Animal nursing: First aid
Objectives
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List the 3 aims and rules of first aid
Classify injuries as life threatening, serious, or minor and describe what that
means in terms of owner response
List the 8 basic questions that should be asked of an owner over the phone in a
first aid emergency to elicit the information required to respond appropriately
Describe 5 important points you will cover in your description of the way an
owner should approach handle and transport a conscious animal with a painful
immobilising injury
Describe the preliminary assessment of the first aid patient and the protocol for
basic CPR should it be required
Discuss the assessment and treatment of a variety of specific first aid conditions
References
Goodwin, J. (2003) First aid. In B.Cooper & D.L. Lane (Eds.) Veterinary Nursing (3rd
ed.) (pp. 101-141). Edinburgh: Butterworth - Heinemann
Tasks
1. Make up a role play to demonstrate the appropriate response to an owner ringing
up the clinic in a panic because their animal has had a first aid emergency.
2. Describe 5 important points you will cover in your description of the way an
owner should approach handle and transport a conscious animal with a painful
immobilising injury.
3. Use Humphrey to ventilate your patient at an appropriate rate depth and rhythm
for a larger dog and a cat (expiratory pause!) and ensure correct placement of
pressure for cardiac massage
4. The vet is busy suturing up the uterine stump in a bitch spey. You are on
reception duty and there is another vet nurse in the pharmacy organising some
medication. An owner brings Humphrey through the door and he is limp and
unresponsive in the owners arms, the owner says he was still breathing as he
picked him up out of the car to bring him in but breathing has now ceased and you
can’t detect a femoral pulse. Role play your response to this situation and use
Humphrey in pairs for 2 person resuscitation in this CPR emergency. Don’t forget
the 4 rules of CPR.
FIRST AID
Definition
The immediate treatment of injured animals or those suffering from sudden illness.
Three aims of first aid are:
a)
To preserve life
b)
To prevent suffering
c)
To prevent the situation from deteriorating.
Legal Limitations
Lay Persons - Anyone over the age of 18 is permitted to amputate the dew claws of a
puppy before its eyes are open; and anyone is allowed to render first aid in an emergency
for the purpose of saving life or relieving pain or suffering.
Special provisions for veterinary nurses in New Zealand don’t exist as they do overseas,
so only a veterinarian may perform surgery. Veterinary nurses and lay persons are
legally unable to do a wide range of even quite minor invasive procedures and treatments.
And with the legal “duty of care” and “negligence” laws they have to be accountable to,
veterinarians in this country are usually quite conservative about what they will use
veterinary nurses to do. However despite those issues, in a first aid situation a veterinary
nurse would be expected to be able to act quickly and appropriately especially in the
absence of a veterinarian. A qualified veterinary nurse might well be expected to respond
using advanced first aid equipment and techniques and manage the patient and its
stabilisation for a longer period independently. Veterinarians who are prepared to allow
their nurses to routinely and independently use their professional skills and abilities may
also use “Standing Orders” to detail expected actions and limitations of a nurses
responsibilities in specific situations. This ensures veterinary nurses are legally covered
to do such things as administer Temgesic or Morphine as pain relief for fracture patient
being stabilised.
In New Zealand we are trying to set up a system similar to many overseas. In Britain any
medical treatment or minor surgery (not involving entry into a body cavity) to a
companion animal may be done by a veterinary nurse if the following conditions are
complied with:
1.
the companion animal is, for the time being, under the care of a registered
veterinary surgeon or veterinary practitioner and the medical treatment or minor surgery
is carried out by the veterinary nurse at their direction; and
2.
the registered veterinary surgeon or veterinary practitioner is the employer or is
acting on behalf of the employer of the veterinary nurse.
3.
Does not apply to veterinary nurses in training. They have the rights of a lay
person and may also carry out nursing duties and assist veterinary surgeons in any way
which does not involve an act of veterinary surgery.
Companion animal means an animal kept as a pet or for companionship, not being a
horse, pony, ass, mule, nor an animal used in agriculture.
Veterinary nurse means a nurse whose name is entered in the list of veterinary nurses
maintained by the RCVS.
Removal of sutures, replacement of dressings, cutting of nails and beaks, and the sealing
of teeth are procedures that are NOT acts if veterinary surgery.
