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FCP Week 3 > Monitoring > Flashcards

Monitoring Flashcards

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1
Q

Why monitor (3)

A
  1. Prevent patient response to surgical stimulation (nociception)
  2. Maintain tissue perfusion and oxygenation so we can improve patient outcome and prevent worsening of subclinical disease
  3. Detect abnormalities before they turn into major complication
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2
Q

Responses to pain under anaesthesia

A

Increased HR and resp. rate

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3
Q

Tissue perfusion

A

Process in which an adequate supple of oxygenated blood and nutrients are delivered to tissues and carbon dioxide and waste products are removed

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4
Q

Purpose of Anaesthesia monitoring chart (3)

A
  1. Legal record of surgery
  2. important tool in handover
  3. Allow trends to be spotted
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5
Q

Components of monitoring chart (5)

A
  1. Time of recording
  2. Amount of oxygen being delivered to the patient in l/min
  3. % volatile agent being delivered
  4. Heart rate
  5. Temperature
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6
Q

Effect of volatile agents (3)

A
  1. Cardiac depression
  2. Respiratory depression
  3. Decreased homeostasis
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7
Q

Causes of poor tissue perfusion (7)

A

Anything that affects blood flow
1. blood pressure
2. Reduced Heart Rate
3. Haemorrhaging
4. Anaemia
Decreased oxygen delivery due to
1. Equipment failure
2. Pulmonary disease
3. An obese patient lying on its back

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8
Q

Brain and Anaesthesia

A

Want to depress cerebral conscious perception areas but maintain hind brain functions

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9
Q

3 hypos

A
  1. Hypotension
  2. Hypothermia
  3. Hypoventilation
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10
Q

How to establish depth of anesthesia

A

Jaw tone- loose
Palpebral Reflex
Eye Position
Capnography

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11
Q

Monitoring depth of anaesthesia with ketamine

A

Increases muscle tone
Eyes won’t be rotated
Jaw tone won’t be loose

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12
Q

Palpebral reflex

A

can inadvertently desensitise the animal to your touch

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13
Q

Monitoring temperature

A

Hypothermia causes slow recovery and post op wound infections
Monitor temperature with simple rectal thermometer or oesophageal thermometer

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14
Q

Oesophageal Thermometer

A

Measured from incisors to scapular

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15
Q

Patient warming

A

Easier to keep patient warm than bring temperature back up

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16
Q

Key factors in monitoring anaesthesia (4)

A
  1. preventing response to surgical stimulation
  2. Detecting abnormalities early on by identifying trends
  3. Minimising decreased tissue perfusion
  4. Minimising the ‘three hypos’
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17
Q

Impact of maintaining patients close to physiological norm

A

Lower morbidity
Lower mortality
Lower infection rates
Faster wound healing
Faster recoveries

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18
Q

How to monitor cardiovascular system (6)

A
  1. HR and rhythm (stethoscope and pulse palpation)
  2. Mucous membrane colour and capillary refill time
  3. Bleeding from surgical site
  4. Measure Blood pressure
  5. Measure haemoglobin oxygen saturation
  6. Detect arrhthmias
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19
Q

Anaesthetised dog/cat HR

A

60-120

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20
Q

Dachshund HR under anaesthesia

A

can be 50-60 due to increased vagal tone

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21
Q

Oesophageal stethoscope

A

useful if patient is draped
measure, insert alongside ETT

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22
Q

Pulse Palpation

A

Important to feel pulse along side auscultation of the heart
identify pulse defecits

