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Immediate Assessment and Triage
Immediate Assessment and Triage
- Definition: The art of prioritizing patients based on rapid history and physical assessment.
- STAT Conditions (Immediate Transfer): Conditions requiring rapid intervention or leading to decompensation include:
1) Respiratory & Cardiac: Cardiopulmonary arrest, respiratory difficulty, and collapse.
1) Respiratory & Cardiac: Cardiopulmonary arrest, respiratory difficulty, and collapse.
2) Trauma & Hemorrhage: Bleeding, snake bites, toxin ingestion, and open wounds.
2) Trauma & Hemorrhage: Bleeding, snake bites, toxin ingestion, and open wounds.
3) Metabolic & Systematic: Allergic reactions, heat stroke, hypothermia, seizures, and dystocia.
3) Metabolic & Systematic: Allergic reactions, heat stroke, hypothermia, seizures, and dystocia.
4) Specific Symptoms: Nonproductive retching (GDV), inability to urinate (male cats), and eviscerated organs.
4) Specific Symptoms: Nonproductive retching (GDV), inability to urinate (male cats), and eviscerated organs.
Clinical Evaluation Parameters
Clinical Evaluation Parameters
- Mucous Membrane (MM) Color:
1) Pink: Normal perfusion. 2) Pale/White: Anemia or shock. 3) Cyanotic/Muddy: Severe hypoxemia or decompensatory shock.
1) Pink: Normal perfusion. 2) Pale/White: Anemia or shock. 3) Cyanotic/Muddy: Severe hypoxemia or decompensatory shock.
- Capillary Refill Time (CRT):
1) 1–2 seconds: Normal. 2) > 2 seconds: Poor perfusion or vasoconstriction. 3) < 1 second: Hyperdynamic states (fever, early shock).
1) 1–2 seconds: Normal. 2) > 2 seconds: Poor perfusion or vasoconstriction. 3) < 1 second: Hyperdynamic states (fever, early shock).
- Heart and Pulse:
1) Normal Rates: Dogs (60–120 bpm); Cats (120–200 bpm).
1) Normal Rates: Dogs (60–120 bpm); Cats (120–200 bpm).
2) Bradycardia: Decreased output; critical in cats (< 120 bpm) as it indicates shock.
2) Bradycardia: Decreased output; critical in cats (< 120 bpm) as it indicates shock.
3) Pulse Quality: Bounding (compensatory shock) vs. Weak/Absent (decreased output or arrest).
3) Pulse Quality: Bounding (compensatory shock) vs. Weak/Absent (decreased output or arrest).
- Level of Consciousness: Ranges from Alert to Obtunded (sleepy), Stupor (arousable only by pain), and Comatose (unarousable).
Airway Management
Airway Management
- Diagnosis: Complete obstruction (unconscious/apneic) vs. Partial obstruction (noisy breathing/stridor).
- Causes: Foreign bodies, edema, laryngeal paralysis, tracheal collapse, and brachycephalic syndrome.
- Intervention:
- Establishment: Immediate tracheal intubation; bypass with emergency tracheotomy if necessary.
- Confirmation: Palpation, bilateral auscultation, visualization of chest movement, or ETCO2 monitoring (Normal: 35–45 mmHg).
- Medications: Rapid sequence induction using etomidate, ketamine/benzodiazepines, propofol, or alfaxolone.
Breathing and Pulmonary Care
Breathing and Pulmonary Care
Respiratory Patterns:
Respiratory Patterns:
✔️Pleural Space Disease: Asynchronous breathing (chest expands while abdomen pulls in); muffled lung sounds.
✔️Pleural Space Disease: Asynchronous breathing (chest expands while abdomen pulls in); muffled lung sounds.
✔️Parenchymal Disease: Synchronous breathing (chest and abdomen move together); crackles or rales upon auscultation.
✔️Parenchymal Disease: Synchronous breathing (chest and abdomen move together); crackles or rales upon auscultation.
Imaging: TFAST (Thoracic Focused Assessment with Sonography) is used to identify pleural fluid or air without the stress of radiographs.
Imaging: TFAST (Thoracic Focused Assessment with Sonography) is used to identify pleural fluid or air without the stress of radiographs.
Treatment:
Treatment:
1) Oxygen: Provided via flow-by, mask, hood, or nasal cannula.
1) Oxygen: Provided via flow-by, mask, hood, or nasal cannula.
2) Sedation: Butorphanol with or without acepromazine to relieve anxiety and struggling.
2) Sedation: Butorphanol with or without acepromazine to relieve anxiety and struggling.
3) Thoracocentesis: Required for pleural air or fluid; tension pneumothorax requires an immediate intercostal incision or large-bore catheter.
3) Thoracocentesis: Required for pleural air or fluid; tension pneumothorax requires an immediate intercostal incision or large-bore catheter.
Circulatory Stabilization and Shock
Circulatory Stabilization and Shock
Stages of Shock:
Stages of Shock:
- Compensatory: Tachycardia, pink/red MM, rapid CRT, and bounding pulses.
- Decompensatory: Pale/gray MM, prolonged CRT, weak pulses, hypothermia, and decreased responsiveness.
Hemostasis: Controlled via direct pressure, compression bandages, or temporary tourniquets (limit to < 10 minutes).
Hemostasis: Controlled via direct pressure, compression bandages, or temporary tourniquets (limit to < 10 minutes).
Fluid Resuscitation:
Fluid Resuscitation:
- Small Volume: Low-normal endpoints (MAP 60–80 mmHg); used for head injuries, hemorrhage, and cats.
- Large Volume: High-normal endpoints (MAP 80–100 mmHg); used for sepsis or systemic vasodilation.
Advanced Techniques:
Advanced Techniques:
- Damage Control: Strategies to avoid the "lethal triad" of acidosis, hypothermia, and hypocoagulation.
- Counterpressure: Hindlimb and abdominal binding to redirect blood flow to core circulation and slow hemorrhage.
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