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Boards Review > Misc Recap > Flashcards

Misc Recap Flashcards

1
Q

What is the holding layer for a linea alba abdominal closure?

A

External leaf of the rectus abdominus

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2
Q

Name the layers that are cut through in order for a lateral thoracotomy in the 4th ICS?

A

Skin
Cutaneous trunci muscle
Latissimus dorsi muscle
Scalenus muscle
Serratus ventralis muscle
intercostal muscle
pleura

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3
Q

Why do you not want to make your thoracotomy incision too far ventrally?

A

Internal thoracic artery runs just lateral to the sternum

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4
Q

How are synthetic absorbable sutures broken down by the body?

A

Hydrolysis (vs antigenic/inflammatory breakdown for organic suture)

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5
Q

What are the main differences between Monocryl and PDS absorbable suture?

A

Monocryl: stronger initially, breaks down faster (50% strength in 1-2 weeks)

PDS: not quite as strong initially, but breaks down slowly (50% strength in 5-6 weeks)

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6
Q

What are the 4 phases of wound healing?

A

Inflammation
Debridement
Repair/proliferation
Maturation

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7
Q

Discuss Inflammation phase of wound healing

A

Typically first 48-72 hours, sometimes longer.

Hemorrhage 🡪 local vasoconstriction 🡪 platelet aggregation 🡪 local vasodilation 🡪 fibrinogen/clotting elements 🡪 clot/scab (clot is scaffolding for invading inflammatory cells/mediators)

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8
Q

Discuss debridement phase of wound healing

A
  • occurs simultaneous with inflammation- phagocytes (neuts in 6 hrs, monos at about 12 hours, monos become macrophages in 24-48 hrs)
  • Neutrophils are not essential for wound healing, but they do release superoxide radicals that help degrade necrotic tissue and kill bacteria
  • Macrophages are the essential inflammatory cell for wound healing and debridement
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9
Q

Discuss repair/proliferation phase of wound healing

A
  • Begins 3-5 days after injury, lasts 2-4 weeks
  • Angiogenesis
  • Granulation tissue formation (fibroplasia): provides a surface for epithelium and high vascularization helps prevent infection
  • Wound contraction:
    — Begins at 5-9 days
    — Minimizes amount of epithelialization needed to close a wound

Epithelialization: mobilization and migration of epithelial cells from wound edges.
— Starts almost immediately for partial-thickness skin wounds
— Requires granulation tissue for full-thickness skin wounds

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10
Q

Discuss maturation phase of wound healing

A
  • Progressive gain of tissue strength
  • Relies on collagen deposition
  • Once adequate collagen deposition is present- rearrangement and increased crosslinking of collagen fibers to improve strength
  • Starts at 17-20 days, can last years.
  • Most tissues are only at about 20% of final strength at 3 weeks
  • Fully mature scar is only ever about 80% as strong as original.
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11
Q

What is the shock index? What is normal?

A

HR/systolic BP

Normal is < 1.0 in dogs

> 1.0- high suspicion for hemorrhage in dogs with trauma

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12
Q

What is the ideal resuscitative fluid for hemorrhagic shock?

A

Fresh warm whole blood! (Or- 1:1:1 FFP, pRBC, Plt)

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13
Q

What is the ideal imaging modality for patients with trauma?

A

Whole body CT- improved sensitivity for fractures (facial trauma is much more common than we think), better sensitivity for pneumothorax, etc

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14
Q

What is the animal trauma triage score?

A

6 categories with a 0-3 score: perfusion, cardiac, resp, eye/muscle/integ, skeletal, neuro

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15
Q

What is the definition of a flail chest?

A
  • Multiple fractures of 3+ adjacent ribs with both dorsal and ventral fractures
  • Creates a “flail segment” of disconnected ribs that has a paradoxical movement with respiration
  • “Pseudo flail” = disruption of thoracic wall musculature that looks like a flail segment
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16
Q

What basic/initial treatment options are recommended for patients with flail chest? When is surgery indicated?

A

Pain control- intercostal block!

O2 supplementation, ventilation if needed, chest tap if pneumothorax

Lay with flail segment DOWN

Chest wrap

Surgery is not indicated just for flail chest unless patient is unable to be managed medically (refractory hypoventilation) or if they have a penetrating chest injury that needs to be explored anyway.

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17
Q

What injuries are most common in cats with high rise syndrome?

A

Head/thorax and extremity injuries- hard palate fractures are very common

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18
Q

What is “Damage Control Surgery”?

