EMERGENCY - Triage and Patient Stabilisation Flashcards
What are the five main stages of an emergency evaluation?
Telephone triage
Waiting room triage
Primary survey
Secondary survey
Emergency plan
When conducting a telephone triage, what steps should you take to gather information from the client?
Gather background information (patient and client details)
Ask the client to describe their main current concern
Ask more specific questions about their concern
Give eight examples of more specific questions you can ask a client about their pet during a telephone triage
- What is the level of consiousness (i.e. is the pet responding to their name or to being touched by the owner)?
- Is the animal having difficulty breathing?
- What colour are the mucous membranes? (if safe for the owners to do so, advise them to lift their pet’s lip and look at the colour of their gums)
- Is the animal actively having a seizure, actively bleeding or has an obvious fracture?
- Can the animal pass urine?
- Can the animal ambulate (walk)?
- Is the any abdominal distention?
- Has the animal ingested anything that may be poisonous?
During telephone triage, why might it be advisable to ask owners to use a muzzle on their pets when handling them?
Animals that have experienced a trauma can be very unpredictable so it is advisable to recommend to owners that they put a muzzle on their pet
When would you avoid using a muzzle on an animal that has experienced a trauma?
You should avoid using a muzzle on an animal that has experienced a trauma if they are having any breathing difficulties as a muzzle could further impede their breathing
During telephone triage, what can you recommend to owners to use as a makeshift stretcher for animals that are unable to walk?
Owners can use blankets as a makeshift stretcher for animals that are unable to walk
During telephone triage, what can you recommend to owners to use as a makeshift stretcher for animals that have a suspected spinal injury?
Owners should use a rigid board as a makeshift stretcher for animals that have a suspected spinal injury
(T/F) Ideally cats should be transported in a cat carrier, even in an emergency case
TRUE.
What key information should be provided to the client before concluding telephone triage?
Before concluding telephone triage make sure you have provided the client with clear directions to the practice as well as establish an estimated arrival time. It may also be useful to double check you have the correct phone number on the system so you can contact the client again if necessary. Furthermore, you need to make it clear treatment will have a cost
How should you prepare the clinic for the arrival of an emergency?
To prepare the clinic for the arrival of an emergency it is important to notify the staff that an emergency is on route and gather any equipment required
What are the five main pieces of equipment that you may require during an emergency?
Keep in mind the equiment required for an emergency may be dependent on the main concerns established during telephone triage
Oxygen provisions +/- an intubation kit
Intravenous (I.V.) catheter supplies
Basic monitoring tools
Point of care ultrasound (if available)
CPR equipment
When your emergency patient arrives at the clinic, what is the first thing you should do?
When your emergency patient arrives at the clinic, the first thing you should do is establish the stability of the patient
How can the stability of a patient be categorised?
The stability of a patient can be categorised using a traffic light system;
Red: Critically unstable
Amber: Urgent/potentially unstable
Green: Stable
How do you establish the stability of an emergency patient?
The stability of the patient can be established purely based on a brief history from the client and a brief look at the animal. However, in cases where the patient’s condition is less obvious, a triage examination is used to establish patient stability
What is a triage examination?
A triage examination is a very brief, focused clinical exam focused on the principles of ABC; Airway, Breathing and Circulation as well as three of the major organ systems; respiratory, cardiovascular and neurological systems
Which aspects of the respiratory system should you assess during a triage examination?
Respiratory rate, rhythm and effort
Which aspects of the cardiovascular system should you assess during a triage examination?
Mucous membrane colour
Capillary refill time (CRT)
Heart rate and rhythm
Pulse rate, rhythm and quality
Which aspects of the neurological system should you assess during a triage examination?
Mentation
Ability to ambulate (walk)
What is a primary survey?
A primary survey is a more detailed evaluation of the same physical parameters as the triage examination. The primary survey and triage exam may be simultaneous if both carried out by the vet, however, the triage examination is often carried out by a nurse or student so the primary survey is the first step of assessment by the vet. The aim of the primary survey is to identify and stabilise any life threatening problems
What principles can be used to direct the primary survey of an emergency patient?
The ABCDE principles can be used to direct the primary survey of an emergency patient
What is a secondary survey?
A secondary survey includes a full physical exam including getting an accurate body weight for the animal and a more detailed history in order to gain a full understanding of the animal’s conditons and to develop a comprehensive diagnostic and treatment plan. This is also the time to determine the animal’s CPR status with the owner.
The secondary survey is carried out after the patient is stablilised
What do the ABCDE principles stand for?
A: Airway
B: Breathing
C: Circulation
D: Demeanor
E: Entire body
What are the four things you need to determine when assessing the airway in an emergency case?
Is there a patent airway?
Is the patient breathing?
Is there stridor or stertor?
Is there an obstruction?
What should be the three first steps when assessing breathing in an emergency case?
Assess the respiratory rate, rhythm and effort
Auscultate the lungs and trachea
Mucous membrane colour
What can be used to further investigate breathing in an emergency case?
Thoracic point of care ultrasound
Pulse oximetry
Capnograpy
Blood/gas analysis
Thoracocentesis
What should you do if a patient does not have a patent airway or is not breathing?
Intubate your patient as soon as possible
Which procedure should be considered if endotracheal intubation is not possible (i.e. if there is an upper airway obstruction)?
Tracheostomy
What can be used to establish an intermediate, lifesaving airway whilst gathering resources ready for establishing a more definitive airway?
A percutaneous catheter insertion into the trachea
What should you do as soon as an airway is established in your patient?
