ANSWERS

1. Define first aid.
   The immediate treatment of injured animals or those suffering from sudden illness by whatever means are available.
2. State the 3 aims of first aid.
   
   • To preserve life.
   • To prevent suffering.
   • To prevent the condition deteriorating.
3. State the 4 rules of first aid.
   
   • Keep calm.
   • Maintain airway.
   • Control haemorrhage.
   • Contact the veterinary surgeon as soon as possible.
4. Who is legally entitled to perform first aid on an animal?
   Any person providing that the first aid is an interim measure undertaken to preserve life and alleviate suffering until a veterinary surgeon is able to attend the case. A veterinary nurse does not have greater powers in law than a lay person, but would naturally be much better equipped to deal with an emergency case than an untrained person.
5. Describe the 3 types of emergency and give an example of each.
   
   • Life-threatening (immediate action necessary by the owner at the location of the accident and by the nurse at the surgery) - poisoning.
   • Serious but not immediately life-threatening (the animal is to be brought immediately to the surgery) - severe dysuria (difficulty urinating).
   • Minor (telephone advice enables the owner to alleviate suffering until a veterinary surgeon is able to attend the case) - minor wounds with no arterial haemorrhage.
6. A client telephones the surgery in a panic. Her cat has just been stung by a wasp and is reacting strangely. Explain why it is vitally important to take a full medical history prior to offering advice.
   
   • Establish the exact time of the incident - the occurrence of the sting may have been some time previous but the "strange reaction" may only have just begun. Anaphylactic reactions to stings are rare and symptoms usually manifest themselves immediately following the sting.
   • Establish exactly where the cat was stung. Stings to the face and mouth may be serious as the subsequent swelling may compromise the animal's respiration.
   • Log the cat's name, age, sex and breed as well as the client's details. It is vital to have a contact telephone number in case the client is in a call box or on a pay-as-you go mobile and runs out of money.
   • Ensure that the sting was actually a wasp sting and not that of a bee. A panicking client may make a mistake, and the treatment of wasp stings (which are alkaline and treated with a mild acid such as lemon juice) are different to that of bee stings (which are acidic and treated with bicarbonate). If the client is in any doubt as to the type of sting it is best to advise that the area be bathed with saline.
7. List the important questions that should be asked when taking down details of an emergency case by telephone.
   The client may well proffer facts without prompting, but by accustoming yourself to the list below you will ensure that vital information is not omitted. Always remember that the client is likely to be very worried and must be treated with as much care and patience as the injured animal.
   
   • On what telephone number can the client be contacted? This is vital in case the caller is cut off. In addition, ask the caller's name and that of the animal. Using names will reassure the client.
   • What type of injury or accident has occurred? Advise another member of nursing staff as soon as possible so that the necessary equipment can be made ready for prompt use.
   • How serious is the condition of the animal? The client may not be able to judge this accurately for themselves so be prepared to ask further questions relating to the case in order to obtain information regarding the demeanour of the animal. (It may be useful to ask the client to tell you the colour of the patient's mucous membranes for example).
   • When did the injury or accident happen? If the client does not know, ask at what time was it first noticed that the animal was suffering.
   • What are the species, breed, age and sex of the animal?
   • Is the patient suffering from any pre-existing medical conditions?
   • Where did the accident or injury occur, and where is the animal now? This is essential information if the caller is unable to bring the patient to the surgery.
   • Is the caller the owner of the animal? It may be that the patient is a stray, or that the caller is telephoning on behalf of the owner. Take down the owner's details including name, address and telephone number. If the animal is not registered at the surgery, find out what practice is usually attended.
     
     By spending just a few moments logging the above details, a far better idea of the situation may be obtained. If immediate first aid is required to be given by the caller - offer concise and clear instructions. If in any doubt, pass the call on to a senior veterinary nurse or veterinary surgeon. Next establish whether the patient is to be brought immediately to the surgery by the caller/owner or whether the animal is to be collected by a member of staff. Bear in mind that in some cases, such as following an epileptic seizure - it would not be wise to immediately transport the animal; see Module 8.
8. Give 5 examples of life-threatening emergencies.
   
   • Poisoning.
   • Severe wounds and arterial haemorrhage.
   • Gastric torsion.
   • Severe burns.
   • Tracheal obstruction.
     
     Any condition where severe dyspnoea (difficulty breathing), shock or collapse is suspected should always be treated as a life-threatening emergency.
9. Give 5 examples of emergencies that whilst not necessarily life-threatening do require immediate attention.
   
   • Fractures.
   • Dislocations.
   • Dysuria (difficulty urinating).
   • Wounds and non-arterial haemorrhage.
   • Dystocia (difficulty giving birth).
10. Give 5 examples of minor emergencies.
    
    • Cat bite abscess.
    • Insect stings (unless an animal is stung in the mouth and subsequent swelling compromises respiration or an anaphylactic reaction is suspected - in which case the situation would be classified as life-threatening).
    • Haematuria (blood in the urine).
    • Minor wounds.
    • Aural haematoma (fluid-filled swelling to the pinna of the ear usually caused by trauma or head-shaking).
11. Explain what is meant by the "ABC" of first aid.
    ABC stands for: airway, breathing, circulation; and it is in this order that an emergency case should be assessed.
    
