One thing we all tend to agree upon in veterinary medicine is that cats and dogs are different. In almost every aspect; behavior, physical and emotional. They are two distinct species and should be treated as such. Each are susceptible to different diseases (FIV vs. Parvo), and have dissimilar responses to the same disease (diabetes-neuropathy vs. cataracts). Nutrition is another area where they differ; hepatic lipidosis is a feline exclusive concern and each species has a distinct way of synthesizing proteins. Behavior; yet another significant variance between the species; consider separation anxiety and behavior in the clinic. Webster's definition of trauma is "an event or situation that causes great distress" which represents almost all cats brought into the clinic. Healthy or sick, being put in a carrier and brought to the vet would be trauma to a feline, according to this definition. Keep this in mind when dealing with our feline patients. No matter which species you prefer (if any) the facts remain; they are different.
That being said, there are also similarities between the two species. Most trauma either feline or canine is preventable. Both strive to deliver oxygen to all body tissues, feel pain, the ABC's are the same, and they both survive significant physical trauma. The key in emergency/critical care medicine is to create balance between the similarities and differences concerning these species.
Most of the time we do not have the luxury of knowing what kind of trauma our patients have suffered, therefore we must assess all systems. A few rules of thumb when dealing with feline trauma; minimize stress, assume hemorrhage, thoracic damage and shock are present and treat conservatively.
The following systems should be examined simultaneously and immediately. Hemorrhage tends to be a more severe problem for cats, simply because they have a lower blood volume. This may be evident upon presentation, or because of severe hypotension may not be observed until after IV fluids have been administered. Pressure should be applied to any actively bleeding vessels.
The respiratory pattern and rate should be noted. Any panting in a cat is not normal. Airway can be affected by any trauma, it is very important to assess where the respiratory problem originates before continuing. Oxygen supplementation via mask should be supplied while other systems are checked; oxygen never hurts, unless the mask itself stresses the patient. For cats that are stressed oxygen should be provided via oxygen cage. Auscultation should be quickly performed (if possible) before placing in O2. Listen to lung sounds of all four quadrants, if they sound muffled (along with shallow respiration) pleural space occupancy should be considered. If the patient is stable a thoracic radiograph can be taken, however this is not usually the scenario and thoracocentesis should be performed without a radiograph.
A quick assessment of the cardiovascular system includes: heart rate, MM color, CRT, pulse quality and rhythm. If temperature is attainable, take it; if not (due to stress) assume the cat is hypothermic and consider heat. Shock should be assumed, pale MM, prolonged CRT, weak/thready pulses and bradycardia. Yes, bradycardia rather than tachycardia is common in a shocky cat, however tachycardia does not rule out shock.
Neurological status is extremely important when dealing with trauma, and will usually dictate treatment. Level of conscious, motor activity, pain response, pupil size and reactivity all provide important information as to neurologic function.
While preliminary assessment is occurring, treatment should begin. This is done based on our previous assumptions, primarily shock. As we are all aware, the best treatment for shock is IV fluids. The route of choice for fluid therapy for patients in shock is IV. An IV catheter should be placed in the cephalic vein and your database collected. This can be done with the blood in the catheter hub, and if possible a few extra drops of blood in a syringe from the catheter. This is not always possible because of severe hypotension, but will save the cat from additional sticks. This includes a PCV/TS, BG and for cats a blood type. It is important to remember there is no universal donor or recipient for cats. Administering the wrong blood type is very likely to lead to the death of the patient. If this is not possible consider oxyglobin which is a synthetic product. Running a blood type with the PCV, will save time and stress later.
IV fluid therapy for cats in shock is different from dogs as well. Cats are more sensitive to fluid overload; therefore the shock bolus (40-60ml/kg crystalloid-5ml/kg colloid) should be given in three to four smaller boluses. Watch for pulmonary edema. Warming fluids will help with hypothermic cats.
Monitoring the feline trauma patient is another delicate balancing act. Balance between collecting information in order to treat and the stress inflicted on the patient in gathering this data. Pain must be managed appropriate for this balance to exist. Cats are more prone to hiding pain; no walks and usually no vocalization. As a nurse, this means it is our responsibility to recognize and access pain, if you are doubtful always err on the side of analgesia. Pain is detrimental to healing because it causes anorexia and stress which is well documented to lengthen hospital stays and inflammation processes thus also increasing healing times.
The renal system must be watched closely as well. Monitoring urine output is essential for cats after trauma. The bladder/urethra may potentially be damaged or ruptured, therefore expressing a bladder can lead to more damage. Measuring urine output also ensures the kidneys are able to handle the fluids being delivered, as well as for cleanliness with open wounds present. The creatinine, BUN, and electrolytes should be carefully monitored.
Oxygenation is very hard to monitor in the cat. Pulse oximeters may not read because of hypothermia/poor perfusion. Arterial blood gasses are very stressful for the feline patient and difficult to obtain. This leaves us with radiographs, auscultation, and observing RR & RE frequently. Keep in mind the cat must be stable before any radiographs are obtained, restraint causes stress.
Cardiovascular monitoring is difficult in the cat as well. Most non-invasive blood pressure machines are not sensitive enough to obtain values from cats in shock or hypovolemic, doppler blood pressure is the best option. Keep in mind when blood pressure drops below a mean arterial blood pressure of 60mmHg the kidneys can not be perfused fully. Heat must be supplied and TPR closely monitored as well as MM, CRT and pulse quality. EKG should be monitored, especially if electrolyte abnormalities are present. PCV/TS, BG and lytes should be monitored closely and glucose and KCL supplemented if needed. Blood/plasma transfusions should be administered if values are low (remember fluids will bring them both down), however every cat must be blood typed or crossmatched before any blood product is given, the reaction can be fatal.
Nutrition tends to be the hardest thing to address in the feline trauma patient. Head trauma or any type of oral trauma a feeding tube must be placed. Appetite stimulants, a quiet box, catnip, and sometimes sitting and talking to them when you offer food can all be helpful for getting these patients eating. Make sure pain is being adequately managed, this tends to be a frequent cause of anorexia. Force feeding is highly discouraged, this often leads to increased stress and food aversion, neither helpful when treating the feline patient. Aside from the fact that they tend to be finicky eaters, hepatic lipidosis is a very real secondary problem to feline trauma and must be addressed. The recommended time is 3-5 days before placing a feeding tube.
Cats and dogs are different, as nurses we must cater to both. Every aspect, from triage to nutrition the balance must be created between treating and stress in order to have a positive outcome. Cats don't treat us like dogs and expect the same in return.