A

Initial emergency exploratory to just control hemorrhage and intra-abdominal contamination- pack abdomen, then close.
Then continue resuscitation in ICU until more stable, then re-explore later for definitive repair and reconstruction.

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19
Q

What is the definition of compartment syndrome?

A
  • Dysfunction of organs or tissues within a compartment that develops secondary to increased pressures within that compartment.
  • Limits the blood supply resulting in reduced or absent perfusion of tissues in this compartment
  • Can lead to dysfunction of the tissues and in some cases irreversible damage and death
20
Q

What is the definition of Intra-abdominal Hypertension (per the most recent guidelines of the World Society of Abdominal Compartment Syndrome)?

A

Intra-abdominal hypertension = IAP > 12mmHg

21
Q

What is the definition of Abdominal Perfusion Pressure (per the most recent guidelines of the World Society of Abdominal Compartment Syndrome)?

A

Abdominal perfusion pressure = MAP - IAP

22
Q

What is the definition of Abdominal compartment syndrome (per the most recent guidelines of the World Society of Abdominal Compartment Syndrome)?

A

Sustained or repeated elevation in Intra-abdominal pressure > 20 mmHg with or without an abdominal perfusion pressure < 60mmHg, that is associated with new organ dysfunction.

23
Q

What are the negative cardiovascular affects of ACS?

A
  • Compression of the vena cava resulting in decreased left ventricular filling and decreased CO
  • Decreased left ventricular compliance because of a secondary rise in intrathoracic pressure
  • Direct myocardial ischemia
24
Q

What are the negative CNS affects of ACS?

A

Increased intracranial pressure secondary to a combination of decreased cardiac output and obstruction of cerebral venous outflow causing a decreased cerebral perfusion pressure.

25
Q

What are the negative Renal affects of ACS?

A

Increased pressure in the abdomen resulting in compression of the urinary collecting ducts and renal vessels, leading to oliguria

26
Q

What are the negative lymphatic affects of ACS?

A

decreased to absent mesenteric lymph flow secondary to compression from the increased abdominal pressure

27
Q

What are the negative pulmonary affects of ACS?

A
  • Decreased diaphragmatic excursion secondary to compression from the abdomens distension, resulting in decreased ventilation and hypoxia
  • Intra abdominal pressure is also transmitted into the thorax through the diaphragm resulting in increased intrathoracic pressures
28
Q

What are the negative gastrointestinal affects of ACS?

A
  • impaired wound healing
  • Gut wall edema secondary to increased inflammatory mediators, decreased lymphatic flow, and capillary leakage
  • Potential translocation of bacteria through compromised gastrointestinal tract
29
Q

What are the negative hepatic affects of ACS?

A

Decreased hepatic blood flow resulting in hypoxia and hepatic dysfunction
Possible acute hepatic failure

30
Q

Explain the most common way to measure intra-abdominal pressure?

A
  • Foley catheter placed in aseptic technique with the tip of the catheter being placed at the trigone.
  • Urinary collection set and three way stop cock attached and the bladder is emptied then instilled with 0.5-1ml/kg of 0.9% saline into the bladder through a water manometer.
  • The patient is placed in lateral recumbency (should be in the same position for each reading) and then the manometer is zeroed at the pubic symphysis. The stop cock is closed to the input source of the saline and the level through the manometer is allowed to equilibrate. This value is the IAP.
31
Q

What are the recommended treatments for ACS?

A
  • Decompress stomach (NG tube, prokinetics)
  • Enemas to remove stool
  • U-cath to keep bladder empty
  • Pain control
  • Avoid excessive fluid therapy (edema)
  • Diuretics if edematous or oliguric (or dialysis)
  • Abdominocentesis if effusion
  • Pain control (relax abdominal muscles)- neuromuscular blockade?
  • Decompressive laparotomy only if medical measures fail or already need surgery… Open abdomen with closed suction
32
Q

Acepromazine - Name the:
mechanism of action
MAIN pros
MAIN cons

A

Phenothiazine- D2 and alpha1 receptor blockade

Pros: good sedation, MAC reduction, anti-emetic, anti-arrhythmic

Cons: hypotension (vasodilation), hypothermia (inhibits thermoregulation), not very reversible

33
Q

Diazepam - Name the:
mechanism of action
MAIN pros
MAIN cons

A

Benzodiazepine: increased GABA and glycine activity (inhibitory NTs)

