Vehicular Trauma

Cassandra Gilday, DVM, North Carolina State University

Adesola Odunayo, DVM, MS, DACVECC, University of Florida

ArticleLast Updated March 20212 min readPeer Reviewed
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ANCILLARY MATERIALS

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FIGURE 1A

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FIGURE 1A

AFAST: Anechoic free abdominal fluid (arrows) at the diaphragmatico-hepatic view (A) and splenorenal site (B). Images courtesy of Silke Hecht, DACVR, DECVDI

GENERAL GUIDELINES FOR FLUID RESUSCITATION & BLOOD TRANSFUSION IN PATIENTS WITH TRAUMA

Perfusion Parameters

Normal Endpoints

Whole blood

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Dogs: 20-30 mL/kg given over 30 minutes to 4 hours, depending on how critical the patient is

Cats: 50-60 mL/cat (NOT mL/kg) given over same time period as for dogs

| | Packed RBCs5 |

Dogs: 15 mL/kg given over same time frame as whole blood

Cats: 30-40 mL/cat (NOT mL/kg) given over same time frame as for dogs

| | Synthetic colloid (controversial)5 | 1-5 mL/kg given over 15 minutes | | Fresh frozen plasma5 | 15-30 mL/kg for patients with coagulopathy and active hemorrhage | | Isotonic fluid shock bolus (LRS, Norm-R, 0.9% sodium chloride, Plasma-Lyte)5,9 |

10-25 mL/kg given over 15 minutes. End goals should be reassessed; may be repeated until entire shock dose administered.

Dog shock dose: 90 mL/kg/hour; cat shock dose: 50-60 mL/kg/hour

| | Hypertonic saline5,9 | 4-6 mL/kg given over 15 minutes; may be repeated 2-3 times in 24 hours | | Mannitol9 | 0.5-1.5 g/kg IV given over 15 minutes, may be repeated 2-3 times in 24 hours | | Lidocaine3 | 2 mg/kg IV bolus, followed by 50-80 μg/kg/minute if rhythm converts |

RESUSCITATION ENDPOINTS

Perfusion Parameters

Normal Endpoints

Heart rate

Dogs: 60-120 bpm

Cats: 140-200 bpm

| | MM color | Pink | | CRT | 1-2 seconds | | Temperature | 99°F-102.5°F (37.2°C-39.2°C) | | Mentation | Alert | | SAP (systolic BP) | >90 mm Hg | | MAP (mean BP) | >70 mm Hg | | Urine output | 1-2 mL/kg/hour | | Lactate | <22.5 mg/dL |

AFAST = abdominal focused assessment with sonography for trauma, BP = blood pressure, CK = creatine kinase, CPR = cardiopulmonary resuscitation, CRT = capillary refill time, Hct = hematocrit, LRS = lactated Ringer’s solution, MAP = mean arterial pressure, MgCl = magnesium chloride, MM = mucous membrane, MODS = multiple organ dysfunction, PCV = packed cell volume, PE = pericardial effusion, POCUS = point of care ultrasound, PT = prothrombin time, PTT = partial thromboplastin time, RR = respiratory rate, SAP = serum alkaline phosphatase, SIRS = systemic inflammatory response syndrome, SpO2 = oxygen saturation, TFAST = thoracic focused assessment with sonography for trauma, TP = total protein, TS = total solids, VPC = ventricular premature contraction