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Animal Decontamination MaryEllen Malysiak, BS, CVT ASPCA Animal Poison Control Center Urbana,IL Decontamination is all about preventing absorption ♦ Decontamination 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 ♦ Stabilize first if symptomatic ♦ Follow the ABCs Airway Breathing Cardiovascular ♦ “Treat the pet not the poison!” “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 Ocular Exposures ♦ Irritation to corrosion ♦ Flush with large quantities to decrease insult to the cornea Tepid tap water Normal saline Artificial tears ♦ Flush for 15 - 30 minutes ♦ Do not use Visine® or other “get the red out” products Ocular Exposures ♦ Eyedropper smaller patients, birds, reptiles ♦ Plastic cup ♦ Sedation or rest periods minimize stress Dermal Decontamination ♦ Remove compounds from the skin or fur to limit or prevent percutaneous absorption ♦ Never use a solvent like kerosene or paint thinner. ♦ Make sure to keep the patient warm and dry thoroughly Protect yourself!! ♦ The handler should wear proper protective clothing including gloves or mask to prevent personal injury. Liquid Dish Washing Detergent ♦ Very effective in removing any agents that are oily or oilsoluble. ♦ Do not use automatic dish washer detergents. Avian 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 Glue traps, Asphalt, Pine Sap ♦ Oily removes sticky compounds Olive oil, mayonnaise, peanut butter, mineral oil, vegetable oil Rub a small amount onto area • Keep rubbing until substance breaks down into “gummy balls” ♦ Wash with liquid dish washing detergent to remove the oily substance Oral decontamination is all about preventing absorption Dilution ♦ Dilution is used to make compounds less irritating ♦ Generally recommended for management of caustic substances (acid or alkaline) and petroleum distillates Dilution ♦ Milk ♦ Water ♦ Milk of Magnesia, Mylanta, Maalox Avoid salicylates Dilution ♦ Rabbits, birds, reptiles yogurt, juicy fruits and vegetables Emetics ♦ Emetics are used to remove substances from the stomach (induce vomiting). ♦ Assume that most animals only vomit 4075% of their stomach contents. ♦ Useful for most substances within 30-90 minutes after ingestion. cold medications chocolate, rodent baits Emesis ♦ Evaluate each case on an individual basis Probably performed far too often Emesis should never be an automatic decision Benefit vs. Risk Emetics -- 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 down Hydrocarbons can be aspirated Emesis -- Contraindications ♦ Do NOT induce vomiting in species that cannot vomit. Rodents Rabbits Horses Ruminants Avian Reptiles Emesis – 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 3% 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 ♦ Dish Soap ♦ Dry powdered mustard ♦ Pharyngeal stimulation ♦ Not effective and not recommended. Other choices Syrup of Ipecac ♦ No longer available for purchase ♦ Average time to emesis is 23 minutes ♦ Withdrawn from market due to abuse by bulemics; no longer recommended for children ♦ Can cause cardiac issues in animals Salt or saltwater ♦ Never should be used – not even as a last resort ♦ Life threatening hypernatremia can result especially if emesis doesn’t occur Review question ♦ Which of the following species can be made to safely vomit? A. B. C. D. E. Rabbits Rats Horses Pot bellied pigs Chickens Adsorbants - Activated Charcoal ♦ Binds most organic compounds and facilitates excretion in the feces Binds large, nonpolar substances best ♦ Powder, gel, liquid formulations 1-2 g/kg (powder) 3-5 ml/lb (gel and liquid) Adsorbants - 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 Adsorbants - Activated Charcoal Cathartics ♦ 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 Bulk Cathartics ♦ Used to help remove heavy items from the GI tract psyllium canned pumpkin, or squash Brown rice ♦ High fiber retain water and produce more bulky stools ♦ Ensure adequate water consumption Emollient Laxatives ♦ ♦ ♦ ♦ Laxatone® Nutrical® Vaseline Mineral oil ♦ Contraindications vomiting Enema ♦ 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 Inhalation ♦ Remove from source of inhalant ♦ Fresh air ♦ Oxygen ♦ Monitor for difficulty breathing Meth labs, and the Animals Impounded from them Methamphetamine The Product N-methyl-1-phenylpropan-2-amine ♦ Discovered in 1893 ♦ Used in WWII “Pilot’s chocolate” Fight fatigue, enhance focus Agitated and aggressive Methamphetamine ♦ Powerful stimulant ♦ Highly addictive Meth Speed Ice Crystal Chalk Crank Tweak Uppers Black Beauties Glass Batu Blade Bikers Coffee Methlies Quick Poor Man’s Cocaine Chicken Feed Shabu Crystal Meth Stove Top Trash Go-Fast Yaba (meth + caffeine) Yellow Bam Methamphetamine appearance ♦ White Crystalline Powder or Chunks May be yellowish or brownish due to contaminants May be clear crystals or chunks • Ice – very pure Photo: State of California Photo: State of California Drugs of Abuse ♦ Popularity Alcohol Marijuana