Emergency Medicine in Animals

Emergency patients present special challenges because their underlying disease processes can cause immediate life-threatening problems that require rapid and aggressive intervention. In addition, the full extent of an animal’s illness, injuries, or toxicosis may not be evident for some time after initial presentation. Problems can arise from an acute illness, toxicosis, or injury; from a chronic illness that has decompensated; or from an unexpected complication of a concurrent illness. Any patient in the immediate postoperative state (whether presenting to the ER or already in the hospital) should be considered critical until life-threatening anesthetic or surgical complications are excluded.

The golden rule of emergency medicine is to treat the most life-threatening problems first. Once stable, a patient should be closely monitored for progression or resolution of disease and possible complications.

Variables that contribute to the overall outcome of emergency treatment include the following:

• severity of the primary illness or injury

• amount of fluid or blood lost

• age of the animal

• number and severity of comorbid conditions

• time delay in instituting therapy

• volume and rate of fluid administration

• choice of fluids (eg, crystalloid, blood components, or synthetic colloids)

• possible complications either from therapy (eg, adverse effects of drugs) or underlying disease

Therapy must be done at the right time, in the right amount, and in the right order. Therapeutic failures are generally a result of failing to act expeditiously at a crucial moment.

Emergency care often begins with the owner’s initial telephone call. Instructing the owner on first aid and transport procedures can be lifesaving for the animal.

The clinic and staff must be ready, especially if more than one animal in critical condition arrives at the same time. The primary survey, or triage, requires a quick and accurate assessment and decision regarding the stability of the animal. As life-threatening airway, breathing, and circulation problems are identified, immediate treatment is initiated (see emergency trauma patient image).

Emergency trauma patient, dog

Image

Courtesy of Dr. Andrew Linklater.

Once the animal has been stabilized, a more systematic and organized approach to the history and physical examination (secondary survey) and more specific diagnostic and therapeutic procedures aimed at the underlying cause can be done.