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Canine Medical Care (FEMA Med Spec Course Unit 11A) Canadian Disaster Medical Specialist Course October 8-12, 2013.

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Presentation on theme: "Canine Medical Care (FEMA Med Spec Course Unit 11A) Canadian Disaster Medical Specialist Course October 8-12, 2013."— Presentation transcript:

1 Canine Medical Care (FEMA Med Spec Course Unit 11A) Canadian Disaster Medical Specialist Course October 8-12, 2013

2 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.

3 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

4 MEDICAL TEAM’S RESPONSIBILITIES/ ROLES IN CANINE CARE OBJECTIVE 1

5 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

6 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

7 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

8 Pre-Deployment Information Current annual physical, vaccines, travel documents if required Mobilization check-in –Hydration, pulse, respiration, attitude, temperature Immediate health concerns –Infectious disease –Current injuries/illness –Recent medical/surgical history –Reproductive status (no females in heat!) –Nutrition

9 Canine Medical Intelligence Canine health threats –Trauma –Vectors –Endemic diseases –Environmental Conditions –Hazardous materials Inhalation, skin contact, ingestion

10 Canine Health Maintenance Review canine health information at mobilization site Assist handlers with preventive care –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

11 Preventive Medicine: Hydration

12 Preventive Medicine: Eye and Nasal Irrigation

13 Preventive Medicine: Work-Rest Cycles

14 Preventive Medicine: Paw Pad Inspection

15 Preventive Medicine: Periodic Examinations

16 Preventive Medicine: End of Operational Period Hygiene and Decon

17 Evacuation: Preplan Veterinary Emergency Evacuation and Care

18 Referral Capabilities/Medical Plan Surgical/trauma Critical Care Extended Care Specialties –Ophthalmology –Orthopedics

19 Emergent Canine Medical Care 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

20 Emergency Veterinary Care Lateral recumbent or prone position Airway Breathing Circulation Prevent heat loss Splint fractures Control Pain

21 Assessment of Life-Threatening Conditions: Airway Does animal have patent airway?

22 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

23 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

24 Assessment of Life-Threatening Conditions: Breathing

25 Emergency Veterinary Care Breathing –BVM assisted ventilation –Supplemental oxygen 100% if available –Needle thoracostomy

26 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

27 Assessment of Life-Threatening Conditions: Circulation

28 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

29 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

30 CANINE EVALUATION OBJECTIVE 2

31 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

32 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

33 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

34 Canine Evaluation Normal Values –Water maintenance ~Approximately 2- 4ml/kg/hr or 3 L/24h (delete) Additional workload needs –Palpable femoral pulse:Systolic SBP > 75 mmHg –Blood glucose:80-125 mg/dl

35 Evaluation

36 Restraint Muzzle and restraint during examination and minor procedures Basket muzzle recommended with facial trauma or to allow panting

37 Pulse Check

38 Hydration and Cap Refill

39 Canine Anatomy

40 ILLNESS/INJURY OBJECTIVE 3

41 Common Problems Paw pad foreign body or laceration Broken toenail Eye foreign body Laceration Skin infections Fractures, soft tissue contusions

42 Common Problems Hyperthermia, hypothermia Vomiting/diarrhea UTI Toxic ingestion Seizure (consider hypoglycemia) Allergy

43 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

44 Gastric Dilation-Volvulus Complex Plan –Oxygen –Start fluid resuscitation 20-30 ml/kg IV into forelegs –Consider OG tube for stomach decompression –EVACUATE

45 Head Trauma Treatment –Oxygen –Elevate head –Maintain perfusion –EVACUATE

46 Spinal Trauma Treatment –Immobilize in lateral position on a board –Pain control –EVACUATE

47 Fractures Treatment –Immobilize –Pain control –EVACUATE

48 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

49 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 –EVACUATE

50 Splinting

51 Bandaging RightWrong

52 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

53 IV Placement Forelimb cephalic vein

54 Cephalic Vein

55 Saphenous Vein

56 Subcutaneous Fluids FEMA

57 Intramuscular Injections Biceps Caudal Lumbar Quadriceps Semitendinosus

58 Entrapment, Engulfment, & Below- Grade 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

59 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

60 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

61 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

62 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

63 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

64 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

65 Chemical Agents K9 Antidote Doses Vesicants: thorough skin and fur decon –Ingestion may cause upper airway, respiratory, and gastrointestinal symptoms Nerve agents/organophosphates –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

66 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

67 EUTHANASIA OBJECTIVE 4

68 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

69 POST-DEPLOYMENT SURVEILLANCE OBJECTIVE 5

70 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

71 WTC Morbidity N=65 of 96 Dogs Studied C.M. Otto, DVM, PhD, DACVECC, 5/03

72 UNIT SUMMARY AND EVALUATION CANINE MEDICAL CARE

73 Summary Canine preventive medicine Emergency veterinary care Canine evaluation Illness and injury in urban search and rescue Euthanasia Post-deployment surveillance

74 QUESTIONS? CANINE MEDICAL CARE


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