Principles and Protocols in the Emergency Approach of the Critically Patient

It is still a great challenge to ensure the best approach to emergency patients. The continuous advancement of techniques, drugs and equipment was not able to suppress the need to control the response time in emergency care.

Source: Veterinary surgeon at work, removing stitches following minor surgery on an abscess on cat’s face. Patrick von Heimendahl, MRCVS of Clarendon Street Veterinary Surgery, Cambridge, UK with Jules a black tom cat. Andrew Dunn 11 July 2005

Patients with heart disease, diabetes, cancer, kidney disease and liver disease, for example, can suffer severe decompensation at any time, and will need immediate care in the emergency room and further care in the intensive care unit.

In addition to patients with chronic illness who suffer acute decompensation, polytrauma patients form a class of patients that in practically 100% of cases must be aggressively approached in the emergency room.

It is common that the most apparent signs and symptoms and external injuries do not reflect the real severity of the internal impairment, generating a false sense of security in the owners and even in the clinic, culminating in inappropriate diagnoses and conduct.

Therefore, it is extremely important to prepare for the arrival of the emergency patient, not underestimating any clinical signs and always aiming to treat what can cause immediate death, and not just seek a diagnosis.


Emergency care is not similar to any other type of approach in the small animal clinic and each step taken during patient examination has a characteristic differentiation from routine care. The challenge is launched from the moment the body tries to “hide” the main lesions in the compensatory stage and the clinician must be quick to decipher the main alterations and correct them before a decompensatory state starts.

In order to achieve success in emergency care, it is necessary to follow protocols and consensus guidelines, generating a standard of care.

Typically, in human medicine, there is a characteristic distribution of post-trauma mortality, as described below.

Severe trauma with imminent death. It usually occurs due to cerebral concussion, cervical medullary rupture, massive cardiac hemorrhage or in large-caliber vessels. There is an immediate need to restore the patency of the airways and ventilation, contain major hemorrhages and replenish blood volume.

Moderate trauma with deaths occurring within the first hour after the trauma.

From this type of trauma, the “golden hour” concept emerged, a focus of interest for all resuscitation protocols in human medicine. Patients in the second range may not die immediately, but they will certainly die if resuscitation does not occur in the first moment. The big difference observed between the human patient and the veterinarian resides in the fact that the veterinarian usually works as in human pediatrics, that is, the decompensation time is not as long as for adult human patients.

Hence the new analogy to the platinum minute, since, in the case of veterinary patients, all efforts must be concentrated in order to comply with complete resuscitation as quickly as possible. Unfortunately the clock doesn’t start ticking in the hospital, but at the time of trauma. As the first stage of trauma is the compensatory one, there is a loss when trying to identify the main sequelae, initially masked by the body, which can last throughout the entire transport period until arrival at the hospital. All time should be devoted to recognizing major changes in a quick and accurate approach. Screening must be done well, the emergency room and necessary equipment must be at hand.

■ Late death caused by failure to approach during the golden hour. Patients who die days after treatment, as a result of neglected sequelae, aggravating sepsis or procedures performed improperly or at the wrong time.


Udall, Denney Hammond. “The practice of veterinary medicine.” The practice of veterinary medicine. (1954).

Morgan, Carol A., and Michael McDonald. “Ethical dilemmas in veterinary medicine.” Veterinary Clinics: Small Animal Practice 37, no. 1 (2007): 165-179.

Cockcroft, Peter, and Mark Holmes. Handbook of evidence-based veterinary medicine. John Wiley & Sons, 2008.

Dold, A. P., & Cocks, M. L. (2001). Traditional veterinary medicine in the Alice district of the Eastern Cape Province, South Africa: Research in action. South African Journal of Science97(9), 375-379.

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