Emergency Patient Examination (ASAN001/3) Flashcards
1
Q
Emergency Patient Examination
(5)
A
A – Airway
B – Breathing
C – Circulation
D – Dysfunction / Disability
E – Evaluation / Examination
2
Q
AIRWAY – Assess Ventilation
What do I need to check to assess if it is adequate? (7)
A
- Is the airway patent?
- Is dyspnoea present?
- Colour of MM’s – cyanosis?
- Facial injury affecting breathing?
- Injury to airway?
- Chest wall movement?
- Injury to chest wall?
3
Q
BREATHING – Respiratory Rate & Effort
What are examples of abnormal RR & Efforts? (8)
A
- Panting
- Tachypnoea
- Bradypnoea
- Abdominal breathing
- Paradoxical respiration
- Cheyne–Stokes
- Hyperpnoea
- Dyspnoea
4
Q
B – RR & Effort – Panting
A
Rapid, shallow breathing with mouth open.
Usually tounge protruding.
5
Q
B – RR & Effort – Tachypnoea
A
Rapid, shallow breathing.
6
Q
B – RR & Effort – Bradypnoea
A
Slow breathing.
7
Q
B – RR & Effort – Laboured
A
Deep abdominal breathing.
8
Q
B – RR & Effort – Abdominal Breathing (2)
A
Animal uses it’s abdo muscles to breathe.
Sign of respiratory distress.
9
Q
B – RR & Effort – Cheyne–Stokes
A
Progressively deeper & sometimes faster breathing, followed by gradual decrease resulting in apnoea.
10
Q
B – RR & Effort – Paradoxical Respiration
A
Instead of chest expanding during inspiration, an area of chest moves inwards
(ie. flail chest)
11
Q
B – RR & Effort – Hyperpnoea
A
Rapid, deep breaths
12
Q
B – RR & Effort – Dyspnoea
A
Difficulty breathing.
13
Q
B – What is the normal range for RR of a Dog?
A
12 - 25 breaths p/min
14
Q
B – What is the normal range for RR of a Cat?
A
20 – 30 breaths p/min
15
Q
B – What is the normal range for RR of a Horse?
A
9 – 16 breaths p/min
16
Q
B – What are the 5 main types of Respiratory Sounds?
A
Stridor
Stertor
Wheezing
Crackles
Dull
17
Q
B – Respiratory Sounds – Stridor
A
High pitched inspiratory sounds generated from turbulent air flow in pharynx & trachea.
18
Q
B – Respiratory Sounds – Stertor
A
Noise from nasal passages
eg. snoring / snuffling noises.
19
Q
B – Respiratory Sounds – Wheezing
A
High pitched inspiratory or expiratory noise caused by narrowed airways.
20
Q
B – Respiratory Sounds – Crackles (2)
A
High pitched inspiratory noise.
Sound is made by increased secretion in small airways.
21
Q
B – Respiratory Sounds – Dull (2)
A
Muted or no sound.
Due to pneumothorax, diaphragmatic hernia.
22
Q
CIRCULATION – What are the 6 Perfusion Parameters?
A
- Mucous Membranes (MM’s)
- Capillary Refill Time (CRT)
- Heart Rate (HR)
- Pulse
- Temperature
- Haemorrhage
23
Q
C – Mucous Membranes (MM’s)
What are the main descriptions of MM’s? (9)
A
Pink
Red
Pale
White / Grey
Yellow
Cyanotic
Petechiae
Ecchymosis
Feel
24
Q
C – What do Pink MM’s indicate & how to describe the colour? (2)
A
Normal, adequate perfusion
Salmon pink in colour.
25
C – How to describe Red MM's & what do they indicate? (6)
Injected.
Vasodilation.
Pyrexia.
Sepsis.
Toad toxicity.
Brick red.
26
C – What do Pale MM's indicate? (3)
Anaemia.
Lack of circulating RBC's.
Reduced perfusion.
27
C – What do White / Grey MM's indicate? (2)
Severe anaemia.
Hypoxia.
28
C – How to describe Yellow MM's & what might they indicate? (4)
Icteric
Jaundice
Liver disease
Severe haemolysis (distruction of RBC's).
29
C – How to describe Cyanotic MM's & what do they indicate? (2)
Blue or greyish blue
Severe hypoxia → 02 immediately!
30
C – How to describe Petechiae on MM's & what does it indicate? (2)
Reddish–purple dots
Indicates clotting disorder → immediate action!
31
C – How to describe Ecchymosis on MM's & what might it indicate? (3)
Bruising
Bleeding underneath
Paintbrush appearance.
32
C – How should MM's Feel & what do they indicate if abnormal? (3)
MM's should feel moist
May be dry or tacky if dehydrated.
Slimy texture or increased salivation may indicate nausea or toxicity.
33
C – What are the Capillary Refill Time (CRT) ranges?
1 – 2 seconds: Normal, adequate peripheral perfusion.
