Triage Disease Flashcards

1
Q

What is triage?

A
  • Prioritisation of needs with cases coming in
  • Working out which of your patients is likely to decompensate/die first, and see those animals above others that arrive at the same time
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2
Q

What factors can be implemented in a practice to ensure success in the emergency patient?

A
  • Need dedicated area with equipment that may be required for these challenging patients
  • Appropriately trained staff and someone to take charge (you as the vet)
  • Appropriate equipment and pharmacological agents
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3
Q

What is the immediate treatment focus of all severely poly-traumatised or critically ill patients?

A
  • recognise and treat life-threatening problems
  • reduce global and local hypoxia and hypercarbia
  • only when the animal is stable do we need to do a head-toe examination
  • if things are deteriorating then fix these first
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4
Q

What secondary survey diagnostics might be used in emergency and critical patients?

A
  • Stabilise first
  • Ultrasound (major body systems assessment)
  • 2 view radiographic study of the entire body in animals with multiple injuries (only if animal is stable)
  • Baseline and serial blood samples
  • Clipping thoracic, flank and abdominal hair to detect bruises
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5
Q

What is the goal with secondary survey diagnostics in emergency and critical patients?

A

Detect all injuries that will lead to life-threatening consequences early enough to prevent serious complications and death

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6
Q

What signs should be evaluated to assess if a patient is in shock?

A
  1. Mentation
  2. Mucous membrane colour -
  3. Capillary refill time (CRT)
  4. Pulse evaluation
  5. Core-extremity temperature difference
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7
Q

Why can mentation be used to indicate levels of shock?

A

The brain is an obligate user of oxygen and glucose and has few energy stores. Inadequate delivery of oxygen and glucose to the brain results in loss of the normal mental state in seconds

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8
Q

What scale of mentation can be used to assess blood supply to the brain and shock?

A
  • alert and normally responsive
  • depressed or obtunded (inadequate blood supply)
  • stuporous or semicomatose (suggests functional brain disease)
  • comatose (suggests functional brain disease)
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9
Q

What causes pale to white mucous membrane?

A

A pale to white colour is caused by depletion of volume or of haemoglobin.

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10
Q

What causes red mucous membrane?

A

A red colour suggests poor perfusion and vasodilatation (blood trapped within the capillary beds) as in sepsis.

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11
Q

What causes blue-purple mucous membrane?

A

Cyanosis, which is represented by a blue-purple discolouration, is caused by the presence of >5g/dl deoxygenated haemoglobin. Severe hypoxaemia can occur without cyanosis

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12
Q

What causes muddy/brown mucous membranes?

A

Methaemoglobinaemia, associated with paracetamol toxicity in cats, can cause mucous membranes to be pale, cyanotic, and muddy or brown in colour.

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13
Q

What causes yellow mucous membranes?

A

Icterus is indicative of bilirubin, suggesting haemolysis, hepatocellular disease or extrahepatic/intrahepatic biliary tract disease

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14
Q

Which emergency patients are likely to be hypovolaemic and which are likely to be dehydrated?

A
  • Majority of our emergency and critically ill patients are HYPOVOLAEMIC
  • In longstanding disease animals may be both HYPOVOLAEMIC AND DEHYDRATED
  • Dogs left in hot cars and those animals’ with severe burns, DEHYDRATION is likely to be the primary fluid loss
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15
Q

Define dehydration.

A

Describe a loss of electrolytes and water from the interstitial and intracellular spaces

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16
Q

How to assess dehydration?

A
  • Gently lift the skin over the back just behind the scapula
  • Assess the moistness of the mucous membranes
  • Interpret changes in light of the effects of other conditions, e.g. azotaemia, which causes dry oral mucous membranes
  • Observe the cornea and conjunctivae for moistness suggesting adequate tear production
17
Q

Scale of dehydration from skin tent?

A
  • Normal <2 seconds
  • Mild – 2-3 seconds (5%)
  • Moderate – 3-5 seconds (7%)
  • Severe - >5 seconds (12%)
18
Q

Why do we care about the distinction between hypovolaemia/ hypovolaemic shock and dehydration?

A
  • Will influence order of likely differential diagnoses
  • May change fluid choices (certain fluids are contra-indicated in dehydration)
  • Will change required fluid resuscitation rates
  • Will change what treatments you will use
19
Q

Evidence of bleeding disorders (disease affecting primary or secondary haemostasis) include…?

