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542 (emerg class) > Triage & Shock > Flashcards

Triage & Shock Flashcards

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1
Q

What broad aspects of the complete physical exam is included in a triage exam?

A

Cardiovas, resp, neuro

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2
Q

When you’re doing your ABC assessment on a pt, if you answer no to any question, what should you do?

A

CPR

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3
Q

What is the acronym for the full triage assessment and what does it stand for?

A

ABCNE

airway, breathing, circulation, neurological, external

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4
Q

How do you answer the question “is my patient dying/dead?” and what is your solution if the answer is yes?

A

You assess ABC
you start resuscitation (CPR)

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5
Q

1st step in triage exam: ____.
What questions are you trying to answer at this stage?

A

A: airway

Is there an airway obstruction?
Sterdor/stridor?
Cyanosis?
Presence of a foreign body?

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6
Q

When you are assessing airway in a triage exam, what are the signs of an abnormal airway?

A

cyanosis, increased resp sounds and efforts, obvious airway obstruction

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7
Q

2nd step in triage exam: ____.
What questions are you trying to answer at this stage?

A

B: breathing

Is the patient breathing?
Effort?
Rate?
Chest wall movement or excursions?
Trauma?

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8
Q

When should you auscultate the lungs during a triage exam?

A

At the same time you listen to the heart

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9
Q

When you are assessing breathing during a triage exam, what are indications of abnormal breathing?

A

Increased resp rate, increase resp effort, abnormal lung sounds

**for increased resp effort, be specific as to when? inspiratory? expiratory? short and shallow?

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10
Q

3rd step in triage exam: ____.
What questions are you trying to answer at this stage?

A

C: circulation

Auscultation
Can I hear a heart?
Heart rate?
Heart murmur?

Touch-observation
Can I feel a pulse?
Pulse quality? (peripheral, proximal)
Mucous membranes?
CRT?
Cool extremities?

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11
Q

Metatarsal pulses are lost when systolic BP is ___ (greater, less, equal) _____ mmHg. How does this differ with femoral pulses?

A

less than or equal to
75 mmHg

Femoral pulses are not lost unless severe hypotension

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12
Q

What is the basic way to tell if a patient is stable/unstable?

A

If CV, resp, or neuro ability is compromised, then unstable

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13
Q

What is shock?

A

clinical expression of decreased cellular O2 utilization

essentially, what happens to the body when it can’t use enough O2

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14
Q

Shock is akin to what kind of instability?

A

Cardiovascular unstable

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15
Q

Shock can result from what 2 things?

A

decrease in O2 delivery

Decrease in cellular O2 consumption = mitochondrial dz

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16
Q

O2 delivery = ____ + _____

A

Cardiac output (CO)
Carrying capacity of O2 (CaO2)

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17
Q

Cardiac output = _____ + ______

A

Stroke vol
Heart Rate

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18
Q

Carrying capacity of O2 (CaO2) = _____ + _____

A

O2 Hb (how much O2 Hb can carry)
H2 dissolved (how much O2 in blood when saturated)

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19
Q

Stroke volume is affected by what 3 things? include definitions

A

preload: amount of blood coming through heart
afterload: resistance heart must overcome for blood to leave heart
contractility: force heart muscle is contracting

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20
Q

How do you calculate O2 Hb?

A

1.34 x Hb x SaO2

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21
Q

How do you calculate O2 dissolved?

A

0.003 x PaO2

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22
Q

Dog has hypovolemic shock. Tell me what happens physiologically?

A
  1. Decrease in CO
  2. Baroreceptors lack of stretch
  3. inhibition of parasympathetic centre –> vasoconstriction of vv & aa –> increase venous return & after load
  4. release of epinephrine –> vasoconstriction unneeded blood supply areas, increase HR, increase contractility = increase CO
  5. Activation of RAAS (due to lack of blood) –> increase Ang 2 = H2O & Na reabsorb –> increase preload & vasoconstriction
  6. ADH release –> increase preload
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23
Q

Animal is in compensated shock. What are the clinical signs?

A

sympathetic release +++
tachycardia (dogs) / bradycardia (cats)
bounding pulses
pale mm
CRT > 2sec

Decreased O2 delivery to brain = decrease mental status

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24
Q

What is the difference between dogs and cats when they are in compensated shock?

