Definition: the first care given for serious injury, or definitive care given for minor injury.

Five Basic Tenets of First Aid

1. Don’t panic!  As difficult as it may sound, stay calm in a crisis.  Not only will it enable you to deal with the crisis more effectively, but remember that animals can sense the emotion of their owners.  Your panic may worsen your pet’s anxiety and stress.

2. Use common sense!  Think through the problem to come up with meaningful and real solutions, then act.  Don’t just react to the crisis; you’ll risk doing the wrong thing and make the situation worse.

3. Above all DO NO HARM!  This is actually the primary edict of all medical treatment.  Know what you know; and (more importantly) know what you don’t know.  Acting upon wrong or incomplete information may not work and can even make the situation worse.  Basically, if you don’t know what to do, don’t do anything.

4. Be careful.  This tenet basically summarizes the first three.  It also is a reminder that animals (and people) can react in extremely unpredictable ways in a crisis.  Even the most trusted and friendly pet can strike out or bite when stressed, afraid and/or painful.  You don’t want to have to go to the hospital instead of your pet.  Please also use caution on the way to the veterinarian if the crisis is severe.  Avoid the temptation to drive recklessly.  Getting to the veterinary clinic safely is the best and quickest way to get your pet the care he/she needs.

5. Be prepared.  Know what to do before you have to do it.  Practice the first aid techniques on your pet when all is well.  That way you’ll know how to do them when a crisis occurs.  Although experience is the best way to learn, you don’t want to be learning during an emergency.  Another great way to be prepared is to have veterinary and emergency numbers close to or programmed into a phone.  Be sure to include numbers for poison control and emergency clinics that are staffed through the night and weekends.

Applying First Aid

Before you can react in a crisis, you need to know what to do and in what order to do it (do I address the 6 inch laceration before or after I stabilize the broken leg?).  To help prioritize problems, you should be able to quickly triage your pet.

The Four Critical Body Systems:

1. Respiratory – this means the airways (including nose and throat), lungs and respiratory muscles.  The basic way to evaluate this is to look at the respiratory rate and effort.

            a. Normal respiratory rates for dogs and cats should be 15 to 35 breaths per minute.  Remember stress and pain can increase respiratory rates above the normal range, not just respiratory distress.  Panting in dogs can be normal or abnormal.  Panting in cats is always abnormal.

            b. The effort should be easy and without noise. 

2. Cardiovascular – this means the heart and blood vessels.  To evaluate this system, we look at heart rate, mucous membrane color, pulses and obvious bleeding.

            a. The normal heart rate is between 60 and 160 beats per minute for a dog and 120 to 180 for a cat.  It is easiest to feel the heart beat on the left side of the chest just behind the armpit.  As a general rule you cannot see the heart beat-it must be felt.

            b. The mucous membranes are easiest to evaluate in the mouth.  Simply lift the lip and look at the gums and tongue.  They should be about as pink as your fingernail.  Blue, purple, white or red mucous membranes are always abnormal.

            c. Pulses can be difficult to find, especially in cats.  The most prominent pulse is the femoral pulse which is found on the inside of the hind leg just in front of the femur (the upper leg bone).  The pulses should be strong and there should be a pulse for every heart beat.

            d. Obvious bleeding - it should quickly be noted if the bleeding just oozes or squirts. Oozing blood is usually venous (less severe), and squirting blood is arterial (more severe).  In either case direct pressure for as long as necessary is always the first method used to stop or decrease the bleeding.

3. Central Nervous System – even though this technically means the brain and spinal cord, it is the brain that we worry about the most.  Since the brain controls the entire body, it is impossible to completely evaluate the entire brain.  In an emergency, however, it’s not necessary to do so.  The important functions of the brain can be determined with a quick glance.  The major functions are mentation, presence of seizures and walking ability.

   a. Mentation means the mental awareness of the pet. We classify mentation in 4 stages:

          1) Bright, Alert and Responsive (BAR)–self explanatory.  This is normal mentation.

          2) Depressed or obtunded–the depressed pet is dull or less responsive to normal stimuli.

