# Veterinary Trauma: Primary Survey and Immediate Stabilization ## Key Takeaways - The primary survey for veterinary trauma follows the ABCDE (Airway, Breathing, Circulation, Disability, Exposure) sequence to rapidly identify and address life-threatening conditions in order of priority, recognizing that hypoxia is a more immediate threat than hypovolemia. - Immediate stabilization involves oxygen supplementation, obtaining intravenous access for fluid resuscitation guided by perfusion parameters (not solely blood pressure), and providing analgesia with opioids, while avoiding NSAIDs in the acute phase due to renal and coagulation concerns. - Shock in trauma is multifactorial, encompassing hypovolemic, obstructive, distributive, and cardiogenic types, and early recognition of compensated shock through subtle findings like mild tachycardia and prolonged capillary refill time is crucial before decompensation occurs. - Neurologic assessment using a modified Glasgow Coma Scale is vital for detecting intracranial injury and guiding prognosis, with particular attention to impact brain apnoea, a phenomenon where head trauma can cause immediate respiratory arrest and subsequent cardiovascular collapse. - Exposure requires a complete physical examination to identify all injuries and assess temperature, as hypothermia is a common complication that impairs coagulation, reduces drug metabolism, and increases mortality, necessitating active rewarming. - Serial reassessment of perfusion parameters, mentation, and temperature is paramount for guiding ongoing treatment and identifying complications like unrecognized hemorrhage or reperfusion injury, with documentation of all interventions and responses being critical. --- Trauma is a leading cause of morbidity and mortality across companion animal, livestock, and wildlife species. In farmed deer and elk, nonspecific trauma is the most frequently reported known cause of death in all age classes, according to producer surveys and diagnostic laboratory submissions [morbidity and mortality in farmed white-tailed deer](https://pubmed.ncbi.nlm.nih.gov/16048010/) and [causes of morbidity and mortality in farmed elk](https://pubmed.ncbi.nlm.nih.gov/16422063/). The first minutes after presentation determine whether a patient survives, and the primary survey is the structured process by which life threats are identified and addressed in priority order. This article serves the practicing veterinarian who receives trauma patients in general practice, emergency settings, or ambulatory field work. It covers the conceptual framework of trauma triage, the ABCDE primary survey, immediate stabilization interventions, and the physiological rationale that underpins each step. Specific surgical techniques are excluded. The companion articles address secondary survey, diagnostic imaging, and salvage resuscitation decisions. The clinical question answered here is direct: in what order do you assess, what do you do when each system fails, and how do you know when your interventions are working? The answer depends on understanding the physiology of shock, hypoxia, and cerebral perfusion, then applying that understanding within a reproducible examination sequence. ## At a Glance | Parameter | Decision or Action | Clinical Rationale | |---|---|---| | Triage priority | Assign at presentation, before full examination | Identifies patients needing immediate intervention | | Airway | Assess patency, cervical spine protection | Hypoxia kills faster than hypovolemia | | Breathing | Evaluate ventilation and oxygenation | Thoracic trauma commonly impairs both | | Circulation | Pulse quality, mucous membrane color, CRT, mentation | Guides fluid resuscitation urgency | | Disability | Neurologic assessment, Glasgow Coma Scale | Detects intracranial injury and guides prognosis | | Exposure | Complete examination, temperature, hemorrhage control | Missed injuries are a leading cause of preventable death | | Resuscitation endpoint | Perfusion parameters, not blood pressure alone | Guides ongoing fluid and vasopressor therapy | ## The Physiology of Traumatic Shock Shock in trauma is not a single entity. Hypovolemic shock from blood loss is the most common, but obstructive shock from tension pneumothorax or pericardial effusion, distributive shock from systemic inflammatory response, and cardiogenic shock from myocardial contusion can coexist or evolve during treatment. The primary survey is designed to detect each pattern through physical examination findings before they become irreversible. Compensatory mechanisms maintain perfusion to vital organs until approximately 15 to 20 percent of blood