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209 Cards in this Set
- Front
- Back
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Phenothiazine example
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Acepromazine
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What acts on the reticular activating system?
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Acepromazine
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Butyrophenone examples
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Droperidol, Azaperone (still used in hogs)
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Key things about Ace?
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Never use labeled dose
Minimal respiratory depression Stallions may exhibit transient or permanent penile paralysis |
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What are the 4 A's for Ace?
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Antihistamine
Antiemetic Antiarrhythmic Anti-anxiety |
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Benzodiazepenes examples
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Diazepam
Midazolam Zolazepam (Telazol= Zolazepam+Telotamine) |
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Are benzos good tranquilizer for small animals?
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No, make them rowdy and cats bitter
Good for small ruminants though |
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Mechanism of Benzos
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Potentiating the effects of GABA, potent anticonvulsants
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Which benzo is better for IM injection?
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Midazolam: water soluble versus propylene glycol in Diazepam and is quite painful
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Reversal agent for benzos?
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flumazenil
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Guaifenesin mechanism
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centrally acting muscle relaxant which acts on the internuncial neuron
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Uses for Guaifenesin
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Muscle relaxant in large animals
Must be given in an IV catheter |
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Mechanism of Action for Opioids
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Inhibition of pain transmission in the dorsal horn of the spinal cord
inhibition of somatosensory afferents at supraspinal levels activation of descending inhibitory pathways |
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Full agonist opioids
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morphine
meperidine Fentanyl: 15-30min T1/2 Hydromorphone Oxymorphone Methadone |
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Partial Agonist
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Buprenorphine: Very long acting (8-12)
great for buccal procedures |
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Agonist-Antagonist
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Butorphanol: short acting (1-2)
Pentazocine Nalbuphine |
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Antagonist
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Naloxone
Naltrexone Nalmefene |
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Clinical signs of Mu activation
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Analgesia!!!
Resp Depression BRADYCARDIA; Incr Vagal Tone Euphoria Physical Dependence: Long term Sedation Vomiting: if the animal is not painful |
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Who reacts the most to opioids?
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cats, horses
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Which opiods release histamine?
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morphine, meperidine
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Alpha 2 agonists
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xylazine
detomidine medetomidine dexmedetomidine |
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What patients are good for Alpha 2?
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Healthy Heart patients
Cardio depression outlasts the outward signs on CNS sedation and analgesia |
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What is the weight range for Resting Energy Requirement?
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> 2kg and < 45kg
[30 x body weight(kg)] + 70 |
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What is Maintenance Energy Requirement for active/healthy animals?
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Dogs= 2 x RER
Cats = 1.5 x RER |
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Reasons for doing early feeding with illness?
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minimize loss of lean body mass
restore nutrient deficiencies improve healing and repair |
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When do you feed?
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Animal has loss > 10% BW
Muscle wasting poor hair coat |
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Illness Energy Requirement needed for ill animals?
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Dogs: 1.25-1.7 x RER
Cats: 1.25 x RER they don't need as much calories |
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What is refeeding syndrome?
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What happens when you feed TPN too fast and you see
Hypophosphatemia Hypokalemia Hypomagnesium |
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Stomach capacity of a dog
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90 ml/kg
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Maximum bolus of food
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35ml/kg
work up to full requirement @ least 3 days |
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Advantages of TPN
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Complete nutrition
the body can use everything immediately must be in jugular |
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Disadvantages of TPN
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Doesn't feed the GI mucosa
chance of sepsis expensive needs to have central catheter and aseptic |
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Types of Enteral feeding
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Assisted feeding
Syringe feeding Appetite stimulation Tube feeding |
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Types of tube feedings
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Nasoesophageal
pharyngostomy esophagostomy gastrostomy jejunostomy |
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Nasoesophageal tubes stipulations
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fairly non-invasive
no G.A. liquid diet short term |
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Pharyngostomy tube Pros
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use blenderized food
easy to manage (at home) large tube can be placed can stay in long term |
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Pharyngostomy tube Cons
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G.A.
