Emergency Patient Care and Triage Systems

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What does triage focus on in an emergency situation?

Sorting patients based on their medical condition (correct)

Evaluating the emergency team’s response

Determining hospital capacity and resources

Assessing the severity of animal behavior

Which of the following is NOT part of an emergency database?

Secondary survey details

Primary survey results

Last vaccination date (correct)

Capillary refill time

What is the first step in telephone triage?

Providing treatment advice over the phone

Recording the pet's vaccination history

Listening carefully to the owner's report (correct)

Asking detailed medical questions

Which of the following conditions is considered urgent and must not wait for treatment?

Severe trauma/wounds (B) Signup and view all the answers

During the initial assessment, what should be evaluated?

All major body systems (B) Signup and view all the answers

What should be prepared for the arrival of an emergency patient?

Oxygen, fluids, and an array of monitoring equipment (D) Signup and view all the answers

Which situation typically requires more immediate evaluation?

Collapse/syncope in a dog (D) Signup and view all the answers

What is typically part of the secondary survey during an emergency evaluation?

Performing a full physical examination (A) Signup and view all the answers

What is indicated by cyanosis in a patient during a respiratory assessment?

A late sign of hypoxia (A) Signup and view all the answers

Which laboratory test is NOT commonly included in point of care testing?

Urinalysis (B) Signup and view all the answers

During the primary survey, what is checked as part of the 'Circulation' assessment?

Heart rate and auscultation (D) Signup and view all the answers

What does auscultation during respiratory assessment primarily aim to identify?

Presence of crackles or wheezes (A) Signup and view all the answers

What does the acronym SAMPLE stand for in the capsule history during triage?

Signalment, Allergies, Medications, Past, Events (C) Signup and view all the answers

Which clinical sign does NOT indicate shock in the cardiovascular assessment?

Bradycardia (D) Signup and view all the answers

What is the purpose of a POCUS scan during an emergency evaluation?

To evaluate abdominal organs for trauma (B) Signup and view all the answers

Which step should be prioritized after the primary survey in an emergency situation?

Performing a secondary survey (A) Signup and view all the answers

Study Notes

Approach to the Emergency Patient

The approach to emergency patients involves gathering information, preparation, initial assessment, further evaluation, assessing body systems, and understanding "emergency databases".
Information gathering includes phone calls and patient history to identify life-threatening emergencies.
Preparation for the patient's arrival at the clinic is critical.
The initial assessment and evaluation are critical components of treating emergency patients.
Assessment of all major body systems helps identify major problems.
An "emergency database" is a crucial concept in the efficient management of emergency patient care.

Triage

Triage is a process of sorting patients based on their medical conditions to prioritize treatment.
The sickest patients are treated first.
The process prioritizes patients who need immediate attention.

Triage Systems

Multiple triage systems exist.
Systems categorize patients into levels based on urgency.
Level 1 patients are immediate, life-threatening emergencies.
Level 2 are emergencies that could become life-threatening.
Level 3 are urgent, but not life threatening.
Level 4 are semi-urgent, not life-threatening.
Level 5 are non-urgent; treatment can be delayed.

Ethos Patient Severity Index

The Ethos Patient Severity Index and triage system categorize animals according to severity from level 1 (resuscitation) to 5 (stable).
Level 1 entails serious physical trauma, cardiac arrest, failure to breathe, or collapse.
Level 5 includes animals with mild problems like soft stools, decreased appetite, or ear/skin issues.

Telephone Triage

Gathering information over the phone is important in assessing emergency situations.
The process includes actively listening, clarifying information, and considering the limitations of pet owners in providing medical details.

Emergency Situations

Various scenarios necessitate immediate veterinary intervention.
These include changes in oral gum color, breathing difficulties, allergic reactions, exposure to chemicals, ingestion of toxins or foreign materials, changes in alertness, seizures or imbalance, trembling, pain, and urinary issues.
Urgent care examples include coughing, sneezing, minor cuts/wounds, minor vomiting/diarrhea, loss of appetite, mild discomfort/lameness, tick removal, ear/skin infections, and eye irritation.

Common Cases

The most common cases for dogs and cats in 2014 varied by species.
Dogs frequently presented with vomiting, trauma, collapse/syncope, pain, lethargy, seizures, lameness, diarrhea, or intoxications.
Cats often presented with trauma/wounds, urination issues, lethargy, collapse/syncope, lameness, pain, vomiting, dyspnea, or anorexia.

Preparation

Critical supplies include oxygen, fluids (with catheters), analgesia, IV catheters, IV lines and T-connectors, IV fluids, Laryngoscopes and tape, gauze bandages, ambu-bags, oxygen source, pulse oximeters, syringes, needles, adrenaline, atropine, drug dosage lists, suction, glucometers, 50% dextrose, blood pressure machines, and ultrasound/X-rays.

Additional Requirements

Laboratory equipment, including blood collection pots and point-of-care tests like blood glucose, lactate, PCV, and TS, is essential.
Other required diagnostic tests include urine analysis, full blood counts/smears, blood gas evaluation, ultrasound (FAST/POCUS), and radiographs.

Triage and Primary Survey

The ABCs of life support, including airway, breathing, and circulation, should be assessed.
Each triage level has a specific urgency, and patients needing immediate stabilization or attention come first.

