Test 4 Notes: Janet Flashcards
(149 cards)
1
Q
What 2 things do we pay attention to when a patient is under anesthesia?
A
- Maintaining adequate depth
2. Vitals stay within acceptable limits
2
Q
What 3 things are used to monitor HR & Rhythm?
A
- Esophageal stethoscope- rate
- ECG- rhythm
- Pulse ox- pulse
3
Q
If the systolic BP is ____ the ____ disappears.
A
<60bpm
Pulse
4
Q
ECG measures ____ only.
A
Electrical activity only
5
Q
Explain the electrical flow of the heart.
A
Pulse originates in the SA node, travels to the AV node (depolarization) then to the bundle of HIS & to right and left bundle branches and finally to the purkinje fibers creating a contraction.
6
Q
P wave
A
atrial depolarization
7
Q
The SA node ____ during the P wave
A
Contracts
8
Q
QRS complex
A
ventricle depolarization
9
Q
The SA node ____ & the AV valve ____ during the QRS complex.
A
Relaxes
Contracts
10
Q
The SA node is also known as the ____.
A
Pace maker
11
Q
What happens during the T wave?
A
Ventricle re-polarizes and relaxes
12
Q
What could cause an interference with the ECG?
A
Cautery (60 cycle)
Circulating H2O blanket (60 cycle)
Leads drying out (flat line: use gel for long surgeries)
13
Q
What is a Lead II?
A
The standard PQRST waves
14
Q
What are the 4 leads?
A
Black- left axillary
Red- left inguinal
White- right axillary
Green- right inguinal
15
Q
What would a complete ECG lead set up include?
A
Lead I Lead II Lead III AVR AVL AVF
All of these leads have different polarities
16
Q
Normal sinus rhythm general facts
A
Normal PQRST waves
Evenly spaced
Not missing anything
17
Q
Respiratory sinus arrhythmia general facts
A
Regularly irregular
Must match respirations
Can be a normal finding
18
Q
What happens with Respiratory sinus arrhythmias?
A
Heart rate increases with inhalation
and decreases with exhalation
19
Q
Who can have a normal Respiratory sinus arrhythmia?
A
Dogs
NOT normal in cats!
20
Q
What drug can make Respiratory sinus arrhythmias disappear?
A
Anticholinergics
more likely with atropine
21
Q
Sinus Tachycardia would have a ____ cardiac output
A
poor
no time to fill
22
Q
Sinus Tachycardia causes & interventions.
A
Too light- increase vaporizer
Drugs- nothing
Hypoxic- Increase flow meter and ventilate
Hypotension- Decrease vaporizer and give fluids or drugs
Hyperthyroid- Press on eyeball to stimulate vagus nerve
Anemia- Give fluids or blood transfusion
Cardiac dz- Drugs
23
Q
Sinus Bradycardia drug of choice?
A
Atropine
24
Q
Sinus Bradycardia values
A
Large dog= <100bpm
25
What can Sinus Bradycardia lead to if not treated?
Cardiac arrest
26
Sinus Bradycardia causes & interventions
Too deep- Turn down vaporizer
Alpha-2 Agonists- Give antagonist (Naloxone)
Vagal stimulation- Give Anticholinergics
Hypothermia- Keep warm
Hyperkalemia- Give IV fluids, Insulin/Dextrose
27
What could sinus tachycardia lead to if untreated?
Increased workload on the heart can lead to cardiac arrest
28
First degree A-V heart block basic facts
Prolonged P-R interval
Every P has QRS, but has a slow electrical flow
Difficult to see
29
If a first degree A-V block is not treated, what could it lead to?
2nd degree AV block
30
Second degree A-V block basic facts
Some P waves not followed by QRS
| ventricle doesn't contract for every atrium contraction
31
What is a second degree AV block also called?
Incomplete heart block
32
If there is a consistent 2nd degree AV block, the patient will have ____ cardiac output and low ____.
Bad cardiac output
| Low pulse/heart rate
33
What is a third degree AV block also called?
Complete heart block
34
Third degree AV block basic facts
Prolonged QRS
| Atrial and ventricular contractions are not in sync
35
Third degree AV blocks have ____ cardiac output and the QRS complex looks ____ & ____
Horrible
| Wide & bizarre
36
What is the treatment for a 3rd degree AV block?
Pacemaker
| resets electrical activity of the heart
37
If you have an abnormal ECG what are the first 2 things you should do?
