Podcast
Questions and Answers
What should be prioritized when dealing with a patient in severe distress and not close by?
What should be prioritized when dealing with a patient in severe distress and not close by?
How should client expectations be managed if the clinic is closing in one hour?
How should client expectations be managed if the clinic is closing in one hour?
What is an appropriate first aid step for a bleeding patient?
What is an appropriate first aid step for a bleeding patient?
What should you do if you are unsure about how to manage an emergency situation?
What should you do if you are unsure about how to manage an emergency situation?
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What should be assessed when a patient arrives at the clinic?
What should be assessed when a patient arrives at the clinic?
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In cases where a patient has ingested a potentially harmful substance, what is the recommended initial course of action?
In cases where a patient has ingested a potentially harmful substance, what is the recommended initial course of action?
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What is the primary reason for not concerning with non-pertinent information during an emergency?
What is the primary reason for not concerning with non-pertinent information during an emergency?
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What is a critical factor when assessing whether a patient can wait for treatment?
What is a critical factor when assessing whether a patient can wait for treatment?
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What is the significance of assessing the pulse during the primary survey?
What is the significance of assessing the pulse during the primary survey?
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In which situation would you auscultate and 'ping' for tympany over the abdomen?
In which situation would you auscultate and 'ping' for tympany over the abdomen?
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What does a dull or depressed mentation indicate during the consciousness assessment?
What does a dull or depressed mentation indicate during the consciousness assessment?
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Which of the following is NOT a classification in assessing levels of consciousness?
Which of the following is NOT a classification in assessing levels of consciousness?
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During a primary survey, which assessment directly helps identify potential spinal injuries?
During a primary survey, which assessment directly helps identify potential spinal injuries?
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What does the appearance of mydriatic pupils suggest about a patient's condition?
What does the appearance of mydriatic pupils suggest about a patient's condition?
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Which change in gait or posture may indicate that a patient is in significant pain?
Which change in gait or posture may indicate that a patient is in significant pain?
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What is the maximum duration recommended to complete a primary survey?
What is the maximum duration recommended to complete a primary survey?
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What is the primary goal of triaging patients in emergency and critical care nursing?
What is the primary goal of triaging patients in emergency and critical care nursing?
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What is one key procedure during telephone triage?
What is one key procedure during telephone triage?
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During a primary survey, what should be assessed first?
During a primary survey, what should be assessed first?
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Which of the following best describes the process of client management during emergencies?
Which of the following best describes the process of client management during emergencies?
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What is one of the primary purposes of triage in veterinary medicine?
What is one of the primary purposes of triage in veterinary medicine?
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When conducting a secondary survey, what aspect is considered after addressing immediate life threats?
When conducting a secondary survey, what aspect is considered after addressing immediate life threats?
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What should a veterinary technician do first when receiving a call for an emergency?
What should a veterinary technician do first when receiving a call for an emergency?
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How does triaging help manage limited resources effectively?
How does triaging help manage limited resources effectively?
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Study Notes
Emergency & Critical Care Nursing
- Triage and shock are covered in this topic.
Emergency & Critical Care (ECC) Nursing
- Emergency and Critical Care Nursing is covered in Chapter 25 of McCurnin's Clinical Textbook for Veterinary Technicians and Nurses, 10th edition.
- Emergency Receiving is covered in Chapter 13 of Small Animal Emergency and Critical Care for Veterinary Technicians, 4th edition.
- Initial Triage and Resuscitation of Small Animal Emergency Patients is covered in the Merck Veterinary Manual (merckvetmanual.com).
Patient Assessment
- Triage is the first step in patient assessment.
- The Primary Survey assesses the airway, bleeding/trauma, and consciousness of the patient.
- The Secondary Survey is done after the initial issues are addressed.
Triage
- Triage in French means "to sort".
- In World War 1, triage was a battlefield strategy to funnel resources (bandages, time, expertise, etc.)
- Triage reduces time & resources spent on patients who would survive without treatment or on patients who would die regardless of intervention.
- Veterinary triage rapidly assesses patients needing immediate care, prioritizing the care of animals closest to death.
- This prioritization of incoming patients is similar to human triage.
