Emergency

If you don’t have transport yourself and in cases of emergencies it’s possible to call the animal ambulance:
Animal ambulance Eindhoven: +31 (0)900 – 1120000

Allergic reactions that can lead to major problems are anaphylactic reactions, in which the immune system takes massive action against a relatively minor cause. Here we are not talking about some itching as a result of a flea or mite allergy, but about an acute life threatening situation.
The most known are reactions against inoculations, bee stings, insect bites, certain food allergies and contact allergies.

Symptoms: swelling of the face, eyelids, ears and lips. Redness of the skin, a lot of itching, sometimes diarrhoea and/or vomiting. The symptoms develop rapidly within 20 minutes of contact with the causing matter. In extreme cases the animal enters into shock.

Anaphylactic shock is a fast and serious reaction of the body which without rapid treatment can lead to death! Symptoms: acute collapse, pale mucous membranes, fast weak pulse, cold feet and coma. Reactions to inoculations and bee stings are the most common causes of anaphylactic shock. This is one of the reasons why a vaccination must be given by a qualified veterinarian. The reaction occurs very quickly after inoculation, even before you leave the surgery. If nothing is done, an anaphylactic shock wil result in death..
With a anaphylactic shock in dogs, the liver is the most important ‘shock organ’, in cats these are the intestine and the lungs. I.e. in these organs the reserve blood vessels open up in great numbers causing the blood circulation to stagnate.

Vomiting and diarrhoea are not diseases, but symptoms of a disease. Not only the results of vomiting and/or diarrhoea must be fought, but also the cause, the underlying disease.

Vomiting
Vomiting is one of the most common symptoms of disorders to the gastrointestinal tract that we encounter in animals. Vomiting is especially a sign of gastritis and can be induced by eating stomach irritants. Vomiting can also be induced by irritation of the vomiting centre in the brain. Motion sickness and toxins released during disease processes elsewhere in the body can cause vomiting, without there being something wrong in the gastrointestinal tract.
Vomiting is usually preceded by nausea, which is characterized by drooling and lots of lip smacking. Then the abdominal movements come and the stomach is emptied by vomiting. After the initial vomiting follows a clear vomit with gastric juices. If vomiting continues we see bile in the vomit, it becomes yellow and frothy. Later we see small flakes of blood in the vomit. Vomit that smells like faeces indicates (serious) intestinal problems, i.e. occlusion (ileus). It is important to know whether it is really vomit or so called ‘regurgitation’.

Regurgitation is giving up food/saliva/water which has not been in the stomach. It looks like vomiting but is not accompanied by the wave movements of the abdomen and usually occurs immediately after food or water intake.
We see regurgitation in oesophagus disorders, for example closure by a tumour or a piece of bone or similar, and by oesophagus paralysis.
If an animal vomits it loses considerable amounts of moisture and salt. This leads quite rapidly to metabolic problems. The prevention of water and feed intake is the best way to prevent vomiting, but by vomiting their water on balance they lose more water than they have drunk. No solids and water in small amounts for 24 hours is the best.

How can you check for dehydration?

1. Turgor: the elasticity of the skin. Grab and release the skin of the neck/back: it should quickly back into place; if a ‘comb’ remains, there is dehydration.
2. Eyes: If they appear ‘sunk’, the animal is dehydrated.
3. Gums: rub your finger over the gums. Dry? Dehydrated.
   Parched animals should be treated with urgency through infusions.

