For locating the approximate area of the heart, put the patient on his/her side and flex the front leg gently -- where the elbow goes across the ribs is where you want to do your chest compressions. For all species except primates, compressions are done on the side (i.e., in lateral recumbency).

I've also used an AED (the veterinary version) in the same manner as we use them for humans.

Checking a pulse in a dog or cat: the jugular artery is in roughly the same location as in a human. The femoral artery is roughly in the same location as in a human. Skinny animals can be palpated on the chest for heartbeat, and the dorsal pedal/plantar arteries are very roughly similar in location to the human versions of those arteries.

In other species: go by the change in color (from pink to blue) and treat accordingly.

So what events are survivable in a dog, after she's been down and getting CPR for a long time?

I understand that the layperson in the field should never give up on a human patient, because expert care can do a lot with what's left, if it's been kept oxygenated. But nobody's coming to scoop up my dog in a well-equipped ambulance - expert care is at best 45min away, and that's with me carrying the dog and driving the car.

Has cardiac care for pets leveled up enough to change the playing field?

Thanks! Any more general first aid tips for pets?

In Seattle, for human CPR, the Medic One system advises (based on randomized trials) that people who don't really know what they are doing^* should just stick to the chest compressions. Would this apply to pets as well, or is the fact that they're less likely to get rapid treatment by paramedics a reason to do the breathing as well?

^* assuming there isn't anyone available who does know what they are doing, obviously. Medic One also does a lot of CPR training, and Seattle has the world's best survival rates for witnessed cardiac arrest.

Camilla @ 2, Thomas @4: Those are good questions.

Under what circumstances might one have to do CPR on a pet (let's restrict this to dogs and cats for now)?

Drowning? Yes, do CPR until you can get to a veterinary hospital, particularly if it's been a cold water drowning -- like humans, no one is dead until they're warm and dead.

Fire/smoke inhalation? Yes, particularly if rescued during the fire and not found afterwards; do CPR and apply oxygen, then take to a hospital for treatment. Smoke inhalation is treated in the same manner as in humans.

Hit by car? That's a tougher call. Is it a chest injury or head injury? Perhaps scoop and run, without worrying about any CPR.

Elderly animals or pets with other pre-existing disease? Doubtful. Heart disease is common in elderly dogs and in cats with hyperthyroidism or renal disease; hypertension is now known to be common in those cats. Most owners should be taking their pets to the vet for at least yearly checkups to prevent and to treat chronic disease. Geriatric workups -- for pets over 7 years of age -- include not just blood tests but also blood pressure checks now.

As for cardiac care, yes, things have leveled up. Veterinary cardiologists do ultrasonograms (echocardiograms) as well as EKGs and blood pressure measurements. The medicines are the same as in humans.

Re: Hit by car -- remember that the patient has teeth, and if it's a cat, claws.

Most animals will bite when in extreme pain, so put either strong gloves or a towel/blanket between you and the pet.

If your cat bites you, get prompt medical attention, if you can't get in to see your doctor, go to an urgent care or ER, you will need antibiotics.

Considering how small some pets are, I would think CPR would be a bad idea if they've been crunched by a vehicle?

I just attended a dog first aid class, and one of the first things we learned to do was how to make a muzzle out of a strip of fabric. Assuming the dog's not wheezing or otherwise choking, it's a wise precaution when dealing with an injured dog; even the sweetest might bite when in pain, and doctors are required to report dog bites. The instructor mentioned that you might get an understanding doc, but if you didn't, you might have a pet who's recovering in quarantine.

Other key take-aways from the class: hope that you have someone to help out if your dog is injured. As was previously mentioned, CPR isn't possible if you have to simultaneously drive to the vet. Also, if your dog has eaten your stash, tell the vet it's marijuana. Many dogs are having stomachs pumped and all manner of expensive and uncomfortable procedures because their owners were too embarrassed to own up to their pot possession. I don't think vets are required to report the pot.

