Page 208 - 2022 Ranger Medic Handbook

d. Emma/EtCO 2 monitor (reference range is 35–45mmHg). Opioids (e.g., fentanyl CRIs) can depress the CNS, leading
to a higher CO 2 reading. Pain will cause an animal to hyperventilate and decrease the CO 2 reading.
5. Respirations
a. Remove the vest. Check both sides of the chest and neck. Thirty percent of our penetrating GSWs to the thorax
communicated with a GSW to the neck.
b. In the conscious patient with an actively sucking wound – use a large, vented occlusive dressings. It is difficult to
get them to adhere; bigger is better. Try to cover as much surface area as possible with the occlusive dressing.
Wrap the chest circumferentially with an Elastikon bandage if adherence is a problem. Be careful not to restrict
breathing. Be prepared to treat a pneumothorax or hemothorax.
c. Dogs with pneumothorax and/or hemothorax often have increased resistance when bagging and may present
EtCO 2 two ways when intubated: they may have (1) a low EtCO 2 reading because the volume of air crossing the
sampling device (emma) is decreased from the restriction of tidal volume movement caused by the tension pneu-
mothorax or (2) a high EtCO 2 reading when sufficient tidal volume is available to move but venous return to the
heart is decreasing from pressure. This causes less blood to move to the lungs, which increases the concentration
of CO 2 that is released when it finally arrives. The wave form is normally square with the right side of the square/
plateau slightly higher. Pneumothoraxes often show a short plateau wave form where the left side of the plateau
is higher. Open chest lacerations/finger thoracostomies need positive pressure ventilation. Increased compliance
while bagging may indicate hemopneumothorax/pneumothorax/hemothorax and the need to be decompressed.
d. Needle decompression: Place between 6th to 8th intercostal spaces cranial to the rib using a standard 14-gauge
catheter. Place in highest portion of chest when laterally recumbent to remove air and lower third (near sternum) to re-
move fluid. Repeat needle decompression often indicates need for tube or finger thoracostomy. NOTE: 92% of dogs
have a fenestrated mediastinum but bilateral decompression may be indicated clinically in a smaller percentage.
e. Chest tube: Indicated if needle decompression does not resolve pneumothorax or hemothorax is present. Place
the dog in lateral recumbency with the affected side up. Pull skin cranially. If conscious, block the rib in front and
the rib behind with 1–2mL of lidocaine (about an inch proximal to your entry point). Use a 28–36 French chest tube
(same as a human). Place mid-thorax between the 7th and 8th intercostal spaces (dogs have 13 ribs per side).
Enter the chest at the highest point of the chest wall. Direct tubes in cranioventrally (toward the head and sternum)
direction. Place entry point cranially over ribs to avoid vessels and nerves. Have an assistant pull the loose skin
cranial before the incision is made in the 7th or 8th intercostal space to obtain a better seal.
SECTION 6 you believe communicate with the thorax (or severe major vasculature of the neck), obvious penetrating wounds to
6. Circulation: Make sure there is not major bleeding and control as necessary. Penetrating wounds to the neck that
the chest, abdomen, or hip are all considered significant mechanisms of injury. Treat for hemorrhagic shock if two or
more clinical signs below are seen):
a. Pulse >160bpm
b. Loss of consciousness
c. Weak femoral pulse
d. HR > systolic BP
e. Systolic BP < 90
f. Tacky mucous membranes
g. EtCO 2 < 35mmHg
h. Estimated 400mL blood loss or more (one saturated roll of Kerlix)
i. Mechanism of injury includes a penetrating wound to the neck, chest, abdomen, or hip
Resuscitate until femoral pulses are palpable or systolic pressure >90mmHg. Intravenous route is preferred; Secondary
route is IO (lateral humoral head or tibial crest). Incorporate fluid therapy as needed. Resources will often limit canine
blood availability to 1 unit, which is generally with the Ranger MEDEVAC asset in theater. Encourage handlers to manage
and carry that unit of blood on target OR convince the company commander to take the Battalion’s animal care tech.
If blood products are unavailable, make sure that it is asked for in line 4 of the 9-line request so other assets in theater
can begin to pull blood from their walking canine blood banks before your patient arrives. Absolutely no human blood
product should go to a Ranger MPC; it has contributed to the death of a Ranger MPC as recently as 2017. If no canine
blood is available, then bolus 500–700mL of crystalloid over 20–30 minutes, reassess vitals, and repeat only if no change
in vitals and there is no foreseeable extraction for the MPC within the next 15 minutes. Do not exceed 2L in 1 hour. Follow
fresh whole blood transfusion protocol if second dog is available. This is most practical after evacuation to higher care.
Monitor for circulatory overload the same as humans.

194 SECTION 6 MPC/CANINE TRAUMA & TACTICAL MEDICAL EMERGENCY PROTOCOLS