Small intestinal diarrhoea
The intestinal tract roughly consists of a small and a large intestine. These two ‘divisions’ give different symptoms when they are sick. The small intestine is intended to break down foods and to convert them into substances that can be absorbed into the blood. To this end, the small intestine breaks down fats, proteins and carbohydrates into their building blocks by using enzymes from pancreatic juice, bile salts from the bile, gastric acid and large quantities of water. A malfunctioning small intestine creates large volumes of watery diarrhoea. The sick animal can usually hold it in, but once outside, the stool is produced as a huge flow. The stench is usually unbearable. The diarrhoea consisting of undigested food, namely fats and proteins. It involves a lot of water loss and the animals can quickly become dehydrated. Small intestinal diarrhoea is caused by eating wrong (spoiled) food, viruses (parvovirus, coronavirus, distemper), coccidiosis, poison etc. Prior to the diarrhoea you will very often see vomiting. Very dark diarrhoea often looks like tar and this is due to the addition of blood in the mixture.. If the animal is not vomiting, treatment consists of water, easily digestible food (if necessary first fasting one day, only water), and diarrhoea-inhibiting drugs. The easily digestible diet consists of white rice, boiled chicken, biscuits, yogurt, buttermilk, weak tea etc. If that is too difficult to prepare, there may be special easily digestible foods from the vet (i.e. diet of Hill’s is a very good alternative!). After three days you can revert to a normal diet.

Colon diarrhoea
The colon is used to temporarily store and thicken the waste products of the digestion system. Loss of this function(s) leads to a typical diarrhoea. Thick-inflammatory bowel disease (colitis) is accompanied by small amounts of stool that are discharged with a high frequency. The piles are small, and often have a slimy ‘coating’. Flakes or strands of bright red blood maybe present. The animal can often not stop the stool and squeezes often heavily on it, just as if there is a blockage (just like when they have eaten bones stuck in the rectum). This increased stool frequency with presses are typical for colitis and which you do not see at by a small intestine inflammation. Moreover, these colon diarrhoea does not smell that bad, although it is obviously not a pleasant smell.
Colitis is caused by allergic reactions, nervous reactions as a result of stress, (whip) worms and certain toxins. Further, in autoimmune diseases and tumours. Usually the blood in the stool is not a cause for great concern. Cats (usually long hair) often have colitis with small amounts of blood in the stool as a result of the hairs in the intestinal contents.
Colitis is often treated with fairly powerful inflammatory inhibitors. Sometimes only a diet with a lot of raw fibre is sufficient, and sometimes the vet will prescribe something for the severe cramps.

Normal birth
About 24 hours before the beginning of the birth her body temperature drops to around 37ºC. The first signs of birth are: restlessness, licking the vulva, scratching the whelping box, frequent urination and whining/squealing/barking/meowing. During labour dogs and cats lay on their side. Initially the outflow is clear and becomes gradually bloody. Most animals (dogs and cats) give birth over a period of 2 to 6 hours , where we see intervals between the pups or kittens from 10 minutes to a half hour. Longer intervals are not so common. After each birth a placenta is supposed to come out, however, sometimes you may see several placentas coming together after the birth a few puppies. It is normal for the mother’s to eat placenta and fetal membranes, but this may cause diarrhoea. Most breeders have their bitch checked by a veterinarian within 24 hours of giving birth. He usually provides some medication to prevent uterine inflammation and eventually boost the milk production.

Abnormal birth
A difficult birth (dystocia) is characterized by:
1. Strong contractions for 1 hour, without birth,
2. More than one hour between births,
3. Squeezing out only part of a young,
4. Bloody bleeding while no puppy is born,
5. Green / black outfow,
6. Overdue (some animals give birth without showing anything, in which the entire farrow will die because the birth is not smooth).
7. Less puppies than predicted on the ultrasound.

In these cases, the animal should be examined by a veterinarian.
We mainly see difficult births in certain breeds: Bulldogs, Lhasa Apso, Shih Tzu, Chihuahua, but also in other dwarf breeds and brachycephalic breeds. You often see problems with inseminations where the dog was much larger than the bitch. Extended gestation may indicate a problem. In that case it is recommended to make an ultrasound to see if the animal is pregnant, if the embryos are alive and how big they are. If a normal birth does not seem possible, it is advised that you make plans for a caesarean section in advance.

