Page 101 - JSOM Spring 2018

FIGURE 4 K9s with gastric dilatation and volvulus often present • Use the least amount of force necessary to restrain the
with a large bulge protruding from the side of their abdomen OpK9.
(photo courtesy of Lee Palmer).
No Longer Than 2-Minute Anticipated Transport Times
to Definitive Care
• Transport immediately (‘scoop-and-run’), allowing the
OpK9 to assume a position of comfort (i.e., standing,
lying, or sitting).
• Do not delay transport to definitive care. Perform any
therapeutic interventions while en route.
• If canine is conscious and responsive:
o o Consider obtaining intravenous (IV) or intraosseous
(IO) access, initiating fluid resuscitation, administer-
ing analgesia, and providing oxygen supplementation.
o o Monitor and record vital signs and progression of
condition.
• If canine is recumbent, obtunded, or unresponsive:
o o Perform gastric needle decompression (GNDC), or
gastric trocarization, as described under Gastric
Decompression.
Most stages of shock are manifested with pale mucous mem- o o Obtain IV or IO access and initiate fluid resuscita-
branes and prolonged CRTs resulting from peripheral vaso- tion to help restore perfusion.
constriction and shunting of blood to the core and/or from o o Administer oxygen supplementation and appropriate
a decrease in effective circulating vascular volume (hypovo- analgesia therapy, as available.
lemia). During the early decompensatory stage, the mucous o o Monitor and record vital signs and progression of
membranes may appear hyperemic. Hyperemia results subse- condition (improvement or deterioration).
29
quent to the presence of inflammatory vasodilatory mediators o o If GNDC was performed, inform veterinary staff
that accompany conditions such as systemic inflammatory re- during transfer of patient care.
sponse syndrome and/or sepsis. Canines with late decompen-
sated or terminal shock present in cardiorespiratory collapse Longer Than 20-Minute Anticipated Transport Times
and are typically obtunded to comatose. to Definitive Care
• Initiate immediate transport. Do not delay transport to
definitive care for the sole purpose of performing thera-
Prehospital Treatment peutic interventions.
GDV is a surgical emergency requiring immediate transport • Allow the OpK9 to assume a position of comfort (i.e.,
to the nearest veterinary facility capable of providing the ap- standing, lying, or sitting).
propriate surgical and postsurgical care. Because surgical in- • Obtain IV or IO access and initiate fluid resuscitation to
tervention is considered definitive care for treating GDV, do help restore perfusion.
not delay transport and keep on-scene time to a minimum. • Perform GNDC (described under Gastric Decompres-
The main goal for preoperative care is to achieve immediate sion) as soon as feasible. Repeat as needed on the ba-
hemodynamic restoration and cardiorespiratory optimization sis of reappearance of clinical signs (e.g., progressive
for surgical intervention. Management is initially aimed at abdominal distention, circulatory collapse [i.e., weak
gastric decompression and intravenous (or intraosseous) fluid femoral pulses, tachycardia, pale mucous membranes,
resuscitation. The following are recommended guidelines for prolonged CRT, respiratory distress]). If GNDC was
prehospital care of GDV. 5 performed, inform veterinary staff during transfer of
patient care.
Safety • Administer oxygen supplementation and appropriate
First and foremost, always ensure scene and personal safety: analgesia therapy, as available.
• Ensure the scene is safe. • Monitor and record:
• Take appropriate protective precautions to prevent o o Vital signs
the injured OpK9 in pain from injuring you and/or o o Progression of condition (improvement or
your team (e.g., avoid getting bit). Consider applying deterioration)
a muzzle if necessary (ideally an open-type basket type o o The number of GNDCs performed on each side of
muzzle). the canine

TABLE 2 Vital Parameter Changes Associated With the Stages of Shock 25
HR SBP
Stage of Shock (bpm) CRT(s) MM Mentation Pulse Quality (mmHg)
Normal (at rest) <130 <2 Pink Bright, alert Strong >90
Acute compensatory >120 <1 Hyperemic or pale Anxious or quiet, alert responsive Fair >90
Early decompensatory >140 >2 Pale Depressed Weak <90
Terminal <80 Absent Pale to muddy Obtunded to stupor Absent Low
CRT, capillary refill time; HR, heart rate; MM, mucous membrane; SBP, systolic blood pressure.

Prehospital Care of Canine Gastric Dilatation and Volvulus | 95