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151 Cards in this Set
- Front
- Back
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What are some facts about reel suture?
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Loose spool
Cheap Easily contaminated Traumatic with needle |
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What are some facts about swaged-on suture?
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Needle pre-attached
Expensive More sterile than reel Atraumatic |
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Define dehisce
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Falling apart of incision
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What are some facts about absorbable suture?
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Used primarily internally
Can be used SQ Can be used on the skin and removed later Dissolves w/in 14-21 days (Catgut) or months (PDS) |
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What are some absorbable types of suture?
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Cat Gut (chromic/plain)
PDS Vicryl Monocryl |
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What are some facts about Non-absorbable sutures?
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Primarily used externally
Used internally for vascular (Prolene) |
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What are some non-absorbable types of sutures?
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Prolene
Ethilon (nylon) Silk Stainless steel |
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What are some facts about monofilament?
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Like fishing line
Slides readily Slippery Has memory Less bact. infxn Doesn't hold knots as well 5-6 throws |
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How many throws makes 1 square knot?
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2
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What are some facts about multifilament?
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Braided
Strionger Doesn't slide as well Takes longer to break Less memory-easier to work Holds knots well Bacteria can colonize 4-5 throws |
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What are some facts about simple interrupted?
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One failed not will not undo entire thing
Excellent holding power Stays in place for long time Good cosmetic appeal |
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What are the size parameters for suture?
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Large (2) to small (10-O)
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What types of suturing needles are there and what are they used for?
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Cutting: for tough things like skin
Tapered: for soft/delicate things like internal organs |
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What are some cons to continuous patterns?
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Lose one knot and the whole thing comes undone
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What are some cons to mattress patterns?
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Can snag (tooth/nail)
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What are some facts about the horizontal mattress?
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Holds together high tension incisions
Primary for closure Secondary as helper Good cosmetic appeal |
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What are some reasons for anesthetic emergencies?
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Human error
Mechanical problems Anesthetic agent Patient factors |
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If an animal is too deep, what do you do?
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Turn vaporizor off
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What are some facts about IV barbituates?
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Dose to effect
Rapid induction |
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What are some facts about IM barbituates?
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Less precise effect, unknown outcome
Takes about 3-20 min |
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What are some facts about PO barbituates?
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Rarely used, only w/very fractious
Slow induction Will sedate |
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What are some facts about inhalation barbituates?
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Takes several minutes
Mask or chamber Stressful, irritating to lungs Personnel exposed |
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What are some keep points during the induction process?
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Know the drugs being used
Calculate dose properly Prep machine and equipment Have at least 1 more person Monitor respiration |
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What are some pros of using injectable agents for maintenance?
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almost none
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What are the cons of using injectable agents for maintenance?
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Margin of safety is less
Cannot alter depth Extra work for organs to eliminate O2 not supplemented No intubation Organs can be compromised |
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What drugs can influence reflexes severely?
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Alpha-2s
Opiates Ketamine |
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What are some good analgesic adjuncts?
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Tranquilizers
Sedatives Ketamine |
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What types of Etubes are there?
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Red Rubber
Clear vinyl Silicone |
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What types of Etubes styles are there?
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Magill: no eye
Murphy: eye Cole: cuffless for neonates |
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What type of volume/pressure do Red Rubber and Vinyl Etubes have?
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RR: Low vol/High press.
V: High vol/Low press. |
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Where should the etube reach?
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thoracic inlet
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Why do we intubate?
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Maintain airway
O2 and gas Prevent/protect from aspiration Min. dead space |
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How long is propofol good for?
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6hrs...
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How are inhalant anesthetics distributed?
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Gas crosses the alveolar membrane into the bloodstream
Then carried to brain |
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What is vapor pressure?
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How long and how much of the liquid evaporates (varies with type)
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What is solubility coefficient?
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The measure of the distribution of the agent b/t the blood and the gas phases in the body
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What is low solubility?
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Remains in gas phase
Quick induction and recovery |
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What is high solubility?
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Passes into blood and tissues quickly
Prolonged induction and recovery |
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What is Minimum Alveolar Concentration (MAC)?
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Indicates strength of agent
Low MAC=potent High MAC=weak Varies with patient |
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Define nociception
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detection, transduction, and transmission of noxious stimuli
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How are nociceptors stimulated?
