Emergency Care for Dogs and Cats

When moving or transporting an injured animal, minimize motion of its head, neck, and spine. A flat, firm surface of wood, cardboard, or thick fabric can be used to provide support. If the animal acts confused or disoriented after trauma, keep the head level or slightly elevated during transport. Avoid any jerking or thrashing motions, and prevent anything from pushing on the neck or jugular veins. Placing cats in boxes can minimize stress during transport. The box should have holes large enough so that you can see the cat.

Any obstruction of the airways can be life-threatening. If the large airways (the trachea, commonly called the windpipe, and its 2 main branches, called the bronchi) are completely obstructed, the animal is unable to breathe and will be unconscious. If the large airways are only partially obstructed, the animal’s breathing will be noisy. The animal may be fearful, and its skin may appear to have a bluish tinge due to lack of oxygen. Possible causes of large airway problems include foreign objects, swelling (perhaps because of an allergic reaction), paralysis of the larynx, collapse of the trachea, and a longer soft palate than is usual. A potentially very serious situation called aspiration refers to breathing in stomach contents that have been vomited. This can lead to respiratory problems such as pneumonia and is one of the reasons why animals must be fasted before anesthesia and surgery.

Animals with severe small airway obstruction have difficulty breathing. They may wheeze and push out their diaphragm when exhaling. They may be fearful or anxious, and their skin, eyes, nailbeds, and other tissues may appear bluish. The animal may be sedated and given medication to expand the airways and make breathing easier. Common causes include allergic reactions; asthma (cats); and fluid, blood, mucus, or foreign material in the lungs.

If an animal is unconscious and not breathing, a tube will be placed through the larynx into the trachea to help it breathe. This is called tracheal intubation. If the upper airway is obstructed, oxygen can be given through a tube inserted below the obstruction to open the airway. The veterinarian will listen to ensure that the air is reaching the animal’s lungs. Heart sounds and pulses are checked and when absent, cardiopulmonary-cerebral resuscitation is done.

If the large airways are only partially obstructed by a foreign object, the veterinarian will remove the object if possible. A tracheal tube may be placed to deliver oxygen. The animal may need to be sedated to relieve anxiety. When tracheal intubation is necessary, sedation, likely general anesthesia, will be needed.

When animals have difficulty breathing, they breathe faster and breathing takes more effort. The breathing pattern often changes, followed by changes in posture. For example, dogs may stand with the elbows spread out and the back arched. Cats may crouch on all 4 limbs and raise their chest slightly, or sit high on the rear haunches and extend their head and neck. Obvious labored, open-mouth breathing and a blue tinge to the skin due to lack of oxygen develop last. These signs indicate significant loss of respiratory function.

The veterinarian will carefully observe the breathing pattern and listen to the animal’s chest. X-rays or other tests may be necessary after the animal has been stabilized. Oxygen is administered by a tracheal tube, a mask, a hood, or other method. The animal may be sedated to relieve anxiety. After the animal has been stabilized, additional tests may be done.

One cause of breathing problems is pleural space disease. The pleural space is the area between the membrane covering the lungs and the membrane lining the chest cavity. In this condition, air, fluid, or abdominal contents are in the pleural space. The veterinarian will hear muffled lung sounds over the affected regions. Treatment of pleural space disease begins with the veterinarian using a needle or catheter to remove the air or fluid that is free in the chest cavity. This procedure relieves the tension within the chest, allowing the heart to beat and the lungs to expand. A chest tube is then placed to continue to relieve the pressure.

Several indicators are used to determine how well the animal’s circulatory system is functioning. These include heart rate, mucous membrane color, capillary refill time, and pulse intensity. Listening to the animal’s heart and breath sounds will help the veterinarian determine what circulatory problems may exist.

Shock is the medical term for changes that develop when the body attempts to compensate for limited heart function, blood volume, or circulation. Shock can develop in many emergency situations, including head trauma, excessive blood or fluid loss, and severe infection. Signs of shock include a rapid heart rate, pale mucous membrane color, very low blood pressure, very little urinary output, and weak pulses. As shock progresses, delivery of oxygen and other nutrients to the tissues drops, eventually leading to organ failure and ultimately death.

