S&a

Front 1

Oxygen Tank Storage

Back 1

Storage area must be: clutter-free, cool and dry, away from heat/open flame;

Tanks must be upright and secured (chained to wall, in stands, or on carts);

Caps/lids must be over valves for all tanks not in use;

If a tank were to fall over the cap/lid would protect the valve from being broken off

Front 2

Oxygen Tank Dangers

Back 2

If the tank falls or is dropped and the valve is broken, the tank becomes a TORPEDO;

High velocity can go through cement walls;

Can seriously injure veterinary medical staff and patients;

Store appropriately and handle with caution

Front 3

Oxygen Tank Tags

Back 3

All tanks come with tags that indicate whether the tank is full, in use or empty;

VT tears off the bottom of the tag to indicate the tanks status;

When the tank is empty "In Use" portion of the tag is removed

Front 4

Oxygen Tank Gauges

Back 4

Oxygen tank pressure is 2200 psi when full;

If the gauge reads less than 500 psi, do not use;

Line pressure is the pressure in the line trough which oxygen flows to get to surgery, radiology room (etc.) which should be 40-60 psi

Front 5

Oxygen Tank Gauge for V115

Back 5

There is a panel outside surgery that alerts staff if the line pressure is too high or too low

Front 6

Pressure Reduction Valve

Back 6

Reduces the pressure to a safe operating pressure of 40-50 psi

Front 7

Oxygen Flow Rate

Back 7

1-3 L/min - >10kg;

3-5L/min- < 10kg;

Metabolized by the lungs- be aware of gas escaping from the sides of the mask

Front 8

Chamber/Tank Induction

Back 8

Often used for wildlife and fractious feline patients;

Oxygen flow rate is 5 L/min

Front 9

Inhalant Anesthesia

Back 9

Depresses the CNS to cause unconsciousness;

Different inhalants have varying degrees of muscle relaxation, different analgesic effects, and different effects on organ system functions

Front 10

Daily Anesthetic Equipment Maintenance

Back 10

wash with warm water and germicidal soap (NOT chlorhexidine);

Scrub inside of ETTS with a brush (pipecleaners for small ones);

Rinse thoroughly and air dry;

When cleaning and drying leave cuff inflated

Front 11

Weekly Anesthetic Equipment Maintenance

Back 11

Use washing machine with water and germicidal cleaner and agitate slightly on gentle cycle;

Place ETT's, reservoir bags and breathing circuit into a mesh bag and let soak;

After soaking run the machine through the entire gentle cycle;

Let items dry overnight- hang up breathing circuits

Front 12

Anesthetic Equipment Used on Contagious Animals

Back 12

Either: Throw it all away, use a disposable circuit, or;

Disinfect completely by going through the weekly cleaning process, or;

Gas sterilization (sporocidal and bacteriocidal)

Front 13

Anesthetic Machine Weekly Cleaning

Back 13

Soak the following part for 20-30 minutes with chlohexidine solution: Empty soda lime canister, inspiratory and respiratory valves and domes;

Rinse well and air dry overnight;

Clean parts of machine that cannot be soaked with cloth containing chlorhexidine solution and rinse;

Clean out castors- wheels to roll it around

Front 14

Maintaining Normothermia- Hypothermia

Back 14

Decrease in core body temperature;

Animals require less anesthetic due to potential over-dose- rate of metabolism by the liver enzymes is decreased - longer lasting drugs;

Increased wound healing time;

In recovery- can shiver now- requiring more oxygen (200-600%);

Can cause problems in patients with cardio pulmonary disease

Front 15

Causes of Hypothermia

Back 15

Vasodilation (drugs);

Patients under anesthetic- cold and dry oxygen cause animals to cool down;

During surgery- open and will lose lots of heat;

Reduced circulation, HR & BP;

Opioids mess with thermoregulatory center of the brain;

Surgical suite is cold;

Shaved areas and swab;

Surgery table is metal=cold;

Cannot shiver to warm themselves;

IV fluids are colder than the animals body temp- drops to 0.25 degrees celcius/hr

Front 16

Pre-Therm Method to Maintain Normothermia

Back 16

Mattress that provides even warming across the whole blanket

Front 17

Circulating Hot Water Blanket Method to Maintain Normothermia

Back 17

Reservoir and blanket must be on the same level- equal height;

Must put a blanket on top of the blanket

Front 18

Bair Hugger Method to Maintain Normothermia

Back 18

Reverse vacuum blowing warm air onto the patient (tiny holes on one side blowing the air at the patient)