Role of a Veterinary Nurse in an Emergency Situation
1.
To establish the nature and severity of the emergency by obtaining a good history.
2.
Give immediate and relevant instructions and advise to the owner/caretaker.
3.
Make the necessary preparations for arrival of the patient.
4.
Administer first aid treatment to an animal by whatever means are available, but
only as an interim measure, designed to preserve life and alleviate suffering until the
veterinarian is available to attend the animal.
The Four Rules of First Aid Are:
1.
2.
3.
4.
5.
6.
Stay calm
Be prepared
Do not put yourself, owners or other staff at risk
Ensure the animal is at no further risk
Assess the severity of the illness/injury (triage the situation)
Contact the veterinarian as soon at possible
Telephone Calls
Often the nurse on reception is the first point of contact for a client. It is the nurse’s job
to elicit information from the client to ascertain the severity of the problem, and offer
appropriate advice without making a diagnosis or offering a prognosis
Classification of emergencies:
EXAMPLE OF TYPES OF EMERGENCIES
Life Threatening requires immediate action
Minor
Unconsciousness
Collapse
Dyspnoea or cyanosis
Anuria
Severe haemorrhage
Severe burns
Prolapsed eye
Poisoning
Dystocia
Open fractures
Insect stings
Minor wounds (where the haemorrhage
is easily controlled by bandaging)
Minor burns (where there is only slight
discomfort)
Abscesses
Slight lameness (where animal is able to
bear some weight on the leg)
Haematuria
Aural haematomata
1. Life-threatening emergencies: involve significant disturbance of major body systems
and have the potential for rapid deterioration and death, requiring urgent life-saving help.
2. Minor emergencies: Emergencies where life is not immediately threatened, where full
evaluation and treatment can be delayed until after the needs of life-threatening
emergencies have been dealt with.
Restraint and Transport of the Injured Animal
With all injured animals, before help can be provided it is necessary for them to be
adequately restrained. The approach to and restraint of the injured animal is a vital
preliminary, although animals that have suffered the most damage are usually the least
likely to offer any resistance. Your approach to an injured animal should be calm, quiet
and yet purposeful. It is often valuable to have the assistance of two or three sensible
people. By talking to the animal in a quiet, reassuring voice you may be able to get close
enough to restrain it, at least temporarily. If all attempts at catching the animal fail, it
may be necessary to get professional assistance, e.g. the vet clinic may do house calls.
Restraint may require drugs or specialist equipment.
Cats
Be careful scruffing dyspnoeic animals, or those showing signs of spinal injury.
Boxes or cages can be placed on top of collapsed or fractious animals, and a cardboard
sheet slid underneath so the cat comes to lie on it.
Dogs
Muzzles may be indicated, but should not be used in dyspnoeic or vomiting animals.
Allow the animal to assume the most comfortable position for transport.
Stretchers may be indicated for animals with spinal injuries. These are simply supporting
surfaces: wood sheets, coats supported by poles, or even a blanket.
Birds
Handle very gently
Do not compress the thorax or abdomen
Gloves may be required for psittacines
Horses
Use of halters, twitches, lifting leg etc.
Arrival at the Surgery: (Preliminary Assessment of Degree of Injury)
Preliminary assessment and triage
1. Safety
On arrival the animal should be examined (with due care for the safety of the professional
staff the client and the animal), a provisional assessment made and treatment given. If
more than one animal arrives at once, the most life threatening emergencies should be
dealt with first.
2. Response
The next step is to assess the level of consciousness of the animal.
If a problem exists it is vital to determine whether an animal is unconscious or dead.
COMPARISON BETWEEN RECENT DEATH AND UNCONSCIOUSNESS
Sign
Death
Unconscious collapse
Heart beat
Absent for more than 3 minutes
Regular, though slowed
Respiratory pattern
Absent, although occasionally Cheyne
Stokes respiration is observed
Varies according to the depth
of CNS depression (mimics
anaesthesia)
Eyeball position
Central
Turned down or central,
according to the depth of CNS
depression
Cornea
Glazed
Normally moist
Corneal reflex
Absent
Present (unless eyelids
paralysed)
Pupil size
Fully dilated
May vary in size, but are rarely
fully dilated
Pupillary light reflex
Absent
Usually present unless iris
paralysed
Movement
Absent, except Cheyne Strokes
respiration
May be roused in stupor
Body temperature
Rigour mortis in a few hours
Cools within 15 minutes
Remains constant
Depth of Unconsciousness.
