Page 113 - JSOM Spring 2020

6. CIRCULATION ◆ Proximal, medial tibia caudal to the distal as-
a. Bleeding pect of the tibial tuberosity
■ Pelvic binders have not been evaluated in dogs. Be- ◆ Recommended IO catheter size is 25mm ×
cause pelvic fractures are very unlikely to result in 15 gauge (BLUE) for MWDs weighing >40
life-threatening hemorrhage in canines, pelvic bind- pounds
ers are not recommended in MWDs at this time. 27 c. Tranexamic Acid (TXA) 13,30,31
■ Reassess sites of major hemorrhage and associ- ■ If an MWD is anticipated to need significant blood
ated hemostatic interventions. Ensure bleeding is transfusion (e.g., presents with hemorrhagic shock,
stopped. If bleeding persists, consider changing or one or more major amputations, penetrating torso
adding additional hemostatic adjuncts (e.g., Com- or abdominal trauma, evidence of severe bleeding):
bat Gauze, chitosan-based dressings, or X-Stat) o Administer 10mg/kg (e.g., 0.25g for a 25kg
and/or reapplying circumferential pressure ban- MWD) TXA as a slow IV push or in 100mL
dages and wound packing, where applicable. normal saline or lactated Ringer’s as soon as
■ Consider using the iTClamp for external hemorrhage possible but NOT later than 3 hours after injury.
of the head and neck where the wound edges are When given, TXA should be administered over
easily reapproximated. The iTClamp may be used as 10 minutes by IV/IO infusion.
a primary option for hemorrhage control. Wounds o Begin a second infusion of 10mg/kg TXA as a
should be packed with a hemostatic dressing or continuous infusion over 8 hours after initial
XStat, if appropriate, before iTClamp application. fluid resuscitation has been completed.
■ Consider application of a wide, elastic, nonwind- d. Fluid resuscitation
lass, moldable-type material (e.g., SWAT-T ), if ■ Assess for hemorrhagic shock (pale mucus mem-
®
available, to MWDs under the following conditions: branes, inappropriate mentation in the absence of
o Extremity hemorrhage appears life threatening head trauma, weak or absent femoral pulse).
(e.g., MWD has suffered a complete traumatic ■ The resuscitation fluids of choice for MWDs in hem-
limb or tail amputation), AND orrhagic shock, listed from most to least preferred,
o Bleeding remains refractory to other methods of are: canine chilled or fresh whole blood; canine
hemostasis (e.g., direct pressure, pressure dress- plasma and packed red blood cells (pRBCs) in a
ing, wound packing, hemostatic adjuncts), AND 1:1 ratio; canine plasma or RBCs alone; crystalloid
o The anatomic site is amenable to tourniquet ap- (i.e., lactated Ringer’s, Normosol R or Plasma-Lyte
plication (e.g., limbs and tail wounds). A) Hextend/Hespan. (Note: Hypothermia preven-
■ Immobilize and elevate the area when practical tion measures [Section 7] should be initiated while
and feasible. Keep the MWD as calm as possible fluid resuscitation is being accomplished.)
to avoid inadvertent elevations in arterial blood ■ If not in shock:
pressure. o No IV fluids are immediately necessary.
■ Expose and clearly mark all tourniquets with the o Fluids by mouth are permissible if the MWD is
time of tourniquet application. Note tourniquets conscious and can swallow.
applied and time of application; time of reapplica- ■ If in shock and canine-specific blood products are
tion; time of conversion; and time of removal on available:
the canine TCCC Card (see Section 18). Use a per- o Resuscitate with canine whole blood (initial
manent marker (if available) to mark on the tourni- dose is one 500mL unit as a bolus or titrated,
quet and the casualty card. depending on situation), or, if not available:
b. IV/IO Access o Canine plasma and canine pRBCs in a 1:1 ratio
■ IV or IO access is indicated if the MWD is in hem- (initial dose is one 250mL unit of plasma plus
orrhagic shock or at significant risk of shock (and, one 250mL unit of pRBCs bolused or titrated,
therefore, may need fluid resuscitation), or if the depending on situation), or, if not available:
MWD needs medications but cannot take them by o Reconstituted freeze-dried canine plasma, ca-
mouth. nine liquid plasma, or thawed canine fresh fro-
o An 18-gauge IV or saline lock is preferred. Place zen plasma (initial dose is one 250mL unit of any
in the cephalic (dorsal/anterior aspect over the of the aforementioned plasma products bolused
radius) or lateral saphenous vein (hind limb over or titrated, depending on situation) alone or
the lateral distal tibia). The external jugular vein canine pRBCs alone (initial dose is one 250mL
can be considered as an alternative option. For unit of pRBC bolused or titrated, depending on
external jugular vein access, because of the in- situation).
creased length and flexibility of the MWD’s neck *NOTE: DO NOT administer human blood products to an
as compared to a human, a longer catheter (e.g., MWD. Human blood products have a high probability of
14 or 16 gauge × ≥3.25 inches) is preferred to causing a hemolytic reaction when transfused into a canine. 32
an 18 gauge × 1.2–1.5-inch catheter commonly o Reassess the MWD after each infused unit.
used for peripheral vein access. Continue resuscitation until a palpable femoral
o If vascular access is needed but not quickly ob- pulse, improved mental status, or systolic blood
tainable via the IV route, use the IO route. pressure (BP) of 80–90mmHg is present.
o Recommended sites for IO placement in a ca- ■ If in shock and blood products are not available due
nine 28,29 include: to tactical or logistical constraints:
◆ Proximal, lateral humerus at the caudal as- o Administer lactated Ringer’s, Normosol R, or
pect of the greater tubercle, or Plasma-Lyte A.

K9TCCC Guidelines | 107