So far in this First Aid blog series, we’ve talked about how to respond when you’re first on the scene to an accident involving your dog; and how to manage common injuries and illness on the scene. In this, the third part, we’ll look at what we’ll do when you bring a seriously injured dog into the practice.
Any injured or other emergency case will of course be given priority over routine consultations – so if you’re waiting for a vaccination appointment and you’re told the vet is busy with an emergency, spare a thought for that pet and their owners! If you bring your dog in with serious or uncertain injuries, you’ll get rushed through into a consult room too. Hopefully, you’ve been able to tell us what’s wrong with the dog over the phone or on arrival, but we will repeat that Primary Survey assessment – we need to know exactly what state your dog is in.
If we pick up anything immediately life-threatening at this stage, we’ll probably take them straight down to our prep room where we can work on them right away. Generally, the duty vet and nurse (or nurses) will take them so they can start to work, while another nurse or a receptionist goes through the consent forms with you.
Assuming, however, that there is no immediate danger, we’ll move onto a secondary survey with you, and ask you some more questions about the incident, and about whatever you may have done in the way of first aid. This isn’t so we can criticise you, it’s so we know what has happened so far!
At this stage, we’ll try to make a complete catalogue of all your dog’s injuries and then decide how we’re going to approach managing them. We may also use an ultrasound scan at this point, to look for internal bleeding or internal organ damage. We’ll often give pain relief at this point too – it is inhumane to make an animal wait for painkillers while we debate how to fix their injuries!
The first step in managing the trauma patient is stabilisation – dogs who have been seriously injured are usually in shock, either due to blood loss, crush injuries, or simply pain and distress. This means that they are very unstable to work on, and even a mild sedative may be dangerous. As a result, unless their injuries are really minor, we’ll usually admit them for medical stabilisation.
The exception is in dogs who are bleeding really badly – we need to stop the bleeding, and if pressure, packing or tourniquets (as discussed last time) don’t work, we’ll need to go in surgically and tie off or repair the damaged blood vessels. At the same time, we’ll start them on the stabilisation protocol as we would for any other injured dog.
Stabilisation involves putting them on intravenous fluids at a high rate (also known as “shock rate” or “shock bolus”) to support their circulatory system, make sure they have good pain relief, and then monitor them really closely for at least a couple of hours. In some situations, we may also provide oxygen through an oxygen tent or cage, to help oxygenate their blood. This phase may last a few hours, or overnight, until they are stable enough for either diagnostic tests and imaging, or definitive treatment of their injuries.
We will quite often take blood samples on admission, to check organ function, but these will often be normal even in the most severe injuries or blood loss. As a result, we’ll usually repeat the bloods once they are stable, to get a better idea of what’s going on. One of the most useful indicators in trauma is the PCV (packed cell volume, or haematocrit), which tells us how many red blood cells there are in the dog’s blood. Normal in a dog is between about 30 and 45 (depending on breed – greyhounds have more than most dogs). The lower it is, the more severe the blood loss. However, this change won’t show up immediately – because the dog has lost whole blood, the concentration of what’s left will be normal until they are rehydrated and their blood is diluted.
The other important test is X-rays, for fractured bones and other internal injuries. This usually requires sedation, so generally has to wait until they are stable.
Once we know what we’re dealing with, and the patient is stable, we can work to repair it – fixing broken bones, repairing damaged muscles and soft tissues, or whatever is required.
Of course, in some cases these stages are a bit mixed up – for example, sometimes, a dog will not survive without immediate surgery, so we go in straight away – but if possible, we’ll get them stabilised first.
Treatment of a severely injured dog is difficult – technically, physically and emotionally – but it’s worth it when we see them go home again. And to give your dog the best chance if they are ever injured, make sure you know how to give life-saving first aid, in case you ever have to.
If your dog is injured, call us as soon as possible for advice and so we can begin setting up to receive them.