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Surgery Test 2
| Question | Answer |
|---|---|
| What does CPCR stand for? | Cardiopulmonary cerebral resuscitation |
| What are the 3 things animals differ in vs human CPCR | 1. Etiology of CPA 2. Response to physical resuscitation 3. Response to drugs |
| How do animals and humans differ in prognosis for survival | Poor prognosis for return to normal function in animals |
| What is the percentage of humans initially resuscitated versus the percentage that actually leave the hospital | 40-60% resuscitated 17% leave |
| What is the percentage of animals initially resuscitated versus the percentage that actually leave the hospital | 13% of dogs and 15.6% of cats 4.1% of dogs and 9.6% of cats leave |
| Why after an animal is initially resuscitated they may still not end up leaving the hospital | - often re-arrest - often are euthanized due to complications |
| what are the 2 levels of care | BLS (Basic Life Support) ALS (Advanced Life Support) |
| what does BLS consist of | airway, breathing, circulation, and some drugs |
| what does ALS consist of | additional drugs, EKG, defibrillation, and possible internal cardiac massage |
| What acronym do we use to assess and address. | CABD (Circulation,airway,breathing,drugs) |
| How to asses circulation | - auscultate chest - palpate pulse - asses MM colour - Assess CRT |
| True or False: never perform compressions when the heart is still beating? | True |
| When does compressions how should the patient be positioned and if this isn't possible what is the alternative | -right lateral recumbency -alternative is dorsal recumbency |
| where are compressions performed at | 5th and 6th intercostal space |
| how to place you hands for resuscitation on a small patient | place fingers under chest and use thumb to compress |
| how to place you hands for resuscitation on a medium sized patient | put one hand under chest and use heal of other hand to perform compressions |
| how to place you hands for resuscitation on a large patient | put book or sandbag under the chest and use both hands interlocked. keep arms stiff and rock forward using your body weight |
| How fast should the compressions be | generally 100 compressions per minute but ultimately as fast as you can go |
| How much of the chest should be compressed | -generally 1/3 of the chest |
| when do you perform breathing and compressions at | -in a clinic , simultaneously -if alone, 2 breaths to 15 compressions |
| how can effectiveness of compressions be assessed? | -palpate femoral pulse or lingual pulse -place doppler probe on eyeball or under tongue -pulse oximeter on tongue -capnometer |
| what to do if compressions are not effective | -change position of patient -change hand position -increase strength of compressions -change person doing the compressions -perform internal compressions |
| when should internal compressions be performed? (8 things) | - patients >20kg -pneumothorax -pleural effusion -pericardial effusion -penetrating chest wound -chest wall trauma -hemoperitoneum -diaphragmatic hernia |
| how long should compressions be performed? | -effective compressions should continue for at least 3 minutes, then stop to see if pulse is palpated |
| methods of providing air to patients | -mouth to snout -mask -ET tube -tracheotomy -transtracheal catheter |
| when is mouth to snout okay? | okay for trauma at scene |
| which ET tube is best for insuring a patent airway | cuffed |
| what must be done if an ET tube cannot be passed? | Tracheotomy |
| True or False? Tracheotomy requires extensive after care | true |
| what is less invasive than a tracheotomy but still provides a high concentration of oxygen? | Transtracheal catheter |
| How often should you bag your patient and what should the % of oxygen be? | every 6 seconds, 100% |
| What is the approximate tidal volume when bagging | 10-15 ml/kg |
| What should you not exceed in cm /water for a cat and dog | 15 cm/water for cats 20 cm/water for dogs |
| An ___________ bag fills automatically | ambu |
| an ambu bag can be attached to what and to give what | anesthetic machine or O2 tank, gives 100% oxygen |
| What is the acupuncture point called when evaluating breathing | Governing vessel 26 |
| How do you perform a acupuncture on the governing vessel 26 | -use point of 25g needle below nasal philtrum to stimulate heart and lungs |
| when should bagging be stopped? | - Continue until MM are pink - should continue even if spontaneous pulse is present -then do intermittent bagging |
| what are recommended routes of administration for emergency drugs | -central vein -Intratracheal - peripheral vein -Intraosseous -intralingual |
| what route of admin is no longer recommended for emergency drugs | intracardiac |