This is assessed by the various eye reflexes. The pedal reflexes are also a useful
indication as to the depth of unconsciousness, since they are the first reflexes to be lost as
brain activity becomes depressed and the last to return as the condition improves.
There are two terms used to describe the depth of unconsciousness:
Stupor, the animal can be roused with difficulty and the pedal withdrawal reflex is still
present, though the toes may need to be pinched quite hard. Pupillary and palpebral
reflexes are also still present.
Coma, the animal cannot be roused, the pedal reflexes are absent and the eye reflexes
indicate a plane of surgical anaesthesia or deeper. The pupils become dilated as the
condition deteriorates and death approaches.
Other clinical signs may be seen in animals with an altered state of consciousness
Convulsions. Convulsions are violent, irregular, involuntary movements of the body.
The time of onset and duration should be noted.
Incontinence. Urine or faeces may be passed by the unconscious animal either passively
(a gradual seepage because the sphincter muscles relax) or actively (e.g. a pool of urine
passed during an epileptiform fit).
Collapse
Collapse is said to have occurred when a conscious animal is unable or unwilling to stand
up.
‘Collapse’ is the most common emergency reported by owners and covers a multitude of
situations from an arthritic dog which is reluctant to get up and go for a walk to a
deceased pet. The cause and severity of the ‘collapse’ must therefore first be discovered
so that the correct first aid procedures may be carried out.
Unconscious animals should always take priority and must be examined and treated
immediately.
3. ABCs
The next step in preliminary assessment and triage is to follow the ABC’s of emergency
care: (note new protocol for resuscitation, assess ABC, resuscitation tx CAB)
Airway Control
Ensuring a clear airway:
Lay the animal in right lateral recumbency. Position against a hard surface to
improve stability and head in a slightly head-down position. Barrel chested dogs
or those weighing greater than 20 Kg should be positioned in dorsal recumbency
and stabilised to prevent rolling (e.g. with sand bags).
Open the jaws, pull the tongue forward and examine the back of the throat with a
light source.
Where possible remove any foreign bodies, e.g. balls, bones, broken teeth with
your fingers or device (e.g. allis tissue forceps).
Wipe away any vomit, mucous or blood from the back of the throat.
Position the head lower than the chest to facilitate drainage of fluid from the
respiratory tract and reduce the risk of aspiration of regurgitated or vomited
gastric contents.
Breathing
If breathing appears to have stopped completely and yet the animal is still alive,
as determined by checking for its heartbeat, etc., artificial respiration is essential.
Intubate the animal with a cuffed endotrachael tube. If under anaesthetic, turn
OFF the anaesthetic. Flush the bag with 100% oxygen. Begin intermittent
positive pressure ventilation (IPPV) with 100% oxygen. If this is not possible,
then IPPV can also be provided by breathing expired air into the animal’s lungs
via the endotracheal tube or by the use of a self inflating resuscitation bag (e.g.
ambu resuscitator) connected to the endotracheal tube. The timing should reflect
natural events of cycles of inspiration expiration pause.
Circulation
Check for a palpable heart beat by feeling between the 4th -6th ribs and femoral pulse. If a
palpable femoral pulse is absent then the cardiac function is insufficient for vital cell
function and CPR should start. Note checking airway breathing and circulation should
take no longer than 15 seconds altogether.
In cats and small dogs the cardiac pump mechanism which directly compresses the heart,
should be used at a rate similar to the normal heart rate of the patient. For medium and
large size dogs the thoracic pump mechanism compresses the thoracic cavity and thus
increased intra- thoracic pressure squeezes the heart. Compressions are approximately
100-120 times per minute for all dogs and cats.
If there are 2 operators, ventilation of the animal after every 5 compressions gives an
appropriate respiration rate. Alternatively for single handed resuscitation attempts,
deliver two lung inflations for every 15 chest wall compressions
The effectiveness of chest compressions can be increased if a second operator can inflate
the chest simultaneously with a compression. Detection of a femoral pulse or monitoring
retinal blood flow with a Doppler probe by a second operator can assess the efficiency of
the compressions. Severe long term organ damage is likely if CPR is required for longer
than 10 minutes. Response to resuscitation is highly unlikely after 30 minutes.
