to

be able to help your animal from there.

Usually, the fits don’t last long, maybe half a minute, two minutes. What we tend

to expect s the pet comes round, is that they are going to look a bit disorientated,

a bit wobbly, a bit groggy. Sometimes, this lasts up to a couple of hours after the

fit. We say to keep a close eye, look at what’s going on, phone your vet and

describe what’s happening to them down the phone. Transport the animal to the

vet once the fit has finished. If you pick them up, like we say, it’s going to prolong

the fit. Keep them calm, keep them in a protected environment and once the fit

finishes, then transport them to your vet’s, having phoned your vet first. If it’s

more of an emergency, we would want to rush the pet in. Regardless, if that fit

was lasting longer then three minutes, we’ve got the risk of the animal getting very

hot and a high body temperature causing problems and damage from there. If the

animal comes out of the fit and then very shortly goes into another, what we call

‘clusters’ of fits or multiple fits close together, that is even more of an emergency.

That is very often going to need medication and drugs to try to control those

seizures at that stage.



Another common problem we tend to see is with vomiting and diarrhoea in cats

and dogs. Same as us, really, it’s a common symptom in humans, it happens to all

of us and it can happen to cats and dogs. In a healthy adult cat or dog that has no

other medical problems, a single episode of vomiting or diarrhoea is very unlikely

to be serious. If they’re vomiting then we tend to starve them for 24 hours,

provide plenty of water, small amounts in the bowl frequently, so that they can

drink as little and often as they want to. Having starved them for 24 hours, we

then tend to feed them a light, bland diet. We are trying to give them protein and

carbohydrate without a lot of fat that may upset the stomach. Ideal things are

things like boiled chicken with rice, or boiled chicken with plain pasta or plain

boiled potatoes. We’ve got the protein from the chicken, we’ve got the

carbohydrate source. We’ve not got a lot of fat and other stuff there as well.

After two or three days of that bland diet, we can gradually re-introduce the

normal diet. What we would do, say on day four, would be to feed half a volume of

rice with some of the normal diet with two or three small meals that day and then

gradually increase the amount of normal diet. So we are gradually going back to

the normal diet that our pet is on.

Vomiting and diarrhoea can be serious. It can be a symptom of much more serious

problems going on as well. So, when would we consider that things are serious? If

we’ve got prolonged or repeated vomiting or diarrhoea with the animal vomiting

several times a day or the diarrhoea is happening time and time again, especially

in small pets, where we run the risk of them getting dehydrated and collapsing,

these are repeated episodes. If we are getting repeated episodes or we are

worried that the pet is getting lethargic or in pain, then we want to seek help

straightaway and phone the vet from there.

If the animal is vomiting or has diarrhoea and it has blood in it, again, that can be

a sign of serious infection or serious inflammation of the bowel and the gastro-

intestinal tract. Again, we would want to phone for advice and phone to see a vet

if we were seeing that kind of symptom. Certainly, a very important emergency is

if the pet, usually a dog in this situation, is demonstrating unsuccessful vomiting.

This is where they look like they are retching and heaving but they are not bringing

anything up at the end, especially with an abdomen that looked to be larger and



getting larger as well. That can sometimes be a tell-tale sign that we’ve got a

condition called ‘bloat’ or GDV or a twisted stomach going on. That is just what

that x-ray is demonstrating on this screen. We’ve got a large gas-filled stomach

that has twisted about itself and this is a very, very rapidly deteriorating condition

that requires urgent surgery as well. Usually, we’ve got a large, tense abdomen

that’s getting bigger and bigger and the animal is making unsuccessful attempts to

vomit as well. So, any of those symptoms of vomiting and diarrhoea that are more

than insignificant and have become a problem, we need to seek advice at that

stage.

Not so much this time of year, being February, but heatstroke can be a problem

we’re presented with at our hospital. Obviously, it sounds daft but the easiest way

with heatstroke is to avoid it altogether rather than having to treat a patient with

heatstroke because it can be very, very dangerous and potentially fatal to our pets.

The obvious things people think about are the public awareness and campaigns to

avoid leaving dogs in hot cars in the summertime and everything else. It can occur

at other times as well. Certainly in the summer it’s a very good idea to avoid

walking your dog during the hottest part of the day. We tend to go for early

morning and late evening when things have cooled down so that the dog is

exercised but isn’t wearing itself out during the heat of the day. We see some

cases where, just at home with the doors open and the dog out in the garden, lay

there in the garden for several hours in the heat, heatstroke can happen and can

develop quite quickly from there.

