Urgent

Please note: We now only provide emergency services to our own clients. This is to ensure the quality of emergency care. Unfortunately, we have been forced to take this step due to the enormous increase in our workload. If you are not a client of ours, we ask that you contact your own veterinarian. All veterinary clinics have their own emergency service policies.

In general, the following situations are considered emergencies. Keep in mind, however, that an animal that occasionally vomits or has diarrhea is not an emergency, nor is a dog with an itchy skin condition caused by an allergy. Emergencies are situations that cannot wait until the next day.

For more information about all kinds of trauma: click HERE

Be careful when treating injured animals: they’re often in a lot of pain and will bite very hard! Put a strap around their muzzle if necessary: nobody benefits from a rescuer with hands that have been bitten to pieces!

Allergic reactions that can lead to serious problems are anaphylactic reactions, in which the immune system mounts a massive response to a trigger that is, in itself, trivial. So we’re not talking here about itching caused by a flea or dust mite allergy, but about an acute, life-threatening situation.
Common triggers include insect stings, insect bites, certain food allergies, and contact allergies.

Symptoms: swelling of the face, eyelids, ears, and lips. Redness of the skin, severe itching, and sometimes diarrhea and/or vomiting. The symptoms develop rapidly, within 20 minutes of contact with the causative substance. In extreme cases, the animal goes into shock.

Anaphylactic shock is a rapid, severe reaction of the body that, if left untreated, can quickly lead to death! Symptoms: acute collapse, pale mucous membranes, rapid, weak pulse, cold feet, and coma. Vaccinations and bee stings are the most common causes of anaphylactic shock. This is one of the reasons why a vaccination must be administered by a veterinarian. The reaction occurs very quickly after the vaccination, before the pet has even left the clinic. Anaphylactic shock is fatal if the veterinarian does not intervene.
In cases of anaphylactic shock, the liver is the primary “shock organ” in dogs, while in cats it is the intestines and lungs. This means that a large number of reserve blood vessels open up in these organs, causing blood circulation to stagnate.

An animal that is having severe difficulty breathing should be examined by a veterinarian. There are many possible causes of difficulty breathing.

Vomiting and diarrhea are not diseases, but symptoms of an illness. It is important to treat not only the effects of vomiting and/or diarrhea, but also the cause—the underlying illness. Vomiting becomes a medical emergency if it is severe and unrelenting. Occasional vomiting is not a medical emergency. The same applies to diarrhea.

Vomiting
Vomiting is one of the most common symptoms of gastrointestinal disorders that we encounter in animals. Vomiting is primarily a sign of gastritis and can be triggered by ingesting substances that irritate the stomach. Vomiting can also be triggered by irritation of the vomiting center in the brain. Motion sickness and toxins (poisonous substances) released during disease processes elsewhere in the body can cause vomiting, even when the gastrointestinal tract is healthy.
Vomiting is usually preceded by nausea, which is characterized by drooling and frequent smacking of the lips. This is followed by abdominal contractions, and the stomach is emptied. After the stomach contents are expelled, clear vomit containing gastric juices is produced. If the vomiting persists, bile appears in the vomit; it then becomes yellow and foamy. Later still, small flecks of blood may be seen in the vomit. Vomit that smells like feces indicates (severe) intestinal problems, including an obstruction (ileus). It is important to determine whether this is actual vomiting or so-called “regurgitation.”

Regurgitation is the expulsion of food, saliva, or water that has not entered the stomach. It resembles vomiting but is not accompanied by the wave-like movements of the abdomen, and usually occurs immediately after eating or drinking. We see regurgitation in cases of esophageal abnormalities, such as obstruction by a tumor or a piece of bone, etc., and in cases of esophageal paralysis.
When an animal vomits, it loses significant amounts of fluid and salt. This leads fairly quickly to metabolic problems. Preventing water and food intake is the best way to prevent vomiting. They want to drink so they can vomit, but on balance, they lose more water by vomiting it up than they have taken in!
It’s best to remove food for 24 hours. Give water in very small amounts at regular intervals.

How can you check for dehydration?

