1
Q
What is a PE
A
Complete evaluation of a patient’s physical condition using the assessor’s hands, eyes, ears, and nose
2
Q
What can be found during a PE that can influence a patient’s anesthetic management
A
Dehydration, anemia, bruising lesions, respiratory system abnormalities, cardiovascular abnormalities, abdominal organ abnormalities, general condition that requires veterinary attention, and physical abnormalities that may influence the procedure
3
Q
Why is dehydration a concern for patients undergoing anesthesia
A
Can lead to hypotension, poor tissue perfusion, and kidney damage
4
Q
What do bruising lesions indicate in the absence of trauma
A
A clotting disorder
5
Q
What systems are the most affected by anesthetic agents
A
Nervous, cardiovascular, and pulmonary
6
Q
What can changes in the patient’s weight reflect
A
The patients food intake, hydration, activity level, or overall state of health
7
Q
What are anesthetic complications in obese patients
A
Compromised cardiovascular function and decreased functional lung volume
8
Q
What does a sudden loss of 1kg of body weight indicate
A
It corresponds to lossing 1 L of fluid
9
Q
What is the level of consciousness
A
It is the patient’s responsiveness to stimuli or how easily it can be aroused to assess brain function
10
Q
What can cause a decrease in LOC
A
Hypoxia, drugs, dehyrdation, and neurologic disease
11
Q
What is lethargic
A
Mildly decreased LOC that can be aroused w/ minimal difficulty
12
Q
What is obtunded
A
More depressed LOC that cannot be fully aroused
13
Q
What is stuporous
A
A sleep like state that can be aroused only w/ painful stimulus
14
Q
What is comatose
A
Cannot be aroused and is unresponsive to all stimuli including pain
15
Q
What type of tranquilizers can be overrode by anxious or excited patients
A
Phenothiazine
16
Q
What does an exam of the exterior surfaces consists of
A
Hair coat, the skin, lymph nodes, mammary glands, and body openings
17
Q
What is the medical term for a large bruise
A
Ecchymoses
18
Q
What is the medical term for a medium bruise
A
Purpura
19
Q
What is the medical term for a pinpoint bruise
A
Petechiae
20
Q
What things do we look out for when evaluating the body openings
A
Odors and discharges
21
Q
What is the PLR
A
Pupillary light reflex is when the eyes under go miosis when exposed to light equally
22
Q
What is the medical term for unequal pupil sizes
A
Anisocoria
23
Q
What is the most accurate way to find a large animal’s heart rate
A
Counting for 30 second and multiply by 2
24
Q
What can a decreased heart sound intensity in a nonobese patient indicate
A
Pericardial and pleural effusion
25
What are normal heart rhythm abnormalities are present in large animals
Horses can have first or second degree AV blocks and a SA ruminants can also have an SA
26
What is a first degree AV block
Conduction delay through the AV node and is recognized by a prolonged PR interval
27
What is a second degree AV block
Periodic block of electrical conduction through the AV node and is recognized by missing QRS complexes on the ECG tracing
28
Where can the pulse be palpated on large animals
Facial artery, digital artery, ventral tail artery, or auricular artery
29
What can pale mucous membranes or prolonged capillary refill times indicate
Shock, vasoconstriction, and hypotension
30
What does cyanotic mucous membranes indivate
Reduced oxygen saturation
31
What does the respiratory character refer to
Aspects of respiration such as effort, relative length of inhalation and exhalation and regularity
32
What abnormalities are seen in respiratory and cardiovascular systems are veterinary emergencies
Cyanosis and dyspnea
33
What type of drug particles affect the body and how does hypoproteinemia affect anesthetics given
Unbound and there for hypoproteinemia increases the drug potency
34
What lab findings should be reported to the veterinarian prior to anesthesia
PCV <25% in a dog or <20% in a cat, horse, or cow, a PP <4 g/dL in any species, decrease in platelet count, or any coagulation test result outside the normal range
35
What is an in house test for abnormal primary hemostasis
The buccal mucosal bleeding time
36
When is an ECG recommended in patients
Known or suspected heart disease, chest trauma, gastric dilation volvulus, splenic disease, electrolyte disturbances, or if they are on medications that affect heart rhythm
37
What is the esophegeal reflux
Result of decreased lower esophageal sphincter tone and flow of stomach acid into the esophagus that occurs when a patient is in a prone position
38
What is regurgitation
A passive process that may occur in an unconscious or conscious patient is not proceded by retching and results in the flow of stomach contents into the esophagus and mouth
39
What type of patients should not be fasted
Neonatal, pediatric, and some exotic patients
40
What does IV catheter allow maintance for
Blood volume and support blood pressure
41
What are central catheters
Single or multiple lumen catheters that are long enough to reach from the jugular to the cranial vena cava
42
What are peripheral catheters
Relatively short single lumen catheters that are placed into a peripheral veins
43
What is the most common catheter type is most commonly used in generalized practice
Over the needle catheters
44
How do almost all anesthetic agents affect the patients
Decrease the force of heart muscle contraction, cause bradycardia, decrease the flow of the blood from the heart, relax the muscle tone of blood vessel, and increase the intravascular volume (vasodilation)
45
What are important cations in the body fluids
Na, K, Mg, and Ca
46
What are important anions in the body
Cl, HCO3, phosphates, and proteins
47
What is homeostasis
Constant state w/in the body created and maintained by normal physiological processes
48
What is electroneutrality
State of electrical balance in any fluid compartment
49
What is the standard osmolarity of all bodily fluids
300mosm/L
50
What conditions will increase osmolarity of the bodily fluids
Dehydration, exercise, heat stroke, and some cases of vomiting and diarrhea
51
What condition can decrease the osmolarity of the bodily fluids
Chronic congestive heart failure
52
What is oncotic pressure
Colloid osmotic pressure as it does not freely diffuse through vascular space procular endothelium
53
What plasma concentrations must be kept in very narrow range to maintain muscle and heart function
K and Ca
54
What does replacement fluids have concentrations of and what conditions are they good for
Na and Cl; these are good for hypovolemia or dehydration
55
What type of fluid is good for mantaining fluids over a long period of time
Maintenance fluids
56
What are crystalloid solutions
Contain water and small molecular weight solutes such as electrolytes that pass freely through vascular endothelium
57
What conditions are contraindicators of crystalloid solutions
Patients w/ low blood protein, low RBC mass, or low platelet count
58
What type of solutions most commonly used in veterinary practices for IV fluids and give an example
An isotonic solution such as polyionic replacement solutions
59
What is a contraindicator of using LR or PLR fluids
Giving blood products
60
What conditions are patients treated w/ hypertonic crystalloid solutions and why
Hypovolemic, traumatic, or endotoxic shocks because it temporarily draws water into the intravascular space to support blood pressure
61
Why can't hypotonic crystalloid solutions be used for sole maintenance fluids
It will dilute electrolytes contained in total body water
62
What are colloid solutions
Large molecular weight solutions that do not freely diffuse across vascular endothelium and stay in the intravascular space
63
What are colloid solutions used for
It is used to support the expansion of blood volume and blood pressure
64
What can synthetic colloid solutions contain
Hetastarch, dextran, pentastarch, or gelatin products
65
What is the initial fluid rate for dogs and cats under anesthesia
5 ml/kg/hr in dogs and 3 ml/kg/hr in cats followed by a reduced rate if the patient is anesthetized for more than an 1 hour w/ a total of no more than 10 ml/kg/hr
66
What percentage of the patients shock fluid dose be given when presenting w/ blood loss, hypotension, or shock
25%
67
What is the formula for a patients shock dose
80-90 ml/kg in dogs and large animals and 50-55 ml/kg in cats
68
What are side effects of giving hypertonic solutions are given too quickly
Hypotension, bradycardia, rapid/shallow breathing, and bronchoconstriction
69
How should colloids be given to dogs, large animals, and cats
For dogs and large animals it is a bolus of 5 ml/kg and in cats 2.5 to 3 ml/kg over 15 to 20 minutes
70
What animals are at the greatest risk for fluid overload
Animals weighing less than 5 kgs and those w/ cardiac or renal disease
71
What are signs of overhydration
Ocular and nasal discharge, chemosis, subcutaneous edema, increased lung sounds, increased respiratory rate, and dyspnea
72
What is a macro drip set
Deliver fluids at a rate of 10 to 15 drops per ml
73
What is a micro drip set
Delivers fluids at a rate of 60 drops per ml
74
What is the patient cut off for using a macro or micro drip set
20 kgs
75
What are anesthetic agents
Any drug used to induce a loss of sensation w/ or w/o unconsciousness
76
What is an adjunct
A drug that is not a true anesthetic but is used during anesthesia to produce other desired effects such as anxiolysis, sedation, muscle relaxation, analgesia, reversal, neuromuscular blockade, or parasympathetic blockade
77
What are preanesthetic agents
Drugs given before general anesthesia
78
What are induction agents
Drugs used to induce general anesthesia
79
What are maintenance agents
Used to maintain general anesthesia
80
What are local anesthetics
Induce a loss of sensation in a localized area of the body
81
What are general anesthetics
Induce a loss of sensation over the entire body
82
What does muscle relaxants do
Decrease muscle tone
83
What do neuromuscular blockers do
Used to relax or paralyze skeletal muscles during ophthalmic, orthopedic, or other surgeries
84
What are anticholinergic agents used for
To decrease effects of parasympathetic nervous system
85
What is pharmacokinetics
The effect the body has on a drug
86
What is pharmacodynamics
The effect the drug has on the body
87
What do agonists do
Bind to and stimulate tissue receptors
88
What are antagonists
Binds to but does not stimulate tissue receptors
89
What are agonist-antagonists
Bind to more than one receptor type and stimultaneouslly stimulate at least one and block at least one
90
Why do many injectable anesthetics have a faster onset of action
Because they are highly lipid soluble
91
How are high lipid soluble drugs removed from the brain tissue
Tissue redistribution
92
What is tissue redistribution
A phenomenon that occurs because of the way in which some drugs are distributed to various tissues based on blood flow w/ absorption being the most rapid in vessel rich group
93
What kind of drugs can be mixed
Water soluble drugs can be mixed w/ other water soluble drugs
94
How long do controlled substance inventory logs have to be kept
For at least 2 years
95
What category of drugs should have their logs separte from other records
Schedule 3-5
96
What do electronic ordering systems use for ordering drugs and what does it do
A public key infrastructure verifies the identiy of those individuals and computers used in ordering drugs then encryps the info so others cannot read it
97
What are anxiolytics
