Triage and major body systems Flashcards
Which systems should first be examinined in the initial emergency examination?
Cardiovascular, respiratory and CNS first then abdominal palpation and body temperature. Stabilisation procedures should be initiated for these prior to the remainder of the PE.
Info from CVS analysis?
Primary heart disease and gives idea of the animal’s systemic perfusion (poor –> shock)
Define ABC. What should you do if this isn’t present
Airway (is there a patent airway?), Breathing (is the animal making useful breathing efforts?), Circulation (is there a heart beat with pulses?). If not, perform CPR.
What perfusion parameters (i.e. haemodynamic parameters) should be observed and noted in all emergency patients during triage? 5
HR, pulse quality, MM colour, CRT, cardiac auscultation findings.
Common conditions that change heamodynamic parameters?
Hypovolaemia, anaemia, sepsis/inflammatory response syndrome, abnormal cardiac function
Normal CRT
1-1.75 seconds
What pulses should be felt? Why?
Femoral and metatarsal. Assess their height (estimate pulse pressure) and width (length the pulse lasts). Both of these allow assessment of the pulse volume. A perceptive clinician can generate a mental image of the pulse profile.
Differentiate stertor and stridor
Stertor - nose problem. Stridor - larynx/pharynx problem
What would a canine HR>220 indicate?
primary arrythmia rather than just sinus tachycardia due to hypovolaemia
Pulse profile of a stressed or painful animal
Slightly higher and narrower pulse profile than a resting animal (this is a normal variation)
Describe the compensatory stage of hypovolaemia dogs
Moderate tachycrdia of 140-160bpm. Pulse is narrower and higher (increased HR, reduced blood volume and increased cardiac contractility). = bounding/snappy pulse. metatarsal pulses still palpable. MM pinker than normal. rapid CRT=<1second
Severe hypovolaemia HR in most dogs = ? Other signs of severe hypovolaemia? 5
180-220, heart sounds often very quiet (mumurs may become apparent following fluid therapy), MM have are white/muddy/grey, CRT is prolonged/absent, femoral pulses are very weak (thready), metatarsal pulses should NOT be palpable.
What would be the different sounds on auscultation for parenchymal disease versus pleural space disease?
PARENCHYMAL = white fluid in alveoli where it should be black (x-ray), harsh and crackly
PLEURAL SPACE = fluid around lungs –>quieter lung sounds
Why might temperature increase with breathing difficulties?
=hyperthermia due to panting impairement
What will most dyspnoeic cats benefit from?
a period in 100% oxygen in an oxygen cage prior to complete MBS evaluation.
Initial things to look at in evaluating the respiratory system - 3
Resp rate, effort and auscultation
Normal resp rate
15-30 bpm
What shouldn’t abdominal effort be confused with?
Paraxodiacal abdominal movement that is a manifestation of severe dyspnoea
Other manifestations of dyspoea
- paradoxical abdominal movement
- straightening of the neck
- open mouth breathing
- other postural movements in non-dogs/cats
- dogs prefer to stand with abducted elbows
- cats prefer to sit in sternal recumbency
- changing body position in cats implies a much worse degree of dyspnoea than it does in dogs.
- lateral recumbency due to dyspnoea is a very serious sign in dogs, often means impending death in the cat
Signs of upper respiratory tract problems
Usually some audible noise (stridor or stertor), typically with a prolonged inspiratory phase, short expuration
Smal aiway disease (e.g. feline asthma) sings
Longer expiratory phase, increased abdominal effort on expiration
How to ensure a complete auscultation?
Divide the chest into a noughts and crosses board then auscult each square. Normally slightly louder and coarser in the cranioventral fields versus dorsocaudal. Symmetrical on both sides (with exception of the area of cardiac dullness in the left cranial fields)
Initial evaluation of CNS
Decide whether gait abnormalities and mentation (AOSC) are appropriate for the other problems identified in the MBS assessment. Dysfunction greater than expected fromt eh degree of CVS or resp compromise present should raise suspicion of CNS disease.
Define AOSC
How to categorise mentation state: alert, obtunded, stupored, comatose.
Define fluid thrill
A dianostic test indicating ascites. With one hand on patient’s flank, flick skin over other flank with finger. If an impulse or ‘fluid thrill’ is felt, this indicates a positive sign/
What do abnormal body temperatures indicate?
