Emergency Patient Examination (ASAN001/3) Flashcards

1
Q

Emergency Patient Examination
(5)

A

A – Airway
B – Breathing
C – Circulation
D – Dysfunction / Disability
E – Evaluation / Examination

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2
Q

AIRWAY – Assess Ventilation
What do I need to check to assess if it is adequate? (7)

A
  • Is the airway patent?
  • Is dyspnoea present?
  • Colour of MM’s – cyanosis?
  • Facial injury affecting breathing?
  • Injury to airway?
  • Chest wall movement?
  • Injury to chest wall?
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3
Q

BREATHING – Respiratory Rate & Effort
What are examples of abnormal RR & Efforts? (8)

A
  • Panting
  • Tachypnoea
  • Bradypnoea
  • Abdominal breathing
  • Paradoxical respiration
  • Cheyne–Stokes
  • Hyperpnoea
  • Dyspnoea
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4
Q

B – RR & Effort – Panting

A

Rapid, shallow breathing with mouth open.
Usually tounge protruding.

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5
Q

B – RR & Effort – Tachypnoea

A

Rapid, shallow breathing.

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6
Q

B – RR & Effort – Bradypnoea

A

Slow breathing.

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7
Q

B – RR & Effort – Laboured

A

Deep abdominal breathing.

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8
Q

B – RR & Effort – Abdominal Breathing (2)

A

Animal uses it’s abdo muscles to breathe.
Sign of respiratory distress.

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9
Q

B – RR & Effort – Cheyne–Stokes

A

Progressively deeper & sometimes faster breathing, followed by gradual decrease resulting in apnoea.

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10
Q

B – RR & Effort – Paradoxical Respiration

A

Instead of chest expanding during inspiration, an area of chest moves inwards

(ie. flail chest)

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11
Q

B – RR & Effort – Hyperpnoea

A

Rapid, deep breaths

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12
Q

B – RR & Effort – Dyspnoea

A

Difficulty breathing.

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13
Q

B – What is the normal range for RR of a Dog?

A

12 - 25 breaths p/min

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14
Q

B – What is the normal range for RR of a Cat?

A

20 – 30 breaths p/min

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15
Q

B – What is the normal range for RR of a Horse?

A

9 – 16 breaths p/min

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16
Q

B – What are the 5 main types of Respiratory Sounds?

A

Stridor
Stertor
Wheezing
Crackles
Dull

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17
Q

B – Respiratory Sounds – Stridor

A

High pitched inspiratory sounds generated from turbulent air flow in pharynx & trachea.

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18
Q

B – Respiratory Sounds – Stertor

A

Noise from nasal passages

eg. snoring / snuffling noises.

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19
Q

B – Respiratory Sounds – Wheezing

A

High pitched inspiratory or expiratory noise caused by narrowed airways.

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20
Q

B – Respiratory Sounds – Crackles (2)

A

High pitched inspiratory noise.
Sound is made by increased secretion in small airways.

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21
Q

B – Respiratory Sounds – Dull (2)

A

Muted or no sound.
Due to pneumothorax, diaphragmatic hernia.

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22
Q

CIRCULATION – What are the 6 Perfusion Parameters?

A
  • Mucous Membranes (MM’s)
  • Capillary Refill Time (CRT)
  • Heart Rate (HR)
  • Pulse
  • Temperature
  • Haemorrhage
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23
Q

C – Mucous Membranes (MM’s)
What are the main descriptions of MM’s? (9)

A

Pink
Red
Pale
White / Grey
Yellow
Cyanotic
Petechiae
Ecchymosis
Feel

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24
Q

C – What do Pink MM’s indicate & how to describe the colour? (2)

A

Normal, adequate perfusion
Salmon pink in colour.

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25
Q

C – How to describe Red MM’s & what do they indicate? (6)

A

Injected.
Vasodilation.
Pyrexia.
Sepsis.
Toad toxicity.
Brick red.

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26
Q

C – What do Pale MM’s indicate? (3)

A

Anaemia.
Lack of circulating RBC’s.
Reduced perfusion.