Front 19

Hot Dog Method to Maintain Normothermia

Back 19

Electrically conductive fabric that provides even heating across the entire blanket;

Has bungee cords to wrap the blanket over on intself

Front 20

Majic Bag Method to Maintain Normothermia

Back 20

Caution when using- can have burn injuries from them;

Must mix oats before placing with patients and wrap in a blanket

Front 21

Hot Water Bottles Method to Maintain Normothermia

Back 21

Put something between the animal and the bottle;

Best between hind legs;

Dry the bottle before placing on patient to avoid steam burns

Front 22

Other Methods to Maintain Normothermia

Back 22

Socks, body heat, garbage bag- put patient inside to avoid getting wet during dental procedures, IV fluid tube passed through a bowl of warm water, hot water in a sink, and put IV bag in a sink and wrap in a towel

Front 23

Anesthetic Drug Protocols

Back 23

A good combination of drugs used to sedate difficult cats for procedures such as x-rays;

Kitty Majic: 0.1mL dexmedetomidine, 0.1mL ketamine, 0.1mL butorphanol

Front 24

Anesthetic Procedure

Back 24

History/physical exam of patient/ diagnostic tests;

Anticipated problems- hypotension, hpoventilation, hypothermia, decreased tear production;

Premedication/Patient Preparation- Venous access, patients pain-free (stop pain before it starts);

Induction- rapid loss of consciousness, no excitation, rapid airway control (intubate quickly);

Maintenance- typically by inhalant anesthesia (few contraindications)

Front 25

Anestetic Procedure of Patient Monitoring

Back 25

Patient support- aiway protection, fluid administration, heat supplementation, respiratory support - fresh O2 and giving IPPV when they aren't breathing on their own, artificial tears- lost blink reflex and prevent corneal ulcers

Front 26

Pop-Off Valve

Back 26

AKA pressure relief valve and exhaust valve;

2 types: typical, and a press down to close

Front 27

IPPV

Back 27

Intermiten Positive Pressure Ventilation;

Maximum pressure= cats+small dogs- 8-10 cm of H2O, medium dogs= 12-15 cm of H2O, large dogs= 15-20 cm of H2O;

Atelectasis - animals are taking shallower breaths (alveoli collapsing slightly);

Done every 5 minutes

Front 28

Methods of Sterilization

Back 28

Autoclave, cold sterilization, and gas sterilization

Front 29

Autoclave

Back 29

Recall the 3 basic principals: heat, pressure, and time;

In order to be effective, surgical packs must be exposed to the proper temperature for a sufficient length of time

Front 30

Autoclave Tuttnauer Times

Back 30

Sterilization- 45 minutes from cold, and 35 minutes from warm;

Dry time- 20-30 minutes

Front 31

Autoclave Temperature

Back 31

273 degress Farhenheit

Front 32

Autoclave Structure

Back 32

Central sterilizing chamber;

Trays inside chamber hold surgical packs;

Seal created by rubber gasket when the door closed;

Temperature/pressure gauges, dial for setting time, button to set sterilized and dry cycles;

Water reservoir and pressure release valve

Front 33

Autoclave Overview of Operation

Back 33

Water is allowed to flow into the chamber;

Surgical packs loaded;

Door closed tightly;

Temperature and pressure build up;

Steam condenses on objects;

Pressure in chamber released when sterilization cycle complete;

Door opened- packs go through drying cycle

Front 34

Autoclave Items Sterilized Using Steam Sterilization

Back 34

Glassware;

Stainless steel instruments;

Some plastics;

Some types of rubber;

Surgical gowns;

Surgical drapes

Front 35

Autoclave Important Points to Remember

Back 35

High pressure in autoclave chamber- do not attempt to open door until pressure released;

Items in autoclave are hot- use caution when removing;

For adequate sterilization steam must be able to circulate- item should be packed loosely in the autoclave

Front 36

Monitoring Steam Sterilization Commercial Test Vials

Back 36

When assessing auto;

Glass vial- inoculated with spores, autoclave should kill them- send vial to lab and they will culture it- if the bacteria grows autoclave is not working;

Usually done at least once a year

Front 37

Material Needed for Autoclaving: Recap

Back 37

Distilled water;

Oven mitts;

Sterilization indicators/autoclave tape

Front 38

Cold Sterilization

Back 38

Often referred to as "cold sterile";

Liquid chemical disinfection;

Involves immersion of instruments in chemical solution;

Effective primarily against vegetative bacterial forms- therefore, more accurate to call it "cold disinfection";

Instruments must be immersed for sufficient time

Front 39

Cold Sterilization Equipment

Back 39

Nail clippers for declaws, individual instruments such as hemostatic forceps, dental instruments

