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Vet 415 - Clinical Skills > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

Anesthesia is a balance between ____ and ____ + ____

A
  1. surgical stimulation

2. drug induced depression + physiological disturbances

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2
Q

Movement during anesthesia

A
  1. gross spontaneous movements (too light)

2. reflex movement in response to surgery (not necessarily because they are too light)

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3
Q

Anesthetic Depth (6 things w/ eyes)

A
  1. globe position
  2. pupil size
  3. nystagmus
  4. lacrimation
  5. palpebral reflex
  6. corneal reflex
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4
Q

Anesthetic depth (globe position)

A

Central (light) –> ventromedial (good) –> central (too deep)

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5
Q

Anesthetic Depth (palpebral aperture size)

A
  • increases with increasing depth
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6
Q

Anesthetic depth (pupil size)

A
  • highly variable

- dilated @ very deep states

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7
Q

Anesthetic Depth (palpebral reflex)

A
  • blink in response to touching the eyelids

- good depth = loss of reflex

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8
Q

Anesthetic depth (corneal reflex)

A
  • touch cornea and animal should blink

- loss of this = animal close to death

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9
Q

Anesthetic Depth (jaw tone)

A
  • resistance to manual jaw opening
  • jaw done decreases as depth increases
  • ketamine = always strong jaw tone
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10
Q

Dissociative Anesthetic Drugs (depth signs)

A
  • eye central
  • retain palpebral
  • too light: blinking, eyes closed, tearing, rapid nystagmus, spont. movement
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11
Q

Non-signs of anesthetic depth

A
  • flaring of nasal alae
  • slight muzzle movement
  • focal muscle twitching/ fasciculations seen w/ propofol, ketamine
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12
Q

What three categories to monitor during anesthesia?

A
  • Cardiovascular
  • Respiratory
  • Temperature
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13
Q

What are the 3 H’s of anesthesia?

A
  • Hypotension
  • Hypoventilation
  • Hypothermia
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14
Q

Most anesthestics are ______ + _____ (cardiovasc)

A
  • neg. inotropes and vasodilators
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15
Q

Why might alpha-2’s cause cyanosis?

A
  • alpha-2’s cause peripheral vasoconstriction that decreases blood flow in the periphery –> increased oxygen unloading
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16
Q

Evaluation of hypotension?

A

MAP < 70mmHg

SBP < 90mmHg

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17
Q

How to set up doppler?

A

cuff size = 40% limb circumference

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18
Q

normal PaCO2 levels?

A

40+-5mmHg

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19
Q

T/F: Patients with elevated intracranial pressure are particularly susceptible to elevated CO2 levels

A

T

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20
Q

Effects of hypothermia

A
  • decreased anesthetic requirements
  • increased rate of complications (hem, bradycardia, infection rate)
  • slows recovery
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21
Q

Large Animal Complications

A

3H’s + handling and hypoxemia

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22
Q

Ruminant Complications

A

Regurgitation (fasting)
Aspiration (keep sternal)
Bloat (fasting)

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23
Q

The Recovery Period (SA and LA)

A

SA - 1/2 of all perianesthetic deaths post-op

LA - 1/3 of anesthesia related deaths

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24
Q

Nursing Care pre-recovery

A
  • empty bladder
  • clean/ dress/ protect wounds
  • position animal comfortably
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25
Q

What determines speed of recovery?

A
  • drugs used (inhalants vs injectables)
  • species (smaller are faster)
  • Body temp (hypothermia slows recovery
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26
Q

Monitoring and Support during recovery

A
  • heat support
  • general observation
  • supplemental O2
  • CV support may be necessary
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27
Q

Should you sedate equines during anesthetic recovery?

A

probably,

  • alpha-2’s cause analgesia, fast onset, ataxia
  • acepromazine is slow onset, non-analgesic
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28
Q

Why prevent bleeding in surgery (3 things)

A
  1. maintain visibility
  2. maintain perfusion
  3. avoid transfusion
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29
Q

How to prevent bleeding in surgery

A
  1. knowledge of anatomy
  2. gentle tissue handling
  3. familiarity w/ hemostatic techniques
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30
Q

Hemostatic Methods

A
  1. blood flow reduction (pressure, forceps)
  2. Vessel Ligation
  3. Energy devices
  4. topical agents
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31
Q

Hemostatic Methods (skin)

