Contributors: Graham Bilbrough, Elisa Mazzaferro, Kate Murphy, Daniel H Lewis, Neus Elias

 Species: Feline   |   Classification: Miscellaneous

Introduction

  • 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, this 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 are often delayed while patients are triaged and are 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 Cardiopulmonary resuscitation. If no, then "do not attempt resuscitation" (DNAR) status should be known to all personnel.
  • The 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 the emergency room

Primary survey

Questions to ask owners when triaging patients

  • Who?  
    • Was the event witnessed or unwitnessed?
    • Who saw the traumatic event?
  • What?  
    • What happened?
    • Did the patient lose consciousness?
    • Was the patient ambulatory after the accident?
    • Did the patient urinate or defecate after the accident?
  • When?
    • When DID the accident happen?
    • If the patient is not breathing, when was the last witnessed breath
  • Where?
    • Where are the injuries?
    • Is the animal in pain?
  • Why?
    • 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.
  • Neurologic system.
  • Musculoskeletal system.
  • Abdominal injuries

ABCDE of Primary Survey

A  Airway

  • 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 or tracheal trauma or disease Thorax: trauma?
  • Is there subcutaneous emphysema present?

B  Breathing

  • Is the patient in respiratory distress?
  • What is the color of the mucous membranes?
  • Is the patient exhibiting flail chest?
  • Is there a sucking chest sound Cardiac sounds: overview?
  • 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?

C Circulation

D Disability

  • 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? Small animal coma score 

E Examination

  • Is there any abdominal injury Abdomen: trauma?
  • Are there lacerations?
  • Are there any fractures?
  • Is there any bruising?
  • Is there presence of abdominal or thoracic fluid on point of care ultrasound?
  • After a brief but thorough physical examination, a minimum data base 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 emergences:
    • 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, such as in 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 may be assigned to the BLACK category, in which they are not treated.
  • This is not practical in a smaller emergency room, but may be necessary in situations of disaster, a task often difficulty for persons assigning triage categories.

Categories for Triage

  • Priority 1/Immediate (RED)
    • Critical.
    • 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.
  • None (BLACK)
    • 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.