Turn down the vaporizer
| increase ventilations
38
Drug of choice for 2nd and 3rd degree AV blocks
Atropine
| may or may not work for 3rd degree
39
Causes & interventions of 2nd & 3rd degree AV blocks
```
Too deep- turn down vaporizer
Drugs (Alpha-2)- give antagonist
Electrolyte imbalance (^K)- give fluids
Acid/base imbalance- give fluids
Myocardia Hypoxia- ventilate
Cardiac Dz.- medical intervention
```
40
If your patient has respiratory acidosis to do hypercapnia what should you do?
Ventilate
41
PVC basic facts
Premature Ventricular Contractions
Originates somewhere in the ventricle
Ventricle contracting too rapidly
Wide and bizarre QRS complexes
42
What is a common cause of a pulse deficit
PVCs
43
PVCs have bad ____ due to ____
Cardiac output
| the ventricles contracting too quickly- doesn't get a chance to fill
44
What would an excessive PVC look like?
3 or more PVCs in a row- may need treatment
45
Ventricular tachycardia basic facts
Multiple VPCs in a row
| Looks like ghosts holding hands
46
V-Tach causes a high ____
Heart rate
47
What is the drug of choice for V-Tach and PVCs?
Lidocaine-
| CRI in fluids or IV injection
48
Causes and interventions of V-Tach & PVCs?
```
Too deep- decrease vaporizer
Drugs (barbiturates)- no intervention
Electrolyte imbalance- fluids
Acid/base imbalance- fluids
Myocardial hypoxia- ventilation
Cardiac dz.- medical intervention
Stress/pain- opioids or tranquilizers
```
49
V-Tach is common in ___ & ___ patients
GDV & HBC
50
Ventricular fibrillation basic facts
Irregular line
no PQRSTs
Heart is quivering
51
V-Fib patients have ____ cardiac output & could lead to ____ if untreated
little to no
| cardiac arrest
52
V.fib treatments
Turn off vaporizer
Defibrillation
ABCDs of resuscitation
53
Hyperkalemia can cause ____ T waves and ____
Tall, spiked T waves
| & bradycardia
54
What could tall and wide T waves indicate?
Myocardial hypoxia or hypothermia
55
Asystole basic facts/treatment
Flat line
Turn off vaporizer
ABCDs of resuscitation
56
What 2 things are pale MM & increased CRT caused by?
Peripheral vasoconstriction
| Decreased tissue perfusion
57
What 3 things can cause Peripheral Vasoconstriction?
Hypothermia
Alpha-2 agonists
Pain
58
What 3 things can cause Decreased Tissue Perfusion?
Patient is too deep- decrease vaporizer
Bradycardia- give atropine
Hypotension- decrease vaporizer, give fluids, or drugs
59
What is cyanosis and what are the first 2 things you should do if your patient has this?
Hypoxia
Increase in the amount of unsaturated hemoglobin
- Ventilate
- Decrease vaporizer
60
When observing respirations what 3 things should you pay attention to?
Respiration Rate
Tidal Volume
Effort
61
What is the formula for choosing a res. bag?
60mls/kg
| always round up to next liter
62
What could happen if your res. bag is too small?
Pneumothorax
Could be too inflated to accurately observe resps.
May show an increase on the pressure manometer
63
If your res. bag is too big it would ____.
Be too difficult to monitor respirations
64
Normal anesthesia RR = ____.
8-30rpm
65
Hypoventilation is ____rpm and has what 3 effects?
<8rpm
Decreased RR
Decreased TV
Increase in CO2 (hypercapnia/resp.acidosis)
66
What are 4 causes and interventions of hypoventilation?
Patient too deep-- decrease vaporizer, ventilate
Obese patient-- ventilate
Patient position-- ventilate
Open thorax sx.-- machine/manual ventilations
67
Hyperventilation may cause a decrease in ____ leading to respiratory ____.
CO2
| Alkalosis
68
Hypoventilation may cause a ____ in CO2, leading to respiratory ____.
Increase
| Acidosis
69
What are 3 causes and interventions of hyperventilation?
Patient too light-- ventilate and maybe increase vaporizer
Metabolic acidosis-- take over ventilations
Respiratory dz.-- ventilate
70
When a patient is _____, less GA is needed due to it causing the MAC to be more potent.
Hypothermic
71
What are 4 complications of hypothermia?
Prolonged recovery
Prolonged clotting time
Delayed wound healing
Shivering increases O2 demands by 600%
72
What are 4 causes of hypothermia?
```
Decreased metabolic rate
Drugs that cause vasodilation
Neonates/Geriatrics/Emaciated pts.
Open body cavity
Shaving and scrubbing (alcohol)
```
73
How would you obtain the temperature during surgery?
Thermometer in nostril +1degree F
| Feel ears/paws
74
What are some ways to prevent hypothermia?
```
Blankets
Circulating H2O blanket
Warmies- disk
Fluid bag- be careful!