Diverse group of agents administered at home prior to travel to the hospital for examination, anesthesia, surgery, or other stressful procedures
98
What are the main effects gabapentin can have on the body
Analgesic (nerve pain), anti-anxiety, and anticonvulsant
99
What are the main side affects of gabapentin
Sedation, ataxia, hypersalivation, and vomiting
100
What are the main effects of trazadone on the body
Behavior changes resulting in sedation and anxiolysis for situational anxiety and postop calming
101
What are adverse affects of trazadone
Sedation, sleepiness, lethargy, ataxia, basic GI issues, changes in appetite, agitation, excitement, behavioral disinhibition, and serotonin syndrome
102
What are anticholinergics commonly used for in large animals
To prevent and treat bradycardia and decrease salivary secretions from parasympathetic stimulation
103
What are cardiovascular affects of anticholinergics
IV injections can cause first or second degree AV blocks followed by sinus tachycardia
104
What are respiratory affects of anticholinergics
Reducing and thickening salivary secretions and bronchodilation increasing anatomical dead space (risk of hypoventilation and hypoxemia)
105
What are other adverse affects of anticholinergics
Mydriasis (dilation), reduced GIT secretions, reduced lacrimal secretions, and decrease intestinal peristalsis
106
What is a tranquilizer
Reduces anxiety but does not necessarily decrease awareness and wakefulness
107
What is a sedative
A drug that causes reduced mental activity and sleepiness
108
What are the 3 classes of tranquilizers or sedatives used in vet med
Phenothiazines, benzodiazepines, and alpha 2 agonists
109
How do phenothiazines affect the CNS
It calms the patient and reduces anxiety
110
What are other adverse affects of phenothiazines
Aniemetic, hypothermia, penile prolapse, decreased PCV, and antihistamine
111
What system is the most affected by benzodiazepines
The CNS
112
What are CNS effects of benzodiazepines
Antianxiety and anticonvulsant
113
What are other adverse affects of benzodiazepines
Skeletal muscle relaxation, disorientation and excitement in dogs, dysphoria and aggression in cats, muscle fasciculation in horses, and ataxia or recumbency in large animals
114
What is the reversible of benzodiazepines
Fumazenil
115
What are reversibles of alpha 2 agonists
Alpha 2 antagonists
116
What are CNS effects of alpha 2 agonists
Short lived analgesia, potent sediatve, temporary behavior changes, muscle tremors in horses, and recumbency in cattle
117
What are cardiovascular effects of alpha 2 agonists
Early dose dependent vasoconstriction that results in a brief period of hypertension, reflex bradycardia, pale mm, first or second degree AV blocks initially and decrease in cardiac output resulting in tissue perfusion
118
What are respiratory effects of alpha 2 agonists
Respiratory depression such as tidal volume and RR
119
What are other adverse affects of alpha 2 agonists
Muscle relaxation, increased effects of other anesthetics, GI effects such as decreased swallowing reflexes, hyperglycemia, hypothermia, increased urination, premature parturition, and sweat in horses
120
What are contraindications of using alpha 2 agonists
Geriatric, diabeties, pregnant, pediatric, or sick
121
What opioids are full agonists
Morphine, hydromorphone, and fentanyl
122
What opioid is a partial agonists
Buprenorphine
123
What opioid is a agonist-antagonists
Butorphanol
124
What are the CNS effects of opioids
Depression or excitement, sedation, anaglesia, increase intraocular and intracranial pressure, and increase in Paco2 in arterial blood
125
What is the cardiovascular effect of opioids
Dose related vagus induced bradycardia
126
What is the respiratory effect of opioids
Potential for dose dependent decrease in RR and tidal volume, thermoregulation center, and severe respiratory depression in higher doses
127
What are other adverse affects of opioids
Hypothermia in dogs, hyperthermia in cats, GI effects such as salivation or vomiting, increased responsiveness to noise, miosis (contraction) in dogs, mydriasis (dilation) in cats, sweating in horses, and decreased urine production and retention
128
What type of opioids have a stronger anaglesic affect
Pure agonists
129
What is macroemulsion
Particles of one liquid are large enough to scatter light
130
What is microemulsion
Particles of the dispersed liquid is too small to scatter light
131
What induction agent is safe for patients w/ liver and kidney disease and why
Propofol due to its metabolized rapidly
132
What are CNS effects of propofol
Dose dependent CNS depression ranging from sedation to general anesthesia and transient excitement and muscle tremors during induction
133
What are cardiovascular effects of propofol
Bradycardia, decreased cardiac output, decreased vascular resistance, and short duration hypotension
134
What are respiratory effects of propofol
Potent respiratory depressant, prolonged apnea, decreased oxygen saturation, and cynosis
135
What are other adverse affects of propofol
Good muscle relaxant, antiemetic, decreased intracranial and intraocular pressure, and pain w/ an IV injection
136
What are the benefits of using etomidate
It has a minimal effect on the cardio and respiratory systems
137
What are adverse affects of etomidate
Pain w/ IV injection, nausea, vomiting, good muscle relaxation, rapid injection can cause RBC hemolysis in cats, and depressed function of the adrenal cortical decreasing cortisol
138
What are the small cardiovascular and respiratory effects of etomidate
Breif period of hypotension and apnea
139
What is the only route etomidate can be given
IV
140
What is windup
Exaggerated response to low intensity pain stimuli that results in worsening of post op pain
141
What is a cataleptoid state
When a patient does not respond to external stimuli w/ muscle rigidity keeping the limbs in the position they were placed
142
What are CNS effects of dissociatives
Cataleptoid state, intact reflexes, no partial closure in the eyelids or rotation of the eyeball, normal or increased muscle tone, somatic anaglesia, sensitivity to sensory stimuli, and nystagmus
143
What are cardiovascular effects of dissociatives
Tachycardia, increase in cardiac output, increase in mean arterial pressure, decrease inotrophy, and increase the risk of cardiac arrhythmias that are a reponse in epinephrine
144
What are respiratory effects of dissociatives
Apneustic respiration, increase in salivation, and increase in respriatory tract secretions
145
What are other adverse affects of dissociatives
Tissue irritation, and increased intracranial and intraocular pressure
146
What determines the rate of diffusion of halogenated inhalations
The concentration gradient between the alveolus and the bloodstream
147
What should be on all syringes containing injectable agents
Patient identification, name of drug, and the drug concentration if there is more than one available
148
What is the benefit of using multiple agents in an anesthetic protocol
It reduces the amount of one agent being used therefore reducing the potential adverse side affects of the agents used
149
What does the word dymanics refer to in terms of veterinary anesthetic events
To the changes in the patient's level of consciousness over time
150
What is the most common method of inducing and maintaining general anesthesia in small animal patients
IV induction and inhalation to maintain
151
What does premedication mean
Administration of anesthetic agents and adjuncts to calm and prepare the patient for anesthetic induction
152
How long does mask or chamber induction typically take
About 5-10 minutes
153
What is the benefit of inducing after IM injections
It typically results in a smooth gradual CNS depression w/ little apparent excitement
154
What is a neuroleptanalgesic
Combination of an opioid and tranquilizer
155
What does "to effect" mean
Only the amount of injectable anesthetic necessary to produce unconsciousness instead of administering the entire dose calculated on a mg/kg basis
156
What is titration in terms of veterinary anesthesia
Series of bolus injections and discontinued when the desired depth is reched
157
How can IV injectable anesthetics be given if the procedure is going to last more than 20 minutes
Repeat boluses or CRI
158
What medications shouldn't be given via boluses or CRIs and why
Ketamine and midazolam because if large amounts of these anesthetics accumlate in the body it can prolong the recovery period
159
What type of inhalants make mask induction possible
Ones w/ low blood gas solubility coefficient
160
What type of oxygen flow rate requirements exist w/ mask induction
Increased oxygen flow rates
161
What are cautions of using mask induction
Significant exposure of personnel to waste anesthetic gas, should only be done on calm patients to reduce epinephrine release, patient's w/ a respiratory risk, patient's at risk for vomiting or regurgitation, keep airway open at all times, and significant dead space resulting in rebreathing of CO2
162
What are complications of anesthetic chambers
Stress, trauma, vomiting, airway blockage, and other issues
163
What are risks to using anesthetic chambers
Hospital personnel have a high exposure to WAGs, epinephrine release can lead to arrhythmias and hypotension, and shouldn't be used in patients that need rapid airway control
164
What IM injections can be used to induce general anesthesia
Telazol, TTDex, and doggie/kitty magic
165
What does TTDex stand for
Telazol, butorphanol, and dexmedetomidine
166
What is in doggie/kitty magic
Ketamine, butorphanol, and dexmedetomidine
167
What is anatomic dead space
Composed of portions of the breathing passages that contain air but no gas exchange takes place
168
What type of patient signalments require smaller than normal tubes
Brachycephalic breeds and obese patients
169
Why is intubating cats more difficult
Smaller size of their larynx, decreased visibility, and the predisposition to laryngospasm
170
What are signs that a patient is ready for intubation
Unconsciousness, lack of voluntary movement, absent pedal reflex, sufficient muscle relaxation to allow the mouth to be held open, and no swallowing when the tongue is grasped
171
What can happen if you force an intubation tube in a cat
Tracheal rupture, pneumothorax, and pneumomediastinum
172
Can normal patients develop minor irritation of the trachea or larynx
Yes, owners should be told coughing should be expected for 1-2 days
173
What is the benefit of using IV anesthetics w/ a CRI
Because it reduces the dose dependent vasodilation and resulting in hypotension
174
What injectable anesthetics are commonly used in a CRI
Fentanyl, hydromorphone, morphine, lidocaine, ketamine, and dexmedetomidine
175
How are most analgesic drugs that support the cardiovascular system and blood pressure given to patients
Using a syringe pump w/ a CRI in a IV catheter dedicated for this
176
What drugs are commonly given via syringe pump w/ its own IV access
Dopamine, dobutamine, phenylephrine, or norepinephrine
177
What is recommended to do differently w/ a syringe pump CRI in patients that are easily fluid overloaded
Raising the concentration of the drug
178
What is balanced anesthesia
Premedication, induction, maintenance, analgesia, and muscle relaxation
179
What can hyperflexion of the neck cause in intubated patients
ET obstruction
180
What is anesthetic recovery
The period between the time the anesthetic is discontinued and the time the animal is able to stand and walk w/o assistance
