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Unit 1 > Primary assessment > Flashcards

Primary assessment Flashcards

1
Q

What is it important to not get distracted by during the primary survey?

A

Obvious injuries that are not life-threatening such as skin lacerations

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2
Q

What are the three major body systems?

A

Respiratory
Cardiovascular
Neurological

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3
Q

How long should it take for a primary survey?

A

60 seconds

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4
Q

What should ideally be assessed after the major body systems?

A

Body temperature, alongside a brief general exam

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5
Q

What are alternative sites for temperature taking?

A

Auricular or axillary

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6
Q

What are important points to keep in mind when obtaining auricular or axillary temperatures?

A

Accuracy may be affected by:
Hair in the ear canal
Pigmentation
Perfusion

Temperatures may not correlate with rectal temperatures

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7
Q

What is the link between cardiovascular and mentation?

A

Compromised blood flow or hypoxaemia will lead to not enough oxygen being delivered to the brain which will alter mentation

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8
Q

What mentation are hypoperfused/shocked patients likely to have?

A

Depressed/obtunded

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9
Q

What might a change in mentation indicate?

A

Toxicity (I.e. marijuana)
Hypoglycaemia
Marked cardiovascular compromise

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10
Q

If the head is not accessible, how else can you check the mucous membranes?

A

Conjunctival membranes
Vulva/penis

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11
Q

What can pale/white mucous membranes indicate?

A

Absence of red blood cells within the capillary beds. Such as:
Anaemia (insufficient red blood cells in the overall circulation)
Hypoperfusion (Hypovolaemia is the most common cause as it leads to vasoconstrictions as a compensatory mechanism)

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12
Q

What does yellow mucous membranes indicate?

A

Icteric/jaundiced
-Indicates elevated bilirubin in the circulation
-Could be due to excessive haemolysis, liver disease or biliary tract disease (pre, post and intra-hepatic)

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13
Q

What does blue/purple mucous membranes indicate?

A

Cyanotic
-Secondary to de-oxygenated haemoglobin
-Seen with severe hypoxaemia (only becomes cyanotic at spo2 of less than 85%)

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14
Q

What does red mucous membranes indicate?

A

Seen in early sepsis/SIRS in dogs

May also be seen in hyperthermic/heat stroke patient
Secondary to a ‘hyperdyanmic state’ of increased cardiac output and vasodilation

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15
Q

What do bright red mucous membranes indicate?

A

Carbon monoxide intoxication

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16
Q

What does brown mucous membranes indicate?

A

Methamoglobinaemia i.e. paracetamol intoxication

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17
Q

What is important to remember regarding hypovolaemia and dehydration?

A

Acutely hypovolaemic patients are rarely dehydrated and dehydrated patients are not necessarily hypovolaemic

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18
Q

Define hypovolaemia

A

Loss of circulating volume which leads to cardiovascular system dysfunction.

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19
Q

Define dehydration

A

Loss of total body water

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20
Q

What does a long CRT indicate?

A

Hypoperfusion/shock

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21
Q

How can you differentiate between anaemia and hypoperfusion/shock when assessing mucous membranes and CRT?

A

Pale mucous membranes and a normal CRT are consistent with anaemia.
Pale mucous membranes and prolonged CRT indicates hypoperfusion/shock

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22
Q

What does a rapid CRT indicate?

A

Sepsis
Usually occurs alongside hyperaemic/red mucous membranes

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23
Q

Define hypoperfusion

A

Decreased blood perfusion of tissues so decreased delivery of oxygen to cells.

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24
Q

What can hypoperfusion lead to?

A

Shock

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25
Q

Define shock

A

Life-threatening lack of oxygen delivery to cells/tissues

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26
Q

What is the most common form of shock?

A

Hypovolaemic

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27
Q

What are the stages of hypoperfusion leading to death?

A

Reduced perfusion

Reduced o2 delivery to tissues and reduced collection of by-products (Co2)

Reduced oxidative metabolism and increased anaerobic metabolism

Impaired cell function

Cell death

Organ failure

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28
Q

What defines tachycardia in dogs?

A

Heart rate above 140bpm

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29
Q

What is the most significant cause of tachycardia in dogs?

A

Hypoperfusion/shock

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30
Q

Name causes of tachycardia in dogs

A

Hypoperfusion/shock

Arrhythmias

Congestive heart failure

Anaemia

Stress

Pain

Excitements

Electrolyte abnormalities

Intoxications

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31
Q

Define tachycardia in cats

A

Heart rate above 180bpm

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32
Q

How do cats in shock differ from dogs?

A

Cats are not typically tachycardic when in shock, whereas dogs are

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33
Q

Name reasons for tachycardia in cats

A

Hyperthyroidism

Congestive heart filure

Electrolyte disturbances

Intoxications

Pain/stress

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34
Q

What would be an example of inappropriate bradycardia?