What we tend to see is an awful lot of panting - very rapid respiratory rate, a lot of

panting, a lot of respiratory noise. Again, going back to those early slides, if we

know what’s normal for our dog in terms of respiratory rate, respiratory noise, you

know, after exercise or at rest, we’re soon going to know the difference when we

get the animal and it’s distressed and panting like this. Certain breeds are going to

be very susceptible to breathing problems following heatstroke. Dogs with short

pushed-in faces like Boxers and bulldogs and overweight dogs or elderly dogs can

be prone to this problem as well.

If we’re confronted with this, there’s a lot we can do at home to try to start off the

process as we’re contacting the vet and thinking of how to transport the animal.

We can think about cooling the animal down. The main problem is that the animal



has got too hot, so we can think about cooling them down and trying to combat

things from that angle. So, when we want to cool the animal, it’s a good idea to

put tepid or cool water on their legs or on their feet and on their abdomen. We

don’t want icy cold water. If we put icy cold water on, all the blood vessels that go

to the skin contract down and stop blood flow to the skin and we can’t cool the

blood. We are just diverting the blood elsewhere. So, if we’re using tepid or cool

water, we can achieve that reduction in the body temperature and try to cool the

dog down. We can put fans on the dog. We’ve got a picture of a dog there in a

kennel with a fan on, trying to cool them down as well. Then, obviously, we want

to transport them to the vet right away. They may need oxygen, they may need

other medication to help with their breathing. If we can transport them to the

vets, we can turn the air-conditioning up as cold as it can be in the car, again, just

to try to help cool the patient on the way there.

Again, more of a problem that we’re going to see in summer along with heatstroke

is insect stings and bites. The most common problems would tend to be wasp and

bee-stings. Cats and dogs, being a bit curious or trying to chase these insects, can

end up being stung by them. If you’ve seen it happen, or the animal comes back

with this swelling, if the sting is still in position within the skin, we can try to

remove that sting. You will usually see the sting and then the swelling at the top

of the sting where the poison sacs are. If we can try to grip the sting below the

poison sacs with tweezers, we can pull it out that way. If you’ve not got that

available, the edge of a credit card can be scraped along the skin, scraping the

sting out that way. Then, really, the same as us, if they’ve got swelling and it’s

painful, from there, we’re going to put an ice pack on or a bag of frozen peas or

something like that, just to take down the initial swelling. It’s often impossible to

know but if we know that it’s definitely been a wasp sting, wasp stings are a strong

alkali so we can put vinegar on to neutralise it and the opposite situation with bee

stings. Bee stings tend to be acidic so we can put an alkali on to neutralise that. A

handy one is sodium bicarbonate which we tend to have in the kitchen. Often,

however, we don’t know what has stung it so an ice pack for cooling is sensible for

either, really.

So, usually, it’s not an emergency that we need to involve the vet in but if the

animal has any breathing difficulties, they become lethargic or they are stung

around the face or the mouth, then that can lead to more complications so

certainly phone the vet for advice in that situation.



Similarly, insect bites, whether it’s mosquito bites or other kinds of insects, if it’s

swollen, if it’s painful, we can put an ice pack on to help take the swelling down.

The main thing we want to do is to stop the pet scratching or licking at it. So,

again, we can use plastic Buster collars, Elizabethan collars to stop them reaching

around and nibbling. If they’re scratching with their feet, we can put socks on their

feet so that they’re not scratching at the skin. Sometimes you’ve got to improvise

and be a little inventive so children’s t-shirts or leggings can be pulled onto dogs to

try to stop them getting to any wounds or bites and making things worse.

The next few slides, we want to talk about resuscitation or CPR, cardio-pulmonary

resuscitation. What we would be talking about in this situation is a patient where

we would be worried that their breathing had stopped, their heart had stopped and

basically, similar to a human situation, there are things and techniques we can use

in this situation to try to get the heart and the breathing going again. We’re going

to use it where we’ve got signs of arrest, where the animal may be collapsed,

there’s no breathing there and, again, we know where to feel for a heart-beat and

we can’t feel a heart beat there at all. It might happen after a particularly nasty

accident, drowning incidents etc. All we can do in that situation is very basic life-

support to try to bridge the gap between the incident happening and trying to get

the patient to the vet, where more advanced techniques can be used and we would

have oxygen available and everything else.

