Reception Triage manual.

RE: Reception Triage manual.

laura kinnear — Thu, 15 Mar 2018 18:06:17 GMT

Are you able to send me a copy lkinnear82@btinternet.com

RE: Reception Triage manual.

Lucy Hudson — Thu, 15 Mar 2018 15:31:51 GMT

Hi Janette

Could i ask your permission to use your protocol for reception triage across our branches, it's really good? thanks

Lucy

RE: Reception Triage manual.

Janette Young — Thu, 26 Jan 2017 22:43:57 GMT

Appointments and emergencies

When a client calls and isn’t sure whether they need to book their pet in for an appointment, it’s always best to offer one anyway and see what they want to do. Here is a list of common things and emergencies that clients may call about.

Kennel cough

Should be called ‘park cough’ as it’s not only picked up in kennels. Similar to the human cold, it’s very contagious between dogs.

Symptoms include;

▪ Coughing which sounds dry, hacking, as if there’s something stuck in the throat

▪ Lethargy

▪ Exercise intolerance

▪ Generally unwell

Small puppies or dogs with existing respiratory or heart conditions should be encouraged to come down.

NOTE: Coughing, lethargy and exercise intolerance are also symptoms of other diseases.

Vomiting/Diarrhoea

Common in dogs and cats, this can be caused by a number of reasons, including eating something they shouldn’t, stomach virus, bacterial infection, stress, dietary t etc.

Symptoms include;

▪ Vomiting

▪ Retching

▪ Coughing

▪ Straining

▪ PAIN when going to toilet

▪ Inappetance

▪ Eating grass

All patients with V+/D+ should be encouraged to make an appointment, but special care should be taken with small dogs and cats, puppies and kittens as they can lose fluid and body condition very quickly. If the patient has not eaten or drunk in 24-48 hours it should ideally be seen the same day, if not early the next day.

NOTE: If the patient is non-productive retching, vomiting straight after eating and non-productive straining to excrete, they MUST COME DOWN STRAIGHT AWAY. This could be indicative of a foreign body stuck somewhere in the digestive system.

Eye infection or trauma

Fairly common, especially in younger animals or patients with brachycephalic (short) faces with eyes that protrude. Symptoms include;

▪ Discharge from the eye (and sometimes nose)

▪ Crust around the eye

▪ Holding the eye closed

▪ Blinking excessively

▪ Redness

▪ Third eyelid coming across the eye

▪ Pain around the face

Owners should be encouraged to bring the patient down the same day or the next day as eye problems can deteriorate quite quickly.

A prolapsed eye is a clinical emergency and must be seen as soon as possible.

NOTE: If a rabbit owner suspects their rabbit has an eye infection, ask if the rabbit is eating properly and producing formed rabbit pellets. Eye issues in rabbits can sometimes be caused by tooth abscesses or problems with the teeth. If the rabbit has not been eating properly and not producing proper poo pellets, it should be seen AS SOON AS POSSIBLE. A rabbit not eating for 12-24 hours is a clinical emergency.

Limping

If a patient has a non-weight-bearing limp (holding it completely off the floor when moving) it should be seen ASAP to get pain relief on board and assess the injury. If the patient is toe-tapping when walking, or walking on it gingerly, it should ideally be seen that day or the next day at the latest. Owners should be advised not to exercise their pet in the meantime and to keep them calm and quiet. Cats should be kept indoors until the appointment.

Road Traffic Accident

This is an emergency whether or not the owner thinks it was ‘just a bump’ or ‘a little knock’. Patients may escape broken bones or serious trauma but can still go into shock after being hit by a car and can also suffer internal bleeding. They need to be seen ASAP for clinical assessment. Advise the owner not to give anything to eat or drink at this stage, just in case the animal needs emergency surgery. Advise the owner to keep the animal warm on the journey to the practice.

Cat ‘constipation’

If an owner calls and says their cat is constipated, check whether it is male or female. Male cats can suffer from a blocked bladder (urinary stones blocking the urethra out of the bladder, causing the bladder to swell with urine) and this can present like trying to poo, when in fact they’re trying to wee. Symptoms include;

▪ Constantly going in and out of the litter tray

▪ Straining to urinate (may produce drops, short trickles or nothing at all)

▪ Howling, meowing, growling

▪ Agitation/aggression

A blocked bladder is a clinical emergency and must be seen straight away. . Often the cat is simply suffering from a bad cystitis, but it’s better to be safe than sorry Note that female cats can also suffer from this, but it’s very rare due to their anatomy.

