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Sea Turtle Quiz 3
| Question | Answer |
|---|---|
| What are the 3 selection criteria for drugs | Mechanism of action/target effect Efficacy Adverse effects |
| What are the questions involved in the mechanism of action/target effect selection criteria | What is the goal of drug? Will it work to achieve that? |
| What are the questions involved in the EFFICACY selection criteria | Is this drug the most effective within its class? Culture and sensitivity profile for antimicrobials? |
| What are the questions involved in the ADVERSE EFFECTS selection criteria | Is this drug safe? What are the potential side effects? Are they worth the risk? |
| what turtle is commonly used in drug experimentation | sliders other reptiles too |
| What are the steps to determine if a drug will work on a certain species? | 1. Formularies/textbooks 2. literature search 3. message boards or servers 4. consult experts in field 5. extrapolation 6. trial and error |
| In summary: what are the different things to consider when selecting a drug | Route of administration frequency of administration efficacy adverse effects cost availability FDA approval in animals Contraindications drug interactions |
| What is epidural anesthesia | administration of anesthetic drugs into the epidural space for desensitization of motor and sensory fibers |
| What is the epidural space | outermost part of spinal canal Space between the vertebral body and dura mater |
| What is the subdural/intrathecal space | space between the dura mater and spinal cord containing spinal fluid |
| Why is spinal anesthesia chosen | fewer complications safer for debilitated patients faster procedure time faster recovery time decrease depth of general anesthesia improves post-op and intra-op pain management |
| What species has a low success rate with general anesthesia | Greens |
| What are the limitations involved with spinal anesthesia | requires restraint (patient still responsive) limited areas of analgesis effectiveness varies risk of infection and trauma |
| What procedures are good for spinal anesthesia | surgeries involving caudal bone or plastron flipper amputations any procedure involving the posterior region |
| What are the three drugs typically used for spinal anesthesia | Lidocaine 2% Bupivacaine 0.5% Morphine and lidocaine 4mg/kg |
| How long does lidocaine 2% typically last | approx 1 hr |
| How often can u repeat dose of lidocaine 2% if the affect isnt adequate | every 15 minutes |
| How long does Bupivacaine 0.5% typically last | 2 hours |
| How often can u repeat dose of Bupivacaine 0.5% if the affect isnt adequate | every 15 min |
| How long does Morphine and lidocaine typically last | up to 48 hrs |
| what is one symptoms seen after using bupivacaine 2% | decreased motor response in rear flippers after anesthesia wears off after 6-12 hrs |
| What is the depth of sedation dependent on | patient temperament, health and procedure preformed |
| What needle sizes are typically used for intrathecal injections | 27-22g 3/4 - 1" needle **BASED ON PATIENT SIZE |
| Where is the injection site for intrathecal injections | caudal vertebrae proximal tail |
| What are the steps to doing an intrathecal injection | use appropriate injection site Feel needle "pop" through dura aspirate inject |
| If aspirating during intrathecal injection and blood is seen what happens next | redirect |
| When aspirating for intrathecal injection what should be seen | flash of spinal fluid |
| What are some examples of when drugs are used | infections (bacterial, parasitic, etc) toxicities critical care GI protectants |
| What are some examples of how drugs are delivered | oral SQ IM IV IO |
| What are some different ways to give a drug P.O (oral) | In food Assist feed/force feed tube feeding Esophagotomy tube |
| What drugs typically absorb well orally | itraconazole, tramadol, enrofloxacin, praziquantel |
| What drugs absorb poorly orally | clindamycin |
| What is important to note about loggerheads' esophagus when giving drugs | the spines help keep solids down but not fluids |
| When should IM not be used for drugs | irritating drugs enrofloxacin, clindamycin, oxytetracycline |
| When is IV best used for drugs | bolus administration |
| What are things to consider when dosing drugs | culture and sensitivity patient temperature renal portal system |
| What are some ways you can determine the dose for a drug | PK and PD studies formularies Allometric scaling Direct extrapolation |
| Why can't Florfenicol be used in turtles | eliminates too rapid for practical use |
| What are two pitfalls of the gold standard | Hazards of single dose PK studies Is it the right drug for the job |
| What are some nonsteroidal anti-inflammatories | Flunixin Ketoprofen Meloxicam Ketorolac Tolfenamic acid |
| What are some bacterial diseases that sea turtles get | opportunistic infections chlamydiosis mycobacteriosis nocardiosis |
| When is Enterococcus spp. found in sea turtles most commonly | cold-stunned ridleys |
