Page 214 - 2022 Ranger Medic Handbook

C2. Canine Gastric Dilatation Volvulus (GDV)
DEFINITION: GDV is an urgent surgical condition in which the stomach becomes distended by excessive gas (dilata-
tion) and can then twist (volvulus), cutting off blood supply returning to the heart. All Ranger MPCs have a surgery to
prevent the volvulus; however, dilatation may still occur. This is an emergency condition resulting in profound shock,
leading to death.
S/Sx: Abdominal distention, nonproductive vomiting/retching, abdominal pain, signs of agitation/discomfort, SHOCK,
may lead to DIC.
MANAGEMENT:
1. Treat for shock first: Insert a large bore catheter in each CEPHALIC vein and start resuscitative fluid therapy. Treat to
a systolic BP above 90mmHg; does not require hypotensive resuscitation.
2. Decompress the stomach: Usually you need to lay the dog in left lateral recumbency (with the right side up). Ana-
tomically in GDV, the big fundus of the stomach will most often be located on the right side. Auscultate the right side
(should sound like a basketball when your finger flicks or “pings” it) and palpate for gas distention, this helps identify
the optimal location for trochar placement. Make sure you insert where the ping is loudest, a dull thud may indicate
the presence of the spleen. Do not insert the needle near a thud. Hold pressure underneath the stomach on the
downside, pushing the stomach upward against the body wall. Insert a 14G, 3-in. catheter two finger widths past the
last rib at the highest point on the side. You must go through the abdominal wall and stomach wall, meaning it must
be a quick, forceful movement. Remove the metal stylet when in the stomach, and air should escape. If not, remove
the catheter and try again.
*To increase speed of air evacuation place a 60mL syringe with 3-way stopcock to the catheter to facilitate faster
aspiration.
NOTE: It is common for the spleen to block access to the stomach. If blood is seen in the catheter, remove it immedi-
ately, then try again in a different location.
DISPOSITION: Evacuate immediately to veterinary care even if stable. Surgical correction is required.
SPECIAL CONSIDERATIONS: MEDEVAC at a low altitude to reduce further expansion of air in the stomach. Dilatation
of the stomach may recur, be prepared to decompress again.
SECTION 6 C3. Canine Altitude Sickness And Pulmonary Edema
To date no Ranger MPC has had a recognized issue with altitude in training or while deployed.
DEFINITION: Hypoxia and/or pulmonary edema usually occurring at altitude above 8,000 ft. Clinical signs uncommon
in dogs, but possibility increases with greater activity levels.
S/Sx: Reduced appetite, listlessness, decreased coordination, dark tongue coloration, cough, dyspnea.
MANAGEMENT:
1. Descend from altitude.
2. Provide flow-by supplemental oxygen at 5L/min if available (place oxygen tubing near the nose and secure on the
muzzle; or make an oxygen mask with a cut plastic bottle running the oxygen tubing through the bottom). 3. Admin-
ister 3–4mL (0.5mg/kg) Dexamethasone SP (4mg/mL) IV or IM.
DISPOSITION: Evacuate to veterinary care if nonresponsive to treatment.
SPECIAL CONSIDERATIONS: PROPHYLAXIS: Acetazolamide (Diamox) 250mg q12hr orally beginning 24 hours prior
to ascent, and continue 48 hours after reaching maximum altitude. If using 500mg sustained release tablets, give one
500mg tablet q24hr. Prophylaxis is not needed for K9s if providers do not prescribe medication for Rangers.

C4. Canine Seizure Management
DEFINITION: Emergency seizure treatment required for status epilepticus or seizures secondary to other injuries. Status
epilepticus is a seizure caused by abnormal electrical activity in the brain that is unprovoked. Provoked seizures may be
caused by head trauma, heat stroke, toxin ingestion, etc.
S/Sx: Status epilepticus is seizures lasting more than 5 minutes or 2 or more seizures occurring without recovery (return
to consciousness) in between.

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