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Slide 1JSOMTC, SWMG(A)
Medical Emergencies in Multi‐Purpose Canines (MPC)
PFN: SOMVML0Q
Hours:
Instructor:
Slide 2JSOMTC, SWMG(A)
Terminal Learning Objective
Action: Communicate knowledge of medical emergencies in Multi‐Purpose Canines (MPC)
Conditions: Given a lecture in a classroom environment
Standards: Received a minimum score of 75% on a written exam IAW course standards
Slide 3JSOMTC, SWMG(A)
References
The Veterinary Merck Manual – 9th edition, published 2005
Plunkett, Signe J. Emergency Procedures for Small Animal Veterinarians. W.B. Saunders, 2000
TMEPS
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Slide 4JSOMTC, SWMG(A)
Reason
As a Special Operations Combat Medic, you are responsible to provide emergency medical care to a government owned animal in the absence of veterinary assets.
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Agenda
Identify the clinical presentation and management of anaphylaxis in the MPC
Identify the clinical presentation and management of upper airway obstruction in the MPC
Identify the clinical presentation and management of poisoning in the MPC
Slide 6JSOMTC, SWMG(A)
Agenda
Identify the clinical presentation and management of high altitude sickness in the MPC
Identify the clinical presentation and management of gastric dilatation and volvulus (GDV) in the MPC
Identify the clinical presentation and management of shock in the MPC
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Slide 7JSOMTC, SWMG(A)
Clinical Presentation and Management of Anaphylaxis
in the MPC
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Anaphylaxis
A rapid allergic reaction to a foreign material or chemical
Vaccines
Medications
Envenomation
Food related
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Anaphylaxis
Treatment
Localized allergic reaction
• Clip, clean, and dress the wound (if applicable)•Monitor breathing
•Administer antihistamines
Diphenydramine 2mg/kg SQ or IM
– Repeat dose if needed in 15‐20 min
•Administer steroids for severe reaction
Dexamethosone 4mg/kg SQ or IM one time only
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Slide 10JSOMTC, SWMG(A)
Anaphylaxis
Treatment
Generalized
•Monitor breathing, supplement oxygen as needed
• Administer antihistamines
• Administer steroids
Dexamethasone
Solu Delta Cortef
– 12 mg/kg IV, given slowly
• If anaphylactic shock occurs: Epinephrine 1:1000, 0.5 ml SQ
Repeat every 10‐20 min as needed
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Clinical Presentation and Management of Upper Airway
Obstruction in the MPC
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Upper Airway Obstruction
Symptoms/Presentation
Playing with or chewing on an object, followed immediately by pawing at the face and throat
Frantic behavior
Unproductive cough and/or choking
Difficult breathing with abnormal “snoring” breath sounds
Blue, white, or pale mucous membranes
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Upper Airway Obstruction
Treatment
Check the airway and determine the type of blockage
•Gently tilt the head slightly back and extend the neck• Look for foreign material (vomit, ball, stick, bone fragments, etc.)
If foreign material is present then use forceps or the “2 Finger” sweep method
•Use forceps to grasp the foreign body and remove
• Run fingers on the inside of the mouth and try to dislodge foreign material
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Upper Airway Obstruction
Modified Heimlich Maneuver
Grasp the dog around the waist so that the rear is towards you
Place a fist just behind the ribs
Compress the abdomen several times with quick thrusts
Check the mouth to see if foreign object has been dislodged
Repeat steps if unsuccessful
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Upper Airway Obstruction
Modified Heimlich Maneuver
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Upper Airway Obstruction
Treatment
“Cric” vs. Tracheotomy
• “Cric”Cricothyroid membrane does not heal as easily as tracheal tissue in canines
Tube can easily “kink” due to canine anatomy
Tracheotomy
• Effective airway• Incision is made in between the 5th and 6th tracheal ring NO MORE THAN 40% circumference
• Constant monitoring and cleaning is needed
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Tracheotomy
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Clinical Presentation and Management of Poisoning
in the MPC
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Slide 19JSOMTC, SWMG(A)
Poisoning in the MPC
Common poisonings
RDX (C‐4) Ingestion
Chocolate
Ethelyne Glycol (Antifreeze)
Warfarin (Rat Poison)
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Poisoning in the MPC
Symptomatic treatmentAtropine, anticonvulsants, GI protectants
Specific treatment Increase clearance
• IV fluids Reverse damage
• Vitamin K for warfarin toxicity
Competitive inhibitors • Ethanol or fomepizole for ethylene glycol (antifreeze)
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Poisoning in the MPC
RDX (C‐4)
Exploded ordinance
Training simulators
S/s of toxicity (4‐6 hours post
ingestion)
Convulsions
Coma
Lethargy
Ataxia
Muscle spasms
Abdominal tenderness
Cardiac arrhythmias
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Slide 22JSOMTC, SWMG(A)
Poisoning in the MPC
RDX (C‐4) Treatment
If recognized immediately
• Induce vomiting Morphine 10‐15mg
Hydrogen Peroxide 30ml PO once
DO NOT use Syrup of Ipecac to induce vomiting
• Control seizures, convulsions, and cardiac arrhythmias Diazepam (Valium) 5 mg IV bolus for a 30kg dog
Repeat as necessary up to a maximum of 4 doses
• Initiate IV fluid therapy Maintenance dose ‐ 60ml/kg/hr
Saline or Lactated Ringers
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Poisoning in the MPC
Chocolate Theobromine & caffeine (methylxanthines)
Results in neurological stimulation, tachycardia/ arrhythmias, vomiting/ diarrhea, seizures.
