Coordinate urgent Medical Evacuation (MEDEVAC) directly to appropriate medical facilities where antivenom is stored, if it is known that those products can be used in MWDs.

Ensure a patent airway and provide supplemental oxygen and ventilation, as needed.

Place an IV catheter and obtain a Complete Blood Count (CBC), blood chemistry panel, and urinalysis.

Administer isotonic crystalloids at a rate based on clinical signs and laboratory findings. A fluid rate of 1.5 – 2 times maintenance is often an appropriate initial starting point; however, fluid boluses may initially be necessary. General maintenance fluid rate is 40-60 mL/kg/day. Adjustment to fluid rate is based on patient’s clinical response, monitoring ins and outs and clinical parameters such as body weight, CBC and chemistry values. Monitor for signs of fluid overload such as increasing body weight (>10%), tissue edema, serous nasal discharge, or increased respiratory rate or effort.

Administer 2-4 mg/kg diphenhydramine IM. Repeat diphenhydramine every 8 hours for 72 hours.

NOTE: MWD handlers may have been issued diphenhydramine and may have initiated therapy before presentation. Do not give diphenhydramine IV because it can cause severe hypotension in dogs.

Manage any open wounds that develop. (See K9 Wound Management CPG.)

Treat pain if noted. (See K9 Analgesia and Anesthesia CPG.)

NOTE: Do not treat with NSAIDs given the propensity for envenomated dogs to develop coagulopathies, thrombocytopenia, thrombocytopathia, and secondary acute kidney injury.

If systemic anaphylaxis is suspected based on the history and clinical signs (weakness, peracute vomiting or diarrhea, collapse, or hypotension), treat the MWD as above, and treat with IV fluid therapy as for shock (see K9 Shock Management CPG) and start an epinephrine CRI at 0.1-1 mcg/kg/min. Though a CRI takes longer to set up, it has demonstrated superiority in the treatment and resolution of anaphylaxis over bolus dosing.7,8 If a CRI is unavailable, give epinephrine (0.01 mg/kg, IM or IV; repeat, if necessary, every 20-30 minutes).

Hospitalize the patient and provide supportive care until resolved or evacuated. During hospitalization, measure and track swelling and progression of local tissue effects.