A
  • Petechiation
  • Haematoma formation in non-traumatised areas
  • Re-bleeding or persistent bleeding from venepuncture sites
  • Can also commonly occur with sepsis and septic shock
  • Bleeding disorders much more common in small animals rather than large
20
Q

What factors should be evaluated in the initial neurologic assessment?

A
  • consciousness
  • breathing pattern
  • pupil size and responsiveness
  • ocular position and movements
  • skeletal motor responses
21
Q

What term has Systemic Inflammatory Response Syndrome (SIRS) replaced?

A

Endotoxaemia

22
Q

Definition of shock?

A
  • Inadequate cellular energy production
  • Most commonly secondary to poor tissue perfusion
23
Q

Types of shock?

A
  • Hypovolaemic (decreased circulating blood volume)
  • Cardiogenic (decreased forward flow from the heart)
  • Distributive (loss of systemic vascular resistance)
  • Metabolic (deranged cellular metabolic machinery) (either rare, or we are poor at identifying it)
  • Hypoxaemic (decreased oxygen content in arterial blood)
  • Cryptic (normal global circulation but poor microcirculation as the capillary beds are shut down)
  • Combined
24
Q

Causes of Hypovolaemic shock?

A
  • Fluid loss from intravascular space
  • Trauma
  • Haemorrhage
25
Q

Causes of cardiogenic shock?

A
  • Congestive heart failure
  • Cardiac dysrhythmias
  • Cardiac tamponade
  • Drug overdose (anaesthetic agents, beta-blockers, calcium channel blockers)
26
Q

Causes of distributive shock?

A
  • Sepsis
  • Obstruction (saddle thrombosis, heartworm)
  • Anaphylaxis
27
Q

Causes of metabolic shock?

A
  • Hypoglycaemia
  • Cyanide toxicity
  • Mitochondrial dysfunction
  • Cytopathic hypoxia of sepsis
28
Q

Causes of hypoxaemic shock?

A
  • Anaemia
  • Severe pulmonary disease
  • Carbon monoxide toxicity
  • Methaemoglobinaemia
29
Q

Causes of cryptic shock?

A
  • SIRS
  • Sepsis
30
Q

Initial clinical signs of hypovolaemic shock?

A
  • Mild to moderate depression
  • Tachycardia with normal to prolonged CRT
  • Cool extremities
  • Tachypnoea
  • Normal blood pressure
  • Pulse quality normal
  • COMPENSATED SHOCK
31
Q

Clinical signs of ongoing compromise in hypovolaemic shock?

A
  • Compensatory mechanisms inadequate and fail
  • Pale mucous membranes
  • Poor peripheral pulse quality
  • Depressed mentation
  • Fall in blood pressure
  • DECOMPENSATED SHOCK
32
Q

What is the shock organ in the dog?

A
  • Dog – GI tract – shock organ
    • Ileus, diarrhoea and melaena
    • Also in the cow GI tract is shock organ
33
Q

Signs of hyperdynamic phase of shock?

A
  • Tachycardia
  • Fever
  • Bounding peripheral pulses
  • Hyperaemic mucous membranes secondary to cytokine (NO) mediated peripheral vasodilatation
  • Also referred to as vasodilatory shock
34
Q

Shock organ in a cat?

A
  • Lung – shock organ
    • Cats in various forms of shock present with some type of respiratory dysfunction
35
Q

How are cats in shock different from other species?

A
  • Rarely see hyperdynamic phase
  • Changes in heart rate unpredictable cf dogs/horses- tachy or bradycardia!!
36
Q

Clinical signs of shock in the cat?

A
  • tachy or bradycardia!!
  • Pale/icteric MM, weak pulses, cold extremities, hypothermia and generalised weakness/ collapse
  • Resp dysfunction
37
Q

What type of shock do you tend to get with GDV?

A
  • Compression of major vessels (due to distended stomach)
    • Decreased venous return
    • Reduced CO
    • Relative hypovolaemia
  • Complex mix of types of shock
  • Cryptic
  • Hypovolaemic/haemorrhagic shock in some cases
38
Q

What types of shock do you get with septic peritonitis?

A
  • Distributive – tissue hypoxia secondary to systemic vascular resistance
  • Hypovolaemic – especially if has severe cavitatory effusions or severe/ prolonged vomiting
39
Q

Diagnosis and monitoring of shock?

A
  • Extent of organ injury
  • Aetiology of shock state (mentation etc.)
  • Lactate
  • Haematology
  • Biochemistry
  • UA