1. Turgor: the elasticity of the skin. Pinch the skin on your neck or back and release it: it should snap back into place quickly; if a “ridge” remains, this indicates dehydration.
2. Eyes: If they appear “sunken,” the animal is dehydrated.
3. Gums: Run your finger over the gums. Dry? Dehydrated!
   Dehydrated animals must be treated immediately with IV fluids.

Small Intestine Diarrhea
The gastrointestinal tract consists, broadly speaking, of the small intestine and the large intestine. These two “sections” present different symptoms when they are diseased. The small intestine serves to break down food components and convert them into substances that can be absorbed into the bloodstream. To do this, the small intestine breaks down fats, proteins, and carbohydrates into their building blocks, using enzymes from pancreatic juice, bile salts from the gallbladder, stomach acid, and large amounts of water.
A poorly functioning small intestine causes large volumes of watery diarrhea. The sick animal can usually hold it in, but once outside, the stool is expelled in a powerful stream. The odor is usually unbearable. The diarrhea consists of undigested food, namely fats and proteins. It is accompanied by significant fluid loss, and the animals can quickly become dehydrated. Small intestine diarrhea is caused by eating contaminated (spoiled) food, viruses (parvo, coronavirus, distemper), coccidiosis, toxins, etc. Vomiting is very common prior to the onset of diarrhea. Very dark diarrhea often resembles tar, which is due to the presence of blood.
If the animal is not vomiting, treatment consists of water, easily digestible food (if necessary, fast for 1 day first, drinking only water), and anti-diarrheal medication. The easily digestible diet consists of white rice, cooked chicken, rusks, crackers, yogurt, buttermilk, weak tea, etc., and if you find that too difficult to prepare, you can
obtain special easily digestible food through your veterinarian (Hill’s ID Diet is a very good alternative!)
After about three days, you can switch back to a normal diet.

Colonic Diarrhea
The colon serves to temporarily store and thicken the waste products of the digestive process. Loss of this function (or these functions) leads to typical diarrhea. Inflammation of the colon (colitis) is accompanied by small amounts of stool, which are passed very frequently. The stools are small and often have a slimy “coating.”
There may be flecks or streaks of bright red blood present. The animal is often unable to hold in the stool and frequently strains intensely to pass it, as if there were a blockage (similar to when they have eaten bones that are stuck in the rectum). This increased frequency of defecation accompanied by straining is typical of colitis and is not seen in small-intestinal inflammation. Furthermore, this colitis-related diarrhea does not smell particularly bad, although it is certainly not a pleasant odor.
Colitis is caused by allergic reactions, nervous reactions due to stress, (whip)worms, and certain toxins. It can also occur in connection with autoimmune diseases and tumors. Usually, blood in the stool is not a cause for major concern. Cats (usually long-haired) often have colitis with small amounts of blood in their stool, caused by hair in the intestinal contents.
Colitis is often treated with fairly strong anti-inflammatory medications. Sometimes a diet high in crude fiber is sufficient, and sometimes the veterinarian prescribes medications to relieve severe cramping.

Normal Birth
The body temperature drops to about 37ºC approximately 24 hours before labor begins. The first signs of labor are: restlessness, licking the vulva, scratching in the whelping box, frequent urination, and whining/squeaking/barking/meowing. During contractions, dogs and cats lie on their sides. The discharge is initially clear and gradually becomes bloody. Most animals (both dogs and cats) give birth to their litter within a timeframe of 2 to 6 hours, with intervals of 10 minutes to an hour and a half between the birth of each pup or kitten. Longer intervals are not normal. A placenta should be expelled after each birth; however, sometimes several placentas are expelled at once after a few puppies. It is normal for the mother to eat placentas and amniotic membranes, but this can cause diarrhea. Most breeders have their female examined by a veterinarian within 24 hours of giving birth; the vet will usually administer medication to prevent uterine infection and, if necessary, to stimulate milk production.

Abnormal Birth
A difficult birth (=dystocia) is characterized by:
1. Strong pushing contractions lasting 1 hour, without a birth,
2. More than 1 hour between births,
3. Only partial expulsion of a pup,
4. Bloody discharge without a puppy being born,
5. Green/black discharge,
6. Going past due. Some animals are giving birth without showing any signs, resulting in the entire litter dying because the birth is not progressing smoothly.
7. Giving birth to fewer puppies than predicted by the ultrasound or X-ray.

