Preparing for a medical emergency involving your pet is always best accomplished before the event takes place. This series is designed to help guide you through the important decisions about first aid, as well as how and when to transport your pet quickly and safely to a veterinary hospital or emergency facility.

VeterinaryPartner.com has provided this reference information for you to browse through and expanding your knowledge of dog and cat first aid.

This Web site is an emergency preparedness ready-reference for dogs and cats. Wise preventive measures, intelligent use of first aid principles, coupled with recognition of abnormal symptoms and treatment of disorders, diseases, and problems, lead to effective health care.

A working knowledge of this information will help you eliminate some potentially dangerous circumstances and help you prepare for emergency situations.

It includes information on what to do and what not to do in specific emergency situations.

The authors encourage careful reading and occasional rereading. We have tried to make this site easy to understand, avoiding technical terms as often as possible, but defining them in context when they are necessary.

**Dedication for Dr. Roger Gfeller

Authored by: The VIN emergency medicine folder staff

The original version of this first aid manual for pet owners was co-authored by one of the most respected and genuine members of our veterinary community, Dr. Roger Gfeller. Roger died in an automobile accident in November of 2007. 

As a memorial to his lifelong commitment to our profession, Roger’s colleagues, friends and disciples, the editors and consultants of the Veterinary Information Network (VIN) – with much input and revision from the general VIN community and Roger’s co-author, Dr. Michael Thomas –have revised and updated the information from the first edition. 

On this 2-year anniversary of the sad date when we were shocked to learn that Roger had suddenly died, we dedicate this revised edition to Roger’s memory and the spirit of collegiality, lifelong learning and commitment to patient care that defined Roger as a doctor, educator, colleague and friend. 

About our Roger

Roger was one of the first veterinarians to become board certified in emergency and critical care medicine. His long and productive career was highlighted by an incredible dedication to the profession and the to discipline of emergency medicine and critical care.  He was a mentor to many veterinarians as they progressed through their residencies in hope of specializing in the field that he loved, and he helped and befriended thousands more through his wit and insight that he shared daily with the community of the Veterinary Information Network (VIN).

By extension, he has no doubt touched the lives of millions of pets and their owners. The magnitude of the loss felt by veterinarians is typified by some of the comments written about him on the VIN message boards during the weeks after his tragic death in late November of 2007.  We have transcribed some of these remarks below. 

Our sincere hope is that this manual will provide helpful information to pet owners and allow Roger's knowledge and insight to help current and future generations of pet lovers feel confident that they can lend first aid to their pet when needed.

Sincerely,

The editors and staff of the emergency medicine folder
Veterinary Information Network (www.VIN.com)
Thomas Day, DVM, MS, DACVA, DACVECC
Beth Davidow, DVM, DACVECC
Teresa Rieser, VMD, DACVECC
Tony Johnson, DVM, DACVECC
Amy Carr, DVM, DACVECC
Adam Reiss, DVM, DACVECC
Elisa Mazzaferro, MS, DVM, PhD, DACVECC
Christopher Byers, DVM, DACVECC, DACVIM (SAIM)
Garret Pachtinger, VMD
and the entire VIN community

Special thanks to Ms. Tammy Maher and Phyllis DeGioia for editorial whipping!  Back to Index

About the Authors and the Illustrator

Roger W. Gfeller, DVM

Dr. Gfeller was a leading and long-standing veterinary emergency practician in Fresno, California. He died in an automobile accident in 2007, and the update to this series was done as a memorial to him.  

A 1973 graduate of Kansas State University School of Veterinary Medicine, Dr. Gfeller was practicing emergency medicine nearly as long as anyone in the country and had been a Board Certified Diplomate of the American College of Veterinary Emergency and Critical Care since 1993.

Dr. Gfeller supervised treatment of over 100,000 emergency cases. He lectured to local, national, and international audiences on emergency medicine and critical care.

Michael W. Thomas, DVM

Dr. Thomas is a full professor in the Department of Animal Science at California State University, Fresno. A 1983 graduate of Washington State University, he has been teaching animal health courses since 1985.

Dr. Thomas is a popular teacher, twice receiving meritorious teaching awards, and has received university and national recognition for his innovative multimedia educational techniques. He has received research and educational grants for the study of infectious disease and development of computer-aided veterinary courseware.

In addition to 3 years of practice experience prior to his university work, he continues veterinary practice as campus veterinarian and clinician at California State University, Fresno.

Isaac Mayo
[currently a veterinary student at Cornell].

He received his degree in Communications from Oberlin College in 1977, and for the past 15 years has been a producer and director of television shows. Isaac has published numerous popular and scientific articles on chemistry, physics, microbiology, and the history of science.

J. Christopher Esparza:
an art student at California State University, Fresno. A freelance artist and illustrator since 1979, he resides in the Clovis, California area and has been selling and displaying art in Fresno for the past 6 years.

He has done commercial illustrations for numerous companies throughout the western United States.  Back to Index

*Introduction

Authored by: The VIN emergency medicine folder staff

This book is an online emergency preparedness ready-reference for dogs and cats. Wise preventive measures, intelligent use of first aid principles, coupled with recognition of abnormal symptoms and treatment of disorders, diseases, and problems, lead to effective health care. A working knowledge of prevention and first aid will help you eliminate some potentially dangerous circumstances and help you prepare for emergency situations.

The guide covers prevention, normal values, first aid, and some specific conditions. Also, information is provided on what to do and what not to do in specific emergency situations.

The authors encourage careful reading and occasional rereading. Consultants from the Veterinary Information Network (VIN) who specialize in emergency medicine, along with the cooperation of the original co-author Michael Thomas, DVM, have carefully reviewed the material. This book was written to be easy to understand, avoiding technical terms as often as possible, but defining them in context when they are necessary.

This information is provided as a guideline for you to learn what to do in an emergency situation, but it cannot replace emergency visits to the veterinarian. IN AN EMERGENCY, CALL YOUR VETERINARIAN OR LOCAL EMERGENCY HOSPITAL and do not rely on anyone on the Internet to help. Back to Index

Abscess

Authored by: The VIN emergency medicine folder staff

Animal teeth and claws easily puncture skin, introducing bacteria under the skin of the affected animal.  If the skin heals quickly the bacteria become trapped, which creates infectious pockets that are commonly referred to as abscesses.

Abscesses may be very small or extraordinarily large, and may feel swollen and warm.  These wounds are often extremely painful.  Typically, animals with abscesses become depressed, and may exhibit a tendency to hide in inconspicuous places in the home.  Occasionally abscesses may rupture prior to the onset of any other signs.  Abscesses of the anal glands are very common and can be mistaken for rectal bleeding if they rupture. They may cause the pet to ‘scoot’ the rectal area on the ground.  Tooth root abscesses typically form just below the eye, and start as a bump or swelling.  They may break open and bleed, and the pet may stop eating due to the pain or experience pain upon chewing.

Small, uncomplicated abscesses may respond to medical therapy, while larger and more extensive abscesses may require surgical treatment.  Proper surgical management of abscesses often requires the placement of a drain or latex tubing (either under sedation or general anesthesia) to provide an escape route for secretions from the damaged tissues of the wound. Tooth root abscesses require tooth extraction – antibiotics alone will only lead to a temporary solution, but the abscess will recur unless the affected tooth is pulled. This surgery requires general anesthesia.

What to Do

• Abscesses should be examined by a veterinarian as soon as possible and within 24 hours. 
• Fluid may normally drain from the site of an abscess.  An abscess does not drain through the tube, but rather around the latex tubing.  Therefore, it is important for you to clean the area around the drain twice daily with warm water.
• Apply a hot compress to the affected site at least two times daily for 3 to 5 days after the animal leaves the hospital.  Wet a clean washcloth with very warm water and place it directly over the affected site, and then apply gentle pressure ideally for 5 to 10 minutes.
• Be sure you and/or other family members wash your hands thoroughly after contacting any fluids draining from the abscess site.
• Be sure to administer all prescribed medications exactly and completely as detailed by your pet’s veterinarian.  Some patients may appear to feel better after only a few days of treatment; however, it is crucial for medications to be administered according to schedule to prevent the infection from recurring.
• Restrict your animal to indoor activities until the infection has resolved completely.
• Notify your pet’s doctor should your pet experience any of the following:
  - Increased redness and/or heat from the site of abscess
  - Failure of abscess to heal
  - Worsening of your pet’s general health
  - Loss of appetite lasting longer than 24 hours

What NOT to Do

• Do not attempt to open the abscess yourself. 
• Do not attempt compressing the wounds of a fractious cat.  Your safety is of utmost importance to us.  Contact your veterinarian for assistance should this situation arise.
• Do not apply medicines, potions, or home remedies unless directed by a veterinarian. Back to Index

Bandaging

Authored by: The VIN emergency medicine folder staff

We use bandages for several reasons: to protect wounds from the environment, protect the environment from wounds, and to discourage a pet from licking or irritating a wound. Bandages may be applied as support for strains or sprains or to prevent motion. Proper application is important – an improperly applied or too-tight bandage can cause decreased blood flow and potential loss of the limb.

Cleaning the Wound

The process of bandaging begins with careful cleaning of the wound. All dried blood, dirt, and debris should be washed away using mild soap and lots of water. Hair should be clipped away so that it cannot lie in the wound. If possible, the area should be patted dry.
 
 
Materials Needed

In an ideal setting, a bandage should have a contact layer, an absorbent layer, and an outer layer.

Antibiotic ointment, Telfa Non-Adherent Pad, cotton wrap, gauze wrap, and Vetrap
 
The Contact Layer

After cleaning the wound, apply antibiotic ointment to the contact layer and use it first. Ideally, this layer should:

• Be sterile and inert. 
• Stay in close contact with, but not stick to, the wound.    
• Be very absorbent.   
• Be free of particles or fibers that might shed into the wound.   
• Conform to all shapes. 
• Allow drainage to pass to the next layer without becoming wet.  
• Minimize pain.

A Telfa Non-Adherent Pad, available at most pharmacies, comes closest to meeting these requirements.
 
It is desirable to apply an antibiotic ointment, such as Neosporin, to the pad but this is not absolutely necessary. Frequent bandage changes are more important. After cleaning the wound, place a new contact layer over the wound.

The Absorbent Layer

After the contact layer is in place, apply the second (absorbent) layer to hold the contact layer snugly, but not tightly, over the wound. This layer is usually a cotton or Dacron material that comes in various widths. Generally, 1-inch rolls are used for small limbs and the tail; 2-inch rolls are for medium-sized legs; and the 3- and 4-inch rolls are for large legs and the body. It is important to use the proper size. Materials that are too narrow often cause a tourniquet effect, especially if the wound causes swelling.

If materials are too wide, they are difficult to apply smoothly. Any wrinkles or ridges may cause the bandage to become uncomfortable for your pet. Uneven pressure may cause necrosis (tissue death) of the underlying tissues.

Begin with just enough of an absorbent layer to hold the contact layer in place. If the wound is on a leg or the tail, wrap from the toes or the tip of the tail towards the body. If you begin at the top of the leg or the tail, the bandage is more likely to restrict blood flow and cause swelling, which may cause tissue damage. Apply several layers of absorbent material, which will soak up the fluid from the wound and increase the patient's comfort by cushioning the wound.

Make sure the material you use as the absorbent layer is the proper width, and wrap from the toes or tail tip up towards the body.

Gauze wrap can be applied next to hold the cotton wrap in place and to add extra support.  This step can be skipped for small wounds or for temporary bandages.

The Outer Layer

Finally, apply the outer (third) layer, usually made up of porous adhesive tape or elastic tape (i.e., Elastikon, Vetrap). Wrapped from the toes up towards the body, this layer should also be smooth and snug. Do not stretch elastic tapes to their limits as this will interfere with circulation and result in bandage failure. It helps to unwrap the Vetrap or Elastikon first and then rewind it to remove the tension from the wrap before placing.

