ASPCA Animal Poison Control Center UrbanaIL Decontamination is all about preventing absorption Decontamination is very important as there are very few antidotes Decontamination is performed in the asymptomatic animal ID: 759560
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Slide1
Animal Decontamination
MaryEllen Malysiak, BS, CVT
ASPCA Animal Poison Control Center
Urbana,IL
Slide2Decontamination is all about preventing absorption
Slide3Decontamination is very important as there are very few antidotes
Decontamination is performed in the asymptomatic animal
The basics of decontamination
processes are
similar amongst species
Slide4Stabilize first if symptomatic
Follow the ABCsAirwayBreathingCardiovascular“Treat the pet not the poison!”
Slide5“The Antidote”
After stabilizing, if the toxic agent is identified, “the antidote” may be given
Vast majority of toxic agents have no specific antidote
treatment is symptomatic and supportive
Even in cases where antidotes exist, there are often barriers to their use
high cost, lack of availability
Slide6Ocular Exposures
Irritation to corrosion Flush with large quantities to decrease insult to the corneaTepid tap waterNormal salineArtificial tears Flush for 15 - 30 minutesDo not use Visine® or other “get the red out” products
Slide7Ocular Exposures
Eyedropper smaller patients, birds, reptilesPlastic cupSedation or rest periodsminimize stress
Slide8Dermal Decontamination
Remove compounds from the skin or fur to limit or prevent percutaneous absorptionNever use a solvent like kerosene or paint thinner.Make sure to keep the patient warm and dry thoroughly
Slide9Protect yourself!!
The handler should wear proper protective clothing including gloves or mask to prevent personal injury.
Slide10Liquid Dish Washing Detergent
Very effective in removing any agents that are oily or oil-soluble.
Do not use automatic dish washer detergents.
Slide11Avian Dermal Exposures
Light exposures:
Spray lightly
Diluted mild liquid dish washing liquid and warm water
Heavy exposures:
Thorough bathing with liquid dish washing detergent and warm water
Slide12Glue traps, Asphalt, Pine Sap
Oily removes sticky compoundsOlive oil, mayonnaise, peanut butter, mineral oil, vegetable oilRub a small amount onto areaKeep rubbing until substance breaks down into “gummy balls”Wash with liquid dish washing detergent to remove the oily substance
Slide13Oral decontamination is all about preventing absorption
Slide14Dilution
Dilution is used to make compounds less irritating
Generally recommended for management of caustic substances (acid or alkaline) and petroleum distillates
Slide15Dilution
Milk WaterMilk of Magnesia, Mylanta, MaaloxAvoid salicylates
Slide16Dilution
Rabbits, birds, reptiles
yogurt, juicy fruits and vegetables
Slide17Emetics
Emetics are used to remove substances from the stomach (induce vomiting).
Assume that most animals only vomit 40-75% of their stomach contents.
Useful for most substances within 30-90 minutes after ingestion.
cold medications
chocolate, rodent baits
Slide18Emesis
Evaluate each case on an individual basisProbably performed far too oftenEmesis should never be an automatic decisionBenefit vs. Risk
Slide19Emetics -- Contraindications
Do NOT induce vomiting with ingestion of a caustic substance or petroleum distillate.Caustics can burn on the way up just as they do on the way downHydrocarbons can be aspirated
Slide20Emesis -- Contraindications
Do NOT induce vomiting in species that cannot vomit.RodentsRabbitsHorsesRuminantsAvianReptiles
Slide21Emesis – General Considerations
Emesis is generally more effective if done with food in the stomach.
Recent meal
Bread or other foods
Patient should be monitored during the process
Vomitus should be examined
Do not let the animal or others to eat the vomitus
Slide223% Hydrogen Peroxide
Acts locally by GI irritation
Give 1ml/lb, up to 45 ml
Can repeat dose once
Large doses can cause bloody vomiting
Cats are more sensitive than dogs – generally not recommended in cats
Slide23Other choices
Dish SoapDry powdered mustardPharyngeal stimulationNot effective and not recommended.
Slide24Syrup of Ipecac
No longer available for purchaseAverage time to emesis is 23 minutesWithdrawn from market due to abuse by bulemics; no longer recommended for childrenCan cause cardiac issues in animals
Slide25Salt or saltwater
Never should be used – not even as a last resortLife threatening hypernatremia can result especially if emesis doesn’t occur
Slide26Review question
Which of the following species can be made to safely vomit?
