Page 957 - Cote clinical veterinary advisor dogs and cats 4th

High-Rise Syndrome 469.e3

• Abdominal and thoracic ultrasound ■ Tracheostomy may be indicated in • Chylothorax
(abdominal and thoracic focused assess- some cases of severe facial trauma • Pancreatitis and peritonitis associated with
VetBooks.ir • A whole-cat radiograph is often performed • Fluid resuscitation from shock Recommended Monitoring Diseases and Disorders
®
pancreatic rupture; clinically manifests as
(p. 1166).
ment sonography for trauma [AFAST and
®
TFAST , respectively]) (p. 1102)
abdominal pain, vomiting, and ascites
○ Obtain IV access in an uninjured limb.
initially as a screening tool, and more focused
IV over 10-20 minutes once if evidence
radiographs may be performed thereafter. ○ Administer hypertonic saline 3-5 mL/kg • In-patient monitoring: particularly close atten-
• Radiographs of skull, thorax, abdomen, spine, of traumatic brain injury, hypotension, tion should be paid to the animal’s breathing
and limbs may be indicated depending on or both. and hemodynamic stability, especially during
the animal’s clinical signs. ○ Administer warm isotonic crystalloid ± the first 24 hours after trauma.
• Whole-body CT is increasingly used for colloid fluids to effect to resolve clinical • Repeat exam and removal of skin sutures
rapid assessment of polytrauma patients to signs of shock. (2 weeks); cerclage wire around mandibles
reduce imaging time (vs. radiographs) and to ○ Start with 20 mL/kg crystalloid bolus in (4-5 weeks)
potentially increase sensitivity for detection dogs or 10 mL/kg in cats, and titrate to • Routine follow-up and radiography to ensure
of injuries. effect up to 80-90 mL/kg/h in dogs and fracture healing after orthopedic surgery
• CBC, serum biochemistry panel, urinalysis 50-60 mL/kg/h in cats. Consider judicious
fluid use, particularly in animals with PROGNOSIS & OUTCOME
Advanced or Confirmatory Testing evidence of pulmonary contusions.
• Coagulation testing (prothrombin time, • Blood product transfusion (whole blood • Good prognosis for survival for ≈90% of
activated partial thromboplastin time, and/ or packed red blood cells) may be neces- cats and dogs
or viscoelastic testing to evaluate fibrinolysis) sary if severe hemorrhage has occurred • Given the high percentage of animals requir-
if there is evidence of significant blood loss (p. 1169). ing surgery, euthanasia due to client financial
or a need for surgery; also useful for the • Provision of appropriate analgesia constraints occurs.
diagnosis of acute traumatic coagulopathy ○ Opioid analgesia is recommended initially • Death, excluding euthanasia, is generally
• CT scan of head, spine, or other areas of and may be supplemented with ketamine due to shock, or respiratory distress due to
interest (e.g., whole-body CT scan) and/or lidocaine (dogs only) as necessary in thoracic trauma.
• Spinal MRI may be indicated if the patient patients without significant head trauma. • Most deaths occur within 24-36 hours of
displays neurologic abnormalities localized ○ Nonsteroidal antiinflammatory drugs may admission or in the immediate postoperative
to the brain or spinal cord without bony be added after patient stabilization and period.
abnormalities observed on radiographs and/ assessment of suitability. • It is suspected that most dogs falling more
or CT scans. • Broad-spectrum antibiotic coverage in than six stories do not survive and therefore
• Abdominocentesis and fluid analysis to animals with penetrating body cavity wounds are not brought to the hospital and assessed
differentiate hemoperitoneum from uro- before exploratory surgery in case series.
peritoneum (pp. 1056 and 1343) • Further treatment depends on the successful
○ The diagnosis of uroperitoneum may be outcome of initial stabilization. PEARLS & CONSIDERATIONS
made by comparison of abdominal fluid • Surgical treatment of skeletal injuries
creatinine concentration and potassium • Exploratory thoracotomy or celiotomy Comments
concentration with those in peripheral in patients with penetrating thoracic or It has been reported that the association between
blood abdominal wounds, respectively injuries and height of fall follows a curvilinear
• Imaging of the oral cavity is indicated in • Oral/dental treatment pattern.
cases of orofacial injury; traditionally, this
has involved full-mouth (intraoral) dental Chronic Treatment Prevention
radiographs and/or radiographs of the head, • If response to emergency treatment is poor, Owner education of the risks in areas where
temporomandibular joints, and bullae; visceral injury (abdominal and thoracic) with high-rise living is common
however, CT is preferred if available. possible hemorrhage should be considered,
even in the absence of penetrating body Technician Tips
TREATMENT cavity wounds. Stabilization of a high-rise syndrome patient
○ Hemorrhage into potential spaces (e.g., should be as for any trauma patient with an
Treatment Overview retroperitoneum) may not be evident at initial focus on the ABCs (airway, breathing,
• Stabilize animal; priorities are to resolve/ presentation but may become visible by and circulation).
improve dyspnea and shock and minimize radiography or ultrasonography with larger
stress (especially in cats). volumes of blood loss. Client Education
• Orthopedic manipulations, radiography, or • Chronic oral/dental treatment Close windows and balcony doors in the
surgical procedures may initially need to be ○ Placement of a feeding tube (e.g., esopha- presence of animals.
delayed, with adjunctive pain control, if the gostomy tube) may be necessary to supply
patient is systemically unstable at the time nutrition in patients with extensive oral SUGGESTED READING
of presentation. or maxillofacial trauma (p. 1106).
Papazoglou LG, et al: High-rise syndrome in cats: 207
Acute General Treatment Nutrition/Diet cases (1988-1998). Aust Vet Pract 31:98-102, 2001.
• Management of respiratory distress For dental injuries, soft food; in patients
○ Oxygen supplementation (p. 1146) with esophagostomy tubes, blended meals are ADDITIONAL SUGGESTED
○ Thoracocentesis if respiratory pattern necessary. READINGS
or thoracic auscultation suggestive of
pneumothorax (p. 1164) Possible Complications Gordon LE, et al: High-rise syndrome in dogs:
○ Intubation to secure the airway in cases • Chronic oronasal communication 81 cases (1985-1991). J Am Vet Med Assoc
202:118-122, 1993.
of respiratory distress with severe oral • Temporomandibular joint ankylosis in very Liehmann LM, et al: Pancreatic rupture in four
hemorrhage or facial deformation due young animals resulting in difficulty or the cats with high-rise syndrome. J Feline Med Surg
to trauma inability to open the mouth 14:131-137, 2012.

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