Page 215 - 2022 Ranger Medic Handbook

MANAGEMENT:
1. Gain IV access.
2. Treat underlying cause, if possible.
3. Monitor body temperature; treat hyperthermia if temperature rises above 104°F.
4. Administer an anti-convulsant– diazepam (Valium) 15–30mg (0.5–1mg/kg) IV or 30–60mg (1–2mg/kg) per rectum (2–3
minutes onset) OR midazolam (Versed) 7.5mg (0.25mg/kg) IV/IM. Levetiracetam (Keppra) 30–60mg/kg (600–900mg)
IV for status epilepticus or acute repetitive seizures. For refractory epilepsy: regular tablets 20mg/kg (600mg – use
of 750mg tab is safe) PO q8hr, extended-release tablets 30mg/kg (900mg – use of 1,000mg tab is safe) PO q12h.
DISPOSITION: Evacuate to veterinary care as soon as possible. Requires critical care monitoring.
SPECIAL CONSIDERATIONS: Seizures may recur. Contact a veterinarian for guidance if one is not located in your location.

C5. Canine Toxicities – Explosives, Others
Training Aid/Agent Toxicosis: Our MPC are exposed to certain small quantities of explosives known as training aids
and may accidently ingest them which could lead to toxicosis in the animal.
1. Nitrate/nitroglycerin-based explosives (C4, TNT, water gel, dynamite, RDX, det cord):
Clinical signs – Ingestion may result in hypersalivation, severe CNS abnormalities (ataxia, incoordination, seizures,
tremors), gastrointestinal irritation (nausea, vomiting), and methemoglobinemia (signs of methemoglobinemia include:
cyanosis, weakness, syncope = loss of consciousness, respiratory distress). Onset of signs usually occurs between
3 and 12 hours after ingestion.
2. Smokeless powder explosive
Clinical signs – Ingestion may result in hypotension, CNS depression (which manifests as ataxia, depressed menta-
tion, incoordination), and methemoglobinemia (cyanosis, weakness, syncope, respiratory distress).
Treatment – Monitor blood pressure and fluid resuscitate as needed. Close monitoring of CBC’s necessary for po-
tential methemoglobinemia.
3. Potassium and sodium chlorate explosives
Clinical signs – Ingestion may also result in methemoglobinemia (cyanosis, weakness, syncope, and respiratory dis-
tress), CNS abnormalities (ataxia, incoordination, and depressed mentation), gastrointestinal irritation (nausea, vomiting,
abdominal cramping and pain, hemorrhagic diarrhea with melena or hematochezia), hematuria, hemoglobinuria, and
renal and liver failure.
Treatment of Training Aid Toxicosis
1. If ingestion occurred ≤ 4 hours before presentation and the MPC is conscious and has normal CNS responses, SECTION 6
induce vomiting.
a. Apomorphine is first choice. ¼ (6mg) tablet in the conjunctival sac or 0.03mg/kg IV.
b. Hydromorphone is second choice 3mg IM
c. 3% hydrogen peroxide (household formula is 3%) Maximum of 30mL can be given orally as the last option. This method
will create esophageal erosion.
d. Don’t try to make an MPC gag manually
2. If ingestion occurred > 4 hours before presentation, or if the dog has abnormal mentation or is unconscious or seiz-
ing, do not induce vomiting.
a. 45g of activated charcoal with sorbitol as an initial dose. Sorbitol is a laxative. This is about 30mL of Toxiban (w/sorbitol).
May require sedation with cuffed ET tube, orogastric intubation and a funnel to get the slurry in.
b. A second dose 4–6 hours later without sorbitol
c. If seizures are present give 10mg of midazolam IV or IN or 10mg of diazepam IV, IN or per rectum. Alternatively 600–
900mg of levetiracetam (Keppra) IV can be given.
d. If methemoglobinemia is present (blue tinge to unpigmented skin, brown blood, brown urine, tachypnea, tachycardia, leth-
argy, recumbence) 30–60mg of methylene blue (MB) 1% (3–6mL) can be given as a slow bolus IV. If respiratory distress per-
sists then repeat dose once or twice. MB will cause a Heinz body anemia so CBC must be monitored every 8 hours if used.
Rat Poison: Is a vitamin K antagonist so it interferes with the production of coagulation proteins. This eventually inhibits
hemostasis.
Clinical signs – Some form of hemorrhage is often seen such as bruising of skin and mucous membranes, especially
the axillae and inguinal regions. Blood may be seen in the urine or coming from the nose. It can also cause weakness,
a painful abdomen, pale mucus membranes, coughing, wheezing, and (rarely) petechiae. Dyspnea can occur from in-
trathoracic or intrapulmonary bleeding. Collapse is possible if pericardial hemorrhage occurs. Pale mucous membranes
will occur if anemia is severe.
Treatment – 1.5–2.5mg/kg (45–75mg) of vitamin K 1 (phytonadione) supplementation BID PO in a fatty meal for up to
4 weeks may be required. Supplied as 25–50mg tablets or 10mg/mL injection that must be given IM or SC. Have a
veterinarian check PT time 72 hours after last dose to know when to stop. Canine FFP or whole blood may be required
to replace clotting factors and/or RBCs.
2022 RANGER MEDIC HANDBOOK 201