Provide immediate fluid therapy targeted to specific endpoints, provide supplemental oxygen, and identify and treat the cause for the shock. Tranexamic acid (TXA) or ɛ-aminocaproic acid (EACA) may be helpful in dogs with catastrophic hemorrhage.

1. Place multiple large-bore IV or IO catheters or perform venous cut-down.

- Do not delay in placing catheters. The IO route is rapid, reliable and safe — USE IT! Place peripheral or central lines when feasible. If one percutaneous attempt is not successful in a shock patient, immediately choose an alternate percutaneous site and also begin an immediate venous cutdown or perform IO catheterization. The cephalic veins and external jugular veins are ideal for peripheral catheterization.
- The proximal cranial medial tibia and the proximal lateral humerus are ideal for IO catheter placement, using the same technique as for people (See Figures 34-37). Most MWDs weigh >40#, so use adult (25mm X 15 gauge) IO catheters. Use pediatric (15mm X 15 gauge) IO catheters in dogs weighing less than 40#.

Figures 34-37. Intra-osseous Catheter Placement (Tibia) in a MWD.

Note: Sterile draping is removed to provide better visualization; perform catheterization using sterile technique.