          3) Stuporous–this means the pet is unresponsive until a noxious or painful stimulus is applied.

          4) Comatose–this means the pet remains unresponsive with even a noxious or painful stimulus.

   b. Seizures – other names for seizures are convulsions or fits.  The most common and most important form of seizure is the generalized seizure.  This is when the pet is unconscious and uncontrollably shaking all body parts.  Drooling, vocalizing, urinating and defecting during a seizure are not uncommon.

   c. Walking ability – this means the coordination level of the gait (not if your pet is lame or limping).  The uncoordinated, or ataxic, pet walks like he/she is drunk. The gait is often irregular with swaying, crossing of legs and dragging of the toes.  It should be noted that if your pet does not want to get up to walk, don’t force him/her to do so.  It’s not that important in the triage setting.

4. Urinary system – this refers to the kidneys and bladder.  In the triage setting, effective evaluation of kidney function is not possible.  You do want to note both urination ease and comfort.  If at any time your pet strains but cannot pass urine, you should take him or her to the veterinarian as soon as possible.  In male cats, this could be due to a urethral obstruction, which becomes fatal within 2-3 days if not treated.  Also, if a large amount of blood is seen after trauma, the pet should be seen as soon as possible.

            Note: This should be distinguished from a dog or cat that is urinating small amounts of bloody urine with mild straining, increased frequency and no history of trauma.  The key factor in this situation is that at least some urine is passed. These signs are most likely due to a urinary tract infection in dogs or bladder irritation in cats–this is not an urgent emergency. 

5. (I know–the heading says four!) Eyes – although technically not one of the four critical body systems and not life threatening, red, swollen, painful eyes should always be treated on an emergent basis.  Failing to do so could risk permanent blindness.

If anything is abnormal in any of the above body systems, immediate veterinary attention should be sought.  Injuries to any other body system are considered more minor, including broken bones, lacerations and gastrointestinal (GI) issues!  The only exception to this rule is if the abnormalities of the minor body systems are severe enough to affect the major body systems.  For example the pet that is vomiting and passing diarrhea to the point of becoming dehydrated.  If this persists, the fluid loss could lead to shock (which is a change of the cardiovascular system).  Keep in mind that insults to the minor body systems still need veterinary care, especially if they persist; they just don’t have to be on an emergent basis.

Specific Techniques and Situations

The following section will demonstrate how to use the above concepts by applying them to commonly encountered injuries.  Specific techniques will be explained when applicable.

Broken toenail:

This is a much more common injury in dogs than cats.  Since the nails of many dogs are long with corresponding long quicks, it’s easy to understand how common this is.  If the break occurs in the quick, which is usually the case, the nail will be painful and bleed (since the nerve and blood vessel live in the quick).  Even though the amount of blood that comes from a broken nail seems like a lot, it really is insignificant to the pet; I’ve never seen a pet bleed to death from a broken toenail.  Therefore this is usually not an emergency (although veterinary care should be sought, especially if the nail didn’t completely break off).

            The important first aid goal is to get the bleeding to stop. To stop the bleeding pack the nail with cotton, flour or corn starch and apply pressure.   Two key rules have to be followed at this point:

      1. Keep firm pressure constantly applied for 5 minutes by the clock–NO PEEKING!

      2. Keep the pet quiet for 2-3 days afterward to allow a firm clot to form. If the nail didn’t break off completely, or if the foot is painful (the pet is lame), red or swollen, get the first available routine appointment with your veterinarian.

Bee stings:

Bee sting reactions are very uncommon in cats.  Like people, dogs can have varying degrees of reaction to a bee sting, from mild, temporary local pain to life threatening anaphylactic shock.  To simplify matters, use the following 3 levels of reaction:

1. Local, temporary pain–usually no medications are necessary.  Applying a cold compress to the site of the sting for 5-10 minutes can soothe the discomfort.  If a stinger is noted, remove it by scraping it off with a credit card or nail file.  Grabbing and squeezing it with tweezers or your finger can inject more venom into your pet.