Indications for caesarean section (sectio caesarea):
Extended gestation: 69 days after which a caesarean section should be performed.
1. Narrowing of the pelvis, such as with certain breeds (Bulldog, Press), or by old pelvic fractures.
2. Too big embryos
3. Strong contractions without the birth of a puppy (max. 45-60 minutes)
4. Weak contractions: birth does not continue, while it already seemed to be long underway.
5. Abnormalities to the embryos (ultrasound/photo).
6. A history of problems at birth.
7. Disease of the mother.
Soon after the operation the bitch is able to take care of the puppies. It is however important to watch over her as she comes round from the aesthetic because the reaction on the pups and mother cannot be predicted.

Every year we face a number of cases of Gastric dilatation – Volvulus, or more commonly known as GDV is a rapidly progressive life-threatening condition of dogs.

It is a disease that mainly occurs in large breeds, but is also found in medium breeds. Every owner of a larger and medium dog should take note of what action needs to be taken if symptoms of Bloating occur.

The cause of the disease is unknown, but it is clear that too much food and/or drink at one time, especially if there is a lot of running, playing and rolling, considerably increases the chance of the occurrence of bloat (GVD). Bloat is a disease which generally leads quickly worsens to an alarming state, and without treatment most of the animals die within hours.

The Bloat begins with a rapid build up of gas in the stomach which thereby significantly expands (dilation). The distended stomach then tilts around the ligaments whereby in- and output of the stomach are screwed shut and the expanding gas cannot get out. The blood supply to the stomach and spleen, which is usually tilts with it, gets closed off. The distended stomach presses through the diaphragm to the chest, which causes the dog breathing difficulties. It presses the large veins in the abdomen so that the blood flows harder back to the heart. The ever-increasing pressure on the chest and organs, the worsening blood circulation, all ensure that the animal enters shock, loses consciousness and eventually dies.

In many cases (but not all!) is treatment of Bloat successful, provided that the owner recognizes the symptoms in time and takes action! The main feature of bloat is greatly increased abdominal size. Dogs with bloat become almost thicker by the minute. Tapping on the right abdomen, emits a hollow sound just behind the ribs, like tapping on a drum. The belly is taut. Other symptoms include: no eating, failed attempts to , lots of overstretch, abdominal pain, restlessness, not daring to lie down and eventually collapsing.

If one finds this combination of symptoms in a dog, one should immediately contact a veterinarian. There is no time to lose. Do not wait for your veterinarian to come to you, go immediately to them. Once they have arrived at the correct diagnosis, there will be a rapid attempt to reduce the pressure from the swollen stomach. Sometimes this will be done by placing a tube through the oesophagus into the stomach, but often the stomach has to be punctured through the right abdominal wall. Furthermore, an infusion is applied to stimulate circulation. In addition, medications are given to prevent shock. In some cases when the animal’s condition permits it, the dog needs surgery to turn back the stomach (and spleen). To prevent repetition, the stomach wall or the suspension band of the stomach will be fixed to the abdominal wall. Today this is often done through a ‘keyhole surgery’ where only a few small openings are made in the abdomen. It should be mentioned that even in dogs that have had surgery, in 30% of cases the bloat reoccurs due to the stitching tearing away. Any dog that has had bloat has a considerably increased chance of reoccurance than a dog who has never had bloat!

The recovery phase after a gastric torsion, is one full of risks. After successful treatment, many dogs have problems with damage to the stomach, liver or pancreas. Furthermore infection and abnormally high blood clotting are risks. Because of this, such dogs almost always have to stay in a veterinary clinic for a couple of days for observation.

Prevention of Bloat is difficult, because the true cause of the disease is not known. Still, there are some factors that have been proven to play a part:

• The breed: Larger dogs with a deep chest, such as Great Dane, St. Bernard, Weimaraner, Irish Setter, Doberman, German shepherd, Bernese mountain dog and Rottweilers all carry a greater risk of developing bloat.
• Frequency of feeding: The more meals per day, the lower the risk. Dogs that eat only once a day have a larger (stretched) stomach, putting them at greater risk of developing Bloat.
• Way of eating: Dogs which gobble are more at risk, probably because they swallow more air than a quiet eater. In itself, you as owner obviously can’t do much about this.
• Spirit of the dog: Nervous dogs are more at risk.
• Frolicking/playing after eating. Dogs need to rest after a meal. First play, then eat, then sleep, and not vice versa! Very famous is the example of the dog that is retrieved from the kennel. At home the dog drinks a large container of water and will to play in the garden to enjoy his regained freedom while the owners quietly unpack the holiday luggage from the car, only to then find their nearly “exploded” dog in the back of the garden!

