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
Greet animal
Get name and gender correct
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Describe tailored approach to physical examination
e.g. for Yearly vaccination, spay check, weight loss.
Head to tail is best.
Head to tail is best.
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pros and Cons of using system approach
Lots of moving around
Useful in emergency presentation when need to identify system in failure quickly.
Useful in emergency presentation when need to identify system in failure quickly.
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Step 1 of physical exam
patient observation (distance- look at eyes, ears, gait and mentation)
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Describe physical signs of tetanus
Locked Jaw
Eyes may point in opposite directions
Limbs may be extended/ rigid
Eyes may point in opposite directions
Limbs may be extended/ rigid
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describe breathing of dog with pneumothorax
High resp rate
Shallow, fast breathing
May be crackling on auscultation
Shallow, fast breathing
May be crackling on auscultation
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Step 2 of physical examination
Patient palpation/ touch
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What 5 things to look for in palpation?
symmetry
shape
size
texture
patient response
shape
size
texture
patient response
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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)
Muscle Condition Scoring (1-3 scale)
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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.
Check MM
Discharge?
Excessive blinking?
Pain - Blepharospasm, Enophthalmos, Lacrimation and Photophobia indicate pain.
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What would you check for in ears?
Discharge
Smell
Crust/ Flaking
Excess wax build-up
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)
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)
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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
yellow - icterus/ jaundice
dark red- hyperaemia, sepsis, shock
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How could you assess hydration of small animal?
Eye position (sunken if dehydrated)
Skin turgor (skin tents if high turgor)
Tackiness of mucous membranes
Skin turgor (skin tents if high turgor)
Tackiness of mucous membranes
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Why might it be difficult to evaluate tackiness of mucous membranes?
If there is excessive salivating
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Why might older animals appear more dehydrated?
They have increased fat which increases skin turgor leading to increased skin tenting.
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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.
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What shape are the prescapular lymph nodes?
bi-lobed (peanut shape)
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Heart in the dog is located in which intercostal space?
3rd - 5th
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What approach should you use to auscultate lung field?
noughts and crosses: compare sides and compare dorsal sounds to ventral.
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Is the lung field quieter dorsally or ventrally?
Quieter dorsally.
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Which species is it unusual to hear lung sounds in?
cat
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Describe approach to abdominal palpation in dog.
Start slow
Cranial to caudal movement
Cranial to caudal movement
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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.
Can occasionally palpate spleen, stomach and kidneys if pathology.
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What may you palpate mid-abdomen on a dog?
Intestinal loops (in slimmer animals)
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What may you feel in caudal abdominal palpation of a dog?
Bladder
Prostate
Colon
Prostate
Colon
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Which artery is more difficult to feel in cats? Femoral or metatarsal?
Metatarsal
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When is it appropriate to perform rectal exam?
If expecting issue or pathology
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What can you palpate on rectal exam?
Prostate
Uterus (if enlarged)
Urethra (if blocked)
Pelvis
Sublumbar lymph nodes
Faeces
Anal sacs
Foreign Material
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)
Bones (pain, swelling, instability)
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What may you assess in Neurologic exam?
Cranial Nerve Assessment
Proprioception
Spinal Reflexes
Proprioception
Spinal Reflexes
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What may you look for in dermatologic exam?
Hair loss, pruritis, flaking
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Difference in mentation of cats vs dogs in clinic?
Cats generally quieter
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Difference in cat vs dog mucous membranes?
Cats generally paler and harder to assess
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What gland may you feel in cat that you won't in dog?
Thyroid: only if enlarged.
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How to palpate thyroid gland in cats?
Pinch thumb and fingers around larynx and move towards thoracic inlet
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What auscultation is important in cats?
Parasternal (better to hear heart)
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Difference in approach to abdominal palpation in cat vs dog?
Use one handed ventral approach in cats
May only feel bladder/ kidney in cats.
May only feel bladder/ kidney in cats.
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What is triaging?
determine urgency of problem
prioritise depending on severity of injuries
prioritise depending on severity of injuries
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What are the ABCs?
Airway
Breathing?
Circulation?
Breathing?
Circulation?
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Once ABCs confirmed, what is next step?
Capsule history
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If ABCs not confirmed, what is next step?
CPR immediately
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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)
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
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What are 3 Major Body Systems?
Cardiovascular
Neurological
Respiratory
Neurological
Respiratory
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What would you assess to evaluate cardiovascular system?
Pulses
Mucous Membranes
CRT
Heart Rate
Cardiac auscultation
Mucous Membranes
CRT
Heart Rate
Cardiac auscultation
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Normal ranges of Heart Rate in dogs and cats in clinic?
Dogs: 80-120bpm
cats: 160-200bpm
cats: 160-200bpm
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Heart rate varies with?
breed, size and excitement/stress.
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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.
Metatarsal artery (medial aspect below hock)
Less likely to use metatarsal as is disappears with poor circulation.
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Describe cardiovascular physical exam signs of mild hypovolaemic shock
HR 130-150
MM N(pinker)
CRT <1s
Pulse amp. increased
Pulse dur. Mild decrease
MM N(pinker)
CRT <1s
Pulse amp. increased
Pulse dur. Mild decrease
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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
MM pale pink
1-2s
pulse amp. Mod decrease
pulse dur. mod decrease
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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
MM White
CRT >2.5s
Pulse amp. Sev decrease
Pulse dur. sev decrease
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Describe normal respiratory exam?
Resp rate: 12-28 bpm
Little chest movement
Chest and abdomen movement are in sync
Little audible noise (breed dependent)
Little chest movement
Chest and abdomen movement are in sync
Little audible noise (breed dependent)
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step one of respiratory exam?
Observe: respiratory pattern and degree of effort
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Step 2 of respiratory exam?
Listen without stethoscope.
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Step 3 of resp. exam?
Listen with stethoscope to localise abnormal sounds.
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postural signs of respiratory distress?
extended neck
abducted elbows
open-mouth breathing
anxious facial expression
increased abdominal movement
paradoxical abdominal movement
abducted elbows
open-mouth breathing
anxious facial expression
increased abdominal movement
paradoxical abdominal movement
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Sign of respiratory distress that isn't audible or postural?
cyanosis
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Signs of Upper airway respiratory disease?
Increased Inspiratory Effort
Loud referred airway noise on ausculatation
Loud referred airway noise on ausculatation
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Signs of lower airway respiratory disease?
Increased Expiratory effort
Wheezes on auscultation
Wheezes on auscultation
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Signs of pulmonary respiratory disease (in alveoli)?
Some increased inspiratory effort
mixed respiratory patterns
Harsh sounds/ crackles on auscultation
mixed respiratory patterns
Harsh sounds/ crackles on auscultation
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Signs of Pleural Space respiratory disease?
Shallow breathing
Dull/distant lung/ heart sounds on auscultation.
Dull/distant lung/ heart sounds on auscultation.
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Different Classifications of mentation?
BAR
QAR
Obtunded
Stuporous
Comatose
Seizuring
QAR
Obtunded
Stuporous
Comatose
Seizuring
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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
swaying
eyes unfocused
eyelids opening/ closing abnormally
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How may you assess gait?
Paresis vs Plegia
Which limbs involved
Is abnormality lateralised?
Which limbs involved
Is abnormality lateralised?
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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
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.
Head to tail is best.
Card 3
Front
pros and Cons of using system approach
Back
Card 4
Front
Step 1 of physical exam
Back
Card 5
Front
Describe physical signs of tetanus
Back
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