What is the emergency treatment protocol for gastric dilatation-volvulus in dogs?

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Immediate stabilization precedes surgery in all GDV patients — aggressive fluid resuscitation, gastric decompression, and cardiac monitoring are initiated simultaneously before the dog enters the operating room. 14 Fluid resuscitation targets reversal of hypovolemic and cardiogenic shock. Intravenous access should be established immediately, with large-bore catheters placed in the cephalic or jugular veins. The veterinary literature does not specify a single crystalloid bolus volume in the provided sources, but the goal is restoration of perfusion prior to anesthesia. Hyperlactatemia that fails to respond to fluid therapy is a negative prognostic indicator, as is the need for splenectomy or gastric resection. 4 Gastric decompression is performed as part of initial stabilization and can be achieved by orogastric intubation or percutaneous trocarization. Orogastric intubation has a success rate of 76% and gastric trocarization 86% for achieving decompression. 9 Decompression alone resolves volvulus in a subset of patients — 49% of dogs had resolution of volvulus at the time of laparotomy following preoperative gastric lavage — but this does not eliminate the need for surgical exploration, derotation, and gastropexy. 1 Cardiac monitoring for arrhythmias is essential throughout stabilization and the perioperative period, as GDV causes myocardial dysfunction through compression of intra-abdominal veins, reduced venous return, and release of myocardial depressant factor from the pancreas. 13 Definitive surgical treatment consists of exploratory laparotomy, gastric derotation, inspection of gastric tissue for necrosis, and gastropexy. Gastropexy is essential following correct gastric repositioning in all GDV patients and is >95% effective in preventing recurrence. 124 The timing of surgery relative to stabilization is flexible: survival rates do not differ between dogs undergoing surgery after 90 minutes of stabilization (median 2.1 hours from presentation) versus prolonge