Triage and stabilisation

Question 1

How do you prioritise cases for triage?

Answer 1

Emergency - requiring immediate assessment

Potentially serious - triage when available

Question 2

Give examples of cases which would fall into the emergency category

Answer 2

• Distended abdomen with non-productive retching
• Breathing difficulties
• Seizure lasting more than 5 minutes
• Collapsed animal
• Major trauma e.g. RTA
• Major bleeding
• Male cat unable to urinate
• Dystocia with pup/kitten stuck
• Toxic ingestion in the last 2 hours

Question 3

Give exams of cases which would fall into the potentially serious category

Answer 3

• Persistent vomiting and diarrhoea with lethargy
• New onset of seizures less than 5 minutes long
• Wounds without major bleeding
• Acute lameness
• Acute onset of a painful eye

Question 4

What are the initial steps involved in triage?

Answer 4

Aiming to get capsule history
- Presenting signs
- Current medical complaints/medications
- Onset and duration
- Consent for initial stabilisation*
Sort your patients into order of priority and explain what is happening to their owners

Question 5

What is the ABCD?

Answer 5

Alert – is the patient alert and awake
Breathing – can the patient breathe effectively
Circulation – is there a palpable pulse or heart beat. Is there major external haemorrhage
Disability – is there significant neurological concern

Question 6

What are the major body systems?

Answer 6

Systems where acute failure leads to rapid death

• Cardiovascular
• Respiratory
• Neurological

Question 7

What type of breathing is abnormal for cats?

Answer 7

Open mouth - immediately requires oxygen

Question 8

What signs are being shown during triage require immediate stabilisation?

Answer 8

Any of the ABCD (Alert, breathing, circulation, disability)

Major body system concerns

Question 9

What are the aims of stabilisation?

Answer 9

• Prevent current problems worsening
• Trying to find the cause of the problems
• Welfare: don’t forget about analgesia

Question 10

What could be the possible causes of an unconscious pateint?

Answer 10

• Hypoglycaemia: check blood glucose and give IV if low
• Severe shock: check CV
• Seizing: IV diazepam
• Toxins
• Heatstroke: patient temp and then active cooling
• arrested: start CPR

Question 11

What are the first aid steps when there is a patient struggling to breathe?

Answer 11

• Reduce stress and provide oxygen
• Consider sedation to minimise stress if needed – butorphanol
• Determine location e.g. obstruction, upper airway, lower airway, pleural space

Question 12

How can you determine the location of a respiratory problem?

Answer 12

Upper = noise on inspiration
Lower = expiratory effort
Pleural space = paradoxical breathing pattern

Question 13

What are the first aid steps when there is an external wound/haemorrhage?

Answer 13

• GLOVES
• Direct pressure on the wound with swabs
• Do not remove base layer of swabs, keep adding if soaking through
• Analgesia important
• Support CV system
• If not able to control bleeding with pressure aim to get BP normal and then surgical control of haemorrhage

Question 14

What are the first aid steps when there is an internal haemorrhage?

Answer 14

• Pale collapsed patient with evidence of cardiovascular exam abnormalities
• Find source: POCUS of body cavities (ultrasonography)
• Stabilise cardiovascular system => fluids to normalise blood pressure
• Definitive control (usually surgery) once stable

Question 15

How should the following neurological conditions be treated with first aid:

• Seizures
• Head trauma

Answer 15

1. Treat with appropriate medications e.g. diazepam

2. fluids, analgesia, elevate head

Question 16

What are the most important parts of having an effective and efficient triage?

Answer 16

• Prep in advance: as soon as you are told a possible emergency is on the way, get all the equipment you might need together
• Communication with the owners is key, keep them well informed
• Trust your gut
• Emergency grab trays