181
What breeds usually recover from anesthesia slower
Greyhounds, salukis, afghan, whippets, and russian wolfhounds
182
When does an anesthetist's intraoperative duties toward the patient end
When the patient is awake, alert, normothermic, and ambulatory
183
What can abnormal vital signs or a delayed return to consciousness indicate
A variety of serious conditions such as shock, hemorrhage, hypoglycemia, or hypothermia
184
What can a patient develop during recovery and not show any signs
Hypoxemia, caridac arrhythmias, and more
185
What are signs to extubate the patient other than a swallow reflex
Voluntary limb, head, or chewing movements
186
What are signs that a cat is ready to be extubated
Swallowing, palpebral, and voluntary limb, tail, or head movements
187
Why should a recoverying patient be rotated every 5-10 minutes
To prevent hypostatic congestion
188
What is anesthesia
State of controlled unconsciousness that affects the whole body or an isolated part or region of the body this is characterized by the absence of pain, memory, and motor response
189
What is general anesthesia
Unconsciousness and insensibility to feeling pain and induced by administration of anesthetic agents given alone or in combination
190
What is induction
The process that is used to take the patient from a state of consciousness to general anesthesia
191
What are benefits of using glycopyrrolate instead of atropine
Less likely to cause tachycardia, cardiac arrhythmias, ileus, and suppresses salivation more effectively
192
What are anticholinergics used for in large animals
Treatment of bradycardia and hypersalivation
193
What does RAT stand for
Xylazine, acepromazine, and butorphanol
194
What does BAG stand for
Butorphanol, acepromazine, and glycopyrrolate
195
What are side effects of ace in small animals
Dose dependent peripheral vasodilation, hypotension, hypothermia, hyperthermia, changes in HR, third eyelid prolapse, and paradoxical excitement or aggression
196
What are side effects of ace in horses
Excitement, sweating, tachypnea, and penile prolapse
197
What are signalments are a contraindication of using ace
Boxers, greyhounds, giant breed dogs, collies, australian shepherds, debilitated, young, or geriatric patients
198
What signalments are resistant to ace
Cats and terriers
199
What alpha 2 adrenergic can be used to induce vomiting in cats
Xylazine
200
What is the reversal for dexmedetomidine
Atipamezole
201
What are adverse affects of alpha 2 adrenergic antagonists
Apprehension caused by rapid arousal, excitement, muscle tremors, and salivation
202
What species are more sensitive to atipamezole
Cats
203
What can atipamezole cause in cats
Vomiting, diarrhea, and sudden arousal
204
What can be seen if alpha 2 antagonists are given too quickly IV
Excitement and aggression
205
What is euphoria
Exaggerated sense of well being
206
What is dysphoria
Restlessness or discomfort
207
What is propofol
A phenolic compound
208
What are affects of propofol
Decreases intracranial and intraocular pressure, provides muscle relaxation, and exerts antiemetic and anticonvulsant effects
209
What are adverse affects of propofol
Bradycardia, hypotension, seizure like symptoms, allergic reaction, heinze body anemia in cats, anorexia, lethargy, and diarrhea especially if given repeat doses or used on a daily basis
210
What are differences between propofol and alfaxalone
Alfaxalone causes minimal cardiovascular depression, no excitement, muscle twitching, or pain when injected IV
211
What can dissociatives induce a state of
Catelepsy or dissociative anesthesia when the patient appears awake but is immobilized and does not respond to its surroundings
212
What is a catelepsy state look like
Open central dilated eyes, nystagmus, normal or increased muscle tone, increased sensitivity to light and sound, and intact palepbral, pedal, and laryngeal reflexes
213
What does TKX mean
Telazol, ketamine, and xylazine
214
What does TDK mean
Telazol, ketamine, and dexdomitor
215
What is ketofol
Ketamine and propofol
216
What is the blood gas partition coefficient
The tendency of an agent to dissolve in blood
217
What is the blood gas partition associated w/
The speed of induction, recovery, and change in depth of anesthesia
218
What is MAC
The percent concentration of an agent required to prevent a response to surgical stimulation in 50% of patients
219
What does a high MAC mean
Drug is less potent
220
What is a murphy tube and why is it useful
It has a side hole called the murphy eye allowing for air flow in the event of a blockage of the tip
221
What is a cole tube used for
Small patients and birds
222
What type of laryngoscopes are straight
Miller blades
223
What type of laryngoscopes are curved
McIntosh blades
224
What is chemosis
Swelling of the conjunctiva
225
What is hypnotic
A drug that induces a state of sleep like sedation or a drug that causes prolonged immobility
226
What are benefits of using etomidate for anesthesia
Minimal changes in cardiovascular and respiratory functions and decreases both intracranial pressure and intraocular pressure
227
What are adverse effects of etomidate for anesthesia
Vomiting, muscle movements, sneezing, excitement during induction and recovery, suppresses adrenocortical function, phlebitis from IV injection, and rapid injection or repeat doses can cause hemolysis
228
What is the only way for guaifenesin be available
Getting it from compounding pharmacies
229
What is blood gas partition coefficient
The tendency of an agent to dissolve in the blood
230
What is the blood gas partition coefficient associated w/
Speed of induction, recovery, and change in depth of anesthesia
231
What are adverse effects of halogenated anesthetics
Vomiting, nausea, ileus, dose dependent respiratory depression, and dose dependent hypotension
232
What anesthetic agent is good w/ kidney or liver patients
Halogenated anesthetics
233
What are rules of using compressed gas cylinders
Never leave an unattended compressed gas cylinder unsupported or lying on its side, never attempt to remove the valve or index pins, when turning a tank on, keep skin and eyes clear of the valve port, and do not use oxygen near any source of ignition
234
When should oxygen cylinders be changed
When the pressure reaches 50 PSI
235
What is tidal volume
The amount of air that passes into or out of the lungs during a normal breath
236
What is the normal tidal volume
10-15 ml/kg
237
What should the relationship of the reservori bag and the patients tidal volume be
The reservoir bag should be at least 5x the patients tidal volume
238
What are principles of the ET tube
Prevents aspiration of stomach contents, blood, fluid, or other debris
239
What are the characteristics for readiness for placing the ET tube
Unconsciousness, lack of voluntary movement, sufficient muscle relaxation to allow the mouth to be held open, and absent pedal and swallowing reflexes
240
What can laryngospasms lead to
Hypoxia and cyanosis
241
What are complications of intubation regarding initial placement
Relatively resilient structures and excessive force will result in damage, perforation, rupture, or irritation of the delicate mucosa
242
What are the principles of patient monitoring
Monitor patients frequently using your hands, eyes, and ears, always check multiple parameters, never depend on instrumentation alone, and do not attempt to judge depth of anesthesia on the basis of drug doses or dial settings
243
What are examples of minor packs
Spay, neuter, and laceration packs
244
What are general packs
Soft tissue surgeries
245
What are bone packs
Orthopedic procedures
246
What are examples of specialized packs
Neurologic packs or vascular packs
247
What is the difference between satin finished instruments and polished instruments
Satin instruments are less resistent to spotting and discoloration so they need more vigilant cleaning and care
248
What are the steps for cleaning insturments
Rinsed w/ distilled or deionized water, soaked in commercial instrument detergent, scrubbed in insturment detergent, ultrasonic cleaner, rinse, dry, and lubricate in a milk bath
249
What are exogenous sources of contamination
Air, surgical instruments/supplies, patient's skin, and surgical team
250
What is endogenous contamination
Something that arises w/in the patient and reaches the wound as a result of bacteremia such as gingivitis or dermatitis
251
What are examples of physical sterilization
Filtration, radiation, and heat
252
What is commonly sterilized by filtration
Pharmaceuticals
253
What method of sterilization does not require a significant increase in temperature
Radiation
254
What are things that can be sterilizated w/ radiation
Gloves and some suture material
255
Which type of heat sterilization takes longer and is more difficult to control
Dry heat
256
How does moist sterilization work
Uses saturated steam under pressure to kill bacteria by coagulation of critical cellular proteins
257
How does dry heat destroy bacteria
By portein oxidation
258
What is the most commonly used liquid for sterilization
Glutaraldehyde
259
What are the most commonly used gases for sterilization
Ethylene oxide and hydrogen peroxide gas plasma
260
What does hydrogen peroxide gas plasma inactivate
Mycobacteria, bacterial spores, fungi, and viruses
261
What can't be sterilized w/ hydrogen peroxide gas plasma
Linen, wood, paper, endoscopes, some plastics, liquids, tubes, or catheters that are long or small in diameter
262
What are the two most commonly used antiseptic agents used in vet med
Povidone iodine and chlorhexidine
263
What things should be steam sterilized
Arthroscope or laparoscope, fiberoptic light cable, and camera
264
What ratio should chlorhexidine be diluted w/ sterile water
1:40 providing a 0.05% solution
265
What are aqueous iodine solutions
Higher levels of free iodine than iodophors giving it a greater bactericidal activity
266
Why can't aqueous iodine be used on living tissue
Because it is cytotoxic
267
What are iodophors
Contain iodine complexed w/ surfactants or polymers so that free iodine is slowly released
268
What is the most commonly used iodophor
Povidone iodine
269
What is the residual bactericidal activity of providone iodine
4-6 hrs
270
What can povidone iodine cause in 50% of patients
Skin irritation or acute contact dermatitis
271
What alcohols ineffective against
Spores, fungi, and viruses
272
What is the most commonly used quaternary ammonium compound used in disinfectants
Benzalkonium chloride
273
What are quaternary ammoniums
Synthetic, cationic, detergents that act on cell membranes and are effective against bacteria
274
What are quaternary ammoniums ineffective against
Spores and some viruses
275
What is chloride
A bactericidal and viricidal
276
What are the most commonly used aldehydes used in vet med
Formaldehyde and glutaraldehyde
277
What are aldehydes
Antimicrobial agents that are toxic and irritating that are require several hours of exposure time
278
What is formaldehydes used for
Preservation of tissue speciments
279
What is glutaraldehyde used for
Chemical sterilization in cold trays and endoscopic equipment
280
What can glutaraldehyde cause if it touches living tissue
It is carcinogenic, causes chemical synovitis, and injurious to chondrocytes
281
What is synovitis
Inflammation to the synovial membrane
282
What are chondrocytes
They maintain and create cartilage
283
How many cycles of presurgical scrub should be applied
3-5 circles
284
How is presurgical scrubbing done