should not see the tube with the mouth is open (obstruct epiglottis) |
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Pharyngostomy complications
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vomiting
stomal infections aspiration pneumonia tube dislodgement |
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Esophagostomy Tube Pros
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larger tube
long term no minimal time prior to removal will not interfere w/epiglottis no sedation needed to remove tube |
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Pharyngostomy placement and structures to avoid
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maxillary, jugular, and linguofacial veins
carotid artery salivary gland |
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Gastrostomy Tube Pros
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Long-term support
easy to manage doesn't interfere w/voluntary eating heals by 2nd intention, no sedation required |
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Gastrostomy Tube Cons
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Stomal infection
Minimum of 7- 10 days before you can remove it |
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Jejunostomy Indications
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pancreatitis
Severe Gastroesophageal reflux gastroparesis aspiration risk patients |
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Jejunostomy requirements
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CRI of liquid diet
endoscopic placement or celiotomy |
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General principles of nutrition
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Feed early
If the gut works, use it Use the most physiologic feeding monitor body weight Don't overfeed |
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Thiopental
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works by modullating GABA transmission
injectable anesthetics |
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Thiopental is terminated by what action?
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muscle redistribution
might need to be careful with high muscular dogs (sight hounds) |
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Thiopental side effects
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Arrhythmogenicity
Protein binding (hypoalbuminemic:careful) Tissue irritation (perivascularly) Highly dependent on liver metabolism Decrease intracranial pressure |
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How should you administer thiopental?
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As a bolus to avoid the excitement stage
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Propofol
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non-barbituate, non-steroidal anesthetic
very painful injection have to use bottle w/in 24 hours/doesn't need to be in fridge |
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Propofol effects
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Profound hypotension from vasodilation
similar to Thiopental can use with Liver failure patients |
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Etomidate
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Great for 3 organ failure (Brain, Heart, Liver)
Like Diazepam solubilized in propylen glycol also derpresses cerebral blood flow |
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Ketamine
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Dissociative anesthetic
can be used as anesthetic or restraint IM will have prolonged recovery |
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Which drug causes apneustic breathing pattern?
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Ketamine
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Dogs and ketamine
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Convulsions and extreme muscle tone
use a muscle relaxant w/it like diazepam |
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Alfaxalone
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neuroactive steroid molecule
Not in the US |
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Palpebral reflex for dogs / cats
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present, too light for surgery
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Palpebral reflex horses
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always maintain weak to moderate
reflex |
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Llamas and palpebral reflex
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always maintain moderate to brisk reflex
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Small ruminants, Cattle and palpebral reflex
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not helpful...put a towel over their head
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Globe position for dogs / cats
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ventral deviation not staring right at you...too light for surgery
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Globe position for Small Ruminants
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not helpful
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Globe position for Horses
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eyes shift a lot
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Globe position for Cattle
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ventral deviation is good
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Nystagmus in horses
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With inhalants the horse is too light, may move :(
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Which animal lacrimates the most under anesthesia?
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Horses
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Is a corneal reflex happen when the animal is alive?
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yes, dead if absent
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What are the four criteria for anesthesia?
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Hypnosis
Analgesia Muscle Relaxant Amnesia |
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Which drugs produce panting reliably?
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opioids
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What should be the MAP for small animals? Horse?
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Small animals: 60 mmHg
Horse: 70 mmHg enough pressure to perfuse the tissues |
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What are indirect ways for monitoring venous pressure?
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doppler (only systolic)
Oscillometric (diastolic, systolic, & mean) |
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What are direct ways for monitoring venous pressure?
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Arterial Pressure (arterial catheter)
Central Venous pressure (most accurate measurement of cardiac output) |
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What does a pulse oximeter measure?
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Amount of Hemoglobin that is saturated w/oxygen
place it peripheral to get an idea of tissue perfussion |
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Why would a patient have low oxygen saturation (7)?
