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146 Cards in this Set
- Front
- Back
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fluorescein eye stain |
indication diagnosis of corneal ulcers, corneal lacerations and cuts, foreign body puncture wounds and test of nasolacrimal duct patency green dye can come out the animals nose |
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schirmer tear test |
indication is to measure the rate of tear production normal tear production between 15mm-20mm/min |
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tonometery/tonometer |
indications to measurement of intraocular pressure/IOP diagnosis of glaucoma-high reading anterior uveitis-low reading normal in dogs is 15-25 mm Hg normal in cats is 15-30 mm Hg |
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telephone triage |
name and phone number! ask questions to determine whats a serious emergency always offer exam |
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dystocia |
difficult labor |
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in hospital triage |
3 groups brief history, quick PE, and target discussion with owners TPR, MM color, hydration status and CRT |
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initial triage exam |
systemic evaluation of essential organ systems cardiovascular, respiratory, neurologic |
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tachypnea |
increased respiratory rate |
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bradypnea |
decreased respiratory rate |
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inspiratory dyspnea |
low, slow inspirations with short exhalations |
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expiratory dyspnea |
increased abdominal effort on expiration |
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labored breating |
prolonged and deep |
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orthopnea |
patient is air hungry neck extended crouching distress or aggression elbows abducted |
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apneustic pattern |
deep inhalation with an abnormally long pause before exhalation |
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cheyne-stokes breathing |
pattern of alternating tachypnea and bradypnea occurring when carbon dioxide regulation of respiration is interrupted |
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kussmauls breathing |
slow deep regular respiratory compensation for metabolic acidosis |
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paradoxical chest excursion |
segment of thoracic wall moves in teh opposite direction in relation to the rest of the chest wall during respiration |
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decreased mentation |
shock state
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tachycardia |
abnormally fast heart rate dogs |
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bradycardia |
inappropriately slow heart rate cats |
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prolonged CRT |
fluid resucitation |
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shortened CRT |
hyperdynamic stage of sepsis |
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obtunded mentation |
reacts to stimuli but at slower pace than normal |
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dull mentation |
not bright or eager, still interactive with environment |
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stuporous mentation |
completely disconnected only respond to noxious stimuli |
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comatose mentation |
completely disconnected, doesn't react to any stimuli |
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mydriatic pupils |
unresponsive big pupils fixed and dilated |
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anisocoria |
one big pupil and one little pupil acute cerebral injury |
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TBI |
traumatic brain injury |
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decerebrate posture |
disconnect between forebrain and brain stem extreme rigidity of all 4 legs may have arching of back and neck comatose or stuporous mentation |
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schiff sherrington posture |
normal mentation ambulatory when picked up and placed on feet t3-t4 spinal cord lesion |
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decerebellate posture |
severe injury to cerebellum rigid forelimbs and flexed hindlimbs normal mentation |
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tympany |
pinging |
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fluid wave during abdominal palpation |
hemorrhaging |
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signs of severe pain |
arched back praying posture |
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dehydration |
decrease in water component of blood tacky or dry mm lack of skin turgor mental status body weight |
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hypovolemia |
loss of blood volume hypovolemic shock tachycardia weak pulses hypotension prolonged CRT |
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treating hypovolemia |
catheterization IV fluids blood transfusion identification of source-emergency surgery intensive monitoring and nursing |
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treating dehydration |
fluid replacement over several hours slower if patient is hyperatremic- can cause cerebral edema monitoring |
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initial diagnostics |
packed cell volume total protein blood glucose blood gas analysis blood pressure pulse oximetry ECG fast ultrasound scan electrolytes colloid osmotic pressure |
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pulse oximetry |
saturation of oxygen in blood anything below 92 should be put on oxygen therapy oxygen level should always be 100 |
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electrolytes |
major role in the maintenance of extracellular compartmental water balance and cell function commonly measured are potassium, sodium, chloride, magnesium and ionzied calcium |
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colloid osmotic pressure/COP |
used to guide guide therapy normal is 20-25 mm Hg keep greater than 18 mm Hg |
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basic first aid for wounds |
clipped cleaned flushed with sterile saline bandages applied |
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emergency care station |
easily accessible clean and well stocked equipment organized and labeled oxygen source suction apparatus crash cart functional clippers |
