# Trauma Triage and Primary Survey in Small Animals ## Key Takeaways - The primary survey in small animal trauma follows a strict Airway, Breathing, Circulation (ABC) sequence, with immediate intervention at each step before proceeding, as airway obstruction is the most rapid cause of death, followed by respiratory failure, then circulatory collapse. - Triage is a dynamic process prioritizing patients based on immediate threat to life, utilizing perfusion, mentation, and respiratory effort, and requires reassessment after any intervention or patient deterioration. - Hemorrhagic shock is presumed in hypotensive trauma patients until proven otherwise; resuscitation should be measured, using small fluid boluses titrated to a palpable femoral pulse and improved mentation, with blood products preferred over crystalloids for severe hemorrhage. - Tension pneumothorax is an immediate life-threatening breathing abnormality requiring prompt needle thoracocentesis for diagnosis and temporary relief, followed by tube thoracostomy for ongoing management. - Recognizing failure modes is critical, such as misattributing ventilatory failure to circulatory shock based on tachycardia and pale mucous membranes, which requires careful assessment of breathing patterns and objective data like capnography. - Documentation of the primary survey must be time-stamped and sequential, detailing findings, interventions, and patient response to ensure continuity of care and support clinical decision-making. --- Trauma is a leading cause of emergency presentation in dogs and cats, and the first minutes of care determine outcome more than any subsequent intervention. This article provides a structured framework for triage prioritization and the primary survey (ABC) in the small animal trauma patient. It is written for the practicing veterinarian who must rapidly identify life-threatening injuries, initiate stabilization, and decide when to advance to the secondary survey and definitive diagnostics. The focus is on the decision logic and examination sequence, not on the specific management of individual injuries. The approach described here draws on principles adapted from human trauma systems and applies them to the anatomical and physiological realities of dogs and cats. A disciplined primary survey, repeated as needed, remains the most reliable way to avoid the common failure mode of fixating on a dramatic external wound while a tension pneumothorax or hemorrhagic shock progresses unnoticed. Team training in trauma skills measurably improves clinician confidence in applying both teamwork and clinical competencies, which supports the value of rehearsing these sequences before an emergency arrives [A predeployment trauma team training course creates confidence in teamwork and clinical skills](https://pubmed.ncbi.nlm.nih.gov/22072008/). ## At a Glance | Parameter | Decision or Action | Notes | |---|---|---| | Triage category | Assign immediately on presentation | Based on perfusion, mentation, and respiratory effort | | Airway | Assess patency and protect cervical spine | Assume spinal injury in any high-impact or unknown mechanism | | Breathing | Evaluate rate, effort, lung sounds, and thoracic wall integrity | Tension pneumothorax and flail chest are immediate threats | | Circulation | Assess pulse quality, mucous membrane color, CRT, and heart rate | Hypotension in trauma is hemorrhagic until proven otherwise | | Perfusion targets | Restore systolic blood pressure to a palpable femoral pulse | Avoid over-resuscitation, permissive hypotension may apply | | Resuscitation fluids | Crystalloids or blood products based on response | Current formulary and transfusion guidelines must be consulted | | Monitoring | Repeat primary survey after every intervention | Deterioration requires re-evaluation of the entire ABC sequence | | CPR readiness | Have RECOVER-based protocols immediately available | Cardiac arrest in trauma carries a poor prognosis but is not futile | ## Triage Priorities in the Trauma Patient Triage in veterinary trauma is a dynamic process, not a single event. The clinician must assign each patient a priority based on the immediacy of threat to life, then reassign that priority as the patient responds or deteriorates. The most useful triage systems in small animal practice classify patients into three groups: those requiring immediate intervention, those requiring urgent but not immediate care, and those that can wait. A patient with an open, bleeding wound but stable perfusion may be lower priority than a patient with no visible external injury but severe tachypnoea and dull mentation. The triage decision should be made with minimal handling. A distressed or painful animal may be dangerous to examine, and physical