Signs of effective CPR:
Early:
Palpation of pulse during compression
Constriction of pupil
Ventromedial location of the eye
Improvement of mucous membrane colour
ECG changes
Late:
Lacrimation
Cranial nerve reflexes return (e.g. blinking, gagging, coughing)
Return of spontaneous respiratory activity.
If early signs are not seen within two minutes, two alternative options remain:
Drugs and External defibrillation:
Emergency thoracotomy and internal cardiac compression
Nurses can prepare for either eventuality by ensuring that the crash cart with resuscitation
drugs is fully stocked and that resuscitation drugs have not expired. You must know the
drugs and equipment required during CPR and be able to reconstitute them.
The secondary survey and stabilisation
If animal is conscious, perform a quick physical examination noting:
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any obvious abnormalities in body conformation
evidence of external haemorrhage
skin colour and mucous membranes
rate and quality of pulse and respiration
temperature
unusual odours
Shock- Treatment and recognition
Definition: Shock is a multisystemic response to a disease process that results in
inadequate tissue perfusion. This results in insufficient oxygen delivery to meet the
tissues needs. The inadequacy of perfusion can be secondary to a number of circulatory
problems that are classified into 4 different forms of shock
Types of shock
Hypovolaemic: due to decreased circulating blood volume eg haemorrhage or
secondary to dehydration
Distributive (anaphalactic, toxic): due to vasodilation of blood vessels and
abnormal distribution of body fluid eg sepsis and allergic reaction
Cardiogenic: due to failure of the heart to pump eg dilated cardiomyopathy or
severe arrhythmia
Obstructive: due to blockage of blood flow in the vessel eg pericardial effusion or
pulmonary thromboembolism
Clinical Signs
Tachycardia, weak and thready pulse quality, vasoconstriction (pale colour,
prolonged CRT, cold appendages, oliguria), low blood pressure.
Treatment for shock
Since treatment of the different types of shock may be quite different, diagnosis of
the cause is quite essential. But…
In general oxygen supplementation and a warm stress free environment are
helpful. Fluid therapy is a key therapy for hypovolaemic shock and may be
helpful for distributive shock but usually contraindicated for cardiogenic shock.
Positioning the patient for comfort, protection of injuries and maintenance of the
vital functions may be required. Sternal recumbency with the cranial end elevated
assists breathing, and if there is damage to the thorax and sternal recumbency
cannot be maintained and the animal is in lateral recumbency the uninjured lung
should be dorsal. If patients need to be moved careful gentle handling is essential.
If the animal is dropped when its organ systems are already compromised the
trauma may precipitate a crisis. Ongoing monitoring and recording of vital signs
is important to ensure recovery is progressing appropriately or lack of progress is
recognized early and dealt with.
Specific first aid conditions and their treatment
1. Haemorrhage
Classification of haemorrhage:
(a) By Type of Blood Vessel Damaged
Arterial haemorrhage
Most serious type of haemorrhage and most difficult to stop.
Arterial bleeding is bright read and spurts in pulses from a wound.
A definite bleeding point can be detected.
Venous Haemorrhage
slightly less serious than arterial haemorrhage but rapid blood loss will
occur if a large vein is damaged.
Easier to control than arterial haemorrhage because of low pressure
Venous blood is darker red and streams steadily from a wound.
A definite bleeding point is visible.
Capillary Haemorrhage
Occurs in all wounds
Blood escapes from multiple, pinpoint sources in the tissues and oozes
from the wound with very little force.
No definite bleeding points are visible.
(b).Destination of blood loss
External Haemorrhage
bleeding that is clearly visible at the body surface.
Internal Haemorrhage
bleeding into tissues or body cavities.
Hidden. In most cases the only way to detect severe internal bleeding is
by recognising the general signs of shock which the haemorrhage
produces.
