Transcript NEFHS.ASPCAdecon - New England Federation of Humane Societies

Animal Decontamination
MaryEllen Malysiak, BS, CVT
ASPCA Animal Poison Control Center
Urbana,IL
Decontamination is all about
preventing absorption
♦ Decontamination is very important as
there are very few antidotes
♦ Decontamination is performed in the
asymptomatic animal
♦ The basics of decontamination processes
are similar amongst species
♦ Stabilize first if symptomatic
♦ Follow the ABCs
 Airway
 Breathing
 Cardiovascular
♦ “Treat the pet not the poison!”
“The Antidote”
♦ After stabilizing, if the toxic agent is
identified, “the antidote” may be given
♦ Vast majority of toxic agents have no
specific antidote
 treatment is symptomatic and supportive
♦ Even in cases where antidotes exist, there
are often barriers to their use
 high cost, lack of availability
Ocular Exposures
♦ Irritation to corrosion
♦ Flush with large quantities to
decrease insult to the cornea
 Tepid tap water
 Normal saline
 Artificial tears
♦ Flush for 15 - 30 minutes
♦ Do not use Visine® or other
“get the red out” products
Ocular Exposures
♦ Eyedropper
 smaller patients, birds,
reptiles
♦ Plastic cup
♦ Sedation or rest periods
 minimize stress
Dermal Decontamination
♦ Remove compounds from the skin or fur to
limit or prevent percutaneous absorption
♦ Never use a solvent like kerosene or paint thinner.
♦ Make sure to keep the patient warm and dry thoroughly
Protect yourself!!
♦ The handler should wear proper protective
clothing including gloves or mask to
prevent personal injury.
Liquid Dish Washing Detergent
♦ Very effective in
removing any agents
that are oily or oilsoluble.
♦ Do not use automatic
dish washer detergents.
Avian Dermal Exposures
♦ Light exposures:
 Spray lightly
 Diluted mild liquid dish
washing liquid and warm
water
♦ Heavy exposures:
 Thorough bathing with
liquid dish washing
detergent and warm
water
Glue traps, Asphalt, Pine Sap
♦ Oily removes sticky compounds
 Olive oil, mayonnaise, peanut
butter, mineral oil, vegetable oil
 Rub a small amount onto area
• Keep rubbing until substance breaks
down into “gummy balls”
♦ Wash with liquid dish washing
detergent to remove the oily
substance
Oral decontamination is all
about preventing absorption
Dilution
♦ Dilution is used to
make compounds
less irritating
♦ Generally
recommended for
management of
caustic substances
(acid or alkaline) and
petroleum distillates
Dilution
♦ Milk
♦ Water
♦ Milk of Magnesia,
Mylanta, Maalox
 Avoid salicylates
Dilution
♦ Rabbits, birds,
reptiles
 yogurt, juicy fruits
and vegetables
Emetics
♦ Emetics are used to remove substances
from the stomach (induce vomiting).
♦ Assume that most animals only vomit 4075% of their stomach contents.
♦ Useful for most substances within 30-90
minutes after ingestion.
 cold medications
 chocolate, rodent baits
Emesis
♦ Evaluate each case on
an individual basis
 Probably performed far
too often
 Emesis should never
be an automatic
decision
 Benefit vs. Risk
Emetics -- Contraindications
♦ Do NOT induce vomiting with ingestion of
a caustic substance or petroleum distillate.
 Caustics can burn on the way up just as they
do on the way down
 Hydrocarbons can be aspirated
Emesis -- Contraindications
♦ Do NOT induce vomiting in species that
cannot vomit.
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Rodents
Rabbits
Horses
Ruminants
Avian
Reptiles
Emesis – General
Considerations
♦ Emesis is generally more effective if done
with food in the stomach.
 Recent meal
 Bread or other foods
♦ Patient should be monitored during the
process
♦ Vomitus should be examined
♦ Do not let the animal or others to eat the
vomitus
3% Hydrogen Peroxide
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Acts locally by GI irritation
Give 1ml/lb, up to 45 ml
Can repeat dose once
Large doses can cause
bloody vomiting
 Cats are more sensitive than
dogs – generally not
recommended in cats
♦ Dish Soap
♦ Dry powdered
mustard
♦ Pharyngeal
stimulation
♦ Not effective
and not
recommended.
Other choices
Syrup of Ipecac
♦ No longer available for
purchase
♦ Average time to emesis
is 23 minutes
♦ Withdrawn from market
due to abuse by
bulemics; no longer
recommended for
children
♦ Can cause cardiac
issues in animals
Salt or saltwater
♦ Never should be used – not even as a last
resort
♦ Life threatening hypernatremia can result
especially if emesis doesn’t occur
Review question
♦ Which of the following species can be
made to safely vomit?
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A.
B.
C.
D.
E.
