Triage and Trauma Flashcards
(30 cards)
What does Triage encompass?
Assessment of patient (systemically)
Injuries interfering with vital functions receive the highest priority
After initial treatment repeat evaluation (adjustments as you go)
What causes decreased lung sounds dorsally?
Pneumothorax
What does paradoxical thoracic wall motion indicate?
Rib fractures
What is a normal lactate value?
< 2
List the systemic assessment priorities
Respiratory (airway, breathing)
Cardiovascular system
Neurological system (head, spinal cord, peripheral nerves)
Abdominal organs
Musculoskeletal system (stabilize fractures)
Integumentary system
Respiratory System (airway) Triage
Highest priority in trauma
Assess airway
Place ET tube if patient is struggling to breathe
Emergency tracheostomy if airway is obstructed
Respiratory System (breathing) Triage
Even in hind end injuries there can be thoracic trauma
Administer supplemental oxygen if dyspneic
Three most common respiratory injuries
Pulmonary contusions
Pneumothorax
Rib fractures
Pulmonary Contusions
Alveoli filled with blood and edema fluid
Results in atelectasis and hypoxemia
Radiographically appears ans infiltrate (may take 12-24 hours to appear); does NOT follow a specific pattern occurs where trauma occurred
Pneumothorax; what can it cause?
Results in atelectasis, hypoxemia, and interferes with venous return (lungs cannot expand to full capacity)
Pneumothorax; treatment
Thoracocentesis for initial therapy; aspirate BOTH sides
Placement of thoracostomy tube:
Done if thoracocentesis has been done multiple times with no resolution of dyspnea
Can connect to a continuous suction device
Can heal without surgery in most cases (will take several days)
Rib Fractures
Painful!
Give 1/4 shock bolus of fluids and then administer analgesia (ex. Fentanyl CRI)
Monitor BP
Most rib fractures do not require surgery
Causes atelectasis and hypoxemia
Cardiovascular system
Triage
Shock (hypovolemic) can occur due to hemorrhage
Need to determine: external, internal, or both
Pulmonary Contusions
Treatment
Isotonic crystalloids?
Do NOT give large volumes of isotonic crystalloids
75% of fluid will redistribute to the interstitial space; includes interstitium of lungs
Pulmonary Contusions
Treatment
Combination options?
Isotonic crystalloids and colloids
Isotonic crystalloids: do NOT exceed 45 mL/kg/hr (dogs) or 22.5 mL/kg/hr (cats)
Do either half shock or quarter shock bolus
Hypertonic saline +/- colloids
What should you avoid doing when administering IV fluids? (hint: monitoring)
Blood pressure should not increase too much (maintain systolic around 90-100 mmHg)
Could dislodge blood clot formation -provides hemostasis at hemorrhage site-
Rapid administration of IV fluids can cause significant increase in BP
Intracranial injuries
Level of consciousness: alert, responsive/unresponsive to stimuli
Pupillary size & reactivity
Abnormal postures (decerebrate, decerebellate, schiff-sherrington syndrome)
Spinal cord injuries
Immobilize as soon as possible
Will require analgesia and sedation
Abdominal Injuries
Perform ultrasound Ruptures? Free fluid? Air? Organ evisceration?
Radiographs can help as well
Hemoabdomen; if good clotting times should be able to stop hemorrhaging
Ruptured bladder; will require surgery once stable
Blunt Abdominal Trauma
Diagnostic test
Abdominocentesis
Ultrasound guided or blind via 4 quadrant sampling
Abdominocentesis
What can you measure?
PCV/TS BUN or Creatinine Total bilirubin Fluid analysis Cytology Culture/Susceptibility
Abdominocentesis
PCV interpretation
If PCV of abdominal fluid is greater than the peripheral PCV:
Splenic, hepatic, or renal parenchymal laceration is present
Best approach for hemoabdomen?
Medical!
Morbidity and mortality are lower if you treat the case medically
How to assess urological injury (diagnostics)
PCV of abdominal fluid is less than peripheral PCV (dilution of urine does this)
BUN/Creatinine of abdominal fluid >2x than peripheral BUN/Creatinine
BUN measured during ACUTE trauma
Creatinine measured for chronic issue