| When are antimicrobial resistance common | cloacal isolates of free range turtles |
| What are some antimicrobials | Ceftazidime Oxytetracycline Amikacin/ampicillin (or amoxicillin) Fluoroquinolones |
| What are the two ways a fungal infection are seen | superficial and systemic |
| When are fungal pneumonias commonly seen | cold-stunned kemp's ridley |
| What are some antibiotics used for fungal infections | Penicillium, Paecilomyces, Fusarium, Rhodotorula, Sporotrichium, Scolecobasidium, Cladosporium, Beauvaria bassiana, Colletotrichum acutatum |
| What are the different parasites a turtle can get | Protozoa Trematodes Nematodes Cestodes (uncommon as adults) external commensals/parasites |
| What are the different antiparasitic drugs | Praziquantel Fenbendazole Ponazuril Pyrantel Levamisole |
| What anti-parasitic is NOT used in turtles | ivermectin |
| What topicals can be used on turtles | Freshwater/low salinity water honey silver sulfadiazine betadine triple antibiotic ointment Tris-EDTA |
| What are the harmful algal bloom toxins | Brevetoxin (NSP) Saxitoxin(PSP) Domoic Acid (ASP) Ciguatoxin (CFP) Okadaic Acid (DSP) |
| what type of drugs are used in the GI | Motility enhancers Histamine H2 receptor antagonists Sucralfate |
| What vitamin/mineral supplement can turtles recieve | Vitamin B complex Vitamin E Calcium/Calcium gluconate Iron dextran |
| What are some causes for injuries in turtles | boat strikes injuries caused by fish hooks and line dredge related trauma sand embedded in skin human induced injuries (machete, spear, etc) cutting turtles out of net to save net shark bites cold stunning induced lesions ulcerative shell lesions |
| Primarily closures frequently ___ in wound healing | fail |
| How do wounds typically heal in turtles | inside out |
| What are some of the ways wounds are managed | flushing, debridement, use of topicals |
| What is often the best therapy for wound healing | leaving wound open in clean salt water |
| What is the first thing that should be done for wound management | remove large debris with tissue forceps |
| How should wounds be flushed | in the ventral direction |
| What are some irrigating solutions | saline/LRS dilute chlorhexidine dilute betadine silvaclenz equisilver |
| Once turtle becomes more stable, what should be done to the wounds | debridement for pain management |
| What are some ways you can temporarily fix a shell | orthopedic plates wires, screws glue/marine epoxy |
| How does Rediheal work | reacts quickly with the body's fluids, stimulaing the generation of new blood vessels |
| Rediheal improves ______ | Blood supply to the wound |
| Why is honey used in wound therapy | antibacterial properties antioxidant capacities enhances immune system Anti-inflamm properties Stimulates cell growth |
| What is a sea turtle skin graft made out of | intact decellularized fish skin |
| What does the fish skin graft contain | fat, protein, elastin, glycans, and other natural skin elements |
| When are fish skin grafts used | partial and full-thickness wounds and burns |
| When are waterproof bandaging used | packing a wound with various products |
| when removing fishing line/rope from a turtle what is most likley to happen to the location | hemorrhage |
| After removing the fishing line what are the next steps | debridement partial or complete amputation (if necessary) |
| What does vacuum-assist closure typically do to healing time | decrease healing time |
| When is VAC therapy preferred | diabetic ulcers |
| VAC can reduce the need for.. | surgery |
| Negative Pressure Wound Therapy (NPWT) | controlled application of sub-atmospheric pressure to the local wound environment, using a sealed wound dressing connected to a vacuum pump |
| V.A.C.® (Vacuum Assisted Closure®) Therapy | delivers negative pressure (a vacuum) at the wound site through a dressing, helps draw wound edges together, remove infectious materials and actively promote granulation at the cellular level |
| What species is the best candidate for VAC wound therapy | Chelonians |
| When the vacuum-assist closure creates negative pressure what occurs in the wound | Increases blood flow/perfusion removes exudate removes edema promotes granulation tissue formation brings lung tissue back into place |
| What are indications that VAC should be used | traumatic injuries early stages of wound treatment shell defects chronically infected wounds slow healing wounds Open coelom with exposed lung or other tissue |
| What are contraindications for VAC | active hemorrhage Dehydration |
| How do you start VAC therapy | set pump to desired pressure when pump turned on, foam should visibly shrivel up |
| What is the most common VAC problem | leaks |
| What is the desired pressure for Chelonians VAC treatment | 75-200 mmHg |
| How does a therapy laser work in wound care | Light penetrates tissue and is absorbed at the cellular level |
