First Aid and Transport of Small Animals

For animals that are critically injured, owners can provide substantial medical assistance at the scene of the injury. During the initial telephone call, the owner should be questioned about the patient's level of consciousness, breathing pattern, type of injury or toxicosis, and, if they can be safely checked, even about some aspects of the animal's perfusion (eg, gum color, level of responsiveness, heart rate).

The first concern is for the safety of the owner. Placing a light cloth over the head of the animal can lessen external stimuli that may cause fearful and aggressive reactions. Owners can be instructed as to how to muzzle most dogs using a long strip of fabric if there are no facial injuries or respiratory distress. Cats can be placed in dark boxes to minimize stress during transport; the box should have holes large enough to observe the cat and to allow adequate fresh air. It is vital that the owner adequately restrain the pet before starting any first aid procedures to ensure the safety of both owner and pet.

When an animal is moved, motion of the head, neck, and spine should be minimized if there is known or suspected trauma to these areas. A flat, firm surface (eg, wood, cardboard, or thick fabric) can be used to provide support. Radiographs can also be taken through these materials without having to move the animal when it arrives at the hospital.

Rapid detection of cardiopulmonary arrest (CPA) in an unconscious animal can be difficult for owners. The pet’s lack of response to external stimuli or presence of limp body tone is an unreliable indicator of CPA. Instructing owners to feel for a pulse or heart rate can delay intervention. Instead, owners can be instructed to "shake and shout" to see if there is a response; other parameters may include watching for chest excursions and touching the cornea or eyelids to elicit a corneal or palpebral reflex in an unconscious pet, with absence of one or both indicative of CPA.

Instruction can be given on administration of CPR. The Reassessment Campaign on Veterinary Resuscitation (RECOVER) Initiative has created an online and in-person pet owner and pet professional CPR certification course; see For More Information. (See image of a professional performing CPR.)

Cardiopulmonary resuscitation, dog

Image

Courtesy of Dr. Andrew Linklater.

Mouth-to-nose resuscitation and chest compressions may provide sufficient respiratory and circulatory support during transport. If the animal is cyanotic and collapsed (and had been pawing at the face), an upper airway obstruction may be present; the owner should be instructed how to manually clear the airway, do a Heimlich maneuver, or perform sudden chest compression to relieve the obstruction. If the animal is unconscious and not breathing, the owner should be instructed to close the animal’s mouth, place their lips over the animal’s nostrils, and give 2–3 strong breaths. The owner can also be instructed to compress the esophagus behind the mandible on the left side so that most of the air will go down the airway instead of into the stomach.

If the animal does not spontaneously breathe, the owner should initiate CPR. Chest compressions should be initiated at a rate of 100–120/minute; appropriate technique is necessary, keeping elbows locked and compressing one-third to one-half of the width of the chest. A compression:ventilation ratio of 30:2 should be performed with a single rescuer.

Owners should be asked whether hemorrhage is ongoing and whether bleeding was seen at the site of injury. Pulsating arterial bleeding should be controlled by direct digital pressure or a pressure bandage. Any long pieces of fabric or gauze can be used. Often, washcloths and hand towels are adequate when applied. Additional material can be placed over the original bandage if it becomes soaked with blood. If the bleeding from a limb is venous (dark, oozing), the limb can be elevated above the heart. Tourniquets should be used only on appendages (eg, limbs, tail) when compression wraps have failed to control bleeding. The tension on the tourniquet must be relaxed every 5–10 minutes to allow blood flow to the distal limb and then tightened again after 2 minutes.

Penetrating foreign objects (eg, sticks, arrows) should be left in place during transport; however, to prevent further injury, care should be taken to keep the object from moving. It is often necessary to stabilize the shaft of the penetrating object just outside the body and, holding it firmly, cut off the shaft, leaving a portion exposed so it can be easily located.

In dogs with fractures below the elbow or stifle, support can be provided to the limb during transport. With any fracture, causing additional damage to muscles, nerves, vessels, and bones is a concern, as is causing pain if support of the fracture is not provided. Once the pet has been adequately restrained, the owner can make a support splint from a rolled newspaper or magazine and secure it in place with long pieces of fabric or duct tape. Fractures above the elbow or stifle are challenging to immobilize. Patient movement should always be minimized.

Animals with altered mentation after trauma should be transported with the head level with the body or elevated 20°. There should not be any jerking or thrashing motions, and manipulations of the neck or occlusion of the jugular veins should be avoided.

When the patient arrives at the hospital, regardless of the presenting complaint, triage should be performed to assess the following vital parameters:

• temperature

• pulse rate

• respiratory rate

• level of consciousness

• level of pain

Additional assessment of perfusion can include pulse quality, mucous membrane color, and capillary refill time. An abnormality in any one of these warrants urgent evaluation by a veterinarian.

Analgesia is necessary in any patient that presents with a condition assessed to be painful; however, a neurological examination should be completed before administering analgesia.

Opioids (eg, fentanyl, morphine, hydromorphone, methadone, buprenorphine) are ideal first-line agents, providing effective analgesia with minimal impact on cardiac or respiratory systems; they are best administered IV, followed by a continuous rate infusion if deemed necessary. Butorphanol has minimal and short-acting analgesic effects. Addition of a benzodiazepine will provide neuroleptanalgesia.

NSAIDs are considered safe in most patients that are not in shock and do not have renal or GI disease or need steroids.

Multimodal analgesia with adjunct infusions of ketamine, alpha-2 agonists (dexmedetomidine), or lidocaine will be helpful in many painful conditions. Local analgesia techniques and even acupuncture may be considered in a variety of painful patients.

If a toxic ingestion has occurred, the owner should be instructed to bring the animal immediately to a veterinarian. Instructing an owner by phone to administer hydrogen peroxide or other substances carries the risk of further injury such as a vagal response (resulting in collapse and bradycardia), choking on vomitus, aspiration pneumonia, further toxic injury from caustic substances, or mucosal injury from hydrogen peroxide administration. If possible, the toxin itself, its container, or a photograph of the toxin/container and label clearly showing the contents should be brought in for identification.