Clin Med - Assessment & Triage

drraythe's version from 2016-03-15 12:16


Question Answer
What do you do in the Triage step? (2)Determine need & obtain Hx
What do you do in the 1° survey of the PTx? (2)Look at body systems & do the ABC's (& D & E)
What do you do in the 2° survey? (2) (Whats the last thing to do after the 2° survey?)Complete the exam & 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 Sx equipment (chest pack, tracheotomy tray, vascular cut down tray, laceration pack)
What’s a FAST exam?Focused Assessment w/ 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” PTx → Classify based on urgency & need for care
Explain the "Tier system" for triageA way to sort PTxs for triage-there are levels 1-5 & you rank PTxs 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)Tier 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 & Tier 5 is non-urgent (such as Ear infxn, 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 Tx. 6 PE categories scored 0-3, where 0 is slight to no injury & 3 is severe injury
Who triages the PTx?RECEPTIONIST → 1st line of communication, 1st to see PTx. TECH/NURSE → does 1st physical assessment, brief Hx (DONT DELAY ASSESSMENT FOR HX), obtains consent to Tx, may obtain code status
SIGNALMENT IS IMPORTANT! (examples of why signalment is important)Tympanic abdomen in a large breed dog
Intact female w/ fever & vulva discharge
Young puppy w/ diarrhea & vomiting
Pregnant dog w/ non-progressive labor signs
Rabbit w/ 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?PTx is immediately taken to Tx area for evaluation by DVM

1° survey

Question Answer
What do the ABC's & DE stand for?Airway
External assessment
A = airway → what do you do FIRST?Determine patency 1st! (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 & if nothing else is working, do what?You can do flow by or cage (*WATCH TEMP OF CAGE!) & 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 3 Parameters should you look at when assessing breathing?Rate, effort & auscultation
B = breathing → what things are you looking at for RATE? (Normal? too fast/slow? absent?)Normal is 10-25 respirations per minute. Tachypnea: ↑ respiratory rate. Slow, prolonged breathing (bradycardia), APNEA is a RATE....of 0
B = breathing → what is Paradoxical respiration & what does it usually indicate?It is when chest wall & abdominal wall do not move synchronously usually due to trauma → If 1 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 or both
B = breathing → what is Orthopnea & 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 auscultating, 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/characterize pulse
Determine if there is shock
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
SIRS (systemic inflammatory response syndrome)
C = circulation → dark blue (cyanosis) mm means?Hypoxia
C = circulation → yellow (icteric) mm means?Hepatic dz
Biliary dz
C = circulation → brown mm means?Methemoglobinemia
C = circulation → Capillary refill time (CRT) → what is normal? What is too fast/slow & 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 w/?Should be consistent w/ normal heart rate for canine & feline PTx
C = circulation → pulse → QUALITY. Describe a normal, weak & hyperdynamic pulse quality & what they might meanNormal: Strong & synchronous w/ heart rate
Weak: indicates poor perfusion
Hyperdynamic: Anemia or sirs/sepsis (this 1 could mean it is Crisp/snappy (tall & thin) or Bounding (tall & wide))
C = circulation → Shock occurs due to ↓ 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 PTx in shock?PERFUSION PARAMETERS!!!
Pulse quality
Extremity temperature
Heart rate
Mucous membrane color
C = circulation → Classifications of shock (3)Hypovolemic
Cardiac failure
C = circulation → Shock → Treat possible cz w/.. (Some stuff you could treat w/)Fluids
Pain control
Cardiac support
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).
Length of use
Drugs to administer
iagnostic utility (CVP)
PTx factors
What are 4 categories of catheter?Butterfly
Over the needle
Through the needle (peel away, Cath guard)
Over the wire (seldinger)
D = disability → what are you looking at in this category?The PTx level of consciousness & their Ability to feel & 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 PTx from head to toe! Look for:
Open wounds

2° SURVEY/ Preliminary plan/ REPEAT ASSESSMENT

Question Answer
What 6 things are incldd in the 2° survey?Complete physical exam
Blood pressure assessment
Pulse oximetry
Emergency lab work
Comprehensive lab work & Imaging
What are some things incldd in emergency lab work? (6)Electrolytes
Blood gases
PCV/Total solids
Hb levels
blood glucose
For the repeat examination, you can now examine closer. What are 6 things you more closely examine along w/ 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
Transfer to ICU
Treat as out-PTx
Wound care & assessment
Fracture stabilization
Drug therapy
Fluid plan
Dr. Kirby's rule of 20Fluid balance
Oncotic pull
Electrolyte & acid-base balance
Oxygenation & ventilation
Perfusion & blood pressure
Heart rate
Albumin levels
Red blood cell & Hb concentration
Renal fxn
Immune status/ABiopsy/doses/WBC count
GI motility
Drug doses
Pain control
Nursing care
PTx mobilization
Wound Care
Bandage change

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