Day 1, Part 1: Introduction to Parvo Treatment

Day 1, Part 1: Introduction to Parvo Treatment

Please read all the Day 1 information including the links before your first shift .

Introduction

The first day of parvo training presents a lot of information very quickly. You are not expected to know everything after one read-through, but you will be expected to answer some questions during training. Reading the curriculum beforehand should make the first day less overwhelming. Here’s what you should expect to do on your first day:

• Review all Essential and Care team skills (see the Volunteer Training Checklist)

• Review the Hand Washing procedure as you will be interacting with animals

• Review the causes of death from parvo and how a shelter can address those in our parvo treatment protocols

• Learn how to use the Patient's Medical Chart

• Learn how to perform a basic physical assessment

• Draw up SQ medications

• Watch the trainer administer SQ medications and fluids to a dog

• Administer SQ medications and fluids (and possibly medications) to at least one parvo dog

• Administer oral medications

Attention to Detail

It is very important that all volunteers pay attention to detail. Volunteers spend much more time with the patients than the doctors do. You are the doctors’ eyes and the patient's voice. Let the doctor know if you notice pain, sneezing, congestion, nasal discharge, hair loss, or any other new or changing symptoms.

Parvo Disease Basics

Parvo is a virus. This means that we cannot cure the virus itself, because antibiotics do not kill viruses. We can only offer supportive care until the dog's own immune system is able to fight off the virus. Parvo is transmitted via "fecal-oral" route, meaning the virus is shed from the feces, which can also infect the environment. Another patient can then ingest virus from the environment, or directly from infected feces. Parvo is an incredibly hardy virus and the only household disinfectant that will kill the virus is Bleach at a 1:32 dilution (or stronger). To contain the virus from sick patients, we have a designated Isolation Unit and follow quarantine protocols.  Please review the page What is Canine Parvo Virus? for more detail.

Symptoms

• Inappetence (also called anorexia in vet medicine)

• Lethargy/depression

• Nausea

• Vomiting

• Diarrhea (often extremely liquid may consist almost entirely of blood)

Causes of Death

Dehydration

• 1. • The virus is attacking and killing the layer of cells that line the puppy’s GI tract which causes profound fluid loss through vomiting and diarrhea in addition to lack of food/fluid intake. This rapidly leads to severe and life-threatening dehydration.

     • Dehydration is treated with fluids to rehydrate the patient and antiemetics (medications that prevent nausea and vomiting).

     • Fluids can be administered in several different ways:

       • Subcutaneous (SQ) Administration: Fluids can be administered under the skin(SQ) with a needle, as demonstrated below.

** Sometimes donations will have LRS + Other Drugs. Pay attention!

• • • • • Intravenous (IV) Administration: fluids can be administered directly into a vein through an intravenous catheter. IV fluids can be administered

          • As a bolus- a large amount of fluid given quickly

          • As a CRI (Constant Rate Infusion) using an IV pump. This allows us to give a dog a certain number of milliliters per hour, 24 hours a day.

Secondary Bacterial Infection

1. • Parvovirus also kills rapidly-growing White Blood Cells which normally fight off infection. As the puppy is fighting off parvo with a depressed and overburdened immune system, the patient becomes more susceptible to bacterial infections they would normally be able to fight off.

   • In addition, the puppy’s compromised intestinal tract may begin to allow normal gut bacteria into the bloodstream, where they can wreak havoc.

   • Once infection penetrates the bloodstream—a condition called sepsis—it spreads to the entire body and causes the patient's system to go into shock.

     • Optional: For a more thorough definition of sepsis, skim through the Sepsis Wikipedia Page.

     • Optional: For a more thorough definition of shock, skim through the Septic Shock Wikipedia Page.

     • Shock can also occur with severe loss of blood volume, called Hypovolemic Shock. Optional: Hypovolemic Shock Wikipedia Page.

   • We use antibiotics to combat these infections and prevent them from causing shock.

   • We also use sterile technique to prevent secondary bacterial infection from arising.

Parvo Medications

• We administer medications through several routes:

  • Orally (PO)

  • Subcutaneously (SQ)

  • Intravenously (IV)

• We use several types of medications:

  • Antibiotics - to prevent and treat sepsis

    • Enrofloxacin (known as Baytril) 100mg/ml - must be diluted 1:20 in fluids SQ

    • Polyflex - SQ ampicillin, NOT for IV use!