Recognizing the type and stage of shock early is vital to treatment. Shock is typically classified into 3 categories: hypovolemic, cardiogenic, and distributive. Hypovolemic shock develops when blood volume is low, usually from loss of blood due to traumatic injury or loss of fluid through metabolic processes. Cardiogenic shock results when the heart fails, no longer pumping blood to the lungs or the rest of the body. Distributive shock is caused by blood flow being directed away from the central circulation because of a problem with peripheral blood vessels and is usually associated with serious widespread infections.

The goal of treatment for shock is to deliver blood to the tissues, bringing oxygen and other nutrients. Oxygen can be administered by a mask, bag, nasal or tracheal tube, or another method. Bleeding must be controlled. However, internal bleeding may not be evident until blood pressure and circulation are restored. Fluids and blood products will be given intravenously as needed to replace what has been lost. Abdominal counterpressure may be used to reduce abdominal bleeding, when present.

Medication to relieve pain is usually provided quickly. Narcotics or local anesthetics can be used. Your veterinarian may use other medications as well.

Accidents, falls, and fights with other animals may result in different types of trauma. In blunt trauma, the animal has been struck by an object (such as a car) but the skin was not penetrated. Blunt trauma is commonly associated with internal bleeding, organ rupture, fractures, and head injuries. In penetrating trauma, a sharp object, such as an arrow or bullet, pierces the skin, and injuries are related to the path of the penetrating object. Falling from a height can cause multiple bone fractures, as well as injuries to the chest and organs. A dog bitten by another larger dog can have deep penetrating bite wounds and will frequently have spinal injuries and tracheal rupture from the thrashing motions experienced during the attack.

For all types of trauma, airway, breathing, and circulation are evaluated and stabilized as described above. Control of bleeding, oxygen if needed, and pain relief are also given immediate attention. After stabilization, the nervous system, chest, abdomen, and bones are carefully evaluated. Blood tests, urine tests, and x-rays may be performed as needed. Trauma to the eye is also a common emergency (see Eye Emergencies).

Animals that have suffered a trauma often have multiple injuries, some of which may not be immediately obvious. Whenever the animal is moved or being examined, the neck and spine should be kept still in case there are spinal fractures or other problems that cannot be readily seen. Broken legs may be wrapped with bandages or splinted. Because many problems are not apparent for 12 to 24 hours after trauma occurs, your pet needs careful monitoring in the veterinary hospital.

Some traumatic injuries to the chest are potentially life-threatening. Bruising of the lungs, air in the space around the lungs (called pneumothorax), heart rhythm problems, internal bleeding, and rib fractures are emergencies that may result from blunt trauma.

Tests to help determine the extent and severity of the problems include chest x‑rays, blood tests, and an electrocardiogram (ECG). A procedure called centesis, in which a needle is inserted into the chest or abdomen of the animal to remove fluid or air, may also be performed. Laboratory examination of any fluid removed can help with diagnosis.

Severe bruising of the lungs causes labored breathing and lack of oxygen to the tissues. Oxygen treatment may require sedation and tracheal intubation, in which a tube is inserted into the trachea to help the animal breathe. When bruising is severe, ventilation (in which air is forced mechanically in and out of the lungs) may be required to provide the best chances for survival.

If air or fluid is trapped inside the animal’s chest cavity, a tube may be inserted through an incision in the chest to drain the air or fluid. Surgery may be recommended either immediately or after several days if the animal does not improve.

A condition called flail chest may be caused by blunt trauma that breaks 3 or more ribs. The portions of ribs that have broken off, called flail segments, may be stabilized by using an external frame of metal rods or cast material that is formed to the shape of the chest. The animal must generally be anesthetized, and surgery is usually necessary.

Bite wounds over the chest must be cleaned and drained. The puncture holes seen on the skin from the bite are only a small portion of the significant damage that may have occurred to the muscles and tissues underneath the skin. Surgery may be required if the wound is penetrating or if there is significant bruising or swelling.

Heart rhythm abnormalities, particularly fast heart rhythms, are often seen after trauma. A sedative may be used to relieve anxiety and slow the animal’s heart rate. The animal should be treated aggressively for shock, and an electrocardiogram should be done to look for primary heart rhythm problems.

