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157 Cards in this Set
- Front
- Back
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At present, the best we can do in monitoring cardiac output in our anesthetized patients is to measure_______________ |
Blood pressure |
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Low circulating blood volume is termed ___________ |
Hypovolemia |
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Vocalization, body posture, and guarding are _________ signs of pain. |
behavioral |
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The minimum laboratory blood tests for any general anesthesia procedure should include a Packed Cell Volume, and a ______ _______. |
total protein |
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Local anesthetics are valuable adjuncts to multimodal pain therapy because they inhibit: |
- peripheral sensitization of nociceptors - central sensitization - impulse conduction |
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What is the best way to reduce windup? |
provide preemptive pain management |
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What is the minimum fasting time for a ruminant undergoing an elective general anesthetic procedure? |
24 hours |
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The most effective drug category for managing severe to moderate pain in the post-operative period are the ______________ |
opioids |
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What is surgical asepsis? |
prevention of microbial contamination of living tissues by killing or removing micro-organisms |
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Exogenous sources of pathogens |
OR environment Surgical instruments Surgical team |
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Endogenous sources of pathogens |
Patient's resident flora** |
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SSI - what is it and what causes it? |
Surgical site infection - most common form of nosocomial infection, usually from endogenous flora in/on patient |
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Bacteria that cause SSI |
Staph E. coli Strep Enterobacter Enterococcus |
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T/F Once opened, sealed edges of the pouches are not sterile |
True |
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How long does it take a nosocomial infection to develop following hospitalization? |
48 hours |
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Antiseptic |
antimicrobial substance applied to living skin/tissue |
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Disinfection |
Applying antimicrobial substances to inanimate objects. Doesn't necessarily kill ALL microorganisms (spores can survive). |
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Sterilization |
any process that eliminates or kills all forms of life |
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What should be used to clean instruments? |
DI or distilled water, soft brush, ultrasonic cleaner NEVER SALINE or WD40 |
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T/F Chemical sterilization indicators provide verification of sterility. |
False - they provide verification that the inside of the pack was exposed to appropriate sterilization temps for the appropriate length of time |
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What are methods of instrument and pack sterilization? |
1. steam - autoclave 2. low temp plasma-peroxide - $$ 3. Ionizing radiation - $$ 4. Cold chemical - glutaldehyde or H2O2 NO ETHYLENE OXIDE |
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What should be used to clean cameras, arthroscopes, laproscopes? |
cold chemicals - glutaldehyde or hydrogen peroxide or PLASMA |
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What is the recommendation for sterilization temp/pressure? |
15 psi @ 250* for 30 min |
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What are the two types of autoclave? Which is more effective? |
Pre-vaccum - mechanical air removal - more effective because that greates resistance to steam sterilization is removal of air Gravity - air displaced by steam |
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What is important to remember about bacteria and spores in autoclaves? |
They can survive in air pockets @ 273*F |
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What is one of the greatest problems with autoclave sterility? |
Wet packs |
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How can verification of proper autoclave function be done? |
biological testing - chemical indicators don't prove sterilization! |
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Which cold chemical should NOT be used to sterilize instruments? |
Nolvasan - used as a disinfectant |
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How long will a double wrapped two layer muslin pack last on a shelf? |
4 weeks |
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What is the longest shelf life possible for packs? |
1 year if plastic-peel pouches and heat sealed |
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How long should dogs and cats be fasted prior to surgery if over 4 months? Under 4 months? |
Over: 6-12 hours Under: 4 hrs due to hypoglycemia risk |
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Should water be restricted for dogs and cats prior to surgery? |
No |
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How long should horses be fasted prior to surgery? Water restriction? |
6-12 hrs No water restriction |
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How long should cattle be fasted prior to surgery? Water restriction? |
24-28 hrs fast 12-24 hrs water restriction |
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How long should sm rmts over 4 weeks be fasted pre-op? Water restriction? Less than 4 wks? |
>4 weeks: 12-24 hrs fast, free water <4 weeks: 2-4 hrs fast |
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What is the scale used for anesthesia physical status? Which means fine? Which means almost dead? |
I-V I = normal V = serious health issues |
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What are some disadvantages to premedicating patients? |
Bradycardia Hypotension Excitment/dysphoria |
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Premed sedative drugs - dogs |
Acepromazine Dexmedetomidine Midazolam/diazepam |
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Premed opioids - dogs |
Butorphanol Buprenorphine Hydromorphone Morphine Methadone Fentanyl |
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Premed sedative and analgesic - cats |
Dex + opioid (butorphanol, buprenorphine) +/- ketamine |