> 2 seconds: Decreased peripheral perfusion eg. shock, heart failure.
< 1 second: Hyperdynamic – vasodilation eg. high blood pressure, pyrexia, local irritation.
34
What does a CRT of 1 - 2 seconds indicate?
Normal, adequate peripheral perfusion.
35
What does a CRT of 2 seconds indicate? (3)
Decreased peripheral prefusion.
Eg. Shock, heart failure.
36
What does a CRT of <1 second indicate? (5)
Hyperdynamic – vasodilation
eg. high blood pressure, pyrexia, local irritation.
37
C – What are the 3 main abnormalities with Heart Rate (HR)?
Tachycardia: Fast heart rate.
Bradycardia: Slow heart rate.
Arrhythmia: An irregular or abnormal beat of the heart.
38
C - Tachycardia
Fast Heart Rate
39
C - Bradycardia
Slow Heart Rate
40
C - Arrhythmia
An irregular or abnormal beat of the heart.
41
C – What is the normal values for Heart Rate (HR) for a dog <25kg?
65 – 120 bpm
42
C - What is the normal values for Heart Rate (HR) for a dog >25kg?
65 – 80 bpm
43
C - What is the normal values for Heart Rate (HR) for a cat?
110 – 180 bpm
44
C - What are the normal values for Heart Rate (HR) for a horse?
28 – 44 bpm
45
C – What is the Pulse an indication of? (2)
An indication of cardiac output & blood pressure.
46
C - What should the Pulse rate be in a normal patient? (1)
Pulse rate should = HR
47
C - What is an abnormal Pulse rate & what does it indicate? (1)
If pulse rate is lower than HR there is an arrhythmia present.
48
C – What are the 3 main Pulse sites?
Femoral artery
Digital artery
Coccygeal (tail) artery
49
C - Where do you assess the Femoral pulse on a patient?
Femoral Artery: Medial (inner) side of femur (thigh).
50
C - Where do you assess the Digital pulse on a patient?
Digital artery: Palmer (underside) aspect of the carpus (front leg)
51
C - Where do you assess the Coccygeal pulse on a patient?
Coccygeal (tail) artery: Ventral (under) side of the tail.
52
C – What are the 4 main descriptions of Pulse Quality?
Normal
Pulse Deficit
Weak pulse
Bounding pulse
53
C – Pulse Quality – Normal
How to describe & what does it indicate? (2)
Rate & 'feel' is even
Matches HR.
54
C – Pulse Quality – Pulse Deficit
How to describe & what does it indicate? (2)
Pulse rate < HR
Ineffectual heart beats (dysrhythmia).
55
C – Pulse Quality – Weak Pulse
How to describe & what does it indicate? (4)
Softer pulse
Not forceful under fingers
Diminished cardiac output
Shock.
56
C – Pulse Quality – Bounding Pulse
How to describe & what does it indicate? (4)
Pulse is strong, forceful & sometimes jerky.
Increased cardiac output.
Occurs normally with heavy exercise.
Associated with high BP, certain valvular problems & early heart failure.
57
C – How should you assess a patient's Temperature? (3)
* Assess core temperature with a rectal (or esophageal) thermometer.
* Assess peripheral temperature by feeling temp of paws with hands (esp. hind limbs)
* Both core & peripheral temp should be assessed during examination.
58
C - Hypothermia (2)
Lower than normal body temperature
< 37.5 °C
59
C - Hyperthermia (2)
Higher than normal body temperature
>39.5 °C
60
C - Pyrexia (2)
Raised temps caused by internal process (eg. infection).
>39.5 °C
61
C – What are the normal values for Temperature in a dog?
38.0 – 39.0 °C
62
C - What are the normal ranges for Temperature in a cat?
38.0 – 39.2 °C
63
C - What are the normal ranges for Temperature in a horse?
37.2 – 38.5 °C
64
C – What are the 4 types of Haemorrhage?
Arterial
Venous
Capillary
Mixed
65
C – Arterial Haemorrhage (4)
* Most serious type.
* Bright red & spurts from wound.
* Blood spurts synchronised with heart beat.
* Definite bleeding point can be detected
66
C – Venous Haemorrhage (5)
* Slightly less serious than arterial.
* Rapid blood loss if large vein is damaged.
* Force of blood is less & easier to control than arterial.
* Blood is darker & flows as a steady stream.
* In large wound, definite bleeding point is visible.
67
C – Capillary Heamorrhage (4)
* Occurs in all wounds – capillary wall easily damaged.
* Blood oozes from pin–point sources with no force.
* No serious blood loss will occur.
* No visible bleeding point.
68
C – Mixed Heamorrhage (3)
* The arteries & veins usually lie close together.
* When both severed at same time, heamorrhage may be so great that arterial damage may not be detectable.
69
DYSFUNCTION / DISABILITY
– How to do a Quick Neurological Assessment or LOC (4)
Quick assessment of Level of Consciousness:
* A – Alert
* V – Responsive to Voice
* P – Only Responsive to Pain
* U – Unresponsive
⁎Must be performed quickly!