Methamphetamine • Midwestern and Western United States Methamphetamine – How it works ♦ Floods brain with dopamine Rush Pleasure, pain ♦ α/β adrenergic activation Increased BP • Constricts blood vessels Increased HR • Stimulates heart Methamphetamine – How it works ♦ Serotonergic effects Serotonin syndrome • Autonomic, neuromuscular, CNS signs ♦ Half-life 8-36 hours 5 half lives to be gone from the body Methamphetamine Intoxication True or False? ♦ Methamphetamine poisoning is commonly seen in animals that have been seized from methamphetamine labs. True False False ♦ Actual methamphetamine toxicosis is uncommon ♦ Precursor chemicals More than final product Meth = $$ ♦ Cats, rabbits, birds Grooming Ingestion of aerosolized meth off fur/feathers Meth intoxication ♦ Stimulation of CV and CNS Agitation, hyperactivity Dilated pupils Increased heart rate Increased blood pressure Increased body temperature Disorientation Tremors Seizures Aggression Irritability Apprehension Panting Erratic heart rhythm Death Meth intoxication ♦ Time frame Signs generally occur within 0.5-1 hour following exposure Last up to 72 hours in severe cases Methamphetamine Testing ♦ Commercial test kits available Blood – 6-12 hours Urine – 48-72 hours ♦ False positives Proin, Adderall, Afrin Nasal Spray, MDMA, NyQuil, Pseudoephedrine ♦ Thanks to Dr. Rob Kessler, Las Vegas, NV Methamphetamine Treatment ♦ Requires veterinary care ♦ Decrease agitation Phenothiazines (chlorpromazine, acepromazine) Cyprohepatadine (serotonin antagonist) Barbiturates Avoid diazepam! ♦ Reduce body temperature IV fluids Prognosis for meth intoxication ♦ Most animals respond well to treatment ♦ Concern if seizures for a long period or high body temperature Chronic Meth Users Behavioral 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 Methamphetamine The Process If only it was this easy…. ♦ Identify the Meth Lab? Meth labs ♦ Many of the chemicals used to produce meth are extremely hazardous ♦ Dangerous to: Individuals who manufacture methamphetamine People living nearby Law enforcement Firemen Possible 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 Chemical burns ♦ Spills of chemicals onto flooring Walk through, lie in, and/or ingest Familyvet.com Possible 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 Possible ingredients - stimulants ♦ Tremors, seizures, high body temperature, heart irregularities, agitation Pseudoephedrine (cold medications), ephedrine, phenylpropanolamine (vet drugs) Possible ingredients - others ♦ High Pressure Acid Gas Hydrogen Chloride Gas ♦ Methyl Sulfonyl Methane (MSM) Cutting Agent ♦ Sodium Chloride (Salt, Rock Salt) ♦ Hydrogen peroxide Other Potential Hazards ♦ Mechanical injury Discarded syringes, razor blades • Needle punctures ♦ Explosion/fire – burns ♦ Neglect Malnutrition, parasites, infectious dz, abuse Animals ♦ 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 Drug 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...) Your 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! Who 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 Meth 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) Meth Lab Bust ♦ SSO determines the level of personal protective equipment (PPE) that must be used to enter the hot zone Eye protection Protective boots and gloves Protective 'clothing' (e.g. Tyvek suits) +/- specialized respirators and/or fully encapsulated HazMat suits with selfcontained breathing apparatus What’s wrong with this picture ? Meth 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 Meth 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 Animal removal Meth 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) Meth 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 Meth 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 Meth 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 Meth 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 Meth 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) Decontamination ♦ 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 Decontamination ♦ 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 Decontamination ♦ 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 Decontamination Decontamination ♦ 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 Evaluation ♦ Veterinary facility ♦ Exam for physical and behavioral abnormalities Methamphetamine Forensics Documentation ♦ You can never have too much documentation Documentation ♦ 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 Documentation Testing ♦ 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 Drug 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 Drug 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 Question? ♦ 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 Answer ♦ 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 Take home points ♦ ♦ ♦ ♦ ♦ Delay behavioral evaluation Successful rehoming can occur Protect yourself Decontaminate Document Questions?