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Severe hypoxia
Inadvertent bronchial intubation Embolic events pulmonary edema Hypoventilation (esp. w/room air) Anaphylaxis Bronchospasm |
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What is the monitor that measures end-tidal level of CO2?
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Capnometer
the display is the capnograph |
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What are blood components?
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blood products prepared by centrifugation, sedimentation, apheresis
packed RBC Plasma (fresh/frozen) Cryoprecipitate PRP Cryosupernatant |
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What are blood derivatives?
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Blood products prepared by biochemical methods
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Indications for Blood transfusions?
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Anemia/blood loss
Hypoproteinemia Bleeding disorders Replace coag anticoag factors (DIC, LF Pancreatitis (alpha 2-macroglobulin) |
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Reasons for whole blood transfusion?
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severe blood loss
anemia thrombocytopenia (not a great option) |
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Packed red blood cells
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Treatment anemia/ongoing blood loss
Concurrent hypoalbunemia or coagulopathy (give colloid too) |
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Plasma indications?
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Bleeding disorders
Colloidal support other (pancreatitis) |
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Is there a universal type for feline blood groups?
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No,cats have natural occurring alloAb except for AB cats
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Which cats have the most severe blood reaction?
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Type B cats; high titer of anti-A Ab
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What type or most cats?
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type A
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What is the universal type for dogs?
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negative 1.1,1.2, 3, 5,7
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blood donor selection screens in dogs?
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Brucella
Ehrlichia** Babesia Mycoplasma HW** |
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Blood donor selection screens in cats?
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FeLV
FIV Mycoplasm Haemofelis Haemominutum |
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What kind of supplementation is needed?
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Iron
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Major blood cross
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Donor RBC & recipient plasma
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Minor blood cross
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Recipient plasma & Donor RBC
Important for whole blood transfusion |
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How to blood products be administered?
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Room temperature
mixed thoroughly Filtered administration set Peripheral veins IO/IP |
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Rate of infusion?
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start @ 2.5 ml/kg/hr
watch for rxn -> increase to 10ml/hr after 30 min. |
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Types of transfusion rxn?
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Immunologic
Non-immunologic |
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What type of Immunologic rxns?
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RBC (hemolytic)
plasma proteins WBCs/platelets |
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What type of non-immunologic rxns?
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volume overload
infection citrate toxicity (anticoag used in blood storage) |
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What do you do if rxn is unclear the source?
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Stop transfusion
Monitor TPR, BP wait restart (maybe slower) |
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Alternatives to blood transfusion?
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Oxyglobin
Synthetic colloids |
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The outcomes of bleeding in regards to hemostasis?
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Bleeding stops (adequate)
Thrombosis (excessive) Persistent bleeding (inadequate) |
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What maintains inactive platelets?
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Prostacyclin and NO from endothelial cells
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Where does the intrinsic pathway take place and what test do you do?
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Intravascularly w/activation of F12
aPTT |
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Where does the extrinsic pathway take place and what test do you do?
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tissue phospholid is released upon injury -> provides surface for Ca++ F7
PT |
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What actually forms the clot?
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Fibrin meshwork
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What does a pre-surgical eval consist of?
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History/Signalment: consider medications/clotting disorders
PE Laboratory Eval (clotting panel) |
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How is hemorraghe controlled?
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Vascular reaction
Formation of platelet plug Activation of coagulation cascade |
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When does a platelet plug form?
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5 minutes after vascular injury
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Series of events for platelet activation
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damage -> exposed collagen -> vWDF helps platelets bind -> platelets secrete ADP and TXA2 -> activates circulating platelets -> growing platelet plug
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What two things help with formation of a platelet plug?
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PF-3 on platelet surfaces
TF released from injured tissues |
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Intrisic pathway
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Intravascularly w/activation of Factor 12
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Extrinsic pathway
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TF is released a provides a surface to bind Ca and Factor 7
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Both pathways end result
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Fibrin
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When do platelets disaggregate from the fibrin clot?
