What is the stepwise emergency management protocol for GDV including pre-surgical stabilization?

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Immediate gastric decompression is the first priority in canine GDV, performed concurrently with intravenous fluid resuscitation before any surgical decision is made. GDV rapidly produces shock, cardiac arrhythmia, myocardial dysfunction from compression of intra-abdominal veins, reduced venous return, and lactic acidosis — all of which worsen the longer the volvulus remains untreated.2 Increased intra-abdominal pressure also reduces total thoracic volume and impairs full lung inflation, compounding cardiovascular compromise.2 Decompression is achieved by orogastric intubation as the preferred method; percutaneous trocharization with a needle is an alternative but carries increased risk of gastric rupture and peritonitis.1 Placement of an indwelling nasogastric tube after decompression prevents re-dilatation during the stabilization period.4 Medical stabilization includes correction of fluid losses and provision of analgesia.1 The duration of pre-surgical stabilization does not affect survival, provided aggressive monitoring is maintained. Dogs stabilized for a median of 2.1 hours before surgery and those stabilized for a median of 9.8 hours (range 5.4–13.7 hours) showed equivalent survival rates at discharge and at one month postoperatively.4 Hyperlactatemia persisting 24 hours after initiation of fluid therapy is associated with increased in-hospital mortality and increased mortality at one month — making lactate clearance the key monitoring target during stabilization.4 Definitive surgical treatment consists of decompression and derotation of the stomach, inspection of gastric tissue for necrosis, and gastropexy to prevent recurrence.25 Gastropexy is essential following correct gastric repositioning in every GDV patient.5 Gastropexy is greater than 95% effective in preventing recurrence, both when performed after GDV and when performed prophylactically.6 Negative prognostic factors that should prompt owner counseling before or during surgery are hyperlactatemia u