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POVN - Emergencies
Emergencies
| Question | Answer |
|---|---|
| What Are The Two Categories Of Emergency? | Life Threatening = Without immediate treatment the animals life is in danger. Minor Emergencies = In which the animal needs immediate treatment but its life is not in danger. |
| Who Can Perform First Aid? | -The veterinary surgeons act 1966 states that diagnosis and treatment of animals can only be performed by veterinary surgeons. -However first aid can be carried out by anyone provided that it is to preserve life and prevent suffering. |
| What Are The Limitations Of First Aid? | -No or a very limited time for preparation. -May be no qualified personnel at the scene. |
| When Can Emergencies Happen? | -Inpatient with pre-existing conditions. -Coming into practice. -Warning over the phone. |
| What Details Should Be Collected Over The Phone In An Emergency? | -Name, address and telephone number (in case they get cut off). -Are they a client, is their animal registered? If not get details. -Get a brief history of the emergency. -Give detailed directions to the surgery and ask for an ETA. |
| How Must Emergencies Be Handled? | -With care as they may be aggressive due to pain/fear, restraint most likely necessary. |
| What First Aid Must Be Carried Out For Animals With Broken Limbs? | -Splint leg. |
| What First Aid Must Be Carried Out For Animals With Haemorrhaging? | -Apply pressure to site. -Tourniquet (if a serious arterial bleed tourniquet must be removed for one minute every 15-20 minutes to allow blood flow to resume). |
| What First Aid Must Be Carried Out For Animals With Burns? | -Douse area in cold water for 10-15 mins, then apply cold/moist dressings on route to the practice, cling film. |
| Define Triage | Evaluation and allocation of treatment to patients according to a system of priorities designed to maximise the number of survivors . |
| What Does ABC Stand For As Part Of An Initial Survey? | Airway Breathing Circulation *Also assess consciousness* |
| What Major Bodily Systems Should Be Assessed After The Initial Survey | -Cardiovascular = Pulse, heart rate, ECG, CRT, blood pressure, etc. -Respiratory = Rate, effort, pattern, mouth breathing in cats, administer oxygen. -Neurological = Mentation, gait, nystagmus, pupillary light reflex, etc. |
| How Often Should Emergency Patients Be Checked Upon? | -Every 15 minutes. |
| What Checks Are Made As Part Of The Secondary Survey Of An Emergency Patient? | -Full clinical examination (head to tail). -History from owner: Allergies? Medications? Past medical issues? Last meal/meds? Event details? |
| What Common Injuries Are Sustained In RTA's? | -Fractures (jaw, pelvis, limbs). -Head trauma. -Ocular trauma. -Pneumothorax. -Spinal injury. -Haemorrhage. |
| What Should Be Done If Spinal Trauma Is Suspected In An Emergency Patient? | -Keep the patient flat. -Handle with caution – do not move patient unless instructed to by a vet. |
| What Should Be Done If Thoracic Trauma Is Suspected In An Emergency Patient? | -Keep patient quiet and calm. -Supplement with oxygen. |
| What Equipment Would You Prepare For An RTA? | Crash kit Oxygen IV catheters and supplies inc fluids Heat pad + blankets and other warming devices Monitoring equipment Hospital/monitoring sheets Warm padded kennel Thermometer Radiography Clippers, scrub etc. Bandage material Pen torch |
| What Is Shock? | A state of acute circulatory collapse - circulation is unable to transport sufficient oxygen to meet the tissues needs. |
| What Is Hypovolaemic Shock? | -Occurs due to a significant loss of circulating volume - haemorrhage. -Most common form of shock, common in RTAs. |
| What Are The Clinical Signs Of Shock? | -Haemorrhage. -Poor pulse quality +/- pulse deficit. -Tachycardia. -Pale mm. -CRT > 2s. |
| What Are The Treatments For Shock? | -Attempt to stop bleeding where possible (direct digital pressure, artery forceps, pressure dressing). -Fluid replacement. -Warm patient slowly – if hypothermic. |
| What Are The Five Levels Of Consciousness? | -Normal or alert. -Depressed. -Obtunded. -Stuporous. -Comatose. |
| Define Altered Consciousness | A state of mind that differs from the normal state of consciousness – loss or change in awareness or response to the surroundings (patient mentation). |
| Define 'Normal Or Alert' Consciousness | Alert and responsive to stimulus and patient displaying signs of normal behaviour/mentation. |
