Page 103 - 2023 SMOG Digital

MILITARY WORKING DOG (MWD)

MWD Shock Fluid Therapy

The “10-20-10-20 Rule”

Shock Fluid Therapy Protocol of MWDs
- Place multiple large-bore intravenous catheters, perform venous cut-down, and/or place intra-
osseous (IO) catheters. Provide flow-by supplemental oxygen therapy.
- Give IV/IO crystalloid therapy utilizing the 10-20-10-10 fluid guideline:
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1. Calculate total fluid “shock” volume (90mL/kg) that might be required.
2. Collect baseline physiologic and clinical data (mentation, NIBP, HCT, TP, HR, pulse quality,
CRT, mucous membrane color).
3. Give one quarter of the calculated “shock” volume over the first 10 minutes.
4. Reassess the patient‘s pulse quality, CRT, mucous membrane color, heart rate, NIBP, etc.
5. Give another one quarter of the calculated “shock” volume over the next 10-20 minutes, if
necessary.
6. Reassess baseline data.
7. If HCT >20% and TP not below 50% of starting value, and further fluid therapy is
required, then give another one quarter of the calculated “shock” volume over 10 minutes.
8. Reassess baseline data.
9. If fluid therapy is still required, give the final one quarter of the calculated “shock” volume
over 10-20 minutes.
- Give a hydroxyethyl starch (HES) IV or IO bolus of 10-20mL/kg over 5-10 minutes if clinical signs of
shock do not abate after the first 30 minutes (first 2 quarter-shock IV challenges) of crystalloid fluids, or
response to crystalloid challenges is not sustained. Repeat this bolus if no response to therapy.
- Give a hypertonic saline (HTS) IV bolus of 4mL/kg over 5 minutes (if 7-7.5% HTS is available) for MWDs
that fail to respond to two or three quarter-shock boluses of crystalloids and/or one or two boluses of HES.

Clinical Pearls:
- Quick calculation for shock dose: Add a zero to the dog’s weight in POUNDS for the quarter shock
volume in mLs.
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- CAUTION: Human blood products and albumin, or other animal blood products, must never be given

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- Blood product transfusions for MWDs are ONLY available from Veterinary Service Support units
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and their administration is only authorized under the direct supervision of a veterinarian.
- Clinical target for resuscitation end point is a mean arterial pressure (MAP) of >65mmHg or a
systolic of >90mmHg. Neonatal or pediatric blood pressure cuffs must be used.
- Consider TXA 10mg/kg in 100mL NS or LRS, IV over 15 min but NOT LATER THAN 3 HOURS post
injury
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