After a diagnosis, the first thing that will be done is decompressing the stomach. This is done either by passing a stomach tube or inserting a large bore needle directly into the abdomen. Dogs that have bloated are usually in shock and need to be stabilized with IV fluids, pain medications, and occasionally antiarrhythmic drugs. Radiographs are taken to confirm bloat and determine if the stomach has twisted.
If the stomach has twisted, then the dog needs to go to surgery as soon as it is stabile enough. The torsion cuts off the blood supply to the stomach and spleen. Tissue dies and toxins are released. During surgery, the organs are rotated back into position and assessed for damage. Sometimes the spleen needs to be removed and parts of the stomach may need to be excised. The stomach is then tacked to the body wall (gastropexy) to prevent a recurrence of volvulus.
If the stomach has not twisted, then surgery can wait, but a gastropexy should be performed. It will not prevent gas bloating but should prevent the stomach from twisting. This procedure can be done preventatively by endoscopy.
After emergency bloat surgery about 50% experience heart arrhythmias, so post operative monitoring is critical.
There may be a situation where you can't get immediate veterinary attention; this is why I've put together bloat kits. It is important to know though that it is not always possible to pass a bloat tube, and even if it is successful 76% of dogs will re-bloat. Get to a vet!!!