U1 O1 Triage & Cardiopulmonary Resuscitation Flashcards
What is meant by the term triage?
Triage is the process of prioritising sick and injured animals, according to the severity of the illness or injury. Patients are evaluated, problems identified and treatments implemented in order to maximise the number of survivors.
How do you triage a patient with multiple injuries?
Similarly, if an animal has multiple injuries or problems (e.g. an RTA), treatment is prioritised so that the most serious problem is focused on before the more minor problems.
What is the main aim of a telephone triage?
The immediate aim of this conversation is to determine whether the pet needs to be evaluated by a vet immediately or whether it can wait until a scheduled appointment. Unfortunately, this is rarely a straightforward decision, since some owners will be overly concerned by minor signs, whilst others will not seek veterinary attention until signs are severe. As such developing a logical approach to the questions, we ask to assess the patient over the phone should focus on major body systems and dysfunction of those initially. We need to try not to be distracted by the owner and their concerns, as often they will focus on what they see, whilst remaining professional and sympathetic to the client’s needs.
What type of questioning style should be used on a telephone triage?
Consider also how you ask the questions. Closed questioning styles do not elicit much information and are mainly Yes/No answers. Open questioning styles allow the client to be descriptive of their concerns. Both may be used throughout a triage phone call
What question should be asked on a telephone triage?
-What is the reason for the phone call - why are they concerned about their pet? An open questioning style at this stage may elicit more information than closed questioning.
• When it started and how it has progressed/ has it occurred previously?
• Are there are significant co-morbid conditions?
• Is their pet receiving any medication? What/ how much? When last administered?
• An attempt to assess the animal’s level of consciousness/ whether collapsed
• An attempt to assess the animal’s demeanour/ presence of pain
• An attempt to assess how the animal is breathing
• It might be prudent to see if the owner can assess respiratory rate/ pattern, heart rate (via chest wall) and colour of mucous membranes (IF deemed appropriate to ask: this judgement will have to be made during the telephone call- it is important not to cause the owner further distress nor to waste time on unhelpful patient assessments. This might be more useful in a situation where the owner is reluctant to bring their pet for emergency assessment.)
o ** N.B. Many owners will be reluctant or unable to make a reliable clinical assessment of their pet- asking them to do so could increase their concern and waste time.
• Frequency of vomiting/diarrhoea +/- presence of blood
• Presence/ location/ description of wounds, possible fractures etc.
** N.B. Asking owners to describe the severity of clinical signs and wounds, also requires them to make a clinical assessment. In this situation, it is preferable to ask closed questions which can elicit, definite answers e.g. ‘how many times has he vomited this morning’ is more reliable and less worrying than ‘how severe is the vomiting’?
• Ability to urinate
• Presence/(degree) of abdominal distension
Basic client and pet details should be taken in an emergency e.g. client name, postcode, phone number, pet name, breed, sex, presenting complaint (as above) and further detail can be gained when they attend the clinic/practice.
Can treatment advice be given over the phone?
Appropriate guidance should be given to the owner to allow them to decide what is in the best interests of their animal (RCVS, 2018: 3.11) - it is, however, important to explain to owners that treatment advice cannot be given over the phone. Equally we can explain the limitations of telephone triage and the inability for a diagnosis of the animal’s condition to be, made without being examined by a veterinary surgeon. Owners should not be advised to give their pet any medication. If the animal is already receiving medication, veterinary guidance should be sought if the owner queries giving an additional dose/or not administering the medication.
In this situation we should be able to advise the client on what we would consider to be a deterioration, whilst reiterating we cannot make a diagnosis over the phone and if there is any doubt whatsoever of the urgency the recommendation is that the pet should be examined.
Concise, clear records of all communication and advice should be kept.
What signs of situations would require immediate evaluation by a veterinarian?
