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Unit 1 > Primary assessment > Flashcards

Primary assessment Flashcards

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1
Q

What is it important to not get distracted by during the primary survey?

A

Obvious injuries that are not life-threatening such as skin lacerations

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2
Q

What are the three major body systems?

A

Respiratory
Cardiovascular
Neurological

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3
Q

How long should it take for a primary survey?

A

60 seconds

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4
Q

What should ideally be assessed after the major body systems?

A

Body temperature, alongside a brief general exam

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5
Q

What are alternative sites for temperature taking?

A

Auricular or axillary

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6
Q

What are important points to keep in mind when obtaining auricular or axillary temperatures?

A

Accuracy may be affected by:
Hair in the ear canal
Pigmentation
Perfusion

Temperatures may not correlate with rectal temperatures

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7
Q

What is the link between cardiovascular and mentation?

A

Compromised blood flow or hypoxaemia will lead to not enough oxygen being delivered to the brain which will alter mentation

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8
Q

What mentation are hypoperfused/shocked patients likely to have?

A

Depressed/obtunded

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9
Q

What might a change in mentation indicate?

A

Toxicity (I.e. marijuana)
Hypoglycaemia
Marked cardiovascular compromise

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10
Q

If the head is not accessible, how else can you check the mucous membranes?

A

Conjunctival membranes
Vulva/penis

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11
Q

What can pale/white mucous membranes indicate?

A

Absence of red blood cells within the capillary beds. Such as:
Anaemia (insufficient red blood cells in the overall circulation)
Hypoperfusion (Hypovolaemia is the most common cause as it leads to vasoconstrictions as a compensatory mechanism)

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12
Q

What does yellow mucous membranes indicate?

A

Icteric/jaundiced
-Indicates elevated bilirubin in the circulation
-Could be due to excessive haemolysis, liver disease or biliary tract disease (pre, post and intra-hepatic)

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13
Q

What does blue/purple mucous membranes indicate?

A

Cyanotic
-Secondary to de-oxygenated haemoglobin
-Seen with severe hypoxaemia (only becomes cyanotic at spo2 of less than 85%)

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14
Q

What does red mucous membranes indicate?

A

Seen in early sepsis/SIRS in dogs

May also be seen in hyperthermic/heat stroke patient
Secondary to a ‘hyperdyanmic state’ of increased cardiac output and vasodilation

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15
Q

What do bright red mucous membranes indicate?

A

Carbon monoxide intoxication

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16
Q

What does brown mucous membranes indicate?

A

Methamoglobinaemia i.e. paracetamol intoxication

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17
Q

What is important to remember regarding hypovolaemia and dehydration?

A

Acutely hypovolaemic patients are rarely dehydrated and dehydrated patients are not necessarily hypovolaemic

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18
Q

Define hypovolaemia

A

Loss of circulating volume which leads to cardiovascular system dysfunction.

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19
Q

Define dehydration

A

Loss of total body water

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20
Q

What does a long CRT indicate?

A

Hypoperfusion/shock

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21
Q

How can you differentiate between anaemia and hypoperfusion/shock when assessing mucous membranes and CRT?

A

Pale mucous membranes and a normal CRT are consistent with anaemia.
Pale mucous membranes and prolonged CRT indicates hypoperfusion/shock

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22
Q

What does a rapid CRT indicate?

A

Sepsis
Usually occurs alongside hyperaemic/red mucous membranes

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23
Q

Define hypoperfusion

A

Decreased blood perfusion of tissues so decreased delivery of oxygen to cells.

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24
Q

What can hypoperfusion lead to?

