Flashcards in Exam 3 Deck (229):
What are five risk factors for anesthesia emergency?
o Patient health
o Experience skills of the vet team
o Case circumstances
o Owner idiosyncrasy
Define laryngeal eversion.
edges of larynx are depressed or are everted
What issues arise when surgically correcting an elongated soft palate?
o Surgical correction with complications of swelling and incorrect length
o Too short causes food in the nares
o Too long does not solve the problem
How do you determine the correct ET tube size?
o Palpate to check size - Should not be tight going down
o Septum of the nares
What is one complication of the ET tube being too tight?
scrapes mucosal surface causing a postoperative cough
What is one factor in determining the order of surgical procedures?
most life threatening goes first
What must one evaluate before performing a procedure which requires anesthesia?
must weigh risks and benefits - benefits must outweigh risks
What is the number one reason for anesthetic emergencies?
What are five examples of human mistakes which may lead to an emergency?
o Lack anesthesia and drug familiarity
o Wrong drugs administered
o Preoccupied or in a hurry
What are four symptoms/warning signs that a patient has a diaphragmatic hernia?
o Internal organs displaced into the thorax
o Skinny abdomen
o Muffled heart sounds
What are two examples of drugs that come in different dosage strengths?
What is a potential route of administration drug complication that may occur with aggressive dogs?
aggressive dogs may be dosed IM in emergency situations, but if there is a struggle the vein may be hit
What is the second most common reason for emergencies?
What are six potential anesthesia machine equipment problems?
o CO2 absorber exhausted
o Decreased O2 flow
o ET tube problems
o Vaporizer problems
o Pop off valve
How often should the CO2 absorber be changed?
every ten hours
What are five symptoms of CO2 absorber exhaustion in the patient?
o Hypercapnia because of the increased CO2 buildup
o Increased HR and RR
o Brick red MM
o No reflexes
What are four possible reasons for decreased O2 flow?
o Tank runs out (change at 500 psi though 2-3 more surgeries could be done)
o Valves are closed
o Flow meter ball is lodged in the flow meter tube
o Obstruction or leak
What is one symptom of decreased O2 flow in the patient?
appears cyanotic when O2 has stopped
What should the tech's reaction to reduced O2 flow be?
o Disconnect the nonrebreathing circuit because room air has 20% oxygen (better than 0%)
o Leave a rebreathing circuit connected as long as the reservoir bag is full (there is still oxygen in it)
What percentage of O2 is found in room air?
What percentage of 02 is administered by the vaporizer?
What are four potential problems with the endotracheal tube?
o Twisting or kinking
o Material in tubes
o Bad positioning
How do you prevent twisting and kinking of the ET tube?
detach before flipping the animal
What drug increases the risk of material being trapped in the tube?
atropine in cats
What may occur when the ET tube is positioned too far past the bifurcation and the thoracic inlet?
only one bronchus is oxygenated and the other side dies
What does blockage of the ET tubes cause?
How does a tech check ET tube placement?
o Bag the patient to check for a rising chest - Abdominal rising means the ET tube is down the esophagus and into the stomach
What should a tech do if there is no rise of the chest or abdomen when bagging the patient to check placement of the ET tube?
disconnect and feel for air coming from the ET tube
What should the tech do when there is no air coming from the disconnected ET tube?
o Remove and replace the tube
o Suction the accumulation if this is the problem
What are six potential issues with the vaporizer?
o Wrong anesthetic
o Tipping machine over
o Dial is stuck and jammed
o 2 vaporizers on
o Over filling the vaporizer
o Increased room temperatures in non-precision vaporizers
What is one potential problem with the pop-off valve?
it is closed
What happens when the pop-off valve is closed?
o The bag will be tense and tight
o The patient will not exhale
o Decreased venous return decreasing heart rate, deceased cardiac output, rapid decrease blood pressure, and possible rapid death
What should the tech's reaction be if the reservoir bag is too full?
o Open pop off valve
o Decrease O2 flow
o Disconnect from machine if correction is taking too long
How does a tech change the O2 concentration in the reservoir bag?
dump the bag three times
What are three common patient types that require a special drug protocol?
