Canine Medical Care (FEMA Med Spec Course Unit 11A) Canadian Disaster Medical Specialist Course October 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. 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 OBJECTIVE 1 MEDICAL TEAM’S RESPONSIBILITIES/ ROLES IN CANINE CARE 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 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 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 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 Canine Medical Intelligence • Canine health threats – Trauma – Vectors – Endemic diseases – Environmental Conditions – Hazardous materials • Inhalation, skin contact, ingestion 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 Preventive Medicine: Hydration Preventive Medicine: Eye and Nasal Irrigation Preventive Medicine: Work-Rest Cycles Preventive Medicine: Paw Pad Inspection Preventive Medicine: Periodic Examinations Preventive Medicine: End of Operational Period Hygiene and Decon Evacuation: Preplan Veterinary Emergency Evacuation and Care Referral Capabilities/Medical Plan • • • • Surgical/trauma Critical Care Extended Care Specialties – Ophthalmology – Orthopedics 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 Emergency Veterinary Care • • • • • • • Lateral recumbent or prone position Airway Breathing Circulation Prevent heat loss Splint fractures Control Pain Assessment of Life-Threatening Conditions: Airway • Does animal have patent airway? 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 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 Assessment of Life-Threatening Conditions: Breathing Emergency Veterinary Care • Breathing – BVM assisted ventilation – Supplemental oxygen • 100% if available – Needle thoracostomy 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 Assessment of Life-Threatening Conditions: Circulation 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 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 OBJECTIVE 2 CANINE EVALUATION 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 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 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 (100.5-102.5F): 101.5F Canine Evaluation • Normal Values – Water maintenance ~Approximately 24ml/kg/hr or 3 L/24h (delete) • Additional workload needs – Palpable femoral pulse: Systolic SBP > 75 mmHg – Blood glucose: 80-125 mg/dl Evaluation Restraint • Muzzle and restraint during examination and minor procedures • Basket muzzle recommended with facial trauma or to allow panting Pulse Check Hydration and Cap Refill Canine Anatomy OBJECTIVE 3 ILLNESS/INJURY Common Problems • • • • • • Paw pad foreign body or laceration Broken toenail Eye foreign body Laceration Skin infections Fractures, soft tissue contusions Common Problems • • • • • • Hyperthermia, hypothermia Vomiting/diarrhea UTI Toxic ingestion Seizure (consider hypoglycemia) Allergy 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 Gastric Dilation-Volvulus Complex • Plan – Oxygen – Start fluid resuscitation • 20-30 ml/kg IV into forelegs – Consider OG tube for stomach decompression – EVACUATE Head Trauma • Treatment – – – – Oxygen Elevate head Maintain perfusion EVACUATE Spinal Trauma • Treatment – Immobilize in lateral position on a board – Pain control – EVACUATE Fractures • Treatment – Immobilize – Pain control – EVACUATE 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 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 Splinting Bandaging Right Wrong 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 IV Placement • Forelimb cephalic vein Cephalic Vein Saphenous Vein Subcutaneous Fluids FEMA Intramuscular Injections Biceps Quadriceps Caudal Semitendinosus Lumbar Entrapment, Engulfment, & BelowGrade 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 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 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 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 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 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 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 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 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 OBJECTIVE 4 EUTHANASIA 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 OBJECTIVE 5 POST-DEPLOYMENT SURVEILLANCE 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 WTC Morbidity 13% 8% 45% 20% 23% 35% 24% C.M. Otto, DVM, PhD, DACVECC, 5/03 N=65 of 96 Dogs Studied G.I. CUTS & ABRASIONS FATIGUE APPETITE CHANGE DEHYDRATION MUSCULOSKELETAL RESPIRATORY CANINE MEDICAL CARE UNIT SUMMARY AND EVALUATION Summary • • • • Canine preventive medicine Emergency veterinary care Canine evaluation Illness and injury in urban search and rescue • Euthanasia • Post-deployment surveillance CANINE MEDICAL CARE QUESTIONS?