Dr. Rosie DVM

Emergency Protocols

RECOVER-based CPR, emergency drugs, shock management, and triage reference

Clinical Reference Only

This page is a quick reference guide for licensed veterinary professionals. Drug doses and protocols should always be verified against current references and adjusted for individual patient factors. This tool does not replace professional veterinary judgment, emergency training, or consultation with a veterinary criticalist. RECOVER guidelines are updated periodically — verify you are using the most current recommendations.

RECOVER CPR Protocol

Compressions

Rate: 100-120 /min
Depth: 1/3 to 1/2 chest width (lateral)
Position: Lateral recumbency; dorsal for barrel-chested breeds
Compressor rotation: Every 2-min cycle
Allow full recoil: Yes — critical

Ventilation

Rate: 10 breaths/min
Tidal volume: 10 mL/kg
I:E ratio: 1:2
Intubate: ASAP — mouth-to-snout only until tube placed
FiO2: 100% during CPR

CPA Drugs

Epinephrine (low): 0.01 mg/kg IV q2min
Vasopressin: 0.8 U/kg IV (alternate w/ epi)
Atropine: 0.04 mg/kg IV (if vagal)
VF/pulseless VT: Defibrillate first; lidocaine 2 mg/kg IV after
IV access: IO if IV fails (<90 sec rule)

Cycle Timing

BLS cycle: 2 minutes uninterrupted
Pulse/ECG check: End of each 2-min cycle only
ETCO2 monitoring: Target >15 mmHg (good CPR quality indicator)
Defibrillation: 2-4 J/kg external, 0.5-1 J/kg internal
ROSC check: ETCO2 >15, palpable pulse, spontaneous rhythm

Post-ROSC: IV fluid support (avoid overload), vasopressors if hypotensive (dopamine 5-15 mcg/kg/min or norepinephrine 0.1-2 mcg/kg/min), treat arrhythmias, target normothermia (avoid hyperthermia), continuous ECG/ETCO2/SpO2/BP, consider mild therapeutic hypothermia, and monitor for re-arrest for a minimum of 4-6 hours.

Emergency Drug Doses

Drug	Indication	Dose	Route	Notes
Epinephrine (low dose)	Cardiac arrest / Anaphylaxis	0.01 mg/kg	IV, IO, IT	Every other BLS cycle (q2min). IT dose: 0.02-0.1 mg/kg diluted in saline.
Epinephrine (high dose)	Prolonged CPA / Vagal arrest	0.1 mg/kg	IV, IO	Consider after multiple standard-dose cycles with no response.
Atropine	Vagal-mediated bradycardia / Asystole	0.04 mg/kg	IV, IO, IT	q3-5min. IT dose: double IV dose. Do NOT use for sinus bradycardia without vagal cause.
Vasopressin	Cardiac arrest (alternative to epinephrine)	0.8 U/kg	IV, IO	Can replace or alternate with epinephrine. Single dose or q3-5min.
Lidocaine	Ventricular tachycardia / VF	2 mg/kg (dog)	IV	Dogs only. Slow IV bolus. CRI: 25-80 mcg/kg/min. AVOID in cats (CNS toxicity).
Amiodarone	Refractory VF / Pulseless VT	2.5-5 mg/kg (dog)	IV slow	Dilute in D5W. Can cause hypotension. Dogs only. Give over 10 min if perfusing rhythm.
Naloxone	Opioid reversal	0.01-0.04 mg/kg	IV, IM, IN	Titrate to effect. Duration shorter than most opioids; may need repeat dosing.
Flumazenil	Benzodiazepine reversal	0.01 mg/kg	IV	Titrate to effect. Can precipitate seizures if benzodiazepine was controlling them.
Dexamethasone SP	Anaphylaxis / Shock	0.1-0.5 mg/kg	IV	Adjunct to epinephrine for anaphylaxis. Not a first-line CPA drug.
Diazepam	Seizures (status epilepticus)	0.5-1 mg/kg	IV, IR	IV bolus or per rectum. If no IV access, midazolam IM is preferred.

All doses are per kilogram body weight unless otherwise noted. Verify concentrations before drawing up. IT = intratracheal, IO = intraosseous, IN = intranasal, IR = intrarectal.

Shock Parameters

Parameter	Dog	Cat
Crystalloid bolus	20-30 mL/kg over 15-20 min	10-15 mL/kg over 15-20 min
Total crystalloid shock dose	60-90 mL/kg	40-60 mL/kg
Colloid bolus	5-10 mL/kg over 15-20 min	3-5 mL/kg over 15-20 min
Hypertonic saline (7.5%)	4-5 mL/kg over 5-10 min	2-4 mL/kg over 5-10 min
Target MAP	>60 mmHg	>60 mmHg
Target systolic BP	>90 mmHg	>90 mmHg
Target HR	80-120 bpm	160-220 bpm
Target CRT	<2 sec	<2 sec
Target lactate	<2.5 mmol/L	<2.5 mmol/L
Target UOP	1-2 mL/kg/hr	1-2 mL/kg/hr

Key principle: Give fluids in boluses and reassess after each. Do NOT blindly give full shock dose — titrate to effect. Cats are especially sensitive to volume overload. Auscultate lungs between boluses. Consider early vasopressor support if inadequate response to 2 crystalloid boluses.

