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69 Cards in this Set
- Front
- Back
What are 3 things a tech should know/do during an anesthetic emergency?
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Recognize signs of crises & alert ver; anticipate needed supplies; assist the vet.
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What are 6 factors which can attribute to an anesthetic emergency?
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Geriatric (reached 75% of life expectancy), pediatric (<3mths), brachycephalic, sighthounds, obese, cesarean.
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What can you do to help a geriatric patient during anesthesia?
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Do a pre-anesthetic history, physical & screening test; reduce anesthetic doses by 30-50%; allow more time to take effect.
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What are some problems than can occur with a geriatric patient?
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They have a poor response to stress; recovery may be pronounced; hypothermia; overhydration.
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What can you do to help a pediatric patient during anesthesia?
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Weigh accurately & dilute injectable drugs; reduce dosages; use inhalation.
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What are some problems that can occur with a pediatric patient?
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Hypoglycemia (avoid prolonged fasting); high risk for hypothermia & overhydration.
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What are some problems that can occur with brachycephalic breeds?
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Airway obstruction - preoxygenate, induce rapidly (IV), delay extubation, observe closely during recovery. They have a high vagal tone, use an anticholinergic.
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What type of drug should you avoid in sighthounds?
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Barbiturates
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What are some things you can do to help an obese patient during anesthesia?
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Preoxygenate; dose according to actual weight; induce rapidly; assist ventilation if necessary; delay extubation; observe closely during recovery.
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What are some things you can to help a c-section patient during anesthesia?
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Preoxygenate; IV fluids; lowest effective dose of anesthetic; avoid ketamine/diazepam & barbiturates.
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What drugs should you avoid giving a cesarian patient?
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Ketamine/diazepam & barbiturates.
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What should you do for a neonate during a c-section?
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Oxygen by mask; atropine for bradycardia; reversing agents; doxapram.
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What are some types of emergency situations?
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Shock, patient doesn't stay anesthetized, patient too deep, respiratory depression, abnormal breathing patterns, bradycardia, tachycardia, cardiac dysrhythmias, cardiac arrest, vom/aspiration/regurgitation, malignant hyperthermia.
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Definition of shock
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Inadequate tissue perfusion leading to cellular hypoxia, metabolic acidosis & ultimately, cell death.
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What are the 4 types of shock?
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Hypovolemic, vasculogenic, cardiogenic & obstructive.
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What are 4 types of shock?
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Hypovolemic, vasculogenic, cardiogenic & obstructive.
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What is hypovolemic shock?
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A decrease in circulating blood volume due to loss of fluid.
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What conditions can cause hypovolemic shock?
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Hemorrhage, vomiting, diarrhea, diuresis, burns or fluid sequestration.
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What is vasculogenic shock?
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The vascular space is increased which leads to a decrease in blood pressure.
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What conditions can caue vasculogenic shock?
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Sepsis, anaphylaxis, drug overdose.
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What is cardiogenic shock?
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A failure of cardiac output.
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What conditions may cause cardiogenic shock?
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Dysrhythmias, valvular insufficiency, congenital defects, heart muscle problems.
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What is obstructive shock?**
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A restriction in blood flow.
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What conditions may cause obstructive shock?
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GDV, pneumothorax, cardiac tamponae (cardiac output is blocked).
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What are some signs of shock?
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Tachycardia, tachypnea, hypotension (prolonged CRT), hypothermia, weakness, restlessness, depressio, reduced urine output, coma, pupil dilation, leads to cardiopulmonary arrest.
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How do you treat shock?
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Rapid IV fluids, dopamine or dobutamine, lidocaine or propranolol, glucocorticoids, antibiotics for sepsis, diuretics for oliguria/anuria.
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Why do you give dopamine or dobutamine for shock?
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To increase the contraction of the heart.
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Why do you give lidocaine or propranolol for shock?
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It helps with arrhythmias.
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What are 5 errors/problems which can lead to a patient not staying anesthetized?
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The endotrach tube, vaporizer, delivery system, oxygen tank & patient.
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What do you need to check with the endotrach tube to make sure it's working?
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Is it in the trachea, large enough, cuff inflated, kinked, firmly connected to the machine?
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What do you check with the vaporizer to make sure it's working properly?
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Is it connect to the oxygen, to the delivery system, correctly set, filled, calibrated?
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What do you check with the delivery system to make sure it's working properly?
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Are there any leaks, is the oxygen flow adequate?
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What do you check with the oxygen tank to make sure it's working properly?
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Is it on, is there an adequate supply in the tank?
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What do you check with the patient if they're not staying under?
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Are they hypoventilating?
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What are some signs that the patient is too deep?
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Dilated pupils, no reflexes, bradycardia, delayed CRT, hypoventilation, no muscle tone.
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What are 2 things that can cause a patient to become too deep?
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The equipment or the patient.
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What should you check with the equipment if the patient is too deep?
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Is the vaporizer setting or calibration correct? Is the correct anesthetic in the vaporizer?
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What should you check with the patient if they are too deep?
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Are they hypothermic, in shock, have a preexisting disease, check drug doses or interactions.
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How do you treat/avoid a patient becoming too deep?
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Proper machine checkout, decrease or turn off vaporizer setting; ventilate patient; warm patient; reverse drugs if possible.
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What are some signs of respiratory depression?
