ER Procedures PP and lecture #1
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| In an Emergency situation can a veterinary technician apply appropriate wound dressings? | Yes, to control bleeding
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| For the veterinary technician to give drugs to control shock what must be true? | They must FIRST be in contact with the veterinarian who must be on premises or enroute to the patient.
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| In an Emergency situation can a veterinary technician perform a tracheostomy? Why or Why not? | NO! They can intubate, but they cannot "perform surgery"
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| In an Emergency situation can a veterinary technician apply a tourniquet? Why or Why not? | Yes, to control bleeding
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| In an Emergency situation can a veterinary technician apply a pressure bandage? Why or Why not? | Yes, to control bleeding
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| In an Emergency situation can a veterinary technician apply a splint. Why or Why not? | Yes, to prevent further damage to bones or soft tissue
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| In an Emergency situation can a veterinary technician give drugs to control shock? What must be true? | Yes, but they must maintain contact with the veterinarian who either needs to be on premises or enroute to the patient.
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| In an Emergency situation can a veterinary technician give parenteral fluids? Why or Why not? | Yes, but they must maintain contact with the veterinarian who either needs to be on premises or enroute to the patient.
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| In an Emergency situation can a veterinary technician placing nasal cannulas for O2 supplementation? Why or Why not? | Yes, to establish an open airway, but cannot do a tracheostomy.
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| In an Emergency situation can a veterinary technician perform internal cardiac resuscitation? Why or Why not? | No, they can only perform EXTERNAL cardiac resuscitation.
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| In an Emergency situation can a veterinary technician provide external treatment in severe burn cases? Why or Why not? | Yes,
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| In an Emergency situation every veterinary technician should do what? | Prepping and placing an IV catheter
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| What is the ONLY time that supplemental O2 is contraindicated? | When the patient is ON FIRE!
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| In an Emergency situation can a veterinary technician provide positive pressure ventilation? | Yes
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| What does CPCR mean? | Cardio Pulmonary CEREBRAL Resuscitation
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| What does the Cerebral part of CPCR mean? | Our goal for pets is to regain some of their ability to function. If they survive, but can't be a good pet they will usually be euthanized.
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| What are the contraindications for inducing vomiting? | Animals in respiratory distress (risk of aspiration), Any caustic material, any acids or alkalines (detergents), extreme weakness (vomiting takes a lot out of us), unconsciousness, depressed CNS, bradycardia
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| If the own suspects the animal has poison on their skin what should they do? | Clean it off before bringing them in.
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| If there is a powder on the animal and they suspect poison how should they proceed? | Vacuum off the powder THEN bathe the animal
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| If the poison may have gotten into the eyes what should they do? | Flush with saline or water (NOT anti-reddening agent like visine)
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| What can happen to the personality of animal exposed to a toxin? | Abnormal behaviors such as aggression
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| Is it generally recommended that a client induce vomiting at home? | No, because they can give too much or not enough.
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| If you were to recommend that the animal vomit at home what do you need to make sure you recommend? | That the head is below the heart.
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| Too much hydrogen peroxide could cause what? | ulcerations of the stomach or throat
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| What is the preferred drug to induce vomiting in Dogs? Cats? | Apomorphine, Xylazine
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| Too little hydrogen peroxide could do what? | They may not full empty their stomach which can mean the toxin is still in their stomach.
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| If you are giving an injection of apomorphine what is important to remember? | Have things ready for them to vomit into because it is almost instantaneous
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| What does activated charcoal do? | It binds to the toxins and they can be
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| What are 4 things you want to observe on the patient during your client interview? | Pulse
Temp
Respiratory rate/effort
MM/CRT
Use all of your senses sight, smell, touch, & intuition. Paying close attention to cardiovascular, respiratory, and central nervous system. Don’t hyper focus on the area of complaint and forget the rest.