restraint can worsen hypoxia or hypotension. Chemical restraint, when needed, should be chosen for cardiovascular stability and titrated to effect. The triage officer must also consider the capacity of the hospital: a patient that requires immediate surgery may need transfer to a referral center, and that decision should be made early instead of after hours of unsuccessful stabilization. ## The Primary Survey: Airway, Breathing, Circulation The primary survey is a rapid, systematic assessment of the ABCs, performed in that order, with intervention at each step before moving to the next. The sequence is deliberate: airway obstruction kills faster than breathing failure, and breathing failure kills faster than circulatory collapse. In practice, the survey takes less than two minutes in a stable patient and is repeated continuously in a deteriorating one. ### Airway Assessment and Management Airway assessment begins with observation. Is the patient making respiratory noise? Stridor or stertor indicates partial obstruction. Is there blood, vomitus, or foreign material in the oropharynx? Is the patient able to maintain a patent airway when recumbent? The cervical spine must be protected during any airway manipulation, as trauma patients with head injuries or high-velocity mechanisms may have vertebral fractures that are not yet apparent. Interventions follow a stepwise progression. Simple measures include clearing the oropharynx, extending the head and neck (with spinal precautions), and placing an endotracheal tube in the apnoeic or severely obtunded patient. In patients with maxillofacial trauma that prevents oral intubation, a temporary tracheostomy may be required. The decision to intubate should be made early: a patient that is struggling to breathe is consuming oxygen that could be used for tissue perfusion, and the metabolic cost of respiratory effort in shock is substantial. ### Breathing and Ventilation Assessment Breathing assessment evaluates both the adequacy of ventilation and the integrity of the thoracic structures. The clinician should observe respiratory rate and pattern, thoracic wall movement, and the presence of paradoxical motion that suggests a flail segment. Auscultation of both hemithoraces, including the dorsal lung fields, identifies absent or muffled lung sounds that indicate pneumothorax, hemothorax, or diaphragmatic hernia. Percussion of the thorax can distinguish a resonant (air-filled) from a dull (fluid-filled) hemithorax, though this is often impractical in the dyspnoeic patient. Tension pneumothorax is the most immediately life-threatening breathing abnormality in trauma. It presents with severe respiratory distress, absent lung sounds on the affected side, and progressive cardiovascular collapse as venous return is impaired. Needle thoracocentesis at the seventh to ninth intercostal space, dorsal to the costochondral junction, is both diagnostic and therapeutic. A rush of air confirms the diagnosis and provides immediate, if temporary, relief. Tube thoracostomy is then indicated for ongoing management. ### Circulation and Hemorrhage Control Circulation assessment in the trauma patient is an exercise in recognizing compensated shock before it becomes decompensated. The classic parameters are heart rate, pulse quality, mucous membrane color, capillary refill time, and mentation. A dog with a femoral pulse that is weak and rapid, pale mucous membranes, and a delayed capillary refill time is in hemorrhagic shock until proven otherwise. Cats are more challenging: they may present with bradycardia and hypothermia instead of tachycardia, and their mucous membranes may appear pale or muddy instead of white. External hemorrhage should be controlled during the circulation assessment. Direct pressure over the wound is the first-line intervention. Tourniquets are reserved for exsanguinating limb hemorrhage that does not respond to direct pressure, and their use carries risks of ischemia and reperfusion injury. Internal hemorrhage, such as that from a ruptured spleen or liver laceration, requires rapid identification and surgical or interventional control. Resuscitation of the trauma patient with hemorrhagic shock has evolved. The traditional approach of aggressive crystalloid infusion to restore normal blood pressure may worsen outcomes by diluting clotting factors, dislodging formed clots, and increasing hydrostatic pressure that promotes further bleeding. Current guidance supports a more measured approach, with fluid administered in small boluses titrated to a target of a palpable femoral pulse and improved mentation, instead of to a specific blood pressure value. When blood products are available, they are preferred over crystalloids for resuscitation of significant