The extent and severity of abdominal injuries are not always obvious immediately. If the abdominal wall is torn open, the injury is clearly serious. Bruising, road burns, cuts, scrapes, swelling, a change in the shape of the abdomen, or pain may indicate internal injuries. If your pet appears to have abdominal pain and is in shock, internal bleeding may be present. The spleen, liver, or kidneys may be injured. All abdominal organs have blood vessels that can be injured by blunt trauma.

It may take several hours for specific signs of an injury to an abdominal organ to appear. Your veterinarian will watch closely for sharp abdominal pain. Abdominal x-rays or ultrasonography may show the location of injury. If fluid is present in the abdomen, a needle may be inserted into various locations to remove it. The fluid is then examined for any evidence of infection, rupture of an organ, cancer, or other problems.

Sometimes, a catheter is placed through an incision in the animal’s abdomen, and warm saline solution is flowed into the abdomen. The fluid is left in the abdomen for several minutes and then drained. This process is called peritoneal lavage. If the fluid is clear, significant internal abdominal bleeding is unlikely. Some blood in the fluid indicates mild bleeding. More blood in the fluid indicates significant abdominal bleeding that warrants careful monitoring and may require surgery. However, bleeding may be present even if the peritoneal lavage shows little or no blood in the fluid. Pelvic fractures in particular may cause complications, including bleeding, that often are not found by peritoneal lavage.

If internal bleeding or other serious internal problem is found, emergency surgery may be needed.

Mouth-to-nose resuscitation is the first step of CPCR. This continues until the veterinary staff can insert a tube to deliver oxygen and help the animal breathe with mechanical ventilation. Chest compressions are used to promote circulation when no pulse is present. The animal is positioned on its back or its side (depending on size) and supported as needed while compressions are performed over the area of the heart. The goal is to improve the return of the blood to the heart between beats.

Constant monitoring is important during basic life support procedures. If circulation continues to fail, additional procedures or drugs may be necessary.

In advanced life support, heart rhythms are monitored by electrocardiogram, and drugs or defibrillation may be used. The purpose is to reestablish the heartbeat.

Fluids are administered, usually intravenously (IV), to promote circulation. Sometimes, blood products are also given.

If basic life support has not been successful, meaning that the animal does not begin to breathe on its own or have a normal heartbeat after 5 to 10 minutes, open-chest cardiopulmonary resuscitation (CPR, see Emergency Care for Dogs and Cats : Open-chest Cardiopulmonary Resuscitation (Emergency Thoracotomy)) may be started. Sometimes open-chest CPR is begun earlier. In severe trauma with blood loss, the chest may be opened to assess the injury as well as to perform CPR. In a large dog, external compressions may not generate enough blood flow. You should make your wishes known to the veterinary team as quickly as possible regarding your permission for open-chest CPR. This technique can be life-saving, but it carries additional expense and requires surgery to close the chest.

When chest compressions are not successful in restoring the heartbeat, the chest may need to be opened to allow access to the heart. If blood has pooled around the heart in the tissue sac called the pericardium, the pressure from this fluid can be relieved by opening the sac. If the heart is not beating, the veterinarian grasps the heart with one or both hands and compresses it. The compression is then released to allow the heart chambers to refill with blood. If blood loss is severe or poor circulation has been prolonged, certain blood vessels may be clamped to direct blood flow to the brain. This is a temporary measure, usually up to 10 minutes.

If the heart begins to beat again, the open chest is rinsed with sterile, warm salt water, and a chest tube is placed before the chest is closed. Treatment continues while the underlying cause of the arrest is determined.

Maintaining volume in the blood vessels and the tissues of the emergency patient is vital. Signs of dehydration (fluid loss in the tissues) include dry skin that does not “smooth” back into its normal position after being pinched, dry mucous membranes, and sunken eyes. When fluid is given, it is distributed evenly throughout the body. This rehydrates a dehydrated animal. However, excessive water volume can cause swelling, called edema. Specific types of fluids are given to injured animals to meet their specific bodily needs.