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24-48 hours
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What is responsible for lysing a clot?
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Plasmin
it is neutralized by anti-plasmin, but plasminogen interferes during clot formation |
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Why does IV coagulation not happen?
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Platelets localize fibrin
Prostacylcin is produced by intact vessel wall Activated factors are removed efficiently Anti-thrombin-3 (liver) |
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Primary Hemorrhage
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Occurs immediately after
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Delayed Hemorrhage
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Ineffective Tx of 1 hemorrhage
- Intermediate (< 24 hours) - Secondary (>24 hours) check blood pressure before closing |
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Types of Surgical Hemostasis
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Digital
Crushing Energy Laser Ultrasonic Energy Vessel Ligation Topical |
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Digital pressure
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low-pressure, small vessels
Blot, don't wipe Temporarily stops hemorrhage |
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What pathway does crushing vessels initiate?
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Extrinsic
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Crushing vessels should only be used on vessels being cuts away?
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True, don't crush the saved ones
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Small vessel forcep direction
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down
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Large vessel forcep direction for ligation
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up
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Electrocoagulation uses
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Cut: low voltage, constant cur
Coag: High voltage, but current is often off Blend: medium voltage with current on 60% of the time |
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Monopolar coagulation
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Form of Electrocoagulation
most common uses a hangpiece and a ground plate under the patient |
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Does the field need to be dry around the patient for Monopolar coagulation?
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Yes
make sure you have ample gel and no alternate energy paths |
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Bipolar coagulation
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No ground plate; electrode does active and return of current to the generator
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Does the field need to be dry around the patient for Bipolar coagulation?
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No
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Laser is used for..
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incision, excision, ablation of soft tissue and hemostasis of vessels < 0.6mm
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What needs to be removed after the Laser prior to suturing?
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eschar
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Ultrasonic energy
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Harmonic scalpel
uses rapid vibrations for cutting and coagulation |
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What is the best form of surgical hemostasis?
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vessel ligation
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Transfixation ligature
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overcomes pulses when recovered: penetrates before suturing
use on pedicles, axillary artery, and femoral |
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What is important for vascular clips?
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Make sure they are the correct size
should be no more than 2/3 or less than 1/3 of the diameter of the vessel |
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How does Gelfoam work?
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Absorbs blood and swells
Acts as a scaffold for clots For oozing surfaces, don't leave in infected sites |
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Types of Topical Hemostastic products
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Gelatin sponge
Bone wax Thrombin Hemablock |
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Does bon wax absorb well?
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No, use sparingly so not to impede healing
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What can excess blood lead to in a wound?
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Pain, Ischemia, Necrosis
Bacterial Medium Blood must be clotted & organized before healing can occur |
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What does a scab provide?
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Limited protection from external
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Stages of wound repair
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Inflammatory
Debridement Repair Fibroblast/Proliferation Capillary infiltration Epithelization Wound contraction Maturation |
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Primary closure (1st intention healing)
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closed primarily by sutures
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When is primary closure appropriate?
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clean surgical incision
clean, wound < 6 hours wound adequately debrided and drained |
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Delayed primary closure
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closed in 3-5 days after injury before granulation tissue has appeared
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What is delayed primary closure indicated?
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heavily contaminated wounds
Infected wounds wounds > 6 hours wounds w/severely contused, edematous wounds |
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Contraction and Epithelialization
(2nd intention healing) |
wound is not sutured but allowed to heal entirely by granulation tissue
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When is 2nd intention healing appropriate?
