Road traffic accidents are one of the most common reasons pets are brought to Sunset Vet. In fact these injuries are far more common in Bali than in pet populations of Australia, USA, Europe etc because of a number of reasons. Firstly the amount of traffic on the road in Bali, and the tendency of dogs to dart out unexpectedly. Secondly the fact that so many dogs are free roaming, and not kept confined within a garden or yard. Many of these free roaming dogs are not in fact strays, but have owners who let them wander somewhat. The model of pet ownership here in Bali is very different from the West, which leads to these kind injuries happening more frequently.
When a dog or cat is hit by a car or motorbike the natural reaction of the pet owner (or Good Samaritan who finds the poor animal on the street) is to be primarily concerned with wounds or broken legs. However wounds and broken legs are rarely life threatening, and it is in fact the ‘hidden’ injuries inside the thorax or abdomen that are of a far greater concern to vets who are triaging the injured patient.
When a patient is first brought to Sunset Vet having been hit by a car or motorbike the most urgent aspects to examine are:
- a) Is the patient in hypovolaemic shock due to fluid loss, requiring aggressive fluid therapy or transfusion?
- b) Is the patient in any respiratory distress, in other words can he/she deliver oxygen to the vital organs and tissues (is oxygen supplementation required, and/or emergency treatment of air or fluid in the chest preventing lung expansion)?
After those issues have been dealt with, the next issue to deal with is pain relief. Unfortunately in Indonesia, opiate drugs such as morphine and its derivatives are not licensed for use in veterinary medicine, which severely handicaps a veterinarian’s choice of pain relief drugs. Medicines that are available are non-steroidal anti-inflammatory drugs, tramadol and local anesthetic drugs such as lidocaine. Pain relief must given at the earliest opportunity, to optimize animal welfare.
What are the most common injuries with road traffic accidents?
a) Head trauma
During triage vets will perform a basic neurological exam to assess whether there is any evidence of raised intracranial pressure or brain injury. This can be an emergency requiring urgent administration of medication to reduce the pressure in the brain and prevent death or permanent disability.
b) Thoracic trauma
Breathing difficulty is a true emergency and the most common traumatic thoracic injuries are either pulmonary contusions (where part of the lung can no longer inflate normally due to being filled with blood) or pneumothorax, where air is trapped in the pleural space, preventing the lungs from expanding. Little can be done to treat the former other than oxygen and supportive care, but the latter urgently requires the air to be aspirated with a needle so that the lungs can inflate normally. Sucking just 20ml of air out is usually enough to save the animal’s life.
c) Diaphragmatic hernia
Being hit by a car can cause a sudden increase in abdominal pressure, which can cause the diaphragm to rupture. The diaphragm is a muscular organ that contracts to create negative pressure in the thorax so that air is sucked in. When this no longer functions due to a hole, the animal is forced to use its abdominal muscles to breathe. Furthermore, abdominal organs can herniated through the hole in the diaphragm, so that the liver, spleen and intestines are adjacent to the heart. This condition requires surgery as soon as the patient is stable enough to tolerate it.
d) Ruptured bladder
Sudden impact from a motor vehicle accident can cause the bladder to rupture. This may not be immediately obvious as it takes time for the urea levels to build up in the body to a point where the animal starts to show signs of kidney failure. Also the inability to pee, when the animal is not straining to pee, is something not noticed without a long period of observation. The lack of a visible bladder on an Xray is a useful clue but not definitive as an empty bladder in a healthy animal may also not be visible radiographically.
e) Hip dislocation
A common injury in Bali Dogs hit by cars is traumatic hip dislocation. The hip is a ball and socket joint held in place by several ligaments. When these ligaments are ruptured the ball pops out and must be pushed back in within a day or so or else the muscle contracture makes it extremely difficult to fix it without surgery. If the hip can be popped back in (under sedation or general anesthesia of course), the dog usually wears something called an Ehmer sling for several weeks while the tissues heal, to stop it popping back out again. Some dogs will require surgery regardless.
f) Spinal fractures
When a dog is brought to Sunset Vet unable to move its back legs, the first thing the vet will do is a neurological exam to see whether the back legs are intact. The absence of deep pain is a very poor prognostic indicator – this is tested by pricking the dog’s back paws with a needle and looking for a response from the head end. The absence of any reaction suggests – if the mentation is normal – that the dog cannot feel the needle and there is likely to be a sever spinal injury. Xrays will then confirm this dreadful scenario, and the owner is faced with the difficult choice of nursing a permanently disabled dog with faecal and urinary incontinence, or euthanasia.
g) Leg fractures
Although broken legs are very painful, they are not life threatening to the dog and with time and money they can usually be fixed so the dog can walk normally again. At Sunset Vet broken legs are treated using a variety of orthopedic implants such as bone pins, plates, wires and external fixators. Usually budget is the constraining factor, particularly for street dogs.
Sunset Vet offers veterinary services via their Kuta (24hr) and Ubud (8am-10pm) clinics. For further information or to make an appointment call them on 03619348915 (Kuta) or 0361975296 (Ubud), or visit www.sunsetvetbali.com or www.facebook.com/sunsetvetbali or Instagram: sunset_vet_bali
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