Emergency Medical Considerations in Sports Medicine and Rehabilitation


Working dogs and elite canine athletes are at risk for injuries or illness associated with performance and training. The basic approach to emergency stabilization is to address the most life-threatening problems first: airway, breathing, and circulation. Many of the problems that result in acute emergencies in these dogs will be the result of the environment in which the dog is working or performing. Traumatic injuries occur frequently and range from mild to life threatening. Any trauma warrants a medical assessment. Prompt management of head trauma, ocular trauma, and musculoskeletal trauma is needed to optimize the chance for return to performance. Heat stroke is a life-threatening condition resulting from environmental exposure, an inability to eliminate heat or excessive heat production from work or seizures. Prevention or early recognition is preferred; however, rapid cooling and advanced veterinary care are required for dogs that develop heat stroke. Other environmental factors that pose threats include toxins and envenomation. The stressful environment of work or performance may lead to mild or severe gastrointestinal distress that could predispose to dehydration. Large breed, deep-chested dogs are at risk of gastric dilatation and volvulus leading to cardiovascular collapse and respiratory compromise. Although field first aid may be beneficial for many minor conditions, early transportation of injured or ill dogs to a fully equipped veterinary hospital is critical for optimal care.

General First Aid

Field care, involving critical assessment and stabilization, may be performed by a veterinarian or layperson at a performance event or working dog deployment and relies on the basic ABC (airway, breathing, circulation) principle of emergency assessment (Table 21.1). Mild conditions including allergic reactions, some toxin exposures, mild dehydration, diarrhea, minor cuts and abrasions, and some ocular injuries may be treated in the field (Table 21.2), but anything that may compromise the return to work or performance of these athletes warrants rapid transportation to a referral facility. Field care or first aid should not delay transportation for definitive veterinary care.

Table 21.1 Principles of first aid for the layperson—is it an emergency?

(1) Airway/Breathing
a. Respiratory rate
i. <12 Is the animal breathing? Is there an airway obstruction?
1. Clear the airway (see text)

2. Consider rescue breaths

ii. 12–30—normal at rest, evaluate effort

iii. >30—evaluate for effort

iv. Panting—may be normal or, if excessive, evaluate for increased temperature

b. Respiratory effort
i. Normal—evaluate circulation

ii. Increased inspiratory effort
1. Noisy respirations?

  • Clear the airway (see text)
  • Evaluate temperature
  • Seek veterinary care immediately
  • Provide supplemental oxygen if available

2. Normal sounding respirations

  • Seek veterinary care immediately
  • Provide supplemental oxygen if available

(2) Circulation
a. Evidence of bleeding
i. Apply direct pressure

ii. Consider topical hemostatic agents (not silver nitrate/QuikStop unless it is a torn toenail)

iii. Seek veterinary care for lacerations requiring sutures or for unstoppable bleeding

b. Heart rate
i. <60—Is this an athletic dog at rest? If not, the heart rate may be dangerously low and should be evaluated. Dogs with very low heart rates may become weak or collapse.

ii. >140 at rest, this is a sign that the body needs more oxygen delivered, and can result from:
1. Exercise

2. Pain

3. Low blood oxygen

  • Poor lung function
  • Anemia

4. Shock

  • The heart not pumping properly
  • Not enough circulating blood (hypovolemia from blood or fluid loss)
  • Anaphylaxis (acute allergic reaction) or sepsis (systemic infection)

c. Heart rhythm
i. Regular

ii. Irregular
1. Varies with breathing—regularly speeds up and slows down (sinus arrhythmia)—this is normal

2. No predictable pattern to the irregular beats—this could be the sign of a severe problem and needs veterinary evaluation

d. Mucous membrane color
i. The color of the gums, prepuce, vagina, or membranes around the eyes should be pink

ii. Seek veterinary care if they are:
1. Blue—provide oxygen if possible, transport

