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VTS(ECC) Preparation > Triage & Initial assessment > Flashcards

Triage & Initial assessment Flashcards

1
Q

Which should occur during the primary survey of a patient?
- Heart rate
- Neurological exam
- Minimum database bloodwork
- thoracic radiographs

A

Heart rate

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2
Q

Which of the below is an example of relative bradycardia?
- dog in hypovolaemic shock HR 100
- hyperkalaemic cat with HR 145
- dog under anaesthesia with HR 70
- dog with DCM with a HR 210

A

a dog with hypovolaemic shock HR 100

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3
Q

RBC Haemolysis, bile duct obstrution and feline sepsis result in which change to mucous membranes
- icteric mucous membranes
- hyperaemic mucous membranes
- pale mucous membranes
- cyanotic mucous membranes

A

icteric mucous membranes

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4
Q

A patient in respiratory distress with an increased expiratory time is most likely suffering:
- pneumonia
- fractured ribs from trauma
- upper airway obstruction
- collapsing trachea

A

pneumonia

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5
Q

Hypovolemia, anemia, sepsis, and primary cardiac dysfunction are the most common conditions that can cause a change in a pets
- respiratory status
- cardiovascular status
- neurological status
- central nervous system

A

cardiovascular status

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6
Q

Who should be the first person to triage every patient that presents to an emergency hospital?
- any available staff member
- an experienced veterinary technician
- a receptionist at the front desk
- an experienced Veterinarian

A

An experienced veterinarian

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7
Q

What are pale mucous membranes caused by:
- poor peripheral perfusion
- methaemoglobinaemia
- hyperbilirubinaemia
- sepsis

A

poor peripheral perfusion

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8
Q

When using START method for disaster victims, who should be coded green?
- those with minor injuries that will likely live without treatment
- patients in critical condition that must receive immediate treatment
- dead or dying patients
- patients that should survive with simple treatment in a few hours

A

those with minor injuries that will likely survive without treatment

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9
Q

What condition is associated with Kussmaul respirations
- GDV
- Myocardial ischaemia
- DKA
- seizure disorder

A

DKA

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10
Q

What may muffled heart sounds indicate
- pericardial effusion
- pulmonary contusions
- congestive heart failure
- endocarditis

A

pericardial effusion

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11
Q

What are pale or white mucous membranes indicative of?

A
  • Anaemia
  • Vasoconstriction as a result of shock
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12
Q

What are red (hyperaemic) mucous mebranes indicative of?

A
  • vasodilation
  • often seen in systemic inflammatory response syndrome (SIRS)
  • hyperthermia
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13
Q

What are cyanotic mucous membranes indicative of?

A
  • Severe hypoxaemia in the face of normal PCV (cyanosis cannot be clinically evident without normal Hb concentrations)
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14
Q

What are icteric mucous membranes indicative of?

A
  • increased bilirubin as a result of hepatic disease or haemolysis.
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15
Q

What are brown mucous membranes indicative of?

A
  • methaemaglobinaemia
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16
Q

Observing petechiae or bruising on mucous membranes indicates what?

A

Platelet dysfunction or thrombocytopaenia and is an early indicator of disseminated intravascular coagulation (DIC)

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17
Q

Which global markers of anaerobic metabolism are more sensitive indicators of perfusion compared to blood pressure or physical exam parameters?

A
  • Base deficit
  • lactate
  • low mixed venous oxygen saturation (SO2)
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18
Q

What does a weak pulse suggest?

A
  • low cardiac output
  • vasoconstriction
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19
Q

What order would you see the following patients?
1. 7Y MN GSD. Restlessness, attempted to vomit last night, hyperaemic gums <1sec CRT, HR 160bpm with deficits.
2. 4y FS Mini Pinscher. Attacked by large dog 20min ago with no visible wounds. Owner covered in blood. HR 120, Temp normal, RR 36
3. 2y MN DSH. Difficult owner - reports cat in pain. Cat growling, RR 60, unable to perform PE.
4. 8Y M Labrador. Owner intoxicated. Dog Fell of dock and is lame in RHL. HR 134, wagging tail, normal Temp, BAR, interactive, pant, normal MM + CRT.

A

1, 3, 2, 4

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20
Q

In disaster triage, what are the two most common triage systems and what do they stand for?

A

START: Simple triage and rapid treatment
SAVE: Secondary assessment of victim end-point

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21
Q

How long should a triage examination take and what should be focused on?

