Emergencies

All the specific knowledge in the world is useless if we forget the basics and the following points are useful to bear in mind long before an emergency arises.
 
You need to have the means to restrain your pet which means either a normal dog lead, an improvised dog lead such as a belt. In a stressful situation, an animal’s natural tendency is for fight or flight, so we always insist on dogs being on leads and cats being in baskets within the clinic and its car park. The potential for escape is heightened during an emergency as the animal may be in pain, disorientated or scared – natural instinct will often make them want to escape from humans.
 
From a similar point of view, it is sensible to have the cat basket in a handy location so that it is available in an emergency rather than necessitating scrambling into the recesses of the loft or moving half the contents of the garage to get it. It is also important that all family members know where that location is rather than not being able to find it because the person who last put it away after the cattery is not there.
 
Finally, drive to the clinic sensibly – the few seconds or minutes saved by speeding or jumping a red light will not make any difference to the chances of survival, but may compound the situation by causing an accident.
 
We are often asked to attend emergency patients away from the clinic and, whilst we are willing to do this where options to get the pet to the clinic are infeasible, it is essential to remember that we have much more diagnostic equipment and treatments available at the clinic and so if there is anyway you can transfer the patient yourself rather than lose time by us coming to you first then this is preferable. More information on specific emergencies is given below, but in general any risk of moving the animal is outweighed by the benefits of getting to the clinic more quickly.
 
In general, it is very difficult to successfully carry out mouth to nose ventilation and/or chest compressions on an animal, in the same way as a human casualty would be treated, before it arrives at a veterinary clinic. It is arguable that attempts to perform CPR are futile outside the veterinary clinic, compared to inside where we have oxygen, breathing tubes and drug treatments available.

Sadly, we expect to see numerous road accidents in dogs and cats within the practice each year. When an animal is knocked over, it will experience a huge surge of adrenaline which is the hormone associated with the fight or flight response. Adrenaline primes the body to escape and is a very powerful stimulant and pain killer. This is how animals are able to run away from the scene of an accident in many cases, sometimes even with fractured spines, only to collapse later. It is very important to realise that the injuries are not always immediately apparent and so never be fooled into thinking, “Thank goodness, everything seems ok”. Always seek veterinary attention.
 
Animals may not respond in their usual way when they are distressed and in pain. If you try to move them, as you will need to, and this causes a fracture to move they will associate the pain with you and not with their fracture as they do not know what the latter is – that requires a human brain to understand. This means they may try to bite you to stop the pain so be careful and do not be fooled into thinking that they would never bite as the rules have changed completely. There is not a great deal that can be done about this but being aware of it helps. A big bath towel or blanket is invaluable here as by scooping the animal up in the towel you can handle it as a whole rather than moving specific parts.
 
Generally you are best to get the dog or cat to the veterinary surgery as there will be the facilities to put the patient on a drip, xray or operate as necessary. Many people want to ask the vet to visit the animal, but this does incur a delay in providing treatment as we cannot offer what is needed at the roadside, so if at all possible get the animal to the surgery. We see far fewer spinal injuries in RTAs than Doctors treating human patients and so there is less concern with this when moving the patient, but that is not to say there is no concern and so make some effort to keep the spine roughly in alignment if possible – that having been said, we would still advise that prompt transfer to the surgery outweighs the risk of trying to move the animal on a board as, unlike human patients, dogs and cats with severe spinal trauma are likely to have to be put to sleep.
 
You may have to provide some basic first aid to stop bleeding, in which case pressure with a clean towel is the best option. Gently wrap any wounds in the towel and compress the bleeding point; don’t be tempted to take the pressure off to check if it is working – let us do that once you arrive. Some animals will be very distressed with their breathing so make sure you do not hold them tightly across the chest or neck as a result of your own tension. Keep the patient warm.

Bleeding may be external, in which case it is obvious as visible blood, or internal, which is more difficult to appreciate prior to veterinary examination. Whatever the cause, keep the patient warm.
 
