Summary Unit 6 - Triage

Emergency Preparedness

  • Triage: Prioritizes treatment based on severity, not arrival order.
  • Crash Cart: Contains essential emergency supplies and medications.
    • Must be organized, labeled, inventoried monthly, and after each use.
  • Oxygen Supplementation: Provides extra oxygen for life-threatening emergencies.

Commonly Used Emergency Drugs

  • Administration Routes: Tablets, injectable, and inhaled agents.
    • Inhaled drugs act quickly; injectable drugs are faster than tablets.
  • Allergic Reactions
    • Antihistamines: Diphenhydramine and hydroxyzine.
  • Anticholinergics
    • Atropine: Increases heart rate, counteracts organophosphate overdose effects.
    • Side effects: Dry mouth, constipation.
  • Cardiac Resuscitation
    • Epinephrine: Stimulates heart rate, increases blood pressure.
  • Opening Airways
    • Albuterol: Beta-2-adrenergic agonist; available in multiple forms.
    • Side effects: Rapid heart rate, high blood pressure.
  • Methylxanthines
    • Aminophylline and Theophylline: Dilate airways, mildly stimulate the heart.
    • Treat asthma, bronchitis, collapsing trachea.
    • Side effects: Hyperexcitability, muscle tremors.
  • Corticosteroids
    • Prednisolone and Dexamethasone: Treat shock, reduce inflammation (low dose), suppress the immune system (high dose).
    • Side effects: Increased appetite and water consumption.
    • Caution: Do not combine with NSAIDs due to increased risk of gastrointestinal ulcers.
  • Doxapram
    • Respiratory stimulant for neonates.

Cardiovascular System Drugs

  • Inotropes: Increase heart contraction strength.
    • Epinephrine: Immediate effect in resuscitation.
    • Dopamine and Dobutamine: improve perfusion to vital organs.
    • Digoxin: slows heart rate, improves filling time.
      • Narrow safety range: high levels cause appetite loss, vomiting, diarrhea.
  • Vasodilators: Dilate blood vessels, reduce heart workload.
    • Examples: Hydralazine, nitroglycerin, nitroprusside.
    • Side effects: Low blood pressure, rapid heart rate, lethargy, vomiting, diarrhea.
  • Antiarrhythmics
    • Procainamide and Lidocaine: Slow tachycardic hearts.
    • Beta-blockers (Atenolol and Propranolol): Reduce blood pressure and heart rate.
  • Diuretics: Promote fluid loss.
    • Furosemide: Treats heart disease.
    • Mannitol: Treats cerebral edema.
    • Side effects: Dehydration, electrolyte abnormalities.

Anticonvulsants

  • Diazepam: Injectable; rapid seizure control.
  • Phenobarbital: Injectable and tablet; long-term seizure control.
  • Both agents have sedative properties.

Antiemetics

  • Maropitant (Cerenia): Treats vomiting and motion sickness.
  • Chlorpromazine: Controls vomiting from GI inflammation and chemotherapy.
  • Metoclopramide: Normalizes stomach and GI contractions.

Emetics

  • Apomorphine: Used in dogs.
  • Xylazine: Used in cats.
  • Both agents can cause sedation.
  • Note: Induce vomitting rapidly after toxin ingestion; follow with activated charcoal.

Miscellaneous Antidotes

  • Activated Charcoal: Absorbs toxins in the GI tract.
    • Do not give with oral medications (within 3 hours), mineral oil, or dairy products.
  • Calcium EDTA: Chelates heavy metals.
  • Methylene Blue: Treats methemoglobinemia, acetaminophen toxicity (ruminants/dogs).
    • Adverse effects: Heinz body anemia; do not give to cats.
  • Acetylcysteine: Treats acetaminophen poisoning (dogs/cats), breaks up mucus.
    • Can cause bronchospasms during nebulization.
  • Dimercaprol: Treats arsenic, lead, mercury, copper, zinc, or gold toxicity.
  • Pralidoxime Chloride (2-PAM): Reverses organophosphate effects.
    • Must be given promptly; may worsen carbamate/pyrethrin reactions.
  • Penicillamine: Chelates copper, lead, iron, and mercury.
  • Sodium Thiosulfate: Treats cyanide toxicity in horses and ruminants.
  • Ethanol: Competitively inhibits harmful crystal formation after ethylene glycol toxicity.
  • Fomepizole: Direct antidote to ethylene glycol toxicity; administer within 8 hours.
  • Antivenin: Neutralizes snake venom; does not reverse existing tissue damage.
  • Vitamin K1: Treats rodenticide poisoning causing bleeding.
  • Thiamine HCL: Treats thiamine deficiency.

Reversal Agents

  • Atipamezole HCl: Reverses medetomidine (Domitor).
  • Flumazenil: Reverses benzodiazepines.
  • Naloxone HCl: Reverses narcotic overdoses.
  • Tolazoline: Reverses alpha-2 agonists (e.g., xylazine) in horses.
  • Monitor for tachycardia, muscle twitching.
  • Neostigmine: Treats ivermectin overdoses in cats.
  • Yohimbine HCl: Reverses xylazine (Rompun).