PowerPoint Presentation

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

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.2ObjectivesIdentify Medical Teams responsibilities and roles in canine careDiscuss canine evaluation modelDiscuss canine illness, injury and treatment in urban search and rescueIdentify veterinary resourcesIdentify euthanasia issues3Medical Teams Responsibilities/ Roles in Canine CareOBJECTIVE 14Medical Teams RoleAssist handlers Mobilization and post-shift physical examsMobilization: Temp, pulse, resp, auscultatePost-shift: Vitals, chest, eyes, skin, feetProvide care for minor to moderate illness/injuryProvide emergent care5Medical Teams RoleArrange referral veterinary careLocal, provincial, or regional resourcesPrivate practice, small animal veterinariansVeterinary emergency clinics and hospitalsNotify of particularly high-risk operations

6NVRT is National Veterinary Response TeamHandlers ResponsibilityBring healthy, immunized animalCore vaccinationsRecommended vaccinations (AAHA)Provide preventive careRest, food, fluids, medications, etc.Bring canine health problems to Medical Teams attentionControl animal before evaluationAssist in evaluation and care7Reference core vaccines to the AAHA (American Animal Hospital Association) websitePre-Deployment InformationCurrent annual physical, vaccines, travel documents if requiredMobilization check-inHydration, pulse, respiration, attitude, temperatureImmediate health concernsInfectious diseaseCurrent injuries/illnessRecent medical/surgical historyReproductive status (no females in heat!)Nutrition8Canine Medical IntelligenceCanine health threatsTraumaVectorsEndemic diseasesEnvironmental ConditionsHazardous materials Inhalation, skin contact, ingestion9Convey info to Search Team ManagersCanine Health MaintenanceReview canine health information at mobilization siteAssist handlers with preventive careWater and foodTransportation mode safetyWork-rest cyclesAnticipated mission hazardsHygiene or decontamination at end of operational periodsDaily check in with medical team

10Preventive Medicine: Hydration

11Preventive Medicine: Eye and Nasal Irrigation

12Preventive Medicine: Work-Rest Cycles

13Preventive Medicine: Paw Pad Inspection

14Preventive Medicine: Periodic Examinations

15Preventive Medicine: End of Operational Period Hygiene and Decon

16Evacuation: Preplan Veterinary Emergency Evacuation and Care

17Referral Capabilities/Medical PlanSurgical/traumaCritical CareExtended CareSpecialtiesOphthalmologyOrthopedics

18Emergent Canine Medical CareMinor problemsMajor illness/injuryDefinitive versus supportive careSimilar to emergency medicineVeterinary medicine referralIST veterinarian via IST medicalLocal vs tertiary veterinary care19Emergency Veterinary CareLateral recumbent or prone positionAirwayBreathingCirculationPrevent heat lossSplint fracturesControl Pain

Assessment of Life-Threatening Conditions: AirwayDoes animal have patent airway?

21Emergency Veterinary CareAirway AssessmentExtend 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 position22Emergency Veterinary CareAirway: Apneic PatientFace-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 tubeEndotracheal tube size: 8.0-12.0 mm O.D.Consider digital intubationAssessment of Life-Threatening Conditions: Breathing

24Emergency Veterinary CareBreathingBVM assisted ventilationSupplemental oxygen100% if availableNeedle thoracostomy25BreathingNot intubatedMouth-to-Nose (visible chest rise)IntubatedRate 20-25 breaths/minute, visible chest rise1:3 ratio with CPR, continuous chest compressionIf alone give 2 ventilations to every 15 compressions 100% oxygen if possibleAssessment of Life-Threatening Conditions: Circulation

27Emergency Veterinary CareCirculationDirect pressure control of hemorrhageFemoral pulseIV 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 effectCirculationIf pulseless: place on left lateral side in trendelenburgTrauma patients are left on whatever side they presentCompression- palm of hand over highest part of chestRate 100 per minute29Canine EvaluationOBJECTIVE 230Canine EvaluationHandlerProvides historyConveys dogs behavioral normAssists in exam and treatmentMonitors animal to the extent of their individual capabilityGiven guidelines w/r to TPRReport changes to medical31Canine EvaluationMedical PersonnelSimilar to pediatric patentCareful observationGentle thorough exam, head to tailRespiratory status, perfusion, mental statusPain control as neededVeterinary consultation earlyCanine EvaluationNormal values based on 80 to 90 lb dogHeart rate (60-140 beats/min): 120/minSinus arrhythmia is normalHeart rate can be to 180/min after exerciseRespiratory rate (10-30): 24/min Core Temperature (100.5-102.5F):101.5F33Canine EvaluationNormal ValuesWater maintenance ~Approximately 2-4ml/kg/hr or 3 L/24h (delete)Additional workload needsPalpable femoral pulse:Systolic SBP > 75 mmHgBlood glucose:80-125 mg/dl

Evaluation

35RestraintMuzzle and restraint during examination and minor proceduresBasket muzzle recommended with facial trauma or to allow panting

36Pulse Check

37Dorsal metatarsal artery another optionHydration and Cap Refill

38Color pink, CRT < 2 seconds; moist mm; normal activity water maintenance 2-4 ml/kg/hr, ~3 liters/day Canine Anatomy

39Hand placement for CPRIllness/InjuryOBJECTIVE 340Common ProblemsPaw pad foreign body or lacerationBroken toenailEye foreign bodyLacerationSkin infectionsFractures, soft tissue contusions41Common ProblemsHyperthermia, hypothermiaVomiting/diarrhea UTIToxic ingestionSeizure (consider hypoglycemia)Allergy42Gastric Dilatation-Volvulus SyndromeStomach obstruction due to twisting of the stomach, fatal if untreatedSignsDistended tympanic abdomenNon-productive retchingRestless pacing, salivationShock