Animals with any of the following should be immediately evaluated by a veterinary surgeon:
• Collapse especially with loss of consciousness (even if they now appear normal)
• Multiple seizures or other neurological abnormalities
• Breathing difficulties (respiratory distress/ dyspnoea)
• Difficulty or inability to urinate
• Extreme pain or dullness
• Protracted/frequent vomiting or diarrhoea, especially if blood
• Toxin ingestion
• Trauma
• Unusual behaviour
This is not an exhaustive list and there are many other reported findings that may lead to an owner being advised to attend as an emergency. As it is often hard for an owner to gauge, if they report that their pet appears to have an unduly rapid, slow or irregular heart rate or has pale mucous membranes they should be seen. Any significant change in demeanour would also be a reason for the animal to be seen.
Should owners be aware of consultation costs? What would happen if they could not afford the consultation fee?
If an emergency attendance charge is to be made for seeing an animal out of hours, the owner must be made aware of this during the telephone call; however patient welfare should be our primary concern and first aid and analgesia should be offered as necessary to prevent and alleviate pain and suffering for any animal including wildlife.
Who is responsible for transporting animals in an emergency?
‘Owners are responsible for transporting their animals to a veterinary practice, including in emergency situations. The RCVS encourages owners to think about how they can do this and make plans before an emergency arises’ (RCVS, 2018).
It is important to be able to give advice to the owners about how best to transport their pet to the practice in an emergency. They should also be given the full name, address and telephone number of the premises they are attending; with details of how to get there. It is essential to take a contact number for the owner, in case of delays etc. As many practices use dedicated out of hours providers it is extremely important to explain clearly to the client which practice to attend and how to access the building e.g. if there is an intercom system.
Whilst it is the owner’s responsibility to transport the animal to the veterinary practice it can be helpful to have a list of pet friendly taxi services to hand should they be needed, as well as discussing other options, such as friends or neighbours. In the emergency situation it is important we are empathetic and as far as possible assist clients with how to get to their pet into the clinic if they do not have transport immediately available.
What should advice to a client regarding transporting their pet always be based on?
Advice to the client regarding transporting their pet should always be based on preserving life and limiting pain; preventing deterioration of the pet’s condition; health and safety of the client and availability of client resources.
Give some different examples of how owners can be advised to safely transport their pet in an emergency situation?
Advice to the client regarding transporting their pet should always be based on preserving life and limiting pain; preventing deterioration of the pet’s condition; health and safety of the client and availability of client resources.
Cats, small mammals, birds and exotics should be transported in appropriate cages or baskets; when ambulatory, dogs should be on leads, although small dogs, especially with respiratory distress/dyspnoea may be better in baskets. Cats, small mammals, birds and exotic patients will all benefit from being in a darkened, covered carrier to reduce the stress associated with car journeys. Large breed dogs can be transported on a duvet or blanket, for example, to the car especially if respiratory distress or collapse is a concern. Sympathetic guidance should be given to the client on how best to handle their pet in the specific situation they are dealing with. It is important to explain that scared or painful animals may become aggressive or try to escape. The advice may be as simple as placing a blanket over the feline patient, for example, prior to picking it up and placing in a basket. Although this advice comes easily to us owners often need clear explanations to carry this out, due to being upset and worried. Owners should be advised about careful handling of animals, potentially or actually, contaminated with toxic materials; or specific situations, such as transporting of pets with suspected spinal injuries.
There is much advice that may need to be given over the phone- including first aid that the owner may need to provide before attending or on the way to the surgery e.g. appropriate cooling of a patient who has been burned prior to transport. This must be tempered with the fact that the pet should be seen as soon as possible. As qualified and experienced veterinary nurses we expect that this should be something with which you are already familiar- it is, however, a very important situation that must be dealt with sensitively and appropriately. It is important to keep accurate records of any communication and advice given.
How does the triage process work when their are several emergencies all at one time?
Triage is the process of sorting out and prioritising which patients require most immediate attention, when there are several patients to be seen; triage is also the process of sorting out and prioritising an individual patient’s problems to see which needs most urgent attention e.g. breathing difficulties, haemorrhage and skin wound.