| What are the benefits of therapy lasers | Enhances ATP production (increase cell energy) Increases cell metabolism and temporarily increases membrane permeability Rapidly increases microcirculation and lymph flow Increases growth of capillaries |
| What does medicinal leeches do | removes locally congested blood |
| What are the benefits of leech saliva | anesthetize the wound – dilates the blood vessels to increase blood flow – Prevent the blood from clotting. – Relieves congestion, and restores normal blood flow. |
| What are the benefits of endoscopy | direct visualization of the organs confirm diagnosis collect biopsies less invasive than surgery |
| Disadvantages of endoscopy | requires sedation can be invasive if surgery involved may not be possible in debilitated patients |
| When doing an endoscopy where are you most liekly to miss lesions | dorsal lung or deep in organs |
| When is flexible endoscopy used | GI tract respiratory eval |
| When is rigid endoscopy used | coelom cloacoscopy respiratory eval in smaller turtles hook eval |
| T or F: both rigid and flexible endoscopy have biopsy capabilities | T |
| Which endoscoy (rigid or flexible) can be used for internal FP eval | both BUT different organ systems |
| What are the two types of flexible endoscopes | fiberscope Video-endoscope |
| What is the fiberscope used for | transmits image via a bundle of fiberoptic nerves |
| What is the video-endoscope | transmits image electronically from a charge-coupled device at distal tip |
| Pros and cons of the fiberscope (endoscope) | Pro: less expensive Cons: smaller diameters, pixelation and lesser image quality |
| Pros and Cons of the video-endoscope | Pro: larger diameter Con: more expensive |
| What are the two light sources that can be connected to the endoscopy | halogen light source xenon light source |
| When are Halogen light sources used for endoscopy | for small animals <2kg |
| When are xenon light sources used for endoscopy | large adult turtles illuminated the body cavity better |
| What are grasping forceps used for in endoscopies | manipulating tissues, debridement, and retrieving foreign objects/parasites |
| When are fine aspiration/injection needles used | aspirating fluids from cystic structures irrigation or drug administation |
| When are biopsy forceps used | tissue samples for histopathology and microbiology |
| What are cannulae and trocars used for with a flexible endoscopy | used to penetrate the coelemic lining and for scope placement |
| Describe a trocar | solid, sharp or blunt metal rod that is inserted into the canula to assist with placement |
| What prevents the loss of gas during insufflation when using a cannulae/trocar in a endoscopy | internal leaflet valves |
| What are the pros for using a threaded canula during an endoscopy | Does not require a trocar or axial penetrative force for insertion |
| What is the external screw used for on the threaded canula during endoscopies | enables gradual advancement by rotation |
| When is bilateral laparoscopy used | complete assessments or exploratory |
| When is unilateral laparoscopy used | sexing |
| How is a patient positioned for a laparoscopy | tape or tie hind flippers together |
| Where is the skin incision made for entry to the coelom | craniocaudal skin incision center of the pre-femoral fossa |
| What should be done prior to making the skin incision for entry into the coelom | flex and extend the hind limb prior to incision |
| The size of a skin incision when entering into the coelom is dependent on... | goal of procedure (exam vs surgical) size of scope |
| what is insufflation used for in endoscopy | spatial separation of organs in some cases |
| Why is sterile saline helpful when using insufflation during endoscopy | creates mild distention |
| During a exploratory coeliotomy where can the liver be found | occupying majority of the ventral coelom bilaterally |
| Where is the lung located while doing an exploratory coeliotomy | dorsally extending most of carapace length |
| When is the lung most obvious during an exploratory coeliotomy | during positive pressure ventilation |
| What is found on the right side of the liver | gallbladder |
| what is located ventreal to liver on left | greater curvature of stomach and duodenum |
| Describe where the gonads would be located | dorsally, bilaterally, caudal to lung cranial to kidney |
| What are the kidneys covered by | coelomic lining |
| Where are the adrenal glands located | cranial to kidney medial to gonads |
| What should be done pre-op in a turtle | stabilize any conditions |
| What are some examples of things that need stabilized pre-op | anemia hypoproteinemia Emaciation/poor nutrition Sepsis |
| How is anemia stabilized | blood transfusion |
| How is Hypoproteinemia stabilized | plasma transfusion |
| How is emaciation/poor nutrition stabilized | Esophagostomy tube, TPN |
| How is sepsis stabilized | culture-guided antimicrobials |
| How do you prep a sea turtle for surgery | 12 hr fasting standard aseptic technique |