In these cases, the animal must be examined by a veterinarian.
We see difficult births primarily in certain breeds: Bulldogs, Lhasa Apsos, Shih Tzus, Chihuahuas, but also in other toy breeds and brachycephalic breeds. Problems are also common in matings where the male is much larger than the female. A prolonged gestation period may indicate a problem. In that case, it may be wise to have an ultrasound performed to determine whether the animal is pregnant, whether the puppies are alive, and how large they are.

Year after year, we encounter a number of cases of gastric dilatation-torsion syndrome—or, simply put, gastric torsion—in our daily practice.

It is a condition that occurs primarily in large breeds, but it can also occur in medium-sized breeds. Every owner of a somewhat larger dog should take the following information to heart so they know what steps to take if the symptoms of gastric torsion appear.

The cause of the condition is unknown, but it is clear that eating and/or drinking too much at once—especially if the animal then engages in vigorous romping, running, or playing—significantly increases the risk of gastric torsion.
Gastric torsion is a condition that generally leads quickly to a life-threatening situation, and without treatment, most animals die within a few hours.

Gastric torsion begins with a rapid buildup of gas in the stomach, causing it to expand significantly (dilatation). The distended stomach then twists around its suspensory ligaments, causing the stomach’s entrance and exit to become tightly twisted shut, preventing the gas from escaping. The blood supply to the stomach and the spleen—which usually twists along with it—is cut off. The distended stomach presses against the chest via the diaphragm, making it harder for the dog to breathe, and compresses the large veins in the abdomen, hindering the return of blood to the heart. The steadily increasing pressure on the chest organs and the progressively worsening blood circulation ultimately cause the animal to go into shock, lose consciousness, and die.

Treatment for gastric torsion is successful in many cases (note: not always!), provided the owner recognizes the symptoms in time and takes action! The most important sign of gastric torsion is a significantly enlarged abdomen. Dogs with gastric torsion get bigger almost by the minute. Tapping the right side of the abdomen, just behind the ribs, produces a hollow sound, as if you were tapping on a drum. The abdomen is tightly distended. Other symptoms include: refusal to eat, dry heaving, frequent stretching, abdominal pain, restlessness, reluctance to lie down, and eventually collapse.

If you notice this combination of symptoms in a dog, you should contact a veterinarian immediately; there is no time to lose. Do not try to persuade your veterinarian to come to your home; this results in an unnecessary—and often fatal—delay. Once at the veterinarian’s office, after the diagnosis is made, the goal is to relieve the pressure on the distended stomach as quickly as possible. Sometimes it is still possible to insert a tube through the esophagus into the stomach, but often the stomach must be punctured through the right side of the abdomen using a long hollow needle. An IV is also started to improve blood circulation. In addition, medications to treat shock are administered. In some cases, as soon as the dog’s condition permits, surgery is required to rotate the stomach (and the spleen) back into place; during this procedure, the stomach wall or the ligament attaching the stomach to the abdominal wall is secured to prevent recurrence. It should be noted that even in dogs that have undergone surgery, gastric torsion recurs in 30% of cases, with the sutures simply tearing apart. Any dog that has had a gastric torsion has a significantly higher risk of experiencing another one than a dog that has never had a gastric torsion!

The recovery phase following gastric torsion is fraught with risks. Many dogs develop complications after successful treatment due to damage to the stomach, liver, or pancreas. Infections and abnormally high blood clotting are also potential risks. That is why these dogs should always remain under observation at a veterinary clinic for a few days.

Preventing gastric torsion is difficult because the exact cause of the condition is not really known. However, there are a number of factors that have been shown to play a role:

• The breed: Larger dogs with deep chests, such as Great Danes, St. Bernards, Weimaraners, Irish Setters, Dobermans, German Shepherds, Bernese Mountain Dogs, and Rottweilers, are at greater risk.
• Feeding frequency: the more meals per day, the lower the risk. Dogs that eat only once a day have a larger (stretched) stomach and are more prone to gastric torsion.
• Eating habits: Dogs that eat quickly are at greater risk, likely because they swallow more air than dogs that eat more slowly. As an owner, there isn't much you can do about this, of course.
• The dog's temperament: Nervous dogs are at greater risk.
• Playing after eating. Dogs need to rest after a meal. Play first, then eat, then sleep—not the other way around! A very well-known example is that of a dog being picked up from a boarding kennel: once home, the dog gulps down a large bowl of water, then goes out to play in the yard and enjoy its newfound freedom, while the owners calmly unload their vacation gear from the car, only to find (too late) their nearly bursting four-legged friend at the back of the yard!

