Initial bloodwork evaluation may include measurement of a packed cell volume (PCV) and total solids by refractometry, blood glucose concentration, and electrolyte assessment. Sign up to The Veterinary Nurse's regular newsletters and keep up-to-date with the very latest clinical research and CPD we publish each month. gingivitis) or systemic (e.g. oxygen cage, thoracocentesis) (Figure 1b) (Rozanski and Chan, 2005). Animals with cardiac arrhythmias (e.g. The cardiovascular system is assessed by observation of mucous membrane colour and capillary refill time, combined with palpation of peripheral pulses. Basic triage (whether the pet should be seen by the veterinarian) Environmental concerns/hazards that might contribute to a particular condition; Long-term care monitoring; For these scenarios, telehealth tools provide sufficient information to assist pet owners without the necessity of Provide updates to the owners if applicable and allowed, especially if a pet was rapidly triaged for further diagnosics or interventions. Has the pet been to a boarding kennel, dog park, day care facility, animal shelter, or other similar venue in the past month? Snail Bait; Chocolate; Heat Stroke; GDV; Snake Bites Bradycardia in patients with head trauma is a serious emergency and may indicate impending herniation of the brain. Part 1 of this series will discuss respiratory and cardiovascular triage, and part 2 will cover triage of neurologic, urogenital, and other conditions. Stridor is commonly associated with animals with laryngeal paralysis; on inspiration the arytenoid cartilage from each side is pulled towards midline, creating a smaller aperture for air to travel through and consequently making a high-pitched noise (Holt, 2004). TRIAGE AND INITIAL ASSESSMENT Elisa A. Rogers CVT, VTS(ECC) MJR Veterinary Hospital University of Pennsylvania Philadelphia Pa Triage and Initial Assessment An emergency can be described as any situation that arises suddenly and unexpectedly resulting in a sudden need for action. Identifying effective methods of reducing client anxiety in an emergency situation. Seconds count and patients' conditions can rapidly change. These range from a sudden illness, to an injury, to more critical situations like poisoning or an animal attack. If the patient is unable to be calmed, however, it may be necessary to induce anesthesia and intubate the patient (Rozanski and Chan, 2005). All rights reserved.Veterinary Website by Beyond Indigo Pets.You can read our Privacy Policy here. A normal pulse should feel round and full, and should be easily palpable, with the possible exception being patients who are overweight. Yellow MM indicate increased amounts of circulating bilirubin (icterus or jaundice), which can occur with liver disease or haemolysis (Figure 2). Acetaminophen ingestion in cats will result in brown MM due to the presence of methaemoglobin. For the sake of your furry friend, be aware and prepare! Human triage models use levels or codes that are assigned to each patient, and which differentiate those patients who require immediate care from those who can wait for medical intervention. Normal CRT in a healthy, well-perfused animal is 12 seconds (Aldrich, 2005). It contains authoritative guidelines for the diagnosis, treatment, and prevention of animal disorders and diseases. there is not enough blood pressure to quickly refill the capillaries), or may be due to other systemic alterations such as vasoconstriction (which makes refill more difficult). Telephone Triage The initial triage may occur over the phone. Appropriate immediate action should be taken when necessary, based on triage history, physical examination, or both. If increased respiratory effort (dyspnoea) is observed, the effort should be characterized as inspiratory, expiratory, or both. Or, after a vigorous game of chase with the dogs at the dog park, your Fido comes back limping and wincing when you try to touch him. Cardiovascular triage assesses surrogates for perfusion and vascular volume status, in addition to cardiac rate and rhythm. Detection of a low heart rate (bradycardia) may also be a cause for concern, especially in cats. due to acute blood loss), cardiac disease, or sepsis (Boag and Hughes, 2005). Treat your pet as you would a toddler, and do a sweep of all potentially dangerous items, such as medications and house cleaners, and stow them away. Petechiae (small pinpoint haemorrhages) may also be noted on the MM, and can indicate thrombocytopenia (Figure 3). The triage examination is a rapid assessment of patients presented to the emergency room. Respiratory emergencies require rapid assessments and decisions. Pulse palpation is most easily accomplished using the femoral pulse, although the metatarsal pulses are also easily palpated in patients with adequate blood pressure (Hackett, 2009). Depending on how your veterinary receptionist responds to questions can make or break your average transaction charge. Evaluation of a veterinary triage list modified from a human five-point triage system in 485 dogs and cats. Certain cardiac arrhythmias may result in tachycardia as well; both ventricular and supraventricular (e.g. Patients presenting in this manner require immediate assessment for systemic disease. Pulses of varying strength may be indicative of a cardiac arrhythmia or of a situation such as pericardial effusion where the cardiac output is compromised (Hackett, 2009). Cats with asthma frequently have a history of a chronic cough, and the owner may also reveal a history of exposure to allergens, such as might be released during home renovations (Dye et al, 1996; Rozanski and Chan, 2005). While there is no magic wand to rid your pet of all potential emergencies in their life, emergency preparedness is key to quick response. Almost every pet will experience a veterinary emergency in their lifetime. Here is a list of medical emergencies that come through our door. The strength of the pulse should also be palpated. Tachycardia may be associated with shock due to hypovolaemia (e.g. The first order of business is to have a pet emergency plan. Owners may also comment on abnormal respiratory noise, or a change in vocalizations. MA Healthcare Ltd A confident veterinary technician with a strong knowledge base, excellent communication skills and the ability to make quick triage decisions will strengthen the team, and contribute to the optimal care of the emergency patient. If the emergency is deemed critical, it is the most immediate level, meaning that its a dire situation, such as your pet isnt breathing. Stertor is a snoring sound created by the vibration of excessive soft tissues in the oropharynx (e.g. The most frequently accessed location is the gums. Plasma lactate concentration is also a helpful measure that can indicate the presence of decreased oxygen delivery to tissues in the body (Pang and Boysen, 2007). Triage examinations and decision making are skills like any other and need practise to improve. atrial fibrillation) tachyarrhythmias can be seen in the emergency room. The actions of the veterinary nurse are looked at from a legal, professional and ethical perspective, Scenario 3 Nic, a 38 year old arborist, has cut his left arm with a chain saw. The triage cardiovascular examination concentrates on mucous membrane (MM) colour, capillary refill time (CRT), and the palpation of pulses (which also allows calculation of heart rate and assessment of pulse quality) (Boag and Hughes, 2005). A follow-up simulation may include a mock conversation between the veterinary nurse and facilitator (who acts as the client). Tuesday, November 1, 2011. Knowledge of the signalment and common emergencies can help to direct questions. The following is a list of critical patients.
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