A

A patient that has signs of hypovolaemic shock such as pale mucous membranes, prolonged CRT and weak pulses but the heart rate remains normal

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35
Q

What are possible causes of bradycardia in dogs?

A

Hyperkalaemia (hypoadrenocorticosm or urethral obstruction)

Increased vagal tone (GI disease or brachycephalic breeds)

Drugs i.e. lidocaine

Bradyarrhythmias (AV blocks or sick sinus syndrome)

Raised intracranial pressure (cushings reflex)

Hypothermia

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36
Q

Cats with hypovolaemic shock or sepsis often have:

A

Bradycardia

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37
Q

Define bradycardia in cats

A

Heart rate less than 120bpm

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38
Q

What are possible causes of bradycardia in cats?

A

Hypovolaemic shock

Sepsis

Hyperkalaemia (urethral obstruction/uroabdomen)

Atrioventricular block

Hypothermia

High vagal tone (less common in cats)

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39
Q

When might palpation of femoral pulses be difficult?

A

In obese patients or in hind limbs fractures

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40
Q

What parameters affect pulse quality?

A

Stroke volume

Cardiac contractility

Vasomotor tone i.e. degree of vasoconstriction

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41
Q

What do you assess when palpating pulses?

A

Pressure

Duration

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42
Q

What does weak femoral pulses indicate?

A

Severely hypovolaemic patients

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43
Q

Why are peripheral pulses difficult to detect in hypovolaemic patients?

A

Compensatory vasoconstriction

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44
Q

At what MAP do peripheral pulses tend to disappear?

A

60mmHg

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45
Q

What should you do if a patient has difficult to detect or absent pulses?

A

Arterial blood pressure reading

46
Q

Describe a bounding pulse

A

Strong and longer duration

47
Q

When might a patient have a bounding pulse?

A

Septic patients due to vasodilation that is present in early stages

48
Q

Describe a snappy pulse

A

Strong but short duration

49
Q

When might a patient have a snappy pulse?

A

Anaemic

50
Q

Which patients is bilateral palpation of the femoral artery important?

A

Cats at risk of an aortic thromboembolism

51
Q

What should you note when auscultating the heart?

A

Rate
Rhythm
Position
Audibility

52
Q

What might muffled/absent heart sounds be secondary to?

A

Pericardial or pleural space disease such as pleural effusion or pneumothroax

53
Q

How do you differentiate between pleural effusion and pneumothorax?

A

Pleural effusion leads to muffled heart sounds ventrally whereas pneumothorax muffles heart sounds dorsally

54
Q

A gallop rhythm may be noted in:

A

Cats with hypertrophic cardiomyopathy

55
Q

What 2 databases make up an emergency databse?

A

Minimum (MDB) and extended (EDB)

56
Q

What’s the minimum amount of blood required for a minimum databse?

A

0.2ml

57
Q

What information is obtained from a minimum database?

A

Packed cell volume (PCV)
Total solids (TS)
Blood urea nutrogen (BUN)
Blood glucose

58
Q

What information is obtained from an extended database?

A

Same as minimum (PCV, TS, BUN & BG)
Also:
Electrolytes
Blood gases
Lactate
Blood smear

59
Q

What does POCUS stand for?

A

Point of care ultrasound

60
Q

Define orthopnoea

A

Postural changes such as head and neck extension and elbow abduction

61
Q

Apart from severe respitatory distress, why else may a cat be open mouth breathing?

A

Injury/disease to the nasal passages andf sinuses

62
Q

When might an increase in respiratory effort be seen?

A

Pleural space disease such s pneumothorax, haemothorax or diaphragmatic hernia/rupture

Pulmonary parenchymal disease i.e. pulmonary contusion

Upper airway disease/airway obstruction

63
Q

What rate is considered tachypnoea in dogs and cats?

A

Above 50 breaths per minute

64
Q

What rate is considered bradypneoa?

A

Less than 10 breaths per minutes

65
Q

Defined increased respiratory effort

A

Increased chest and abdominal muscle movement

66
Q

How may a patient with an upper airway obstruction present?

A

Marked inspiratory effort and paradoxical abdominal movement

67
Q

Define paradoxical breathing

A

The increase in intercostal muscle action draws the diaphragm cranially and abdominal muscles appear to be sucked inwards

68
Q

Define a tension pneumothroax

A

Air enters the pleural space but cannot exit

69
Q

How might a patient with a tension penumothorax present?

A

Respiratory distress with minimal thoracic movement
Cyanotic
Lateral recumbency

70
Q

How should the lungs be auscultated?

A

Each hemi thorax should be auscultated dorsally, medially and ventrally including cranial to caudally in each zone

71
Q

Define stridor

A

High pitched sounds of upper airway origin
Can be heard on inspiration and expiration

72
Q

What causes stridor?

A

Damage/obstruction to the upper airways
Created as air passes through a narrowed airway during breathing

73
Q

What should you be careful with when auscultating stridor?