During the triage process what is is helpful for the owner to understand?
Communication with the client is important during the triage process. We need to often build a rapport rapidly, whilst ensuring the client understands we are the RVN on duty and are checking for injuries and clinical signs that indicate a threat to life so we can act on those promptly.
What should the initial triage focus on?
It is vital to follow the same process of triage assessment and not be distracted by injuries that, although will need attention, are not life threatening. Our initial triage focuses on the stability of the major body systems as this is what keeps our patient alive. Clients naturally will be distracted by what they can see e.g. wounds and fractures. However, these will only very rarely threaten the animal’s life.
How long should the initial primary survey triage take?
The initial primary survey, triage, assessment should take no longer than 60-90 seconds – obtaining a detailed patient history or performing a full physical examination is not required at this stage. This will be done after the initial primary survey assessment.
What is signalment and how can it help in a primary survey triage?
Signalment (age, breed and sex) can help to provide important clues as to the disease/injury process that is affecting the patient.
What does a primary survey involve when triaging an animal?
The primary survey involves assessing the three major body systems- whilst at the same time determining the presenting complaint and signalment.
What three major body systems need to be assessed in a primary survey?
• Respiratory
• Cardiovascular
• Neurological
If there is dysfunction of any of these systems, then immediate veterinary attention is necessary
In what situations would you hold off taking a patient’s temperature during a triage?
There will be some exceptions to this, and they may include the patient presenting with breathing difficulty, for example, who would deteriorate should a rectal temperature measurement be attempted. It may also not be appropriate in patients with pelvic and hind limb trauma.
As well as assessing the 3 major body systems during a triage what else should be obtained?
Following assessment of the major body systems, a baseline body temperature should be obtained ideally, as well as a brief general examination of the rest of the patient
What factors can affect the accuracy of auricular thermometers?
Whilst this is a useful technique and can be utilised to monitor trends in body temperature, the accuracy is questionable and affected by multiple factors including presence of hair in the ear canal, pigmentation and perfusion. Auricular thermometer readings are not interchangeable with rectal temperature readings
Aside from the 3 major body systems, what other systems or history would need urgent veterinary attention?
Veterinary attention should also be sought, immediately, if other important systems, especially the urinary system, are affected or there is a history of: • Recent toxin ingestion/or topical exposure • Recent seizures • Trauma • Open wounds/excessive bleeding • Snake bite • Burns • Dystocia • Hyperthermia • Difficulty or inability to urinate • Inability to walk • Distended abdomen
What should always be considered in a triage (including telephone) with any male cat with vague clinical signs?
Cats with urethral obstruction may present with a definite history of dysuria but the presenting signs are often vague; such as hiding, lethargy and inappetence. Straining to urinate may not have been noticed. As such, urethral obstruction is a potential consideration in any male cat with vague clinical signs. Following the primary and secondary survey approach means that life threatening issues are identified rapidly, and a treatment plan can be devised whilst ensuring all of the patient is assessed.
What basic patient details should be collected by a receptionist/VS/RVN whilst an animal is being triaged?
Basic patient details can be collected by a receptionist (or VS/RVN) whilst the animal is being triaged by a member of the medical team. The patient details should be recorded as shown: • Age • Species • Breed • Sex • Neutering status • Vaccination status • Previous medical/surgical history • Other current medical problems • Current medication • Previous trauma etc. • Any previous blood / plasma transfusion
What questions can be asked to an owner to gain a history for a patient that has presented for an emergency?
Questions to ask include:
• What is the major problem?
o Termed presenting complaint
• When was the patient last normal?
o This helps to determine chronicity
• Have signs been getting better, worse or stayed the same?
o Termed progression of illness
o Chronological progression
• Systemic manifestations of disease?
o Are there signs such as vomiting, diarrhoea, PUPD etc., that are not associated with the presenting complaint
• Current and previous medications? What and when was this given/administered?
o Has the owner given the animal any treatment e.g. aspirin, NSAIDs? If so what, how much and when?
o Is the pet on any prescription only medicine? If so, what is it and what is the frequency and dose administered? When was this last administered? Is there any possibility the animal may not have received the medication?
o It is also sensible to ask if the patient is on any additional supplements. Turmeric for example may alter coagulation and be relevant. Cannabis oils compete with the opioid receptors. In this situation, complications could arise if a pure opioid or some other agents are given.