External blood loss needs to be stopped if possible and the single most important fact is for you to apply pressure to the bleeding wound. This needs to be done with the cleanest thing available to you. Occasionally, a dressing will be available from a human First Aid kit, but more commonly you will have to use a clean towel, sheet or take off your jumper. Choose something which is clean and will not shed too much fabric into the wound. Apply it across the wound and press hard; on a limb, wrap it around the limb and hold it on by curling your hand round the limb too. In general, you will not be able to apply too much pressure as you will only be applying it for a short period until you can get to the vets; however, we would not advise binding on a tight dressing and then coming in later or the following morning as, if it is on for more than 20-30 minutes, it may cause more harm than good.
 
The arteries supplying the limbs can be compressed by pressing on the inside of the foreleg above the elbow or the inside of the thigh on the hind leg. This may help to slow bleeding from a wound lower down the leg but should not be used as an alternative to placing a rudimentary dressing. Tourniquets, belts or cord should not be used to close off the blood supply to the limb totally as this will cause significant problems.

A traumatic wound can arise in a RTA, or may be inflicted by a fight, barbed wire, glass or other sharp object. Sometimes, large “grazes” can be seen where the hair and superficial layers of skin have been removed, usually when an animal skids across tarmac in a RTA. Bleeding wounds should be treated as above and presented to the surgery as quickly as possible. There is not quite so much panic with a non-bleeding wound, where the most important factor is to keep it as clean as possible and, where there is a little more time, it is worth searching for the most appropriate dressing available such as a clean tea towel, or even wrapping it in cling film! If the wound is dirty, it is best you cover it and leave us to clean it surgically as hosing it off may simply drive the dirt further into the wound. Large, bleeding and/or contaminated wounds should be seen as emergencies, but there is less urgency with a clean, non-bleeding, small wound.
 
Cut pads are notorious for spreading a little bit of blood a long way! They will usually bleed quite heavily and we do need to see them quite quickly if we are to be successful suturing them as exuberant scar tissue forms very quickly and forces the edges of the pad wound apart. Alternatively, we can decide to treat them with dressings and allowing natural healing, so there is no need for life-threatening urgency provided blood loss has been stopped.

Fractures of the bones of the leg may result from RTAs, falls from height, collisions whilst running or being trodden on by their owners. There will be pain and again consideration must be taken that your pet may not react in the normal way to you, especially if you try to move it and inadvertently disturb a fracture site. Scooping the animal up in a big towel, trying specifically not to touch the fracture site, is usually the best way to move such an animal.
 
Occasionally, the fracture will be open which means there is a skin wound through which contamination may enter and bones extrude. Pressure may need to be applied to stop bleeding, but irrespective of whether this is required, an attempt should be made to cover the wound with a clean towel or cling film to minimise contamination. Do not wash the wound or try to clean it – we’ll do that surgically.
 
Fractures of the spine are obviously serious and most animals will already be paralysed if there is a spinal fracture. In theory, such an animal can be strapped to a board lying on its side, provided that it is calm. If it starts to struggle then it is at more risk than if it were allowed to simply lie on the back seat of the car. Sadly, most animals with severe spinal trauma will need to be put to sleep anyway.

When we talk about medical shock, we mean that the blood pressure has dropped too low and the supply of oxygen and nutrients to the vital organs like brain, heart and kidneys has decreased. Depending on the severity of this, life threatening complications can arise. Affected animals will be weak, with poor pulses and pale mucous membranes. There are medical causes of shock, but those cases applicable to First Aid will have usually been the subject of trauma. Keeping the patient warm is important here as hypothermia is one consequence of shock. Once at the clinic, we will administer intravenous fluids or blood products to support the circulation.