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crash cart |
emergency medications needles syringes laryngoscope endotracheal tubes ambu bag instrument packs red rubber catheters large bore intravenous catheter |
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shock |
altered blood flow or impaired delivery of oxygen to tissues early stages are; depressed or anxious, tachycardic and tachypneic, normal, decreased or increased pulse, hyperglycemia |
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hypovolemic shock |
most common in dogs and cats decreased circulating blood volume weak pulse, delayed CRT, pale mm and altered mentation treatment- IV crystalloids, colloids or hypertonic solutions blood transfusion |
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distributive shock |
maldistribution of blood flow from inappropriate vasodilation and from pooling of blood in capillaries anaphylaxis, heatstroke and envenomation treatment- fluid therapy and vasopressors weak or bounding pulse and pink mm |
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obstructive shock |
venous return to the heart impaired GDV treatment-surgery or pericardiocentesis |
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cardiogenic shock |
impaired cardiac output secondary to problems with the heart cardiomyopathy, valvular heart disease and arrhythmias weak pulses, hypotension and pale mm treatment- antiarrhytmics, inotropes, vasopressores and pacemakers |
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septic shock |
severe infectious insult pneumonia, parvovirus, gastric or intestinal perforation or infected bite wound sequeal to severe tissue damage-heatstroke or pancreatitis |
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complications of shock |
systemic inflammatory response syndrome/SIRS disseminated intravascular coagulation/DIC multiple organ dysfunction syndrome/MODS |
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systemic inflammatory response syndrome |
sepsis just a source of active infection |
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disseminated intravascular coagulation |
thrombosis and bleeding often fatal throw blood clots clotting cascade |
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multiple organ dysfunction syndrome |
permanent organ failure and death |
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reperfusion injury |
cells become starved for oxygen after shock-elevated levels of lactate and by products causing tissue damage blood flow and oxygen are restored in tissue lactate and free radical molecules can be released into circulation risks-SIRS, complications, organ failure |
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lactate concentration |
hyerlactatemia is an increased lactate concentration lactic acidosis results and decrease in systemic blood pH Type A- inadequate oxygen delivery or increased oxygen demand type B- inadequate utilization of oxygen |
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tracheostomy tube placement |
blocked airway or distress cant get endotracheal tube in allows breathing until upper airway is cleared |
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capnography |
measures carbon dioxide |
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flow by oxygen |
flow rates need to be 100-150 ml/kg/mi |
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mask oxygen |
with diaphragm on or off tight mask can stress patient without diapragm reduces oxygen blast |
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oxygen hood/cage |
some have benefit to control temp and humidity ensure cage is safe and patient cant get trapped whole body or head and neck can be involved |
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nasal cannula |
prongs works well for brachycephalic breeds can irritate and cause patient to sneeze benefit is they are sold with etCO2 capabilities |
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naso-oxygen catheter |
most invasive best for long term oxygen placed into nasal cavity, nasopharynx or trachea complication-gastric distention or epitaxis contraindicated in patients with known coagulation disorders |
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transtracheal oxygen catheter |
administer oxygen directly into trachea same catheters used for nasal oxygen may cause patients to cough prolonged use should include humidified |
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hyperbaric oxygen therapy |
use increased atmospheric pressure to allow more dissolved oxygen in teh blood hand off type therapy-pressurized chamber cant be simply opened, must be depressurization first more indicated for wounds, severe burns and infections helps healing process |
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oxygen toxicity |
damage to pulmonary epithelium pulmonary edema fibrosis can cause damage after 6 hours and signs not observable until later |
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pulse oximetry |
normal saturation- 95-100% doesnt measure partial pressure of oxygen below 95 need oxygen therapy |
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capnography |
measures carbon dioxide levels inserted into breathing circuit of intubated patient end tidal carbon dioxide reflect amount of carbon dioxide present in expired air at the the end of exhalation increased-hypoventilation decreased-hyperventilation or decreased cardiac output |
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arterial blood sample |
assess pulmonary function measured on pH and blood gas analyzer reveals ability to ventilate and oxygenate |
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arterial blood gas monitoring |
SaO2 arterial hemoglobin saturation PaO2 partial pressure of oxygen-oxygenation PaCO2 partial pressure of carbon dioxide-ventilation status |
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hypoventilation |
increased PaCO2 occur with airway obstruction, lung disease, brain disease, sedation/anesthesia, toxicities can cause academia/decreased blood pH |
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hyperventilation |
decreased PaCO2 can be caused by hypoxemia, metabolic acidosis, stress, pain and anxiety |
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arterial blood samples |
arteriopuncture dorsal metatarsal artery femoral artery |
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urinary output |
normal urine production is 1-2ml/kg/hr decreases when perfusion decreases or when MAP is less than 60 mm Hg |
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central venous pressure/CVP |
measures the hearts ability to pump fluids returned to it an estimate of the relationship of blood volume to blood volume capacity used when heart failure is suspected |
