Exam 1: Lecture 2: Patient Evaluation Flashcards by Matthew Irvin

Q

Who should perform the pre-anesthetic evaluation on the patient

A

ultimatley the responsibility of the veternarian in charge of the patient

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

What do you always start with during the pre-anesthetic evaluation?

A

Signalment

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

What are the part to giving a doctor or another team member signalment

A

Species, breed, age, sex, and reproductive status

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

What should be done or checked during a pre-anesthetic evaluation?

A

Signalment
History (including anesthesia events or if the patient is currently ill)
Physical exam (Body weight and body condition score)
Blood and urine sample
Temperment / mentation and level of pain
Advances diagnositics if done

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

What patients should receive a routine ECG screening?

A

Patients with evidence of CV disease
Geriatic patients
underlying diseases that may lead to arrythmais

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

What are some underlying diseases that may lead to arrhythmias

A

hyperkalemia
GDV
splenomegaly
traumatic myocarditis

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

What should you look for/ give during a physical exam findings

A

Temperature
Pulse
Respiration
MM / CRT
Body weight

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

What percent dehydration describes the following?

Not detectable

A

Less than 5

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

What percent dehydration describes the following?

Not detectable

A

Less than 5

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

What percent dehydration describes the following?

Subtle loss of skin elasticity

A

5-6

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

What percent dehydration describes the following?

Definite delay in return to skin to normal position

A

6-8

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

What percent dehydration describes the following?

Slight prolongation of CRT
Possible dry MM

A

6-8

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

What percent dehydration describes the following?

Eyes possible sunken in orbits

A

6-8

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

What percent dehydration describes the following?

tented skin stays in place
eyes sunken in orbit

A

10-12

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

What percent dehydration describes the following?

Definite prolongation of CRT
Possible signs of shock
Dry MM

A

10-12

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

What percent dehydration describes the following?

Definite signs of shock
(Tachycardia, cool extremities, rapid and weak pulse)

A

12-15

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

What percent dehydration describes the following?

Death Imminent

A

12-15

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

What systems are important when preforming a physical exam?

A

integument (skin)
Lymph nodes
GI tract / abdominal palpation / gut sounds
Genitourinary tract
Central nervous system

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

What lab work should be preformed on an animal that is less than 5 years old (young) having an elective procedure with no abnormal history?

A

PCV
Glucose
BUN

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

What lab work should be preformed on an animal that is older having an elective or non-electice procedure
- any history of recent illness
- Screening for suspected infectious disease in endemic regions
- All patients included in a research study

A

CBC
Chemistry Profile
UA

+/- the following:
- ECG
- blood pressure
- thoracic rads
- echocardiogram
- blood gas analysis
- coag profile
- liver function testing
- 4Dx

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Where is the pre-anesthetic evaluation performed?

A

Typically in the clinic, but also done during farm calls

Find a quite place so you can better auscultate the heart and lungs

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

What happens if you cannot approach the animal because it is fractious or is a zoo or wild animal patient?

Study These Flashcards

A

Be cautious and use drugs if needed

Q

When should you perform the pre-anesthetic evaluation on a normal procedure?

Study These Flashcards

A

usually the day before or up to 1 week before the planned procedure
make sure to do another short exam on the day of anesthesia

Q

When should you perform the pre-anesthetic evaluation on an emergency case?

Study These Flashcards

A

Done immediately before the procedure

What questions should be asked of the owner when doing the pre-anesthetic exam for an emergency?

drugs given, diet, home life, etc.

Why should pre-anesthetic evaluation be done on all patients?

- safety - organ function and risk - To see if the client is willing to take the risk (this conversation should take place and be documented prior to sedating or anesthetizing any patient)

What category does the following fall under? - Normal healthy patient

I

What category does the following fall under? - OVH - casteration - ear/tail docking - declaw

I

What category does the following fall under? - patients with mild systemic disease

II

What category does the following fall under? - skin tumor - fracture - local infection - compensated cardiac disease

II

What category does the following fall under? - well controlled diabeties - uncomplicated hernia - pregnancy - obesity

II

What category does the following fall under? - patient with severe systemic disease

III

What category does the following fall under? - fever - dehydration - anemia - cachexia

III

What category does the following fall under? - uncontrolled DM - COPD - renal failure

III

What category does the following fall under? - Patient with severe systemic disease that is a constant threat to life

IV

What category does the following fall under? - Uremia - toxemia - sepsis - shock - severe dehydration

IV

What category does the following fall under? - cardiac decompensation or failure - emaciation - high fever

IV

What category does the following fall under? - moribund patients not expected to survive without operation

V

What category does the following fall under? - extreme shock and dehydration - terminal malignancy or infection - severe trauma

V

When should the ASA PS be assigned?

- after the PE is complete and the lab work or diagnostic tests have been interrupted

Case Example: A 3-year-old intact beagle presents to your clinic in an emergency for a laceration over the right flank region after getting tangled in barbed wire. The laceration is about 4 inches long and will require cleaning the wound, placing a Penrose drain, and surgical closure of the remainder of the wound. The remainder of the PE is WNL. The owner says the dog is UTD on vaccines, flea/tick prevention, and HW medication. What ASA level is this?

ASA level 2 - no severe signs, but tear in integument

Case Study: Molly a 12 year old QH mare referred to the University teaching hospital for colic of 12 hour duration. Trainer gave a dose of banamine - she is 9 months pregnant - pawing and rolling intermittently PE - tachycardia - tachypnea and increased effort - distended abdomen - no gut sounds - MM are dark pink what is the ASA level?

ASA level 4 or 5

Why is ASA's physical status important?

- Used to assess anesthetic risk of a case - physical status effects the PK and PD and aids in the selection of drugs and or techniques for a patient - Important criteria used in selection of patients in research studies - Can also be used from a legal standpoint (retrospectively)

Give examples of considerations that are important for dosing drugs?

- Age - disease - obesity - SA vs LA - size - pregnancy

Give some examples of patient preparation which are important

- Fasting recommendations - Hygiene and patient comfort - correct dehydration and electrolyte imbalance - Preoperative antibiotics

What species of animals do not require fasting before surgery

rodents and rabbits birds less than 200 grams neonates

What species of animals do not require water deprivation before surgery

Canine feline equine

Do you know why a patient is fasted prior to general anesthesia?

- decreased food and fluid in the stomach - decrease risk of aspiration - distended stomach or rumen impairs ventilation and could lead to hypoxemia and hypercapnia

What consequence could happen in horses if their stomach is full

Rupture at induction

Why is it not necessary for neonates, small birds, and some mammals to fast before surgery

- prone to hypoglycemia within a few hours of starvation - increased metabolic rate in birds and small mammals

What about depriving water from patients with increased fluid requirements

- renal insufficiency - febrile - diabetes - hot environment

What are the 4 H's of General anesthetic concern

hypotension hypoventilation hypothermia hypoxemia

What are other concerns are species, age, disease or procedure specific for general anesthetic concerns

hemorrhage pain delayed recovery regurgitation laryngeal spasms difficult intubation dysphoria arrythmisa myopathy

What do you always want to do and never forget regarding surgery

ALWAYS get a signed consent form by the owner - can get a verbal consent over the phone, but best to have a 2nd person to confirm the owners decision