volume is lost. Tachycardia, vasoconstriction, and increased contractility preserve cardiac output and blood pressure. These compensations fail rapidly once exhausted, and decompensated shock carries high mortality. The clinician must therefore recognize compensated shock through subtle findings: mild tachycardia, prolonged capillary refill time, cool extremities, and anxiety or depression. Cerebral perfusion deserves specific attention. The brain requires continuous oxygen delivery, and hypotension combined with hypoxia produces secondary brain injury that can exceed the primary injury in severity. Impact brain apnoea, the cessation of spontaneous breathing immediately following traumatic brain injury, is a recognized phenomenon in human trauma and has been demonstrated in animal studies [impact brain apnoea in trauma](https://pubmed.ncbi.nlm.nih.gov/27211834/). This reinforces the priority of airway and ventilation management in any patient with head trauma, even when the thoracic examination appears normal. ## Triage and the Primary Survey Triage assigns treatment priority based on physiological derangement instead of the visual severity of wounds. A patient with a small thoracic wound and severe dyspnea outranks a patient with extensive limb lacerations and stable vital signs. The institutional preparation for triage, including staff roles and equipment readiness, determines how efficiently the primary survey proceeds [first aid, transport, and triage](https://pubmed.ncbi.nlm.nih.gov/7879363/). The primary survey follows the ABCDE sequence: Airway, Breathing, Circulation, Disability, Exposure. Each step is performed rapidly, and life threats are corrected as they are found before moving to the next step. The sequence is not a checklist to complete in order, it is a priority hierarchy. A patient in respiratory arrest receives airway intervention before circulation assessment, regardless of suspected hemorrhage. ### Airway Assessment Airway obstruction in trauma results from foreign material, blood, vomitus, or anatomical disruption. In cattle and other ruminants, regurgitation and aspiration are particular risks during recumbency. In all species, the cervical spine must be protected during airway maneuvers when head or neck trauma is suspected. The assessment includes observation of respiratory effort, auscultation of the trachea, and inspection of the oral cavity. Upper airway obstruction produces stertor, stidor, or absent breath sounds despite respiratory effort. ### Breathing and Ventilation Breathing assessment evaluates both ventilation and oxygenation. Thoracic trauma can produce pneumothorax, hemothorax, flail chest, pulmonary contusions, or diaphragmatic hernia. Each impairs gas exchange through different mechanisms. Tension pneumothorax produces progressive hypotension through mediastinal shift and reduced venous return, and it requires immediate decompression. Auscultation, percussion, and observation of chest wall motion are the primary tools in the field. ### Circulation and Hemorrhage Control Circulation assessment begins with pulse quality, heart rate, mucous membrane color, capillary refill time, and mentation. External hemorrhage is controlled with direct pressure, pressure bandages, or tourniquets for exsanguinating limb wounds. Internal hemorrhage is suspected based on abdominal distension, pallor, and progressive shock despite fluid resuscitation. The decision to pursue surgical intervention versus medical stabilization depends on response to initial therapy. ### Disability and Neurologic Assessment Disability assessment evaluates mentation, pupillary light reflexes, and motor function. The modified Glasgow Coma Scale provides a reproducible scoring system for dogs and cats, and similar approaches apply to other species. Serial assessments are more valuable than a single examination because deterioration indicates progressive intracranial pathology. The [RECOVER Initiative veterinary CPR guidelines](https://recoverinitiative.org/) emphasize that neurologic outcome depends on maintaining cerebral perfusion and oxygenation throughout resuscitation. ### Exposure and Temperature Exposure requires a complete examination of all body surfaces, including the thorax, abdomen, limbs, and perineum. Hypothermia is a common complication of trauma, particularly in small patients and after fluid administration. Cold patients have impaired coagulation, reduced drug metabolism, and increased mortality. Active rewarming begins during the primary survey when hypothermia is detected. ## Immediate Stabilization Principles Stabilization begins with oxygen supplementation for any