What to Expect at the ER Following Vehicular Trauma
Vehicular trauma is a common emergency requiring immediate veterinary attention. Knowing what to expect at the ER can help prepare you to make the best possible decisions for you and your pet.
Triage and Stabilization
If possible, call ahead so the veterinary team is ready and waiting to receive your pet. On admission, the veterinary team will assess your pet’s vital parameters and initiate necessary treatment to stabilize your pet. This includes placing an intravenous (IV) catheter for injectable medications and fluids, supplementing oxygen, applying pressure bandages to bleeding wounds and providing pain control.
Baseline Diagnostic Tests
Once your pet is considered stable, the veterinary team will perform further diagnostics to determine the extent of injuries.
Full body radiographs (X-rays) are important to identify any internal injuries. Common traumatic internal injuries found on radiographs include diaphragmatic hernias (abdominal contents herniate into the chest through the diaphragm), broken bones, dislocated joints, pulmonary contusions (bruising of the lungs) and pneumothorax (air has entered the chest cavity around the lungs).
Blood tests can help determine severity of hemorrhage, electrolyte abnormalities and possible underlying diseases that may complicate treatment, such as liver or kidney disease. Elevated liver enzymes are common after being struck by a vehicle but may be transient and do not necessarily indicate liver dysfunction. These values are usually rechecked sometimes weeks to months after the initial accident to ensure that liver dysfunction does not develop.
Focused ultrasound or a “FAST” scan is another useful diagnostic tool used to detect fluid in the abdomen and/or thorax commonly indicating internal bleeding, a ruptured urinary bladder or ruptured gallbladder.
Once initial injuries are identified, a treatment plan is tailored to your pet and is constantly adjusted to address new and resolving problems. Treatment may include emergency surgery to address life-threatening injuries (e.g., internal bleeding, diaphragmatic hernias, chest wounds). If an injury is not life-threatening but still requires surgery (e.g., a broken leg or laceration), your veterinarian will often wait several days to ensure your pet is stable enough to undergo general anesthesia and surgery, thus ensuring the procedure is as safe as possible for your pet.
Depending on the severity of injuries, your veterinarian may recommend transfer to a specialist once your pet is stable enough to be transported. Specialists such as criticalists, neurologists and surgeons can provide advanced care for more serious injuries.
Ongoing Care and Hospitalization
Hospitalization for a minimum of 24 to 48 hours is recommended not only for treatment of current injuries but also to monitor for new problems that may need immediate medical attention. Many traumatic injuries take time to present themselves. For example, respiratory distress from pulmonary contusions often occurs hours to days after the incident because lung bruising takes time to develop, a rupture in the urinary bladder may not be apparent until there has been sufficient time for urine to collect in the abdomen and clinical signs from head trauma may not be seen until enough pressure has built up in the skull. If complications such as these develop, the hospital is the safest place for your pet.
After Discharge from the Hospital
Once your pet has been discharged from the hospital, rechecks and/or bandage changes are often necessary. It will be important to adhere to your veterinarian’s discharge instructions to ensure your pet continues to recover successfully at home.
Jennifer Marshall, DVM, is a graduate of Texas A&M College of Veterinary Medicine who lives in Dallas, Texas. Dr. Marshall practices at Hillside Veterinary Clinic in Dallas.