K9 First-Aid fail

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CrossCut
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K9 First-Aid fail

Post by CrossCut » Thu Jun 14, 2018 11:54 am

So my 90-pound 8yr old lab is lying on her side at the top of the steps as I'm climbing the stairs last night and I notice she has a 2" laceration on her chest, almost in her 'armpit' (under/behind her elbow). Edges of the wound are sharp, not jagged at all, almost looks like a surgical incision. It's completely through the skin and down to the muscle (but the muscle itself doesn't appear to be cut, and no bone or white/shiny stuff noted). It gapes open easily (over an inch!) with the slightest pressure/movement, the skin moving freely over the underlying muscle tissue. No clue what she cut it on, we have another dog and they play aggressively but this doesn't look like a bite/tooth wound. No bleeding, and no inflammation or excessive redness. Minimal exudate from the wound, and it's clear. She's not in any distress, comes with her tail high and wagging when called and not really favoring the opposite leg much.

So out comes the first-aid kit. We (wife and I) get her lying on her side and I start irrigating the wound with saline solution ("for sensitive eyes") from a 12 oz bottle with a squirt tip for some pressure. Dog is not happy with this and begins struggling. The location of the wound makes cleaning it difficult, have to lift her leg at the shoulder joint to get at it, which then makes the wound gape open (good for irrigation, but probably painful too which is why she's uncooperative and struggling). I don't irrigate it even half as much as I would have liked to, and cutting/shaving away the fur might have been better first anyway, but we've already decided we'll take her to the vet in the morning so I decide just to put a dressing on it until then. After trying (and failing) to secure a couple 3x3 gauze pads with a roll of kerlix as a bandage (wrapped around her entire chest a couple times, in front and behind her front legs), I instead try a roll of vet wrap to secure the dressing which works somewhat better, at first. The nice 4" wide vet wrap wrapped around her chest covers the 3x3s nicely while we have her lying down - but quickly becomes a 1" wide "vet rope" under her armpit (bunching up and sticking to itself) after she takes a couple steps, and the 3x3 is hanging out from under the vet wrap now on either side and the wound is exposed. Try taping the edges of the 3x3 down, but tape stuck to fur doesn't work very well or for very long. I give her a gram of Keflex, and finally get to sleep after she's quiet and resting with the dressing loosely in place.

Anyway, dog is at the vet now and they'll be anesthetizing her to examine it better, prep, then likely suture her up. Except for the bill later, this actually makes me feel a little better. Had the vet examined, shaved her, and closed the wound with her conscious I'd have felt even more of a failure.

And meanwhile I just spent about $150 online for more keflex (a recent dog fight and porcupine incident had us down to one bottle left), two surgical staplers (have sutures and injectable 1% lidocaine but no staplers), a bottle of veterinary tissue adhesive (always figured I'd just use superglue, but the adhesive was only $11 so I threw it in the cart), and a case (18 rolls) of 4" vet wrap. Impulse buy maybe, but this for a time when a trip to the vet isn't an option.

I think the greatest challenge if we had to handle this ourselves would have been keeping an injured animal still for examination, wound cleaning/prep, and treatment. Any thoughts on restraining or safely calming an animal that doesn't require scheduled drugs? It really would have been an easy wound to suture (except for the location), but bought the stapler and the adhesive because it'd be faster and less of a delicate, precise, procedure than suturing would be on an uncooperative patient. Shaving the fur around the wound would have been difficult as well, partly because of the location and partly because of her struggling. Thinking an electric hair clipper would be faster than emt shears and a safety razor, even if some fur stubble remains? Suppose the noise of clippers might cause stress without conditioning them to it beforehand too... Any thoughts on anything else I missed, or done? I like to think our medical preps are better than average, and while I have little (or recent) formal training I'm not completely without some minimal practice and knowledge - but this minor emergency has me feeling less than prepared now.

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Stercutus
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Re: K9 First-Aid fail

Post by Stercutus » Thu Jun 14, 2018 12:47 pm

Our previous dog was over 200lbs. The only thing that worked other than drugs was having the wife engage with the head (he was most imprinted on her) keeping him calm while three to four people held him down and another person did what needed to be done.
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Re: K9 First-Aid fail

Post by JayceSlayn » Thu Jun 14, 2018 1:51 pm

I think doing anything invasive on animals without sedation is a pretty tricky task. And of course "invasive" has more than one meaning and degrees in this case: a particularly trusting and relaxed family dog might let you get away with more, versus one who is less secure with the people trying to mess with them. Animals tend to have less understanding of what your intentions are, and also have more basic instinctual reactions to being threatened. Sedation is a pretty common practice for dealing with that kind of patient. While physical restraints may work to varying degrees, again because of misunderstanding and instinctual reactions, they may push themselves very hard to escape, and potentially cause further injury to themselves (and/or others) and certainly emotional stress as well.