Define balanced anesthesia.
o Using more than one drug (using a preanesthetic) to decrease the amount of gas needed
What five patient factors need to be considered for geriatric patients?
o Aging (how quickly certain breeds age)
o Organ function
o Stress response decrease
o Increased hypothermia risk
o Increased risk of overhydration
What is one example of a dog breed that ages slowly?
What is one example of a dog breed that ages quickly?
What consideration should be made for the heart when choosing an anesthetic agent?
decreased cardiac function calls for isoflurane (decreased heart effects)
What is the role of the liver in metabolizing anesthetic agents?
metabolizes injectable agents
What is the role of the lungs in metabolizing anesthetic agents?
removes anesthetic gas through blow off
What is the role of the kidneys in metabolizing anesthetic agents?
excretes (does not metabolize!) injectable agents
What is different about the kidney's metabolism and secretion mechanism in the cat?
kidneys completely remove the agents
Explain anesthetic redistribution.
o Anesthetic goes from the machine to the patient’s lungs where diffusion across capillary walls increases the concentration in the blood stream
o The anesthetic then travels to the highly vascularized tissues such as the brain
o Then the agents are pulled into the fats and muscle of the body which are poorly vascularized
o This decreases the concentration in the brain causing the animal to “wake up” even though there is still adequate anesthetic in the body
o The liver cannot metabolize the agents fast enough to eliminate the drugs completely before redosing
Why do older dogs have a higher hypothermia risk?
lost insulation (low body fat content)
Why do older dogs have a higher risk for overhydration?
impaired heart circulation and decreased kidney function
What anesthetic should be used for a patient with liver problems?
inhalation induction (mask, chamber, or cage)
What is the safest minimum age to begin anesthesia induction?
Why are pediatric patients at higher anesthetic risk?
o Decreased liver function pathway
o Increased hypothermia and overhydration risk
o Difficulty intubating
o Fasting avoidance
o Catheterization problems
What is the safest way to induce a pediatric patient?
Why are pediatric patients not fasted?
hypoglycemia, dehydration risk
When is hypoglycemia most likely to occur in a pediatric patients, and what patients are at greatest risk?
patients less then 6 months old (especially toy breeds) fasted longer then 8 hours
Besides hydration, what must be checked in pediatric patients before surgery?
What is the most common problem in pediatric patients?
What is the most common problem in brachycephalic dogs?
tendency for airway obstruction
What causes airway obstruction in brachycephalic dogs?
o Stenotic nares
o Elongated soft palate
o Everted laryngeal ventricles
o Small, short trachea
When should stenotic nares be examined?
at the patient's first exam
What may cause bradycardia in a brachycephalic dog?
increased vagal tone which causes increased vagal response inducing bradycardia
How is vagal tone decreased?
o Use anticholinergics for preanesthetics which prevent bradycardia and secretions
o Proxygenate before drugs
o Induce rapidly
Why should brachycephalic dogs be induced rapidly?
to avoid stage 2 (excitatory stage)
What special instructions are suggested for brachycephalic patients?
leave the ET tube in as long as possible - until they chew or pick up the head
What is the anesthetic drug of choice for sighthounds?
Why is propofol the drug of choice for sighthounds?
o Sight hounds lack body fat so drugs will have a larger effect on them
o Propofol is eliminated quickly through liver metabolism
o Because there is less fat and muscle to absorb the drug from the blood stream, rapidly metabolized drugs are a good thing for sight hounds (little to no redistribution)
What drug is not given to sighthounds?
barbiturates because there is no redistribution to decrease concentration of the agents in the brain and blood
How are obese patients dosed?
for ideal body weight, not current body weight
What are three anesthetic complications associated with obesity?
o Difficult for accurate dosing (guessing the dose by weight)
o Poor distribution of anesthetics
o Respiratory difficulty
Why is respiration compromised in obese patients?
fat takes up space where the lungs and diaphragm normally would expand
How should obese patients be treated before surgery?
o Induce rapidly (injectable and inhaled)
How is respiration supplemented in obese patients?