70
D – Neuro assessment - After AVPU, what further sub-divisions & observations can be made? (6)
* Alert & Responsive
* Depressed / Dull
* Hyperexcitability (uncontrollable)
* Obtunded (mentally dulled)
* Stupor (depressed consciousness)
* Coma (unconscious)
71
D – An Alert & Responsive animal is: (2)
- observing it's surroundings
- responding to stimuli incl. name calling, petting & movements.
72
D – A Depressed / Dull animal is: (3)
* aware of surroundings
* responding to stimuli
* unwilling to interact, move etc.
73
D – A Hyperexcitablity (uncontrollable) animal has: (2)
* uncontrolled excitement
* over reaction to stimuli
74
D – An Obtunded (mentally dulled) animal is/has: (3)
* not quite yet unconscious
* mild to moderate reduction in alertness
* diminished sensation to pain
75
D – A Stupor (depressed consciousness) animal is: (3)
* in a state of impaired consciousness
* has reduced ability to react to environmental stimuli
* will respond to noxious stimuli (pain)
76
D – An animal in a Coma (unconsciousness) is: (3)
* is in a state of extreme unresponsiveness
* exhibits no voluntary movement or behaviour
* does not respond to noxious stimuli (pain)
77
D – What needs to be noted about patient Posture? (2)
Any abnormal posture should be noted.
eg. Schiff–Sherrington.
78
D – What does Schiff–Sherrington (Posture) look like in a patient? (3)
* Front limbs extended & extremely tense.
* Head often arched backwards.
* Hind limbs are non–responsive.
79
D - What causes Schiff-Sherrington posture? (2)
* Caused by compression lesion of thoracolumbar spinal cord.
* Often result of trauma (HBC).
80
D - What is important to note about examining or transporting a patient displaying Schiff-Sherrington posture? (2)
* Minimal movement of patient.
* Keep on a flat, stiff surface.
81
D - What can the patient's Pupils give us an indication of? (1)
Neurological function.
82
D – What do we need to observe about a patient's Pupils? (4)
Size: Are they the same size? Anisocoria – one pupil smaller than the other.
Reaction to light: They should constrict.
Position: Are they in the same position? Ventral, medial etc.
General: Any discolouration of the eye? Sclera red indicated haemorrhage etc.
83
EVALUATION / EXAMINATION (2)
* A general evaluation & examination of the animal is performed once all other areas have been assessed.
* First Aid intervention for abnormalities found in A, B, C &/or D should already have been implemented.
84
E – What do we need to do if we suspect the patient has Fractures? (3)
* Note any signs of fractures or dislocations.
* Patient is made comfortable (not laying on limb).
* Gentle handling of patient.
85
E – What do we need to do if Wounds (general) are found during patient examination? (3)
* Wounds should be assessed
* Perform first-aid
* Place damp, sterile saline swabs over injured area to prevent necrosis of tissue.
86
E – What do we need to note about any Bruising on a patient? (3)
* Note any areas showing signs of bruising
* Size of bruise.
* Bruising on abdomen important → may indicate abdominal haemorrhage / injury.
87
E – What other General observations should we note about the patient's body? (2)
* Note any areas of the body that appear swollen or misshapen.
* Eg. Swollen abdomen may indicate internal haemorrhage.
88
E – What do we need to note about any Wounds (detailed)? (4)
* All wounds must be assessed
* Haemorrhage
* Size
* Location
89
E - Why do we need to correctly classify wounds? (2)
Wounds are classified to enable correct first aid & treatment plans.
90
E - What are the two main classifications of wounds? (2)
* Open wound (skin is broken)
* Closed wound (skin is intact)
91
E – What are the 5 types of Open Wounds?
Incision
Laceration
Puncture
Abrasion
Burns & Scalds
92
E – What are the 2 types of Closed Wounds?
Contusions
Crush injury
93
E – What are the characteristics of an Incised wound? (5)
* Caused by sharp cutting instruments eg. knives, glass.
* Edges are clean cut & defined.
* Generally wound will gape open.
* Wound is usually quite deep.
* Wound can be of any size.
94
E – What are the characteristics of a Lacerated wound? (5)
* Generally caused by road accidents, dog fights, barbed wire etc.
* Are irregular in shape & generally gape open.
* Edges are jagged.
* Usually contaminated by dirt, debris etc.
* Very painful
95
E – What are the characteristics of a Puncture wound?
* Caused by small sharp pointed objects eg. fish hook, cats teeth.
* Small wound – easily overlooked.
* Generally causes a deep wound & tracks down through tissues.
96
E – What are the characteristics of Abrasions (grazes)?
* Caused by road accidents & when animal is dragged along the ground.
* Doesn't penetrate the whole skin thickness – superficial.
* Can be any size.
* Very painful.
* Wound is generally contaminated.
