Managing dogs with thoracic impalement injuries: A review of nine cases - Veterinary Medicine
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Managing dogs with thoracic impalement injuries: A review of nine cases
Managing thoracic impalement injuries is well-described in people, but not in veterinary patients. These clinicians present their findings from a review of nine cases of such injuries in dogs to help you prevent life-threatening complications and achieve excellent outcomes.


VETERINARY MEDICINE



Figure: 1. A Labrador retriever that presented after having been inadvertently shot with an arrow during hunting season. The arrow entered the thoracic cavity near the scapula. This dog recovered uneventfully with treatment.
In the other two cases, one dog was inadvertently shot with an arrow (Figure 1), and one dog jumped onto a broken plastic door.

Initial presentation and physical examination findings

Five dogs presented as emergencies immediately after injury, and three dogs were treated by their veterinarians before referral: A Labrador retriever was treated for four days, the Doberman pinscher was treated for two days, and one dog was stabilized and immediately referred for definitive therapy.

In addition to the impalement history, presenting clinical signs in all dogs included tachypnea (respiratory rate > 36 breaths/min) and labored breathing, tachycardia (> 120 beats/min), and apparent pain. Four dogs appeared hypovolemic (based on heart rate, pulse quality, and a delayed capillary refill time), and three dogs were hyperthermic (> 103 F [39.4 C]).

Initial stabilization

All dogs were treated with intravenous fluids on arrival. The dogs received an intravenous bolus (between 10 and 60 ml/kg) of a balanced electrolyte solution. During initial stabilization, all dogs received supplemental oxygen, usually administered as flow-by then either by an oxygen cage or nasal insufflation if further support was necessary. All dogs also received broad-spectrum antibiotics.

Mechanism of object removal

The externally visible portions of four foreign bodies were removed by the dog, the owner, or the referring veterinarian before anesthesia and surgical removal, and five foreign bodies were removed during surgical exploration by the surgeon at the referral hospital.

Laboratory testing

A CBC and serum chemistry profile were performed in all dogs before anesthesia and surgery. In seven dogs, samples were collected after dogs received intravenous rehydration therapy. In one dog, the timing of the sample collection could not be determined from the medical record. All dogs were hypoproteinemic (median total solids = 3.7 g/dl, range = 2 to 4.9 g/dl [reference range = 5.8 to 7.2 g/dl]), and four dogs were anemic (hematocrit < 35%; reference range = 37% to 55%). Three dogs had neutrophilic leukocytosis with a median total white blood cell count of 23,100/μl (range = 17,200 to 26,000/μl [reference range = 6,000 to 17,000/μl]). No other clinically relevant laboratory abnormalities were present in any dog.

Diagnostic imaging

All dogs had a thoracic radiographic examination before surgery. All radio graphs revealed abnormalities, including pleural effusion (eight dogs), subcutaneous emphysema (five dogs), pneumothorax (four dogs), pneumomediastinum (three dogs), and rib fractures (one dog). In five dogs with stick impalement, the stick appeared as a radiolucent area and soft tissue opacities compatible with local soft tissue swelling were present, probably secondary to hemorrhage. Ultrasonography or computed tomography was not used initially in any affected dog.

Surgical treatment

All dogs underwent exploratory thoracotomy a median of 31 hours after the initial injury (range = three to 96 hours). General anesthesia was induced and maintained with a variety of protocols. All dogs had controlled ventilation, either mechanically or manually, during the thoracotomies. Three dogs had lateral thoracotomies, and six dogs had median sternotomies in addition to wound explorations. The entry wound was explored, all foreign objects were removed, and the area was copiously lavaged with sterile saline solution. The surgical order was at the surgeon's discretion; however, most wounds were explored before the thoracotomy was performed.

Additional important intrathoracic injuries were detected in some dogs. Two dogs had full-thickness diaphragmatic lacerations; in each dog the abdomen was explored before the diaphragmatic rent was débrided and sutured. Another dog had severe pulmonary contusions of the right cranial lung lobe near the site of the foreign body penetration, and a complete right cranial lung lobectomy was performed.


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Source: VETERINARY MEDICINE,
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