The tape should be in contact with the skin (hair) at the bandage margins, anchoring the bandage so it will not slip.

 
The outer layer of a bandage should be applied smoothly and snugly, but not tight enough to cut off blood circulation.

Bandage Changes

Bandages should be checked frequently for any signs of swelling, skin discoloration or coolness, odor, or saturation of the bandage material. The bandage should be changed whenever any of the above are noticed or any time it appears to be uncomfortable for the pet. Wounds that are draining heavily may require bandage changes every 1 or 2 hours. Bandages over wounds with little or no drainage should be changed every 24 hours. Back to Index

Bee Stings / Insect Bites

Authored by: The VIN emergency medicine folder staff

Any insect or spider can cause problems if they bite or sting your pet. A bite or sting can cause swelling, redness, and itching. Some animals can have an allergic reaction to a sting or bite that may result in mild hives, facial swelling, vomiting, difficulty breathing or even collapse

What to Do:

• If the stinger can be found, scrape it out with a credit card or other stiff material. Alternatively, use tweezers by grasping the stinger, which is located below the venom sac. If the sting just happened, don't put pressure on the venom sac, as that would inject more of the venom into the pet.     
• Apply cool compresses to the area.  
• To help neutralize some of the acidic venom, apply a paste mixture of baking soda and water to the sting area. 
• Your pet should be examined immediately by a veterinarian if there is facial swelling, breathing difficulty or collapse.

What NOT to Do:

• Do not administer any medications without first contacting your veterinarian or a veterinary emergency hospital. The veterinarian may need to examine your pet before recommending medications. Back to Index

 Bleeding

Authored by: The VIN emergency medicine folder staff

Pets often suffer blood loss as a result of trauma. Some bleeding is visible, and is a result of a cut or laceration, while internal bleeding occurs inside the body (such as in the chest or abdomen) and is not be visible to the naked eye. If bleeding is severe or continuous, the pet may lose enough blood to cause shock; loss of as little as 2 teaspoons per pound of body weight may cause shock, which doctors usually detect as a high heart rate and low blood pressure. Emergencies may arise that require you to control the bleeding, even if it is just during transportation to the veterinary facility. Pet owners should know how to safely stop hemorrhage (bleeding) if their pet is injured.

Techniques to Stop External Bleeding 

The following techniques are listed in order of preference. The first rule when dealing with an injured pet is to avoid injury to yourself, so take appropriate precautions (such as the use of a muzzle) to avoid being bitten. For all techniques below, seek veterinary attention immediately after stopping the bleeding, or on the way to the veterinary hospital.

Direct Pressure
Gently press a compress (a pad of clean cloth, feminine sanitary product or gauze) over the bleeding area, so it can absorb the blood and allow it to clot. Do not disturb blood clots after they have formed. If blood soaks through, do not remove the pad; simply add additional layers of cloth and continue the direct pressure more evenly. The compress can be bound in place using loosely applied bandage material, which frees the hands of the first provider for other emergency actions. If you don’t have a compress, you can use a bare hand or finger.
 

  
Direct pressure on a wound is the most preferable way to stop bleeding.

Elevation
If a severely bleeding wound is on the foot or leg, gently elevate the leg so that the wound is above the level of the heart.
 

  
Elevation uses the force of gravity to help reduce blood pressure in the injured area, slowing the bleeding. Elevation is most effective in larger animals with longer limbs where greater distances from the wound to the heart are possible. Direct pressure with compresses should also be maintained to maximize the benefits of elevation.

Elevation of a limb combined with direct pressure is an effective way to stop bleeding.

Pressure on the Supplying Artery
If external bleeding continues after you have used direct pressure and elevation, use your finger or thumb to place pressure over the main artery to the wound. Apply pressure to the femoral artery in the groin (on the inside of the thigh) for severe bleeding of a rear leg; to the brachial artery in the inside part of the upper front leg for bleeding of a front leg; or to the caudal artery at the base of the tail if the wound is on the tail. Continue application of direct pressure.  Seek veterinary attention immediately.
 

  
Tourniquet
Use of a tourniquet is potentially dangerous and it should be used only for a severe, life-threatening hemorrhage in a limb (leg or tail) not expected to be saved. If you see blood spurting or pumping from a wound, which is a rare occurrence, consider the use of a tourniquet. Use a wide (2-inch or more) piece of cloth and wrap it around the limb twice and tie it into a knot. Then tie a short stick or similar object into the knot as well. Twist the stick to tighten the tourniquet until the bleeding stops. Secure the stick in place with another piece of cloth and write down the time it was applied. Every 20 minutes loosen the tourniquet for 15 to 20 seconds. Remember this is potentially dangerous and can often result in disability or amputation.
   

 
A tourniquet should only be used as a last-resort, life-saving measure!

Internal Bleeding
Internal bleeding is a life-threatening condition, but it is not obvious like external bleeding. Any bleeding that is visible is external. Internal bleeding occurs inside the body and will not be seen. In internal bleeding, blood pools in the stomach or chest but does not result in blood in the stool or bleeding from the rectum. There are, however, some external signs of internal bleeding:

• The pet is pale (check the gums). 
• The pet is cool on the legs, ears, or tail. 
• The pet is coughing up blood. 
• The pet is unusually subdued.

If you see any of these signs, immediately transport your pet to a veterinary facility for professional help. Most cases of internal bleeding will require intensive therapy in a veterinary hospital. Remember: internal bleeding is not visible on the outside. Back to Index

Bloat

Authored by: The VIN emergency medicine folder staff

Bloat is a life-threatening condition in which the stomach fills with air (dilatation) and/or twists upon itself (volvulus). It’s also called GDV.

What to Do

• Transport to a veterinary hospital or emergency facility immediately. In all cases, this condition requires professional assistance. 

What NOT to Do

• Do not attempt to relieve the gas from the stomach.  
• Do not give anything by mouth.

It is imperative that this condition be recognized early. Your pet's abdomen may not have a bloated appearance. Signs of bloat include:

• drooling of saliva 
• frequent retching and attempts to vomit (occasionally victims may be able to regurgitate a pool of foamy saliva) 
• anxiousness, restlessness, and pacing 
• lethargy or agitation
• depression and shock.

Much has been learned about bloat in the past decade. Decades ago, a diagnosis of bloat was almost always a death sentence because only 25% survived. Today the survival rate is better than 80%. Part of the reason for this is increased owner awareness. The earlier the veterinarian gets started with treatment, the better chance there is for survival. Extremely aggressive medical and surgical intervention early in the course of the disease has the most dramatic impact on overall treatment success.

Prevention

No one entity has been shown to prevent this disease process.  Elevated feeding may actually increase the risk of GDV in some patients.  Smaller kibble size, feeding smaller more frequent meals, and not breeding animals with a history of GDV in their lineage may potentially decrease the risk of GDV for the animal and future generations.

In breeds with a high risk of bloat, there is a preventive surgery called a prophylactic gastropexy that can often be performed when the dog is being spayed. This involves surgically attaching the stomach to the inside of the abdomen to prevent rotation.  This procedure can also be done in male dogs, and can sometimes be done through ‘minimally invasive surgery’ or laparoscopy. Ask your veterinarian for details and advice if you would like to discuss preventive surgery for bloat.

Any dog of any size can develop bloat, but large and giant breeds with a deep chested conformation are most at risk.  Great Danes, German Shepherd Dogs and Akitas are often afflicted. Back to Index

Burns

Authored by: The VIN emergency medicine folder staff

A burn is any injury of tissue caused by heat, flame, chemicals, or electricity. Burn classification determines the severity of the wound based on the depth of the tissue injury.

First-degree burns are limited to redness and minor pain at the site of injury. These burns only involve the top layer of skin and heal quickly. 

Second-degree burns have superficial blistering of the skin, and can involve deeper layers of the skin. 

Third-degree burns occur when the top layer of skin is lost with damage to the deeper layers. Burns exhibit charring and extreme damage. Third-degree burns result in scarring and may require skin grafting.

What to Do

• Extinguish all flames. 
• Use appropriate measures to avoid being bitten (muzzle your pet).
• Avoid touching any pet that has been electrocuted until the power has been turned off.
• For thermal or electrical burns, immediately apply cool water compresses with a clean cloth to the site of the injury, changing them frequently as necessary to keep the site cool and wet. Continue this for at least 30 minutes.  
• For chemical burns, see chemical injuries.  
• Transport your pet to a veterinary facility as soon as possible for further care. Burns can become worse before they get better, and may require several weeks of therapy, multiple surgeries and possibly skin grafting.

What NOT to Do

• Do not apply ointments or butter. 
• Do not delay seeking veterinary attention.  
• Do not attempt to remove burned hair or skin yourself. Back to Index

Cardiopulmonary Resuscitation (CPCR)

Authored by: The VIN emergency medicine folder staff

Cardiopulmonary cerebral resuscitation (CPCR, formerly abbreviated as CPR) is the treatment required to save an animal (or human) life when suffering cardiopulmonary arrest. The intent of CPCR is to provide sufficient blood flow and oxygen to the brain and vital organs to support life until more advanced medical therapy can be started. Unlike what we see on television, most patients who suffer from cardiac arrest are unable to be saved, even with CPCR. In a study from the University of California at Davis, researchers discovered that long-term survival among feline patients is extremely poor. In this study, only 2.3% of feline patients who received CPCR survived to be discharged from the hospital alive. This closely parallels findings of similar studies in human medicine.  
 
CPCR consists of two parts: Rescue breathing and chest compressions.

These two techniques combine to keep the lungs supplied with oxygen and to keep blood circulating, carrying oxygen to the other parts of the body such as the brain and vital organs.

Basic CPCR is CPCR performed by trained bystanders at the scene of the arrest.

Advanced CPCR is CPCR performed by trained teams of professionals.

Basic CPCR is the most important for pet owners, and is described in this section.

All body tissues require a steady source of oxygen. If the source is interrupted for only a few minutes, irreversible damage may be done. If cardiopulmonary arrest occurs, basic CPCR must be initiated at the scene.

Recent research has shown that using only chest compressions was as effective as chest compressions and rescue breathing together. As long as the airway is open, compression of the chest may cause forward flow of blood and may cause adequate movement of air-at least for the first few minutes of arrest. Therefore, if only one rescuer is available to perform CPCR, it is advisable to perform only chest compressions.

Basic CPCR: Rescue Breathing (If two people are present)

Make Certain the Animal is actually Arrested and Unconscious
Talk to the pet first. Gently touch and attempt to awaken the pet. You could be seriously injured should you attempt to perform CPCR on a pet who was only sleeping heavily and was startled awake.

Ensure an Open Airway

Extend the head and neck and pull the tongue forward. 
 
Look in the mouth and remove any saliva or vomitus. If it is too dark to see into the mouth, sweep your finger deep into the mouth and into the throat to remove any vomit or foreign body. Be aware of a hard, smooth, bone-like structure deep in the throat, which is likely to be the hyoid apparatus (Adam's apple). Serious injury could result if you pull on the hyoid apparatus.

Observe for Effective Breathing
Sometimes an animal will begin to breathe spontaneously when the head is put in the position discussed above (head and neck extended, tongue pulled forward). Watch for the rise and fall of the chest while listening closely for sounds of breathing. If no breathing is evident in 10 seconds, begin rescue breathing.

Begin Rescue Breathing
Rescue breathing is performed by covering the pet’s nose with your mouth and forcefully blowing your breath into the lungs. In cats and small dogs, you must hold the corners of the mouth tightly closed while you force the air in. 
 

In larger dogs, the dog’s tongue should be pulled forward and the mouth and lips held shut using both hands cupped around the muzzle. Force air into the lungs until you see the chest expand. Take your mouth away when the chest has fully expended. The lungs will deflate without help. Air should be forced into the lungs until you see the chest expand.

