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FCP > Emergency care > Flashcards

Emergency care Flashcards

1
Q

What is triage ?

A

prioritising
gather data - make decisions

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2
Q

What makes up your primary survey in triage?

A

-TPMR
-POCUS e.g GFAST ( TFAST,AFAST and VetBLUE )
-BP- how aggressive do fluids need to be
-neuro assessment - quick mentation and eyes
-pain assessment - pain relief ( * be careful of hypovolaemic patient NSAIDS will inhibit prostaglandin )

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3
Q

What makes up your secondary survey ?

A

-further diagnosis - patient side tests
-focused exam -neuro, opthp, ortho, organ - ultrasound

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4
Q

What makes up tertiary survey ?

A

-full clinical exam
-full history
-imaging /radiography
-other - bloods - haematology/biochem

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5
Q

Shock

A

tissue hypoxia

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6
Q

What is hypovolaemic shock ?

A

loss of intravascular volume causing inadequate perfusion ( less cardiac preload )

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7
Q

What 3 things can cause hypovolaemic shock ?

A

-trauma - fluid pulled out of blood
-haemorrhage - coagulopathy
-fluid loss - vomiting , diarrhoea , polyuria

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8
Q

Clinical signs seen in hypovolaemic shock .

A

*all relate to body compensating to try restore bp

-tachycardia
-peripheral vasoconstriction- pale mm , prolonged CRT , poor pulse quality
-low bp
-elevated lactate - not enough oxygenated blood to tissues
-on POCUS - collapse of caudal vena cava , poorly filling heart

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9
Q

How to treat hypovolaemic shock ?

A

-fluid loss - isotonic fluids ( use bolus fluids need to restore quickly )
-blood/plasma loss - transfusion

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10
Q

Distributive shock

A

relative hypovolemia due to pathological redistribution of intravascular volume

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11
Q

What causes distributive shock ?

A

-loss of regulation of vascular tone (primarily inappropriate vasodilation )
-leaky vessels

-septic most common form we’ll see - inflammatory cascade release pro inflammatory cytokines to promote vasodilation and permeability

  • can occur due to sepsis , anaphylaxis , neurogenic cause
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12
Q

Clinical signs of distributive shock .

A

-vasodilation - injected mm, shortened CRT ( pooling of blood in membrane capillaries ) ,bounding pulse ,tachycardia due to hypotension

-permeability - peripheral odema , pulmonary oedema , cavitatory effusion * fluid everywhere

-low BP
-elevated lactate
- on POCUS - collapse caudal vena cava , poor heart filling , septic abdomen ( free fluid ) , fluid , gal bladder halo ( oedema of wall )

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13
Q

What are you feeling when feeling a bounding pulse ?

A

feeling the difference between systolic and diastolic - feels bigger

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14
Q

How to treat distributive shock ?

A

-volume support - bolus
-vascular tone support - vasopressor - noradrenaline or dopamine
-permeability support - ( make sure oncotic pressure is adequate ) - check albumin levels -if low plasma transfusion , start feeding

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15
Q

TRUE/FALSE distributive and hypovolaemic shock can both occur at the same time

A

true

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16
Q

How can tell difference between hypovolaemic and distributive shock ?

A

give fluid bolus- if not responding assume distributive shock and treat as such

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17
Q

What are 2 other types of shock not including distributive and hypovolaemic ?

A

cardiogenic
obstructive

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18
Q

Cardiogenic shock

A

cardiac dysfunction - reduced pumping - poor perfusion - blood isn’t getting out to body - only in very small amount

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19
Q

Causes of cardiogenic shock

A

-myocardial failure - end stage heart disease
-arrythmias - cardiac disease or secondary of splenic disease , hyperkalaemia
-valvular disease -not common

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20
Q

Clinical signs cardiogenic shock

A

*to do with poor output and peripheral vasoconstriction

-poor pulse
-pale mm
-prolonged CRT
-reduced temp
-low BP - less than 90 systolic
-elevated lactate
-on POCUS - poorly contracting heart , cardiac disease
-ECG - brady-arrythmia or tachy-arrythmia

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21
Q

How treat cardiogenic shock ?

A

*depend cause
-hyperkalaemia - glucose, insulin , fluid therapy
-splenic disease - remove spleen
-myocardial failure - use a positive inotrope

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22
Q

Obstructive shock

A

obstruction of big vessels or heart itself

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23
Q

What does bstructive shock cause?

A

-less circulation - reduced filling - cardiac tamponade
-increased workload for right ventricle
-impendance - blood flow wrong way e.g due to aortic stenosis ( narrowing )
-reduced pre load - e.g reduced venus return due vena cava compression

24
Q

Clinical signs obstructive shock

A

-elevated lactate
-on POCUS
loss of glide sign ( tension pneumothorax ) cardiac tamponade =pericardial effusion, collapse RV and A
pulmonary thromboembolism - pulmonary hypertension and RV enlargement
CVC distention / compression
aortic flow obstruction
neoplasia

25
Q

How treat cardiac tamponade ?

A

pericardiocentesis

26
Q

How treat tension pneumothorax ?

A

thoracocentesis

27
Q

How to treat GDV ?

