ADV-Lesson 2- Triage
Triage is the art of assigning priority to emergency patients and their problems based on rapid assessment of historical and physical parameters. The triage should take about 5 minutes. The goal is to quickly identify patients with life-threatening problems so that they can be treated immediately. If a patient needs immediate evaluation by a veterinarian verbal permission or signed medical consent should be obtained from the owners that authorizes the appropriate emergency treatment (CPR, IV catheter, medication, radiographs, blood work, etc.) as quickly as possible. Perform a rapid whole-body exam looking for wounds, bruises (petechiae, purpura or ecchymosis), abdominal pain/distention and any other signs of debilitation. Wounds to the thorax or abdomen can be critical even if the patient appears stable on triage. [9]
Triage Levels
Obvious Emergency: *Life threatening condition*
- Cardiopulmonary arrest
- Cyanosis/Severe respiratory distress
- Collapse/Unresponsive
- Profuse blood loss
- Penetrating wound
- Severe trauma
- Heat stroke
Strong Potential for Emergency: *Conditions that could become life threatening without treatment*
- Difficulty breathing/Wheezing
- Allergic reaction with swelling around face, mouth or neck
- Smoke inhalation
- Saddle thrombus
- Neurologically inappropriate
- Paralysis of hind limbs or all limbs
- Active seizures or a pet that has had a seizure in the last 3 hours
- GDV (Gastric Dilatation Volvulus)/Dog with unproductive vomiting or abdominal distention
- Any animal – especially a male cat – unable/straining to urinate.
- Male cats may present with other symptoms such as vomiting or lethargy. Consider palpating their bladder during triage to see if they are blocked.
- Trauma
- Large laceration; Hit by car; Puncture wound to head, neck, chest or abdomen
- Electrocution
- Snakebite
- Proptosed eye/Eye injury
- A diabetic that is not presenting for a different reason (i.e. torn nail)
- A puppy that is lethargic or not These patients may have a contagious disease (and should be isolated) or may be hypoglycemic (will need immediate attention).
- Dystocia/active labor
- Ingestion of toxic substance or foreign body
- Severe pain
Triage to a room: *Any patient waiting to be seen that has been diagnosed with a contagious disease, showing symptoms of a potentially contagious disease, or may be aggressive animals*
- Unvaccinated dogs with diarrhea or vomiting
- Puppies < 16 weeks of age with diarrhea or vomiting
- Potential URI
- Coughing dogs (without known history of heart disease, if they are not dyspneic)
- Sneezing cats
- Any non-Rabies-vaccinated patient with undiagnosed neurological signs
- Aggressive pets should go into an exam room for safety
Non-Emergent Triage: Stable and presenting with general complaints. Low stress handling for patients that are fractious but do not appear to need immediate treatment should be considered when possible. Safely obtain whatever vitals possible and advise the doctor of the situation. Vitals can be obtained at the same time as the doctor’s exam in order to reduce stress on the patient.