Give 3 to 5 Full Breaths
After several breaths are given, stop for a few seconds to recheck for breathing and heart function. If the pet is still not breathing, continue rescue breathing 20 to 25 times per minute in cats or small dogs, or 12 to 20 times per minute in medium or large dogs. Push down on the stomach area every few seconds to help expel the air that may have blown into the stomach. If the stomach is allowed to distend with air, the pressure will make the rescue breathing efforts less effective. Try to coordinate breaths with chest compressions for 2-person CPCR.

If Breathing is Shallow or Non-existent
If you find that breathing is either shallow or non-existent and the pet is still unconscious, continue rescue breathing 10 to 15 times per minute and transport the pet to the nearest veterinary facility.

Basic CPCR: Chest Compressions (If one or two people are present)

After Ensuring an Open Airway, Check for a Pulse
If no pulse is detectable, begin chest compressions.

In Small Dogs or Cats
Squeeze the chest using one or both hands around the chest. Depress the rib cage circumferentially (see illustration).

Do this 100 to 150 times per minute.
 
In Large Dogs
Compress the chest wall with one or both hands, depending on the size of the dog and the size of the rescuer (whatever works best for you). If the dog is on her side, place your hand(s) on the side of the chest wall where it is widest. If she is on her back, place your hand(s) on the breastbone. Depress the rib cage 1.5 to 4 inches, depending on the dog's size. Do this 80 to 120 times per minute.

Coordinate Rescue Breathing and Chest Compressions
If possible, give breaths during the compressions. If it is not possible, give two breaths after every 12 compressions.

Continue CPCR until
• You become exhausted and can't continue. 
• You get the animal transported to a veterinary facility and professionals can take over.
• The pulse is palpable or heartbeats are felt and they are strong and regular.

In the vast majority of cases, artificial ventilations will continue to be required for a period of time, even though heart function has returned. This is due to the nervous system depression that occurs as a result of the arrest.

All resuscitated animals should be transported to a veterinary facility for further examination and care! Back to Index

Chemical Injuries

Authored by: The VIN emergency medicine folder staff

Chemical injuries to tissue are caused by contact with harmful chemicals such as lye, acids, and strong cleaning supplies.  Also called chemical burns, they can be similar to thermal (heat) burns and treatment can be complex and last many weeks. Prompt removal of the chemical agent and rapid veterinary medical attention can help minimize the injury and speed healing.

What to Do

• Wash the contaminated area with large volumes of tepid flowing water for at least 15 minutes.  
• In the case of dry chemicals, brush them away carefully, taking care to protect the eyes, nose, and mouth of both you and your pet.
• If the chemical is in the eye, flush the eye with large volumes of water or contact lens saline  for 15 minutes. (See below for saline recipe.)  
• Seek veterinary attention as soon as possible. 
• Avoid being bitten by using a muzzle on your pet if your think there is a risk of being bitten.
• Make sure the area is well ventilated as some chemicals can release strong fumes.

What NOT to Do

• Do not apply neutralizing agents to the skin or eyes. They can cause a chemical reaction that produces heat and cause further injury to tissues.  
• Do not immerse your pet in non-flowing water if a dry chemical has spilled on him or her. These dry chemicals are usually activated by water. The water must be flowing in order to rinse the chemical away.

Pure water can be quite irritating to the eyes and raw skin. It is much more comfortable for your pet if you use saline: simply dissolve 2 teaspoons of table salt in one quart of water (metric: 9 grams of salt in 1 liter of water). Back to Index

Choking

Authored by: The VIN emergency medicine folder staff

Choking is interference with breathing caused by foreign material in, or compression on, the trachea (windpipe). Thankfully, true choking is a very rare occurrence. Many pet owners will seek veterinary care because they believe their pet has something stuck in its throat, and this is rarely the case. It is far more likely that your pet has something mild and infectious such as tracheobronchitis (commonly called kennel cough) and is coughing rather than choking.

Frequently, coughing is confused with choking. Both cause the pet to forcefully exhale. With choking, the pet has difficulty inhaling. When coughing, the pet can inhale almost normally. Be careful to distinguish the two: attempting to give first aid to a pet who is merely coughing can cause injury.

If you are in any doubt, have your pet evaluated by a veterinarian. To evaluate the throat, most pets will require sedation and some will require evaluation with a fiber-optic endoscope or X-rays to look for foreign material.

If the Pet is Unconscious

Perform a Finger Sweep
Open your pet's mouth and do a finger sweep by placing your finger along the inside of the mouth, sliding it down toward the center of the throat over the base of the tongue, and gently "sweeping" toward the center to remove any foreign material. Warning: there is a structure deep in the throat (the Adam's apple) that feels like a smooth bone. Do not attempt to pull it out!

Begin Rescue Breathing
Rescue breathing is described in the article on CPCR, formerly called CPR. If air is not entering the lungs, slap the chest wall firmly or perform the Heimlich maneuver by putting the pet on his back, placing your hands over the abdomen near the bottom of his rib cage, and gently but firmly thrusting toward the spine. Perform a finger sweep and begin rescue breathing. Repeat until the foreign body is clear and the lungs can be inflated. Transport to the veterinarian.

If the Pet is Conscious

Stay calm and try to keep the pet calm. If the pet is overheated, cool them with cool (not cold) water applied to their extremities (ears and feet) and belly, and transport them to the nearest veterinarian. Perform a finger sweep only if it will not excite the pet. Do not perform a finger sweep if you believe your pet will bite you. Back to Index

 Dehydration

Authored by: The VIN emergency medicine folder staff

Dehydration is excessive loss of water from the body (typically through vomiting and/or diarrhea) or inappropriate intake of water into the body (decreased thirst).  The most common mistake with a vomiting pet is to encourage food and water intake while the pet is still vomiting. This actually makes matters worse by not allowing the stomach and intestinal tract time to rest, and can cause additional vomiting and water loss. Removing access to food and water for a short period of time may seem like it would make dehydration worse, but it can help your pet avoid further dehydration. Dehydration makes your pet feel lethargic, and can potentially cause severe problems with the kidneys and other internal organs if untreated.

What to Do

• If moderate or severe dehydration, seek veterinary attention.  (See below for how to assess if dehydration is potentially severe in your pet.) 
• If dehydration is mild and the pet is not vomiting, give frequent, small amounts of water by mouth; that means in the range of 1 tsp for a cat or small dog to 1 tbsp to 1/4 cup for a medium to large dog every few hours.
• If your pet is lethargic, in pain, or has not eaten for 24 hours, seek veterinary attention.

What NOT to Do

• Do not allow your pet to have immediate free access to large amounts of water or other liquid.  
• Do not feed your pet any dry food until directed to do so by a veterinary professional.

Dehydration often accompanies symptoms like vomiting, diarrhea, hypothermia (low body temperature), fever, no access to water, and other conditions. It can be detected by several tests:

Mouth: Are the tongue and gums moist or dry? If they are dry, there is a chance your pet may be dehydrated. Is the saliva thick or ropey? Normally, saliva is quite watery and hardly noticeable.

Eyes: Are they normal, or do they sink into the sockets? Sunken or dry eyes may indicate dehydration, and warrant veterinary attention.

Skin: Do the skin turgor test outlined in the Physical Exam Checklist. If the skin is slow to return to position, the pet may be moderately to severely dehydrated. If the skin does not return fully to its position, your pet may be severely dehydrated and may be in critical condition. Seek veterinary attention immediately. The skin turgor test is not always accurate and several factors such as age, weight loss and condition of the skin can give misleading results. A veterinary professional can help you determine how dehydrated your pet is, what the cause may be, and the best course of treatment. Back to Index

Diarrhea and Vomiting

Authored by: The VIN emergency medicine folder staff

Diarrhea is the frequent evacuation of watery stools. Vomiting is the forceful expulsion of stomach contents through the mouth.

What to Do

• Remove all food and water. 
• Check for signs of dehydration. 
• If the diarrhea and/or vomiting continues or the pet acts ill, seek veterinary attention. Diarrhea and vomiting can quickly lead to serious fluid loss and electrolyte imbalance, especially in very young and very old animals.  
• If no vomiting occurs for 6 to 8 hours, begin to frequently give small amounts of clear liquids (water, Gatorade, Pedialyte, or other electrolyte solution). A rule of thumb is to give 1 teaspoon per pound of body weight every 2 or 3 hours throughout the day and night.  If your pet does not vomit the fluid, the following day offer small frequent meals of boiled hamburger and rice or boiled chicken and rice. If your pet does not want to eat, starts to vomit, or continues to have diarrhea, go to the veterinarian for medical care.
• Isolate the sick pet from other pets.

What NOT to Do

• Do not administer any over-the-counter or prescription medications to your pet without talking to a veterinarian first.  
• Do not allow the pet to eat or drink anything until there has been no vomiting for 6 to 8 hours.

Vomiting and diarrhea are associated with a host of problems that are referred to collectively as gastroenteritis. Some cases are quite severe (e.g., poisoning), and some are not (e.g., dietary indiscretion). If fever is present, infection may be a cause. Most infections that cause diarrhea and vomiting are contagious, so it is wise to assume that other pets might be vulnerable if they are exposed. 
 
If your pet is not feeling well and has vomiting and/or diarrhea, see a veterinarian. Back to Index

Difficult Birth

Authored by: The VIN emergency medicine folder staff

Puppies are born 59 to 65 days after mating.  The cat gestation period is similar at 63 to 65 days. At the beginning of labor, the contractions may be infrequent, weak, or incomplete. The female may continue for up to 3 hours before a veterinary examination is necessary as long as she does not seem to be ill or in undue pain. If the contractions are frequent, regular, and strong, and no young is produced in 15 to 30 minutes, the pet should be taken to a veterinarian. A dark green vaginal discharge called lochia should be followed within 5 to 10 minutes by puppy or kitten, but only before the first one.

Cats can take up to 24 hours to complete the birthing process, while most dogs have completed the process within 4 to 6 hours.

About two out of three cases of difficult birth (known as dystocia) that need to be seen by a veterinarian will need to have an emergency C-section performed. It is good practice to know long before the due date where your local veterinary emergency facility is, and when and if they can perform a C-section. C-sections are risky and expensive surgeries and careful consideration should be given to the decision to breed your pet or not. X-rays taken after the 42nd day of gestation can show how many babies will be born. This will allow you to know when the mother is done giving birth.
 
Reddish to brownish vaginal discharge can continue for several weeks after a normal birth. If the mother is eating normally and is normally active, this isn’t a problem. If she becomes lethargic, stops eating or acts ill, prompt veterinary attention is needed.

Some new mothers can experience a condition called eclampsia in which their blood calcium levels drop dangerously low. This is due to the large amount of calcium secreted in milk for the newborns. Dogs with eclampsia experience severe muscle tremors, difficulty walking and seizures. Immediate veterinary care is needed if your dog is showing any of these signs. Eclampsia can happen anytime around birth, but is most common during peak milk production (2 to 4 weeks after birth).

What to Do

• Prepare a clean, warm and easy-to-clean area for the birth.
• Check on the mother frequently, without disturbing the process. Repeated interruptions will only delay birth.
• If a baby is visible in the birth canal and appears stuck, gently grasp the foot or feet with a clean cloth. With a steady motion gently pull on the baby only when the female is contracting. If the baby does not come out easily, transport the pet to a veterinarian.  
• When the baby is born, it will likely be covered in a membrane. If the mother doesn't remove it, tear this membrane and remove it from the baby’s head region.  
• If the mother doesn't remove the umbilical cord, or is being rough with it, tie it with a piece of string or dental floss one fourth of an inch from the baby's abdomen. Then cut the cord one half of an inch from the abdomen with a sharp scissor. Apply iodine to the stump.  
• Keep the babies warm. It is best to leave them with their mother, but sometimes she doesn't stay with them. In that instance, put a plastic bottle filled with warm water near the babies. A hot water bottle works, as does a heating pad (set on low only, and under a layer of towels!) Allow room for the babies to move toward or away from the heat source.