A. Rabbits
B. Rats
C. Horses
D. Pot bellied pigs
E. Chickens
Slide27Adsorbants - Activated Charcoal
Binds most organic compounds and facilitates excretion in the fecesBinds large, nonpolar substances bestPowder, gel, liquid formulations1-2 g/kg (powder)3-5 ml/lb (gel and liquid)
Slide28Adsorbants - Activated Charcoal
My require repeated doses
Chocolate,
bromethalin
,
invermectin
, Cholecalciferol
Not always indicated
Other chemicals that are not effectively absorbed:
Ethanol, methanol
, xylitol, fertilizer
, fluoride, petroleum distillates, most heavy metals, iodides, nitrates, nitrites, sodium chloride, and chlorate
Slide29Adsorbants - Activated Charcoal
Slide30Cathartics
Decrease GI transit time
Without
cathartics, the toxicant bound by activated charcoal can eventually be released and reabsorbed
.
Given
with or shortly after activated
charcoal- Check your labels!
Do not use if animal is dehydrated or has
diarrhea
Avoid in renal patients
Slide31Bulk Cathartics
Used to help remove heavy items from the GI tractpsylliumcanned pumpkin, or squashBrown riceHigh fiber retain water and produce more bulky stoolsEnsure adequate water consumption
Slide32Emollient Laxatives
Laxatone®
Nutrical®
Vaseline
Mineral oil
Contraindications
vomiting
Slide33Enema
Helpful when elimination of toxicants from the lower GI tract is desired
gets things “moving through”
Warm water, warm soapy water
Not recommended for birds
Slide34Inhalation
Remove from source of inhalant
Fresh air
Oxygen
Monitor for difficulty breathing
Slide35Meth labs, and the Animals Impounded from them
Slide36Methamphetamine
The Product
Slide37N-methyl-1-phenylpropan-2-amine
Discovered in 1893Used in WWII“Pilot’s chocolate”Fight fatigue, enhance focusAgitated and aggressive
Slide38Methamphetamine
Powerful stimulantHighly addictiveMeth SpeedIce Crystal Chalk CrankTweak Uppers Black BeautiesGlass BatuBlade
Bikers Coffee
Methlies
Quick
Poor Man’s Cocaine
Chicken Feed
Shabu
Crystal Meth
Stove Top
Trash
Go-Fast
Yaba
(meth + caffeine)
Yellow Bam
Slide39Methamphetamine - appearance
White Crystalline Powder or Chunks
May be yellowish or brownish due to contaminants
May be clear crystals or chunks
Ice – very pure
Slide40Photo: State of California
Slide41Photo: State of California
Slide42Slide43Slide44Slide45Drugs of Abuse
PopularityAlcoholMarijuanaMethamphetamine Midwestern and Western United States
Slide46Methamphetamine – How it works
Floods brain with dopamine
Rush
Pleasure, pain
α
/
β
adrenergic activation
Increased BP
Constricts blood vessels
Increased HR
Stimulates heart
Slide47Methamphetamine – How it works
Serotonergic effectsSerotonin syndromeAutonomic, neuromuscular, CNS signsHalf-life 8-36 hours5 half lives to be gone from the body
Slide48Methamphetamine
Intoxication
Slide49True or False?
Methamphetamine poisoning is commonly seen in animals that have been seized from methamphetamine labs.
True
False
Slide50False
Actual methamphetamine
toxicosis
is uncommon
Precursor chemicals
More than final product
Meth = $$
Cats, rabbits, birds
Grooming
Ingestion of aerosolized meth off fur/feathers
Slide51Meth intoxication
Stimulation of CV and CNSAgitation, hyperactivityDilated pupilsIncreased heart rateIncreased blood pressureIncreased body temperatureDisorientation
Tremors
Seizures
Aggression
Irritability
Apprehension
Panting
Erratic heart rhythm
Death
Slide52Slide53Meth intoxication
Time frameSigns generally occur within 0.5-1 hour following exposure Last up to 72 hours in severe cases
Slide54Methamphetamine Testing
Commercial test kits availableBlood – 6-12 hoursUrine – 48-72 hoursFalse positivesProin, Adderall, Afrin Nasal Spray, MDMA, NyQuil, Pseudoephedrine
Slide55Thanks to Dr. Rob Kessler, Las Vegas, NV
Slide56Methamphetamine Treatment
Requires veterinary careDecrease agitationPhenothiazines (chlorpromazine, acepromazine)Cyprohepatadine (serotonin antagonist)BarbituratesAvoid diazepam!Reduce body temperatureIV fluids
Slide57Prognosis for meth intoxication
Most animals respond well to treatmentConcern if seizures for a long period or high body temperature
Slide58Chronic Meth Users
Slide59Behavioral evaluations – Time!
