Clin Med- Assessment & Triage of the Emergency Patient

kelseyfmeyer's version from 2015-11-30 13:43


Question Answer
what do you do in the Triage step? (2)Determine need and obtain history
what do you do in the primary survey of the pt? (2)look at body systems and do the ABC's (and D and E)
what do you do in the secondary survey? (2) (whats the last thing to do after the secondary survey?)complete the exam and do the emergency database.....(after this you end by repeating assessment)
what are the 8 basic things(categories of things) you should have in your Resuscitation Area? (4)(1) general equipment (Gurney, backboard, adequate lighting) (2) Crash cart (3) OXYGEN (cylinder, anesthetic machine, central hook-up) (4) FLUIDS (catheters, fluids (crystalloids, colloids, blood products), lines, pumps, warming device) (5) Additional equipment (blood pressure, pulse ox, ETCO2, suction, clippers) (6) Diagnostics (x-ray, ultrasound (FAST exam), blood gas analyzer, “QATs” - (PCV, TS, BG) ) (7) Wound care (flush, pressure wraps, bandage material, splints, surgical scrub) (8) Emergency surgical equipment (chest pack, tracheotomy tray, vascular cut down tray, laceration pack)
what's a FAST exam?focused assessmnt with sonography for trauma
What's a QAT?quick assessment tests (things you can do fast like a PCV/total solids/blood gas)
what's triage?it's A way to “sort” patients--> Classify based on urgency and need for care
explain the "tier system" for triagea way to sort pts for triage- there are levels 1-5 and you rank pts based on their tier.
what do tiers 1-5 mean for the tier system? (put exs but dont think we need to memorize them exactly)level 1 is most urgent- it is the "IMMEDIATE" tier (exs: cardiopulmonary arrest, massive hemorrhage, major trauma, GDV, severe dyspnea, status epilepticus). Tier 2 is emergent (exs are acute abdominal pain, heat exhaustion, severe pain, acute onset of paresis). Tier 3 is urgent (exs are abdominal pain, back pain, paresis, large lacerations, cellulitis, abscess). Tier 4 is semi-urgent and Tier 5 is non-urgent (such as Ear infection, skin rash, general malaise)
what is the Animal Trauma Triage (ATT) scoring system, explain it a little bit1st veterinary triage system. helps ID those in need of immediate treatment. Six PE categories scored 0-3, where 0 is slight to no injury and 3 is severe injury
who triages the pt?RECEPTIONIST--> first line of communication, first to see pt. TECH/NURSE--> does 1st physical assessment, brief hx (DONT DELAY ASSESSMENT FOR HX), obtains consent to tx, may obtain code status
slide 12 has "Questions…if & when there’s time"...not too important i dont think but can read it overderp
SIGNALMENT IS IMPORTANT! (examples of why signalment is important)Tympanic abdomen in a large breed dog, Intact female with fever and vulva discharge, Young puppy with diarrhea and vomiting, Pregnant dog with non-progressive labor signs, Rabbit with abdominal pain (can get bloat), Male cat straining to urinate
during the Triage exam, what 4 major body systems are assessed? (how/ looking at what specifically?)(1) Neurologic (mentation, ambulation) (2) Respiratory (character, effort, auscultation) (3) Cardiovascular (pulse quality, heart rate) (4) Renal (ability to urinate, bladder palpation, hydration status)
If any gross abnormality is noted during triage, what do?patient is immediately taken to treatment area for evaluation by DVM