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do not use jugular catheter when |
a patient has a coagulation problem |
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do not use back legs to catheterize when |
cats have a thromoembilism |
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winged need IV catheter |
for short term use, pet has limited movement blood collection administration of nonirritating medications easy to puncture vessel wall |
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multilumen IV catheter |
2-3 lumens in one catheter allow simultaneous infusions at one catheter site |
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through the needle catheter |
placed in jugular vessels or saphenous 8-12 length and 8-20 gauge needle guard protects need from sticking animal and shearing catheter |
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over the needle catheter |
most common placed in peripheral vessels 10-24 gauge, 3/4 to 5 1/2 length catheter is fitted outside or over a steel needle needlepoint extends beyond the catheter for entry into the vein |
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general supplies for peripheral catheters |
catheter syringe with heparinized saline flush injection cap tape bandage material clippers antiseptic scrub and solutions |
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catheter maintenance |
inspect every 24-48 hours check every 2 hours if receiving fluid therapy flushed with heparinized saline every 6-8 hours to prevent clots dont leave in longer than 72 hours/3 days |
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phlebiitis |
vein inflammation |
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cardiopulmonary arrest |
cessation of spontaneous respirations and lack of perfusion heart rhythm |
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CPR |
cardiopulmonary resuscitation |
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CPCR |
cardiopulmonary cerebral resuscitation importance of restoring blood flow to the brain as well as the heart and lungs |
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reasons for CPR |
obstructed airway shock poisoning prolonged seizure coma head injury electric shock sudden cessation of heart activity and breathing |
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ABC |
airway breathing circulation |
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CAB |
circulation airway breathing |
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closed chest compressions |
cardiac pump place animal in right right lateral recumbency technician's hands encircle the ventral chest perform compressions directly over the heart use whole hands 120-130 compressions per minute] large dog-must let the wall recoil back to normal positioning before next compression, 100 compressions per minute never stop compressions even with other interventions being provided |
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closed chest compressions with abdominal compressions |
used to enhance venous return to the heart during CPCR increased abdominal pressure can facilitate blood flow towards the heart abdomen is compressed during the recoil phase of the chest compression complications-organ contusion, hemoabdomen |
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open chested CPCR |
incision in the left 5th intercostal space, freeing heart from attachments directly massages heart from apex to base can occlude descending aorta promoting preferential delivery of blood to the brain and heart decision must be decided after 1-2 cycles of resuscitation to maximize chances of success indications- pleural/pericardial effusion, pneumothorax, diaphragmatic hernia, flail chest, penetrating chest trauma, giant breeds |
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airway during CPR |
insert endotracheal tube in lateral recumbency regardless of size 8-12 respirations per minute governors vessel 26/G26 acupuncture helpful in stimulating respirations-25 gauge needle and twirl to stimulate receptors in brainstem |
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one cycle of CPCR |
compressions and ventilations administered for 2-3 minutes at a time before the patient is reassessed |
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3 main arrest rhythms |
asystole/flatline pulseless electrical activity/PEA ventricular fibrilation |
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asystole |
complete cessation of all mechanical and electrical activity of heart epinephrine, vasopressin, atropine |
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pulseless electrical activity |
electrical system of heart is functioning but no mechanical heartbeat occurs in response to electrical stimulation epinephrine, vasopressin, naloxone |
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ventricular fibrillation |
disorganized contractile activity of the heart proceeded by ventricular tachycardia defribrillation treatment |
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defibrillator |
never use alcohol for risk of fire initial dose is 2-4 j/kg |
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NAVEL |
drugs used in the endotracheal tube naloxone atropine vasopressin epinephrine lidocaine |
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cardiovascular system after post arrest |
effects of local ischemia and reperfusion injury of the heart muscle can develop arrhythmias and systemic hypotension |
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respiratory system after post arrest |
at risk for pulmonary edema, atelectasis, pulmonary thromboembolism, acute respiratory distress syndrome, pulmonary contusions hemorrhage, or rib fractures |
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gastrointestinal tract post arrest |
microscopic breakdown of GI mucosal barrier at risk for sepsis to bacterial translocation GI hemorrhaging |
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kidneys post arrest |
acute kidney injury, hypotension and hypoxia, monitor urine output and electrolytes |
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central nervous system post arrest |
mechanisms lost to keep supply of oxygen, hypoxic brain injury, altered mental state and nerve function, blindness evaluate neurologic function hourly |
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post arrest |
physical examination every 30-60 minutes monitor blood glucose concentration- at risk of hyperglycemia from stress and epinephrine exposure hypoglycemia due to sepsis or reperfusion |
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lidocaine |