Front 40

Gas Sterilization

Back 40

Uses ethylene oxide- is colourless, flammable and explosive;

Kills all microorganisms (highly sporacidal);

Highly toxic- irritating to skin and mucous membranes;

Prevents replication of microorganisms by inactivating DNA;

Requires special chamber, to contain gas, and proper ventilation;

Items must air out for period of 24 hours

Front 41

Items for Gas Sterilization

Back 41

Endotracheal tubes;

Rubber catheters;

Syringes;

Intravenous catheters;

Needles

Front 42

Scissors

Back 42

Man different types;

Used for such tasks as removing sutures, dissecting tissue during surgery, or cutting bandage material

Front 43

Stage 1 of Anesthesia

Back 43

Immediately after inhalation or injectable agent administered;

Decreased sensitivity to pain;

All reflexes present;

Patient may struggle, urinate, defecate or show other signs of fear or anxiety

Front 44

Stage 2 of Anesthesia

Back 44

Begins with loss of consciousness;

All reflexes present- may appear exaggerated;

Animal can chew and swallow- may yawn;

Brain starts to lose control of voluntary bod functions- animal may exhibit involuntary excitement: rapid limb movement, vocalization, struggling;

Breathing may be irregular or animal may appear to hold its breath;

Potentially unpleasant for patient and hazardous for staff;

Epinephrine release, cardiac arrhythmias and arrest;

Important to ensure smooth passage to Stage 3

Front 45

Stage 3 of Anesthesia

Back 45

Subdivided into 4 planes- each indicates increasing anesthetic depth

Front 46

Stage 3 Plane 1

Back 46

Light plane or anesthesia;

Respiratory pattern becomes regular;

Limb movement cease;

Eyeballs begin to rotate ventrally;

Gag and swallow reflexes depressed;

Pedal palpebral reflexes present but weaker

Front 47

Stage 3 Plane 2

Back 47

Medium plane of anesthesia- suitable for most surgical procedures;

Eyeballs rotate ventromedially;

Respiration regular but shallow;

RR, HR, and BP decreased;

Pedal and swallowing reflexes lost;

Laryngeal and palpebral reflexes are weakened or lost

Front 48

Stage 3 Plane 3

Back 48

Deep plane of anesthesia;

HR, BP, and RR decrease- increases CRT;

Eyeball position is central

Front 49

Stage 4 of Anesthesia

Back 49

Plane 4;

Early anesthetic overdose;

Marked drop in HR and BP;

CRT is prolonged- pale MM;

Abdominal breathing - inadequate ventilation;

Pupils dilate- pupillary light reflex is lost (PLR);

Too deep an anesthetic plane- animal in risk of cardiopulmonary arrest (CPA)

Front 50

Stage 4 Result

Back 50

Respiration ceases;

Cardiac Arrest;

Death;

Resuscitation of patient required

Front 51

Reflexes

Back 51

Healthy animals respond to different stimuli;

Reflexes lost with anesthesia- monitored to help determine depth of anesthesia

Front 52

Palpebral Reflex

Back 52

Blink reflex;

Lightly tap medial or lateral canthus of eye;

Loss of this reflex dependent upon drugs used

Front 53

Swallow Reflex

Back 53

Lost at medium depth of anesthesia;

Regained just before patient regains consciousness;

Once returns, safe to remove ET tube

Front 54

Pedal (toe pinch) Reflex

Back 54

Patient withdraws limb in response to pinching of a digit or pad;

Helpful for mask inductions (when assessing other reflexes difficult)

Front 55

Pupillary Light Reflex

Back 55

Constriction (miosis) of pupils in response to light

Front 56

Corneal Reflex

Back 56

Touch cornea with sterile object and note whether blinks;

Not commonly used in dogs and cats (used primarily for large animals)

Front 57

Laryngeal Reflex

Back 57

Stimulated when larynx touched by object;

This reflex protects animal from aspiration into lungs;

Present during intubation if animal not sufficiently anesthetized

Front 58

Muscle Tone Reflex

Back 58

Deeper anesthesia increases muscle relaxation;

One example is jaw tone- is lost when animal anesthetized

Front 59

Monitoring Equipment

Back 59

Assists with monitoring patients during general anesthesia;

Does not replace the senses of the veterinary technician

Front 60

Back 60

Regular stethoscope;

Sound vibrate plastic disk and send sound waves to ear pieces;

Maintain asepsis- ensure sterile surgical field not contaminated when auscultating heart and lungs

Front 61

Why might heart rate be difficult to hear when patient is under anesthesia?

