Memorizable things Flashcards
(179 cards)
1
Q
What are the three stages of laryngeal collapse?
A
Stage 1 = Laryngeal saccule eversion
Stage 2 = Medial deviation of the cuneiform cartilage and aryepiglottic fold or aryepiglottic collapse
Stage 3 = Medial deviation of the corniculate process of the arytenoid cartilages or corniculate collapse
2
Q
What are some dfdx for arytenoids that aren’t opening?
A
- Too sedate
- Laryngeal paralysis
3
Q
What is the procedure for stenotic nares?
A
Stenotic nares resection or rhinoplasty
4
Q
What is the procedure for everted laryngeal saccules?
A
Resection of the laryngeal saccules
5
Q
What is the procedure for elongated soft palate?
A
Elongated soft palate resection or staphylectomy
6
Q
What is the procedure for hypoplastic trachea?
A
No procedure available
7
Q
What is the procedure for aryepiglottic collapse?
A
Permanent tracheostomy
8
Q
What are two landmarks that you can use to know where the soft palate should end, and which one is easier to find in an intubated animal?
A
- Epiglottis
2. Middle/caudal aspect of the tonsilar crypt*** (easier to find in an intubated dog)
9
Q
What are the key points for stabilization of a mandibular symphyseal fracture to convey to a client?
A
- Treat with cerclage wire
- Wire is inserted caudal to the canine teeth
- Can be removed once the fracture has healed (6-8 weeks) by cutting it with wire scissors
- There will be exposed wire through the skin incision
10
Q
Where is the most caudal edge of the mandibular symphysis relative to the visible portion of the mandibular canine teeth?
A
- Caudal
11
Q
Description of the mandibular symphyseal procedure
A
- Make a 0.5 cm ventral midline skin incision on the chin about mid-symphysis with a #15 scalpel blade
- Insert a large hypodermic needle into the incision and exit through the gingiva, lateral to one mandible and just caudal to the canine tooth
- Pass cerclage wire through the needle from the point to the hub end. Pull the needle out, leaving the wire in the tissue.
- Repeat the steps on the remaining side, using the same incision and opposite end of the same piece of cerclage wire
- Reduce the fracture and tighten the wire with the wire twister, exerting a steady pull AWAY from the bone as you twist so that each new twist lies down next to the previous twist
- Cut the ends of the wire, leaving ~5 twists in place. Bend the wire caudally so that it won’t poke anyone handling the animal
- The wire will stay in place for ~6-8 weeks
- To remove the wire, cut where it lies caudal to the canine teeth and pull it out ventrally by grasping the twist
- Leave it to heal by 2nd intention
12
Q
What is the name of the process of the mandible that forms the TMJ?
A
- Condylar process of the mandible
13
Q
What are the two largest muscles used to close the jaw?
A
- Temporalis and masseter muscles
14
Q
Origin and insertion of the temporalis muscle
A
- Temporal fossa to coronoid process of the mandible
15
Q
Origin and insertion of the masseter muscle
A
- Arises from zygomatic arch and inserts in the masseteric fossa and the angular process of the mandible
16
Q
What is the main muscle used to open the jaw?
A
- Digastricus
17
Q
Origin and insertion of the digastricus?
A
- Paracondylar process of the occipital bone and inserts on the body of the mandible
18
Q
What direction does the mandible move relative to the mandibular fossa most often in TMJ luxation?
A
- Cranially and dorsally relative to the mandibular fossa
19
Q
What findings on PE suggest a unilateral TMJ luxation?
A
- Rostral aspect of the mandible shifts towards the opposite side of the mouth
- They will be reluctant to close their mouth
20
Q
What findings on PE suggest a bilateral TMJ luxation?
A
- Entire mandible will protrude forward
- They will be reluctant to close their mouth
21
Q
What prevents the TMJ from moving caudally and ventrally?
A
- Masseter and temporal muscles are strongest, and would move the jaw dorsally
- Mandibular notch and condylar process prevent it from moving caudally
22
Q
How do you reduce a TMJ luxation?
A
- Dog under anesthesia
- Wooden dowel transversely between mandibular and maxillary molars
- Squeeze the rostral ends of the upper and lower jaws together to cause the mandible to pivot on the dowel
- Condylar process will move ventral to the level of the mandibular fossa of the skull
- Mandibular condyle can then be caudally repositioned into the mandibular fossa
23
Q
What parts of the body drain into the mandibular lymph nodes?
A
- Muzzle
- Salivary glands
- Tongue
- Intermandibular space
24
Q
What pathologic conditions could cause mandibular lymphadenopathy?
