Triage and major body systems assess (Buckley) Flashcards
1
Q
Phone triage is almost always a…
A
trap
2
Q
Why triage
A
- allows you to set priorities
- resource allocation
- sickest patients first
3
Q
Triage question
A
- Does animal have a life threating problem?
- what is it?
4
Q
How long should triage take?
A
- < 1 min assessment
- brief reason why patient presented today
5
Q
Triage assessment
A
- Heart and perfusion
- Breathing
- Neuro status
- Abdomen
- Bleeding
- Male cats
6
Q
Triage categories
A
- Category 1: Will die without immediate intervention
- Category 2: Critical, needs urgent attention w/in 30 min
- Category 3: Sick, needs attention within hours
- Category 4: Not true emergency, treat within 24 hours
7
Q
Inappropriate Loss of Conciousness
A
- cardiopulmonary arrest
- unconsciousness
- status epilepticus
8
Q
Respiratory problems
A
- Not breathing
- Respiratory distress
- open-mouthed breathing cats
9
Q
Abnormal gum color
A
- Extremely pale/white
- Blue/cyanotic
10
Q
Cardiac
A
- Severe arrhythmias
- Profound tachycardia
- Profound bradycardia
11
Q
Hemorrhage
A
- Uncontrolled bleeding
- Arterial bleeding
12
Q
Specific abnormalities
A
- Sucking chest wound
- Gun shot wound
- Visible internal organs
- Impalement injuries
- Large breed with abdominal distention
13
Q
Cat 1 ex
A
- GDV
14
Q
Cat 2 ex
A
- Pale mucus membranes
- Severe fever
- Dystocia
- Toxicity patients
- Possible lower urinary tract obstruction
- Severe pain
- Trauma
- Severe dehydration: bad V/D, DKA
15
Q
Cat 3 ex
A
- Minor allergic rxns: puffy face
- Lacerations without major bleeding
- Stable fractures
- Vomiting/diarrhea
- Cat bite abscess
16
Q
Cat 4 ex
A
- Mild vomiting/diarrhea (1-2 episodes)
- Mild-mod lameness
- Mild cut/abrasion
- Broken toe nail
- Sneezing/ URT signs
- Hematuria
17
Q
After triage
cat 1, 2
A
- Permission to do basic, life saving tx
- bloodwork, IV cath, fluids, O2
- Resuscitation code
- Back to tx area
- Major body syst assess
18
Q
Major body system assessment
A
- Can be done while someone places cath
- Heart
- Brain
- Lungs
- Bladder of male cat
19
Q
Heart
Assess
A
- Heart rate and rhythm, murur
- Pulse quality-can be very helpful
- Mucous membrane color
- Capillary refill time
20
Q
Tacycardia
Arrhythmia
A
- Tachycardia
- Sinus tachycardia
- Hypovolemia-number 1 life threatening prob, give fluid
- Anemia
- Pain
- Anxiety
- Arrhythmia
- ventricular tachycardia-know what this looks like
- supraventricular tachycardia-atrium
- atrial fibrillation-know what this looks like
- Sinus tachycardia
21
Q
HBC dog, high heart rate
A
- tempting to bolus opiods
- might actually need fluids
22
Q
Bradycardia
A
- Sinus bradycardia
- drug intoxication
- anesthetic drugs
- intracranial dz
- AV block
- cardiac disease
- opioids
- Atrial standstill
- hyperkalemia
- cardiac dz
- hypothermia
23
Q
2 main causes of hyperkalemia
A
- blocked cat
- addisons
24
Q
Pulse quality
A
- normal pulse doesn’t equal normal blood pressure
- normal
- weak
- hypovolemia
- poor cardiac output
- heart failure
- pericardial effusion
- Tall and narrow ‘bounding’
- compensated hypovolemia
- anemia
25
Hyperemic CRT
\< 1s
* compensated hypovolemia
* fever
26
Pale prolonged CRT
\> 2 s
* Decompensated shock
27
Pale, normal CRT
* Anemia
28
Pale, absent CRT
* Severe anemia
* Cardiovascular collapse
29
cyanotic
hypoxia
30
Lungs
Assess
* Rate
* Effort
* Pattern
* Sound
* Auscultation
31
Rate
descriptors
* Rapid
* Shallow
* Gasping
* Slow
* sedation
* airway obstruction
* brain dz/herniation
* Panting
* dyspnea?!?
32
Inspiratory effort
* Upper airway obstruction
* Abdominal distension
* Pleural space dz
* Diaphragmatic hernia
33
Expiratory effort
* Lower airway dz
* feline asthma
* severe bronchitis
34
Inspiratory and expiratory effort
* Parenchymal dz
35
Non-specific dyspnea
* PTE
* Pain
* Abdominal distention
36
Short and shallow breathing
* Parenchymal disease
* Pleural space dz
37
Paradoxical breathing
* Pleural space disease
* Diaphragmatic hernia
38
Focal paradoxical breathing
* Flail chest
39
Stridor
* Upper airway obstruction
* lar par
* laryngeal tumor
* BOAS
* Foriegn body
40
Ascultation
Quiet
Loud
* Quiet
* pleural space dz
* Loud
* Crackles
* pulmonary edema
* pneumonia
* pulmonary contusions
* bronchitis
* Wheeze
* lower airway dz
41
Summary
Parenchymal dz
* Mixed inspiratory and expiratory dyspnea
* Loud/Harsh lung sounds or crackles
* short, shallow respirations
42
Pleural space dz or diaphragmatic hernia summary
* Inspiratory dyspnea
* Short, shallow respirations
* Sometimes paradoxical respiration
* Quiet lung sounds on auscultation
43
Summary of breathing patterns
* Flail chest
* focal paradoxical pattern
* Lower airway dz
* Expiratory dyspnea
* Loud/harsh lung sounds or crackles
* Wheezing
* Upper airway obstruction
* Inspiratory
* Stridor
* Referred upper airway noise on auscultation
44
Brain
Assess
* Mental status
* Level of conciousness
* Seizure activity
* Ability to walk
45
Level of concsiousness
* Coma
* Stupor
* Obtunded
* Dull
* Quiet
* Normal
46
Aim of MBSA
* Is patient
* dying and in need of intervention right now
* stable enough for diagnostics/tx
* is life threatening problem primarily
* cardiac
* respiratory
* neuro
47
Minimum database laboratory values
* PCV/TS
* Glucose
* Renal values
* Electrolytes-esp K
\*Try to take blood during catheter placement
48
Emergency interventions
Cardiac/circulatory
Arrhythmias
* Ventricular arrhythmia
* lidocaine: 2mg/kg (1/10th the dose in cats)
* Severe bradycardia
* atropine
* fix electrolytes
* warm up
* emergency pacing
49
Emergency interventions
Cardiac/circulatory
Hypovolemia
* Fluid therapy
* Consider
* crystalloids
* colloids
* hypertonic saline
* blood products
50
Emergency interventions
Cardiac/circulatory
Severe anemia
* Blood transfusion
* PRBCs, whole blood
* Blood type cats
* don't need to blood type dogs first time
* Oxyglobin
51
Emergency interventions
Respiratory
* Oxygen
* flow by
* oxygen cage (esp cats)
* Intubation
* upper airway obstruction
* severe respiratory distress
* respiratory failure
* Ventilation
* severe hypoxemia
* hypoventilation