| How is a turtle positioned for most intracoelomic procedures | dorsal recumbency |
| While prepping the patient what are two things that need to be prepped and ready for patient support in surgery | Ventilation fluid support |
| What type of suture is best for turtles | monofilament, synthetic, absorbable |
| What sizes of sutures should be used on turtles | smallest size possible 4-0, 3-0 or 2-0 |
| Why is the smallest suture size possible used on turtles | limit foreign material in wound |
| Why is ventilation more challenging during procedures | lungs are lie at the dorsal carapace viscera is pressed on those lungs |
| What is done with ventilation to help get the air to a turtle's lungs during surgery | extra force during positive pressure ventilation |
| Why is fluid support important for surgery | develop hyperlactatemia during anesthesia and in dorsal recumbency |
| How is fluid therapy during surgery guided | blood gases and lactates |
| What two suture materials were best tolerated in loggerheads | poliglecaprone and polyglyconate |
| During post-op what are two things that are typically seen due to the sutures | a strong foreign body reaction dehiscence |
| What is dehiscence | wound rupture along surgical line |
| How soon can a turtle return to the water after a surgery | roughly 1hr post-reversal **must be active, moving and lifting head |
| When is the neck (cervical or lateral) used as an approach for surgery | to access esophagus or place an E-tube |
| When is the supraplastron approach used in surgery | intracoelomic esophagus |
| What is something you can do to the esophagus from a supraplastron approach | evert the esophagus |
| When is the axillary approach used for surgery | get to the stomach |
| When is the caudal coelom approach used for surgery | to access almost anything from the jejunum and distal, reproductive tract, kidneys, spleen |
| What is one of the most common reasons youll take a turtle to surgery | hooks |
| All turtle who enter a rehab facility need to be radiographed for | hooks |
| What are the two views that should be used when radiographing a turtle to look for hooks and why | DV and lateral localize hook to know how to approach the hook in surgery |
| Why is it important for the turtle's neck to be extended on radiographs | the hook will like intracoelomic when its not if the neck is scrunched up |
| What is a good landmark to note if a hook is intra or extra coelomic | 8th cervical vertebrae |
| What is categorized as extra-coelomic on a radiograph | cranial to 8th cervical vertebrae |
| What is categorized as intra-coelomic on a radiograph | caudal to 8th cervical vertebrae |
| What plane is most ideal for a hook to be located in | horizontal plane |
| When the point of a hook is facing cranial in the horizontal plane what does this mean | minimal risk of damage |
| When the point of a hook is facing caudal in the horizontal plane what does this mean | the hook can potentially hook around the L bronchus |
| Which plane is more problematic if a hook is found there | sagittal plane |
| Why is the sagittal plane a worse spot for hooks to be found | higher risk to the surrounding tissues |
| Hooks facing ventral in the sagittal plane what should be watched out for | the R bronchus and brachiocephalic trunk |
| Hooks facing dorsal in the sagittal plane what should be watched out for | the hook looping around L bronchus and causing a pneumocoelom |
| When a hook is in the cavity what type of numbing/anesthesia should be used? | sedation or local anesthesia |
| What are two ways to remove a hook from the oral cavity | Antegrade Retrograde |
| How do you remove a hook antegrade from oral cavity | push hook completely through tissues cut in half once barb is exposed |
| How do you remove a hook retrograde from oral cavity | slightly widen entry hole flatten or file barb |
| removing a hook antegrade reduced the risk of | tissue tearing |
| What should not be incorporated when closing the cranial esophageal | esophageal papilla in closure |
| How can the intracoelomic esophagus be exteriorized | supraplastron approach |
| What approaches can be used to remove a hook from the caudal GIT | L or R prefemoral fossae |
| Which side of the prefemoral fossae is able to exteriorize more of the GIT | R side |
| Surgical approach (in order) of how to remove a hook from the caudal GIT | skin, SQ, rectus abdominus, coelomic membrane |
| Is there frequently fluid in the coelomic membrane when a foreign body is there | yes |
| What should be done with the fluid found in the coelomic membrane (from a foreign body) | collect it to do a fluid analysis and culture |
| Why should fluid from the coelomic membrane (in correlation to a foreign body) be cultured | to determine if it is a septic peritoneum or something else |
| What is a ultrasound needed for when discussing linear foreign bodies | if a plication is present |
| What are some surgical techniques used to remove a linear foreign body | Red rubber catheter technique Enterotomy Resection and anastomosis Intussusception |