A

Less than 5 minutes
Assess the cardiovascular, respiratory, neurologic and renal status of the patient.
Obtain a brief history from the client focused on the primary complaint, how long this has been going on for and any current medications/illnesses.

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22
Q

What is the main goal of triage?

A

To identify and treat any immediate life-threatening conditions.

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23
Q

What should be easily accessible in an emergency?

A
  • IVC equipment
  • Intubation equipment inc. tracheostomy equipment
  • Defibrillator
  • Chest drain/centesis kit
  • Oxygen and oxygen equipment
  • Emergency drugs
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24
Q

What is the importance of obtaining an IVC in an emergent patient?

A
  • administration of emergent medications
  • administration of IVFT/Resuscitative fluids to re-establish effective circulating volume
  • Rapid administration of blood products
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25
Q

Describe the shock index

A

Shock index = HR/SBP. >1.0 indicative of a patient in extreme shock.
Monitor change in shock index as resuscitating.

26
Q

What types of presentation should be seen right away?

A
  • Respiratory distress
  • CPA
  • Choking
  • Cyanosis
  • Pallor
  • Collapse and/or LOC
  • Status epilepticus
  • Haemorrhage
  • Extreme pain
  • Bloating/distended abdomen/unproductive vomiting
  • Electrocution
  • Burns
  • Heat stroke
  • Acute poisoning
27
Q

What types of presentations are still deemed emergencies but may be stable to wait a short period of time (should be seen ASAP)?

A
  • Choking without respiratory distress
  • Pain
  • Paralysis, paraplegia
  • Severe vomiting and diarrhoea
  • Trauma patients
  • Stranguria
  • Acute deterioration
  • Loss of appetite with lethargy
  • Abscess
  • Bite wounds
  • Fractures
  • Self mutilation
  • Temp <36.5, or >39.5
28
Q

What should you establish in an over the phone triage?

A
  • Patient signalment
  • Owner name and phone #
  • Main complaint
  • Vitals, how are they breathing
  • Pre-treatment or pertinent history
  • General patient condition
  • Advise the client of any specific transportation requirements and give the location of the clinic. Ask approx. arrival time and then prepare for their arrival
29
Q

What is the Manchester triage system?

A

5 tier, colour coded system
Red = Immediate = Now
Orange = Very urgent = 15min
Yellow = Urgent = 60min
Green = Standard = 120min
Blue = Non-urgent = >120min

30
Q

What does providing a quick ‘why, what, how’ to a client entail?

A
  • why does their pet need immediate treatment
  • what treatment will be given
  • rough estimate of how much this initial emergency treatment will cost
31
Q

What are some important points to consider when handling emergent neonate patients?

A
  • 11-34% neonates will die within first 12 weeks of life
  • a sick neonate should be brought in separately to rest of litter to avoid pathogen exposure and transmission
  • must be kept warm
  • Assess HR, BG and temperature
  • Hypoglycaemia and dehydration very common and even mild vomiting and diarrhoea can be serious.
32
Q

What are some important points to consider when handling emergent wildlife and exotics patients?

A
  • consider individual husbandary requirements
  • if endangered need to let appropriate authorities know
  • if wildlife need accurate information about where the animal was found
  • minimise stress. Most are going to think you are a predator
  • be aware of what is normal and abnormal for them
33
Q

What are some important points to consider when handling disaster/high casualty incidents?

A
  • distinguish what may be a pre-existing issue and what is directly related to the disaster
  • transfer stable patients away from the area to allow those requiring life-saving treatment can be seen sooner.
  • be organised
  • adapt a triage technique i.e. START, SAVE
34
Q

In disaster triage what is the START system? Describe it.

A

Simple triage and rapid treatment
Focus on RAP status: respiration, alertness and perfusion
Red = critical, simple life-saving procedures to ensure survival
Yellow = pt should survive if care received in a few hours
Green = minor injuries, pt can wait for treatment and survive
Black = pt dead or dying, pt unlikely to survive even with treatment

35
Q

In disaster triage what is the SAVE system? Describe it.

A

Secondary assessment of victim endpoint
Aims to conserve resources as well as personnel and is quicker than START. It focuses on patients with the best chance of survival.
1. Those that will die regardless of treatment
2. Those that will survive regardless of treatment
3. Those that will benefit if medical intervention occurs immediately

Only groups 2 & 3 receive treatment

36
Q

Should patients have imaging or other procedures before stabilisation?

A

No.
Treat what will kill them first and address life-threatening systemic disease before further diagnostics.
‘Nothing should die in radiology’

37
Q

Feline patients vasodilate when in shock. How do we address shock in Cats?

