First aid vn117

First aid & emergency care for small animals Emergency: A set of circumstances or a sudden unexpected event demands urgent action First aid: The immediate treatment of injured animals or those suffering from sudden illness

3 aims & 4 rules (An emergency in the absence of a vet is not a licence for the vet nurse doing first aid to practice veterinary medicine) Aims ◦Preserve life ◦Prevent suffering ◦Prevent the patient deteriorating Rules ◦Stay calm ◦Maintain the ABCs ◦Control haemorrhage ◦Contact the vet

The role of the NZ first aider Triage-sort emergencies from non urgent situations attend to life threatening injuries in the absence of the vet Notify the vet asap reduce suffering & promote healing

Classification of emergencies Life threatening and serious emergencies Lesser emergency Dysentry, protracted vomiting or diarrhoea and significant depression and lethargy Difficulty urinating but still passing urine Collapse or unconsciousnessStings Open fractures or those with wounds close to the broken ends Small wounds or burns Gaping wounds, severe haemorrhage or burns abscess DystociaWeight bearing lameness Serious emergencies require transport to the clinic without delay and may require life saving immediate action Minor emergency may require immediate veterinary examination or a scheduled appointment

Initial action plan-DRABCS Danger! begin scene assessment from a distance and think of safety issues- self, bystanders, animal Response! level of consciousness-Alert or only responds to voice or pain, is it unconscious or dead? YELL FOR HELP check Airway, Breathing, Circulation (15 sec)& Severe bleeding and treat any life threatening injuries (CPR etc start asap) ◦ONCE LIFE THREATENING PROBLEMS ARE SORTED OUT Tip of the nose to tip of the tail examination, Stabilisation of shock and other first aid conditions Transport to and contact the vet as soon as possible

Danger! Animals in distress may react abnormally and bite Muzzle may be required ◦If airway or breathing are compromised the animal is usually too distressed to attack effectively and a muzzle may be lifethreatening

Response Response Is the animal alert? or responds only to voice or pain? Is the animal unconscious or dead? Call for help if not responsive

CPR protocol Recent changes Assessment: ABC Treatment: CAB

Background to changes in CPR protocol Previous veterinary CPR protocols based on human advice RECOVER initiative (Reassessment Campaign on Veterinary Resuscitation)is an evidence based review of veterinary literature More information at Complete overview in the June 2012 issue of Journal of Veterinary Emergency and Critical Care

The chain of survival Early recognition High quality CPR Post resuscitation care Survival rates for animals in a clinic with anaesthetic emergency nearly 50% Very, very poor survival rates without support facilities and medication

The Unresponsive patient Assessment ABC: takes <15 seconds Airway: is it patent? tongue, look, straighten Breathing: look, listen, feel Circulation: palpable femoral pulse/heartbeat? (If no breathing and no pulse detected immediately move on. take 15 sec for this whole assessment otherwise it has taken too long) 100% sure NOT in arrest: do a complete survey Otherwise, start basic life support

Basic Life Support Treatment: CAB Compressions Airway Breathing Main difference is compressions are the most important part of treatment. Start with these! Algorithm based on 2 minute cycles before checking for signs of life

Compressions In general, done in right lateral recumbency Rate is bpm irrespective of size/species Compress 1/3 to ½ of chest Allow chest wall to recoil 2 minute cycles of compressions and rescue breathing without interruption

Compression techniques Interlacing hands, heel over heel, locked elbows Bend at the waist Cats and small dogs: one hand cardiac pump

Medium to large DOGS: thoracic pump B. Keel chested dogs: lateral, over the heart C. Flat chested dogs: on back, compress sternum A. Round chested dogs: lateral middle of chest

Airway - breathing Ensure airway patent: open mouth, pull tongue out to the side, look and remove obvious blockage, straighten head and neck Rescue breathing mouth to nose, entubate and supply 100% oxygen asap Inspiration, expiration pause If on own do 30 compressions to 2 breaths Breaths should be quick and completed within 5 seconds Don’t stop compressions to breathe if 2 people working CPR 10 breaths per minute

