Triage and Stabilisation Flashcards
What is triage?
The ability to…
- Sort multiple cases into order of priority
- Recognise genuinely sick patients who need further interventions to prevent deterioration
What steps do we follow when managing emergency cases
STEP 1: Prioritisation
STEP 2: TRIAGE
STEP 3: MAJOR BODY SYSTEMS
STEP 4: STABILISATION
List presentations that would count as EMERGENCY and therefore immediate triage in SA practice (List not extensive)
• Distended abdomen with non-productive retching (dog) o GDV! • Breathing difficulties • Seizure lasting, especially >5 minutes • Collapsed animal • Major trauma (hit by car etc) • Major bleeding (pulsatile flow/large vol) • Male cat unable to urinate • Dystocia with pup/kitten stuck • Toxin ingestion within last 2h o Time frame where can make sick
List presentations that would count as Potentially Serious and therefore triage when available in SA practice (List not extensive)
• Persistent vomiting and diarrhoea with lethargy
• New onset seizures shorter than 5 minutes/not actively seizuring now
• Wounds without major bleeding
• Acute lameness (painful!) welfare
• Acute onset painful eye
• Not exhaustive
Triage and make sure stable then wait until slot comes available
Once sorted order of priority what must you do?
explain what is happening to their owners
Get brief history (easier if collegue can do this and you go onto assessing patient)
- presenting signs
- current meds
- onset and duration
- consent for initial stabilisation - depends on budget, explain this to owner as this changes the next steps
Then ABCD
First thing you do with patients
ABCD
• Alert – is the patient alert and awake
• Breathing – can the patient breathe effectively and effort
• Circulation – is there a palpable pulse or heart beat. Is there major external haemorrhage
• Disability – is there significant neurological concern
If any concerns on ABCD then immediate treatment is required, pet at risk of dying
• If not then progress to major body systems assessment
• Aim – rule in or out life-threatening conditions to sort patients
• If not sure, urr on the side of caution
What major body systems are be concerned with in emergency?
Those that if fail, lead to rapid death:
• Cardiovascular
- Respiratory
• Neurological
Identified the major body system concerns. if abnormaltiites… Then…
Abnormalities, provide stabilisation steps
What are we checking for CV
HR, heart rhythm Pulse quality Pulse rate MM colour Cap refil Ausultation
What specifically are we worried about mm colour?
What about pulse quality are we specifically looking for?
If perfused as moist and tacky = dehydration which kills slowly
- Pulse quality (central and peripheral)
- Consistent or variable?
- Synchronous with HR? dropped or skipped?
- Central = femoral
- Metatarsal/ carpal = peripheral
What we assessing with respiratory?
- Respiratory rate
- Effort
- Pattern
- Noise (assess without stethoscope)
- Auscultation with stethoscope
- Does my patient require oxygen? – if in doubt, always best to give some.
- If in doubt GIVE!
More specifically what are we looking for with respiratory system -
pattern and auscultation
- Pattern
- Open mouth breathing in cats bad sign
- Inspiratory vs expiratory dyspnoea
- Paradoxical patterns
- Auscultation with stethoscope
- Areas of dullness
- Lung sounds – normal, increased, decreased
- Abnormal sounds in thorax – e.g. gut sounds
What are we assessing when assessing the neural body system?
Mentation
Ambulatory?
This is not a full exam, just checking for basic signs
What is mentation?
Mental activity:
• Alert and responsive vs quiet vs dull vs obtunded vs comatose vs seizuring (further away from normal)
What are the 3 main aims for stabilisation?
- Preventing current problems worsening
- Trying to find cause for these problems
- WELFARE – don’t forget about analgesia
Stabilising an unconscious patient…..
What should your aim be?
Try and establish cause and reverse:
Stabilising an unconscious patient. What could be going wrong and what would you do
o Hypoglycaemia - check bg and give IV glucose if low
o Severe shock - check cardiovascular signs
o Seizuring - give medications – IV diazepam/intranasal midazolam
o Toxins - check history and treat appropriately
Never induce vomiting in unconscious
o Heatstroke - history and patient temp then active cooling if needed
o Arrested – start CPR!
Better to start CPR and stop then be too late
Stabilising a patient struggling to breathe. What do you do?
- Reduce stress and provide oxygen
- Then determine location - obstruction?
Upper?
Lower?
Pleural space?
How to stabilise a patient with large volume haemorrhage if external wound
What analgesia would you use?
PUT on Gloves!
Apply direct pressure to wound with swabs
NEVER remove base layer of swabs as this is acting as a scaffold for the clot. Just keep adding more
Methadone: full mu licensed espec if procedure after as long lasting (4hrs)
fentanyl: full mu, licendes, lasts 20 mins
Support CV system
If cannot control bleeding with pressure then aim to get normal BP and then durgical control
How to stabilise a patient with large volume haemorrhage if internal wound
- how do you know internal haemorrhage?
Then..
o Pale collapsed patient with evidence of cardiovascular exam abnormalities
o Find source: POCUS of body cavities
o Stabilise cardiovascular system – fluids to normalise blood pressure
o Definitive control (usually surgery) once stable
How to stable a patient with seizuring
o Seizuring - give medications – IV diazepam/intranasal midazolam
How to stable a patient with head trauma
fluids, analgesia, elevate head
Top tips
Prep in advance – as soon as you are told a possible emergency is on the way, get all the equipment you might need together
Communication with owners is key! Let them know what’s happening at every stage
Trust your gut – if you think it’s bad, act like it is until you can prove otherwise
Multiple triage systems exist, find one that works for you:
ABCD
ATT – animal trauma triage system
4Fs – fine, fixable, very ill, and freezer-bound
