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Subject: What to do when an animal is hit by a car

Question from Jose:
I work at a veterinary clinic. Several times a year, clients come
rushing in with an animal who has been hit by a car. In fact, this
happens so frequently that there's an industry abbreviation for the
phenomenon, HBC.

Can you detail which sorts of problems resulting from HBC can be
addressed by a local clinic, and which will need to be addressed at a
full service emergency hospital? I think that would be really
helpful information for everyone to know.

Response from Dr Andrea Oncken:
Unfortunately, animals are hit by cars much more frequently than we
would like! It is the most common traumatic emergency seen at our 24-
hour emergency and critical care hospital. We often receive HBC
referrals from local veterinary clinics for continued care once
initial care has been instituted. Depending on the location of the
impact, the speed of the car, and other factors, several different
injuries can occur when an animal is hit. If a hit by car patient
presents to a local hospital, a quick examination should be
undertaken to look for immediately life-threatening emergencies.

Common life-threatening injuries include pneumothorax, or free air
within the chest cavity; head trauma; severe hypovolemic shock;
extensive blood loss; and hemorrhage into a body cavity. Often, if
the injury is severe enough, these animals will not survive a trip to
a critical care center, so the local veterinarian must be able to
perform basic life-saving procedures. If pneumothorax is present,
and the patient is struggling to breathe, a quick thoracocentesis
(chest tap) should be performed. If the air builds back up
immediately or cannot be fully evacuated with a thoracocentesis, a
chest tube may need to be placed. This is often a procedure that is
performed at a referral center, but many times a local veterinarian
is faced with an emergency situation in which they may need to know
how to place a chest tube before the animal can be transferred. If
an animal is in hypovolemic shock, a local veterinarian may need to
place an IV catheter and give quick boluses of sometimes large
amounts of fluids in order to get oxygen to the vital organs.

If ongoing hemorrhage is occurring, boluses should be given carefully
in order to keep from increasing the bleeding. If the hemorrhage is
external, a pressure bandage should be applied (NOT a tourniquet).
Bone fractures are also common injuries with HBC patients. The local
veterinarian may want to apply a splint prior to transfer to prevent
further damage to the limb. If the animal has fractured its spine,
it should be immobilized on a flat board for transport. The most
important therapy a local veterinarian can perform will be pain
control. It should always be assumed that an animal that has been
hit by a car will be in pain, and there is rarely a contraindication
to giving pain medications.

If there is a pneumothorax present, hemorrhaging into body cavities,
injuries to the lungs, head trauma, or severe shock, the patient will
need 24-hour critical care monitoring and further intensive
treatment. Once the patient is stable enough for transport, these
animals should be sent to a critical care facility. Serial blood
pressure monitoring, chest tube care, 24-hour oxygen supplementation,
serial neurologic evaluations, and any necessary emergency
surgical procedures can be undertaken at this facility.

Posted on SHARE Yahoo group Jan. 26, 2005