TPRs and Triage (VET 2210) PDF

TPRs and Triage VET 2210  Job of a Tech Veterinarians rely on their techs to do the following: ▶ Monitor patients under anesthesia ▶ Being able to tell what is normal and what is not normal ▶ Providing a thorough patient history ▶ Perform triage on patients that walk thr...

TPRs and Triage VET 2210  Job of a Tech Veterinarians rely on their techs to do the following: ▶ Monitor patients under anesthesia ▶ Being able to tell what is normal and what is not normal ▶ Providing a thorough patient history ▶ Perform triage on patients that walk through the door Back to Basics TPR Temperature Sites: ▶ Rectal ▶ Axillary ▶ Inguinal ▶ Aural ▶ Body surface (IFT) ▶ Esophageal  Temperature Equivalents ▶  TPR Pulse ▶Reflects perfusion to peripheral tissue ▶Place tips of index and middle fingers at any site where an artery crosses over bone or firm tissue: ▶ Femoral ▶ Dorsal pedal ▶ Facial and submandibular ▶ Digital ▶ Lingual ▶Should be easily palpated and strong  TPR ▶Bounding Pulse—the difference between systole (contraction) and diastole (relaxation) is great ▶Use analgesics and fluids ▶Weak Pulse—immediate concern, decreased cardiac output ▶Cardiac meds and aggressive fluid therapy are necessary  TPR Respiration: ▶Respiratory Tract: Nasal passages, pharynx, larynx, and lungs ▶Signs of respiratory distress: ▶ Increased rate ▶ Change in pattern ▶ Postural changes ▶ Open mouthed / labored  TPR Respiratory Patterns: ▶Stridor ▶Stertor ▶Rapid/Shallow ▶Labored on inspiration/expiration ▶Expiration distress with short inspiration  CRT Capillary Refill Time: ▶Normal is 1-2 seconds ▶> 2 sec = Vasoconstriction Impaired perfusion Oxygen admin and aggressive fluid therapy required ▶< 1 sec = Vasodilation Anxiety, shock, fever, pain  MM Color Color Interpretation Cause Pink Normal Adequate Perfusion Inadequate Oxygenation Cyanotic to Periphery=Emergency Hypoxemia Hepatic disorder, Icteric Bilirubin Interpretation hemolysis Early septic shock, fever, Brick Red Excessive Vasodilation Inflammatory response Anemia, blood loss, pain, Pale Poor perfusion shock Brown Methemoglobinemia Acetaminophen toxicity DIC, platelet disorders, Petechia Coagulation disorder coagulation deficiencies Normal Ranges Animal Respiratory Body Temperature Heart Rate Rate Canine 60-180 10-30 100°-102.5° F Feline 120-240 15-30 100°-102.5° F Equine 30-45 8-20 99°-100.5° F Bovine 60-80 8-20 100°-102.5° F Triage  Triage Triage: french word for “select or sort” ▶ The severity of the patient determines when they are seen ▶ Not the time they arrived ▶ Can be frustrating for owners that are moved back in the cue Triage Primary Survey a. Airway / Attitude b. Breathing / Bleeding c. Cardiovascular / Circulation  Triage Look: Is the patient responsive? Are they breathing? Is there active bleeding? Listen: Auscultate heart, lungs and trachea. Feel: Palpate a pulse. Feel for any obvious trauma.  Triage Must include: ▶ Brief history ▶ Important questions for owners ▶ Quick physical exam  Triage Brief History ▶ Chief complaint ▶ Time frame ▶ What has been done so far? ▶ Work up from a previous hospital ▶ Medical Diagnoses ▶ Medications  Triage Important questions ▶ Resuscitation status ▶ Permission to give medications ▶ Permission to perform diagnostics ▶ Cost  Triage Quick physical exam ▶ TPR ▶ MM ▶ CRT ▶ Auscultate heart and lungs ▶ Weight ▶ Trauma ▶ Obvious fractures ▶ Wounds Triage Training  Crash Cart Having your crash cart fully stocked can mean the difference between life and death ▶ Routine maintenance ▶ Label everything ▶ Get to know the cart ▶ Located in central treatment area  Crash Cart Venous supplies ▶ Iv catheter ▶ Catheters ▶ T-ports ▶ Tape ▶ Tourniquet ▶ Fluids ▶ Fluid bags ▶ IV pole / pump  Crash Cart Airway supplies ▶ Laryngoscope ▶ ET Tubes ▶ Ties for tubes ▶ Ambu Bag ▶ Masks ▶ Oxygen ▶ Suction ▶ SpO2 ▶ Capnograph  Crash Cart Cardiovascular supplies ▶ ECG ▶ Blood pressure cuffs ▶ Defibrillator  Crash Cart Medications ▶ Epinephrine ▶ Atropine ▶ Naloxone ▶ Lidocaine ▶ Dextrose ▶ Diazepam ▶ DexSP ▶ Lasix ▶ Propofol ▶ Calcium Gluconate ▶ Syringes Crash Cart Miscellaneous ▶ Gloves ▶ Sterile and exam ▶ Scalpel blades ▶ Bandage supplies ▶ Clippers ▶ Alcohol ▶ Paper ▶ Clock / timer ▶ Bandage scissors ▶ Hemostats ▶ Thermometer  Crash Cart Optional You can create premade kits for specific situations. Thoracocentesis Blocked cat ▶ 60ml syringe ▶ Urinary catheter ▶ IV tubing ▶ Sterile lube ▶ 3 way stop cock ▶ Suture ▶ Catheters ▶ Needle drivers ▶ Collection bag ▶ Flush ▶ Drape Questions?