Final Exam Flashcards
Triage
Sorting patients according to severity of their injury or illness
What is the primary Survey
Assess level of consciousness, Airway Assessment, Breathing Assessment, Circulation Assessment, Rapid assessment, Vital signs
How do you assess level of consciousness?
Alert
Responsive to painful stimuli
Unresponsive (if so, extend head and neck to help provide clear airway)
How to perform airway assessment?
Look, listen, feel
Respiratory distress requiring immediate treatment
How to perform Breathing Assessment
Watch chest wall motion
Listen to tracheal and lung sounds bilaterally
How to perform circulation Assessment
Mucous membrane (MM) color
Capillary refill time (CRT)
Auscultating heart
Palpating femoral pulses
Locations of Rapid Assessment
Abdomen, flanks
Pelvis, spine, limbs
Trunk
Vital Signs
Heart rate, pulse rate and strength Respiratory rate Temperature (check last) Patients with very slow heart rates may have vagally induced arrest with stimulation of the rectum Blood pressure Elevated with pain Low with shock
Immediate treatment in emergency
Airway Breathing Circulatory Resuscitation Analgesics Control hemorrhage
How to control hemorrhaging
Pressure bandage
Blood pressure cuff inflated to control hemorrage of distal limbs
Abdominal wrap – take care not to limit movement of diaphragm (2 finger rule)
Capsule History (what to ask)
Allergies? Medications? Past History? Lasts? Meal, defecation, urination, medication Events What is the problem now? Give details.
Secondary Survey for head and face
Consciousness (LOC = level of consciousness) Pupil size and symmetry Traumatic brain injury Fractures Hemorrhage
Survey of cervical soft tissue injury
Airway avulsion
Airway obstruction from hemorrhage or swelling
Laceration of major vessels
Muscle, SQ, skin injury
Survey of Thoracic Injury
Musculoskeletal Fractured ribs Lacerated muscles Thoracic wall herniation Diaphragmatic herniation Bruising Intrathoracic injury (consider thorocentesis)
Survey of Abdominal injury
Solid organ hemorrhage Liver, spleen Vascular injury to major vessels Lacerations to the bowel Peritonitis Ruptured urinary bladder; injured urinary system organs Ruptured gall bladder Torsion of gut or other organs (testicle, etc.) Uterine trauma in pregnant animal
Survey of musculoskeletal injury
<b>Relieve of weight bearing and immobilize trauma areas until evaluated</b>
Non-weight bearing lameness
May lead to laceration of underlying soft tissue
Spinal trauma/fracture
Immobilize/tape to board until can radiograph
Additional Diagnostic tests
Radiographs Ultrasound Abdominocentesis Thorocentesis ECG Blood chemistries and counts Pulse oximetry Etc.
Communication Requirements for a veterinary technician
Veterinary technician may serve as the patient’s advocate and the owner’s advocate
Important role in relaying basic information from owner to doctor and vice versa
Gain permission for procedures and treatment
Support owner psychologically and emotionally
ABC’s of resuscitation
A = Airway B = Breathing C = Cardiac Massage D = Drugs E = Electrical Manipulation F = Fluids
A = Airways
Respiratory arrest
Brain cells die without oxygen over 4-5 minutes
Myocardium becomes hypoxic, leading to cardiac arrest
Establish airway
Endotracheal tube, ideally
Mouth to nostrils if tube not available
B = Breathing
Methods
Anesthesia machine delivers 100% oxygen
Ambu-bag delivers room air (20% oxygen)
Blow into tube or nostrils if no equipment available
One breath every 5 seconds (12/minute)
Pupils – indicator of state of oxygenation
Widely dilated, non-responsive = extremely poor prognosis – brain damage (but consider drugs administered which might dilate pupils)
C = Cardiac Massage
Cardiac arrest
Absence of heartbeats or ineffective heartbeats (as with ventricular fibrillation)
Assessment – femoral or lingual pulse
If no pulse, initiate cardiac massage
Cardiac Massage (How to perform)
Lateral recumbency
Goal is to compress thoracic cavity by 1/3
May force blood from heart
May alter thoracic pressures as to “draw” blood to the heart from the great veins
Stand along patient’s back or sternum
Height that allows forceful arm motion with flat of palm for large dogs; squeezing motion for small cats and dogs
60 or more strokes per minute – no cessation while giving breath – person massaging counts aloud
Assess effectiveness by palpating pulse
May attempt internal massage if external ineffective
D = Drugs
Epinephrine if heart not beating
IV or intratracheally (2X IV dose) or intracardiac
May be repeated if heartbeat not initiated
Atropine for bradycardia
Isoproterenol, lidocaine, etc. for dysrhythmia
Doxapram is respiratory stimulant`
E = Electrical Manipulation
Defibrillator – for ventricular fibrillation
Assess heart function by ECG if available
F = Fluids
IV fluids essential to sustain blood pressure
Careful with smaller patients to not overdo fluids
Place IV catheter ASAP if not already catheterized
Other Considerations with the ABC’s of resuscitation
Not every patient should be resuscitated
If arrest seems likely, discuss with owner the appropriate response beforehand
Owner may sign “Do Not Resuscitate” form or may request that full resuscitation efforts be made
Levels of consciousness
Normal, Stupor, Coma
Cervical Spinal Injury concerns
Do not move until stabilized
Injury at or above C4 can lead to loss of diaphragm function
Methods of assissting breathing
nesthesia machine delivers 100% oxygen
Ambu-bag delivers room air (20% oxygen)
Blow into tube or nostrils if no equipment available
How pupils indicate state of oxygen
Widely dilated, non-responsive = extremely poor prognosis – brain damage (but consider drugs administered which might dilate pupils
