Trucker’s Critical Care Success Story: Car Accident Recovery
No one wants to see a pet struggling. But if it happens, our highly trained and experienced criticalists at Virginia Veterinary Centers Fredericksburg are here for you. Our team provides the very best care for patients with life-threatening conditions, working hard for the best possible results. Just ask Trucker.
Emergency Presentation
Trucker is a 5 year old shepherd mix who presented to VVC Fredericksburg in January 2024 after being hit by a car. On presentation, he was unable to walk, was hypotensive (low blood pressure), and had decreased responsiveness to stimulation. These signs are concerning for possible head trauma/traumatic brain injury and a possible spinal injury. He was breathing heavily, had epistaxis (nose bleed), and some minor wounds on his front legs. Dr. Parsley and our ER department started him on IV fluids, gave an IV high salt solution to help with suspected brain swelling, pain medications, antibiotics, and oxygen supplementation while he awaited additional diagnostics that night to see the extent of his trauma.
X-rays showed:
A severe tension pneumothorax (free air within the chest outside of the lungs which prevents the lungs from expanding fully)
Suspected ruptured bullae (tearing/rupture of the lung tissue)
Pulmonary contusions (bruises of the lungs).
A large amount of free air was removed from the right side of his chest using a needle in a procedure called thoracocentesis. He was breathing more comfortably after that but because of the contusions, he was still provided with oxygen supplementation.
Some cases of pulmonary contusions are unfortunately very severe and some of these patients do not survive, even with advanced therapies such as mechanical ventilation.
In many cases of pneumothorax and bullae, surgery is required to remove the affected lung lobes to stop the leaking of air. Thankfully, Trucker’s lungs were eventually able to heal on their own and surgery was avoided.
X-rays also showed fluid build-up in his abdomen and retroperitoneum (space behind the main abdominal cavity which contains the kidneys). This fluid was never a large enough volume to sample but was suspected to be blood caused by either damage to the liver/spleen or tearing of small blood vessels. In Trucker’s case, his urinary bladder appeared intact but sometimes rupture of this organ occurs after trauma and can cause free fluid in the abdomen as well. Luckily, most of the time, traumatic bleeds (i.e. a bleed in the abdomen caused by a high impact trauma) do not need surgery. Usually, we place a special bandage, called a mermaid wrap, to help increase pressure in the abdomen and slow down or stop bleeding. However, because of Trucker’s pulmonary issues, this was more likely to cause increased discomfort and trouble breathing so it was not placed. Medications, such as aminocaproic acid, tranexamic acid, and yunnan baiyao can help strengthen blood clot formation to stop bleeding as well. Sometimes these patients require blood/plasma transfusions to help stabilize the blood clots and replace lost blood. Luckily, Trucker did not need these.
Additionally, x-rays showed a suspected fracture to his left scapula (shoulder blade) and fracture to his left zygomatic arch (cheek bone) which usually does not require surgery. There was concern for possible traumatic intervertebral disc disease in his neck. However, x-rays are not the best tool to diagnose this and clinically he was able to get up and walk once his blood pressure improved and the air was removed from his chest.
Critical Care Consult
The next morning he was transferred to Dr. Donahue and the critical care service. Additional air had slowly built back up in his chest and thoracocentesis was repeated. Because of the large volume, the decision was made to place a temporary chest tube in the right side of his chest. This is a stationary tube which stays in the chest cavity and allows veterinary staff to more quickly and easily access the air (or fluid in some cases) when needed. The tube usually stays in place until the patient is discharged. It can sometimes require additional pain control since the tube goes through the muscle and tissue between the ribs but often animals are unbothered by it. Some animals need chest tubes on both sides and some animals have to have a vacuum system set up to continually remove air/fluid because it builds up so quickly. Luckily, Trucker did well with just one chest tube which was evacuated intermittently.
Hospitalized Support
Trucker’s mentation/attitude and ability to walk improved by the next day. There was still a small amount of free fluid in his abdomen but this completely resolved by the 3rd day he was in the hospital. He was eventually able to be weaned off of oxygen supplementation and had very little air build-up in his chest. His bloodwork initially showed a low red blood cell count (because of the suspected bleed into his abdomen) but this number never became low enough to need a transfusion and slowly improved with time. Bloodwork also showed a high ALT which is traditionally considered a liver enzyme however can also increase with muscle trauma/damage. This value improved with time but can take 10+ days to resolve depending on the cause.
Trucker did develop a cardiac arrhythmia called AIVR (accelerated idioventricular rhythm) which progressed to v-tach (ventricular tachycardia). This is common in patients about 12-24 hours after a trauma, a period of very low blood pressure, or significant blood loss. This most likely happens due to a process called ischemia-reperfusion injury. When your tissues/cells do not receive the blood flow and oxygen they require (in Trucker’s case because of likely blood loss into his abdomen), the cells start to die. This affects cells everywhere, including the cells and tissues of the heart muscle. Once blood pressure and oxygen are restored to these cells via better circulation, bi-products from the dead cells get carried through the bloodstream and can affect the heart muscle leading to arrhythmias.
Ventricular tachycardia occurs when the wrong part of the heart generates a heartbeat (the ventricle instead of the atrium) which generates multiple or continuous VPCs (ventricular premature contractions) on an ECG. If the heart rate is high (tachycardia), this can cause blood flow interruptions and sudden death.
AIVR (accelerated idioventricular rhythm) is when the heart is beating abnormally and generates intermittent or short runs of VPCs but the rate is not dangerously high. In trauma cases, this can sometimes be a pre-cursor to ventricular tachycardia or may resolve without further incident.
He was started on IV lidocaine for his arrythmias and eventually was able to be weaned off of this medication. Some patients will require transition onto an oral medication for a period of time but luckily Trucker was able to avoid this.
Recovery
When Trucker was comfortable on oral pain medications, off oxygen, and off the heart medications, he was discharged for continued care and monitoring at home. We saw him again a few days after his discharge for a planned recheck. His ECG looked normal and he overall looked great. His leg wounds were healing nicely and he was breathing comfortably. His family reported that he was doing great at home.
Dr. Donahue and the Critical Care department at Virginia Veterinary Centers (VVC) Fredericksburg is equipped with the skills, training, and advanced equipment to address any emergency that may arise. Should you have any questions please contact us for more information.