| Define 'Depressed' Consciousness | Alert but not as responsive to stimulus. Quiet, may respond to stimulus such as calling their name or clapping. |
| Define 'Obtunded' Consciousness | Collapsed, decreased level of consciousness, will only respond to painful stimuli. |
| Define 'Stuporous' Consciousness | Unconscious, only rousable in response to painful stimuli. |
| Define 'Comatose' Consciousness | Unconscious and not rousable to painful stimuli, palpable heart and pulse rate present. |
| What Are Some Differences Between A Deceased And Unconscious Patient? | Unconscious patients have (while deceased patients don't have)... -Heart rate and respiration rate (however may be slow). -Moist corneas. -Stable body temperature. -Pupillary light reflex. -Anal tone. -Flaccid muscles. |
| What Are Some Causes Of Altered Consciousness? | -Metabolic disease. -Vestibular disease. -Hypoglycaemia or hyperglycaemia (diabetes melitus). -Trauma (especially head trauma). -Poisoning. -Heat stroke (hyperthermia). -Drowning. -Asphyxiation. -Hypercapnia. -Electric shock. -Neoplasia. |
| What Advice Can Be Given To Clients Over The Phone With Patients With Altered Consciousness? | -Remain calm. -Maintain the airway. -Monitor mucous membrane colour and respiration. -Transport patient to Veterinary Practice ASAP. -Cover the patient’s body to help keep them warm. |
| What Should Nurses Do With A Patient In A State Of Altered Consciousness? | -Remain calm. -ABC. -Notify a Veterinary Surgeon. -Establish cause of altered consciousness. -Provide supportive care treatment. |
| What Are Some Causes Of Respiratory Distress? | -Ruptured Diaphragm. -Pneumothorax. -Pyothorax. -Airway obstruction. -Pulmonary Oedema. -Pleural Effusion. -Asthma. -Thoracic Trauma. |
| What Are Some Clinical Signs Of Respiratory Distress? | -Cyanotic Mucus Membranes. -Abducted Elbows. -Paradoxical Abdominal Movements. -Hypersalivation. -Open Mouth Breathing. -Extended Neck. -Dilated Pupils. -Collapse. |
| What Should Nurses Do With A Patient In Respiratory Distress? | -Remain calm. -ABC, notify a Veterinary Surgeon. -Minimal handling. -Provide supportive care treatment, sedate if required. -Keep the patient cool. -Be prepared for endotracheal intubation, tracheostomy and CPCR. |
| What Are Some Ways In Which We Can Give Patients Oxygen? | -Flow-by Oxygen. -O2 Mask. -Nasal Prongs. -Nasal Catheter. -Transtracheal Catheter. -Improvised Oxygen Cage. -Oxygen Cage/Incubator. -Intubation and Ventilation. |
| What Is The Difference Between Arterial and Venous Haemorrhage? | Arterial = Ruptured artery, blood spurts out in large volumes, can lead to death. Venous = Ruptured vein, dark red, low pressure blood oozes out, less critical. |
| What Are The Clinical Signs Of Haemorrhage? | -Visible external blood loss. -Contusions (internal haemorrhage). -Distended and painful abdomen. -Dyspnoea. -Pale and/or petechial mucous membranes. -Melena/haematemesis (GI haemorrhage). -Shock in severe cases. |
| How Can Haemorrhages Be Controlled? | -Direct digital pressure for at least 5 minutes using fingers/hands. -Pressure dressing and bandage. -Artery forceps (haemostats) if artery visible. -Pressure points. -Tourniquet. -General anaesthesia and surgical intervention. |
| Define Anaphylaxis | Occurs when the body has an allergic reaction to an allergen to which the patient has become sensitised. Can be localised or systemic. |
| What Are The Clinical Signs Of Anaphylaxis? | -Localised inflammation and swelling. -Tachycardia. -Hypotension. -Vomiting. -Tachypnoea, dyspnoea/bronchoconstriction. -Shock (distributive). -Collapse, seizures and death (severe anaphylaxis). |
| What Are The Treatments For Anaphylaxis? | -Remove agent causing reaction. -ABC and take appropriate action based on findings. -IVFT to target shock and dehydration. -Life support. -Epinephrine, antihistamines, corticosteroids. -Intensive monitoring (24-48 hours). |
| Define Seizure | A seizure is an acute disturbance of the electrical activity of the brain. |
| What Are The Causes Of Seizures? | -Idiopathic. -Neoplasia. -Trauma. -Toxins. -Inflammation. -Infection. -Metabolic disorders. |
| What Are The Stages Of A Seizure? | -Pre ictal. -Ictal. -Post ictal. |
| What Are The Three Classifications Of Seizure? | Petit Mal = Short minor convulsions, consciousness. Grand Mal = Loss of consciousness and violent muscular contractions. Status Epilepticus = Repeated convulsions lasting >5 minutes without the animal regaining consciousness = life threatening. |
