Page 385 - ATP-P 11th Ed

NOTES:
i. Due to the extensible nature of the canine’s skin and their vast subcutaneous
space (SC), placing a chest seal that occludes only the external skin wound,
and not the defect in the chest wall, may allow air from chest cavity to leak and
become trapped into the SC space, resulting in significant amount of subcutane-
ous emphysema. With that in mind, if a tension pneumothorax develops after
placement of an occlusive chest seal, burping or removing the chest seal may
not completely resolve a tension pneumothorax in canines, particularly, if the
occlusion is occurring at the level of the defect in the chest wall (due pieces of
tissue, bone, etc.).
ii. Always consider decompressing both sides of the chest when treating a tension
pneumothorax in a MWD, even with trauma isolated to one side of the MWDs
thorax. Since, the canine mediastinum is fenestrated (like a cheesecloth) in a
large proportion canine it is common for air to migrate to both sides of the
thoracic cavity.
iii. The intercostal artery, vein, and nerve run on the caudal aspect (behind or to-
wards the tail) of each rib; therefore, similar to the technique in human casual-
ties, the best approach for inserting chest-NDC device is in the center of the
intercostal space or at the cranial aspect (towards the head) of the rib to avoid
damaging the nerve and vascular structures.
iv. Pulse oximetry probes used for people (typically finger probes) are best placed
on the tongue for optimal reliability in unconscious, sedated or anesthetized
dogs. In conscious dogs, use the ear pinna, lip fold, or inguinal skin fold; while
not optimal for oximetry, these alternate sites generally yield reliable results SECTION 4
in most instances. Alternatively, a neonatal pulse oximetry adhesive sensor at-
tached to the base of a canine’s tail may be used as alternative site in MWDs.
6. Circulation
a. Bleeding
i. Reassess sites of major hemorrhage and associated hemostatic interventions.
Ensure that bleeding is stopped. If bleeding persists, consider changing or add-
ing additional hemostatic adjuncts (e.g., Combat gauze, chitosan-based dress-
ings, or X-Stat) and/or re-applying circumferential pressure bandages and
wound packing, where applicable.
ii. iTClamp should be considered to close bleeding open wounds or can be used
concurrently with hemostatic agents.
iii. If major bleeding cannot be stopped with dressings, consider application of a
tourniquet if:
(a) Extremity hemorrhage appears life threatening (e.g., MWD has suffered a
complete traumatic limb or tail amputation), AND

ATP-P Handbook 11th Edition 375