Page 509 - ONLINE PROCEEDING BOOK WSAVA 2017
P. 509

WSVA7-0281
NURSES I
TRIAGE AND ASSESSMENT OF THE EMERGENCY PATIENT
D. McBride1
1Royal Veterinary College, Clinical Sciences and Services, North Mymms, United Kingdom
TRIAGE AND ASSESSMENT OF THE EMERGENCY PATIENT
Duana McBride BVSc DACVECC MVMedSc MRCVS
Royal Veterinary College, Hawkshead Lane, North Mymms, United Kingdom
dmcbride@rvc.ac.uk
Triage by de nition is ‘the sorting of patients for treatment priority when resources are insuf cient for all to be treated immediately in an emergency setting’. This concept originated in the 1700s in warfare to treat mass casualties, and has been applied to organise human emergency rooms to maximise the available staff and facilities while optimising patient outcome. A veterinary triage system, modi ed from the Manchester Triage Group was validated to be more effective than subjective assessment of patients when sorting emergency patients. One system the author has used which summarises these systems is described in the table below:
Although these systems are available, it is challenging
to develop a universal consensus triage system due to the variability in hospital size, staf ng and facilities. In developing a system for your hospital the key elements of triage should be considered:
· Being prepared and well equipped at all times.
· Rapid assessment and treatment of the respiratory, cardiovascular and neurological systems; using brief history, physical exam and minimal diagnostics.
· Training of veterinarians and technicians/nurses in triage.
· Good communication between staff and with clients.
Respiratory Assessment
Physical examination:
Initial assessment involves observation of respiratory rate, effort and pattern. Normal respiratory rate is 8 – 40 breaths per minute. Upper respiratory tract disease results in inspiratory dyspnoea, while lower respiratory tract disease usually results in expiratory dyspnoea.
If cyanosis is observed, this indicates presence of severe hypoxemia (PaO2 < 60 mmHg; SpO2 < 90%) and requires immediate oxygen therapy.
Auscultation should be performed by dividing the thorax into 9 quadrants. Decreased lungs sounds ventrally can be due to pleural effusion, dorsally due to pneumothorax, while decreased or displaced lung sounds can be due to diaphragmatic hernia/rupture.
Thoracocentesis
If ultrasound is unavailable, and physical examination indicates a possible pleural effusion or pneumothorax, thoracocentesis can be a life-saving therapeutic and diagnostic tool.
Pulse oximetry
Pulse oximetry provides a minimally invasive assessment of a patient’s oxygen levels. Normal is 98 – 100%, hypoxaemia is < 93 – 95%, and severe hypoxaemia is < 90%. Any value below 95% must receive oxygen therapy. Another advantage of pulse oximetry is that response to oxygen can be monitored. However its use can be limited in the emergency room as movement, hypoperfusion, icterus, pigmentation, oedema, and severe hypoxaemia can result in inaccurate readings.
An Urban Experience
Triage Clas- si cation
Time to Veterinary Attention
Examples
1
Immediate
Arrest, near arrest, unconscious, seizure
2
< 10 minutes
Shock, severe pain, trauma, dyspnoea, recent toxin
3
< 1 hours
Moderate dehydration, mild/ moderate pain, historical seizures
4
1-2 hours
Vomiting, diarrhea, minor wounds
5
1 – 4 hours
Lame, skin, cough
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