Chapter 1- Evaluation and Triage of the Critically Ill Patient

Question 1

Triage, Triage Systems

Answer 1

• derived from French workd -trier- refers to the sortin gof patietns for treatment priority when resources are insufficient for all to be treated immediately in an ER setting.
• Miltary triage demostrated taht early triage assessment and prompt resuscitation significantly reduced mortality rates.
• ATT or Animal Trauma Triage = a score 0-3 with higher scores being prioritized after evaluation of 6 categories
• VTL or Veterinary Traige List = based on human color codes (red >orange>yellow> blue >greed)

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Question 2

Primary Survey

Answer 2

1) Respiratory System - for evalution of hypoxemia or hypoventilation. Airway patency, respiration rate/effort, MM color. +/- pulse ox or blood gas
2) Cardiovascular System - for evaluation of poor tissue perfusion (which would result in decreased oxygen delivery- may trigger cascade of events that could result in MODS). MM color, CRT, HR, pulse quality and auscultation of heart, BP +/- EKG (for arrythmia) +/- lactate
3) Neurologic System- for brain or spinal cord injury. Seizures, change in mentation, acute paresis or parlysis or increase in ICP.
4) Urinary System- for AKI or UO, which could lead to metabolic acidosis, high K, arrythmias and death. Male cats.
5) Other considerations - toxin ingestion, reproductive, hemorrhage or open wounds or significant pain (neuro exam before pain medication).

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Question 3

Triage Diagnostics

Answer 3

• Vascular access
• Minimum Datebase (our ER STAT panel)
• AFAST/TFAST scan +/- cardiac evaluation for contractility and LA size

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Question 4

Secondary Survey

Answer 4

• Occurs after primary survey and stabalization treatments
• A full and complete physical (+/- neuro/ortho) examination
• Includes re-evaluation of all of the points of a primary survey

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