Emergency and Critical Care: triage, shock, and CPR
Emergency and Critical Care
This domain tests triage prioritization, recognition and treatment of shock, and delivery of CPR according to current Recover-style guidelines.
Core rules and concepts
- Triage: airway, breathing, circulation first; then disability and pain. Stable patients wait; open-mouth breathing cats, GDV, and profuse hemorrhage go immediately.
- Shock: tachycardia, pale or muddy gums, prolonged CRT, weak pulses, hypothermia, altered mentation. Cats may show bradycardia instead of tachycardia.
- Fluid resuscitation: crystalloid bolus about 20 mL/kg in dogs and 10–15 mL/kg in cats over 15–20 min, reassessed after each bolus. Withhold large boluses in cardiogenic shock or pulmonary contusion; use smaller aliquots.
- CPR: 100–120 compressions/min at one-third chest depth, 2-minute cycles, intubation with 10 breaths/min, minimize interruptions. Epinephrine 0.01 mg/kg IV every 3–5 min; reverse known causes (hypovolemia, hypothermia, tension pneumothorax).
- Monitoring: ECG, blood pressure, lactate, urine output, temperature.
Worked example
A 30 kg dog with unproductive retching and a distended abdomen: tachycardic, pale gums, CRT 3 s. Treat as GDV. Place two large-bore IVs, give a 20 mL/kg bolus (600 mL) over 15–20 min, decompress the stomach, take radiographs, and prepare surgery - do not wait for a definitive film before stabilizing.
Traps
Assuming bradycardia rules out shock in cats. Giving a full bolus to a cardiogenic patient. Pausing compressions to place a catheter. Forgetting to check glucose and temperature.