In the Netherlands, overheating in pets is almost always the result of spending too much time in a car that is too hot and poorly ventilated. On very hot days, excessive exertion can also lead to (usually fatal) overheating.

Symptoms:
• Gasping for breath and panting very rapidly
• The tongue is dry, often purple-blue
• The animal is usually unable to stand (collapse)
• The animal loses consciousness

Treatment • Cool the person down immediately in a shower, bath, or under a garden hose. You may also want to use a fan.
• If necessary, apply alcohol to the skin (eau de cologne, etc.) to cool the animal down
• If necessary, use ice water, but do not let the body temperature drop below 39 degrees Celsius
• Let the animal drink small sips of water
• Take the animal to the veterinarian, even if the resuscitation appears to have been successful.

Complications
• Overheating can lead to seizures and brain damage
• Bloody diarrhea is common and is a bad sign
• Kidney failure can develop weeks after the overheating!
• Because clotting factors in the blood are depleted on a massive scale during spontaneous blood clotting in the vessels, a significantly increased tendency to bleed can develop. At that point, the animal is usually doomed.

Many attempts to resuscitate a dying animal fail because people blindly try to apply techniques that work well on humans to animals. The differences in resuscitation techniques between humans and animals are small, but they are crucial to the success of resuscitation. If you take these small differences into account, you should be able to resuscitate an animal just as effectively as a human!
During resuscitation, it is important to check off and complete a number of steps in a specific order.

Ensure a clear airway
The most important thing that keeps an animal alive is oxygen. It is absolutely essential that you first ensure the animal has a clear passage of air to the trachea and lungs.
Many people are hesitant to feel inside the throat of a (large) dog; however, if someone is there to hold the mouth open, this is actually quite manageable.
If the animal isn’t breathing, you should always suspect a complete airway obstruction.
a. Extend the neck and try to clear the throat with your finger.
b. Give 5 or 6 thrusts to the abdomen, directed forward and upward (Heimlich maneuver)
c. Repeat the throat inspection with a finger, then perform the Heimlich maneuver again
d. Strike the back
e. Repeat this, but not for too long:
f. If the obstruction persists, the windpipe must be opened (tracheotomy).

However, keep the following points in mind during resuscitation attempts (in other words, keep thinking logically):
1. If the animal is walking around and/or whining/squeaking, its airway is open!
2. An animal in the agonal stage cannot be saved. Agonal refers to a stage in which the animal occasionally “gasps” for air, without actually breathing. There is usually no heartbeat, the pupils are dilated and fixed, and the corneal reflex (blinking in response to pressure on the eyeball) is absent. Many animals are rushed to the veterinarian by their owners when they are in this stage, because people think the animal is still alive.

Rescue Breathing
Older CPR guidelines recommend giving one rescue breath every 5 seconds. Today, it is generally accepted that one rescue breath every 1 to 2 seconds is necessary to prevent severe brain damage caused by oxygen deprivation. When performing CPR on an animal, the mouth should be closed (with the tongue out!) and ventilation should be administered through the nose. This makes it virtually impossible to perform a complete CPR procedure alone: you cannot provide ventilation every two seconds without hyperventilating yourself! A second person must be available to take over. Ventilation should be alternated with chest compressions as much as possible.

