Sunday, April 10, 2022

Preparing for Pet Emergencies: What To Do and When To Go

     No one ever wants for an emergency to happen with their pet- and despite our best efforts to maintain the health of our companion animals, unexpected things can happen. In the event of a true medical emergency, time of often of the essence, and has a significant impact on outcome. Being prepared for an emergency, as well as knowing how to recognize the signs of common ones, could potentially save your pet's life, and in some cases, reduce the cost of care needed for their recovery. 

This article is intended for educational purposes only and is not exhaustive. Information online, including this article, is not intended as medical advice or a substitute for either it or consultation and physical exam with a licensed professional. If you ever have concerns about your pet's health or suspect there may be an emergency occurring, call your veterinarian or, if after hours, your closest ER, who may be able to advise you further and recommend a visit. When in doubt, it's safer to go in just in case than to wait. If you call an ER and they advise a long wait time, remember that patients are triaged on intake and your pet will be seen sooner and stabilized if necessary, even if you are waiting for an extended period to speak with a doctor or move forward with less-urgent needs. 

Preparation for an Emergency

If you have a pet, you need to be prepared in advance for a possible emergency. The following may save you valuable time if you ever find yourself needing emergency veterinary services: 

1. Identify any after-hours urgent or emergency care facilities local to you. In some regions, this may mean the single closest veterinary clinic offering after-hours services. In other regions, there may be multiple dedicated ER facilities within several miles of your residence. 

2. Familiarize yourself with where the ER is. If possible, drive there at least once. During an emergency, it may be difficult to think straight. It may also be dark out, if after-hours. Driving to the clinic in advance to have an idea of where it is may be very helpful for you in the event of an actual emergency. 

3. Know the number for the ER. Have it saved in a safe and accessible place in the house, and also in your cell phone contacts. 

4. Save the number for Pet Poison Control. The number for ASPCA Animal Poison Control Center is (888) 426-4435. The number for the Pet Poison Helpline is 800-213-6680. These services may include a fee at the time of calling, so be prepared with a credit card if needed. 

5. Have a plan for safely transporting your pet. This may mean a carrier for cats or other small animals, and a crate or a restrained space in the car for your dog to otherwise travel. 

Major Signs of an Emergency

Providing a complete list of emergencies would be impossible, particularly as different pets present in different ways, and evaluation can be subjective, particularly to untrained eyes. Again, this information is intended for educational purposes only and any questions or concerns should always be directed to your pet's veterinarian or an emergency service local to you. Even if your pet's symptoms are not on this list, you should call when you have concerns.

 In general, the following signs or circumstances are almost always indicative of a time-sensitive emergency, and your pet should be evaluated by a veterinarian as soon as possible:

  • Respiratory distress (labored breathing, open-mouth breathing, rapid breathing, straining to breathe such as craning the neck, gasping, or blue, grey, or muddy coloration of the gums)
  • Sudden and unrelenting vomiting, or non-productive retching
  • Profuse, bright red diarrhea
  • Difficulty urinating 
  • Lethargy or unwillingness to move, especially when accompanied by pale or white gums
  • Pale or white gums
  • Abnormally distended abdomen
  • Collapse or sudden loss of limb function (all limbs or some/one)
  • New or unrelenting seizures
  • Ingestion of a known toxin or medication overdose
  • Trauma, especially blunt forces (hit by car) or injuries with deep wounds or severe bleeding
  • Animal bites 
  • Eye injuries or sudden changes to the eye
  • Sudden unexplained pain or distress (including abnormal vocalizations)
  • Opening of any abdominal incision 
  • Unexplained or non-stop bleeding
  • Abnormal bruising or clusters of red pinprick discoloration of the skin 

Common Emergencies

As above, these examples are not exhaustive, do not always present in the way described, may have some but not all signs, and can happen to more than just the 'at risk' breeds and species identified. Please direct any questions or concerns about your personal pet to a veterinarian either in-person or by phone. Most emergency clinics accept calls. This list is for educational purposes only.

Gastric Dilatation and Volvulus (GDV, "Bloat")
Poster Pets: Large or deep-chested dogs, especially certain breeds like Great Danes, but any dog can be affected.
What it is: The stomach fills with air and rotates on itself, obstructing at both ends. 
Signs at home: Swollen, tight/firm belly, lethargy/weakness or collapse, unproductive retching/vomiting with just foam or saliva coming up, panting/discomfort, restlessness
Why it's an emergency: If the stomach rotates on itself, the blood flow is impaired, which can damage the organ. Movement out of the stomach is also obstructed, and as gas builds up from having nowhere to go, other organs are compressed and the body may go into shock.
What to expect: This is almost always a surgical emergency. Your vet may want to start with x-rays and stabilizing measures like fluids. Hospitalization will be required after surgery to monitor for complications.