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27
Q

C – What do White / Grey MM’s indicate? (2)

A

Severe anaemia.
Hypoxia.

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28
Q

C – How to describe Yellow MM’s & what might they indicate? (4)

A

Icteric
Jaundice
Liver disease
Severe haemolysis (distruction of RBC’s).

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29
Q

C – How to describe Cyanotic MM’s & what do they indicate? (2)

A

Blue or greyish blue
Severe hypoxia → 02 immediately!

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30
Q

C – How to describe Petechiae on MM’s & what does it indicate? (2)

A

Reddish–purple dots
Indicates clotting disorder → immediate action!

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31
Q

C – How to describe Ecchymosis on MM’s & what might it indicate? (3)

A

Bruising
Bleeding underneath
Paintbrush appearance.

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32
Q

C – How should MM’s Feel & what do they indicate if abnormal? (3)

A

MM’s should feel moist
May be dry or tacky if dehydrated.
Slimy texture or increased salivation may indicate nausea or toxicity.

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33
Q

C – What are the Capillary Refill Time (CRT) ranges?

A

1 – 2 seconds: Normal, adequate peripheral perfusion.
> 2 seconds: Decreased peripheral perfusion eg. shock, heart failure.
< 1 second: Hyperdynamic – vasodilation eg. high blood pressure, pyrexia, local irritation.

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34
Q

What does a CRT of 1 - 2 seconds indicate?

A

Normal, adequate peripheral perfusion.

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35
Q

What does a CRT of 2 seconds indicate? (3)

A

Decreased peripheral prefusion.
Eg. Shock, heart failure.

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36
Q

What does a CRT of <1 second indicate? (5)

A

Hyperdynamic – vasodilation
eg. high blood pressure, pyrexia, local irritation.

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37
Q

C – What are the 3 main abnormalities with Heart Rate (HR)?

A

Tachycardia: Fast heart rate.
Bradycardia: Slow heart rate.
Arrhythmia: An irregular or abnormal beat of the heart.

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38
Q

C - Tachycardia

A

Fast Heart Rate

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39
Q

C - Bradycardia

A

Slow Heart Rate

40
Q

C - Arrhythmia

A

An irregular or abnormal beat of the heart.

41
Q

C – What is the normal values for Heart Rate (HR) for a dog <25kg?

A

65 – 120 bpm

42
Q

C - What is the normal values for Heart Rate (HR) for a dog >25kg?

A

65 – 80 bpm

43
Q

C - What is the normal values for Heart Rate (HR) for a cat?

A

110 – 180 bpm

44
Q

C - What are the normal values for Heart Rate (HR) for a horse?

A

28 – 44 bpm

45
Q

C – What is the Pulse an indication of? (2)

A

An indication of cardiac output & blood pressure.

46
Q

C - What should the Pulse rate be in a normal patient? (1)

A

Pulse rate should = HR

47
Q

C - What is an abnormal Pulse rate & what does it indicate? (1)

A

If pulse rate is lower than HR there is an arrhythmia present.

48
Q

C – What are the 3 main Pulse sites?

A

Femoral artery
Digital artery
Coccygeal (tail) artery

49
Q

C - Where do you assess the Femoral pulse on a patient?

A

Femoral Artery: Medial (inner) side of femur (thigh).

50
Q

C - Where do you assess the Digital pulse on a patient?

A

Digital artery: Palmer (underside) aspect of the carpus (front leg)

51
Q

C - Where do you assess the Coccygeal pulse on a patient?

A

Coccygeal (tail) artery: Ventral (under) side of the tail.

52
Q

C – What are the 4 main descriptions of Pulse Quality?

A

Normal
Pulse Deficit
Weak pulse
Bounding pulse

53
Q

C – Pulse Quality – Normal
How to describe & what does it indicate? (2)

A

Rate & ‘feel’ is even
Matches HR.

54
Q

C – Pulse Quality – Pulse Deficit
How to describe & what does it indicate? (2)

A

Pulse rate < HR
Ineffectual heart beats (dysrhythmia).