| What Advice Should Be Given To Clients Regarding Seizures? | -Record the time the seizure begins and ends. -Monitor the animal closely, do not handle. -Remove any harmful objects. -Turn off lights and maintain a dimmed and quiet environment. -When safe to do so, transport the animal to the veterinary practice. |
| What Should Nurses Do With Seizuring Patients? | -If seizure activity is evident, administer anti-epileptic drugs. -Monitor patient vitals and keep their airway clear. -Gain and maintain intravenous access. -Administer oxygen if required. -Lubricate eyes. -Maintain dimmed and quiet environment. |
| What Are Some Clinical Signs Of Hypoglycaemia? | -Altered mentation and behaviour. -Seizures, muscle twitching and tremors. -Syncope. -Somnolence. -Ataxia. -Exercise intolerance. -Collapse. -Impaired vision. -Death. |
| What Are Some Clinical Signs Of Hyperglycaemia? | -Polydipsia. -Polyuria. -Polyphagia. -Weight loss despite a good appetite. |
| Define Poison | Substance that when introduced into or absorbed by a living organism, causes illness or death. |
| What Are The Main Poison Categories? | -Human food. -Plants. -Household/garden chemicals. -Noxious gases. -Drugs. |
| Give Some Examples Of Human Foods Toxic To Dogs? | Raisins, grapes, peaches and stones, mushrooms, macadamia nuts, coffee/caffeine, chocolate, alcohol, onions, chewing gum and peanut butter. |
| What Are Some Clinical Signs Of Chocolate Toxicity? | -Gastrointestinal signs. -Restlessness. -Hyperactivity. -Panting and vomiting. -PUPD. -Tachycardia, cardiac arrhythmias and seizures (in higher doses). |
| What Are The Treatments For Chocolate Toxicity? | -Decontamination. -Activated charcoal. -IVFT and drugs to treat cardiac arrhythmias. |
| What Plant Is Extremely Toxic To Cats? | Lilies - Acute renal failure. |
| What Are The Clinical Signs For Lily Toxicity? | -Hypersalivation. -Vomiting. -Lethargy. -Inappetence. -Dehydration. -PUPD, followed by anuria (1-2 days after ingestion). |
| What Are The Treatments For Lily Toxicity? | Decontamination and aggressive IVFT. |
| What Are The Clinical Signs Of Paracetamol Toxicity? | Tachypnoea, tachycardia. -Dyspnoea. -Cyanosis. -Oedema of face and paws. -Hypersalivation. -Lethargy, vomiting. -Jaundiced mucous membranes, liver damage, abdominal pain, icterus, collapse. |
| What Are The Treatments For Paracetamol Toxicity? | N-acetylcysteine, decontamination, activated charcoal, IVFT, oxygen therapy, blood transfusions. |
| Name Some Toxic Household/Garden Chemicals? | -Anti-freeze (ethylene glycol). -Disinfectants (bleach, dettol). -Rat poison (warfarin, anticoagulant rodenticides). -Weed killer (paraquat). -Slug bait (metaldehyde). |
| Define Burn | A burn is a lesion caused by an extreme of temperature (hot or cold) or by contact with a chemical substance, electricity or radiation. Can result in both local and systemic complications. |
| What Causes Dry Burns? | Contact with a heat source - hot objects, fire, heat pad. |
| What Causes Scald/Wet Burns? | Contact with hot liquids and flammable substances. |
| What Causes Cold Burns? | Contact with intensely cold objects, exposure to extreme cold temperatures/weather. |
| What Causes Electrical Burns? | Contact with a voltage source. |
| What Causes Radiation Burns? | Ultraviolet (UV) rays from the sun (sunburn), oncological patients receiving radiation therapy. |
| What Causes Chemical Burns? | Contact with caustic, acidic or alkali liquids (paint stripper, sulphuric acid, caustic soda). |
| What Are The Clinical Signs Of Burns? | -Erythematous, moist skin. -Charred, leathery skin (full-thickness burns). -Pain (less pain in full-thickness burns due to nerve ending destruction). -Singed hair and whiskers. -Localised heat. -Shock. |
| How Are Burns Managed? | -Primary survey, ABC, wear PPE. -Douse the burnt area in cool water for 10 mins. -Analgesia, treat the patient for shock. -Cover the area with a sterile non-adhesive dressing or cling film. -Maintain a warm room environment. -Wound management. |
| What Are The Potential Complication To Burns? | -Metabolic complications. -Smoke inhalation (house fires). -Infection. -Long term tissue damage/scarring. -Fluid loss and dehydration. -Pain. |
| Define Gestation Period | Foetal development period from the time of conception until birth. |
| What Is The Gestation Period For Dogs? | 56-72 days. |
| What Is The Gestation Period For Cats? | 64-68 days |
| What Is The Gestation Period For Rabbits? | 31-33 days. |