o Assisted PPV when needed
o Delay extubation (maintain airway until completely recovered to breathe on own)
How should all patients be placed in the cage during recovery from anesthesia?
o Face towards the cage door
o Propped so that the nose is not obstructed by the cage wall or bedding
What four complications are c-section patients at increased risk for?
o Heart workload increases
o Compromised respiration
o Vomiting and regurgitation
Why is workload to the heart increased in c-section patients?
there are puppies inside that require blood flow so the heart works overtime to compensate
Why is respiration compromised in c-section patients?
uterus takes up abdominal space restricting diaphragm space for contraction
Why is there an increased hemorrhage risk for c-section patients?
uterus is highly vascularized
What are five special considerations in the care of c-section patients?
o IV fluids
o Clip prior to induction with patient on the left side
o Give lowest effective dose of drugs
o Avoid certain drugs
Why are c-section patients given IV fluids?
a lot of fluid is lost and blood pressure must be maintained
Why are c-section patients clipped while laying on their left side and prior to induction?
o if placed on their back the additional weight on the caudal vena cava would compromise blood flow to dam and puppies
o decreases the amount of anesthetic to the puppies
What five drugs are avoided in c-section patients?
How are c-section patients induced?
What are three common breeds of c-section patient?
English bulldogs, pug, French bulldog
Why are c-sections common in these breeds?
puppies have large heads when compared to the birth canal
What problems may occur with c-section puppies?
agents can cross the placenta which reduces respiratory and CDVS function
What are five ways reduced respiratory and CDVS function can be prevented in c-section puppies?
o Use reversal agents
o Use doxopram
o Administer oxygen with face mask
o Administer atropine for bradycardia
o Keep warm
When should the puppies be allowed to nurse?
ASAP once the mother has recovered enough to put the puppies out of danger
What calls for the use of doxopram in c-section cases?
the use of narcotics
When does doxipram work?
only when there was an initial respiratory effect
What are two ways that the bladder may be emptied in the c-section patient?
o Normal outside urination
o NOT MANUAL EXPRESSION
What three things should be done before trauma patients are induced if they are stable enough to have them done?
How is respiration examined in trauma patients?
What can be done if there is a complete oxygen exchange loss from blood or fluid filled lungs?
Fluid in the chest calls for what treatment?
When do cardiac arrhythmias occur in trauma patients?
within 3 days
What are two common signs that occur with trauma in many of the cases?
What are two other potential internal problems with trauma patients?
o Internal injury
o CNS problems
What three clinical signs indicate internal injury or CNS problems in trauma patients?
o Cerebral edema
How are patients with a diaphragmatic hernia positioned
patients will try to keep their front ends up
How are diaphragmatic hernia patients treated for surgery?
o Rapid intubation
o Rapid induction (IV)
o Respiration is supported right away
How are diaphragmatic hernia patients bagged?
o Lower than normal patient respiration because we are more efficient at breathing than the patient
What are two symptoms of left heart failure?
o Lung edema
What considerations should be taken with a left heart failure anesthetic patient?
o Gas should be used because of increased margin of safety
o No fluids are given because of too much accumulation that has occurred
o For anesthesia give the lower end of the formula (2ml/lb/hr)
What are four potential CDVS problems?
o Compromised circulation
o Pulmonary edema
What are four ways to prevent CDVS problems?
o Alleviate pulmonary edema
o Avoid agents that depress CDVS function
o Avoid overhydration
Are heart murmurs always bad?
no because the dog has a normal sinus arrhythmia
What are three potential respiratory disease problems?
o Poor tissue oxygenation
o Anxiety leading to difficulty in restraint
o Respiratory arrest (COMMON)
What are two problems caused by anxiety in the patient with respiratory disease?
o They are not getting air so they panic
o Anxiety decreases the amount of air getting to the lungs
How are patients with existing respiratory disease treated?
o Reduce handling stress
o Use injectables
o Avoid mask
o Rapid intubation
o Assisted PPV if needed
o Close monitoring in recovery
Why might hepatic disease be overlooked on a chem panel?
without secretions there are no indications of liver disease even though the liver is dead
What are five potential complications in a liver disease patient?