It begins over the proposed incision site extends outward in a spiraling pattern
285
How are procedures such as feline onychectomy, tail docking, and dewclaw removal of neonatal puppies prepped
Unclipped surgical site and soaked or gently scrubbed w/ antiseptic solution and is swabbed w/ alcohol before
286
What is the standard minimum number of personnel needed to position a horse for surgery
3
287
What is the use of large exam gloves or obstetric gloves in prepping horses for surgery
They are used to cover the feet to reduce the contamination in the field
288
What is the anesthetist doing to prep the horse for surgery
Placing an arterial catheter, attaching the electrocardiography monitor, and attaching fluids to the IV catheters
289
What should everyone entering the OR have have on
A cap, mask, booties, and scrub suit
290
What is the contact time for surgical scrub on your hands
5 minutes
291
Why is closed gloving more sterile
Because the outside of the gloves never contacts the skin
292
What are the 2 layers of drapes that cover the animal
1 large drape that covers the entire animal and the instrument table and 4 quarter drapes
293
What factors are used to position the patient
The particular surgery to be performed, the number of surgeries to be performed, the surgical approach, and the draping technique for the procedure
294
What does a ventral midline incision allow good access for when doing abdominal sx
Peritoneal cavity and retroperitoneal
295
What should be done w/ contaminated instruments
It should be passed off the instrument table to an OR tech or placed in an isolated region of the instrument table
296
How do monopolar electrocautery work
It passes a current throught the target tissue and disperses the current through the patient to a ground pad underneath this has a cutting and coagulation mode and is most efficient w/ a dry surgical site
297
How does a bipolar electrocautery unit work
It passes a current between two tips of a forceps, is controlled by a foot switch, and is typically used in surgeries where precisely targeted cauterization is necessary
298
What is the most common temporary implant used for in vet med
Drains
299
What can drains cause when present in tissue
It may stimulate fluid production
300
What are passive drains
A gravity dependent drain that must be secured in place w/ the secured location readily accessible at the time of removal; this is used to drain subcutaneous wounds
301
What is the most common passive drains used in vet med
Penrose
302
What is an active drain
Use negative pressure to suction fluid an air from a wound this should be used in medium or large subcutaneous wounds and should be secured to the skin
303
What is suturing
Joining two surfaces together w/ a stitch or a series of stitches
304
How are most sutures selected
Should be at least as strong as the normal tissue through which it has been placed and the smallest diameter suture that will adequately hold healing tissues together
305
What is a swaged needle
Suture needles that are preloaded w/ suture
306
How are suture needles classified
According to size, shape, and type of needle point
307
What type of needle is most commonly used
3/8ths and 1/2 inch needles
308
How are needle points categorized
Cutting, tapered, or blunt
309
What controls the rate of diffusion of inhalant drugs
The concentration gradient between the alveolus and the blood stream
310
What are CNS adverse affects of using halogenated inhalents
Reversible depression, hypothermia, paddling, excitement, muscle fasciculations, and increased intracranial pressure if hypercarpnia is present
311
What are cardiovascular adverse affects of halogenated inhalants
Depressed cardiovascular function, dose dependent vasodilation, dose dependent hypotension, dose dependent decreased cardiac output, dose dependent tissue perfusion, and potential to decrease renal blood flow
312
What are respiratory adverse affects of halogenated inhalants
Dose dependent depression of ventilation by decreasing the tidal volume and RR, hypoventilation predisoposing the patient to hypercarpnia and respiratory acidosis, and respirtory arrest
313
What are other adverse affects of halogenated inhalants
Cross the placenta possible resulting in fetal respiratory depression and production of CO when exposed to desiccated CO2 absorbent
314
What does volatile mean in terms of vapor pressure
It evaporates readily
315
What concentration of isoflurane evaporation causes fatal anesthetic overdose
Over 30%
316
What type of vaporizer must be used w/ votile agents
Precision vaporizer
317
Can vapoizers be used for more than one inhalant agent
No separate vaporizors should be used for each
318
What is MAC used for
To determine the avg vaporizer setting that must be used to produce surgical anesthesia
319
What stage and plane of anesthesia will 1xMAC maintain
Stage 3 plane 1
320
What stage and plane of anesthesia will 1.5xMAC maintain
Stage 3 plane 2
321
What stage and plane of anesthesia will 2xMAC maintain
Stage 3 plane 3
322
What can MAC vary w/
Age, metaolic activity, body temperature, disease, pregnancy, and obesity
323
What inhalant is safest for cardiac patients
Isoflurane
324
Why is sevoflurane often used in equine anesthesia
High controllability of anesthetic depth
325
What are adverse affects of desflurane
Induces coughing and holding breath
326
What is known as one breath anesthesia
Desflurane
327
Why is nitrous oxide used
Used w/ other agents to reduce speeds of induction/recovery and adverse effects of the cardiovascular, pulmonary, and other systems
328
How does ET tubes decrease anatomical dead space
By transfering anesthetic gases directly from the anesthesia machine into the patients lungs transferring anesthetic
329
What are functions of ET tubes
Allow precise administration of inhalant anesthetics/oxygen, prevent pulmonary aspiration of stomach contents/blood, enables rapid response to respiratory emergencies, and allows the anesthetist to accurately monitor/control the patients respiration
330
What can excessive inflation of the endotracheal cuff result in
Decreased blood perfusion ot the tracheal mucosa, necrosis of the tracheal wall, or tracheal wall rupture
331
What are cole tubes used for
Species w/ complete tracheal rings such as birds and reptiles
332
What replaces the conventional cuff in safe seal ET tubes
6 baffles
333
What is a supraglottic airway device
Used to maintain an open airway in an anesthetized patients by connecting w/ the opening of the glottis
334
What is the function of the anesthesia machine
To deliver precise amounts of oxygen and volatile anesthetic under controlled contitions to patients undergoing general anesthesia
335
What are the 4 systems of the anesthetic machine
Compressed gas supply, anesthetic vaporizer, breathing circuit, and scavenging system
336
What are the functions of giving oxygen thru the compressed gas supply
To sustain normal cellular metabolism and to carry vaporized anesthetics to the patient
337
What is line pressure
Oxygen pressure remaining in the intermediate pressure lines after the valve is closed
338
What does an oxygen concentrator device do
Uses a compressor and special adsorbent to extract nitrogen from room air
339
What were nonprescision vaporizers onced used for
Delivering low vapor pressure anesthetics
340
What are the purposes of using reservoir bag
To prevent atelectasis, prevent hypercapnia/hypoxia, and to normalize respiratory rate
341
What is atelectasis
Collapse of lung alveoli
342
When should CO2 granules away be changed
6-8 hrs of use, every 30 days, hard/brittle, and changes to a purple color
343
What can excessive pressure in the breathing circuit result in
Dyspnea, lung damage, or pneumothorax
344
Why are nonrebreathing systems preferred in small patients
Its easier on their low respiratory drive and tidal volume
345
What are potential consequences of inhalating cool oxygen w/ anesthesia
Hypothermia, dehydration, damage to respiratory eithelium, thickening of respiratory mucus, bronchospasm, and inflammation
346
How often should anesthesia machines be evaluated by qualified repair professionals
Every 4-12 months
347
What parts of the anesthesia machine require no maintenance
Tank pressure gauge, line pressure gauge, pressure manometer, and oxygen flush valve
348
Why is monitoring necessary
To keep the patient safe and to regulate anesthetic depth
349
What vital signs indicate a response to anesthesia
Heart rate, heart rhythm, respiratory rate, respiratory depth, mucous membrane color, CRT, pulse strength, blood pressure, and temperature
350
What is a reflex
Involuntary response to stimulus
351
What reflexes are used in vet med to monitor while under anesthesia
Palpebral, corneal, pedal, swallowing, laryngeal, and pupillary light reflex
352
What are other indicators used in vet med when monitoring anesthetic patients
Spontaneous movement, eye position, pupil size, muscle tone, nystagmus, salivary secretions, lacrimal secretions, and response to surgical stimulation
353
What are normal patient responses to stage 1 of anesthesia
Tachycardia, tachypnic, panting, urination, and defectation
354
What are normal patient responses to the excitement stage 2 of anesthesia
Tachycardia, tachypnic, vocalizing, struggling, chewing, paddling, mydriasis, marked muscle tone, and present reflexes
355
What can stage 2 be so dangerous to our patients
There is a high risk of epinephrine release that can lead to cardiac arrhythmias or arrest
356
What are normal patient responses to stage 3 of anesthesia
Bradycardia, bradypnic, progressive muscle relaxation, gradual mydriasis, decrease in tear production, and loss of reflexes
357
Why is stage 3 plane 3 considered excessively deep for dogs and cats
It brings significant bradycardia, bradypnic, decrease in tidal volume, hypotension, decrease in pulse strength, pale mucous membranes, prolonged CRT, poor PLR, eyes are central, and mild to wide mydriasis
358
What are the best indicators of anesthestic depth
Reflexes, muscle tone, pupil size, eye position, and response to surgical stimulation
359
What is the swallowing reflex
Response to the presence of saliva or food in the pharynx
360
What is a laryngospasm
Sustained or exaggeration of the laryngeal reflex
361
What is associated w/ stage 3 plane 1 of anesthesia in ruminants
Spontanous blinking
362
What species can have a slight palpebral in a surgical plane of anesthesia
Horses
363
What is the pedal reflex
Flexion or withdrawal of the limb in response to vigorous squeezing, twisting, or pinching of SA patients
364
What is the corneal reflex
Retraction of the globe w/in the orbit and/or blink in response to stimulation of the cornea
365
What reflex is used to determine death
Corneal
366
At what stage of anesthesia is the PLR lost
Stage 3 plane 3 or deep surgical anesthesia
367
What are spontaneous movements that can be seen depending on anesthetic depth
Shivering, alternating flexion, extension of the limbs, muscle twitching, or tremors
368
What can provide a false interpretation of jaw tone when assessing anesthetic depth
Opening the patients mouth too wide
369
Why is gaging jaw tone not useful in large animal patients
Due to the size to their masseter muscle
370
Which species do we not look at eye position when gaging their anesthetic depth and why
Pigs because their eyes get quite sunken into the orbit
371
What is commonly seen during stage 3 plane 1 of anesthesia in horses
Fast nystagmus, increased lacrimation, and increased salivation
372
What are objectives of surgical anesthesia
