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99 Cards in this Set

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  • Back
What percentage of blood is found in the veins? Heart/lungs? Arteries? Capillaries?
70% veins
15% heart/lungs
10% arteries
5% capillaries
Which part of the ECG waveform corresponds with...
...atrial depolarization?
P wave
Which part of the ECG waveform corresponds with...
...conduction through the AV node?
PR segment
Which part of the ECG waveform corresponds with...
...ventricular depolarization?
QRS complex
Which part of the ECG waveform corresponds with...
...ventricular repolarization?
T wave
How does inhaled anesthesia interfere with cardiac function?
Reduces contractility by reducing Ca.
What is the approximate distribution of the cardiac output?
75% to vessel rich group (brain/heart/kidney)
20% to muscles/skin
5% to fat
<1% to vessel poor group
What are some important factors that should be examined/noted during a physical exam of a patient with suspected cardiovascular disease?
Ascult heart
Jugular distention/pulse
Femoral pulse
Respiratory pattern
Abdominal palpation
Which diagnostic tool gives the best information about a cardiac case?
a) ECG
b) Ultrasonography
c) Radiography
d) Blood pressure
e) Echocardiography
e) Echocardiography (which is technically a form of ultrasonography)
What is the first step in a procedure involving cardiac tamponade?
Tap tap tap that sucka!
Which drugs should be avoided for patients with cardiac disease?
Acepromazine
Alpha-2 agonists
Which is the most acceptable combination of drugs for preanesthesia in a patient with cardiac disease?
a) Acepromazine + Hydromorphone
b) Ketamine + etomidate
c) Dexmedetomidine + telezol
d) Diazepam + Hydromorphone
e) Etomidate alone
d) Diazepam + Hydromorphone
T or F:
Isofluorane or sevofluorane alone is not appropriate for maintenance of small animal patients w/cardiac disease.
False! However, inhalants are often augmented with opioids or local anesthetics.
Which commonly used large animal anesthetic should be avoided in the patient with cardiac disease?
Xylazine!
Which commonly used class of anesthetic drug presents no problem to a patient with hepatic dysfunction?
Inhalants! They're not metabolized by the liver!
What effect would a normal dose of diazepam have upon a PSS dog?
a) no effect
b) reduced effect
c) normal effect
d) increased effect
d) increased effect; PSS dogs have increased BNZ receptors!
The fraction of drug extracted over the delivered load of drug describes the...
...extraction ratio
The hepatic clearance of a drug with a high extraction ratio is highly dependent on ________.
hepatic blood flow
T or F:
The hepatic clearance of a drug with a low extraction ratio is not very dependent on hepatic blood flow.
True
Which is more affected by hepatic disease, drugs with a high or low extraction ratio?
Low extraction ratio
Describe the extraction ratios of the following drug classes:
Phenothiazines
Benzodiazepines
Alpha-2 agonists
Opioids
Describe the extraction ratios of the following drug classes:
Phenothiazines (unknown)
Benzodiazepines (low)
Alpha-2 agonists (unknown)
Opioids (high)
What corrective pre-op measures should be explored before an anesthetic procedure is performed on a hepatocomprimised patient?
Correct blood glucose levels w/dextrose
Coagulation profile
Colloid support
Which is probably the best premedication protocol for a dog with hepatic disease?
a) acepromazine + hydromorphone
b) diazepam + hydromorphone
c) hydromorphone alone
d) ketamine + benzodiazepine
c) hydromorphone alone
What pre-op measure should be taken in a patient set to undergo hepatic surgery?
Cross-match for blood products
Respiration occurs at the ___________ level while ventilation occurs at the ___________ level.
Respiration = cellular
Ventilation = alveolar
Which of the following can effect functional residual capacity?
a) pregnancy
b) positioning
c) obesity
d) colic
all of the above!
What is the KEY component in neural control of ventilation?
Arterial CO2
What effect does mechanical ventilation have on cardiac output?
a) reduced CO
b) no effect
c) increased CO
a) reduced CO; positive pressure ventilation reduces venous return
What is the ventilation:perfusion of physiologic dead space? Of a shunt?
Dead space = no perfusion but good ventilation = infinitity;
Shunt = good perfusion but no ventilation = 0
The defense mechanism that deflects perfusion away from poorly ventilated regions of the lung is known as...
...hypoxic pulmonary vasoconstriction
What does a LEFT SHIFT mean in the oxyhemoglobin dissociation curve? Name some things that can cause a left shift...
Left shift = increased O2 affinity (doesn't unload O2 as readily);
Caused by DECREASED temp, 2,3 DPG, or increased pH
What fraction of oxygen is read by a blood gas machine?
Dissolved (unbound) oxygen (only about 2%)
What is a quick formula to determine the projected PaO2 levels?