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thermal, mechanical, or chemical tissue damage
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What factors make pain varie b/t patients?
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age
sex health status species breed |
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What is acute pain?
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mild to severe
short duration responds to analgesics |
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What is chronic pain?
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Long lasting
difficult to treat |
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What are some ways we can recognize pain?
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Changes in attitude/personality
Abnormal vocalization Licking, biting... area Haircoat Posture/movement Activity level Appetite Facial expression Sweating/salivation BM/urination Inc HR, RR, temp |
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What are some very painful sx procedures?
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Ocular
Orthopedic Amputation Cervical vert, Perirectal |
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What are delta fibers?
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Transmit sharp, discrete pain
Localize Myelinated Rapid signals Acute |
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What are C fibers?
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Transmit dull, aching, throbbing pain
Can't really localize Nonmyelinated Chronic |
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What is somatic pain?
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In skin, muscle, bones
Delta and C fibers |
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What is visceral pain?
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In internal organs
C fibers |
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What does the Pulse Ox do?
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Estimation of arterial O2 saturation
Hb that is saturated with O2 binds to infrared light |
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How should the light of the pulse ox be placed?
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down- away from light
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What can lower pulse?
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hypotension
hypovolemia tachycardia hypothermia |
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What can pain lead to?
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Prolonged hospital stays
Immune suppression Inappetance Cahexia Windup (chronic) Stress response later |
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What is neuropathic pain?
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worst
underlying pathology intense and difficult to control |
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What are the 4 periods of anesthesia?
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Preanesthetic
Induction Maintenance Recovery |
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What does the preanesthetic period involve?
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Assesment:
history Pex lab work preanesthetic prep (drugs, physically) |
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What is the purpose of the preanesthetic exam?
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Identify existance of abnormalities
Characterize the severity of them |
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What does the history of the preanesthetic period involve?
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Signalment
Diseases/conditions Previous anesthetic Hx/Sx Hx Recent feeding Hx of trauma |
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Define anesthesia
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without sensation
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What does the PEx of the preanesthetic period involve?
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CV
Respiratory CNS Palpation Temp |
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What is the MDB of the preanesthetic period?
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Minimum Data Base (labs)
PCV TP Urine SP (U/A. Chem, CBC) |
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What are some factors that may increase risk status in anesthetizing a patient?
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Anorexia/starvation
Dehydration Anemia/Hypoproteinemia/blood loss CV abnormalities Resp. abnormalities Renal abnormalities Liver abnormalities Old age Obesity Pregnancy Certain meds |
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What 2 things do we look at when evaluating risk status for anesthesia?
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Patient condition
Clinical situation/procedures |
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What is shock?
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inability to perfuse tissues
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What can anorexia/starvation lead to in anesth?
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OD
hypotension cardiac arrest hypoventilation prolonged recovery delayed healing risk of infection |
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Why is anemia a problem in anesth?
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inability to deliver 02 to tissues
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What should one do before anesth a patient in regards to risk?
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Assess, analyze, and prioritize the abnormalities and anesth. risk
Attempt to correct abnormalities Alter anesth. protocol Cancel or delay if needed |
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What is a class 1 risk?
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Minimal
Normal/healthy No dz Minor procedures |
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What is class 2 risk?
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Slight risk
Minor dz, able to compensate Minor-mild procedures |
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What is class 3 risk?
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Moderate risk
Obvious dz |
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What is class 4 risk?
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High risk
Compromised by dz of severe nature Severe condition |
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What is class 5 risk?
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Extreme risk
Desperate need for surgery May not survive |
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What are some reasons for an IV cath?
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Simultaneous inj
Rapid admin of drugs Fluid/plasma/blood/drugs Repeat dosing of anesth drugs |
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What are some IVC warnings?
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Air
Overhydration |
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If a patient becomes overhydrated, what drugs are then used?
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Lidocaine
Lasix |
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When are fluids wrong?
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Heart failure
Overhydration |
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What are the maintenance fluid rates?
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Lrg dogs: 2ml/kg/hr
Sm dogs/cats: 4ml/kg/hr (30 cc/lb/day) |
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What are the surgical fluid rates?
