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168 Cards in this Set
- Front
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What is an Emergency?
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A situation that poses an immediate risk to health and life.
Or a situation that has a high probability of escalating into an immediate cause of danger to health and life. |
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Why do clients arrive at emergency clinics?
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Regular clinic already closed.
Specialty testing Observation Pre/Post Surgery Care Cantagious or Zoonotic |
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How do clients typically arrive at emergency clinics?
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Call ins
Walk ins sometimes also referrals Typically no history |
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Who will your clients be?
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Private Owners
Agency drop offs Other vets Haulers / Trainers Educated & Ignorant Owners No Owners |
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What are some of the possible conditions of the patient animal?
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Dead
Barely alive Bleeding Respiratory / Cardio Distress Open wounds Parasite Infestation No external signs Preferectly healthy |
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What do you expect in emergency medicine?
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Expect anything.
Have to be prepared for anything. Some shifts are simply monitoring patients. Some shifts have multi calls and monitoring current patients. |
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What are some types of emergencies?
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Trauma
Respiratory Problem Cardiovascular GI/Abdominal Urogenital Musculoskeletal Ocular Toxic |
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Can you recognize an emergency when it walks in the door?
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It's a train wreck!
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What is the primary GOAL of emergency medicine?
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Stabilize the Patient!
Take away the immediate threat to life! |
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What is a stabile patient?
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Vital signs within normal limits.
Patient is relatively comfortable. |
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What are some special considerations of emergency medicine?
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Owners state of mind!
Resources People Equipment $$$$$ (Money) |
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What are emergency protocols?
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Standardized procedures for common clinical presentations and Written Procedures & manuals.
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What is the three step systematic approach to an emergency?
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Through examination
Triage and prioritize Monitor |
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What does MM stand for?
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Mucus Membranes
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What does CRT stand for?
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Capillary Refill Time
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What does CV stand for?
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Current Vitals?
Pulse, Heart Rate, Heart Rhythm |
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What is Triage?
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Prioritization of patients based on a quick check of their major body systems.
1. MM, CRT 2 CV - Pulse, Heart Rate, Heart Rhythm 3 Respiratory 4 Neurologic 5 Musculoskeletal |
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How do you prioritize in an emergency situation?
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Vital signs are unstable and not within normal limits!
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How do you prioritize in multiple emergencies?
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Severity
Save the one you can save Resources |
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What does ABC of emergency stand for?
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Airway!
Breathing! Cardiac! |
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What is the top priority in the cardiovascular system emergency?
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It's a top priority in combo with respiratory!
MM CRT Femoral artery pulse Auscultation Blood Loss - MM color, CRT hematocrit with TP |
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What is one of the essential treatments in helping an animal in an emergency?
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Treatment of pain!
Decreases stress Helps patients mental health Easier to treat! analgesic (opioids) can depress or slow down cardiac and respiratory. NSAIDS may effect GI and renal. Systemic or Local admin |
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What are some signs of pain?
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Vocalization
Depression Panting Hypertension Hypotension Anorexia Increased temperature Tachycardia Tachypnea Pale MM Aggression Abnormal posture Excess salivation Dialated pupils |
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What are some signs of Shock in an animal?
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Perfusion failure!
Impaired delivery of oxygen to the cells! Evaluate by skin color of MM, Temperature, and capillary refill time. |
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What is it called when oxygen needs are not met?
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Hypoxia!
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What happens in a hypoxia state?
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Ischemia - Loss of Blood Supply
Necrosis! Organ failure Death! |
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What does the body do in the first parts of shock!
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Vasoconstriction!
Increased heart rate! Maintain blood pressure Increase cardiac output! |
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What are the signs of an animal in the first phase of shock?
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Increased heart rate and respiratory rate!
Pounding pulse! Bright red mucus membranes! |
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What does HR stand for?
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Heart Rate
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What does RR stand for?
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Respiratory Rate
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What does the body try to do during shock?
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It tries to compensate and move blood (oxygen) to vital organs such as the brain and heart at the expense of other organs!
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What is hypovolemic shock?
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Loss of blood volume! Dehydration!
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What is distributive shock?
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Pooling of blood! Vasodilation!
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What is cariogenic shock?
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Decreased heart output!
Heart disease, Obstructive shock |
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What is septic shock?
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Triggered by infections!