Telephone Triage
- #1 Answer the Phone: Always answer the phone; the caller may have a real emergency or a less serious complaint. "Failure to plan... does not constitute an emergency..." Ensure to get the client's name and phone number.
- #2 Obtain Client Name and Phone Number: In case of a call disconnection, have a method to retrieve the client's information. A patient's cell phone call may be unreliable, requiring an alternate way to contact the client.
- #3 Determine How Urgent?: Gather a history: what happened, when, how long, current status, location, ETA, and other immediate concerns. Determine severity and if the client should come to the facility right away, or if they can schedule an appointment later.
- #4 Give Advice: Determine if there is a need for professional care or if first aid is appropriate, including how to handle bleeding, transporting the patient, and cautions if the patient has any possible dangerous behaviours (like biting).
- #5 Do not Waste Time: True emergencies can be life and/or death matters of minutes. If unsure, talk to another RVT or DVM quickly. Non-essential details, like vaccination status, can be addressed later.
Patient Arrival & Assessment
- Veterinary Technicians (RVTs) assess the patient's acuity level upon arrival.
- Assess if a patient can wait and if not, move them to the treatment area, prioritizing life-threatening problems.
- Evaluation and resuscitation begin immediately for urgent cases.
Assessing Patient in Triage
- The goal is patient sorting within 1-2 minutes.
- Assess patients for immediate care/stabilization.
- Categorize patients needing treatment for other reasons (vomiting, diarrhea, contagious, injury)
- Categorize patients who can wait until appointment time (when not bleeding or in immediate danger).
Primary Survey
- Rapid evaluation of critical problems (within 1-2 minutes).
- Brief patient history from the owner about pertinent information.
- Assess the patient's ABCs (Airway, Breathing, Circulation), or "ABCs" in short.
- Prepared items, such as a stethoscope, pen, light/otoscope, thermometer, muzzle, towel, gloves, and stocked supplies, are helpful.
Primary Survey: Airway
- LOOK: for signs of respiratory distress such as increased respiratory effort, stance posture, body movements (abdomen, nasal flare, open mouth), position of the animal's hand (in front of the nose for airflow), and laboured breathing with fast, shallow, or abdominal effort. Look in the animal's mouth.
- LISTEN: cranial to caudal, ventral to dorsal lungs, and remember to check the trachea. Listen for abnormal sounds like snoring, roaring, wheezing, and decreased/absent sounds.
- FEELE: Palpate the trachea. Note: multitask - do both listening and palpating at same time. Palpate the chest wall checking for fractures, subcutaneous emphysema, and wounds.
Primary Survey: Bleeding
- Active bleeding (especially arterial) needs immediate direct pressure and appropriate fast bandaging (gauze, vet wrap).
- Tourniquet use for extended periods may only be necessary when amputation is an option and must be applied on the legs and or tail and not the head or body. Utilize haemostatic clamps to stop the bleeding if necessary.
Primary Survey: Bleeding
- Assess (by looking at) Color of mucous membranes (MM) and capillary refill time (CRT).
- Palpate for pulse quality (weak, strong, bounding, etc.)
- Check temperature (rectal or axillary).
- Assess hydration.
- Complete a musculoskeletal (body part) palpation.
- Check for tympany if suspected bloat.
Primary Survey: Consciousness
- Mentation: Neurologic concerns and signs (injuries, toxins, spinal cord, pathogens, fevers). Assess the patient's level of alertness via observing interactive behaviours.
- Terms: Assess levels of consciousness through assessing dullness/depression (interactive but not bright or eager), obtunded (reacts to stimuli, but very slowly), stuporous (in response to noxious stimuli), and comatose (disconnected from environment, unresponsive).
- Pain Perception: Assess the patient's pain response via skin pinches and toe pinches.
- Pupils: Evaluate pupils for size, shape, and response to light using mydriatic (big pupils), fixed and dilated pupils. Determine if the response to light stimulus is present. Determine if the response is a cat-like stress response to light stimulus (sympathetic response). Verify both pupils are the same size and if not, inquire about Horner's syndrome (unequal pupil sizes paired with eyelids raised, not normal). Evaluate pupil light reflex time.
