Vehicular Trauma
Cassandra Gilday, DVM, North Carolina State University
Adesola Odunayo, DVM, MS, DACVECC, University of Florida
ANCILLARY MATERIALS
THORACOCENTESIS
Thoracocentesis is often a life-saving treatment that should be performed during initial stabilization, ideally prior to radiographic confirmation of pneumothorax or pleural effusion to prevent patient decompensation in radiology.1,2,4
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
ANALGESIA IN TRAUMA
Quick and effective analgesia is essential for patients with vehicular trauma. Opioids are the drug of choice because of their efficacy and limited adverse effects. NSAIDs should be avoided until the patient is hemodynamically stable. In addition, butorphanol has minimal analgesic effects and should not be used. IM or SC administration of pure μ-receptor agonists may cause vomiting; IV administration is strongly preferred.1,13
Morphine (0.1-0.5 mg/kg IV every 4 hours)
Hydromorphone (0.05-0.2 mg/kg IV every 4-6 hours)
Methadone (0.1-0.5 mg/kg IV every 4-6 hours)
Fentanyl (2-5 µg/kg bolus, then 2-6 µg/kg/hour IV CRI)
Buprenorphine (0.01-0.03 mg/kg IV or IM every 6-8 hours)
GENERAL GUIDELINES FOR FLUID RESUSCITATION & BLOOD TRANSFUSION IN PATIENTS WITH TRAUMA
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 |
SYSTEMIC CONSEQUENCES OF TRAUMA
Common metabolic consequences6,12
Activation of the coagulation cascade
Hypothermia
GI disturbance (eg, vomiting, diarrhea)
Systemic inflammation (eg, SIRS, MODS)
Common clinical pathologic abnormalities2,6,12
Hyperglycemia
Hyperlactatemia
Metabolic acidosis
Hypoalbuminemia
Anemia
Thrombocytopenia
Increased ALT
Increased CK
Prolonged PT/PTT
RESUSCITATION ENDPOINTS
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 |
THREE COMPARTMENT MODEL
Dorsal column: laminae, spinous processes and their ligaments
Middle column: dorsal longitudinal ligament, dorsal annulus, dorsal cortex of the vertebral bodies
Ventral column: ventral longitudinal ligament, ventral annulus, ventral cortex of the vertebral bodies
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