First aid procedures



First aid procedures


Trish Scorer



INTRODUCTION


Under the Veterinary Surgeons Act 1966 anyone may perform first aid on an animal to save life, prevent suffering or prevent the condition from deteriorating but only until such time as a veterinary surgeon is able to attend to the animal. Although, by law, lay people and veterinary nurses are able to perform the same procedures, the veterinary nurse will have the greater knowledge and training to be able to assess the situation, deal with the frightened animal and have the clinical experience to apply the relevant techniques.





Procedure: Evaluation of the emergency patient



1. Action: Call a veterinary surgeon as soon as possible.


    Rationale: This must be done at the first available opportunity. While you are waiting you can assess for airway, breathing and circulation.


2. Action: Ensure that the environment is safe to treat the animal.


    Rationale: Do not attempt to treat the animal if there is any risk to you, e.g. fire, electrocution, traffic, radiation or falling masonry.


3. Action: Stand back from the animal and evaluate the situation. What are you presented with?


    Rationale: You must remain calm and in control. The owners are likely to be panicking. Avoid rushing in to help before you have assessed the situation.


4. Action: Make sure that the patient is restrained appropriately. If the animal is breathing normally, it may be necessary to apply a tape muzzle (see Chapter 1).


    Rationale: This is made easier if you have an assistant. The animal is likely to be frightened and in pain and its immediate reaction is to escape and/or bite.


5. Action: Check that the animal has a patent airway (see resuscitation techniques).


    Rationale: The animal may be trying to breathe but if the airway is blocked, respiration will be difficult.


6. Action: Check the animal is breathing. If not, check that the heart is beating, and begin artificial respiration (see resuscitation techniques).


    Rationale: Lack of oxygen to the body will kill the animal within a few minutes.


7. Action: Check that the animal has a heart beat. If not, start cardiac massage and artificial respiration (see resuscitation techniques).


    Rationale: If the heart is not beating, blood will not circulate around the body to supply the vital organs.


8. Action: Once the patient is stable, check for haemorrhage and control it (see Control of haemorrhage).


    Rationale: Loss of blood may cause the animal to go into shock.


9. Action: Examine the patient for fractures and immobilize (see Fracture management in Chapter 8).


    Rationale: This must be done before attempting to move the patient to reduce pain and prevent the injury deteriorating.


10. Action: Check the patient’s capillary refill time, mucous membrane colour, pulse and temperature. Record all the information (see Chapter 2).


    Rationale: These all indicate the condition of the animal.


11. Action: Examine the patient for other wounds.


    Rationale: These can be cleaned and dressed as appropriate once the patient is stable.


12. Action: Treat for shock.


    Rationale: See Treatment of shock.


Examples of conditions requiring emergency treatment are shown in Table 9.1.



Table 9.1


Conditions requiring emergency first aid





























Condition Definition Symptoms
Death Absence of a heart beat for more than 3 minutes. Until death is confirmed, emergency treatment must continue (see Cardiac massage) No heart beat
No respiration (Cheyne–Stoke respiration may be present)
Pupil is fixed and dilated
No corneal reflex
Cornea is dry and glazed
Mucous membranes are cyanotic and dry
Body temperature cools
Rigor mortis sets in after a few hours
Unconsciousness Occurs when the animal’s brain is unable to respond to sound and touch. Usually the patient is flaccid and still but occasionally the brain becomes overactive, e.g. epilepsy, and the patient’s muscles convulse. There are two types of unconsciousness:

Treatment starts by evaluating the patient’s airway, breathing and circulation (ABC) (see Evaluation of the emergency patient)
Heart beat present but may be slow
Respiration present
Pupil may be reactive to light but slow (compare both pupils’ reactions as a difference may indicate brain damage)
Nystagmus (side-to-side or up-and-down movement) or strabismus (squint) may be present
Cornea is moist
The eyeball position, as in anaesthesia, can indicate the depth of unconsciousness
Muscles are flaccid
Epilepsy A type of unconsciousness. Occurs when there is abnormal electrical activity in the brain. Various causes include brain damage, poisoning, infection and metabolic disease, e.g. liver or kidney failure
Treatment of epilepsy is covered in Chapter 3
There are three phases:
Collapse A collapsed patient is unable and/or unwilling to stand up. Ensure constant monitoring as this can progress into unconsciousness
Evaluate the patient’s airway, breathing and circulation (see Evaluation of the emergency patient)
Vital signs may be normal. It will respond to sound, light and touch
Asphyxia/respiratory failure Occurs when the lungs are unable to oxygenate the blood. Causes may include trauma, airway obstruction, neoplasia, anaesthetic overdose and poisoning
Evaluate the patient’s airway, breathing and circulation (see Evaluation of the emergency patient, and Treatment of asphyxia)
Cyanosis
Dyspnoea
Tachypnoea
Orthopnoea
Tachycardia
Collapse leading to unconsciousness


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Procedure: Control of haemorrhage



1. Action: Place the animal in a comfortable position on a table or at a comfortable height for you.


    Rationale: If the animal feels uncomfortable it will try to escape.


2. Action: Ask an assistant to restrain the animal so that it is relaxed and secure and the wound is accessible for treatment.


    Rationale: The assistant will be able to react quickly if the animal tries to escape. The animal may resent the wound being touched.


3. Action: Clean your hands with a surgical scrub (see World Health Organization (WHO) hand-washing technique in Chapter 7 and Fig. 7.1) and put on sterile gloves.


    Rationale: It is important not to introduce infection into the wound.


4. Action: Assess what type of haemorrhage you are presented with (Table 9.2).



    Rationale: The extent of the haemorrhage depends on the type of blood vessels that have been damaged, e.g. an arterial bleed is much more serious than a capillary bleed.


5. Action: Control the haemorrhage using one of the methods described in Table 9.3.



    Rationale: The method used will depend on materials to hand, e.g. you may be in the surgery or at the roadside.


6. Action: Once haemorrhage has been controlled, check for signs of shock and treat if necessary (see Treatment of shock).


    Rationale: Blood loss will reduce the circulating blood volume – hypovolaemic shock. This must be treated or the animal may die.


7. Action: Monitor the animal closely. If blood soaks through the dressing you have applied, place further dressing material on top.


    Rationale: Removing the previous dressing will pull off any clot formed and restart the haemorrhage.



Procedure: Treating burns and scalds



1. Action: Ensure the environment is safe to treat the animal.


    Rationale: Do not attempt to treat the animal if there is any risk to you, e.g. fire, electrocution, radiation or falling masonry.


2. Action: Place the animal in a comfortable position.


    Rationale: The animal may be in extreme pain and may try to escape and/or bite.


3. Action: Ask an assistant to restrain the animal so that it is relaxed and secure, and the burn is accessible for treatment.


    Rationale: The assistant will be able to react quickly should the animal try to escape. The animal may resent the wound being touched.


4. Action: Clean your hands with a surgical scrub using the WHO method (Fig. 7.1) and put on sterile gloves.


    Rationale: It is important not to introduce infection into the wound.


5. Action: Cool the area with cold water. A shower hose is ideal as it covers a large area with little pressure. Continue for at least 10 minutes.


    Rationale: This will cool the area, limiting the number of cells destroyed. The use of an ice pack is not recommended as it puts pressure on the burnt area.


6. Action: Keep the patient warm by wrapping it in dry blankets. Care must be taken, as the animal will be in severe pain.


    Rationale: Although the burns must be cooled, the patient must be warmed to reduce shock. Avoid the use of direct heat, i.e. lamps and pads.


7. Action: Clean the area gently with sterile saline.


    Rationale: The area is extremely painful and proper cleaning may only be achieved under a general anaesthetic. General anaesthesia is only recommended if the patient is stable.