hemorrhage, as evidence from experimental models shows that whole blood or blood components improve survival and lessen the pathophysiological burden of traumatic hemorrhagic shock compared with crystalloid alone [Resuscitation with whole blood or blood components improves survival in a pre-clinical porcine model](https://pubmed.ncbi.nlm.nih.gov/35900383/). The [RECOVER Initiative veterinary CPR guidelines](https://recoverinitiative.org/) provide the framework for managing the patient that progresses to cardiac arrest, and the [AAHA/AAFP fluid therapy guidelines](https://www.aaha.org/resources/2024-aaha-fluid-therapy-guidelines-for-dogs-and-cats/) should inform fluid selection and monitoring in all trauma patients. ## The Physiology of Traumatic Shock Traumatic shock is not a single entity. It is a combination of hypovolemia from blood loss, tissue injury that triggers a systemic inflammatory response, and, in some patients, direct damage to the heart or great vessels. The body's compensatory response to hemorrhage is initially effective: baroreceptor activation increases heart rate and systemic vascular resistance, and neuroendocrine responses conserve sodium and water. These mechanisms maintain perfusion to the brain and heart at the expense of the skin, kidneys, and gastrointestinal tract. The clinical signs of compensated shock are the visible expression of this redistribution. The transition from compensated to decompensated shock occurs when compensatory mechanisms are overwhelmed. This is a dynamic process, and the rate of deterioration depends on the rate of blood loss, the patient's baseline cardiovascular reserve, and the presence of concurrent injuries. A young, fit dog may lose 30% of its blood volume before showing significant hypotension, while a geriatric cat with underlying cardiac disease may decompensate after a much smaller loss. The primary survey must therefore be interpreted in the context of the individual patient, and repeated assessments are more valuable than a single snapshot. ## Limitations and Uncertainty in Trauma Assessment The evidence base for veterinary trauma triage is limited. Much of what is practiced is extrapolated from human medicine, and the anatomical and physiological differences between species mean that some extrapolations are more valid than others. The clinical signs of shock in cats, for example, differ markedly from those in dogs, and the thresholds for intervention that are well established in human trauma may not apply. The clinician should acknowledge this uncertainty and rely on serial assessments and response to therapy instead of on any single parameter. Biomarker-based approaches to trauma prognostication are an active area of research, with emerging data suggesting that individual responses to injury are heterogeneous and that molecular signatures may eventually guide resuscitation and prognostication [Molecular and biomarker signatures of trauma](https://pubmed.ncbi.nlm.nih.gov/42419069/). These tools are not yet ready for clinical use in veterinary practice, but they point toward a future where trauma care is tailored to the individual patient's biology instead of to population averages. For now, the disciplined application of the primary survey, combined with sound clinical judgment and a willingness to repeat the assessment, remains the foundation of trauma care. ## The Structured Primary Survey in Practice The primary survey is a sequence, not a checklist of independent observations. Each step feeds the next, and the sequence must be restarted whenever the patient's status changes. A dog that deteriorates during the circulation assessment needs a fresh look at airway and breathing before further vascular access attempts. This cyclical approach mirrors the team-based trauma training models used in human military medicine, where repeated rehearsal of the survey sequence improves both teamwork confidence and clinical skill application [McLaughlin et al., predeployment trauma team training](https://pubmed.ncbi.nlm.nih.gov/22072008/). ### Positioning and Handling During the Survey Position the patient in lateral recumbency for the initial assessment unless respiratory effort is markedly better in sternal recumbency. A patient that fights sternal positioning should be allowed to choose its own posture, as forced recumbency can precipitate decompensation in a marginal breather. For brachycephalic breeds, maintain sternal or head-elevated positioning whenever possible. Cats are often best assessed in a carrier or towel wrap initially, with the survey performed in stages to limit stress. Chemical restraint is avoided during the primary survey unless the patient is dangerously fractious or the examination cannot otherwise proceed. When sedation