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Very large wounds
when primary closure fails **have used punch graphs & get nutrients from granulation tissue |
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Secondary Closure (3rd intention healing)
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the wound is closed later than five days after injury
granulation tissue is present so bring the two surfaces together after 5 days |
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Second Closure (3rd intention) indications
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severly infected wounds
wounds w/massive tissue destruction not enough skin to close |
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Clean surgical wound
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no breaks in aseptic technique
GI, urinary tract not entered no apparent inflammation no prophylactic antibiotics |
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Clean-contaminated surgical wound
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contaminated area is entered but no spillage
antimicrobial prophylaxis, but not needed for post-op |
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Contaminated surgical wound
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Fresh traumatic wound
break in aseptic technique gross spillage has occured acute inflammation w/o pus antimicrobial prophylaxis indicated |
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Dirty surgical wound
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pus is present
perforate viscus traumatic wound > 4hours Therapeutic antibiotics are indicated |
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Components to the Inflammatory Stage of Wound repair
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Acute Inflammatory Rxn
*Vascular *Movement of cells *Localization of the inflammatory Chronic Inflammatory Rxn |
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what leaks out during the vascular rxn of the inflammatory stage?
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plasma-like fluid out of the venules
no cells dilutes the toxic substances and aid in movement of cells |
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What is the main characteristic of the movement of cells?
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Mostly PMNs force their way through venule openings
* when they die (quickly) their exudate assumes puss * not all pus is from bacterial inflammation |
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Factors determining if pus will lead to an abscess?
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extent of injury to normal tissue
extent of cellular rxn extent to which PMN's accumulate and die |
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Why would inflammation or infection spread so quickly?
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If they lymphactics could not be plugged by fibrin
lymphatics are always injured during injury |
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What produced the classic inflammation signs?
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Vasodilation
Leakage of fluid lymphatic obstruction to localize pressue/chemical stimulation |
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Wounds require what cell to heal?
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Mononuclear cells-macrophages
they attract fibroblasts into the wound and may have a role in causing firbroblast maturation they clean up the area |
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Debridement stage characteristics
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6 hours after wounding
necrotic tissues, organisms are eaten by neutrophils, macrophages and lymphocytes might help w/immunity |
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Repair stage characteristics
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lag phase during the 1st 4-6 days of wound healing
there is no increase in wound strength |
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Processes of repair stage
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Fibroblast proliferation & fibroplasia
Capillary infiltration Epithelialization Wound contraction |
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When do fibroblasts appear in the wound?
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3rd day
move by contact guidance and cease moving by contact inhibition |
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Collagen is usually synthesized on what day?
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4 or 5
fibroblast & collagen cross-linking increase tensile strength |
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What is fibroblast replication and collagen prodction dependent on?
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New capillary ingrowth into the wound
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What is granulation tissue?
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The result of proliferation of capillary loops from the endothelium of cut capillaries in the wound
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When does granulation tissue appear?
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3-6 days after wounding
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healthy granulation tissue should appear...
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red
firm flat nonexuberant |
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Proud flesh?
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Exuberant granulation tissue
mounded, dull collage exceeded capillary formation |
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Why is granulation tissue so important?
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extremely resistant to infection
epithelium can migrate across wound contraction supplies fibroblast -> collagen |
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What is the first sign of repair?
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epithelialization
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Can epithelization occur prior to fibroplasia?
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Yes
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Incised/Surgical wounds
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can epithelialize w/o granulation tissue
may bridge gap w/in 24-48 hours by the 5th day cells produce keratin and dislodge scab |
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excised or open wounds need what for epitheliaization?
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Granulation tissue
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wound contraction
|
independent of epithelialization
no new skin formed seen 5-9 days after wounding stops when wound edges meet |
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What theory is more suppported for wound contraction?
