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ICU & Triage

WK 1

QuestionAnswer
Trier to sort identify patients with life threatening conditions organise patients according to severity not a full diagnostic work up or treatment plan
clear, concise questions, e.g. Current signs? When did they start? Progression? Are they alert? Are they ambulatory? What is their breathing like? Any wounds or trauma? Toxin ingestion? Current medical condition or medication?
Phone triage How to safely travel +/- commence treatment? What to expect
what is an emergency respiratory distress collapse or non responsive status epilepticus toxin ingestion trauma rapid abdominal distension or unproductive retching lack of urination, unproductive straining high temp nemates exotics
primary survey A B C D E Airway Breathing Circulation Disability External
Secondary survey A CRASH PLAN
A = Airway
C = Cardiovascular
R = Respiratory
A = Abdomen
S = Spine and tail
H = Head
P = Pelvis
L = Limbs
A = Arteries
N = Nerves
By full body system: Respiratory Cardiovascular Neurological Urinary Gastrointestinal Musculoskeletal Reproductive Etc….
FAST (AFAST / TFAST) Focussed Assessment using Sonography for Trauma/Triage/Tracking
Basic profile – NOT a diagnostic work up Might include: PCV Lactate Total protein Glucose Creatine Urea Electrolytes Blood gases Acid: base balance
owner communication appear calm and confident explain what to expect informed consent (CPR) Estimate CPR keep updated
principles of triage be prepared communication training manage the owner not just the patient
air way - possible abnormalities may patent (trauma, blood?)
cardiovascular - possible abnormalities tachycardia, reduced CRT, pale mm, signs of haemorrhage
abdomen - possible abnormalities haemoabdomen, ruptured bladder, pain on palpitation
spine and tail - possible abnormalities possible spinal damage - posture
Head - possible abnormalities reduced mentation, miosis, wounds (eg jaw)
pelvis - possible abnormalities possible crepitus, pain
Limb - possible abnormalities non weight bearing, fractures, pain, wounds
Arteries - possible abnormalities weak pulses
Nerves - possible abnormalities Ataxia, lack of reflexes
AFAST/TFAST Pneumothorax Pneumoperitoneum Haemothorax Haemoabdomen Uroabdomen
intensive care unit what are the aims of the ICU Continuous nursing support Provide specialised equipment and trained staff Continual evaluation of the physiological state of the patient Facilitate early recognition of life threatening complications Emergency resuscitation if required
Kirbys rule of 20 look at the table
AFAST/TFAST Pneumothorax Pneumoperitoneum Haemothorax Haemoabdomen Uroabdomen
intensive care record Tend to be a lot more detailed than hospitalisation sheets – A3 in size and plenty of room to write observations!
heatstroke Dogs and cats are homeotherms - 38.5oC Normal cooling mechanisms: Vasodilation Sweat production (limited efficiency) Panting Behavioural changes If these fail, patient becomes hyperthermic
heat stroke vs pyrexia Hyperthermia elevation of body temperature due an inability to thermoregulate Pyrexia physiological response to an infection or inflammatory response
causes of hyperthermia hot enviroment excessive exercise prolonged seizure activity upper airway obstruction
Predispositions to hyperthermia Brachycephalic breeds Laryngeal disease Darker coloured coats Racing/working dogs Weight Lack of acclimatisation
Pathophysiology It’s warm... so what?! Compensatory mechanisms start to fail Pooling of blood = reduced circulating volume = hypotension = shock Denaturing of proteins Endothelial damage = coagulopathies = DIC GI damage = translocation of bacteria & diarrhoea Multi-organ failure
hyperthermia telephone triage what questions will you ask Keep shaded Hose/sponge with COOL water DO NOT IMMERSE IN WATER Fans if available Cooling mats ?? Wet towels ?? Offer small amounts of lukewarm water Travel in air conditioned car (or windows wide open)
clinical signs of heatstroke Markedly elevated temperature (sometimes >41oC!) Restlessness Panting Hypersalivation Tachypnoea Tachycardia Red mucous membranes Signs of coagulopathy Vomiting / diarrhoea Ataxia Collapse
treatment of heatstroke External cooling Wetting haircoat Fan Clipping CARE with wet towels IVFT – room temp or slightly cooled Supportive treatment +/- O2 +/- Cool water enemas +/- Peritoneal lavage
heat stroke nursing considerations IVFT Regular temperature checks (every 10mins) Vital parameters Blood tests Haematology, biochem, lactate, electrolytes, coags Urine output Care of the recumbent patient if required Nutrition
Created by: lucy.fox
 

 



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