Handling emergency triage in veterinary medicine

Kristin Welch, DVM, DACVECC, criticalist and founder of DVM STAT Consulting, presented the lecture “Revolutionizing trauma care: advanced techniques for triage, severity assessment and stabilization” at the 2024 Fetch dvm360 Conference in Charlotte, North Carolina. In an interview with dvm360, she said the presentation was created to help veterinarians in a broad group of practices—from single-doctor general practices to emergency and urgent care practices—feel more comfortable assessing patients with trauma.

In this video, Welch discusses the triage process in emergency veterinary care and how it is used to assess the physical condition of a patient with trauma. This process can determine immediate next steps.

The following is a transcript of the video:

Kristin Welch, DVM, DACVECC: Triage is probably the most important single step that allows you to be able to stratify the severity of injuries in a trauma patient. And in smaller clinics, it's an ‘all hands on deck’ type process.

Part one is that you want to have a form that's preprinted, and maybe even laminated with a wipe off marker, where you can ask the client specific questions about when the injury happened. What did they witness? Has the patient walked since the injury? Has the patient urinated since the injury? Do they have any past medical history? Are they on any medications that might impact the treatment? And have they had any past transfusions? Having that [form] ready by your triage station is really helpful because a CSR (customer service representative) or a veterinary assistant can take that [completed form] and walk up front and talk to the client while the medical team is assessing the patient.

The triage process involves a physical exam, primarily. Your initial triage physical exam should be 2 to 3 minutes, an abbreviated version of what you do in a full-fledged physical, but with the goal of assessing level of consciousness. Is there any indication for traumatic brain injury strabismus and anisocoria? Does the patient have motor pain sensation? And do they have any pain or divots or irregularities on palpation of their spine? Do they have normal respiratory pattern? Lung sounds on all 4 quadrants to help rule out pneumothorax for pleural effusion. Is their respiratory rate normal or elevated? And all of the patients during triage should help flow by oxygen until proven otherwise because one of our triage goals is to maximize oxygenation and minimize hypoxia.Auscultation of the heart, while simultaneously feeling the pulses and having somebody look at the mucous membrane color and capillary refill time, will allow you to be able to determine whether this patient has signs of compensated or decompensated shock, which is a really important distinction when we're determining injury severity scoring.

Finally, [there is] looking at external wounds. Is there any evidence of severe bruising? And do you, on your physical exam, identify any indication of significant blood loss?

Those are abbreviated steps that are part of a comprehensive triage physical exam I would recommend that everybody get into the practice of doing in the same order every time on every patient so that you don't get that tunnel vision where you're looking at the obvious injury like, for instance, an open fracture on a pelvic limb that's bleeding significantly, but forget to notice that the patient has muffled lung sounds and has a pneumothorax and really pale gums with a delayed CRT (capillary refill time).