2. Angioneurotic edema – this reaction is characterized by swelling to the face and muzzle, and the development of large hives (or wheals) all over the body.  These areas are usually itchy, so the pet might seem irritated by them.  The pet is usually BAR.  Although this is more severe, it is usually not life threatening unless the swelling of the face extends into the mouth or throat.  To treat this, giving 1mg/lb of Benedryl by mouth every 2-3 hours for 3 doses is usually all that is necessary.  Mild to moderate drowsiness may be seen at this dosage.  The hives and swelling usually start improving within 1-2 hours and is completely resolved within 18-24 hours.  If no improvement is seen within 1-2 hours, the pet has noisy or difficulty breathing, or has signs of anaphylaxis (see below), see your veterinarian immediately.

3. Anaphylaxis – this is a life threatening allergic reaction characterized by depressed to stuporous mentation, vomiting, diarrhea, difficulty breathing, pale pink mucous membranes, increased heart rates, poor pulses and sudden collapse.  This can be preceded by angioneurotic edema, progress rapidly from milder signs (vomiting/diarrhea) to severe signs (collapse), or just start with sudden collapse.  The only thing you can do is get your pet to your veterinarian immediately for emergency treatment.  Unfortunately that treatment isn’t always successful.  Fortunately, this is a rare reaction to bee stings.

Poisoning:

Literally thousands of toxic or poisonous substances exist.  Every poison acts differently, has different symptoms, has different antidotes (many have no antidotes) and is diagnosed differently.  No one can do a “toxicity screen” to see if an animal (or person) has been poisoned.  In order to keep this discussion meaningful, I will limit this section to known toxin exposures (you saw your dog or cat eat something that may be poisonous), not the pet that is sick with malicious poisoning being a potential cause.  Fortunately, malicious poisoning is very rare despite popular belief to the contrary.

            Because there are so many toxins, your veterinarian may not be the best person to find out if a certain substance is toxic to your pet.  Poison control is an easy resource for you to use.  I’ve used poison control hundreds of times and have always found their advice helpful.  There are two poison control centers: animal poison control and human poison control.  The animal poison control is best to use, but the human poison control can be used in a pinch.  Call your veterinarian or poison control as soon as your pet ingests the substance in question.  Don’t wait for symptoms to occur; that will be too late.  If you call poison control first, still call your veterinarian to get any follow-up advice or care that may be necessary.  As a general rule, if the poison control advises you to see your veterinarian, do so ASAP.  Following their advice on giving symptomatic or definitive antidote treatments is also good to do.  There are two general approaches to treating toxicities (for you or your veterinarian):

1.  Giving the antidote – unfortunately it is unusual for any particular toxin to have an antidote that is widely available, safe and easy to give.  Even if an antidote is available, veterinary care can still be necessary.

2. Minimizing the absorption of the toxin – this usually means making your pet vomit.  Dogs can be made to vomit at home, but cats need to be taken to the veterinary clinic.  Hydrogen peroxide is an effective inducer of vomiting for dogs.  The dose is one teaspoon per 10 lbs by mouth.  This is repeated every 20 minutes until vomiting occurs.  If no vomiting occurs after 3 attempts, seek veterinary care immediately.  I have never had peroxide fail to make a dog vomit.  Even if the dog vomits, getting veterinary advice and/or care is strongly recommended.  Don’t think that all exposure to the toxin is avoided by inducing vomiting alone.

            NOTE: Don’t make your dog vomit if:

            a. your dog ingested a caustic substance (an acid or basic     chemical).

            b. your dog ate something solid (string, bones, carpet, shoes, pillows, rocks, etc.)—although sometimes it may be warranted to make you dog vomit after ingesting a solid foreign body, only do so under the advice or direction of a veterinarian.

            c. it has been more than 6 hours since your dog ate the toxin -it won’t be in the stomach anymore.

Lacerations (cuts)/wounds:

For this discussion, lacerations or wounds refer to trauma or injury to the soft tissues of the body (skin, subcutaneous tissue, fat and muscle).  Remember these areas aren’t included in the critical body system categories; these injuries may look awful, but are usually not critical for your pet.