    • A = First check that the animal's trachea is not obstructed. Pull the tongue forwards if the animal is unconscious.
    • B&C = Next ensure that the animal is breathing. If not, listen for a heart beat. If the animal is not breathing but does have a heart beat, commence artificial respiration. If a heartbeat is absent, commence artificial respiration and cardiac massage. Animals that are able to breathe, but with difficulty, should be given oxygen.
    • C = The third stage is to control haemorrhage.
12. Define shock.
    A profound physiological change in the body with circulatory collapse. This condition is produced by severe illness or trauma in which there is a sudden fall in blood pressure, which leads to lack of oxygen in the body tissues. There are several different types of shock, and each is categorised by cause. One example is hypovolaemic shock, which is defined as shock resulting from the reduction in the volume of blood in circulation following haemorrhage or severe burns.
    
    Shock is described in more detail in the Fluid Therapy chapter of Part II.
13. List 6 signs of shock.
    
    • Pale, dry mucous membranes.
    • CRT (capillary refill time) of greater than 2 seconds.
    • Rapid, feeble pulse.
    • Tachypnoea (increased respiratory rate).
    • Cold extremities.
    • Depressed demeanour.
14. List 10 possible signs of pain. An animal may show any combination of these signs but not necessarily all of them.
    
    • Vocalisation.
    • Panting.
    • Tachypnoea (increased respiratory rate).
    • Tachycardia (increased heart rate).
    • Dilated pupils.
    • Heat.
    • Abnormal posture.
    • Depressed demeanour.
    • Aggressive demeanour.
    • Lameness or favouring of an affected area.
15. What is meant by capillary refill time (CRT)? Describe how you would perform assessment of a patient's CRT.
    
    • CRT is a test used to quickly assess shock or circulatory failure.
    • Pressure is applied with the tip of a finger to a pink area of the gum (this causes blanching); upon removal of the pressure the time taken for the gum to return to a pink colour is measured in seconds.
      
      A normal CRT is <2 seconds.
16. The eyes can tell a lot about an injured patient. List abnormalities that may be observed following an accident and explain their significance.
    
    • Discharge present - clear fluid may indicate a ruptured eyeball, blood indicates trauma, purulent (pussy) fluid may be indicative of a foreign body.
    • Third eyelid pulled across the cornea - indicates general malaise, but may be red and swollen if infection or foreign body present.
    • Unusual colour of conjunctival mucosae - pale pink/white indicate anaemia, yellow indicates jaundice, blue/mauve indicate cyanosis (inadequate oxygenation).
    • Corneal opacity - may be as a result of an old injury or cataract but could be indicative of trauma.
    • Nystagmus (involuntary side-to-side movement of the eyeball) - may indicate vestibular disease or brain damage.
    • Mydriasis (dilated pupils) - may indicate a neurological problem.
    • Epiphora (increased tear production) - may be due to the presence of a foreign body.
    • Horner's syndrome (different sized pupils) - dysfunction of the sympathetic nerve supply.
17. Describe what is meant by conscious proprioception.
    This is also known as the "placing" reflex and is the sense of spatial awareness and limb position. A "normal" animal will reach for the ground when lifted slightly.
18. List common sense first aid actions that you would take having performed your initial "ABC" examination.
    
    • Contact a veterinary surgeon.
    • Keep the animal still, quiet and calm.
    • Keep the animal warm (this is especially important in cases of shock).
    • Do not offer any food or water in case anaesthesia is required (fluids by mouth are also contraindicated in cases of vomiting, unconsciousness or severe oral injuries).
    • Keep any dressings clean and in place.
    • Prepare further equipment/drugs ready for the arrival of the veterinary surgeon.
    • If the owner of the animal is present, keep him/her informed as to the progress of the animal (it is a nice gesture to ensure that a colleague offers tea or coffee).
    • Observe the patient's vital signs very closely and keep accurate records.
    • Assist with fluid therapy and the administration of the necessary medication under the direction of a veterinary surgeon.
      
      A student veterinary nurse should never be expected to deal alone with an emergency.
19. List 5 vital signs to be assessed when monitoring a critical care case. State the normal ranges for each in both cats and dogs.
    
    • Respiration rate/depth/character - Cats 20-30 breaths/minute, Dogs 10-30 breaths/min (small breeds tend to have a faster respiration rate that larger breeds).
    • Pulse rate/rhythm/depth/character - Cats 110-180 beats/minute. Dogs 60-180 beats/minute (again, small breeds have a faster pulse rate).
    • Mucous membrane colour - should be pink.
    • Capillary refill time - < 2 seconds.
    • Temperature - Cats 38-38.5° C, Dogs 38.3-38.7° C
20. Name 4 pulse points and explain where on the body they are found.
    
    • Coccygeal artery - ventral aspect of the tail base.
    • Digital artery - palmar aspect of carpus.
    • Femoral artery - medial aspect of femur.
    • Lingual artery - underside of the tongue.
21. What is meant by a pulse deficit?
    A pulse deficit describes a pulse rate that is lower than the heart rate.
22. In addition to the vital signs listed in your answer to Q19, list other important facts to be monitored and recorded.
    
    • Incidences of vomiting (Note the type, quantity and frequency).
    • Hydration status.
    • Defecation (note any abnormalities such as blood present or diarrhoea).
    • Urination (again note an abnormalities such as haematuria or tenesmus).
    • Appetite & thirst if the patient is able/allowed to eat/drink voluntarily.
    • Weight (this helps to indicate whether the animal is receiving adequate nutrition throughout the period of hospitalisation).
    • General attitude and demeanour.
    • Medication given (state the route and time in addition to the drug, strength and quantity).
    • Observation of dressings (ensure that these are kept clean and dry and changed regularly under the direction of the veterinary surgeon).
    • Close monitoring of other equipment such as urinary catheters and intravenous cannulae (catheter care is described in detail in the General Nursing chapter).
    • Close monitoring of any wounds (and prevention of patient interference).
    The General Nursing chapter contains further useful advice regarding the nursing care of hospitalised patients.