| what vein is used more frequently when administering emergency drugs | jugular vein |
| what needs to happen to the drug dose if its given IntraTracheal | needs to be doubled |
| what must you use to deposit a drug the IT route | red rubber feeding tube or urinary catheter |
| what do you do after giving the drug IT | flush and dilute with 3-5 ml of sterile saline |
| what is the intraosseous route good for | -pediatric patients - avain - exotics |
| what bones should you use for IO route | - trochanteric fossa - proximal humerus - tibial crest |
| why do we use the Intralingual route | - has a large vascular bed - close to cerebral circulation |
| what 3 things may the intracardiac route cause | -pulmonary laceration -cardiac trauma -pneumothorax |
| what are the most commonly used emergency drugs | -epinephrine or vasopressin -atropine -lidocaine -dopamine |
| what is the first drug to be given | epinephrine |
| what does epinephrine stimulate and how | stimulates sympathetic nervous system through vasoconstriction |
| what kind of drug is epinephrine | catecholamine |
| how fast does epinephrine work and how often should it be given | works within seconds and must be given every 3-5 minutes |
| what drug is vasopressin | antidiuretic hormone |
| where is vasopressin synthesized and where is it released from | hypothalamus and released from posterior pituitary |
| what does vasopressin do in CPCR | -improve cerebral O2 -resuscitation -better neuro outcome and blood flow |
| what is the vasopressin dose for IV, IT or CRI | 0.4-0.8 untits/kg for IV and IT 0.01-0.04 units/kg/min for CRI |
| what drug is dopamine | cardiac stimulant |
| True or False? dopamine can be used when heart is still beating | true |
| Dopamine is a __________ drug and must be given _________ IV drip | inotropic, slow |
| What kind of drug is atropine | anticholinergic |
| what does atropine treat and how fast does it work | treats bradycardia and works within several minutes |
| what is an alternative to atropine and what is it less likely to induce | Glycopyrrolate, less likely to induce tachycardia |
| what kind of drug is Doxapram? | analeptic drug |
| what 2 functions does doxapram have | -resp stimulant - increase myocardial oxygen demand |
| what are 2 corticosteroids that are most frequently used in emergencies | predniosolone sodium succinate (fast) and dexamethasone (slow) |
| what are the 3 functions of corticosteroids | -stabilize cell membranes -help metabolize lactic acid -make vessels less sensitive to endotoxins |
| what might happen is corticosteroids are given without IV fluids | cause circulatory collapse |
| why kind of drug is lidocaine | anti-arrhythmic |
| what is lidocaine good for what does it increase | good for PVC and ventricular tachycardia and increases defibrillation threshold |
| what does lidocaine need and what form should you use | needs EKG tracing and use lidocaine "neat" |
| what is sodium bircarbonate used to treat | acidosis and hyperkalemia |
| how long should wait to give sodium bicarbonate | 10 minutes after start of cardiac arrest |
| what does Calcium gluconate treat | -hypocalcemia -hyperkalemia -calcium channel blocker overdoses |
| what did Calcium gluconate used to treat routinely but does not anymore? | CPA |
| original shock rates for dogs and cats | dogs: 90ml/kg for first hour cats: 45ml/kg for first hour |
| what have the original shock rates been associated with? | -hemodilution -overhydration -increased intracranial pressure |
| it is now recommenced to give how much of the original shock rate and how often | give 1/4 of calculated shock rate every 15 mins and reassess anf gi ve more as necessary |
| what fluids are best for initial treatment in emergencies | crystalloids |
| avoid dextrose unless __________ is present | hypoglycemia |
| what are 3 other fluids that you should consider | colloids, hypertonic saline, and oxyglobin |
| what do the new "smart" defibrillators detect | whether arrhythmias are present and administer required joules |
| what fibrillation responds best to defibrillation | Ventricular Fibrillation (VF) |
| how common is ventricular fibrillation in humans, cats and dogs | Humans: common Cats: rare Dogs: not very common |
| what position should the patient be in for defibrillation | dorsal or lateral recumbency |
| what are the steps to defibrillation? | -place patient in dorsal or lateral recumbency -shave if possible -apply lots of electrode gel |
| what do you avoid putting on the patient when performing defibrillation? | ALCOHOL |
| initial shocks are given at what power/joules | 3-5 joules/kg |
| how much should you increase by if shocks are ineffective | 50% |
| after the initial shocks how much joules do you use? | 0.5-1 joule/kg |
| how many L of oxygen to you generally start with | 2 L |