A
  1. pressure
  2. forceps
  3. electro and laser
  4. clips for deeper vessels

Generally, skin vessels are small and do not require ligation

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32
Q

Hemostatic Methods (SQ tissue and muscle)

A
  1. pressure
  2. forceps
  3. clips or sutures
  4. electro
  5. vessel sealing device
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33
Q

Hemostatic Methods (Larger vessels and pedicles)

A
  1. pressure and forceps (good to help buy time)
  2. clips or sutures
  3. vessel sealing devices
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34
Q

Hemostatic Methods (Parenchymal Organs)

A
  1. pressure
  2. gelatin sponges, oxidized cellulose
  3. organ removal

small bleeds = pressure (anything more will increase bleeding)

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35
Q

Hemostatic Failure (sources)

A
  • suture or clip fails
  • inappropriate method of hemostasis used
  • iatrogenic damage (rough handling of tissues)
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36
Q

How to identify hemostatic failure?

A
  • blood pooling
  • blood clots
  • visual inspection of pedicles, divided vessels
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37
Q

Benefits of placing a drain?

A
  • evacuate foreign material, necrotic tissue, bacteria and inflammatory mediators
  • remove serum and blood
  • relieve pressure
  • reduce dead space
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38
Q

Indications of Open Passive Drain?

A

Therapeutic: abscess; wound not in thoracic or abd
Prophylactic: minimize dead space after dermal or SQ benign mass removal

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39
Q

Open Passive Drain (advantages)

A
  • inexpensive
  • simple to place and remove
  • effective drainage of SQ pockets
  • fit into small tisue pockets
  • can be maintained at home
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40
Q

Open Passive drain (disadvantages)

A
  • air and env. contamination
  • not for thoracic and abd cavities
  • external bandage dressing and fluid collection must be done regularly
  • wound exudate can damage skin
  • dif. to quantify or sterile sample fluid
  • must be positioned well
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41
Q

Indications of Closed suction drain

A

Therapeutic: wounds and abscesses; peritonitis; pneumothorax; areas where gravity not helpful

Prophylactic: large areas of SQ dead space; surgeries in thoracic cavity; major reconstructive of GI, urogential, biliary tracts

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42
Q

Closed Suction Drain (advantages)

A
  • decreased risk of ascending inf.
  • effective drainage of fluid and air
  • active suctions brings tissue layers in contact
  • quantify draining material
  • obtain sterile samples
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43
Q

Closed Suction Drain (disadvantages)

A
  • more expensive
  • must maintain closed, sterile system
  • must reapply suction and empty grenade
  • drains often too large for small vet pockets
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44
Q

T/F: oxidative stress results from an increase in ROS and decrease in antioxidants

A

T

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45
Q

Exogenous sources of ROS

A
  • UV light
  • ionizing radiation
  • smoking/ air pollution
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46
Q

Endogenous sources of ROS

A
  • mitochondria and NADPH oxidase
  • 5-lipoxygenase
  • xanthine oxidase
  • NO synthase
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47
Q

ROS attack on lipids mech

A
  • toxic “chain reaction” that kinks tail structure of phospholipids causing disordered packing and loss of cell structure
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48
Q

Anti-oxidant defense mechanisms

A
  1. Enzymes
  2. Proteins
  3. Low-molecular weight substances (glutathionine)
  4. Keap1-Nrf2 pathway
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49
Q

T/F: in order to prevent oxidant damage against lipids, you only need to have one of the many antioxidants

A

F: you need to have the entire list of antioxidants in order to prevent lipid damage

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50
Q

Keap1-Nrf2 pathways

A
  • oxidant stress mobilizes the Nrf2 antioxidant response that activates transcription of many antioxidant genes
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51
Q

Glutathionine (moa)

A

fxs by reducing lipid peroxidases to less-toxic alcohols; also reduces Vit C

52
Q

White Muscle Disease

A
  • dietary deficiency in selenium or Vit. E

- degenerative muscle disease in large animals

53
Q

Heinz Body Anemia ( in cats)

A
  • Hb is highly susceptible to oxidation damage due to larger numbers of -SH groups in cats than others
  • -SH oxidation causes Hb to precipitate, distort RBC, and lysis
54
Q

Red Maple Ingestion (horses)

A
  • methemoglobin and heinz body anemia
55
Q

Ischemia/ Reperfusion (moa of damage)