Rice bag
Warm IV fluids
Bair Hugger
Wrap feet
```
75
What are the 3 things that make up blood pressure?
Cardiac Output-- "pump"
Vascular Resistance-- "tubes"
Blood Vol.-- "fluid"
76
What is the cardiac output equation?
Stroke Vol. X Heart Rate= CO (in mls/min)
77
What 3 values make up the arterial blood pressure?
Systolic-- top #
Diastolic-- bottom #
MAP-- mean arterial pressure
78
What is the best indicator of tissue perfusion?
MAP= the average pressure in the arteries through a cycle
79
Hypotension systolic value=
<80mmhg
80
Hypotension MAP value=
<60mmhg
81
Systolic is an indication of when the ventricles are ____.
contracting
82
Diastolic is an indication of when the ventricles are ____.
relaxing
83
What are the 3 most important organs that need good perfusion?
1. Kidneys
2. Heart
3. Brain
84
What are 3 causes of Hypotension?
1. Excessive depth
- vasodilation
- bradycardia
- decreased CO
2. Drugs
- Inhalant anesthetics
- Acepromazine
- Alpha-2s
3. Blood loss
- hemorrhage
- hypovolemia
85
What are the first 3 interventions of Hypotension?
Decrease vaporizer
Bolus/Change fluid
Drugs
86
You should always anticipate fluid loss and ____ before surgery
Bolus fluids
87
What type of fluids are normally administered during surgery? At what rate?
Crystalloids
| 10mls/kg/hr
88
What are the 2 options when a bolus is needed?
3-5mls/kg (can be done twice)
double surgery fluids and run for 15min. (20mls/kg/hr)
89
What would be another option of fluids if your patient is having difficulty maintaining fluids?
Colloids
90
What are a few examples of Colloids?
Hetastarch
Dextran
RBCs
91
What do Inotrope drugs do?
Increase the force of cardiac contraction (pump)
92
What do Chronotropes do?
Increase the heart rate (pump)
93
What do Vasopressors do?
Cause vasoconstriction-- increases BP (tube)
94
What are 3 common drugs to treat hypotension?
Dopamine
Dobutamine
Ephedrine
95
Dopamine is a ____ & ____ so it increases ____ and ____ output.
+ inotrope & + chronotrope
| Increases renal perfusion and urine output
96
How is Dopamine administered?
It is diluted in fluids and given in micrograms/kg/min.
| IV drip CRI
97
Dobutamine is a + ____ & lower + ____
+inotrope & lower +chronotrope
| increases force of cardiac contractions and heart rate
98
Ephedrine is a +____, lower +____ & ____.
+Vasopressor, lower chronotrope & inotrope
99
How is dobutamine given?
Diluted in fluids -IV drip CRI
100
How is Ephedrine given?
IV injection
101
What are 4 benefits of Ephedrine?
Cheap
Easy to give
Can give 2 injections
Has a 20min. duration
102
With Ephedrine, you may see an increase in ____, but its main action is ____.
Heart rate
| Vasoconstriction
103
What hypotension drug would you use for a shorter surgery?
Ephedrine
104
What hypotension drug would you use for a longer surgery?
Dobutamine or Dopamine drip
105
What are the 2 ways to measure BP?
Indirect- Doppler or Oscillometer
| Direct- Direct Arterial Pressure
106
Doppler BP monitor measures?
Systolic BP and pulse
107
With a doppler the crystal (probe) should be placed ____ to the cuff
distal
108
How should the cuff of the doppler be measured?
The width of the cuff should cover 40% of the circumference of the limb or tail
109
How does the probe of a doppler work?
You place ultrasound gel on the probe and place it on the artery, it will emit high frequency sound waves and when the waves encounter the pulsating artery, it will create a whooshing sound (the pulse)
110
What are some problems with the doppler?
Not very accurate in cats
Probes are fragile
Cuff size must fit accurately
Works best on long, straight legged, hairless dogs
111
How does the Oscillometer blood pressure monitor work?
Machine automatically inflates cuff and reads Systolic, Diastolic and Mean arterial pressure, some also display a pulse
Also has a cat setting
112
Direct arterial pressure info.
Common in equine anesthesia
More accurate, but invasive
Indwelling catheter is placed in an artery and connected to a monitor
113
What does a Capnograph measure?
ETCO2 Insp.C02, and Respiratory Rate
114
What is the most common type of capnograph?
Side stream- monitors samples of gas from small tube attached between the ET tube and the breathing system
115
Inspiration CO2 should fall into what range?
0-5mmHg
116
End Tidal CO2 should fall into what range?
35-45mmHg
117
Normal Capnographs show ____ on the monitor and represent the ____.