CPR
If the heart has stopped or is fibrillating (ineffective tremors of the heart muscle), it may be necessary to restart the heart using a “shock response.” You can feel the heart between the ribs, where the tip of your elbow touches the rib cage. If you cannot feel the heart beating, deliver a short, sharp blow to the heart to restart it without using electric shocks. Cardiac massage is intended to take over the heart’s pumping function from the outside. Initially, the primary goal of chest compressions is to restore blood flow through the heart itself (via the coronary arteries). The heart stops beating when breathing stops. However, the heart rarely stops first. Circulation through the heart is achieved by compressing the chest at the level of the third intercostal space, at a normal heart rate. 80–120 rapid compressions per minute are applied to the widest part of the chest (i.e., not too close to the sternum), thereby maintaining blood supply to both the heart and the rest of the body. The head should ideally be positioned slightly lower than the rest of the body to facilitate blood flow to the brain. If necessary, an elastic bandage can be quickly wrapped around the hind legs to help squeeze blood from the legs into the systemic circulation. Abdominal compressions (70–90 per minute) can be performed alternately with chest compressions; this significantly enhances blood flow.
Internal cardiac massage is the most effective method for maintaining circulation. This involves making an incision in the chest and massaging the heart by hand. Due to the high risk of fatal bleeding and infection, we do not perform this procedure on animals.

Medications
Medications should generally be administered intravenously or intratracheally (into the windpipe). This is usually done by the veterinarian.

Assessment Assessment is the next step. Often, a stopped heart can be restarted, but the causes of the cardiac arrest are often still present! Constant monitoring of the heart and breathing is essential: the heart often stops again quickly, and then the whole process starts over.
Heart and Pulse Monitoring: You can usually feel the heartbeat clearly on the lower chest wall. You can feel the pulse on the inner side of the thigh.
Monitor consciousness: If you touch the eye and the animal blinks, it is usually conscious. If you tap around the eye and the animal blinks, it is often truly awake. These are good signs. The pupils are a good indicator of brain function:
Maximally dilated pupils are a bad sign. This often indicates brain death. It appears as if the animal has no irises. Very constricted pupils indicate pain or increased pressure in the brain. Pupils of unequal size indicate a severe concussion.
Keep an eye on the oral mucosa:
The CRT (capillary refill time) is the best way to monitor heart and vascular function. If the mucosa above the upper teeth is pink, and this color returns within 1 second after being pressed, then blood circulation is virtually normal. In cases of shock or poor circulation, the gums appear white.
Pain or serious illness causes the mucous membranes to appear “injected”: the individual blood vessels are clearly visible. Blue mucous membranes indicate a lack of oxygen, not poor circulation. Bright red mucous membranes indicate stagnation of blood flow. In a dead animal, you may encounter all of the above conditions.

As soon as the animal's condition seems to have stabilized, take it to the vet!

What is shock?
Shock is a term commonly used to describe a serious disruption within the body: (very) poor blood circulation. The circulatory system delivers oxygen to the tissues and, consequently, to the body’s cells. Without oxygen, these cells begin to die. In some organs, this cell death begins very rapidly, which further exacerbates the shock.

Blood flows through arteries to the tissues (organs, muscles, etc.) and returns to the heart through veins. At any given moment, only a small portion of all these blood vessels is in use; the rest are closed and serve as a reserve, for example, in case there is a local increase in blood demand (such as during inflammation).

Animals in shock usually have pale mucous membranes, cold ears and feet, and a rapid, weak heartbeat. Shock can result from many causes. We will discuss a few of them.

• Hypovolemic shock: a deficiency in circulating blood volume, as seen in cases of (severe) blood loss. When blood is lost, less blood can flow to the brain, muscles, organs, etc. The body has a safety mechanism (via the autonomic nervous system) that ensures blood is directed to the vital organs (heart, brain), while other parts receive reduced blood flow (skin, intestines). During this process, the cells in these less vital parts of the body, as it were, cry out for oxygen and eventually die.
  As a result, the body’s additional blood vessels open up en masse. The remaining blood cannot fill these vessels sufficiently to generate blood pressure; it simply remains in them. Blood can only flow when there is sufficient pressure, but that pressure is precisely what is lacking. The lack of circulation we are now experiencing is shock.
• Neurogenic shock: In severe situations, the brain can trigger a shock response, in which a signal is (incorrectly) sent to the muscles surrounding the blood vessels to dilate, causing all the blood vessels to open up. This causes a very sharp drop in blood pressure and, consequently, poor circulation, even though the total blood volume remains normal in this case. We see this, for example, in cases of severe startle responses, electric shock, and head injuries.
• Cardiogenic shock:Failure of the heart to pump blood effectively leads to poor circulation and inadequate oxygen supply to the tissues. This results in an increased demand for oxygen, causing the blood vessels to dilate and leading to even worse circulation. The animal, as it were, “bleeds out” into its own “reserve” vascular bed.