A
- Dental disease, gingivitis, neoplasia (SCCa, lymphoma, melanoma), sialadenitis, thrush, foreign body, tooth root bascess
25
WHat is the relationship of the mandibular salivary gland, submandibular LN, and two branches that come together to form the jugular vein?
- Mandibular lymph nodes are medial and cranial to the mandibular gland
- The linguofacial vein and maxillary vein will divide them
26
Treatment of sialocele?
1. Surgical resection of the salivary gland that is the source of the saliva
2. Drainage of the sialocele
27
What is a ranula?
- Sialocele under the tongue
28
Mandibular salivary gland location
- On the lateral side of the head just caudal to the angle of the mandible, where it lies between the maxillary and linguofacial veins
29
Sublingual salivary gland location
- Rostral to the mandibular gland
| - Located within the same capsule as the mandibular salivary gland
30
Zygomatic salivary gland location
- Between the eyeball and pterygoid muscles, hidden laterally by the zygomatic bone
31
Parotid salivary gland location
- Lies between the mandibular salivary gland and the ear
32
Which two glands are associated in a way that if you have to excise one you have to excise the other?
- Sublingual (slightly rostral)
| - Mandibular
33
Which salivary gland is most likely to cause a sialocele?
- Sublingual
| - You would need to remove both sublingual and mandibular
34
What clinical signs would you expect in a patient who needs emergency intervention due to a ranula?
- Dyspnea and hypoxia
35
How can you quickly resolve dyspnea and hypoxia due to a ranula?
- Aspirate the sialocele
36
What history do you want to gather from a patient with a sialocele?
- How long or when did you first notice?
- Where did you first notice?
- Has it gotten worse?
- Eating normally and drinking normally?
- Vomiting/diarrhea/coughing/sneezing/urinating?
- Previous health issues
- Other meds?
- Vaccines?
- Travel out of the PNW?
37
What are differentials for a mass?
- Sialocele, tumor, foreign body, inflammation, sialadenitis, sialdenosis, salivary neoplasia, sialolith, cervical abscess, hematoma, cystic or neoplastic lymph nodes
38
What is the density of a sialocele?
- Fluctuant
| - Usually can't move base relative to underlying tissue
39
Zygomatic sialocele signs
- Exophthalmos, dorsolateral strabismus, third-eyelid protrusion, and superficial axial corneal ulcer
40
Treatment options for sialocele?
- Surgical removal
| - Marsupialization (but recurrence is much more common)
41
What position should a patient be in for bone marrow aspiration or intra-osseous catheter placement?
- Dog in lateral recumbency
- Elbow should be rotated inward such that the shoulder joint is turned outward, placing the greater tubercle so it is easier to esat the bone marrow needle
42
Method for bone marrow aspiration
- Position as mentioned previously
- Make a small skin incision at the distal end of the greater tubercle
- Insert the Rosenthal needle at a 45° angle from a line parallel to the long axis of the humerus, pushing it through the muscle until it rests on the bone
- Make sure the stylet totally occludes the needle and rotate clockwise/counter-clockwise
- Aspirate with a 12 or 20 mL syringe (may need to pull it back 10-15 mL to break particles loose)
- Place a small drop of marrow on each of several slides
- Make smears immediately after obtaining it as the marrow clots very rapidly
43
How do you prep a patient for arthrocentesis?
- Sedation or general anesthesia
- Sterile prep of the area (clippers, surgical scrub, sterile gloves)
- 22g 1.5 inch needle for the shoulder, elbow, and stifle joints in larger dogs
- Insert a needle attached to a syringe into the joint and apply gentle suction
- After fluid is collected, release negative pressure and withdraw the needle
44
What is normal consistency and appearance of joint fluid?
- Viscous and forms a long string
45
What are two different tests that should be performed on all synovial fluid samples?
- Cytology (for complete cell count and differential cell count) and culture
46
What are the landmarks for arthrocentesis of the shoulder?
- Lateral approach: insert needle just distal to the acromion process
- Cranial approach: Insert just medial to the greater tubercle and ventral to the supraglenoid tubercle of the scapula
47
Elbow landmarks for arthrocentesis
- Insert just medial to the lateral epicondylar ridge, proximal to the olecranon process
- Advance parallel to the olecranon process into the olecranon fossa
48
Carpus landmarks for arthrocentesis
- Partly flex the joint
| - Palpate and enter the craniomedial aspect of the middle carpal or radiocarpal space
49
Bone marrow biopsy skin incision location
- Want to position it so that if the biopsy tract is "seeded" with tumor cells, you can remove that during the definitive treatment procedure
- Basically, don't want it to interfere with skin flaps
50
Which are the main weight bearing digits?
- third and fourth digits
51
What are the primary tumors that are present on the digits that might need to be amputated?