Gastric Dilation-Volvulus ComplexPlanOxygenStart fluid resuscitation20-30 ml/kg IV into forelegsConsider OG tube for stomach decompressionEVACUATE

44Fluids in forelegs due to risk of abdominal compartment syndrome Head TraumaTreatmentOxygenElevate headMaintain perfusionEVACUATE

45Spinal TraumaTreatmentImmobilize in lateral position on a boardPain controlEVACUATE

46FracturesTreatmentImmobilizePain controlEVACUATE

47WoundsMinorClean and bandageLaceration closureMajorCover with protective dressingImmobilize dog if possiblePain control: topical lidocaine for foot pad; up to 2 mg/kg lidocaine local wound infiltration for skin

48Ocular InjuriesRed eyesIrrigateAssess for corneal ulcers, retained foreign bodyOcular traumaIrrigate, lubricate (artificial tears or topical antibiotic)Consider E collar to prevent self-traumaEVACUATE49Splinting

50BandagingRight

Wrong

51Dressings and SplintsDressings Include limb distal to the wound SplintsWrap from distal to proximal to prevent tourniquet effectInclude joints above and below fracture52IV PlacementForelimb cephalic vein

53Cephalic Vein

54

Saphenous Vein

55Subcutaneous FluidsFEMA

56

Intramuscular InjectionsBicepsCaudalLumbarQuadricepsSemitendinosus57Advantages and disadvantages (sciatic nerve)Entrapment, Engulfment, & Below-Grade Search Operations - Non WMD ParticulatesHousehold, office, commercial, and industrial chemicals, and radiologicalsGases and vaporsNatural gas, LPG, refrigerants, ammonia, chlorine, sewer gases, fossil fuels, solvents58Exposure and Absorption Risks - Non-WMDInhalationSkin absorption (fur may offer some protection)Ingestion: canines personal grooming behavior may result in GI symptoms in addition to other organ system symptomsInduced emesis using 3% hydrogen peroxide within few minutes to 2 hours post-ingestion of toxic substance other than corrosive, hydrocarbon, or with altered mental status59Toxic Ingestion HazardsCommon chemicals, foods, and drugs encountered during search operations in damaged structureEthylene glycol in antifreeze: kidney failureAntidote: fomepizoleAcetaminophen (Tylenol): liver failureAntidote: acetylcysteineChocolate: seizuresRodenticides: bleeding disorder, seizures60Emergency Decon - Non-WMDAcute symptoms: upper airway/respiratory distress, altered mental status/ unconsciousness, seizures, vomitingPersonnel with access to PPE and water supplyCommunication with canine may be difficult through respirators61Emergency Decon - Non-WMDMuzzle as neededWater deconEye and wound irrigation, consider topical ophthalmic anestheticHand dishwashing soap if availableConsult IST emergency veterinary care62End of Operational Period Hygiene and Decon - Non-WMDBulk dust removal with dampened clothCanine equipment wash (collar and vest)Water wash, hand dishwashing soapWarm water as availableThorough dryingHairdryer as availableHealth surveillance 63WMD EnvironmentsEmergency decon preplanRoutes of absorption include ingestion as well as inhalation and skin contactEffective decon versus disposal of collars and vests64Chemical Agents K9 Antidote DosesVesicants: thorough skin and fur deconIngestion may cause upper airway, respiratory, and gastrointestinal symptomsNerve agents/organophosphatesAtropine: 0.05-0.1 mg/kg IM or IVPralidoxime: 20 mg/kg IM or IVAerosolized Albuterol: 2.5-5 mgDiazepam: 0.25-0.5 mg/kg IV(comparatively higher than human dose)CyanidesSodium thiosulfate 25% solution: 1.65 ml/kg IV65Radiologicals and BiologicalsRadiologicalsIngestion more likely route of exposure than in humansAlpha-emitters particularly mutagenic when ingested or inhaledAlpha-emitter detection on fur or skin can be reduced by presence of waterBiologicalsIngestion more likely route of exposure than for humansHealth surveillance66EuthanasiaOBJECTIVE 467Euthanasia ConsiderationsInvolve handler in ALL decisionsDecisions very individualizedHumanitarian relief of pain and sufferingVeterinary consultation and evaluationTransport to veterinary emergency hospital preferredPreferably performed by veterinarianMorphine, diazepam, then succinylcholine as an alternative (very high doses)Handler stress intervention68Post-Deployment SurveillanceOBJECTIVE 569Symptom or Syndromic SurveillanceFollow up on injuries sustained while deployedFollow up on symptoms occurring during deploymentEvaluation of new-onset symptomsHealth evaluation for future deployments70WTC MorbidityN=65 of 96 Dogs StudiedC.M. Otto, DVM, PhD, DACVECC, 5/0371Of the 96 dogs at the 3 sites, a total of 65 dogs dogs suffered morbidity during deployment.This chart represents a breakdown of the most commonly identified injuries and illnesses.GI signs were the most common signs reported and included vomiting, diarrhea and weight loss. (pink at 6)Cuts and abrasions were also common w/ 35% of the dogs affectedOverlap in groups!!! certain dogs had multiple morbidities so total >100 (fatigue, change in appetite and dehydration b/c tended to run together)Incidence of respiratory disorders was remarkably lowUnit Summary and EvaluationCANINE MEDICAL CARE72SummaryCanine preventive medicineEmergency veterinary careCanine evaluationIllness and injury in urban search and rescueEuthanasiaPost-deployment surveillance73Questions?CANINE MEDICAL CARE