Tag Archives: emergency

CPR – What can you do at home?

Keeping a cool head in the event of a life-threatening injury may be the only thing that gives your pet a chance higher than zero to survive.  The statistics are sadly pretty dismal.  About 6% of pets that undergo cardiac arrest survive to leave the hospital.  The aftercare of a successful resuscitation is incredibly important, which means that a pet MUST go to a critical care facility for intensive care after a resuscitation.

Six percent.  Why bother?  The blunt truth is that the reason for the arrest informs the likelihood of success.  A patient that’s very sick with cancer or organ failure or  heart disease isn’t likely to make it.  A younger animal in a trauma case or some other accident has a better chance of surviving.  I think it’s worth it if your pet is otherwise young and healthy.  Even if it’s not, it’s important for you as an owner to feel that you’ve done everything you can.  Trying CPR is one of the things that you can do wherever you are, including on your way to the hospital.

CPR (cardiopulmonary resuscitation) in pets is very similar to what is done in people.  Recently, the human CPR guidelines/instructions were changed.  Veterinarians have adopted the same recommendations for pets.  I’ll briefly go through the steps here.

First, you need to determine if your pet is breathing and has a pulse.

Breathing can be assessed by the rise and fall of the chest, or the motion of air through the nose, which you can feel with your hand on most dogs.  There is a breathing pattern called an “agonal breath” that is NOT actual breathing.  This happens when an animal has undergone arrest.  A pet may open its mouth wide and the chest may heave, but it’s not a normal breath.  I promise that if you see this, you will not mistake it for a normal breath.

The pulse is best felt on the inside of the thigh.  The videos below shows you where to feel for a pulse.  It will take a bit of pressure to feel the femoral artery.  My best tip for this is to find the thigh bone and move your fingers into the sort of groove formed by the muscles in front of and behind the bone.  The pulse may be weak and just barely there, but that still counts.  You can also put your ear against your pet’s chest, but there’s a caution with this strategy.  Hearing a heart noise does NOT necessarily mean that the heart is generating a pulse and circulating blood.

If you don’t have breathing, but you do have a pulse, you can start rescue breathing.  First, open the mouth and make sure there isn’t anything blocking the airway.  If there is, get it out before you start rescue breathing.  The next step is to close your pet’s mouth.  Seal your mouth around the nose of the pet and gently breathe out.  You only breathe out until you see your pet’s chest rise a little bit.  It is entirely possible for you to overpressurize the lungs and cause severe damage.  So, just enough breath to raise the chest a bit.  You should repeat two breaths every 4-6 seconds.   You can stop if your pet starts to breathe on its own.

If there is no breathing and no pulse, or just no pulse, you will need to start chest compressions.  This is where the guidelines have changed.  It was decided that chest compressions are more important than the breathing, so instead of airway-breathing-circulation, we have circulation-airway-breathing.

Compressions for most pets are accomplished with the pet on its side.  For dogs, you’ll want to place your hands on the chest right where the elbow would touch the ribcage if you pulled the elbow up and back.  It’s at the 4th-6th rib spaces.  Compressions should be done with you on your knees and bent over your pet.  Your elbows should be locked and you should have your hands placed one atop the other.  You’ll push the chest down about 1/3 of its total thickness.

Figure4a

Figure4c

Figure5a

(Images credited to the Journal of Veterinary Emergency and Critical Care.)

The pace of the compressions should match the beat for one of these songs:   Stayin’ Alive (Bee Gees), Another One Bites The Dust (Queen), or Cecilia (Paul Simon).  Compressions continue for a total of 30 compressions before you then breathe for your pet.  For very small dogs or cats, you can use one hand to perform compressions by slipping your fingers under the chest and “pinching” the chest between your thumb and fingers.  You will need to brace your pet’s back so that you can keep your pet in place for effective compressions.  For big round-chested dogs like bulldogs, you should position your pet on its back and compress the chest in that position, right over the breastbone, just like for people.

Compressions and breathing should continue for 2 minutes, after which you can reassess breathing and pulse.  If there is another person with you that can continue compressions after the quick check, you should trade off.  CPR is more exhausting than it seems, and it’s important that you don’t get too tired to perform effective compressions.

If, after 20 minutes, your pet has not had a heartbeat or breathing resume, it’s time to stop resuscitation.  If you become too exhausted to continue, then you’ve done all you can, and stopping is OK.

If you’re one of the lucky 6% and your pet’s heartbeat and breathing come back, get to the emergency hospital as quickly as you can.  Emergency-critical care is required because these pets need 24 hour monitoring and often fairly complex treatments.

Here are a few links to help review and show the CPR procedure.  Keep in mind that the recommendations have changed to be C-A-B instead of A-B-C.

The video below is a live dog that they’re demonstrating on, so she was absolutely incredible through the procedure. The timing of the breaths and compressions here is NOT too accurate compared to current recommendations.