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Pull theory- granulation tissue fibroblasts act as smooth muscle
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Intussusceptive growth
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skin thickness being restored to normal after being stretched during contraction
new collagen and epithelial proliferation |
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Maturation stage
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collagen content in the wound rapidly increases during the first 3 weeks of healing
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Properties of Povidone-iodine solution
|
controls wound sepsis
broad antimicrobial should be used diluted (1%) Inactivated by blood cells, pus, serum Toxic to would healing cells |
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Properties of Chlorhexidine diacetate
Nolvasan |
Effective antibacterial @ high dilutions - lavage @ 0.05 -1&
Broad spectrum w/body fluids, pus Not effective again Pseudomonas |
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Properties of Chlorhexidine diacetate
Hibiclens |
wide antimicrobial INCLUDING Pseudomonas
Effectiveness not significantly reduced by organic matter Has residual activity following application |
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Layered debridement
|
remove layers starting @ surface to wound depth
most commonly used - especially on extremities |
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En bloc debridement
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complete excision
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Silver sulfadiazine
|
Topical Antibiotic cream
great for burns & wounds w/necrotic debris might suppress bone marrow & lymphocytes w/large wounds |
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Nitrofurazone
|
topical wide spectrum for contaminated wounds
draws body fluids through tissues to dilute exudates |
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Triple Antibiotic
|
Small contaminated wounds
Inactivated by purulent exudate stimulates wound re-epitheliaization |
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Sugar or Honey
|
Osmotic bacteriocidal action
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Adherent bandages
|
early debridement stage
|
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Wet-to-dry bandage
|
wounds with necrotic tissue, foreign matter or a viscous exudate on the surface
fluid dilutes the exudate so it can be absorbed |
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Dry-to-dry
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wounds w/loose necrotic tissue & foreign material on their surface
place an absorbent layer on top of it |
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Wet-to-wet
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wounds w/copious exudate and little foreign debris and necrotic tissue
stay wet, less damage, but can promote bacterial growth |
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Nonadherent
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reparative stage of healing w/formation of granulation tissue
either with or w/o petrolatum, depending on granulation tissue |
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Occlusive
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Nonabsorbent bandages that occlude the wound surface, but permeable to air
partial thickness wounds, clean, non-draining |
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Hydrogel wound dressing
|
amorphous gel that rehydrates necrotic tissues
nonadherent use on healthy tissue during re-epitheilalization |
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How to decide to close a wound...
|
time since injury
degree of contamination amount of tissue damage thoroughness of debridement location patient's condition possibility of closure w/o dead-space or tension |
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Principles of Wound closure?
|
Control hemorrhage
maintain blood supply when healthy, close by suturing obliterate dead space avoid tension on the suture avoid tight sutures |
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What sutures don't you use with wound closure in contaminated wounds?
|
Mutlifilament
Nonabsorable Chromic gut |
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How deep should undermining happen in the skin?
|
Deep to cutaneous trunci muscle
suture subQ then skin |
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Tension-relieving techniques
|
Walking sutures
Stent Relaxing incision Multiple punctate relaxing incisions |
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walking sutures have small bites in wound, bigger bites of dermis?
|
True
obliterates dead space |
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Indications for wound drainage?
|
Incomplete debridement
massive contamination excessive dead space questionable tissue |
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Types of drainage
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Active: Jackson Pratt
Passive: Penrose |
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Why are diabetic patients prone to infection?
|
Decreased humoral antibody production
Vasculitis Leukocyte deficits |
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When does anemia hinder wound healing?
|
when there is hypovolemia
<15% see changes |
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At what time do steroids have to be present to decrease many wound requirements?
|
at the time of wounding or immediately after
4-5 days later will still have normal collagen synthesis |
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Are there more leukocytes and necrosis with electroscalpels?
|
Yes, risk of infection is double
|
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What is the main way to limit infection of wound?
|
Remove dead spaces
|
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Seroma predisposing factors
|
excessive dead space that is not closed or drained
excessive motion of surgical site |
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How to manage a seroma?
|
immobilize area
pressure bandage: fluid will reabsorb can aspirate is large amount -> scrub first |
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Dehiscence
|
would fails to gain sufficient strength to withstand the stresses on it
#1 Improper suture placement |
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Signs of dehiscence
|
serosanguineous discharge from wound
5-8 days after manage: clean, debride, suture w/monofilament non-absorbable or 2nd intention |
