MSAT two Flashcards

Question

Describe your method for intravenous regional anaesthesia of the distal hind limb ?

Answer 1

Regional anaesthesia of the distal hind limb (This block the entire distal hind limb) Method - tourniquet rubber tubing - 21G butterfly catheter or 21G 1.5" needle - 20ml lignocaine Method Venous plexus - ensure surgical prep and restraint - tourniquet - inside the second crease midline (about 2.5cm below the fetlock) - insert needle only quickly full length - manipulate until you see blood - attach syringe (no draw back) quickly inject anaesthetic solution Method dorsal digital vein - ensure restrain, surgical prep and tourniquet in place - push down on the dew claws - palpate vein - place needle - inject anaesthesia with no draw back Takes 10-15mins to take effect. Tournequet may be safely left in place upto one hour. When complete slowly release tourniquet over a period of about 10sec, avoids risk of toxication into the systemic circulation.

Answer 2

Horse; Four sites for venipuncture 1. Jugular vein 2. Cephalic vein 3. Lateral thoracic vein 4. Facial venous sinus Location transverse facial sinus - place finger and thumb at the lateral and medial canthus of the eye, bring fingers together to a point approximately 2cm below the facial crest.

Answer 3

Four locations for an arterial pulse - Transverse facial artery - Facial artery - Digital artery - Carotid artery transverse facial artery = blue paint

Answer 4

Four intramuscular injection sites. 1. Neck triangle - ventral to nuchal ligament - dorsal to the cervical vertebrae - cranial (about a hand) to the scapular. 2. Semitendinosus / semimembranosus 3. Gluteal muscles 4. Pectoral muscles

Answer 5

Venipuncture of the jugular; equine 1. Aim to inject proximal 1/3 of neck (further back the jugular groove is less visable and the carotid is more superficial) 2. Swab (alcohol) dampens fur to make the jugular more visable, no sterility is obtained 2. Place thumb in jugular groove and pull trachea twoards you. May stroke the jugular enabling visualisation of the fluid wave. 3. Hold needle at right angles to thumb and index allowing fast wrist action for placement. 4. Place needle (syringe unattached) should see dribble of blood. Release hand occluding the jugular to ensure needle is not within the carotid (blodd will still flow if wrongly placed). 5. hold hub of needle or place thumb underneath and with draw sample.

Answer 6

Indications for the use of bandages 1. Arrest haemorrhage 2. Wound protection (environment, self trauma, transport) 3. Prevent or reduce swelling 4. Assist healing

Answer 7

Leg wrap / transport bandage Purpose - Cover and protect wound wraps, protection during transit, protection of the underlying structures of the limbs and carpus. Materials required Two layers 1. Soft orthopedic padding; - gamgee, cotton wool or a combination 2. Polo wraps - to ensure bandage stays in place

Answer 8

Procedure; application of a leg wrap Two layer; soft padding gamgee + polo wraps 1.Ensure the area to be wrapped is thouroughly cleaned and dry 2. Each layer should be wrapped front to back, outside to inside (counter clockwise on left legs, clockwise on right legs). 3.Place padding layer evenly over the area to be wrapped and around the limb. Ensure that the padding is wrinkle free and as smooth as possible 4.With firm pressure (50%) stretch apply polo wrap over the padding spirralling down. Each layer should overlap by 50% 5. You should aim for two complete layers of polo wrap. 6. The bandage should include the fetlock for stabilization and support. 7. The polo wrap should be started just below the carpus to avoid points of pressure. 7. Neatness counts trim any excess cotton

Answer 9

Pressure bandage Purpose To apply pressure to the underlying structures. Often used to mitigate oedema in the distal limbs. This may also be used to prevent more proximal banadages from slipping down the limb. Recommended supplies Three layers 1. Thick padding - gangee, cotton wool or a combination dressing 2. Conforming layer 3. Tertiary layer vetwrap or Elastoplast

Answer 10

Application of a compression bandage to the distal limb 1. Ensure the area to be wrapped is thouroughly cleaned and dried 2. Each layer should be wrapped front to back, outside to inside (counter clockwise on left legs, clockwise on right legs). 2. Palce thick padding evenly over the area to be wrapped. Ensure the padding is wrinkle free and as smooth as possible. 3. Apply the conforming layer over the padding. Each successive spiral must overlap by 50%. Use firm even tension. 4. Application of the tertiary layer (vetwrap or elastoplast) - tertiray layer should begin just distal to the carpus to prevent a pressure sore 5. The bandage should include the fetlock for stabilisation and support. Note should almost be able to place one finger inside - to assess if the bandage will stay on.