55
Q

C – Pulse Quality – Weak Pulse
How to describe & what does it indicate? (4)

A

Softer pulse
Not forceful under fingers
Diminished cardiac output
Shock.

56
Q

C – Pulse Quality – Bounding Pulse
How to describe & what does it indicate? (4)

A

Pulse is strong, forceful & sometimes jerky.
Increased cardiac output.
Occurs normally with heavy exercise.
Associated with high BP, certain valvular problems & early heart failure.

57
Q

C – How should you assess a patient’s Temperature? (3)

A
  • Assess core temperature with a rectal (or esophageal) thermometer.
  • Assess peripheral temperature by feeling temp of paws with hands (esp. hind limbs)
  • Both core & peripheral temp should be assessed during examination.
58
Q

C - Hypothermia (2)

A

Lower than normal body temperature
< 37.5 °C

59
Q

C - Hyperthermia (2)

A

Higher than normal body temperature
>39.5 °C

60
Q

C - Pyrexia (2)

A

Raised temps caused by internal process (eg. infection).
>39.5 °C

61
Q

C – What are the normal values for Temperature in a dog?

A

38.0 – 39.0 °C

62
Q

C - What are the normal ranges for Temperature in a cat?

A

38.0 – 39.2 °C

63
Q

C - What are the normal ranges for Temperature in a horse?

A

37.2 – 38.5 °C

64
Q

C – What are the 4 types of Haemorrhage?

A

Arterial
Venous
Capillary
Mixed

65
Q

C – Arterial Haemorrhage (4)

A
  • Most serious type.
  • Bright red & spurts from wound.
  • Blood spurts synchronised with heart beat.
  • Definite bleeding point can be detected
66
Q

C – Venous Haemorrhage (5)

A
  • Slightly less serious than arterial.
  • Rapid blood loss if large vein is damaged.
  • Force of blood is less & easier to control than arterial.
  • Blood is darker & flows as a steady stream.
  • In large wound, definite bleeding point is visible.
67
Q

C – Capillary Heamorrhage (4)

A
  • Occurs in all wounds – capillary wall easily damaged.
  • Blood oozes from pin–point sources with no force.
  • No serious blood loss will occur.
  • No visible bleeding point.
68
Q

C – Mixed Heamorrhage (3)

A
  • The arteries & veins usually lie close together.
  • When both severed at same time, heamorrhage may be so great that arterial damage may not be detectable.
69
Q

DYSFUNCTION / DISABILITY
– How to do a Quick Neurological Assessment or LOC (4)

A

Quick assessment of Level of Consciousness:
* A – Alert
* V – Responsive to Voice
* P – Only Responsive to Pain
* U – Unresponsive

⁎Must be performed quickly!

70
Q

D – Neuro assessment - After AVPU, what further sub-divisions & observations can be made? (6)

A
  • Alert & Responsive
  • Depressed / Dull
  • Hyperexcitability (uncontrollable)
  • Obtunded (mentally dulled)
  • Stupor (depressed consciousness)
  • Coma (unconscious)
71
Q

D – An Alert & Responsive animal is: (2)

A
  • observing it’s surroundings
  • responding to stimuli incl. name calling, petting & movements.
72
Q

D – A Depressed / Dull animal is: (3)

A
  • aware of surroundings
  • responding to stimuli
  • unwilling to interact, move etc.
73
Q

D – A Hyperexcitablity (uncontrollable) animal has: (2)

A
  • uncontrolled excitement
  • over reaction to stimuli
74
Q

D – An Obtunded (mentally dulled) animal is/has: (3)

A
  • not quite yet unconscious
  • mild to moderate reduction in alertness
  • diminished sensation to pain
75
Q

D – A Stupor (depressed consciousness) animal is: (3)

A
  • in a state of impaired consciousness
  • has reduced ability to react to environmental stimuli
  • will respond to noxious stimuli (pain)
76
Q

D – An animal in a Coma (unconsciousness) is: (3)

A
  • is in a state of extreme unresponsiveness
  • exhibits no voluntary movement or behaviour
  • does not respond to noxious stimuli (pain)
77
Q

D – What needs to be noted about patient Posture? (2)

A

Any abnormal posture should be noted.

eg. Schiff–Sherrington.