What NOT to Do

• Do not put your fingers in the birth canal as you can cause trauma or infection. 
• Do not forcibly attempt to remove a baby.  
• Do not assist delivery by pulling on the head of a baby or on the umbilical cord as it exits the mother.  
• Do not lift the baby by the umbilical cord.  
• Do not use a heating pad on a high or medium setting. 
• Most kitten and puppy births go smoothly, with the mother doing all the work. The babies contentedly nurse on the mother soon after birth.
• You may not see the afterbirth (placenta) being passed. Many mothers will eat this after it is passed without anyone noticing. It’s not a problem if all of the placentas are not passed and should be resorbed by the mother’s body. Back to Index

Drowning (Near Drowning)

Authored by: The VIN emergency medicine folder staff

Suffocation by drowning is caused by lungs filling with water or other fluid. Some pets can seemingly recover from a near drowning incident, only to succumb to a collection of fluid in the lungs (known as pulmonary edema) hours later. This phenomenon is known as ‘dry drowning’ and can be fatal. For this reason, all pets that have fallen into a pool or other body of water should be evaluated by a veterinarian and observed for complications.

What to Do

• Remove him from the water. 
• Place him on his side with his head and neck extended. It's preferable to have the head slightly lower than the body to promote drainage of water from the lungs and to avoid inhalation of stomach contents (aspiration). 
• To expel water from the lungs and stomach, pull the tongue forward and gently push on the chest wall and stomach. Take care to avoid being bitten.
• Begin CPCR, formerly called CPR, as required.  
• Cover the pet with a blanket to avoid further heat loss.  
• Seek veterinary help as soon as possible. 
• Secure the water source to prevent other pets and children from gaining access and falling in.

What NOT to Do

• Do not fail to seek veterinary help just because your resuscitation is successful and your pet seems to be recovering. Numerous secondary complications (i.e., electrolyte imbalance, hypothermia, pneumonia, fluid in the lungs) can occur. 
• Do not leave the pet unattended as they may be confused and wander back to the water.

Almost all cats and dogs instinctively know how to swim. Unfortunately, they also instinctively swim to the nearest edge of a pool to get out. Usually that is not the right decision. Most animals are unable to get out of a swimming pool at the edge and must swim to a step. If your pet has access to a swimming pool, you must teach him where the steps are. If he doesn’t know where the steps are and falls in, he will swim to the nearest edge and attempt to get out until he either accidentally arrives at a step or tires and drowns.

If your pets have access to a swimming pool, you must teach them where the steps are located. Back to Index

Electrocution

Authored by: The VIN emergency medicine folder staff

In order to avoid injury to yourself, it is imperative that you do not touch the pet until the electrical source has been turned off or moved. Electricity can flow through your pet and affect you as well.

Electrocution can cause severe tissue damage (like a thermal or heat burn can) and can also lead to serious internal complications like pulmonary edema (fluid in the lungs). Immediate veterinary care is needed, but several things you can do at home can minimize the extent of the injury and promote healing.

What to Do

• Unplug the electrical cord or shut off the electricity. 
• If this is not possible, use a dry wooden broom or other non-conductive object to move the pet away from the source of the electricity.  
• Check for breathing and pulse. Begin CPCR (formerly called CPR) if necessary.  
• If the pet is breathing, check the mouth for burns if this can be done safely. Apply cool compresses to burns.  
• Cover the pet with a blanket to prevent heat loss.  
• Seek veterinary attention as soon as possible.

What NOT to Do

• Do not fail to get the pet examined even though he or she seems perfectly normal after being separated from the source of electricity. 
• Do not give any medications or liquids unless instructed to by a veterinarian.

Any animal that has suffered electrocution should be taken to a veterinarian, even if there are no apparent complications. Electrocution is a life-threatening emergency. It may cause abnormal electrical activity of the heart or a build-up of fluid in the lungs that could be fatal hours after the shock. Most patients are observed for several hours or overnight to make sure the lungs are normal, and  chest x-rays may be recommended. Back to Index

If you notice any of the following:

• Your pet squinting or protecting an eye
• Any suspected trauma to the eye
• Abnormal appearance of the eyeball
• Excessive redness to the white part of the eye (sclera)
• Any time the eyelid cannot cover the eyeball

You should seek veterinary attention immediately as these signs can indicate potentially serious eye problems that can risk your pet’s vision.

Conditions like trauma, glaucoma, perforation of the cornea (the clear membrane in the front of the eye), serious infections, foreign bodies and autoimmune diseases can all affect your pet’s eye and may need medical care.

Take care not to get bitten when treating your pet, and use a muzzle when needed to stay safe.

What to Do

• If an eye has been dislocated from the socket (proptosis) or the lids cannot close over the eyeball, keep the eyeball moist with contact lens wetting solution, K-Y jelly, water, or moist compresses. 
• If an irritating chemical or other product accidentally gets into the eye, flush it with running water, contact lens saline or homemade saline solution squeezed from a compress or a sponge for a minimum of 15 minutes. (Saline: dissolve 2 teaspoons of table salt in 1 quart of water)  
• Always seek veterinary attention immediately. Eyes are quite fragile and just a few minutes could mean the difference between sight and blindness.  Referral to an eye specialist (ophthalmologist) may be needed for more severe cases.

What NOT to Do

• Do not attempt to treat the eyes, or remove a foreign object, yourself. 
• Do not try to push a proptosed eyeball back into the socket. This must be done under anesthesia so as not to cause damage to the eyeball's interior. Back to Index

Fainting/Dizziness (Syncope)

Authored by: The VIN emergency medicine folder staff

Fainting is the sudden loss of consciousness or a sudden and marked weakness. It may be associated with numerous medical conditions and can be caused by anything from low blood sugar and neurological diseases to severe heart disease. 

What to Do

• Immediately position the pet with the head down and the hind quarters elevated. This will improve brain blood flow. 
• Cover the pet with a blanket to preserve body heat. 
• If the pet vomits, make sure he or she does not inhale any of the vomitus into his lungs by keeping the head down. 
• Seek veterinary attention.

What NOT to Do

• Do not administer anything by mouth. It can be aspirated into the lungs and cause serious problems. 
• Do not slap the pet or douse him with cold water trying to shock him into consciousness. 
• Do not fail to seek veterinary attention just because the animal recovered quickly and seems fine now. Several of the conditions that cause fainting or dizziness are extremely serious and require diagnostic tests in order to determine the cause and prevent future episodes. Back to Index

Fever

Authored by: The VIN emergency medicine folder staff

Fever is an elevated body temperature that occurs as a response to infection or inflammation (also see hyperthermia). Normal body temperature is 101 to 102.5 degrees Fahrenheit for both dogs and cats. The temperature is most accurately taken with a rectal digital electronic thermometer; these usually give results in less than one minute. Lubricate the thermometer with a water-based lubricant (such as K-Y jelly, baby oil or soap), and then insert the thermometer about 1-2 cm (about 1/2 to 1 inch). Ear thermometers designed for humans do not work well in pets. 
 
What to Do

• Take and record the rectal temperature if you pet feels ill or warm. If it is above 103 degrees, call your veterinarian or local emergency center. A temperature above 106 degrees can be life threatening and demands immediate attention. 
  • If the animal's temperature is over 105 degrees, moisten the pet's hair coat with cool (not COLD) water and pay particular attention to the ears and feet, which are sites of heat exchange. Direct a fan on the moistened areas.
  • Encourage (but do not force) your pet to drink small, frequent quantities of water unless she has vomited in the past 4 to 6 hours.

What NOT to Do

• Be careful not to overtreat! Discontinue cooling once the rectal temperature reaches 103 degrees or the pet may become too cold (hypothermic). 
• Do not give aspirin or other drugs as many of these are poisonous to pets.

When a pet is lethargic, depressed, shivering a lot, or you see any other reason to suspect that she is not well (not eating, or is vomiting, coughing, has greenish nasal discharge), suspect a fever. The only way to confirm this is to take her temperature using a medical thermometer. Detailed information on taking rectal temperature can be found in the in the temperature section of the Physical Exam Checklist. Back to Index

Fractures / Injuries

Authored by: The VIN emergency medicine folder staff

A fracture refers to a break or crack in a bone. There are several different types of fractures, and each type has different complications and methods of repair. Your veterinarian can help you decide how best to fix the fracture and if referral to a specialist is in your pet’s best interest. Although splinting will allow a small number of fractures to heal, most will require surgery to ensure the best outcome. Toy breeds of dogs (such as Pomeranians, rat terriers and similar small, long-legged dogs) always require surgery on foreleg fractures due to the high failure rate of splinting.

Fracture Types

Closed fracture: fractures in which there is no related external wound.

Open (formerly known as compound) fracture: fractures associated directly with open wounds (the bone may or may not be visible through the wound).

Dislocation: an injury to the connective tissues holding a joint in position that results in displacement of a bone at the joint.

Sprain: an injury to a joint, ligament, or tendon in the region of a joint. It involves partial tearing or stretching of these structures without dislocation or fracture.

Other types of orthopedic injuries can involve torn ligaments, particularly in the knee. Many athletic, large breed dogs will tear the cranial cruciate ligament in their knee, which results in a sudden loss of use of the leg, and joint pain and swelling in the knee. Surgical stabilization is the best means to repair this injury.

What to Do

• Before treatment, precautions should be taken to prevent biting injury to the first aid provider. Muzzle your pet.
• Stop bleeding with direct pressure.
• Open fractures should be covered with a sterile gauze dressing if possible. If this is not available, use a clean cloth or feminine pad applied over the opening and bone.  
• If possible, the pet should be immobilized on a large board for transport.
• If the pet can still use three legs, support the rear legs with a towel under the abdomen (with the ends held together above the back) used as a sling.
• Splinting the fracture at home without pain medication greatly increases the risk of being bitten, and may actually make the fracture worse. Some fractures, such as thigh or femur fractures, cannot be splinted. The best advice is to keep the pet quiet and calm, protect yourself and head directly to a veterinary hospital.

What NOT to Do

• Do not flush the wound with saline or water as this only risks driving contaminants deeper into the wound. 
• Never attempt to set or reduce a fracture or try to push a protruding bone back into position. 
• Do not give any over-the-counter or prescription medications to your pet unless directed to do so by a veterinarian

A fracture, dislocation or severe sprain may be suspected when the animal suddenly appears lame on a leg, or picks up a leg and won't use it. These may also be suspected following any major fall or blunt injury. Obvious findings of a bone sticking out from (protruding) a wound are rare. What is more common is the unusual angle or deformation of the fractured area, and swelling. Accurate diagnosis requires the use of x-rays, which usually must be taken with sedation or anesthesia to get the most accurate results.
 
An x-ray is the only way to accurately diagnose a fracture. Back to Index

Hyperthermia (Heat Stroke, Heat Prostration)

Authored by: The VIN emergency medicine folder staff

Body temperature may be elevated because of an infection (fever), but it may also increase because of hot and/or humid conditions outside.  An increased body temperature caused by environmental conditions is commonly referred to as hyperthermia, heatstroke, and heat prostration. 

Hyperthermia may be a life-threatening condition, and does require immediate treatment.  A dog’s normal body temperature is 101.5°F plus or minus 1 degree Fahrenheit, and any time the body temperature is higher than 105°F, a true emergency exists.  Heatstroke generally occurs in hot summer weather when dogs are left with inadequate ventilation in hot vehicles.  However, heatstroke may also occur in other conditions, including:

1. When an animal is left outdoors in hot/humid conditions without adequate shade.
2. When exercised in hot/humid weather.  
3. When left in a car on a relatively cool (70°F) day; a recent study from Stanford University Medical Center found the temperature within a vehicle may increase by an average of 40 degrees Fahrenheit within one (!) hour regardless of outside temperature. 