From your description, I think you did great on about everything you could do. Sterile irrigation and then trying to keep crap out of the wound is probably sufficient in a situation where further care is unavailable. It could take a long time to heal up, and it might scar over badly, but basic wound care gives the body a chance to do its work and fix things naturally. I've had to let a few gashes heal up that way, and it certainly isn't ideal, but good wound care kept them from getting infected at least.

For my basic wound wash on myself and animals: I mix my own 0.9% saline (9 grams of common table salt per liter of clean water - use a scale if you can, otherwise it's just under a teaspoon), and then sterilize it using some PVP-I until I get a medium brown color. Ideally, this solution could also be boiled for additional sterilization (though with a lid, to avoid too much water loss, imbalancing the osmolarity), but oftentimes I just use it after it has sat for about 10 minutes. The wash is then applied under pressure via 60 mL irrigation syringes. I mix my own wash solution, because a lot of wash is better than a little wash, and large volumes of sterile saline solutions are expensive.
Rahul Telang wrote:If you don’t have a plan in place, you will find different ways to screw it up
Colin Wilson wrote:There’s no point in kicking a dead horse. If the horse is up and ready and you give it a slap on the bum, it will take off. But if it’s dead, even if you slap it, it’s not going anywhere.

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Re: K9 First-Aid fail

Post by CrossCut » Fri Jun 15, 2018 6:54 am

Stercutus wrote:Our previous dog was over 200lbs. The only thing that worked other than drugs was having the wife engage with the head (he was most imprinted on her) keeping him calm while three to four people held him down and another person did what needed to be done.
That's a big dog... Wonder if wrapping her hind legs in a blanket would have helped here, stop her from being able to get her feet under her and we could hold the blanket tightly without directly holding her tightly? Just thinking out loud.
JayceSlayn wrote:I think doing anything invasive on animals without sedation is a pretty tricky task. And of course "invasive" has more than one meaning and degrees in this case: a particularly trusting and relaxed family dog might let you get away with more, versus one who is less secure with the people trying to mess with them. Animals tend to have less understanding of what your intentions are, and also have more basic instinctual reactions to being threatened. Sedation is a pretty common practice for dealing with that kind of patient. While physical restraints may work to varying degrees, again because of misunderstanding and instinctual reactions, they may push themselves very hard to escape, and potentially cause further injury to themselves (and/or others) and certainly emotional stress as well.
With this one of ours it's a struggle just to trim her toenails, our other one isn't bothered by it and holds still. Had a lab a few years ago that we had to give enemas to about twice a week, he'd lay there and let me without moving. On sedation, have tried diphenhydramine a couple times for calming our dogs for porcupine de-quilling - read it sometimes helps but didn't notice much if any affect.
JayceSlayn wrote:From your description, I think you did great on about everything you could do. Sterile irrigation and then trying to keep crap out of the wound is probably sufficient in a situation where further care is unavailable. It could take a long time to heal up, and it might scar over badly, but basic wound care gives the body a chance to do its work and fix things naturally. I've let a few gashes heal up that way, and it certainly isn't ideal, but good wound care kept them from getting infected at least.

For my basic wound wash on myself and animals: I mix my own 0.9% saline (9 grams of common table salt per liter of clean water - use a scale if you can, otherwise it's just under a teaspoon), and then sterilize it using some PVP-I until I get a medium brown color. Ideally, this solution could also be boiled for additional sterilization (though with a lid, to avoid too much water loss, imbalancing the osmolarity), but oftentimes I just use it after it has sat for about 10 minutes. The wash is then applied under pressure via 60 mL irrigation syringes. I mix my own wash solution, because a lot of wash is better than a little wash, and large volumes of sterile saline solutions are expensive.
Thanks. Any idea how long the solution would last if stored, 2-liter soda bottle kept in the dark maybe? Make a new batch each year? I do need to get larger syringes, think my largest is a 20mL.

Should have gotten some before pics, but here's the after.