• Are there any other medical problems?
o Identify prior relevant medical history
o Identify co-morbid conditions such as diabetes mellitus or hyperadrenocorticism
• When did the animal last eat and what is the normal diet?
• Has it had this problem previously? If so when?
• Are any other members of the household affected?
• Other questions may be relevant depending on the circumstances e.g. has the patient ever/ recently been in another country?
Some emergency clinics have an admission questionnaire covering these points and others that may be useful if the animal is hospitalised e.g. the type of substrate the animal prefers. Whilst these can be useful it’s important in the emergency to communicate sympathetically and clearly with the client.
What does examination of the cardiovascular system enable assessment of?
The cardiovascular system examination enables assessment of the haemodynamic stability of a patient. Blood flow to body tissues (perfusion) is vital to supply enough oxygen for normal cellular activity and therefore patient survival.
What is appropriate mentation dependent on?
Appropriate mentation is dependent on a normal blood flow to the brain, as well as normal CNS neuron function.
How does cardiovascular compromise alter mentation?
If the blood flow is compromised (e.g. hypovolaemic shock) or the patient is hypoxaemic, there will not be enough oxygen delivered to the brain and mentation will be altered. Understandably, therefore, ensuring there is enough blood and oxygen delivery to the brain is always a priority. Alteration in cerebral blood flow, enough to affect mentation, is an indicator of marked cardiovascular compromise.
What type of problems can alter mentation?
Changes in mentation can also be seen in patients with electrolyte and acid-base disturbances, as well as intoxications. Marijuana toxicity, for example, has some specific clinical signs but significant CNS depression is commonly noted. Patients with a low blood glucose on presentation will often be depressed and may even be seizuring.
cardiovascular compromise
Patients with hypoperfusion/shock are likely to be depressed or obtunded.
What are the 6 patient consciousness levels?
Patient consciousness levels can be assessed as -
- Normal – alert and appropriately responsive to stimuli
- Depressed – alert but not appropriately responsive to stimuli
- Obtunded – decreased consciousness or appearing unconscious but rousable with non-noxious stimuli
- Stuporous – unconscious and only rousable with noxious stimuli
- Comatose – unconscious and not rousable with any stimuli including noxious
- Hyperexcitable – excessive reaction to stimuli
What is delirium? and what condition is it usually seen with?
We may on occasion encounter patients that have periods of delirium. They spend some of the time behaving and responding normally to voice, touch and the environment and then have periods of time where they do not respond or respond inappropriately. This type of alteration to mentation is common in patients with a space occupying lesion, problem within the brain structure or in patients with intermittent increases in intra-cranial pressure.
What information does assessment of the mucous membranes give you?
Mucous membrane (MM) colour can be quickly assessed and provides rapid information regarding the cardiovascular system. The colour of the gums is most commonly assessed, but conjunctival membranes can also be evaluated, as can the vulva or penis if the head of the patient is not accessible. Care should be taken to avoid getting bitten when evaluating an animal’s gums. Mucous membranes are sometimes pigmented, so that assessment of colour may be difficult.
What is the normal colour of mucous membranes and why are they this colour?
The mucous membranes of most animals are normally pale pink- this colour is due to the presence of red blood cells within the capillary beds of the mucous membranes (peripheral circulation). The colour of mucous membranes may be affected by abnormalities of the cardiovascular system; abnormalities of the respiratory system and other conditions e.g. poisoning/intoxication.
What can pale/white mucous membranes indicate?
Indicates absence of red blood cells with the capillary beds
What can cause an animal to have pale/white mucous membranes?