patient with respiratory compromise or suspected shock. Intravenous access is obtained early, and fluid therapy is initiated based on perfusion parameters. The [AAHA/AAFP fluid therapy guidelines](https://www.aaha.org/resources/2024-aaha-fluid-therapy-guidelines-for-dogs-and-cats/) provide a framework for fluid selection and rate planning in small animal patients. Crystalloids are the initial choice for most trauma patients, but colloids, synthetic hemoglobin-based oxygen carriers, or blood products may be indicated depending on the nature and severity of blood loss. Analgesia is an essential component of stabilization. Pain increases sympathetic tone, worsens shock, and complicates assessment. Opioids are the mainstay of trauma analgesia across species, with dosing adjusted for the degree of cardiovascular compromise. Nonsteroidal anti-inflammatory drugs are avoided in the acute phase due to renal and coagulation concerns. The response to initial resuscitation is the most important prognostic indicator. Patients who stabilize with modest fluid volumes have different management requirements than those who remain hypotensive despite aggressive therapy. Serial reassessment of perfusion parameters, not a single blood pressure reading, guides ongoing treatment. The [MSD Veterinary Manual](https://www.msdvetmanual.com/) provides species-specific reference ranges and monitoring guidance for the trauma patient. ## Species and Context Considerations The primary survey applies across species, but practical adaptations are required. Ruminants and horses are difficult to position for thoracic auscultation and may require standing examination. Wildlife patients present unique challenges in handling and stress reduction. Production animals may be evaluated in field conditions where diagnostic equipment is limited, and euthanasia decisions may be influenced by economic and welfare considerations. The [AVMA practice resources](https://www.avma.org/resources-tools) and [WOAH terrestrial animal health standards](https://www.woah.org/en/what-we-do/standards/codes-and-manuals/terrestrial-code-online-access/) provide guidance on professional obligations and welfare standards that apply across practice settings. ## Structured Primary Survey Checklist The primary survey is a standardized sequence, not a menu of optional tests. Every trauma patient receives the same initial sweep, in the same order, regardless of presenting complaint. The sequence is Airway, Breathing, Circulation, Disability, Exposure. Each step has explicit endpoints that must be met before moving to the next. If an endpoint is not met, the clinician intervenes immediately and reassesses before proceeding. | Step | Assessment | Endpoint | Common Failure Mode | |------|-----------|----------|---------------------| | Airway | Patency, stertor, foreign material, jaw or laryngeal trauma | Unobstructed passage of air with no audible noise | Tongue or soft palate occlusion in brachycephalic breeds | | Breathing | Respiratory rate, effort, lung sounds, thoracic palpation, pulse oximetry | Rate within species reference, no paradoxical effort, SpO2 above 94% | Tension pneumothorax presenting as progressive dyspnea | | Circulation | Mucous membrane color, capillary refill time, pulse quality, heart rate, blood pressure | Perfusion parameters within reference, no active hemorrhage | Occult intra-abdominal hemorrhage with normal external exam | | Disability | Mentation, pupil size and symmetry, postural reactions, Glasgow Coma Scale score | Stable or improving neurologic status | Impact brain apnoea causing respiratory arrest after head injury | | Exposure | Full body examination, temperature, wound inventory | All wounds identified, hypothermia corrected | Missed penetrating wound in a thick-haired or recumbent patient | The checklist is performed in under two minutes in a stable patient. In an unstable patient, the sequence becomes iterative: the clinician addresses the immediate threat, then returns to the start of the survey. A patient who arrests during the survey requires immediate transition to cardiopulmonary resuscitation following the [RECOVER Initiative Veterinary CPR Guidelines](https://recoverinitiative.org/), which provide evidence-evaluated protocols for basic and advanced life support. Documentation begins at the first assessment. Record the time of each survey, the findings at each step, and the specific intervention applied. Serial reassessments are more informative than a single snapshot. A patient with a normal initial survey can deteriorate within minutes, particularly with thoracic or abdominal hemorrhage. ## Decision Tree for Immediate Interventions The decision tree branches at each survey step. The clinician selects an intervention based on the specific failure identified, then evaluates the response before proceeding. **Airway branch.