Dogs, Part 1: Hurt Dogs

I think most people who read this are paramedics or EMTs. So I feel like I can open myself up to you and let you all in on a secret.

When I see a person (adult, of course) get hit by a car, it is like letting the good times roll. It is probably a little funny, and I know that I am likely about to do a lot of fun stuff to them. Fun for me, at least. And I’d be willing to bet most ambulances who witness an auto-ped hear some form of conversation that begins with: “Ha! Holy crap, did you see that?!? That was awesome! Pull over! Pull over and set me up!” It is a little bit funny to see cars hit adults. But keep that between you and me.

It is not even a little funny when we see a dog get hit by a car. The last dog I saw get hit staggered around like it was head-injured, snapping at the air and dragging its back legs. I couldn’t sleep for a week. When I would close my eyes, I would think about that poor dumb dog. Terrible. Sad.

Once I responded to a jogger who had been hit by a car. He was jogging along a sidewalk when a car came out of an alley. The car broke the jogger’s ankle, but ran his Rottweiler the hell over. We had to extricate the dog from under the car, and found it to have a massive avulsed scalp wound, burns over its right flank, and an unstable pelvis. I couldn’t believe the jogger – he was mad that we were taking care of the dog and had only splinted his ankle.

“Take me to the hospital!”

“Go to hell! You’ll go after your dog gets taken care of!”

Triage, fools!

Anyway, we got the Rottie muzzled with some Kerlix gauze, called a supervisor to transport the dog, and wound up using a cop to transport the dog to a nearby emergency animal hospital because the EMS supe was taking too long. The police officer was as worried about the poor dog as we were.  On the way to the human hospital with Captain Ankle Fracture still complaining about my triage choices, I called in a trauma set-up to the animal hospital: “Hi, you have a police car coming to you lights and siren with a… Dude, how old is your dog? Four? Okay. Coming to you lights and siren with a four-year-old male Rottweiler, struck by a car. He required extrication from under the vehicle and presented with a large scalp avulsion, partial thickness burns to his right flank, and...” According to the cop, the vet hospital had a bed and a team waiting out front when she squealed into their parking lot.

The dog lived. I assume the human did, too, but I didn’t care enough to check.

Occasional canine veterinary care is required of paramedics. It could be a dog hit while his owner was jogging, but it could also be a police dog wounded in the line of duty. Are you willing to look at the police canine’s handler and shrug? I’m not. But I am also limited in my ability to transport dogs. My boss would have a stroke if I transported every injured dog I found to a veterinary hospital. I am a paramedic, not a mobile vet. (Wait. Am I a mobile vet? That would explain a lot.) But some basic principles of veterinary trauma care are helpful knowledge.*

First, most of the concepts of trauma care work for all mammals, dogs or humans. Keep airways open, stop bleeding, and so on. Trauma is trauma. Dogs get tachy as they hemorrhage. Their gums will show pallor. You can increase your comfort level greatly if you understand that you are a skilled caregiver to human victims of trauma, so you are probably a fairly skilled caregiver to traumatically injured dogs.

Second, understand that humans (for the most part) don’t bite their caregivers. I know there are exceptions to that. Most dogs will bite when they are hurt. Secure them so you aren’t chomped.

 

Try to convince this dog you're there to help when it is hurt or in the red zone.
U.S. Air Force Photo by Josh Plueger, via Wikimedia Commons

When it comes to airways, my suggestion is to not intubate animals. That being said, understand that dogs can take big honking endotracheal tubes, in the 7.0-10.0 mm range, and intubating them is as easy as lifting the hypomandibular flesh on a supine dog. It is supposed to be easy, but I haven’t done it. There are a few websites, videos, and articles that explain how to do it if you care to learn. But you can also get control of that big airway without the tube by pulling the dog’s tongue out of its mouth, keeping the neck straight and inline with the head and body, and not hyperextending the neck. Oxygenate via blow-by O2. Don’t try to screw around calculating the tidal volume and minute volume for a dog. Straighten the anatomy, pull the tongue out without being bit, and blow some oxygen past. Move on.

If you feel the need to start an IV, the best spot is usually on the forelegs. The cephalic vein is on the middle of the foreleg and can even been seen without shaving. For the hind leg, consider the saphenous vein running from the back of the knee to the front of the shin. Secure the line with a ton of tape and make sure the dog doesn’t pull the line. (Lampshade of shame, anyone?) Saline is fine, but most veterinary websites seem to prefer lactated ringers as the initial volume replacement fluid. Dogs can handle big volume, so don’t worry about volumes like 60 ml/kg if it is warranted. Click here for more IV information on hypovolemic dogs. Subcutaneous infusion is an option, as well, but that seems to work best as pretreatment before putting a dog to work in a hot, dry environment rather than a treatment for moderate-severe hypovolemia.

Dogs can handle medications like morphine, antibiotics, Zofran, Benadryl, and such. But don’t be that medic. Don’t screw around with medicating dogs.**

Normal heart rates for dogs are in the 60-80 range. It would be normal to find a heart rate up to 130 bpm after exercise, though. Normal respiratory rate is between 10 and 40 per minute, again depending on exercising and panting. Capillary refill should occur in under two seconds and mucus membranes and gums should be pink. Tachycardia, pale gums, dry membranes, and poor skin turgor are signs of hypovolemia or dehydration.  Pulse oximetry is reported to be possible on the tongue or prepuce. Good luck with that.

Hope this helps, if it ever comes to it. In Part 2, I plan to discuss how to operate around police dogs. Part 3 will cover service dogs.

*This isn’t about cats. Screw cats. There ain’t no such thing as a police cat. We’re here to talk about dogs.

**As an aside, the morphine dose for dogs is 0.5-1 mg/kg. I can only imagine the look on my boss’ face if I told him I used all my narcs on a German Shepard with a broken leg. Apoplectic would be a good description. Any supervisor would flat have a stroke. That conversation is funny to even think about…