Triage of the emergency patient Flashcards
What are the 4 main components of triage
-Telephone
-Waiting room
-Primary survey with interventions
-Secondary survey with interventions
What are the aims of telephone triage (3 things)
-to determine if patient needs to be seen immediately
-to see what owner can do before arriving
-preparation at hospital (resp emergency, seizing, etc)
What things should you determine over the phone
-type of injury, respiration speed and effort + coughing, MM color, consciousness level/head trauma/seizing, ambulation ability, weakness, any obvious fractures, abdominal distension, intoxication
Which four systems should be assessed during waiting room triage
-Respiratory
-Cardiovascular
-Neurological
-Renal
Should patients be taken back in the order that they arrive
NO! Patients should be sorted and classified in order of disease severity, and a member of the team should quickly assess every patient that arrives for brief history, nature of complaint, and progression
What are some signs of an animal with a respiratory emergency
-Increased heart rate, rhythm, and effort
-Open mouth breathing
-Paradoxical breathing (pleural effusion)
-extended head and neck
-abducted elbows
-flared nostrils
What are some signs of an animal with a respiratory emergency
-Increased heart rate, rhythm, and effort
-Open mouth breathing
-Paradoxical breathing (pleural effusion)
-extended head and neck
-abducted elbows
-flared nostrils
What should you do to assess a patient’s cardiovascular system in the waiting room
-Assess for heart murmur
-Check if heart rate is slow/fast, regular/irregular
-check pulse quality and rate
-check CRT assessment
-check MM color
-Auscultate lungs for pulmonary oedema/dull lung sounds ventrally
What should you look for to assess a patient’s neurological system
-Assess mentation
-assess ability to ambulate
-check if patient is seizuring
- Check for head trauma
-Assess intracranial pressure, decerebrate rigidity, cushings reflex
-hyperexcitability
What should you look for when checking patients renal system
-Is the animal urinating/when did it last urinate
-Assess bladder size and compressibility
-Check is urethra is blocked
-think about AKI if anuric
What is the objective of primary survey
To determine if any life threatening conditions are present and to treat immediately
What should be assessed in the respiratory system during primary survey
-Evaluate if airway is patent
-Check pulse oximetry (60:90 rule), check arterial blood gas
-give pre-oxygen supplementation (20 minutes) if necessary or if hypoxemic
-thoracocentesis
What differential diagnoses should be considered in the cardiovascular system during primary survey
-Congestive heart failure (backward or forward or both)
-Hypotension due to hemorrhage, fluid loss, sepsis
What treatments can you give if you have a cardio issue, and what can you give if you have a vascular issue
Cardio: furosemide, pimobendan, other positive inotropes, antiarrhythmics
Vascular: fluid therapy if hypovolemic shock due to fluid loss/hemorrhage/sepsis
What treatments should you give for seizuring an increased ICP
-Phenobarbital, treat with glucose/dextrose if hypoglycemic, treat with Ca if hypocalcemic
-Mannitol if ICP too high, neeeds to be treated rapidly so brain doesn’t herniate through foramen magnum