Square wavelengths, RR
118
What are some causes of decreased ETCO2?
Increased RR
ET tube in esophagus
Respiratory arrest/cardiopulm. arrest
119
What can a decreased ETCO2 lead to?
Respiratory alkalosis
120
2 reasons for increased ETCO2
Decreased rate and tidal volume
121
What can increased ETCO2 lead to?
Respiratory acidosis
122
How do you correct increased ETCO2?
Increase ventilations!
| you may also need to decrease the gas %
123
If you have increased Insp.CO2 that could mean ____ or the ____.
The soda lime granules are exhausted and need to be changed.
O2 flowrate is not high enough
124
What does a Pulse Ox measure?
% of Hgb saturated with Oxygen & Pulse
125
How does the Pulse Ox work?
By using 2 different lengths of light
126
Pulse Ox:
Red light measures ______.
Infrared light measured ______.
```
Reduced Hgb (unsaturated)
Oxygenanted Hgb.
```
127
Pulse Ox:
| What is a Plethysmograph & what does it indicate?
a pulse waveform
It indicates the pulse strength
Tall wave= strong
Short wave= weak
128
How do you place the Pulse Ox probe on the tongue?
With the sensor side ON TOP and the light side BELOW the tongue (light from above may interfere with readings)
129
Where can a pulse ox probe be placed?
Thin, hairless, non-pigmented area
| Best & most common placement= tongue
130
The Pulse Ox probe cannot be placed on ___ some other places it will work are ____.
A black tongue (the pigment will absorb the light)
Lip, Pinna, Toe web, Achilles tendon, Vulvular fold
Rectal probes are also available (reflective probe) usually used for dentals
131
Pulse Ox readings should be ____ under anesthesia
>95%
132
Pulse Ox:
Borderline Hypoxia=
Hypoxia=
Cyanosis=
(O2 Saturation)
```
Borderline= 90-95%
Hypoxic= <85% patient is BLUE!
```
133
Pulse Oximeters can detect ____ before it is visually evident
Hypoxia
| before it is Cyanotic
134
2 Probe reasons for decreased Pulse Ox readings
Probe placement- may be on pigmented skin, dry tongue, patient movement, overhead light
Probe pinching- can cause decreased perfusion to tongue
135
Perfusion issues for decreased Pulse Ox readings
Poor perfusion caused by hypotension, cradycardia, peripheral vasoconstriction,
Alpha-2 agonists!
Cold tongue = crappy readings!
136
Oxygen reasons for decreased Pulse Ox readings
ET tube may be disconnected, kinked, or in esophagus
| O2 flow rate too low
137
Lung reasons for decreased Pulse Ox readings
Respiratory failure, inadequate ventilation
V/Q mismatch= alveolar ventilation/pulmonary perfusion ratio determines adequacy of gas exchange in lungs (see chart on worksheet)
Lung Dz.
138
What are 2 examples of V/Q mismatch & what is the result of both?
Pulmonary thromboembolism: V is okay, Q has bad pulmonary perfusion
Collapsed lungs: V has poor alveolar perfusion, Q is fine
End result= NO OXYGEN
139
What does the V & Q stand for in a V/Q mismatch?
```
V= alveolar ventilation
Q= pulmonary perfusion
```
140
Heart reasons for poor Pulse Ox readings?
Poor perfusion due to bradycardia, arrhythmias, V/Q mismatch
141
How do you improve O2 Saturation?
Ventilate!!!! and maybe increase O2 flow rate
142
What are the most important things to continue monitoring post-op?
Respirations
MM color & CRT
Palpate pulse
143
What are 6 common post op complications?
```
Respiratory distress (esp. brachys)
Hypothermia
Vomiting
Chewing/licking
Hemorrhage
Analgesics wearing off
```
144
What should you do if your patient is in respiratory distress Post-Op
```
Reposition- sternal
Extend head & neck
Pull tongue out
Give O2 (mask or flow-by)
Re-intubate if nothing works
```
145
If your patient is vomiting, how can you prevent them from aspirating
Lift butt up and put their face down
146
What are some signs of post op hemorrhage?
```
Prolonged hypothermia
Pale MM, increased CRT
Slow recovery
Increase HR & RR
Decreased BP
```
147
What should you do if you think your patient is hemorrhaging before getting the Dr?
Get PCV & TP
| Do a centesis or ultrasound
148
What are 4 issues with brachycephalics
elongated soft pallet
narrow trachea
narrow nares
increased sympathetic tone
149
How to decrease risk of brachys
```
Decrease stress- tranq/sedatives
Anticholinergics- glyco/atropine
Pre Oxygenate- increase O2Sat.Hgb
IV induction- faster
Leave ET in longer
```