antiarrhythmic medication treat rapid or unstable ventricular tachycardia given as bolus |
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mannitol |
osmostic diuretic remains in intravascular space, draws water from interstitial space between cells causes shift of fluid from tissue into blood stream decreases cerebral edema caution with patients in renal failure |
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dopamine |
synthetic catecholamine peripheral vasoconstriction improves blood pressure |
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dobutamine |
synthetic catecholamine increases cardiac output by enhancing cardiac contractility |
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vasopressin |
used in hypotensive patients to improve blood pressure |
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furosemide |
loop diuretic increases urine output and causes volume contraction help resolve cardiogenic pulmonary edema or fluid overload do not use with hypovolemic patients |
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fluid therapy for critically ill |
used to restore and or maintain body water in animals that are unable to keep up with their daily losses through eating and drinking |
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routes of fluid therapy |
subcutaneous-slowest intravenous-faster and larger volumes intraosseous PO- per os- by mouth-slowest |
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healthy animal loses how many mg/ml of fluid per day |
50mg/ml |
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signs of dehydration |
sunken eye scruffy, dull coat lethargy |
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fluid administration calculation after determining perceived percentage of deydration |
volume to deliver/ml= %dehydration(decimal) X body weight in kg X 1000 divide by 24 to determine volume replaced over the first 24 hours |
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maintenance fluid requirements |
50 ml/kg/day-compensates for measurable and immeasurable losses weight in kg X 50=maintenance combine initial fluid rate with maintenance for fluid plan |
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isotonic crystalloids |
most common osmolality equal to blood hypovolemic shock electrolyte concentration similar to extracellular fluid lactated ringers, normal saline |
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hyertonic crystalloids |
osmolality greater than blood 7.5% saline saline causes fluids shifts from the intracellular space to the extracellular space resulting in improved venous return and cardiac output causes vasodilation and reduced swelling must be given slowly |
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colloids |
high molecular weight solutions that dont cross capillary membrane readily better blood volume expanders natural-plasma/syntethic colloids not indicated for hypovolemia shock |
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hypotonic fluids |
osmolality less than blood contain too much free water and distribute excessively to the intracellular compartment 5% dextrose in water never use for resuscitation |
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whole blood or packed RBC fluid |
treating hemorrhagic shock |
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hypertonic solution |
cells shrink |
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isotonic solution |
cells are normal |
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hypotonic solution |
cells swell |
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hydration assessment |
PCV urine output urine specific gravity changes in body weight clinical signs of dehydration |
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how do you know if a patient isnt tolerating fluid rate |
patients hock will show loss of detail or edema thoracic auscultation reveals moist lung sounds cardiac auscultation reveal irregular rhythms |
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complications of fluid therapy |
volume overload electrolyte/acid base distrubance |
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volume overload in fluid therapy |
peripheral edema cough increased rr serous nasal discharge restlessness vomiting, diarrhea pulmonary edema pleural effusion |
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fluid additives |
potassium chloride/KCl-hyokalemia- increase blood sugar dextrose- hypoglycemia sodium bicarbonate- metabolic acidosis, severe hyperkalemia, chronic metabolic acidosis |
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micro drip set |
used for pediatrics |
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macro drip sets |
60 gtt/ml set-60 gtt/min=1 cc 10 gtt/ml set-10 gtts/min=1 cc 15 gtts/ml set-15 gts/min=1 cc |
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determining GGT/drops |
determine volume based on maintenance and fluid deficit volume X drip set(10,15,60) / minutes= ggt/min 60 / ggt/min= ggt/sec |
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5% dehyrdation |
mm tacky or dry Hx of fluid loss |
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7% dehydration |
dry mm prolonged skin tent increased HR pulse pressure/BP normal Hx of fluid loss somewhat prolonged |
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10% dehydrdation |
Hx of fluid loss somewhat prolonged dry mm prolonged skin tent increased heart rate weak to thread pulse pressure hypotension |
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12% dehydration |
Hx of marked fluid loss dry mm, prolonged skin tent increased/decreased HR hypotension pulse weak or absent decreased body temp, cool extremities diminished mentation sunken eye |
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sympathomimetics |
drugs support myocardial contractility and BP used when patient is unresponsive to vigorous fluid therapy domamine and dobutamine |
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mechanical ventilation |
central line catheter and central venous pressure measurement arterial catheter continuous direct BP monitoring, pulse ox, temp etCO2 indwelling urinary catheter |
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complications of mechanical ventilation |
pressure ulcers peripheral edema edematous tongue pneumonia |
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central venous pressure/CVP |
refers to the blood pressure in central veins before it enters the right atrium 0-5 cm H2O is normal in dog used to assess volume status and response to fluid therapy |
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normal values for arterial blood pressure |
systoic- 80-140 diastolic- 50-80 mm Hg |