- Squamous cell carcinoma is most common
- Digital tumors in cats can be metastatic, most commonly pulmonary adenocarcinoma
- Malignant melanomas
- Soft tissue sarcomas
- Osteosarcomas
- mast cell tumors
52
Description of a caudolateral approach to the shoulder for osteochondroplasty of the humerus
- Incise skin, SC tissue, and deep fascia extending from the midscapular spine to the midhumeral diaphysis
- Incise the intermuscular septum between the caudal border of the scapular portion of the deltoid muscle and the long head of the triceps to separate them
- Use blunt dissection to free the deltoid muscle and expose the caudal circumflex artery and vein, the muscular branch of the axillary nerve (these are on the teres minor muscle), and the teres minor muscle
- Elevate and retract the teres minor muscle cranially, exposing the axillary nerve and joint capsule. Place a penrose drain around the axillary nerve
- Incise the joint capsule 5 mm from and parallel to the glenoid rim to expose the humeral head
- To expose OCD lesions, internally rotate the humerus and flex the shoulder
- Explore the joint and remove cartilage as described
- Close the joint capsule in an interrupted pattern with 3-0absorbable suture
- Then suture intermuscular septum, deep fascia, SC tissue, and skin separately
53
What two muscles are incised after the initial fascial incision?
- Caudal border of the scapular portion of the deltoid muscle
- Long head of the triceps
54
What other options exist for surgical debridement of a humeral head OCD lesion?
- Infraspinatus tenotomy
| - Arthroscopic approach
55
Description of exposure of medial coronoid process via muscle splitting
- Incise skin and subcutaneous tissue as described previously. Basically, make an incision on the medial surface starting at the medial epicondylar crest and extending distally over the medial epicondle to the proximal radius. Protect the median nerve and brachial artery and vein, which run cranially.
- Identify demarcation between the flexor carpi radialis and superficial digital muscles, and separate and retract them
- Expose the joint capsule and incise it parallel to the muscle-splitting incision to expose the coronoid process.
- Remove the fragmented coronoid and/or perform a subtotal coronoidectomy as described previously.
- Suture joint capsule with interrupted, absorbable sutures
- Suture fascia, SC tissue, and skin separately.
56
What two muscles is the intermuscular incision made between for approach to the medial aspect of the humeral condyle between?
- Flexor carpi radialis and superficial digital flexor muscle
57
Which nerve is on the cranial aspect of the approach for the intermuscular incision made for the approach to the medial aspect of the humeral condyle?
- Median nerve
58
What surgical procedure is the approach to the medial aspect of the humeral condyle used for?
- fragmented medial coronoid process
59
Digital amputation desscription
- Have pet in ventral or lateral recumbency with leg suspended.
- Place a tourniquet and drape the area
- Release the aseptically prepared paw into the sterile field
- Begin a dorsal skin incision at the distal end of the appropriate metacarpal or metatarsal or the proximal end of the first phalanx.
- Make a transverse encircling incision of the appropriate interphalangeal joint (inverse Y incision).
- Transect the flexor and extensor tendons, ligaments, and joint capsule.
- Ligate the digital arteries and veins with 3-0 or 4-0 absorbable suture.
- Disarticulate with a scalpel blade or transect the phalanx with bone cuttors, including sesamoid bones.
- Suture the extensor tendon to the dorsal surface of the pad when it is preserved.
- Appose SC tissues over the end of the bone with interrupted absorbable sutures
- Appose skin with approximating sutures
60
What is the Ortolani maneuver used for?
- Used to subluxate a dysplastic hip
61
How to do the Ortolani maneuver?
- Have patient in lateral recumbency
- Place the upper hand dorsal to the pelvic region to stabilize the patient
- Apply proximal pressure on the stifle joint to force the subluxed femoral head against the dorsal acetabular rim. Abduct the femur and feel and watch for the femoral head to reduce into the acetabulum
62
What is the most common direction for traumatic hip luxation?
- Craniodorsal, so the luxated femoral head is located craniodorsal relative to the acetabulum
63
How can you diagnose a craniodorsal hip luxation on physical exam?
- Palpable lack of symmetry noted between the tuber ischii and the greater trochanter on the affected side
- With craniodorsal displacement the greater trochanter is dorsal to an imaginary line drawn from the crest of the ilium to the tuber ischii, and the distance between the tuber ischii and greater trochanter is greater than in the normal limb
64
How else can you diagnose a hip luxation?
- Place your thumb in the space between the ischiatic tuberosity and greater trochanter, then rotate the femur externally
- In a normal hip, the trochanter will displace your finger as the limb is rotated
- In a dog with a hip luxation, the greater trochanter is too far cranial and will not push your fingers out of place
65
What are long-term prognoses for femoral head ostectomies?