is required, choose agents with minimal cardiovascular depression and have reversal agents drawn up before administration. ### The Airway Step in Practice Open the mouth and inspect for foreign material, blood, vomitus, or displaced soft tissue. A simple sweep of the pharynx with a finger or gauze may clear obstruction. In patients with suspected cervical trauma, minimize neck manipulation and use a laryngoscope for visualization instead of blind digital sweeping. If the airway is patent but the patient cannot protect it, place an endotracheal tube. If the airway is obstructed and cannot be cleared, perform an emergency tracheostomy. The decision to intubate is clinical: absent gag reflex, severe maxillofacial trauma, or progressive stertor all justify immediate intubation. Confirm tube placement by capnography where available, as auscultation alone can be misleading in a noisy emergency room. ### The Breathing Step in Practice Observe thoracic wall motion before touching the patient. Paradoxical movement, asymmetrical excursion, or an entirely still chest with abdominal effort indicates significant pathology. Auscult both hemithoraces in at least three zones. Muffled heart sounds with absent ventral lung sounds suggest hemothorax or diaphragmatic hernia. Hyperresonance with absent lung sounds suggests pneumothorax. Subcutaneous emphysema over the thoracic inlet or flanks indicates airway or pulmonary disruption. Pulse oximetry provides trend data but is unreliable in hypothermic, vasoconstricted, or hypotensive patients. Capnography on a spontaneously breathing patient with a nasal or mask sampling line gives a more reliable ventilation trend. End-tidal carbon dioxide below 30 mmHg with tachypnoea suggests hyperventilation, while a rising value with decreasing respiratory rate signals impending fatigue. ### The Circulation Step in Practice Assess mucous membrane color, capillary refill time, pulse quality, and heart rate simultaneously. A rapid, weak femoral pulse with pale membranes and a prolonged capillary refill time indicates hypovolemic shock. A slow or normal heart rate with weak pulses in a cat is an emergency, as feline compensation relies on vasoconstriction instead of tachycardia. Jugular distension with weak pulses suggests obstructive shock from pericardial effusion or tension pneumothorax. Apply direct pressure to any actively bleeding wound during this assessment. Do not probe wounds blindly, as this can disrupt clot formation. Tourniquets are reserved for exsanguinating limb hemorrhage that pressure cannot control, and the application time must be recorded. ## Triage Priority Tables for Common Injuries The following table provides a rapid prioritization framework for common traumatic presentations. Priority 1 requires immediate intervention, Priority 2 requires intervention within minutes, and Priority 3 can wait for the secondary survey. | Injury Pattern | Priority | Immediate Action | Red Flags Requiring Escalation | |---|---|---|---| | Open chest wound | 1 | Occlusive dressing, immediate thoracocentesis | Worsening respiratory effort, subcutaneous emphysema spreading | | Tension pneumothorax | 1 | Immediate thoracocentesis | Absent lung sounds, distended jugular veins, deteriorating mentation | | Hemothorax with shock | 1 | Volume resuscitation, thoracocentesis if respiratory compromise | Falling hematocrit, rising respiratory rate | | Blunt abdominal trauma, stable | 2 | IV catheter, serial abdominal assessment | Progressive abdominal distension, falling blood pressure | | Pelvic fracture, stable | 2 | Analgesia, urinary catheter, pelvic radiographs | Inability to urinate, severe hematuria | | Long bone fracture, closed | 3 | Splint, analgesia | Neurovascular compromise distal to fracture | | Maxillofacial trauma, stable airway | 2 | Oxygen, head elevation, oral examination | Progressive swelling, stertor, epistaxis | | Ocular trauma | 3 | Cover eye, analgesia | Proptosis, hyphema with elevated intraocular pressure | ## Monitoring Parameters and Their Interpretation Serial monitoring detects deterioration before it becomes clinically obvious. The following parameters should be reassessed at intervals determined by the patient's stability, not by a fixed schedule. A stable patient may be checked every 15 minutes, while a crashing patient requires continuous monitoring. | Parameter | Frequency | What It Detects | Action Trigger | |---|---|---|---| | Heart rate and pulse quality | Continuous to every 15 min | Hypovolemia, arrhythmia, obstructive shock | Pulse quality loss, rate change >20% from baseline | | Respiratory rate and effort | Continuous to every 15 min | Pneumothorax progression, pulmonary contusions, fatigue | Rate >60/min or <10/min, increased abdominal