Patient does not move, is not aware, does not feel pain, has no memory of the procedure afterward, and does not have dangerous depression of the cardiovascular/respiratory system
373
What are the 3 groups of vital signs
Reflection of circulation, oxygenation, or ventilation
374
What are common causes of tachycardia in anesthetized patients
Pain form surgical stimulation, hypotension, blood loss, shock, hypoxemia, and hypercapnia
375
What are common causes of tachypnea in anesthetized patients
Anticholinergics, alpha 2 agonists, cyclohexylamines, barbiturates, hypoxia, hypercarbia, heart disease, trauma, and gastric dilation volvulus
376
What species do we use a lead other than lead 2 to evaluate the heart's rhythm by itself
Horses we use the base apex lead
377
When does the patient's positioning affect the interpretation of ECG readings
When doing a complete electrocardiographic evaluation not when evaluating the heart rhythm only
378
Where is the S-T segment located on an ECG
Between the QRS complex and the T wave
379
What is the R wave
The first positive deflection after the P-R interval
380
How can the P-R interval be measured
Multiply the number of the small boxes between the beginning of the P wave and the QRS by 0.02 seconds or by 0.04 seconds depending on the paper speed
381
What are other causes of a 2nd degree AV block
High vagal tone, hyperkalemia, and cardiac disease
382
What is fibrillation
Chaotic uncoordinated contraction of small muscle bundles w/in the atria or ventricles
383
What two things regarding ECGs are associated w/ cardiac arrest
Ventricular tachycardia and PEA
384
What is CRT indicative of
Perfusion of the peripheral tissues w/ blood
385
What can cause a prolonged CRT
Vasoconstriction or hypotension caused by hypothermia, cardiac failure, excessive anesthetic depth, blood loss, or shock
386
What is systolic blood pressure
Produced by the contraction of the left ventricle as it propels blood through the systemic arteries
387
What is diastolic blood pressure
The pressure that remains in the arteries when the heart is in its resting phase
388
What is mean arterial pressure
The average pressure through the cardiac cycle
389
What is the most important part of BP to the anesthetist and what does it indicate
The MAP because it indicates the blood perfusion of the internal organs
390
How far can the MAP fall before there is a clinical risk to the oxygenation of tissues
Under 60 mmHg
391
Where can pulse strength be determined
Lingual, femoral, dorsal pedal, auricular, and carotid
392
What type of BP is measured using a sphygmomanometer
Systolic BP
393
What recumbency should the patient be in to get the most accurate BP reading
Lateral w/ the arm being at the level of the heart
394
Why are pale mucus membranes not a great indication of perfusion
Because other factors such as body temperature, vascular resistance, and gum disease can cause it
395
What are the two forms of oxygen in the blood
The unbound that is found in plasma and the bound that is found bound to hemoglobin
396
What can cause a decrease in the accuracy of the pulse oximeter reading
Tissue pigmentation, motion, excessive pressure, drying of mucous membranes, and patient conditions such as anemia, icterus, vasoconstriction, hypotension, hypothermia, or edema
397
What does ventilation mean
The movement of gases in and out of alveoli
398
What does respiration mean
The processes of oxygen being supplied to be used by the tissues and CO2 is eliminated from the tissues
399
What are indications of a narrow or obstructed airway such as fluid in the lungs
Harsh noises, crackles, gurgling, whistles, or squeaks
400
What is the normal ETCO2 rate in anesthetized patients
Typically 40-55 mmHg but up to 60 is acceptable
401
What are causes for an upward bump at the end of the expiratory plateau
Obese or pregnant patients due to changes in emptying of the alveoli or a lead in sampling line of a sidestream unit
402
What are causes for no waveform to be on the capnogram
Esophageal intubation, machine malfunction, sensor not properly connected, and cardiac arrest
403
What are causes for sudden loss of waveform on a capnogram
Apnea, cardiac arrest, ET tube disconnected, accidental extubation, complete ET tube circuit obstruction, machine malfunction, and ventilator malfunction
404
What are causes of hypocapnia
Hyperventilation, hypothermia, excessive mechanical ventilation, and reduced cardiac output
405
What are causes of rapid decrease in ETCO2
Cardiac arrest, severe blood loss, pulmonary embolism, and sudden hypotension
406
What are causes of hypercapnia
Hypoventilation, fever, muscle tremors, shivering, malignant hyperthermia, and inadequate mechanical ventilation
407
What are causes of a rapid increase in ETCO2
Return of spontaneous circulation after successful CPR and malignant hypothermia
408
What are causes to an increase in baseline of ETCO2
Due to the rebreathing of CO2 due to malfunction of expiratory unidirectional valve, saturation of CO2 absorbent, inadequate fresh gas flow w/ NRS, excessive dead space, and leak in the inner tube of a brain coaxial system or contamination of sensor w/ secretions
409
What are causes to a slow upward stroke on a capnogram
Slow expiration due to asthma or other obstructive lung disease or partially obstructed endotracheal tube or breathing circuit
410
What are causes to a plateau irregular or terminal dip in plateau on a capnogram
Leaky ET tube cuff or partially kinked ET tube
411
What can cause a cleft in the expiratory plateau on a capnogram
Pushing on the chest wall during exhalation, spontaneous breaths in a patient that is on a ventilator, or spontaneous breaths in a patient recovering from neuromuscular blocks
412
What are causes for oscillations during the expiration plateau on a capnogram
Cardiac contractions
413
What body temp can causes dangerous CNS depression and changes in heart function
89.6
414
What is an example of hypsodont teeth
Cheek teeth in horses
415
What are examples of aradicular
Cheek teeth and incisor in rabbits
416
What type of teeth do most mammals have
Diphyodonts
417
What numered quadrant is decidious 500
Right maxillary
418
What numbered quadrant is decidious 600
Left maxillary
419
What numbered quadrant decidious 700
Left mandibular
420
What numbered quadrant is decidious 800
Right mandibular
421
What does occlusion mean
Spatial relationship of teeth w/in the mouth
422
What is anisognathism
When the upper jaw is wider than the lower jaw
423
What is buccal mucosa
Mucosa that begin at the mucocutaneous junction and lines the cheeks and lips
424
What is alveolar mucosa
Mucosa that lies against the bone of the upper or lower jaw and meats the gingiva at the mucogingival junction
425
What is the periodontal probe used for
As a intraoral ruler to measure attachment levels, sulcus depth, pocket depth, loss of bone in furcation areas, size of oral lesions, mobility of teeth, and presence of gingival bleeding
426
What is a dental explorer used for
The sharp wire like tips are used to explore the topography of the tooth surface
427
Can shepherd's hook be used subgingivally
Yes
428
What is abrasion
Tooth wear associated w/ aggressive chewing on external objects
429
What is attrition
Tooth wear associated w/ tooth to tooth contact over time
430
What is the sensor used for direct radiography
Charged coupled device
431
What teeth can the parallel technique used for
Caudal to the mandibular third or fourth premolar
432
What structures appear radiodense blocking radiation appearing light on dental radiographs
Cementum, dentin, and bone
433
What are the two types of ultrasonic scalers
Magnetostrictive and piezoelectric
434
What is the part of the ultrasounic scaler that concerts electrical energy into mechanical energy
Transducer
435
What does the infraorbital nerve block
The tip of the needle rostrally on the ipsilateral maxilla
436
What does the middle mental nerve block
Ipsilateral rostral lower lip from the labial frenulum rostrally
437
What does the inferior alveolar nerve block
Soft tissue and bone of the entire ipsilateral mandible
438
What does the maxillary nerve block
Entire maxillary quadrant on buccal and palatal sides of teeth
439
How much attachment loss is needed for grade 3 periodontal disease
25%-50%
440
How much attachment loss is needed for grade 4 periodontal disease
50% or greater
441
What is the bass technique
Brush at a 45 degree angle against the tooth along the gingival margin to enable some bristles slide into the sulcus
442
What is the stillman technique
Used in areas of periodontal surgery where bristles apical to the gingival margin are moved w/ a gental sweeping motion in the coronal direction against the gingiva w/o placement of bristles into the healing sulcus
443
What are endodontics used for
Treatment of the inside of the tooth and periapical tissues
444
What is restorative dentistry
Restores or maintains the structure and function of a tooth
445
What teeth are crowns most commonly placed
Canines and maxillary fourth premolar
446
What are examples of class 1 malocclusions
Lingually displaced mandibular canines, anterior cross bite, and lance canine teeth
447
What are class 1 malocclusions
When the maxillary and mandibular jaw lengths are normal but one or more teeth are in an abnormal position
448
What can class 1 malocclusions result in
Oronasal fistula
449
What is a rostral cross bite
Occurs when a closed mouth examination reveals that one or more maxillary incisors are positioned lingual to the mandibular incisors
450
What are caudal cross bite
Occurs when one or more maxillary premolar or molar teeth are positioned lingual to the opposing mandibular premolar or molar
451
What are examples of class 2 malocclusions
Distoclusion, overjet, overshot, overbite, and mandibular distoclusion
452
What are class 2 malocclusions
Mandible is relatively shorter than the maxilla which is the result of either an abnormally long maxilla or an abnormally short mandible
453
What are examples of class 3 malocclusions
Mesioclusion, underjet, undershot, underbite, or a mandibular mesioclusion
454
What is a class 3 malocclusion
Maxilla is relatively shorter than the mandible this is a result of either an abnormally long mandible or an abnormally short maxilla
455
When is a class 3 malocclusion considered normal
When they are found in brachycephalic breeds such as boxers, boston terriers, bulldogs, and pugs
456
What are the three types of skulls
Brachycephalic, mesaticephalic, and dolichocephalic
457
What does a brachycephalic skull look like
Wide skull w/ a short maxilla
458
What does a mesaticephalic skull look like and what are a couple of examples
Well proportioned skull width and maxillary length examples are german shepherds and labradors
459
What does a dolichocephalic skull look like and what are a couple of examples
Narrow skull and a long maxilla examples are sight hounds and siamese cats
460
What is a wry bite
Unilateral maxillary mandibular asymmetry
461
What are interceptive orthodontics
The extraction of persistent deciduous or adults teeth that are causing or will cause problems associated w/ malocclusion
462
What are the only adult teeth that erupt mesial to the persistent decidous teeth
Maxillary canines
463
What is an uncomplicated tooth fracture
No pulp exposure
464
What is a complicated tooth fracture
Pulp exposure
465
What is the most common oral tumor in cats
Squamous cell carcinoma
466
What is the most common benign tumor dogs
Gingival tumor
467
What are the 3 types of gingival tumors found in dogs