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23
Q

Capillary Refill time

A

Assessment of peripheral perfusion and oxygenation
Should be 1.5-2 s

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24
Q

very pink/ red mucous membranes

A

Vasodilation
- sepsis
- anaesthetic drugs (e.g. anaphylaxis)
- low MAP

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25
Dry/tacky mm
dehydration/ hypovolaemia
26
Wet mm
over infusion, nausea, risk of regurg/ gastric reflux, aspriation
27
Very pale mm + slow CRT
Vasoconstriction - anaemia - inadequate blood flow - alpha 2 agonist
28
Cyanosis
Bluish/ purple discolouration of skin or mm due to low O2 saturation near skin indicates severe hypoxaemia Animal is close to death
29
Weighing swabs after intraoperative bleeding
1g=1ml of blood lost
30
BP cuff width
40% of circumference of area of the limb you are placing it on very important to get right
31
Doppler- what odes it show in cat vs dog
MAP in Cats Systolic in dogs
32
BP cuff too large
reading too low compared to true value
33
BP cuff too small
reading too high compared to true value
34
Normal bp ranges for healthy non anesthetised animals
Systolic- 100-160 mmHg Diastolic- 80-120 mmHg Mean- 60-100mmHg
35
minimum MAP to perfuse heart, kidneys and brain
60mmHg (>90mmHg systolic)
36
Possible consequences of MAP <60mmHg for over 30 mins
Renal Failure Delayed recovery Neuromuscular complications Decreased hepatic metabolism of drugs CNS abnormalities such as blindness
37
How to take BP using Doppler
Place cuff on shaved area of patient Place sensor over pulse and turn volume up Listen to pulse, sounds like flushes Inflate cuff until you occlude the limb enough that the sound disappears Slowly release pump until the sound comes back The point where the sound comes back is the animals blood pressure Repeat 5-6 times and take average
38
SpO2
% of haemoglobin that is saturated with oxygen
39
Healthy SpO2
>95%
40
What does pulse oximetry tell us?
SpO2 Detects hypoxaemia measures pulse rate Displays Photoplethysmography (used to detect volumetric changes in blood in peripheral circulation) within multiparameter
41
PPG
Photoplethysmography waveform
42
Limitations of pulse oximetry
may be showing normal SPO2 but animal is hypoxic (low oxygen in tissues) not hypoxeamic (low oxygen in blood) The blood is well oxygenated but the circulation is insuffient to distribute the oxygenated blood
43
Causes of inaccurate pulse ox readings
vasoconstriction (aplha 2 agonists, hypothermia, shock) Hypoperfusion Movement Hyppothermia Bright lights overhead Smoke inhalation (abnormal haemoglobin) Pigmented skin Anaemia Shock
44
Hypoxia
Low oxygen content in bodily tissues
45
Hypoxaemia
Low blood oxygen content
46
ECG Cords (Red, yellow, green)
Yellow-left & cranial Green- Left and caudal (grass under sun) Red- right & cranial
47
Monitoring Respiratory system under anaesthesia
You can monitor - Resp rate, rhythm and effort With equipment you can - assess adequacy of respiration (EtCO2) Check or estimate blood gases
48
Listening to lung sounds
Identify breath sounds Compare both sides of the chest Compare ventral to dorsal Change? Inspiratory/ expiratory sounds
49
Limitation of resp. rate
Does not provide information on the quality of ventilation Same number of breaths could have different volumes and therefore provide different degrees of ventilation
50
What is capnography
Non-invasive, continuous measurement of inhaled and exhaled carbon dioxide over time
51
What is EtCO2
End tidal carbon dioxide, usually measured in mmHg High= HYPOventilation or increased CO2 production/cardiac output low= hyperventilation or decreased CO2 production/cardiac output
52
Capnography and IPPV
Give breaths based on capnogrpah-> aiming to keep EtC02 as close to normal as possible
53
What does capnography tell us
A change in ETCO2 value suggests an alteration in one or more of these parameters: Tissue metabolism (CO2 metabolism) Perfusion (blood flow carryign carbon dioxide from tissue via the heart to the pulmonary capillaries) Ventilation (carrying carbon dioxide from alveoli in exhaled breath)
54
Why look at CO2
Gives an easy way of assessing state of respiratory and cardiovascular system
55
Normal EtCO2 for dogs
35-45 mmHg
56
Normal EtCO2 for cats
28 to 45 mmHg
57
What does blood gas analysis measure
PaCO2 PaO2 Blood pH Electrolytes Lactate
58
Lurcher HR under anaesthesia
Will be lower than expected as they are fit dogs-> not worrying
59
Invasive/ Non-Invasive Blood Pressure
Invasive is more accurate
60
What is nociception
physiological response to noxious stimuli the processes leading to sensitisation of the spinal and medullary dorsal horn neurones is still present under anaesthesia
61
What is neuroleptanalgesia
combination of an opioid and a tranquilizer or sedative and reduces the amount of each required and results in improved sedation.
62
What is a noxious stimuli
A stimulus that is damaging or threatens damage to normal tissues
63
What is central sensitisation
Increased responsiveness of nociceptive neurons in the central nervous system to their normal or subthreshold afferent input
64
What is somatic/visceral/neuropathic pain
Somatic Pain: Pain experienced from skin, muscle, bone damage/disease Visceral pain: Pain experienced because of organ pain (abdominal or thoracic) Neuropathic pain: Pain caused by a lesion or disease of the somatosensory nervous system (in contrast to nociceptive pain)
65
hypoxia vs hypoxaemia
While hypoxemia refers to low oxygen levels in your blood, hypoxia refers to low levels of oxygen in the tissues of your body. The two can sometimes, but not always, occur together. For example, hypoxia can happen in the absence of hypoxemia if blood flow to an organ or tissue is disrupted. In this case, the blood may have normal levels of oxygen, but it can’t reach the affected area.
66
What is blood paO2
partial pressure of oxygen in the blood Can be related to spO2 (oxygen saturation) which can be shown from pulse oximetry should be about 80-100 mmHg can be measured directly by blood gas analysis

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