Triage COPY

Question 1

Define triage

Answer 1

Triage is the prioritisation of critically ill or injured animals.

Question 2

What are the classes of triage?

Answer 2

Class 1-4

Question 3

What is involved in the telephone triage?

Answer 3

• Owner name, address and contact number
• Signalment – Name, species, age, breed, sex, neuter status
• Detailed history – when did it start, difficulty breathing, can animal move?, conscious?, any bleeding? Open wounds or fractures?
• Time to surgery and any directions needed
• Warn owner about health and safety + remaining calm

Question 4

What does the telephone triage allow for?

Answer 4

Preparation for the emergency case

Question 5

• You are in the middle of a ovariohysterectomy of an obese bitch
• The receptionist informs you ‘an emergency’ will be here in ‘any minute’
• Your colleague will return in ½ hour
• What do you do in the meantime?

Answer 5

• Keep working on the spay – get nurse to triage using checklist:
• https://inpractice.bmj.com/content/inpract/38/Suppl_4/6.full.pdf

Question 6

• The emergency has arrived
• The receptionist informs you that the owner ran over his dog as he reversed out of the drive
• The owner is in reception and is very distressed
• The dog is in his truck and he doesn’t know if it is still alive

What do you do next?

Answer 6

Send two nurses to safely get dog from the car on stretcher

Question 7

How do you assess the 4 main body systems of the case?

Answer 7

• MSK – radiography
• Cardio/resp – CRT, HR, BR, breathing effort, chest ausc, mucous membrane assessment (colour, tackiness etc)
• Neuro – reflexes (full body including PLR etc)
• GI – radiography, ultrasound, incontinence,

Question 8

What other procedures might you be doing concurrently with the primary survey?

Answer 8

• Primary = triage phone call+ severity of case (ABCD)
• Consent from owner, insurance status of dog, how much owners willing to spend, what outcome they would like, prepare for surgery if required
• Stabilise any life threatening conditions (eg. Not breathing – PPIV etc.)

Question 9

After performing a primary survey and the life threatening problems are being addressed, a more organised and in depth assessment of the patient can start

Why is this necessary?

Answer 9

Secondary survey – always important to perform indepth physical exam systematically to avoid overlooking any organ systems. Initial diagnostics (Haem, Biochem, radiographs), detailed Hx, TPR

Question 10

How can you assess airway?

Answer 10

Respiratory pattern and airway patency (confirm clear airways)

Question 11

How do you assess the cardiovascular system?

Answer 11

Circulation (BP, distal limb pulse + temperature), heart sounds, CRT

Question 12

How do you assess the respiratory system? (3)

Answer 12

Respiratory sounds, BR, any bruising or external chest wounds

Question 13

How do you assess the abdomen?(5)

Answer 13

Palpation, bruising and external wounds, ultrasound, free fluid, bladder integrity

Question 14

How do you assess spine and tail? (3)

Answer 14

Gate and posture, pain sensation, any crepitus

Question 15

How do you assess the head? (7)

Answer 15

Mentation, cognitive function, cranial nerve assessment (eyes – symmetry, 3rd eyelids, eye position, hemorrhage) ears, nose, check any bruising or external wounds

Question 16

How do you assess the pelvis? (4)

Answer 16

Wounds and bruising, crepitus, perineum and ext. genitalia

Question 17

How do you assess limbs? (6)

Answer 17

Deformities, fractures, pain, bruising, wounds, weight bearing?

Question 18

How do you assess arteries?

Answer 18

Pulse and pressure of all accessible superficial arteries

Question 19

How do you assess nerves? (7)

Answer 19

Cranial nerves tests, conscious proprioception, postural reflexes, peripheral spinal reflexes and withdrawal reflexes, cutaneous trunk reflex, deep pain, anal tone