Thoracocentesis is often a life-saving treatment that should be performed during initial stabilization, ideally prior to radiographic confirmation of pneumothorax or pleural effusion to prevent patient decompensation in radiology.1,2,4
1 of 5
FIGURE 1A AFAST: Anechoic free abdominal fluid (arrows) at the diaphragmatico-hepatic view (A) and splenorenal site (B). Images courtesy of Silke Hecht, DACVR, DECVDI
2 of 5
FIGURE 1B AFAST: Anechoic free abdominal fluid (arrows) at the diaphragmatico-hepatic view (A) and splenorenal site (B). Images courtesy of Silke Hecht, DACVR, DECVDI
3 of 5
FIGURE 2 Lateral thoracic radiograph of the pneumothorax in a dog. Increased gas opacity in the pleural space, retraction of the lung lobes from the thoracic wall and diaphragm (arrowheads), separation of the cardiac silhouette from the sternum (arrow), and diffusely increased opacity of the lungs due to atelectasis can be seen. Image courtesy of Silke Hecht, DACVR, DECVDI
4 of 5
FIGURE 3A Thoracic radiographs of diaphragmatic hernia in a dog. Cranial displacement of abdominal viscera (circle), loss of normal diaphragm outline (line), and displacement of thoracic structures can be seen. Images courtesy of Silke Hecht, DACVR, DECVDI
5 of 5
FIGURE 3B Thoracic radiographs of diaphragmatic hernia in a dog. Cranial displacement of abdominal viscera (circle), loss of normal diaphragm outline (line), and displacement of thoracic structures can be seen. Images courtesy of Silke Hecht, DACVR, DECVDI
FIGURE 1A AFAST: Anechoic free abdominal fluid (arrows) at the diaphragmatico-hepatic view (A) and splenorenal site (B). Images courtesy of Silke Hecht, DACVR, DECVDI
FIGURE 1B AFAST: Anechoic free abdominal fluid (arrows) at the diaphragmatico-hepatic view (A) and splenorenal site (B). Images courtesy of Silke Hecht, DACVR, DECVDI
FIGURE 2 Lateral thoracic radiograph of the pneumothorax in a dog. Increased gas opacity in the pleural space, retraction of the lung lobes from the thoracic wall and diaphragm (arrowheads), separation of the cardiac silhouette from the sternum (arrow), and diffusely increased opacity of the lungs due to atelectasis can be seen. Image courtesy of Silke Hecht, DACVR, DECVDI
FIGURE 3A Thoracic radiographs of diaphragmatic hernia in a dog. Cranial displacement of abdominal viscera (circle), loss of normal diaphragm outline (line), and displacement of thoracic structures can be seen. Images courtesy of Silke Hecht, DACVR, DECVDI
FIGURE 3B Thoracic radiographs of diaphragmatic hernia in a dog. Cranial displacement of abdominal viscera (circle), loss of normal diaphragm outline (line), and displacement of thoracic structures can be seen. Images courtesy of Silke Hecht, DACVR, DECVDI
Quick and effective analgesia is essential for patients with vehicular trauma. Opioids are the drug of choice because of their efficacy and limited adverse effects. NSAIDs should be avoided until the patient is hemodynamically stable. In addition, butorphanol has minimal analgesic effects and should not be used. IM or SC administration of pure μ-receptor agonists may cause vomiting; IV administration is strongly preferred.1,13
- Morphine (0.1-0.5 mg/kg IV every 4 hours)
- Hydromorphone (0.05-0.2 mg/kg IV every 4-6 hours)
- Methadone (0.1-0.5 mg/kg IV every 4-6 hours)
- Fentanyl (2-5 µg/kg bolus, then 2-6 µg/kg/hour IV CRI)
- Buprenorphine (0.01-0.03 mg/kg IV or IM every 6-8 hours)
Table 1
GENERAL GUIDELINES FOR FLUID RESUSCITATION & BLOOD TRANSFUSION IN PATIENTS WITH TRAUMA
| Perfusion Parameters |
Normal Endpoints |
| Whole blood5 |
Dogs: 20-30 mL/kg given over 30 minutes to 4 hours, depending on how critical the patient is
Cats: 50-60 mL/cat (NOT mL/kg) given over same time period as for dogs
|
| Packed RBCs5 |
Dogs: 15 mL/kg given over same time frame as whole blood
Cats: 30-40 mL/cat (NOT mL/kg) given over same time frame as for dogs
|
| Synthetic colloid (controversial)5 |
1-5 mL/kg given over 15 minutes |
| Fresh frozen plasma5 |
15-30 mL/kg for patients with coagulopathy and active hemorrhage |
| Isotonic fluid shock bolus (LRS, Norm-R, 0.9% sodium chloride, Plasma-Lyte)5,9 |
10-25 mL/kg given over 15 minutes. End goals should be reassessed; may be repeated until entire shock dose administered.