2. Dark red—check the temperature, cool if appropriate, transport

3. White—control any external bleeding, transport

4. Yellow—seek veterinary care

5. Brown—provide oxygen if possible, transport

6. Gray—provide oxygen if possible, transport

e. Capillary refill time
i. Press on the gums. The time for the pink color to return should be between 1 and 2 seconds
1. If <1 second—check the temperature, cool if appropriate, transport

2. If >2 seconds, control any external bleeding, provide oxygen if possible, transport

(3) Mental State
a. Normal is bright, alert responsive

b. Abnormal
i. Dull
1. Evaluate other vitals, consider veterinary assessment

ii. Barely rousable
1. Transport

iii. Unable to rouse (coma)
1. Ensure airway/breathing and transport

iv. Seizures
1. Protect from injury

2. Consider Karo syrup on the gums

3. Transport

v. Hyperexcitable
1. Protect from injury, transport

Note: Evaluate vital signs within the context of the situation (work vs. rest).

Table 21.2 Basic components of a handler first aid kit

H2O2 to induce emesis
Diphenhydramine (2 mg/kg PO)
Styptic powder
Betadine solution (small bottle for cleansing wounds)
Alcohol or antiseptic wipes (in individual packets)
Antibiotic ointment
Saline eye flush
Bandaging material (nonadherent dressing, gauze wrap, cohesive bandage material)
Multitool, or bandage scissors, forceps

Emergency Assessment and Stabilization

The basic emergency examination assessment involves checking airway, breathing, and circulation. Guidelines for triage and primary survey of the emergency patient can be found in emergency texts (see Beal, 2011). Table 21.3 is a guide for the localization of the cause of respiratory distress. Table 21.4 provides an outline of the typical clinical signs of shock. Table 21.5 provides details on the assessment of mucous membranes.

Table 21.3 Localization of respiratory distress


Table 21.4 Typical clinical signs of shock


Table 21.5 Assessment of mucous membranes

Color Interpretation Possible causes
Pink Normal
White Poor perfusion or anemia Cardiogenic shock, hypovolemic shock, blood loss
Red Hyperdynamic Sepsis, heatstroke
Blue Cyanosis Hypoxemia, pulmonary dysfunction
Brown Methemoglobinemia Toxins
Yellow Icterus Hemolysis, liver disease, biliary obstruction
Petechia Thrombocytopenia, thrombocytopathia Immune, infectious, drug/toxin


Upper Airway Obstruction

Complete airway obstruction can be functional (laryngeal paralysis) or mechanical (ball/toy). Some foreign bodies can be dislodged by the Heimlich maneuver. For large dogs this involves locking both hands together in a fist under body where the rib cage meets the abdomen and pressing up and forward 4–5 times (Figure 21.1). For small dogs, kneel down, sitting back on your feet. Place the dog on its back resting in the gap between your legs with its head near the floor and its rear legs in one hand. With the other hand thrust the heel of your palm into the dog’s rib cage just where it meets the abdomen several times. Functional obstructions or foreign bodies that cannot be removed may necessitate a tracheostomy. Table 21.6 provides a list of actions and equipment needed for field treatment of acute airway obstruction.

Figure 21.1 Technique for administering the Heimlich maneuver to a large breed dog.


Table 21.6 Field treatment of acute airway obstruction/respiratory arrest

Purpose Action Equipment
Dislodge a complete obstructiona Heimlich maneuver
Determine whether there is a foreign body Oral pharyngeal exam (may require sedationb) Gauze, laryngoscope
Initial treatment of hyperthermia External cooling IV fluids, transport
Treatment of acute allergic reaction Intramuscular injection Diphenhydramine (2 mg/kg IM)
Treatment of allergic and other causes of edema Intramuscular injection Glucocorticoids (0.1–0.5 mg/kg IM dexamethasone)
Treatment of partial obstruction (for military working dogs or intractable dogs that require muzzling) Needle tracheostomy Clippers, scrub, needle, through-the-needle catheter
Delivery of large volumes of air/oxygen Intubation IV catheter, injectable anesthetics, laryngoscope, endotracheal tubes, gauze to secure the tube, syringes to inflate the tube, ambu bag to deliver breaths, anesthesia once dog is intubated
Delivery of large volumes of air/oxygen when there is upper airway obstruction Emergency tracheostomy IV catheter, injectable anesthetics, clippers and scrub, surgical blade, forceps, suture material, trach tube, umbilical tape to secure the tube

aTreatments are listed in increasing levels of intensity.

