Dog Owner's Home Veterinary Handbook.pdf - Mr. Walnuts

THE NERVOUS SYSTEM • 359
Signs of death are no pulse, no effort to breathe, dilated pupils, and soft
eyes. Usually it is impossible to tell at the time of an accident whether such
signs are reversible. Accordingly, begin administering CPR immediately if you
suspect the dog is dead (see CPR, page 9).
At the scene of the head injury, before transporting the dog to the nearest
veterinary hospital, be sure to:
• Handle the dog with extreme care and gentleness. Pain and fright
deepen the level of shock. Cover the dog with a warm blanket.
• Control bleeding as described in Wounds, page 42.
• Place the dog on a flat stretcher as described in Spinal Cord Injuries, page
375.
• Stabilize all fractures, if possible (see Broken Bones, page 15).
• Record a baseline neurological exam (level of consciousness, limb
movements, pupil size).
• Transport the dog with her head higher than her hindquarters; this
helps lower intracranial pressure.
Signs of cerebral edema can appear at any time during the first 24 hours
after a blow to the head. The most important thing to observe is the dog’s
level of consciousness. An alert dog is easily aroused (no apparent brain
swelling). A semi-comatose dog is sleepy but arousable (mild to moderate
brain swelling). A comatose dog cannot be aroused (severe brain swelling).
Cerebral edema is treated with intravenous corticosteroids, oxygen, and
diuretics such as mannitol or furosemide. Seizures are controlled with an
intravenous or oral anticonvulsant such as diazepam (Valium).
Open skull fractures require surgical cleansing and removal of devitalized
bone. Depressed bone fragments may need to be elevated to relieve pressure
on the brain. Antibiotics are often necessary with open fractures to prevent
infection.
Only dogs who are fully alert, are not having seizures, and exhibit no neurological
signs should be permitted to return home. Awaken the dog every
two hours for the first 24 hours at home to check her level of responsiveness.
Any change from an alert status is an indication to return at once for veterinary
evaluation. In addition, be sure to check the dog’s pupils. They should be
of equal size. An enlarged pupil that does not constrict when light is shined in
the eyes indicates pressure on the brain. Also notify your veterinarian if the
dog’s breathing becomes rapid or irregular, if she exhibits any form of muscle
weakness, or if she has a seizure.
The prognosis for recovery depends upon the severity of the brain injury.
When the dog remains in a coma for more than 48 hours, the outlook is poor.
However, if the dog steadily improves throughout the first week, the outlook
is good.