Anaemia (insufficient red blood cells in the overall circulation)
Hypoperfusion - various causes but hypovolaemia is the commonest cause. As a result of the compensatory mechanisms stimulated by hypovolaemia, peripheral vasoconstriction will lead to decreased blood supply to the area thus pale mucous membranes
What can cause icteric mucous membranes and what is this problem due to?
icteric or jaundiced
▪ Indicates elevated bilirubin in the circulation. This may be due to excessive haemolysis, liver disease or biliary tract disease (pre-hepatic, hepatic or post-hepatic jaundice)
What can cause blue/purple mucous membranes?
Blue/purple
o Termed cyanotic
o Secondary to de-oxygenated haemoglobin
o Seen with severe hypoxaemia (N.B. clinically evident cyanosis only occurs at a SPO2 of <85%)
o The absence of cyanosis does not preclude hypoxaemia
What can cause red mucous membranes?
o Seen with early sepsis/ SIRS in dogs
o May also be seen in patients that are hyperthermic/ suffering from heat stroke
o Secondary to a ‘hyperdynamic state’ of increased cardiac output and vasodilation
What can cause bright red mucous membranes?
Carbon monoxide intoxication
What can cause brown mucous membranes?
Methaemoglobinaemia e.g. paracetamol (acetaminophen) intoxication
How should you assess the mucous membranes?
it is important to assess the colour of the mucous membranes, the texture and the capillary refill to obtain meaningful information.
What does tacky or dry mucous membranes indicate?
Tacky or dry mucous membranes will be present in dehydrated patients. Dry mucous membranes may also be present in animals that are mouth breathing.
Are hypovolaemic patients usually dehydrated?
Remember that acutely hypovolaemic patients are rarely dehydrated; and dehydrated patients are not necessarily hypovolaemic. Hypovolemia is defined as a loss of circulating volume which leads to cardiovascular system dysfunction –it must addressed rapidly once identified. Dehydration is a loss of total body water and, on its own, will rarely be immediately life threatening. However, if a patient is both hypovolaemic and dehydrated, the hypovolaemia will need prompt treatment.
Why would mucous membranes be excessively moist?
Mucous membranes can be excessively moist in animals that are hypersalivating due to nausea or have recently vomited etc.
What is the capillary refill time?
Capillary refill time (CRT) is defined as the amount of time it takes for blood, and therefore colour, to return to the capillary bed after it has been forced out of the capillaries through digital pressure
What would be considered a normal and prolonged capillary refill time?
Normal CRT is 1-2 seconds.
Prolonged CRT > 2 seconds
What would be the cause of a prolonged CRT?
o Consistent with hypoperfusion/shock
o CRT may not be discernible if very prolonged
How could the CRT help to differentiate between anaemia and hypoperfusion?
Assessing CRT can help in the differentiation between anaemia and hypoperfusion/ shock as the cause of the pale mucous membranes:
▪ Pale MMs and normal CRT is consistent with anaemia (N.B. If anaemia is significant, however, it may be impossible to evaluate CRT)
▪ Pale MMs and prolonged CRT is consistent with hypoperfusion/ shock
What can a rapid CRT be associated with?
Rapid CRT
o Less than 1 second is abnormally fast
o Usually occurs along with the hyperaemic/red mucous membranes and can be associated with sepsis
What is hypoperfusion?
Hypoperfusion= decreased blood perfusion of tissues so decreased delivery of oxygen to cells. Hypoperfusion can lead to shock.
What is shock?
Shock = this is a life-threatening lack of oxygen delivery to cells/ tissues. Decreased cell oxygenation causes organ dysfunction and cell death.
What can happen if shock is left untreated?
If untreated, this will result in multiple organ dysfunction (MOD) and patient death.
Describe the progression of shock and compromised perfusion in 6 steps?
reduced perfusion
reduced oxygen delivery to tissues and collection of bi products (carbon dioxide)
reduction in oxidative metabolism and and increase In anaerobic metabolism
impaired cellular function
cell death
organ failure
What is a pulse deficit?