A

Dogs display tachycardia
Cats display bradycardia

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25
Animal is in **worsening compensated shock**. What are the clinical signs?
Altered mental status hypothermia cold distal extremeties Cats: HR < 140 bpm (severe bradycardia) vol loss increases
26
Animal is in **decompensated shock**. What are the clinical signs?
decrease in BP hypotension MAP <70 mmHg
27
Animal is in **refractory shock**. What are the clinical signs?
Absent BP Stuporous to comatose Bradycardia (both cats and dogs)
28
What does refractory shock mean?
failure of organ vitals shock no longer reversible imminent death
29
What are the stages of shock?
1. compensated shock 2. worsening compensated shock 3. decompensated shock 4. refractory shock
30
What is hypovolemic shock?
decreased blood vol not enough blood to bring O2 to tissues
31
What is distributive shock?
bad distribution of blood to tissues bc of inappropriate vasodilation vessels don't constrict despite catecholamines and Ang 2 = too much vasodilation
32
What are the two types of distributive/vasodilatory shock?
Septic shock Anaphylactic shock
33
Vasodilation causes ------?
decrease in tissue perfusion decrease in venous return decrease in preload decrease in CO
34
What are the specific clinical signs associated with vasodilatory shock?
hyperaemic mm fast CRT abnormal pulse quality everything else is the same as hypovolemic shock
35
What is obstructive shock?
physical obstruction of heart/major vessels = inability for blood to return to or be pumped from heart = O2 not able to get to tissues
36
What common emergency cases cause obstructive shock?
Pericardial effusion GDV thromboembolism (rare in cats)
37
obstructive shock causes ----?
decrease in preload decrease in CO
38
How does a GDV cause obstructive shock?
stomach compresses caudal vena cava
39
How does pericardial effusion cause obstructive shock?
right auricle compressed by pericardial sac being full of fluid
40
How does a pulmonary thromboembolism (PTE) cause obstructive shock?
obstruction of pulmonary artery, blood can't go to L side of heart
41
clinical signs associated with obstructive shock are _____ to the disease process
specific
42
what are the clinical signs associated with obstructive shock with pericardial effusion?
muffled heart sounds pulsus paradoxus = BP decreases with inhalation distended jugs with jug pulse
43
what are the clinical signs associated with obstructive shock with GDV?
non-productive retching large tympanic stomach painful abdomen
44
what are the clinical signs associated with obstructive shock with thromboembolism?
resp distress collapse
45
What are the 5 types of shock? *I think supposed to be 4 but there are 5 in this lecture*
Hypovolemic Distributive Obstructive Cardiogenic Hypoxic
46
What is cardiogenic shock?
Myocardium itself isn't able to pump
47
What causes cardiogenic shock?
DCM, HCM, arrhythmias (ARVC = arrhythmogenic ventricular cardiomyopathy), myocardial depression associated with sepsis, myocarditis, ischemic injury
48
Cardiogenic shock leads to ----?
decrease in stoke vol decrease in CO
49
How does DCM cause cardiogenic shock?
decrease contractility of heart
50
how does HCM cause cardiogenic shock?
decreased ventricular filling
51
how does ARVC cause cardiogenic shock?
not enough time to fill ventricle + decrease contractility
52
What are the clinical signs associated with cardiogenic shock?
heart murmur arrhythmia collapsing episodes (not enough blood to brain) poor pulse quality peripheral edema ascites/jug distension (if R side heart impaired)
53
True or false: cardiogenic shock is the same as congestive heart failure
FALSE! IT IS DIFFERENT! Cardiogenic shock: pump activity not allowing enough O2 to brain and tissues CHF: there is congestion (regurg blood flow) in heart
54
CHF can lead to ____ shock.
hypoxic
55
What is hypoxic shock?
carrying capacity of O2 is decreased so O2 delivery to tissues is impaired
56
What causes hypoxic shock?
decrease in CaO2, which is caused by: 1. decrease in hemoglobin/RBC --> anemia 2. decrease in SaO2 --> hypoxemia (lung dz)
57
What are the physiologic consequences of hypoxic shock?
anemia/low PaO2 --> tissue hypoxia increase in CO, increase preload decrease blood viscosity arterial vasodilation, ROS vasodilation, flow mediated vasodilation
58
What are the clinical signs of hypoxic shock?
C/S are specific to the underlying disease - resp distress - pale mm
59
True or false: More than 1 type of shock can be present at the same time
TRUE!!!
60
Shocky cats will have a _____ HR, >/
slowwwwwww < 160 bpm the slower the HR, the closer to death is the cat!!!
61
The indicators of shock = _____ _____
abnormal perfusion
62
What are the broad indicators of shock/abnormal perfusion? like where should you be looking in the patient?
- mentation - abnormal HR - abnormal mm - CRT - pulse quality - extremity temp