"Pet First Aid, including CPR, with nice manikins to practice on"

Not manikins, presumably. Catkins.

Dogkins. Bunnykins. Odd bodkins. Kithnkins.

Lori @ 6: If the pet is not conscious, that's when the responder would try CPR, as long as it seems reasonable to assume that the heart could function. If the pet is conscious, there's no question of needing CPR.

In other words, CPR assumes an unconscious patient.

For a conscious patient, particularly one who is now aggressive, one might elect not to attempt muzzling it, and simply call for professional assistance.

Tad Brennan @8: Webkinz?

This is another area where I would suggest, if you have a pet, taking a class before the emergency arises.

Highland Animal Sanctuary has some good tips for pet first aid.

The thoughts about putting large dogs on their backs comes from Wag'N Enterprises.

We do carry animal O2 masks since the fire at the Humane Society shelter.

Ginger, agreed, unconscious unresponsive not-breathing pet = CPR.

The "hit by car" advice was for Trey, who asked for other pet first aid tips.

Lots of areas now have emergency clinics for injured pets -- knowing where the closest one is, and having their phone number available would be a good idea.

Jim, so glad to hear you've got the masks. Our fire department does too -- IIRC, someone donated the funds to the department for them.

About thirty five years ago I did a modified CPR (careful breaths, tapping with a finger, on my seven year old's beloved budgie. Beloved by him, not me me as the damned thing shit over everything when it flew about his room. Then when it's little heart beat returned, I fed it sugar water every two hours for 24 hours. It lived another six months making more messes than you can count.

Next time it died, I commiserated with him. I am a slow learner, but I DO learn.

One thing to remember with any CPR is that the patient needs to be on a hard surface, not on a bed, couch, etc. Else when you're doing compressions you run the risk of compressing the cushion, not the chest.

Shouldn't dogs and cats be less prone to choking than humans, since they are evolved to gulp down their food in large bites? I have the impression that with humans the anatomy comprising the mouth, teeth, jaw and throat got smaller as we evolved away from our primate ancestors.

This is assuming dog, cat, etc. doesn't try to eat something not intended to be food.

Since Karen works frequently for an AED manufacturer, I have to ask: are there AEDs for animals? And can the new type of very automatic ones actually be used directly on animals, without worries of over-shocking them? Don't know if their locking mechanism prevents them being used on animals without special prep....

I performed the Heimlich maneuver on our Labrador when he choked on a piece of rawhide. No air was coming in or out. I rolled him onto his side and compressed his ribcage with a quick thrust.

It came up into his mouth, he started breathing, and then he tried to swallow it and it got stuck (but he could still breath) so I reached in and hooked it out.

Tom Whitmore @15: No, the AED are not yet made for veterinary patients. I was using an older model on a nonhuman primate.

A college friend of mine just lost her cat this morning to what appears to have been a stroke. The cat yowled, convulsed and then stopped breathing. Could anything could have been done?

Jon Meltzer @ 18: No, there's nothing we can do for a catastrophic event like that. It's happened to other people on ML, seeing their cats go that suddenly. Regular checkups can reduce the likelihood of a hidden chronic disease, but even those cannot prevent sudden death.

Jon Meltzer @ 18: No. It happened to me with one of my cats 14 months ago - she just jumped backwards, slowly fell over on her side, went into opisthotonus (back arched) and was gone. I did start trying cardiac massage, but then realised that her pupils were fixed and dilated and there was no corneal reflex and... Consensus was probable cardiac arrest. She was five years old. I cherish every day I have with her sister, and hope it wasn't a familial cause.

Lori Coulson @6
If your cat bites you, get prompt medical attention, if you can't get in to see your doctor, go to an urgent care or ER, you will need antibiotics.

Really? I've had cats all my life, and have been bitten and clawed more times than I can possibly count. If you ever meet me, you will see my hands are covered in small white scars.

Without exception, these wounds have healed without incident.

