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38.e2 Aggression Toward Veterinary Personnel

Aggression Toward Veterinary Personnel Client Education
Sheet
VetBooks.ir

• Auditory (increased panting, growling,
BASIC INFORMATION
barking, hissing, spitting) behaviors escalate to a veterinary behavior
specialist.
Definition • Olfactory (spraying, scratching, urination,
A threat, challenge, or attack directed toward defecation, anal sac expression) Acute General Treatment
individuals at the veterinary clinic or when • Tactile (teeth and/or claws) • Patients that are aroused should be allowed
handled by veterinary clinic personnel • Complete physical exam may be difficult to approach rather than be approached.
without sedation or anesthesia; unremarkable • Any approaches for assessment or care should
Epidemiology except for comorbid medical conditions. be slow and calm. Speak quietly; avoid direct
SPECIES, AGE, SEX eye contact.
Any dog or cat Etiology and Pathophysiology • Avoid using punishment or forceful tech-
• The most common causes of in-office aggres- niques; these usually escalate aggression and
RISK FACTORS sion are fear- or pain-related aggression; anxiety. Highly aroused cats or dogs should
• Hand-reared, underexposed/unsocialized, multiple exposures can reinforce responses. not be forcibly restrained.
neglected/abused dogs and cats (those that • The hypothalamus and amygdala are involved • The use of basket muzzles, head collars, and/
missed or were mishandled or neglected during in defense and aggression. or towels for staff safety may be needed.
key sensitive periods during development) • Monoamines and androgenic steroids act as • If treatment or assessment is essential, seda-
• Previous unpleasant experiences involving modulators of established offensive and tion or anesthesia should be used if aggression
fear/pain defensive aggressive behaviors. escalates (for safety of the staff and welfare
• Patients with any behavioral disorder that of the animal).
may make them more reactive DIAGNOSIS • Calming caps, Thundershirts, and anxiety
wraps can be useful for some patients, but
ASSOCIATED DISORDERS Diagnostic Overview the patient should be habituated to them
• Any condition causing pain • The diagnosis is circumstantial when aggres- before the visit. These do not help profoundly
• Any procedure that causes fear or anxiety sion occurs in the veterinary care setting. distressed patients.
• Underlying anxiety disorder • There may also be a history of overt or covert • Clients should be encouraged to work with
aggressive incidents directed toward people a positive reinforcement trainer who can help
Clinical Presentation at other times. teach the pet to not fear veterinary visits
DISEASE FORMS/SUBTYPES and cooperate with physical examination,
• Usually involves fear, anxiety, or panic Differential Diagnosis phlebotomy, or other procedures.
• Behaviors exhibited are designed to increase Many different diagnostic categories of aggres-
distance between the patient and veterinary sion are recognized and may co-occur. Ruling Chronic Treatment
personnel and involve flight, fight, or freeze out pain is essential. • Desensitization and counter-conditioning to
or behaviors associated with anxiety (e.g., handling can be attempted slowly; the patient
lip licking, yawning, panting, sniffing, Initial Database is always rewarded for appropriate acceptable
circling). • CBC, serum biochemistry profile, urinalysis, behavior. Offering non-treatment visits (e.g.,
diagnostic imaging: to rule out contributing having the patient come to the veterinary
HISTORY, CHIEF COMPLAINT medical factors and before prescribing hospital and offering treats in the car park,
• The bite or scratch may seem sudden, but medications, if possible. If the patient is too reception area, and consultation room) may
the patient usually gives advance warning aggressive for a pre-treatment assessment help increase the positive experience of visits.
signs that it is fearful or anxious. without further trauma, caution client and • Use nonslip matting on scales, examination
• The patient’s presence at a veterinary clinic medicate the patient. tables, and floor to provide secure footing
is usually associated with a heightened state • Use a standardized rating scale to score the and decrease anxiety. Teach dogs that are
of arousal associated with novel people, other response of the patient to all aspects of the already aggressive to accept wearing a basket
animals, poor footing, and unfamiliar sights, veterinary visit (waiting room through muzzle so that if muzzling is necessary, it is
sounds, and smells. examination). Compare data across and not anxiety provoking.
• Patients may show signs of apprehension, between visits for anticipatory guidance, risk • Patients that are known to react aggressively
fear, reactivity, or arousal before arriving at minimization, and the well-being of the should be premedicated before placement
the veterinary hospital (e.g., appearance of patient. in cages.
the cat carrier, car travel). • Use signs on cages such as “I BITE” to warn
• Aggression may be passive (covert) or active TREATMENT staff members to approach with caution.
(overt) and involve a threat, challenge, or • Detailed records should be kept for each
an actual attack. Treatment Overview patient on successful approaches to make
• A complete history should include a descrip- Goals of treatment: future handling easier.
tion of the location, body posture, vocal and • Prevent the dog or cat becoming aggressive • Aggressive dogs should be placed in ground-
physical signals, behavior sequences involved, by reducing the stress response and underly- level cages to make it easier to move them.
any triggers that may have precipitated ing arousal and anxiety. • When placing dogs into cages, use a quick-
aggression, and identification and behavior • Reduce stress/distress before or during vet- release leash. Basket muzzles/head halters
of personnel involved. erinary visits by use of antianxiety/panicolytic can remain attached only under constant
medication. Institute and follow clinic supervision.
PHYSICAL EXAM FINDINGS procedures that address the underlying causes • Insulate metal cages to decrease noise.
Signs may be and provide management strategies. • All staff should understand body language
• Visual (changes in body posture, piloerection, • Refer cases that involve aggression in so they are able to read fearful displays and
licking of lips, scanning the environment) other situations or where the aggressive threats that might escalate to aggression.

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