The next video is a practice dummy. This is an older video as well, but there are good examples of how to locate the heart and how to breathe for your pet.

Cornell reports on the new recommendations, including timing and length of CPR.

AVMA info on CPR.

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Resources for information on Canine Circovirus

Many of our clients have called and sent email to ask about Canine Circovirus. The news has picked up the stories of dogs in Ohio, California, and Michigan. New information is somewhat hard to come by. The virus isn’t thoroughly understood at this point in time. Investigators are working hard to bring us more information. In the meantime, here are a few links that lead to more info on Circovirus.

Circovirus FAQ from the AVMA

Guidance for Veterinarians about Circovirus

Information from Michigan State University’s Diagnostic Center for Population and Animal Health:

LANSING, MI – Based on recent cases in California and Ohio that may indicate the emergence of a new canine circovirus, the Diagnostic Center for Population and Animal Health (DCPAH) at the Michigan State University College of Veterinary Medicine has added two real time PCR assays for canine circovirus to its test catalog. Running two PCRs for this virus is important as the initial research on the virus indicates some genetic variation. The PCR assay can be run on fresh or formalin-fixed tissue. DCPAH has received requests for canine circovirus testing from Michigan clients and two positive results have been found. However, both animals also had simultaneous infections with other organisms; therefore identification of the circovirus was not necessarily linked to the cause of the disease shown by the animals. DCPAH is currently working on an in situ hybridization (ISH) technique which is a crucial next step. ISH is a method that uses DNA or RNA probes to detect virus in microscopic lesions.

“It is important to note that circovirus has been found in the feces of healthy dogs. Also, the initial research shows that nearly 70% of dogs showing clinical signs of illness and found positive for circovirus were also infected with other viruses or bacteria known to cause disease. Currently, circovirus by itself is not associated with a specific disease process. However, coinfection with canine circovirus and other pathogens may have the potential to cause disease as has been demonstrated in other species, for example pigs,” says DCPAH acting director Thomas Mullaney.

Matti Kiupel, section chief for DCPAH’s pathology laboratory adds, “In order to link circovirus to the cause of a disease process, a full diagnostic work-up (including a postmortem in the case of deceased animals) is essential. This also allows diagnosticians and pathologists to identify the full spectrum of infections and/or diseases that are present in a specific case.”
Recent publicity about circovirus in Michigan dogs is not cause for panic. Veterinarians should consider possible circovirus infection in animals showing clinical signs including vomiting, diarrhea (possibly hemorrhagic) only after other more common causes have been diagnostically excluded. Ascites, pleural effusion, hypovolemic shock, bicavitary hemorrhage, and disseminated intravascular coagulation may also be present, but as with gastrointestinal symptoms, more common causes should be excluded. According to the early research by Li et al, circovirus “should be considered in cases of unexplained vasculitis in dogs.”

Dog owners whose pets show signs of illness, including vomiting, diarrhea, lethargy, should contact their veterinarian and seek diagnosis and treatment. There is no evidence to-date that canine circovirus can be transmitted to humans or cause human disease. Since many pathogens are transmitted from animals to humans (zoonotic diseases such as rabies, leptospirosis, salmonellosis) thorough hand-washing should be standard practice after handling animals, especially those showing signs of illness, or animal waste.

Additional information on circovirus developed by the American Veterinary Medical Association (AVMA) for veterinarians and the general public is available on the DCPAH website at animalhealth.msu.edu.

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Wow!

Dr. Wright and I both have over 10 years of experience being vets.  We’ve both worked in emergency hospitals, and we’ve both seen our fair share of crazy things.  It takes quite a bit to rile us up.  Usually, when a receptionist or technician lets us know that there’s an emergency coming in, we’ve dealt with the problem before.  Sometimes, what’s coming in is a new experience or a big twist on an old theme.  In the past 2 weeks, we’ve had that happen twice.

The first case was a dog with a fishhook.  That’s nothing special — happens all the time.   The hook usually ends up in the lip or the tongue, which is easy to deal with.  A quick pop of anesthesia, push the hook through, cut it off, and you’re done.

This one?  Not so easy!  We had a bit of line coming out of the dog’s mouth with no hook in sight.  I decided it must be partway down the throat, which is still reasonably easy to retrieve.  We took an x-ray to confirm.  I was wrong.  The hook and swivel attachment were in the stomach.

After discussing the possibility for using an endoscope to retrieve the hook, the owner opted to have us retrieve it from the stomach surgically.  As it turns out, this was the right way to go.  Though I didn’t know it at the time we started surgery, this dog had swallowed the hook, then tried to run on the dock.  The line and fishing pole were enough weight to set the hook in the stomach.  What should have been a simple hook retrieval turned into quite an ordeal.  Definitely not one of the simpler surgeries that I’ve completed.

We did all right, though!  The dog has made a good recovery and shouldn’t be any worse for the wear.  Moral of the story:  keep your dog away from fishing tackle.