Other predisposing factors may be obesity and/or diseases affecting a pet’s airway.  Keep in mind that prolonged seizures, eclampsia (milk fever), poisonings, and many other conditions may cause hyperthermia.  Also, brachycephalic (short-nosed) breeds (Pekingese, Pug, Lhasa apso, Boston terrier, etc.) may suffer from ineffectual panter syndrome that results in an increased body temperature that may be fatal.

Initially the pet appears distressed, and will pant excessively and become restless.  As the hyperthermia progresses, the pet may drool large amounts of saliva from the nose and/or mouth.  The pet may become unsteady on his feet.  You may notice the gums turning blue/purple or bright red in color, which is due to inadequate oxygen.

What to Do

• Remove your pet from the environment where the hyperthermia occurred. 
• Move your pet to shaded and cool environment, and direct a fan on her. 
• If possible, determine rectal temperature and record it.
• Begin to cool the body by placing cool, wet towels over the back of the neck, in the armpits, and in the groin region.  You may also wet the ear flaps and paws with cool water.  Directing a fan on these wetted areas will help to speed evaporative cooling.  Transport to the closest veterinary facility immediately.

What NOT to Do

• Do not use cold water or ice for cooling. 
• Do not overcool the pet.
• Most pets with hyperthermia have body temperatures greater than 105°F, and a reasonable goal of cooling is to reduce your pet’s body temperature to 102.5-103°F while transporting her to the closest veterinary facility. 
• Do not attempt to force water into your pet’s mouth, but you may have fresh cool water ready to offer should your pet be alert and show an interest in drinking.
• Do not leave your pet unattended for any length of time.

Rapidly cooling the pet is extremely important. While ice or cold water may seem logical, its use is not advised. Cooling the innermost structures of the body will actually be delayed, as ice or cold water will cause superficial blood vessels to shrink, effectively forming an insulating layer of tissue to hold the heat inside. Tap water is more suitable for effective cooling.

Severe hyperthermia is a disease that affects nearly every system in the body. Simply lowering the body temperature fails to address the potentially catastrophic events that often accompany this disorder. A pet suffering from hyperthermia should be seen by a veterinarian as soon as possible. Back to Index

Hypothermia

Authored by: The VIN emergency medicine folder staff

Hypothermia occurs when the body temperature goes below 100.5°F. The normal body temperature of dogs and cats is between 101 and 102.5°F. If the rectal temperature of a dog or cat is below 100.5°F, the pet is suffering from hypothermia. Usually the pet is lethargic and doesn't have much of an appetite. The cause may be environmental, such as being exposed to cold air, or metabolic, such as kidney or heart failure. Regardless of the cause, the low temperature indicates that the pet is in need of urgent veterinary attention.

Hypothermia may be a sign of serious illness (i.e., diabetes, heart failure, shock or serious infection, among others). Do not overlook its significance. Hypothermia is especially a problem in cats and small dogs, and it can contribute to shock and organ failure. It is very important that hypothermic pets receive medical attention right away.

What to Do:

• Move the pet to a warm environment. 
• Bundle the pet in warm blankets. You can warm the blankets by putting them in a clothes dryer. 
• Put a hot water bottle in the blankets to add heat. 
• Seek veterinary attention.

What NOT to Do

• Do not risk causing burns by using blankets, heating pads, water, etc., that are too hot; that may damage the skin. 
• Do not use excess superficial heat. This may cause superficial blood vessels to dilate, resulting in shock. 
• Do not allow the pet to lie directly on a heating pad - use several layers of towels and make sure it is set on LOW. Back to Index

Impalement and Penetrating Injuries

Authored by: The VIN emergency medicine folder staff

Impalement and penetrating injuries involve a foreign body stuck in an animal, usually in a body cavity like the abdomen or chest, or deep wounds where the skin is broken. Common examples in small animals include pets shot with arrows or crossbow bolts, dog fight injuries and gunshots. Dogs frequently carry sticks in their mouths and suffer mouth or neck injuries when the end of the stick jams into the ground. Pets can also fall from multiple storey buildings and become impaled on fences or other sharp objects. A veterinarian should be seen as soon as possible. Impalement injuries can lead to serious internal damage.

Sedation and/or general anesthesia are often needed to determine where the impalement occurred and how much internal or hidden damage has occurred. Some foreign bodies, such as wood, do not show up on routine X-rays, so more advanced tests (such as ultrasound or MRI) may need to be used.

Occasionally, parts of the foreign body will become lodged in the pet’s skin or tissues, even after most of it has been removed. These can migrate to different parts of the body and cause problems weeks later.

Some injuries inflicted by others dogs can appear minor at first, but may actually have severe damage to deeper tissue; we call these ‘tip of the iceberg’ injuries.  Dog fight injuries can sometimes become worse before they become better due to the crushing forces involved in the bite injury and death of the overlying skin (necrosis). Sometimes a pocket of infection (abscess) may form that requires placement of a tube to drain accumulated fluid.

What to Do

• Calm and blanket the pet. 
• Muzzle the pet so you avoid getting bitten.
• Attempt to immobilize both the foreign body (if it’s still there) and the pet. Severe and continuing damage is done whenever the foreign body is allowed to flail about the inside of the pet. 
• If the foreign body is in the chest, or there is damage to the chest, listen for sounds of air sucking or whistling around the wounds. If it appears that there is an open wound in the chest, cover the wound (and the foreign body, if necessary) with plastic wrap. Before you place the plastic wrap, apply petroleum jelly, sterile lubricant or antibiotic ointment to help seal the wound.  
• If the foreign body can easily be cut, shorten it, leaving only 3 to 6 inches sticking out of the pet.

What NOT to Do

• Never try to remove the foreign body yourself. 
• Do not allow the pet to move.
• Do not move the foreign body while cutting it.
• Do not avoid seeking veterinary attention, just because a wound seems minor – there can be extensive hidden damage that needs medical attention. Back to Index

Nosebleed

Authored by: The VIN emergency medicine folder staff

A nosebleed (epistaxis) is bleeding or hemorrhage from the nose. It is important to stop a nose bleed, but is equally important to get to the bottom of why it’s happening.   Stopping nose bleeds in pets is often the easy part, but finding out why a nose is bleeding may sometimes be more challenging.

Your pet should be kept calm, as excitement may cause an increase in blood pressure that will make control of the nosebleed difficult.  As a pet owner, you too must remain composed; if your pet sees you getting frantic, he will become further distressed.

Place an ice-pack over the bridge and on the side of the nose to help to control bleeding as that constricts the blood vessels in this area.  If possible, look in the mouth to see if there is blood or if the gums are pale.  In either case, your pet should be evaluated by a veterinarian immediately.

What to Do

• Notice if the blood is coming from one nostril (note which one) or both. 
• If your pet is sneezing, note how often. 
• Attempt to keep your pet calm. Encourage your pet to lie down and relax. 
• Place an ice pack (covered by one or more layers of clean cloth) or cold compress on the bridge and side of the nose. 
• If the nose is bleeding profusely and/or the bleeding lasts more than 5 minutes, seek veterinary attention.

What NOT to Do

• Do not put anything up the nose, as this will likely cause your pet to sneeze. Sneezing will dislodge a clot (if one has formed), and the bleeding will resume.

A bloody nose in a cat or dog may be associated with foreign bodies (foxtail awns are common), polyps, infections, poisoning, bleeding disorders, or even cancer. It is a sign whose significance should not be underestimated, and veterinary medical attention should be sought as soon as possible. Back to Index

Paralysis

Authored by: The VIN emergency medicine folder staff

Paralysis is the inability to voluntarily move a part or parts of the body. The paralyzed part (legs, neck, etc.) may be rigid or stiff or, more commonly, relaxed and flaccid. Severe pain can often accompany paralysis, and treating for pain is an important part of the overall therapy, regardless of cause. For some cases of paralysis, you may need a referral to a specialist in neurology or surgery to maximize the chance that your pet will walk again.

What to Do

• Calm the pet. If necessary, cover with a blanket. 
• Muzzle the pet in order to transport her to the veterinary hospital. 
• Transport the pet using one of the techniques described. 

What NOT to Do:

• Do not assume she won't bite. 
• Do not encourage the pet to move about. 
• Do not medicate her with over-the-counter or prescription medications unless instructed to do so by a veterinarian. 
• Do not delay evaluation by a veterinarian. This is an emergency.

The inability to walk can develop suddenly (with or without a history of injury) in dogs due to the rupture of an inter-vertebral disc, especially in certain breeds like the Dachshund. The ruptured disk causes swelling and inflammation of the spinal cord and severe cases often need surgery immediately. Paralysis of this type should be considered an emergency and your veterinarian or an emergency facility should be consulted immediately.

Paralysis can also be associated with traumatic episodes such as falls, being struck by a motor vehicle, spinal cord tumors, or fights with other animals. When paralysis is associated with trauma, fractures or instability of the spine should be suspected. It is extremely important to immobilize the spine before and during transportation.

Paralysis is a serious matter but many patients can hope to walk again with the right treatment. A considerable investment on the part of the pet owner in terms of time, effort and money may be required. Many patients will need help with physical therapy, walking and bodily functions (such as urination) for several weeks after the injury. Your veterinarian or specialists can help you make decisions on the right treatment plan to get your pet back to health as soon as possible. Back to Index

Physical Exam Checklist for Pets

Authored by: The VIN emergency medicine folder staff

To identify an illness or abnormal situation, you must first be able to recognize what is normal for your pet. You know your pet better than anyone else and will have to decide when an abnormal situation warrants professional help. Sometimes the condition is so serious it leaves no doubt. Frequently, the changes are subtle or happen over a long period of time and it is important that they are recognized and addressed. Early recognition of a serious problem can save your pet's life.

The following information teaches you how to examine your pet and determine what is normal. The primary suggestion is to give your pet a "mini" physical exam occasionally when there is nothing wrong so you get used to what is normal for your pet. Record the normal values using the guide at the end of this article.

Hands-on Physical Exam 
 

Before starting a hands-on exam, stand back and look at your pet for a few minutes. The posture, breathing, activity level, and general appearance can tell you a lot.

Now start the physical exam, making sure to look at the following areas. Consult a veterinarian if an abnormal condition exists or you are concerned about any exam findings.

A hands-on physical exam in the comfort of your own home is the best way to learn what is normal for your pet.

Nose
 

Normal:  Moist and clean

Abnormal:

• Dry or cracked 
• Nasal discharge (such as thick greenish mucus)
• Bleeding

Skin

The skin is an important indicator of overall health.  Feel your pet’s skin and haircoat, noting any masses or sores. Many older pets can develop accumulations of fatty tissue known as lipomas. In order to differentiate these benign masses from cancerous ones, it is important to have your pet evaluated by your veterinarian and have an aspirate performed. This simple and quick procedure can help your veterinarian determine the nature of the lump and help you decide if further tests or treatment are needed.

Normal

• Shiny and smooth haircoat
• Soft and unbroken skin
• Minimal odor

Abnormal

• Sparse or patchy haircoat
• Open sores or sounds
• Oily or greenish discharge
• Foul or rancid odor

Eyes
 

Normal

• Bright, moist, and clear
• Centered between the eyelid
• Pupils equal in size
• Whites of the eye should not appear colored (such as red or yellow) and should have only a few visible blood vessels
• Pupils shrink equally when bright light is shined into either eye
• Pupils enlarge equally when the eyes are held closed or the room darkened.

Abnormal

• Dull, sunken eyes. Eyes that appear dry. Thick discharge from eyes. 
• One or both eyes not centered. 
• Pupils unequal in size. 
• Abnormal colors that indicate problems are yellow (jaundice), or red (bloodshot). 
• Pupils fail to respond or respond differently when bright light is shined into either eye. 
• Pupils fail to respond or respond differently to the dark.