Tissue is damaged, necrosis, cyclic, toxicosis! |
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What are the basic steps that we do in emergency medicine?
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1. Assess!
2. Prioritize! 3. Deal with ABCs, Pain and Shock! 4. Stabilize 5. Monitor 6. Diagnosis & Prognosis 7. Treatment |
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What are the two major things you need to think about on an emergency phone call with a client?
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What are you going to ask the client?
How to assess the situation? |
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What are good questions on the phone with a client?
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What's the pet doing?
For how long? Previous problems? Any medications? Changes in breathing? Vomiting? Eating and drinking? Gum color? Weight loss? Toxins & Poisons? Any chance of physical trauma? Blood loss? |
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What is something that should be in the back of your mind but you hopefully personally won't have to deal with directly concerning the client?
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The aspect of money! Emergency medicine is expensive!
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What is the most important aspect to remember on the phone!!!
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You are the tech and you don't diagnose things on the phone!
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What's the first rule in every service industry?
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Client is always right!
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If the client thinks its an emergency is it?
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Yes it is, no matter what the situation is.
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What is the most important safety concern in an emergency?
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The clients safety!
Animals that are suffering can be very dangerous! |
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In an emergency situation when the client arrives what do you need to do?
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Be concise and efficient, assessing the emergency.
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When you think you have seen everything! What happens?
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Be ready for anything. You can never expect everything. You must be OVER prepared!
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What are you always assessing?
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The patient!
We don't worry about the machines. They are tools. If the machine says one thing and the patient seems contrary toss the machine and get to work! Treat the patient, not equipment or lab results! |
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What are the responsiblities of the vet tech in trauma medicine?
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Receive and screen phone calls!
Prepare emergency room and supplies Establish airway and ventilate Place IV catheter Set up connect monitoring equipment Maintain charts/records of drugs and patient status Communicate with clients regarding status of patient. |
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What do you need to do before patient arrival?
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Prepare for a serious injury arrival!
The entire staff should be informed on incoming emergency so that they can be prepared! Prepare the trauma area! |
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What does a crash cart have?
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Contains materials to establish an airway, place an IVC, stop bleeding.
Emergency drugs! Dosage charts! Cheat sheet! Blood tubes! Cold Pack Treatment & Wound Pack IV fluid set up Diagnostic tools General suppplies (You don't want to think, worry, or look for things. You want to act immediately!) |
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During Triage the vet is going to do what with you as the vet tech?
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They are going to rely on you for accurate information!
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What does Hx stand for?
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History
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What is the pimary client survey composed of?
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Brief history!
Duration? Rabid or Slow? Previous history of problem? Medications? Toxins? Trauma? Travel history! Vaccination status? Focus on most life threatening problems first! Goal is to get adequate delivery of oxygen to all tissues asap! |
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What is one of the biggest problems in an emergency?
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It is easy to be distracted by grotesque abnormalities that may have nothing to do with saving the patients life!
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What is a major concern in dealing with any emergency situation of an animal?
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Safety First!
Nice animals can be vicious when scared, pained, or stressed! |
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What are some priority patients?
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Unconcious or unresponsive!
Cardiac or respiratory arrest! Active seizure! Respiratory distress! Profuse bleeding!' Pain |
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What is the first objective of the primary survey?
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To find out if the patient is stable enough to allow a slower and more methodical approach.
If ABC's are in deficit those must be delt with immediately! |
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The A of ABC's is?
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Airway!
Is the animal moving air? Is it open? Noise? Obvious swelling? If not open treat ASAP! |
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The B of ABC's is?
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Breathing!
Noises? MM Color? Initial therapy is find a way to oxgenate tissues! |
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The C of ABC's is?
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Circulation!
Is the heart beating? Strength of pulse? Heart rate? Bleeding? |
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When is the secondary survey done?
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After the patient is relatively stable you can slow down a little and do a more through physical exam from head to toe!
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What does PE stand for?
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Physical Exam!
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What does TPR stand for?
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Temperature
Pulse Respiration |
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What is the most common way to take a temperature on an animal?
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Rectally!
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Need to know the normal temperature ranges for common animals!
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What are they?
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Need to know the normal pulse ranges for common animals!
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What are they?
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Need to know the normal respiration rate for common animals!
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What are they?
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What does signalment stand for?
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What is this?
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What do you present to the vet?
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Signalment!