Your turn! To the tune of Staying Alive Staying Alive (or ‘Another One Bites the Dust)Another One Bites the Dust

Signs of effective CPR Early signs ◦Palpable pulse during CPR ◦Constriction of the pupil ◦Ventromedial rotation of the eyeball ◦MM colour improves ◦ECG changes Late signs ◦Lacrimation ◦Cranial nerve reflexes return (blink gag cough) ◦Spontaneous breathing

If in a veterinary clinic CPR performed in a clinic may involve the use of more resources than available elsewhere After checking ABC, perform CAB If no signs of life in the first 2 minutes DEF (administer Drugs, Electrodefibrillation, and Follow up with post crisis stabilisation of compromised body systems) om/watch?v=Gl11AOLli XE om/watch?v=Gl11AOLli XE

Follow up: After the event The animals body systems will be seriously out of balance even if the CPR has “saved” the animal’s life Seek veterinary assistance but get advice before moving the animal. The stimulus of movement may cause a set back.

choking If the animal is seen choking and is initially still conscious the protocol for first aid focuses on airway management until the animal becomes unconscious and unresponsive

Choke What can be done if a dog is choking? Why does it happen? What are the signs?

First step Initially, if your dog is capable of coughing, wait a few moments to see if your dog can manage to cough up the obstruction on his own If the problem continues, try to look in the dogs mouth and remove the blockage ◦ Restrain the dog and open its mouth using the dogs own lips to protect your fingers use a piece of cloth to help grab the tongue and move it out to the side ◦ If you see the object and it is easy to grasp and pull it is preferable to use a blunt spoon end or round ended pliers to dislodge it than your fingers ◦ Do not blindly sweep or reach down the throat

Second step If the airway blockage remains Tilt the dog or try chest compressionschest compressions

Third step: The heimlich manoever Third step: The heimlich manoever Small dog ◦Position: kneel behind or hold against your stomach ◦Use the one or two knuckles Medium and large dog ◦Position: stand behind ◦Use one fist

Step 4: CPR The dog is likely to become unconscious Begin CPR Continue CPR in transit to the vet

finally Even if the dog seems to have recovered a vet check for throat trauma that may lead to complications is advised

Severe bleeding and wounds

Priorities of wound care Bleeding stopped with pressure  Direct pressure  Bandage or improvised  If bandage soaks through add another on top Do not remove penetrating foreign objects  cut them short and ring bandage Protect exposed tissues from further contamination  Cover wound surface with commercial sterile dressing and bandage or clean, non stick, non fluff material Assess and treat shock ◦Wrapt

Bandaging technique Limb and foot bandage Ear bandage

Handling and transport Use least restraint possible & a quiet assertive approach-ensure airway not compromised (consider human safety) If ambulatory allow self movement Non-ambulatory carry in arms or …and ensure injuries supported Allow animal to lie in position it finds most comfortable Restrain and monitor in the vehicle Ensure safe procedures carpark to vet clinic

Scenario tasks With a group brainstorm your response to your scenario. Record your decisions and actions for others to share. Ensure you cover the following ◦classification of your emergency-explain why ◦Initial action plan ◦(Assume a full body examination found no other issues than those noted) ◦First aid stabilisation of shock and injuries ◦Positioning and transport issues

Scenario 1 A dog has been just been hit by a car and skidded across the gravel to the road edge. It hopped slowly towards you, and is now sitting with its mouth wide open and breathing hard. He has a skinned and lacerated paw that is bleeding, but not profusely

Scenario 2 First thing in the morning a huntaway is found with a bloated abdomen and having difficulty breathing.

Scenario 3 A Lab is having a grand mal fit. It has never had one before.

Scenario 4 A dog has been chasing sticks and it is suddenly distressed, pawing at its mouth, coughing and retching

Scenario 5 A crossbred dog has had itchy ears. It has been shaking its head and now one of its ears is very swollen

Scenario 6 The dog has just been run over and is lying in the road whining. It is lifting its head and scrabbling with its front paws but its hind end is not moving.