Page 213 - 2022 Ranger Medic Handbook

Canine Tactical Medical Emergencies
C1. Canine Heat Injury
DEFINITION: Hyperthermia as a result of heavy physical exertion and/or extended exposure to hot environments. Nor-
mal temperature range for a dog is 99.5°–102.5°F, most acclimated/conditioned dogs can work up to 106°F. Dogs not
affected by heat injury normalize their temperature within about 15 minutes.
S/Sx: Mild Heat Injury (Heat Stress): Excessive thirst, can still control panting (will stop panting when exposed to
stimulus such as a ball or treat for instance), discomfort associated with physical activity (wants to hide, go lay down).
Management Mild Heat Injury: Remove MPC from the heat source/stop exercise, cool with fans or move to an air-
conditioned area. Monitor for several hours by taking rectal temperature. Watch for progression by looking for changes
in mentation, blood in the urine, petechiae, weakness, collapse, signs of shock (rapid breathing, rapid heart rate, weak
pulse, pale membranes, anxiety or restlessness.
S/Sx Moderate Heat Injury (Heat Exhaustion): Signs of mild heat injury are present but include weakness anxiety and
UNCONTROLLED panting (pants through exposure to stimulus such as a ball or treat). CNS signs are not present.
Temp is often over 106°F.
MANAGEMENT: Moderate Heat Injury: Remove MPC from the heat source/stop exercise, cool with fans or move to
an air-conditioned area. Wet the fur with lukewarm water. Caution: Using high pressure to hose down animals can
cause stress and anxiety, compounding the problem. Wet towels, bottles, or low-pressure hosing can be used. Ice baths
and ice sheets may cool the animal too fast and can only be used if core temperature is monitored intensely. All cooling
must stop at 104°F. Once the animal’s body temperature is below 103°F provide supportive warming and dry the animal
to prevent rebound hypothermia. Give small, frequent drinks of cool water; do not give a full bowl – vomiting may occur.
If water is unavailable for soaking the fur of the animal, then apply copious amounts of isopropyl alcohol on the inguinal
and axillae areas. Intravenous fluid may be given to replace dehydration losses and help cool the animal. These can be
found at the back of this section on the MPC card (for instance, a 70lb dog can receive 560mL/hr of LRS for 2 hours if
he is assessed 5% dehydrated). IV fluids at room temperature will also help cool the animal. Monitor the temperature
frequently and discontinue cooling once achieving 104°F; rebound hypothermia may result with rapid cooling.
S/Sx Severe Heat Injury (Heat Stroke): Includes many of the signs of moderate heat injury but the difference includes
varying degrees of CNS signs. CNS signs include changes in mentation and level of consciousness (from depressed
looking to coma), seizures, abnormal pupil size, blindness, head tremors and ataxia. Most temperatures are above 107°F, SECTION 6
but it has occurred as low as 105.8°F. Severe heat injuries are associated with a 50–64% mortality rate
Management Severe Heat Injury: Any animal considered a severe heat injury should be evacuated as an URGENT
patient when feasible. Treatment in severe heat injury is the same for a moderate heat injury (remove from heat source/
stop exercise, wet the fur with lukewarm water, etc.) but may require other measures to treat shock, dehydration,
protect the airway (if there is loss of consciousness), or treat seizures. Treat concurrent shock (e.g. weak femoral pulses,
MAP < 60, systolic BP < 90) with room temperature fluid therapy (1/4 shock dose of crystalloid fluids is approximately
700mL then reassess). Warm fluids are required after the animal’s temperature drops below 103 o F. Again, in the ab-
sence of shock use the MPC card and replace dehydration loses with fluid therapy (i.e., at 560mL/hr for 2 hours if 5%
dehydrated). Intubation (use a bite block) in the apneic, unconscious patient may be necessary, especially while cooling
an unconscious patient down with running water. Monitor mental status closely and initiate the seizure protocol (10mg
of midazolam or diazepam IV, IO or intranasal as needed) if necessary. Discontinue cooling at 104°F. Begin drying and
warming at 103°F. Keep systolic BP > 90mmHg, MAP > 65mmHg, RR 8–10 bpm, EtCO 2 25–60mmHg, SpO 2 > 95% with
supplemental O 2 . If cerebral edema is suspected 30–60g of mannitol IV over 30 minutes with 15mg of dexamethasone
IV (or 900mg of methylprednisolone IV) once. If ventricular arrhythmias are recognized/present only treat them if animal
is hemodynamically unstable at 1.5–2.3mg/min (2mg/kg IV bolus, then 50–75mcg/kg/min) of lidocaine in a CRI/syringe
pump. Monitor blood glucose for hypoglycemia q4–6hr if possible (normal glucose is 60–110mg/dL). Supplement main-
tenance IV fluids with dextrose to 5% and with KCl at 20mEq/L routinely to maintain normoglycemia and normokalemia
(normal potassium is 3.7–5.8mmol/L). Vomiting and/or diarrhea often occurs (sometimes with gastrointestinal bleeding),
begin famotidine at 30mg IV or PO q12hr, 16mg of ondansetron IV or PO q12–24hr and 1g of sucralfate PO q8hr. No
food or water until vomiting has resolved. Antibiotic treatment may begin with cefazolin (Ancef) 600mg IV over 5 minutes
q8hr OR ertapenam 500mg IV q12hr if GI hemorrhage is present.
DISPOSITION: Evacuate to veterinary treatment facility for further treatment.
SPECIAL CONSIDERATIONS: Critical care monitoring from veterinary personnel required after initial resuscitation due
to sepsis and/or DIC.

2022 RANGER MEDIC HANDBOOK 199