Test 4 Notes: Janet Flashcards Preview

Anesthesia -Scott Newman & Janet King > Test 4 Notes: Janet > Flashcards

Flashcards in Test 4 Notes: Janet Deck (149):
1

What 2 things do we pay attention to when a patient is under anesthesia?

1. Maintaining adequate depth
2. Vitals stay within acceptable limits

2

What 3 things are used to monitor HR & Rhythm?

1. Esophageal stethoscope- rate
2. ECG- rhythm
3. Pulse ox- pulse

3

If the systolic BP is ____ the ____ disappears.

<60bpm
Pulse

4

ECG measures ____ only.

Electrical activity only

5

Explain the electrical flow of the heart.

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

P wave

atrial depolarization

7

The SA node ____ during the P wave

Contracts

8

QRS complex

ventricle depolarization

9

The SA node ____ & the AV valve ____ during the QRS complex.

Relaxes
Contracts

10

The SA node is also known as the ____.

Pace maker

11

What happens during the T wave?

Ventricle re-polarizes and relaxes

12

What could cause an interference with the ECG?

Cautery (60 cycle)
Circulating H2O blanket (60 cycle)
Leads drying out (flat line: use gel for long surgeries)

13

What is a Lead II?

The standard PQRST waves

14

What are the 4 leads?

Black- left axillary
Red- left inguinal
White- right axillary
Green- right inguinal

15

What would a complete ECG lead set up include?

Lead I
Lead II
Lead III
AVR
AVL
AVF

All of these leads have different polarities

16

Normal sinus rhythm general facts

Normal PQRST waves
Evenly spaced
Not missing anything

17

Respiratory sinus arrhythmia general facts

Regularly irregular
Must match respirations
Can be a normal finding

18

What happens with Respiratory sinus arrhythmias?

Heart rate increases with inhalation
and decreases with exhalation

19

Who can have a normal Respiratory sinus arrhythmia?

Dogs
NOT normal in cats!

20

What drug can make Respiratory sinus arrhythmias disappear?

Anticholinergics
(more likely with atropine)

21

Sinus Tachycardia would have a ____ cardiac output

poor
(no time to fill)

22

Sinus Tachycardia causes & interventions.

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

Sinus Bradycardia drug of choice?

Atropine

24

Sinus Bradycardia values

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