63
what are the shocky abnormal HRs for dogs and cats?
Dogs: 80-140 bpm Cats: 160-220 bpm ???
64
in shocky patients, what can their mm look like?
pale or bright red (depending on type of shock)
65
CRT in a shocky pt looks like:
<1 sec > 2 sec ???
66
Which types of shock is it ok to give a fluid bolus for?
hypovolemia distributive obstructive
67
what is the point of giving a fluid bolus to a patient in shock?
to restore intravascular volume = circulating vol
68
How do you give a fluid bolus to a shocky dog? like tell me timing, dosage, what type of fluid
small aliquots (portions) of isotonic crystalloids over 25-30 mins 10-30mL/kg
69
How do you give a fluid bolus to a shocky cat? like tell me timing, dosage, what type of fluid
small aliquots (portions) of isotonic crystalloids over 25-30 mins 5-20 mL/kg
70
You give a shocky patient a fluid bolus and are looking for improvement. what are you looking for?
- improved mentation - normalization of HR - improvement of mm color (pink) - normalization of CRT (< 2 sec) - normal pulse quality - extremities no longer feel as cold
71
How should you treat hypoxemic shock?
provide RBCs and improve CaO2, if anemia supplement O2, if severe hypoxemia
72
How should you treat cardiogenic shock?
improve contractility if that's the issue (DCM) slow HR if that's the issue (arrhythmia & HCM)
73
4th step in triage exam: ____. What questions are you trying to answer at this stage?
Neurological What does mentation looks like? seizure present? history of seizure? ambulation?
74
What is the range of mentation, from normal to the worst?
Normal Lethargic Obtunded, auditory stimuli Stuporous, noxious stimuli Comatose, non responsive
75
How do you assess brainstem reflexes?
PLR and physiologic nystagmus looking at rigidity
76
What is **decerebrate** rigidity? what is the prognosis?
opisthotonus with extension of front and rear limbs, severely affected mentation & are stuporous to comatose grave prognosis
77
What is opisthotonus?
extension of head and neck
78
What is **decerebellate** rigidity? What is the prognosis? What is this a sign of?
opisthotonus with extension of front limbs. hind limbs often flexed, but can be extended (may be intermittent) better prognosis than decerebrate rigidity sign of progressive brain injury
79
5th step in triage exam: ____. What questions are you trying to answer at this stage?
External assessment - reserved for trauma patients bleeding? lacerations? punctures? abrasions? contusions? instability?
80
____ bleeding is life threatening. Others need to be covered and addressed later.
arterial
81
Mentation can be abnormal due to ____ or ______.
1. primary neuro dz 2. shock and decreased O2 delivery to the brain
82
What are the steps of a triage exam? like broad categories, not talking about organ systems that we're looking at
initial triage primary survey secondary survey
83
What are you doing during your initial triage?
30 sec-1min animal has arrested: inform O, ask for CPR status, transport to ICU for resuscitation Animal has not arrested: do primary survey
84
What are you doing during your primary survey?
ABC, auscultation, neuro status (CNs, basic spinal reflexes), external wounds (cover if possible), abdominal palp, rectal temp, POCUS
85
When should you start stabilizing the patient? how do you do this?
during your initial assessment place IV catheter, obtain emergency blood samples, supplement O2, connect ECG, measure BP, obtain pulse ox, record values on medical file PERFORM LIFE SAVING MEASURES! (ex. thoracocentesis, back board, etc)
86
true or false: our primary survey is a complete PE.
FALSE!
87
What is your secondary survey? what is your goal with this?
a complete PE (including fundic and rectal exams) goal is to ID all injuries relative to the trauma
88
During your secondary survey, should you take your time and be thorough, or be as fast as possible?
take your time and be thorough - you might only have this 1 time to do a complete PE
89
True or False: you should do rads on triage
false!
90
What should you do after completing your secondary survey?
get the big picture list problems (from hx, primary and secondary surveys, POCUS, min emergency database, dx tests) from most to least life threatening for each major problem: ddx, dx plan, therapeutic plan overall estimate and prognosis
91
Tell me the difference between emergency and urgent situations. give me 2 examples of each.
Emergency: needs immediate to quick w/I 10 mins dr assistance urgent: should be assessed by dr w/i 30-60 mins after arrival E: cardio/resp arrest, trauma (HBC, GSW, stepped on, high rise injury, bite), seizures/abnormal mentation, abnormal vital signs, resp distress, unstable GDV, blocked cat, unstable vomiting pt, most toxins U: IVDD, stable non-ambulatory, minor lac, stable pt w/ fx

542 (emerg class) (1 decks)

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