Critical care and management of Penetrating and blunt

trauma in Siberian Husky

INTRODUCTION
Trauma is defined as a “wound or injury” and may occur secondary to motor accidents, fall from height, animal
interaction, human animal interaction etc. Severity may range from mild to fatal. Traumatic skeletal injuries as a
result of motor vehicle accidents are commonly encountered in small animal practice. Blunt cardiac trauma may
be particularly difficult to identify on physical examination. However, whether clinically detected or undetected,
traumatic cardiopulmonary lesions may have serious implications with regard to patient management and
recovery. Accurate evaluation of the trauma patient may require thoracic radiographs and electrocardiograms in
conjunction with the physical examination. Therefore, a global and thorough approach is required to improve
survival and decrease morbidity in trauma patients.
The critical care and management of blunt and penetrating thoracic trauma in a Siberian Husky, or any dog,
involve prompt assessment, stabilization, and appropriate intervention. Here's an overview of the steps
involved:

1. Initial Assessment and Stabilization:

Initial assessment of the trauma patients occurs quickly but can theoretically be broken down into two major
phases; primary assessment and secondary assessment.

1.Primary assessment: it mainly involves in the assessment of respiratory and cardiovascular

system, followed by assessment of the central nervous system and urinary tract system (Loogna
et al., 2007)

a. Airway: we should evaluate the respiratory sound of a traumatic animal. During thoracic trauma the
respiration sound rather increases or decreases. Airway passage of patients should be ensured and should be
checked properly. If there is evidence of respiratory distress. Arterial o2 should be provided to the severely
affected patients until assessment of arterial blood gas measurement confirms that O2 supplementation is not
required.
b. Breathing: Evaluate respiratory rate and effort. During traumatic injury to the thoracic cavity animal
shows increased respiration rate and effort of respiration. Animals become restless and extend their neck, head,
and abducted elbow. Provide respiratory support as needed.
 c. Circulation: Thoracic trauma results in traumatic shock which is due to maldistribution of blood flow
because of hypovolemia and increased vascular hormone. Endothelial injury due to trauma results in release of
inflammatory mediators and stimulation of coagulation. Assess heart rate, pulse quality, and mucous
membrane color. Establish intravenous (IV) access for fluid resuscitation.
d. Neurological Assessment: Check for signs of neurological impairment.it is important to assess brain
function at presentation to obtain a baseline for potential dynamic change that may occur. Assess spinal cord
function.

Secondary survey/Diagnostic Evaluation: during secondary assessment full physical examination should be
done.
a. Radiography: Conduct thoracic radiographs (X-rays) to identify and assess the extent of thoracic trauma.
This helps in evaluating lung, heart, and vascular injuries.
b. Blood Tests: Perform blood tests to assess oxygenation, blood gas levels, and organ function. arterial o2
should be provided to the severely affected patients until assessment of arterial blood gas measurement
confirms that O2 supplementation is not required.

A. Critical care and management of blunt Thoracic Trauma:

Introduction
Blunt trauma includes vehicular trauma, crush (Simpson et al., 2009). Physical traumatic injury induces an
acute inflammatory response. Following trauma or shock there occurs activation of the complementary system.
It results as a result of chemotaxis of neutrophil and leukocyte activation. This initial response in injury is
protective however if its activation is access or widespread a systemic inflammatory response may result
(Simpson et al., 2009). In Blunt thoracic trauma macroscopic examination didn’t reveal any external chest
injury. Myocardial rupture is an injury frequently found at the autopsy of blunt thoracic trauma due to fatal
accident in Siberian Huskey. In humans, fracture of 1st and 2nd ribs is a hallmark for thoracic trauma. Although
fracture of first and second ribs is rare in Siberian Husky dogs due to anatomical differences (forelimb muscle
being more protective). In blunt thoracic trauma death of dog occurs due to
· Cardiac injuries
· Pulmonary contusion
· Neurological injuries
For the management of blunt thoracic trauma primary assessment should be focused to restore these systems.
Thus, following organ function should be restored and assessed primarily in blunt thoracic trauma.
1. Lung Injuries: Pulmonary contusion occurs commonly in blunt thoracic trauma of Siberian Husky. Manage
lung contusions or pneumothorax with appropriate respiratory support. Severe cases may require chest tube
placement
2. Cardiac Injuries: Myocardial laceration is an injury frequently observed in autopsy of blunt thoracic trauma
of Siberian Husky. Address cardiac injuries by stabilizing the dog and considering surgical intervention if
necessary.
3.Vascular Injuries: Control bleeding from vascular injuries through direct pressure and, if needed, surgical
repair. Thoracic trauma results in traumatic shock which is due to maldistribution of blood flow because of
hypovolemia and increased vascular hormone. Endothelial injury due to trauma results in release of
inflammatory mediators and stimulation of coagulation.