A
  • low [O2] initially
  • reperfusion causes oxidative burst that produces large number of ROS quickly
  • paired immune response (activated PMN, TNF, IL1,6,8,12)
  • tissue damaged in vascularized tissues
56
Q

T/F: during reperfusion, you should have animals on supplemental O2 to make sure the tissues all get O2 as quickly as possible

A

F: this will cause increased damage

57
Q

T/F: ROS can damage Proteins, DNA, and Lipids (membranes)

A

T

58
Q

Antioxidant Defense Enzymes (2 of them)

A
  1. Superoxide Dismutase

2. Catalase

59
Q

What is the Fenton Reaction

A

Breakdown of H2O2 into OH* (ROS)

60
Q

Organ Sensitivity to I/R

A
  1. Brain
  2. Heart
  3. Kidneys
  4. Intestines
  5. Skeletal Muscle
61
Q

Therapies for I/R

A
  1. Enzymatic antioxidants (superoxide dismutase)
  2. Dietary antioxidants (Vit. E, N-acetyl cysteine, melatonin)
  3. Xanthine Oxidase inhibitors
62
Q

What are the 6 types of shock?

A
  1. Hypovolemic
  2. Cardiogenic
  3. Metabolic
  4. Hypoxic
  5. Distributive
  6. Obstructive
63
Q

What is the most common form of shock?

A

Hypovolemic

64
Q

Clinical signs of hypovolemic shock?

A
  • Decreased perfusion parameters (low volume)
  • Hypotension
  • Decreased urine volume
65
Q

Oxygen Extraction Ratio (OER)

A

(SaO2 - SvO2)/ SaO2

looks for offloading problems

66
Q

Distributive Shock

A
  • inappropriate vasodilation –> septic shock, anaphylactic shock, neurogenic
67
Q

Cardiogenic Shock (3 types and clinical signs)

A
  1. Systolic Dysfunction (dec. contractility)
  2. Diastolic dysfunction (inadequate fill)
  3. Dysrrhymthias (v. fib or something)
  • hypoperfusion, hypotension, ECG abn, murmurs
68
Q

Obstructive Shock

A
  • extracardiac mechanical obstruction to cardiac output

- pulmonary thromboembolism

69
Q

Hypoxic Shock

A
  • blood volume and blood flow may be n

- deficiency in O2 leads to shock

70
Q

5 causes of Hypoxic shock

A
  1. low PiO2
  2. V/Q mismatch
  3. diffusion impairment
  4. hypoventilation
  5. R–>L shunt
71
Q

Metabolic Shock

A
  • impaired O2 utilizaiton (either mitochondrial problem or decreased substrate, severe hypglycemia)
72
Q

How to treat hypovolemic shock?

A

IV fluids

73
Q

How to treat Distributive shock?

A

Septic: antimicrobials
Anaphylactic: epi, antihistamines
Neurogenic: treat neuro dz

74
Q

How to treat Cardiogenic shock?

A

systolic: inotropes
diastolic:
Tachyarrhymthias =: SVT, VT

75
Q

How to treat obstructive Shock?

A

relieve obstruction

76
Q

How to treat hypoxic shock?

A

O2 supplementation, mech. ventilation

77
Q

Fluids TROL?

A

Types, Rates, Objectives, Limits

78
Q

Hypertonic crystalloids benefits?

A
  • will pull water from interstitial space for large animals

- increased contractility

79
Q

2 approaches to shock fluid rates

A
  1. deficit volumes

2. fluid challenge (give bolus then reassess)

80
Q

What are the ABCs of CPR?

A

Airway
Breathing
Compressions

81
Q

Difference between Cardiac Pump vs Thoracic Pump?

A

Cardiac Pump –> direct compression of the heart

Thoracic Pump –> changing intrathoracic pressure to move blood through the heart

82
Q

When to use a direct cardiac massage

A
  • already in the abdominal or thoracic cavity

- failure of n compression techniques

83
Q

How to check efficacy of compressions?

A
  • pulse palpation (not v good)
  • doppler flow probe (not v good)
  • End Tidal CO2 (best way to check)
84
Q

What are the DEFs of CPR

A

Drugs
ECG
Fluid Therapy

85
Q

What drugs to use in CPR?

