7. Emergency Anesthesia

Question 1

Hemoabdomen - what do you worry about

Answer 1

hypovolemia, ventilatory compromise, loss of oxygen carrying capacity, poor periph perfusion, met and lactic acidosis, mismatch in oxygen supply and demand

Question 2

correct hypovolemia

Answer 2

• isotonic crystalloids, 1/4 to 1/3 of shock dose (90ml/kg) and give as bolus.
• consider hypertonic or colloid
• monitor

Question 3

correct anemia

Answer 3

• whole blood (helps O2 carrying capacity and coag factors)

Question 4

clinical signs of loss of O2 arrying capacity

Answer 4

tachycardia, tachypnea, hypotension, collapse, lethargic

• some same PCV <20%, or serial PCV with significant decrease
• lactate inc.

Question 5

indication patient needs transfusion

Answer 5

loosing blood at high rate

Question 6

preanesthetic hemoabdomen

Answer 6

pre-oxygenate, minimal CV effects (opiods, benzos), analgesia, may be ventilation

Question 7

common hemoabdomen arrthymia

when do you treat it?

Answer 7

ventricular tachycardia / VPCs

- treat if super high rate or hypotensive, treat with lidocaine (can do CRI)

Question 8

hemoabdomen induction and maintenance

Answer 8

propofol -> splenic engorgement
ketamine doesn’t
alfaxolone

Question 9

permissive hypotension

Answer 9

keep MP low until you control the source of bleeding, thus reducing amount of fluid dilution
- goal is to maintain SAP <90mmHg with MAP 50-55mmHg

Question 10

Thoracic trauma what do you do

Answer 10

multiple xrays! thorax and abdomen

Question 11

preanesthetic considerations in thoracic trauma

Answer 11

• hold chest up above abdomen

- monitor if using full mu (resp depression)

Question 12

induction in thoracic trauma

Answer 12

rapid induction and rapid intubation

be careful with PPV, can cause pulmonary edema (ards) can tolerate a higher co2 in these animals

Question 13

PEEP

Answer 13

positive end expiratory pressure

• opens up collapsed alveoli
• keeps some positive pressure in alveoli after breath
• can use peep valve or put scavenge tube into a bucket of water (ghetto peep)
• can cause drop in BP or cause more hypoxemia by only expanding open alveoli

Question 14

GDV What do you worry about?

Answer 14

1. inc P on portal vein and CVC (dec. venous return, dec. CO, GI system congestion)
2. dec. tissue perfusion causes ischemia of stomach (free radical damage, lactic acidosis, arrhythmia)
3. Compromised coronary blood supply (-> arrythmias, difficult ventilation)

Question 15

GDV Checklist

Answer 15

1. Two large bore catheters (in forelimbs) for fluid resuscitation for 1/4-1/3 shock dose
2. BW (PCV/TS, electrolytes, lactate, A/B status)
3. ECG (spleen torsed or dec. coronary BF -> VTach/VPCs)
4. R lateral radiograph to confirm
5. Analgesia! (full mu)
6. Trocarize(use US) or pass stomach tube (needs to be sedate)

Question 16

GDVInduction

Answer 16

• use ECG

- rapid, inflate cuff (prone to regurg!!)

Question 17

post op gdv

Answer 17

• suction pharynx before extubating
• continue fluids
• recheck lactate, and electrolytes

Question 18

C section

Answer 18

• maintain BP (directly correlated to placental BF)
• ensure oxygenation
• minimize drug effects on fetus

Question 19

C section steps

Answer 19

1. place IV
2. pre clip, line block if tolerated
3. pre place monitoring
4. preoxygenate 3-5 minutes
5. have surgeons ready
6. rapid intubate
7. full mu after delivery

Question 20

MAC of pregnant animals is ____, another reason to _______

Answer 20

reduced

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