Answer 11

Carpal wrap Purpose Cover and protect cleaned debrided wounds, surgical incisions etc Recommended supplies - (Brad two layers video, notes four layers) 1. Sterile dressing with appropriate medication (keep in place with softban is required) 2. Tertiary layer - vetwrap, elastoplast 3. Potential to use electrical tape proximally to hold the bandage in place.

Answer 12

The procedure for a carpal wrap 1. Apply dressing with appropriate medication over the wound as needed. You can hold this in place with softban. 2. Each layer should be wrapped front to back, outside to inside (counter clockwise on left legs, clockwise on right legs). 3. With firm pressure apply the conforming layer over the padding - each successive layer overlapping by 50% + aim for two layers of conforming wrap - use a figure of eight pattern to avoid **- accessory carpal bone - lateral and medial tuberosities of the radius** - allow the contour of your joint and how the gauze sits dictate your wrapping pattern. 4. With firm pressure apply the tertiary layer (vetwrap or elastoplast). - should end up with a single layer of vet wrap.

Answer 13

Bony land marks Pink = accessory carpal bone Blue = radial eminance The two major bony prominances which must be avoided in a carpal wrap - to avoid a pressure sore.

Answer 14

Hock bandage / figure of eight Purpose Cover and protect wound wraps and underlying structures of the hock. Materials - sterile sressing (keep in place with soft ban if required). - conforming layer ? - Tertiary layer elastoplast or vet wrap

Answer 15

Hock bandage / figure of eight. 1. Ensure the area to be wrapped is thouroughly cleaned and dried 2. Each layer should be wrapped front to back, outside to inside (counter clockwise on left legs, clockwise on right legs). 3. Apply conforming layer ?, over the dressing around the limb spiralling upwards or downwards. - avoid all bony promennaces - calcaneous - allow the contour of the joint and how the conforming layer wants to lie dictate your wrapping pattern - should have 1-2 layers of conforming bandage. 4. Initiate the vet wrap one inch below the padding layer - each successive spiral overlapping by 50%. - allow for some slack in the bandage across the superficial flexor tendon to prevent pressure sores. - distally finish one inch above the padding. - if using vet wrap remember to apply 2-4 spirals of elastoplast tape proximal and distal ends of the wrap (prevention of banadage sllip).

Answer 16

Pressure points of the hock Green = calcaneous Yellow = medial malleolus Pressure point often occurs proximal to the calcaneous on the gastrocnemius tendon - ensure bandage is not puuled tight at this site.

Answer 17

Equine bandaging pressure points to know Carpus 1. accessory carpal bone 2. radial eminance Hock 1. calcaneous 2. medial malleolus

Answer 18

Hoof bandage poultice Purpose; Provide protection to underlying hoof structures that have been injured. Materials needed; - Poultice / iodine soaked swabs / dressing - cotton pad or Gamgee - Elastoplast or Vet wrap - Duct tape

Answer 19

Hoof bandage / Poultice application 1. Ensure the area to be wrapped is thouroughly clean and dry 2. Encase sole and hoof in poultice/padding/bandage, ensuring the bandage is as smooth as possible. - wrap elastoplast so that half the width is on the distal vertical hoof wall, and half is on the horizontal plane of the bottom of the hoof. - 50% overlapping layers until the entire hoof is wrapped - allow the contour of the hoof and how the tape wants to lie dictate your wrapping *Care should be taken to ensure the coronary band is not wrapped unless sufficient padding is used. The tertiary layer should be firm over the coronary band if it is included in the bandage. * 3. Make a flat patch of multi layerd duct tape (2-3 layers) opposing pattern. The patch should be sufficient in size to cover the bottom of the hoof wall. The bigger the better as duct tape is cheap and excess may be trimmed. Additional - padded layer = gamgee and place in a fluid bag to seal and ensure the bandage will last longer.

Answer 20

Cranial nerve 3 Oculomotor Lesion - lateral and ventral strabismus - ptosis - mydroasis (dilation of the pupil) - loss of PLR (pupillary light response) Cranial nerve four = Trochlear - Lesion causes dorsomedial strabismus Cranial nerve five = Abducens - Lesion causes ventromedial strabismus - globe retraction

Answer 21

Cranial nerve 5 = Trigeminal Sensory to head, motor to masticatory muscles (temporalis, masseter and pterygoid) Dysfunction of the trigeminal causes; - lesion causes atrophy and dropped jaw - Unilateral, lower jaw deviated to normal side - lesion causes loss of sensation palpebral and corneal reflex.