1. General concepts for lacerations or wounds:

            a. Bleeding – no matter where these injuries occur, the most immediate consideration is to determine if significant bleeding is present.  If considerable bleeding is noted, the first action is to apply firm and consistent pressure to the injury.  If the bleeding is not controlled with pressure, continue to apply that pressure until definitive veterinary care is obtained.  If you can avoid it, don’t apply a tourniquet to stop the bleeding–too much potential exists for permanent tissue damage.  If a tourniquet is applied, it should be done as a last resort, with the knowledge that the area that no longer has blood supply may be lost permanently, and for no longer than 15 minutes at a time.

            b. Cleaning – once bleeding is controlled, or determined to be minimal, the next objective is to decrease the dirt and debris within the wound.  For the cleaning the wound at home, water is best.  Be very liberal about the amount of water used to clean the wound – the wound cannot be too clean.  A helpful saying to remember is, “dilution is the solution to pollution in a wound.”  Don’t use alcohol or chemical disinfectants in the wound–leave that for your veterinarian to do.

            Note: Don’t apply topical medications like antibiotic ointments to the wound unless advised by your veterinarian.  Not only will they draw your pet’s attention to the wound and encourage him/her to lick it, they can trap bacteria and dirt in the wound, and they can be a barrier to medications your veterinarian would apply.

            c. Protecting the wound – avoid placing a bandage over the wound in an attempt to protect it.  As long as the pet leaves the wound alone, it is better for it to stay open to the air.  The only true indications that make bandaging necessary are: continued bleeding, the need to protect the wound from further contamination or trauma (including licking of the wound by the pet) or to provide support to fragile or mobile wounds.  If bandaging is deemed necessary, remember the medical adage that a bad bandage is worse than no bandage at all.  To minimize complications, wrap the bandage material gently around the wound (don’t pull tight), and keep it on for short periods only (several hours at most).  If bandaging is necessary, it is best done by your veterinarian, where longer bandage durations are possible.  Be sure to follow all your veterinarian’s instructions on bandage care and follow-up!

            d. Seek veterinary care – even if the wound seems minor, most are contaminated.  That makes infections more likely.  For this reason, most wounds should be evaluated by your veterinarian to see if antibiotics and other medications (pain relievers) are warranted, if bandaging is necessary, or if surgery is needed.

2. Bite wounds – the general concepts for wounds reviewed above also apply to bite wounds.  Bite wounds however are a unique type of trauma because of way they’re inflicted.  The tooth of the attacking animal usually only punctures a small hole in the skin.  Once through the skin, that tooth can tear a great deal of tissue beneath the skin when the attacking animal shakes after he/she bites.  The obvious small puncture wound in the skin is very much just the tip of the iceberg of damage.  Remember also that animals’ mouths are full of bacteria.  These two facts make it so that all bite wound require at least antibiotic treatment, and most bite wounds require surgical exploration to identify the full extent of the damage and repair it.

3. Ear flap and tail wounds – I mention these wounds separately because their location make them particularly difficult to handle.  Both ear flaps and tail tips have tremendous blood supplies, and they are locations easily traumatized.  That means they tend to bleed a large amount, and they reopen easily since they are bumped often.  The bleeding from these wounds is similar to the bleeding from broken nails–it looks horrible but it is usually not enough to be critical.  If they occur to your pet, initially follow the concepts reviewed under general wounds.  Because the bleeding is difficult to control, it is best to have your veterinarian guide the definitive care of these wounds.

             If for some reason, there is a time delay until you can get your pet to the veterinarian, bandaging these areas may be necessary.  Because of the way ear flaps and tails are shaped, keeping a bandage on them is challenging.  I’ve found the best way to keep bandages on is to use very sticky tape.  At home, that usually means duct tape.  First cover the wound with non-adhesive padding, then cover the area with the duct tape. Sticking the tape to as much fur as possible also helps.  This should be a temporary bandage only; allow your veterinarian to apply a better, longer lasting bandage.

