Emergency and Critical Care
Emergency and critical care tests ordered thinking under time pressure: triage, shock recognition, resuscitation, and the technician's role in a team running a code.
Triage and shock
- Primary survey: airway, breathing, circulation, then neurologic status; the secondary exam comes after stabilization.
- Perfusion is judged from mucous membrane color, capillary refill time, heart rate, mentation, pulse quality and lactate.
- Crystalloid bolus is commonly 20 mL/kg in dogs and 10-15 mL/kg in cats, given rapidly and reassessed before repeating.
- Decompress a bloated abdomen and treat pain; gastric dilatation-volvulus is surgical after stabilization.
- Hyperkalemia with arrhythmia: calcium gluconate 10% slowly intravenously first to protect the myocardium, then insulin with dextrose and fluids.
Cardiopulmonary resuscitation
- Compress at 100-120 per minute to one-third to one-half chest width, switch compressors every 2 minutes, intubate and ventilate about 10 breaths per minute.
- Epinephrine about 0.01 mg/kg intravenously every 3-5 minutes, atropine about 0.04 mg/kg, vasopressin about 0.8 units/kg; reverse known triggers such as opioids or alpha-2 agonists.
- Defibrillate ventricular fibrillation; treat hypothermia and hypoglycemia as they are found.
Worked example
A 30 kg dog arrives retching unproductively with a distended abdomen. Triage confirms tacky gums and tachycardia. A 20 mL/kg bolus is 600 mL over 15-20 minutes, with analgesia and decompression by tube or trocar, ECG monitoring for arrhythmia, and surgery once perfusion improves. Radiographs wait until the patient is stable.
Traps that cost marks
Delaying fluids to obtain images, giving oral medication to a vomiting patient, ignoring hypothermia during CPR, and interpreting a single normal blood pressure as adequate resuscitation.