    • Cefazolin or IV Ampicillin - IV only, in place of Polyflex when on IV's

  • Antiemetics - to reduce and prevent nausea and vomiting

    • Cerenia - stings, most often SQ SID, can be IV BID

    • Metoclopromide (known as Reglan) - SQ or IV

    • Ondansetron - SQ or IV

  • Fluids - to prevent and treat dehydration

    • Lactated Ringers - preferred choice

    • Sodium Chloride - to dilute vitamin c

  • Antiparasitics/dewormers- to kill intestinal parasites

    • Panacur - hooks, rounds, whips

    • Marquis Paste - coccidia

    • Praziquantel - tapeworms

  • Antacids - to reduce damage to the stomach and esophagus from vomiting stomach acid

    • Famotidine (Pepcid) - SQ, IV, or oral

    • Omeprazole - oral

  • Pain medications

    • Bup SR

    • Tramadol

    • Gabapentin

• Treatment Order

  • Triaging - determine which patient is the most critical and treat that dog first (unless otherwise indicated)

  • Treat dogs with URIs, mange, distemper, or ringworm last because these conditions are contagious to other dogs. See Intake and Grouping information. 

Patient's Medical Chart  

Physical Assessment

• Doctors use the volunteers’ observations to determine the treatments, so this is very important

• We look at several parameters to determine overall health

  • Attitude is their demeanor which can be observed from outside the cage. 

    • Are they bright, alert, and responsive (BAR), like a normal, healthy puppy?

    • Are they quiet, alert, but responsive (QAR) to your presence or movement/noise?

    • Are they lethargic - little response to your presence, laying?

  • Gum color is an indication of blood circulation or perfusion. Healthy gums are bubble gum pink, but can also have purple pigmentation on the surface.

  • Temperature - in the ICU we do NOT routinely take temps. We are only looking for extremes (high or low). If a puppy feels hot or cold then always check temp. 

    • A dog’s normal temperature is between 99.5 and 102.5

      • Fever is an indication of systemic infection

      • A low temperature is an indication of shock

    • The temperature of extremities, such as paws, can be an indication of perfusion. A dog’s paws should feel warm, while cold paws are an indication of possible shock. Check the webbing between toes if the patient is on stainless steel 

  • Hydration

    • If a dog is dehydrated the skin will not immediately spring back into place when pulled up or pinched and his gums will feel tacky.

  • Absorbance of SQ fluids

    • Check the chest and under the arm pits to see if SQ fluids, which are administered between the shoulder blades, were not absorbed and have been dragged down by gravity.

    • If SQ fluids aren’t absorbed then the dog may need to be switched from SQ to IV treatment

Medication Section

• Medications and doses are prescribed by the doctor based physical assessment

• Check boxes denote when each drug is to be given. If there is no box, that medication should not be given that shift.

  • Check the box after you have given a medication.

  • If a box has a horizontal line through it, it either should not be given (is discontinued by the doctor) or was not given.

• Draw up your medications and label the drug name and route it is to be administered.

Intake and Output = Consumption and Excretion

• Feeding Guidelines

  • Always initially offer just a spoonful or small meatball size of food initially. Don’t waste a whole bowl of food if the dog is not going to eat.

  • If the dog is drinking water but not eating, offer wet food or baby food mixed with water. This allows them to get some protein, even if just a little.

  • Only offer a half bowl water to dogs that are frequently vomiting. Parvo dogs get very thirsty but if they drink a lot it will make them vomit more.

  • Always remove food from a nauseous dog’s cage. We don’t want them to make them feel more nauseous than they already are. Dogs also have smell memory and, once feeling better, will still get nauseous when smelling a food that made them nauseous before.

  • Dogs not eating a normal amount of need must be syringe fed. 

• Record all food consumption, vomit and feces

  • Note quantity, color, consistency, if there is blood, and anything else abnormal. Doctors will review your notes to edit the treatment plan as needed.

• Cage cleaning - in the ICU we do NOT deep clean kennels daily due to time and staff constraints. 

  • All feces must be flushed down the toilet. You should flush poop instead of throwing it away to prevent the spread of parvo to other parts of the facility

    • Do not clog the toilet

      • Only flush fist-sized amounts of feces/toilet paper at a time. This may take several rounds! Be patient.

      • Do not flush paper towels

      • Watch to make sure everything goes all the way down

  • Replace blankets only if they are sufficiently wet or soiled.

Review the Medical Volunteer Expectations, if needed.

A word document with the Day 1 information can be downloaded from the bottom of the page.