5 * inhaled concentration (eg: 5 * 20% atmospheric = 100 mm Hg)
Alveolar ventilation has the greatest effect upon:
a) Pa O2
b) Pa CO2
c) Proportionally inverse relationship between PaO2 and PaCO2
d) O2 saturation
b) PaCO2
What is the best way to evaluate ventilatory function?
Arterial blood gas
T or F:
Hypoxemia and hypoventilation both occur at 60mm Hg.
True! However they are measuring different things (60mm Hg O2 for hypoxemia and 60mm Hg CO2 for hypoventilation)
What are the components of brachycephalic syndrome?
Stenotic nares
Elongated soft palate
Everted laryngeal vesicles
Hypoplastic trachea
T or F:
Tracheal intubation can overcome the issues associated with brachycephalic syndrome.
True!
Patients with ____________ disease experience perhaps the most catastrophic of all inductions.
RESPIRATORY
Which of the following are good choices when administering pre-anesthetic drugs to a patient with respiratory disease?
a) Benzodiazepines
b) Phenothiazines
c) Alpha-2 Agonists
d) Anticholinergics
e) Opioids
a) Benzodiazepines
b) Phenothiazines
d) Anticholinergics (maybe)
e) Opioids
What should be used instead of propofol when inducing a patient with respiratory disease?
Etomidate
How should large animal protocol be changed when respiratory disease is present?
Rarely changed
What are two issues with azotemia that may affect anesthesia and surgical procedure?
Azotemia interferes with the BBB and platelet function
With what type of kidney dysfunction is hyperkalemia most often associated?
Post renal azotemia
What is the rule of thumb regarding the degree of hyperkalemia and anesthesia?
If K is > 6meq/L DON'T ANESTHETIZE
What are some treatment options for hyperkalemia? Which is used for life-threatening situations?
Dilution
Dextrose + insulin
NaHCO3
Ca gluconate or CaCl2 (first choice for life threatening arrhythmias)
What are the ECG features of hyperkalemia?
Low P wave
PR Prolongation
Widening of QRS
Peaked T wave
Which drugs should be avoided in patients with renal disease and why?
Drugs with renal excretion (ketamine, diazepam, morphine)
Drugs that can potentiate nephropathy (aminoglycosides, NSAIDs)
What is the MAP range within which blood pressure autoregulation occurs?
between 60 and 160 mm Hg
Catecholamines produce this important cause of reduced renal blood flow...
...alpha 1 activation (vasoconstriction)
What are intraoperative goals for patients with kidney disease in terms of MAP?
MAP should be >70mm Hg
Which sympathomimetics should be avoided in patients with renal disease?
Vasopressors (alpha 1 agonists)
What is the general age of large animal of neonates? Small animal?
How about pediatrics?
LA <1-2 wks
SA < 6wks
Pediatrics are <12wks
What are some PK/PD anesthetic considerations in the young patient?
Neonatal hypoalbuminemia (incrases free active drug)
Increased BBB permeability
Lower body fat
Immature renal and hepatic fxn
Increased volume of distribution
What is the major determinant of CO in the neonate? What is the approximate percentage by which a neonate can increase CO?
Heart rate; CO can increase by ~30% (vs 300% in the adult)
How does the young animal's pliable ribcage affect ventilation effort and efficiency?
Increased effort and reduced efficiency
What are normal PCV & TP ranges for neonates?
a) 15-25% PCV; 4-5 gm/dL TP
b) 25-30% PCV; 3-4 gm/dL TP
c) 15-25% PCV; 3-4 gm/dL TP
d) 25-30% PCV; 4-5 gm/dL TP
d) 25-30% PCV; 4-5 gm/dL TP
Which of the following are acceptable choices for neonatal premedication?
a) Opioids
b) Benzodiazepines
c) Anticholinergics
d) Phenothiazines
a) Opioids
b) Benzodiazepines
c) Anticholinergics
T or F:
Due to the reduced functional residual capacity and increased minute ventilation of the neonate, propofol is not a good choice for induction.
False! Propofol works fine although other agents are commonly used.
What is a normal MAP for puppies?
~50 mm Hg!!! They're always hypotensive under anesthesia!
Why might NSAIDs not be OK in pediatric/neonates?
COX may be important for kidney development; don't wanna inhibit this!
What is the definition of geriatric?
An animal exceeding 75-80% of projected lifespan.
Why are geriatric animals less tolerant of hypovolemia?
Increased vascular stiffness, lower blood volume, reduced renin/angiotensin responsiveness
T or F:
Low dose acepromazine is OK to use in geriatric patients.
Yeah it is. Seems a bit counterintuitive though with its hypotensive side effects...
T or F:
Drug selection in geriatric anesthesia differs greatly from anesthesia of a patient of normal age.
False...not really as far as I can tell. Looks like you just lay-off the ace a bit and consider etomidate for induction. Monitoring is key though!
NSAID use is contraindicated in:
a) pediatrics
b) neonates
c) geriatrics
d) none of the above
e) all of the above
d) none of the above; pros and cons must be weighed in each case!
