Pet Emergency Education

1.  Areas of medicine that pertain
to emergency care, response
and management of life
threatening conditions
 Two specialties joined as one
 Immediate needs of a severely
ill and/or injured animal
What is Veterinary Emergency and
Critical Care

2. Communicating to Clients
 Be in a similar position
 Listen
 Ask specific questions
 Do not talk about worst case scenarios
 Do not judge
 Be aware of your posture, tone and attitude
 Stay calm
 When delivering bad news, be direct

3. Communicating to Other Staff
 Practice emergency scenarios
 Review emergency cases
afterwards to educate staff on
what went right/wrong
 Work together

4. How well do you know your clinic?
Grab a pen/paper and write down your answers. Do not look at anyone else! No
cheating!
 1. Are you a general or emergency practice?
 2. How many of the following do you have on staff?
 DVM
 DVM Specialists
 Credentialed Vet Techs
 Support Staff
 3. Who is your designated leader in the ICU?
 4. Who is designated to speak to the hysterical client in an emergency
situation?
 5. Where is your crash cart/box?
 6. How often do you check your crash cart/box for expired drugs, etc?
 7. How often do you review hospital protocols with staff?
 8. How do new hires find out about hospital protocols?
 9. How do you alert the team when an animal codes somewhere in the
hospital?
 10. What is your procedure if a DVM is not available when a code enters the
hospital?

5. Preparation
 Go through the crash cart/box
with all of your staff and make
sure everyone knows what
supplies are in there
 Train the team to recognize
rapidly declining patients
 Have protocols in place and make
sure everyone knows them

6. Triage
 The assignment of degrees of urgency to wounds or
illnesses
 To decide the order of treatment of a large number of
patients or casualties

7. Rapid Ready Checklist
 General:
 Gurney, small/medium and large backboards
 CPR:
 Crash cart with defibrillator and endotracheal tubes of various sizes, a laryngoscope and assorted syringes and blades,
key emergency drugs (Atropine, Epinephrine, Naloxone, Vasopressin, Magnesium sulfate, Lidocaine, Calcium
gluconate)
 Oxygen administration:
 Oxygen source, ambu bag or breathing circuit that allows manual ventilation, infant/pediatric and adult cone masks
 Fluid resuscitation:
 IV catheters of various sizes, syringes, replacement fluids (Normosol-R, Saline, LRS), Hetastarch, blood collection
tubes
 Miscellaneous:
 Doppler blood flow detector and BP cuffs, suction unit, warming device (water circulating heating pad or warm air
flowing device), clippers, portable US unit, pleurovac, 3 way stop cocks
 Wound management:
 Sterile towels to pack wounds, wet saline dressings/ surgical scrub, other dressing materials, vetwrap, splints
 Emergency surgical procedures:
 Emergency tracheostomy kit, emergency chest tube/surgical pack for CPR or chest tube placement, vascular cut-
down tray, emergency thoracocentesis and abdominocentesis supplies, surgical gloves in a variety of sizes

8. Tier Triage System
 Obvious Emergency
 Cardiac arrest, major trauma GCV
 Strong Potential for Emergency
 Dyspnea, abdominal pain
 Potential Emergency
 Extremity injury, lacerations
 Non Emergency

9. Primary Survey
 Airway
 Breathing
 Respiration
 Circulation
 Heart Rate
 Pulses/pulse deficits
 Mucous membrane color
 CRT
 Body Temp
 Pain
 Abdominal Distention
 Neurologic
 Eyes
Refer to the chart “Parameters to Evaluate” in the Reference Guide

10. Normal Temperature, Pulse and
Respiratory Rates for Dogs and
Cats
 Temperature
 Dogs and Cats approx.100.5-102.5 Degrees F
 Respiratory Rate
 Dogs- 12-24 br/min
 Cats- 20-30 br/min
 Heart Rate
 Dogs- 60-140 bpm
 Cats- 160-240 bpm
*figures are based on most current veterinary industry suggested values- cited
https://www.gopetplan.com/

11. Conditions Needing
Emergency Attention
 Be ready to counsel a client over the phone
 All staff should be knowledgeable about emergency first
aid steps that can communicated to clients
 Keep safety in mind for both the animal and its owner
 Be conscious of zoonoses
 Brochures and handouts

12. Cardiopulmonary Arrest (CPA)
An event when an animal’s heart stops beating and their
respiratory system stops functioning. CPR is a procedure that
increases cardiac output (amount of blood pumped through the
heart) and keeps oxygen delivered to the tissues

13. Primary Dysfunctions (CPA)
 It can be caused by three primary dysfunctions;
 Asystole
 Pulseless Electrical Activity (PEA)
 Ventricular Fibrillation

14. Cardiac Output/Stroke Volume
 Cardiac Output is the result of the stroke volume and
the heart rate.
 Stroke volume is the amount of blood pumped during
each contraction of the ventricle and the heart rate is
the number of times the ventricle contracts per minute.
 A normal dog’s cardiac output is 100mL/kg/min and a
normal stroke volume is 1-2 mL/kg.