| deine cardiopulmonary arrest | cessation of the circulation if oxygenated blood to the tissues due to the failure of the heart to pump effectively |
| clinical signs of impending cardiac arrest | -cyanosis -dyspnea -resp arrest -prolonged CRT |
| why do you not want to over ventilate animal | lower CO2 levels and take away bodies drive to breath alone |
| which is cheaper atropine or glycopyrrolate | atropine |
| which is faster acting and which is slower acting, atropine or glycopyrrolate | atropine is fast glyco is slow |
| what kind of drug is aminophylinne | bronchodilator |
| what is aminophylline used for? | bronchodilation for resp and cardiac stimulation. as well as relax smooth muscles and has smooth muscle diuretic activity |
| what drug is used to treat asthma | aminophylline |
| Flucort is the same Dexamethasone but what makes them different? | formulated for large animal use |
| why are steroids contradicted? | make you feel good which covers up clinical signs and delays healing |
| What kind of drug is furosemide | diuretic |
| how is furosemide used | treatment of heart failure due to its ability to decrease pre-load through diuresis |
| what organ does furosemide kick start | kidneys |
| What does PCV stand for? | Pre-ventricular contraction |
| how does vasopressin differ from epinephrine | golden standard, and very expensive -brings ALL internal fluids together to stimulate the heart |
| 3 possible causes animal wont stay asleep | 1. ET tube is too small 2. Vaporizer is turned off 3. machine is not assembled correctly |
| 3 things you can do if the animal wont stay asleep | 1. inform surgeon 2. check oxygen flow and tank 3. check vaporizer |
| 5 signs you patient is too deeply anesthetized | 1. slow resp rate 2. Pale MM 3. Slow CRT 4. Weak Pulse 5. Pupils have poor response to light |
| what resp rate indicates a minor problem vs a serious problem | minor = 12/min serious = 8/min |
| what heart rate is concerning for a dog and cat | dog = 80 bpm cat 100 bpm |
| what to do if you aren't sure what you patients depth is during anesthesia | - consult with vet - look at other indications of depth - assume animal is too deep |
| what are the indications of depth | -heart rate -resp rate -jaw tone -reflexes |
| what causes pale MM | -anemia -blood loss during surgery -prolonged surgery -certain drugs |
| what are possible cases of prolonged CRT | -shock -anesthesia is too deep -individual reaction |
| what does cyanotic MM mean | -animal isnt getting enough oxygen -animal is unable to breath adequately |
| cyanosis is always associated with inadequate _________ intake and is _________! | oxygen, emergent |
| what heart rate is considered to be bradycardia | below 50-60 bpm |
| what drug causes bradycardia | Demedetomadine |
| which is a sign of shock, tachycardia or bradycardia? | tachycardia |
| which drugs cause bradycardia WITHOUT given with atropine | Xylazine and narcotics |
| what drugs can cause tachycardia | -atropine -ketamine -epinephrine |
| what existing conditions can cause tachycardia | -hyperthyroidism, congestive heart failure |
| what 6 things can cause a cardiac arrhythmia | 1. existing condition (heart disease, hyperkalemia) 2. effect of drugs (xylazine) 3. thoracic surgery 4. ET intubation if atropine isn't used 5. prolonged surgery 6. hypercarbia |
| if body temperature is greater than 39.5 degrees celcius _________ is present | hyperthermia |
| how should you cool an animal with hyperthermia? | -wet towels -alcohol on foot pads -cool IV fluids |
| what is an open pneumothorax | air can freely enter or leave the chest cavity |
| what is a closed pneumothorax | air is entering the chest cavity and cannot leave |
| what always stops before the heart beat stops | respirations |
| what cause cause resp arrest | - anesthetic overdose -oxygen tank empty - ET blocked or kinked - pre-exsisting problem -too much oxygen -IV injections |
| what IV injections can cause resp arrest | -barbiturates -narcotics -muscle paralytics |
| how many people are required for good CPCR and what are their jobs | 1: heart 1: resp 1: fluids and drugs |
| how to prepare for vomiting post surgery | - tilt head lower than body -keep ET tube in to protect airway -if there isnt an ET tube try to put one in -Sweep out oral cavity after vomiting |
| what are the 4 common causes of post-surgery seizures | -ketamine anesthesia -myelography -epilepsy - hypoglycemia |
| how to treat seizures | - give diazepam - put in a quiet and dark place |
| what is a symptom upon ketamine and atropine recovery in cats | clawing at their face - you can bandage paws |
| largyngospasm is wheezing on ___________ and normal growling is on ___________. | inspiration, expiration |
| what to do if patients MM are pink post intubation/surgery | -monitor -laryngospasm will result on its own -oxygen mask may be helpful |