Answer 22

**Cranial nerve seven = Facial nerve** Motor to muscles of facial expression, parasympathetics to salivary and lacrimal gland Affect of a facial nerve lesion - causes facial paralysis muzzle deviation towards the normal side. - Loss of palpebral reflex - Dry eye (loss of lacrimal gland secretions)

Answer 23

**Cranial nerve eight = vestibulocochlear** - hearing, posture and balnce **The effect of a lesion in the vestibulocochlear nerve** - Head and eye position strabimus - nystagmus; fast phase away from the side of the lesion - lesion causes head tilt (toward the side of the lesion) - balance loss - response to noise: deafness (clapping).

Answer 24

**Cranial nerve nine = Glossopharyngeal nerve** Sensory and motor to the pharynx; Ability to swallow (observation and endoscopy) Lesion of CR nerve nine Glossopharyngeal causes - lesion causes dysphagia and displaced soft palate

Answer 25

Cranial nerve ten; Vagus Sensory and motor to the pharynx and larynx. - ability to swallow and laryngeal movement - observation and endoscopy. The effect of a vagal lesion - lesions causes dysphagia, laryngeal paralysis and displacment of the soft palate. The real test = Thoracolarngeal slap. - stand on the left side - hook the index and middle fingers of the left hand over the highest palpable point of the larynx (muscular process of the arytenoid) - request handler to move the head slightly to the left of midline - gentle slap of horse behind the withers several times (palm of right hand) - repeat the procedure on the right side The expected response is palpable movement (adduction) of the arytenoid in response to each slap. - sensory T7-T11 - vagus and recurrent laryngeal nerve.

Answer 26

**Spinal accessory nerve** Motor to cervical muscles, larynx and oesophagus. Lesion os spinal accessory nerve - lesion causes muscle atrophy (trapezius, sternocephalicus, brachicephalicus). - dysphagia

Answer 27

**Cranial nerve 12 Hypoglossal** The motor to the tongue. Test - tongue strength and symetry - lesions can causes atrophy and paralysis

Answer 28

Oculocephalic reflex - Dolls head Assessment of cranials nerves 3,4,6 and 8 The Dolls head test - tested by holding the eyes open and rotating the head up and down + side to side - in the prescence of reflex the eyes move in the opposite direction of the head movements. - lesion = nystagmus In the awake dolls eyes may not present because voluntary eye movements mask the reflex. - in a comatose patient the absence of dolls eye reflects suggest brainstem dysfunction, but can be normal in the awake patient. - independant of visual input and still present in total darkness, or when the eyes are closed.

Answer 29

Indications for a Caslick - recurrent endometritis - pneumovagina - incompetant vulvovaginal sphincter - incompetant vaginal seal - poor perineal confirmation - history of recurrent pregnancy loss due to ascending infection.

Answer 30

Caslick procedure 1. Start - bandage the tail and disinfect the area - twitch or sedation considered for the mare 2. Determination of caslick size - determine the length of vulva lips to be closed - 3-4cm of the ventral vulva should remain unsutured. - + vulva lips should be closed 1-2cm ventral to the pelvic floor of the pelvis 3. Infiltration of lignocaine - **2% lignocaine 10-20ml 1inch 22G needle - dorsal two thirds** - inject into the labia of the vulva in the region of the mucous cutaneous junction - from just below the ischium to the dorsal commissure. 4. Remove a thin strip of tissue 0.5cm wide from the mucocutaneous junctions - rat tooth forceps to retract tissue and metzenbaums to remove it - clear band of skin is removed from the dorsal commissure - the edges of the incision will split apart exposed subcutaneous tissue on each of the vulva lips can then subsequently be apposed with sutures. - simple interupted sutures - the needle is inserted through the skin, then on the opposite side through exposed subcutaneous tissue. Non absorbale suture material is removed 10-14 days later. - administer tetanus prophylaxis if indicated

Answer 31

Caslick removal close to foaling Open the caslick (with scissors approximately one month prior to foaling. - local infiltration of anaesthetic may be needed

Answer 32

Breeding stitch In mares which will be bred following Caslick surgery a breeding stich may be inserted 0.5 to 1cm dorsal to the ventral extent of the suture line. - single non absorbable simple interupted suture loosely placed - should be a minimum of 1cm placed from the vulva lips to ptevent abrasions to the stallions penis. - the purpose of a breeding stich is to prevent splitting of the suture line during service.

Answer 33

**Endometrial swab ** is carried out for culture and cytology (culture and cytology should always be carried out together). - a positive culture should only be considered positive in the pressence of active inflammation. - important component of a breeding soundness examination in the mare - used to screen mares prior to service (veneral transmission pseudomonas, klebsiella spp.) **Cytology** cytology demonstrates the pressence or absence of active inflammation within the uterus. < 1 neutrophil per high powered field (400X) - more than one neutrophil per high powered field indicates active inflammation. **Culture** - provides an indication of whether or not a bacterial or fungal infection is present within the uterus.