Fibromatous, ossifying, and acanthomatous
468
What are the most common malignant oral tumors in dogs
Melanoma, SCC, fibrosarcoma, and osteosarcoma
469
What is stomatitis
Inflammation that extends beyond the mucogingival junction
470
What are causes of stomatitis
Ingestion of caustic substance, uremia, viral exposure, plant foreign bodies, allergic response to drugs, and immune mediated causes
471
What is masticatory myositis
Immune mediated disease in which the immune system forms antibodies toward a specific component of myosin found only in muscles of mastication
472
What are the most common causes of jaw fractures
Motor vehicle trauma, high rise syndrome, and severe periodontal disease resulting in pathological fractures
473
When should sick or injured animals be fed and why
As soon as they are able to eat and drink to avoid making them worse
474
What are medical reasons to push feeding patients
Medical therapies to correct fluid/electrolyte imbalances, decreased perfusion, any type of shock, infection, or pain
475
What issues can malnutrition cause in the GIT
Increase transit times, decrease absorption due to villi atrophy, and increase the risk of bacterial translocation
476
What issues can malnutrition cause in the kidneys
Increased excretion of urinary calcium and phosphorus w/ a decreased ability to excrete acid and decreased GFR
477
What issue can malnutrition cause the liver
Increase in gluconeogenesis
478
What issues can malnutrition cause the immune system
Decrease humoral immunity, barrier function, inflammatory response, leukocyte motility, and bactericidal activities
479
What issues can malnutrition cause the pulmonary system
Decreased response to hypoxia, decreased lung elasticity, secretion production, altered permeability, and decreased tidal volume
480
What issues can malnutrition cause the cardiovascular system
Increased incidence of arrhythmias and decreased weight of the heart muscle
481
How does malnutrition affect pharmacokinetics
It can alter the metabolism of certain drugs
482
Why is force feeding a bad idea
Because it causes food adversions
483
What are the common types of feeding tubes used in vet med
Nasoesophageal, esophagostomy, gastrostomy, and jejunostomy
484
How do we decided which feeding tube is best to use
Anticipated duration of nutritional support, need to circument, certain segments of the GIT, clinician experience, and the patients ability to withstand anesthesia
485
How long can NE tubes be in place
3-7 days
486
What types of tubes are used for NE feeding tubes
Polyurethane and silicon
487
What size of NE feeding tubes are recommended for dogs and cats
8 Fr for dogs and 5 Fr for cats
488
What sizes of feeding tubes are recommended for a pharyngostomy or esophagostomy tubes
8 to 16 Fr
489
What type of food administration is better for patients that vomit after each feeding
A slow continuous drip administered via a pump or gravity
490
What sizes of feeding tubes are recommended when placing a jejunostomy tubes
5 to 8 Fr
491
What parts of the GIT are bypassed w/ an jejunostomy tube
From the proximal duodenum and up
492
How should food be delivered to the patient when they have a jejunostomy tube
At a slow continuous drip rate
493
What are indications for patients needing assisted feedings
No longer than 72 hrs of hospitalization w/o eating, 10% or greater weight loss, 5% weight loss in young animals, and patient presents in a debilitating condition
494
How much of a horses day do they spend grazing
60% to 75%
495
How much of a horses body weight is ingested while grazing
2%
496
What is the purpose of arterial blood gas samples
Evaluating the patient's pulmonary function, gas exchange w/in the lungs, measurement of the oxygen and CO2 levels w/in the blood, and pH levels of the blood
497
What are the 4 most common arteries that are used to obtain arterial samples
Dorsal pedal artery, the dorsal metatarsal arteries, the femoral artery, and the lingual artery
498
When can the femoral and lingual arteries be used to obtain ABG samples
When the patient is unconscious or anesthetized
499
Where is the dorsal pedal artery located
On the dorsomedial aspect of the metatarsals just distal to the hock
500
Why is the dorsal pedal artery a good option of arteriopuncture
Because the interstitial connective tissue is much tighter than say the femoral artery making it well positioned and good at maintaining postpuncture hematoma formation
501
What sites are known for being the most common sites for ABG sample venipuncture
Dorsal pedal and dorsal metatarsal arteries
502
How long should direct pressure be applied to the dorsal pedal or dorsal metatarsal arteries after venipuncture
1-5 minutes
503
How do we avoid false ABG readings
By pushing all air out of the syringe and placing a rubber stopper at the end of the needle
504
What should be done before obtaining an ABG sample
All supplies should be gathered and prepped for immediate evaluation
505
What does ACT stand for
Activated clotting time
506
What does PT stand for
Prothrombin time
507
What does APTT stand for
Activated partial thromboplastin time
508
Why should we minimize the amount of tissue fluid that can enter a sample being used for testing clotting times
Because the thromboplastin w/ tissue fluid can initiate the clotting cascade creating a false reading
509
What are the most important aspects of venipuncture technique
Proper restraint of the animal and proper distention/immobilization of the vessel
510
What is a trick for immobilizing the cephalic vein of loose skinned patients
Flexing the carpus
511
Where can peripheral blood be collected when checking for erythropatasitic organisms or monitoring BG levels
Clipping the quick, lacerating the buccal mucosa, or using the marginal ear vein
512
Where is the marginal ear vein located
The dorsal aspect of the pinna
513
What are good ways to cause vasodilation of the marginal ear vein to make venipuncture easier
Using a heated cloth, a light source, or the technician's hand to warm the vessel
514
What is the best way to assess pulmonary function
An ABG
515
How does an ABG measure ventilation and oxygenation of the patient
Measuring the partial pressure of Co2 (PaCO2) assess ventilation and measuring partial pressure of oxygen (PaO2) assess oxygenation
516
What can an ABG sample be placed in a for a few hours if it can't be ran immediately or for transporting it to the lab
An ice water bath
517
What are the advantages of using a jugular vein catheter
Allows safe administration of fluids that have osmolality greater than 600 mOsm/L and constant rate infusions of drugs that cause phlebitis, enables measurement of central venous pressure, facilitates frequent aspiration of blood samples, and is neccessary for the administration of total parenteral nutrition
518
How is a patient restrained for jugular vein catheterization
Lateral recumbency w/ the head extended and its forelimbs positioned caudally by an assistant
519
What can be the benefit of placing things such as a bag of fluid, a sandbag, a roll of gauze, or a rolled towel under the patients neck when placing a jugular catheter
It will help stretch or flex the neck to make the vessel more accessible and stable
520
Who holds off the jugular vein while placing the jugular vein catheterization
The assistant
521
How is a jugular vein catheter secured after placing
Should be flushed w/ heparinized saline, capped w/ an injection cap or a T connector, flushed again w/ heparinized saline, sutured or stapled close to the insertion site before covering w/ a sterile 2x2 inch gauze pad, and the catheter site is bandaged
522
What type of catheter is a seldinger guidewire
A multilumen catheter
523
Where do the jugular catheters placed w/ seldinger guidewires lie
W/in the thoracic inlet just cranial to the right atrium
524
How is seldinger guidewire measured prior to placing the jugular catheter
Distance from the intended insertion site to the caudal edge of the triceps muscle
525
What is made prior to starting to insert the seldinger guidewire when placing a multilumen jugular catheter
A small relief incision through the dermis
526
What is the only point of a multilumen jugular catheter that is not capped
The distal port
527
When is a throacic drain or chest tube indicated in patients
When they have needed 2 or more thoracocenteses w/in a few hours
528
Where are chest tubes placed
Seventh, eighth, or ninth intercostal space at the junction of the upper 1/3 and lower 2/3 of the thorax
529
How long is the lidocaine bleb allowed to sit prior to placing a chest tube
5 minutes
530
What type of catheter is a introducer used for chest tubes
Over the needle
531
Why is a 3 way stop cock used at the end of a chest tube
To prevent air from entering the chest
532
What can provide clues for underlying causes of dyspnea
Respiratory pattern and performing careful auscultations
533
What does the angle for an arteriopuncture look like
It is steep often perpendicular to the artery
534
What continous monitoring is required for ventilator patients
Arterial catheterization, direct blood pressure monitoring, ETCO2 monitoring, pulse oximetry, temperature monitoring, and placement of a central line and indwelling urinary catheter
535
What are nursing care tasks that make ventilator patients highly labor intensive
Every 4-6 hrs administration of an eye lubricant, swabbing of oral cavity to remove secretions, inspection of all catheters, inspection and maintenance of the ET or tracheostomy tube, passive range of motion exercises, and repositioning to prevent pressure ulcers
536
What is a common complication of patients being on a mechanical ventilator and what can it result in
Pneumonia can lead to sepsis and organ failure
537
What patients are at risk for CPA
Underlying cardiac or respiratory disease, trauma, critical illness, anesthesia complications, shock, acid base or electrolyte disorders, seizures, anemia, or increased vagal stimulation
538
What are indications that a patient might suffer a CPA
Sudden tachycardia or bradycardia, pallor, changes in pusle strength, increased respiratory rate or effort, and acute agitation or depression
539
What compression method is used for keel chested dogs such as greyhounds
Cardiac pump
540
What is the cardiac pump method of CPR
Used to compress the heat directly over the fifth intercostal space in lateral recumbency
541
What compression method is used for round chested dogs
Thoracic pump
542
What is the thoracic pump method of CPR
Compressions are applied to the widest part of the chest around the 7th intercostal space in lateral recumbency allowing the heart to function passively pushing blood out of the ventricle w/ compressions and blood to enter the right atrium w/ relaxation of the thorax
543
What can be used to enhance venous return to the heart during CPR
Interposed abdominal compressions
544
How are interposed abdominal compressions done
The abdomen is compressed during the recoil phase of the chest compression
545
What are complications of abdominal compressions
Organ contusions and hemoabdomen
546
What does open chest CPR involve
Making an incision in the left fifth intercostal space, freeing the heart from its attachments, and directly massaging the heart from the apex to the base
547
What acupuncture point can be used to stimulate the respiratory center of the brain
Governing vessel 26
548
Where is governing vessel 26 located
Nasal philtrum at the level of the ventral edge of the nares down to the bone and twirl
549
What are the 2 ECG categories while a pet is in a CPA