First Aid Treatment of Haemorrhage
 direct digital pressure, wear gloves and apply for at least 5 minutes
 use of artery forceps and ligation of vessel
 pad and pressure bandage, if blood seeps through do not remove , apply another
bandage over the first. Monitor the circulation distal to the bandage eg nail bed,
should remain pink and toes should not swell. Pressure bandaging of the
abdomen for internal bleeding should only be left in place for a maximum of 12
hours
2. Wounds
Definition: A wound is an injury in which there is a forcible break in the continuity of the
soft tissues.
CLASSIFICATION OF WOUNDS
Open
Closed
Incised
Contusion
Lacerated
Haematoma
Puncture
Haemorrhage into body cavity
Abrasion
Open wounds
Involve an injury that breaks the body surface (skin or mucous membrane). These
wounds are externally visible and blood loss can be evaluated.
There are four types of open wounds:
Incised
Caused by sharp, cutting instruments e.g. scalpel, knives, glass, cat claws. Edges are.
clean cut and clearly defined, usually gape, especially with movement. Avulsed, incised
wounds are often V-shaped. Usually bleed freely. Often penetrate deeply to damage
underlying structures, e.g. tendons, nerves.
Laceration
Wounds are irregular in shape, with jagged and uneven edges. Areas of skin may be
literally be worn away. Edges of the wound always gape because the skin has been torn
apart. Severity depends on the depth of the wound. Often little haemorrhage. Wounds
are contaminated and dirty thus increasing the risk of infection. Healing is slow.
Puncture Wounds
Wounds produced by penetration of sharp pointed objects e.g. teeth, claws, stakes, nails,
thorns, bullets. The actual skin would may be quite small but this will often lead to a
long narrow track which penetrates deeply into the underlying tissues. Little
haemorrhage, close quickly, but are often contaminated. Rapid healing if adequate
drainage is provided and infection is controlled.
Abrasions
Are the same as a graze wound. Such wounds do not penetrate the entire skin thickness.
Are superficial, often contaminated and rarely serious.
First Aid of Open Wounds and Abrasions:
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Treat for shock.
Cover the wound with a sterile dressing while stabilization is carried out
Control any severe haemorrhaging.
Consider analgesia
Once the patient is stable
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Clip the hair around the wound. Before you do this, fill the wound with KY
jelly or if the wound is large, fill the periphery of the wound with KY jelly
and pack the rest of the wound with sterile saline soaked swabs. This will
help to prevent hair from falling into the wound. Moisten the hair with saline
to facilitate removal in clumps and inhibit contamination of the wound with
multiple fine hairs.
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Remove contamination, eg grit dirt hair with dressing forceps. DO NOT
REMOVE DEEPLY PENERATING FORIEGN BODIES. Large penetrating
foreign bodies which protrude from the body should be cut off so that they
only protrude above the skin surface. A ring pad dressing can then be applied
over the whole wound.
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Flush the wound mechanically, use copious amounts of non-toxic solution. eg
Isotonic sterile saline, syringed into the wound. Take care not to disturb blood
clots and not to further contaminate the wound from surrounding skin.
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Dress the wound. Apply wound dressing appropriate to the type and stage of
the wound. Oily ointments should be avoided as they are difficult to remove
at subsequent surgery. Likewise, cotton wool should never be applied directly
to the wound as it will stick to the wound.
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If antibiotics are indicated generally parenteral administration is more
effective than topical treatments and less cytotoxic on damaged devitalised
tissue
Closed wounds
A Closed Wound is one where the injured does not cause a break in the body covering.
Contusions (Bruise)
A contusion is produced by a blow with a blunt instrument which causes rupture of blood
vessels in the skin and in the soft tissues beneath. Signs of a contusion are heat, pain, and
swelling. White-skinned animals show discolouration of the skin, which is first red
(immediately after the blow), then purple (within a few hours) and finally yellow/green
(after several days).
Treatment of Contusions
Cold compresses. Apply immediately to cause vasoconstriction and thereby reduce the
volume of blood entering the damaged area. This reduces swelling and also pain.
Application of a pressure bandage will also help to control haemorrhage and reduce
swelling.
Haematoma
Haematomas are soft and usually painless and cool to the touch. They result from rupture
of a blood vessel, most often a vein under the skin with bleeding into the connective
tissues. Examples include aural haematomas on the ear flaps of dogs and those produced
at venipuncture sites if pressure is not applied with the needle is withdrawn.