B. Critical care and management of Penetrating Thoracic Trauma Management:

Penetrating thoracic trauma occurs mainly due to injury from sharp objects like knife gun shot and bite from
other dogs and carnivores. Laceration of internal organs like heart lungs and vessels may lead to life threatening
situations (Mc Kiernan and other 1984, Davidson 1998). In most cases of penetrating thoracic trauma of
Siberian Husky it is managed by simple non operative measures. In a few cases urgent operative measurement
is required to avoid lethal consequences.
Most of the cases can be managed by a simple chest drainage method. Several authors have advocated
exploratory surgery of all penetrating wound after clinical and radiological examination (Mc Kiernan and other
1984)
. Subcutaneous emphysema, pulmonary infiltrates pneumothorax and ribs separation were most common
radiographic findings of penetrating thoracic trauma of Siberian Husky.
Siberian Husky with penetrating thoracic trauma exhibit following clinical signs
· Respiratory distress
· Presence of skin perforation
· Subacute emphysema and flail chest.
Management of penetrating thoracic trauma in Siberian Husky involves several steps to stabilize patients and
address any life-threatening injuries.
1. Initial Assessment and Stabilization:
Initial assessment of the trauma patients occurs quickly. It mainly involves the assessment of the respiratory and
cardiovascular system, followed by assessment of the central nervous system and urinary tract system.
a. Airway: we should evaluate the respiratory sound of a traumatic animal. During thoracic trauma the
respiration sound rather increases or decreases. Airway passage of patients should be ensured and should be
checked properly. If there is evidence of respiratory distress. Arterial o2 should be provided to the severely
affected patients until assessment of arterial blood gas measurement confirms that O2 supplementation is not
required.
b. Breathing: Evaluate respiratory rate and effort. During traumatic injury to the thoracic cavity animal
shows increased respiration rate and effort of respiration. Animals become restless and extend their neck, head,
and abducted elbow. Provide respiratory support as needed.
c. Circulation: Thoracic trauma results in traumatic shock which is due to maldistribution of blood flow
because of hypovolemia and increased vascular hormone. Endothelial injury due to trauma results in release of
inflammatory mediators and stimulation of coagulation. Assess heart rate, pulse quality, and mucous
membrane color. Establish intravenous (IV) access for fluid resuscitation. Control any active bleeding if
present.
d. Neurological Assessment: Check for signs of neurological impairment.it is important to assess brain
function at presentation to obtain a baseline for potential dynamic change that may occur. Assess spinal cord
function.
2. Foreign Body Removal: If a penetrating object is present, carefully remove it and address associated
injuries. Surgically repair damaged structures such as the lungs, heart, or blood vessels.

3. Thoracic Trauma Evaluation: Perform a thorough examination to identify the extent of the
injury (Hunt et al., 2006) look for the sign of pneumothorax, hemothorax, or tension
pneumothorax (buildup of air causing pressure on the heart and lungs).

4. Diagnostic Imaging: x-ray or ultrasound may be used to further evaluate the extent of thoracic trauma and
identify any internal injuries.
5.Treatment: Treatment may include chest tube placement to drain air fluid from the chest cavity. In most
cases, penetrating trauma is managed by non-operative measures (Hunt et al., 2006). In few cases patient
requires urgent operative measurement to avoid lethal consequence (Scheepens et al., 2006)
.

6. Pain Management
- Administer appropriate analgesics to manage pain. Pain control is crucial for the dog's comfort and recovery.
7. Monitoring:
- Continuously monitor vital signs, including heart rate, respiratory rate, blood pressure, and oxygen
saturation and response to treatment. Regularly reassess the dog's neurological status.
8. Postoperative Care
- Provide postoperative care, including wound management and administration of medications.
 - Monitor for signs of complications such as infection or respiratory distress.
9. Rehabilitation and Follow-up:
After stabilization, provide ongoing care and monitoring to ensure the dogs continued recovery. This may
involve additional imaging follow-up appointments, rehabilitation as needed. Gradual reintroduction of activity
based on the dog's recovery. Regular follow-up appointments to monitor healing and address any complications.
The specific treatment plan may vary based on the severity and nature of the injuries. Rapid intervention and
comprehensive care are key factors in the successful management of thoracic trauma in dogs (Loogna et al.,
2007).

References :
1.Manual of Trauma Management in the Dog and Cat

Loogna, P., Bonanno, F. G., Bowley, D. M., Doll, D., Girgensohn, R., Smith, M. D., Glapa,
M., & Degiannis, E. (2007). EMERGENCY THORACIC SURGERY FOR PENETRATING,
NON-MEDIASTINAL TRAUMA. ANZ Journal of Surgery, 77(3), 142–145.
https://doi.org/10.1111/j.1445-2197.2006.03994.x

Scheepens, E. T. F., Peeters, M. E., L’Eplattenier, H., & Kirpensteijn, J. (2006). Thoracic
bite trauma in dogs: a comparison of clinical and radiological parameters with surgical
results. Journal of Small Animal Practice, 47(12), 721–726. https://doi.org/10.1111/j.1748-5827.2006.00114.x
Hunt, P., Greaves, I., & Owens, W. A. (2006). Emergency thoracotomy in thoracic trauma—a
review. Injury-International Journal of the Care of the Injured, 37(1), 1–19.
https://doi.org/10.1016/j.injury.2005.02.014

Simpson, S. A., Syring, R. S., & Otto, C. M. (2009). Severe blunt trauma in dogs: 235 cases
(1997–2003). Journal of Veterinary Emergency and Critical Care, 19(6), 588–602.
https://doi.org/10.1111/j.1476-4431.2009.00468.x