GDV (Gastric Dilation and Volvulus)

This is where a dog’s stomach swells with gas or food, flips over and blocks at either end. This is a life-threatening condition and must be considered an emergency. Symptoms include;

▪ Massive swelling of the stomach

▪ Painful abdomen and back

▪ Howling/barking/aggression

▪ Prayer position (forelegs down, bum in the air)

▪ Non-productive retching (this can sound like coughing)

▪ Restlessness, unable to get comfortable, pacing

This can happen in all dogs (and very rarely, cats) but is more common in barrel-chested breeds such as Setters, Labradors, German Shepherds, Bassett Hounds, Mastiffs, Vizslas and Weimaraners. Treatment involves releasing the gas in the stomach and surgery.

Bloat is a similar condition without the flipping over of the stomach. This also needs to be seen ASAP as it could turn into a GDV.

Cat bite abscess

Caused by cat fighting, an abscess is a pocket of infection under the skin. This can be anywhere on the body, but more commonly found on the face, front paws, chest, rump and tail. Symptoms include;

▪ Swelling at the wound site

▪ Pain around the wound site

▪ A grumpy cat!

▪ If the infection has progressed, the cat may vomit

▪ Anorexia

▪ Limping (if on a foot)

This should ideally be seen the same day or early the next day to get some antibiotics and pain relief on board.

Dog bite wounds

Can be found anywhere on the body, the owner should be encouraged to make an appointment within a few days ideally. Dog bites are rarely stitched up unless they are large as this traps infection under the skin. Instead, they are normally clipped, cleaned and a course of abs (antibiotics) may be prescribed.

NOTE: If the wound is bleeding and won’t stop, the owner should bring the dog to the practice straight away. They should be advised to put pressure on the wound until they can get to the practice.

Collapsed animal

A patient that is collapsed (can’t stand up by itself) should be considered a clinical emergency and must come to the practice immediately. Be aware that there is a difference between a collapsed animal and a weak or lethargic animal. A collapsed animal cannot hold its weight at all, whereas a lethargic or weak animal may be able to sit or stand in position for a short amount of time. Either way, the owner should bring the patient to the practice where it can be triaged on arrival by a vet/nurse.

Respiratory distress

This is also considered a clinical emergency and must be brought to the practice immediately. Symptoms include;

▪ Struggling to breathe

▪ Increased abdominal effort (obvious abdominal movement in inhalation/expiration)

▪ Lethargy/collapse

▪ Coughing

▪ Panting

▪ Blue mucous membranes (gums)

▪

Toxicity/poisoning

Common things that are toxic to both cats and dogs are;

▪ Chocolate

▪ Lilies (extremely toxic to cats)

▪ Rat/slug bait

▪ Antifreeze

▪ Raisins/sultanas/grapes/dates/currants

▪ Alcohol

▪ Paracetamol/ibuprofen (extremely toxic to both cats and dogs)

▪ Bleach/household cleaners (Dettol and Jeyes fluid are extremely toxic to cats)

If a patient has ingested any of these they need to be seen straight away. If you’re unsure whether something is toxic to a pet, find out from the owner how much they ate, what strength (if relevant), how long ago they ate it and if they’re showing any other symptoms. There is a specialist toxicity helpline for vets with a huge database of toxins/poisons who can check whether it’s dangerous or not. Bring empty packet with them.

Diabetes

Diabetic animals can bring with them a host of problems if not controlled. The first is hypoglycaemia (low blood sugar) or hypoglycaemic coma. This often comes about if the animal has been given its insulin dose but hasn’t eaten meaning all the glucose in the blood is taken into the cells. Symptoms of hypoglycaemia are;

▪ Wobbly gait

▪ Malcordination

▪ Collapse

▪ Fitting

▪ Coma

This must be seen ASAP. A nurse can advise the owner in the meantime to rub honey on the patient’s gums.

The second issue is ketoacidosis. Uncontrolled diabetes (caused by no insulin, inconsistent insulin dosage, wrong dose or undiagnosed diabetes) means the body can’t use glucose for energy, so it burns fat instead. A product of fat metabolism is ketones, which circulate in the blood causing a change in the blood PH. Symptoms of ketacidosis include;

▪ Lethargy

▪ Vomiting

▪ Weight loss

▪ Diarrhoea

▪ Weakness

▪ Fruity, ‘pear drop’ breath

▪ Increased drinking/urinating

▪ Changed appetite

▪

These are both life-threatening conditions and must be seen ASAP.