effort | | Mucous membrane color and CRT | Every 15 min | Perfusion status | Pale or grey membranes, CRT >2 seconds | | Blood pressure (Doppler or oscillometric) | Every 15 min | Perfusion adequacy | Systolic <90 mmHg in dogs, <80 mmHg in cats | | Lactate | Every 1 to 2 hours | Tissue hypoxia, resuscitation adequacy | Rising or static lactate despite resuscitation | | Urine output | Hourly if catheterized | Renal perfusion | <1 mL/kg/hour over 2 hours | | Temperature | Every 30 min | Hypothermia, systemic inflammation | <36.5°C or >39.5°C | Blood pressure measurement requires an appropriately sized cuff, approximately 40% of limb circumference. Doppler methods are more reliable in small patients and hypotensive states than oscillometric devices. Lactate clearance is a stronger prognostic indicator than a single lactate value, and a failure to clear lactate within 6 to 12 hours of resuscitation warrants reassessment of perfusion and a search for ongoing hemorrhage. The emerging role of biomarker and omics profiling in trauma prognostication may eventually refine these broad measures, but current clinical decision-making still depends on serial physical examination and basic laboratory trends [Brugere et al., molecular and biomarker signatures of trauma](https://pubmed.ncbi.nlm.nih.gov/42419069/). ## Documentation of the Primary Survey Documentation must capture the sequence, the findings, and the interventions in a format that supports continuity of care. Use a standardized trauma sheet with time-stamped entries. Record the patient's status on arrival, the findings of each survey step, and the response to each intervention. Include the following elements in every primary survey record: - Time of arrival and time of each survey step - Airway patency and any interventions required - Respiratory rate, effort, lung sounds, and oxygen saturation or capnography values - Heart rate, pulse quality, mucous membrane color, capillary refill time, and blood pressure - Estimated blood loss from visible wounds - Neurological status using a simple scale such as mentation, pupil response, and motor function - Fluid and blood product administration with volumes and times - Response to each intervention, including deterioration after an intervention Photographs of wounds or obvious deformities are useful for serial comparison, but they do not replace written documentation. The record should allow a clinician who did not witness the initial presentation to reconstruct the patient's trajectory and understand the rationale for each decision. This documentation also supports team communication during shift changes and transfers, and it provides the basis for the secondary survey and definitive care planning. ## Recognized Complications and Failure Modes The primary survey can fail at several discrete points, and recognizing the failure pattern matters more than restarting the sequence. The most consequential failure is the missed airway obstruction in a patient that appears to be breathing. Upper airway noise, paradoxical chest wall motion, and progressive abdominal effort with diminishing thoracic expansion all signal obstruction that has not been cleared. Detection requires auscultation over the trachea and both hemithoraces, not simply observation of thoracic movement. Ventilatory failure is frequently misattributed to circulatory shock. A patient with a flail segment, pulmonary contusion, or diaphragmatic rupture may present with tachycardia, pale mucous membranes, and weakness that superficially resembles hypovolemia. The discriminating finding is the breathing pattern: rapid shallow respirations with normal or elevated blood pressure early in the course point to ventilatory compromise instead of volume loss. Pulse oximetry, where available, and capnography provide objective separation, but neither replaces serial physical re-examination. Circulatory failure modes include the unrecognised non-hemorrhagic shock state. Neurogenic shock after cervical or high thoracic spinal injury produces bradycardia with hypotension, a pattern that is easily mistaken for end-stage hemorrhage. The absence of tachycardia in a hypotensive trauma patient should prompt consideration of neurogenic shock, cardiac contusion, or pre-existing cardiac disease before additional fluid is administered. Serial lactate measurement, where available, helps distinguish compensated hypoperfusion from adequate resuscitation, though the evidence base for biomarker-guided resuscitation in veterinary patients remains limited [molecular biomarker signatures in trauma precision medicine](https://pubmed.ncbi.nlm.nih.gov/42419069/). | Observation | Likely cause | Discriminating check | |---|---|---| | Progressive abdominal effort, quiet lung fields | Upper