Pyometra
Poster Pets: Intact female dogs of any age, but increasing risk with age. 2-8 weeks after a heat cycle. Less often, but possible, in cats.
What it is: The uterus is infected with bacteria and fills with pus that may be stuck inside and build-up (closed) or leak out through the vulva (open). 
Signs at home: Purulent or smelly discharge from the vulva, loss of appetite, vomiting, decreased energy/lethargy, and sometimes a visibly swollen belly. Lack of discharge does not rule out a pyometra, which can be 'closed.'
Why it's an emergency: The bacteria can cause sepsis and septic shock. A pyometra can also rupture, spilling infectious material into the entire abdomen.
What to expect: This is almost always a surgical emergency. Some pets may be candidates for antibiotic therapy, but are likely to experience another pyometra in the future. Treatment is removal of the uterus, or spaying. If your pet is very sick, they may need stabilized before surgery. 

Obstructive Gastrointestinal Foreign Body 
Poster Pets: Young dogs with a tendency to chew or eat things they shouldn't, including trash or ripping up toys. Labradors and retriever mixes are common offenders. Cats may eat string, tinsel, or hair ties.
What it is: An item like fabric, plastic, or even a corn cob becomes lodged in the stomach or intestines and prevents the normal flow.
Signs at home: Repetitive vomiting, loss of appetite (sometimes), lethargy, abdominal pain, "not doing right."
Why it's an emergency: If the intestinal contents can't move around the obstruction, they back up with nowhere to go. The electrolytes that maintain the pH of the blood can become altered and disrupt other body systems. Decreased blood flow can cause parts of the intestines to die.
What to expect: This is sometimes a surgical emergency but may be treated with hospitalization as a first step depending on the circumstances. Your vet may want to start with x-rays or ultrasound to look for evidence of obstruction or a foreign object. Sometimes pets are "imaging negative" but still obstructed, and exploratory surgery will be recommended. Some pets may be a candidate to "watch and wait" with IV fluids, monitoring, and repeat imaging to see if the object starts moving. Other pets will need to go to surgery as soon as possible.

Urinary Obstruction
Poster Pets: Male cats, especially with anxious personalities. Certain dog breeds like Dalmatians. Any pet, but males more often than females.
What it is: Inflammation, crystals, stones, or a combination result in an obstruction between the bladder and the outside world, a tube called the urethra.
Signs at home: Straining to urinate, posturing but producing only drops or small amounts of urine, vocalizing while urinating or attempting to urinate, vocalizing in the litter box, frequently visiting the litter box, lethargy, collapse, pain in the abdomen, a firm structure in the rear abdomen near the pelvis. Sometimes confused with constipation.
Why it's an emergency: Urine needs to leave the bladder. If the bladder cannot empty, it is at risk of rupturing and spilling urine into the rest of the abdomen, which can cause inflammation and damage. Obstruction in the urinary system can damage the kidneys and can also cause electrolyte disturbances that can eventually stop the heart. 
What to expect: Physical exam can often confirm urinary obstruction. Sedation or anesthesia will most likely be required so that your vet can attempt to pass a urinary catheter and dislodge the obstruction. They will most likely want to take x-rays to look for stones, as well as analyze the urine for crystals or signs of infection. If stones are present, surgery to remove them from the bladder may be needed. If attempts to pass a catheter fail, surgery may be required. Pets that obstruct will often need hospitalized for several days to keep their urinary catheter in and receive fluids and medicine to support their kidneys and correct electrolyte changes. They may need additional care moving forward to prevent another obstruction.
 
Congestive Heart Failure
Poster Pets: Older dogs, especially small and toy breeds. Any older dog or cat. Certain breeds (Cavalier King Charles Spaniel, Doberman, Great Dane).
What it is: The end-stage of heart disease, where changes to the heart and blood flow dynamics have caused 'back-up' or congestion to the lungs (left-sided heart disease) or liver (right-sided heart disease) that had led to fluid leaking from vessels. This can happen suddenly with no prior diagnosis of heart disease. Pets compensate well until the can't anymore.
Signs at home: Coughing, respiratory distress (panting, struggling to breath, increased abdominal effort when breathing), lethargy, collapse, less common and associated with other emergencies, fluid in the abdomen (swollen belly with a 'fluid wave' like a water bed), usually unique to cats, paralysis or weakness in one or both legs with vocalizations and pain.
Why it's an emergency: Fluid in the lungs can cause a pet to struggle to breathe and eventually tire and stop breathing. Fluid in the abdomen can cause discomfort or difficulty breathing fully. Loss of limb function can indicate an obstructive blood clot (thromboembolism) which is very painful. 
What to expect: Expectation vary based on the underlying cause of the heart failure. Pets with left-sided heart failure may require extended hospitalization and oxygen therapy. Pets with right-sided heart failure may need fluid removed from their abdomen. Pets in heart failure will require medications daily at home for treatment. Some pets cannot be brought out of heart failure even with medical therapy. Your vet may want to take x-rays or do an echocardiogram to confirm underlying heart disease and rule-out other causes of symptoms. 

