INTRODUCTION

Care of the seriously injured or critically ill patient requires a state of around-the-clock readiness of the appropriate facility, supplies, equipment, and staff. Triage means to sort and describes the process of prioritizing patient care when there is more than one patient requiring attention. In critical care medicine patients requiring triage will include those arriving at the hospital on an emergency basis, hospitalized patients being transferred to the ICU from other areas of the hospital, and current ICU patients that deteriorate suddenly. Priority of need is based on the level of urgency required to ameliorate the global, tissue, and cellular consequences of their conditions. Optimal management involves horizontal resuscitative care, a collective effort done by several individuals working together. This is in contrast to vertical resuscitative care, during which diagnostic and therapeutic tasks are completed in a step-by-step fashion. The latter is an effective way to deliver care but is slower and more burdensome to the practitioner.¹

READINESS

There is good evidence that critically and multiply injured patients benefit from preplanned preparedness of facility and staff and a team approach with preplanned objectives (Box 2-1).^2,3 The ideal number of staff to have on a veterinary triage-resuscitation team has not been fully investigated. However, in the author’s experience three to four is considered the minimum and is supported by research in human trauma centers⁴; these would include a veterinarian and at least two technical support staff. In the case of emergency patient assessment and stabilization, it is important that emergency team members be familiar with both their own roles and those of their colleagues.²

Resuscitation and stabilization of critical patients require rapid reestablishment of adequate oxygen delivery to the tissues. Research has shown that if cellular hypoxia of the gastrointestinal tract in dogs that are in hemorrhagic shock continues beyond 1 hour, death from organ dysfunction and sepsis from gastrointestinal bacterial translocation and endotoxin absorption across the gut wall may occur a day to several days later.⁵ Speed of resuscitation is also pivotal in saving the life of a pet with multiple injuries.⁴ Therefore shock and tissue hypoxia must be reversed rapidly in the critically ill patient. To accomplish this, preplanning is imperative.

A “ready area” that is set up for immediate resuscitation is required.¹ The area should have excellent lighting and be organized in an “open system,” where most items that may be needed are in the open and can be accessed readily. Suggested items for the “ready area” are listed in Box 2-1. It is highly recommended that the bag-valve and reservoir and the masks (small and large) be assembled for immediate use. A crash cart that is fully stocked and prepared for cardiopulmonary arrest should also be kept in the “ready area.” Around-the-clock radiographic and ultrasonographic capabilities, laboratory capabilities, and continuous ICU care are required for most critically ill or injured patients. Laboratory assessment is mandatory and may include arterial and venous blood gas analysis, clinical chemistry levels (especially glucose), red and white blood cell counts, and urinalysis. Assessment of coagulation, serial hematocrits, and total plasma solids must be possible and readily available.