Answer 34

Endometrial swab collection 1. Wash and disinfection of the perineal area 2. place sterile glove on hand 3. The tip of a guarded uterine swab is placed into the palm of a hand that is covered with a sterile rectal glove 4. the sterile hand gentle guides the swab through the vulva through the vestibulum upto the vulva 5. The operator inserts their finger through the cervix first, the tip of the swab is guided through the cervix into the uterine body. 6. the tip of the swab is then pushed through the guarded end 7. held in the uterine lumen for 30-60secs to absorb any fluid 8. rotate the swab clockwise and anticlockwise against the wall of the uterus 9. with draw the swab into the outer guard 10. withdraw the guarded swab from the uterus 12. The swab is then transferred into a transport medium for culture at a laboratory or rolled on a microscope slide and stained with diffquick

Answer 35

The ideal time to collect an endometrial swab in a mare = oestrus Oestrus - mares are more resistance to iatrogenic infection at this time - lack of progesterone Some practitioners collect during dioestrus - the uterus should be sterile at this time - however, the risk of introducing an infection is increased. - to reduce this risk mare may be treated with PGF2a this will induce luteolysis between days 5-14 of their oestrus cycle + mare is more likly to clear any infectious agent. NOTE; ABSENCE OF PREGNANCY MUST BE CONFIRMED BEFORE ANY ENDOMETRIAL SWAB OR BIOPSY IS PERFORMED.

Answer 36

Indications for a Uterine lavage 1. fluid remaining in uterus dose not provide an optimal environment for pregnancy - ultrasonographic evidence of pooling fluid within 18hrs of intended mating 2. fluid may encourage the development of endometritis 3. purulent material or debris exist with the uterus of a mare Uterine lavage with or without ecbolic agents is used to promote evacuation of fluid from the uterus of mares.

Answer 37

Intrauterine lavage Fluid to be used - isotonic saline or lactated ringers solution - weak antiseptic solution 0.2% povidone iodine solution - avoiding the use of antiseptic close to mating may have negative affects on gamaete survival. - follow an antiseptic lavage with isotonic saline to remove traces of the antiseptic solution. Procedure for lavage - ensure the perineum of the horse has been washed and cleaned -ensure bulb of catheter is working inflate / deflate - introduce catheter in the same manner as a culture swab is introduced - use a finger to guide through the passage of the cervix - try not to dilate the cervix more than is needed (a contracted not dilated cervix will assist retain fluid within the uterus) Dilate ballon cathetr 100ml of air - fluid is then instilled into the lumen (normally until the mare becomes uncomfortable and shuffles) this indicates the time to siphon out the fluid - use tip of finger as a guid to prevent the catheter becomming occluded against a fold of endometrium during the siphoning process - 3-4 flushes of the uterus are required. - maintain a record of how much fluid has been instilled and recovered to assist in determining the amount of fluid remaining in the uterus at the end of the procedure May administer oxytocin IV to mare while intrauterine catherter is still inplace to induce contractions nad fluid removal. Exercise mares at a walk post lavage to facilitate evacuation of fluid from the uterus.

Answer 38

Uterine lavage and the use of Ecbolics - oxytocin PGF2a - may be given to improve the clearance of fluid from the uterus at the end of lavage - oxytocin induces uterine contractions for 20-40mins - PGF2a are though to induce uterine contractions for 2-4 hours + contraindicated with pregnancy Antibiotics - completely evacuate fluid from the uterus at the end of lavage infuse antibiotics imediately - if fluid can not be removed administer oxytocin and antibiotics one hour later. - if small volumes of antibiotics are used can provide a rectal massage of the uterus to ensure distribution of the drug through out the uterus If possible intrau-uterine treatments should coincide with oestrus when a mares uterine defence mechanisms are optimal - but avoid the day of mating

Answer 39

Endometrial biopsy collection The biopsy procedure is carried out without the need for anesthesia. - use a strile gloved hand to guid the biopsy instrument through the cervix - index finger to guid the head of the instrument through the cervix - withdraw the gloved hand, and insert this hand into the rectum - position jaws of the instrument against the dorsal wall of the uterus - open the jaws of the instrument, and place a slight pressure per rectum into the open jawsfor biopsy - close jaws and withdraw from the uterus The sample is then preserved in formalin or Bouins fixative.

MSAT two Flashcards

(63 cards)