Broken Bones:

Broken bones are also called fractures.  Fractures usually occur with more severe traumatic events (hit by cars, falls, fights, etc.).  Remember that broken bones aren’t critical to survival.  Don’t forget to evaluate the critical body systems with a triage exam before addressing any fracture.

1. General concepts–from the first aid and triage perspective, only two classifications of fractures are important, open and closed fractures.

            a. Open fractures (also called compound fractures) – this is when the skin over the fracture is torn.  This either allows the bone to protrude through the wound or creates a direct path from the air to the bones of the fracture.  Once the critical body systems are stabilized, an open fracture should be repaired ASAP.  Delaying too long increases the risk of bone infection and non-healing.  To minimize contamination, an open fracture should be covered by a protective bandage or wrap until definitive surgical correction can be done.   This is not necessarily a supportive splint.  Please follow all the precautions of applying bandages when covering these wounds.

            b. Closed fractures – this is when the skin is intact over the fracture site.  It is not critical to repair these fractures as soon as possible.  The surgical repair can be delayed for several days without compromising healing, recovery time and function of the bone once healed.

            c. Splinting or supporting fractures – the most pain and tissue damage from a fracture occur when the bones move over one another and through the surrounding soft tissues.  Keeping the leg as immobile as possible is important to provide comfort and prevent more soft tissue damage.  In order to completely immobilize a fractured bone, the joints above and below the fracture must also be immobilized.  This is an important concept to understand–failure to do so will result in more pain and damage!  For example, to stabilize broken forearm bones, the elbow and wrist must be immobilized; the splint must extend from the middle of the upper arm to the paw.  Anything shorter will not support the fractured bones effectively.  A fractured thigh bone can only be stabilized by immobilizing the hip and knee joints.  That means the splint must wrap around the pelvis and extend to the mid shin area.  If a splint is placed from the mid thigh to the ankle joint, the splint will only make the limb below the fracture heavier, thus allowing it to swing around like a pendulum.  This causes a lot more pain and damage.   In this case, it is better to not splint the leg at all; just keep the pet lying quietly until definitive treatment is provided by your veterinarian.

Heat Stroke:

Heat stroke is often confused with heat induced illness.  There are 3 different degrees of heat induced illness: heat stress, heat exhaustion and heat stroke.  The only difference between these three categories is severity.  All three occur when the body temperature goes above normal (>102.5 degrees Fahrenheit) despite attempts by the body to cool itself.

a. Heat stress – this is characterized by increased thirst, panting, dehydration and discomfort with physical activity.

b. Heat exhaustion – this is characterized by intense thirst, anxiety, discomfort and fainting with physical activity.

c. Heat stroke – this is the classic severe illness with central nervous system and multiple internal organ system dysfunctions.

            Contrary to common belief, heat induced illness does not occur only if the weather is intensely hot and humid.  Cooler environments, if the right conditions exist (poor ventilation, lack of water to drink, animal anxiety, etc), can still allow heat induced illness to occur.  Even in these situations, a pet’s temperature can reach as high as 106-108 degrees Fahrenheit.  Body temperatures in this range can lead to shock and death if they persist.  Temperatures above 109 degrees Fahrenheit will cause critical enzyme systems (required for normal body function) to break down.

            Although strictly speaking, heat induced illness is based on the pet’s temperature, you don’t need to actually take your pet’s temperature to suspect it is occurring and start treatment.  If you see any of the symptoms mentioned above, start cooling measures.  Once cooling measures are started, it becomes important to measure the pet’s temperature to guide treatment intensity and duration.  Even though you can start the cooling measures, it is best to have a veterinarian continue treatment and monitor your pet for complications.

                        Note: The only accurate way to take a pet’s temperature is rectally.  Don’t use the ear or armpit thermometers; they’re not accurate enough in dogs and cats.  Also you cannot feel your pet to know if its body temperature is high–a thermometer must be used.