In the Netherlands, overheating in pets is almost always due to a long stay in a hot and poorly ventilated car. On very hot days, too much exercise can also lead to a (usually fatal) overheating.

Symptoms:

• Rapid gasping and panting
• The tongue is dry, often purple or blue
• The animal can’t usually stand (collapse)
• The animal loses consciousness

Treatment

• Immediately cool under the shower, in the bath or under the hose. If available use a cooling fan
• If possible rub alcohol (eau de cologne etc) for cooling
• Ice water is also good, but do not cool the body to less than 39˚C
• Let the animal drink small amounts
• Transport the animal to the vet, even if it seems a successful resuscitation

Complications

• Overheating can lead to seizures and brain damage
• Bloody diarrhoea is common, and is a bad sign
• Kidney failure can occur weeks after the initial overheating!
• An increased risk of spontaneous bleeding due to clotting factors in the blood being used through spontaneous clotting of the blood in the veins. At this point death is the most likely outcome.

Many attempts fail to resuscitate a dying animal because we indiscriminately use techniques that work well in humans but not on animals. The differences in resuscitation techniques between humans and animals are small, but of great importance for the success of resuscitation. If you take these small differences into account, it is possible to be able to resuscitate an animal just as successfully as a human!

During CPR is important to follow a list of points in the correct order.

1. Provide an open airway
Oxygen is vital for life. It is imperative that you first ensure that the animal has a free airway leading into the trachea and lungs. Many people are wary of feeling in the throat of a (large) dog; if there is someone to keep the mouth open, this will reduces the fear. If the animal is not breathing you should always be suspicious of a total closure of the airway.
a. Stretch the neck, use a finger to wipe the throat clean.
b. Give five or six pokes in the belly, forward/up (Heimlich manoeuvre)
c. Repeat the inspection of the throat with a finger, then repeat the Heimlich
d. Slap on the back
e. Repeat this, but not for long
f. If a closure still remains, the trachea should be surgically opened (tracheotomy).

However, take careful note during resuscitation of the following issues (in other words, keep thinking logically)
1. If the animal walks around and/or whines/squeaks, the airway is open!
2. An animal in the agonal stage cannot be saved. Agonal indicates a stage where the animal occasionally gasps for a breath, without there being any actual breathing. There is usually no heart action, pupils are wide and rigid, and there is no corneal reflex (push the eyeball and blink). Many animals in this stage are quickly brought to the vet because the owner believes that the animal is still alive.

2. Respiration
Older artificial respiration methods indicate that one breath every 5 seconds should be given. Nowadays, it is assumed that once every 1 to 2 seconds artificial respiration is necessary to avoid significant brain damage caused by oxygen deficiency. Artificial respiration on an animal is performed through the nose with his mouth closed (tongue out!). It is therefore virtually impossible to do a complete resuscitation by yourself. You cannot breath for the animal every two seconds without hyperventilating yourself! A second person is required to step in. Respirations should be alternated as much as possible with chest compressions.

3. Cardiopulmonary resuscitation
If the heart stops, or is fibrillating (non-effective vibrations of the heart muscle), it may be necessary to start the heart trough a ‘startle response’. You can feel the heart between the ribs, where the elbow touches the rib wall. If you do not feel the heart beating, give a brief fierce blow to the heart, so as to get the heart, without an electric shock, back to beating. Chest compression is intended to take over the pump function from the outside. In the beginning, the blood flow through the heart (via the coronary arteries) is the main purpose of CPR. The heart stops beating if breathing has stopped. But rarely the heart stops first. The circulation through the heart is achieved by compressing the chest at the height of the 3th inter costal space, using a normal heart rate. 80 – 120 rapid compressions per minute are given at the widest part of the breast (thus not too close to the sternum), whereby the blood supply to the heart and the rest of the body is kept going. In order to make it easier for the blood to flow to the brains, the head should be preferably slightly lower than the rest of the body. Optionally, an elastic bandage can be quickly rotated around the hind legs, whereby blood is squeezed out of the legs to the larger circulation. Alternating the chest compressions with abdominal compressions (70-90 / min), may promote stronger blood flow. Internal cardiac massage is the most effective method to maintain the momentum of circulation. Here, the thorax is cut open, and the heart massaged by hand. Because of the high risk of fatal bleeding and inflammation we do not do this in animals.