| What do all liner foreign bodies start with | enterotomy |
| What is an enterotomy | using a forceps to remove a loop of bowel distal to foreign body |
| Why is an enterotomy used | allows for healthy tissue to do the healing instead of damaged tissue |
| When does the red rubber catheter technique not work | chronic or embedded cases **most cases |
| With shell repair, what is considered a good px | intact coelomic membrane |
| With shell repair, what is considered a fair px | coelomic penetration, bone fx |
| With shell repair, what is considered a guarded px | traumatized viscera and inability to use limb |
| With shell repair, what is considered a grave px | spinal trauma, head trauma, internal injury or multiple fx |
| What type of shell injury required very little care | Non-displaced fractures |
| If shell fragments are overlapping what should be done | reduce and stabilize the fragments |
| What are some ways you can stabilize shell fragments | screw or cerclage cerclage alone zip tie plating epoxy |
| What is the standard of care for fibropapillomatosis | CO2 laser |
| What are some reasons why CO2 lasers are the standard of care | cuts and coagulates at the same time Able to adjust settings based on soft tissue, bone, and eye ablation vs excision |
| Where do fibropapillomatosis lesions typically occur in the eye | sclera and third eyelid |
| How can fibropapillomatosis on the sclera or third eyelid be removed | CO2 laser (low power) |
| Why does the CO2 laser need to be on lower power when working around the eye | prevents the cornea from being burned |
| How are lesions around the cornea handled | keratectomy |
| If the globe is infiltrated with fibropapillomatosis what needs to be done | CT or US to diagnose |
| When is tarsorrhaphy used | treatment for corneal diseases |
| What is tarsorrhaphy | suture eyelids together for 5-7days to help corneal healing |
| Are turtles releasable with only 1 eye | yes |
| What should be avoided and where to prevent contralateral blindness | traction on optic nerve |
| How many limbs ca be removed from a turtle and still be releasable | 1 |
| For the forelimb, where should the amputation be located | scapulohumeral joint |
| In order what do you incise for a forelimb amputation | skin, deltoideus + supracoracoideous muscles , brachial plexus, joint capsule |
| For the hindlimb, where should the amputation be located | coxofemoral joint |
| In order what do you incise for a hindlimb amputation | skin, pibotibialis + flexor tibialis internus muscles, sciatic + puboischiofemoralis nerves, joint capsule |
| What is one of the most common surgical procedures done | esophageal tube placements |
| How is the distal esophagus measured | measure to the end of the vertebral scute |
| What is incised to place an esophageal tube | skin, constrictor coli m, esophagus |
| How can GI endoscopy be preformed | awake or sedated |
| What does the bite block permit good visualizations of | oral cavity, oropharynx and nasopharynx |
| When is a lower GI endoscopy used | cloacal prolapse, stricture, enteritis, hematochezia, hematuria, egg retention |
| What is a cystoscopy used for | urine sample collection, visualization of coelomic viscera through bladder wall |
| How can a rhinoscopy be performed | under sedation or local anesthesia |
| What type of scope is mostly used for a rhinoscopy | rigid telescope |
| How is the nasal cavity broken up | dorsal olfactory and ventral intermediate region |
| What ducts connects to the oropharynx | nasopharyngeal duct |
| When is a bronchoscopy useful | get images of the lungs and bronchus |
| When looking at the bifurcation of the bronchus, which side (healthy or unhealthy) side should be examined first and why | the healthy side followed by the unhealthy side to prevent any microbes or issues from the unhealthy side contaminating the healthy side |
| A coelioscopy done by incising the prefemoral fossa can allow what to be seen | ventral lung, pericardium, serosal GIT, urinary bladder, gonads, kidney, adrenals, liver |
| What can a coelioscopy also be used for | sexing FP scanning exploratory |
| What is a common reason to need to do endosurgery | lung bullae |
| What are some complications from the pneumoncoelom | chronic pressure on ligaments that attach to the rest of the viscera |
| What ligament attaches to the ventral left lung | gastropulmonary ligament |
| What ligament attaches to the ventral right lung | hepatompulmonary ligament |
| what are the four phases of wound healing | inflammation, debridement, repair, maturation |
| What type of environment allows optimal healing in turtles | moist |
| Why do abscesses remain solid | reptiles lack proteolytic enzymes |
| What is no curative for abscesses | lancing and curettage |
| What must be removed for the abscess to be curative | entire capsule |
| What does negative pressure wound therapy encourage | contraction, granulation, perfusion, exudate, edema |
Created by:
Kayla_K