CCU: Triage Flashcards
From the patient presenting to ER to the secondary survey, how long should it take you to triage a patient
3 minutes
What is the goal of triage
Identify life-threatening abnormalities that require immediate intervention
Sorting of patients for treatment priority when resources are insufficient for all to be treated immediately
What is the first step of triage after a patient presents to ER
Primary survey
What are the steps of primary survey
exsanguination
airway
breathing
circulation
disability
exposure
X-ABCDEF
generally arterial hemorrhage
full body sweep
exsanguination
What are you assessing with the patient’s airway when doing primary survey
-laryngeal paralysis, BOAS, foreign body, mass, trauma/displacement,etc
-severe stertor, stridor
achieved by visual inspection (not the breathing)
What are you assessing with the patient’s breathing when doing primary survey
visual and auditory assessment
intubate and ventilate
easier to be able to complete assessment and obtain diagnostics
what should you assess about the patient’s circulatory system when doing primary survey
1) Identify patient in shock
2) Perfusion parameters
-Mentation
-HR
-Pulse quality
-Mucous membrane color
-CRT
-Core-toe web temperature gradient
What should you assess about the patient’s disability when doing a primary survey
1) Assess for evidence of TBI or spinal instability
2) Focus on: mentation, limited cranial nerve exam, brief vertebral column palpation, voluntary motor activity
How do you assess for TBI when doing triage
Mentation: obtunded, stuporous, comatose
Brainstem Reflexes: pupil size- anisocoria, mydriasis, miosis
PLRs- slow, incomplete, absent
How do you assess for spinal instability when doing triage
1) Palpation- deviation, malalignment, step
2) Absent voluntary motor activity or lack of pain perception
How do you assess for exposure when triaging patients
-Minimize heat loss
-Cover open wounds with sterile lap pads and consider wet lap pads with warm, sterile, saline
How do you control exsanguination
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
How do treat issues with the airway when doing triage
opioids, propofol to effect - intubate or tracheostomy
allows you time to perform exam and diagnostics
What should you do if you cant intubate a patient
tracheostomy tube
What are your interventions for patients with breathing issues
oxygen
sedation- commonly butorphanol, acepromaze
What are your concerns with sedating patients with breathing troubles
you are sedating them and decreasing their respiratory drive
What are the respiratory emergencies
-Pneumothorax
-Pleural effusion
-Cardiogenic pulmonary edema
-Non-cardiogenic pulmonary edema
-Aspiration pneumonia
-Upper airway obstruction
-Asthma
What do you do if your patient is in cardiopulmonary arrest
CPR
What do you do if your patient is in shock
1) Fluid Resuscitation
-Isotonic Crystalloid
-Hypertonic Saline
-Hydroxyethyl starch solutions
-Blood Productions
2) Vasopressors for Vasodilatory Shock
*No fluids for cardiogenic shock patients
Inadequate cellular energy production due to inadequate oxygen and nutrient delivery
DO2 doesnt equal VO2
Shock
What are the 6 perfusion parameters that are important in identifying patients that are in shock
1) Mentation (level of consciousness)
2) HR
3) Pulse Quality
4) Mucous Membrane Color
5) Capillary refill time
6) Extremities Temp
What are the 6 shock classifications
1) Hypovolemic
2) Distributitive / Vasodilatory
3) Obstructive
4) Cardiogenic
5) Anemic / Hypoxemic
6) Metabolic
You can give fluids to all patients with shock unless
it is cardiogenic shock
When assessing for disability what two things are you assessing for
1) TBI
2) Spinal instability
How do you treat an animal that is having seizures
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
How do you treat for spinal injury
immobilization - cranial and caudal to the injury
How would you triage animals with exposure (fracture, evisceration, etc.)
minimize heat loss
cover open wounds with sterile lap pads
-consider wet lap pads with warm, sterile saline
What should you do for a patient with allergic reaction
diphenhydramine 2.2mg/kg IM
What would you see on bloodsmear in a patient with rattlesnake envenomation
echinocytes
When triaging patients, what should you do for after your primary survey (XABCDE)
immediate stabilization
When triaging patients, what should you do after immediate stabilization
secondary survey