A

They are often hypothermic therefore, they should have their low temperature addressed ASAP and care should be taken with providing fluids due to their vessel size. Often, they are at higher risk of fluid overload as when their vessel size returns to normal this fluid leeches into interstitial tissue as it has nowhere else to go -> lungs etc

38
Q

Describe the animal trauma triage system (ATT).

A

Focuses on perfusion, cardiovascular, respiratory, eye/muscle/integument, skeletal and neurologic status.
- scored 0-3 (3 = severe)
- higher the score the sooner the pt is seen
- prediction of survival (high score unlikely to survive)

39
Q

Describe the Veterinary triage list (VTL).

A

Modified MTS, 5-tier, colour-coded triage system with target wait times.
Red - seen immediately.
Orange- 15min
Yellow - 30-60min
Green - 120min
* Blue * - >120min

40
Q

Briefly, what are the steps taken in the initial assessment of a patient.

A
  1. Brief history.. signalment, presenting complaint, pex meds
  2. Brief examination.. ABCD
  3. Ask permission for immediate treatment.. provide rough est.
  4. Provide life-saving treatment.. IVC, Oxygen, Fluid etc
  5. Perform primary survey
  6. Perform secondary survey
41
Q

What are the common signs of poor perfusion?

A
  • pale MM
  • Prolonged CRT
  • cool core & peripheral temperature
  • Dull mentation
  • Poor/absent pulses
  • Tachycardia (dogs), Bradycardia (cats)
42
Q

What are the consequences of not treating seizures immediately?

A
  • cerebral oedema
  • hyperthermia
  • irreversible brain injury
43
Q

What are some signs of increased intracranial pressure? Why do we need to treat it immediately.

A
  • low HR and high BP
  • severely altered mentation
    Need to treat immediately otherwise can cause ischaemia to the brain and herniation through the foramen magnum.
44
Q

What are some signs of AKI/urinary obstruction/uroabdomen?

A
  • hyperkalaemia
  • metabolic acidosis
  • cardiac arrhythmias
  • death
  • palpable or non-palpable bladder (depending on presentation)
45
Q

What is a secondary survey? When is it performed?

A

Secondary surveys are performed once triage, the primary survey and life-saving treatment has been provided.
- includes a more thorough examination of the patient
- re-evaluate respiratory, cardiovascular, neurologic and urinary signs

46
Q

What could slow, deep respirations indicate?

A

UAO, dynamic airway collapse, bronchitis

47
Q

What may an increased inspiratory effort indicate?

A

Laryngeal disease, tracheal collapse

48
Q

What may an increased expiratory effort indicate?

A

intrathoracic airway collapse

49
Q

What may a restrictive breathing pattern indicate?

A

parenchymal disease

50
Q

What does a slow, apneustic breathing pattern indicate?

A

Brink of respiratory arrest, respiratory failure

51
Q

It is unusual for a critically ill patient to be bradycardic. What are some types of conditions that may induce bradycardia?

A
  • electrolyte disturbances, conduction disturbances or increased ICP.
52
Q

Tachycardiac animals may have a short increase in CO but as tachycardia persists fast diastolic filling and a decrease in stroke volume physiologically limits this leading to overall decreased CO. True or false?

A

True

53
Q

What does petechiae and bruising of the gums suggest?

A

Platelet dysfunction or thrombocytopaenia. Is also an early indicator of DIC.

54
Q

Is palpating a DP pulse a reliable way to conclude a systolic BP above 80mmHg?

A

No.
They can sometimes be felt even in hypotensive patients

55
Q

What are some early signs of fluid overload on thoracic ausculation?

A

Wheezing (UA), stertor, crackles

56
Q

What may expiratory wheezing indicate?

A

small airway collapse, bronchitis

57
Q

What might cause you to hear crackles on lung auscultation?

A

Pneumonia, pulmonary oedema, pulmonary haemorrhage

58
Q

What might cause you to hear dull lung sounds?

A

pulmonary consolidation, pneumothorax, pleural effusion

59
Q

What are the complications of a reduced gag reflex? How to we address it?

A
  • Greater risk of aspiration pneumonia
  • Withhold oral intake
  • consider intubation
60
Q

Why should hyperthermic patients be investigated immediately?

A

Potentially showing signs of systemic inflammation or infection.

61
Q

What systems are evaluated in the primary survey of a patient?

A

Cardiovascular
Respiratory
Neurologic
Urinary

62
Q

Haemoglobin level required to show cyanosis

A

5g/dL

VTS(ECC) Preparation (21 decks)

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