1* survey

Question Answer
what do the ABC's and DE stand for?Airway, breathing, circulation, disability, external assessment
A= airway--> what do you do FIRST?Determine patency first! (intubate if any doubts!)
A= Airway--> always Consider early aggressive O2 supplementation. BUT, when is the only time you don't wanna give O2?paraquat poisoning
A= Airway--> what are some ways you can provide O2? how can you provide PPV(positive pressure ventilation)? if any doubts, do what, and if nothing else is working, do what?you can do flow by or cage (*WATCH TEMP OF CAGE!), and if PPV is needed, you can give Ambu-bag or anesthesia cart. If there are any doubts, INTUBATE! If you cannot intubate, Consider emergency tracheotomy
B= breathing--> what three parameters should you look at when assessing breathing?Rate, effort, and ascultation
B= breathing--> what things are you looking at for RATE? (normal? too fast/slow? absent?)normal is 10-25 respirations per minute. Tachypnea: increased respiratory rate. Slow, prolonged breathing (bradycardia), APNEA is a RATE....of 0.
B= breathing--> what is Paradoxical respiration, and what does it usually indicate?it is when chest wall and abdominal wall do not move synchronously usually due to trauma---> If one part of ribcage is moving opposite of breathing--> broken rib (flail breathing)
B= breathing--> if breathing is labored, what should you try to differentiate?if it is labored for inspiration, expiration, both?
B= breathing--> what is Orthopnea and how would you describe it?how body is positioned when struggling to breathe. Stands, abduct elbows, abdomen moves, Extends neck, open mouth, head lifted
B= breathing--> when asculting, what should you try to listen for?Crackles, wheezes, can you hear sounds at all?
C= circulation--> what 5 things should you assess/ do for C?look at Mucous membrane color, Capillary refill time (CRT), find/charaterize pulse, determine if there is shock, and Obtain vascular access
C= circulation--> Pink mm means?normal
C= circulation--> pale/grey mm means?anemia or poor perfusion
C= circulation--> brick red (hyperemic) mm means?shock, sepsis, sirs(systemic inflammatory response syndrome)
C= circulation--> dark blue (cyanosis) mm means?hypoxia
C= circulation--> yellow (icteric) mm means?hepatic disease, hemolysis, biliary disease
C= circulation--> brown mm means?methemoglobinemia
C= circulation-->Capillary refill time (CRT)--> what is normal? what is too fast/slow and what does those results indicate?Normal: 1 - 2 seconds. Prolonged: > 2 seconds: poor perfusion. Rapid: < 1 second: hyperdynamic state
C= circulation--> what should pulse be consistent with?Should be consistent with normal heart rate for canine and feline patients
C= circulation--> pulse--> QUALITY. describe a normal, weak, and hyperdynamic pulse quality and what they might meanNormal- Strong and synchronous with heart rate. Weak: indicates poor perfusion. Hyperdynamic: anemia or sirs/sepsis (this one could mean it is Crisp/snappy (tall and thin), or Bounding (tall and wide))
C= circulation-->Shock occurs due to decreases in: (4)(1) Effective circulating blood volume (2) Oxygen carrying capacity (3) Ability to pump blood effectively (4) Vascular tone
C= circulation-->Shock--> what should you assess if you have a pt in shock?PERFUSION PARAMETERS!!! Pulse quality, mentation, extremity temperature, heart rate, CRT, mucous membrane color
C= circulation-->Classifications of shock (3)Hypovolemic, Vasodilatory, Cardiac failure
C= circulation-->Shock--> Treat possible cause with.. (some stuff you could treat with)Fluids, Oxygenation, ventilation, Drugs, Pain control, Cardiac support
C= circulation--> Obtain vascular access (considerations and vein selection)look at slide 21, it's a bunch of Qs....helpful to think about tho
C= circulation--> 4 peripheral venous sites?Cephalic vein, Accessory cephalic vein, Medial / lateral saphenous vein, Dorsal pedal vein
C= circulation--> 2 central venous sites? considerations if using a central site?Jugular, PICC(peripherally inserted central catheter) line (femoral/saphenous). CONSIDER: length of use, drugs to administer, diagnostic utility (CVP), patient factors
what are Four categories of catheter?Butterfly, Over the needle, Through the needle (peel away, cath guard), and Over the wire (seldinger)
D= disability--> what are you looking at in this category?The Patients level of consciousness, and their Ability to feel and move limbs. Some different results of assessing this are alert, responsive, obtunded, stuporous, Comatose
E= external assessment--> what are some things you are looking at in the external assessment?you are Evaluating the entire patient from head to toe! look for... Fractures, open wounds, deformities, hernias, hemorrhage, bruising, swelling.

2* SURVEY/ preliminary plan/ REPEAT ASSESSMENT

Question Answer
what 6 things are included in the 2* survey?Complete physical exam, Blood pressure assessment, Pulse oximetry, Emergency lab work, Comprehensive lab work, and Imaging
what are some things included in emergency lab work? (6)Electrolytes, Blood gases, PCV/Total solids, Hemoglobin levels, Lactate, and blood glucose
for the repeat examination, you can now examine closer..what are 6 things you more closely examine along with a WHOLE BODY ASSESSMENT??Full neurologic exam, Thoracic auscultation, Abdominal palpation, Orthopedic evaluation, Oral Exam, rectal exam
the PRELIMINARY PLAN can end up being many things.... what are some examples of things it could be?Additional diagnostics, Surgery, Hospitalization, Transfer to ICU, Treat as outpatient, Wound care and assessment, Fracture stabilization, Drug therapy, Fluid plan, Referral
look at slide 30 for Dr. Kirby's rule of 20Fluid balance, Oncotic pull, glucose, Electrolyte & acid-base balance, Oxygenation & ventilation, Mentation, Perfusion & blood pressure, Heart rate, rhythm, contractility, Albumin levels, coagulation, Red blood cell & Hgb concentration, renal function, Immune status/antibiotics/doses/WBC count, GI motility, integrity, Drug doses, metabolism, Nutrition, pain control, Nursing care, patient mobilization, Wound Care, bandage change, TLC!!!!!!!