** If the airway is obstructed, position the head and neck in extension, clear visible debris, and suction if available. If obstruction persists, place an endotracheal tube. In patients with maxillofacial trauma that prevents orotracheal intubation, a temporary tracheostomy is indicated. Brachycephalic breeds require particular attention because their anatomy predisposes them to obstruction even with minor trauma. **Breathing branch.** If ventilation is inadequate, provide supplemental oxygen and assess for thoracic injury. Decreased lung sounds with hyperresonance on one side suggests pneumothorax. Perform thoracocentesis if tension pneumothorax is suspected. Flail chest segments require oxygen, analgesia, and careful positioning. If respiratory effort remains inadequate despite these measures, institute mechanical ventilation. **Circulation branch.** If perfusion is poor, obtain intravenous access with two large-bore catheters. Begin volume resuscitation using the [AAHA/AAFP Fluid Therapy Guidelines for Dogs and Cats](https://www.aaha.org/resources/2024-aaha-fluid-therapy-guidelines-for-dogs-and-cats/) as the framework for fluid selection and rate planning. Apply direct pressure to any external hemorrhage. Do not use tourniquets as a first-line measure, they are reserved for exsanguinating limb hemorrhage that cannot be controlled by pressure. If the patient remains hypotensive after initial fluid resuscitation, consider blood products and reassess for ongoing hemorrhage. **Disability branch.** If mentation is depressed, maintain oxygenation and perfusion as these directly affect cerebral oxygen delivery. The phenomenon of impact brain apnoea, described in the human trauma literature, demonstrates that head injury can cause respiratory arrest followed by cardiovascular collapse, and this pattern should be anticipated in veterinary patients with cranial trauma [impact brain apnoea as a cause of cardiovascular collapse in trauma](https://pubmed.ncbi.nlm.nih.gov/27211834/). Serial neurologic assessments document progression or improvement. **Exposure branch.** After the patient is stabilized, perform a complete physical examination. Clip hair over suspected wounds. Measure rectal temperature. Cover the patient with warm blankets and use active warming devices if hypothermic. ## Monitoring Parameters and Their Interpretation Monitoring begins immediately and continues throughout stabilization. The parameters selected depend on the patient's status and the available equipment. Heart rate and pulse quality reflect perfusion but are nonspecific. Tachycardia occurs with pain, hypovolemia, and anxiety. Bradycardia in a trauma patient suggests increased intracranial pressure, severe hypoxia, or impending arrest. Blood pressure, measured oscillometrically or by Doppler, provides a more objective perfusion assessment. Hypotension in a trauma patient is hemorrhage until proven otherwise. Respiratory rate and effort are monitored continuously. Pulse oximetry detects hypoxemia but does not detect hypoventilation. Capnography provides a more complete picture of ventilation and is particularly valuable in intubated patients. End-tidal carbon dioxide below the reference range may indicate hyperventilation, low cardiac output, or pulmonary embolism. Mentation is the most sensitive indicator of cerebral perfusion. A patient who becomes progressively dull despite adequate oxygenation and blood pressure requires immediate reevaluation for intracranial hemorrhage or metabolic derangement. The modified Glasgow Coma Scale provides a reproducible scoring system for serial comparison. Temperature is measured at presentation and at regular intervals. Hypothermia impairs coagulation and increases the risk of arrhythmias. Active rewarming is indicated when temperature falls below the species reference range. ## Equipment and Consumable Selection The equipment required for trauma stabilization is determined by the species and the practice setting. Small animal practices typically maintain a dedicated emergency cart with airway supplies, intravenous catheters, fluids, and monitoring equipment. The [MSD Veterinary Manual](https://www.msdvetmanual.com/) provides species-specific guidance on emergency equipment and drug selection. Endotracheal tubes should be available in a range of sizes appropriate for the species treated. A practice that sees both dogs and cats requires tubes from 2.5 to 14 mm internal