Common Emergency Presentations

GDV (Gastric Dilatation-Volvulus)

1.IV catheter (2 large-bore, both cephalic)
2.Aggressive fluid resuscitation (crystalloid bolus)
3.Decompress: trocar or orogastric tube
4.ECG monitoring (ventricular arrhythmias common)
5.Lidocaine CRI if VPCs >160 bpm or R-on-T
6.Right lateral radiograph to confirm
7.Surgery ASAP once hemodynamically stable

CRITICAL: Do NOT delay decompression for radiographs if patient is in shock.

Anaphylaxis

1.Epinephrine 0.01 mg/kg IV (or 0.01 mg/kg IM if no IV)
2.Aggressive IV crystalloids
3.Dexamethasone SP 0.1-0.5 mg/kg IV
4.Diphenhydramine 2 mg/kg IM
5.Famotidine 0.5 mg/kg IV
6.Oxygen supplementation
7.Monitor for biphasic reaction (4-8 hrs)

CRITICAL: Do NOT give steroids INSTEAD of epinephrine. Epi is FIRST LINE.

Status Epilepticus

1.Diazepam 0.5-1 mg/kg IV (or midazolam 0.2 mg/kg IM/IN)
2.If no response in 5 min: repeat benzodiazepine
3.If refractory: levetiracetam 60 mg/kg IV over 5 min
4.If still seizing: phenobarbital 4 mg/kg IV q20min (max 24 mg/kg)
5.Check glucose — treat if <60 mg/dL (dextrose 0.5-1 mL/kg of 50%)
6.Propofol CRI for refractory SE (0.1-0.6 mg/kg/min)
7.Monitor temperature — active cooling if >106F

CRITICAL: Do NOT give IV diazepam through a peripheral catheter in cats (propylene glycol toxicity risk).

Severe Trauma / Hemorrhage

1.Primary survey: Airway, Breathing, Circulation
2.Control visible hemorrhage (direct pressure)
3.IV catheter + crystalloid bolus to effect
4.Whole blood or pRBC if PCV <20% / acute loss
5.Focused assessment (AFAST/TFAST)
6.Pain management (methadone 0.1-0.3 mg/kg IV)
7.Serial lactate monitoring

CRITICAL: Do NOT normalize BP too aggressively before surgical hemorrhage control (permissive hypotension: MAP 60-70).

Acute Toxicosis

1.Identify toxin — call ASPCA (888-426-4435) or Pet Poison Helpline (855-764-7661)
2.Decontamination if within window: emesis (apomorphine 0.03 mg/kg IV, or hydrogen peroxide 1-2 mL/kg PO dogs only)
3.Activated charcoal 1-2 g/kg PO (if not corrosive/hydrocarbon)
4.IV fluid diuresis
5.Specific antidotes if available
6.Baseline: CBC, chem, coag, UA, ECG
7.Monitor for 12-72 hrs depending on toxin

CRITICAL: Do NOT induce emesis for corrosives, hydrocarbons, sharp objects, or seizing/obtunded patients.

Triage Categories

RED — Immediate

Life-threatening. Requires immediate intervention.

Timeframe: Immediate (0 min)

Cardiac arrest / respiratory arrest
Active uncontrolled hemorrhage
Anaphylaxis
GDV / acute abdomen
Status epilepticus
Airway obstruction
Open pneumothorax / flail chest

YELLOW — Urgent

Serious but stable. Risk of deterioration without timely care.

Timeframe: Within 15-30 min

Closed fractures
Moderate dyspnea (stable)
Toxin ingestion (stable)
Urethral obstruction
Eye injuries / proptosis
Moderate hemorrhage (controlled)
Burns >15% BSA

GREEN — Non-Urgent

Stable. Can wait for assessment without significant risk.

Timeframe: Within 1-2 hrs

Minor lacerations
Vomiting / diarrhea (hydrated)
Mild lameness
Skin wounds (non-penetrating)
Chronic conditions with mild exacerbation

Emergency Hotlines

ASPCA Animal Poison Control

(888) 426-4435

$75 consultation fee — 24/7/365

Pet Poison Helpline

(855) 764-7661

$85 consultation fee — 24/7/365

AVMA Emergency Resources

avma.org/resources

Disaster preparedness, VMAT deployment

Drug doses based on RECOVER 2024 guidelines and current emergency medicine references. Always verify doses against your facility's protocols and current pharmacopeia. Last reviewed: March 2026.