exam 1 - intro Flashcards
medical emergency
urgent or pressing need for medical attention
who determines a medical emergency
owner
critical care patient
patient whose condition can deteriorate rapidly
icu
facility for management of critical care patients
is icu same as er
no
what are the 4 obligations to the patient
alleviation/prevention of pain
minimization of stress and suffering
attempted correction of disease or injury with reasonable prognosis
humane euth when needed
what are the 5 obligations to the client
honesty, courtesy, and respect
protection of client confidences
reasonable fees
informed consent
competent and caring services
steps to facilitating client decision making
avoid hasty decisions
hard decisions in emotional times
empathetic third party can expedite these decisions
how to deal with client disenchantment with previous vet
avoid criticism
listen and allow client to calm
focus on animals present condition
consider consultation with previous vets for the patient
consider reporting misdeeds after completing care
are there major differences with clients who cant afford care
no - patient must receive vets best services unless client consents to lesser services
patient must be treated the same as when client is paying in full
what to do about strays
good samaritan doesnt foot bill unless they want to
obligation to the animal for supportive care
owner once found can refuse to pay
when should we make the decision to treat or not
in advance to treatment
what is the decision not to treat
for treatable or untreatable conditions that result in poor quality of life
what is passive euthanasia
decision not to treat and not actively euthanize
what is negligence
deviation from accepted standards
who is held to higher standards
specialists
how does the vet-client relationship begin
verbal or written agreement
when does the vet-client contractual liability end
treatment is complete
care is transferred to another vet
client decides to terminate contract
who is liable if client is told over the phone to not come into the vet
vet is liable
how do we deal with financials in emergencies where costs arent communicated
vet is entitled to a reasonable fee
can you prescribe meds in MO without an exam
no
how to deal with euth when a client cant be contacted
decision must be based on good judgement
defendable if action is similar to what other vets would do
who is liable if client helps restrain their animal
vet is liable if injury occurs if no foresight is given
aspects of hospital readiness
ready area
wall chart for dosing
training and drill sessions
maintenance of equipment and supplies
what occurs in triage
1 minute
consciousness
airway and breathing
CV assessment
nervous and MS assessment
class I triage
most urgent, catastrophic
immediate treatment needed
class II triage
severe, critical
action needed in minutes to hours
class III triage
serious
action needed in few hours
class IV triage
less serious, but pressing
action needed within 24 hrs
not classified triage
emergency because of owners concern or convenience
action when classified patients are controlled
what is the minimum database for emergencies
PCV and TP, glucose, BUN, USG is bareminimum
usually get CBC, chem, UA
what does buccal mucosal bleeding time assess
platelet function
which is intrinsic vs extrinsic - PT and PTT
PT - extrinsic
PTT - intrinsic
what clotting test when PT/PTT not available
activated clotting time ACT
what is one test that assesses hypo- and hyper-coagulopathy
thromboelastography TEG
what are some non-invasive monitoring tools
temp, pulse, myocardial performance, respiratory performance, urine output, blood pressure, ECG, lab tests, neuro exam, PE
what are some invasive monitoring techniques
central venous pressure, direct arterial pressure, pulmonary artery catheter, intra-abdominal pressure
what does central venous pressure reflect and what is it used for
right atrial pressure
used for early detection of fluid overload during IV fluid therapy
normal values for central venous pressure
0-5 cm H2O
varies with position of catheter tip
what could low CVP mean
hypovolemia, vasodilation
what could high CVP mean
artifact, physiological alterations
hypervolemia, cardiac decompensation, cardiodepressant anesthesia or cardiopulmonary disease, increased intrathoracic pressure
what artifact could elevate CVP
peripheral location of catheter tip
obstructed catheter
does elevated CVP require a response
yes - check for artifact, slow or stop IV fluids
where do you place catheter for direct arterial BP
dorsal pedal artery
