First Aid for Dogs - Shock, Rescue Breathing, and CPR

By Malcolm Weir, DVM, MSc, MPH; Ryan Llera, BSc, DVM; Ernest Ward, DVM

Emergencies come in all forms - automobile accidents, bite wounds, burns, heat stroke, poisoning, seizures, and more. For a general overview of what constitutes an emergency and how to handle common crisis situations, see the handout “Emergencies in Dogs”.  

What is first aid?

First aid is the initial treatment given in a medical emergency. Its purpose is to preserve life, reduce pain and discomfort, and minimize any risk of permanent disability or disfigurement

In an emergency, what should I do first?

  1. Keep calm and assess the scene for any additional threats to you or your pet. This is important for everyone's safety.
  2. Keep your dog warm (except in the case of heat stroke), as quiet as possible, and keep movement to a minimum, especially if there is possible trauma, broken limbs, or any neurological symptoms.
  3. Contact your veterinary hospital, inform them of the situation, and get specific first aid advice.
  4. To safely move or transport an injured dog, get somebody to help you. For a small dog, put him into his carrier (remove the top for easy and safe access to the carrier; DO NOT push an injured dog through the small door or opening) or use a suitable container such as a strong cardboard box. For a larger dog, use a makeshift stretcher made from some rigid material such as an appropriate-sized, sturdy piece of wood. Carefully maneuver your dog onto a blanket or coat so that he can be gently moved to the carrier, box, or stretcher.
  5. Get to a veterinary hospital as soon as possible.

What are some tips on restraining or calming an injured dog?

Most injured animals will be panicked and/or disoriented. The stress of an emergency can cause an otherwise friendly animal to act aggressively. Although most panicky dogs will respond to a calm, soothing voice, use caution when approaching or touching any injured animal. It is important to ensure the safety of all rescue personnel that are attempting to assist an injured animal.

Some of the types of restraint that can ensure the safety of both dogs and humans include:

Muzzling: You can create a muzzle out of a leash, belt, necktie, sock, rope, or strap. Loop the cord around your dog's muzzle and tighten it to prevent him from biting. Dogs have only one muscle to open their jaw so once the jaw is closed, it is relatively easy to hold it safely shut. Dogs can breathe through their nostrils unless the nose is injured or obstructed.

Wrapping: You can wrap the body of an unmanageable dog in a blanket or towel. Be sure to keep his head exposed and do not constrict the trachea.

Immobilizing: If you are suspicious of spinal injury, lay your dog on a board and secure him on the board with straps or cords. Try to keep the head and neck immobilized.

What is shock?

Shock is a complex systemic (whole-body) reaction to a number of emergency situations, including severe trauma, hemorrhage or sudden blood loss, heart failure, and other causes of decreased circulation (e.g., severe and sudden allergic reaction and heat stroke). A life-threatening fall in blood pressure is a dangerous part of shock. If not treated quickly and effectively, systemic shock may cause irreversible injury to body cells and can be fatal.

What are the signs of shock?

Clinical signs of systemic shock include rapid breathing and elevated heart rate with pale mucous membranes (gums, lips, and under the eyelids). Your dog’s feet or ears may feel cold, and he may vomit or shiver. As shock progresses, most pets become quiet and unresponsive.

What should I do if my dog is showing signs of shock?

Keep your dog as quiet as possible and try to conserve heat by covering him with blankets, towels, or even newspapers. Follow the A, B, and Cs of first aid:

A      Airway

B     Breathing

C     Cardiac function

Airway. Anything that obstructs the airway prevents oxygen from entering the lungs. Do your best to clear the mouth and throat of any obstruction (e.g., vomit, saliva, or foreign bodies such as grass, sticks, or balls). Be careful - your dog may bite you in panic.

Breathing. If your dog is unconscious and does not appear to be breathing, try gently pumping his chest with the palm of your hand, at the same time feeling just behind the elbow to detect a heartbeat or pulse. If unsuccessful, perform rescue breathing (see below). Be careful - injured pets may bite you out of fear.

Cardiac function. If you are unable to detect a heartbeat or pulse, or if it appears weak and slow, try pressing on the chest with your palm and elevating the lower half of the body to promote blood flow to the brain. Follow the CPR steps below.

How do I perform rescue breathing for my dog?

If your dog is unresponsive, ensure that there is an open airway.

  1. Carefully pull the tongue out of the mouth.
  2. Extend the head and neck so that they are in a straight line. DO NOT overextend the neck if your dog has obvious head and neck trauma.
  3. Carefully clear the mouth of any debris that may be obstructing breathing.
  4. Place your hand over your dog’s muzzle while holding the mouth shut and extending the neck. For small dogs, you can sometimes improvise with a Styrofoam cup or other similar item, by placing the opening over your dog's face and poking a large hole in the bottom for you to breathe through. Ensure a relatively tight seal around the muzzle.
  5. Blowing into the nostrils, give two to three breaths and watch for a rise in the chest. If you do not see a rise in the chest, reposition the neck or search for airway obstruction.
  6. If you see an obstruction but cannot remove it, you can attempt the XXT maneuver if your dog is unconscious. This is useful in dogs who have balls stuck at the entrance of their trachea and is gentler than the Heimlich maneuver. Lay your dog on his back on the floor and straddle his body while positioning his head and trachea parallel to the floor. Larger objects will be palpable in the throat area just behind the bone of the lower jaw (mandible). Use your fingers to press down on the lower jaw, keeping the neck straight and the head stable and on the floor, then use your thumbs to “milk” the palpable obstruction with a “J-stroke” downwards and toward the nose
  7. If you believe there is an airway obstruction that you cannot see, you can attempt a modified Heimlich maneuver on your dog to attempt a forceful expulsion of an obstruction. If your dog is standing, you can stand or kneel over and behind your dog. Place your hands under his body just behind his ribs and thrust quickly upwards and forwards. If your dog is lying down, use one hand on his back and the other hand to squeeze the belly upwards and forwards. Smaller dogs can be gently picked up by their thighs and swung side to side. Pressure can be applied just behind the ribcage in a forward motion if obstruction persists.
  8. For rescue breathing, provide 20 breaths per minute.
  9. If your dog fails to breathe on his own, you may attempt an acupressure maneuver. Press firmly with your fingernail or another hard, dull object in the space just beneath the nose on the upper lip (nasal philtrum). Maintain the pressure for 10-30 seconds.

What if my dog requires CPR?

If there are still no obvious signs of life after you have established an airway and begun rescue breathing, you should attempt chest compressions:

  1. Make sure there is no major bleeding. If there is bleeding, have an assistant manage the bleeding while you perform CPR.
  2. If possible, lay your dog on his right side.
  3. Feel for a heartbeat or femoral pulse. The femoral pulse is located inside the leg in the groin region. Dogs do not have a readily palpable carotid (neck) pulse.
  4. Bend the left forearm and note the location where the elbow touches the chest. This is close to the middle of the rib cage.
  5. Placing one hand on each side of the chest in the middle of the rib cage, vigorously compress the chest 100-120 times per minute. For small dogs (under 10 pounds), use one hand to compress the chest from both sides by putting your fingers on one side and your thumb on the other side of the chest. The rate should be about 30 compressions for every 2 breaths.
  6. Try to compress the chest wall at least 30-50%. This is about 1" (2 cm) in small dogs and 2-3" (5-8 cm) in larger dogs.

Is there anything else I should know?

After being involved in an emergency or accident, it is important that you take your dog for a veterinary examination as soon as possible, even if he appears to have recovered fully. More handouts in the First Aid series provide advice specific to other types of injuries and medical emergencies.

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