CVA Emergency and Critical Care Basics — Questions and Answers
Question 1: When triaging multiple patients arriving simultaneously at a veterinary clinic, which patient should receive care FIRST?
- A dog with a 3-day history of vomiting and lethargy
- A cat with an upper respiratory infection and mild nasal discharge
- A dog that is unconscious and not breathing (Correct answer)
- A rabbit with a broken nail that is bleeding slowly
Correct answer: A dog that is unconscious and not breathing
An unconscious, apneic (not breathing) patient is an immediate life-threatening emergency requiring CPR and resuscitation before any other intervention. Triage prioritizes patients by urgency: immediate (life-threatening) → urgent (stable but serious) → non-urgent (minor). The other patients in this scenario are urgent or non-urgent.
Question 2: What is the recommended chest compression-to-ventilation ratio for basic CPR in a small dog or cat, according to current RECOVER guidelines?
- 15:2
- 30:2 (Correct answer)
- 5:1
- 50:2
Correct answer: 30:2
The RECOVER (Reassessment Campaign on Veterinary Resuscitation) guidelines recommend a 30:2 compression-to-ventilation ratio for cats and small dogs — 30 chest compressions followed by 2 rescue breaths. Compressions should be performed at a rate of 100–120 per minute. Continuous compressions without pausing are ideal when two rescuers are available.
Question 3: Which combination of clinical signs is MOST consistent with hypovolemic shock in a canine patient?
- Bradycardia, hypertension, and bounding pulses
- Tachycardia, pale mucous membranes, and prolonged capillary refill time (>2 seconds) (Correct answer)
- Hyperthermia, tachycardia, and injected (red) mucous membranes
- Bradycardia, hypotension, and normal mucous membranes
Correct answer: Tachycardia, pale mucous membranes, and prolonged capillary refill time (>2 seconds)
Hypovolemic shock occurs when circulating blood volume is insufficient. The body compensates with tachycardia (to maintain cardiac output), vasoconstriction causing pale mucous membranes, and decreased peripheral perfusion causing prolonged CRT (>2 sec). Hypotension is a late and ominous sign. Bounding pulses and normal/red mucous membranes suggest distributive (septic) shock instead.
Question 4: A dog is presented in respiratory distress with labored open-mouth breathing. What is the FIRST action the veterinary assistant should take while the veterinarian is being paged?
- Administer subcutaneous fluids immediately
- Obtain a full blood panel before any treatment
- Provide flow-by or mask oxygen supplementation and minimize stress (Correct answer)
- Place the patient in dorsal recumbency for abdominal palpation
Correct answer: Provide flow-by or mask oxygen supplementation and minimize stress
In a patient with respiratory distress, supplemental oxygen should be provided immediately (flow-by oxygen held near the face is well-tolerated and reduces stress), and all non-essential handling should be minimized. Stress and restraint can precipitate respiratory collapse in a dyspneic patient. Diagnostics and invasive procedures should follow once the patient is more stable.
Question 5: Which drug is the FIRST-LINE pharmacological agent administered during cardiopulmonary arrest (CPA) in dogs and cats?
- Atropine
- Lidocaine
- Epinephrine (adrenaline) (Correct answer)
- Dexamethasone
Correct answer: Epinephrine (adrenaline)
Epinephrine (0.01 mg/kg IV/IO) is the primary drug in veterinary CPR per RECOVER guidelines. It causes vasoconstriction (increasing coronary and cerebral perfusion pressure during compressions) and has positive chronotropic and inotropic effects. Atropine is used for vagally mediated bradycardia, lidocaine for ventricular arrhythmias, and corticosteroids are not indicated in CPA.
Question 6: When placing an intravenous catheter in an emergency patient, which vein is MOST commonly used as the first choice in dogs?
- Jugular vein
- Saphenous vein
- Cephalic vein (Correct answer)
- Auricular vein
Correct answer: Cephalic vein
The cephalic vein (running along the cranial foreleg) is the most accessible and commonly used first-choice IV site in dogs. It is easy to visualize, restrain, and catheterize. The jugular vein is reserved for rapid volume delivery, central venous pressure monitoring, or when peripheral access fails. The saphenous vein is a secondary peripheral option, and the auricular vein is used in rabbits.
CVA Emergency and Critical Care Basics
When triaging multiple patients arriving simultaneously at a veterinary clinic, which patient should receive care FIRST?