SA triage, physical exam and patient management

Flashcards based on information extracted from: 

Humm K. (2022) 'Introduction to Small Animal Physical Exam, Triage and Major Body System Assessment' [Lecture], Principles of Science: Principles of Clinical Practice.

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  • Created by: ZoeCouch
  • Created on: 04-10-22 13:36
What 3 things should you do immediately upon meeting client?
Introduce yourself
Greet animal
Get name and gender correct
1 of 69
Describe tailored approach to physical examination
e.g. for Yearly vaccination, spay check, weight loss.
Head to tail is best.
2 of 69
pros and Cons of using system approach
Lots of moving around
Useful in emergency presentation when need to identify system in failure quickly.
3 of 69
Step 1 of physical exam
patient observation (distance- look at eyes, ears, gait and mentation)
4 of 69
Describe physical signs of tetanus
Locked Jaw
Eyes may point in opposite directions
Limbs may be extended/ rigid
5 of 69
describe breathing of dog with pneumothorax
High resp rate
Shallow, fast breathing
May be crackling on auscultation
6 of 69
Step 2 of physical examination
Patient palpation/ touch
7 of 69
What 5 things to look for in palpation?
symmetry
shape
size
texture
patient response
8 of 69
Step 3 of Physical Exam
Patient demeanour (BAR/ QAR/ Obtunded/ Stuporous/ Comatose/ Aggressive)
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What scoring systems are included within patient observation?
Body Condition Scoring (1-9 or 1-5 scale)
Muscle Condition Scoring (1-3 scale)
10 of 69
How would you examine eyes?
Push upper eyelid to bring 3rd eyelid down
Check MM
Discharge?
Excessive blinking?
Pain - Blepharospasm, Enophthalmos, Lacrimation and Photophobia indicate pain.
11 of 69
What would you check for in ears?
Discharge
Smell
Crust/ Flaking
Excess wax build-up
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What would you check when examining mucous membranes?
Colour
Capillary refill time
Hydration (dry/tacky = dehydrated)
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What is normal capillary refill time (CRT)?
1-2 seconds (NOT less than 2)
14 of 69
What does the colour of the mucous membrane tell you?
pale - hypoperfusion, poor blood supply, possible anemia
yellow - icterus/ jaundice
dark red- hyperaemia, sepsis, shock
15 of 69
How could you assess hydration of small animal?
Eye position (sunken if dehydrated)
Skin turgor (skin tents if high turgor)
Tackiness of mucous membranes
16 of 69
Why might it be difficult to evaluate tackiness of mucous membranes?
If there is excessive salivating
17 of 69
Why might older animals appear more dehydrated?
They have increased fat which increases skin turgor leading to increased skin tenting.
18 of 69
Is it easier to palpate salivary or lymphatic nodes?
Lymph: you can palpate some nodes, and get your fingers around them e.g. prescapular. However, most are still difficult to palpate. If obvious, then pathology likely.
19 of 69
What shape are the prescapular lymph nodes?
bi-lobed (peanut shape)
20 of 69
Heart in the dog is located in which intercostal space?
3rd - 5th
21 of 69
What approach should you use to auscultate lung field?
noughts and crosses: compare sides and compare dorsal sounds to ventral.
22 of 69
Is the lung field quieter dorsally or ventrally?
Quieter dorsally.
23 of 69
Which species is it unusual to hear lung sounds in?
cat
24 of 69
Describe approach to abdominal palpation in dog.
Start slow
Cranial to caudal movement
25 of 69
What may you feel in cranial abdominal palpation of dog?
Sometimes feel caudal border of liver (not always obvious)
Can occasionally palpate spleen, stomach and kidneys if pathology.
26 of 69
What may you palpate mid-abdomen on a dog?
Intestinal loops (in slimmer animals)
27 of 69
What may you feel in caudal abdominal palpation of a dog?
Bladder
Prostate
Colon
28 of 69
Which artery is more difficult to feel in cats? Femoral or metatarsal?
Metatarsal
29 of 69
When is it appropriate to perform rectal exam?
If expecting issue or pathology
30 of 69
What can you palpate on rectal exam?
Prostate
Uterus (if enlarged)
Urethra (if blocked)
Pelvis
Sublumbar lymph nodes
Faeces
Anal sacs
Foreign Material
31 of 69
What may you assess in Orthopaedic exam?
Joints (pain, swelling, heat, ROM, crepitus)
Bones (pain, swelling, instability)
32 of 69
What may you assess in Neurologic exam?
Cranial Nerve Assessment
Proprioception
Spinal Reflexes
33 of 69
What may you look for in dermatologic exam?
Hair loss, pruritis, flaking
34 of 69
Difference in mentation of cats vs dogs in clinic?