First aid of Haematomas:
Bandage the affected area firmly, as soon as possible, or apply firm pressure with a cold
compress if bandaging is impractical.
3. Burns
Definition: A scald is caused by wet heat (steam, oil etc.). A burn is an injury to the body
caused by dry heat, electricity, chemicals radiation and friction.
Burns are classified /evaluated according to:
Depth - superficial in the skin or deep involving underlying tissues.
Area involved and % of the body surface affected
Cause – dry, scald, electrical radiation etc.
All burns cause tissue damage and inflammation with fluid loss from damaged
capillaries. Pain can be severe especially when large areas are involved. Superficial
burns are more painful than deep burns because the nerves have been damaged in deeper
burns.
Treatment:
If burns are severe and involve more than 50% of the body, euthanasia should be
considered. Less severe burns or those involving smaller areas of the body surface can be
treated. Initially, immersion of the affected part in cold water, running water, or packing
the area with cold packs for 10 minutes, will help to reduce the pain and lessen tissue
oedema. Treatment of shock is often required.
Aims of Treatment of burns:
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Remove the source
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Cool the damaged area as quickly as possible(clip fur to ensure the affected
area is identified).
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Keep patient warm once the initial cooling treatment is complete.
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Dress wound.
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Analgesia
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Splint to limit movement if necessary and or E-collar to prevent self
mutilation.
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Prepare an IV drip.
4. Electric shock
Electric shock is most commonly seen in puppies and kittens usually as a result of
chewing on electric cords. The severity of problems will vary with the voltage and with
the pathway of the current through the body. As the electricity traverses the bodies
tissues it is converted to heat. There is coagulation necrosis (tissue death) at the site of
entry and exit, and within the striated muscle it passes through. Wounds of the palate,
lips, and tongue are frequently seen. Focal necrosis may occur in nerves, spinal cord and
brain. Stupor, coma, cardiac arrest or arrhythmias, cardiogenic shock, convulsions, and
death are all possible complications. Lung oedema is a more common sequel in small
animals and causes laboured breathing and cyanosis (blue mucous membranes from lack
of oxygen).
It is essential to remember to switch off the power supply before touching the animal, as
it may be electrically ‘live’ even though it is clinically dead. If this is not possible then
use an electrically non-conducting implement to push the animal away from the electrical
source (e.g. dry wood or plastic pole).
If the animal is alive on presentation, treatment will depend on the severity of it’s
condition. Early treatment often requires oxygen therapy, intravenous fluids, diuretics,
bronchodilators, and corticosteroids. These materials and therapeutics should be made
ready.
5. Heat stroke
Most often seen when animals, frequently dogs, are confined for prolonged periods in
hot, poorly ventilated surroundings, especially if they do not have access to water. The
animal becomes unable to regulate its body temperature, which gradually rises. Initially
the animal is distressed, panting and drooling excessively and restless. The animal
becomes weak and its tongue and lips initially appear bright red. Eventually the animal
will collapse, go into a coma and subsequently die. On presentation the animal feels
burning hot and it’s temperature is off the scale.
Treatment:
 Cool the animal by hosing it with cold water.
 Administer cooled intravenous fluids.
 Confine the animal to a cool, airy kennel, preferably with a concrete floor.
 Lay a wet blanket over the animal to keep the coat wet and reduce it’s insulative
properties.
 If unconscious, swab away saliva. Position the head so that saliva will drain from
the mouth instead of into the back of the throat.
 Give oxygen if the animal is cyanotic (mucous membranes blue)
 Monitor the temperature every 15 minutes to avoid overcooling the body. When
the body temperature reaches 40.5 degrees or less aggressive cooling should be
discontinued. Once it is in the normal range, it should be dried off, kept in a cool
kennel with access to cold drinking water. Monitor the temperature every 30
minutes to ensure it doesn’t rise again.
6. Convulsions and seizures
A convulsion/fit/seizure is usually sudden in onset. The animal having a fit collapses on
to its side and goes into violent convulsions. The legs are extended and often paddling in
motion, its head pulled back and neck extended; there is involuntary champing of jaws,
which results in the foaming saliva from around the lips. Eyes are open and fixed in a
stare. Respiration rate is increased and defecation and urination are common during
severe fits. Most convulsions subside after a few minutes but occasionally the animal
will be experiencing continuous fits. These attacks represent gross overactivity of the
central nervous system ‘circuits’ and any extra stimulus usually only worsens the
situation and prolongs the fit.