The second case is quite a bit more shocking.  We’re all familiar with the usual risks for small dogs.  They have problems with dental disease, heart disease, back injuries, and higher risk for injuries from jumps and so on.  What doesn’t always occur to us is the risk of a dog becoming prey for a larger wild species.  Hawks are a prime example of this kind of risk.

A very small dog was outside in the yard with the owner.  He heard a scream and turned to see a large hawk standing on his dog.  He managed to scare the hawk away, scooped up his dog and raced to the hospital.

Dr. Wright was able to stabilize the poor little dog.  He didn’t have any immediately life-threatening injuries, but one eye had been badly damaged by a claw or beak.  We sent him to the emergency hospital for overnight monitoring and aggressive pain control.  Even if the eye can’t be saved, this little dog should recover fully.  Moral of the story:  Keep a -close- watch on your small dogs when you’re out in the yard.  Even in the suburbs, there are potentially dangerous predators nearby.

See you in two weeks!

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Be Careful With the Internet — A Lesson in Bloat & Torsion (GDV) — CORRECTION 1/26/12!

I am issuing a correction after corresponding with one of the commenters on this post. She’s a fellow vet, and she astutely pointed out an error I made in interpreting the study abstract I used as the basis for some of the numbers.

I stated that the study found an increased risk of 20 and 52% with elevated bowls. The study’s abstract used these exact words:

“Approximately 20 and 52% of cases of GDV among the large breed and giant breed dogs, respectively, were attributed to having a raised feed bowl.”

‘Attributed’ seems to imply that elevation was the cause for GDV in 20 and 52% of the cases in those groups in the study.

Another source specifically stated that an increase in risk of 110% was found with elevated food bowls.

The bottom line, I believe, is as Dr. Leslie said. There are many factors, and we’re best able to help our dogs by addressing more than any single one. Putting too much emphasis on one factor as if it were the only cause or cure is not the best approach.

—–Original Post Below This Line——————————————————–

Now and then, a non-veterinary blog will post something concerning pets or veterinary medicine. I give these posts careful scrutiny when I come across them. I worry about readers getting poor advice. At best, it might mean small problems. At worst, it could cause death.

Two weeks ago, I read a post about ways to keep a pet’s food and water bowl area clean. It turns out that the post was originally written for a style and design blog based in New York City. The advice was:

…use an elevated feeding station to keep bowls in place and up off the floor. Elevated bowls aid in digestion and prevent strain on your pet’s back and neck. Place near a wall to prevent tipping.

This is very bad advice if you have a large or giant breed dog. Elevated food bowls were tied to an INCREASE in risk for a large or giant breed dog to develop bloat or bloat/torsion. This problem is also known as gastric dilation and volvulus (GDV).

Bloat simply means that the stomach undergoes rapid expansion with food and/or gas. It can get so big and so high-pressure that it starts to squeeze the other organs in the abdomen. While bloat alone can be dangerous for a dog, it’s generally not lethal.

Sometimes as a stomach is bloating, it flips in the abdomen. The stomach literally rotates, which twists the attachment at the esophagus and the outflow part at the duodenum. Once a stomach is twisted (volvulus), no gas can be burped or vomited out, so the stomach continues to bloat. Thi sis highly dangerous. Shock, organ damage, and death can occur rapidly.
Stomachnorm
GDVstomach
GDVLatAbd
TThe dog’s head is far to the left off the xray, and the spine is at the top, running left to right. The big darker circle in the middle of the radiograph is the distended stomach. It’s full of gas. The pylorus of the stomach is seen at the top near the spine in those 2-3 very dark oblong shapes.

Dogs present in bad shape most of the time. The only way to fix GDV is to treat shock and then take the dog to surgery, untwist the stomach, and then deal with any of the many complications that come from the torsion. The risks of complications during and after surgery is often fairly high. Some complications are minor, but some can be lethal in and of themselves. GDV is a nasty, nasty problem. It’s extremely hard on the dogs and costly to handle.

When I read that tip, I was horrified. I emailed the original authors. They told me they would issue a correction on the blog. Three days later, the correction went up and the post was removed from the authors’ main blog. The site that I read it on first has not been corrected.

The study I cited recruited 1,637 dogs. Owners were contacted yearly to see how many had developed GDV. Several factors were considered for increased risk. The results showed a 20% increase in large breed dogs and a 52% increase in giant breed dogs with elevated bowls. That’s a huge increase in risk!

Body shape/size, temperament, and breed may play a part in developing GDV. We can’t affect those factors. We can lower risk with meal frequency, meal size, time of exercise, food/water bowls. Dogs should have 2-3 smaller meals spread out across the day instead of one big one. Exercise should be avoided for a few hours after a meal. We certainly should NOT elevate food and water bowls.

Today’s moral: be careful what you read and check with your vet!

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