Home > Horse Care > Intro to Vet Tech > Emergency Medicine
Fall 2006
Emergency Medicine, Emergency Nursing, and Critical Care
1.Define Triage and a triage classification
system.
”Triage” is the process of determining the priority of need
and the proper order of treatment when evaluating a clinical situation.
A standard protocol is used to identify which problems and which body
systems should be evaluated first. In emergency cases, priority is given
to treating respiratory, cardiac, and vascular problems. Other body systems
are subsequently evaluated in a systematic manner. Secondary complications
of trauma include but are not limited to disseminated intravascular coagulation,
sepsis, multiorgan failure, and distress due to pain.
Triage Classification System: CRASH PLAN
Airway Cardiovascular Pelvis
Respiratory Limbs
Abdomen Arteries/veins
Spine Nerves
Head
2. Define CPR or CPCR and when it is used.
Cardiopulminary arrest is defined as the cessation of breathing and effective
blood circulation, and in most veterinary patients, it occurs as the terminal
stage of an advanced disease. However, arrest can occur as a complication
of any critical illness or even in healthy patients undergoing anesthesia.
Resuscitation efforts attempting to reverse the state of arrest is commonly
known as as CPR or cardiopulmonary cerebrovascular resuscitation. The
acronym CPRP emphasizes the importance of maintaining the perfusion and
oxygen delivery to the central nervous system during and after an arrest.
3. Describe the basic steps to provide “Basic
Life Support” in cases of arrest. (A,B,Cs).
A is for airway. Those responding to a potentially arrested
animal should note if the animal is breathing. If respirations are absent
or weak, the mouth should be opened and the oropharnyx examined for possible
obstructions. Common sources of airway obstructions include respiratiory
secretions, aspirated vomitus, bllod, ingested foreign material, and mass
lesions. If obstruction is noted, the airway should be cleared with suction,
or manual removal of foreign matter. Caution is indicated to avoid being
bitten. A sponge forceps and gauze may may be helpful in clearing some
exudates. Once the airway is cleared, staff members should note whether
these steps have stimulated the animal to breath.
B is for breathing. If the animal does not begin to breath, then the patients must receive ventilation assistance. Mouth-to-nose resuscitation may be performed by sealing the lip margins and blowing into the animal’s nose. This method requires no special equipment and will deliver 16% oxygen. This level of oxygenation is inadequate and should be done temporarily until a higher supply of oxygen can be provided. The best method of assisted ventilation is endotracheal intubation and delivery of 100 percent oxygen from an orxygen source. Ideally animals should be intubated in lateral recumbancy to prevent elevation of the head and positional changes that impair cerebral blood flow. If intubation isn’t possible, a narrow orotracheal catheter or a transtracheal cannulae is sometimes useful. Accupuncture might work when other methods have failed.
C is for circulation. Once the airway is established and ventilation provided, circulation must be assessed by palpation pf pulses (or apex heartbeat) and auscultation of the heart. Peripheral pulses are non palpable when the mean blood pressure is less than 60 mm Hg. An apex heart beat may be indistinguishable when the pressure is less than 40 mm Hg. It’s important to note that some animals suffer respiratiory arrest without cardiac arrest. Improper chest compressions can increase stress to the patient and precipitate cardiac arrest in some cases. Once cardiac arrest has been confirmed chest compressions should be started immediately.
4. What is a crash cart and what does it
contain in order to provide basic life support?
The crash cart is a box (for example, a fishing tackle box with necessary
items on a large cart with wheels and a multiple drawer. A hardware store
tool storage cart can also work quite well. It should be located at the
emergency station, and contain items necessary for treating the patient
that’s medically unstable. Additional crash carts may be placed
at select locations throughout the hospital (ie, oprating room or dental
suite. Basic supplies contained in the crash cart should include items
necessary to establish an airway, venous access, emergency drugs, plus
a dosage chart.
5. List as many ways as possible to quickly
assess blood loss in the trauma patient.
Blood loss must be evaluated and addressed immediately. Mucous membrane
color, capillary refill time, and hemacrit with total plasma solids should
be evaluated as soon as possible. If outward hemorrhage is apparent, this
must be addressed and replacement with fluid therapy/and or blood products
should be considered. Internal hemorrhage may be occurring, which is not
easily observed in sites such as the pleural space and peritoneal cavity.
An abdominal pressure bandage may be placed if abdominal or pelvic injuries,
(i.e femur or pelvic fractures, road rash, are outwardly evident. Application
of such bandages may help to preempt a worsening condition hemoabdomen
and pevent further cardiovascular decompensation. Proper application of
abdominal pressure bandages is important. First, a folded gauze pad or
rolled towel is placed on midline and secured with gauze cling. Further
tension may be applied with cohesive bandage material. Care is taken not
to secure the bandage so tightly that the animal has discomfort or impaired
respiration. Thoracocentesis and bdomincentesis may be considered if patient
monitoring suggests the presence of ongoing unrecognized hemorrhaging.
If ongoing abdominal hemorrhage is detected, surgery may be considered
once approporiate attempts have been made to ensure that the animal is
hemodynamically (!) stable.
6. List clinical signs associated with
pain in animals.
Common signs frequently associated with pain include vocalization, depression,
anorexia, tachypnea, tachycardia, hypertension, hypotension, pale mucus
membranes, aggression, abnormal postures, excess salivation, and dialated
pupils. Abnormal pain in particular may be expressed by a classic “praying”
or “play bow” position in which the forequarters are crouched
and the abdomen and hindquarters elevated from the ground.
7. In six steps or more describe how to
perform CPR on a dog or cat.
1. Position animal correctly.
-- In small animals and/or those with narrow chest confirmation, use the
cardiac pump technique.
-- In large animals and those with barrel chests use the thoracic heart
model technique.
2. To optimize the cardiac and thoracic pumps, place animals that weight
less than 15 pounds in lateral recumbency. Animals greater than 15 pounds
should pounds may be placed in lateral or dorsal recumbency.
--The point of compression (hand placement) for the cardiac pump is located
directly over the heart. The poing of compression for the thoracic pump
is located at the widest part of the chest.
3. Assess the effectiveness of CPRP by palpating for a pulse and evaluating
the mucous membrane color.
4. If need be, change places with another team member, change the animals’
position, and/or alter your compression technique.
5. Ventilation and chest compressions may be interposed or administered
simultaneously.
6. Once compressions have begun, a solid rhythm can develop if the breaths
are administered simultaneous to the compressions.
-- This rate should be 120/minutes for animals less than 15 pounds, and
80 to 100 minutes for animals greater than 15 pounds.
-- Interposed abdominal compressions assist in directing blood in the
lower half of the body back toward the heart (via increased intraabdominal
pressure) and may be administered by another team member.
8. List six reasons for fluid support for
the critically ill patient.
Common reasons for providing fluid support in critically ill patients
include:
1. Maintaining hydration.
2. Replacing fluid losses.
3. Maintaining intravenous access and delivering other medications.
4. Treatment of shock of hypoproteinemia
5. Increasing urine output.
6. Correcting acid-base or electrolyte disturbances.
7. Providing nutritional support.
Emergency Medicine