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NCERT ECC IMPROVE INTERNATIONAL > Triage, monitoring and stabilisation > Flashcards

Triage, monitoring and stabilisation Flashcards

1
Q

What are the 3 levels in the 3 tier system of triage

A
  1. those likely to live regardless or treatment
  2. those likely to die regardless of treatment
    3 those which immediately treatment would result in a positive outcome.
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2
Q

Name 10 clinical signs that suggest bringing a patient to the clinic

A
  1. respiratory distress
  2. CNS dysfunction
  3. slow or rapid heart rate
  4. pale mucous membranes
  5. abdo distention
  6. inability to urinate
  7. toxin ingestion
  8. Pain
  9. Burns
  10. Dystocia
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3
Q

What are the 3 major body systems required for a correct triage initial assessment

A
  1. Respiratory
  2. Cardiovascular
  3. Neurological
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4
Q

How long should an initial assessment take

A

30secs

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5
Q

What should a brief capsular history involve

A

Signalment (sex, breed, age, neutred)
Vaccination history
Duration or reported problem
Current medications

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6
Q

What does ABCD stand for in the major body system assessment?

A

A - airway
B- breathing
C - circulation/cardiovascular
D - dysfunction of CNS

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7
Q

Observation and examination of A + B (Respiratory)

6 ARPEAT

A
  • Airway
  • Rate
  • Pattern
  • Effort
  • Auscultation
  • Palpation for obvious trauma
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8
Q

What is the aim of the initial assessment of the cardiovascular system

A

The aim is the gauge the effectiveness of the heart in the pumping blood to deliver oxygen to the tissues and to perfuse body tissues.

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9
Q

Observation and examination of C (Cardiovascular/Circulation) (PHMCA)

A 
Pulse (deficits) 
Heart Rate 
Mucous Membranes 
CRT 
Auscultation
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10
Q

What may a rapid heart rate indicate (tachycardia)

A

Sepsis, cardiac disease, or shock due to reduced blood volume (compensation)

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11
Q

What may happen to a cats heart rate if presented with hypovolemic shock

A

bradycardia

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12
Q

Observation and examination of D (CNS)

A 
Posture 
Level of consciousness 
interaction and response to surroundings 
Gait 
Proprioception 
Mentation 
Recumbent or ambulatory?
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13
Q

What is the average respiratory rate

A

10-20 breaths per min

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14
Q

What is the average heart rate for dogs

A

60-120 bpm

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15
Q

What is the average heart rate for cats

A

160-200 bpm

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16
Q

What does a second evaluation involve?

A

Abdominal Palpation
Body temperature
Diagnostic imaging
Blood work

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17
Q

What is hypoperfusion

A

Hypoperfusion (shock) is the inadequate delivery of vital oxygen and nutrients to body tissues

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18
Q

What are the perfusion parameters (7)

A
  1. Mucous membrane colour
  2. Capillary refill time
  3. Peripheral Pulse
  4. Toe web temperature vs. Core temperature
  5. Urine output
  6. Blood Lactate levels
  7. Arterial Blood Pressure
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19
Q

What is evidence that hypovolemia is worsening in terms of pulse.

A

An increase in pulse rate and decrease in amplitude.

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20
Q

What is essential for detecting hypovolemia and the response to treatment?

A

Pulse rate and character.

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21
Q

What is a normal CRT

A

1-1.75 seconds

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22
Q

What may a prolonged CRT suggest

A

reduced blood flow in tissues

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23
Q

What may a prolonged CRT be caused by

A

Vasoconstriction from hypovolemia

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24
Q

What can mucous membranes and CRT give us an idea of?

