Code Red Triage: The First 10 Minutes That Save Lives
This episode breaks down the critical first minutes of a Code Red triage, from recognizing life-threatening signs to using the TLC framework to communicate calmly with panicked owners. It also covers the Pre Doctor Bundle, including IV access, point-of-care testing, blood pressure technique, and setting up the crash room for fast, coordinated care.
Chapter 1
The 60 Second De escalation: Bridging Panic and Consent
Claire Brooks
Triage STAT, front lobby. Triage STAT. If, if your heart rate just spiked hearing that, yeah, mine too. That page means somewhere in the lobby, a pet is fighting for their life, and the next ten minutes belong to us.
Dr. Erika Sikina
And here is what I want every technician to hear before anything else: those ten minutes are not about being fearless. They, they are about having a plan. Fear with a plan looks exactly like confidence. Welcome back to the AVS Tech Training Podcast.
Claire Brooks
Last episode we covered sorting patients at triage. Today is what happens when triage screams Code Red. Critical Level 1. Death could be imminent without immediate action.
Dr. Erika Sikina
Right. Any one trigger buys an immediate trip to the treatment room. Open mouth breathing in a cat, weak or absent pulses, altered mentation, active hemorrhage, non productive retching with a distended belly. If you see it, you call it.
Claire Brooks
And notice the language we use when moving that patient. We have a strict rule about this. We never, ever tell an owner we are taking their pet to the back.
Dr. Erika Sikina
Never. To the back sounds like a black hole where things disappear. We always say the treatment area. It tells the owner exactly what happens there, treatment.
Claire Brooks
Now, before that pet leaves their arms, we need two verbal consents in about sixty seconds, from an owner who is utterly panicking.
Dr. Erika Sikina
Which is why we do not wing it. We use the TLC framework. Tune in, set the Limit, provide the Choices. It is empathy with a spine.
Claire Brooks
Step one, tune in. You look them in the eye and say, I can tell you care deeply about Fluffy and are worried about her.
Dr. Erika Sikina
Ten words, and everything changes. A panicking brain literally cannot process medical options until it feels heard. That is brain science, not a soft skill.
Claire Brooks
Step two, set the limit. Right now we need to take Fluffy to the treatment area for further assessment.
Dr. Erika Sikina
And step three, choices. Do you approve initial stabilization up to six hundred dollars? That allows the doctor to examine Fluffy, lets us run basic tests, and starts initial treatment. Or would you prefer to wait to speak with a doctor first?
Claire Brooks
And then comes the question everyone dreads asking, CPR status.
Dr. Erika Sikina
Here is the exact phrasing: Okay, the last question I need to ask, and we have to ask everyone: in the event Fluffy's heart were to stop, do you want us to begin CPR efforts? It is never something we expect or want, but we always ask so we know your wishes ahead of time.
Claire Brooks
Notice the scaffolding in that sentence. We ask everyone, so it does not feel like a secret prognosis. Never something we expect or want, so it does not sound like we are giving up.
Dr. Erika Sikina
Asking in triage is compassionate. Asking for the first time during an active arrest is the cruelest moment in emergency medicine.
Claire Brooks
And what if a tech hesitates? What if they call a Code Red and it turns out to be Level 2?
Dr. Erika Sikina
Listen to me clearly. There is zero penalty at AVS for calling a Code Red that turns out to be Level 2. I would rather be called to twenty patients who did not need me than miss the one who did. Over calling is active learning. Under calling is how we lose patients.
Chapter 2
The Pre Doctor Bundle: What Your Hands Do Before the Doctor Arrives
Claire Brooks
Okay, you have consent, the pet is in the treatment area, and the doctor is thirty seconds to two minutes out. Enter the Pre Doctor Bundle.
Dr. Erika Sikina
This is where your hands take over. First, IV catheter, largest bore the patient can take. And here is the move that separates good from great: collect your blood samples off the catheter hub as you place it.
Claire Brooks
One stick. The patient feels one poke, and you walk away with every sample you need.
Dr. Erika Sikina
Immediately run four point of care values: blood glucose, lactate, PCV, and total solids. Add ketones if you suspect diabetes.
Claire Brooks
Talk to me about lactate, because that is your favorite number in a shock case.
Dr. Erika Sikina
Lactate is what cells produce when they are starved of oxygen. When lactate climbs above 2.5 millimoles per liter, the body is telling you in writing that cellular oxygen delivery is failing. It is the shock alarm bell.
Claire Brooks
And why is pulling extra blood tubes off the hub pre emptively so critical before hanging fluids?
Dr. Erika Sikina
Because the moment we start IV fluids, we dilute the blood and change the numbers. Pulling pre treatment blood gives us an untainted baseline. Draw it now and set it aside; if you skip it, that true baseline is gone forever.
Claire Brooks
Next up, blood pressure. But you have to do the cuff math right, or the numbers are meaningless.
Dr. Erika Sikina
Right. Cuff width should be forty percent of the limb circumference in dogs, thirty percent in cats. Wrong cuff size gives wrong numbers. If you see a systolic under ninety mmHg, say it out loud. That is hypotension, and we need to fix it immediately.
Claire Brooks
Then hook up EKG, start flow by oxygen, turn on the ultrasound machine so it is warm for a fast scan, and assign one person to hold the clipboard and scribe.
Dr. Erika Sikina
Picture what I walk into when a tech runs this bundle: catheter in, blood pressure done, glucose 62, lactate 5.1, PCV 18, oxygen flowing, ultrasound ready. You have compressed fifteen minutes of critical decision making into ninety seconds.
Claire Brooks
That technician autonomy completely transforms a crash room from chaotic panic into synchronized team execution.
Dr. Erika Sikina
It truly does. Technicians run this playbook, and patients live because of it. That is not an exaggeration, that is emergency care at its finest.