Pay close attention to the color of the whites of your pet's eyes, as well as the pupils' response to changes in light.

Ears

Chronic ear problems are common in pets, and are often a result of allergies to inhaled pollen (like hay fever in people) that are then complicated by secondary infections with bacteria or fungus. Ear infections can be painful and head shaking can lead to an accumulation of blood (or hematoma) in the floppy part of the ear called the pinna.

Normal

• Skin smooth and without wounds
• Clean and dry
• Almost odor-free
• Typical carriage for breed
• Pain-free

Abnormal

• Wounds or scabs on skin. Lumps or bumps on skin. Any sign of rash
• Crust, moisture, or other discharge in ear canal
• Any strong odor from the ear
• Atypical carriage for breed; for example, a droopy ear in a breed with normally erect ears
• Painful or swollen ears.

Your pet's ears should be clean and odor-free.

Mouth

 
  Normal

• Teeth are clean and white
• Gums are uniformly pink.

Abnormal 

• Tartar accumulation around the base of the teeth
• The gums are red, pale, inflamed, or sore in appearance.

Press on the gum tissue with your finger or thumb and release quickly. Watch the color return to the gums. This checks the capillary refill time (CRT) and is a crude assessment of how well the heart and circulatory system are working. A normal CRT is 1 to 2 seconds for color to return. This can be a difficult test to interpret sometimes (for example, if your pet has dark or pigmented gums), and should not be relied upon as definitive evidence that your pet is sick or healthy.

Gums should be pink -- teeth should be clean and white.

Neck, Chest, and Breathing

Normal

• It is difficult to hear the pet breathe at all except when he or she is panting. 
• The chest wall moves easily to and fro during respiration. 
• Most of the act of breathing is performed by the chest wall. 

Abnormal

• Any unusual noise heard while the pet is breathing could indicate a problem, especially if the noise is new for the pet. 
• There is noticeable effort by the pet to move the chest wall. 
• The abdomen is actively involved in the act of inhaling and exhaling.
• The pet stands with elbows held out further than normal or, is unable to rest or lie down.

Abdomen (Stomach)
 

Touch and feel (palpate) the stomach. Start just behind the ribs and gently press your hands into the abdomen, feeling for abnormalities. If your pet has just eaten, you may be able to feel an enlargement in the left part of the abdomen just under the ribs. Proceed toward the rear of the body, passing your hands gently over the abdomen.

Normal

• No lumps, bumps, or masses
• No discomfort on palpation 
• No distension of the abdominal wall.

Abnormal 

• Any lump, bump, or mass may be abnormal. 
• Palpation causes groaning or difficulty breathing. Any evidence or indication of pain is a serious finding. Use caution to avoid being bitten.
• The abdomen feels hard or tense and it appears distended.

Any pain felt during an abdominal palpation could be a problem. Consult your veterinarian.

Skin Turgor Test 
 

The skin turgor test may be the most helpful one to determine whether an animal is well hydrated. (See dehydration.) This test can be affected by several factors other than hydration status, such as weight loss, age and general skin condition, but it can help you make a rough determination of your pet’s hydration status. To perform this test, pull the skin over the chest or back into a tent and release it quickly; avoid the skin of the neck as it's often too thick for this test. Observe the skin as it returns to its resting position.

Normal

• The skin snaps back into position quickly.

Abnormal 

• The skin returns slowly or remains slightly tented. This is a sign of possible dehydration.

Pulse and Heart Rate

 
Learn to locate the pulse on your pet before a crisis. The best place on a cat or dog is the femoral artery in the groin area. Place your fingers around the front of the hind leg and move upward until the back of your hand meets the abdominal wall. Move your fingertips back and forth on the inside of the thigh until you feel the pulsing sensation as the blood rushes through the artery. Count the number of pulses in 15 seconds and multiply by 4. This will give you the pulse rate in beats per minute (BPM). Pulse rate is a highly variable finding and can be affected by recent exercise, excitement or stress. Do not use the heart rate at the sole evidence that your pet is sick or healthy.

Normal

• Cats: 100 to 160 breaths per minute (bpm). A relaxed cat may have a slower pulse.
• Small dogs: 90 to 130 bpm
• Medium dogs: 70 to 110 bpm
• Large/giant dogs: 60 to 100 bpm. A relaxed dog may have a slower pulse.
• Pulse is easily palpated, strong, and regular.

Abnormal

• Too rapid or too slow
• Pulse is weak, irregular, or hard to locate.

Learn how to properly take your pet's pulse.

Temperature 
 

Taking your pet's temperature is an easy and important procedure and can be done with a glass mercury or a digital thermometer. Digital thermometers are easier to read and can be inexpensively purchased at a pharmacy.

Rectal temperatures are more accurate than axillary (between the front leg and the body) temperatures. Lubricate the thermometer with petroleum jelly. Gently and slowly insert the thermometer into the rectum about 1 or 2 inches. If it does not slide in easily, do not force it. Leave it in for 2 minutes, then read and record the temperature.

Normal

• Temperature is between 101°F and 102.5°F. 
• The thermometer is almost clean when removed.

Abnormal

• Temperature is below 100°F or above 103°F. 
• There is evidence of blood, diarrhea, or black, tarry stool on the thermometer.

It may be easier to take your cat's temperature if you have someone to help you. Do not risk taking your pet’s temperature if you feel there is a risk of being bitten.

Normals: A Final Note

Know the normals for your pet. Record the results of your pet’s home examination using the outline on the following page. Watch your pet closely so you know when something is wrong. Become familiar with these normals before a crisis so you can recognize an abnormal finding.

Normal Values for my Pet

My pet ______________________ has the following normal values:
Normal Weight: _______________pounds
Resting Heart Rate (Pulse): ______________________ beats per minute
Resting Respiratory Rate: ______________________ breaths per minute
Rectal Temperature: ______________________ degrees Fahrenheit
Normal Gum Color: ______________________
Normal Whites of the Eyes: ______________________ Back to Index

Poisoning

Authored by: The VIN emergency medicine folder staff

Poisoning is a condition that results from the ingestion, inhalation, absorption, injection, or application of a substance that causes structural damage or functional disturbance of body  tissues. The poison can be a plant, a medication given in excess, a cleaning product, or other household chemicals.

What to Do

• Try to get in touch with a veterinarian or a poison control center, and follow their instructions. If you do not have a local poison control center, you can call the ASPCA's Animal Poison Control Center at (888) 426-4435 (a consultation fee may be applied to your credit card).
• If you can't get in touch with either one and the poisoning occurred within the last 3 hours, consider inducing vomiting. Do not induce vomiting if your pet is unconscious, seizing, not able to stand, or is having trouble breathing. Also do not induce vomiting if the poison is a petroleum product, a cleaning solution, or a strong acid or alkali. 
• If the product is a petroleum product, cleaning solution, strong acid, or strong alkali, if the substance was ingested more than 3 hours ago, or if your pet is unconscious, not able to stand, or is having trouble breathing, you must get your pet to a veterinarian as soon as possible. 
• If the pet vomits, save a sample of the vomitus for later inspection by the veterinarian. You can carry it in a ziplock bag.
• Read about chemical injuries if a chemical has injured your pet.

What NOT to Do

• Do not give any liquid (other than the hydrogen peroxide if you’re inducing vomiting): liquids may move the poison into the body sooner. Back to Index

Preventing a Health and Safety Crisis

Authored by: The VIN emergency medicine folder staff

Nutrition and Feeding

Good nutrition is essential for a healthy pet. Nutrients in pet foods should provide what is needed for metabolic body processes and should help fight off disease.
 
Proper feeding habits with nutritious food on a regular schedule can prevent:

• Disease 
• Nutritional deficiencies 
• Irritation or malfunction of the digestive system

Improper feeding habits can cause or contribute to:

• Obesity 
• Dental disease 
• Heart disease 
• Liver disease 
• Pancreatitis 
• Arthritis 
• Inflammation and/or bleeding in the intestines

Many animals die each year from such diseases. Avoid table scraps, high fat foods, and foods that cause choking. Your pets should be offered foods developed for them or recommended by your veterinarian.

Provide Plenty of Clean Water

All animals, especially the very young and the very old, are susceptible to dehydration and kidney disease if deprived of water, quickly leading to serious complications.

Nutritious food and clean, fresh water are important to your pet's health!

Avoid Vigorous Exercise after Meals

Vigorous exercise after meals can lead to a life-threatening condition called bloat, which affects all breeds of dogs, but large, deep-cheated dogs are affected more frequently. With early and aggressive medical and surgical treatment, 80% or more of these patients survive this horrible condition.

Safe Environment

Unsafe situations may occur in your pet's surroundings, even with animals who are confined to the house or an outside run. A responsible pet owner should always have control of their pet and their pet's environment. Injury or death after being hit by a car or being attacked by another animal can be prevented if your pet is properly controlled. Your pet may be injured or shot if allowed to wander unrestricted. Controlling your pet and providing a safe home can eliminate several dangerous situations.

Temperature 
 
Animals have more problems in hot environments than in cold. Pets can suffer heat prostration and die in a short period of time, even minutes, under severe conditions. Good ventilation is vital. Animals cool themselves by panting, which becomes inefficient in extreme heat, poor ventilation, or when dehydration causes a lack of moisture on the tongue. If it is absolutely necessary to leave your pet in the car, even for a short time, keep the windows partially open. In the summer, the car's interior can quickly rise to over 150°F, and your pet's body temperature may rise to 110°F or more, causing irreversible brain damage and/or death within minutes.

Exercise

Your pets need room to move around safely to get exercise. Provide an area with adequate room, shelter, and bedding that can be cleaned. Lots of space to exercise, some toys, and clean, comfortable bedding are some simple things that can add years to your pet's life.

Leash Choking 

Confinement created by a chain tied to a post or a cable can result in death by suffocation if the chain becomes too tightly wrapped around the post or around your pet's neck.

Proper Identification

Remember to have ID on your animal; people will usually return your pet if your phone number is provided. Also, if your animal is injured and transported to a veterinarian by someone else, the doctor can reach you for medical decisions.

Proper identification tags and/or microchips will help you recover your pet if he wanders off.

Electric Cords

Electric cords should be inaccessible to pets, especially puppies and kittens, who tend to chew on anything. A bite through the insulation can result in a serious burn, fluid accumulation in the lungs, or death (see electrocution).

Dangling electric cords are an irresistible (but dangerous) temptation to a playful kitten or puppy. Make sure all cords are inaccessible!

Choking 

Many common household items can cause your pet to choke:

• String 
• Needles and thread 
• Hosiery 
• Garbage 
• Balls 
• Yarn 
• Socks 
• Bones 
• Gristle 
• Small toys

These items should be kept away from pets, as ingesting them may cause foreign body blockages or injuries to the esophagus, stomach or small intestine. Make sure that small household items are kept in a place that your pets can't reach!

Poisoning

Accidental poisonings can be tragic. Guard against ingestion of:

• Garden supplies, such as insecticides, fertilizers, and snail bait. 
• poisonous plants: Many plants in live or dried forms are toxic. Even food items like dried onions can cause problems in pets. Discuss potential problems with your veterinarian or check with the nursery or a more complete reference before buying plants. 
• Pennies can contain zinc, which can cause vomiting, anemia, and even death if ingested.  
• Chocolate: As little as one ounce of unsweetened (baker's) chocolate may poison a small dog. Milk chocolate isn't as toxic, and if ingested in reasonable quantities there is no cause for alarm. Many dogs, however, ingest unreasonable quantities and may be poisoned.  
• Antifreeze has a sweet taste to dogs and cats, and they may lick it off the ground. As little as one teaspoonful (easily available from a radiator boil over) can lead to irreversible kidney damage and death in a small dog or cat.  
• Medications: Some medications that are safe for us are not safe for pets: Tylenol (acetaminophen) is deadly poison to cats; No-Doz may cause convulsions in both cats and dogs;  Solarcaine may cause anemia in cats; Advil (ibuprofen) may cause kidney damage or gastric ulcers in dogs.