airway obstruction | Recheck airway patency, auscultate trachea, assess for foreign material | | Tachycardia with normal blood pressure | Compensated hypovolemia | Serial pulse quality, lactate trend, mucous membrane color | | Bradycardia with hypotension | Neurogenic shock or cardiac contusion | ECG, spinal palpation, response to fluid challenge | | Worsening respiratory effort after fluid bolus | Pulmonary contusion or volume overload | Thoracic auscultation, pulse oximetry, imaging when stable | | Recurrent collapse after initial improvement | Ongoing internal hemorrhage | Repeat abdominal and thoracic assessment, serial PCV and lactate | ## Common Errors and Corrective Actions Less experienced clinicians most often err by treating the survey as a single pass instead of a continuous process. The patient that deteriorates during diagnostic imaging or wound management has not developed a new problem, the survey has simply not been repeated. The corrective action is a defined re-survey interval, typically every 5 to 10 minutes during active resuscitation, with documentation of each reassessment. A second common error is prioritizing diagnostic confirmation over immediate intervention. Obtaining radiographs before securing the airway, or placing a central line before controlling external hemorrhage, delays the interventions that determine survival. The survey sequence exists precisely to prevent this ordering error. Team-based training improves confidence in applying these clinical skills under pressure, and structured rehearsal of the survey sequence reduces omission of critical steps [predeployment trauma team training course validation](https://pubmed.ncbi.nlm.nih.gov/22072008/). A third error is failure to escalate fluid therapy when the initial response is inadequate. The AAHA/AAFP fluid therapy guidelines emphasize that the response to a fluid challenge, not the initial volume administered, should guide subsequent decisions [AAHA/AAFP fluid therapy guidelines](https://www.aaha.org/resources/2024-aaha-fluid-therapy-guidelines-for-dogs-and-cats/). A patient that fails to improve after a bolus requires reassessment of the shock category, consideration of blood products, and earlier surgical consultation instead of repeated crystalloid administration. Whole blood and blood component resuscitation improve survival in prolonged hemorrhagic shock compared with crystalloid alone, and the decision to transition to blood products should be made early instead of after crystalloid failure becomes obvious [resuscitation with whole blood or blood components in traumatic hemorrhagic shock](https://pubmed.ncbi.nlm.nih.gov/35900383/). ## Evidence Limitations and Divergent Expert Opinion The veterinary trauma literature is dominated by retrospective studies and expert consensus. Prospective randomised trials comparing resuscitation strategies in dogs and cats are scarce, and much of the hemorrhagic shock research derives from human military medicine and experimental porcine models. Extrapolation from these sources to clinical small animal practice requires caution, particularly for fluid volume targets and transfusion triggers. Expert opinion diverges on several practical points. The role of permissive hypotension in veterinary trauma patients remains contested, with some authorities advocating lower systolic pressure targets to reduce ongoing hemorrhage and others arguing that the risk of organ hypoperfusion outweighs this benefit. The optimal crystalloid to colloid ratio, the threshold for initiating blood products, and the value of point-of-care lactate monitoring in guiding resuscitation all lack definitive veterinary data. The RECOVER initiative provides structured consensus recommendations for CPR and post-arrest care, but comparable consensus processes for trauma resuscitation are less developed [RECOVER veterinary CPR guidelines](https://recoverinitiative.org/). ## Referral, Consultation, and Reporting Referral is indicated when the facility cannot provide the level of monitoring or intervention the patient requires. Specific triggers include persistent hypotension after two fluid challenges, suspected ongoing thoracic or abdominal hemorrhage, deteriorating respiratory function despite oxygen supplementation, and any patient requiring mechanical ventilation. Specialist consultation should occur early for suspected cardiac contusion, spinal injury with neurologic deficits, or penetrating wounds involving body cavities. Laboratory involvement is warranted for serial lactate, coagulation panels, and blood typing before transfusion. These tests inform resuscitation decisions but should never delay immediate life-saving intervention. Regulatory reporting obligations vary by jurisdiction. Bite