The list of diseases which may lead to collapse, either in the sense of passing out or in the sense of simply not being able to get up, is very long and a full discussion is not relevant to First Aid advice. In some cases, you may have witnessed an RTA or blood loss in which case the cause is obvious and the action required is as stated above. The biggest problem posed by a collapsed animal is how to move a large breed dog. Transferring the dog on to its bed or a larger duvet may help by creating a makeshift stretcher with a person on each end or corner to help lift – ask your neighbours to help if necessary. Sometimes, the front legs may be working but the back legs not be able to support weight – in these cases, a towel slung under the belly and held by a person on each side may support enough of the hind weight to allow the animal to support the remainder of its weight and walk on its front legs. However, the inability to lift a recumbent patient would be the most common reason for us to pay a house visit in an emergency, in which case the ideal situation of getting the pet to the clinic as fast as possible has to be abandoned.

Shortness of breath can occur with asthma, laryngeal paralysis, inhalation of a foreign body or grass awn, pneumonia, heart failure, bleeding into the chest or rupture of the diaphragm, among others. The ability to breathe will be further compromised by body position, tight holding, anxiety/panic, heat and pain. You cannot address the cause of the problem at home, but you can make sure you don’t exacerbate it by offering as minimal restraint as possible and this is one scenario where a cat is best sitting still in its basket than being restrained whilst trying to escape; allow dogs to take up the position which suits them best which will often be sitting up with their elbows pushed away from their chest.
 
Difficulty breathing also leads to overheating and this is one case where animals should be kept cool rather than hot, provided there is no history of trauma or shock as described above where keeping the pet warm takes precedence. When we say keep the animal cool, we mean a wet towel over its back and not packing it with ice so please do not take this to the extreme.
 
Once at the surgery, we will be able to provide oxygen to further support respiration until it is safe to intervene. Often we will put the animal in an oxygen rich environment and stand back to observe, rather than make the situation worse by too much handling for x-rays and samples – this is one case where less can be more!

The significant problems we see with wasp and bee stings usually relate to multiple stings if the dog is engulfed by a swarm or stings inside the mouth or throat which can cause swelling and problems breathing. Stings can lead to anaphylactic shock where animals show facial swelling, generalised hives, intense itching, laboured breathing, vomiting and/or collapse. Thankfully, deaths from anaphylaxis in animals seem uncommon. Once swallowed, stomach acid will kill the wasp but stings on the way down and vomiting associated with this or anaphylaxis is possible.
 
If you know your pet has a solitary sting then apply a cold compress to it for 5-10 minutes – for example, a bag of frozen peas inside a towel. A small amount of Wasp-Eze can be safely applied provided care is taken not to allow it to spray into eyes and licking off is prevented. However, cases where a number of stings have been sustained and/or facial swelling or vomiting are displayed, should be examined by the vet relatively quickly.

The only poisonous snake in the UK is the adder as most people know. Dogs can encounter them, especially in summer and early autumn, whilst exploring undergrowth. In the vast majority of cases, the snake will bite the dog in order to allow itself to escape, but will not inject a significant amount of venom. In order to properly envenom as it would to kill prey, the snake needs to hold on and chew on the wound for some time, which it will not want to do when it has been disturbed by a larger animal and simply wants to get away. Therefore, most cases do not need anti-venom but will nonetheless require emergency treatment to control swelling and pain, offer antibiotics and address any allergic reaction. There are no specific actions necessary on behalf of the owner and certainly there is absolutely no need to suck the wound!

Watching your pet have a seizure is inevitably one of the most distressing things for an owner to witness. However, rest assured that your pet is unconscious and knows nothing about it.
 
Above all …… DON'T PANIC! Look at a clock so that you can time the seizure; they generally last for only a short period but this can seem an eternity to a worried owner! – it is important you time the seizure so that we have an accurate idea of how long it has lasted. Approach your pet with care – whilst having a seizure, the jaw is champing with great force so keep your hands well away from the mouth so as not to be bitten and remember that even the most friendly of pets can act aggressively when they come round from a seizure as they are disorientated. Roll your pet away from furniture into the middle of the room and ensure he or she is not in any danger such as lying next to an open fire or pressing onto a hot radiator. Remove all stimuli by dimming the lights, switching off the radio/TV and keeping quiet yourselves. It is usual for the seizure to settle after 1-3 minutes and full recovery is usually complete after a short time.
 
