CCU: Triage

Question 1

From the patient presenting to ER to the secondary survey, how long should it take you to triage a patient

Answer 1

3 minutes

Question 2

What is the goal of triage

Answer 2

Identify life-threatening abnormalities that require immediate intervention

Sorting of patients for treatment priority when resources are insufficient for all to be treated immediately

Question 3

What is the first step of triage after a patient presents to ER

Answer 3

Primary survey

Question 4

What are the steps of primary survey

Answer 4

exsanguination
airway
breathing
circulation
disability
exposure

X-ABCDEF

Question 5

generally arterial hemorrhage
full body sweep

Answer 5

exsanguination

Question 6

What are you assessing with the patient’s airway when doing primary survey

Answer 6

-laryngeal paralysis, BOAS, foreign body, mass, trauma/displacement,etc
-severe stertor, stridor
achieved by visual inspection (not the breathing)

Question 7

What are you assessing with the patient’s breathing when doing primary survey

Answer 7

visual and auditory assessment
intubate and ventilate
easier to be able to complete assessment and obtain diagnostics

Question 8

what should you assess about the patient’s circulatory system when doing primary survey

Answer 8

1) Identify patient in shock
2) Perfusion parameters
-Mentation
-HR
-Pulse quality
-Mucous membrane color
-CRT
-Core-toe web temperature gradient

Question 9

What should you assess about the patient’s disability when doing a primary survey

Answer 9

1) Assess for evidence of TBI or spinal instability
2) Focus on: mentation, limited cranial nerve exam, brief vertebral column palpation, voluntary motor activity

Question 10

How do you assess for TBI when doing triage

Answer 10

Mentation: obtunded, stuporous, comatose

Brainstem Reflexes: pupil size- anisocoria, mydriasis, miosis
PLRs- slow, incomplete, absent

Question 11

How do you assess for spinal instability when doing triage

Answer 11

1) Palpation- deviation, malalignment, step
2) Absent voluntary motor activity or lack of pain perception

Question 12

How do you assess for exposure when triaging patients

Answer 12

-Minimize heat loss
-Cover open wounds with sterile lap pads and consider wet lap pads with warm, sterile, saline

Question 13

How do you control exsanguination

Answer 13

1) apply firm, direct pressure with sterile lap pads for 5-10 minutes (dont stop and look) if it fills with blood, put new pad on top of it and then identifty artery to ligate
2) Ligate artery
3) Tourniquet if necessary

Question 14

How do treat issues with the airway when doing triage

Answer 14

opioids, propofol to effect - intubate or tracheostomy

allows you time to perform exam and diagnostics

Question 15

What should you do if you cant intubate a patient

Answer 15

tracheostomy tube

Question 16

What are your interventions for patients with breathing issues

Answer 16

oxygen
sedation- commonly butorphanol, acepromaze

Question 17

What are your concerns with sedating patients with breathing troubles

Answer 17

you are sedating them and decreasing their respiratory drive

Question 18

What are the respiratory emergencies

Answer 18

-Pneumothorax
-Pleural effusion
-Cardiogenic pulmonary edema
-Non-cardiogenic pulmonary edema
-Aspiration pneumonia
-Upper airway obstruction
-Asthma

Question 19

What do you do if your patient is in cardiopulmonary arrest

Answer 19

CPR

Question 20

What do you do if your patient is in shock

Answer 20

1) Fluid Resuscitation
-Isotonic Crystalloid
-Hypertonic Saline
-Hydroxyethyl starch solutions
-Blood Productions

2) Vasopressors for Vasodilatory Shock

*No fluids for cardiogenic shock patients

Question 21

Inadequate cellular energy production due to inadequate oxygen and nutrient delivery
DO2 doesnt equal VO2

Answer 21

Shock

Question 22

What are the 6 perfusion parameters that are important in identifying patients that are in shock

Answer 22

1) Mentation (level of consciousness)
2) HR
3) Pulse Quality
4) Mucous Membrane Color
5) Capillary refill time
6) Extremities Temp

Question 23

What are the 6 shock classifications

Answer 23

1) Hypovolemic
2) Distributitive / Vasodilatory
3) Obstructive
4) Cardiogenic
5) Anemic / Hypoxemic
6) Metabolic

Question 24

You can give fluids to all patients with shock unless

Answer 24

it is cardiogenic shock

Question 25

When assessing for disability what two things are you assessing for

Answer 25

1) TBI
2) Spinal instability

Question 26

How do you treat an animal that is having seizures

Answer 26

1) Midazolam 0.3-0.5 mg/kg - can repeat multiple times
2) Phenobarbital 2-4mg/kg, 10-12mg/kg loading dose
3) Keppra 60mg/kg loading dose

make sure to assess if it is a seizure- muscle tremors, hypoglycemia, other cause is not treated

can always do propofol, general anesthesia

Question 27

How do you treat for spinal injury

Answer 27

immobilization - cranial and caudal to the injury

Question 28

How would you triage animals with exposure (fracture, evisceration, etc.)

Answer 28

minimize heat loss
cover open wounds with sterile lap pads
-consider wet lap pads with warm, sterile saline

Question 29

What should you do for a patient with allergic reaction

Answer 29

diphenhydramine 2.2mg/kg IM

Question 30

What would you see on bloodsmear in a patient with rattlesnake envenomation

Answer 30

echinocytes

Question 31

When triaging patients, what should you do for after your primary survey (XABCDE)

Answer 31

immediate stabilization

Question 32

When triaging patients, what should you do after immediate stabilization

Answer 32

secondary survey