wounds, suspected animal abuse, and injuries involving wildlife may carry mandatory reporting requirements, and practitioners should consult their regional veterinary board or the relevant authority [AVMA professional practice resources](https://www.avma.org/resources-tools). International movement of injured animals, including those requiring referral across borders, falls under animal health standards that vary by region [WOAH terrestrial animal health code](https://www.woah.org/en/what-we-do/standards/codes-and-manuals/terrestrial-code-online-access/). ## Frequently Asked Questions ### How Do I Prioritize Multiple Trauma Patients With Limited Staff and Resources? Use a dynamic triage system that assigns priority by immediate threat to life, not by order of arrival. A patient with apnoea, pulselessness, or uncontrolled hemorrhage takes precedence over a stable patient with visible fractures. Reassess every patient at regular intervals because deterioration can be rapid. When staffing is constrained, assign one team member to continuous monitoring of the highest-acuity patient while others manage lower-priority cases. The [RECOVER Initiative veterinary CPR guidelines](https://recoverinitiative.org/) provide a structured framework for identifying and responding to the most critical deterioration, cardiorespiratory arrest. If resources remain inadequate, contact referral centers early to arrange transfer of stable patients, freeing capacity for those needing immediate intervention. ### What Can I Do When Point-of-Care Ultrasound or Capnography Is Unavailable? Physical examination substitutes for most monitoring equipment if performed systematically. Serial assessment of mucous membrane color, capillary refill time, pulse quality, and respiratory effort provides a practical estimate of perfusion and ventilation. Palpate the trachea and auscultate the larynx to confirm airway patency. Measure blood pressure with a Doppler or oscillometric device when available, but recognize that a palpable femoral pulse generally corresponds to a systolic pressure above approximately 60 mmHg. The [MSD Veterinary Manual professional edition](https://www.msdvetmanual.com/) describes these examination techniques in species-specific detail. When capnography is absent, monitor ventilation by observing thoracic excursion and auscultating lung fields repeatedly. Document the limitations of your monitoring in the medical record so subsequent clinicians interpret trends appropriately. ### How Does the Primary Survey Differ in Exotic or Non-Traditional Species? The ABC sequence remains valid across species, but anatomical differences change the examination. In rabbits and rodents, oropharyngeal anatomy makes visual airway inspection difficult, and these species are obligate nasal breathers, so nasal obstruction can cause rapid decompensation. Birds have a complete tracheal ring structure and a syrinx, which complicates endotracheal intubation. Reptiles have a glottis at the base of the tongue and can tolerate prolonged apnoea, making breath-by-breath assessment misleading. The [WOAH terrestrial animal health standards](https://www.woah.org/en/what-we-do/standards/codes-and-manuals/terrestrial-code-online-access/) address welfare and handling considerations that affect restraint during assessment. For any non-traditional species, consult species-specific references before attempting advanced airway management, and consider early referral if your caseload does not include that species regularly. ### What Should I Document During the Primary Survey and Why Does It Matter? Record the time of each assessment, the specific findings for airway, breathing, and circulation, and every intervention with its response. Use a standardized trauma sheet or a structured electronic template so that serial assessments are comparable. Document the patient's mentation, respiratory rate and effort, heart rate, pulse quality, mucous membrane color, capillary refill time, and blood pressure at each reassessment. The [AAHA/AAFP fluid therapy guidelines for dogs and cats](https://www.aaha.org/resources/2024-aaha-fluid-therapy-guidelines-for-dogs-and-cats/) emphasize that monitoring data must be recorded to guide fluid titration and detect complications. Accurate documentation supports clinical decision-making, provides medicolegal protection, and enables effective communication when the patient is referred. Note any equipment limitations or environmental constraints that affected the assessment. ### How Do I Explain Triage Decisions to a Client When Their Pet Is Not the Highest Priority? Be direct, factual, and brief. Explain that the team is attending to patients with immediately life-threatening conditions first and that their pet is being monitored