VTNE Emergency & Critical Care

VTNE Emergency Triage: Primary Survey, Shock Recognition, and Critical Interventions

June 23, 2026 11 min read 0 views

Master the VTNE emergency domain: the primary survey, shock recognition and classification, oxygen delivery, fluid therapy calculations, and critical monitoring parameters.

VTNE emergency and critical care questions test rapid, prioritized decision-making. The exam expects you to perform a primary survey, recognize and classify shock, choose the right oxygen delivery and fluid therapy, and know the basics of CPR. This guide organizes the must-know emergency knowledge.

Quick Reference

  • The primary survey follows Airway, Breathing, Circulation (ABC).
  • Shock dose of crystalloid: about 90 mL/kg for dogs, 45 mL/kg for cats.
  • CPR compressions are 100-120 per minute at a 30:2 ratio.
  • Triage sorts patients by how soon they need intervention.

The Primary Survey (ABC)

The primary survey is a rapid assessment of life-threatening problems in a fixed order.

  • Airway: confirm the airway is open and unobstructed; clear secretions or foreign material; be ready to intubate.
  • Breathing: assess rate, effort, and symmetry of respiration; auscultate; provide oxygen and ventilation if breathing is inadequate.
  • Circulation: check heart rate, pulse quality, mucous membrane color, and capillary refill time; establish IV access and address hemorrhage.

Types of Shock

Type Cause / Signs Treatment Focus
HypovolemicBlood or fluid loss; pale membranes, weak pulses, tachycardia.Rapid fluid resuscitation; control hemorrhage.
Distributive (septic)Vasodilation from sepsis; may show injected red membranes early, then collapse.Fluids, antibiotics, vasopressors per orders.
ObstructivePhysical obstruction to flow (GDV, pericardial effusion); distended abdomen or muffled heart sounds.Relieve the obstruction (decompression, pericardiocentesis).
CardiogenicPump failure; weak pulses, arrhythmia, pulmonary edema.Cautious fluids; treat the underlying cardiac disease.

Shock Index

The shock index is a quick bedside estimate of cardiovascular status:

Shock Index = Heart Rate ÷ Systolic Blood Pressure

A shock index greater than 1.0 in a dog suggests shock and warrants aggressive assessment and treatment.

Fluid Therapy

  • Crystalloids (lactated Ringer's, 0.9% saline) distribute throughout the extracellular space and are the first-line resuscitation fluid.
  • Colloids contain large molecules that stay in the vascular space longer to support oncotic pressure.
  • Shock dose: roughly 90 mL/kg for dogs and 45 mL/kg for cats, given in incremental boluses (often one quarter at a time) while reassessing.

Oxygen Delivery Methods

Method When to Use
Flow-byImmediate, least stressful; for the initial unstable patient.
MaskHigher concentration; for tolerant patients short term.
Oxygen hood / tent / cageHands-off enriched environment; good for stressed or dyspneic patients.
Nasal cannulaLonger-term delivery in cooperative patients.
Intubation / mechanical ventilationApnea or respiratory failure; highest level of support.

Triage Priority System

  • Emergent (immediate): airway obstruction, severe hemorrhage, cardiopulmonary arrest, GDV, dystocia, active seizures.
  • Urgent (minutes to an hour): moderate dehydration, controlled fractures, stable vomiting and diarrhea.
  • Non-urgent (can wait): minor wounds, chronic stable conditions, routine recheck.

Cardiopulmonary Arrest and CPR

Cardiopulmonary arrest (CPA) is recognized by unresponsiveness, apnea or agonal gasping, and absence of a heartbeat or pulse. Begin CPR immediately:

  • Chest compressions at 100-120 per minute, compressing one third to one half of chest width.
  • A compression-to-ventilation ratio of 30:2 if not yet intubated.
  • Switch compressors about every two minutes to prevent fatigue.
  • Once intubated, give continuous compressions with about 10 breaths per minute.

Emergency Drug Reference: Critical Care Dosing

These drugs and doses appear frequently on the VTNE emergency domain. Know the drug, route, and indication for each.

Drug Dog Dose Cat Dose Route Indication
Epinephrine0.01 mg/kg0.01 mg/kgIV or IOCPA — every 3-5 min during CPR
Atropine0.02-0.04 mg/kg0.02-0.04 mg/kgIV, IO, ITBradycardia, vagally-induced CPA
Naloxone0.01-0.04 mg/kg0.01-0.04 mg/kgIV, IM, SQOpioid reversal (respiratory depression)
AtipamezoleEqual volume to dexmedetomidine givenSameIMAlpha-2 reversal (dexmedetomidine)
Flumazenil0.01 mg/kg0.01 mg/kgIVBenzodiazepine reversal
Dextrose 50%0.5-1 mL/kg diluted 1:40.5 mL/kg diluted 1:4IV slowHypoglycemia (glucose <50 mg/dL)
Lidocaine1-2 mg/kg slow IV bolusCONTRAINDICATEDIVVentricular tachycardia (dogs only)

VTNE Exam Tip: Lidocaine is the antiarrhythmic of choice for ventricular tachycardia in dogs but is TOXIC in cats. This distinction appears frequently on the VTNE. Always check the species before selecting an antiarrhythmic.

VTNE Exam Tips for This Topic

  • Always work the primary survey in ABC order.
  • Match each shock type to its defining cause and treatment.
  • Memorize crystalloid shock doses: 90 mL/kg dog, 45 mL/kg cat.
  • Know CPR numbers: 100-120 compressions/min, 30:2 ratio.
  • Triage is about timing, not just severity - sort by who needs care first.

Key Takeaways

  • The primary survey is Airway, Breathing, Circulation.
  • Shock is hypovolemic, distributive, obstructive, or cardiogenic.
  • Shock index above 1.0 in a dog suggests shock.
  • Crystalloid shock dose is 90 mL/kg (dog) and 45 mL/kg (cat).
  • Choose oxygen delivery by patient tolerance and severity.
  • CPR is 100-120 compressions per minute at a 30:2 ratio.

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