The heart rate and the pulse rate should be the same. With some cardiac arrhythmias, there may be fewer pulses palpated than heart beats heard-this is termed a pulse deficit.
How do you assess the pulse rate and heart rate?
The pulse rate and heart rate should be assessed by simultaneous cardiac auscultation and pulse palpation. The heart rate and the pulse rate should be the same.
What would be considered tachycardic in a dog?
Tachycardia (dogs)
o Generally, heart rates above 140 beats per minute (bpm) would be considered tachycardic (although this depends on the context, age, breed etc.) e.g. for some dogs > 120/ bpm would be abnormal. It is very important to monitor and note alterations in the individual patient’s heart rate- ‘trends’ e.g. a heart rate that is consistently at 140 bpm, may be of less concern than a heart rate that changes from 80 bpm to 130 bpm in a patient with a recent history of trauma.
What are the causes of tachycardia in dogs? what would be the most significant?
o The most significant cause of tachycardia is hypoperfusion/shock
o Additional causes include cardiac arrhythmias, congestive heart failure, anaemia, stress, pain, excitement, electrolyte abnormalities and intoxications
What is inappropriate bradycardia?
In a dog that has signs of hypovolaemic shock (pale mucous membranes, prolonged CRT, weak pulses), tachycardia would be expected. If it has a normal heart rate in this situation, e.g. 90 bpm, this would be inappropriate bradycardia.
What are the possible causes of bradycardia in dogs?
Possible causes of bradycardia (or inappropriate bradycardia) include:
▪ Hyperkalaemia (e.g. typical hypoadrenocorticism or urethral obstruction)
▪ Increased vagal tone
▪ Drugs e.g. lidocaine
▪ Atrioventricular blocks
▪ Sick sinus syndrome
▪ Raised intracranial pressure (Cushing’s reflex)
▪ Hypothermia
What are the causes of tachycardia in cats?
Differentials for tachycardia include ▪ Hyperthyroidism ▪ Congestive cardiac failure ▪ Electrolyte disturbances ▪ Intoxications ▪ Pain/stress Unlike dogs, cats with shock are not typically tachycardic especially as the shock becomes more advanced
What rate would be considered tachycardia in a cat?
A heart rate above 180bpm. Would be considered tachycardic in a cat It is however important to consider other factors that may cause such as stress, pain anxiety, white coat effect.
What can be the causes of bradycardia in cats?
Cats with hypovolaemic shock are often bradycardic, especially in the later stages, when they have decompensated, or if they have septic shock (Pachtinger, 2015).
o Cats with sepsis are often bradycardic (e.g. < 120 bpm) (Pachtinger, 2015).
o Hyperkalaemia (e.g. urethral obstruction/ uroabdomen)
o Atrioventricular block
o Hypothermia
o High vagal tone
What pulses should be assessed during the primary survey?
Central e.g. femoral pulses should be assessed bilaterally. This may be challenging in obese patients or those with hind limb trauma. Care should be taken when attempting to palpate femoral pulses in patients that have trauma not to cause further discomfort. Additionally, peripheral dorsal metatarsal or pedal pulses should be palpated in dogs and, attempted in cats- these may be difficult to palpate even in normal cats, however. Regular assessment of central and peripheral pulses should be performed in normal animals as well as sick ones.
What does the pulse quality reflect the difference between?
Pulse quality reflects the difference between diastolic and systolic blood pressure-
What parameters can pulse quality be affected by?
it can be affected by several parameters including stroke volume, cardiac contractility and vasomotor tone e.g. degree of peripheral vasoconstriction.
What is assessed when feeling a pulse quality?
Pulses are assessed for pressure (strength of pulse) and duration.
What type of pulse quality would you expect to find in an animal with sepsis and why?
Bounding pulses (strong and longer duration) may be palpated in septic dogs due to the vasodilation that is present in early stages.