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10ml/kg/hr
Less for certain medical problems |
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What are the fluid rates for rapid rehydration?
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Dogs: 40ml/kg/hr
Cats: 20ml/kg/hr |
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What are the fluid rates for shock patients?
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Dogs: 90ml/kg/hr
Cats: 50-70ml/kg/hr divide by 4, then give over 15 min and assess |
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Define recovery
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return of consciousness and homeostasis
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What are the most dangerous times of the anesthetic process?
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1. induction
2. recovery |
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What are some things that affect recovery?
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Duration of anesthesia
Pre-existing condition Idiopathic rxns Drugs/anesthetics used Other meds Degree of Sx |
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What are the 4 hypos of anesthesia and what must be remembered?
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Hypothermia
Hypoventilation Hypotension Hypovolemia All can happen, but must be recognized/prevented/treated |
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What is relative hypovolemia?
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Fluids leave core and only exist in extremities
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What is absolute hypovolemia?
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Not enough fluids anywhere in the body
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What are some things that cause hypothermia?
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Clipping/prepping
No shiver reflex Open body cavities Loss of blood IV fluids (if not heated) Loss of ability to vasoconstrict/retain heat Harder for 02 to leave Hb and enter tissues Surface temp |
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What causes Hypoventilation?
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Insufficient anesthesia
Hypoxic tissues Acidosis (from drugs) Hypothermia compounds problem |
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What causes hypotension?
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Insufficient fluids
Vasodilation (drugs/anesth) Dec. CO |
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What causes hypovolemia?
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Loss of fluids during Sx
Insufficient hydration Loss of fluids in airway Evaporative water loss Loss of blood |
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What are some important machine etiquette tips?
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One breathing circuit set up at a time
Pop-off open E- tank on or bled out |
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How long can a FULL recovery take?
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7-10 days
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What signs indicate full recovery?
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Achieve/maintain sternal recumbency
Response to normal stimuli Swallowing reflex Stable/normal body temp Palpaple/regular pulse Normal HR Stable/regular RR Hydrated |
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What are some reasons for an unsuccesful recovery?
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Failure to recognize a problem
Failure to initiate treatment Inadequate backup equipment Ignorance/lack of trained person to monitor Poor patient response |
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What is a common disorder in anesthesia?
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Respiratory acidosis
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What is ALE?
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Atropine
Lidocaine Epinephrine *All can go down e-tube in emergency |
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What meds are analgesics?
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Opiates
NSAIDS Locals |
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Why can't bunnies get atropine?
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They have atropinase
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How much ace should any animal get?
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no more than 3mg
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How should an animal be when premeding with tranqs or sedatives?
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calm
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What are some pure agonists sedatives?
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Morphine
Oxymorphone Fentanyl |
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What are some partial agonist sedatives?
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Buprenorphine
Butophanol |
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How long does it take for Fentanyl patch to kick in?
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24 hours
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What is a Neuroleptanalgesic?
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Tranquilizer/sedative + opioid
ex: torb/ace |
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What are some drugs that bring about hypersensitivity to sound?
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Opiates
alpha-2 ketamine |
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What are some abnormalities to look for when doing a Pex?
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Impacted K9s/deciduous teeth/crowding
lumps/bumps Cryptorchid Dewclaws/polydactil/nailbeds hernias (reduceable?) |
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What are the essential steps of a Pex?
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Sig
HR/RR and sounds/temp/BP/mm/CRT Wt/distribution of fat to muscle Freely visually assess: head to tail or body system |
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What should you look for when examining the head in Pex?
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symmetry
head tilt D/C smells Gums Lymphnodes Eyes Ears |
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If a patient is going to be anesthetized, what should be looked at during the Pex?
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Heart
Pulse pressure Respirations Hydration Neuro Immune status Neonate/old Endocrine problems (diabetes...) |
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What are the stages of anesthesia?
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I: Relaxed
II: Excitement III: P1: Light P2: Surgical** P3: Deep P4: Over-dose IV: Moribund |
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What 5 things will be looked by Dr.Mac when checking anesthesia set up/induction?
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Flowmeter
Vaporizor Pop-Off Circuit Patient jaw tension |
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How can you take away the sting od injecting lidocaine?