A

Gastric decompression

28
Q

What to do if immediate removal of obstruction in obstructive shock isn’t possible ?

A

supportive care
-pulmonary thromboembolism -platlet inhibitors ,oxygen therapy
-neoplasia - force preload through fluid bolus before surgery

29
Q

Why is ultrasound good for emergency patients ?

A

-safe
-minimal restraint
-can be performed in unstable patients
-quick

30
Q

FAST

A

Focused assessment using sonography for trauma

31
Q

T-FAST

A

thoracic FAST
-pericardial effusion , cardiac chambers and contractility
-5 point scan

32
Q

A-FAST

A

abdominal FAST
-free fluid in abdomen - abdominal fluid score
-caudal vena cava and gall bladder
- 4 point scan

33
Q

VetBLUE

A

vet beside lung ultrasound exam

34
Q

Global FAST

A

VetBLUE + TFAST + AFAST

35
Q

PLUS

A

Pleural lung Ultrasound

36
Q

FLASH

A

fast localised abdominal sonography of horses
-abdominal and thoracic free fluid and small intestine loops
-7 point scan

37
Q

TRUE/FALSE critical illness promotes protein catabolism and impairs healing

A

true

38
Q

Enteral feeding

A

using tube to enter GI tract to delivery food

39
Q

Parenteral feeding

A

use pharmacologically designed product via IV

39
Q

Approach to head trauma

A

-can animal breathe - Bony stuc ( crushed nasal bones) , soft tissue ( oral bleeding aspiration risk m crushed/damaged airway )

-brain - bony struc ( skull ) , soft tissue trauma to brain

other injuries - not emergent - e.g broken jaw , proptosis of eye

39
Q

What can occur secondary to head trauma )?

A

-rapid metabolism of energy stores in brain - neuronal damage
-proinflammatory state - neuronal damage
- loss of BBB

40
Q

How to detect head trauma ?

A
  • mentation - obtunded
  • eyes - miosis , PLR , mydriasis ( if bilateral mydriasis /normal size pupil /no PLR - poor prognosis )
    -cushings reflex = cerebral response to ischaemia - hypotension , bradycardia ( severe )
    -glucose - elevated ( stress response )
41
Q

How treat head trauma ?

A

-reduce intracranial pressure - with hypertonic fluids
-normalise perfusion - if hypotension fluid therapy and vasopressor , if hypertension pain relief and anti-hypertensive med *don’t want to use , last point of call
*if CO2 doesn’t fix with bp consider intubating

42
Q

What are the 2 types of thoracic trauma ?

A

-blunt trauma -pneumothorax, haemothorax ,chylothorax , diaphragmatic hernia
- penetrating injury

43
Q

Why is getting IV access in a thoracic trauma case important ?

A

deteriorate rapidly so need to be able to induce and ventilate

44
Q

Why is tension pneumothorax life threatening ?

A

-build up of air in the thoracic cavity obstructs venous return to heart , can’t fill properly

45
Q

TRUE/FALSE completely draining a haemothorax can make it worse

A

true - allows them to keep bleeding out , pressure stops bleeding ( try not do anything surgical can heal on own)

46
Q

Approach to penetrating thoracic injury

A
  • anaesthetise
    -close wound
    -antibiotics
47
Q

Approach to traumatic thoracic injury

A

-drain ( unless haemothorax -can resolve on own ) * if not air drain til ventilation improves

48
Q

Approach to blunt trauma haemoabdomen ( non-penetrating

A

-usually nonsurgical - if organ not ruptured
-conservative management - fluid therapy ( help perfusion )
-could do abdominal wrap
-tranexamic acid - helps clots form and stay ( seems quite dangerous , maybe good grey hounds as they bleed )

49
Q

Approach to penetrating haemoabdomen injury

A

-usually surgical
-stabalise - fluid therapy , transfusion ( blood products )
-anesthetise ( have lidocaine ready )
-ex lap - look for site of bleed *if can’t be stopped pack and close re-operate 24-48 hours later

50
Q

Approach to pneumoperitoneum ( blunt or penetrating

A

-usually surgical
-radiography better than POCUS ( air interferes )
-stabilise - can become septic ( distributive shock )
-antibiotics
-exlap ( free gas usually indicative of GI damage - looking for damaged GI )

51
Q

Approach to uroabdomen

A

-usually surgical * not always emergency
-life threatening problem =hyperkalemia -treat with glucose and insulin ( these will drive potassium into cells ) , alkalising fluid therapy
-drain abdomen and lavage
-urinary catheter - drain , can use contrast to look at origin of injury (* if not leaking from bladder can be leaking from ureters )

52
Q

Why is hyperkalemia life threatening ?

A

prevents repolarisation - bradycardia – atrial standstill

53
Q

How to spot spinal trauma

A

-neurological deficits
- at risk distributive shock - lack response to fluid therapy , need vasopressor therapy

54
Q

TRUE/FALSE if no lesions on radiography of suspected spinal trauma could have spinal bruising which can resolve with time

A

true

55
Q

TRUE/FALSE if pectin in back of eye of birds damaged - will never recover

A

true

FCP (24 decks)

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