diameter. Stylets, laryngoscopes, and suction equipment are essential. For patients with maxillofacial trauma, a surgical pack for emergency tracheostomy must be immediately available. Intravenous catheters are selected based on patient size and anticipated fluid needs. Large-bore catheters are preferred for trauma resuscitation because they allow rapid fluid administration. Intraosseous access is a viable alternative in pediatric patients, small exotic species, or patients with vascular collapse. Fluid warmers, blood pressure cuffs in multiple sizes, pulse oximeter probes, and a capnograph are standard monitoring equipment. A Doppler flow detector is useful for blood pressure measurement in small patients and in patients with weak pulses. ## Documentation and Communication The medical record must capture the timeline of the primary survey and the response to each intervention. Record the time of presentation, the findings at each survey step, the interventions applied, and the patient's response. Use objective measurements wherever possible: blood pressure values, heart rate, respiratory rate, temperature, and oxygen saturation. Photographs of wounds are valuable for documentation and for monitoring progression. They are particularly useful in cases of suspected non-accidental injury, where objective documentation supports later legal proceedings. The [AVMA practice resources](https://www.avma.org/resources-tools) provide guidance on professional standards for record keeping and case documentation. Communication with the owner or handler occurs throughout the stabilization process. Provide regular updates on the patient's status, the interventions performed, and the prognosis. In production animal practice, the owner may be the person administering initial first aid before veterinary arrival. [First aid, transport, and triage guidance](https://pubmed.ncbi.nlm.nih.gov/7879363/) emphasizes that prehospital care directly influences outcome, and veterinary facilities should be prepared to give telephone instructions to clients before the patient arrives. The primary survey is complete when all five steps have been assessed, all immediate threats have been addressed, and the patient is stable enough for the secondary survey. The transition point is determined by clinical judgment, not by a fixed time interval. A patient with multiple injuries may require repeated primary surveys before the secondary survey can begin. ## Recognized Complications and Early Detection Trauma patients deteriorate along predictable pathways, and each failure mode has a detectable early signature. The most dangerous complication is unrecognized hemorrhage into a body cavity, particularly the thorax, abdomen, or retroperitoneum. Serial measurement of heart rate, pulse quality, mucous membrane color, and packed cell volume with total protein every 30 minutes during the first 2 hours identifies trends that a single examination cannot. A falling total protein with a stable packed cell volume suggests ongoing blood loss with compensatory splenic contraction, a falling packed cell volume confirms dilution or hemorrhage. Reperfusion injury becomes clinically relevant after successful resuscitation. Restoration of perfusion to ischemic tissues generates reactive oxygen species, and the resulting inflammatory cascade can produce arrhythmias, acute kidney injury, or worsening pulmonary function. Detection relies on continuous electrocardiography, serial lactate measurement, and urine output monitoring where catheterization is feasible. Impact brain apnoea deserves specific attention in patients with head trauma. This phenomenon, cessation of spontaneous breathing following traumatic brain injury accompanied by a catecholamine surge and subsequent cardiovascular collapse, can mimic primary shock and lead to mismanagement if the clinician attributes hypotension solely to hemorrhage [Wilson et al., impact brain apnoea review](https://pubmed.ncbi.nlm.nih.gov/27211834/). The discriminating feature is the temporal sequence: apnoea and hypertension precede the collapse, whereas hemorrhagic shock produces tachycardia and hypotension without preceding apnoea. Hypothermia compounds every other complication. A patient below 36.5 degrees C has impaired coagulation, reduced drug metabolism, and increased myocardial irritability. Continuous rectal or esophageal temperature monitoring, not intermittent measurement, detects the gradual decline that rewarming efforts fail to reverse. ## Common Errors and Corrective Actions Less experienced clinicians frequently prioritize the visible wound over the silent physiologic derangement. A degloving