As soon as an airway is established you should start intermittent positive pressure ventilation (IPPV) with 100% O2 with CPR if the patient has suffered a cardiopulmonary arrest
When should you provide a patient with oxygen supplementation?
You should provide oxygen supplementation to any patient that shows evidence or suspicion of respiratory comprimise
What are five methods that can be used to provide a patient with oxygen supplementation?
Flow by oxygen
Face mask
Oxygen hood
Oxygen cage
Nasal prongs
What are the main advantages and disadvantages of flow by oxygen?
Flow by oxygen causes minimal stress and it allows you to have access to the animal however it can be a less effective method of oxygen supplementation and cannot be used long term
Why is it important to take care when carrying out mask oxygen supplementation?
Take care if using a tight-fitting mask as re-breathing CO2 and detrimental increases in temperature can occur
What are the main advantages and disadvantages of oxygen cages?
Oxygen cages are very effective for oxygen supplementation however you cannot access the patient and there is a risk that they may overheat
Why are nasal prongs not recommended for oxygen supplementation in conscious animals?
Nasal prongs can cause a lot of stress in conscious animals and stress can worsen dyspnoea
When should you consider sedatives for dyspnoeic patients?
Sedatives should be considered if a dyspnoeic patient is very stressed as this can worsen their dyspnoea
Give two examples of sedatives that would be safe to use in dyspnoeic patients
Butorphanol
Acepromazine
Be aware that butophanol is a partial agonist so if you think you will need a full agonist at some point later don’t use this
What should be the five first steps when assessing circulation in an emergency case?
Assess mucous membrane colour
Assess capillary refill time (CRT)
Auscultate the heart
Palpate pulses
Take core body temperature
What can be used to further investigate circulation in an emergency case?
Blood pressure measurement
ECG
Cardiac point of care ultrasound
Blood lactate levels
What is one of the first things you should do if you suspect circulatory compromise or shock?
If you suspect circulatory compromise, one of the first things you should do is establish vascular access ready for intravenous fluid therapy or administration of blood products
When would an emergency pericardiocentesis be appropriate?
An emergency pericadiocentesis can be lifesaving in patients diagnosed with pericardial effusion with cardiac tamponade
What should be the two first steps when assessing demeanor in an emergency case?
Mentation
Basic neurological exam
Why is it so important to assess pupil size and pupil reactivity to light during a basic neurological exam of an emergency patient?
Assessing pupil size and pupil reactivity to light can indicate the presence or absence of head trauma
How should you manage a patient with increased intracranial pressure?
Hyperosmolar therapy
What should you do if you are presented with a patient in an active seizure?
When presented with a patient in an active seizure, establish intravenous access if possible and administer antiepileptic medication as soon as possible
Which first line antiepileptic drugs are especially useful when you cannot establish intravenous access in a patient?
Diazepam (can be administered rectally)
Midazolam (can be administered intranasally)
What are refractory seizures?
Refractory seizures are when most antiepileptic drugs are no longer controlling the seizures
Which drug can be used for refractory seizures?
Propofol can be used as a continuous infusion for refractory seizures
How should you treat hypoglycaemia in an emergency patient?
Important to note hypoglycaemia can have marked effects on mentation
Hypoglycaemia can be treated with an intravenous bolus of dextrose diluted in isotonic crystalloid solution
What should you do if you’ve treated a hypoglycaemic patient with a dextrose bolus diluted in isotonic crystalloid however they are still not maintaining glycaemia?
If your patient is still unable to maintain glycaemia you may want to start a continuous dextrose infusion
What should be the first four steps when assessing the entire body in an emergency case?
Identify any life-threatening injuries (i.e. spinal fractures, arterial bleeding or open body cavities)
Decontamination (if indicated)
Apply any temporary pressure bandages (if indicated)
Full body assessment including abdominal palpation
What can be used to further assess the abdomen if indicated in an emergency case?
Abdominal point of care ultrasound
(T/F) Penetrating objects should be immediately removed from the patient
FALSE. Penetrating injuries should not be removed until conditions are controlled and a full understanding of the patient’s condition has been established
(T/F) The main goal of point of care ultrasound in emergency patients is not to carry out a comprehensive full body scan, but to answer more specific questions about the patient’s conditon
TRUE.
When and why should an ultrasound scan be performed in all trauma patients?
Ideally an ultrasound should be performed in all trauma patients within minutes of presentation to check for the presence of free fluid
Why is it important to repeat abdominal ultrasounds in patients that have undergone fluid resuscitation?
This is important as free abdominal fluid can accumulate following fluid resuscitation
What are four methods that can be used to establish vascular access in trauma patients?
Peripheral venous catheter
Central venous catheter
Peripherally inserted central catheter (PICC)
Intraosseous catheter
Which two vessels are most commonly used for peripheral venous catheterisation?
Cephalic vein
Saphenous vein
Which vessel is most commonly used for central venous catheterisation?
Jugular vein
When is intraosseous catheterisation more commonly used?
Intraosseous catheterisation is more commonly used in neonatal patients
Why should intraosseous catheters be replaced by intravenous catheters as soon as possible after stabilisation of the patient?
Intraosseous catheters should be replaced by intravenous catheters as soon as possible as intraosseous catheters are prone to infection
(T/F) Blood products can be administered via an intraosseous catheter
TRUE.
Which seven paramaters should be included when establishing an emergency database in trauma patients?
PCV/Total solids (TS)
Blood glucose
Blood lactate
Blood urea nitrogen (BUN)/Creatinine
Blood smear
Venous blood gas parameters
Electrolyte parameters