A

We use vasopressors (mainly Epinephrine and ADH)

  • Epi has B1 activity that can be bad upon resuscitation
  • ADH is just expensive
86
Q

ECG in CPR?

A
  • need to stop compressions to evaluate

- use for V. fibrillation vs asystole vs Pulseless Electrical Activity

87
Q

Fluid Therapy in CPR?

A
  • good if hypovolemic
  • bad if not hypovolemic as it increases work that the heart has to do
  • ER patient give 1/2 to full dose; ICU patient only flush drugs
88
Q

Post-Cardiac Arrest Care

A
  • most that resuscitate don’t survive long enough to leave the hospital
  • don’t oxygenate either way because bad
89
Q

Define: ostium

A

opening into a tube

90
Q

Define: perforation

A

a hole or opening into an organ

91
Q

Define: Atresia

A

abn closure or absence of an orifice or passage

92
Q

Define: -otomy

A

to cut or make an incision into

93
Q

Define: -ostomy

A

surgically creating a new opening

94
Q

Define: -ectomy

A

surgical removal

95
Q

Define: -pexy

A

surgical fixation

96
Q

Why use contrast studies for hollow organs

A
  • look for leakage
  • look for obstructions/ strictures
  • assess diameter/ size
97
Q

Basic Surgery Principles ( Gastrotomy )

A
  • stay sutures
  • laparotomy sponges
  • intraperitoneal irrigation
  • clean/ dirty instrumentation
98
Q

Basic Surgery Principles (Intestinal Surgery)

A
  • delicate tissue handling
  • respect the blood supply
  • protect against leakage of int. contents
99
Q

Basic Surgery Principles ( Cystotomy)

A
  • stay sutures
  • laparotomy sponges
  • prevent urine leakage
100
Q

T/F: You should consider complications during and after surgeries and for those impacting all surgeries

A

T

101
Q

Myocardial perfusion pressure equation

A

(aortic diastolic pressure) - (R. Atrial pressure)

102
Q

the volatility of a liquid anesthetic in a carrier gas is

A

saturated vaport pressure

103
Q

Alpha 2 agonist that is 10x more potent in cattle than horses

A

Xylazine

104
Q

hypoventilation

A

40+-5 mmHg

105
Q

best non-invasive way of measuring PaO2 during anesthetic recovery

A

pulse oximeter

106
Q

minimum fresh gas flow rate for bain circuit is…

A

200mL/kg*min or 500mL/min

107
Q

What drug would you give that would increase heart rate when paired w/ opioid

A

Atropine, glycopyrrylate

108
Q

The two ‘shockable’ ecg waveforms

A

pulseless ventricular tachycardia and v. fibrillation

109
Q

This fluid type is anti-inflammatory and a positive inotrope

A

hypertonic saline

110
Q

way to check for dehydration

A

skin turgor, mucous membranes, tear film

111
Q

recommended compression rate and duration of compressions per cycle

A

120bpm for 2 minutes

112
Q

sedation in adult sheep, goats, but not cats and dogs

A

diazepam and midazolam

113
Q

3H’s

A

hypotension, hypothermia, hypoventilation

114
Q

LRS admin during n anesthesia (rates)

A

3-5mL/kg/hour

115
Q

inhaled agent with lowest MAC

A

isoflurane

116
Q

6 perfusion parameters

A 
mucous membrane color
CRT
mentation
heart rate
pulse quality
extremity temp
117
Q

Hepatic clearance relies on (3 things)

A
  1. blood flow
  2. intrinsic clearance
  3. protein binding
118
Q

Are high ER (extraction ratio) drugs more or less dependent on blood flow than low ER drugs?

A

more

119
Q

decreased hepatic blood flow effect on abs. and clearance

A

increased abs

decreased clearance

120
Q

decreased phase 1,2 enzymes on clearance

A

decreased clearance

121
Q

decreased albumin on distribution and clearance

A

increased distribution

variable clearance

122
Q

Total renal excretion = _____ + ______ - _______

A

rate of filtration + secretion - reabsorption

123
Q

in an animal with renal disease what should happen to dose and dose intervale

A

dose should decrease

dose interval should increase

124
Q

GI dz primarily affects _____

A

absorption

125
Q

Cardiac dz problems

A

redistribution of blood flow (all phases)
retention of Na/ H2O
decreased hepatic blood flow

Vet 415 - Clinical Skills (3 decks)

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