Emergency Medicine in Animals

Emergency patients present special challenges because their underlying disease processes can cause immediate life-threatening problems that require rapid and aggressive intervention. In addition, the full extent of the animal’s illness, injuries, or toxicity may not be evident for some time after initial presentation. Problems can arise from an acute illness, toxicity, or injury; from a chronic illness that has decompensated; or from an unexpected complication of a concurrent illness. The status of all postoperative patients should be considered critical until life-threatening anesthetic or surgical complications are excluded. The golden rule of emergency medicine is to treat the most life-threatening problems first. When a patient is then stable, it should be closely monitored for progression or resolution of disease and possible complications.

Variables that contribute to the overall success of emergency treatment include:

• severity of the primary illness or injury

• amount of fluid or blood lost

• age of the animal

• previous health problems

• number and extent of associated conditions

• time delay in instituting therapy

• volume and rate of fluid administration

• choice of fluids (eg, crystalloid, blood components, or synthetic colloids)

• possible complications that can occur either from therapy (eg, side effects of drugs) or the underlying disease

Therapy must be done at the right time, in the right amount, and in the right order. Therapeutic failures are generally a result of failing to act expeditiously at a crucial moment.

Emergency trauma patient, dog

Image

Courtesy of Dr. Andrew Linklater.

Emergency care often begins with the owner’s initial telephone call. Instructing the owner on first aid and transport procedures can be life-saving for the animal. The clinic and staff must be in readiness, especially if more than one animal in critical condition arrives at the same time. The primary survey, or triage, requires a quick and accurate assessment and decision regarding the stability of the animal. As life-threatening airway, breathing, and circulation problems are identified, immediate treatment is initiated. Once the animal has been stabilized, a more systematic and organized approach to the history and physical examination (secondary survey) and more specific diagnostic and therapeutic procedures aimed at the underlying cause can be done.