o Metabolism of injectables is delayed
o Clotting factors are decreased
How can you tell if clotting factors are decreased?
o The patient will drip after being stuck or cut
How should decreased clotting factors be treated prior to surgery?
administer blood or plasma transfusion
Why might a patient with liver disease not wake up from anesthesia?
the drug cannot be metabolized so it is not broken down and stays in the bloodstream
Why is decreased protein a problem?
less binding of drugs so more free drug exerts its effect
Why are liver disease patients icteric?
cannot conjugate bilirubin properly
How are patients with existing liver disease treated for surgery?
o Preanesthetic blood work
o No injectables
o Prolonged recovery
How much isoflurane is metabolized?
How much sevoflurane is "blown off"?
What are three potential renal disease problems?
o Delayed inj excretion
o Electrolyte imbalances
What are four common electrolyte imbalances seen in the renal patient?
o Metabolic acidosis
Why are renal patients commonly dehydrated?
they are both polydipsic and polyuric, and eliminate more then they take in
How should the renal patient be treated for surgery?
o Renal function test
o Correct electrolyte imbalances
o Avoid injectables
Urinary tract obstruction occurs most commonly in what species?
Cats can have problems with just _____.
In how much time can a urinary tract obstruction be fatal in the cat?
3 days of obstruction in lateral recumbency
What five problems may occur with urinary tract obstruction?
What two drugs should be avoided in cases of renal disease?
o IM ketamine
What gas is used in cases of renal disease?
What deficiency is important to correct when present?
Why might a catheter get hung in the urethra?
a stone present may block catheter advancement
Why might a catheter be passed?
to relieve an obstruction ASAP
What should be done after the obstruction is relieved?
What happens after a prolonged obstruction?
What type of epi can be used in a crash cart?
epi that can be safely stored at room temprature
If there is an emergency protocol or if there is a life threatening emergency what can the tech do in most states?
Act to save the animal in the vet’s absence
What are eight common complications during surgery?
o Animal will not stay under
o Animal is too deep
o Dyspnea and cyanosis
o Respiratory arrest
o Cardiac arrest
What eleven things should be checked if the animal will not stay under?
o Vaporizer setting
o Oxygen setting
o Anesthetic in vaporizer
o ET tube placement
o Cuff inflation/deflation
o Breath holding in the patient
o Respiration depth
o Machine function and assembly
o Oxygen flow rate adequacy
o Agonal breathing in the patient
o Patient assessment
What two types of patient require PPV every five minutes if they are deficient?
o Toy breeds
o Obese patients
What are ten signs that an animal is too deep?
o Respiration is 2 seconds
o Bradycardia (
How can CRT be normal in a dead patient?
the capillaries will pool with blood
What is the first thing you check in a patient that is too deep?
vital signs other then mucous membranes
What drug USED TO be given to stabilize mucous membranes?
What is the appropriate response to a big decrease in heart rate?
What are four reasons a patient might be too deep?
o High vaporizer setting
o High inj dose
o Inj given IV rather then IM
o Preexisting problem
What are seven ways increased anesthetic depth is treated by the technician?
o Turn vaporizer to 0 if needed
o Inform vet
o Bag with pure O2 q5s
o IV fluids
o External heat
o Drugs as ordered by vet
o Decrease and watch for arousal
What are six causes of pallor?
o Pre-existing anemia
o Surgical blood loss
What are three ways pallor is treated by the technician?
o Ascertain anesthetic depth
o Monitor vitals
o Consult vet
What four things might the vet order for pallor treatment?
o IV fluid therapy
o Blood transfusion
o Corticosteroids (IV)
o Pain management
What are five possible causes of hypotension?
o Preexisting conditions like trauma
o Surgical blood loss
o Deep anesthesia
o Circulatory shock
What two common drugs can cause hypotension?
What are ten ways that hypotension may be treated by the technician?
o Check CRT
o Check pulse quality
o Rapid IV fluids with shock
o Reduce anesthetic depth
o Give 100% oxygen
o Supplement heat
o Drugs as ordered by vet
What blood pressure readings indicate hypotension?
