A cat that drops mid-step is usually not dead and usually not fine. The next 60 seconds decide more than the next 6 hours: 4 checks, 2 things to avoid, and a car within 5 minutes. On the way, nothing goes in the mouth, the cat does not sit up, and you do not wait for round 2.
Breathing and gum color come first, transport second, diagnosis last. A cat in shock has 30 to 60 minutes before compensation fails; a cat with a clot in the hind legs has 4 to 6 hours before the muscle dies.
The first 60 seconds: 4 moves
Watch the chest instead of guessing. At 20 to 30 breaths per minute, 3 to 5 breaths in 10 seconds is normal and 1 or 2 is not. If the chest is still, extend the neck, look in the mouth for 2 seconds, sweep with 1 finger only if the object is visible, then compress at 100 to 120 per minute to one third of chest depth until you reach the clinic.
The femoral pulse sits high inside the thigh and should feel like a firm cord. Press the gum until it whitens: color should return in 1 to 2 seconds, and 3 or more means poor perfusion. White, grey or muddy gums mean shock or internal bleeding, and that cat needs a vein within 20 minutes.
Left side down, head level with or 2 to 3 cm below the chest, neck straight, no pillow. A cat down for 2 minutes loses heat fast, and under 37.0 C clotting and drug handling get worse, so add 1 blanket, not 3 hot water bottles.
Call while you are still kneeling: say collapse, then breathing rate, gum color, conscious or not. Ask whether they have oxygen and a Doppler; if not, drive 10 minutes further.
The 2 things you must not do
Never pour water, food, sugar water or medicine into the mouth of a cat that is unconscious or partly conscious. Swallowing is unreliable and 100 percent of it goes down the trachea. A 2 to 3 ml syringe of honey water can cause aspiration pneumonia: 3 to 7 days in hospital, 800 to 2,000 dollars.
Never sit the cat up, carry it by the scruff or shake it awake. Sitting upright drops venous return in a cat that may be bleeding into the abdomen, and scruffing kinks the airway. Do not compress the chest of a cat that is breathing and has a pulse.
3 timelines that sort the collapse
Duration is the cheapest test you own. A faint lasts 5 to 15 seconds, the gums stay pink, and the cat is orientated within 30 seconds; in a cat that points at the heart, so book an ECG within 24 to 48 hours. A seizure lasts 30 seconds to 3 minutes and leaves 10 to 60 minutes of confusion; 2 in 24 hours, or 1 over 5 minutes, is a cluster.
| Event | How long it lasts | Gums and pulse | Time to vet |
|---|---|---|---|
| Faint (syncope) | 5 to 15 seconds | pink, pulse present | 24 to 48 hours |
| Seizure | 30 seconds to 3 minutes | pale during, pink after | now if over 5 minutes |
| Bleeding into the belly | 10 minutes to decompensation | white or grey, weak fast pulse | 20 minutes |
| Clot in the hind legs | continuous, no recovery | pink front, blue pads behind | 4 to 6 hours |
| Low blood sugar | 10 to 60 seconds, may repeat | pale, trembling first | 30 minutes |
White gums and a distended abdomen is bleeding until proven otherwise: 30 to 40 percent of blood volume can sit in the belly while the cat still walks, then fail in under 10 minutes. Cold, painful hind legs with no femoral pulse is a clot, window 4 to 6 hours, and those legs are not for massaging. A cat unresponsive over 60 seconds, or down twice in 1 day, goes in however normal it looks.
In the car: 4 things not to do
Do not let the cat walk to the car; a second event in the 20 steps to the door is common. Slide it onto a rigid board and carry it flat. Skip the soft bag that folds around the body: a rigid base keeps the spine straight and lets you watch the gums at every light.
Do not stop for food, water or a human painkiller, because 1 tablet of 500 mg acetaminophen or 200 mg ibuprofen is a toxic dose for a 4 kg cat. Do not run the heater on full either: 20 to 25 C, 1 window cracked, chest counted for 10 seconds every 5 minutes.
Hour 0 to 1 at the clinic
The first 20 minutes are access and oxygen, not imaging. Expect a catheter, flow-by oxygen at 40 to 60 percent, and 10 to 20 ml per kg of balanced crystalloid over 15 to 20 minutes. A glucose under 3.0 mmol/L gets 1 to 2 ml per kg of 50 percent dextrose diluted 1 to 3, and a packed cell volume under 20 percent gets blood.
At the same time: packed cell volume, total protein, lactate (over 4 mmol/L is a red flag), potassium between 3.5 and 5.0, and an ECG. An abdominal FAST scan takes 3 to 5 minutes and finds fluid a hands-on exam misses in 3 of 4 cases.
Hour 1 to 2: the recheck that decides
By 60 minutes the numbers should move 1 way: capillary refill under 2 seconds, systolic pressure 100 to 160 mmHg by Doppler, heart rate settling to 180 to 220, urine output 1 to 2 ml per kg per hour. A packed cell volume that drops 5 points in 1 hour is active bleeding, and surgery versus transfusion is decided between minute 60 and minute 120.
Hour 2 to 6: the quiet window
Repeat the chest ultrasound at 2 to 4 hours, because a small pericardial effusion can become a large one, and arrhythmias surface 3 to 6 hours after a cardiac event. Temperature should be 37.5 to 39.0 C; under 37.0 C at hour 4 means active warming with a blanket and warm air.
Hour 6 to 24: what discharge looks like
Discharge needs 25 to 50 percent of a meal eaten, capillary refill under 2 seconds, 38.0 to 39.0 C, no arrhythmia on a 6 hour strip, and a packed cell volume stable across 2 checks 4 to 6 hours apart. Recheck at 24 to 72 hours, and an ECG at 7 to 14 days if the cause was cardiac.
Cost, and what to keep by the door
An emergency consult runs 120 to 250, a full workup 600 to 1,400, and 24 hours of oxygen and fluids 800 to 2,500; a transfusion adds 300 to 900. That is why 5 minutes on the phone at minute 1 beats any guess at home.
Keep 5 things within reach in the dark:
- a rigid board or a firm carrier,
- 1 folded blanket,
- the clinic number written on the carrier,
- a card with weight, age, medication and 2 contacts,
- a phone note with the time of the collapse.
If the collapse followed a plant or a puddle, say it first: it changes the treatment order. see the plant poisoning timeline and the toxicity checker. If it looked like a seizure and there was more than 1 in 24 hours, read what a seizure cluster means.
Frequently asked
My cat collapsed and then seemed fine. Do I still need a vet?
Yes, within 24 to 48 hours. A faint that lasts 5 to 15 seconds and resolves is often a heart rhythm problem, and the ECG can be normal between episodes, so the cat looks healthy at the exam. Any collapse over 60 seconds, or 2 in 1 day, needs to be seen immediately rather than booked.
Should I do CPR if my cat collapses and is not breathing?
Only when there is no breathing and no pulse. Check for 10 seconds, extend the neck, look in the mouth for 2 seconds, then compress at 100 to 120 per minute to one third of chest depth until you reach the clinic. Compressions on a cat that still has a pulse can trigger a fatal arrhythmia.
What should I never give a collapsed cat?
Nothing by mouth: no water, food, sugar water or human painkillers. Swallowing is unreliable and 2 to 3 ml of liquid can cause aspiration pneumonia, while 1 tablet of 500 mg acetaminophen or 200 mg ibuprofen is a toxic dose for a 4 kg cat. Do not sit the cat up or carry it by the scruff either.