Rabbits
Rats
Horses
Pot bellied pigs
Chickens
Adsorbants - Activated Charcoal
♦ Binds most organic
compounds and facilitates
excretion in the feces
 Binds large, nonpolar
substances best
♦ Powder, gel, liquid
formulations
 1-2 g/kg (powder)
 3-5 ml/lb (gel and liquid)
Adsorbants - Activated Charcoal
♦ My require repeated doses
 Chocolate, bromethalin, invermectin,
Cholecalciferol
♦ Not always indicated
♦ Other chemicals that are not effectively
absorbed:
 Ethanol, methanol, xylitol, fertilizer, fluoride, petroleum distillates,
most heavy metals, iodides, nitrates, nitrites, sodium chloride,
and chlorate
Adsorbants - Activated Charcoal
Cathartics
♦ Decrease GI transit time
 Without cathartics, the toxicant bound by
activated charcoal can eventually be released
and reabsorbed.
♦ Given with or shortly after activated
charcoal- Check your labels!
♦ Do not use if animal is dehydrated or has
diarrhea
♦ Avoid in renal patients
Bulk Cathartics
♦ Used to help remove heavy
items from the GI tract
 psyllium
 canned pumpkin, or squash
 Brown rice
♦ High fiber
 retain water and produce more
bulky stools
♦ Ensure adequate water
consumption
Emollient Laxatives
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Laxatone®
Nutrical®
Vaseline
Mineral oil
♦ Contraindications
 vomiting
Enema
♦ Helpful when elimination
of toxicants from the
lower GI tract is desired
 gets things “moving
through”
♦ Warm water, warm
soapy water
♦ Not recommended for
birds
Inhalation
♦ Remove from source of inhalant
♦ Fresh air
♦ Oxygen
♦ Monitor for difficulty breathing
Meth labs, and the Animals
Impounded from them
Methamphetamine
The Product
N-methyl-1-phenylpropan-2-amine
♦ Discovered in 1893
♦ Used in WWII
 “Pilot’s chocolate”
 Fight fatigue, enhance
focus
 Agitated and
aggressive
Methamphetamine
♦ Powerful stimulant
♦ Highly addictive
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Meth
Speed
Ice
Crystal
Chalk
Crank
Tweak
Uppers
Black Beauties
Glass
Batu
Blade
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Bikers Coffee
Methlies Quick
Poor Man’s Cocaine
Chicken Feed
Shabu
Crystal Meth
Stove Top
Trash
Go-Fast
Yaba (meth + caffeine)
Yellow Bam
Methamphetamine appearance
♦ White Crystalline Powder or Chunks
 May be yellowish or brownish due to
contaminants
 May be clear crystals or chunks
• Ice – very pure
Photo: State of California
Photo: State of California
Drugs of Abuse
♦ Popularity
 Alcohol
 Marijuana
 Methamphetamine
• Midwestern and
Western United
States
Methamphetamine – How it
works
♦ Floods brain with dopamine
 Rush
 Pleasure, pain
♦ α/β adrenergic activation
 Increased BP
• Constricts blood vessels
 Increased HR
• Stimulates heart
Methamphetamine – How it
works
♦ Serotonergic effects
 Serotonin syndrome
• Autonomic,
neuromuscular, CNS
signs
♦ Half-life 8-36 hours
 5 half lives to be gone
from the body
Methamphetamine
Intoxication
True or False?
♦ Methamphetamine poisoning is commonly
seen in animals that have been seized
from methamphetamine labs.
 True
 False
False
♦ Actual methamphetamine toxicosis is
uncommon
♦ Precursor chemicals
 More than final product
 Meth = $$
♦ Cats, rabbits, birds
 Grooming
 Ingestion of aerosolized meth off fur/feathers
Meth intoxication
♦ Stimulation of CV and
CNS
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Agitation, hyperactivity
Dilated pupils
Increased heart rate
Increased blood
pressure
 Increased body
temperature
 Disorientation
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Tremors
Seizures
Aggression
Irritability
Apprehension
Panting
Erratic heart rhythm
Death
Meth intoxication
♦ Time frame
 Signs generally occur within 0.5-1 hour
following exposure
 Last up to 72 hours in severe cases
Methamphetamine Testing
♦ Commercial test kits
available
 Blood – 6-12 hours
 Urine – 48-72 hours
♦ False positives
 Proin, Adderall, Afrin
Nasal Spray, MDMA,
NyQuil,
Pseudoephedrine
♦ Thanks to Dr. Rob Kessler, Las Vegas, NV
Methamphetamine Treatment
♦ Requires veterinary care
♦ Decrease agitation
 Phenothiazines (chlorpromazine,
acepromazine)
 Cyprohepatadine (serotonin
antagonist)
 Barbiturates
 Avoid diazepam!