Which drug can cause regurgitation upon induction?
Etomidate
When intubating a cat, approximately what air volume should fill the cuff?
<3mL
What feature of and ET tube prevents bevel obstruction?
Murphy eye
OH NOOOOOOOOOO!!!! Somebody put iso in my sevo machine!! What to do!!!
Drain, dry, refill
T or F:
Compressed gas cylinders can punch a hole through walls!
Bam its true! Mythbusters approved!
Match the bradycardia cutoff with the correct animal:
<25 Sheep
<60 Horse
<80 Cat
<90 Large dog
<100 Titty dog
<25 Horse
<60 Large Dog
<80 Ruminant
<90 Titty dog (toy breed)
<100 Cat
What are the 4 steps to treating cardiovascular complications while under anesthesia?
1. Normalize HR/rhythm
2. Assess anesthetic depth
3. Fluid bolus
4. Administer inotropes/vasopressors
Match the tachycardia cutoff with the correct animal:
>60 Sheep
>120 Horse
>140 Cat
>160 Large dog
>220 Titty dog
>60 Horse
>120 Ruminant (sheep)
>140 Large dog
>160 Titty dog (toy)
>220 Cat
What are two good treatments for tachycardia?
Fentanyl or esmolol
What are 5 causes of hypoxemia and which is most important?
V/Q mismatch (most important)
Decreased inspired O2
Severe hypoventilation
Diffusion impairment
Intra/extrapulmonary shunting (form of V/Q mismatch)
What are causes of tachypnea?
Pain
Hypoxia
Hyperthermia
Inadequate anesthetic depth
Word association time!
Myopathies are to horses as __________ are to cattle?
Neuropathies
What are two ways to prevent myopathies/neuropathies?
Adequate perfusion
Padding
Why are vital signs taken at least every 5 minutes?
Neuronal injury occurs within 5 min of hypoxia!
What are the signs of cardiopulmonary arrest? Which are pretty much useless during anesthesia?
Absence of cardiac activity
Cyanosis (worthless when on 100% O2)
Agonal gasps
Unconsciousness (worthless when under anesthesia)
What are the 4 ECG RHYTHMS OF DEATH!!!
Asystole
Fibrillation (V-fib)
Pulseless indioventricular rhythm (least common)
Pulseless electrical activity
What factor is the most important in successful cardiopulmonary cerebral resuscitation?
TIME
What are the MUST HAVE drugs in a crash cart?
Atropine
Epinephrine
Lidocaine
Dopamine
What is the first step in basic life support of the anesthetized patient?
Turn off the vaporizer!!
In the ABCs of basic life support of the anesthetized patient, what does "A" stand for and what should be checked with this?
A = airway
Check for obstructions
Check to see if pop-off valve is closed (shouldn't be)
What is the suggested rate for mechanical breathing in the anesthetized patient in a life-threatening situation?
8-12 bpm
What is the theoretical difference between the cardiac and thoracic pump? In which animals is each used?
Cardiac pump (heart is OK and is being mechanically pumped; used for animals <10kg)
Thoracic pump (heart is not OK; differences in intrathoracic pressures collapse great veins to move blood; used for animals >10kg)
What are some indications for internal cardiac massage?
Any time the thoracic wall is compromised (rib fracture, open thorax, diaphragmatic hernia)
Pericardial dz
Open abdomen
What diagnostic tool provides the best assessment of chest compression effectiveness? How do specific readings correlate with prognosis?
Capnography!
ET CO2 <10 (poor prognosis)
ET CO2 >20 (associated w/survival)
What are the three arrthymias preceding cardiopulmonary arrest and how is each treated?
Bradyarrthymia (Atropine)
Sinus tachycardia (treat underlying problem)
Ventricular tachy (treat underlying prob; use lidocaine)
Which drug is used to treat asystole?
Epinephrine
Maybe vasopressin
What is used to treat ventricular fibrillation?
Electrical stimulation (defib)
Amiodarone
What are the goals of euthanasia?
Rapid loss of consciousness
No pain
Respiratory/cardiac arrest
Loss of brain fxn
reliability
Compatible with other requirements (post mortem & etc)
Minimal unfavorable aesthetics
What are the inhalant agents used in euthanasia? Where are these usually used?
CO2, Ar, N2, CO;
Used in shelter med, poultry operations, or for rodents
What are the ONLY acceptable sites for injectible euthanasia solution?
IV
IP
MAYBE intracardiac (last resort)
What are the following injectable anesthetics is/are acceptable in awake animals in the US?
a) barbiturates
b) KCl
c) Chloral Hydrate
d) MgSO4
e) T-61
a) barbiturates
c) Chloral Hydrate
What are some examples of UNACCEPTABLE injectable anesthesia?
Strychnine, Nicotine, KCl/MgSO4 (awake), muscle relaxant alone, surfactant, solvent
What drug can be administered along with barbiturates to smooth out the euthanasia?
Propofol (expired)