A

Shock

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25
Define shock
Life-threatening lack of oxygen delivery to cells/tissues
26
What is the most common form of shock?
Hypovolaemic
27
What are the stages of hypoperfusion leading to death?
Reduced perfusion Reduced o2 delivery to tissues and reduced collection of by-products (Co2) Reduced oxidative metabolism and increased anaerobic metabolism Impaired cell function Cell death Organ failure
28
What defines tachycardia in dogs?
Heart rate above 140bpm
29
What is the most significant cause of tachycardia in dogs?
Hypoperfusion/shock
30
Name causes of tachycardia in dogs
Hypoperfusion/shock Arrhythmias Congestive heart failure Anaemia Stress Pain Excitements Electrolyte abnormalities Intoxications
31
Define tachycardia in cats
Heart rate above 180bpm
32
How do cats in shock differ from dogs?
Cats are not typically tachycardic when in shock, whereas dogs are
33
Name reasons for tachycardia in cats
Hyperthyroidism Congestive heart filure Electrolyte disturbances Intoxications Pain/stress
34
What would be an example of inappropriate bradycardia?
A patient that has signs of hypovolaemic shock such as pale mucous membranes, prolonged CRT and weak pulses but the heart rate remains normal
35
What are possible causes of bradycardia in dogs?
Hyperkalaemia (hypoadrenocorticosm or urethral obstruction) Increased vagal tone (GI disease or brachycephalic breeds) Drugs i.e. lidocaine Bradyarrhythmias (AV blocks or sick sinus syndrome) Raised intracranial pressure (cushings reflex) Hypothermia
36
Cats with hypovolaemic shock or sepsis often have:
Bradycardia
37
Define bradycardia in cats
Heart rate less than 120bpm
38
What are possible causes of bradycardia in cats?
Hypovolaemic shock Sepsis Hyperkalaemia (urethral obstruction/uroabdomen) Atrioventricular block Hypothermia High vagal tone (less common in cats)
39
When might palpation of femoral pulses be difficult?
In obese patients or in hind limbs fractures
40
What parameters affect pulse quality?
Stroke volume Cardiac contractility Vasomotor tone i.e. degree of vasoconstriction
41
What do you assess when palpating pulses?
Pressure Duration
42
What does weak femoral pulses indicate?
Severely hypovolaemic patients
43
Why are peripheral pulses difficult to detect in hypovolaemic patients?
Compensatory vasoconstriction
44
At what MAP do peripheral pulses tend to disappear?
60mmHg
45
What should you do if a patient has difficult to detect or absent pulses?
Arterial blood pressure reading
46
Describe a bounding pulse
Strong and longer duration
47
When might a patient have a bounding pulse?
Septic patients due to vasodilation that is present in early stages
48
Describe a snappy pulse
Strong but short duration
49
When might a patient have a snappy pulse?
Anaemic
50
Which patients is bilateral palpation of the femoral artery important?
Cats at risk of an aortic thromboembolism
51
What should you note when auscultating the heart?
Rate Rhythm Position Audibility
52
What might muffled/absent heart sounds be secondary to?
Pericardial or pleural space disease such as pleural effusion or pneumothroax
53
How do you differentiate between pleural effusion and pneumothorax?
Pleural effusion leads to muffled heart sounds ventrally whereas pneumothorax muffles heart sounds dorsally
54
A gallop rhythm may be noted in:
Cats with hypertrophic cardiomyopathy
55
What 2 databases make up an emergency databse?
Minimum (MDB) and extended (EDB)
56
What's the minimum amount of blood required for a minimum databse?
0.2ml
57
What information is obtained from a minimum database?
Packed cell volume (PCV) Total solids (TS) Blood urea nutrogen (BUN) Blood glucose
58
What information is obtained from an extended database?
Same as minimum (PCV, TS, BUN & BG) Also: Electrolytes Blood gases Lactate Blood smear
59
What does POCUS stand for?
Point of care ultrasound
60
Define orthopnoea
Postural changes such as head and neck extension and elbow abduction
61
Apart from severe respitatory distress, why else may a cat be open mouth breathing?
Injury/disease to the nasal passages andf sinuses
62
When might an increase in respiratory effort be seen?
Pleural space disease such s pneumothorax, haemothorax or diaphragmatic hernia/rupture Pulmonary parenchymal disease i.e. pulmonary contusion Upper airway disease/airway obstruction
63
What rate is considered tachypnoea in dogs and cats?
Above 50 breaths per minute
64
What rate is considered bradypneoa?
Less than 10 breaths per minutes
65
Defined increased respiratory effort
Increased chest and abdominal muscle movement
66
How may a patient with an upper airway obstruction present?
Marked inspiratory effort and paradoxical abdominal movement
67
Define paradoxical breathing
The increase in intercostal muscle action draws the diaphragm cranially and abdominal muscles appear to be sucked inwards
68
Define a tension pneumothroax
Air enters the pleural space but cannot exit
69
How might a patient with a tension penumothorax present?