Delay for at least a week
Elimination of meth from the body
Adapt to its environment and show more of its normal character
Many dogs and cats seized from meth labs have been successfully placed in homes and have lived normal life spans
Prognosis is generally considered good for those animals that are able to be rehabilitated
Slide60Methamphetamine
The Process
Slide61If only it was this easy….
Identify the Meth Lab?
Slide62Meth labs
Many of the chemicals used to produce meth are extremely hazardous
Dangerous to:
Individuals who manufacture methamphetamine
People living nearby
Law enforcement
Firemen
Slide63Possible ingredients – corrosive agents
Irritation or ulceration of skin, eyes, mouth, throat, lungs, digestive tract
Anhydrous ammonia, acids (rust removers, auto battery acid),
alkalines
(drain cleaner), iodine (vet products), lithium (batteries), red phosphorous (matches)
Anhydrous ammonia can cause freeze injury
Lithium metal + water = explosion
Red phosphorus is highly flammable and can form deadly
phosphine
gas
Slide64Chemical burns
Spills of chemicals onto flooring Walk through, lie in, and/or ingest
Familyvet.com
Slide65Possible ingredients - Solvents
Irritating fumes, skin irritation, inebriation, liver and kidney damage, vomiting, coma
Acetone, ether (engine starter), ethyl alcohol, methanol, isopropyl alcohol,
xylene
, toluene (brake cleaner),
trichloroethane
Flammable
Can be absorbed across skin.
Freon (Non-Flammable Liquid Solvent)
Asphyxiant
Slide66Possible ingredients - stimulants
Tremors, seizures, high body temperature, heart irregularities, agitation
Pseudoephedrine (cold medications), ephedrine,
phenylpropanolamine
(vet drugs)
Slide67Possible ingredients - others
High Pressure Acid Gas
Hydrogen Chloride Gas
Methyl
Sulfonyl
Methane (MSM)
Cutting Agent
Sodium Chloride (Salt, Rock Salt)
Hydrogen peroxide
Slide68Other Potential Hazards
Mechanical injuryDiscarded syringes, razor bladesNeedle puncturesExplosion/fire – burnsNeglectMalnutrition, parasites, infectious dz, abuse
Slide69Slide70Animals
Types of animals that might be present
Household pets
Livestock
Captive-kept wild animals
Massachusetts methamphetamine laboratory raid, police found alligators guarding the residence!
Guard dogs
Slide71Drug Lab Response = Team Effort
Investigation & Seizure (Law Enforcement)
Chemical Emergency Response (Hazmat)
Fire Suppression (Fire)
Assessment/Inventory (Law, Health, Fire)
Removal & Disposal (DTSC, Contractor)
Remediation (Health, Property Owner)
Other Support (CPS, Animal Control, Ag Inspector, Fish & Game, Water Resources...)
Slide72Your role
Range
Actively assisting with removal
Decontamination of animals
Evaluating animals
Immediately
Days or weeks following seizure
Evidence preservation and
documentation
Protect yourself and others!
Slide73Who is in charge ??
Communicate expectations (veterinarian, law enforcement, animal control, humane organization)
Who is authorized to approve medical decisions, including authorization of euthanasia?
Agreed-upon fee payment schedules and euthanasia permission should be IN WRITING
Slide74Meth Lab Bust
Federal and state authorities
Established protocols for managing MLs
Compliance may vary with jurisdiction
The unit housing the laboratory (i.e. house, garage, etc.) is considered the 'hot' zone
Entry into hot zones is regulated by the site safety officer (SSO)
Slide75Meth Lab Bust
SSO determines the level of personal protective equipment (PPE) that must be used to enter the hot zone Eye protectionProtective boots and gloves Protective 'clothing' (e.g. Tyvek suits)+/- specialized respirators and/or fully encapsulated HazMat suits with self-contained breathing apparatus
Slide76Slide77What’s wrong with this picture ?