| what to do if patients MM are blue (cyanotic) post intubation/surgery | - reinduce anesthesia (IV ketamine, propofol) -intubate - bag -monitor MM -consider giving dexmethasone to reduce spasm and swelling |
| why might there be a prolonged recovery in obese animals | dose was calculated on its actual weight rather than lean-weight |
| why might there be a prolonged recovery in thin animlas | impaired renal or hepatic function |
| during regular anesthesia what should the ISO be set at and how often do you bag | 2%, 5-10 mins |
| what is the surgery rates | 5ml/kg/hr for the 1st hour 2ml/kg/hr for the 2nd hour |
| what is the goal of patient preperation | to achieve asepsis |
| why do we express the patients bladder before abdominal surgery | increase space in the abdominal cavity and prevent animal from eliminating on the surgery table |
| how to clip animals fur for surgery | 1. use #40 blade 2. held flush to surface with firm pressure 3. apply tension to the skin 4. frequently spray blades with Clipper aid as a collant product 5. start by clipping in the direction of hair 5. finish going agaisnt the direction of hair |
| how much hair is to be clipped for most laporotomies | -cranially up the rib margin and xiphoid process -caudally to the pubis -laterally in cats past nipple line and in dogs at least 4inches of hair on either side of the midline |
| what do you place in open wounds before clipping and why | -water soluble lubricant -prevents further contamination from loose hair |
| abdonimal scrub is performed in what kind of pattern | target type patterm moving from the inside to the outside of the surgical site |
| the scrubbing process is to be completed a number of _______ times | 2 |
| how many times do you scrub for each section | 10 strokes/scrubs |
| after the scrub is done wipe the __________ then finishing with a _________ ________ on top | alcohol transfer drape |
| what kind of knots do you use when securing the patient to the table | half-hitch quick release knots |
| when is the final prep applied | in the surgery room after being transferred by the instrument person or assistant surgeon |
| why do orthopedic surgeries require a larger surgical area prepared | to enable surgeon to manipulate the limb |
| what should you do before clipping the eye area? | cover eye with ophthalmic ointment to prevent corneal damage |
| what drape is placed first and where | tissue drapes on unprepared portion of skin |
| what is the order they are placed | head, tail, near, far |
| towel clamps are placed to ________ the __ __________ of the tissue drapes | secure, 4 corners |
| what is the last sheet placed on the surgical site | Laparotomy sheet |
| what is commonly done on tom cats because of their tough skin prior to a IV catheter | create a peephole |
| common ET tube size for cats | 3.5-4.5 |
| where do you tie the ET tube on a cat | behind the head |
| what is the average rebreathing bag size for a cat | 0.5-1 L |
| when do you use a non-rebreathing circuit | animals are less than 7kg |
| gas flow pattern for a bain circuit | 1. anesthetic mixes with oxygen 2. travels through green tube in main circuit 3. out through the outer clear part of the bain tubing 4. to the rebreathing bag 5. out through the scavenger |
| what is the MINIMUM oxygen flow rate and what is the IDEAL rate | minimum= 500ml/min ideal= 200ml/kg/min |
| 4 ways to obtain a urine sample | - free catch -manually express - male urinary catheter -cystocentesis |
| urinary obstructions are most common in.... | young, neutered, male cats |
| true or false: urinary obstruction is life threatening and is mostly affected by diet | true |
| what is a perineal urethrostomy | procedure that removes the narrowest portion of the urethra where the crystals are most likely to bottleneck and create a bloackage |
| 5 purposes for feline castration | 1. prevent breeding 2. less disease 3. reduce urge to spray urine 4. urine smells less 5. causes desirable behaviour changes |
| when is the ideal age for cat castration | 6 months to 2 years |
| 2 problems that may occur after castration and why | bleeding- knot in spermaticord does not form properly infection-incomplete retraction from the cord back into scrotum, or litter becomes lodged, or if cat licks excessively |
| what to do if there is post castration bleeding | put cat on clean towels and change very half hour to monitor amount of bleeding. if its excessive they may need to be re-anesthetized and local pressure applied |
| what to do if there is infection post castration | give cats antibiotics and surgeon may need to re-anesthetize the cat to open surgical site for cleaning and drainage |
Created by:
jscott41
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