Triage, monitoring and stabilisation Flashcards
1
Q
What are the 3 levels in the 3 tier system of triage
A
- those likely to live regardless or treatment
- those likely to die regardless of treatment
3 those which immediately treatment would result in a positive outcome.
2
Q
Name 10 clinical signs that suggest bringing a patient to the clinic
A
- respiratory distress
- CNS dysfunction
- slow or rapid heart rate
- pale mucous membranes
- abdo distention
- inability to urinate
- toxin ingestion
- Pain
- Burns
- Dystocia
3
Q
What are the 3 major body systems required for a correct triage initial assessment
A
- Respiratory
- Cardiovascular
- Neurological
4
Q
How long should an initial assessment take
A
30secs
5
Q
What should a brief capsular history involve
A
Signalment (sex, breed, age, neutred)
Vaccination history
Duration or reported problem
Current medications
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
7
Q
Observation and examination of A + B (Respiratory)
6 ARPEAT
A
- Airway
- Rate
- Pattern
- Effort
- Auscultation
- Palpation for obvious trauma
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.
9
Q
Observation and examination of C (Cardiovascular/Circulation) (PHMCA)
A
Pulse (deficits) Heart Rate Mucous Membranes CRT Auscultation
10
Q
What may a rapid heart rate indicate (tachycardia)
A
Sepsis, cardiac disease, or shock due to reduced blood volume (compensation)
11
Q
What may happen to a cats heart rate if presented with hypovolemic shock
A
bradycardia
12
Q
Observation and examination of D (CNS)
A
Posture Level of consciousness interaction and response to surroundings Gait Proprioception Mentation Recumbent or ambulatory?
13
Q
What is the average respiratory rate
A
10-20 breaths per min
14
Q
What is the average heart rate for dogs
A
60-120 bpm
15
Q
What is the average heart rate for cats
A
160-200 bpm
16
Q
What does a second evaluation involve?
A
Abdominal Palpation
Body temperature
Diagnostic imaging
Blood work
17
Q
What is hypoperfusion
A
Hypoperfusion (shock) is the inadequate delivery of vital oxygen and nutrients to body tissues
18
Q
What are the perfusion parameters (7)
A
- Mucous membrane colour
- Capillary refill time
- Peripheral Pulse
- Toe web temperature vs. Core temperature
- Urine output
- Blood Lactate levels
- Arterial Blood Pressure
19
Q
What is evidence that hypovolemia is worsening in terms of pulse.
A
An increase in pulse rate and decrease in amplitude.
20
Q
What is essential for detecting hypovolemia and the response to treatment?
A
Pulse rate and character.
21
Q
What is a normal CRT
A
1-1.75 seconds
22
Q
What may a prolonged CRT suggest
A
reduced blood flow in tissues
23
Q
What may a prolonged CRT be caused by
A
Vasoconstriction from hypovolemia
24
Q
What can mucous membranes and CRT give us an idea of?
A
Perfusion and vasomotor tone
25
What is a normal systolic blood pressure range
100-160mmHg
26
What is a normal diastolic range
50-100 mmHg
27
What is a normal mean range
70-120mmHg
28
What systolic arterial pressure is required for adequate flow to vital organs
90 mmHg
29
Define Hypotension
A lower than normal blood pressure resulting in a decrease in tissue perfusion
30
What are 5 common cause of hypotension
1. hypovolemia
2. heart failure
3. cardiac arrhythmias
4. Obstructed venous return (GDV)
5. reduction in systemic vascular resistance (SIRS, Sepsis or drug induced)
31
Define Hypertension
A higher than normal blood pressure which can be classified as primary or secondary
32
Define primary hypertension (idiopathic hypertension)
Primary hypertension is due to an imbalance between the systemic venous return and the heart
33
Define secondary hypertension
Occurs secondary to another process (e.g renal disease, hypercortisolism or pheochromocytoma/adrenal mass) or administration of medications
34
What monitoring equipment is used to monitor the cardiovascular system
ECG, Stethoscope, Pulse oximetry, BP - invasive/non-invasive. ( Arterial line, oxillemetric ( cuff) or CVP)
35
What monitoring equipment is used to monitor oxygen saturation
```
Pulse oximetry
Blood Gas (arterial)
```
36
What monitoring equipment is used to monitor respiration.
Ausculation of the lungs
Observation (resp rate + effort)
Capnography,
Spirometry
37
What monitoring may be used to assess perfusion
```
Pulse oximetry
ECG (heart rate)
MM + CRT
Thermometer
BP - invasive or non invasive
Blood lactate
Peripheral pulses
UOP
```
38
What is a global reason an animal may have altered mentation?
Hypovolemia, Hypoglycaemia or developing a systemic inflammatory response.
39
What are two 'scores' used to assess a patients mentation
The Small Animal Coma (SAC) The Glasgow Come Score (GSC)
40
What is a quick way of assessing kidney function ?
USG and UOP
41
What is a normal urine output
1-2 ml/kg/hr
42
What type of fluid therapy to hypovolemic patients need?
Rapid fluid administration (Bolus treatment)
43
What type of fluid therapy do dehydrated patients need?
Correction of the fluid deficit over 24 hours.
44
What may abnormal body temperatures cause?