4. Medicines
The administration of medicines should usually be done intravenously or intra-tracheal (into the trachea) and is normally done by the vet.

5. Evaluation
The next step is evaluation. Often, a stationary heart can be set in motion again, but the reasons why it stopped often still exist! Constant monitoring of heart and breathing is a must: often the heart will stop again and everything starts over again.
Heart and pulse monitoring: usually you can feel the heart quite good by the underlying chest wall. You can feel the pulse at the inside of the thigh,.
Keep an eye on consciousness. If you touch the eye and the animal blinks, he is usually conscious. If you tap around the eye and the animal blinks, the animal is often awake. These are good signs. A good indicator of brain function are the pupils: Maximum dilated pupils are a bad sign. Often, there is brain death. It seems as if the animal has no irises. Very narrow pupils indicate pain or increased pressure in the brain. Pupils of unequal size indicate a severe concussion. Keep the mouth mucous in mind:
CTR (capillary refill time, the refill time of the capillaries) is the best way to monitor the function of cardiovascular system. If the mucosa above the upper teeth is pink, and within 1 sec after pressing the colour returns, we have an almost normal blood circulation. With shock or poor circulation, we see white gums.
Pain or serious illness provide ‘injected’ mucous membranes: individual blood vessels are clearly visible. Blue mucosa indicate oxygen deficiency, not poor circulation. Brick red mucous membranes point to stagnation in the circulation. With a dead animal, you can get all the above mentioned symptoms.

6. Once the situation appears to have stabilized, the animal must be brought to the vet!

What is shock?
Shock is a term commonly used to refer to a significant misalignment within the body: a (very) poor circulation of blood. The circulatory system brings oxygen to the tissues and therefore to the body cells. Without oxygen these cells begin to die. In some organs this cell death begins very quickly, furthermore aggravating the shock.

The blood flows through the arteries to the tissues (organs, muscles, etc.), and through veins back to the heart. At any given time, only a small part of all of these blood vessels are used, the rest are closed and serve as a reserve, for example, in case that there is local increased need for blood by inflammation.

Animals in shock usually have pale mucous membranes, cold ears and feet and a rapid weak pulse. Shock can occur in many ways. We will discuss some.

• Hypovolemic shock: a shortage of circulating blood volume which we see in (severe) bleeding. In case of blood loss, less blood can flow to the brains, muscles, organs, etc.. The body has a safety system
  (through the autonomic nervous system) that ensures that blood is directed to the vital organs (heart, brains) and that other parts receive less blood (skin, gut). During this process, the less vital cells are screaming for oxygen, and eventually die.
  As a result, the extra blood vessels in the body all open. The remaining blood cannot fill these vessels and the blood pressure rises; it simply remains in the vessels. Only with sufficient pressure can the blood flow, but now the pressure is incorrect. The lack of circulation that we have now, is shock.
• Neurogenic shock: In serious situations the brain can trigger a shock reaction, wherein a signal is (wrongly) given to the muscles around the blood vessels to dilate, so the blood vessels all open. This causes very strong drop in blood pressure and poor circulation, although the total amount of blood in this case, is normal. We see this amongst others with severe startle response, electric shock and head injury.
• Cardiogene shock: the failure of the heart in its pumping function is a reason for poor circulation and poor oxygen supply to the tissues. This leads to an increased demand for oxygen, whereby the blood vessels open, and an even worse circulation arises. The animal ‘misbleeds’ as it were in its own ‘reserve’ blood vessels.

