Approach to the Emergency Patient 2024 PDF

THE APPROACH TO THE EMERGENCY PAT I E N T LEARNING OBJECTIVES Describe how to gather information pertaining to the emergency patient (phone call/history) in order to recognise some of the problems that represent a true life- threatening emergency. Describe how to prepare for th...

THE APPROACH TO THE EMERGENCY PAT I E N T LEARNING OBJECTIVES Describe how to gather information pertaining to the emergency patient (phone call/history) in order to recognise some of the problems that represent a true life- threatening emergency. Describe how to prepare for the arrival of an emergency patient at the clinic. Recognise how to perform initial assessment and further evaluation of the emergency patient on arrival. Describe how to assess all major body systems to evaluate for major problems. Identify what constitutes an “emergency database”. TRIAGE What is ? – French word trier – means to Patients are sorted based on their medical condition to help – the sickest must be treated first. Primary survey Capsule history Secondary survey Emergency database MANY DIFFERENT TRIAGE SYSTEMS TELEPHONE TRIAGE G AT H E R I N G I N F O R M AT I O N Listen Then listen more Ask questions Understand limitations – OWNERS ARE ALMOST NEVER MEDICALLY EDUCATED Give information Record details triage-list-standiford.jpg (1920×1280) (standifordveterinary.com) What can wait? *Skin *Mild GIT *Mild Musculoskeletal MOST COMMON CASES SEEN (2014) Dogs Cats Vomiting Trauma/wounds Trauma/wounds Urination issues Collapse/Syncope Lethargy Pain Collapse/Syncope Lethargy Lameness Seizure Lameness Pain Diarrhoea Vomiting Intoxications Dyspnoea Anorexia W H AT D O W E P R E PA R E ? Oxygen Fluids (catheter) Analgesia  W H AT D O W E P R E PA R E ? Laryngoscope Gauze bandage ET tubes/mask/chamber Suction Ambu-bags Oxygen source Glucometer Pulse oximeter 50% dextrose Blood pressure machine/monitors Ultrasound machine/Xrays W H AT E L S E M I G H T B E R E Q U I R E D ? Laboratory equipment Blood collection pots Point of care tests such as blood glucose, blood lactate, PCV, TS What else might we want to check? A Techy Small Animal Triage Technique: the FAST Scan Urine analysis (vmdtechnology.com) Full blood counts and blood smears Blood-gas evaluation Ultrasound FAST/POCUS FAST (Focused Assessment with Sonography for Trauma) Radiographs POCUS (Point-of-Care Ultrasonography) TRIAGE AND PRIMARY SURVEY Airway – is it patent? Breathing –is air moving? Circulation – is there a pulse and a heartbeat? CAPSULE HISTORY S – Signalment A – Allergies M – Medications P – Past illness L – Last normal E – Events leading to the emergency  R E S P I R ATO R Y S Y S T E M Look for hypoventilation & hypoxemia Poor tissue oxygenation – multiple organ failure Patent airways Rate and effort Thoracic vs abdominal Cyanosis – late sign!! Auscultation – crackles/wheezes CARDIOVASCULAR SYSTEM Tissue oxygen delivery Clinical signs of shock (compensatory vs decompensated) Mucus membrane colour Capillary refill time Heart rate & auscultation Pulse quality (notice pulse deficits) Body temperature/ cold extremities NEUROLOGIC SYSTEM Indication of cardiorespiratory wellness Brain and spinal cord injury Seizures, stupor, coma, paralysis Increased intracranial pressure Hypoglycaemia URINARY SYSTEM Acute kidney injury Urinary tract obstruction Palpate bladder (big/small/absent) Check for bradycardia (Kᶧ) Paraphimosis W H AT C O U L D / S H O U L D B E D O N E ? OWNER CONSENT and ££££ Place i/v catheter – ?Fluids? Peripheral vs central vein Give oxygen Stop any obvious bleeding CCPR? Give diazepam (Valium) if seizures Give analgesics Emergency database Draw blood for geriatric/basic profile Get urine if possible POCUS scan? …. And now you stop to think…. SECONDARY SURVEY Done after primary survey and initial stabilisation. More thorough and complete clinical examination. Nose to tail examination, re-evaluating the major body systems as well. MINIMUM EMERGENCY D ATA B A S E ( M E D B ) PRIORITIZING (golden period)