Veterinary care should include diagnostic tests and subsequent treatment recommendations.
A complete medical history and physical examination will be performed to evaluate for broken bones and/or internal chest or abdominal injuries. Most traumatic injuries are self-evident; however, the diagnosis of trauma may be difficult if the owner does not witness the traumatic event and the dog does not have external injuries. A complete blood count (CBC) is often performed to look for evidence of blood loss (anemia) and a low or high white blood cell count, which can indicate infection or inflammation. The white blood cell count is particularly important if the injury is suspected to be older than 24 hours or if the dog has a fever.
Your veterinarian will likely ask whether you witnessed the accident to determine where your dog was struck.
Tests other than the physical examination often are necessary to rule out the presence of internal injuries. These may include:
A serum chemistry profile allows evaluation of the internal organs such as the liver, pancreas and kidneys. The liver enzymes are usually elevated in a traumatized patient due to direct trauma. Increases in pancreatic enzymes could indicate a traumatic pancreatitis (inflammation of the pancreas). Elevations in kidney blood values could indicate direct injury to the kidneys, rupture of the ureters (ureters carry urine from the kidneys to the bladder), rupture of the bladder or rupture of the urethra (connection between the bladder and the outside). A disruption of the urinary tract is life threatening and requires surgical intervention.
Chest radiographs (X-rays) are essential in a traumatized animal regardless of the animal's appearance. Chest X-rays identify pulmonary contusions (bleeding into or bruising of the lungs), pneumothorax (air in the chest cavity) and diaphragmatic hernia (abdominal organs in the chest cavity). These conditions may be missed with auscultation (listening to the chest with a stethoscope).
Abdominal radiographs are indicated if the dog has abdominal pain, bruising or distension. Abdominal X-rays are used to identify fluid or gas in the abdomen, which could indicate the accumulation of blood or urine or a rupture in the intestinal tract. These X-rays are also used to identify whether the bladder is visible and intact.
An electrocardiogram (EKG) may be run to identify the presence of an abnormal heart rhythm.
Additional diagnostic tests may be required on an individual pet basis, including:
Plain X-rays of the abdomen are not always sufficient to identify a leak in the urinary tract. If your veterinarian suspects a rupture to the bladder or urethra that cannot be identified on plain X-rays, a contrast cysto-urethrogram may be recommended. A contrast cysto-urethrogram is an X-ray taken of the bladder and urethra after a dye has been injected into the bladder. The injected dye outlines the contour of the bladder and urethra and is used to identify urine leakage from the bladder or urethra due to a tear or rupture. This procedure requires general anesthesia.
An IVP (intravenous pyelogram) is a radiographic study to identify the kidneys and the ureters. This study is done when your veterinarian suspects the kidney or ureter has been damaged. This study requires general anesthesia.
Radiographs of the skull are necessary if your dog has suffered severe head or facial injuries. These x-rays help identify fractures that may require surgical repair.
Surgery is considered a diagnostic and therapeutic tool when a wound appears to penetrate the chest or abdominal cavity. These wounds must be explored and repaired to prevent an infection in either cavity.
Thoracocentesis (inserting a needle in the chest to withdraw fluid or air) may be performed to diagnose a pneumothorax or hemothorax if your animal is in respiratory distress.
Abdominocentesis (inserting a needle into the abdominal cavity to withdraw fluid) is often used to diagnose the presence of internal bleeding or urine in the abdomen.
Treatments for trauma/automobile injury may include the following: Hospitalization of several days duration may be necessary to treat traumatic injuries; however, if your pet does not have external injuries and radiographs appear normal, he/she may be released after the examination. Despite a normal physical examination, your veterinarian may recommend one night of hospitalization for observation in the event of late developing problems.
Intravenous fluids are administered to treat or prevent shock.
Supplemental oxygen is given to animals in shock and to those with injuries such as pneumothorax, pulmonary contusions, head trauma, and blood loss.
Animals with head trauma may receive drugs to reduce brain swelling after they have been treated for shock. These drugs may include mannitol. Anticonvulsants such as diazepam or phenobarbital are used to control seizures.
Pain medication such as butorphanol, buprenorphine, fentanyl or oxymorphone is administered to animals with fractures and muscle bruising. Additional pain relief may be provided with non-steroidal anti-inflammatory drugs such as deracoxib, aspirin, carprofen or Etogesic®. Anti-inflammatory drugs may be contraindicated in some animals so check with your veterinarian before giving any medications to your pet.
Antibiotics are given to animals with skin wounds, lacerations and open fractures (the fractured bone punctured through the skin to the outside).
Anti-arrhythmic drugs such as lidocaine or procainamide are administered intravenously or orally to control an abnormal heart rhythm that may result from trauma. The arrhythmias are usually transient (last less than 3 to 4 days) and animals are rarely discharged on heart medication.
If your pet experiences serious blood loss, your veterinarian will administer a blood transfusion or give a blood substitute (e.g., Oxyglobin®). A wrap may be applied to the animal's abdomen to limit bleeding into the abdominal cavity.
Thoracocentesis. During this procedure, a needle is place into the animal's chest to withdraw air or blood that is restricting his/her ability to breathe. If thoracocentesis is not sufficient to deal with the volume of air or fluid, a chest tube may be inserted for several days.
Surgery may be necessary for some injuries; however, it is usually delayed until the patient has been stabilized. Types of wounds/problems that may require surgery include:
Skin wounds and lacerations.
Fractures involving the legs or back. Occasionally a leg fracture may heal with application of a cast. Fractures of the pelvis that do not involve weight-bearing surfaces may heal with 4 to 6 weeks of cage rest.
Bleeding. If your pet experiences internal bleeding that cannot be controlled with blood transfusions and other medical support, your veterinarian may need to do an abdominal exploratory to locate and stop the source of bleeding.
Urinary tract trauma. Surgery is required if any part of the urinary system (kidney, ureter, bladder, urethra) is disrupted and is causing leakage of urine into the abdomen.
Any wound that appears to penetrate the chest or abdominal cavity must be explored to prevent pyothorax (pus in the chest) or peritonitis (infection in the abdominal cavity) from developing.
Hernias (diaphragmatic or body wall) must be repaired surgically. Surgery is delayed for the first 24 hours to allow stabilization of the dog's condition.