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| When Triaging in the hospital, how do you determine if the animal needs to be brought to “the back”? What are the 3 reasons discussed in class? | • CPCR
• ABCD’s
• Inadequate Ventilation
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| What is the definition of Triage? | The assignment of degrees of urgency to wounds illness to decide the order of treatment of a large # of patients or casualties. It’s French for “To sort” and comes out of WWII
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| What is the difference between Primary and Secondary assessment? | Primary= Determine if the patient is stable or in crisis (true medical emergency) & requires immediate care
Secondary= More in depth, encompasses all systems
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| What are the normal ranges of systolic blood pressure? | 90-140 mmHg
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| What are the normal ranges of diastolic blood pressure? | 60-90mmHg
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| What are the normal ranges of MAP(mean arterial pressure) blood pressure? | 70-105mmHg
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| What devices are used to measure blood pressure? | Oscillometric, Doppler, & Transducer
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| If the animal’s vessels are constricted, will the blood pressure be high or low? Why? | High, more blood and less space means more pressure
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| What is blood pressure and why is it important to monitor/measure? | Blood pressure is the force of the blood in the veins, it tells us if the blood is getting to the tissues and is of particular importance in regards to the kidneys.
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| What does the pulse oximeter measure and in what units? What is the normal range? | The pulse oximeter measures the oxygen in the red blood cells and the normal ranges are 95% to 100% It’s measured in percent.
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| Peripheral pulses are not palpable when the mean arterial blood pressure is less than? | 60mmHg
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| What are the ABC’s and how often should you recheck them? | A= Airway
B= Breathing
C= Cardiovascular/Circulatory
Every 5 min
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| In addition to the lungs what should you listen to when checking the airway? Why? | The trachea. The sounds you hear can indicate an obstruction and you won't necessarily hear this if you are only listening to the lungs.
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| When an electrocuted patient arrives at the hospital what are 3 things that should be checked immediately on presentation? | Breathing, Pulse, and check for burns (mouth, feet, anything that is touching the ground)
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| Why do we check the mouth of an electrocuted animal? | Because they often BITE cords meaning the entrance wound will be the mouth and would be burns.
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| Why do we check the feet of an electrocuted animal? | Because electricity has an exit wound and often this means the feet since an animal may be standing when they bite cord.
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| What are the 4 classifications of burns? | 1st degree
2nd degree
3rd degree
4th degree
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| What is a first degree burn? | Superficial, epidermis only, no blisters, painful
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| What is a second degree burn? | partial thickness to full thickness, Blisters can be present, Involves the entire epidermis and upper layers of the dermis to most of the dermis, can be red or white in appearance but will appear dry, painful
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| What is a third degree burn? | Full thickness, All layers of the skin are destroyed. Extends into the subcutaneous tissues, areas can appear black or white and will be dry, can appear leathery in texture, NOT painful
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| What is a fourth degree burn? | Full thickness that extends into muscle and bone, all layers of skin are destroyed. Not Painful.
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| How should you handle a patient coming in to the hospital with a potential spinal injury? | Use a board and if the patient is larger you should use 2 people to reduce risk of injury to the animal AND yourself.
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| What are 5 examples of a TRUE emergency? | Respiratory distress
Blocked Cat
GDV, Distended abdomen
Seizures (Not shivering)
Arterial bleed (Not a small cut)
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| Why is it important for a Vet Tech to be a team leader in an emergency? | They assess the patient, direct the staff, and inform the veterinarian so that everything gets done and
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| When would we use a oxygen cage? | To provide noninvasive oxygen to the patient if they are stable enough that they don't need to be intubated.
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| What does the capnograph measure? | End Tidal CO2
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| What is the ETCO2 measured in? | mmHg
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| What is the advantage of the capnograph over the pulse oximeter? | It is a much more sensitive indicator of hypoventilation
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| What is one brand of Capnograph? | Cardell
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| What does the Blood Gas Analyzer measure? And why is it important? | Provides rapid and accurate assessment of blood gases, which are import in respiratory or cardiac emergencies
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| Why does the Blood Gas Analyzer require and arterial blood sample? | Because it tells us how much oxygen is getting to the tissues
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| Where do we usually get the arterial blood sample for the Blood Gas Analyzer? | Bottom of the foot
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| What does the Blood Chemistry Analyzer & CBC tell us? | How the patient's body is functioning and it also gives us a base line of blood work to compare against as treatment progresses.
