Triage and Trauma Flashcards
What does Triage encompass?
Assessment of patient (systemically)
Injuries interfering with vital functions receive the highest priority
After initial treatment repeat evaluation (adjustments as you go)
What causes decreased lung sounds dorsally?
Pneumothorax
What does paradoxical thoracic wall motion indicate?
Rib fractures
What is a normal lactate value?
< 2
List the systemic assessment priorities
Respiratory (airway, breathing)
Cardiovascular system
Neurological system (head, spinal cord, peripheral nerves)
Abdominal organs
Musculoskeletal system (stabilize fractures)
Integumentary system
Respiratory System (airway) Triage
Highest priority in trauma
Assess airway
Place ET tube if patient is struggling to breathe
Emergency tracheostomy if airway is obstructed
Respiratory System (breathing) Triage
Even in hind end injuries there can be thoracic trauma
Administer supplemental oxygen if dyspneic
Three most common respiratory injuries
Pulmonary contusions
Pneumothorax
Rib fractures
Pulmonary Contusions
Alveoli filled with blood and edema fluid
Results in atelectasis and hypoxemia
Radiographically appears ans infiltrate (may take 12-24 hours to appear); does NOT follow a specific pattern occurs where trauma occurred
Pneumothorax; what can it cause?
Results in atelectasis, hypoxemia, and interferes with venous return (lungs cannot expand to full capacity)
Pneumothorax; treatment
Thoracocentesis for initial therapy; aspirate BOTH sides
Placement of thoracostomy tube:
Done if thoracocentesis has been done multiple times with no resolution of dyspnea
Can connect to a continuous suction device
Can heal without surgery in most cases (will take several days)
Rib Fractures
Painful!
Give 1/4 shock bolus of fluids and then administer analgesia (ex. Fentanyl CRI)
Monitor BP
Most rib fractures do not require surgery
Causes atelectasis and hypoxemia
Cardiovascular system
Triage
Shock (hypovolemic) can occur due to hemorrhage
Need to determine: external, internal, or both
Pulmonary Contusions
Treatment
Isotonic crystalloids?
Do NOT give large volumes of isotonic crystalloids
75% of fluid will redistribute to the interstitial space; includes interstitium of lungs
Pulmonary Contusions
Treatment
Combination options?
Isotonic crystalloids and colloids
Isotonic crystalloids: do NOT exceed 45 mL/kg/hr (dogs) or 22.5 mL/kg/hr (cats)
Do either half shock or quarter shock bolus
Hypertonic saline +/- colloids
What should you avoid doing when administering IV fluids? (hint: monitoring)
Blood pressure should not increase too much (maintain systolic around 90-100 mmHg)
Could dislodge blood clot formation -provides hemostasis at hemorrhage site-
Rapid administration of IV fluids can cause significant increase in BP
Intracranial injuries
Level of consciousness: alert, responsive/unresponsive to stimuli
Pupillary size & reactivity
Abnormal postures (decerebrate, decerebellate, schiff-sherrington syndrome)
Spinal cord injuries
Immobilize as soon as possible
Will require analgesia and sedation
Abdominal Injuries
Perform ultrasound Ruptures? Free fluid? Air? Organ evisceration?
Radiographs can help as well
Hemoabdomen; if good clotting times should be able to stop hemorrhaging
Ruptured bladder; will require surgery once stable
Blunt Abdominal Trauma
Diagnostic test
Abdominocentesis
Ultrasound guided or blind via 4 quadrant sampling
Abdominocentesis
What can you measure?
PCV/TS BUN or Creatinine Total bilirubin Fluid analysis Cytology Culture/Susceptibility
Abdominocentesis
PCV interpretation
If PCV of abdominal fluid is greater than the peripheral PCV:
Splenic, hepatic, or renal parenchymal laceration is present
Best approach for hemoabdomen?
Medical!
Morbidity and mortality are lower if you treat the case medically
How to assess urological injury (diagnostics)
PCV of abdominal fluid is less than peripheral PCV (dilution of urine does this)
BUN/Creatinine of abdominal fluid >2x than peripheral BUN/Creatinine
BUN measured during ACUTE trauma
Creatinine measured for chronic issue
Urological injury management
Drainage of urine via indwelling urinary catheter or abdominal drain
Monitor electrolytes specifically potassium (worry about cardiac effects)
Can surgically repair once stable
Musculoskeletal Injuries Assessment
Usually not life-threatening
Pay attention to nerves, blood vessels, and soft tissue damage
Blood loss from femur and pelvic fractures can be severe in large breed dogs (blood loss can exceed 25% of total blood volume):
see continuous drop in PCV, will have to fix fracture to stop bleeding
Closed Fracture Assessment
Stabilize fracture by applying splint (relieve pain, lessen swelling) ONLY if you can immobilize joint above AND below fracture
Monitor splint/cast by looking at toes (color, swelling, discharge, odor)
Fractures - Repair time
Repair can be delayed until patient is stable (want to decrease anesthetic risk)
Usually 1-5 days post fracture incident
Integumentary Injuries
Assessment
Not life-threatening; treat after other systems have been addressed
Follow surgical principles of wound closure
Most are contaminated: clip, clean, bandage and do not suture closed
Wait for granulation tissue to form and keep clean and moist
May place on antibiotics depending on how bad the wound is
Trauma & Triage
Two Important Considerations
- Over treatment can be just as hazardous as under treatment
- Constant monitoring and reassessment of the patient are mandatory
