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
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 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
When would an emergency pericardiocentesis be appropriate?
An emergency pericadiocentesis can be lifesaving in patients diagnosed with pericardial effusion with cardiac tamponade
