Triage

what is the goal of triage?

quickly recognize life-threatening conditions and institute life-saving therapies

What are the components of triage?

Brief hx

Consent and code status

Vital parameters

Focus PE/primary survey

Triage diagnostics

Stabilization

Finish PE/secondary survey

color based on history and initial assessment that indicates highest acuity at UF ECC

red

color based on history and initial assessment that indicates urgent to emergent status at UF ECC

yellow

color based on history and initial assessment that indicates an urgent case at UF ECC

green

color based on history and initial assessment that indicates a non-urgent case at UF ECC

blue

are open or closed ended questions recommended when getting a triage history?

closed

1 multiple choice option

What is evaluated during the primary survey?

respiratory, cardiovascular, and neurologic systems (e.g. ABC system)

short and shallow breaths/chest excursions indicate

pleural space or thoracic wall disease (e.g. pneumothorax, plrual effusion, thoracic wall trauma)

increased respiratory effort indicates

pulmonary parenchyma disease (e.g. pulmonary edema, pneumonia, contusions)

prolonged expiration and wheeze indicates

feline lower airway disease

stertor and stridor indicate

upper airway obstruction (e.g. BOAS, facial trauma, laryngeal paralysis, tracheal collapse)

sounds on thoracic auscultation that can indicate pneumonia or pulmonary edema?

soft crackles

sounds on thoracic auscultation that can indicate pulmonary fibrosis or pulmonary hypertension?

coarse harsh crackles

sounds on thoracic auscultation that can indicate pleural space disease?

absent or decreased breath sounds

does normal pulmonary auscultation rule out disease?

no

1 multiple choice option

a PaO2 of ? indicates hypoxemia

<80mmHg

a Hb saturation (pulse ox) of ? indicates hypoxemia

<95%

Three causes of hypoxemia?

Low FiO2

Hypoventilation

V/Q mismatch

do pink mucous membranes indicate a normal PaO2?

no

1 multiple choice option

cyanosis is a ? indicator of hypoxemia

late - appears at 80% SpO2

1 multiple choice option

an SpO2 greater than ?% at room air is considered normal

95%

decreased or ineffective chest excursions resulting in a PCO2 greater than 50mmHg

hypoventilation

how is circulation assessed?

MM color

CRT

Pulse quality and rate

Extremity temperature vs. core temperature

global tissue hypoperfusion with decreased O2 delivery

shock

What are the requirements for normal oxygen delivery (DO)?

Sufficient cardiac output

Functional Hb

Sufficient amounts of hemoglobin to deliver O2

What are the consequences of hypoperfusion?

Anaerobic metabolism -> more lactate -> metabolic acidosis -> reduced cell function

What are the six signs of poor tissue perfusion?

Pale mm

Prolonged CRT

Tachycardia (brady in cats)

Weak/thready pulse

Cool extremity temp compared to core

Poor mentation

shock caused by hemorrhage, GI losses, or 3rd space loss

hypovolemic

animals in hypovolemic shock tend to be in a ? state upon PE

vasoconstricted

shock caused by decreased forward flow from the heart or arrhythmias

cardiogenic shock

shock due to obstruction of blood flow and venous return (e.g. GDV, PTE, pericardial effusion, caval syndrome etc.)

obstructive shock

what type of shock is characterized by a vasodilatory state due to blood pooling in the periphery?

distributive shock

what can cause distributive shock?

sepsis

anaphylaxis

PE findings for distributive shock?

Hyperemic mm

Rapid CRT

Bounding pulses

Warm extremities

Treatment for vasoconstricted shock states such as hypovolemic or obstructive shock?

-Volume support

-Decompression in case of tamponade, pneumothorax, GDV etc.

Treatment for cardiogenic shock state?

Anti-arrhythmics

Diuretics

Beta-agonists

Treatment for vasodilatory shock state (distributive shock)?

Fluids

Vasopressors

How is tissue perfusion assessed?

BP

Lactate/lactate clearance

Base excess

Cardiac arrhythmias

a systolic BP of ? indicates hypotension

<90mmHg

doppler BP may be close to MAP in

cats and small dogs

substance produced by anaerobic metabolism that is useful as a prognostic and resuscitation parameter

lactate

lactate greater than ? is abnormal

2.5

How is the neurological system evaluated?

-Mentation eval

-Brainstem reflexes

-Signs of elevated intracranial pressure (e.g. cushing reflex)

what constitutes the secondary survey of triage?

Full physical examination once the patient has been stabilized and diagnostic testing

what animals should have a urogenital exam as part of their secondary survey?

-ALL male cats

-urethral obstructions

-dystocias

-azotemic/hyperkalemic pts