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Initial examination of the patient should include evaluation of the patient's mentation, posture, gait, as well as palpation for spinal or rectal pain. Decreased levels of consciousness, with increasing severity are depressed/dull, obtunded, stuporous, and comatose. The depressed/dull or obtunded patient will react normally to evoked stimuli, while the stuporous patient responds to only noxious stimuli, and the comatose patient is completely unresponsive except for reflex activity [5].

Animals with acute abdominal pain are sometimes described as having a hunched appearance or holding themselves in the “bow” or “praying position.” Painful spinal conditions including intervertebral disk disease, discospondylitis, spinal fractures, and spinal neoplasia may mimic this hunched positioning and be mistaken for abdominal pain. A complete neurologic examination should be performed before administration of pain medications to effectively rule out neurologic disease as the cause for pain. The use of opioids is preferred over other classes of drugs, including nonsteroidal anti‐inflammatory drugs (NSAIDs), owing to their rapid onset and better pain control, as well as the common findings of hypoperfusion and the potential for further adverse renal and gastrointestinal effects of NSAIDs.

Initial stabilization of patients with central nervous system (CNS) injury includes immobilization in the case of suspected spinal injuries and intravenous fluid support. Animals with a suspicion of spinal trauma should be immobilized by affixing to a board to prevent further injury. Patients with traumatic brain injury should be maintained at an incline of approximately 20 degrees to promote adequate venous drainage (after appropriate volume resuscitation). Fluid therapy should be instituted to maximize cerebral perfusion pressure by maintaining an adequate peripheral mean arterial pressure, and oxygen therapy instituted as described earlier to maximize blood oxygen content and oxygen delivery.