Multiple Seizures
Poster Pets: Any. Some breeds are predisposed to epilepsy, and some dogs may develop seizure disorders late in life. Certain toxins can cause seizures.
What it is: An abnormal and inappropriate 'firing' of neurons causing a loss of consciousness and convulsions or repetitive motion of limbs. Other more rare manifestations of seizures also exist. 
Signs at home: A pet having a seizure will lose consciousness (awareness of their surroundings) and will not respond to their name or touch. They may convulse or freeze or move certain limbs. Some pets may "space out" and stare. Pets may urinate or defecate during a seizure. They will also have a period of altered consciousness after the seizure.
Why it's an emergency: Prolonged seizing can raise the body temperature, causing hyperthermia and potentially heat stroke. The brain can also be damaged by prolonged or repeated seizures, reducing the effectiveness of treatment.
What to expect: Your vet will likely have questions about what you saw, especially if the pet is no longer seizing once you get to the hospital. If you are able to get a video, that may be helpful. Some pets can be discharged home with medication and monitoring instructions. Other pets may need to be hospitalized. If your pet is having a seizure when you arrive, your vet may administer an injectable medication to make the seizure stop. Some causes of seizures can be treated. Others cannot. 

Heat Stroke
Poster Pets: Any pet, but especially brachycephalic types, dogs playing outside on a hot or humid day, or pets left in a car.
What it is: A dangerously increased body temperature.
Signs at home: Collapse, exhaustion, hot to the touch
Why it's an emergency: Extremely elevated temperature is damaging to the body and can cause multi-organ failure. The longer the temperature is elevated, the more severe the condition can become.
What to expect:Aggressive life saving measures are often required for heat stroke, and some pets can continue to decline even after therapy is initiated. The best treatment for heat stroke is prevention.

Hemo-abdomen from ruptured mass
Poster Pets: Older dogs, especially certain breeds prone to cancer.
What it is: Blood in the abdomen. 
Signs at home: Collapse, lethargy, loss of appetite, swollen abdomen with a "fluid wave"
Why it's an emergency: If a dog is bleeding into their abdomen, they can die from shock.
What to expect: If it is determined that your dog has a mass causing active bleeding into the abdomen, exploratory surgery may be recommended. Your vet may ask to check chest x-rays for evidence of cancer in the lungs first. If the mass is on the spleen, your vet may remove the entire spleen and recommend biopsy. Some forms of cancer that cause bleeding into the abdomen are very aggressive. A quality of life discussion may be needed.  
 

Common Toxins

The ASPCA has made a list of the Top Ten Pet Toxins.

Not all toxins are listed, but these are common ones! If your pet ingests something toxic, you should seek veterinary advice before attempting to induce vomiting. Vomiting is sometimes contraindicated for certain substances and toxins, and there are hazards associated with the limited means available for inducing vomiting at home. The safest way to manage toxin ingestion is to seek immediate in-person veterinary care when possible. If you call a pet poison service, they can open a case for a fee and consult with your veterinarian on anticipated complications and treatment recommendations.  The number for ASPCA Animal Poison Control Center is (888) 426-4435. The number for the Pet Poison Helpline is 800-213-6680. These services may include a fee at the time of calling, so be prepared with a credit card if needed. 

 Avoid toxin exposures by being aware of your pet's environment and minimizing access to potential hazards. This includes keeping all medications (OTC, Prescription, and Pet Meds) in a secure location, and storing pet medications separately from human medications to avoid a mix-up. Medications should never be administered to a pet without veterinary instruction- many Over-the-Counter human medications are toxic to dogs and cats. Food and trash should be kept out of reach as much as possible, even if that means keeping the trash can in a separate room like the garage. Caution should always be exercised when giving table scraps or "human foods" to pets, to avoid exposure to common toxins like grapes, raisins, onions, garlic, and chocolate.  Never leave a pet unsupervised in a room where housework like cleaning or remodeling is being done, to avoid exposure to caustic substances such as bleach products, mop water, or paint and household glues.

The Bottom Line

The best way to manage an emergency is avoiding it altogether. However, this isn't always possible! And many pet emergencies are out of our control. Being prepared and recognizing an emergency early could save your pet's life.

Thank you for reading! This article is intended for educational purposes only and is not exhaustive. Information online, including this article, is not and should not be intended as medical advice or a substitute for either it or personal consultation and physical exam with a licensed professional. If you ever have concerns about your pet's health or suspect there may be an emergency occurring, call your veterinarian or, if after hours, your closest ER, who may be able to advise you further and recommend a visit. When in doubt, it's safer to go in just in case than to wait. If you call an ER and they advise a long wait time, remember that patients are triaged on intake and your pet will be seen sooner and stabilized if necessary, even if you are waiting for an extended period to speak with a doctor or move forward with less-urgent needs. 
 
 

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Resources for Pet Emergencies:

AVMA Pet Owner Resources: Emergency Care

Veterinary Emergency and Critical Care Society

ASPCA Emergency Care for your Pet




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