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Premed sedative + opioid - equine |
Alpha 2 agonsit - xylazine, detomidine Butorphanol NSAID - phenylbutazone, flunixin |
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Which anesthetic premeds are good for ruminants |
Butorphanol, low dose xylazine |
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What is noteworthy about xylazine in ruminants? |
cows = 1/10 equine dose Can cause hypoxemia in sheep |
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Anesthetic inducers: dogs and cats |
Propofol, ketamine |
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Anesthetic inducers - horses |
ketamine,benzodiazepine |
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Which anesthetic inducer can be used in all animals? |
ketamine |
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Opiods can inhibit pain perception, central sensitization, peripheral sensitization of nociceptors but do not inhibit ___________. |
transmission |
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The initial fluid therapy rate for treating shock due to hypovolemia is to administer one _______ ________ over one hour. |
blood volume |
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Fluids containing electrolyte and nonelectrolyte solutes capable of entering all body fluid compartments are called _________ solutions. |
isotonic |
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The most important reason for withholding food from patients undergoing anesthesia is to prevent vomiting and resultant ____________ ____________. |
aspiration pneumonia |
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Spinal cord synapses are the sites where __________ of the pain response occurs. |
modulation |
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Pain perception occurs in the ______. |
brain |
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The combined use of a local anesthetic, an NSAID, and an opioid along with a general anesthetic is a good example of ___________ anesthesia |
multimodal |
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What do anesthetists monitor? |
anesthetic depth Oxygenation Ventilation Circulation Body temp |
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What is the minimum alveolar concentration? |
inhalant anesthetic concentration in the lungs required to prevent purposeful movement in 50% animals in response to a noxious stimulus |
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What is strike through? |
Term used to describe contamination that occurs when moisture carries bacteria from a nonsterile to a sterile surface |
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What is the most useful method to detect apnea, hypoventilation? |
End tidal carbon dioxide (EtCO2) |
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Fluid therapy that contains ions/solutes that distribute to all body fluid compartment, are isotonic, and have a composition similar to extra-celllar fluid |
crystalloids : LR, Sodium Chloride, Normosol |
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What sort of fluid therapy would be given to a patient with low albumin (want to increase oncotic P)? |
colloids |
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What fluid therapy can be given to increase blood volume and blood pressure? |
hypertonic saline |
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What is the pathway of pain? |
Transduction --> transmission --> modulation --> projection --> perception |
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Transudction |
1st in pain pthwy Nociceptors transform stimuli into action potentials |
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Transmission |
2nd in pain pthwy Action potential transmitted via dorsal root gg to the grey matter of spinal cord |
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Modulation |
3rd in pain pthwy Occur @ level of spinal cord -- impulses synapse in dorsal horn of spinal cord and are amplified |
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Projection |
4th in pain pthwy Nociceptive information conveyed to brain by nerve tracts |
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Perception |
5th in pain pthwy integration, processing, recognition -- mult areas of brain |
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The glasgow pain scale is based on: |
behaviour based on observation, interaction |
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The CSU pain scale is based on: |
body tension, arousal (behaviour too) |
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Which surgical hand scrub is the most used? |
Chlorhexidine Gluconate |
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Which scrubless solution is the most popular? |
Avagard (chlorhexidine with ethyl alcohol) |
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How long is skin protected when scrubless solution is used? |
6 hours |
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How are alcohol products used to scrub patients? |
One coat - skin must be clean beforehad NOT for open wounds/mm |
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What is the minimum contact time for patient scrubbing? |
3 scrubs with 3 minute contact time minimum |
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Which drape material is NOT waterproof? |
cotton and linen |
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Theoverall incidence of glove defects increases significantly in surgicalprocedures exceeding ___ minutes in length. |
60 |
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The best group of drugs to inhibit transmission of sensory afferent nerve impulses of pain are _____________ |
local anesthetics |
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Wheredoes "windup" occur? |
spinal cord |
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Hairremoval prior to surgical skin preparation should be accomplished as follows: |
#40 clipper just prior to surgery |
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What are Halsted's surgical principles? |
1. gentle tissue handling with appropriate instruments 2. use aseptic technique 3. use sharp dissection of tissue 4. meticulous hemostasis 5. obliterate dead space 6. avoid tension |
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Which of the following in NOT one of Halsted's surgical principles. Answers: Use aseptic technique Use preoperative antibiotics Use sharp dissection of tissue Employ meticulous hemostasis |
Use preoperative antibiotics |
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T/F Oneof the principles of restraint in large animals is that in most instances ifyou control the head, you can control the animal. |
True |
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What are the 4 ways to restrain horses? |