Hyperthermia/heatstroke

Can be common in hot weather, especially dogs who have run around in the park and not had access to shade or water. Must be seen ASAP. Advise the owner to cover the dog in a cool (not freezing cold) wet towel if they can. A change from too hot to too cold can be worse than staying too hot. Advise the owner to offer water little and often, and not to let the animal gorge itself (or it will vomit). Hyperthermia is more common than hypothermia (too cold) and sadly does still happen to dogs and cats left in hot cars.

Paraphimosis

Essentially a dog’s penis that has come out of its sheath and won’t go back in. This needs to be seen ASAP as it can cause damage to the penis. Not common, but sometimes happens.

Flystrike

An affliction that affects rabbits. Flystrike happens when a rabbit hasn’t groomed itself properly or lives in an unclean environment. Flies become attracted to the smell of urine and lay their eggs in the rabbit’s rump and around the tail area. The eggs hatch quickly into maggots, which immediately start to eat the rabbit’s flesh. This is a clinical emergency and must be seen straight away. Rabbits are very delicate and can die quickly from toxic shock.

Off back legs/neurological signs

Lack of balance, head tilt, ‘off it’s legs’, paraplegia, hemiplegia or any other neurological symptoms (e.g. ‘fly-catching’, biting at things in the air, circling etc) need to be seen straight away. These are signs of a neurological problem.

Seizures

If a client calls to say their pet is having a seizure right now, tell them to do the following;

1. Stay calm. If they are calm, the pet will pick up on it. If they panic, the seizure could last longer.

2. Ask them to tell you how long the patient has been fitting and what the pet was doing leading up to the fit

3. Turn down the lights, close the curtains, turn off all TVs, radios, music players etc.

4. As long as it is safe to do so, move objects away from the patient that they may injure themselves on

5. As long as it is safe to do so, try to support the patient’s head with a cushion or blanket

Make the owner aware that even the nicest dog or cat may bite when fitting. If you don’t, the owner could sue if they are injured as a result. The owner will probably want to bring the patient to the surgery straight away. This is sometimes counter-productive, as after a seizure a patient is in a higher state of excitability and getting into the car, travelling and seeing the vet could set off another seizure. You need to find out if there is a known cause for the seizure. Ask the owner;

▪ Is the patient, or could the patient be epileptic? (see action 1 below)

▪ Has the patient, or is it suspected that the patient had any access to poisons or toxins? (see action 2 below)

▪ Is the patient, or could the patient be diabetic? (see action 2 below)

Action 1 – Time the seizure. If the patient continues to seizure for more than 3 minutes, or has cluster seizures (one after another) then the owner should bring the patient to the practice AS SOON AS IT IS SAFE TO DO SO. If the seizure stops, make sure the owner keeps the pet calm and quiet and book in for an appointment later that day or the next day.

Action 2 – Bring the patient to the surgery AS SOON AS IT IS SAFE TO DO SO. Tell the owner not to put themselves in any danger moving a fitting animal. Give the number of an animal ambulance company if necessary, who may be able to help.

Anaphylaxis

Caused by acute allergic reactions such as insect bites/stings, snake bites, vaccinations, reactions to medications/food, antibiotics etc. Symptoms of anaphylactic shock are;

▪ diarrhoea

▪ Vomiting

▪ Shock

▪ Seizures

▪ Swelling (especially if stung around the face, can cause a closure or blockage of the pharynx or swollen tongue), leading to;

▪ Respiratory distress

▪ Coma

This is an emergency and must be seen as soon as possible. Try and find out from the owner what the patient was doing prior to the onset of symptoms.

A final note;

If in doubt, book it in as soon as you can and then tell the vet or nurse what’s happened. They may then want you to call the owner back to be seen sooner.

Make sure you check the owner’s phone number if you think there is a possibility they might need to be called back

If an emergency case is coming down, get the following information:

▪ Surname

▪ Patient’s name

▪ Correct telephone number

▪ How long they will take to get to the practice

▪ If a poisoning case, ask the owner to bring all packaging (even if chewed/fallen apart)

▪ If the patient is on medication, ask the owner to bring the medication with them if possible

Finally, tell someone that the patient is coming down so that they can prepare for it’s arrival.

RE: Reception Triage manual.

Janette Young — Thu, 26 Jan 2017 22:41:56 GMT