Asystole or PEA and pulseless ventricular tachycardia or ventricular
550
What is the treatment of choice for pulseless ventricular tachycardia or ventricular fibrillation
Defibrillation that is done after the first 2 minute cycles of CPR if this does not work chest compressions are resumed for another 2 minute cycle
551
What are contraindications of giving emergency drugs IT
Pulmonary conditions such as pulmonary edema
552
What type of fluids are given during hypovolemic or hemorrhagic shock
Small crystalloid boluses of 10-15 mL/kg followed by colloid after return to spontaneous circulation
553
What are cardiovascular postarrest affects that can be seen
Ischemia, reperfusion injury of heart muscle, effects of inflammatory mediators or other substances released by the peripheral circulation, and drugs used during CPR such as epi and atropine could lead to severe arrhythmias and systemic hypotension
554
What are respiratory system postarrest affects that can be seen
Pulmonary edema, atelectasis, pulmonary thromboembolism, acute respiratory distress syndrome, pulmonary contusions, hemorrhage, and rib fractures
555
What do bandages protect wounds from
Contamination and self mutilation
556
Why do we leave 2 middle toes exposed for most limb bandages
Swelling and balance
557
What is important to include in a bandage that is stabalizing a fracture
The joint distal and proximal to the fracture
558
What are the functions of the modified robert jones bandage
Prevention of post surgical edema and wound management
559
What are functions of the robert jones
Temporary immobilization of fractures distal to the humerus and femur using a large bulky bandage to provide rigid stabilization
560
What are the functions of the bergh bandage
Prevention of post surgical edema and wound management
561
What is the unique characteristics of the bergh bandage
It has tape stirrups go up the entire length of the limb to prevent slippage of bandage
562
What is an indication of using a bergh bandage
Short legged cats and dogs
563
What are functions of an abdominal bandage
Used for hemostasis of abdominal bleeding and absorbs wound exudate
564
What are functions of the head bandage
Post aural hematoma surgery to secure 1 or both ears on the top of the head
565
How is the head bandage secured
Use the opposite ear than what is secured in
566
What is the function of neck bandages
Jugular catheter and hematoma reduction
567
How do we determine if the neck bandage is 2 tight
Must be able to insert 2 fingers under the bandage cranial and caudal
568
What are the functions of the inguinal bandage
Post inguinal surgery and scrotal hemorrhage
569
What does the criss-cross pattern allow for w/ an inguinal bandage
Free limb motion, minimal pressure on peripheral veins, and exposure of vulva and anus
570
What are closed toe bandages used for
Broken nail, post foot surgery, and post declaw
571
What is the function of the velpeau sling
Immobilizes shoulder post dislocation or reduction of the humeral head into the glenoid cavity and scapular fractures that don't require open reduction or internal fixation
572
What is the function of ehmer sling
Hip joint immobilization post coxofemoral dislocation reduction
573
What is the only tape that should be used w/ an ehmer sling
Adhesive such as elastikon
574
What foot rotation helps keep the femoral head in the acetabulum in the ehmer sling
Hock out and toes in
575
What is a tongue depressor splint used for
Metatarsal/metacarpal and digit fracture stabilization
576
What should be done before putting the splint on a tongue depressor splint
Pad the foot before applying the splint
577
What are indications of a tube gauze bandage
Same as a closed toe bandage and possibly a tail amputation
578
How is a vaginal cytology obtained
Moisten a cotton tipped applicator w/ saline, part labia of vulva w/ fingers, pass swab craniodorsally into the caudal vagina w/ care to avoid the clitoral fossa, once cranial to the urethral orifice roll the swab against vaginal wall to collect cells, roll swab gently across once end of a microscope slide two to three times to minimize distortion of cells, and allow the slide to air dry
579
What is an alternative way to collect a vaginal cytology and why is it not recommended
By using a bulb pipette containing sterile saline to flush and aspirate from the vagina however this method can cause cell distortion
580
What is trichrome stain used for regarding vaginal cytologys
Aids identification of keratin precursors w/in cells
581
What does dyschezia mean
Difficulty or painful defecation
582
What can be confused w/ an anal gland abscess
Perianal adenoma
583
What are characteristics of perianal glands
Small and numerous glands that surround the anus and contain both sebaceous and non sebaceous
584
Where are sublingual vessels located
On the distal portion of the tongue lateral to the frenulum
585
How is the sublingual injection done
Insert the needle bevel up and use gentle aspiration to avoid collapse of the vein
586
How do you know placement of the sublingual injection was correct
The vessel will clear when injecting
587
When can the marginal ear vein be used for veinpuncture
When needing small amounts of blood such as measuing blood glucose that need checked frequently
588
What is the purpose for putting vaseline when doing a marginal ear vein stick
Allows the blood to pool on top of the ear and not diffuse in the hair
589
What is the lacrimal apparatus responsible for
Production and drainage of tears from the surface of the eye
590
What do lacrimal glands produce
The tear film that flows down the surface of the cornea
591
What is the function of the lacrimal puncta
The tears produced by the lacrimal glands is drained from the surface of the eye
592
Where is the lacrimal puncta located
On the medial canthus of each eye
593
What is the path of tears after they flow thru the lacrimal puncta
They travel to the nasolacrimal sac then is carried thru the duct to the nasal cavity then exits thru the nasal punctum
594
What things can obstruct the nasolacrimal system indicating the need for a nasolacrimal duct flush
Cellular debris, mucus, lesions, tissue scarring secondary to herpes, and congenital abnormalities
595
What is the clinical presentation of an animal in need of a nasolacrimal duct flush
Watery mucoid ocular discharge and tear staining under the medial canthus
596
How is a nasolacrimal duct flush done
After sedating or anesthetizing an animal evert the eyelid to expose the punctum then insert the cannula into the punctum directing toward the medial canthus of the eye after sliding the cannula gently through the duct system gently flush, fluid should come out of the opposite punctum once observed gently apply pressure that punctum to redirect the flow through the nasolacrimal duct to the nasal punctum
597
How do you know if the nasolacrimal duct is obstructed while doing a nasolacrimal duct flush
If its obstructed you won't see the fluorescein stain drain from the nasal punctum
598
What humidity levels are maintained to keep the oxygen therapy moist air
50%
599
What is blow by oxygen therapy
Tubing from an oxygen tank is placed in front of the patient's mouth w/ a high flow rate typically around 3 to 10 liters/min resulting in a inspired oxygen concentration of approximately 40%
600
What is mask oxygen therapy
Anesthetic mask connected to an oxygen souce placed on the patients face after removing the rubber diaphragm from the mask this results in a inspired oxygen concentration of approximately 50%
601
What is the down side of using masked oxygen therapy
They are not tolerated well by patients in respiratory distress
602
What oxygen flow rate is used w/ masked oxygen therapy to prevent a buildup of carbon dioxide
Minimum 100 ml/kg/min
603
How is an oxygen collar made and used
Place an oversized E-collar on the patient then put plastic wrap over the bottom 2/3 of the collar then place an oxygen supply line under the patient's chin resulting in an inspired oxygen concentration of approximately 60%
604
What is the required oxygen flow rate when using the oxygen collar
2 to 6 liters/min
605
What is a caution of using an oxygen collar
Build up of heat and CO2 is possible in panting patients
606
What oxygen flow rates are requried when using an oxygen cage
HIGH
607
What are the disadvangates of using oxygen cages
Every time the cage is opened for treatments or exams the inspired oxygen concentration drops and there is a risk of building up heat and CO2
608
How long does it take to achieve an therapeutic oxygen levels of 50% in an oxygen cage
20 mins
609
Where is a nasal oxygen catheter placed and where does it lie
In the ventral nasal meatus lying in the nasopharynx
610
What is the oxygen flow rate used w/ a nasal oxygen catheter
50 to 100 ml/kg/min resulting in a 40%-80% inspired oxygen concentration
611
What are contraindications of using a nasal oxygen catheter
Epistaxis, coagulopathies, and head trauma
612
How is a nasal oxygen cathetr placed
Apply 2-3 drops of topical anesthetic in both nares then measure the red rubber cathet from the alar notch to the medial canthus of the eye marking where it should exit the alar notch, lubricate the catheter w/ lidocaine gel then insert it in a dorsomedial direction then suture the catheter in place along the nasal sulcus between the eyes or lateral to the base of the ear
613
What is the trick for correctly placing a dog nasal oxygen catheter
Push the nasal planum dorsally and direct the tube ventromedial
614
What is the mechanical phase of hemostasis
Primary hemostasis when the endothelium attracts the platelets at the injury site where they begin to adhere to each other releasing the initiating factor to begin the chemical phase
615
What is the chemical phase of hemostasis
The secondary and tertiary hemostasis when the coagulatio cascade begins w/ coagulation factors participates in a chemical reaction that initiates the next step w/ an end result is a mesh of fibrin strands that form a clot
616
What are common tests used for coagulation screening
Platelet count, platelet estimate, ACT, PT, aPTT, and BMBT
617
What is the normal platelet range
200,000-500,000
618
When is a platelet count or estimate inaccurate
In cases of a coagulation disorder resulting in platelet clumping or RBC overlap
619
What does ACT (activated clotting time) test and what test tube is used
The intrinsic pathway and uses a grey top tube
620
What is the normal value of an ACT (activated clotting time) test
60-90 seconds
621
What does the PT (prothrombin time) test and what test tube is used
The extrinsic pathway and uses a blue top tube
622
What is the normal value of the PT (prothrombin time) test
7-10 seconds
623
What does a prolonged PT (prothrombin time) test indicate
Sever liver disease, DIC, and factor deficiency of the extrinsic pathway
624
What does the aPTT (activated partial thromboplastin time) test and what test tube is required
The intrinsic pathway and uses a blue top tube
625
What is the normal value of the aPTT (activated partial thromboplastin time) test
9.5-10.5 seconds
626
What is the BMBT (buccal mucosal bleeding time) test
Platelet number/function and a deficiency of factor VIII decreasing vonWillebrands factors ability to gather platelets
627
What does factor VIII aid in
Parts of primary hemostasis such as platelet aggregation at initiation of coagulation pathway
628
What breed of dog are more likely to have a deficiency of factor VIII
Dobermans
629
What is the normal value of a BMBT