8. Action: Dress the wound with wound gel and/or paraffin tulle.


    Rationale: The wound must be kept moist at all times.


9. Action: Apply a light, non-adhesive dressing on top.


    Rationale: Heat must be able to escape, and moisture loss must be avoided so the dressing must be minimal.


10. Action: Apply a polythene bag or cling film over the dressing.


    Rationale: This will prevent moisture evaporating from the area.


11. Action: Gently place a cold wet towel on top. Replace regularly.


    Rationale: This will keep the area cool.


12. Action: Observe and treat for shock.


    Rationale: Fluid therapy is essential to replace the fluid lost from the wound.


13. Action: Consult the veterinary surgeon on the administration of antibiotics and analgesia.


    Rationale: A burn is extremely susceptible to infection so antibiotic cover is essential.



Procedure: Treating frostbite



1. Action: Ensure the environment is safe to treat the animal.


    Rationale: Do not attempt to treat the animal if there is any risk to you.


2. Action: Place the animal in a comfortable position.


    Rationale: The animal will be in pain and will try to escape and/or bite.


3. Action: Ask an assistant to restrain the animal so that it is relaxed and secure, and the frost burns are accessible for treatment.


    Rationale: Common places for frostbite are anywhere that the blood supply is reduced, e.g. on the ear tip, nose, paws, pads and scrotum.


4. Action: Clean your hands with a surgical scrub using the WHO method (Fig. 7.1) and put on sterile gloves.


    Rationale: It is important not to introduce infection into the wound.


5. Action: Apply warm water (body temperature) to the areas. Continue until all areas are warmed to body temperature.


    Rationale: This will gradually warm the area, reducing the number of cells destroyed.


6. Action: Do not rub the area.


    Rationale: This will shatter frozen cells.


7. Action: Observe and treat for shock.


    Rationale: See Treatment of shock procedure.


8. Action: Consult the veterinary surgeon on the administration of antibiotics and analgesia.


    Rationale: Frostbite wounds are susceptible to infection so antibiotic cover is essential.



Procedure: Treatment of asphyxia



1. Action: Clear any blockages from the mouth and pharynx by opening the mouth and removing any obstruction.


    Rationale: The animal may be unconscious but trying to breathe. Examples of obstructions are vomit, balls, toys, blood, water and leaves (if fallen into water).


2. Action: Loosen and/or remove collar.


    Rationale: Be aware that the animal may recover quickly and try to escape. A dog running around without its collar is a stray.


3. Action: If the animal has water or a foreign body blocking the trachea then the Heimlich manoeuvre can be used.


    Rationale: This technique is designed to force foreign matter from the trachea.


4. Action: Hold the animal up by its hind legs, or for larger animals, hang it upside down over a table or door frame.


    Rationale: The obstructing material may move downwards by gravity.


5. Action: Administer a sharp punch to the abdominal wall, above the xiphisternum, angled down towards the diaphragm (Fig. 9.1).



    Rationale: This will force air down the respiratory tract, from the lungs to the trachea, and dislodge the blockage.


6. Action: Repeat up to four times.


    Rationale: Repeating the procedure too often can inflict damage.


7. Action: If attempts to remove the blockage are unsuccessful, provide an emergency airway by pushing a wide-gauge needle through the ventral midline of the neck into the trachea.


    Rationale: This will act as an air inlet/outlet until a proper tracheotomy can be performed.


8. Action: Prepare the animal for a tracheotomy by clipping and scrubbing the ventral throat area. (See Tracheotomy procedure)


    Rationale: This is a surgical procedure carried out by the veterinary surgeon.



Procedure: Tracheotomy

This procedure creates a temporary opening in the trachea which allows the animal to breathe when there is upper-airway obstruction. It is usually done as an emergency procedure under local anaesthetic or sedation. The patient may present with increased inspiratory effort, dyspnoea, cyanosis, open-mouth breathing and orthopnoea (extension of the neck and abduction of the elbows). If the patient has an acute upper-airway obstruction and there is no time to prepare for a tracheotomy, i.e. patient is close to death, then a wide-gauge hypodermic needle can be pushed through the ventral midline of the trachea as a temporary measure.



