Transcript Canine Medical Care

Canine Medical Care
(FEMA Med Spec Course Unit 11A)
Canadian Disaster Medical Specialist Course
October 8-12, 2013
Search Canine Veterinary Care
Please note: This presentation is based entirely on the FEMA/TEEX Disaster Medical
Specialist Course (Unit 11A) and is used by CanTF2 with verbal permission from
FEMA/TEEX.
Objectives
• Identify Medical Team’s responsibilities
and roles in canine care
• Discuss canine evaluation model
• Discuss canine illness, injury and
treatment in urban search and rescue
• Identify veterinary resources
• Identify euthanasia issues
OBJECTIVE 1
MEDICAL TEAM’S RESPONSIBILITIES/
ROLES IN CANINE CARE
Medical Team’s Role
• Assist handlers
• Mobilization and post-shift physical exams
– Mobilization: Temp, pulse, resp, auscultate
– Post-shift: Vitals, chest, eyes, skin, feet
• Provide care for minor to moderate
illness/injury
• Provide emergent care
Medical Team’s Role
• Arrange referral veterinary care
– Local, provincial, or regional resources
• Private practice, small animal veterinarians
• Veterinary emergency clinics and hospitals
• Notify of particularly high-risk operations
Handler’s Responsibility
• Bring healthy, immunized animal
– Core vaccinations
• Recommended vaccinations (AAHA)
• Provide preventive care
– Rest, food, fluids, medications, etc.
• Bring canine health problems to Medical
Team’s attention
• Control animal before evaluation
• Assist in evaluation and care
Pre-Deployment Information
• Current annual physical, vaccines, travel
documents if required
• Mobilization check-in
– Hydration, pulse, respiration, attitude,
temperature
• Immediate health concerns
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Infectious disease
Current injuries/illness
Recent medical/surgical history
Reproductive status (no females in heat!)
Nutrition
Canine Medical Intelligence
• Canine health threats
– Trauma
– Vectors
– Endemic diseases
– Environmental Conditions
– Hazardous materials
• Inhalation, skin contact, ingestion
Canine Health Maintenance
• Review canine health information at
mobilization site
• Assist handlers with preventive care
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Water and food
Transportation mode safety
Work-rest cycles
Anticipated mission hazards
Hygiene or decontamination at end of operational
periods
– Daily check in with medical team
Preventive Medicine: Hydration
Preventive Medicine: Eye and Nasal
Irrigation
Preventive Medicine: Work-Rest
Cycles
Preventive Medicine: Paw Pad
Inspection
Preventive Medicine: Periodic
Examinations
Preventive Medicine: End of Operational
Period Hygiene and Decon
Evacuation: Preplan Veterinary
Emergency Evacuation and Care
Referral Capabilities/Medical Plan
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Surgical/trauma
Critical Care
Extended Care
Specialties
– Ophthalmology
– Orthopedics
Emergent Canine Medical Care
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Minor problems
Major illness/injury
Definitive versus supportive care
Similar to emergency medicine
Veterinary medicine referral
– IST veterinarian via IST medical
– Local vs tertiary veterinary care
Emergency Veterinary Care
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Lateral recumbent or prone position
Airway
Breathing
Circulation
Prevent heat loss
Splint fractures
Control Pain
Assessment of Life-Threatening
Conditions: Airway
• Does animal have patent airway?
Emergency Veterinary Care
• Airway Assessment
• Extend neck, open jaws, pull tongue
forward and depress posterior tongue
(laryngoscope, tongue depressor)
• For suspected cervical spine injury
maintain lateral recumbent position and
head/neck in neutral position
Emergency Veterinary Care
• Airway: Apneic Patient
– Face-to-Face technique:
– Retract tongue and place laryngoscope to
base of tongue. Vocal cords are easily
visualized.
– Tie end of endotracheal tube to maxilla (top of
snout) using gauze to stabilize the tube
– Endotracheal tube size: 8.0-12.0 mm O.D.