Primary Complaint Physical Exam Findings! |
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What two parts is blood composed of?
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Plasma (proteins) and Cells
Cells: Red, White, Platelets |
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What is a transfusion essentially?
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Blood transfusions are essentially temporary tissue transplants.
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What is an RBC (Red Blood Cells) normal life span?
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100 days.
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Is transfused bloodl lifespan shorter or longer?
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Shorter!
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A transfusion provides what?
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plasma proteins and coagulation factors until the animals body can do the job.
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What are the major indications for transfusions?
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Blood loss (hypovolemia)
Poor Oxygen Capacity (anemia) Bleeding disorders Loss of plasma proteins. |
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What do plasma proteins do?
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Transport molecules like lipids, hormones, vitamins.
As enzymes block protein breakdown and stop inflatmation. Also stops viral growth, immune system. |
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What is oncotic pressure?
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Large plasma proteins cannot easily cross the capillary walls. Pulls fluid into and keeps fluid from leaking out.
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What is hemostasis?
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The body's natural attempt at stopping blood loss and maintaining blood flow.
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What is primary hemostasis functions?
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Vascoconstriction
Platelet Aggregation - Form a Plug |
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What is secondary hemostasis functions?
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Creation of fibrin - form barrier.
Fibrinolysis - Digest clot after healing. |
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What are some hemostasis disorders?
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Low platelet counts
Immune-mediated desruction of platelets Decrease in function + response Coagulatin factor deficiencies Causes: hemophilia, liver disease |
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What is Anemia?
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Decrease in circulating RBC (red blood cells)!
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What does RBC stand for?
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Red Blood Cell!
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What are four types of Anemia?
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Regenerative - bone marrow capable of regererating cells.
Non-Regenerative - bone marrow not capable of reproduction. Normovolemic - Normal blood volume but chronic blood loss. Hypovolemic - Loss of RBC's and plasma. |
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One cause of regenerative anemia is Hemorrhage (physical blood loss)! What are some of the underlined issues that can
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A. Blood sucking parasites.
B. Gastrointestinal lesions. C. Urogenital lesions. D. Hemorrhage into body cavity E. Trauma (Wounds) F. Blood clotting issues (Hemophilia) |
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What are two major causes of regenerative anemia?
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Hemorrhage
and Hemolysis |
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What is hemorrhage?
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physical blood loss!
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What is hemolysis?
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Destruction of red blood cells!
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What does blood loss do to intravascular space?
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It casues a change in volume which changes the pressure. This affects packed cell volume, protein levels, and delivery of oxygen.
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In an acute blood loss situation what is the goal?
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Improve blood volume and oxygen carrying capacity!
1. Stop bleeding! 2. Get blood volume levels restored! |
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How is accute blood loss tested?
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MM, CRT, Urine outpot
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What does PCV stand for?
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Packed Cell Volume!
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In an acute blood loss situation what can be misleading?
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PCV!
Packed Cell Volume because of vasoconstriction. As volume is restored PCV will begin to drop! |
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Chronic blood loss leads to?
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Normovolemic anemia!
Gradual onset of signs and PCV is below 20% |
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What's important to remember in a chronic blood loss situation?
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Improve oxygen carrying capacity without trying to affect volume too much. You want to becareful of IV fluids as you might cause volume overload!
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What is the goal in a coagulation deficiency case?
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Provide the needed coagulation factors while minimizing effects on blood volume and rections to foreign antigens.
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What are some concerns after an initial hemorrhage?
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Was volume replacement enough?
Oxygen delivery? Ongoing signs! MM, CRT, HR, Pulse strength. It helps to know cause of hemorrhage! History, Medical hx, vacc, enviornment, parasites... |
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What are some testing and monitoring tools for blood loss?
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PCV/TP - Quick, simple, accurate
Blood Smear - Morophology and maturity! CBC (machine) - Hemoglobin levels, counts! |
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In a blood loss situation what do you use?
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Use a product with needed ingredients and few extra's!
-Needs oxygen or blood volume? Examples: Acute Blood Loss - Whole blood, oxyglobin Chronic - packed RBC's Coag def - Plasma products! |
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What types of transfusions are there?
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Oxygen Carrying Products
- Fresh Whole Blood - Refrigrated Whole Blood - Refrigerated Packed RBC's - Synthetics (Oxyglobin) Non-Oxygen Carrying Products -Fresh Frozen Plasma (FFP) -Frozen Plasma (FP) -Platelet Rich Plasma (PRP) |
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What type of product is the following?
