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Small Animal Medicine II > Triage and Trauma > Flashcards

Triage and Trauma Flashcards

1
Q

What does Triage encompass?

A

Assessment of patient (systemically)

Injuries interfering with vital functions receive the highest priority

After initial treatment repeat evaluation (adjustments as you go)

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2
Q

What causes decreased lung sounds dorsally?

A

Pneumothorax

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3
Q

What does paradoxical thoracic wall motion indicate?

A

Rib fractures

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4
Q

What is a normal lactate value?

A

< 2

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5
Q

List the systemic assessment priorities

A

Respiratory (airway, breathing)
Cardiovascular system
Neurological system (head, spinal cord, peripheral nerves)
Abdominal organs
Musculoskeletal system (stabilize fractures)
Integumentary system

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6
Q 
Respiratory System (airway)
Triage
A

Highest priority in trauma

Assess airway
Place ET tube if patient is struggling to breathe
Emergency tracheostomy if airway is obstructed

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7
Q 
Respiratory System (breathing)
Triage
A

Even in hind end injuries there can be thoracic trauma

Administer supplemental oxygen if dyspneic

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8
Q

Three most common respiratory injuries

A

Pulmonary contusions
Pneumothorax
Rib fractures

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9
Q

Pulmonary Contusions

A

Alveoli filled with blood and edema fluid

Results in atelectasis and hypoxemia

Radiographically appears ans infiltrate (may take 12-24 hours to appear); does NOT follow a specific pattern occurs where trauma occurred

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10
Q

Pneumothorax; what can it cause?

A

Results in atelectasis, hypoxemia, and interferes with venous return (lungs cannot expand to full capacity)

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11
Q

Pneumothorax; treatment

A

Thoracocentesis for initial therapy; aspirate BOTH sides

Placement of thoracostomy tube:
Done if thoracocentesis has been done multiple times with no resolution of dyspnea
Can connect to a continuous suction device

Can heal without surgery in most cases (will take several days)

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12
Q

Rib Fractures

A

Painful!
Give 1/4 shock bolus of fluids and then administer analgesia (ex. Fentanyl CRI)

Monitor BP

Most rib fractures do not require surgery

Causes atelectasis and hypoxemia

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13
Q

Cardiovascular system

Triage

A

Shock (hypovolemic) can occur due to hemorrhage

Need to determine: external, internal, or both

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14
Q

Pulmonary Contusions
Treatment
Isotonic crystalloids?

A

Do NOT give large volumes of isotonic crystalloids

75% of fluid will redistribute to the interstitial space; includes interstitium of lungs

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15
Q

Pulmonary Contusions
Treatment
Combination options?

A

Isotonic crystalloids and colloids
Isotonic crystalloids: do NOT exceed 45 mL/kg/hr (dogs) or 22.5 mL/kg/hr (cats)
Do either half shock or quarter shock bolus

Hypertonic saline +/- colloids

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16
Q

What should you avoid doing when administering IV fluids? (hint: monitoring)

A

Blood pressure should not increase too much (maintain systolic around 90-100 mmHg)
Could dislodge blood clot formation -provides hemostasis at hemorrhage site-

Rapid administration of IV fluids can cause significant increase in BP

17
Q

Intracranial injuries

A

Level of consciousness: alert, responsive/unresponsive to stimuli

Pupillary size & reactivity

Abnormal postures (decerebrate, decerebellate, schiff-sherrington syndrome)

18
Q

Spinal cord injuries

A

Immobilize as soon as possible

Will require analgesia and sedation

19
Q

Abdominal Injuries

A 
Perform ultrasound
Ruptures?
Free fluid?
Air? 
Organ evisceration?

Radiographs can help as well

Hemoabdomen; if good clotting times should be able to stop hemorrhaging

Ruptured bladder; will require surgery once stable

20
Q

Blunt Abdominal Trauma

Diagnostic test

A

Abdominocentesis

Ultrasound guided or blind via 4 quadrant sampling

21
Q

Abdominocentesis

What can you measure?

A 
PCV/TS
BUN or Creatinine
Total bilirubin
Fluid analysis
Cytology
Culture/Susceptibility
22
Q

Abdominocentesis

PCV interpretation

A

If PCV of abdominal fluid is greater than the peripheral PCV:
Splenic, hepatic, or renal parenchymal laceration is present

23
Q

Best approach for hemoabdomen?

A

Medical!

Morbidity and mortality are lower if you treat the case medically

24
Q

How to assess urological injury (diagnostics)

A

PCV of abdominal fluid is less than peripheral PCV (dilution of urine does this)

BUN/Creatinine of abdominal fluid >2x than peripheral BUN/Creatinine

BUN measured during ACUTE trauma

Creatinine measured for chronic issue

25
Q

Urological injury management

A

Drainage of urine via indwelling urinary catheter or abdominal drain

Monitor electrolytes specifically potassium (worry about cardiac effects)

Can surgically repair once stable

26
Q

Musculoskeletal Injuries Assessment

A

Usually not life-threatening

Pay attention to nerves, blood vessels, and soft tissue damage

Blood loss from femur and pelvic fractures can be severe in large breed dogs (blood loss can exceed 25% of total blood volume):
see continuous drop in PCV, will have to fix fracture to stop bleeding

27
Q

Closed Fracture Assessment

A

Stabilize fracture by applying splint (relieve pain, lessen swelling) ONLY if you can immobilize joint above AND below fracture

Monitor splint/cast by looking at toes (color, swelling, discharge, odor)

28
Q

Fractures - Repair time

A

Repair can be delayed until patient is stable (want to decrease anesthetic risk)

Usually 1-5 days post fracture incident

29
Q

Integumentary Injuries

Assessment

A

Not life-threatening; treat after other systems have been addressed

Follow surgical principles of wound closure
Most are contaminated: clip, clean, bandage and do not suture closed
Wait for granulation tissue to form and keep clean and moist

May place on antibiotics depending on how bad the wound is

30
Q

Trauma & Triage

Two Important Considerations

A
  1. Over treatment can be just as hazardous as under treatment
  2. Constant monitoring and reassessment of the patient are mandatory

Small Animal Medicine II (17 decks)

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