Primary Survey: Gait/Posture
- Assess if the animal is guarded (due to pain) or recumbent (on its side), and if they are limping, have a specific gait, or show issues with weight bearing, sawhorse stance, or rigid gaits (forelimbs vs hindlimbs).
- Localize injuries (such as TBI, spinal fractures or trauma, etc.)
Primary Survey Complete
- Multitask: During the primary survey, simultaneously do looking, listening, and feeling.
- Triage: Address any catastrophic abnormalities at this time and note if the ABCs (Airway, Breathing, Circulation) are stable and consciousness is normal.
Secondary Survey
- After immediate, life-threatening issues are addressed (such as pressure bandaging, catheter/IV insertions), the secondary survey is conducted.
- Complete history is taken from the owner. A thorough physical exam (PE) is completed.
- Diagnostics and plans are formulated.
- Vital signs are recorded if not done previously:
- Heart Rate & Heart Auscultation
- Pulse Rate & Quality
- CRT & Mucous Membrane Color/Moisture
- RR & Auscultation
- Blood Pressure
- Body Temperature, and extremity feeling
Vital Signs and Other Considerations
- Record vital signs for any shock patient: heart rate, pulse rate and quality, CRT, mucous membranes, RR, and blood pressure.
- Note body temperature.
- Note how the extremities feel.
- Conduct ECG or QATS.
- PCV, TP, BUN, and BG.
- Baseline blood work (CBC, chemistry, electrolytes, blood gasses).
Always Be Prepared
- Equipment and Crash Cart preparations for "unstable" patients. Arrange supplies according to the immediate "task".
- Gather and keep organized a crash cart with important supplies (airway equipment, resuscitation aids, emergency drugs). Include needed supplies for an animal with airway issues, aids and equipment, and needed drugs.
GCVH Crash Cart
- Include items and supplies for an animal requiring emergency care.
2nd Crash Cart
- A smaller and more portable version of a crash cart that lives in the dental area.
Shocking Facts
- Shock is a condition/medical emergency where inadequate blood flow (perfusion) to organs/tissues deprives them of oxygen and causes waste products to build up.
- Shock can damage the cell/tissue/organ to the point of death. Lack of ATP (from failure in the cell/cellular respiration) causes shock and death. The goal in treatment is restoring tissue perfusion and oxygen to normal to prevent death.
Types of Shock
- Cardiogenic: Heart disease
- Hypovolemic: Decreases in intravascular volume
- Distributive: Decreases in blood vessel tone
- Obstructive: Obstruction to blood flow
Pathophysiology of Shock
- Step 1: Event occurs, causing decreased cardiac output and hypotension
- Step 2: The body compensates via the sympathetic nervous system, secreting hormones (epinephrine, norepinephrine, and cortisol).
- Step 3: The body's response to these hormones includes the heart contracting faster, and blood flow being redirected to vital organs at the expense of other organs.
Stages of Shock
- Stage One (Compensated): SNS is activated; tachycardia, peripheral vasoconstriction, decreased pulse quality, prolonged CRT.
- Stage Two (Decompensated): Tachycardia, weak pulse, decreased MM color(s) , variable CRT, hypothermia, Weakness and reduced LOC
- Stage Three (Irreversible): Unconscious/unresponsive, prolonged hypoxemia, low BP, vasodilation, CV collapse, Cold/poor MM color, hypothermia, no response to treatment.
Reperfusion Injury
- Shock treatment is followed by efforts to minimize the aftereffects of shock. The body uses anaerobic respiration to address oxygen deprivation and this results in an increased level of lactate, and other damaging byproducts.
- White blood cells (WBCs) gather to damaged tissues resulting from the inadequate blood supply.
Shock Treatment Summary
- Venous access required.
- Aggressive fluid and oxygen therapy.
- Drugs.
- Treat the underlying disease.
- Goal: Restore O2 delivery, perfusion and circulation.
Saving Lives
- Veterinary technicians (RVTs) save lives one pet at a time.
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Description
Test your knowledge on prioritizing care for patients in severe distress, managing expectations in a clinic, and assessing patients upon arrival. This quiz covers essential first aid steps and emergency management practices crucial for healthcare providers.