78
Q

D – What does Schiff–Sherrington (Posture) look like in a patient? (3)

A
  • Front limbs extended & extremely tense.
  • Head often arched backwards.
  • Hind limbs are non–responsive.
79
Q

D - What causes Schiff-Sherrington posture? (2)

A
  • Caused by compression lesion of thoracolumbar spinal cord.
  • Often result of trauma (HBC).
80
Q

D - What is important to note about examining or transporting a patient displaying Schiff-Sherrington posture? (2)

A
  • Minimal movement of patient.
  • Keep on a flat, stiff surface.
81
Q

D - What can the patient’s Pupils give us an indication of? (1)

A

Neurological function.

82
Q

D – What do we need to observe about a patient’s Pupils? (4)

A

Size: Are they the same size? Anisocoria – one pupil smaller than the other.
Reaction to light: They should constrict.
Position: Are they in the same position? Ventral, medial etc.
General: Any discolouration of the eye? Sclera red indicated haemorrhage etc.

83
Q

EVALUATION / EXAMINATION (2)

A
  • A general evaluation & examination of the animal is performed once all other areas have been assessed.
  • First Aid intervention for abnormalities found in A, B, C &/or D should already have been implemented.
84
Q

E – What do we need to do if we suspect the patient has Fractures? (3)

A
  • Note any signs of fractures or dislocations.
  • Patient is made comfortable (not laying on limb).
  • Gentle handling of patient.
85
Q

E – What do we need to do if Wounds (general) are found during patient examination? (3)

A
  • Wounds should be assessed
  • Perform first-aid
  • Place damp, sterile saline swabs over injured area to prevent necrosis of tissue.
86
Q

E – What do we need to note about any Bruising on a patient? (3)

A
  • Note any areas showing signs of bruising
  • Size of bruise.
  • Bruising on abdomen important → may indicate abdominal haemorrhage / injury.
87
Q

E – What other General observations should we note about the patient’s body? (2)

A
  • Note any areas of the body that appear swollen or misshapen.
  • Eg. Swollen abdomen may indicate internal haemorrhage.
88
Q

E – What do we need to note about any Wounds (detailed)? (4)

A
  • All wounds must be assessed
  • Haemorrhage
  • Size
  • Location
89
Q

E - Why do we need to correctly classify wounds? (2)

A

Wounds are classified to enable correct first aid & treatment plans.

90
Q

E - What are the two main classifications of wounds? (2)

A
  • Open wound (skin is broken)
  • Closed wound (skin is intact)
91
Q

E – What are the 5 types of Open Wounds?

A

Incision
Laceration
Puncture
Abrasion
Burns & Scalds

92
Q

E – What are the 2 types of Closed Wounds?

A

Contusions
Crush injury

93
Q

E – What are the characteristics of an Incised wound? (5)

A
  • Caused by sharp cutting instruments eg. knives, glass.
  • Edges are clean cut & defined.
  • Generally wound will gape open.
  • Wound is usually quite deep.
  • Wound can be of any size.
94
Q

E – What are the characteristics of a Lacerated wound? (5)

A
  • Generally caused by road accidents, dog fights, barbed wire etc.
  • Are irregular in shape & generally gape open.
  • Edges are jagged.
  • Usually contaminated by dirt, debris etc.
  • Very painful
95
Q

E – What are the characteristics of a Puncture wound?

A
  • Caused by small sharp pointed objects eg. fish hook, cats teeth.
  • Small wound – easily overlooked.
  • Generally causes a deep wound & tracks down through tissues.
96
Q

E – What are the characteristics of Abrasions (grazes)?

A
  • Caused by road accidents & when animal is dragged along the ground.
  • Doesn’t penetrate the whole skin thickness – superficial.
  • Can be any size.
  • Very painful.
  • Wound is generally contaminated.