ASR- Lesson 1- Physical Assessment

The physical exam is a series of observations that are made to determine the severity of a victim’s medical condition and what approach for first aid should be made. It is important to be thorough but as quick as possible. This animal does not have much time so finding out what first aid it needs is imperative. Before starting a hands-on exam, stand back and look at the pet. Look at the animal’s posture, breathing, activity level, and general appearance. Four different observations are used to conduct a physical exam. These include visual inspection, palpation (sense of touch), percussion(tapping on areas of the body), and auscultation(listening to) The use of these senses helps us determine any abnormalities. Clinical examination can be undergone by taking vital sign, general clinical examination, and systemic examination of animals.

The following are the parts of a general physical exam:

Listening to an animal’s lungs and heart
Checking the cat or dog’s stance, gait, and weight
Examining the pet’s eyes for signs of excessive tearing, discharge, redness, cloudiness, or eyelid issues
Checking the pet’s coat for overall condition, abnormal hair loss, or dandruff
Examining the pet’s nails and feet for damage or signs of a more serious health condition
Looking at the pet’s ears for signs of bacterial infection, ear mites, or wax
Examining the condition of the pet’s teeth for any indications of periodontal disease, damage, or decay
Checking a pet’s skin for a handful of problems such as parasites, dryness, lumps, and bumps (specifically in skin folds)
Feeling the pet’s abdomen to access the internal organs to see if they appear normal and to check for signs of discomfort
Feeling along a cat or dog’s body (palpating) for hints of illness including swelling, evidence of lameness ( such as limited range of motion), and signs of pain

It’s important for every pet owner and animal professional to know the basics when it comes to an animal’s vital signs. Vital signs are measurements of the body’s most basic functions. Obtaining vital signs can help assess the pet’s physical condition in an emergency situation and better prepare for sharing important information with a veterinarian. The three main vitals to assess are: heart rate/pulse, respiratory rate, and temperature. The primary survey is a series of observations that are made to determine the severity of a victim’s condition and what approach for first aid should be made. It is important to be thorough but as quick as possible. This animal does not have much time so finding out what first aid it needs is imperative.

AIRWAY: Check for a patent airway. Ensure the mouth and throat are clear of obstructions.

CIRCULATION: Check for a heartbeat and note the heart rate and rhythm. Palpate the femoral arterial pulses. Feel the gums, ears, and extremities to see if they are cool. See if there is any evidence of bleeding. Look for any bruising or petechiae.

PULSE DEFICITS: Pulse deficit is not a normal state. A pulse deficit is defined as an inefficient heartbeat that does not generate a palpable pulse. When listening to the heart with a stethoscope at the same time you palpate the pulse, you will hear a heartbeat, but no pulse will be generated. The most common cause of a pulse deficit is ventricular premature contractions (VPC). VPCs can be seen in cases of splenic ruptures or torsions, GDVs, and primary cardiovascular disease. It can take up to 36 hours for the VPCs to develop, and they can progress to a life-threatening arrhythmia. Palpating a pulse deficit is an indication to connect an ECG (if not already placed on the animal) and alert the doctor immediately.

MUCOUS MEMBRANE COLOR: Normal = pink

CAPILLARY REFILL TIME (CRT): Normal = 1-2 seconds

Mucous membrane color and capillary refill time (CRT) serve to evaluate perfusion, oxygenation, and some underlying diseases. Mucous membrane color is assessed by lifting the upper lip and quickly pressing on the gums with your finger to push the blood out of the tissue, then removing your finger and counting the number of seconds it takes for the color to return. This should normally take 1 to 2 seconds.

Hyperthermia may be due to infection, immune-mediated diseases, allergic reaction, and prolonged exposure to heat, seizures, and stress/anxiety. Temperatures >106 can cause diminished clotting ability (DIC). Hypothermia may result from shock, blood loss, dehydration, heart failure, prolonged exposure to cold, or the patient being very immature or a toy breed. External re-warming alone can often help improve hemodynamic stability for hypothermic cats.

PAIN: No pain is the normal state. Pain has also been shown to delay healing. Pain increases the stress response and causes tachycardia. This increased workload puts more pressure on the cardiovascular system. If a patient is painful, judge whether the level of pain is more intense than expected. The pain may be an indication of a new issue and should be brought to the doctor’s attention. Usually pain medications are not withheld, but there are some exceptions. Pain medication may alter the responses during the neurological exam. This is particularly important in trauma cases or neurologic patients.

ABDOMINAL DISTENTION: Distention of the patient’s abdomen can suggest severe life-threatening complications. Blood in the abdomen may be due to a clotting problem, ruptured spleen or ruptured tumor, or a ruptured blood vessel post-surgery. An infection in the abdomen may be the result of a rupture of the gastrointestinal tract from a foreign body, abscess, or tumor. A rupture from blockages, trauma, or tumors in the urinary tract will cause urine in the abdomen. Sterile inflammation in the abdomen may be caused by pancreatitis; FIP; cancers. Fluid in the abdomen may result from low protein, heart failure; low protein levels/liver disease. Air in the stomach/not free in the abdomen is from GDV or bloat.

NEUROLOGIC or DISABILITY/DYSFUNCTION – The patient’s level of consciousness should be bright, alert and responsive. Abnormal responses would be dull, stuporous, obtunded or comatose. Their posture, response to pain, and if they are ambulatory or not may indicate an issue. The patient

should be evaluated for any seizure activity, whether the fore limbs and hind limbs both shift or if the hind limbs are flaccid. If there is a decrease in gag, or no gag reflex, this puts the patient at high risk for aspiration. The patient may need to be intubated to protect the airway. Suction may be needed. [2]

Neurological considerations:

Levels of consciousness:
Alert: Normal awake and responsive
Obtunded/depressed/dull: State of decreased Drowsy, but rousable. Patients are generally inattentive and display little spontaneous activity.
Stuporous/semi-comatose: Patient is in a sleep state, can be aroused only with painful stimuli
Coma: Cannot be aroused, even with painful stimuli

Quality of consciousness:

Dementia or delirium: patient is alert with normal level of consciousness but exhibits abnormal behavior and responds inappropriately to interactions or stimuli
Motor activity and posture
Ambulatory non-ambulatory
Ataxia, hemiparesis, tetraparesis, hemiplegia, or tetraplegia
Decerebrate posture: the patient is usually rigid with an arched back, head thrown backward, and extensor rigidity of all 4 Mentation is stuporous to comatose.
Decerebellate posture: the patient is usually rigid with an arched back, head thrown backward, and extensor rigidity of the thoracic limbs and either extension or flexion of the pelvic limbs present. Patient should be responsive and have voluntary muscle movement.
Schiff-Sherrington occurs when there is a spinal cord lesion or injury somewhere between T3-L3. In these paraplegic animals, the fore limbs are rigid.

EYES: Normal = equally sized responsive pupils, centrally positioned eyes. Normal pupils should be midrange, of equal size, and constrict when exposed to light. Pupillary abnormalities may appear:

Unilateral mydriatic, unilateral miosis or anisocoria
Bilateral pinpoint pupils or May precede bilateral mydriatic unresponsive pupils.
Bilateral mydriatic, midrange fixed pupils or dilated fixed pupils