Halter Stocks Nose twitch Chemical |
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Which has a contact time: scrub or solution? |
scrub |
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Types of retractors: |
Balfour Senn Kelly Ribbon Army navy Weitlaner Gelpi |
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Types of forceps |
Lahey (sharp pointy teeth) Sponge Mosquito |
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External method of castration for pendulus scrotums |
burdizzo emasculotome |
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Best kind of emasculator |
Serra |
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The mineralocorticoid, aldosterone, is synthesized and released in the adrenal zona ________. |
glomerulosa |
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Most histamine in body tissues is found in _____ cell granules. |
mast |
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Following injury, the initial systemic proteolysis and increased urinary nitrogen excretion are mediated primarily by ___________. |
glucocorticoids |
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If an animal has symptoms of SIRS, and it has an identifiable source of bacteria, then the animal has _______. |
sepsis |
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In the liver, cortisol stimulates ____________, but induces insulin resistance in muscle and adipose tissue. |
gluconeogenesis |
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SIRS stands for _____________________. |
Systemic Inflammatory Response Syndrome |
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The recruitment of circulating neutrophils to endothelial surfaces is mediated by adhesion molecules called _______ that are elaborated on cell surfaces. |
selectins |
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Eicosanoids are generated from arachidonic acid by either teh cyclooxgenase pathway or the ___________ pathway. |
lipooxygenase |
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The hypermetabolic state observed following severe injury is attributed to activation of the ___________ system. |
adrenergic |
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Histamine causes _______capillary permeability. |
increased |
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Following ischemia and restoration of blood flow and oxygen supply, large quantitites of oxygen metabolites (free oxygen radicals) are produced, leading to _________ injury. |
reperfusion |
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Adrenocorticotropic Hormone signaling activates intracellular pathways that lead to cortisol production within the zona _________ if the adrenal gland. |
fasciculata |
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Lipopolysaccharide has a dominate role in signaling the immune system of the presence of gram ________bacteria. |
negative |
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Following any type of injury, there is a central nervous system response, a hormonal response, and a _________ response. |
cellular |
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Following injury, afferent signals from the site of inflammation are sent to the hypothalamus via the _______ nerve. |
vagus |
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The primary goal of administering a readily available energy source (glucose) to post-operative surgical patients or traumatized patients is to prevent _________. |
muscle wasting |
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If an animal is showing the clinical signs of increased temperature, increased heart rate, and increased white blood cell count, then by definition, it is displaying _____________________. |
SIRS |
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This leukocyte is considered one of the first responders in the local inflammatory response. |
neutrophil |
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_________ appear to be the most potent mediators of the inflammatory response. |
cytokines |
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The major function of aldosterone is to conserve ________ and thereby maintain intravascular fluid volume. |
sodium |
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What are vicryl sutures made from and how long does it take for 50% strength retention? |
braided synthetic - rapide takes 1 week, other takes 3 weeks |
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Which ethicon suture will last 4 weeks? |
PDS - synthetic monofilament |
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Which synthetic monofilament lasts 1 week? |
monocryl |
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Which synthetic monofilament lasts indefinitely? |
Prolene (polypropylene) |
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How long does Ethilon (nylon) last? What is it made of? |
20% loss/year - made of synthetic monofilament |
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When is the "golden period" in wound contamination? |
6-8 hours |
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What is the limiting factor to natural wound healing? |
Debridement - collagen debrides very slowly debridement is the most important part of treating a wound! |
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In general, how can most hemorrhage be stopped? |
direct compression |
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IPF |
Infection potentiating factors - in clay soil, as few as 100 organisms can cause infection |
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Which parts of the body requiring suturing and which should you leave? |
head and legs - suture because they don't get infected that much Limbs - heal slower, contract less, bigger scar Body - let it close alone by 2nd intent |
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Should animals should be given antibiotics prophylactically or after debriding? |
PROPHYLACTICALLY! (IV antibiotics prior to treating the wound) |
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What are the steps to treating a wound? |
1. prep skin around wound 2. prep skin - use clippers 3. disinfect the skin - detergents ONLY for skin around wound - they irritate it! 4. anesthetize before debriding (lidocaine) 5. block nerves 6. Debridement (included lavage and dissection) |
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What happens if you use lidocaine with epinephrine on a leg? |
it causes vasoconstriction and can cause ischemia because there is limited blood flow on the leg |
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What is the best product to use for wound lavaging? |
saline |
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Why is low pressure lavage better? |