Ask a professional before administering drugs of any kind to your pet.

Traveling 
 
Animals must be contained while riding in a car or truck. Cats jump out of cars quickly. Put them in well-ventilated pet boxes. Dogs can be trained to a seat belt. We recommend that dogs not ride in the back of trucks. In some states it is illegal for a dog to ride in the back of a pick-up truck without tethers. Besides the risk of injury from a fall, the dog may be killed in traffic. Even properly tethered dogs have little protection in the event of an accident.

If your dog must travel in the back of a pick-up, then he should be securely tethered in.

Regular Veterinary Check-Ups
 
Regular veterinary examinations will help avoid some preventable disease problems and permit early detection of others, thus facilitating treatment. Your pet should be seen by your veterinarian at least once a year. During the check-up regular vaccinations are given and the animal is given a physical exam, a dental check-up, and teeth cleaning.

Your pet's annual physical examination is vital for continued good health.

Vaccination Programs

Many dangerous infectious diseases can be prevented or lessened in severity with a proper vaccination program. No vaccine is 100% effective, but regular vaccinations are the most effective way to prevent such diseases.

Approved vaccines are available for the following diseases:
 
Dogs:

• Rabies 
• Distemper 
• Parvoviral enteritis 
• Coronaviral enteritis 
• Hepatitis leptospirosis 
• Parainfluenza/Bordetella 
• Lyme disease

Cats:

• Rabies 
• Panleukopenia 
• Rhinotracheitis 
• Calicivirus pneumonitis 
• Feline leukemia virus 
• Feline infectious peritonitis

With so many formerly deadly diseases now preventable by vaccination, you owe it to your dog or cat to make sure she is up on her booster shots. Consult your veterinarian for the vaccines needed in your area and a proper vaccination schedule.

Dental Health

Dental problems that go untreated not only cause problems in the teeth and gums, but their effects may extend to other areas of the body. 

• Infections from decaying teeth may spread directly to the sinus cavities or the eyes. 
• Bacteria from dental infections and/or plaque accumulation may spread to the heart, liver, kidneys, or other organs.

Good oral hygiene and regular veterinary examination and treatment can eliminate dental problems.

Dental health and good overall health go hand in hand.

Prevention: A Final Note

Seek professional veterinary help immediately if your pet suffers an accident or illness. Getting help early prevents complications and more suffering. Waiting can only result in undue worry, serious deterioration of conditions, and make recovery more difficult. Back to Index

Seizures / Convulsions

Authored by: The VIN emergency medicine folder staff

A seizure is any sudden and uncontrolled movement of the animal's body caused by abnormal brain activity. Seizures may be very severe and affect all of the body, or quite mild, affecting only a portion of the pet. The pet may or may not seem conscious or responsive, and may urinate or have a bowel movement.

Seizure activity that lasts longer than 3 to 5 minutes can cause severe side effects, such as fluid in the lungs (pulmonary edema) or brain (cerebral edema). A dramatic rise in body temperature (hyperthermia) can also result, causing internal organ damage.

Seizures can be caused by epilepsy, toxins, low blood sugar, brain tumors and a host of other medical conditions. Your veterinarian can help you determine the cause of seizures in your pet, and if necessary can refer you to a specialist to help with the diagnosis or treatment of seizures. In general,  animals less than one year of age typically have seizures due to a birth defect such as hydrocephalus (water on the brain) or a liver defect called a portosystemic shunt (among others). Animals that have their first seizure between 1 and 5 years of age typically suffer from epilepsy, while those over 5 years of age often have another medical condition causing the seizures such as a brain tumor, stroke or low blood sugar. These are general guidelines, however, and they may or may not apply to your pet.

All pets that have a seizure should have lab tests to help diagnose the underlying cause, and make sure their organs can tolerate any medications that may be needed to control seizures. Once underlying diseases are ruled out by your veterinarian, some pets require medications such as phenobarbital or potassium bromide, among others, to control seizures. These medications may require frequent dose adjustments and monitoring of blood levels, so it is best to have an open and honest discussion with your veterinarian about the effort and costs involved in treating your pet for seizures.

What to Do

• Protect the pet from injuring herself during or after the seizure. Keep her from falling from a height and especially keep away from water. 
• Remove other pets from the area as some pets become aggressive after a seizure.
• Protect yourself from being bitten. 
• Record the time the seizure begins and ends, and if it started with a certain body part (such as twitching of an eye). 
• If the seizure or convulsion lasts over 3 minutes, cool the pet with cool (not cold) water on the ears, belly and feet, and seek veterinary attention at once.  
• If your pet has two or more seizures in a 24-hour period, seek veterinary attention.
• If your pet has one seizure that is less than 3 minutes and seems to recover completely, contact your veterinarian’s office for further instructions. A visit may or may not be recommended based on your pet’s medical history.
• If the pet loses consciousness and is not breathing, begin CPCR, formerly called CPR.

What NOT to Do

• Do not place your hands near the pet's mouth. (They do not swallow their tongues.) You  risk being bitten. 
• Do not slap, throw water on, or otherwise try to startle your pet out of a seizure. The seizure will end when it ends, and you cannot affect it by slapping, yelling, or any other action.

Special instructions for toy breeds and diabetic pets on insulin: If your pet is a toy breed, such as a Yorkshire terrier or Maltese, or a diabetic, the seizure may be due to hypoglycemia (low blood sugar). If the pet is able to stand, is not vomiting and acts normally, offer a small meal. If the pet is non-responsive, vomiting or actively seizing, rub some honey or pancake syrup on the gums - take care not to get bitten - and proceed immediately to your veterinarian or local emergency center. Prolonged low blood sugar can cause irreversible brain injury. Back to Index

Shock

Authored by: The VIN emergency medicine folder staff

Shock is a condition resulting from a depressed state of many vital body functions caused by a lack of effective circulation.  A veterinary textbook on emergency medicine defines shock as "the clinical state resulting from an inadequate supply of oxygen to the tissues or an inability of the tissues to properly use oxygen." The term ‘shock’ can mean different things to different people, and medical professionals still debate the true meaning of the word.  Regardless of cause, shock is life-threatening and requires immediate attention and treatment. If signs of shock are recognized, or a serious injury has taken place, supportive care, such as intravenous (IV) fluids, oxygen and other measures can help reverse shock and prevent permanent organ damage. The key to successful overall treatment is prompt professional care.

Shock and the Cardiovascular System

To gain a basic understanding of shock, one must first have an understanding of the normal cardiovascular system of dogs and cats. Think of the cardiovascular system as a closed circuit consisting of a pump (the heart) and a series of stretchable tubes (blood vessels). The system is filled to capacity with a fluid (blood) that circulates through the tubes delivering fuel (oxygen and other metabolic substances) and picking up trash (carbon dioxide and other metabolic waste). In order to be efficient, the pump must be able to deliver a proper amount of the fluid and there must be enough fluid to completely fill and stretch the system of tubes. An insult to any part of this system that results in lower fuel delivery, excess fuel burning, and/or excess waste accumulation may result in shock and decreased oxygen delivery.
 
Causes of Shock

The most common cause of shock in our pets is trauma: e.g., fights with other animals, being hit by a car, and gunshots. Other causes include poisoning, insect stings, fluid loss from vomiting and/or diarrhea, infections, burns, and lack of oxygen caused by heart failure or obstruction of airways (pneumonia or choking, for example). Regardless of the cause, shock is life-threatening. Immediate identification is crucial.

Signs of Shock

Early Signs of Shock

• The pet may be either excited or subdued. 
• Rapid heart rate. 
• Pulse not difficult to find.
• Gums may be normal or pale

Late Signs of Shock

• Gums extremely pale or show a bluish discoloration. 
• Heart rate is probably elevated and irregular, but may be normal or below normal as heart muscle begins to fail. 
• The pulse will be weak and either difficult or impossible to locate. 
• The pet will feel cold to the touch and rectal temperature will be below normal.
• Respiration may be slow or rapid, shallow or deep. 
• The eyes may take on a glazed appearance and appear not to focus normally. 
• Mental condition deteriorates from depression to stupor to coma.

What to Do

Successful treatment of a patient in shock involves prompt recognition of the signs, immediate initiation of first aid procedures, and safe and rapid transport to a veterinary facility for definitive treatment.

• Provide adequate breathing if needed (see CPCR, formerly called CPR). 
• Stop bleeding. 
• Apply a muzzle, if pain or apprehension may cause the pet to bite, but make sure that the muzzle does not interfere with breathing. The animal should remain covered (and muzzled, if necessary) during transport to the emergency facility.  
• Gently immobilize the pet. 
• Protect obvious fractures from further injury. 
• Prevent loss of body heat by covering the patient with one or more blankets. 
• Immediately  transport the patient to a veterinary facility for definitive treatment of shock and other injuries and illnesses.

What NOT to Do

Well-meaning pet owners often use first aid procedures that may seem helpful, but, in fact, may prove dangerous to the animal.

• Do not pour water (or anything else) into the animal's mouth. Animals in shock are weak and may inhale anything given by mouth into the lungs, causing a serious complication. 
• Do not administer any medications (including aspirin, ibuprofen or other pain relievers) unless instructed to do so by a veterinarian. 
• Injured animals should not be encouraged to walk. They definitely should not be allowed to move into or out of the transport vehicle on their own. Internal bleeding may be increased with movement.
• Do not assume the pet is not in shock after an accident. Early, mild stages of shock are difficult to recognize, and the pet may deteriorate rapidly if not treated. 
• Do not hesitate to seek veterinary assistance. Many injuries and illnesses that cause shock may cause irreparable damage in minutes. Any hesitation could mean the difference between a pet making a full recovery and a pet that cannot be saved. Back to Index

Snakebite

Authored by: The VIN emergency medicine folder staff

If your pet is bitten by a snake, it is best to assume it is a poisonous bite.

What to Do

• Muzzle your pet to avoid being bitten – snakebites can be painful, and your pet may try to protect herself.
• Immobilize the part of the animal that has been bitten by the snake, if this can be done safely. Try to keep it at or below the level of the heart. 
• Keep the pet calm and immobile; carry if necessary. 
• Seek veterinary attention as soon as possible. 
• Try to identify the snake if it can be done without risk: DO NOT ATTEMPT TO CAPTURE OR KILL THE SNAKE. It is helpful to identify the type of snake to aid your veterinarian with treatment. Do not bring the snake into the veterinarian’s office – a photograph will do.

What NOT to Do

• Do not cut over the fang marks. 
• Do not attempt to capture or kill the snake
• Do not manipulate the bitten area any more than needed. 
• Do not allow the pet to move about freely. 
• Do not ice pack or tourniquet the area. 
• Do not administer any medications except on a veterinarian's advice.

Snakebite is a complex problem. The severity and type of damage done by venom depends on the type of snake involved, the age of the snake, and the size of the pet who was bitten. The vast majority of pets who are bitten by a snake will survive, but medical attention is vital to ensure the best outcome.

Some snakes have venom that causes severe shock and rapid death. Others have most of their effect on the muscles or have effects that can be delayed by days or weeks. Some venom is concentrated and some isn’t, thus requiring a large quantity before damage is done.

The first goal in snakebite treatment is to keep the venom from circulating in large quantity throughout the body. However, keeping all the venom in the area of a bite (as happens with ice packs or tourniquets) may cause severe muscle damage. Antivenin administered at the hospital is the most direct and helpful treatment for your pet. Antivenin can cause severe allergic reactions in some pets, and must be administered under controlled conditions and monitored closely. Most pets that have been bitten will need to be admitted to the hospital for treatment, and some pets can have large areas of dead tissue that need to be surgically cleaned over several days or weeks.

