Dr Isak Kasuto - Triaging and Emergency Care/Patient Assessment

Question 1

What is triage?

Answer 1

Triage is the prioritization of treatment based on medical need

Question 2

What are the skills required to gather information while conveying concern to the client?

Answer 2

Excellent assessment and communication skills are required

Question 3

Where does most initial contact and questioning begin with clients?

Answer 3

Most initial contact and questioning begins over the phone.

Question 4

What are the benefits to speaking to clients over the phone (in regards to an emergency/medical condition)?

Answer 4

It is an opportunity to get information and provide help if possible. It also allows us to get an ETA (so we can prepare).

Question 5

What are some common questions used over the phone to retrieve information about the animal or the emergency?

Answer 5

Client name
Telephone Number
Patient Species
Age of Patient
Sex of Patient
Current and Prior Conditions

Question 6

What is the technician (or CSR) role over the phone?

Answer 6

To calm the owner
Advise on appropriate handler’s safety
Determine severity of the situation

Question 7

What are two important things to remember in relation to the technician’s role over the phone?

Answer 7

DO NOT diagnose

DO NOT discourage the owner to seek medical attention - let them decide for themselves.

Question 8

If multiple patients need to be triaged, how do we prioritize and categorize them?

Answer 8

Patients will have to be prioritized according to the severity of the illness. We classify triaged patients into categories.

Question 9

What is the primary survey of a patient used for?

Answer 9

The primary survey of a patient is to allow us to identify immediate life-threatening injuries (usually confined to the thoracic cavity).

Question 10

What does the A of “A,B,C’s” stand for?

Answer 10

Airway

Question 11

What does the B of “A,B,C’s” stand for?

Answer 11

Breathing and Bleeding

Question 12

What does the C of “A,B,C’s” stand for?

Answer 12

Cardiovascular, Circulation, level of Consciousness

Question 13

After the A,B,C’s, what other parameters are assessed?

Answer 13

Temperature,
Pulse/Heart Rate
Respiratory Rate/Quality
Mucous Membranes
CRT (Capillary refill time)

Question 14

When you are taking patient history while triaging, what should be asked?

Answer 14

~What is the primary complaint and when was the onset of signs?
~Was there any emergency care received prior to arrival (first aid)?
~Is the pet on any medications for current or non-related problems (including human medication given by client)

Question 15

What is important to remember if an animal is a class 1 or class 2 triage level?

Answer 15

If appropriate, it can be a good idea to get them to sign an emergency authorization form.
*** Ask to what extent emergency or resuscitative procedures can be performed (open or closed chest CPR)

Question 16

What does it mean when an animal has been placed in class 1 triage?

Answer 16

The animal is critical and could pass away

Question 17

What conditions are associated with a class 1 triage position?

Answer 17

~Cardiac Arrest (CODE BLUE)
~Respiratory Arrest (CODE BLUE)
~Unconsciousness
~Respiratory Distress
~Active Hemorrhaging
~Active Convulsions
~Severe Trauma
~Gastric Torsion - GDV (in shock)
~Thoracic Cavity Penetrating Injury

Question 18

What conditions are associated with a class 2 triage position?

Answer 18

~Multiple Injuries (but normal respiration)
~Toxicity 
~Shock/Pale MM
~Abdominal Cavity Penetrating Injury
~Difficulty giving birth 
~Urinary Blockage
~Suspicion of a GDV

Question 19

What conditions are associated with a class 3 triage position?

Answer 19

~Open fractures
~Trauma (but no evidence of shock or altered mental state)
~Convulsions within the last 24 hours
~Perfuse Diarrhea (with lethargy and severe dehydration)
~Vomiting (with lethargy and severe dehydration)
~Chronic Anorexia (with lethargy and severe dehydration)
~Severe Pain

Question 20

What conditions are associated with a class 4 triage position? (SICK BUT STABLE)

Answer 20

~Anorexia
~Vomiting
~Diarrhea
~Limping
~Ear Infections
~ETC...

Question 21

What are common treatments or diagnostics for class 1/2 triage patients?

Answer 21

** ALERT DVM IMMEDIATELY **

~ALWAYS administer oxygen (suction airway and intubate if necessary)
~Active bleeding - apply external pressure
~Place catheter with T-port
~ Establish emergency minimum database (explained in next slide)
~Initiate appropriate therapy - warming/cooling techniques, fluids (if ok by vet), etc

Question 22

What is the emergency minimum database?

Answer 22

TPR, MM, CRT
Blood Pressure
ER Stat Panel (PCV/TP,BG, lactate) - can be done off of IV catheter hub

***NOTE: PULL BLOOD AND KEEP ON HOLD (green top, purple top)