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| Why should a CBC be done as well? | It gives us a more complete picture of the patient's status such as if they have an ongoing anemia or a sudden blood loss anemia
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| Why is the information we get from the Blood Chemistry Analyzer and CBC important? | It tells us how the body is responding to the treatment and if it's working or causing a problem. If their liver or kidney values are going up. Which helps us to assess and change treatment we are providing.
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| What is the Electrolyte Analyzer used for? | This gives us a base line of the general body functions such as BUN and Creatine as well as the patient's electrolyte status. (Sodium, potassium, glucose, etc)
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| What is the difference between a Fluid Pump and a Syringe pump? | Fluid pumps deliver a specified amount of fluid over a specified time while a syringe pump is used to give small amounts of drugs over an extended period of time.
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| What does a defibrillator do? | Provides electricity to restart the heart
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| Where is the defibrillator usually located? | on top of the crash cart
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| In what percent of animals is CPR successful? | 3-5%
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| Of successful CPR patients what percent goes home to be functional pets? | less than 10%
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| What should a Crash Cart contain? | Drugs, ET Tubes & supplies, syringes, IVCs, needles, ambu bags, tracheostomy tube, big pair of gauze forceps
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| Why does Miss Kelli like to see a big pair of gauze forceps in the crash cart? | Balls and removal of other foreign bodies
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| Where are the big pair of gauze forceps usually found? | In the airway area
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| What information should you get over the phone? | - Stay calm to keep owner calm
- Get basic patient information
- Get an assessment of patient (MM, CRT, HR, RR)
- Time of Arrival (be prepared)
- Record everything
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| What is the difference between indirect and direct blood pressure? | Direct blood pressure requires an arterial catheter and is the most accurate measurement. It is also continuous rather than periodic
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| What are two forms of indirect blood pressure monitoring? | Oscillometric and Doppler
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| How does Doppler blood pressure work? | a crystal is placed on an artery which picks up the sound of a pulse, a cuff with a sphygometer is then placed and inflated. The BP is measured when the sound of the pulse is heard
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| How does Oscillometric blood pressure work | The cuff is placed around a leg, the cuff inflates and the BP is measured.
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| What is a Bair hugger | a bag made from fabric (like a blanket) where warm air is blown into it
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| What forms of heating supplies are NOT recommended and why? | Heating pads, heated tables, heating lamps... because the animal can be easily burned
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| What forms of heating supplies are recommended? | Bair huggers, warm blankets, warm water bottles
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| How do some clinics do their own blood banking? | They keep a controlled "colony" of dogs and cats, most others have the capabilities to store frozen blood and plasma
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| What should your advice over the phone consist of in a phone triaging situation? | stabilizing the patient during transport
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| What should you never do over the phone? | Diagnose! The client needs to bring their pet in to see the DVM
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| What’s the difference between a wasp sting and a bee sting? What do you need to be concerned with when either insect bite is presented? | Wasp stings do not leave a stinger behind so there can be multiple sting site. Bee stings do leave a stinger that must be removed. Anaphylaxis which often presents as vomiting & diarrhea
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| In ABCD what does A stand for? And how should you check for it? | Airway – Check for obstructions, breathing sounds, and patterns (you need to listen to the trachea and not just the lungs because the sounds you hear can indicate an obstruction.) Agonal Breathing or not breathing we intubate.
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| In ABCD what does B stand for? And what should you check for? | Breathing – monitor rate and sound
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| In ABCD what does C stand for? And what should you check for? | Cardiovascular/Circulatory – HR, MM/CRT, Pulse
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| In ABCD what does D stand for? | Drugs - Diuretics, opioids, and tranquilizers
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| What does HBC stand for? | Hit By Car
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| How often should you recheck the ABCs? | Every 5 minutes
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