Emergency Medicine
Emergency medicine represents an exciting and developing field in veterinary medicine. Success in emergency medicine requires a strong knowledge base in all areas of medicine and surgery and the ability to make decisions in an expedient fashion.
Triage refers to the evaluation of patients in order to determine urgency of further therapy and to help prioritize cases for care by the veterinarian and the technician. Triage may occur initially over the telephone or may occur when a patient is presented to the animal hospital. ‘Telephone triage’ may be very difficult to perform safely. In many daytime practices and emergency hospitals, clients frequently call for advice on whether or not a situation is an actual emergency. In practice settings, where the clients are well known to the receptionists or technicians, it may be easier to determine the ability of a client to recognize an emergency in their pet. In general, the safest advice is ‘if the client thinks it is an emergency then the pet should be seen’. However, it may be possible to help the clientover the phone. Any animal that has collapsed, is having difficulty breathing, or has suffered a major trauma should obviously be seen immediately without the need to ask further questions. Otherwise, basic questions regarding signalment, past medical history, and clinical signs exhibited by the pet should be asked. It is important to maintain control of the conversation politely but firmly. The receptionist/technician should try to verify the stability of the major body systems (cardiovascular,respiratory, and neurological). Ideally the emergency policy of the practice should be well understood among all employees and be well explained to the clients prior to the development of an emergency situation. For example, some practices always (24 hours a day) want to see their own emergencies, while other hospitals elect to refer some emergencies to other facilities, depending on the time of day and theactivity level in the hospital. Appropriate triage of the patient presented to the animal hospital is an important job for the veterinary technician in all types of veterinary hospitals. All animals that are presented for emergency care should be evaluated by a technician for stability within moments of arrival. Some emergency conditions require immediate therapy to prevent the death of the patient. The patient should be rapidly evaluated for stability of the major body systems. A brief (‘capsule’) history from the owner should also be obtained. A triage should generally be able to be completed within 2–3 min of patient arrival. The ABCs (airway, breathing, circulation) should be immediately assessed. The technician should try to follow a systematic approach to triage to ensure that no step is overlooked and to help with efficiency. The breathing pattern and effort should be evaluated. Any animal appearing to have difficulty breathing requires immediate further therapy. Loud or noisy breathing oftensuggests upper airway obstruction, such as may occur with laryngeal paralysis. Short, shallow breathing suggests pleural space disease, such as pleural effusion or pneumothorax. Laboredbreathing often indicates low oxygen levels (hypoxemia) that may occur with pneumonia or CHF. The cardiovascular system may be evaluated by checking the mucous membrane color and capillary refill time, heart rate, and the pulse quality. |
The neurological status of the pet should also be evaluated. A typical dog or cat should be alert and oriented to his environment. Any mental depression suggests that further evaluation is indicated. The bladder of any male cat with abnormal behavior should be palpated for possible obstruction. Finally, the capsule history from the owner should be evaluated for any historical complaints that would require rapid therapy (such as the ingestion of rat poison or other toxins). After triage, patients should be assigned to either the ‘stable’ or ‘not stable’ category. Patients that are stable should be cared for using the standard approach at the specific veterinary hospital. Patients that are unstable should have immediatecare begun. Patients with signs of cardiovascular instability (tachycardia, weak pulses, prolonged capillary refill time), should be immediately placed on a treatment table and given supplemental oxygen. An intravenous catheter should be placed and blood samples should be collected for analysis (ideally a CBC, biochemistry profile, and urinalysis) but minimally a PCV/total solids/glucose/ azo-stik. Shock fluid therapy may be begun ifthere is no concern about cardiogenic shock. Patients with respiratory instability should be administered supplemental oxygen and kept in a quiet environment. Pets (particularly cats) are intolerant of stresses when respiratory distress is present so testing should be kept to a minimum. Animals demonstrating mental depression should be evaluated for metabolic causes and placed in a cage where their mental status can be easily assessed. Some animals that appear depressed may be weak from other causes, such as anemia orhypoglycemia. |
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