TX: induce emesis, control symptoms with diazepam
Lethal dose • 7.0 g/kg baking chocolate• 60 g/kg milk chocolate
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Poisoning in the MPC
Ethylene Glycol (antifreeze)
Sweet taste
Metabolized by liver to toxic by‐products
Death from renal failure/ metabolic acidosis
TX: fomepizole 20 mg/kg loading dose, then 15 mg/ kg q 12 hours x 2 doses Ethanol – given PO or as IV additive(5ml/kg)
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Warfarin (Rat Poison)
• Rodenticide
• S/S
Epistaxis
Unexplained bruising
Paralysis
Lethargy
• Death caused by hypovolemic shock and anemia
• TX: Vitamin K
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Clinical Presentation and Management of High Altitude
Sickness in the MPC
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High Altitude Sickness in the MPC
S/s
Reduced appetite
Listlessness
Reduced activity level
“Mildly dusky” tongue color/pale gums
Brown or pink tinted fluids from the mouth or nose
Pulmonary edema
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High Altitude Sickness in the MPC
Prophylaxis
Acetazolamide (Diamox)• 250mg PO BID 24 hrs prior to ascent and continued for 48 hours after maximum altitude, or
• 500mg sustained release tablet PO every 24 hours
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High Altitude Sickness in the MPC
Treatment at onset
Descend from altitude
Oxygen therapy
Dexamethasone• 2mg/kg IV initially; repeat in 6‐8 hours with 1mg/kg. Follow with tapering dose.
Albuterol inhaler
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Clinical Presentation and Management of Gastric Dilitation
and Volvulus in the MPC
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Gastric Dilatation and Volvulus (GDV)
Life‐threatening emergency condition
Deep‐chested dogs most susceptible
Stomach twists on itself which:
Leads to bloat
Tears in gastric arteries
Gastric ischemia – stomach “death” or necrosis
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GDV – Hallmark Signs
Abdominal distension
Filled with gas, fluid, and food
Nonproductive retching, attempted vomiting without result, “dry heaves”, excessive salivation
Signs of pain
Grunting, especially when abdomen is palpated
Anxiety, noted as pacing, anxious stares, inability to get comfortable
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GDV – The Stomach
Normal GDV
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GDV – Hallmark Signs
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GDV – Radiographs
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GDV – Treatment
9 Line MEDEVAC!!!!!
Insert IV catheters –both cephalic veins –rapidly infuse fluids
Gastric decompression using a trocar
Medevac to nearest surgical facility
Surgical gastropexy
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Clinical Presentation and Management of Shock in the MPC
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Shock
Secondary to underlying issue
Signs and symptoms
Increased heart rate
Increased respirations
Prolonged CRT
Pale mucous membranes
Weak peripheral pulses
Ataxia
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Shock
Treatment
Treat the underlying issue
Gain access for fluid replacement
• IV (recommended)
• IO (if unable to obtain IV access)• “Shock Dose”
90ml/kg/hr
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Slide 40JSOMTC, SWMG(A)
Shock
Fluid choices
Isotonic
•Give ¼ of “shock dose” over 15 – 20 minutes. Recheck vitals. If no improvement give another ¼ dose. Repeat until vitals improve. Do not exceed 2 liters.
Colloid
•Give 250 ml bolus IV over 20 min and recheck vitals. If no improvement, give another 250 ml. Do not exceed 500 ml.
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Questions?
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Terminal Learning Objective
Action: Communicate knowledge of environmental injuries in Multi‐Purpose Canines (MPC)
Conditions: Given a lecture in a classroom environment
Standards: Received a minimum score of 75% on a written exam IAW course standards
6/10/2015
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Slide 43JSOMTC, SWMG(A)
Agenda
Identify the clinical presentation and management of anaphylaxis in the MPC
Identify the clinical presentation and management of upper airway obstruction in the MPC
Identify the clinical presentation and management of poisoning in the MPC
Slide 44JSOMTC, SWMG(A)
Agenda
Identify the clinical presentation and management of high altitude sickness in the MPC
Identify the clinical presentation and management of gastric dilatation and volvulus (GDV) in the MPC
Identify the clinical presentation and management of shock in the MPC
Slide 45JSOMTC, SWMG(A)
Reason
As a Special Operations Combat Medic, you are responsible to provide emergency medical care to a government owned animal in the absence of veterinary assets.