| Define Parturition | The act of giving birth. |
| When Is Prepartum Hypothermia Seen and What Temperatures Are Seen? | -8-24 hours prior to parturition. -35-37 degrees. |
| What Are The Five Stages Of Parturition? | 1) Preparation. 2) First Stage – Onset of contractions. 3) Second Stage – Propulsion of the foetus. 4) Third Stage – Passing of the placenta. 5) Puerperium – After parturition. |
| What Is Eclampsia? | -Hypocalcaemia secondary to pregnancy or lactation. -Commonly known as ‘milk fever’. -Most commonly observed in small breed bitches. -Can be life threatening if not treated. |
| What Are The Clinical Signs Of Eclampsia? | -Restlessness. -Agitation. -Anxiety. -Panting. -Hypersalivation. -Hyperthermia. -Tachycardia. -Twitching and trembling. -Muscular spasms. -Seizures. -Collapse. -Cardiac arrest. |
| How Can Eclampsia Be Treated? | -Slow intravenous infusion of 10% calcium gluconate. -Calcium and vitamin D supplementation. -Wean the puppies and start to hand rear. |
| Define Dystocia | Difficulty and/or abnormalities during the process of parturition (birthing). |
| What Are Some Causes Of Dystocia? | -Primary uterine inertia. -Secondary uterine inertia. -Breed disposition. -Abnormal pelvic canal. -Foetal malpresentation. -Foetal disproportion. -Foetal monsters. -Death of the foetus. |
| When Should Pregnant Dams See The Vet? | -Exceeds the average gestation period. -A drop in the dams rectal temperature then a return to normal with no signs of birth. -Weak, irregular and unproductive straining. -More than 2 hours since the last foetus. -Green, brown, black vulval discharge. |
| How Is Dystocia Diagnosed? | -Vaginal Examination. -Abdominal Ultrasound. -Abdominal Radiography. |
| What Are Some Treatments For Dystocia? | -Accommodation. -Manual manipulation and/or delivery. -Medical delivery. -Surgical delivery/caesarean section. |
| What Nursing Considerations Are There For Newborns Delivered By C-Section? | -ABC. -Airway - Clear the airway, break the sac, hold head lower than body. -Breathing - Stimulate breathing by rubbing, oxygen therapy. -Circulation - Check heartbeat and colour. -Warm and tie off umbilical cord. |
| What Are Some Common Congenital Abnormalities? | -Hydrocephalus. -Umbilical Hernia. -Cleft Palate. -Atresia Ani. |
| What Are The Clinical Signs Of Pyometra? | -Vomiting. -PUPD. -Weakness. -Lethargy. -Vaginal Discharge. -Abdominal Pain. -Shock. |
| What Are The Clinical Signs Of A Retained Placenta? | -Green vulval discharge. -Lethargy. -Abdominal pain. -Pyrexia. -Metritis (if retained placenta is not removed). |
| What Is Paraphimosis? | -The inability to retract the penis into its natural position within the prepuce. -Most common in small breed entire males. -Occurs after coitus or due to a small preputial orifice, reproductive emergency. |
| What Are The Treatments For Paraphimosis? | -Analgesia. -Keep moist/lubrication, clean the penis. -Manual retraction of the penis within the prepuce (often requires sedation or anaesthesia). -Surgical correction (especially if situation reoccurs). -Elizabethan collar. |
| What Is GDV? | -Abnormal accumulation of fluid and/or air within the stomach causing the organ to stretch beyond its normal dimensions. -Obstruction caused by twisting. -May also be known as ‘bloat’. |
| What Is The Pathophysiology Of GDV? | -Stomach compresses the caudal vena cava and hepatic portal vein. -Decreased cardiac output, blood pressure and tissue perfusion. -Decreased perfusion to the stomach. |
| What Are The Predisposing Factors Of GDV? | -Breed predisposition. -Increasing age. -Feeding dry food. -Feeding large meals. -Rapid consumption of food and/or water. -Exercise. -Lean/underweight body condition. -Stress, aggressive or fearful behaviour. |
| What Are The Clinical Signs Of GDV? | -Restlessness. -Non-productive retching. -Hypersalivation. -Abdominal pain. -Distended abdomen and tympany. -Reluctance to lie down. -May be recumbent. -Cyanosed mucous membranes, prolonged CRT. -Tachycardia, tachypnoea. -Weak pulses. -Dyspnoea. |
| What Are The Treatments For GDV? | -Check ABC’s. -Stabilise the patient. -Intravenous Fluid Therapy. -Analgesia. -Radiography. -Decompression. -Surgery. |
| How Can GDV Be Prevented? | -Smaller frequent meals. -Slow transition when introducing new foods. -Slow consumption of food and water. -Do not exercise the dog before or after food. -Prophylactic gastropexy. |
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