What fluid administration rates are used for rapid shock fluid treatment in the dog?
20 ml/kg/1st 15 min to max of 90 ml/kg/1st hour
What fluid administration rates are used for rapid shock fluid treatment in the cat?
10 ml/kg/1st 15 min to max of 45-65 ml/kg/1st hour
What are three types of fluids that may be given IV?
o Blood transfusions
What are four potential sources of supplemental heat?
o Warm towels
o Heating pads
o Rice socks
o Hot water bottles
What five things do a cyanotic patient indicate?
o Not enough oxygen
o Not enough CO2 elimination
o Pulse oximetry
What are six potential causes of respiratory distress?
o Lack of oxygen supply
o Too full reservoir bag
o Respiratory disease
o Airway obstruction
o Heavy drapes or constricting bandage
o Too deep
What are five ways that dyspnea may be treated by the technician?
o Check oxygen delivery
o Turn off vaporizer and bag q5s
o IV fluids
o Emergency drugs
o Observation for cardiac arrest
What three things need to happen when bagging the patient?
o Observe for chest rise and fall with bagging
o Bag until MM color improves and pulse ox reaches 90-95%
o Tracheotomy with complete obstruction
What is done in the event of cardiac arrest?
CPR with chest compressions
What drug class commonly induces tachypnea?
Why might a patient in the surgery room have a spike in heart rate?
stimulation with too light anesthesia
What are two ways that deep anesthesia causes tachypnea?
o Low oxygen
o High carbon dioxide
When is it OK to see the heart rate spike?
when the ovarian pedicle is clamped
What temperature change can increase heart rate?
When is increased temperature OK to induce increased heart rate?
What are three ways tachypneal may be treated by the technician?
o Assess anesthetic depth
o Check CO2 absorber and capnography for hypercapnia
o Vitals ok: wait 1-2 minutes to see if the patient can self-correct
What does tachypnea due to pain indicate?
analgesia should be administered
What does tachypnea due to obesity indicate?
How is anesthetic depth assessed?
Reflexes such as palpebral reflex present
What are five signs of hypercapnia?
o Brick red MM
When may respiration stop during surgery?
o After induction
o After prolonged bagging
What is the first thing that should be done if respiration stops?
o Check other vitals (HR, MM, pulse strength)
o Check pulse ox (> 95% is good)
o Deliver occasional breaths q30s for 1-2 minutes while observing for respiration return
What are three potential causes of respiratory arrest?
o Anesthetic overdose
o Cesation of O2 flow
o Pre-existing respiratory disease
What also may occur with respiratory arrest?
What seven steps should the technician take to treat respiratory arrest?
o Inform vet
o Turn off vaporizer
o Intubate and connect to 100% O2
o Check HR with ECG is possible
o Check O2 flow and airway
o Bag q5s until stable
o IV fluids and drugs as ordered by vet
What are four alternative methods of getting oxygen to the patient besides the 100% O2 method?
o Ambu-Bag (positive pressure pushed into patient)
o Mouth to ET tube
o Mouth to muzzle (close nose and breathe into mouth)
o Tube tracheostomy
What drug may be given to stimulate respiration?
Define cardiac arrest.
sudden cessation of effective circulation and ventilation
What are eight signs of cardiac arrest?
o Loss of consciousness in 10-15 seconds
o No heart beat
o No palpable pulse
What does asystole look like on an ECG?
What does ventricular fibrillation look like on an ECG?
What does electromechanical dissociation look like on an ECG?
Normal QRS complexes without a heart beat
uncommonly, normal ECG without heartbeat
What are the ABCDEF steps to cardiac arrest response?
What is the CPR protocol?
o 15 compressions
o 2 breaths
o OR as many compressions in a minute without the breaths
How long do you have before the brain is damaged permanently from oxygen deprivation?
What are the four team member jobs in CPR?
o Response, pulse, and ECG assessor
o Drugs as ordered and record keeper
Which job may be neglected if needed?
record keeper (should try to do it as soon as the drugs are administered)
What is noted on the record first in cases of cardiac arrest?
time of arrest
What method can be used to establish an airway?