A similar situation to humans, when we are looking at resuscitation, is that we try

to remember A, B, C. So, we’re looking at Airway, Breathing and then Circulation,

to try to restore the flow of blood around the body, to get blood to the lungs and

get that oxygen from the lungs delivered to the vital organs. One point to make is

that the chances of success are slim, even in the hands of trained professionals.

Even in a hospital environment, the chances of recovery are usually very slim,

similarly with humans. It’s worth having a go but not to feel guilty if things aren’t

successful.

So, A for Airway. If the animal has stopped breathing, we want to make certain

that we’ve not got an obstruction there that is blocking the airway and that’s the

reason that they’re unable to breathe. We want to place the animal on their side



as we’ve got with the model in the top photo, open their mouth, get hold of their

tongue and pull their tongue right forward out of their mouth. What we want to do

is check the mouth for obstruction. Be very careful that the animal is not going to

regain consciousness and bite your fingers at this point. Following an accident, we

can have things like blood clots or broken teeth causing an obstruction at the back

of the mouth. Toys, balls, other things as well. We need to open the mouth, pull

the tongue forwards. You can just scoop with your finger if you can’t see, just to

make certain. Do be very careful in case the animal regains consciousness.

If we’ve done that, we’ve opened up the mouth, we’ve checked the airways and

tried to remove any obstruction, sometimes that’s enough for the patient to start

breathing again. You can put an ear close to their mouth or close to their nose to

see if we can hear any breathing. We can look at their chest to see if it is rising

and falling and if breathing has started again just with clearing the airway.

Sometimes what we can do if we can’t hear anything is to pluck a wisp of hair off

the patient and hold that wisp of hair between finger and thumb just in front of the

nostrils and, if there’s breathing, the draught will push that hair backwards and

forwards and we can see the hair moving. This is similar to using a mirror or

something in front of humans, looking for the misting of the mirror.

If the animal is still not breathing at that point, we’ve then got the option of trying

to breathe for the animal and trying to force air down into the lungs. What we

want to do is lift the chin up and extend the neck so it’s right out rather than the

head or neck being bent at all. What we’re doing in the top picture there is

cupping our hands around the animal’s muzzle and just holding the mouth closed.

We can do mouth to nose respiration. In humans, obviously, it’s mouth to mouth

but the shape of a dog or cat’s mouth doesn’t lend itself in the veterinary world to

mouth to mouth resuscitation. What we tend to do is mouth to nose respiration,

where we would put our mouth around the nostrils and blow air down in the lungs

that way. We can do that in direct contact with the animal or, what we’re just

illustrating on the right with this model, is cupping our hands around the muzzle,

making sure they’re nice and tight and then forming a funnel where we’re actually

going to leave a gap between our thumbs that you can see here. We’re going to

apply our mouth here and actually blow between the thumbs and keep an airtight

seal around the muzzle and direct that air down the nostrils from there.



So, you want to give strong, regular breaths, whichever technique you’re using.

What we want to do is, while we are carrying out those breaths, is try to watch the

chest to make sure the chest is actually moving to make certain that what we’re

doing is actually effective.

So, we come to C. C standing for circulation, if the heart has stopped, if we cant

hear the heartbeat, feeling in this area again, just behind the elbow, just to the

side of the chest, then what we’re going to do is chest compressions to try and

help squeeze the heart and try to push some blood around the body. We will try to

keep oxygen delivery going to the major organs. What we’re trying to do is to not

completely flatten the chest and squeeze the chest right down. We’re after the

kind of movement, in a very small patient like a cat, a small movement such as

one centimetre depressing the chest wall. In larger animals we would be maybe

looking at three or four centimetres. That kind of movement is what we’re after

and we’ll demonstrate that with a video in the next slide. In a small patient, a cat

or a small dog, it should be sufficient to just have a finger and a thumb each side

of the chest and just squeeze between that finger and thumb to achieve those

kinds of chest compressions that we’re talking about. Medium-sized patients, like

this photo would illustrate at the side, we’re just going to use the palm of one

hand. We’re just steadying the dog to stop it sliding with our other hand. One

hand is going to be sufficient to depress the chest as much as we need to carry out

these chest compressions. In a larger patient, we would treat them pretty much

the same way as we would with a human, where we’re going to use two hands,

bringing a second hand on top of the other one to push down with both arms onto

the chest from there. Regardless, we’re always going to have the patient laying on

their side, which is quite different to how we would do human resuscitation. In

humans, we would be laying on our back and that’s due to the shape of cats and

dogs’ chests, in that they are flattened this way, from top to bottom.

