Triage in the veterinary emergency room: part 2
Abstract
The triage examination is a rapid assessment of the major organ systems in patients presenting emergently to the veterinarian. Major organ systems that are assessed as part of the primary survey are the respiratory, cardiovascular, neurologic, and urogenital systems. Certain abnormalities in these systems merit immediate further examination for assessment and stabilization. Part 1 of this series discussed common findings on triage of the respiratory and cardiovascular systems in veterinary patients. Part 2 will focus on guidelines for triage of the neurologic and urogenital system, as well as other ailments that do not ft into these categories, but which merit immediate veterinary attention. The mentation, gait, and cranial nerves are evaluated to determine neurologic status, and abdominal palpation alerts the examiner to the possibility of urinary obstruction. A thorough primary triage examination can allow the stratification of emergency room patients and allow those in most need to receive rapid, directed care.
The triage examination identifies patients with life-threatening conditions who require immediate attention from a veterinarian, and distinguishes them from patients that are not as ill (Aldrich, 2005; Drobatz, 2010). The systematic evaluation of patients in triage includes rapid assessment of the respiratory, cardiovascular, neurologic, and urogenital systems. Respiratory and cardiovascular triage were covered in part 1 of this series, and this manuscript will focus on neurologic and urogenital triage. Specific approaches to the history and owner communication during triage were also covered in part 1 of this series.
The neurologic triage examination begins as soon as the patient is seen. It is an abbreviated neurologic examination that observes components of the patient interacting with the environment. If abnormalities are identified on triage, a more in-depth neurologic examination should be conducted. Common neurologic diseases that cause an animal to present to the emergency room include seizures, head trauma, acute changes in mentation (e.g. as due to ingestion of toxins), and spinal cord disease (Figure 1) causing paresis or paralysis. Patients with neurologic consequences of systemic disease (e.g. hepatic encephalopathy or rapid changes in serum sodium concentration) may also present for or develop neurologic signs (Aldrich, 2005).
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