While trauma is devastating, small animal deaths may be prevented if certain conditions are promptly recognized and treated. This presentation will provide guidelines for a systematic, thorough, physiologically sound approach to the traumatized small animal. Concentrating on the first few hours of hospitalization.

Initial evaluation should concentrate on any internal injuries causing an immediate threat to life (respiratory, cardiovascular and neurologic systems). Avoid the natural urge to deal with more obvious external signs of trauma such as fractures, luxations, and open wounds until the cardiopulmonary system has been assessed and problems corrected. If the patient survives the first few hours, there will be plenty of time to clean wounds, apply splints and plan the orthopedic repairs that are so often necessary in dogs and cats suffering major trauma.

The “primary survey” is an assessment of the ABCD's

 Airway – is the patient having difficulty breathing? Are there mandibular injuries that are interfering with the airway? Has the bite wound disrupted the larynx or trachea?

 Breathing – Is the patient dyspneic? Does it have a restrictive breathing pattern? What is the color of the mucous membranes? Pulmonary contusions, pneumothorax, diaphragmatic hernia and broken ribs are the most common respiratory injuries. Often, thoracocentesis will be performed during the primary survey to diagnose and treat pleural space problems immediately.

 Circulation – Is there evidence of internal or external hemorrhage? Is the hemorrhage arterial or venous? How large is the swelling associated with the extremity fracture? Are the mucous membranes pale and tacky? Are the femoral pulses weak and rapid? Are the extremities cold? Is the abdomen distended or painful? The etiology of shock in traumatized animals is usually hypovolemia, which should respond rapidly to intravenously administered fluid and blood unless severe bleeding continues. Intravenous catheters are inserted for rapid fluid replacement. At the time the venous catheter(s) is inserted, blood samples are collected for analysis of the packed cell volume and total solids (protein). The rate fluid should be administered in shock should be individualized as severe pulmonary contusions or head trauma can be made worse by overzealous fluid therapy. Packed cell volume and total solids should be rechecked frequently (initially every hour or after 1/2 a shock volume of crystalloid fluids). Fluid therapy should be adjusted and blood products or synthetic colloids added if indicated.

 Disability – Is there any evidence of intracranial or spinal injury. Postures such a decerebrate rigidity (rigid quadrilateral extension of all limbs in a comatose patient) suggest severe intracranial trauma. Shiff-Scherington posture (rigid forelimb extension with flaccid paralysis of the hind limbs) suggests serious spinal trauma.

Once the patient is more stable the “secondary survey” repeats the first looking closer for other internal injuries. Blunt abdominal trauma can result in hemorrhage, rupture of the urinary bladder, bile peritonitis or even sepsis if the gastrointestinal tract is compromised. Abdominal radiographs, abdominocentesis, diagnostic peritoneal lavage, and ultrasound can all be used to search for evidence of intraabdominal disease. Comparing packed cell volume, BUN, and bilirubin of abdominal fluid to peripheral blood will help determine the source of injury

Frequent rechecks of vital signs and serial physical examinations are necessary to pick up subtle changes in patient condition as they recover from trauma. Trauma is a multisystemic disease. These patients are at high risk for many complications including organ failure. Systematic examination and careful monitoring are required to maximize chances for a successful outcome.