I think we’ve just got a video which will show us those chest compressions in

action. The same model as we were talking about before. I just put my right hand

on top. The left hand is underneath just to stop the patient slipping or sliding

away. What we’re going to do with that top right hand is apply compressions to

the chest. Obviously this is just a model but you can see what we’re doing is

compressing the chest by, say, three or four centimetres on what is effectively a

large dog such as this. What we’re trying to do is to go at a rate of about 120/140

beats per minute. It’s fairly rapid and we’re trying to keep that as a continuous



rhythm as we’re going. We’re not stopping to check, we’re just going to push,

push, push and keep going for a decent period of about two minutes before we

stop and check for a heartbeat again from there. If we keep stopping and starting,

we’re not getting effective circulation. That’s a fairly rapid rhythm that we’ve got

going there just to try to squeeze that heart and help to circulate the blood around

the body.

That’s resuscitation. In the last few slides I just wanted to look at something which

I know from experience clients have difficulty with. If we’ve seen a vet, if we’ve

had this emergency, we’ve had the diagnosis and we’ve been prescribed treatment,

it’s how we’re actually going to administer that treatment to our patients.

The first slide we’ve got there shows my dog again. We are looking at eye drops.

Eye problems such as conjunctivitis, infection or ulcers or traumas, knocks and

bangs which are very common. Vets tend to prescribe one type of eye drop, often

two or three kinds of drops which need to go in there at certain times of the day.

What we’re aiming to do, if we’ve got the animal’s head held in a normal position

so that they’re looking straight ahead at us, not lifting them up or anything, nice

and comfortable. What we’re doing with my left hand here, with my thumb, is just

pulling down the lower eyelid and creating this little pocket. We can just see pink

on the inside of the eyelid from here. What we’re aiming to do is to drop the drops

directly down from above so that they drop down into that pocket and we’ve got

the drops within the eye circulating back and forwards. You can see the other

hand, the right hand that holds the drops, going to come from above the animal’s

head. We’re not waving the drops backwards and forwards in front of their face

where they can see things coming. If we’ve got the hand above the head, we’ve

got the bottle held vertically, we can rest that hand against the head, just to make

sure everything is nice and steady and we’ve got a good aim and we can then

squeeze the bottle so that the drops fall vertically down into this nice little pouch

that we’ve created with our thumb. Usually, that’s the easiest way to get the eye

drops in. Where we tend to go wrong is, if you lift the animal’s head up so that

their nose points at the ceiling, they know something is wrong, they’re

uncomfortable and then you wave your hand around in front of their eyes with the

drops. So, from over the top of the head, leaving the head in a normal position

that they would adopt, they will be a lot more comfortable with that.



Again, ear infections are very common and certainly we can struggle with putting

drops in. Again, it’s important that the animal is in a neutral, relaxed position.

The head should be held at a normal angle. What we can see here is, with the

right hand again, which is holding the drops, we have just lifted the ear flap up and

are holding that with one finger so that it’s pushed across the top of the head. This

nicely exposes the ear canal that we can see here. We can just steady the head

with the left hand and hold onto the ear here as well. A dog’s ear goes vertically

down before taking a right-angle bend somewhere around here to go into the ear-

drum. What we’re trying to do is drop our drops from above so we have not

actually got the bottle in contact. We’re not needing to shove the tip of this bottle

right down the ear. If we’ve got it positioned like this, at a normal angle, we can

drop the drops from there. They can drip nicely down into our open ear canal, go

down to where they need to be. If we put the drops on before we let go of the

animal’s head we can, with this hand, just give a good rub around here and just

massage it into the area. Otherwise, you tend to find that as soon as they shake

their head, everything sprays back out again.