15. To increase cardiac output
(goal in CPR)
• Increase stroke volume
• Increase heart rate
• Increase both stroke volume and heart rate

16. Compression Theories
 Thoracic Pump Theory-
 (most dogs) recoil of the chest between compressions
causes negative pressure within the thorax, drawing blood
into the cranial and caudal vena cava and into the heart.
 Cardiac Pump Theory-
 (cats, keel chested dogs) left and right ventricles are
directly compressed between the sternum and the spine
when compressions are done in dorsal recumbency or
between the ribs on the opposite sides of the chest when
in lateral recumbency.

17. The Respiratory System
https://thumbs.dreamstime.com/z/respiratory-system-dog-vector-
illustration-medical-veterinary-61165699.jpg

18. Breathing
 Spontanous Breaths- When negative pressure in the chest
draws air into the respiratory system. (normal breaths)
 Positive Pressure Breaths- This is when air is forced into the
airway such as in CPR through mouth to snout resuscitation

19. Respiratory Dysfunction
 Agonal- gasping, labored breathing
 Orthopnea- breathing with the neck extended and elbows
abducted in an attempt to maximally open the airways
 Push- pronounced expiratory effort is associated with severe
lower airway disease such as feline asthma. Characterized by
increased expiratory effort.
 Tachypnea (distressed)- very short, shallow inspiratory periods
and evidence of distress.
 Tachypnea (panting)- increased respiratory rate that is not
associated with distress.

20. Mouth to Snout
Make sure tongue is pulled all the way out and mouth is completely shut
Utilized in Manual CPR when intubation is not possible
2 breaths for every 30 compressions

21. Intubation and Oxygen Delivery
Utilized when the animal is able to be intubated
1 breath every 6 seconds/continuous compressions

22. Manual CPR
 Performed in the field when
emergency equipment and
supplies are not readily
available
 Taught to owners, pet sitters,
kennel workers, rescues and
more as a means of first
response to a cardiac arrest
animal in their care

23. Primary Assessment
Should not take more than 10 seconds to complete
 A- Check Airway for
Obstructions
 B- Check to see if the
animal is breathing
 C- Check the pulse to
see if the animal’s heart
is functioning
 CPR needs to begin within 10
minutes of the animal going
into arrest or it is unlikely it
will survive.
 After 10 minutes of no CPR
an animal will sustain
irreversible damage to tissues
and organs.

24. Positioning
Average Chested Dogs Keel Chested Dogs Barrel Chested Dogs
Puppies, Kittens, Small
Dogs and Cats

25. Body Position for
Performing Compressions

26. Other Guidelines to Follow for
Compressions
• Compress the chest 1/3 to 1/2 of the total width
of the chest
• Rate of compressions should be between 100-
120 bpm no matter the size of the animal
• Make sure the chest fully recoils between
compressions

27. Lets Put It Together
 Ratio is 30 Compressions to 2 Breaths
 You are to perform 4 continuous sets of compressions
and breaths before stopping to recheck breathing and
circulation
 After the 4th set stop and recheck the breathing and
circulation to see if there is any response.
 If no response begin another 4 sets of compressions and
breaths.

28. Begin Compression and
Breath Sequence
 30:2
 You should perform 2 minutes of continuous CPR,
uninterrupted
 We recommend that you rotate with another person
after 2 minutes as to minimize fatigue
 ROSC- Return of spontaneous circulation

29. CPR Algorithm
 Unresponsive, apneic patient
 CPR (1 cycle= 2 minutes)
 Compressions: 100-120/min
 Ventilate: 10/min
 Initiate Monitoring: ECG/ETCO2
 Evaluate Patient/Check ECG
 ROSC- Post CPR Care
 Vfib
 Continue CPR while charging
defibrillator
 Give one shock
 Resume CPR immediately for 1 cycle
 OR
 Asystole
 Resume CPR immediately for 1 cycle
 Low dose epinephrine or vasopressin
 Evaluate Patient/Check ECG
 ROSC- Post CPA care
 Vfib
 Continue CPR while charging defibrillator
 Give one shock
 Resume CPR immediately for 1 cycle
 Give epinephrine or vasopressin
 OR
 Asystole
 Resume CPR immediately for 1 cycle
 Low dose epinephrine or vasopressin
 Consider high dose epinephrine after 10
minutes
 Consider Atropine
Boller M, Fletcher DJ. RECOVER evidence and knowledge gap analysis on veterinary CPR—Part 1: Evidence analysis and consensus process: Collaborative
path toward small animal CPR guidelines. J Vet Emerg Crit Care 2012; 22(S1):S4-S12.

30. Resuscitation Order
Red Do not resuscitate
Yellow Closed chest CPR only
Green Open chest CPR is approved by owner**
 Practices should have a protocol in place to obtain
and document owners’ resuscitation wishes for their
pet.
 It is important to obtain written authorization so that
there is no confusion if and when that time comes.

31. Post CPA Care
 Required to minimize the potential for recurrence
 One study showed that over 50% of dogs and cats will
suffer another CPA event in the hospital.
 Fluid Therapy
 Oxygen Supplementation
 Referral to Specialty Center
 Research has indicated that patients were more likely to
survive when drugs, such as dopamine and vasopressin, were
available and more staff were involved in resuscitation
efforts. (1)
 (1) Smarick SD, Haskins SC, Boler M, et al. (2012). RECOVER evidence
and knowledge gap analysis on veterinary CPR—Part 6: Post-cardiac
arrest care. J Vet Emerg Crit Care 2012; 22(S1):S85-S101.