Flashcards in Chpt. 2 - Tech Notes Deck (31):
When should the minimum patient database be acquired?
An appointment should be scheduled several days before the planned procedure to acquire the minimum patient database, so that unforeseen problems can be discovered and addressed well in advance of surgery.
What should you pay attention to when taking a patient history?
Emphasize open-ended questions. Avoid leading questions or questions that can be answered "yes" or "no".
When gathering historical information about signs of illness (e.g. vomiting or coughing), always ask about the following:
1. The duration (how long has it been going on?)
2. The volume or severity (how much or how severe?)
3. The frequency (how often?)
4. The character or appearance (what does it look like?)
What should you always reconfirm when the patient is admitted?
Always reconfirm the nature of the scheduled procedure when the patient is admitted, including the exact location of tumors or lesions, the affected limb (for procedures involving a limb), and the owner's wishes regarding testing (such as histopathology).
What patients respond to anesthetic procedures differently?
Patients that are very large, very small, very young (75% of the normal lifespan) respond to anesthetic procedures differently than other animals and have special needs of which the anesthetist must be aware.
When obtaining the history, determine each of the following:
*Current and past illnesses
*Medications currently being administered
*Allergies or drug reactions
*The status of preventive care
What should you give to and obtain from the owner before any anesthetic procedure?
Always give the owner a written estimate of the expected charges and obtain a signed consent form authorizing anesthesia and surgery.
What should the technician always do immediately before the procedure?
The technician should always perform a brief physical assessment immediately before the procedure, to uncover hidden problems that may increase risk or alter patient management.
What should you place on all patients on admission to the hospital?
Identification collars must be placed on all patients on admission to the hospital.
Before anesthetizing a patient, do whatever you need to do to make sure the animal in your hands is the correct one!
Is getting a weight immediately before any anesthetic procedure important?
All animals should be accurately weighed immediately before any anesthetic procedure. Animals under 5 kg should be weighed on a pediatric scale, and those under 1 kg should be weighed on a gram scale.
Why is serial monitoring of BW an important tool?
Serial monitoring of BW is an excellent indicator of hydration, with a sudden loss of 1 kg corresponding to 1 L of fluid loss.
When are dental cleanings commonly performed?
Dental cleanings are commonly performed during the same anesthetic event used to perform another Sx or procedure. Combining two procedures minimizes the number of anesthetic events, decreases the number of visits to the clinic, and in most cases also costs less.
How do you accurately determine the HR?
The HR in beats/minute (bpm) can be accurately determined in small animals by counting the number of beats in 10 seconds and multiplying the number by 6 or in large animals by counting the number in 30 seconds and multiplying by 2.
What is sinus arrhythmia?
Sinus arrhythmia is a rhythm in which the HR cyclically increases during inspiration and decreases during expiration. This rhythm may be pronounced in young, healthy dogs and can sound to the inexperienced anesthetist as if there are skipped or premature beats. Abnormal rhythms can be differentiated from sinus arrhythmia by observing the respirations while listening to the heart.
What are pale MMs or prolonged CRT indicative of?
Pale MMs or prolonged CRT are indicative of decreased perfusion from shock, vasoconstriction, hypotension, or a variety of other issues.
Pale MMs can also be associated with anemia. Cyanotic MMs indicate reduced oxygen saturation, which is a medical emergency.
Dyspnea and cyanosis
Dyspnea and cyanosis are both medical emergencies and should be brought to the DVM's attention immediately.
Avoid stressing dyspneic or cyanotic patients, as they are very intolerant of handling and can die during examination.
The following findings should be reported to the VIC immediately:
*A PCV <4.0 in any species
*Any decrease in the platelet count
*Any coagulation test result outside of the normal range
Define buccal mucosal bleeding time
Buccal mucosal bleeding time is a simple in-house screening test that is an excellent indicator of the likelihood of perioperative bleeding.
Which class of patients can be safely anesthetized with standard protocols and which patients need special protocols?
In general, class P1 and class P2 patients can be safely anethetized with standard anesthetic protocols. Class P3 to P5 patients often require special protocols, and their condition should be stabilized before Sx if possible.
How serious is pulmonary aspiration?
Pulmonary aspiration is always serious and may lead to pneumonia that is difficult to treat, permanent disability, and in some cases even immediate respiratory arrest and death of the patient.
Unless told otherwise by the VIC, food should be withheld from all patients except for neonatal, pediatric, and some exotic patients.
What to do when placing and maintaining an IV catheter for use during Sx!
*Choose a catheter of sufficient length to minimize the risk of dislodgement.
*Choose a catheter of large diameter.
*Choose a location that will not interfere with the procedure.
*Use an administration set with an injection port.
*After positioning the patient, check that fluids are flowing freely.
*Avoid excessive catheter and patient movement during transfer.
*Administer IV drugs slowly.
*Use saline flush following IV injection of a drug.
Plasma concentrations of what solutes must be kept in a very narrow range in order to maintain normal muscle and heart function?
The plasma concentration of certain solutes such as potassium and calcium must be kept in a very narrow range in order to maintain normal muscle and heart function.
Relatively small deviations in levels of these cations can cause significant clinical signs and can endanger the patient.
Difference between replacement and maintenance fluids
Replacement fluids have high concentrations of Na+ and Cl- (as ECF does) and are designed to replace fluid losses.
Maintenance fluids have lower concentrations of Na+ and Cl- but somewhat more K+ and are designed to maintain fluid balance over a longer period.
What is the first choice for fluid therapy of healthy PTs undergoing routine Sx as well as many sick PTs?
Isotonic, polyionic replacement crystalloids are the first choice for fluid therapy of healthy PTs undergoing routine Sx as well as many sick PTs, as long as the PCV is over 20% and the plasma protein is over 3.5 gm/dL.
What is an accepted IV administration rate for crystalloids during routine anesthesia and Sx?
For both small and large animals, a rate of 10 mL/kg/hr during the first hour followed by 5 mL/kg/hr for the remainder of the procedure is an accepted IV administration rate for crystalloids during routine anesthesia and Sx.
What are crystalloid infusion rates for healthy, young patients with excessive bleeding or hypotension?
40 mL/kg/hr (dogs and large animals) or 20 mL/kg/hr (cats) for a maximum of 1 hour, with half of this given over the first 15 minutes.
Many clinicians recommend an initial bolus of 10 to 20 mL/kg, reevaluation of the patient, and additional boluses as necessary.
What are crystalloid infusion rates for animals in shock?
Crystalloid infusion rates for animals in shock are up to 90 mL/kg as rapidly as possible for dogs and for large animals and 55 mL/kg as rapidly as possible for cats.
Many clinicians recommend an initial bolus of 10 to 20 mL/kg, reevaluation of the PT, and additional boluses as necessary.
How do you expand blood volume in large and small animals?
For blood volume expansion in large and small animals, administer 7% hypertonic saline IV at a rate of 3 to 4 mL/kg slowly over a 5-minute period, followed by administration of isotonic crystalloids.
How are synthetic colloids administered?
Synthetic colloids are administered IV at a rate of 10 to 20 mL/kg/day for dogs and for large animals as a slow bolus over 15 to 60 minutes, and 5 to 10 mL/kg/day for cats as a slow bolus over 30 to 60 minutes.
Signs of overhydration
*Ocular and nasal discharge
*Chemosis (edema and swelling of the conjunctiva)
*Increased lung sounds
*Coughing and restlessness (may be seen when PT is awake)