bSedation is often indicated for the dog with a partial airway obstruction to relieve anxiety and return to a more effective respiratory pattern. Caution should be used as the associated relaxation of the pharyngeal muscles may result in a complete obstruction and the sedation may complicate any circulatory compromise associated with the condition.


Dogs exercising in extremely cold or dry environments may develop bronchospasm and cough. Inhalation of smoke or other irritants can cause similar signs. Oxygen therapy should be provided (Figure 21.2).

Figure 21.2 Administering oxygen and IV fluids to a search and rescue dog.



Although human responders to the site of the attack on the World Trade Center, September 11, 2001, suffered vari­­ous respiratory disorders (Moline et al., 2006), the canine responders had minimal evidence of respiratory disease (Fox et al., 2008; Otto et al., 2010). Respiratory irritants, exercise in extreme conditions, travel stress, and exposure to other dogs, may contribute to infectious respiratory diseases in working and performance dogs. Canine influenza has been reported as a potentially deadly infection in racing Greyhounds (Payungporn et al., 2008). Dogs participating in flyball competitions experience canine influenza virus (CIV) exposure similar to that in the general canine population at <3% (Serra et al., 2011). Aspiration pneumonia was reported as a cause of unexpected deaths in racing sled dogs (Dennis et al., 2008). Treatment of infectious/inflammatory respiratory diseases is based on the etiology and severity of signs. Supportive care, appropriate use of antibiotics, oxygen therapy, gastric ulcer prophylaxis, and isolation from naïve populations should be considered.


Pulmonary trauma can result from blunt trauma, concussive injury, or penetrating injury. Trauma patients should be evaluated for penetrating injuries, chest wall discontinuity, pleural space disease, and pulmonary contusions. Once stabilized, these patients should be transferred for advanced diagnostics and monitoring (Table 21.7).

Table 21.7 Field treatment of respiratory distress

Action Equipment
Pain control Pain medications
Treat suspected cardiogenic edema Furosemide (2 m/kg IV or IM)
Treat general respiratory disorders while establishing the etiology Supplemental oxygen for general respiratory disorders while establishing the etiology
Treat life-threatening pleural space disease (e.g., tension pneumothorax). Field thoracocentesis for moderate pleural space disease and associated respiratory distress should be performed prior to transport if definitive care is not immediate. Clippers, scrub, butterfly needle or 1.5 inch hypodermic with extension tubing, 3-way stopcock, syringe
Initial treatment of shock IV catheter, IV fluids as appropriate

Respiratory Arrest

Intubation is the preferred route of providing artificial respiration. Breaths should be provided at a rate of 10 breaths per minute (Figure 21.3) (Boller et al., 2012). Chest compressions should not be interrupted for ventilation. If one person is attempting cardiopulmonary resuscitation (CPR), give 2 breaths for every 30 compressions or rely on chest compressions to provide ventilation (Boller et al., 2012).

Figure 21.3 Rescue breaths—after evaluating for airway obstruction, extend the neck in a straight line, cup your hands around the dog’s mouth and nose and provide rescue breaths through the nostrils at 10 breaths per minute or if performing CPR, 2 breaths every 30 compressions.

(Photo by Marcy Burke.)


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Jul 9, 2017 | Posted by in EQUINE MEDICINE | Comments Off on Emergency Medical Considerations in Sports Medicine and Rehabilitation

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