Capsule History

The SAMPLE method for gathering information on the patient's recent health is critical.
S - Signalment, A - Allergies, M - Medications, P - Past Illness, L - Last Normal, and E - Events Leading to the Emergency.

Respiratory System

Observing for signs like hypoventilation, hypoxia, poor tissue oxygenation, patent airways, and breathing effort including rate and effort is essential.
Additional assessments include looking for cyanosis and lung sounds using auscultation.

Cardiovascular System

Assessing tissue oxygen delivery, clinical signs of shock (compensatory vs. decompensated), mucus membrane color, capillary refill time, heart rate and auscultation, pulse quality, and body temperature/extremities.

Neurological System

Indication of cardiorespiratory wellness, brain and spinal cord injuries, seizures, stupor, coma, paralysis, and increased intracranial pressure are key aspects.
Identifying Hypoglycemia is important in the neurologic evaluation.

Urinary System

Acute kidney injury, urinary tract obstructions, palpation of the bladder (assessment of size, presence), evaluation for bradycardia, and paraphimosis identification are vital.

Procedures to be Performed.

Necessary patient procedures include acquiring owner consent. Implementing intravenous fluid therapy, oxygen administration, cessation of obvious bleeding, administering diazepam for seizures, and administration of analgesics are crucial steps in emergency management.
Performing blood tests (especially basic and geriatric profiles), urine testing, and diagnostic imaging assessments like ultrasound are important.

Secondary Survey

After the initial stabilization and primary survey, this detailed evaluation reassesses the body systems in a more comprehensive approach.
More thorough and complete clinical examinations, from nose to tail, are carried out, further evaluating major body systems.

Minimum Emergency Database (MEDB)

This database (MEDB) is a vital record of a patient's key health information organized for use in emergency situations.
Vital body system information, including pulmonary, cardiovascular, neurological, and urogenital aspects, is essential to recording.
Specific information (including bleeding, respiratory status, color, CRT, pulse rate, consciousness, wounds/fractures, PCV, TSP, BUN, glucose, blood lactate, blood smear, and electrolytes) are collected to determine a comprehensive clinical picture of the patient.
Further tests like ECG, BP, pulse oximetry, blood tests, ultrasound, and urinalysis are recorded.

Possible Therapies

Possible treatments include oxygen, fluid therapy, analgesic therapy, sedation, antibiotic therapy, antiemetic therapy, antiepileptics, diuretic therapy, antihistamines/cortisone, wound/fracture management, thoracentesis/abdominocentesis, gastric lavage/enema, urinary catheterization, assisted birth, blood/plasma transfusions, and disease-specific medications.

Respiratory Distress

Key signs include a stretched neck, open mouth, abducted elbows, abdominal breathing, a bewildered facial expression, reluctance to lie down, cyanosis, and inspiratory/expiratory noises (stridor).

Emergency Stabilization

Maintaining patient calm, avoiding non-essential procedures, placement in a controlled environment (high oxygen), professional "neglect", performing a brief clinical exam if possible, and administering sedation are vital considerations.
Effective pain management often involves opioids like methadone, morphine, or butorphanol.

Improvisation

The ability to improvise is a key component of managing emergency situations.

Oxygen Percentage

The recommended FiO2 ranges from 30-40%. High oxygen concentrations (above 50%) should be limited to 24 hours to avoid oxygen toxicity.
Oxygen flow rates vary according to the specific technique, ranging from 100-200ml/kg per minute in most scenarios.

Fluid Therapy

A six-point fluid therapy plan must address the issues of fluid therapy indication, fluid type, fluid amount and administering rate, route of administration, and how the therapy will be monitored.

Fluid Selection

Crystalloids versus colloids
Crystalloids are maintenance fluids; colloids are replacement fluids.
These solutions include natural and synthetic forms.

Fluid Amount

Fluid requirements need to account for the replacement volume + maintenance requirements + ongoing losses.
Initial boluses for stabilization typically range from 10-20 ml/kg over 5 minutes, and further assessments should be conducted.
Important factors in calculating fluids include the body weight and the degree of dehydration.

Fluid Resuscitation Goals

Mucus membranes and CRT (capillary refill time) normalization are key metrics for determining sufficient hydration. Also critical are heart and respiration rates, PCV, temperature, urine output, CVP (central venous pressure), and blood pressure.

Pain Recognition

Pain assessment protocols are essential for appropriate treatment.
Multiple pain scales exist for assessing pain levels in animals, both for dogs and cats, to create the best and most appropriate treatment plan.

Pain Medication

Understanding the cause of pain can help determine the right medications.
Different approaches (opioids, NSAIDs, local anesthetics) are suitable for various pain scenarios.
Supportive care and methods for managing pain may be required, depending on the circumstances.

Study summary of the learning

Emergency patient care requires a systematic approach, from initial contact to stabilization and treatment.
Information gathering, preparation, initial and secondary assessment, monitoring body systems and the development of an emergency database are central to the emergency plan.

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

This quiz covers the vital approaches to emergency patient care, including information gathering, assessment, and management. It delves into the process of triage, emphasizing how patients are prioritized based on their medical conditions. Understand the significance of emergency databases and the different triage systems used in medical settings.