continuously. State what you are doing for their pet now and when the next reassessment will occur. Avoid minimizing their concern, but do not promise a specific wait time. The [AVMA practice resources](https://www.avma.org/resources-tools) offer communication guidance for difficult clinical conversations. If their pet's condition changes, inform them promptly. For staff, debrief after high-volume trauma events to review triage decisions and identify system improvements. Structured team training has been shown to increase confidence in applying clinical skills during real trauma responses, as described in a [predeployment trauma team training validation study](https://pubmed.ncbi.nlm.nih.gov/22072008/). ### When Should I Start Blood Products or Whole Blood During the Primary Survey? Initiate blood product administration when hemorrhagic shock is recognized and crystalloid resuscitation alone is insufficient to restore perfusion. Do not delay blood products while completing the rest of the survey if the patient is exsanguinating. Fresh whole blood provides red cells, plasma, and platelets in one product, which is advantageous when component therapy is unavailable. A [porcine model of traumatic hemorrhagic shock](https://pubmed.ncbi.nlm.nih.gov/35900383/) demonstrated that resuscitation with blood or blood components improved survival compared with crystalloid alone when advanced care was delayed. In practice, this supports early blood product use in severe trauma. Cross-matching is ideal but should not delay transfusion in a moribund patient, use a signed owner consent and document the risk. Consult your current formulary and blood bank protocols for product availability and administration guidance. ## Related Clinical & Scientific Guides * [Toxicology in Emergency Practice: Common Poisons and Diagnostic Approach](/knowledge/veterinary-medicine/emergency-critical-care/toxicology-emergency-practice-common-poisons-diagnostic-approach) * [Veterinary Cardiopulmonary Resuscitation: Post-Cardiac Arrest Care](/knowledge/veterinary-medicine/emergency-critical-care/veterinary-cardiopulmonary-resuscitation-post-cardiac-arrest-care) * [Fluid Therapy Guidelines for Dogs and Cats: A Practical Update](/knowledge/veterinary-medicine/emergency-critical-care/fluid-therapy-guidelines-dogs-cats-practical-update) ## References and Further Reading - [A predeployment trauma team training course creates confidence in teamwork and clinical skills: a post-Afghanistan deployment validation study of Canadian Forces healthcare personnel.](https://pubmed.ncbi.nlm.nih.gov/22072008/). 2011. - [Resuscitation with whole blood or blood components improves survival and lessens the pathophysiological burden of trauma and hemorrhagic shock in a pre-clinical porcine model.](https://pubmed.ncbi.nlm.nih.gov/35900383/). 2023. - [Molecular and Biomarker Signatures of Trauma: The State of Precision Medicine.](https://pubmed.ncbi.nlm.nih.gov/42419069/). 2026. - [RECOVER Initiative Veterinary CPR Guidelines](https://recoverinitiative.org/). Veterinary Emergency and Critical Care Society. - [AAHA/AAFP Fluid Therapy Guidelines for Dogs and Cats](https://www.aaha.org/resources/2024-aaha-fluid-therapy-guidelines-for-dogs-and-cats/). AAHA. - [MSD Veterinary Manual, Professional Edition](https://www.msdvetmanual.com/). MSD Veterinary Manual. - [American Veterinary Medical Association Practice Resources](https://www.avma.org/resources-tools). American Veterinary Medical Association. - [WOAH Terrestrial Animal Health Code](https://www.woah.org/en/what-we-do/standards/codes-and-manuals/terrestrial-code-online-access/). WOAH. ## Related Articles - [Veterinary Trauma: Primary Survey and Immediate Stabilization](/knowledge/veterinary-medicine/emergency-critical-care/veterinary-trauma-primary-survey-immediate-stabilization) - [Veterinary Trauma: Secondary Survey and Diagnostic Imaging](/knowledge/veterinary-medicine/emergency-critical-care/veterinary-trauma-secondary-survey-diagnostic-imaging) - [Veterinary Emergency Medicine: Common Presentations and Triage Priorities](/knowledge/veterinary-medicine/emergency-critical-care/veterinary-emergency-medicine-common-presentations-triage-priorities) - [Veterinary Triage Flowchart: From Triage Nurse to Veterinarian](/knowledge/veterinary-medicine/emergency-critical-care/veterinary-triage-flowchart-triage-nurse-veterinarian) - [Veterinary Triage Sheet: Design and Implementation](/knowledge/veterinary-medicine/emergency-critical-care/veterinary-triage-sheet-design-implementation) > This article is educational professional reference material for veterinary audiences. It is not a substitute for veterinary diagnosis, individual clinical judgment, current product labeling, or applicable regulatory requirements.