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Reduced respiratory rate, reduced tidal volume, cyanosis.
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What are some causes for respiratory depression?
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Patient is too deep; anesthetic drugs; surgical positioning (pressure on check or diaphram); hypocarbis (ventilating too fast); CNS or metabolic disease.
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How do you treat respiratory depression?
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Lighten plane; 'sigh' all patients; supplement if <10rpm; correct surgical positioning; use doxapram if nothing else is effective.
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What are some signs of abnormal breathing patterns?
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Increase effort -abdominal breathing; decreased movement of chest or reservoir bag; cyanosis; unusual sounds -rales, crackles, muffled.
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What are some causes of abnormal breathing?
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Patient too deep; misplaced endotrach tube; obstruction w/in resp system(aspirated material, musous); obstruction w/in equipment (endotrach tube, delivery tube, closed popoff valve; disease of respiratory system.
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How do you treat abnormal breathing?
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Check popoff valve & ventilation bag first!! Assess depth-lighten if necessary; ventilate & watch chest-no movement ~obstruction; can disconnect system & aspirate endotrach tube.
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Sign of bradycardia?
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Dogs = <60 bpm
Cats = <100 bpm |
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What are some causes of bradycardia?
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Anesthetic plane too deep; increased vagal tone; hypothermia; metabolic problems; late stages of hypoxia.
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How do you treat bradycardia?
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Lighten anesthetic plane if possible; support ventilation; keep patient warm; administer anticholinergic (atropine).
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What are signs of tachycardia?
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Dogs - large >120bpm
medium >140bpm small >150bpm Cats - >200bpm |
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What are some causes of tachycardia?
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Patient too light; hypotension, hypovolemia, shock; inadequate ventilation-early stage of hypoxemia; drug induced (ketamine, anticholinergics); hyperthermis.
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How do you treach tachycardia?
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Adjust anesthetic depth if necessary; provide adquate fluid support; support ventilation; check temp, maintain normothermia.
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What are some signs of a cardiac arrhythmia?
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Irregular pulse rate & pressure; pulse deficits; irregular heart sounds; hypotension; pallor, cyanosis; abnormal ECG tracing.
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What are some causes of cardiac arrhythmias?
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**Drug sensitizes heart to epinephrine. Too light or too deep; anesthetic drugs; hypoxemia; hypercarbia; electrolyte or acid-base imbalance; surgical manipulation.
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How can you prevent cardiac arrhythmias?
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Presurgical PE & labwork; correct any hydration & metabolic imbalances b/4 anesthesia; fluids for cardiac support; porper anesthetic depth monitoring; follow proper drug protocol.
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How can you treat cardiac arrhythmias?
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Assess & adjust anesthetic depth; ventilation; fluid therapy.
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What are some signs of cardiac arrest?
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Resp arrest; no pulse; no heart sounds; dilated, fixed pupils; lack of bleeding at surgical sites; blue/gray tissue color; ECG changes.
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What are some causes of cardiac arrest?
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Inadquate ventilation which leads to resp arest; anesthetic overdose; hypothermia; acidosis, other metabolic problems; cardiovascular disturbances.
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How do you treat cardiac arrest?
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CPR; epinephrine; after resuscitation give dopamine or dobutamine; evaluate CNS status.
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What are some causes for vomiting, aspiration, regurgitation?
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***Drugs (opiates, barbiturates, xylazine); light anesthesia (stage 2); feeding b/4 anesthesia; stress, excitement; surgical manipulation.
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What are some signs of aspiration?
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Cyanosis; bronchospasm (wheezing, can't breath in); apnea or tachypnea. On radiograph: pulmonary edema, pneumonia.
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How do you prevent aspiration?
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Fast 12 hours b/4 anesthesia; avoid stress & excitement; acepromazine; rapid induction techniques (avoid stage 2); leave cuff inflated until ready to extubate.
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How do you treat vomiting?
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Place in sternal recumbancy; keep mouth open, tongue out; tilt table head downward; afterward, examine & cleanse pharynx.
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How do you treat aspiration?
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Suction airway, may lavage w/ sterile saline; administer O2; broad-spectrum antibiotics; steam or mist; coupage; if bronchospasm occurs - steroids or aminophylline.
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What is malignant hyperthermia?***
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A hypermetabolic state induced by drugs which leads to uncontrolled increase in temperature, metabolic crisis which may lead to death.
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What are some predisposing factors to malignant hyperthermia?
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Genetics; infections; drugs (ketamine, anticholinergics, inhalation drugs, succinylcholine); environmental stress & excitement.
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What are some early signs of malignant hyperthermia?
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Hyperventilation, tachypnea; elevated body temp; skin & MM flushed which leads to cyanosis; tachycardia & dysrhythmmias; BP first elevated, the profoundly decreased; muscle rigidity.
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What are some late signs of malignant hyperthermia?
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Muscle rigidity; core body temp 108-110; severe metabolic acidosis; hemolysis, coagulopathy; acute renal failure; hypoglycemia; cerebral edema; death.
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How can you prevent malignant hyperthermia?
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Be aware of signs to recognize while monitoring post-anestheic patients.
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How do you treat malignant hyperthermia?
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Remove triggering agents, if possible; IV fluids; cool body -bath, snow, hose down; oxygen; diuretics; corticosteroids.
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