Fatal organ dysfunction
45
What are indicators of pain? (9)
```
Tachycardia / cardiac arrhythmias
Pale mucous membranes
Depression,
Aggression,
Restlessness
Changes in posture and expression
Vocalisation
Hypotension or Hypertension
Anorexia
```
46
When is hypoglycaemia commonly seen? (4)
Hypovolemia
Sepsis,
Hyperthermia
Liver disease
47
What may high levels of pain cause?
High levels of blood cortisol
48
What will having high levels of blood cortisol cause
Effects on the immune system and healing.
49
What can a increased PCV and TP suggest?
Dehydration
50
What can a decrease in PCV and TP suggest?
Aggressive intravenous fluid therapy,
| Haemorrhage
51
What can a decreased PCV and normal TP suggest?
increased destruction of red blood cells
52
What can an increased PCV and decreased TP suggest?
dehydration with protein loss (e.g haemorrhagic gastroenteritis)
53
What are the changes in posture you will notice in a dyspnoeic patient?
```
Flared nostrils
open mouth breathing
extended neck
abduction of elbows to avoid compression of chest
sitting or lying in lateral recumbency
Restlessness
Panic
```
54
What are the changes in breathing pattern in dyspnoeic patients?
Abdominal effort
Paradoxical breathing
inspiratory phase is longer than expiratory
55
What are the 4 areas of the airway
Upper airway
Lower airway
Lung parenchyma
Pleural space
56
What may 'wheezes' be caused by on dyspnoeic patients
Masses or inflammation
57
What is happening in the airway that may cause a patient to wheeze?
Narrowing of the airway
58
What is happening in the airway that may cause you to hear 'crackles' on auscultation of the thorax?
The bubbling of air though fluid or the opening or closing of small airways
59
What may be the cause of crackles in the thorax?
Pulmonary oedema
Haemorrhage
exudates of the alveoli
60
What is happening in the airway that may cause a patient to have muffled sounds on auscultation of the thorax?
Suspected pleural space
| liquid or air in the pleural space
61
What may be the cause of muffled sounds on auscultation of the thorax?
Diaphragm rupture
Pneumothorax/Haemothorax
Pleural effusion
62
What does the upper airway consist of?(5)
```
Nose
Mouth
Pharynx
Larynx
Trachea
```
63
What are 6 examples of an upper airway cause of respiratory distress?
```
BOAS
Foreign Body
Laryngeal paralysis
Pharyngeal or laryngeal oedema
Trauma
Abscess/Mass/Neoplasia
```
64
Patients with an upper respiratory tract obstruction normally present how?
Audible respirator noise
| Stridor
65
How to respond/ treat a patient presenting with laryngeal paralysis?
cooling
anti-inflammatories
oxygen therapy
low doses of sedation
66
What tracheal ring is the incision made for a trach tube placement?
between 3rd-4th or 4th-5th
67
What equipment is needed for trach tube placement?
```
Trach tube (size differs)
Surgical kit
retractors/gelpis
tape ties to secure around neck
monofilament suture material
```
68
Diseases of the lower airway usually refer to what part of the body?
Small bronchi
69
What are common symptoms of lower airway diseases?
Coughing
Expiratory effort
Wheezes
70
Feline asthma is an example of what disease?
lower airway disease
71
If lower airway disease what will you see on radiography?
Bronchial pattern
72
What happens in lung Parenchyma
Anything to do with gas exchange
73
What is lung parenchyma disease?
The interference with the ability to expel C02 and absorb O2 in the alveoli
74
Bronchitis is an example of what airway disease?
lower airway disease
75
Bronchial irritation is an example of what airway disease?
lower airway disease
76
Foreign body is an example of what airway disease?
lower airway disease
77
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?
Lung Parenchymal disease
78
Pulmonary oedema is an example of what airway disease
Lung Parenchymal disease
79
Neurogenic pulmonary oedema is an example of what airway disease ( strangulation, choking)
Lung Parenchymal disease
80
Pneumonia is an example of what airway disease
Lung Parenchymal disease
81
Pulmonary Haemorrhage is an example of what airway disease
Lung Parenchymal disease (lung tissues)
82
Pulmonary inflammatory disease is an example of what airway disease
Lung Parenchymal disease
83
What is the pleural space
The pleural space is the potential space that exists between the pleura of the lungs and the pleura of the chest
84
What are common findings of a patient with a pleural space disease
increased respiratory rate and effort
dyspnoea
cough
dull or muffled heart sounds on auscultation
85
What are two examples of pleural space disease
Pneumothorax
| Pleural effusion
86
What are 8 techniques of oxygen supplementation?
```
Flow by
Mask
Nasal prongs
trach tube
intubation
ventilation
cone
02 box
```
87
The delivery of oxygen from the atmosphere to the tissues of the body rely on what 4 things?
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
What % is room air at sea level
21%
89
Exposure for the lungs to fraction inspired oxygen over 60% for 24-72 hrs can lead to what
Oxygen toxicity
90
When Pleural Space Disease is suspected what procedure if performed?
Thoracentesis
91
What is Thoracenesis?
a procedure to remove fluid or air from around the lungs
92
What number intercostal space is the needle inserted in a thoracentesis?
the 7th or 8th
93
What angle is the needle inserted at in the chest wall in a thoracentesis?
45 degrees