A

Noise can be referred during thoracic auscultation
Laryngeal and tracheal auscultation will aid in localising the noise

74
Q

Define stertor

A

Lower pitched sounds generally of pharyngeal origin
Often gasp or snore-like
heard during inspiration

75
Q

A decrease or absence of lung sounds indicates what?

A

Pleural space disease

76
Q

What types of pleural space disease lead to a decrease/absence of lung sounds?

A

Pneumothorax
pleural effusion
soft tissue/organ displacement i.e. diaphragmatic hernia

76
Q

How may a patient with pleural space disease present?

A

Rapid, shallow breathing pattern (unable to expand lungs properly)
potentially air hunger if the pleural space disease affects volume
Dull lung sounds

77
Q

How can you diffrentiate pleural effusion and pneumothorax on cardiac auscultation?

A

Pneumothorax - dull sounds heard dorsally
Pleural effusion - dull sounds heard ventrally

77
Q

Name causes of pleural effusion

A

Pure transudate
Haemorrhage
Chylothorax
Pyothorax

78
Q

What might be auscultated in a patient with a diaphragmatic hernia?

A

Dull sounds either dorsally or ventrally
Borborygmi

79
Q

What PaO2 is a patient deemed seriously hypoxaemic?

A

<60mmHg

79
Q

Over what time do patients with a pulmonary contusion detioriate?

A

Over 6-24 hours

80
Q

The absence of cyanosis does not rule out….

A

signfiicant respirastory compromise and hypoxaemia

80
Q

At what PaO2 will a patient present cyanotic?

A

35-40mmHg

80
Q

Is possible, what position should a patient be in for thoracocentesis?

A

Sternal

81
Q

Define hyperexcitable

A

Excessive reaction to stimuli

81
Q

What are the 5 categories of consciousness?

A

Normal
Depressed
Obtunded
Stupurous
Comatose

81
Q

Define a normal consciousness

A

Alert and appropriately responsive to stimuli

82
Q

Laboured inspiration and expiration indicates what?

A

Parenchymal (lung tissue) disease

82
Q

Laboured inspiration and audible noisy breathing indicates

A

Upper airway issue

82
Q

Laboured expiration indicates what?

A

Lower airway issue

82
Q

Abdominal pulling (paradoxical) on expiration indicates what?

A

Loss of negative pressure within the pleural space

83
Q

Define a depressed consciousness

A

Alert but not appropriately responsive to stimuli

84
Q

Define an obtunded consciousness

A

Decreased consciousness or appearing unconscious but rousable with non-noxious stimuli

85
Q

Define a stuporous consciousness

A

Unconscious and rousable with noxious stimuli

86
Q

Define a comatose consaciousness

A

Unconscious and not rousable with any stimuli including noxious

87
Q

When might a patient present with periods of delirium?

A

Space-occuping lesions
Problem with brain structure
Intermittent increases in intra-cranial pressure

88
Q

What can be given to determine if decreased mentation is due to decreased perfusion?

A

IVFT

89
Q

What gait abormalities should be assessed?

A

Ataxia
Knuckling
Hypermetria

90
Q

Define schiff-sherrington pose

A

Forelimb extensor rigidity and hind-limb flaccidity secondary to a serious spinal cord lesion between T2 and L4

91
Q

Define decerebrate rigidity

A

Opisthotonus with hyperextension of all four limbs and loss of consciousness

92
Q

Define decerebellate rigidity

A

Hyperextension of the forelimbs with variable flexion and extension of the hind-limbs and appropriate level of consciousness

93
Q

How can you eprform a deep pain assessment?

A

Applying forceps at the base/perioseum of the phalanx three

94
Q

What should be avoided in cases of intra-cranial pressure

A

Jugular samples due to applying pressure to the jugular veins
Placement of intra-nasal catheters or any irritation of the nose (sneezing)
Inducing the gag reflex or administering drugs that can cause vomiting

95
Q

How is cerebral perfusion pressure calculated?

A

CPP = MAP - ICP

96
Q

What should be done toa patient with a raised intra-cranial pressure?

A

Head and neck elevated by 15-30 degrees usinf a flat board

96
Q

What can be administered in cases of raised intra-cranial pressure?

A

Mannitol
Hypertonic saline

97
Q

How can spinal injuries occur?

A

IVDD (most common)
Fracture/luxation if secondary to trauma
Fibrocartilaginous embolism
Neoplasia

97
Q

What is the most common analgesia fo choice in spinal patients?

A

Opioids

98
Q

A patient recumbent for >12 hours should be….

A

Catheterised

99
Q

Why would movement of an unconscious./sedated patient with a spinal injury risk further damage?

A

Relaxation of the muscles which would otherwise support the unstable vertebral column

100
Q

A recumbent spinal patient requires:

A

Suitable bedding
Regular movement to prevent pneumonia
Padding of bony promenences
Grooming
Urinary catheter care
Mental stimulation

Unit 1 (6 decks)

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