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Vehicular Trauma

Cassandra Gilday, DVM, University of Tennessee

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

Emergency Medicine & Critical Care

|March 2021|Peer Reviewed

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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

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)

Table 1

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

Perfusion Parameters Normal Endpoints
Whole blood5

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 

Table 2

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

 

THREE COMPARTMENT MODEL

  1. Dorsal column: laminae, spinous processes and their ligaments
  2. Middle column: dorsal longitudinal ligament, dorsal annulus, dorsal cortex of the vertebral bodies
  3. 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

References

For global readers, a calculator to convert laboratory values, dosages, and other measurements to SI units can be found here.

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