injury on a limb draws attention while a tension pneumothorax develops unnoticed. The corrective action is strict adherence to the ABCDE sequence regardless of what is visible on initial presentation. A second error is administering fluid boluses without reassessing the response. A single volume bolus followed by a long delay before re-examination allows the clinician to miss ongoing hemorrhage. Each bolus should be followed by immediate reassessment of perfusion parameters, and the decision to repeat the bolus should be based on that reassessment, not on a predetermined total volume. Current consensus guidance on fluid selection and rate planning emphasizes this iterative approach [AAHA/AAFP fluid therapy guidelines](https://www.aaha.org/resources/2024-aaha-fluid-therapy-guidelines-for-dogs-and-cats/). Students often fail to secure the airway before pursuing diagnostic imaging. Transporting an unstable patient to radiology without a definitive airway, intravenous access, and ongoing monitoring converts a manageable situation into a cardiac arrest. The corrective action is a pre-transport checklist that confirms airway patency, vascular access, and monitoring capability before the patient leaves the treatment area. A third error is the assumption that a normal initial lactate or blood pressure excludes significant injury. Compensatory mechanisms can maintain normal vital parameters for a period, particularly in young animals. The corrective action is serial reassessment, not a single snapshot. ## Limitations of Current Evidence The veterinary trauma literature is dominated by retrospective studies and expert opinion. Prospective randomized trials comparing resuscitation strategies in trauma patients are scarce, and much of the current practice is extrapolated from human medicine. The evidence base for specific endpoints of resuscitation, such as target blood pressure or lactate clearance thresholds, is limited in veterinary patients. Expert opinion differs on several points. The optimal fluid type for initial resuscitation, the role of vasopressors in hemorrhagic shock, and the threshold for surgical intervention versus continued medical stabilization remain contested. Some clinicians advocate permissive hypotension in penetrating trauma, while others argue that this approach risks underperfusion of vital organs. Neither position is supported by robust veterinary data. Species-specific evidence is even more limited. Trauma is a leading cause of mortality in farmed white-tailed deer and farmed elk, yet the published literature focuses on population-level causes instead of treatment protocols [trauma as a cause of mortality in farmed white-tailed deer](https://pubmed.ncbi.nlm.nih.gov/16048010/) [nonspecific trauma as a cause of mortality in farmed elk](https://pubmed.ncbi.nlm.nih.gov/16422063/). The clinician managing trauma in non-domestic or production species must extrapolate from small animal and human evidence with caution. ## Escalation, Referral, and Reporting Immediate referral is warranted when the patient requires capabilities the practice does not possess. This includes mechanical ventilation for refractory hypoxemia or hypercapnia, continuous renal replacement therapy, advanced imaging such as CT or MRI, or specialist surgical expertise. The decision to refer should be made early, because transport itself is a physiologic stressor and the patient must be stable enough to survive the journey. Specialist consultation is appropriate for patients with progressive neurologic deterioration, refractory arrhythmias, or coagulopathy that does not respond to initial therapy. Telemedicine consultation with a boarded emergency or critical care specialist can provide decision support without the risks of transport. Laboratory involvement extends beyond routine hematology and biochemistry. Blood gas analysis, coagulation panels, and blood typing are essential for guiding resuscitation. Crossmatching is required before transfusion in patients that have previously received blood products [blood transfusion compatibility guidance](https://www.msdvetmanual.com/). Regulatory reporting obligations vary by jurisdiction and species. Bite wounds from animals suspected of having rabies, suspected malicious injury, and cases involving protected wildlife species may trigger mandatory reporting. The clinician should be familiar with local requirements and the international standards for disease reporting where relevant [WOAH terrestrial animal health standards](https://www.woah.org/en/what-we-do/standards/codes-and-manuals/terrestrial-code-online-access/). | Observation | Likely Cause | Discriminating