Front desk and triage staff should be aware of presenting conditions that require immediate evaluation by a veterinarian and be instructed on how to call medical personnel STAT if required. They are listed in the Initial Triage and Resuscitation section of Evaluation and Initial Treatment of the Emergency Patient.
All members of the veterinary team must be familiar with the triage area and location of all necessary emergency equipment and medications (see triage area image).
Courtesy of Dr. Andrew Linklater.
Regular drills should be organizedfor emergency situations such as cardiopulmonary arrest with subsequent CPR efforts to ensure all veterinary professionals know their roles and to improve techniques. An emergency treatment or crash cart should contain materials necessary to perform CPR and/or institute other emergency therapy.
The Reassessment Campaign on Veterinary Resuscitation (RECOVER) Initiative released updated guidelines for CPR in dogs and cats in 2024, with certification available for both veterinary professionals and pet owners. CPR training can improve outcomes in dogs and cats. Professionals who deliver medical care can be certified in veterinary CPR either online or in person; these courses use evidence-based medicine to ensure the proper delivery of basic and advanced life-support techniques.
A triage area includes the following components:
multiparameter monitor (ECG [electrocardiography], ETCO2 [end-tidal CO2], BP [blood pressure], SpO2 [pulse oximetry]; may or may not include invasive monitoring)
IV and/or intraosseous catheter supplies (clippers, aseptic scrub, tape, catheters of various sizes)
crash cart (see image of crash cart and crash cart supply list, below)
oxygen supply with masks, humidifier
oxygen cages with environmental oxygen, CO2, humidity and temperature monitors (optional/nice to have)
suction with Yankauer 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
RECOVER Initiative–based CPR algorithms and drug/defibrillation dose 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 laryngoscope and various size blades, a variety of endotracheal tube sizes with tie-ins, 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). Additional medications used during CPR may also be present and include vasopressin, amiodarone, lidocaine, and esmolol. Reversal agents may include naloxone, flumazenil, and atipamezole.
Courtesy of Dr. Andrew Linklater.
Third drawer of a crash cart with materials for thoracocentesis and suction, an intraosseous 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 laryngoscope and various size blades, a variety of endotracheal tube sizes with tie-ins, 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). Additional medications used during CPR may also be present and include vasopressin, amiodarone, lidocaine, and esmolol. Reversal agents may include naloxone, flumazenil, and atipamezole.
Courtesy of Dr. Andrew Linklater.
Third drawer of a crash cart with materials for thoracocentesis and suction, an intraosseous 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 include the following:
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, and esmolol may be considered)
oxygen and a small and large airway-mask-bag unit (AMBU bag) or other ready access to oxygen (such as an anesthetic machine flushed free of anesthetic gas)
saline flush
bandage scissors
suction unit with sterile Yankauer and whistle-tip suction attachments
defibrillator with gel and internal and external paddles
RECOVER Initiative–based CPR drug dosage charts and algorithm sheets
thoracotomy 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 triage area and crash cart are crucial for successful management of patients.
Analgesia should be administered when appropriate.
For More Information
Also see pet owner content regarding emergency care for dogs and cats and emergency care for horses.