A

Perfusion and vasomotor tone

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25
Q

What is a normal systolic blood pressure range

A

100-160mmHg

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26
Q

What is a normal diastolic range

A

50-100 mmHg

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27
Q

What is a normal mean range

A

70-120mmHg

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28
Q

What systolic arterial pressure is required for adequate flow to vital organs

A

90 mmHg

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29
Q

Define Hypotension

A

A lower than normal blood pressure resulting in a decrease in tissue perfusion

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30
Q

What are 5 common cause of hypotension

A
  1. hypovolemia
  2. heart failure
  3. cardiac arrhythmias
  4. Obstructed venous return (GDV)
  5. reduction in systemic vascular resistance (SIRS, Sepsis or drug induced)
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31
Q

Define Hypertension

A

A higher than normal blood pressure which can be classified as primary or secondary

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32
Q

Define primary hypertension (idiopathic hypertension)

A

Primary hypertension is due to an imbalance between the systemic venous return and the heart

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33
Q

Define secondary hypertension

A

Occurs secondary to another process (e.g renal disease, hypercortisolism or pheochromocytoma/adrenal mass) or administration of medications

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34
Q

What monitoring equipment is used to monitor the cardiovascular system

A

ECG, Stethoscope, Pulse oximetry, BP - invasive/non-invasive. ( Arterial line, oxillemetric ( cuff) or CVP)

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35
Q

What monitoring equipment is used to monitor oxygen saturation

A 
Pulse oximetry 
Blood Gas (arterial)
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36
Q

What monitoring equipment is used to monitor respiration.

A

Ausculation of the lungs
Observation (resp rate + effort)
Capnography,
Spirometry

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37
Q

What monitoring may be used to assess perfusion

A 
Pulse oximetry 
ECG (heart rate)
MM + CRT 
Thermometer 
BP - invasive or non invasive 
Blood lactate 
Peripheral pulses 
UOP
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38
Q

What is a global reason an animal may have altered mentation?

A

Hypovolemia, Hypoglycaemia or developing a systemic inflammatory response.

39
Q

What are two ‘scores’ used to assess a patients mentation

A

The Small Animal Coma (SAC) The Glasgow Come Score (GSC)

40
Q

What is a quick way of assessing kidney function ?

A

USG and UOP

41
Q

What is a normal urine output

A

1-2 ml/kg/hr

42
Q

What type of fluid therapy to hypovolemic patients need?

A

Rapid fluid administration (Bolus treatment)

43
Q

What type of fluid therapy do dehydrated patients need?

A

Correction of the fluid deficit over 24 hours.

44
Q

What may abnormal body temperatures cause?

A

Fatal organ dysfunction

45
Q

What are indicators of pain? (9)

A 
Tachycardia / cardiac arrhythmias 
Pale mucous membranes 
Depression, 
Aggression, 
Restlessness
Changes in posture and expression 
Vocalisation 
Hypotension or Hypertension 
Anorexia
46
Q

When is hypoglycaemia commonly seen? (4)

A

Hypovolemia
Sepsis,
Hyperthermia
Liver disease

47
Q

What may high levels of pain cause?

A

High levels of blood cortisol

48
Q

What will having high levels of blood cortisol cause

A

Effects on the immune system and healing.

49
Q

What can a increased PCV and TP suggest?

A

Dehydration

50
Q

What can a decrease in PCV and TP suggest?

A

Aggressive intravenous fluid therapy,

Haemorrhage

51
Q

What can a decreased PCV and normal TP suggest?

A

increased destruction of red blood cells

52
Q

What can an increased PCV and decreased TP suggest?

A

dehydration with protein loss (e.g haemorrhagic gastroenteritis)

53
Q

What are the changes in posture you will notice in a dyspnoeic patient?

A 
Flared nostrils
open mouth breathing 
extended neck 
abduction of elbows to avoid compression of chest 
sitting or lying in lateral recumbency
Restlessness 
Panic
54
Q

What are the changes in breathing pattern in dyspnoeic patients?

A

Abdominal effort
Paradoxical breathing
inspiratory phase is longer than expiratory

55
Q

What are the 4 areas of the airway

A

Upper airway
Lower airway
Lung parenchyma
Pleural space

56
Q

What may ‘wheezes’ be caused by on dyspnoeic patients

A

Masses or inflammation

57
Q

What is happening in the airway that may cause a patient to wheeze?

A

Narrowing of the airway

58
Q

What is happening in the airway that may cause you to hear ‘crackles’ on auscultation of the thorax?

A

The bubbling of air though fluid or the opening or closing of small airways

59
Q

What may be the cause of crackles in the thorax?

A

Pulmonary oedema
Haemorrhage
exudates of the alveoli

60
Q

What is happening in the airway that may cause a patient to have muffled sounds on auscultation of the thorax?