Respiratory distress with minimal thoracic movement Cyanotic Lateral recumbency
70
How should the lungs be auscultated?
Each hemi thorax should be auscultated dorsally, medially and ventrally including cranial to caudally in each zone
71
Define stridor
High pitched sounds of upper airway origin Can be heard on inspiration and expiration
72
What causes stridor?
Damage/obstruction to the upper airways Created as air passes through a narrowed airway during breathing
73
What should you be careful with when auscultating stridor?
Noise can be referred during thoracic auscultation Laryngeal and tracheal auscultation will aid in localising the noise
74
Define stertor
Lower pitched sounds generally of pharyngeal origin Often gasp or snore-like heard during inspiration
75
A decrease or absence of lung sounds indicates what?
Pleural space disease
76
What types of pleural space disease lead to a decrease/absence of lung sounds?
Pneumothorax pleural effusion soft tissue/organ displacement i.e. diaphragmatic hernia
76
How may a patient with pleural space disease present?
Rapid, shallow breathing pattern (unable to expand lungs properly) potentially air hunger if the pleural space disease affects volume Dull lung sounds
77
How can you diffrentiate pleural effusion and pneumothorax on cardiac auscultation?
Pneumothorax - dull sounds heard dorsally Pleural effusion - dull sounds heard ventrally
77
Name causes of pleural effusion
Pure transudate Haemorrhage Chylothorax Pyothorax
78
What might be auscultated in a patient with a diaphragmatic hernia?
Dull sounds either dorsally or ventrally Borborygmi
79
What PaO2 is a patient deemed seriously hypoxaemic?
<60mmHg
79
Over what time do patients with a pulmonary contusion detioriate?
Over 6-24 hours
80
The absence of cyanosis does not rule out....
signfiicant respirastory compromise and hypoxaemia
80
At what PaO2 will a patient present cyanotic?
35-40mmHg
80
Is possible, what position should a patient be in for thoracocentesis?
Sternal
81
Define hyperexcitable
Excessive reaction to stimuli
81
What are the 5 categories of consciousness?
Normal Depressed Obtunded Stupurous Comatose
81
Define a normal consciousness
Alert and appropriately responsive to stimuli
82
Laboured inspiration and expiration indicates what?
Parenchymal (lung tissue) disease
82
Laboured inspiration and audible noisy breathing indicates
Upper airway issue
82
Laboured expiration indicates what?
Lower airway issue
82
Abdominal pulling (paradoxical) on expiration indicates what?
Loss of negative pressure within the pleural space
83
Define a depressed consciousness
Alert but not appropriately responsive to stimuli
84
Define an obtunded consciousness
Decreased consciousness or appearing unconscious but rousable with non-noxious stimuli
85
Define a stuporous consciousness
Unconscious and rousable with noxious stimuli
86
Define a comatose consaciousness
Unconscious and not rousable with any stimuli including noxious
87
When might a patient present with periods of delirium?
Space-occuping lesions Problem with brain structure Intermittent increases in intra-cranial pressure
88
What can be given to determine if decreased mentation is due to decreased perfusion?
IVFT
89
What gait abormalities should be assessed?
Ataxia Knuckling Hypermetria
90
Define schiff-sherrington pose
Forelimb extensor rigidity and hind-limb flaccidity secondary to a serious spinal cord lesion between T2 and L4
91
Define decerebrate rigidity
Opisthotonus with hyperextension of all four limbs and loss of consciousness
92
Define decerebellate rigidity
Hyperextension of the forelimbs with variable flexion and extension of the hind-limbs and appropriate level of consciousness
93
How can you eprform a deep pain assessment?
Applying forceps at the base/perioseum of the phalanx three
94
What should be avoided in cases of intra-cranial pressure
Jugular samples due to applying pressure to the jugular veins Placement of intra-nasal catheters or any irritation of the nose (sneezing) Inducing the gag reflex or administering drugs that can cause vomiting
95
How is cerebral perfusion pressure calculated?
CPP = MAP - ICP
96
What should be done toa patient with a raised intra-cranial pressure?
Head and neck elevated by 15-30 degrees usinf a flat board
96
What can be administered in cases of raised intra-cranial pressure?
Mannitol Hypertonic saline
97
How can spinal injuries occur?
IVDD (most common) Fracture/luxation if secondary to trauma Fibrocartilaginous embolism Neoplasia
97
What is the most common analgesia fo choice in spinal patients?
Opioids
98
A patient recumbent for >12 hours should be....
Catheterised
99
Why would movement of an unconscious./sedated patient with a spinal injury risk further damage?
Relaxation of the muscles which would otherwise support the unstable vertebral column
100
A recumbent spinal patient requires:
Suitable bedding Regular movement to prevent pneumonia Padding of bony promenences Grooming Urinary catheter care Mental stimulation

Unit 1 (6 decks)

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