Cats generally quieter
35 of 69
Difference in cat vs dog mucous membranes?
Cats generally paler and harder to assess
36 of 69
What gland may you feel in cat that you won't in dog?
Thyroid: only if enlarged.
37 of 69
How to palpate thyroid gland in cats?
Pinch thumb and fingers around larynx and move towards thoracic inlet
38 of 69
What auscultation is important in cats?
Parasternal (better to hear heart)
39 of 69
Difference in approach to abdominal palpation in cat vs dog?
Use one handed ventral approach in cats
May only feel bladder/ kidney in cats.
40 of 69
What is triaging?
determine urgency of problem
prioritise depending on severity of injuries
41 of 69
What are the ABCs?
Airway
Breathing?
Circulation?
42 of 69
Once ABCs confirmed, what is next step?
Capsule history
43 of 69
If ABCs not confirmed, what is next step?
CPR immediately
44 of 69
Examples of things to include in capsule history?
Age
Breed
sex
Primary/Chief complaint
Duration of issue
Appetite
Water intake
Activity level
Vax status
Current meds (prescribed and owner administered)
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What is next step after capsule history taken?
Major Body Systems Assessment
46 of 69
What are 3 Major Body Systems?
Cardiovascular
Neurological
Respiratory
47 of 69
What would you assess to evaluate cardiovascular system?
Pulses
Mucous Membranes
CRT
Heart Rate
Cardiac auscultation
48 of 69
Normal ranges of Heart Rate in dogs and cats in clinic?
Dogs: 80-120bpm
cats: 160-200bpm
49 of 69
Heart rate varies with?
breed, size and excitement/stress.
50 of 69
Which sites would you take pulse?
Femoral artery
Metatarsal artery (medial aspect below hock)
Less likely to use metatarsal as is disappears with poor circulation.
51 of 69
Describe cardiovascular physical exam signs of mild hypovolaemic shock
HR 130-150
MM N(pinker)
CRT <1s
Pulse amp. increased
Pulse dur. Mild decrease
52 of 69
Describe cardiovascular physical exam signs of moderate hypovolaemic shock
HR 150-170
MM pale pink
1-2s
pulse amp. Mod decrease
pulse dur. mod decrease
53 of 69
Describe cardiovascular physical exam signs of severe hypovolaemic shock
HR 170-220
MM White
CRT >2.5s
Pulse amp. Sev decrease
Pulse dur. sev decrease
54 of 69
Describe normal respiratory exam?
Resp rate: 12-28 bpm
Little chest movement
Chest and abdomen movement are in sync
Little audible noise (breed dependent)
55 of 69
step one of respiratory exam?
Observe: respiratory pattern and degree of effort
56 of 69
Step 2 of respiratory exam?
Listen without stethoscope.
57 of 69
Step 3 of resp. exam?
Listen with stethoscope to localise abnormal sounds.
58 of 69
postural signs of respiratory distress?
extended neck
abducted elbows
open-mouth breathing
anxious facial expression
increased abdominal movement
paradoxical abdominal movement
59 of 69
Sign of respiratory distress that isn't audible or postural?
cyanosis
60 of 69
Signs of Upper airway respiratory disease?
Increased Inspiratory Effort
Loud referred airway noise on ausculatation
61 of 69
Signs of lower airway respiratory disease?
Increased Expiratory effort
Wheezes on auscultation
62 of 69
Signs of pulmonary respiratory disease (in alveoli)?
Some increased inspiratory effort
mixed respiratory patterns
Harsh sounds/ crackles on auscultation
63 of 69
Signs of Pleural Space respiratory disease?
Shallow breathing
Dull/distant lung/ heart sounds on auscultation.
64 of 69
Different Classifications of mentation?
BAR
QAR
Obtunded
Stuporous
Comatose
Seizuring
65 of 69
What iatrogenic action may change mentation from normal?
Medication/ drugs
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How does sodium affect mentation?
Rapid changes of sodium in blood leads to rapid changes of Na+ in brain:
swaying
eyes unfocused
eyelids opening/ closing abnormally
67 of 69
How may you assess gait?
Paresis vs Plegia
Which limbs involved
Is abnormality lateralised?
68 of 69
Major Body System Assessment overlaps?
Lungs only: resp rate, resp effort
Lungs/ Heart: Thoracic auscultation, mucous membranes.
Heart only: Pulses, CRT, HR, cardiac auscultation
Heart/ Brain: Mentation status
Brain only: Gait
69 of 69

Other cards in this set

Card 2

Front

Describe tailored approach to physical examination

Back

e.g. for Yearly vaccination, spay check, weight loss.
Head to tail is best.

Card 3

Front

pros and Cons of using system approach

Back

Preview of the front of card 3

Card 4

Front

Step 1 of physical exam

Back

Preview of the front of card 4

Card 5

Front

Describe physical signs of tetanus

Back

Preview of the front of card 5
View more cards

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