Contributors: Elisa Mazzaferro, Graham Bilbrough, Kate Murphy, Daniel H Lewis, Neus Elias
Species: Canine | Classification: Miscellaneous
- Definition: French word "trier" which means to sort or to select.
- Triage is the process of determining the priority of patients’ treatments based on the severity of their conditions.
- If there is more than one emergency at a time, it allows examination of all patients quickly and classification of the patients according to the urgency in which their injuries must be addressed. Traditionally, the most urgent cases would involve problems with the cardiovascular, respiratory or neurological body systems.
- Immediate transport to treatment area - include patients with:
- Detailed histories often delayed while patients are triaged and initially treated; a ‘capsule history’ may, however, be useful during emergency assessment and treatment.
- Permission for stabilization and treatment must be signed by client before proceeding.
- Client should be asked if, in the event of cardiopulmonary arrest Cardiac arrest Cardiopulmonary arrest: pathophysiology , whether they would like the triage/critical care team to initiate cardiopulmonary cerebral resuscitation Emergency resuscitation. If no, then "do not resuscitate" (DNAR) status should be known to all personnel.
- Triage team must be prepared and organized. Various tasks should be delegated to appropriate trained personnel and the team should practice in order to maintain efficiency when faced with real emergencies or disaster situations.
Essential equipment in emergency room
- Oxygen source.
- Crash cart.
- Electrical defibrillator .
- Pulse oximeter Anesthetic monitoring: pulse oximetry.
- Capnograph Anesthetic monitoring: respiratory system (capnograph).
- Endotracheal tubes Endotracheal intubation. Rigid long urinary catheters and tracheostomy /difficult intubation kits.
- Electric clippers.
- Laryngoscope(s) Laryngoscopy.
- ECG ECG: overview.
- CPR drug chart.
- Intravenous catheter set-up Cephalic catheterization Seldinger technique, intraosseous catheter materials.
- Intravenous fluids Fluid therapy.
- Ambubag or anesthesia equipment to oxygenate and ventilate patients.
- Fluid administration sets Fluid therapy.
- Pressure infusion bags.
- Bandage materials and splints.
- Heat source and temperature monitor.
- Thoracocentesis and pericardiocentesis kits Thoracocentesis.
- Light source.
- Centrally located table with room around it for personnel.
- Portable ultrasound.
Questions to ask owners when triaging patients
- Was the event witnessed or unwitnessed?
- Who saw the traumatic event?
- What happened?
- Did the patient lose consciousness?
- Was the patient ambulatory after the accident?
- Did the patient urinate or defecate after the accident?
- When DID the accident happen?
- If the patient is not breathing, when was the last witnessed breath?
- Where are the injuries?
- Is the animal in pain?
- Are there any ongoing medical problems?
- Is the patient on any chronic medication?
- Does the owner want to pursue treatment or cardiopulmonary cerebral resuscitation?
- Is cost a factor in making a decision to pursue treatment?
Immediate treatment priorities for life-threatening problems
- Arterial bleeding.
- Respiratory system.
- Cardiovascular system.
- Transfusion or hemorrhage control.
- Neurological system.
- Musculoskeletal system.
- Abdominal injuries.
ABCDE of primary survey
- Does the patient have breathing difficulty? Is the patient open mouth breathing?
- Is there facial trauma making breathing difficult or obstructing airway?
- Is there fluid obstructing the airway (saliva, vomit, blood…)?
- Is there laryngeal Larynx: paralysis or tracheal Thorax: trauma trauma or disease?
- Is there subcutaneous emphysema Lung: pulmonary emphysema present?
- Is the patient in respiratory distress?
- What is the color of the mucous membranes?
- Is the patient exhibiting flail chest Thoracic wall trauma ?
- Is there a sucking chest sound?
- Is there a restrictive respiratory pattern?
- Is there an obstructive respiratory pattern?
- What do you hear on thoracic auscultation Respiratory: disease - clinical investigation?
- Is thoracic percussion normal?
- Do you hear lung sounds?
- Are there crackles or wheezes?
- Is there obvious hemorrhage?
- Is the patient tachycardic or bradycardic Heart: dysrhythmia ?
- Are there audible heart murmurs Murmur: overview or arrhythmias on ausculatation Heart: disease - clinical investigation?
- What is the quality of the pulses? Is the pulse synchronous?
- What is the blood pressure?
- What is the ECG rhythm ECG: overview ?
- Are there any fractures Fracture: overview with extreme swelling?
- Are there any neurologic injuries Neurological examination ?
- What is the patient's posture?
- What is the patient's mentation?
- Is the mentation deteriorating?
- Is the patient responsive to external stimuli?
- What is the pupil size and reactivity?
- Is there any abdominal injury Abdomen: trauma ?
- Are there lacerations?
- Are there any fractures Fracture: overview ?
- Is there any bruising?
- After a brief but thorough physical examination, a minimum database including a PCV Hematology: packed cell volume , total protein Blood biochemistry: total protein , BUN Blood biochemistry: urea and blood glucose Blood biochemistry: glucose should be performed.
- The START technique can also be used to triage emergencies:
- START = Simple Triage And Rapid Assessment
- Technique used in emergency situations to perform triage at the disaster scene.
- Systematic standardized approach to emergencies to minimize not treating and recognizing problems to all organ systems and anatomic areas.
Categories for triage
- When dealing with multiple patients in an emergency situation, ie a natural or man-made disaster, it is often helpful to place the animals in categories and assign them color codes to allow medical personnel to take care of the most life-threatening problems and most critically ill patients first.
- Animals that are so critical that they are not expected to live despite all aggressive efforts assigned to the BLACK category, in which they are not treated.
- Not practical in a smaller emergency room, but may be necessary in situations of disaster; a task often difficult for persons assigning triage categories.
Categories for triage
Priority 1/Immediate (RED):
- Patient may survive if life-saving measures are applied.
Priority 2/Delayed (YELLOW):
- Patient likely to survive if simple care is given within hours.
Priority 3/Non-urgent (GREEN):
- Patient has minor injuries.
- Care may be delayed while other patients receive treatment.
Priority 2 or 3 (BLUE):
- Catastrophic injuries.
- Patients are unlikely to survive.
- Also in this category place patients that need extensive care within minutes.
- Dead or dying patients that are so severely injured that are not expected to survive.
The BLUE category is often not used, as it makes it difficult to triage effectively.