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Critical Care - Triage

Courtesy of Elizabeth Warren, RVT and Deb Stafford, CVT, VTS (ecc)

Triage = classifying patients and their medical problems according to the urgency of their situation and constantly reaccessing.

Triage Classification Description Example
First PriorityPatient Critical
Treatment must be initiated within seconds to minutes Bring immediately to treatment room
Major bleeding, Breathing problems, altered mentation, shock, history of toxin ingestion, etc.
Second PriorityPatient Urgent
Currently stable, but may become first priority patient, need to be reassessed, or have treatment initiated within minutes to hours
History of major trauma, history of unsuccessful urination, repeated vomiting or diarrhea, etc.
Third PriorityPatient Stable
Pressing problem that is non critical
Treatment initiated within hours
Fever, lacerations, vomiting, diarrhea, etc.
Fourth Priority Patient Completely Stable
Needs evaluation, but not urgently
Anything not listed above.

  • INITIAL CONTACT PRIMARY SURVEY
    • Phone Call
      • Recognize emergencies
      • Give advice regarding first aid and transport of critical care patients
      • Trained to recognize emergencies and to give first aid and transport advice
      • Obviously critical patients based on the phone contact will go straight to the treatment area.
    • Primary Survey
      • Triage team member determines degree of urgency based on chief complaint, general appearance, vital signs, and history
        • Use ABC's of emergencies (see below)
        • Include neurologic evaluation
      • All parameters must be checked by the team prior to determining if patient is stable. If the patient is critical (near death), the client should be consulted to give permission to continue stabilization.
      • ABC's of Emergency
        • Airway -
          • First Priority = animal not breathing
            • Determine if airway is blocked or not (positional vs. obstructed by something)
            • Heimlich maneuver, intubate, or Tracheostomy
            • Begin positive pressure ventilation
        • Breathing -
          • Assess quality and rhythm and character
          • Normal versus Abnormal
            • Patients that are in pain, fearful, or anxious may pant, but not have a respiratory abnormality
            • First Priority = abnormal respiratory sounds, dyspneic, character, rhythm, or effort.
          • Respiratory distress (below or above normal range)
          • Character may indicate location of problem
            • Loud breathing = large airway disease (nasal passages, trachea, larynx/pharynx)
            • Inspiratory noise or difficulty = extra thoracic airway disease (esp. larynx)
            • Expiratory noise or difficulty = intrathoracic or tracheal disease
            • Rapid/shallow breathing = pleural space disease (fluid or air)
            • Difficulty breathing on both inspiration and expiration = lung disease
            • Late stage respiratory disease (First Priority)
              • Posturing - animals stand/sit up; back arched, neck extended; elbows out
              • Open-mouth breathing
              • Cyanosis
        • Circulation
          • Assess heart rate, heart rhythm, and perfusion parameters (pulse, mucous membranes color [MMC], and capillary refill time [CRT]
          • Heart Rate/Rhythm:
            • Stethoscope over left and then right side of thorax at the 4th-6th intercostals space
            • Tachycardia = dogs >180; cat >200
            • Bradycardia = dog < 70; cat <145
            • Muffled heart sounds = pericardial fluid, pleural air or fluid, abdominal organs in the chest, etc.
            • Pulse deficits = significant difference between the ausculted heart rate and palpated pulse rate = true emergency
            • Pulse rates should NEVER be used instead of ausculted heart rates, use as an adjunct.
            • Remember, pain, fear, and stress may cause an increased heart rate.
          • Perfusion (Pulse quality) = rough evaluation of circulatory function
            • Femoral pulses should be palpable and strong
            • Bounding pulses may indicate early shock
            • Absent pulses may indicate late shock or other circulatory failure
            • Pulses that are different on one side than the other in cats may indicate a saddle thrombus
          • Perfusion (MMC) = should be pink
            • Pale = +/- anemia or shock
            • Blue = cyanosis (hypoxemia)
            • Brick Red = early shock, sepsis, fever, heat stroke, etc.
            • Yellow or icteric gums = liver disease or red blood cell destruction
            • Brown = may indicate Tylenol (acetaminophen) toxicity
            • Red spots on skin +/- splotches on the gums = blood clotting disorder, potential for DIC
          • Perfusion (CRT) normal is 1 2 seconds
            • Prolonged = shock, heart failure, etc.
            • Short (<1 second) = anxiety, pain, or true abnormality
        • Neurological status
          • Level of consciousness (LOC) - AVPU
            • A = alert (normal)
            • V = responsive to voice
            • P = responsive to pain
            • U = unresponsive
            • Any level other than A requires immediate attention
  • SECONDARY SURVEY VITAL SIGNS
    • Repeat and reassess vitals done in primary survey
    • Include head to tail physical examination
    • Include a thorough history
    • Include Temperature on this survey
      • Hypothermic <100 degrees F (37.7 degrees C)
      • Hyperthermic >103 degrees F (39.4 degrees C)
      • Abnormal temperatures are a non-specific indicator of disease.
    • Review initial diagnostics (laboratory, radiographs, etc.)
    • Secondary survey initiated AFTER treatment of catastrophic emergencies has already begun

Courtesy of Elizabeth Warren, RVT and Deb Stafford, CVT, VTS (ecc)

The Nerd Book
The VSPN Nerdbook was created by veterinary technicians and veterinary support staff for their colleagues. The Nerdbook provides information that veterinary technicians and support staff need in practice, but is not meant to contain everything. Procedures and policies vary among practices, so feel free to modify your Nerdbook fit your facility.
Volume One
Contributors
Introduction
Clinical Pathology
You are hereCritical Care - Triage
Emergency-Receptionist tips
Medical Calculations
Medical Records
Medical Terminology
Pharmacology
Physical Exam
Preventative Health
Radiology

Address (URL): http://www.vspn.org/Library/Misc/VSPN_M02345.htm

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