♦ Reduce body temperature
 IV fluids
Prognosis for meth intoxication
♦ Most animals respond well to treatment
♦ Concern if seizures for a long period or
high body temperature
Chronic Meth Users
Behavioral evaluations – Time!
♦ Delay for at least a week
 Elimination of meth from the body
 Adapt to its environment and show more of its
normal character
♦ Many dogs and cats seized from meth
labs have been successfully placed in
homes and have lived normal life spans
♦ Prognosis is generally considered good for
those animals that are able to be
rehabilitated
Methamphetamine
The Process
If only it was this easy….
♦ Identify the Meth Lab?
Meth labs
♦ Many of the chemicals used to produce
meth are extremely hazardous
♦ Dangerous to:
 Individuals who manufacture
methamphetamine
 People living nearby
 Law enforcement
 Firemen
Possible ingredients – corrosive
agents
♦ Irritation or ulceration of skin, eyes, mouth,
throat, lungs, digestive tract
 Anhydrous ammonia, acids (rust removers,
auto battery acid), alkalines (drain cleaner),
iodine (vet products), lithium (batteries), red
phosphorous (matches)
• Anhydrous ammonia can cause freeze injury
• Lithium metal + water = explosion
• Red phosphorus is highly flammable and can form
deadly phosphine gas
Chemical burns
♦ Spills of chemicals onto flooring
 Walk through, lie in, and/or ingest
Familyvet.com
Possible ingredients - Solvents
♦ Irritating fumes, skin irritation, inebriation,
liver and kidney damage, vomiting, coma
 Acetone, ether (engine starter), ethyl alcohol,
methanol, isopropyl alcohol, xylene, toluene
(brake cleaner), trichloroethane
• Flammable
• Can be absorbed across skin.
 Freon (Non-Flammable Liquid Solvent)
• Asphyxiant
Possible ingredients - stimulants
♦ Tremors, seizures, high body temperature,
heart irregularities, agitation
 Pseudoephedrine (cold medications),
ephedrine, phenylpropanolamine (vet drugs)
Possible ingredients - others
♦ High Pressure Acid Gas
 Hydrogen Chloride Gas
♦ Methyl Sulfonyl Methane (MSM)
 Cutting Agent
♦ Sodium Chloride (Salt, Rock Salt)
♦ Hydrogen peroxide
Other Potential Hazards
♦ Mechanical injury
 Discarded syringes,
razor blades
• Needle punctures
♦ Explosion/fire – burns
♦ Neglect
 Malnutrition, parasites,
infectious dz, abuse
Animals
♦ Types of animals that might be present
 Household pets
 Livestock
 Captive-kept wild animals
• Massachusetts methamphetamine laboratory raid,
police found alligators guarding the residence!
♦ Guard dogs
Drug Lab Response = Team
Effort
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Investigation & Seizure (Law Enforcement)
Chemical Emergency Response (Hazmat)
Fire Suppression (Fire)
Assessment/Inventory (Law, Health, Fire)
Removal & Disposal (DTSC, Contractor)
Remediation (Health, Property Owner)
Other Support (CPS, Animal Control, Ag
Inspector, Fish & Game, Water
Resources...)
Your role
♦ Range
 Actively assisting with removal
 Decontamination of animals
 Evaluating animals
• Immediately
• Days or weeks following seizure
 Evidence preservation and documentation
♦ Protect yourself and others!
Who is in charge ??
♦ Communicate expectations (veterinarian,
law enforcement, animal control, humane
organization)
 Who is authorized to approve medical
decisions, including authorization of
euthanasia?
• Agreed-upon fee payment schedules and
euthanasia permission should be IN WRITING
Meth Lab Bust
♦ Federal and state authorities
 Established protocols for managing MLs
 Compliance may vary with jurisdiction
♦ The unit housing the laboratory (i.e.
house, garage, etc.) is considered the 'hot'
zone
 Entry into hot zones is regulated by the site
safety officer (SSO)
Meth Lab Bust
♦ SSO determines the level of
personal protective equipment
(PPE) that must be used to enter
the hot zone
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Eye protection
Protective boots and gloves
Protective 'clothing' (e.g. Tyvek suits)
+/- specialized respirators and/or fully
encapsulated HazMat suits with selfcontained breathing apparatus
What’s wrong with this picture ?