If the seizure continues for more than 5 minutes or a second one starts very soon after the first finishes, please contact your Veterinary Surgeon immediately – this is a state called status epilepticus and requires emergency treatment.

The following substances are known to be poisonous to animals so, firstly, please do your best to prevent access by pets and, secondly, call us immediately if you realise your pet has ingested one. We would not generally advise you inducing vomiting with mustard or washing soda at home as we feel this is a bit outdated and it can cause ulceration of the mouth, throat and oesophagus. We would prefer to examine the animal as soon as possible, determine whether vomiting is safe and then induce it with an injection of a drug called apomorphine.

Be alert to the following poisons:

• Raisins and grapes
• Paracetamol
• Ibuprofen
• Dark chocolate – it has to have a high cocoa content
• Antifreeze (including many de-icer sprays)
• Some weedkillers
• Rat bait
• Chewing gum containing xylitol (usually stolen out of handbags)
• Slug bait containing metaldehyde

 Key point: Wherever possible, we ask that you bring the container, box, bottle or whatever the substance was contained in so that we can assess exactly what has been eaten.

Animals are fortunately saved from many situations that would burn humans by their hair coat which protects the skin. The most common cause of burning is when hot water from a pan or the kettle is spilled on to a pet’s back, often because they have got themselves under foot in the kitchen whilst pestering for food. Such animals will often appear unbothered at first as the hair stops the water immediately having direct contact with the skin, but the burning will occur insidiously over the next hours so definitely act to cool the area as detailed below. Sometimes, cats may walk across an electric or ceramic hob whilst it is hot and burn their pads.
 
As with human burns, the most important thing to do is to apply cold water to the area for a full 10 minutes before coming to the surgery. This is best done in the shower with a shower head or in the garden with a hose. Do not worry if it is cold outside and you are hosing your pet off. Because it is essential to cool the wound. Make sure you part the hair coat to allow the cold water to reach the skin. Once the wound is cooled, apply a dressing of cling film or hold a clean tea towel over the wound whilst you transfer the animal to the clinic.

This is rare in animals as most animals are either competent in water or go nowhere near it. It can happen if an elderly, disorientated or blind dog wanders into the pond. Occasionally, a healthy animal may get trapped under a swimming pool cover or struggle to get out of a rough sea such that the time taken for it to get out allows considerable water to be inhaled. As mentioned above, never follow your dog into a rough sea or a frozen pond as your safety has to be preserved.
 
If the animal does emerge from the water with difficult breathing and/or exhaustion, lift its hindend so that water can drain from the lungs under gravity and offer some firm pats to the back and/or rub the chest vigorously forwards. Much of the water will eventually be absorbed, but anything that comes out is one bit less for the lungs to have to work against. Immediate veterinary attention is required where oxygen can be given, but sadly even with this a lot of the outcome is down to chance.

Smoke inhalation to the extent that it causes problems is really only possible in animals trapped in house fires and then released. Once again, common sense dictates that it should not be you going into the house to release the animal and if the Fire Service decides it is not safe for them to do so then this decision must be accepted. Needless to say these cases are rare, but one of our Vets has treated a cat removed from a house fire by the Fire Service so they do occur.
 
The release of the animal to fresh air is the single most important element of care, followed by presentation to the veterinary clinic for oxygen therapy. Bronchitis can follow on. As with near-drowning, there is very little that can be specifically offered as a First Aider.

The most common cause of domestic electrocution is animals who chew through electrical cables. As well as the electric current, they may receive burns to the mouth. Make sure the electricity supply is switched off before moving the pet if they are still in contact with the exposed wire in anyway. Again, there is little which can specifically be done in the way of First Aid before veterinary examination.
 
Cats and dogs are occasionally electrocuted when they stray on to railway lines and generally this will be fatal, do not go on to the line as there is a risk to both of you from electrocution and/or being hit by a train. Call 999 and request that the Police help by closing the line and attending.