It minimizes the tissue damage that happens with high P leading to remaining bacteria |
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Which tissue will heal more quickly? - skin - urinary bladder - muscle fascia - tendon |
urinary bladder |
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What type of needle is most appropriate to use when anastamosing a blood vessel that has been severed? |
taper |
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What is the smallest diameter suture material? |
0000 |
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Which of the following suture materials is broken down by hydrolysis? - polypropylene - polyester - polyglycolic acid - chromic catgut |
polyglycolic acid |
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T/F Catgutis a natural suture derived from the submucosa of cats. |
False |
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Whichof the following instruments does NOT remove the testicle when performing acastration: - Reimber emasculator - Henderson emasculator - Burdizzo emasculatome - Serra emasculator |
Burdizzo emasculatome |
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Whichof the following suture patterns should never be used to close the skin? Halsted Ford interlocking Horizontal mattress Vertical mattress |
Halsted |
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Whichof the following is not an inverting suture pattern? Gambee Cushing Lember Connell |
Gambee |
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Ifyou see granulation tissue in a wound, you know that at least that part of thewound is in the __________________ phase of wound heaing. Proliferation/repair Inflammatory/debridement Remodeling/maturation |
Proliferation/repair |
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Whichgrowth factor is considered to have the greatest "profibrotic"influence on wound repair? TGF-b TGF-a FGF-a FGF-2 |
TGF-b |
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Theprimary cell type responsible for hemostasis and the initiation of theinflammatory phase of wound healing is the |
platelet |
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T/F Woundcontraction will not occur until there is a complete bed of healthy granulationtissue present. |
True |
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T/F Remodelingand maturation of the scar may take a year or more, but eventually the woundregains its original strength. |
False |
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Whichof the following can be used as a tension suture pattern? Far-far-near-near Far-near-near-far vertical mattress all of above |
all |
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Whichof the following can be a possible consequence of protein-calorie malnutrition? - muscle atrophy due to protein catabolism - impaired immunocompetence - delayed wound healing - all of the above |
all of the above |
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Insituations of severe trauma, there is an increased blood cortisol level. Whatis the mechanism for this increase? |
Inflammationor injury results in the release of corticotropin releasing hormone from thehypothalamus which stimulates the release of ACTH from the anterior pituitarygland, which activates pathways in the zona fasciculata of the adrenal glandthat leads to the production of cortisol. |
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Insmall animals, the Systemic Inflammatory Response Syndrome (SIRS) ischaracterized by 2 or more specific criteria. It is important that you be ableto recognize these criteria. What are they? |
Decreasedor increased temperature, increased heart rate, increased respiratory rate, andincreased or decreased white blood cell count. |
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Itis important for the surgeon to recognize the metabolic changes that occur in atraumatized patient, and to provide the proper nutritional support tocounteract the adverse effects that occur. Which of the following bestsummarizes the metabolic response to injury? |
Increasedprotein catabolism, increased Basal Energy Requirement (BER), increasedutilization of triglycerides for energy, increased gluconeogenesis, anddecreased utilization of glucose in muscle. |
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Whatis the predominant energy source during critical illness and following severeinjury? |
Triglycerides from adipose stores in the body |
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Themost common nutritional state in the post-operative patient is a negativenitrogen balance due to |
Increasedmetabolic demand and decreased caloric intakeL |
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T/F Ifthe post-operative small animal patient will not eat, but the GI tract is stillfunctional, then enteral hyperalimentation is much preferred to over parenteralhyperalimentation. |
True |
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T/F Analgesicsmust be given before a painful stimulus in order to prevent central nervoussystem "wind up". |
True |
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At which level in the nervous system does transduction occur? |
tissue level nociceptors |
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At which level in the nervous system does transmission occur? |
Peripheral sensory nerves |
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At which level in the nervous system does modulation occur? |
dorsal horn of the spinal cord grey matter |
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At which level in the nervous system does projection occur? |
spinal cord nerve tracts |
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At which level in the nervous system does perception occur? |
multiple areas of the brain |
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The term for surgical puncture of the urinary bladder. |
cystocentesis |
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The term for surgical fusion of a joint |
arthrodesis |
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Term for surgical fixation of the stomach to the abdominal wall |
gastropexy or gastropexis |
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Term for surgical creation of a new opening into the colon |
colostomy |
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term for surgical removal of the spleen |
splenectomy |
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term for surgical reconstruction of the larynx |
laryngoplasty |
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term for suturing a hernia |
herniorrhaphy |
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term for visually examining the inside of a joint |
arthroscopy |