What type of pulse quality would you expect to find in a hypovolaemic patient? why?
Weak femoral pulses may be palpated in seriously hypovolaemic patients
Peripheral pulses may be hard to detect/absent in hypovolaemic patients due to compensatory mechanisms e.g. vasoconstriction
What is the blood pressure likely to be if there are absent peripheral pulses?
They tend to disappear when the mean arterial pressure (MAP) decreases below 60 mmHg
What type of pulse quality would you expect with anaemia?
Snappy pulses (strong but short duration) may be present with anaemia.
Why is it important to assess pulses bilaterally? especially in cats?
It is important to compare femoral pulses bilaterally, especially in cats at risk of aortic thromboembolism (ATE). Attempts should ideally be made to assess forelimb pulses as ATE may occasionally affect the forelimbs.
What should be assessed and noted when listening to an animals heart?
The heart of all animals should be auscultated- noting the rate, rhythm, position and audibility of heart sounds.
What might muffled/absent heart sounds be secondary to?
Muffled/absent heart sounds may be secondary to pericardial or pleural space disease e.g. pleural effusion (ventrally) or pneumothorax (dorsally)
If the primary survey shows a patient is showing clinical signs suggestive of shock (e.g. hypovolaemic), What initial treatment will be required?
- Provide emergency oxygen by the manner most well-tolerated by the patient
- Intravenous fluids are likely to be indicated- choice, route and rate will be chosen by the veterinary surgeon. (Fluid therapy is discussed further in Unit 1, outcome 2) - an intravenous catheter should be placed (under veterinary direction) It is however essential that the RVN can select an appropriate site of placement for an intra-venous catheter; as well as a suitable type and size of catheter for the patient.
- At the time of placement, blood can be collected for, at least some of, the following emergency tests (it may, however, only be possible and appropriate to get sufficient blood at this stage to put into two capillary tubes) A minimum database can be performed with 0.2ml of blood, so should be achievable from the catheter, thus providing important information rapidly.
What would a vets NOW minimum database include?
A blood test including: Minimum database (MDB) ▪ Packed Cell volume (PCV) ▪ Total solids (TS) ▪ Blood urea nitrogen (BUN) ▪ Blood glucose
What would a vets NOW extended database include?
o Minimum database (MDB) ▪ Packed Cell volume (PCV) ▪ Total solids (TS) ▪ Blood urea nitrogen (BUN) ▪ Blood glucose plus o Extended database (EDB) ▪ MDB as above ▪ Electrolytes Blood gases o Lactate o Blood smear
After the initial primary survey and blood collection has been performed, what other diagnostic tests will help with the immediate investigation?
Following the primary survey, it might be decided that additional immediate investigation may be needed to give a better assessment of the cardiovascular/ haemodynamic status of the patient
• Electrocardiography (ECG)
• Blood pressure measurement
o Indirect Doppler
o Indirect Oscillometric
o Direct Arterial.
• POCUS (Point of care ultrasound) may also be carried out bedside for the trauma patient or emergency presentation.
What are the signs that an animal is in respiratory distress?
The respiratory system should be assessed in ALL patients during triage. Signs of respiratory distress (dyspnoea) can be subtle, especially initially, and include:
• postural changes such as head and neck extension and elbow abduction
• abnormal breathing patterns e.g. rapid/ shallow, irregular, stridor, paradoxical abdominal breathing,
• restlessness
Why is stress an important consideration in animals in respiratory distress?
It is important to remember that patients demonstrating these signs are at the limit of their physiologic reserves. It is essential to minimise patient stress to avoid respiratory and/or cardiac arrest. A hands-off approach is essential for any patient in respiratory distress to avoid fatality.
What conditions might cause an increase in respiratory effort?
An increase in respiratory effort may be seen with:
o Pleural space disease (e.g. pneumothorax, haemothorax, or diaphragmatic hernia/ rupture)
o Pulmonary parenchymal disease (e.g. pulmonary contusion)
o Upper airway disease / airway obstruction