Check | |---|---|---| | Falling total protein, stable PCV | Ongoing hemorrhage with splenic contraction | Repeat PCV/TP in 30 min, consider abdominal or thoracic ultrasound | | Hypertension then collapse after head trauma | Impact brain apnoea with catecholamine surge | Document apnoea and temporal sequence, do not attribute solely to hemorrhage | | Progressive hypothermia despite warming | Severe shock, impaired thermoregulation | Continuous temperature monitoring, check warming device function | | Rising lactate after initial improvement | Reperfusion injury or ongoing ischemia | Serial lactate, assess perfusion and urine output | | Normal vitals 1 hour after trauma | Compensated shock | Repeat full assessment, do not rely on single examination | ## Frequently Asked Questions ### How Do I Prioritize Interventions When Advanced Monitoring Equipment Is Unavailable? When capnography, invasive blood pressure, or point-of-care ultrasound are absent, rely on serial physical examination and basic monitoring. Pulse quality, mucous membrane color, capillary refill time, heart rate, respiratory rate and effort, and mentation trends provide sufficient direction for most immediate stabilization decisions. Urine output, when a urinary catheter is placed, offers a practical perfusion estimate. Recheck parameters every 5 to 15 minutes during the unstable period. The [RECOVER Initiative veterinary CPR guidelines](https://recoverinitiative.org/) emphasize that high-quality basic life support and serial reassessment outperform delayed advanced interventions. If a parameter deteriorates despite intervention, escalate therapy empirically and document the response. ### What Fluid Strategy Should I Use When Blood Products Are Not Available? Crystalloid boluses remain the default when blood products are unavailable, but they should be administered judiciously. Titrate to perfusion endpoints instead of giving fixed volumes, and reassess after each bolus. Hypertonic saline with colloids may be considered for hemorrhagic shock with head trauma, though current formulary references must be consulted for dosing. The [AAHA/AAFP fluid therapy guidelines](https://www.aaha.org/resources/2024-aaha-fluid-therapy-guidelines-for-dogs-and-cats/) stress that excessive crystalloid resuscitation worsens hemorrhage by diluting clotting factors, disrupting clots, and increasing hydrostatic pressure. If hemorrhage is uncontrolled, accept lower-than-normal blood pressure targets to permit clot formation. Re-evaluate the patient for ongoing blood loss frequently, and arrange transfer to a facility with transfusion capability when the patient stabilizes enough to travel. ### How Does the Primary Survey Differ in Production Animals? The same ABCDE sequence applies, but physical constraints alter execution. Ruminants and horses are often assessed in stocks or chutes, which limits access to the caudal abdomen and hindlimbs. Recumbency in a large ruminant carries additional risks of rumenal bloat and muscle ischemia, so positioning and frequent turning matter. Trauma is a leading cause of mortality in farmed deer and elk, and handling stress can compound shock in these species, so minimize restraint time and consider sedation only when it will not worsen hypotension. [WOAH terrestrial animal health standards](https://www.woah.org/en/what-we-do/standards/codes-and-manuals/terrestrial-code-online-access/) address welfare during handling and transport, which applies to the injured production animal awaiting assessment. Prognostic decisions in production animals must also weigh economic value and herd biosecurity, also physiologic salvageability. ### What Should I Document During the Initial Stabilization Period? Record the time of presentation, mechanism of injury, and every intervention with its time and response. Use a flowsheet format with repeated vital parameter columns so trends are visible at a glance. Document estimated blood loss, fluid volumes administered, and any drugs given with routes. Note the patient's mentation and pain score at each reassessment. The [AVMA practice resources](https://www.avma.org/resources-tools) emphasize that contemporaneous medical records support continuity of care and defensible decision-making. Photographs of external wounds are useful but must be taken with owner consent and stored per local privacy expectations. If the patient is transferred, send a written summary that includes pending problems, current medications, and the next planned diagnostic step. ### How Do I Explain Prognosis and Costs to an Owner During the Emergency? Give the owner a time-limited prognosis based on the primary survey