1. Assessment and Management of trauma cases in small animals

2. What is trauma?
Trauma is Greek for wound , Medically, the term has come to be used to call : An injury inflicted by any degree of force, suddenly, by physical or chemical action . In small animal medicine trauma implies to many emergencies met in every day practice.

4. What is the big deal about emergencies ?!!!!
1/8 of the cases we see in the practice is a critically traumatized patient
2/3 of these emergencies are car accidents (dogs)
The next biggest is animal aggression (same or different species)
Cats are climbers (fall) Dogs are runners (car , sharp objects )
Other : burns and scalds, electrocution, swallowing objects ……………

5. Requirements What do you need?
In Vet Heaven we have everything for everything , rapid blood tests, oxygen and ventilator , MRI, trained staff, all drugs and of course a patient that knows or shows what they are suffering from!!! But since we are on Earth and in a “veterinary developing country”

6. A place in the clinic must be ready with:
1) inhalation anaesthesia machine with ventilator
2) different sizes of tracheal tubes
3) intravenous catheters of different guages
4) different types of intravenous fluids
5) urinary catheters, suction, sterile surgical instruments , blankets and heat pads and hot water bottles.

7. What drugs do I need on hand?
Emergency box
Basic contents :
Epinephrine
Atropine sulphate
Dexamethasone
Doxapram hydrochloride
A list of contents and doses should be included in the box to facilitate usage

8. Staff

9. Staff
The staff should have some training on handling traumas from handling the owner on the phone to stabilizing the patient

10. ASSESSMENT:
In Veterinary Heaven the in-depth assessment is achieved using data from blood pressure, electrocardiography, full haematology and biochemestry analysis, urinalysis, cerebrospinal fluid analysis, blood gas analysis and whole body radiograghy!!!
But 99% of the cases presented to 99% of the clinics in this country can not have this kind of extreme monitoring
Too much attention is given to these tests can distract the vet from very obvious signs that he can work on to save the animal’s life and also cause the loss of valuable time

11. Rules of engagement !!! (everyone)
1) Assess airway sufficiency
2) Stop substantial external bleeding
3) Assess cardiopulmonary status
4) Dress and cover major external wounds
5) Assess state of central nervous system
6) Assess bone and joint status
7) Make an overall assessment of the animal’s wellbeing
Never ignore the owner and his/her emotions

12. First aid :
First aid starts on the phone!!! The moment a troubled animal owner calls and reports an emergency, competent, calm and authoritative advice on how to transport the animal, maintain air way and stop any blood gushing should be given until the animal arrives to the place of care.

13. Taking history Questions of immediate interest are :
What happened? Did you see it? Where did it happen?
How long ago did the trauma occur ?
Was the animal conscious after the trauma? Did it remain so?
Has the animal’s condition improved, stayed the same or became worse after the trauma ?
Did the animal walk after the trauma and how well did it do so?
Did you see any haemorrhage and if so from where ?
What have you done in terms of first aid ?

14. Questions of later interest
Are there any medical or surgical problems and is the animal receiving any medication now?
When was the animal fed and when did it last pass feces or urine?
What is the animal’s age and has it been neutered?

15. Veterinary procedures (the vet)
1) Ensure adequate airway passage patency and that there is sufficient ventilation and oxygenation
2) control severe external bleeding
3) establish one or more intravenous cannulae
4) administer intravenous fluids , ringer lactate then sodium bicarbonate (40 to 90 ml /kg bodyweight)
5) Administer intravenous corticosteroids , prednisolone (rapid short acting) then dexamethasone (slow long acting)
6) Administer antibiotics intravenously

16. 7) take a blood sample for PCV, total blood protiens and BUN
8) Catheterize urinary bladder, perform urinalysis and monitor urine production
9) monitor PCV, Total blood proteins, urine output, body temperature, pulse and respiration rate and quality, capillary refill time and perhaps ECG (if temperature is below 34 a source of heat is needed to jumpstart the thermoregulatory mechanism of the body)
10) A further rapid but more detailed general physical examination should be performed in this order of priority: Respiratory system, Cardiovascular system, abdomen, soft tissues, peripheral and central nervous system, fractures and dislocations
At this point owners should be informed of prognosis and progress of procedure and further history can be taken

17. Specific problems and how to deal with them

18. Shock
Shock is a syndrome seen when the cardiovascular system is unable to maintain blood pressure and flow above the minimal physiological tissue requirements
Acute decline in tissue blood supply
There are 3 categories of shock :
Cardiogenic , Hypovolemic, Vasculogenic

19. Signs of shock Tachycardia Pale and cold mucous membranes
Slowed capillary refill time
Weak main arterial pulse
Non palpable peripheral arterial pulses
Cold extremities and collapsed viens
Dry tongue
Anuria
Subnormal temperature and absence of shivering
Increased respiratory rate with lack of depth
Altered consciousness and muscle weakness

20. Treatment of shock Maintain airway
Correct volume by administering fluids
Keep animal warm
Avoid excessive movement
Avoid depressant drugs
Delay use of analgesics before correction of hypovolemia to avoid drop of blood pressure
Avoid anesthesia until case is stable
Monitor until symptoms are alleviated

21. Central nervous system trauma
Brain damage :
Cats are twice as prone to brain injury than dogs
Basic care :
Move animal on a firm flat carrier and instruct owner to do so
Ensure patent airway , free from blood mucous or vomitus
Perform tracheal intubation and oxygenation
Administer cautious fluid therapy as it may increase cerebral edema if present
Monitor CNS vital signs : Consciousness, pupil sizes and responses, posture and motor functions, vision, charcter of respiration and presence of convulsions
Determine the use of mannitol , corticosteriods, anticonvulsants as needed

22. Spinal injury
spinal injury is very common in car accidents or falling from high places The assessment of the degree of damage requires certain neurological knowledge ,experience and diagnostic equipment The patient is to be refered to a specialist as soon as it is stabilized

23. Other examples of trauma
Ocular injury Wounds Burns Thoracic trauma Abdominal trauma

24. Thank you very much for your time
Dr Mohamed Hegab