Other causes of shock are as follows: infections, tumours, poisoning, drowning, extreme cold, overheating and hypersensitivity reactions (bees stings, inoculate reactions). Shock is often seen in trauma (collisions etc.).

A good method to determine shock is the viewing of the colour of the gums and the measurement of the CRT, the re-filling time of the capillaries. The CRT is time elapsing between the release of the pressed gum, and the return of the pink colour. So, the longer, the worse. Normally, the CRT is 1 sec. or less, while more than 3 sec. indicates a life-threatening condition.
Normally, the gums are a lovely pink colour. A dog with pain has injected mucous membranes: against a pink background we see clear drawing of the vessels. An animal in shock has pale or white mucous. Also look at the legs: in shock, under the feet usually gets very cold. The same applies for the ears.

How do we treat shock?
Shock means that the tissues do not get enough oxygen; this as a result of poor circulation or too little blood in the circulatory system. We solve this lack of volume by filling the vessels with infusion fluid. The lack of oxygen can be reduced by respiration with pure oxygen, which can be done in the clinic, and almost never at home. The circulation will be restored in the clinic by administering liquid as much as possible as quickly as possible, possibly even through multiple intravenous catheters. As a stopgap, the hind legs and belly can be tightly wrapped in elastic bandages to prevent bloodflow and redirecting blood to the vital organs. Then, if possible of course, something should to be done about the cause of shock.

Be careful with treating animals with injuries: they often have a lot of pain and then they bite very hard!
If necessary, put an strap around the snout. Nobody want a rescuer with bitten hands.

Toxins enter the body through:

• Eating/drinking
• Inhalation
• Absorption through the skin
• (Mistakenly given) injections

Emergency treatment:
The treatment is strongly dependent on the type of poison. It is always very important to determine the cause of the poisoning, although this is not always possible. Take along medicine bottles, packaging, vomit and stool with you to the vet.

With every poisoning or suspicion of, a veterinarian must be consulted as soon as possible before you treat them yourself. For some types of poison, one must induce vomiting while it just is not allowed in other types of poison!

Common toxins:

• Aspirin: highly toxic to cats. Agitation, spasms, vomiting, drooling and bloody diarrhoea are the most common symptoms.
• Organic phosphates: Bolfo and Exile flea drops. Symptoms: salivation, urination, cramping, watery eyes, diarrhoea, small pupils, muscle tremors, unsteady walking and seizures. Antidote: Atropine.
• Coagulation inhibitors such as rat poison. If possible take the package along to the veterinarian because the type of poison is important for the length of the treatment. Symptoms: general malaise, weakness, pale mucous membranes. Also: bleeding from the nose, gums, minor wounds, blood in the urine and/or faeces, and/or saliva. In severe cases, one can see a collapse as a result of acute haemorrhage in the lungs or in the abdomen.
• Chocolate: cocoa powder for hot chocolate and dark chocolate in large quantities are toxic. Symptoms: vomiting, diarrhoea, hyperactivity, restlessness, muscle tremors, seizures and a very fast heartbeat.
• Antifreeze (ethylene glycol): malaise, staggering, vomit and urinate very often are the main symptoms. One teaspoon is lethal to a cat, one tablespoon for a dog !!!
• Snail poison (Metaldehyde). symptoms: anxiety, muscle tremors, involuntary eye movements (nystagmus) and overheating.
• Pyrethrin (some flea pesticides) is toxic to cats when swallowed. Is often seen after the application of dog flee treatments on cats! Symptoms: cramps, salivation, vomiting, unsteady walking, bending back of the head. Treatment: Properly wash where flea drops for dogs have been administered!
• Strychnine (moles poison): prohibited by law. Was often deliberately used as a means to poison pets. Symptoms: seizures, extreme muscle stiffness, sensitivity to sounds. Causes a very painful death.
• Toads: the poison is in the skin mucus of the toad. Symptoms: salivation, swollen red mucous membranes and seizures. In Particular in Southern Europe we see regular fatal poisonings!