Crashing Puppy/Shock Protocol

This is the general DVM protocol followed when a patient is in shock when intake is done, or when a current patient is having full-blown symptoms and starts crashing.

Signs

Signs of shock: 
  • comatose
  • pale, grey, tacky and/or white gums
  • thready pulses
  • lateral recumbency
  • non-responsive
  • very weak, cannot stand
  • cannot swallow

Procedure

  1. Place IVC - ASAP, even if it means you don’t scrub. Shaving helps. 
  2. Hetastarch - 10ml/lb. Over 5-15 minutes, or as fast as it will go. During hetastarch:
    1. Warmth –  "burrito" the patient in blankets, covered with a heating pad set on LOW, with only catheter paw sticking out. Do not remove from burrito unless essential because heat must be trapped inside to warm patient.. 
    2. Rectal Temp - alert vet if feverish (above 102.5) (most will be cold), do not remove burrito blankets 
    3. Dextrose 50% - IV repeatedly (3cc/10lb) every 3 minutes (set up a timer) until you hook up patient on pump with dextrose later. 
    4. Call the vet on-call 
  3. Assess - After hetastarch is finished, assess gum color and feet temperature (should be warm) 
    1. If still cold feet, gray gums: Repeat Heta Bolus
    2. Do not give a third bolus without doctor advice.
  4. Bloodwork - get a PCV/TP. This will allow the doctor to formulate a plan.
  5. Force Feed - Once warm, start force feeding if patient is swallowing and not vomiting. If not swallowing, try IV dextrose boluses and dextrose on the gums until patient will allow better food. 
  6. Pump - Place on IVF at 3x maintenance (3ml/hr/lb) for the next 24 hours. Start regular treatment. 
  7. Offer food mixed with water - do not give plain water (more likely to vomit)