A

Suspected pleural space

liquid or air in the pleural space

61
Q

What may be the cause of muffled sounds on auscultation of the thorax?

A

Diaphragm rupture
Pneumothorax/Haemothorax
Pleural effusion

62
Q

What does the upper airway consist of?(5)

A 
Nose 
Mouth 
Pharynx 
Larynx 
Trachea
63
Q

What are 6 examples of an upper airway cause of respiratory distress?

A 
BOAS 
Foreign Body 
Laryngeal paralysis 
Pharyngeal or laryngeal oedema 
Trauma 
Abscess/Mass/Neoplasia
64
Q

Patients with an upper respiratory tract obstruction normally present how?

A

Audible respirator noise

Stridor

65
Q

How to respond/ treat a patient presenting with laryngeal paralysis?

A

cooling
anti-inflammatories
oxygen therapy
low doses of sedation

66
Q

What tracheal ring is the incision made for a trach tube placement?

A

between 3rd-4th or 4th-5th

67
Q

What equipment is needed for trach tube placement?

A 
Trach tube (size differs) 
Surgical kit 
retractors/gelpis 
tape ties to secure around neck 
monofilament suture material
68
Q

Diseases of the lower airway usually refer to what part of the body?

A

Small bronchi

69
Q

What are common symptoms of lower airway diseases?

A

Coughing
Expiratory effort
Wheezes

70
Q

Feline asthma is an example of what disease?

A

lower airway disease

71
Q

If lower airway disease what will you see on radiography?

A

Bronchial pattern

72
Q

What happens in lung Parenchyma

A

Anything to do with gas exchange

73
Q

What is lung parenchyma disease?

A

The interference with the ability to expel C02 and absorb O2 in the alveoli

74
Q

Bronchitis is an example of what airway disease?

A

lower airway disease

75
Q

Bronchial irritation is an example of what airway disease?

A

lower airway disease

76
Q

Foreign body is an example of what airway disease?

A

lower airway disease

77
Q

collapsing or filling of the alveolar or thickness of the diffusion barrier of the alveoli due to infiltration may be due to what airway disease?

A

Lung Parenchymal disease

78
Q

Pulmonary oedema is an example of what airway disease

A

Lung Parenchymal disease

79
Q

Neurogenic pulmonary oedema is an example of what airway disease ( strangulation, choking)

A

Lung Parenchymal disease

80
Q

Pneumonia is an example of what airway disease

A

Lung Parenchymal disease

81
Q

Pulmonary Haemorrhage is an example of what airway disease

A

Lung Parenchymal disease (lung tissues)

82
Q

Pulmonary inflammatory disease is an example of what airway disease

A

Lung Parenchymal disease

83
Q

What is the pleural space

A

The pleural space is the potential space that exists between the pleura of the lungs and the pleura of the chest

84
Q

What are common findings of a patient with a pleural space disease

A

increased respiratory rate and effort
dyspnoea
cough
dull or muffled heart sounds on auscultation

85
Q

What are two examples of pleural space disease

A

Pneumothorax

Pleural effusion

86
Q

What are 8 techniques of oxygen supplementation?

A 
Flow by 
Mask 
Nasal prongs 
trach tube 
intubation 
ventilation 
cone 
02 box
87
Q

The delivery of oxygen from the atmosphere to the tissues of the body rely on what 4 things?

A

Oxygen being efficiently inhaled via the respiratory tract
Oxygen being exchanged across the alveoli
Oxygen being carried via the haemoglobin in the RBC’s
Red blood cells reaching the tissues via circulation.

88
Q

What % is room air at sea level

A

21%

89
Q

Exposure for the lungs to fraction inspired oxygen over 60% for 24-72 hrs can lead to what

A

Oxygen toxicity

90
Q

When Pleural Space Disease is suspected what procedure if performed?

A

Thoracentesis

91
Q

What is Thoracenesis?

A

a procedure to remove fluid or air from around the lungs

92
Q

What number intercostal space is the needle inserted in a thoracentesis?

A

the 7th or 8th

93
Q

What angle is the needle inserted at in the chest wall in a thoracentesis?

A

45 degrees

NCERT ECC IMPROVE INTERNATIONAL (8 decks)

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