Finally, we’ve got administering tablets, which is always difficult whether it is cat,

dog, regardless of size. Some tablets your vet will advise you to give with food

and we can hide that away in a meal or something else, but what we’re showing

here is the technique if we need to give a tablet at times other than mealtimes, or

a tablet that can’t go in with food. What we’re doing here is administering a

worming tablet to my other dog. The left hand is gripping the upper muzzle. A

thumb this side, finger the other side and we’ve just got hold of the upper lip and

the upper jaw. We’re just going to squeeze with our finger and thumb each side

here just to force the jaws apart. With the left hand, we’ve just got finger and

thumb holding the lower jaw here, just below the teeth. Again, we’re just pulling

the mouth slightly open from here. In this situation, we’ve got the nose pointing

slightly upwards towards the ceiling. If we pull this open, it just leaves a finger

and thumb on this hand free that we can just drop the tablet in between the teeth.

If we keep the head up like this, pointing up towards the ceiling, we can then relax

this hand so that the jaw closes. A good tip is to keep the dog’s head pointing

slightly up like this and to give them a bit of a tickle or a massage beneath the chin

until you see them swallow. The same with cats, exactly the same technique as

well. A bit of massage underneath here until we see them physically swallow. We

can then be sure that the tablet has gone where it should have rather than us

letting go and the dog immediately spitting things out. I just wanted to cover that.



Hopefully we’ve seen the vet, everything is fit and well, been prescribed medication

but how can we get that medication into the pet when we get back to the home

situation.

So, I think that was all we wanted to cover for this evening.

Moderator:Paul, thank you very much indeed for such an excellent presentation.

We’ve had numerous comments in from attendees, saying how much they’re

enjoying it, how much they’ve been taking notes and how practical and helpful it’s

been. So, it’s been packed with really great practical advice and, for me, the not-

so-obvious steps that you covered right at the start, perhaps the least likely things

that people want to get on and do, where they want more of the ‘action’ side of

things, but the working out what is normal for your pet was such great advice and

time well-spent. The other thing is how willing your own dogs are to be models

and assistants for these various procedures. What you didn’t actually show was

that you have to get them out from under the bed or on top of the wardrobe each

time!

PA:Yes, when they see the camera coming, they usually run away! They see a

packet of ointment, a bandage or a thermometer and they’re off!

Moderator:Great, well, we’ve had lots of questions, Paul, so I think if we just start

and work through some, I will try to put them together into groups and we’ll get

through as many as we can.

The first question is an interesting one on bites. I think it is actually something

that you didn’t go into and it’s such a rare one, I think. What do you do if your dog

is bitten by an Adder? Particularly, do you use a tourniquet? What do you do in

that situation?

PA:I don’t think so. Obviously I work in urban Manchester so we don’t see an

awful lot of them. I certainly have worked in areas where we used to see Adder

bites. I think the advice nowadays is not to apply tourniquets. It doesn’t make an

awful lot of difference to the actual absorption of the venom. It’s more a locally-



acting problem in terms of tissue damage and everything else as well. It’s a

situation where I would recommend getting them to the vet’s safely but as rapidly

as possible and phoning ahead. Certain vets, in areas where Adders are common,

in heathland in the south of England, will stock Adder anti-venom, or it is available,

so I would just get to the vets as soon as possible, warn them that you’re coming

so they can try to deal with the more generalised problems that the toxin can bring

on.

So, nothing specific you can do?

I would do nothing.

Moderator:A couple of questions that came in when you were talking about

wounds. One is if you don’t have, I think this is related to a road traffic accident, if

you don’t have a clean cloth at hand, what would you suggest we use to cover the

wound? Someone else has asked can you sue clingfilm to cover wounds in an

emergency.

PA:You could do. If you didn’t have a clean cloth or dressing to hand, depending

upon how you were dressed, we get clients who have taken t-shirts off and applied

those. So, any cloth, if we’ve got bleeding wounds. Any cloth that can be folded

up can be used to apply pressure. Clingfilm would work in a very temporary

situation. If we had a scrape or a graze or a nasty kind of wound like that. I think

the worry with clingfilm is if it was a wound that was bleeding very heavily, is the

idea with the cloth is that it gives a surface for the clot to form against. With

clingfilm, we would struggle to control the bleeding. Again, it’s what is to hand in

an emergency. So, in terms of keeping a wound clean if it wasn’t heavily bleeding,

I think clingfilm would be useful. It’s certainly something that’s used a lot with

burns and other injuries as well.

But is it generally a case of whatever you’ve got that you think is clean?

