Emergency Medicine

Question 1

What is a triage?

Answer 1

Refers to the sorting of ill animals for treatment based on priority when resources are insufficient for all to be treated immediately.

In other words, it’s having animals with multiple injuries at once, and you need to choose which one to see first (sickest are first).

Question 2

How long ago to triage systems date back to?

Answer 2

Triage systems date back to the mid-1800’s on the battlefield

Question 3

What part of hospitals developed their own triage systems?

Answer 3

Late 1970s emergency departments in hospitals developed their own triage systems

Question 4

What makes a veterinary triage successful?

Answer 4

Rapid and accurate triage of the animal is essential!

Question 5

How do trained veterinary technicians perform a triage?

Answer 5

They usually perform the initial brief exam and ID’s animals that need immediate attention or life-saving interventions.

Question 6

What do you do if there are multiple urgent patients?

Answer 6

You must decide how long patients can safely wait.

Question 7

What’s the order of patients for a triage?

Answer 7

Sick animals are treated first, and less urgent cases are typically seen on a first-come, first-served basis.

Question 8

Are there a few or several human triage scoring systems? What’s the scoring like?

Answer 8

There are several, and they are scored in 5 levels, where level 1 patients must be seen immediately.

Question 9

Where was the first veterinarian triage scoring system developed?

Answer 9

Developed at the University of Pennsylvania for animals presented for treatment after acute trauma.

Question 10

What is the Animal Trauma Triage Score?

Answer 10

Scored from 0-3.
0 = slight or no injury
3 = severe injury

Question 11

Tell me about the veterinary triage list (VTL).

Answer 11

There is a five-point color-coded scoring system similar to human triage scales.
- Red = immediate
- Orange = 15 min
- Yellow = 30 min
- Green = 120 min

Question 12

When a patient is assigned a red color, what does that tell you about their airway? What about orange?

Answer 12

Red = obstructed airway
Orange = threatened airway

Question 13

What are the steps of an initial exam?

Answer 13

1) Brief medical history from the owner (reason for seeking emergency care, concurrent medical conditions, etc)
2) Brief visual inspection of the animal and focused physical exam (Respiratory, Cardiovascular, Neurologic, and Urinary Systems)
3) If found to have any abnormalities in any areas, they are taken to the treatment area immediately.
4) Verbal or signed permission from the owner agreeing to the initial estimate of medical care and treatment should be obtained.
- This allows for stabilization without the veterinarian being removed from the treatment area

Question 14

What are some conditions that warrant immediate evaluation/treatment?

Answer 14

• Severe pain
• Recent snake bites
• Active bleeding
• Recent ingestion of a toxin
• Seizures
• Hyperthermia and hypothermia
• Fractures
• Dystocia (difficulty of giving birth)
• Death

Question 15

For felines, what’s something you should ALWAYS ask about?

Answer 15

Always ask about the urine system!! “Did your cat urinate today?”

Question 16

How long should a primary survey take?

Answer 16

Should take less than 2 minutes (very quick)

Question 17

What are you checking in the respiratory system in your primary survey?

Answer 17

breathing —> rapid?

Question 18

What are you checking in the cardiovascular system in your primary survey?

Answer 18

heat beat —> rapid?

Question 19

What are you checking in the nervous system in your primary survey?

Answer 19

Do they look dull? Are they responsive? Are they alert?

Question 20

What are you checking in the urogenital system in your primary survey?

Answer 20

Palpate the bladder —> is it small? large? hard?

Question 21

What are some things you look for in the respiratory system?

Answer 21

1) Try and determine the presence or absense of hypoxemia or hypoventilation
2) Is the airway patent/clear?
3) Lung sounds (dull, crackles, wheezes)
4) Tachypnea (RR>40)
5) Any signs of stridor or stertor (snoring sounds - tumors, polyp, foreign body in nose)
6) Should you consider supplemental oxygen?
7) If airway is compromised or you diagnose an airway obstruction (intubate immediately)

Question 22

What are some feline upper respiratory infections?

Answer 22

1) Feline Herpes Virus
2) Feline Calicivirus

Question 23

What are the symptoms of feline calicivirus?

Answer 23

• Ocular discharge
• Nasal discharge
• Conjunctivitis
• Decreased appetite (because they cannot smell food)

Question 24

What is feline asthma? What are the signs? How do you treat it?

Answer 24

• Feline asthma = allergic reaction to inhaled allergens. This can be severe and life threatening
• Will see signs of difficulting breathing, wheezing, open mouth breathing, or coughing.
• Treated with steroids and bronchodilators

Question 25

What are some things you look for in the cardiovascular system?

Answer 25

1) Identify poor tissue perfusion resulting in decreased tissue oxygen delivery. 2) Mucus membrane color (gum color) 3) Capillary Refill Time 4) Heart Rate 5) Pulse Quality 6) Auscultation of the heart (murmur/arrhythmia)

Question 26

What's the heart rate that indicates a red flag?

Answer 26

They tend to have a higher heart rate, but if it's over 180, 200, or 220, that's a red flag!

Question 27

What is capillary refill time?

Answer 27

Pressing the gums and seeing how long it takes to get back to normal. It should take less than 2 seconds to get back to normal. If it takes 3 or 4 seconds, that's a red flag!

Question 28

What are some things you look for in the neurological system?

Answer 28

1) Evaluate for brain or spinal cord injury 2) Seizures 3) Mentally Inappropriate (stupor, coma) 4) Acute paralysis 5) TBI

Question 29

What are some things you look for in the urinary system?

Answer 29

1) IS IT A MALE CAT?? (male castrated cats are overrepresented in this area). 2) Large, firm urinary bladder (is it easy to express? is it painful to the touch? has there been little to no urine production in the past 12-24 hours?) 3) Need to consider a urinary obstruction - very common in male castrated cats

Question 30

What is some general knowledge regarding urinary catheterization?

Answer 30

1) Sedation or General Anasthesia is required 2) Use aseptic technique and remain sterile 3) Place an indwelling urinary catheter (usually in place for 24-48hrs +/-)

Question 31

What's the difference between males and females regarding their opening between the anus and the bladder?

Answer 31

Male = arched way Female = straight way

Question 32

What are some ER diagnostics?

Answer 32

1) IV access and collect blood ( peripheral catheter - cephalic or saphenous) 2) Minimum database (PCV/TS, glucose, blood smear, venous blood gas, electrolytes, blood pressure, lactate) - these are quick diagnostics 3) aFAST/tFAST

Question 33

What is a point of care ultrasound?

Answer 33

- Also known as "pocus," "aFAST," or "tFAST." - Checks to see if there are any fluids in specific areas. - There are four quadrants where ultrasounds are taken: 1st quadrant = DH (diaphragmaticohepatic), 2nd quadrant = SR (spleno-renal), 3 quadrant = CC (cysto-colic), and 4th quadrant = HRU (hepato-renal) - Scored out of 4: 0/4 = no free fluid, 4/4 = free fluid in all 4 quadrants

Question 34

What does a-FAST and t-FAST mean in a pocus ultrasound?

Answer 34

a-FAST = abdominal. abdominal effusion t-FAST = thoracic. pericardial effusion, pleural effusion, and La/Ao Ratio (heart failure)

Question 35

What's the point of a secondary survey?

Answer 35

After completing the primary survey and treating the patient properly till stable, go back and do another complete physical exam and find all the little things you missed (things that are not considered emergencies).