– Consider digital intubation
Assessment of Life-Threatening
Conditions: Breathing
Emergency Veterinary Care
• Breathing
– BVM assisted ventilation
– Supplemental oxygen
• 100% if available
– Needle thoracostomy
Breathing
• Not intubated
– Mouth-to-Nose (visible chest rise)
• Intubated
– Rate 20-25 breaths/minute, visible chest rise
– 1:3 ratio with CPR, continuous chest
compression
– If alone give 2 ventilations to every 15
compressions
– 100% oxygen if possible
Assessment of Life-Threatening
Conditions: Circulation
Emergency Veterinary Care
• Circulation
– Direct pressure control of hemorrhage
– Femoral pulse
– IV 0.9%NS fluid bolus, 20-30ml/kg Q 15
minutes, not to exceed 90 ml/kg/hr first hour
with reassessment q15 min, then titrate to
effect
Circulation
• If pulseless: place on left lateral side in
trendelenburg
– Trauma patients are left on whatever side
they present
• Compression- palm of hand over highest
part of chest
• Rate – 100 per minute
OBJECTIVE 2
CANINE EVALUATION
Canine Evaluation
• Handler
– Provides history
– Conveys dog’s behavioral norm
– Assists in exam and treatment
– Monitors animal to the extent of their
individual capability
• Given guidelines w/r to TPR
• Report changes to medical
Canine Evaluation
• Medical Personnel
– Similar to pediatric patent
– Careful observation
– Gentle thorough exam, head to tail
• Respiratory status, perfusion, mental status
– Pain control as needed
– Veterinary consultation early
Canine Evaluation
• Normal values based on 80 to 90 lb dog
– Heart rate (60-140 beats/min): 120/min
• Sinus arrhythmia is normal
• Heart rate can be to 180/min after exercise
– Respiratory rate (10-30): 24/min
– Core Temperature (100.5-102.5F): 101.5F
Canine Evaluation
• Normal Values
– Water maintenance ~Approximately 24ml/kg/hr or 3 L/24h (delete)
• Additional workload needs
– Palpable femoral pulse: Systolic SBP > 75
mmHg
– Blood glucose: 80-125 mg/dl
Evaluation
Restraint
• Muzzle and restraint
during examination
and minor procedures
• Basket muzzle
recommended with
facial trauma or to
allow panting
Pulse Check
Hydration and Cap Refill
Canine Anatomy
OBJECTIVE 3
ILLNESS/INJURY
Common Problems
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Paw pad foreign body or laceration
Broken toenail
Eye foreign body
Laceration
Skin infections
Fractures, soft tissue contusions
Common Problems
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Hyperthermia, hypothermia
Vomiting/diarrhea
UTI
Toxic ingestion
Seizure (consider hypoglycemia)
Allergy
Gastric Dilatation-Volvulus
Syndrome
• Stomach obstruction
due to twisting of the
stomach, fatal if
untreated
• Signs
– Distended tympanic
abdomen
– Non-productive retching
– Restless pacing,
salivation
– Shock
Gastric Dilation-Volvulus Complex
• Plan
– Oxygen
– Start fluid resuscitation
• 20-30 ml/kg IV into
forelegs
– Consider OG tube for
stomach
decompression
– EVACUATE
Head Trauma
• Treatment
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Oxygen
Elevate head
Maintain perfusion
EVACUATE
Spinal Trauma
• Treatment
– Immobilize in lateral
position on a board
– Pain control
– EVACUATE
Fractures
• Treatment
– Immobilize
– Pain control
– EVACUATE
Wounds
• Minor
– Clean and bandage
– Laceration closure
• Major
– Cover with protective dressing
– Immobilize dog if possible
– Pain control: topical lidocaine for foot pad; up
to 2 mg/kg lidocaine local wound infiltration for
skin
Ocular Injuries
• Red eyes
– Irrigate
– Assess for corneal ulcers, retained foreign
body
• Ocular trauma
– Irrigate, lubricate (artificial tears or topical
antibiotic)
– Consider ‘E’ collar to prevent self-trauma
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Splinting
Bandaging
Right
Wrong
Dressings and Splints
• Dressings
– Include limb distal to the wound
• Splints
– Wrap from distal to proximal to prevent
tourniquet effect
– Include joints above and below fracture
IV Placement
• Forelimb cephalic vein
Cephalic Vein
