Introduction Module 1

Question 1

What is assessed as part of the primary survey?

Answer 1

A - airway: is it patent?
B - breathing: is if effective?
C - circulation: is there a pulse? peripheral v. central apex

Major body systems
- Cardiovascular - HR, pulse quality, MM color, CRT, Auscultation
- Respiratory - RR, respiratory effort, auscultation
- Neurological - Mentation/consciousness, Gait/posture, deep pain

Question 2

What makes up a capsule history?

Answer 2

SAMPLE

S - Signalment/signs
A - Allergies
M - Medications
P - Past illness
L - Last normal
E - Events leading up to illness/injury

Question 3

What are the respiratory patterns and what are common differentials?

Answer 3

Inspiratory Pattern - Upper airway - polyps, neoplaisa/inflamm, servere URT, FB, LP

Obstructive Pattern - Lower airway - asthma

Restrictive Pattern -
Parenchymal disease: edema, haem, exudate, neoplasia, fibrosis
Pleural space disease: CHF, chylo, pneumo, pyo, FIP, haemo, neoplastic, diaphragmatic
Chest wall disease: trauma, abscess, neoplasia

Question 4

What are trauma/severity scoring systems that can be used in general practice?

Answer 4

1. Shock index - looks at HR, sys BP and measured against lactate
2. Glasgow modified coma scale - head injury, 1-6 in motor activity, brainstem reflexes and level of consciousness, lower the score the worse the prognosis
3. Animal trauma triage score - can be modified to use with perfusion, resp, neuro

Question 5

What are the 4 sites of the AFAST

Answer 5

Looking for fluid - graded from 1-4 based on where fluid is found

1. Diaphragmatic-hernia
2. Spleno-renal view
3. Reno-hepatic
4. cystocolic

Question 6

How do you identify a pneumothorax?

Answer 6

1. TFAST: Chest tube site - highest point of the chest where the lung may be visualised against the thoracic wall
   - Look for glide sign : decreasing gain can help
   - M-mode: seashore - normal, barcode - abnormal

Question 7

Wet lung v. Dry lungs

Answer 7

Dry Lungs: A-lines + glide signs
- not representative of all lung just that section
- feline asthma
- upper airway obstruction
- bronchial diesase
- PTE

Wet lungs: B-lines present
- if focal - pneumonia, contusions
- pulmonary edema - if 3 or more in 2 diff sites - CHF likely

Question 8

What are the 5 criterion of B-lines?

Answer 8

1. Vertical white lines
2. Originate from lung surface
3. Move with pleura
4. Extends into far filed
5. Obscures a-lines

Question 9

Protocol for CPR

Answer 9

1. Recognise arrest - absence of resp movements, pulses, consciouness
2. Call for help - ideally 3 -
   - 5 roles: leader, compressor, breather, drug pusher, recorder
3. BLS: ventilation and compressions
   - 2 min cycles (takes 60s to get myocardial perfusion pressure to optimal level)
   - 100-120/min 1/2-1/3 compressed with full recoil
   - Cardiac, thoracic, sternal
   - ventilation: 1 breathe every 6 secs
4. ALS
   ECG - Fast >200 (v-fib, pulseless v-tach) defib/thump Slow <200 asystole, PEA (adrenaline/atropine)
   Capnograph - Gold standard for checking return to spontaneous ventilation, over 15mmHg = good compressions
   Drugs
   IV access

Question 10

How do you correct hypovolaemia without haem?

Answer 10

Isotonic fluids - crystalloids
- 10-20ml/kg (d), 5-10ml/kg (C) over 15mins and then reassess perfusion parameters
- If severe shock consider adding in colloids
- If brain trauma is present isotonic fluids and hypertonic saline

Question 11

What are the end parameters of corrected shock?

Answer 11

HR 80-120/160-200
T 38-39.5
CRT/MM pink mm with <2 secs
BP sys 100-120mmHg
TS/PCV - >45/>25
UO - 1-2ml/kg/hr

Question 12

What is dehydration?

Answer 12

Dehydration is a fluid deficit in the extracellular space and should be corrected slowly for 24-48hours

Question 13

How is fluid deficit calculated?

Answer 13

% dehydration + maintenance + ongoing losses
% dehydration => BW x % x10 = ml
Basal fluid rate => RER = (30xBW) + 70
Ongoing losses can be weight or 4ml/kg per vomit/diarrhea