Dog shock dose: 90 mL/kg/hour; cat shock dose: 50-60 mL/kg/hour
|
| Hypertonic saline5,9 |
4-6 mL/kg given over 15 minutes; may be repeated 2-3 times in 24 hours |
| Mannitol9 |
0.5-1.5 g/kg IV given over 15 minutes, may be repeated 2-3 times in 24 hours |
| Lidocaine3 |
2 mg/kg IV bolus, followed by 50-80 μg/kg/minute if rhythm converts |
- Common metabolic consequences6,12
- Activation of the coagulation cascade
- Hypothermia
- GI disturbance (eg, vomiting, diarrhea)
- Systemic inflammation (eg, SIRS, MODS)
- Common clinical pathologic abnormalities2,6,12
- Hyperglycemia
- Hyperlactatemia
- Metabolic acidosis
- Hypoalbuminemia
- Anemia
- Thrombocytopenia
- Increased ALT
- Increased CK
- Prolonged PT/PTT
Table 2
RESUSCITATION ENDPOINTS
| Perfusion Parameters |
Normal Endpoints |
| Heart rate |
Dogs: 60-120 bpm
Cats: 140-200 bpm
|
| MM color |
Pink |
| CRT |
1-2 seconds |
| Temperature |
99°F-102.5°F (37.2°C-39.2°C) |
| Mentation |
Alert |
| SAP (systolic BP) |
>90 mm Hg |
| MAP (mean BP) |
>70 mm Hg |
| Urine output |
1-2 mL/kg/hour |
| Lactate |
<22.5 mg/dL |
- Dorsal column: laminae, spinous processes and their ligaments
- Middle column: dorsal longitudinal ligament, dorsal annulus, dorsal cortex of the vertebral bodies
- Ventral column: ventral longitudinal ligament, ventral annulus, ventral cortex of the vertebral bodies
AFAST = abdominal focused assessment with sonography for trauma, BP = blood pressure, CK = creatine kinase, CPR = cardiopulmonary resuscitation, CRT = capillary refill time, Hct = hematocrit, LRS = lactated Ringer’s solution, MAP = mean arterial pressure, MgCl = magnesium chloride, MM = mucous membrane, MODS = multiple organ dysfunction, PCV = packed cell volume, PE = pericardial effusion, POCUS = point of care ultrasound, PT = prothrombin time, PTT = partial thromboplastin time, RR = respiratory rate, SAP = serum alkaline phosphatase, SIRS = systemic inflammatory response syndrome, SpO2 = oxygen saturation, TFAST = thoracic focused assessment with sonography for trauma, TP = total protein, TS = total solids, VPC = ventricular premature contraction
- Reineke EL. Trauma overview. In: Drobatz KJ, Hopper K, Rozanski E, Silverstein DC, eds. Textbook of Small Animal Emergency Medicine. John Wiley and Sons; 2019:1039-1051.
- Simpson SA, Syring R, Otto CM. Severe blunt trauma in dogs: 235 cases (1997-2003). J Vet Emerg Crit Care (San Antonio). 2009;19(6):588-602.
- Reiss AJ. Myocardial contusion. In: Silverstein DC, Hopper K, eds. Small Animal Critical Care Medicine. 2nd ed. Elsevier; 2015:236-239.
- Sauvé V. Pleural space disease. In: Silverstein DC, Hopper K, eds. Small Animal Critical Care Medicine. 2nd ed. Elsevier; 2015:151-156.
- Prittie J, Cazzolli D. Crystalloids versus colloids. In: Drobatz KJ, Hopper K, Rozanski E, Silverstein DC, eds. Textbook of Small Animal Emergency Medicine. John Wiley and Sons; 2019:1103-1114.
- Roa L, Streeter EM. Metabolic consequences of trauma. In: Drobatz KJ, Hopper K, Rozanski E, Silverstein DC, eds. Textbook of Small Animal Emergency Medicine. John Wiley and Sons; 2019:1068-1071.
- Davis E, Vite CH. Spinal cord injury. In: Silverstein DC, Hopper K, eds. Small Animal Critical Care Medicine. 2nd ed. Elsevier; 2015:431-436.
- Jeffery ND. Vertebral fracture and luxation in small animals. Vet Clin North Am Small Anim Pract. 2010;40(5):809-828.
- DiFazio J, Fletcher DJ. Traumatic brain injury. In: Drobatz KJ, Hopper K, Rozanski E, Silverstein DC, eds. Textbook of Small Animal Emergency Medicine. John Wiley and Sons; 2019:107-117.
- Fletcher DJ, Syring RS. Traumatic brain injury. In: Silverstein DC, Hopper K, eds. Small Animal Critical Care Medicine. 2nd ed. Elsevier; 2015:723-727.
- Sande A, West C. Traumatic brain injury: a review of pathophysiology and management. J Vet Emerg Crit Care (San Antonio). 2010;20(2):177-190.
- Lynch A, Goggs R. Trauma-associated coagulopathy. In: Drobatz KJ, Hopper K, Rozanski E, Silverstein DC, eds. Textbook of Small Animal Emergency Medicine. John Wiley and Sons; 2019:1060-1067.
- Wetmore LA. Opioids. In: Drobatz KJ, Hopper K, Rozanski E, Silverstein DC, eds. Textbook of Small Animal Emergency Medicine. John Wiley and Sons; 2019:1250-1254.