<4 minutes in dogs and <3 minutes in cats
630
What toxicity will produce a normal BMBT
Anticoagulant rodenticide toxicity
631
T/F the BMBT is used to diagnose a specific disorder
False it is used for perliminary information indicating there is something wrong w/ primary hemostasis
632
What supplies are needed for a BMBT
BMBT lancet, blotting paper, gauze, and timer
633
How is BMBT done
W/ the patient in lateral recumbency tie a piece of gauze around the proximal maxilla w/ the lip everted to expose the buccal surface, place the lancet firmly on the cheeks above the premolars, then activate the lancet to make a standardized incision and start the timer
634
What makes the MBMT specific to primary hemostasis
The standardized depth of the incision preventing the need for fibrin formation
635
T/F it is important to make sure we do not touch the incision of the BMBT when we blot the blood
True doing so will affect the platelet plug formation
636
What does prolongation of the BMBT test indication
Platelet dysfunction, thrombocytopenia, or vWF deficiency
637
What are the indications of urinary catheterization
If the patient is either post surgical, paralysis, or is having a UA done
638
What are complications from a urinary catheterization
Trauma to the bladder or urethra and infection
639
When are metal urinary catheters used
Temporary catheterizing female dogs
640
When are polypropylene urinary catheters used
Temporary catheterizing male dogs
641
When are red rubber urinary catheters used
When catheterizing male dogs and sometimes cats
642
When are foley urinary catheters used
When catheterizing male and female dogs
643
What assists in placement of foley urinary catheters
The removable stylet
644
When are tom cat urinary catheters used
When temporary catheterizing male cats
645
Why are tom cat catheters not recommended for long term urinary catheterization
It causes a very reactive and traumatic reaction
646
How long should urinary catheters be
From the tip of the penis/vulva to the neck of the bladder
647
How do we straighten the sigmoid flexure when catheterizing male cats to allow the catheter to pass over the ischial arch
After initially placing the catheter let the penis retract into the prepuce and gently grasp the skin then pull the prepuce caudal and ventral while advancing the catheter
648
Where is the speculum directed when placing a urinary catheter in canine females
In a cranial and dorsal direction
649
How is the bladder isolated when doing a cystocentesis
Find the water balloon that slips in between your fingers then close your fingers around the caudal end of the bladder making the bladder just cranial to your fingers then pull your whole hand slightly cranial to create a bit of tension to fully isolate the bladder and prevent it from slipping
650
What can you do if you can't isolate the bladder in a dog
Draw an X between the last 4 teats and insert the needle where the X crosses
651
What are clinical applications to orogastric tubes
GDV gas decompression, administer large quantities of liquids/medications, route for feeding, and if the tube can be left in only for time needed to deliver meds/food
652
What are contraindications of using an orogastric tube
Patients w/ respiratory distress
653
What are complications of placing an orogastric tube
Potential for aspiraton so placement should be confirmed
654
Why should an orogastric tube be kinked before removal
It prevents contents of the tube from being aspirated
655
What are clinical applications for a nasoesophageal and nasogastric tubes
If a temprary method of tube feeding is needed w/ thin liquid diets
656
What are contraindications of placing a nasoesophageal and nasogastric tubes
Vomiting patients, head trauma, facial trauma, esophageal damage/disease, and tumors in the nasal passage
657
What are complications of placing a nasoesophageal and nasogastric tubes
Aspiration so placement should be confirmed
658
How should a nasoesphageal and nasogastric tubes be maintained
Flushed before and after meals to maintain patency and clean accumulated nasal secretions at nares daily
659
What are long term enteral feeding options
Esophagostomy, gastrostomy, and jejunostomy
660
Where is an esophagostomy tube
Enters the esophagus at the mid cervical area and ends in the distal esophagus
661
What are clinical applications for a esophagostomy tube
Head trauma, facial trauma, jaw fractures, mouth tumors, hepatic lipidosis, and kidney failure so they can get their full nutritional needs met
662
When is a good inidication that a esophagostomy tube can be removed
When the animal starts eating normally w/ the tube
663
Where are esophagostomy tubes typically sutured to the animal
At the periosteum of the atlas
664
What are contraindications of an esophagostomy tube
Vomiting patients and those w/ diseases in the proximal GIT
665
How should an esophagostomy tube maintained
Flushed w/ water before and after feeding to keep patient, capped when not used, should not feed patient for 24 hrs after placement to allow seal to form, check for signs of infection, and change the bandage every few days
665
What are complications of an esophagostomy tube
Kinking of the tube, clogging of tube, infection at insertion site, inappropriate placement, and patient vomits it up
666
How should a pateint w/ an esophagostomy tube be fed
Slowly for 5-15 mls every 2-3 hrs allowing the animal to swallow after every 5 mls
667
How is a clogged esophagostomy tube fixed
Placing coca-cola in the tube for a few hours then flush w/ water so the carbination can dissolve the contents
668
How can gastrostomy tubes be placed
W/ a surgical laparotomy and endoscope
669
What is another term for gastrostomy
PEG tube (percutaneous endoscopic gastrostomy)
670
What are clincial applications for a gastrostomy
Esophagitis, esophageal trauma, pancreatitis, oropharyngeal disorders, nasal neoplasia, hepatic disease, and megaesophagus
671
How long can gastrostomy tubes be placed
Moths to years
672
How long can an esophagostomy tube be placed
Weeks to months
673
What are contraindications for placing a gastrostomy tube
Patients w/ stomach disease
674
What are complications of gastrostomy tubes
Accidental premature removal and irritation to the stomach
675
How is a gastrostomy tube maintained
Flushed before and after feeding, aspirated prior to feeding to ensure the past meal is out of the stomach, and monitor insertion site for signs of infection
676
What covers the insertion site of gastrostomy tubes
Stockinette or a shirt
677
What are clinical applications for placement of a jejunostomy tube
Patients that have a major dysfunction of the proximal GIT such as gastric mucosal disease, delayed gastric emptying, pancreatitis, vomiting, and post foreign body surgery
678
What are contraindications of a placing a jejunostomy tube
SI damage
679
What are complications of having a jejunostomy tube
May cause cramping and diarrhea, can induce jejunal perforation, subcutaneous leakage, peritoneal leakage, and premature removal
680
How is a jejunostomy tube maintained
Must be flushed to maintain patency and can only use liquid diet
681
What tubes can not be used to pill animals
Gastrostomy and jejunostomy tubes
682
T/F: An ECG gives an all inclusive understanding of the electrical conductivity, mechanical, or pumping ability of the heart
False it can only assess the electrical activity
683
What is the electrical state of the heart at rest
Polarized w/ the intracellular fluid being more negative and the extracellular fluid being more positive
684
What is the sinoatrial node
Strip of specialized muscle tissue that is located at the right atrium at the level of the cranial vena cava
685
What is the atrioventricular node
Located in the septal wall of hte right atrium this continues and slows the impulse generated in the SA node allowing the ventricles to fill w/ blood
686
What is the Bundle of His
Receives impulse from the AV node and carries it through the ventricular septum via the right and left bundle branches
687
What are the right and left bundle branches
Divisions of the Bundle of His that carry the electrical impulse through the ventricular septum
688
What are the Purkinje fibers
The terminal ends of the bundle branches that continue the electrical impulse to the ventricular walls
689
What parts of the electrical pathway of the heart is responsible for ventricular depolarization
The AV node, Bundle of his, bundle branches, and purkinje fibers
690
What position does the patient have to be in for an ECG if heart enlargement is suspected
Right lateral recumbency
691
What ishte sensitivity setting of the ECG
Adjusts the amount of movement the recording stylus makes in response to the mv of electric charge recieved from the patient
692
What can be done if the waveforms are too small on and ECG
The sensitivity setting can be changed to 2 doubling the amount of boxes to 2 cm from 1mv charge
693
What is the standard paper speed for dogs and cats and what does each small box equal on this setting
50mm/sec making each small box on the horizontal axis equal 0.02 seconds
694
How long should an ECG recording be
5-6 complexes
695
What can an absent P wave indicate
Atrial conduction problems or electrolyte imbalance
696
What do upright and narrow QRS complexes indicate
Supraventricular problems
697
What do wide and bizarre QRS complexes indicate
A ventricular problem
698
What does the S-T segment being elevated off the baseline indicate
Electrolyte imbalances or hypoxia
699
What do long and high T waves indicate
Hyperkalemia or hypoxia
700
What are corrects for 60 cycle interference
Clean clips, turn out lights, unplug appliances, and check electrode attachment
701
What is the volume for CO (cardiac output)
HR x SV (stroke volume)
702
What is the formula for BP
BP = CO x PVR
703
What is the top number in a BP measurement
Systolic the highest pressure during the cardiac cycle
704
What is the pulse pressure
Difference between systolic and diastolic
705
What is the normal systolic pressure in dogs and cats
110-160
706
What is the normal diastolic in dogs and cats
70-90
707
What is the normal MAP for dogs and cats
85-120 and 80-100
708
What is the normal systolic for horses
90-130
709
What is the normal diastolic for horses
65-85
710
What is the normal MAP for horses
75-100
711
What is the normal systolic pressure for bovine
120-150
712
What is the normal diastolic for bovine
80-110
713
What is the normal MAP for bovine
90-120
714
What are advanatages of measuring direct BP
More accurate in all species and physiological conditions while allowing for continuous monitoring
715
What are disadvantages of measuring direct BP
Invasive, requires higher technical skill, time consuming, more costly, and higher risk for complications in the patient
716
What should the size of an indirect BP cuff be
40% of the circumference of the limb
717
What are advantages to measuring indirect BP
Quick, non invasive, and relatively inexpensive
718
What are disadvantages of measuring indirect BP
Time consuming, learning curve for technician, and systolic measurement only
719
What are advantages to measuring BP w/ an oscillometric
Noninvasive, relatively inexpenisve, widely available, and can be used for continuous monitoring under anesthesia
720
What are disadvantages of measuring BP w/ an oscillometric
Not accurate in small animals under 4kg, animal movement and cardiovascular status can affect reading, and proper size/placement of cuff is critical
Vet Tech 3
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