Back 61

Strength of heart contractions diminished due to anesthetic drugs;

Position of heart (gravity)- patient in dorsal recumbency or in lateral recumbency

Front 62

Information that can be acquired using a regular stethoscope

Back 62

Heart rate;

Heart abnormalities;

Respiration rate;

Quality of respiration;

Abdominal Sounds

Front 63

Back 63

Esophageal Stethoscope;

Placed in esophagus of patient;

Amplifies sounds of heartbeat

Front 64

Esophageal Stethoscope

Back 64

Has a variety of catheter sizes;

Measure the catheter from the nose to the 5th rib;

Lubricate catheter- water or lubricant;

Can be attached to an audio monitor;

Used to acquire heart rate and heart rhythm;

If using a stethoscope tube, can clip ear pieces to the surgery table (for storage during surgery)

Front 65

Back 65

Pulse Oximeter;

Probe is clipped to pink/non-pigmented tissue- tongue, lip, inside of pinna, between toes, vulva/prepuce, skin of abdomen (shaved);

Also a rectal probe

Front 66

Information Acquired from a Pulse Oximeter

Back 66

Pulse -NOT heart rate;

Saturation of oxygen in the hemoglobin of the RBC's

Front 67

Back 67

Doppler Blood Pressure Monitor;

To use, shave the area between the metacarpal and the carpal pads (front, back or tail);

Appropriate size of cuff on patient just below the elbow;

Attach the cuff to the sphygmomanometer;

Palpate for pulse;

Place ultrasound get on probe- concave side;

Place probe on shaved area;

Inflate cuff to 20mm above when last heard pulse;

Deflate the cuff slowly- systolic pressure read at point that round returns

Front 68

Doppler Blood Pressure Monitor

Back 68

Amplifies sound of pulse- "whoosh whoosh";

Acquires systolic blood pressure (mm Hg), and pulse;

Do not use cleaning solution or alcohol to clean the probe (water only)

Front 69

Back 69

ApAlert;

Detects apnea- cessation of breathing;

Beeps each time a patient exhales;

Adapter connects to ETT and breathing circuit;

Sensor detects temperature changes between the warm exhaled air and cool inhaled air;

Will alarm if animal does no breathe in set period of time

Front 70

ApAlert Attachment

Back 70

Can increase mechanical dead space

Front 71

Back 71

Capnograph;

AKA End-Tidal CO2 monitor;

Different brands;

One of the functions of the Cardell

Front 72

Information Acquired From using the Capnograph

Back 72

Monitors breathing by measuring exhaled (end tidal) CO2 and inhaled CO2;

End tidal CO2=EtCO2;

Inhaled CO2=inspCO2

Front 73

Back 73

ECG;

AKA electrocardiogram;

Another function of the Cardell monitor;

Acquires the rhythm of the heart- helps diagnose arrhythmias and a variety of heart problems

Front 74

Oscillimetric Blood Pressure Monitor

Back 74

Blood pressure measuring device that automatically inflates and deflates the blood pressure cuff;

Can be set to measure pressure every 1, 2, 3, 5, 10, 45, and 60 minutes;

Another function of the Cardell

Front 75

Information acquired by the Oscillometric Blood Pressure Monitor

Back 75

Systolic BP;

Diastolic BP;

Mean Arterial Pressure (MAP);

Pulse;

NOT RELIABLE IN PATIENTS UNDER 5KG

Front 76

Heart Rate Under Anesthesia

Back 76

Dogs: 70-120

Cats: 130-170

At Rest=

Dogs: 70-160

Cats: 150-210

Front 77

Respiratory Rate Under Anesthesia

Back 77

Dogs: 8-15

Cats:12-18

At Rest=

Dogs: 8-20

Cats: 8-30

Front 78

Rectal Temperature Under Anesthesia

Back 78

Dogs: 38

Cats: 38

At Rest=

Dogs: 37.5-39

Cats:38-39

Front 79

Systolic Blood Pressure Under Anesthesia

Back 79

Dogs: 120 (Intervene is <90, >170)

Cats: 120 ""

At Rest=

Dogs: 100-160

Cats: 100-160

Front 80

MAP (mm Hg) Under Anesthesia

Back 80

Dogs:100 (Intervene is <90, >170)
Cats:100 ""
At Rest=
Dogs:80-120
Cats:80-120

Front 81

Saturation of Hemoglobin with Oxygen on Room Air Under Anesthesia

Back 81

Dogs:98%

Cats:98%

At Rest=

Dogs:99-100%

Cats:99-100%