- Likely have reduced coxofemoral pain and reduced lameness, although there may be some residual
- He may still develop osteoarthritis in that joint, but likely will be less than they would without the procedure
66
Describe the craniolateral approach to the hip joint
1. To expose, make a craniolateral skin incision centered over the hip joint
2. Retract the biceps femoris muscle caudally and the tensor fasciae latae muscle cranially
3. Incise the vastus lateralis muscle and reflect it ventrally
4. Incise the joint capsule and perform the ostectomy by externally rotating the limb such that joint line of the stifle is parallel to the operating table
5. Identify the line of ostectomy perpendicular to the operating table at the junction of the femoral head and femoral metaphysis
6. Identify the osteotomy line on the femoral neck, which should be from the medial aspect of the greater trochanter to the lesser trochanter so that you can remove the femoral head AND neck
67
What are the landmarks for arthrocentesis of the stifle?
- Insert the needle just lateral to the straight patellar ligament and distal to the patella (lateral approach)
- If doing a dorsal approach, insert the needle just dorsal to the patella so it passes between the patella and trochlear groove of the femur
68
Origin and insertion of the cranial cruciate ligament
- Origin: Caudomedial surface of the lateral femoral condyle
- Runs distally and diagnoally in a distocranial direction to insert on the cranial portion of the intercondylar area of the tibia
69
What does an intact cranial cruciate ligament prevent?
- Cranial movement of the tibia relative to the femur and prevents medial rotation of the tibia relative to the femur
70
Describe how to perform the cranial drawer test
- Patient in lateral recumbency and heavily sedated
- Stand to patient's rear and position thumb and forefinger of one hand on the femur
- Place thumb directly behind the fabell and forefinger over the patella
- Remaining fingers are wrapped around the thigh
- Other hand is placed on the tibia with the thumb directly behind the fibular head and the forefinger over the tibial crest
- Three remaining fingers are wrapped around the tibial shaft
- Stabilize the femur with one hand while the second hand moves the tibia forward and back in a direction parallel to the transverse plane of the tibial plateau
- Apply pressure to move the tibia forward through the thumb behind the fibular head
71
Describe how to perform a tibial compression drawer test
- Patient in lateral recumbency
- Grasp the distal quadriceps with one hand from the cranial surface so that the index finger can be extended down over the patell and the tip of the finger on the tibial crest
- Second hand grasps the foot at the metatarsal region from the plantar surface
- Position the limb in moderate extension and as the lower hand flexes the hock, the upper hand prevents stifle flexion
- Index finger of the upper hand is used to feel for cranial movement of the tibial crest while the hock is being flexed
72
What does a normal tibial compression test feel like?
- Upper hand should feel pressure from the patella on the index finger
73
What does a tibial compression feel like with a ruptured CCL?
- Tibial crest will be advanced forward as the hock is flexed
74
What are some things that radiographically suggest CCL rupture?
- Effusion in cranial and caudal joint space
- Osteophyte formation
- Fuzzy trochlear ridge
75
What are some rule outs for joint effusion in the stifle?
- CCL rupture
- Lateral collateral ligament rupture
- OCD
- Immune mediated polyarthritis
76
Describe the lateral approach to the stifle
1. Make a craniolateral skin incision centered at the level of the patella
2. Begin the incision 5 cm proximal to the patella, and continue it distally 5 cm below the tibial crest
3. Incise the SC tissue alone the same line to visualize the septum between the superficial leaf of the fascia lata and the biceps femoris muscle proximally and the lateral retinaculum distally
4. Make an incision through the joint capsule, beginning 1cm distal to the patella
5. Continue the incision proximally along a line adjacent to the patellar tendon and proximal to the patella
6. Then incise along the border of the vastus lateralis muscle toward the fabella
7. Displace the patella medially to expose the cranial surface of the joint
77
Describe the extracapsular stabilization of the stifle
- Use heavy gauge fishing line
- Joint capsule is closed, thus extracapsular
- Secure the fishing line around the lateral fabella and is passed through a bone tunnel made in the tibial tuberosity and tied on the lateral aspect of the joint
78
What are some indications for placing an NO tube in a patient?
- provide supplemental oxygen if increased respiratory rate, decreased SPO2, decreased PaO2
79
What direction should you pass a nasal oxygen tube?
- Ventromediocaudally
80
What can happen if you pass a nasal oxygen tube into the dorsal meatus instead of the ventral meatus?