Yields RBC, WBC, platelets, plasma proteins, coagulation factors. Best if given immediately after collection! |
Fresh Whole Blood (FWB)
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What is pretransfusion testing for?
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Screening donors to prevent blood borne diseases and looking for appropriate blood type matching!
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What happens if antidobies in a recipient's blood or the donor's blood recognize other cells as foreign?
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Hemolysis!
That's why we blood type! |
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What are the blood types for cats?
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A, B, and AB (rare).
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What blood type is strongly reactive in cats?
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Type B!
A type in B cat is very bad! A cats can take B type okay. |
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What is DEA stand for?
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Dog Erythrocyte Antigen!
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How many antigens in blood types have been identified in dogs?
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13 types!
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What is the universal blood type donor for dogs?
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Negative DEA 1.1
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In Hosopital Kits are available for blood typing! How long does it take?
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About 15 minutes!
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What is agglutination?
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Agglutination means the RBC's stick together to form small lumps in the blood!
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What does crossmatching do?
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It detects the presence of hemolysin or agglutinin antibodies in the serum of one individual directed against the red cell antigens of a second individual.
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How much blood can be donated from a dog?
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10mls/lbs every 21 days.
Typically 2-3 months though. 1 Unit = 450 mls |
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How much blood can be donated from a cat?
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10-15 mls/kg every 2-3 months.
1 Unit = 60 mls |
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What do you typically collect blood in?
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Soft Bags
Syringe |
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What are the advantages and disadvantages of collecting blood in soft bags?
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Less expensive!
Easy Storage Filters clots Disadvantages: Takes longer, gravity pull. Have to weigh bag to figure volume. |
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What are the advantages and disadvantages of collecting blood in a syringe?
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Easy
Cheap Good for small volumes! Disadvantages Can collapse veins if to much suction! Need to make anticoagulant to blood ratio correct! 9:1 Need to manually administer or use syringe pump! |
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What is the time table for trunsfusing blood?
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Every 5 minutes initially, and spread out 10, 15, 20. Starts slow and gradually increase as checks look good.
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What are some common transfusion reactions?
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Increased Temp
Increase Resp Rate Vomiting |
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What are some severe transfusion reactions?
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Hemolysis
Pulmonary Edema Anaphylaxis |
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What drug do you normally give before peforming a transfusion?
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Benadryl IV 0.5 mg/lb
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What is the big list of transufusion reactions?
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Shock/Anaphylaxis
Fever Pruritus (Scratching) Urticaria (hives) Facial Edema Nausea / Salivation Vomititing Dyspnea / Cough Chills Tremors Bleeding |
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If you have a transfusion reaction what do you do?
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Mild reaction! Probably will resolve, can resume at slower rate.
Most reactions can resolve with antihistamines and steroids. Most are mild. Major Reaction - STOP! |
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What is fluid therapy used for correcting?
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volume, electrolyte and acid base status!
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What is the goal in all diseases that require fluid therapy?
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It doesn't matter what the disease is the point is to correct volume, electrolyte, and acid base status.
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What is the technicians role?
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To understand the why and not just the how to avoid inadvertent errors!
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When do we give intravenous fluids?
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Dehydration (hypovolemia)
Shock Blood Loss Blood Pressure Electrolyte Replacement To induce diuresis Toxicosis Maintenance of fluid volume Replace ongoing fluid loss (vomiting, diarrhea etc) Correct acidosis / alkalosis |
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How can you tell if an animal is dehydrated?
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Skin Turgor test
MM - moist, color HR - Pulse quality Blood and urine tests And history, vomiting, diarrhea, anorexia, not drinking |
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What are the three parameters to note when testing the mucous membranes for dehydration?
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Moisture / Hydration
Color - Pink, white, yellow? CRT - Count seconds! |
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In what time period is weight loss mostly fluid loss?
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24 to 48 hours!
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What can cause hypovolemia? (dehydration?
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GI - vomiting, diarrhea
Urinary - diabetes, renal failure, failure to concentrate urine. Respiratory - evaporative, panting, heat stroke Large wounds - Blood loss, burns Water deprivation - lack of water! |
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What is shock?