If your pet is bitten by a snake, assume the bite is poisonous and seek veterinary attention quickly. Back to Index

Straining to Eliminate

Authored by: The VIN emergency medicine folder staff

Straining is a frequent and sometimes exaggerated effort to have a bowel movement or to urinate.

It is often difficult to tell if the pet is having trouble urinating or defecating. Most owners think their pet is constipated when they first notice them straining. Straining produced by constipation may be identical to straining produced by a blocked urethra, diarrhea or an inflamed colon. Therefore, treatment of an assumed cause of straining may be the opposite of what is actually needed.

In cats, straining is often indicative of urinary tract inflammation. Cats sometimes develop a condition called feline lower urinary tract disease in which the bladder becomes inflamed due to an unknown cause.  This can also sometimes be accompanied by tiny crystals in their urine. When there are too many crystals, they can plug the urethra (the tube that empties urine from the bladder) and prevent the bladder from emptying – this is a life-threatening emergency! The bladder becomes distended and the pet strains to relieve itself. Urethral obstructions are more common in male cats, while both males and females can be afflicted with urinary tract inflammation. Without help, this pet may be in critical condition within 12 hours. True urinary tract infections are actually quite rare in male cats. Dogs may also have obstructed urinary tracts due to stones, tumors or inflammation.

Many other conditions can cause straining in cats and dogs: an enlarged prostate gland; irritated bowels; cancer of the bladder or bowel; intestinal or bladder polyps; and more. This is why the simple act of straining should not be assumed to have a simple solution.

In either species, an obstruction of the urinary tract is a potentially life-threatening emergency and warrants a trip to the veterinarian right away.

What to Do

• Transport the pet to a veterinary facility for examination and diagnosis. 
• If the pet seems systemically ill, is vomiting or is in pain, a visit to the emergency clinic is warranted.

What NOT to Do

• Do not delay getting the pet examined. 
• Do not put pressure on the abdomen as you lift or carry the pet.
• Do not administer medications unless instructed to by a veterinarian. Back to Index

Sunburn

Authored by: The VIN emergency medicine folder staff

Sunburn is damage to the tissues caused by exposure to the sun's rays and ultraviolet radiation.

Animals are usually covered by hair, fur, or pigmented skin that protects them from the harmful rays of the sun. Any circumstance that removes this natural protection may allow the pet to receive enough ultraviolet radiation to burn.

If your pet has a shaved or non-pigmented area, you may apply a sunscreen that contains PABA as the active ingredient. Some sunscreens contain other drugs (such as zinc) that may be harmful if ingested.

What to Do

• Prevention is much better than treatment. Keep your pets out of direct sunlight. 
• If your pet must be in the sun, apply sunscreen containing PABA  as you would for yourself, and prevent your pet from licking it off. 
• If your pet has burned, apply liberal quantities of an aloe vera preparation and seek veterinary attention.

What NOT to Do

• Do not apply any other form of medication without first discussing it with your veterinarian. Back to Index

Transporting the Injured Pet

Authored by: The VIN emergency medicine folder staff

The first aid provider must not only identify and treat injury or illness, but must also safely transport the patient to the veterinary facility for further treatment. Improper technique when transporting a patient can result in further injury or complications, and risks a bite injury to the person transporting the injured pet. Although this Web site cannot fully prepare the reader for all specific examples, it can provide the following general recommendations.

Handle the Pet as Little as Possible

Try to make the pet comfortable by encouraging him to lie down and stay. Smaller dogs and cats can most effectively be transported in commercially available carriers or in a cardboard box with a lid.

Handle the Pet Gently

Rough handling may cause further internal bleeding, more damage to the soft tissues around a fracture, and many other complications.

Lie the Pet on its Side if Possible 

If the pet seems to resent this or has more difficulty breathing on its side, it may indicate the pet has an injury to the chest or lungs. In this case, it is better to leave the pet in a comfortable position of his choosing.

Minimize Movement

If possible, gently tie or tape the pet to a flat surface such as a large board or piece of plywood. This is imperative when handling an unconscious patient or the patient with a suspected back injury to ensure that they do not thrash about – this could potentially make any internal or spinal injuries worse.

Do Not Put Pressure on the Stomach

This is most important for the pet who is having difficulty breathing, has been vomiting, or has pain in the abdomen.

Use a Backboard 
 
If the pet seems paralyzed or unable to get up, a spinal injury is suspect and the pet must be firmly immobilized to prevent further damage to the nerves. Get a firm, flat support (an ironing board, a piece of plywood, a collapsed cardboard box, a table leaf -- think of one in your house before you need it). Grasp the skin over the back of the neck and over the small of the back and gently slide the pet on to the support. Try to keep the back and neck straight. Gently tie or tape the pet to the support. As stated above, if this causes the pet to struggle, you will need to find another method of transport, such as a large blanket to use as a stretcher.

 
Position the Head

If the pet is unconscious, position the head in normal alignment with the body. It should not flex abnormally downward nor extend excessively upward. Improper flexing or extending can cause decreased blood drainage from the brain and cause serious damage. If the pet has vomited or appears likely to vomit, put the head down below the level of the heart. This will allow the vomitus to run out of the mouth and not down into the windpipe and the lungs. Be aware that pets with severe head injuries are likely to vomit, even while they are unconscious.

Cover the Patient with a Blanket

Covering an injured pet has a calming effect. More importantly, it prevents heat loss. A blanket can also be used as a transport device. In this case, the animal can be gently lifted with the blanket. Gently slide the pet into the center of the blanket. Roll the edges of the blanket to provide a better grip. Gently lift the blanket and the pet into the transport vehicle. This is usually a two-person procedure.

Know the Route to the Veterinary Facility and Call Ahead

Get precise directions and drive directly to the facility. This will result in the fastest delivery of the pet for professional care. Call them to let them know you are on the way.

Drive Carefully!

Driving out of control or in a panic may result in delays (while the officer writes a ticket) or injuries if you are involved in an accident.

Emergency situations require prompt and safe transport of the sick or injured pet. If done properly, this will give your pet a better chance for recovery. If delayed or done carelessly, the outcome may be less favorable. As with most first aid principles, prior planning and awareness of proper techniques will prevent many problems.

First Aid: A Final Note

Most veterinary hospitals are not open around the clock. Some may provide emergency service (meaning someone will meet you there if you call first). If you do not call first, you may arrive to find that a doctor is not available. To avoid wasting time in a crisis, ask your veterinarian ahead of time about emergency services available, and learn the shortest route to your veterinarian and to a 24-hour emergency facility, if one is available in your area. A list of emergency hospitals can also be fond online at http://www.VECCS.org.

Back to Index

When Your Pet Cannot Breathe

Authored by: The VIN emergency medicine folder staff

Difficulty breathing is also called dyspnea and is a medical emergency.

Respiratory distress is recognized by increased effort to breathe; noisy or squeaky breathing; cyanosis (a bluish tinge to the lips and mucous membranes); and an inability to inhale or exhale. In cats, breathing with the mouth open (panting like a dog) is a sign of severe distress and should be evaluated by a veterinarian right away.

It is imperative to get the pet examined to determine the cause. Diagnostic tests (such as x-rays, blood tests and ultrasound) will be needed, but the pet must be stabilized (often with oxygen or by removing fluid from the chest) before they can withstand the rigors of testing if respiratory distress is severe.

Brachycephalic (short-nosed) breeds (e.g., English bulldog, Pekingese, and Pug) warrant a special mention. Because of the short nose, the soft palate can interfere with breathing. On hot days or in hot environmental conditions these dogs try to cool off by panting vigorously, and the soft palate interferes even more. This cycle continues until the dog is severely dyspneic and overheated. Cooling these dogs is imperative. Move them to a cool environment and seek immediate veterinary care. This syndrome is manageable only by protecting these breeds from heat or by surgically reconstructing the soft palate.

What to Do

• Keep the pet and yourself calm. 
• If the pet has choked on a foreign body, perform the Heimlich maneuver and/or a finger sweep (see choking).  
• Perform rescue breathing if necessary (see rescue breathing in the choking article).  
• If the pet is overheated, moisten the feet and ears with cool (not cold) water to promote heat exchange.  
• Seek veterinary assistance as soon as possible.

What NOT to Do

• Do not upset the pet. 
• Do not perform rescue breathing on a conscious pet. 
• Do not give anything by mouth.

Dyspnea, or difficulty breathing, is a serious sign. Causes include:

• Congestive heart failure
• Asthma
• Cancer
• Fluid buildup in or around the lungs
• Bronchitis 
• Pneumonia 
• Laryngeal paralysis (a condition usually seen in older pets in which they lose ability to open and close their airway)
• Obstruction of the trachea
• …and many other conditions. Back to Index

Wounds

Authored by: The VIN emergency medicine folder staff

A wound is any break in the continuity of the tissues of the body, either external or internal. Injured pets can act in unusual and unpredictable ways. When dealing with an injured pet, remember to protect yourself from being bitten by using a muzzle or heavy towel as needed to gently restrain your pet.

Many wounds will require pain control and sedation or general anesthesia for cleaning and closure once your pet has been evaluated by a veterinarian. Some wounds, like those inflicted by another animal, can become worse before they get better as dead tissue is removed by the body’s immune system. This process can take many days and may require repeated bandaging, repeated surgeries or skin grafting for severe wounds.

What to Do

Deep Wounds (generally those that are bleeding or have exposed muscle, fat, or bone)

• Stop the bleeding using direct pressure. 
• Do not attempt to clean the wound unless instructed to do so by a veterinarian. 
• Protect the wound from contamination by applying a water or saline-soaked compress. Do not remove it until instructed to do so by a veterinarian.  
• Immobilize the wound to prevent further damage.  
• Provide shock care if necessary.  
• Obtain professional veterinary care. Transport the animal with the affected area facing up.

Superficial Wounds (wounds that do not penetrate all the way through the skin)

• Stop the bleeding. Clean and bandage the wound as instructed in bandaging.

What NOT to Do

• Do not apply materials (other than those mentioned) to the wound unless specifically instructed  to by your veterinarian. Back to Index

z: In Closure

Authored by: The VIN emergency medicine folder staff

A Final Note

Many other types of emergencies can, and do, occur. If you have questions concerning symptoms your pet is exhibiting, seek advice from a veterinarian. Do not administer any prescription or over-the-counter medication without first discussing your pet’s condition with a veterinarian.

Know your clinic's hours and if they provide after hours emergency care. Determine before an emergency where you are supposed to go in the event one does occur. Post the phone numbers of where you are supposed to go so that you don't waste time looking for it, and enter them into your cell phone. Emergency and critical care centers (where after-hours and 24-hour care is provided), and specialists in veterinary emergency medicine are becoming more prevalent. Know the location and hours of operation of the closest facility.  There may not be time for you to call first in some very critical emergencies, but in most cases a phone call to the emergency facility is a good idea. Visit www.VECCS.org and click on ‘Public” for a listing of veterinary emergency hospitals by state.

If there are any questions concerning your pet's health, call your veterinarian or the emergency facility. As a general rule, if you are worried enough to call for advice, you should have your pet examined by a veterinarian as soon as possible.

Veterinary care in general, and emergency and critical care specifically, can place a high financial burden on families – make sure you openly discuss finances with your pet’s caregivers and plan ahead for the unexpected. Pet health insurance is widely available and can help you make decisions on what is medically the best option, not just the most affordable one.

This Web site was written in the spirit of providing pet owners with medical information to assist in their pets’ care, and it is not intended to replace the advice of a veterinarian. Participating in your pet’s care at home carries certain risks, both to your pet and to yourself.

Remember to spay or neuter your pet, and use a leash to prevent unexpected and potentially tragic consequences. Back to Index

Date Published: 12/31/1994
Date Reviewed/Revised: 9/15/2009

Copyright 2009 - 2010 by the Veterinary Information Network, Inc. All rights reserved.