How should respiration be supplemented in CPR?
bag with 100% O2 q5s
What should happen when the patient is bagged?
chest rises with inhalation and falls with exhalation
What recumbency is the patient placed in for CPR?
How is the chest compressed for CPR?
1/3 chest diameter of chest wall 1-2 times per second
How are wide chested dogs placed for CPR?
on their backs
What are two examples of wide chested breeds?
o English bull dog
o French bulldog
What are the two things that are done by CPR to induce circulation?
(these are debated as to which actually occurs)
o Force blood through the heart
o Inducing blood flow with pressure changes
What do compressions cause during CPR?
o Each compression should cause a palpable femoral pulse
o MM color should improve
How can breaths be administered during CPR?
o Simultaneously with compressions
o 10-15 compressions at every 2 breaths
What is one alternative to external cardiac compressions?
internal cardiac compressions (sterile hand directly grasping the heart)
When might internal compressions be performed?
o After 2 minutes of ineffective external compressions
o Immediately with chest trauma, pericardial effusion, or hypovolemia
How are internal compressions performed?
o Quick shave
o Alcohol rinse
o Sticky drape
o Skin incision between 7-8 rib
o Gloved hands grasp heart
o 80 compressions per min
o Close chest
How are fluids administered during cardiac arrest?
o Rapidly through IV catheter prn to expand blood volume
What nine drugs may given during cardiac arrest?
o Sodium bicarbonate
o Anesthetic reversal agent
Why is sodium bicarb contraindicated?
an accidental alkalosis will occur if too much sodium bicarb is administered
What is the drug of choice to treat cessation of the heart?
What two alternate routes exist for drug administration during cardiac arrest?
o Intratracheal through the ET tube with a double dose
o Injected into base of tongue
How is the patient cared for post cardiac arrest?
o Support vital function
o Heat supplement
What are four common complications of cardiac arrest recovery?
o Repeated arrest
o Disseminated intravascular coagulation (DIC)
o Acute renal failure secondary to epinephrine shutting down the blood flow
o Cerebral edema
What is DIC (disseminated intravascular coagulation)?
o Commonly called death is coming or dead in cage
o Comes secondary to cancer or end stage heart worm disease
o Causes coagulation in the vessels and uses up clotting factors which causes the patient to bleed everywhere else
o Will look bruised even though coagulant is there
What happens with cerebral edema?
o Brain swells
o Possibly cause blindness
What are six potential anesthetic recovery problems?
o Regurgitation and vomiting
o Anesthesia in unfasted patient
o Post anesthesia seizures and excitement
o Dyspnea in cats
o Dyspnea in dogs
o Prolonged recovery
What are the complications of regurgitation and vomiting while under anesthesia?
o Risk of esophagitis
o Aspiration pneumonia
How is vomiting responded to in an unconscious patient lacking an ET tube?
o Head lower than the body
o Clean oral cavity
o Assist respiration as needed
How is vomiting responded to in an unconscious patient with an ET tube?
o Ensure cuff inflated
o Head lower than body
How is vomiting responded to in a conscious patient?
assist as required
How is an unfasted patient treated?
o Rapid induction and intubation
o Avoid head down positioning
o Suction made available
o Antiemetics adm but up to vet
What does excitement look like?
How is excitement treated?
o Reassure and calm
o Occasional anesthetic and analgesic administration
o Cover the cage of cats that are crazy and give Valium to calm
What do seizures look like?
o Uncontrolled violent movements
What three drugs are given for seizures?
What are two causes of dyspnea in cats?
o Laryngospasm from intubation or extubation
o Laryngeal edema
What does dyspnea sound like?
o Losing consciousness
What must be done if the patient is turning blue or losing consciousness?
If you are unable to intubate, what must be done?
What six things might cause dyspnea in the dog?
o Foreign objects
o Laryngeal edema
o Post operative tissue swelling
o Tracheal collapse
What does dyspnea look and sound like in a dog?
o Cyanosis after tube removal
How is dyspnea in the dog treated?
assist in airway clearance and oxygenate as needed