Front desk and triage staff should be aware of presenting conditions that require immediate evaluation by a veterinarian. They are listed in the Primary Survey section of Evaluation and Initial Treatment of the Emergency Patient.
Courtesy of Dr. Andrew Linklater.
All members of the veterinary team must be familiar with the ready area and location of all necessary emergency equipment and medications.
Regular drills should be organized for emergency situations such as cardiopulmonary arrest (CPA) with subsequentCPR efforts to ensure everyone knows their role and to improve techniques. An emergency treatment or “crash” cart should contain materials necessary to perform CPR and/or institute other emergency therapy.
A ready area includes:
multiparameter monitor (ECG, ETCO2, BP, SpO2 , +/- invasive monitoring)
IV and/or IO catheter supplies (clippers, aseptic scrub, tape, catheters of various sizes)
crash cart (see below)
oxygen supply with masks, humidifier
+/- oxygen cages with environmental oxygen, CO2, humidity and temperature monitors
suction with Yankaur and whistle-tip suction attachments
materials to collect blood (syringes, blood tubes, etc)
IV fluids, sets, pumps, pressure bag, etc
access to rapid-acting injectable anesthetic agents
supplies for centesis (needles or catheters, IV sets, three-way stopcock, syringe, and bowls)
bandage materials
patient transport and restraint materials (muzzles, blankets, gurney)
tools to warm or cool a patient (circulating water blankets, warm air blower, IV fluid warmer, fans, etc)
charts
Mobile crash cart located in a dedicated spot where many emergency patients first arrive.
Courtesy of Dr. Andrew Linklater.
On top of the crash cart is a defibrillator, suction unit with Yankaur and whistle-tip attachments, ECG electrode gel, a daily inventory (check-off) list, and a clipboard with a chart of calculatedness doses, algorithms, and materials for recording.
Courtesy of Dr. Andrew Linklater.
First drawer of a crash cart with laryngoscopes and various size blades, a variety of endotracheal tube sizes, stylets, and a cuff-inflating syringe.
Courtesy of Dr. Andrew Linklater.
Second drawer of a crash cart, with syringes of various sizes with needles attached and emergency drugs (epinephrine and atropine).
Courtesy of Dr. Andrew Linklater.
Third drawer of a crash cart with materials for thoracocentesis and suction, an IO catheter, and sterile gloves.
Courtesy of Dr. Andrew Linklater.
Fourth drawer of a crash cart with additional sterile supplies.
Courtesy of Dr. Andrew Linklater.
Bottom drawer of a crash cart with sterile supplies for emergency thoracotomy and internal defibrillation paddles.
Courtesy of Dr. Andrew Linklater.
Mobile crash cart located in a dedicated spot where many emergency patients first arrive.
Courtesy of Dr. Andrew Linklater.
On top of the crash cart is a defibrillator, suction unit with Yankaur and whistle-tip attachments, ECG electrode gel, a daily inventory (check-off) list, and a clipboard with a chart of calculatedness doses, algorithms, and materials for recording.
Courtesy of Dr. Andrew Linklater.
First drawer of a crash cart with laryngoscopes and various size blades, a variety of endotracheal tube sizes, stylets, and a cuff-inflating syringe.
Courtesy of Dr. Andrew Linklater.
Second drawer of a crash cart, with syringes of various sizes with needles attached and emergency drugs (epinephrine and atropine).
Courtesy of Dr. Andrew Linklater.
Third drawer of a crash cart with materials for thoracocentesis and suction, an IO catheter, and sterile gloves.
Courtesy of Dr. Andrew Linklater.
Fourth drawer of a crash cart with additional sterile supplies.
Courtesy of Dr. Andrew Linklater.
Bottom drawer of a crash cart with sterile supplies for emergency thoracotomy and internal defibrillation paddles.
Courtesy of Dr. Andrew Linklater.
Crash cart contents:
endotracheal tubes of various sizes
laryngoscope with various sizes of blades
syringes of different sizes with 18- or 20-gauge needles attached
CPR drugs (minimally, epinephrine and atropine; additionally, reversal agents [atipamezole, flumazenil, naloxone], lidocaine, amiodarone, vasopressin, etc may be considered)
oxygen and a small and large bag-valve-mask apparatus or other ready access to oxygen (such as an anesthetic machine flushed free of anesthetic gas)
saline flush
bandage scissors
suction unit with sterile Yankaur and whistle-tip suction attachments
defibrillator with gel, internal and external paddles
CPR drug dosage charts and algorithm sheets
thoracostomy kit including sterile gloves, Mayo scissors, scalpel, Finochietto retractors, vascular clamps, large curved hemostats, red rubber or other materials for a modified Rummel tourniquet, etc
Key Points
The golden rule of emergency medicine is to treat the most life-threatening problems first.
Therapy must be implemented at the right time, in the right amount, and in the right order.
Patients, when stable, should be closely monitored for progression or resolution of disease or possible complications of therapy for the underlying disease.
Owners can be instructed to initiate basic first aid before transport.
Stocking and maintaining a "ready area" and crash cart is crucial for successful management of patients.
Analgesia should be administered when appropriate.
For More Information
Also see pet health content regarding emergency care for dogs and cats and emergency care for horses.