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Inadecquate organ prefusion and tissue oxygenation resulting in altered cellular metabolism, cell death, organ failure and ultimately death!
Basically a major lack of oxygen to all the tissues in the body! |
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What happens to the heart rate during hypovolemia shock? (dehyrdation)
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Increases!
Wants to increase blood flow to organs! |
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What happens to the CRT during hypovolemia shock? (dehydration)
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Increases CRT beyond 2 seconds!
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What happens to the pulse strength / blood pressure during hypovolemia? (dehydration?)
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Decreases!
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What happens to the body temperature during hypovolemia? (dehydration?)
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Temperature decreases, especially in extremities!
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What happens to urine output during hypovolemia? (dehydration?)
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Decreases as long as kidneys are functioning normally!
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What lab parameters are used to determine fluid balance?
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PCV or hematocrit > 50%
Albumin > 4.5 g/dl Urine sp. Gravity BUN Serum Osmolality - Most reliable Electrolytes Acid-base balance |
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If you have a dehydrated patient that needs fluids, where are you going to give it to them?
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Orally - Only if they can take lots and it's slow!
Subcutaneous (SQ Fluids) - Only mild dehydration or outpatient. Intravenous (IV fluids) - Most efficient and greatest control |
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When are you going to administer IV fluids?
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5% or greater dehydration
Expected fluid loss or Sx. |
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Where are IV fluids administered?
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Peripheral veins most common.
Jugular veins for rapid administration or with peripheral vascular collapse |
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What is the benefits of peripheral catheter type of IV?
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Easy to place normally
Less cumbersome Easy to maintain |
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What are the negatives of peripheral catheters?
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Small size limits fluid rates.
Slow transit time Difficult to place in severely debilitated animals. |
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What are the benefits of jugular catheters?
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Large port and allows large volumes of fluids and medications
Allows easy blood sampling |
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What are the negatives of jugular catheters?
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More technically demanding placement.
More cumbersome wrap to protect stabilize catheter. More involved catheter care! |
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What two types of fluids do we give intravenously?
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Crystalloids
and Colloids |
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What type of fluids are these solutions? Isotonic, Hypertonic, Hypotonic?
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Crystalloids!
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What type of fluid are these considered? Synthetics : Hetastarch, Dextran, Oxyglobin
Natural : Albumin, blood products! |
Colloids!
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What are the three major fluid compartments?
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1) Intravascular
2) Interstitial 3) Intracellular |
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Where do the IV fluids go?
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They are introduced into the circulatory system!
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How do you select parenteral fluids to be given?
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Selecting is based on which electrolytes are lost! If possible wait until the electrolyte balance of the patient is assessed!
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An important fact to note about crystalloids is they don't provide?
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Direct oxygen or nutritional support!
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What are the three phases of fluid therapy?
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Emergency
Replacement Maintenance |
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What is the goal of emergency fluid therapy
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Cardiovascular support!
Prevent shock! |
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What are the clinical signs of overhydration?
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Serous nasal discarge
Gelatinous skin Chemosis Pulmonary congestion Pulmonary edema Death |
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What are two causes of over-hydration?
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Inputs - To much IV Fluids!
Outputs - Decreased urine output! |
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What is the main thing to remember in adminstering IV fluids? What's the purpose?
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It's purpose is to correct volume, electrolyte and acid base balance!
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What is the normal body temperature for dogs?
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100 to 102.5
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What is the normal respiratory rate for dogs?
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10-34 breaths per minute!
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What is the normal heart rate for dogs?
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60-100 large breeds
100-140 small breeds |
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What is normal body temperature for a cat?
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100 to 102.5 F
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What is the normal respiratory rate for cats?
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16-40 breaths per minute
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What is the normal heart rate for cats?
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120-140 beats per minute
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What is the normal temperature for a horse?
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99-101 F
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What is the normal heart rate of a horse?
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28-44 beats per minute
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What is the normal breaths per minute of a horse?
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10-24 breaths
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Fluid Problems!
Write Equation! 454 mls=1lb of BW Total Body Fluid = 80% |
weight X (454) X 0.8 = current weight
(454 X loss) = loss weight loss / current = dehydration |
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What is diuresis?
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Increased or excessive production of urine!
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What is hypoxia?
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Deficiency in the amount of oxygen reaching the tissues.
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What is hypovolemic shock?
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Shock caused by severe blood loss or fluid loss!
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