Pros: good sedation, muscle relaxation, anxiolysis, anticonvulsant, minimal cardiovascular effects, reversible

Cons: water insoluble- precipitates with other drugs/fluids, not absorbed well IM or SQ, liver toxicity in cats, can cause excitement in some animals (particularly young/healthy)

34
Q

Morphine - Name the:
mechanism of action
MAIN pros
MAIN cons

A

Opioid- pure mu receptor agonist

Pros: excellent analgesia- strongest opioid pain control (pure mu), minimal cardiovascular effects, anti-tussive, reversible

Cons: only lasts 2-4 hrs, can cause histamine release and nausea (both are more common with morphine than some other pure opioids), respiratory depressant

35
Q

Buprenorphine - Name the:
mechanism of action
MAIN pros
MAIN cons

A

Opioid- partial mu agonist with high receptor affinity

Pros: lasts 6-8 hrs, minimal side effects, can be absorbed bucally in cats

Cons: takes 20-30 min to work IV (longer IM), less effective pain control, not very reversible and blocks other opioids at receptor

36
Q

Dexdomitor - Name the:
mechanism of action
MAIN pros
MAIN cons

A

Alpha 2 receptor agonist

Pros: excellent sedation (near anesthesia level), maintain BP, good analgesia (comparable to opioids for visceral pain), reversible

Cons: increased SVR/reflex bradycardia, arrhythmias, decreased cardiac output, induces vomiting (may be a pro if desired?), O2 supplementation recommended, difficult to assess SPO2 due to vasoconstriction

37
Q

Ketamine - Name the:
mechanism of action
MAIN pros
MAIN cons

A

Dissociative, NMDA receptor antagonist- prevents glutamate binding (excitatory NT)

Pros: Minimal respiratory and cardiovascular effects, actually stimulates sympathetic NS, excellent sedation, excellent analgesia and decreases wind-up

Cons: poor muscle relaxation- add a muscle relaxant, can increase ICP/IOP, sometimes rough recovery

38
Q

Alfaxalone - Name the:
mechanism of action
MAIN pros
MAIN cons

A

Neuroactive steroid molecule, binds to GABA receptors

Pros: can be given IM, rapid onset, excellent sedation/anesthesia, can combine with other drugs, smooth induction/recovery

Cons: respiratory depression, hypotension/vasodilation, short shelf life (working on this

39
Q

Define Potency

A

dose required to get a desired effect (does not reflect the magnitude of effect)

40
Q

Define Efficacy

A

maximal pharmacologic effect a drug can induce (unrelated to dose required)

41
Q

Define Solubility

A

affinity of the drug for a medium (blood, fat, other tissue)

For anesthetic gases- very blood soluble agents will want to stay in blood, vs blood insoluble agents will want to go into brain and alveolus (induction and recovery are faster)

42
Q

Define MAC

A

minimum alveolar concentration.
% of the total alveolar volume of air which must be occupied by the anesthetic to immobilize 50% of patients.
A measure of potency, and a dosage guideline for vaporizer setting.

43
Q

Draw a basic re-breathing anesthetic circuit— NEEDS PICTURE

A
44
Q

Components of circle systems or “rebreathing systems”

A
  • Fresh gas inlet
  • Inspiratory one way valve
  • Breathing hose (inspiratory limb, 22 mm diameter connection)
  • “Y” Piece (to patient, 15 mm diameter connection)
  • Breathing hose (expiratory limb)
  • Expiratory one way valve
  • Pop-off Valve (exhaust valve, 19 mm diameter connection, exhaust hose often blue)
  • Canister for CO2 absorber (2x Tidal Volume recommended)
  • Soda lime – granules must be fresh, moist, white and crumbly; indicatory dye (white to blue and consistency changes from soft to hard)
  • Reservoir or breathing bag (6x Tidal Volume recommended)
  • Pressure Gage or Manometer – calibrated in cm of H2); positive pressure ventialtion
45
Q

How rebreathing/circle systems work.

A
  • Recirculate the gasses around the circle
  • Valves maintain unidirectional flow
  • Fresh gas flow rates determine the extent of “rebreathing” function
    —Gas flow rates are based on metabolic oxygen consumption rate
    —Sleepy dog: 3-14 ml/kg/min
    —Semi-Closed Circle
    — 2-3x patients O2 consumption
    — typically 15 mls/lb/min with a minimum of 500 mls O2/minute
  • CO2 removed by chemical reaction

Boards Review (14 decks)

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