- It will run into the ethmoid turbinates, which you don't want to damage
81
Describe the procedure for placing a nasal oxygen tube
1. can be placed in an awake patient by putting a few drops of proparacaine ophthalmic drops or 2% lidocaine in the nostril
2. Choose an appropriately sized tube (mostly 5-8Fr) and mark it at a length from the tip of the nose to the medial canthus of the eye
3. Lubricate the distal end of the tube with sterile lubricant or lidocaine gel
4. Direct the tube ventromediocaudally into the ventral meatus until the mark is reached
5. Place a butterfly of tape on the tube and staple or suture it to the skin on the muzzle and again on the dorsal midline caudal to the eyes
6. Set up the oxygen to run through a nebulizer with sterile or distilled wate
7. Attach oxygen line to patient and run at 2-5 L of O2/min
8. Place an Elizabethan collar on the patient to protect the tube
82
Describe some indications for placing an NG tube
- Provide supplemental nutrition, remove fluid from stomach
83
What direction do you run a nasogastric tube?
- Ventromediocaudally
84
Describe placing a nasogastric tube
1. Measure the tube from the nose to the last rib
2. Can place in an awake patient by putting a few drops of topical anesthetic (e.g. Proparacaine drops or 2% lidocaine) in the nostril
3. Choose an appropriately sized tube (usually 5-10 Fr) that is long enough to reach the stomach (measure from nose to last rib)
4. Lubricate the distal end of the tube with sterile lubricant or lidocaine gel
5. Direct the tube ventromediocaudally into the ventral meatus. Once the tube is 2-3 cm in, pushing the nostral dorsally may help open the meatus. As the tube enters the pharynx, the patient may swallow the tube down the esophagus. Even without an active swallow, the path of least resistance is typically the esophagus. Continue passing the tube until the mark is reached. Coughing is a sign that the tube is in the trachea and should be backed out.
6. Place a butterfly of tape on the tube and staple or suture it to the skin on the muzzle and again on the dorsal midline caudal to the eyes
7. Confirm appropriate tube placement with a lateral radiograph
85
What might be an indication that you are in the trachea when placing an NG tube?
- Coughing
86
What does -ectomy mean?
- Excise or remove
87
What does ostomy mean?
- Enter into lumen to create temporary or permanent stoma
88
What does otomy mean?
- Enter into the lumen and close the lumen when done
89
What are the landmarks for a frontal sinusotomy?
- Zygomatic process of the frontal bone laterally
- Midline of the skull medially
- Orbital rim ventrally
90
What are some reasons for performing a frontal sinusotomy in a dog or cat?
- Diagnosing and treating nasal aspergillus (debriding fungal plaques)
- Biopsy of a mass identified on CT in the frontal sinus
91
What band of tissue connects the zygomatic process of the frontal bone and the frontal process of the zygomatic arch?
- Orbital ligament
92
Describe a frontal sinusotomy approach
1. Mark the spot for the hole midway between dorsal midline and the lateral-most point of the zygomatic process of the frontal bone and on a line connecting the left and right zygomatic processes of the frontal bones
2. use a #15 blade to make a 1cm incision through skin, SQ, muscle, and periosteum, down to the bone
3. Use the hand chuck and pin to drill a hole into the frontal sinus. Place the pin in the chuck so that enough length is exposed to o through the dorsal cortex of the sinus but not so much that it can go through the ventral side of the sinus
4. Place a red rubber tube into the hole to prove you are in the sinus (either use it to instill antifungal medication or can be made bigger with rongeurs to allow biopsy of the frontal sinus contents
93
Where is teh frontal sinus relative to the zygomatic process of the frontal bone?
- Medial
94
Where is the brain relative to the frontal sinus?
- Ventral and medial
95
If you are drilling the hole for a frontal sinuostomy in the correct spot, what would have to happen to hit the brain?
- Would have to have a very long pin or go too ventral
96
List some indications for an esophagostomy tube in a patient
- Supplemental nutrition
- Need to pill or feed a cat longer term
- Want to avoid food going through the oral cavity due to fracture or some other reason
97
Where is the cervical esophagus relative to the larynx?
- Lateral and to the left
98
Where is the cervical esophagus relative to the trachea?
- left and lateral
99
Where is the cervical esophagus relative to the carotid artery?
- ventral and medial
100
Where is the cervical esophagus relative to the sternohyoid muscles?
- Lateral and dorsal
101
Where is the cervical esophagus relative to the jugular vein?
- Jugular vein
102
How can you find the jugular vein to avoid it when placing an E-tube?
- Have someone distend the jugular vein bey placing pressure on it
103
Where is an E tube most commonly exited?
- left side of the neck because that's where the esophagus is primarily located
104
Why is it okay for the NG tube but not an esophagostomy tube to go all the way down to the stomach?
- E tube is much larger, so it will cause more irritation to the lower esophageal sphincter
105
Describe the procedure for placing an esophagostomy tube
1. Patient would be intubated and on inhalant anesthesia. Place the patient in lateral recumbency. Shave the hair and perform a sterile preparation of the skin on the left side of the neck.