Cheryl #21:

Lori may have been thinking of deeper bites when she calls for the doctor, but I find that even shallow scratches from my cat "start out infected". That is, they need to be disinfected ASAP, or they will swell painfully (and take longer at healing).

Cheryl @21:

I'm talking about deep puncture wound bites, where the cat gets one or more fangs into the flesh -- hands are usually the target, though I know of one case where the cat latched on to the owner's foot right behind the big toe. (The owner was in flipflops, and the over-stimulated moggy mistook the toe for the catnip mouse the owner was pushing with said toe...)

These wounds are difficult to clean, and a cat's mouth is loaded with nasty bacteria. Usual treatment involves two antibiotic shots (each for a different kind of bacteria).

More severe cases (or cases where the patient waited more than 24 hours to seek treatment) may require use of stronger antibiotics that are administered via IV.

If you've ever watched Animal Planet's "Emergency Vets" there's an episode where the cat owner, a pianist, almost lost her hands rescuing her cat from a fall that impaled it on an ironwork fence. The owner was bitten multiple times as she lifted the cat off the fence-post.

Both cat and owner recovered, but ...shudder...

Cheryl @ #21: after my cat was attacked by a dog, I picked her up to put her in a carrier to transport to the vet (yes, I am a dumbass). She bit me THROUGH the knuckle of my left index finger (the proximal interphalangeal joint capsule, for those keeping score). After getting her cared for (she recovered) I took myself to the ER. Fortunately the antibiotic shot + pill combo and vigorous local scrubbing prevented any infection--but boy howdy, it hurt for a good long while.

I too have those little tiny scars all over my hands and forearms, but this was a totally different issue.

A neighbor once asked me to try to "perform the Heimlich Maneuver" on her cat. I gave it my best shot, until the poor thing lost consciousness, without getting anything out of it. I asked the owner if she'd seen what the cat had swallowed, and she told me that the cat had been unable to breathe after getting its throat crushed by a dog.

If I'd known that, I'd have made the even more desperate attempt to perform a tracheotomy, but it was kind of late by then....

Lori Coulson @ 23 ...
More severe cases (or cases where the patient waited more than 24 hours to seek treatment) may require use of stronger antibiotics that are administered via IV.

I can unfortunately vouch that you don't need to wait 24h for an initially innocuous bite to move from "Ow, I'll clean that" to "I hope those red lines don't go any further..."

This is great information, thank you for posting it.

I would add one caution to this information, when it comes to rescue breathing for cats or small dogs: remember, this is a SMALL animal. One of the saddest things I ever encountered at a vet's was a woman with a cat that had been hit by a car and given A/R by the woman's boyfriend. The A/R saved the cat from immediate death, but in the process too much air had been forced into the lungs, doing serious and irreparable damage to them, and the poor animal had to be put down.

skadhu @27: I'll second that. I remember back when I was at veterinary school and the anaesthetist was being very cautious because she was having to use an insufflator to keep a cat oxygenated while the surgeon was trying to remove the pebble the cat had managed to inhale. She was worried because even though it was a paediatric insufflator, it wasn't really meant for something only weighing 3 or 4 kg.

Amazingly (to those of us who know how easily a cat's larynx swells up), despite some considerable length of time with various instruments poking down through the cat's larynx, followed by a tracheotomy (the stone refused to be brought back up through the larynx) then sewing the trachea closed again, the cat stayed nice and pink throughout the operation and its breathing stayed just fine afterwards. How on earth it had been breathing with the stone in there was one of those mysteries.

Not in any way emergent, but I'm having a hell of a time trying to collect a urine sample from my corgi mix. She's very low to the ground and does not appreciate my shoving a shallow aluminum tray under her while she's trying to do her business. The vet was unable to collect any this morning, even via needle. Anyone got any hints?

Is manikin the right word here? It's a model of a dog, not a man, so maybe it's a dogikin.

#27 ::: skadhu

That's why I said "slow breaths to chest rise."

nerdycellist: Sponge on a stick?