Other causes of shock include: infections, tumors, poisoning, drowning, extreme cold, overheating, and hypersensitivity reactions (bee stings, allergic reactions). Shock is often seen in cases of trauma (car accidents, etc.).

A good way to diagnose shock is to check the color of the gums and measure the CRT, or capillary refill time. The CRT is the time that elapses between releasing the pressure on the gums and the return of the pink color. The longer it takes, the worse the condition! Normally, the CRT is 1 second or less, while a CRT of more than 3 seconds indicates a life-threatening condition.
Normally, the gums are a healthy pink. A dog in severe pain has flushed mucous membranes: against a pink background, we can clearly see the vascular pattern. An animal in shock has pale or white mucous membranes. Also check the paws: the pads of the feet usually become very cold during shock. The same applies to the ears.

How do we treat shock?
Shock means that the tissues are not receiving enough oxygen; this is caused by poor circulation or insufficient blood volume in the circulatory system. We correct the volume deficit by filling the blood vessels with intravenous fluids. The oxygen deficiency can be reduced by administering pure oxygen via a ventilator, which is easily done at the clinic but almost never at home. Circulation is restored in the clinic by administering as much fluid as possible as quickly as possible, if necessary even through multiple intravenous catheters. As an emergency measure, the hind legs and abdomen can be wrapped as tightly as possible in elastic bandages to direct as much blood as possible to the vital organs.

Next, if possible, the cause of the shock is addressed as quickly as possible, of course.

Toxic substances enter the body through:

• eating/drinking
• inhale
• absorption through the skin
• (by mistake) injections

Emergency Treatment:
Treatment depends heavily on the type of poison. It is always very important to determine the cause of the poisoning, although this is not always possible. Bring any medication bottles, packaging, vomit, and feces with you to the veterinarian.

In the event of any poisoning, or suspected poisoning, a veterinarian must be consulted as soon as possible before attempting to treat the animal yourself. With some types of poison, you must induce vomiting in the animal, while with other types, you must not!

Common toxins:

• Aspirin: highly toxic to cats. Agitation, cramps, vomiting, drooling, and bloody diarrhea are the most common symptoms.
• Organophosphates: Bolfo and Exil flea drops. Symptoms: drooling, urination, cramps, watery eyes, diarrhea, constricted pupils, muscle tremors, unsteady gait, and seizures. Antidote: atropine.
• Anticoagulants such as rat poison. If possible, bring the packaging with you to the veterinarian, as the type of poison is important for determining the duration of treatment. Symptoms: general malaise, weakness, pale mucous membranes. Additionally: bleeding from the nose, gums, or minor wounds; blood in the urine and/or feces and/or saliva. In severe cases, acute collapse may occur as a result of bleeding in the lungs or abdomen.
• Chocolate: Cocoa powder used to make hot chocolate and dark chocolate in large quantities are toxic. Symptoms: vomiting, diarrhea, hyperactivity, restlessness, muscle tremors, seizures, and a very rapid heartbeat.
• Antifreeze (ethylene glycol): Nausea, staggering, vomiting, and frequent urination are the main symptoms. Just one teaspoon is fatal to a cat, and one tablespoon is fatal to a dog!!!
• Snail poison (metaldehyde). Symptoms: anxiety, muscle tremors, jerky eye movements (nystagmus), and overheating.
• Pyrethrin (found in certain flea control products) is toxic to cats if ingested. This is often seen after applying dog products to cats! Symptoms: cramps, drooling, vomiting, unsteady gait, head tilting backward. Treatment: Thoroughly wash the area where the dog’s flea drops were applied!
• Strychnine (mole poison): prohibited by law. Was often used to deliberately poison pets. Symptoms: seizures, extreme muscle stiffness, hypersensitivity to sounds. Causes a very painful death.
• Toads: The poison is found in the toad’s skin secretions. Symptoms: drooling, swollen red mucous membranes, and seizures. Fatal poisonings occur regularly, especially in Southern Europe!