Cooling measures:

a. Get out of the hot environment - get out of car, get off black top asphalt, get out of the sun, etc.

b. Provide ventilation – get into the shade, an air conditioned house/car, place a fan next to the pet, or even hand wave air towards your pet.  Avoid crowding people and objects (blankets, stuffed animals, pillows, etc.) around the pet.  Keep the pet in the open–don’t put him/her into a cage or small space.

c. Actively cool your pet – place your pet into a cool or tepid water pool or tub (DO NOT use cold or ice water; this can cool your pet too quickly or too much, inducing hypothermia, or low body temperature).  Alternatively, place rubbing alcohol on the paws, armpits and groin.  If necessary, do both a cool water bath and alcohol simultaneously.  While cooling, monitor your pet’s temperature every 10-15 minutes.  Stop all cooling measures when the pet’s temperature reaches 103.0 degrees Fahrenheit to avoid overcooling.

d. Watch for recurrence or complications – even though the temperature becomes normal, it may not stay that way; resume cooling measures if the temperature increases.  Also, it can take time (hours to days) for the damage from the high body temperature to become evident, especially if you don’t know how high the initial body temperature was.  If your pet becomes ill in anyway within hours to a few days after a heat induced injury, see your veterinarian ASAP.  Listing specific signs to expect is not possible because all the body systems can be injured by heat; any combination of symptoms is possible.

HBC (Hit By Car):

Witnessing your pet getting hit by a car can be extremely distressing.  This is one of the times that following the 5 basic tenets of first aid can make the difference between a catastrophe and a happy ending.  I grant you that it will be difficult to do, but keeping your cool will help everyone involved, especially your pet.  Although quick, decisive, definitive action is required in these situations, taking a few seconds to take a deep breath and calm your nerves will not risk your pet’s life; not having a clear mind will!

            Once your mind is able to work again, the next thing to do is triage your pet.  Avoid the tendency to focus on the obvious injuries and overlook the critical body systems.  For example, don’t focus on the obviously broken leg and overlook your pet’s shortness of breath from a collapsed lung.  The collapsed lung is far more life threatening than the broken bone.  This is where practice before the crisis comes into play.  Have a systematic, thorough, quick routine of evaluating your pet’s vital systems.  If there are abnormalities in any of these systems, get your pet to the veterinarian immediately.  Only if your pet is stable should you turn your attention to the minor body system injuries.  Specific techniques necessary for the minor body systems are covered in other sections of this handout (see lacerations/wounds and broken bones).  Even if you feel your pet is stable, still take him/her to your veterinarian for evaluation.  He/she may be able to detect worrisome changes that were unapparent to you.

            Getting your pet to the veterinarian has to be done with care to avoid causing further damage or hurting your pet.  Cats should be gently put in a carrier for their comfort and safety.  If your cat is too injured or painful to be placed in a carrier, gently wrap him/her securely in a large towel or blanket for transport to your veterinarian.  If your dog can walk, gently guide him/her to your car and drive safely to your veterinarian for care.  If your dog cannot walk, or walks unsteadily or painfully, lifting him/her in a simple stretcher is best.  A blanket or large towel usually works nicely.  Simply lay your dog in the middle of the blanket or towel, and lift by holding all four corners.  This minimizes the chance your dog will jump or fall out, but still be careful it doesn’t happen.  Move slowly and purposefully to your car.  Placing your dog on the floor of the car is best to avoid a fall from the seat while in transit.  Once at the clinic, allow your veterinarian and the staff help get your pet out of the car and into the clinic.  During the entire time from the accident to the arrival at the clinic, remember your pet will be anxious at least and afraid and painful at worst; that makes him/her more likely to bite.  Using a muzzle to prevent injury to yourself and the veterinary staff is many times warranted, even if you trust your pet with your life.

            There is one last important concept about hit-by-car injuries to understand.  Many life threatening injuries such as collapsed lungs, lung bruises, abnormal heart rhythms, internal bleeding, kidney and bladder tears and concussions may not become evident until 24 to 72 hours after the accident, even when perfectly normal immediately afterward.  Make sure you keep a close watch on your pet’s critical systems for a few days after being hit by a car.  Therefore, it is strongly encouraged to repeat your triage exam several times a day until your pet is out of danger.  Keeping in close contact with your veterinarian during this time can ensure nothing will be missed, making that happy ending a reality.