Page 479 - Clinical Small Animal Internal Medicine

46 Medical Management of Trauma and Burns 447

energy balance with protein catabolism, gluconeogenesis, relatively uncommon. Head trauma is more likely to be
VetBooks.ir glycogenolysis, hepatic insulin resistance, lipolysis, encountered in animals with a higher total trauma load
and is associated with a worse outcome
decreased lean body mass, and fever. Ultimately, energy
Little is known about the incidence of penetrating
requirements during this period can be increased three-
fold above basal metabolic rate. ballistic injuries in dogs and cats although a recent study
Patients that suffered burn injuries in an enclosed struc- of military working dogs sheds some light on the topic.
ture fire are also at risk for developing inhalation injury. Obviously, military and law enforcement working dogs
The inhalation of hot gas and particulate debris results in are at a higher risk than the general pet population of
direct thermal injury to the airway mucosa and chemical ballistic trauma and that trauma is more likely to be due
irritation. Patients are at risk for developing upper airway to high‐velocity/high‐energy projectiles (rifle bullets). A
obstruction, bronchospasm, small airway occlusion, pul- higher incidence of penetrating ballistic injury is also
monary infection, and respiratory failure. The effect of likely in young, male dogs of the working breeds with
direct thermal injury and chemical irritation is develop- lower velocity/energy ballistics (shotgun pellets) more
ment of an inflammatory response resulting in interstitial likely.
edema formation. The damaged mucosal surface gener-
ates large amounts of cellular and necrotic debris, leading
to further inflammation and distal migration within the Signalment
bronchial tree with resultant lower airway plugging. This
typically occurs 3–5 days post inhalation injury and, in Young (1–3 years) large‐breed dogs of both sexes are
conjunction with mucociliary dysfunction, can lead to more likely to suffer blunt trauma (hit by car) than small‐
development of bronchopneumonia.
breed dogs. Conversely, small‐breed dogs are more likely
than large‐breed dogs to be victims of animal attacks,
Epidemiology with males being more commonly affected than females.
Male cats are more likely to suffer trauma associated
with vehicles or animal interaction than female cats
The incidence of trauma in veterinary medicine is rela- while female cats appear more likely to fall from heights.
tively unknown with one large retrospective study find- Burn injuries most often occur in the veterinary hospital
ing that trauma accounted for 13% of admissions to an setting (heating pads) or structure fires; there is no
urban referral hospital. When it does occur, trauma in species, breed or sex predilection.
veterinary patients appears to be more likely to affect
dogs than cats, with dogs comprising approximately
80–90% of trauma patients. In dogs, the mechanism of
trauma is most likely to be blunt trauma associated with History and Clinical Signs
vehicular injury followed by sharp trauma and animal
attacks. In the feline population, the mechanism of The diagnosis of trauma is generally made based on
trauma is often unknown. In cases where the mechanism history and physical exam findings rather than diagnos-
behind the trauma is known, cats are essentially equally tic test results. Often, the medical history is incomplete
as likely to suffer from blunt vehicular trauma, falls from and it is not uncommon for the animal to be presented
height, crush injury or weapon‐related trauma. The pre- by a Good Samaritan rather than the owner. Cats fre-
hospital mortality rate of veterinary patients suffering quently present with no history but with physical exam
trauma is unknown; in hospital, mortality ranges from findings that are consistent with trauma.
approximately 10% to 20%. Clinical signs associated with trauma will be dependent
Blunt trauma in the canine patient is more thoroughly on the mechanism behind the trauma and the location
described. The thorax and extremities are the most likely on the body at which that trauma was inflicted. Typical
sites of injury from blunt trauma in dogs, with pelvic injuries following trauma include fractures, contusions
fracture, head trauma, and abdominal trauma occurring and abrasions, bruising or bleeding. Any animal presenting
less frequently. The most common thoracic injuries with one or more of these findings should be considered
incurred are pulmonary contusions, pneumothorax, and to have suffered trauma until proven otherwise. Blunt
chest wall trauma/rib fractures. In blunt abdominal trauma patients are frequently presented with few out-
trauma, the most commonly encountered injuries are ward signs of trauma but often have difficulty breathing,
hemoperitoneum (25%), body wall hernia (5%), and rup- reluctance or inability to ambulate or decreased mentation.
ture of the urinary system (3%). The two most commonly Initially, clinical signs may be mild and the animal may
encountered orthopedic injuries are pelvic fractures appear stable due to the catecholamine surge associated
and long bone fractures. Axial orthopedic injuries are with the fight or flight response. Animals suspected of