1. Action: Restrain the patient in sternal recumbency on the table.


    Rationale: This is the optimal position for the procedure. The trachea can be palpated and the skin overlying it is taut.


2. Action: Clip and clean the area selected for the tracheotomy, with surgical scrub and warm water, until aseptic.


    Rationale: This is a surgical site and should be aseptic. There may not be time for scrubbing up if the patient’s life is at risk.


3. Action: A small incision is made in the skin, between the fifth and sixth tracheal rings, in the ventral midline of the neck. This is usually done with a size 15 scalpel blade.


    Rationale: This is the optimal site for the tube. It is away from the larynx and the tube will not be disturbed as the patient moves its neck.


4. Action: Separate the pair of longitudinal neck muscles which overlie the trachea.


    Rationale: This exposes the cartilaginous tracheal rings.


5. Action: Incise between the tracheal rings and insert the tracheotomy tube.


    Rationale: The incision should be one-third of the circumference of the tracheal rings.


6. Action: Secure the tube in place with sutures placed cranially and caudally.


    Rationale: Sutures in this position will ensure equal tension on the tube and prevent it pulling out.


7. Action: If the tube is left in place for some time the area must be cared for correctly (Box 9.1).



    Rationale: The wound is liable to infection which may compromise the patient’s recovery.



Procedure: Artificial respiration in the intubated patient



1. Action: Place an endotracheal tube of an appropriate size in the larynx and trachea of the unconscious animal.


    Rationale: An endotracheal tube must not be used in a conscious animal as the cough reflex will initiate gagging.


2. Action: Check that the endotracheal tube is free from blockages.


    Rationale: The airway must be clear to allow air to pass through.


3. Action: Place the animal in the recovery position (Fig. 9.2). Connect the endotracheal tube to an oxygen supply via a closed anaesthetic circuit.



    Rationale: This is the most efficient and hygienic way for the veterinary nurse to perform artificial respiration.


4. Action: Squeeze enough oxygen out of the rebreathing bag to raise the chest slightly. Use gentle pressure at approximately two breaths per second.


    Rationale: This rate mimics the patient’s own panting.


5. Action: Rest every 15 seconds for 5 seconds.


    Rationale: This time allows you to monitor for the recommencement of the animal’s own breathing.


6. Action: If there is no oxygen supply to hand, then blow down the tube at 1 second intervals.


    Rationale: The carbon dioxide in your own respiration will act as a respiratory stimulant.


7. Action: Continue until the animal begins to breathe on its own.


    Rationale: This process may be continued for about 30 minutes. If breathing has not restarted by this time the animal may be pronounced dead.



Procedure: Artificial respiration with no endotracheal tube in place – assume no damage to chest wall



1. Action: Lay the animal on its right side. Extend the head and neck and pull the tongue forwards. Pull the front legs forward so that the upper leg does not lie on the chest.


    Rationale: This is the optimum position for maximum air intake.


2. Action: Place the palm of your hand in the middle of the chest wall (Fig. 9.2).


    Rationale: This hand is used to push the chest wall on to the lungs, forcing air in and out.


3. Action: Apply firm steady pressure downwards and then release.


    Rationale: The elastic rib cage springs back, drawing air into the lungs.


4. Action: Apply the pressure at ½ to 1 second intervals, depending on the size of the animal.


    Rationale: The smaller the patient, the faster the respiration rate should be.


5. Action: Continue until the animal begins to breathe on its own.


    Rationale: This process may be continued for about 30 minutes. If breathing has not restarted by this time, the animal may be pronounced dead.

Jan 8, 2017 | Posted by in NURSING & ANIMAL CARE | Comments Off on First aid procedures
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