Page 97 - JSOM Spring 2018

An Ongoing Series

Clinical Update

Prehospital Care of Canine Gastric Dilatation and Volvulus

Lee Palmer, DVM, MS, DACVECC, CCRP, EMT-T, WEMT, NRP, TP-C

ABSTRACT
The intent of the Operational K9 (OpK9) ongoing series is your unit. No veterinary personnel are attached to your team
to provide the Special Operations Medical Association com- nor are any readily available within your area of operation.
munity with clinical concepts and scientific information on An OpK9 handler wakes you at around 0200; he is concerned
preventive and prehospital emergency care relevant to the about his multipurpose canine, Zeus. Zeus is a 6-year-old,
OpK9. Often the only medical support immediately available male-intact, German Shepherd that started nonproductive
for an injured or ill OpK9 in the field is their handler or the vomiting (dry heaving) about 2 hours ago.
human Special Operations Combat Medic or civilian tactical
medic attached to the team (e.g., Pararescueman, 18D, SWAT Your initial history gathering from the handler revealed that
medic). The information is applicable to personnel operating Zeus has been in country for 3 months. Zeus had only worked
within the US Special Operations Command as well as civilian about 4 hours within the last 24 hours and had been kenneled
Tactical Emergency Medical Services communities that may at 1600 yesterday. Until tonight, Zeus has seemed apparently
have the responsibility of supporting an OpK9. healthy; he has not displayed any abnormal behaviors nor
clinical signs of illness. Zeus is fed 2 cups of dry kibble every
Keywords: operational K9; gastric dilatation and volvulus; 12 hours. There has been no change in his diet or feeding regi-
bloat; gastric decompression; trocarization; dogs men; his last feeding was at 1900 last evening and Zeus ate his
full meal. Zeus is up to date on all vaccinations and preventive
health care; he has no known allergies, and he is not currently
prescribed nor taking any medications or nutraceuticals.
Concept
The intent of the OpK9 ongoing series is to provide the Special Upon physical examination, Zeus appears anxious and uncom-
Operations Medical Association community with clinical con- fortable (i.e., panting, pacing around, arched back, tail tucked
cepts and scientific information on preventive and prehospital between his legs). When he is not pacing, he goes into a pray-
emergency care relevant to the OpK9. Most Special Operations ing type position with his hind end raised and his front legs
Forces (SOF) or civilian tactical units do not deploy into an aus- and chest laying on the ground. The right side of his abdomen
tere environment or to a high-risk operation with a veterinary appears significantly enlarged, like he swallowed a basketball.
asset attached to the teams. During these times, it is not unre- Upon abdominal palpation, Zeus reacts as if in extreme pain
alistic for the nearest veterinary resource to be several hundred (i.e., growls, looks back at you, bares his teeth); his abdomen
miles and hours to days away. Often the only medical support is very taut and resonates like a kettledrum when you percuss
immediately available for an injured or ill OpK9 in the field is it. Zeus is salivating profusely, his oral mucous membranes
their handler or the human Special Operations Combat Medic appear pale pink, and his capillary refill time (CRT) is pro-
or civilian tactical medic attached to the team (e.g., Pararescue- longed at longer than 3 seconds. Further assessment reveals a
man, 18D, SWAT medic). The information is applicable to per- heart rate of 160 bpm with weakly palpable femoral pulses;
sonnel operating within the US Special Operations Command occasional pulse deficits are noted. Respirations are fast and
as well as civilian Tactical Emergency Medical Services commu- shallow with a resting respiratory rate of 50/minute (normal is
nities that may have the responsibility of supporting an OpK9. between 12 and 40 breaths/minutes; Table 1).

Differential Diagnosis
Case
The acute onset of severe abdominal pain (a.k.a., acute abdo-
You are an advanced tactical paramedic deployed in a remote, men) often serves as an important indicator of significant in-
austere location and two OpK9 teams are embedded within traabdominal pathology. In canines, the presence of an acute
1
Address correspondence to 1003 Felton Lane, Auburn, AL 36830; or Lpalmer2508@gmail.com
Dr Palmer is a veterinarian, Anti-terrorism Assistance Program, Canine Validation Center, and chair, K9 Tactical Emergency Casualty Care
Working Group, and LTC in the US Army Reserve, Veterinary Corps.

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