Saphenous Vein
Subcutaneous Fluids
FEMA
Intramuscular Injections
Biceps
Quadriceps
Caudal
Semitendinosus
Lumbar
Entrapment, Engulfment, & BelowGrade Search Operations - Non WMD
• Particulates
• Household, office, commercial, and
industrial chemicals, and radiologicals
• Gases and vapors
– Natural gas, LPG, refrigerants, ammonia,
chlorine, sewer gases, fossil fuels, solvents
Exposure and Absorption Risks Non-WMD
• Inhalation
• Skin absorption (fur may offer some
protection)
• Ingestion: canine’s personal grooming
behavior may result in GI symptoms in
addition to other organ system symptoms
– Induced emesis using 3% hydrogen peroxide
within few minutes to 2 hours post-ingestion of
toxic substance other than corrosive,
hydrocarbon, or with altered mental status
Toxic Ingestion Hazards
• Common chemicals, foods, and drugs
encountered during search operations in
damaged structure
– Ethylene glycol in antifreeze: kidney failure
• Antidote: fomepizole
– Acetaminophen (Tylenol): liver failure
• Antidote: acetylcysteine
– Chocolate: seizures
– Rodenticides: bleeding disorder, seizures
Emergency Decon - Non-WMD
• Acute symptoms: upper airway/respiratory
distress, altered mental status/
unconsciousness, seizures, vomiting
• Personnel with access to PPE and water
supply
– Communication with canine may be difficult
through respirators
Emergency Decon - Non-WMD
• Muzzle as needed
• Water decon
– Eye and wound irrigation, consider topical
ophthalmic anesthetic
– Hand dishwashing soap if available
• Consult IST emergency veterinary care
End of Operational Period Hygiene
and Decon - Non-WMD
• Bulk dust removal with dampened cloth
• Canine equipment wash (collar and vest)
• Water wash, hand dishwashing soap
– Warm water as available
• Thorough drying
– Hairdryer as available
• Health surveillance
WMD Environments
• Emergency decon preplan
• Routes of absorption include ingestion as
well as inhalation and skin contact
• Effective decon versus disposal of collars
and vests
Chemical Agents K9 Antidote Doses
• Vesicants: thorough skin and fur decon
– Ingestion may cause upper airway, respiratory,
and gastrointestinal symptoms
• Nerve agents/organophosphates
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Atropine: 0.05-0.1 mg/kg IM or IV
Pralidoxime: 20 mg/kg IM or IV
Aerosolized Albuterol: 2.5-5 mg
Diazepam: 0.25-0.5 mg/kg IV
• (comparatively higher than human dose)
• Cyanides
– Sodium thiosulfate 25% solution: 1.65 ml/kg IV
Radiologicals and Biologicals
• Radiologicals
– Ingestion more likely route of exposure than in
humans
• Alpha-emitters particularly mutagenic when ingested or
inhaled
• Alpha-emitter detection on fur or skin can be reduced
by presence of water
• Biologicals
– Ingestion more likely route of exposure than for
humans
– Health surveillance
OBJECTIVE 4
EUTHANASIA
Euthanasia Considerations
• Involve handler in ALL decisions
– Decisions very individualized
• Humanitarian relief of pain and suffering
– Veterinary consultation and evaluation
• Transport to veterinary emergency hospital preferred
• Preferably performed by veterinarian
• Morphine, diazepam, then succinylcholine as
an alternative (very high doses)
• Handler stress intervention
OBJECTIVE 5
POST-DEPLOYMENT
SURVEILLANCE
Symptom or Syndromic Surveillance
• Follow up on injuries sustained while
deployed
• Follow up on symptoms occurring during
deployment
• Evaluation of new-onset symptoms
• Health evaluation for future deployments
WTC Morbidity
13%
8%
45%
20%
23%
35%
24%
C.M. Otto, DVM, PhD, DACVECC, 5/03
N=65 of 96 Dogs Studied
G.I.
CUTS & ABRASIONS
FATIGUE
APPETITE CHANGE
DEHYDRATION
MUSCULOSKELETAL
RESPIRATORY
CANINE MEDICAL CARE
UNIT SUMMARY AND
EVALUATION
Summary
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Canine preventive medicine
Emergency veterinary care
Canine evaluation
Illness and injury in urban search and
rescue
• Euthanasia
• Post-deployment surveillance
CANINE MEDICAL CARE
QUESTIONS?