> 40 = concerning
42 can be life threatening
<36 should be evaluated for hypoperfusion
Describe the minimal diagnostic database for all emergency patients
PCV, total protein, blood glucose, venous blood gas analysis with eletrolytes, acid-base status, metabolic indicators (e.g. lactate).
Why is minimal diagnostic database important?
Instrumental in assessment of the collapse patied. Basis of inital therapy, allow for minitoring of patient, enable titration
What is paramount in traumatised patients?
Correction of hypovoalemia and fluid therapy (adequate perfusion is the single most important variable in improving outcome)
Describe constituents of a capsule history - 6
- SIGNALMENT (age, breed, sex)
- Primary/chief complaint
- Duration of problem
- Appetite, water intake and activity level
- Vaccination status
- Any current medications (vet/owner prescribed)
Define proptosis
Globe luxation from the orbit (if traumatic and immediate try pressing back in as secondary haemorrhage and swelling displaces globe further from the orbit)
Define MBS
Major Body Systems Assessment - CVS, Neurological, Respiratory
Typical HR (dogs and cats)
Dog = 80 -120 bpm (vary with breed, size and excitement)
Cat = 160-200bpm
>220-240 is usually an arrythmia
Complicating evaluation just below hock 4
Femoral fractures, fractious animals, obesity and heavy muscling
Define pulse amplitude
Size between systolic BP and diastolic BP
Desrive differences in HR, MM, CRT, pulse amplitude and pulse duration for mild, moderate and severe shock
MILD: HR130-150, N-pinker MM, CRT2.5s, pulse amp. severely decreased, pulse duration severely decreased.
Where should the respiratory system be evaluated? 6
Upper airways, small airways, pulmonary parenchyma, pleural space, chest wall and diaphragm
What is paradoxical abdominal movement?
Abdomen and thorax move in opposite direction.
Signs of upper airway problem - 2
- increased inspiratory effort
- referred airway noise (loud)
Signs of lower airway problem - 2 (e.g. feline allergic airway disorder)
- increased expiratory effort
- wheezes
Signs of pulmonary problem - 2
- some increased inspiratory effort but also mixed patterns
- harsh sounds or crackles
Signs of pleural space problem - 2
- shallow breathing
- dull and distant lung and heart sounds
Signs of neuro problem - 2
- irregular respiratory pattern, often slow
- quieter auscultation (due to reduced gas mvt?)
Distinguish pyrexia and hyperthermia
PYREXIA - inflammation or infection, hypothalamus raises temperature set point
HYPERTHERMIA - seizure because of muscle activity. involuntary
Define obtunded
Depressed/mentally dull but rousable
Define stuporous
Rousable only by painful stimuli
What non-neuro effects must be taken into consideration when asessing the animal’s mentation?
Hypoglycaemia, drugs, hypoperfusion (is the degree of mental depression appropriate?)
Distinguish paresis and plegia
PARESIS = weakness of voluntary movement PLEGIA = hemi/para/quadra = limb involvement
What happens at the end of an MBS exam?
Is neuro disease a major factor in the patient’s illness? If yes, a more thorough neuro exam is performed.
What are you feeling for with abdominal palpation? 6
- Abdominal distension or pain
- Distended bladder
- Masses
- Liver and kidneys
- Distended bowel loops
- Prostate and body temperature
Why take temperature?
It rarely allows complete exclusion of differentials but may need to be addressed.
3 types of shock
- Hypoperfusion
- Severe pulmonary disease/severe anaemia
- Cyanide toxicity (rare, cherry pips contain cyanide!)
Commonest form of shock
Hypovolaemic (i.e. lack of circulating blood volume, secondary to haemorrhage, severe GI fluid loss, or severe fluid loss into 3rd space)
4 types of shock
Hypovolaemic
Maldistributive
Cardiogenic
Obstructive
What is maldistributive shock? Causes? 3
Inappropriate vasodilation –> alterations in distribution of blood flow bw tissues.
CAUSES: sepsis, SIRS, anaphylaxis (rare)
Define cardiogenic shock
failure of heart to pump blood effectively. seen in end stages of many cardiac diseases. also seen with arrythmias.
Rarest type of shock in vet med? Causes? 2
Obstructive shock = obstruction to BF (e.g. pulmonary thromboembolism, pericardial effusion)