Meth lab – animal removal
♦ Done with care
 Animals themselves may be contaminated
 Hazard to those that handle them
♦ Entry into the ‘hot zone’ may be restricted
♦ Animal control officers may be requested
to enter the hot zone to remove animals
 Personal safety becomes paramount
 Cannot help the animals if you become
injured or ill
Meth lab – animal removal
♦ After human suspects are removed
 After noise and confusion
♦ Catch poles and nets are commonly
employed
♦ Unfortunately, the removal process can be
quite stressful to the animals
Animal removal
Meth lab – animal removal
♦ Upon entering the hot zone
 Do not touch anything unless absolutely
necessary
 Avoid stepping into pools, puddles, or solid
materials (including syringes)
Meth lab – animal removal
♦ Avoid contaminating other areas outside
the hot zone
 Leashes, carriers, and cages should be
brought into the area rather than using the
contaminated items in the laboratory
 Collars and halters should be removed prior
to removing the animal from the hot zone if
possible
Meth lab – animal removal
♦ Personnel handling the animal
 Remain in protective gear until such time that
the animal can be adequately decontaminated
♦ Carrier used to transport the animal should
be washed thoroughly with hot water and
soap
Meth lab – animal removal
♦ Consider all animals to be contaminated
with potentially hazardous materials
 Need to be decontaminated in order to
minimize the contamination of the animal
control vehicle and facilities
♦ Triage
 Determine if animal needs immediate
veterinary care
Meth lab – animal removal
♦ Animals in need of immediate care
 Life-threatening injury or illness
 Transported immediately without
decontamination
♦ Vet staff needs to wear protective gear
until the animals are stable enough to be
decontaminated
Meth lab bust
♦ Prior to decontamination
♦ Ask if law enforcement officials desire any
samples be taken from the animals for
later analysis
 Hair swabs (place in clean plastic jars)
Decontamination
♦ Animals not judged to be in need of
immediate veterinary care at the site are
decontaminated
 Bath with liquid dish soap (e.g. Dawn) and
warm water
 Animals that are difficult or dangerous to
handle may require sedation
Decontamination
♦ Supplies
 Water source (preferable warm)
 Liquid dish soap
 Four wading pools to make a decontamination
line away from the hot zone
• Bath 1, rinse 1, bath 2, rinse 2
 Sterile saline (eye rinse)
 Cloth towels and paper towels
 Pallet or riser or pallet to keep the animals'
feet from sitting in the wash water
Decontamination
♦ First bather wets and washes the animal
 Full PPE
♦ Transfers the animal to the first rinser who
rinses the animal thoroughly
 Full PPE
♦ Transfer to the third pool and re-washed,
then transferred to the final rinse pool
♦ Towel dry and placed in a clean carrier for
transport to the veterinary facility
Decontamination
Decontamination
♦ Birds, pocket pets, etc.
 Can be very stressed by aggressive bathing
 Spritz with a mixture of warm water and dish
soap (be careful around eyes) from a spray
bottle followed by a rinse in clean water from
a different spray bottle
 Towel off, place in clean carriers and
transported to an area where they can be
evaluated by a veterinarian
Evaluation
♦ Veterinary facility
♦ Exam for physical and behavioral
abnormalities
Methamphetamine
Forensics
Documentation
♦ You can never have too much
documentation
Documentation
♦ Injuries, body condition scores
 Writing, photography
♦ Photographs should include overall views
of the entire animal and subsequent closer
views of specific lesions
 Each photograph should contain an
identifying label with the case number and
date
Documentation
Testing
♦ Is the veterinarian/animal control expected to
gather evidence from the patient(s)?
 What evidence is to be collected and who is
responsible for storage/testing of the evidence?
 Sometimes law enforcement initially is not interested
in testing, but later request testing in order to
strengthen their case and possibly add additional
charges
 Blood, urine, hair (pre-decontamination)
♦ Samples stored in a secure area and carefully
labeled with date and time of collection, case
number, animal identification, breed, and signature
of person collecting the sample
Drug testing
♦ If requested by law enforcement, urine
and/or blood may be taken for
methamphetamine testing
♦ Blood should be collected within 6-12
hours and urine within 48-72 hours
Drug testing
♦ Samples sent to human or veterinary
diagnostic laboratories
 Accredited veterinary diagnostic laboratory for
the best evidentiary value
 A negative methamphetamine test does not
rule out the possibility that the animal was
exposed to toxic precursor chemicals rather
than the end product
Question?
♦ Law enforcement has presented you with two cats
that were removed from a house containing a
large meth lab operation two days ago. They now
want to know if the cats had been exposed to
methamphetamine; if so, they can add animal
cruelty charges to the case. Which of the following
is the *best* sample to obtain under these
circumstances?
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A. Swab of hair coat for methamphetamine residue
B. Blood sample
C. Fecal sample
D. Urine sample
Answer
♦ Correct answer is D: Urine sample
 Metabolites can be detected for 48-72 hours
♦ Swabbing the hair coat
 Any methamphetamine residue would have been
washed away during decontamination
 Only indicates dermal exposure
♦ Blood samples
 Levels below detectable levels within 12 hours
♦ Fecal samples
 Not excreted in stool
Take home points
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Delay behavioral evaluation
Successful rehoming can occur
Protect yourself
Decontaminate
Document
Questions?