2. E tube will extend from mid-cervical region to the mid-thoracic region. Hold the tube up against your patient nad mark this length on the tube with a small piece of tape
3. Person 1 will insert a long, curved Carmalt forceps into the mouth and down the esophagus. orient the Carmalts so that the handle is down by the table (lateral to the right mandible). Using the tips of the Carmalts, press the esophagus against the left side of the neck so that the tips tent up the skin in the mid-cervical region (stay dorsal to the jugular vein!). Keep pressing as B incises (see below) until the tips of the Carmalt come through the skin.
4. Person 2 makes a SMALL incision over the tips of the Carmalts with a #15 blade. Incise through the skin, SC tissue, muscle, and esophagus until the Carmalt tips exit through the skin.
5. Person 2 places the distal end of the ET in the Carmalts and A pulls the Carmalts and end of the tube out through the mouth (STOP IF RESISTANCE). Release and then regrasp the tube and try to pull it orally again.
6. Person 1 places a polypropylene tube in the hole near the end of the ET and uses it to push the end of the ET down the esophagus to mid-thoracic. Allow the portion of the tube exiting the cervical region to back out as you advance the opposite end down the esophagus. Stop when the mark you made in step b reaches the skin.
7. Remove the polypropylene tube. Anchor the ET to the skin with a pursestring and fingertrap suture pattern of 2-0 Nylon. Further secure the tube with a light bandage.
106
When can you remove an E tube?
- Any time after placement. Just cut the pursestring suture, clamp off the end of the tube or fold it over with your fingers to prevent leakage out the end of the tube, and gently pull the tube out.
Place a non-adherent pad with abx ointment on the wound and secure with a light bandage. The wound is allowed to heal by second intention.
107
How long does a gastrotomy or jejunostomy tube need to stay in place?
10-14 days
108
Why does a gastrotomy tube or jejunostomy tube need to stay in longer?
- Waiting for an adhesion to form between either the stomach wall or intestine and body wall
109
Describe how to do a pursestring and fingertrap suture pattern.
1. Place a pursestring of non-absorbable suture in teh skin by taking 4 bites through the skin to form a square around the tube. WHen the fingertrap is completed, the tube will be pulled in the direction of the knot of the pursestring. Plan ahead so that the knot is positioned so the tube will lie against the body wall and not be kinked.
2. Pull the suture through so that both ends are equal in length. Cut the needle off of the suture.
3. Use hand ties to place 3 square knots (6 throws) to anchor the pursestring snugly around the tube.
4. Pass the 2 suture ends under the tube, cross them, and bring them back up to the top side of the tube.
5. Place a surgeon's throw on the upper side of the tube. The throw should be tight enough to grip the tube but not so tight as to significantly narrow the tube's diameter.
6. Repeat steps 4 and 5 five more times.
7. Finish with 3 square knots on the last time through step 5. Cut the suture ends to ~4 mm long.
110
Describe the procedure for a transverse (horizontal) temporary tracheostomy
1. Place the patient in dorsal recumbency. Clip hair and do a sterile prep on the ventral neck. If in respiratory distress, this is greatly abbreviated.
2. Make a ventral midline incision through the skin and SC tissues extending caudally from the cricoid cartilage (make it big).
3. You will encounter the sphincter colli first. Transect with scalpel or Metzenbaum scissors.
4. ID the junction between the right and left sternohyoid muscles. use Metzenbaums to bluntly separate these along their junction and expose the trachea.
5. Palpate the trachea and select an appropriately sized tracheostomy tube. Cuffs are not needed unless they will be anesthetized.
6. Use a #15 blade to incise the annular ligament between rings 3/4 or 4/5. Do not incise >50% the diameter of the trachea to avoid damage to the tracheal blood supply and recurrent laryngeal nerves.
7. Insert the tips of a Kelly or mosquito hemostat into the incision between the 2 tracheal rings. use the hemostat to hold open the incision and/or push down the cranial rings while you insert the tracheostomy tube.
8. Place stay sutures around the tracheal ring cranial and caudal to the incision. Leave suture ends long. Tape the ends of each suture together and label as cranial or caudal. I the tracheostomy tube should come out accidentally or be removed, you can grasp these sutures, pull them cranially and caudally as labeled, and easily find the tube in the trachea, which will simplify the process.
9. If there is a significant amount of open tissue cranial and caudal to the site, it can be closed with suture (3-0 or 4-0 PDS in the muscle and SQ, 3-0 or 4-0 nylon in the skin). Do not close down tissue over the tracheostomy site.
111
How big should a tracheostomy tube be?
