The initial stages of care are critical and the patient’s response over this time may be an important indicator of prognosis. Some animals may demonstrate mild clinical signs but rapidly deteriorate over the following 24 to 48 hours, whereas others may be severely affected at presentation but improve a great deal during this key period. The initial appearance of a patient can be deceiving. It is impossible to provide a definitive prognosis on the degree of function that each individual patient will attain. Some patients may lose housetraining ability and need to relearn the behavior, whereas other animals may return to normal function. Neurologic recovery can encompass a variety of forms and may be complete, partial, or unacceptable to the owner of the pet. Animals have a remarkable ability to compensate for loss of cerebral tissue. Potential complications include seizures, blindness, sepsis, and coagulopathies. 1įew data are available regarding prognosis in animals with TBI. Other aspects of patient care include bladder management, frequent turning of the recumbent patient, and passive range-of-motion exercises. Insulin therapy may be provided in animals that are persistently hyperglycemic. Special attention should be placed on serum glucose concentrations. Nutrition should be considered early, and electrolytes should be monitored often and supplemented as required. Corticosteroid use in human head trauma patients has also been associated with hyperglycemia, immunosuppression, delayed wound healing, and gastric ulceration. The use of corticosteroids in veterinary head trauma patients is not currently recommended, as they have been shown in human clinical trials to increase mortality. Opioids are used commonly because they are easy to reverse and do not result in cardiac effects. Analgesia is paramount in these patients, as it may help prevent further ICP elevation. 9Īnticonvulsant therapy should be initiated as soon as a patient with TBI has a seizure. Mannitol is given at a dose of 0.5 to 2 g/kg as a slow bolus over 15 to 20 minutes and should be administered through a filter to account for the possibility of crystal formation at lower temperatures and in concentrations >15%. When elevated ICP is suspected based on the presence of the Cushing reflex and acute deterioration of the patient’s status, hyperosmolar therapy should be initiated. The patient’s head should be elevated at a 15°- to 30°-angle. Similarly, placing jugular central lines and occluding the jugular vein should be avoided. Increases in ICP can be minimized by limiting obstruction to venous drainage. Intracranial therapy involves minimizing increases in ICP and maximizing CPP. Nasal oxygen tubes or cannulas should be avoided as these may cause sneezing and/or coughing, which can lead to ICP elevation.

Oxygen therapy should be administered via flow-by mask, oxygen tent, or oxygen cage to maintain a pulse oximetery oxygen saturation >95%. The recommended dose is 4 to 6 mL/kg of 7.5% NaCl over 10 to 15 minutes.

Hypertonic saline, a hypertonic crystalloid, is an excellent choice for resuscitation in TBI patients. Blood products should be considered in animals with significant hemorrhage. Isotonic crystalloids should be administered at 10 to 20 mL/kg given over 10 to 15 minutes. Avoidance of hypoxia and hypotension is vital to maximizing the chance of a successful outcome. 4Įxtracranial therapy includes maintenance of adequate intravascular volume, oxygenation, and ventilation. Hyperglycemia has been associated with a worse outcome in human patients with TBI. A minimum database-including lactate concentration, CBC, serum chemistry panel with electrolytes, and urinalysis-should be obtained. The patient may then be evaluated for skull and vertebral fractures and extremity injuries as well as damage to the abdominal and thoracic cavities. Patients with cardiovascular instability (eg, hypotension, tachycardia, bradycardia in cats, weak peripheral pulses) should be treated with appropriate fluid boluses aimed at intravascular volume resuscitation. Oxygen should be provided and the primary cause of the breathing difficulty addressed, if possible. Breathing abnormalities may be associated with concurrent injuries such as pneumothorax, rib fractures, pulmonary contusion, or blood loss. Airway obstruction may be present, and intubation should be performed if there is any question about airway integrity. The ABCs (airway, breathing, cardiovascular status) must be addressed first. Initial evaluation should focus on immediate life-threatening abnormalities.

Signs of head trauma in small dogs