Yes, what we’re aiming for is A, if it’s cloth, we can control the bleeding but B,

inevitably any wound is contaminated, whatever we can use that is reasonably



clean to stop more dirt and more dust and more hair getting in that wound, then

the better the healing result is going to be at the end of it. I think, in that

situation, that clingfilm would be useful to keep contamination out.

Moderator:Thank you. Here’s an interesting situation and one we can all imagine.

This is regarding transporting your pet to the surgery if there’s been an accident.

How do you deal with a frantic cat which is difficult normally to get into a pet

carrier, never mind in a stressful situation?

PA:I think that’s a very good point really. The trouble can be that cats often

become stressed just at the sight of the cat carrier. I think a handy technique is

certainly a nice thick towel. If you can put a towel over the top of the whole

animal and then literally scoop them up or wrap them up in that towel. Often the

best way to get a cat into the cat carrier is, rather than having it on a flat surface,

is to turn it up on its end so that the entrance is pointing up at the ceiling. Then

hold on to the animal and lower them down, vertically, into the cat carrier, rather

than trying to slide them in horizontally. Usually it’s the claws and the teeth that

we’ve got to worry about but a good thick towel or cloth that you can wrap around

them and scoop them up in before getting them into the container from there. A

pair of gardening gloves can be handy if the accident has happened at home.

Moderator:I suppose some of them may be quite depressed rather than frantic

anyway if they have been in an accident. Maybe just gentle lifting may be

appropriate.

PA:Maybe, often we’ve got the two extremes depending on what’s happened in the

trauma really.

Moderator:Yes. A couple of things, Paul, about assessing patients. Firstly, we

very sensibly said to find out what’s normal for your own pet but could you give a

ballpark figure of what is normal? Heart rates, resting heart rates for cats and

dogs?



PA:Yes, I think the smaller the animal, the quicker things are going to go. I would

say, roughly speaking, normal resting heart rate for a cat at home, we would

expect to be somewhere around 140 to 150. Small dogs, if we’re talking Yorkie,

Jack Russell kind of size, maybe about 90 or 100. As the dogs get bigger, we

expect the heart rate to get slower. I would say something like a Labrador would

be 70 or 80 if they’re relaxed at home. If we get to giant breed dogs, Great Danes

or St Bernards, they’ll often have quite a slow heart rate more similar to ours at

rest, 60 or 70 would be normal for the giant breed dogs, as we would term them.

Moderator:That’s very helpful. Somebody did mention as well, whether it was true

that dogs have irregular heart beats and, if so, how do you actually count the heart

rate?

PA:What we’re trying to do, if we count a heart rate over a minute, you know

we’re going to have a good average beats per minute showing what’s going on. If

you feel a dog’s heart rate, they have a heart rate that varies with their breathing.

Usually, you’ll find that, as they breathe in and out, the heart rate will speed up

and slow down. If they’re nice and steady with their breathing over a period of a

minute when we’re counting, we’re going to get an average figure over that period

of time. I think if we’re counting for long enough, we’re going to get a

representative figure. A fit healthy dog should have a heart rate that varies as

they breathe in and breathe out.

Moderator:Yes, I think that’s what the person was getting at. I hope it was. Just

one more question and I think we’ll have to stop. There are a lot more! I think

this is a particularly good question. If you are the sole person doing CPR, if you’re

in that unfortunate situation where you feel that you have to try something, how

many chest compressions to how many breaths should you do? How should you

balance it out?

PA:It’s a very interesting question because I think opinion is changing in terms of

recommendations at the moment. I think what we would want to do is 20 chest

compressions to one breath, that kind of rate. If we were going at a rate, with our

chest compressions, of about 140 to 150 per minute, we would be looking at about



8 breaths per minute. If I were on my own like that, I would probably do 20 chest

compressions and then one breath and keep alternating like that.

Moderator:OK, thank you very much. I think, everyone, we ought to stop there

and let Paul go and get a well-earned drink, have a sit down and perhaps watch

the TV. Paul, thank you ever so much for such a tremendous presentation. It’s

very obvious that you have a great level of experience in dealing with these

situations, but also advising people and being in tune with the sort of questions

that people will have and the situations that they are in. I hope everyone has

enjoyed it and the comments we’ve had in are tremendous and we appreciate

those. I’ll pass them on to Paul.

So, Paul, thank you very much again.

Documents

Part 1 – First Aid - theveterinaryexpert.com fileillness occurring, putting some of these plans into action prior to getting the pet seen by a veterinary surgeon and, hopefully,