Image

Think they are mattress sutures, mix of vertical and horizontal? I should have asked the vet, we'll be taking them out in two weeks so will find out then. Not sure how this one might have healed under secondary intent, think we might have had to crate/cage her to keep her from moving much - maybe for a couple weeks or more. Lots of gauze/bandaging supplies would be needed too, but suppose some could be re-used after boiling in a pinch? But, no way we'd be able to suture that wound either, which I guess leaves glue or staples to close the surface and hope it didn't develop an abscess with a gap underneath (with the help of antibiotics). When I explained to the vet our problem trying to bandage the wound and asked for suggestions, she said they don't even try to bandage them - but unsaid was "so bring them to us and we'll close the wound so you don't need to worry about bandages". Need to get some hair clippers too, it's obvious the vet didn't shave her so guess some stubble isn't a problem.

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Re: K9 First-Aid fail

Post by Stercutus » Fri Jun 15, 2018 7:38 am

That's a big dog... Wonder if wrapping her hind legs in a blanket would have helped here, stop her from being able to get her feet under her and we could hold the blanket tightly without directly holding her tightly? Just thinking out loud.
If we could not get him under control we would actually put his head in a pillow case. An English Mastiff has jaws that can easily wrap around a thigh. He would never bite down even when thrashing around (with family anyway) but it is enough to scare the crap out of you. Normally whatever needed to be done was in the body.

There was a case when he had a pocket in his ear that we wanted to drain. He ended up going to the vet for that one. It takes an amazing amount of anesthetic to knock out a 210lb dog. So said the vet.

This dog looks to be slightly smaller than our dog to get the idea. I had some pics posted up of him years ago but they went away with photobucket.

Image

BTW if you ever want a giant breed of dog that will:
follow you around everywhere,
shake the ground when he comes running at you,
eat two pounds of food a day,
leave a pattern of slobber on a 12' ceiling and every wall in your house,
be capable of running down and killing game as large as woodchucks and big beavers with ease,
scare the actual crap out of trespassers and package delivery people,
be gentle with kids,
be a very useful first and second line of defense,
Be an awesome guard dog,
Terrible watch dog (when you are not home),
and an excellent judge of character and intent of others... there's your dog.

Since he was the wife's dog, nobody and I mean nobody, ever messed with the wife when the dog was around.
You go 'round and around it
You go over and under
I go through

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Re: K9 First-Aid fail

Post by Iowa_guy » Fri Jun 15, 2018 8:09 am

Stercutus wrote:
BTW if you ever want a giant breed of dog that will:
follow you around everywhere,
shake the ground when he comes running at you,
eat two pounds of food a day,
leave a pattern of slobber on a 12' ceiling and every wall in your house,
be capable of running down and killing game as large as woodchucks and big beavers with ease,
scare the actual crap out of trespassers and package delivery people,
be gentle with kids,
be a very useful first and second line of defense,
Be an awesome guard dog,
Terrible watch dog (when you are not home),
and an excellent judge of character and intent of others... there's your dog.

Since he was the wife's dog, nobody and I mean nobody, ever messed with the wife when the dog was around.

You forgot pull a plow holy shit that is a big dog.

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Re: K9 First-Aid fail

Post by JayceSlayn » Fri Jun 15, 2018 8:24 am

CrossCut wrote: With this one of ours it's a struggle just to trim her toenails, our other one isn't bothered by it and holds still. Had a lab a few years ago that we had to give enemas to about twice a week, he'd lay there and let me without moving. On sedation, have tried diphenhydramine a couple times for calming our dogs for porcupine de-quilling - read it sometimes helps but didn't notice much if any affect.
Dogs are different than humans in metabolism of various drugs, so you might have to source something specifically for them. I know that there are a variety of dog-specific NSAIDs, like carprofen, that work better for them because they don't get as much effect and more toxicity out of human NSAIDs like ibuprofen. I buy animal supplies from Revival Animal Health, but you'll still need a prescription for many of their drugs.
CrossCut wrote:
JayceSlayn wrote:For my basic wound wash on myself and animals: I mix my own 0.9% saline (9 grams of common table salt per liter of clean water - use a scale if you can, otherwise it's just under a teaspoon), and then sterilize it using some PVP-I until I get a medium brown color. Ideally, this solution could also be boiled for additional sterilization (though with a lid, to avoid too much water loss, imbalancing the osmolarity), but oftentimes I just use it after it has sat for about 10 minutes. The wash is then applied under pressure via 60 mL irrigation syringes. I mix my own wash solution, because a lot of wash is better than a little wash, and large volumes of sterile saline solutions are expensive.
Thanks. Any idea how long the solution would last if stored, 2-liter soda bottle kept in the dark maybe? Make a new batch each year? I do need to get larger syringes, think my largest is a 20mL.
I mix my irrigation solutions for each instance and don't usually store them. I don't always make a whole liter, but doing a very thorough rinse out can go through half a liter pretty quick. You could save some for later days of caring for the same wound probably. I've heard a variety of expiration dates for the 10% betadine solutions from stores, ranging from 30 days after opening, to none indicated (assumed to be a few years). A diluted solution, as the kind I describe, should probably err on the shorter side.