Slide78Meth lab – animal removal
Done with care
Animals themselves may be contaminated
Hazard to those that handle them
Entry into the ‘hot zone’ may be restricted
Animal control officers may be requested to enter the hot zone to remove animals
Personal safety becomes paramount
Cannot help the animals if you become injured or ill
Slide79Meth lab – animal removal
After human suspects are removed
After noise and confusion
Catch poles and nets are commonly employed
Unfortunately, the removal process can be quite stressful to the animals
Slide80Animal removal
Slide81Meth lab – animal removal
Upon entering the hot zone
Do not touch anything unless absolutely necessary
Avoid stepping into pools, puddles, or solid materials (including syringes)
Slide82Meth lab – animal removal
Avoid contaminating other areas outside the hot zone
Leashes, carriers, and cages should be brought into the area rather than using the contaminated items in the laboratory
Collars and halters should be removed prior to removing the animal from the hot zone if possible
Slide83Meth lab – animal removal
Personnel handling the animal
Remain in protective gear until such time that the animal can be adequately decontaminated
Carrier used to transport the animal should be washed thoroughly with hot water and soap
Slide84Meth lab – animal removal
Consider all animals to be contaminated with potentially hazardous materials
Need to be decontaminated in order to minimize the contamination of the animal control vehicle and facilities
Triage
Determine if animal needs immediate veterinary care
Slide85Meth lab – animal removal
Animals in need of immediate care
Life-threatening injury or illness
Transported immediately without decontamination
Vet staff needs to wear protective gear until the animals are stable enough to be decontaminated
Slide86Meth lab bust
Prior to decontamination
Ask if law enforcement officials desire any samples be taken from the animals for later analysis
Hair swabs (place in clean plastic jars)
Slide87Decontamination
Animals not judged to be in need of immediate veterinary care at the site are decontaminated
Bath with liquid dish soap (e.g. Dawn) and warm water
Animals that are difficult or dangerous to handle may require sedation
Slide88Decontamination
Supplies
Water source (preferable warm)
Liquid dish soap
Four wading pools to make a decontamination line away from the hot zone
Bath 1, rinse 1, bath 2, rinse 2
Sterile saline (eye rinse)
Cloth towels and paper towels
Pallet or riser or pallet to keep the animals' feet from sitting in the wash water
Slide89Decontamination
First bather wets and washes the animal
Full PPE
Transfers the animal to the first
rinser
who rinses the animal thoroughly
Full PPE
Transfer to the third pool and re-washed, then transferred to the final rinse pool
Towel dry and placed in a clean carrier for transport to the veterinary facility
Slide90Decontamination
Slide91Decontamination
Birds, pocket pets, etc.
Can be very stressed by aggressive bathing
Spritz
with a mixture of warm water and dish soap (be careful around eyes) from a spray bottle followed by a rinse in clean water from a different spray bottle
Towel off, place in clean carriers and transported to an area where they can be evaluated by a veterinarian
Slide92Evaluation
Veterinary facilityExam for physical and behavioral abnormalities
Slide93Methamphetamine
Forensics
Slide94Documentation
You can never have too much documentation
Slide95Documentation
Injuries, body condition scores
Writing, photography
Photographs should include overall views of the entire animal and subsequent closer views of specific lesions
Each photograph should contain an identifying label with the case number and date
Slide96Documentation
Slide97Testing
Is the veterinarian/animal control expected to gather evidence from the patient(s)?
What evidence is to be collected and who is responsible for storage/testing of the evidence?
Sometimes law enforcement initially is not interested in testing, but later request testing in order to strengthen their case and possibly add additional charges
Blood, urine, hair (pre-decontamination)
Samples stored in a secure area and carefully labeled with date and time of collection, case number, animal identification, breed, and signature of person collecting the sample
Slide98Drug testing
If requested by law enforcement, urine and/or blood may be taken for methamphetamine
testing
Blood
should be collected within 6-12 hours and urine within 48-72 hours
Slide99Drug testing
Samples sent to human or veterinary diagnostic laboratories
Accredited veterinary diagnostic laboratory for the best evidentiary value
A negative methamphetamine test does not rule out the possibility that the animal was exposed to toxic precursor chemicals rather than the end product
Slide100Question?
Law enforcement has presented you with two cats that were removed from a house containing a large meth lab operation two days ago. They now want to know if the cats had been exposed to methamphetamine; if so, they can add animal cruelty charges to the case. Which of the following is the *best* sample to obtain under these circumstances?
A. Swab of hair coat for methamphetamine residue
B. Blood sample
C. Fecal sample
D. Urine sample
Slide101Answer
Correct answer is D: Urine sample
Metabolites can be detected for 48-72 hours
Swabbing the hair coat
Any methamphetamine residue would have been washed away during decontamination
Only indicates dermal exposure
Blood samples
Levels below detectable levels within 12 hours
Fecal samples
Not excreted in stool
Slide102Take home points
Delay behavioral evaluationSuccessful rehoming can occurProtect yourselfDecontaminateDocument
Slide103Questions?