- Not more than 50% of the lumen of the trachea and should extend 6-7 rings down the trachea.
112
What can happen with tubes that are too large?
- Mucosal irritation and increased tracheal secretions that may clog the tube.
113
How can you secure a tracheostomy tube in?
Tie a long piece of umbilical tape or roll gauze to the flange on either side of the tracheostomy tube.
- Tie the opposite ends in a bow behind the patient's neck. DO NOT SUTUER IT
114
What type of monitoring do patients with a temporary tracheostomy tube require?
- Intensive care with 24 hours supervision.
115
To create a permanent tracheostomy site, what needs to be sutured to what?
- Skin must be sutured to tracheal mucosa
116
To do a permanent urethrostomy, what needs to be sutured to what?
- urethral mucosa to skin
117
What are potential causes for a retrobulbar abscess?
- Tooth root abscess
| - Foreign body
118
Which teeth might lead to retrobulbar abscess?
- Carnassial teeth
| - M2 on either side
119
What path is a foreign body likely to take to go from the oral cavity to the retrobulbar space?
- Dorsal lateral
120
Why are patients with retrobulbar abscesses often so painful?
- Ramus of the mandible can ram the abscess
121
Describe how to establish drainage for a retrobulbar tooth root abscess?
1. If tooth root abscess, extract the tooth and allow drainage via the alveolus.
2. Surgical removal is needed if there is FB - best performed by an experienced surgeon.
3. Even if surgery is ultimately needed, you may need to drain the abscess to provide some relief.
4. Inesrt #15 or #11 blade dorsally through the mucosa immediately caudomedial to upper M2
5. Gently push sterile mosquito or Kelly forceps through the medial pterygoid muscle (position your fingers so the forceps can't enter too far and damage the globe.
6. Spread the forceps, if you enter the abscess, purulent material will drain into the oral cavity.
7. Leave the hole open to heal on its own.
122
Paraparesis meaning
- Weakness in both pelvic limbs
123
Tetraparesis
- Weakness in all four limbs
124
Hemiparesis
- Weakness in the thoracic and pelvic limbs on one side
125
Monoparesis
- Weakness in one limb
126
How can you further classify paresis?
- Ambulatory or non-ambulatory
127
What is the meaning of -plegia?
- No voluntary motor
128
What is normal conscious proprioception delay?
~1 sec
129
Difference between head turn and head tilt
- Head turn is more forebrain
| - Head tilt is more vestibular (ear or brain)
130
Decerebrate rigidity
- Opisthotonos
- Typically all four limbs
- Midbrain
131
Where does Schiff-Sherrington localize?
- Spinal cord localization (T3-L3)
132
Where can you localize a problem that occurs with decreased conscious proprioception?
- Anywhere from the spinal cord to the brain
| - Efferent/motor pathway also an issue
133
What are other ways to test postural reactions?
- Hopping
- Hemiwalking
- Wheelbarrowing
134
What are spinal reflexes in the thoracic limb?
- WIthdrawal
135
What are spinal reflexes in the hind limb?
- Patellar reflex
| - Withdrawal reflex
136
How many synapses are in the patellar reflex?
- Just one
137
What is being tested with the patellar reflex?
- Femoral nerve
| - L4-6 spinal cord segments and nerve roots
138
What are the two things you're looking at with withdrawal reflex?
- Presence of the reflex
| - Strength of the flexion
139
How many synapses are in the withdrawal reflex?
- Multiple!
| - Polysynaptic
140
What is being tested with the withdrawal reflex in the pelvic limb?***
- Pelvic limb --> sciatic nerve (L6, L7, or S1
141
What is being tested with the withdrawal reflex in the thoracic limb?
- Multiple nerves (C6-T2)
142
What are other spinal reflexes?
- Biceps reflex
- Triceps reflex
- Extensor carpi radialis reflex
- Gastrocnemius reflex
- Cranial tibial reflex
143
What are you looking for with cutaneous trunci reflex?
- Bilateral contraction
144
Is the menace a response or reflex?
- RESPONSE
| - Voluntary control
145
What is the pathway for a menace response?
1. Afferent is optic nerve --> optic chiasm*, optic tract*, thalamus*, visual/occipital* cortex, motor/frontal cortex*, descending tracts, cerebellar influence
* = opposite side
2. Efferent: Facial nerve causes a blink
146
Pupillary light reflex pathway
Afferent: Optic nerve --> optic chiasm, optic tract*, pretectal area
* = opposite side
Efferent: Oculomotor nerve (CN3) --> bilateral or direct and indirect pupillary constriction
147
Ocular sensation reflex pathway
Afferent: Trigeminal nerve (ophthalmic branch)
Efferent: Facial nerve for blinking and abducens nerve for eyeball retraction and elevation of the third eyelid
148
Palpebral reflex pathway
Afferent is trigeminal nerve (CNS) maxillary and ophthalmic branches
Efferent is facial nerve which should blink
149
Which branch of the trigeminal is medial palpebral reflex?