Seizures may be primary (epileptiform, more common in dogs than cats, usually seen in
young animals, 1 to 3 years of age) or secondary. Secondary fits often occur in older
animals following brain damage by diseases (such as distemper), trauma (such as a blow
to the head), or toxaemia (as seen in uraemia or poisoning cases, e.g. organophosphates,
slug bait).
Treatment for seizures:
 Owners should be advised to get the animal to the surgery as soon as possible.
 Owners should be advised to keep visual and auditory stimuli to a minimum. If it is
possible the animal should be kept in a dark and quiet area.
 Owners should remain with the animal but be advised not to touch it (minimise
tactile stimulus).
 Owners need to remain calm.
 Once at the surgery, the animal should be placed in a dark, quiet cage until the vet
arrives.
 Valium and Barbiturates should be prepared as it may be necessary to sedate or
anaesthetise the animal to control the seizures.
 Under no circumstances should the owner or vet nurse attempt to put a hand into the
animal’s mouth until the convulsions subside. Such attempts are fruitless and may
result in severe bites.
8. Fractures
Definition: A fracture is a forcible break in the continuity of bony tissue, i.e. the bone is
broken.
Classification of Fractures(can be by anatomical description, type of displacement,
direction of the fracture line, number or types of fractures, by joint affected etc). Some of
the more commonly used terminologies are the following:
Simple fracture is one where there is one fracture line, e.g. the bone is broken cleanly into
two pieces.
Comminuted fracture is a complex fracture creating three or more fragments.
Greenstick fracture is an incomplete fracture. The bone has a fissure in one cortex but
there is not a complete separation of bone at the fracture line. These occur most
frequently in immature animals.
Open fracture is one where there is a wound communicating between the skin or mucous
membranes and the fracture site. This allows contamination of the fracture site with
bacteria.
Closed fracture is one where there is no overlying wound.
Pathological fracture results from normal use of a bone weakened by a disease process.
The disease process may be generalised (for example, a nutritional deficiency of calcium
and phosphate causing weak bones), or localised (for example, a tumour affecting the
bone).
Avulsion fracture occurs when a bone prominence is torn away from the rest of the bone,
usually by the pull of a muscle.
For further information and examples see
Anderson,D. & Smith, J. (2012). Small animal surgical nursing. In B.Cooper & D.L.
Lane (Eds.) Veterinary Nursing (3rd ed.) (pp. 791-800). Edinburgh: Butterworth Heinemann
Clinical signs of fractures
Most fractures are caused by trauma. In the initial phases a fracture is an inflammatory
lesion and many of the clinical signs can be attributed to acute inflammation. The major
clinical signs seen are:
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Loss of function and unnatural gait if a limb is involved
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Visible or palpable deformity of the affected bone
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Abnormal mobility at the fracture site
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Crepitus when the injured part is moved.
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Pain localised to the affected bone
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Local swelling, bruising and heat due to haemorrhage from the surrounding
tissues
First Aid of Fractures:
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Animals with broken bones are in pain. They may bite and must be safely
restrained prior to administering first aid. A muzzle is often needed.
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Attend to life threatening problems first. Always ensure that there is an
adequate airway, breathing and circulation. Many times these animals also
have soft tissue injuries that are more life threatening than the broken bone.
Shock is often a problem and fluid therapy is often needed early in treatment.

Cover any open wounds with a clean (preferably sterile) dressing

Immobilise the fracture prior to moving the animal and cage rest to minimize
movement till surgery

If a spinal fracture is suspected, the entire spine should be immobilised by
strapping the animal to any straight and rigid structure of suitable length.

Arrest haemorrhage.

Support Dressings applied must include a joint above and below the fracture
site eg Robert Jones and other Bandaging, Splinting. These may not be
possible to apply with the animal conscious. If both arterial and venous flows
are obstructed, the toes may become swollen and cold. If any swelling should
occur, the dressings must be removed immediately and replaced by looser
bandaging. See Anderson and Smith (2012) for further details
Try the self assessment questions at the end of the first
aid chapter in your text book