Emergency Medicine Flashcards
Outline the colours in the veterinary triage list.
- Red = Immediate attention
- Orange = 15 mins
- Yellow = 30-60 mins
- Green = 120 mins
Provide examples of animals that would be colour coded red in the veterinary triage list.
- Decompensatory shock
- Haemorrhage
- Severe respiratory distress
- Seizures
What does ABCDE stand for?
Airway
Breathing
Circulation
Disability/neurologic
Evacuation e.g. urinary/exposures
How is airway in ABCDE assessed? What intervention is immediately required? and what is the goal of stabilisation?
Assessing?
- For stridor/ stretor
- For inspiratory effort
- SpO2
Intervention?
- Oxygen
- IV catheter
- Orotracheal intubation
- Sedation (if stressed)
- Cooling
Goal?
- Patient airway
How is breathing in ABCDE assessed? What intervention is immediately required? and what is the goal of stabilisation?
Assessed by assessing:
- Respiratory rate and effort
- Thoracic auscultation
- Respiratory pattern
- MM colour (cyanosis)
- SpO2
- ABG
- POCUS
Intervention?
- oxygen
- IVC
- May require orotracheal intubation
- Medications e.g. fruesemide for CHF
Goal?
- Ensure adequate oxygenation and ventilation
How is circulation in ABCDE assessed? What intervention is immediately required? and what is the goal of stabilisation?
Assessed?
- MM colour
- HR
- CRT
- Pulse quality
- NIBP
- Shock index
- SpO2
- ECG
- PCV/TP, lactate
- POCUS
Intervention?
- IVC
- IVFT
- Blood transfusion
- Control haemorrhage
- +/- vasopressors
Goal?
- Stabilise circulation
How is disability/neurologic in ABCDE assessed? What intervention is immediately required? and what is the goal of stabilisation?
Assessed?
- Mentation
- Pupillary size and PLRs
- Ambulatory status
- Seizures?
- ECG/NIBP
- Glucose, electrolyte, Toxin exposure
Intervention?
- Control seizures
- Elevated head and neck
- Osmotic agents
- Dextrose bolus
- Immobilise patient with suspect spinal fracture
Goal?
- Stabilise neurological system
How is evacution/urinary in ABCDE assessed? What intervention is immediately required? and what is the goal of stabilisation?
Assessed?
- Last sign of urination
- Urinary signs
- Bladder palpation
- ECG
- K+, BUN and creat
Intervention?
- IVC
- Treatment of arrhythmias
- Analgesia
- UCATH
Goal?
- Stabilise urinary system
What are the major body systems that need to be assessed during the rapid assessment?
- Respiratory
- Cardiac
- Neurologic
- Urinary
What should done simultateously as the rapid assessment?
Obtaining the presenting complaint and relevant medical history
What should the estimate and written consent include?
- IVC and fluids
- Point of care bloods
- Point of care ultrasound/AFAST/TFAST
- ECG
- Blood pressure
- Pulse oximetry
- Medication administration
What should the point of care blood include?
PCV/TP, blood gas, glucose and BUN
What does the primary survey entail?
Refers to evaluating the same organ systems as performed during the initial triage in more detail. This is similar to ABCDE.
What should occur during the subjection assessment of the respiratory system?
- Determination of airway patency and identification of breathing problems.
- Assessment for stretor or stridor with increased breathing effort may indicate an upper airway obstruction.
- Assessment of respiratory rate and breathing effort
What is important about cats and respiratory disease?
Cats with upper airway conditions often do not have loud upper airway noise and signs may be subtle consisting of increased respiratory effort and loud or noisy breath sounds on tracheal auscultation.
What should occur if a patient is not breathing?
Immediate ET intubation and positive pressure ventilation initially. During intubation, the soft palate, oropharynx and larynx should be quickly evaluated for foreign bodies, masses or severe inflammation that might be responsible for airway obstruction.
What can hypercapnia cause?
Vasodilation, hypotension and altered mentation due to cerebral oedema
Define tachypnoea.
> 40 breaths/min
Define pardoxical breathing.
Chest wall moves out and abdomen moves inwards
What can pardoxical breathing be associated with?
Pleural space disease
What other condition can cause tachypnoea without respiratory compromise?
Hypovolaemia
Pain
Abdominal distension
Hyperthyroidism
Fear
And others
Patients will usually have normal respiratory effort.
What should the objective assessment of the respiratory system include?
- Pulse oximetry
- Ideally arterial blood gas, venous blood gas can be useful
Define hypoxaemia.
SpO2 < 95%
OR a PaO2 < 80mmHg
What should be considered in cats with respiratory compromise?
Cats showing respiratory signs can be particularly fragile and a simple physical examination and IV catheter can result in cardiopulmonary arrest. Such cats often benefit from being placed immediately in an oxygen rich cage before physical examination. Once respiratory signs improve, the primary survey can be completed, or if the cage allows physical examination can be performed in the cage
What are with assess on POCUS?
TFAST for:
- Pleural space disease
- Evidence of cardiac disease, assessment of cardiac contractility
- B-lines
AFAST for:
- FF
- Evidence of obvious sign of pathology.
What are indications of cardiac disease on POCUS?
- La/AO > 1.5:1
- > 3 B-line in multiple view
- Poor cardiac contractility
What do B-lines indicate?
Interstital alveolar disease
What are some differentials for B-lines?
CHF
Fluid overload
Pneumonia
Contusions
Non-cardiogenic pulmonary oedema
Acute respiratory distress syndrome
What should occur immediately if there is a pleural effusion, pneumonthorax or perdicardial effusion?
Thoracocentesis or pericardiocentesis
What are the types of shock?
- Hypovolaemic - loss of intravascular volume
- Cardiogenic - Failure of the cardiac pump
- Distributive/vasodilatory - maldistribution of blood e.g. anaphylaxis, sepsis or SIRS
- Obstructive - obstruction to venous return
What is the main goal in the initial subjective assessment of the cardiovascular system?
Primary cardiovascular system assessment includes evaluation for abnormalities in tissue perfusion that may result in shock.
What causes poor tissue perfusion?
Caused by the different types of shock.
What are the physical exam findings that can indication poor tissue perfusion?
- Pale mucous membrane
- Prolonged CRT
- Tachycardia or bradycardia in cats
- Poor and absent peripheral pulses, both femoral and pedal pulses should be assessed.
- Dull mentation
- Dull heart sounds
- Low body temperature
- Cool extremities