- Ophthalmic branch
150
Which branch of the trigeminal is the lateral palpebral reflex?
- Maxillary branch
151
Facial reflex pathway
Afferent is trigeminal nerve (ophthalmic, maxillary, and mandibular branches)
Efferent is facial nerve which should blink and twitch
152
Facial response pathway
Trigeminal nerve (ophthalmic branch --> thalamus*, somatosensory/parietal cortex*, motor cortex*
Descending pathways should move the head/body away from stimulus (pull-away response)
153
What is jaw tone testing?
- CN 5 mandibular branch
154
Which facial nerves impact facial symmetry?
- CN 5 and CN 7
155
What might you find on physical exam with trigeminal nerve mandibular branch dysfunction?
- Temporal muscle degeneration
| - Most common cause is trigeminal neuritis
156
Facial nerve paralysis appearance
- Drooping on one side
157
Which nerve impacts vestibular dysfunction?
- CN 8
- Rotary or horizontal nystagmus
- Head tilt
- Could be ear infection/polyp or central lesion
158
What impacts gag reflex?
- CN9 and CN 10
159
What impacts tongue muscle tone?
CN 12
| - Will be atrophied on the side that's impacted, and tends to fall towards the weaker side
160
What is normal range of motion for the neck?
- Most should be able to move their head to touch their shoulder
161
Spinal palpation
- Firm pressure OVER the spinous processes
- Move the tail up and down
- Can be standing or in lateral recumbency
162
Deep pain sensation when to do?
- ONLY WITH A PARALYZED DOG
- Once they lose deep pain, if it's been less than 24-48 hours it's a 50/50 chance
- If it's longer, closer to 5-10%
163
What does a deep pain response require?
- Cortical response such as crying, biting, or trying to get away
164
Which parts of the brain are considered supratentorial?
- Telencephalon
- Diencephalon
- CN 1-2
165
Do supratentorial lesions cause contralateral or ipsilateral CP deficits and paresis?
- Contralateral
166
Infratentorial brain regions?
- Mesencephalon
- Metencephalon
- Myeloencephalon
- CN 3-12
167
Do infratentorial lesions cause contralateral or ipsilateral CP deficits and paresis?
- Ipsilateral
168
Where is functional cross over?
- Mesencephalon
169
What are signs of UMN problems?
- Normal to increased spinal nerve reflexes
- Normal to increased muscle tone
- DISUSE muscle atrophy
170
What are signs of LMN problems?
- Decreased to absent spinal reflexes
- Decreased to absent muscle tone
- Neurogenic muscle atrophy
171
UMN/LMN signs for thoracic and pelvic limbs if lesion is in...
The brain
- Thoracic limbs: UMN
| - Pelvic limbs: UMN
172
UMN/LMN signs for thoracic and pelvic limbs if lesion is in...
C1-C5
- Thoracic limbs: UMN
| - Pelvic limbs: UMN
173
UMN/LMN signs for thoracic and pelvic limbs if lesion is in...
C6-T2
Thoracic limbs: LMN
| Pelvic limbs: UMN
174
UMN/LMN signs for thoracic and pelvic limbs if lesion is in...
T3-L3
- Thoracic limbs: normal
| - Pelvic limbs: UMN
175
UMN/LMN signs for thoracic and pelvic limbs if lesion is in...
L4-S1-S3
- Thoracic limbs: Normal
| - Pelvic limbs: LMN
176
Localization for the following case:
- CP deficits in both pelvic limbs
- Normal patellar reflexes bilaterally
- Normal withdrawal reflexes bilaterally
- UMN problem to pelvic limb
- T3-L3
- Tone is normal to increased
- Atrophy due to disuse
177
Localization for the following case:
- CP deficits to both pelvic limbs
- Decreased patellar reflexes bilaterally
- Decreased withdrawal reflexes bilaterally
- LMN problem to pelvic
1. ) L4-S1 or
2. ) Bilateral femoral AND sciatic nerves
- Tone will be decreased to absent
- Atrophy is neurogenic
178
Localization for the following case:
- CP deficits in all four limbs
- Normal spinal reflexes in all limbs
UMN problem of all 4
- C1-C5 or infratentorial or supratentorial
- C1-C5 is most likely because no other intracranial signs
179
Localization for the following case:
- CP deficits to all four limbs
- Normal spinal reflexes in the pelvic limbs
- Decreased withdrawal reflexes in the thoracic limbs
C6-T2