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add 10% of sodium bicarbonate to 90% of lidocaine
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Define preememptive analgesia
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Admin of analgesic drug before pain
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Define hyper/hypoesthesia
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Inc./dec. sensitivity to sensation
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Define multimodal analgesia
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Use of multiple drugs with different actions to produce optimal analgesia
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Define wind-up
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Temporal summation fo painful stimuli in spinal cord
C fibers |
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What is the pain pathway?
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Transduction (stimuli turns into nerve signal)
Transmission (signal carried to spinal cord) Modulation (signal altered) Projection (signal sent to brain) Perception (concious recognition of pain) |
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Locals block what part of pain pathway?
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Transduction
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NSAIDs block what part of pain pathway?
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Transduction
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Opiates block what part of pain pathway?
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Modulation
Projection Perception |
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What are some groups of analgesic adjuncts?
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Corticosteroids
Locals Tranqs/sedatives Anticonvulsants Antidepressants Sympatholytics Misc.(tramadol, ketamine) |
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What are some analgesics in horses?
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Corticosteroids
NSAIDs Opioids Alpha 2s |
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Can opthaine be used for more than just the eye?
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yes, any MM
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How do locals work?
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exert their effects in the area closest to the site of inj.
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Why are locals used for csxn?
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don't tranfer across placenta
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Describe an epidural block
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Loss of sensation and voluntary mvmnts to areas innervated by sensory and motor neurons
Loss of pain, cold, warmth, touch, joint sensation, deep pressure |
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Where can locals be inj into?
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joint
nerve plexuses vein epidural space |
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What is EMLA cream?
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cream that is used to desensitize intact skin for superficial minor procedures
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What is a splash block?
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topical anesthetic sprays for wounds or open sx sites
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What are 2 reasons epi is added to lidocaine?
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vasoconstriction
reduces toxicity of drug |
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Define nerve blocks
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injecting locals in proximity to a nerve to desensitize a particular anatomic site:
lameness dehorning dental... |
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Define line blocks/ring block
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a continuous line of local inj immediately proximal to area
Ring block for digits, teats... |
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Define regional anesthesia
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locals inj into a major nerve plexus
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What 3 classes of drugs can be put into an epidural?
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Alpha-2s
Lidocaine Opioids |
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What types of anesthesias can be used for horses?
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Locals (eyes, lameness)
Chemical restraint (standing) General (castration, fx) |
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When treating lameness in a horse, do we start at the top or bottom?
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bottom
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What are the early signs of infxn in wound healing?
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2-3 day
Red, swollen, moist open Normal ap/enrgy |
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What are the signs of normal healing in wound care?
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2-3 days
Induration: hard/non-painful lump gone by 5-7 days |
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What is wicking in wound healing?
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SQ suture erodes above leading to infxn
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What are some types of locals?
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Surface/topical (MM)
Infiltration (SQ, not blood vessels) Epidural Intraarticular/intrabursal |
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What are some problems with locals?
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Improper technique
Insufficient drug Too much drug (ataxia, motor blockade) Lack of aseptic tech. |
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What areas are commonly anesthetized with locals in horses?
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Head (eyes...)
Perineal area Limb (regional) |
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What is a caslick?
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Trimming away of the vulva so poop does not fall on it and contaminate
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What are some concerns with general anesthesia in horses?
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Hypoventilation (need ventilator)
Respiratory acidosis Poor perfusion to limbs Compressed muscles Injury to people and horse |
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What type of premeds can be used for horses?
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Ace
xylazine detomidine |
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What type of induction agents can be used in horses?
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Surital/thiopental
Diazepam Ketamine Telazol Mask foals |
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What is the nerve blocked for dehorning in cattle?
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cornual nerve
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What is an inverted L block?
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Used in cattle
Can be used with a proximal paravertebral block |
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What are some anatomical and physiological problems in brachycepahlics?
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Stenotic nares
Elongated soft palate Hypoplastic trachea and larynx Everted laryngeal saccules Bronchiole collapse Cor pulmonale High vagal tone Obesity Big tongue |
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What are some eye problems in brachycephalics?
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Proptose easily
Corneal trauma Ulcers Ruptured eyes Distichia Entropian |
