Page 129 - PJ MED OPS Handbook 8th Ed

first sign of overheating or vomiting. If possible, get another person who can hold the dog,
while performing an examination and treating the dog.
i) Carefully pull the tongue out of the animal’s mouth.
ii) Even an unresponsive dog may bite by instinct!!
iii) Make sure that the neck is reasonably straight; try to bring the head in-line with the neck.
iv) Do not hyperextend in cases where neck trauma exists.
b. Visibly inspect the airway by looking into the mouth, and down the throat for foreign objects
occluding the airway. Unlike human CPR, rescuers may reach into the airway and remove
foreign objects that are visible.
c. Intubation if necessary to assure airway
i) Do not attempt to intubate a conscious animal, personnel must have prior training. ET
tube size can range from 7–10.
d. If intubation is not possible, then attempt surgical airway.
e. After achieving a patent airway, one must determine whether the animal is breathing, and
whether this breathing is effective.

NOTE: Surgical airways are not warranted in an unconscious or anesthetized MWD that has
no direct upper airway trauma unless the performance of basic airway positioning maneu-
vers is unsuccessful in opening the airway and / or the provider is unable to successfully
perform ETI.

WARNING Blind Insertion Airway Device/Nasopharyngeal airways/ Extraglottic Airway Devices
have not been evaluated in canines and should not be utilized in MWDs.

i) Surgical Cricothyrotomy (CTT) Use techniques recommended for humans
1) Bougie-aided open surgical, flanged and cuffed airway cannula, 6–9 mm internal di-
ameter, 5–8 cm intratracheal length.
2) Standard open surgical, flanged and cuffed airway cannula, 6–9 mm internal diame-
ter, 5–8 cm intratracheal length.
ii) Surgical Tube Tracheostomy (TT)
1) Use the largest internal diameter tube that fits into MWD trachea; aim for a TT that
is at least 70% of the estimated internal tracheal lumen diameter.
2) Select a TT length of 5–8 cm or one that does not extend beyond the thoracic inlet/
point of shoulder.
iii) Procedure
1) Position MWD on its back, extend the neck and place something under it to force it
upwards, making it easier to visualize the trachea.
2) Make a full thickness skin incision along the center of the neck 2–3 finger widths
below the larynx (voice box) using a scalpel blade.
3) If obstruction is in the trachea you must use a lower spot; otherwise use landmarks
given.
4) Do NOT make a transverse skin incision (perpendicular to the long axis of the tra-
chea), as this increases the risk of injury to adjacent vessels and nerves.
5) Use a scalpel to carefully separate the muscles the run parallel to the incision.
6) Hold the muscles apart to visualize the trachea.

Chapter 8. Tactical Medical Emergency Protocols (TMEPs) n 127