The main idea is that a bottle of PVP-I (povidone iodine / Betadine) is pretty cheap, can be found at almost any drug store, and will make a few liters of solution, compared to storing numerous bags/bottles of sterile saline at much greater price. You'd probably still be ahead in rotating a new bottle in your stockpile every year, even if you didn't use up the last one.

As for irrigation syringes: larger syringes just require less refilling, and a 60 mL syringe is about the largest I can use with one hand (the other hand needed for positioning and holding open the wound etc.). Moderate pressure irrigation seems to be generally preferred, but the required pressure and techniques to attain it are not really solid in the literature (e.g. irrigating with a syringe through an 18g blunt needle, but some people press harder than others, etc.). The goal should be to completely remove any foreign debris and dead tissue, but without causing much more trauma to the remaining healthy tissue. You also don't want to drive bacteria etc. deeper into the wound.

Overall, it's not quite a science yet, but there's a good read at Medscape if you have a login (free): https://emedicine.medscape.com/article/ ... verview#a1. Also, re-reading some of that article, it seems that my solution could be tweaked with a little detergent of some kind to help dislodge dirt and pathogens, but I'm not certain if a tiny bit of mild soap (like Dr. Bronner's or something) would be OK.
Rahul Telang wrote:If you don’t have a plan in place, you will find different ways to screw it up
Colin Wilson wrote:There’s no point in kicking a dead horse. If the horse is up and ready and you give it a slap on the bum, it will take off. But if it’s dead, even if you slap it, it’s not going anywhere.

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Re: K9 First-Aid fail

Post by CrossCut » Wed Jun 27, 2018 3:29 pm

JayceSlayn wrote:For my basic wound wash on myself and animals: I mix my own 0.9% saline (9 grams of common table salt per liter of clean water - use a scale if you can, otherwise it's just under a teaspoon), and then sterilize it using some PVP-I until I get a medium brown color. Ideally, this solution could also be boiled for additional sterilization (though with a lid, to avoid too much water loss, imbalancing the osmolarity), but oftentimes I just use it after it has sat for about 10 minutes. The wash is then applied under pressure via 60 mL irrigation syringes. I mix my own wash solution, because a lot of wash is better than a little wash, and large volumes of sterile saline solutions are expensive.
<...>

Can't argue that's a lot cheaper, the main reason I purchased some was it didn't require any prep time to make a batch. Have a few larger 12 oz bottles at home and smaller bottles in the car FAKs. For continuing care making your own would be the way to go. Read some recent studies that antiseptics weren't necessary for irrigation and that they could impair healing by damaging healthy tissue, just clean/potable water was recommended in professional settings. Mixed thoughts on this myself, particularly for a contaminated wound in the zpaw. Seems to me some delayed healing is acceptable if the risk of infection is lessened, it's not likely we'd have tetanus vaccine booster if that was recommended by the guidelines either (although I do keep 2 vials of equine tetanus antitoxin - but the wisdom/folly of that is better discussed in it's own thread I think :) ). We do have a few bottles of Betadine at home and carry a small 1.5 oz bottle in the car FAKs, and I'm inclined to agree with you on it's use in irrigation solutions.

Removed the stitches last night, applied some 5% lidocaine in a petroleum base about an hour before - figured that might help both with the pain and lubricate the skin and sutures for easier removal. Used a needle driver to hold and lift the knot and fingernail clippers to cut one side. Believe they were mostly vertical mattress sutures, the "far-far-near-near" stitching was apparent on some anyway. The patient was cooperative this time at least.

Supplies arrived, in the event a trip to the vet isn't an option next time.
Image

Two (35 staple, wide) skin staplers and removers, two 100-count bottles of 500mg Fish-Flex (Keflex), tissue adhesive (8 sec hold) with 5 applicators, and a case of sensi-wrap self adhering wraps. Still need to get a pair of hair clippers, debating on the $50'ish Amazon's Choice one or just getting a $19.99 one from a discount store. Feeling slightly better prepped to handle something like this now anyway.

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