findings, and separate immediate stabilization costs from projected diagnostic and surgical costs. Use plain language for physiologic concepts, for example "the lungs are bruised and need oxygen support" instead of "pulmonary contusions with hypoxemia." Offer a range of treatment options from minimal supportive care to full intensive management, with honest survival estimates for each. The [MSD Veterinary Manual](https://www.msdvetmanual.com/) provides species-specific prognostic information that can inform these discussions. Acknowledge uncertainty explicitly, and set a re-evaluation point, such as 12 or 24 hours, at which the prognosis will be refined. Document the owner's chosen level of care and their consent for emergency procedures. ### When Should I Stop Resuscitation Efforts in a Trauma Patient? Cease resuscitation when the patient remains asystolic or pulseless despite 10 to 20 minutes of appropriate basic and advanced life support, or when the underlying injuries are incompatible with meaningful recovery. Impact brain apnoea, the transient cessation of breathing and cardiovascular collapse immediately after head injury, can mimic death but may be reversible with rapid airway support, so do not abandon a fresh head trauma patient prematurely. The [RECOVER Initiative veterinary CPR guidelines](https://recoverinitiative.org/) provide evidence-based criteria for terminating CPR. In production animals, economic and welfare considerations may justify earlier cessation than in companion animals. If the owner is present, explain the physiologic basis for stopping and offer them time with the patient. Document the duration of resuscitation, all drugs administered, and the reason for termination. ## Related Clinical & Scientific Guides * [Toxicology in Emergency Practice: Common Poisons and Diagnostic Approach](/knowledge/veterinary-medicine/emergency-critical-care/toxicology-emergency-practice-common-poisons-diagnostic-approach) * [Veterinary Cardiopulmonary Resuscitation: Post-Cardiac Arrest Care](/knowledge/veterinary-medicine/emergency-critical-care/veterinary-cardiopulmonary-resuscitation-post-cardiac-arrest-care) * [Fluid Therapy Guidelines for Dogs and Cats: A Practical Update](/knowledge/veterinary-medicine/emergency-critical-care/fluid-therapy-guidelines-dogs-cats-practical-update) ## References and Further Reading - [First aid, transport, and triage.](https://pubmed.ncbi.nlm.nih.gov/7879363/). 1994. - [Impact brain apnoea - A forgotten cause of cardiovascular collapse in trauma.](https://pubmed.ncbi.nlm.nih.gov/27211834/). 2016. - [The challenge of CT and MRI imaging of obese individuals who present to the emergency department: a national survey.](https://pubmed.ncbi.nlm.nih.gov/18787528/). 2008. - [The impact of ebinyo, a form of dental mutilation, on the malocclusion status in Uganda.](https://pubmed.ncbi.nlm.nih.gov/16161877/). 2005. - [A cross-sectional study of the causes of morbidity and mortality in farmed white-tailed deer.](https://pubmed.ncbi.nlm.nih.gov/16048010/). 2005. - [A retrospective study of the causes of morbidity and mortality in farmed elk (Cervus elaphus).](https://pubmed.ncbi.nlm.nih.gov/16422063/). 2005. - [RECOVER Initiative Veterinary CPR Guidelines](https://recoverinitiative.org/). Veterinary Emergency and Critical Care Society. - [AAHA/AAFP Fluid Therapy Guidelines for Dogs and Cats](https://www.aaha.org/resources/2024-aaha-fluid-therapy-guidelines-for-dogs-and-cats/). AAHA. - [MSD Veterinary Manual, Professional Edition](https://www.msdvetmanual.com/). MSD Veterinary Manual. ## Related Articles - [Trauma Triage and Primary Survey in Small Animals](/knowledge/veterinary-medicine/emergency-critical-care/trauma-triage-primary-survey-small-animals) - [Veterinary Trauma: Secondary Survey and Diagnostic Imaging](/knowledge/veterinary-medicine/emergency-critical-care/veterinary-trauma-secondary-survey-diagnostic-imaging) - [Salvage Resuscitation in Severe Trauma: When to Stop or Continue](/knowledge/veterinary-medicine/emergency-critical-care/salvage-resuscitation-severe-trauma-veterinary) - [Blood Transfusion in Dogs and Cats: Crossmatching and Compatibility](/knowledge/veterinary-medicine/emergency-critical-care/blood-transfusion-dogs-cats-crossmatching-compatibility) - [Capnography in Veterinary Emergency and Critical Care](/knowledge/veterinary-medicine/emergency-critical-care/capnography-veterinary-emergency-critical-care) > This article is educational professional reference material for veterinary audiences. It is not a substitute for veterinary diagnosis, individual clinical judgment, current product labeling, or applicable regulatory requirements.