I had the same problem with one of my dachshunds but managed adequately with an aluminum pie pan--easier, because he's a male.

Ooh, I figured it out - I used a kitchen ladle. That seemed to work with a minimal amount of dog pee on my hand. I won't know the results until tomorrow. I hope it's just a standard UTI and not stones!

Xeger #26: Me, too, complicated by willful stupidity on my part: if the hand is unusable within a few hours of the bite, that is not generally a sign that it will All Be Better by tomorrow. Red lines to the elbow by morning. Red lines to the shoulder a few hours later (and me thinking, "um, maybe I should see the doctor now?").
That was the only time in my life that my doctor has told me to leave, right now, go to the emergency room - and don't stop at the desk to give them your copay. That last bit gets your attention.
It came to x-rays to see if they needed to open up the arm, an overnight stay on IV antibiotics and no food in case they decided to open up the arm, ten days of Augmentin and a sling. Oh, and, while I was still in the ER, a doctor bringing in another patient, pointing to my arm and telling the patient "You don't want your arm to look like that". Also, being laughed at by a nurse, probably the most painful part of the whole experience. There is a little knot of scar tissue, right where the lines come together on my left hand, as a reminder of the whole thing.

I breed goats, and I actually had to do CPR on a newborn goat kid a few months ago. The doe was pretty much checking out on me -- massive bleeding. She had quads. Got two very dead ones out, and the two behind 'em were not exactly in the best of shape. One had no pulse. Still amazed the two of them lived.

'cellist -- My corgi mix had a huge mass of bladder crystals. Before resorting to surgery, and while the antibiotics did their thing on her UTI, the vet put her on an expensive prescription food and it worked. Soon no more crystals. The special diet doesn't always work as well for all dogs, but it was certainly worth the try and worth the continuing expense ($50 a big bag). Hope your furry friend gets well soon.

Thanks Tracie -

I just got the results from the vets office. They found bacteria but no crystals, thank god. I'm rather relieved that the "blood" I thought I saw in one of her puddles was actually just some dye from the wrapping paper she decided to pee on. No pancreatitis either (why she barfed up her breakfast remains a mystery to me; she only usually barfs on an empty stomach). I'll have to pick up another week's worth of clavimox since I'm told female dogs need a little more help in the UTI department.

I understand this is a fairly common thing for dogs, but it was still a shock to come home to a wretchedly soiled house - from a rescue who's never had an accident in the five years we've owned her, and wouldn't potty in her kennel during her stint at the shelter. At least I now know for sure that she can open the baby gate, the crafty little mutt.

Ledasmom @ 34 ...
Xeger #26: Me, too, complicated by willful stupidity on my part: if the hand is unusable within a few hours of the bite, that is not generally a sign that it will All Be Better by tomorrow. Red lines to the elbow by morning. Red lines to the shoulder a few hours later (and me thinking, "um, maybe I should see the doctor now?").
[ ... ]
There is a little knot of scar tissue, right where the lines come together on my left hand, as a reminder of the whole thing.

Yargh! Red lines to the elbow was more than enough for me! (there were a variety of extenuating circumstances around why I didn't get myself to casualty more quickly once it became apparent that I really needed to...).

The one requiring IV antibiotics didn't scar -- but the cat that (obscured for the squeamish) ovg guebhtu gur cnq bs zl zvqqyr svatre, naq tbg fgbccrq ol obar/svatreanvy left behind some nerve damage (an odd not-quite-blank spot).

Xeger # 38, that sounds painful. Very painful. I have a blank spot on my little finger, but from a kitchen accident, not a cat bite. With the various knife accidents and burn accidents and cat scratches, the hands in general, when tanned, look like it's snowing - as the father in "Danny, the Champion of the World" said about his father's rear end.
I wonder if Jim would consider doing a post on infections, and when one should worry about them? I have never been quite clear on when it becomes necessary to see the doctor for an infected whatever, despite having had several infected whatevers.