Vet 135 Chapter 2

Front 1

cachexia

Back 1

weight loss, loss of muscle mass, general debilitation that may accompany chronic diseases

Front 2

Borborygmus

Back 2

intestinal noises caused by gas moving through the GI tract

Front 3

cardiac output

Back 3

total blood flow from the heart per unit time

Front 4

colloids

Back 4

large molecular weight plasma proteins that provide oncotic pressure

Front 5

comatose

Back 5

in a sleep like state, unresponsive to all stimuli

Front 6

constant rate infusion

Back 6

slow continuous administration of a drug at a rate sufficient to achieve the desired affect

Front 7

crystalloids

Back 7

fluids containing water and small molecular weight solutes that pass freely through vasculature endothelium

Front 8

dead space

Back 8

the breathing passages and tubes that convey fresh oxygen from the source to the alveoli, but in which no gas exchange can occur

Front 9

anatomic dead spaces

Back 9

bronchi, trachea, larynx, pharynx, and nasal cavities

Front 10

mechanical dead spaces

Back 10

y piece of breathing circuit, where there is bidirectional flow of gases, portion of trach tube extending beyond the nose or the y-piece and mask

Front 11

debilitated

Back 11

lacking strength

Front 12

drip rate

Back 12

gtt/min or sec, value used to adjust administration set

Front 13

dyspneic

Back 13

having difficult or labored breathing

Front 14

ecchymoses

Back 14

large bruises

Front 15

hypercarbia

Back 15

elevated carbon dioxide levels

Front 16

hypoxia

Back 16

low tissue oxygen levels

Front 17

hypoxemia

Back 17

low blood oxygen levels

Front 18

ileus

Back 18

intestinal obstruction caused by inhibition of bowelmotility (gi stasis)

Front 19

infusion rate

Back 19

value used to program an iv infusion pump

Front 20

inotropy

Back 20

force of heart muscle contraction

Front 21

lethargic

Back 21

depressed but able to be aroused with minimal difficulty

Front 22

level of consciousness (LOC)

Back 22

patient's responsiveness to stimuli, how easily patient can be aroused. Used to assess brain function

Front 23

macrodrip

Back 23

set that delivers fluids at a rate of 10-15 drops/ml. Used to deliver fluids at infusion rates equal to or greater than 100ml/hr

Front 24

microdrip

Back 24

deliver fluids at a rate of 60gtt/ml. Used for infusion rates less than 100ml/hr

Front 25

minimum patient database

Back 25

a compilation pertinent information from the patient history, PE, and diagnostic tests. used to diagnose and manage a case

Front 26

miosis

Back 26

pupil constriction

Front 27

moribund

Back 27

near death

Front 28

obtunded

Back 28

depressed and unable to be fully aroused

Front 29

oncotic pressure

Back 29

osmotic pressure provided by large molecular weight colloids like albumin

Front 30

osmolarity

Back 30

a measurement of the number of dissolved solute particles per unit water in body fluids. expressed as osmoles or milliosmoes/liter (mOsm/L) of water

Front 31

osmotic pressure

Back 31

the pressure required to prevent water flow through a semipermeable membrane from a region of lower solute concentration to a region of higher solute concentration

Front 32

petechiae

Back 32

small or pin point purple discolorations of the skin or MM resulting from hemorrhage

Front 33

physical status classification

Back 33

a graded assessment of the patient's physical condition, used to plan patient management prior to administering anesthetics and to gauge risk

Front 34

purpura

Back 34

purple discolorations of the skin and MM caused by hemorrhage, larger than petechiae

Front 35

regurgitation

Back 35

flow of stomach contents into the esophagus and mouth unaccompanied by retching

Front 36

solutes

Back 36

an atom or molecule dissolved in body water

Front 37

signalment

Back 37

species, breed, age, sex,and reproductive status

Front 38

stridor

Back 38

noisy breathing caused by turbulent air flow in the upper airways

Front 39

stuporous

Back 39

in a sleep like state and can only be aroused by painful stimulatin

Front 40

thrombocytopenia

Back 40

low platelet count

Front 41

vasodilation

Back 41

dilation of blood vessels

Front 42

vesicants

Back 42

drugs that damage tissues if injected perivascularly

Front 43

chapter 2 notes

Back 43

-minimum patient database:

1. patient history including signalment

*obtain as much information as possible when inquiring about signs of illness (duration, volume, severity, frequency, character, and appearance)

-unique needs of different species:

*horses and cats are more sensitive to opioids

*unique dosing requirements per species (cats require lower doses of lidocaine and are more resistant to the effects of phenothiazine tranquilizers - acepromazine)

*horses have rougher recoveries from inhalant anesthetics

*anticholingeric (atropine) use in ruminants can cause their saliva to become thick and ropy causing airway obstruction

*ruminants may regurgitate while under anesthesia and steps must be taken to avoid aspiration

*ruminants are more sensitive to xylazine and require about 1/10 the dose of horses

*cats can tolerate the administration of dissociative agents alone, but in dogs may cause seizure like activity unless given with another agent.

*large animals are prone to respiratory depression and dependent atelectasis (collapsed lung) and often require ventilatory support.

*large animals experience pressure necrosis when placed in lateral recumbancy and require padding

*horses may fracture limbs when recovering from anesthesia

*cats, small dogs, and peds are prone to hypoxemia and hypercarbia caused by increased mechanical dead space

*cats and ruminants are prone to airway blockage due to development of excess airway secretions

*ruminants are prone to bloat

*sighthounds are sensitive to barbiturates due to their lack of body fat and slow metabolism of the agents

*boxers and giant breeds are more sensitive to ace and terriers are resistant

*neonates (up to 2 weeks old) and peds (2-8 weeks old) are less capable of metabolizing injectable drugs because the necessary liver metabolic pathways are not fully developed.

*geriatrics may be unable to tolerate normal drug dosages because of poor hepatic or renal function.

*intact females in heat are prone to bleeding due to the effect of estrogen on the clotting cascade

*tricyclic antidepressants (amytriptylline and clomipramine) may predispose patients to cardiac arrhythmias and excessive responses to anticholinergics and CNS depressants

*chloramphenicol may decrease biotransformation of barbiturates leading to a prolonged recovery period

*some MAO-B may increase the effects of morphine and other opioids if given within a 14 day period

*common disease signs: anorexia, vomiting, diarrhea, coughing, sneezing, pu, pd, tenesmus, dysuria, behavioral change, exercise intolerance, weakness, fainting, seizures, or bleeding

2. PE

*dehydration increases risk for complications like hypotension, poor tissue perfusion, and kidney damage

*anemia decreases the oxygen carrying capacity of the blood and predisposes the patient to hypoxemia

*Bruising lesions on the skin or MM in the absence of trauma can indicate a clotting disorder which increases risk of intraoperative and postoperative bleeding

*respiratory or cardiovascular disease

*abnormalities of abdominal organs may be associated with abnormal organ function and a reduced ability to metabolize or excrete anesthetic agents

*general conditions requiring vet attention (ear mites, fleas, otitis, dental disease, overgrown nails, anal sac impaction)

*physical abnormalities that may influence the procedure (retained testicle)

*Patient ID: cage cards, name collars (prior to any procedure match the cage tag, id collar, and external characteristics to the medical record)

*animals under 5kg should be weighed on a ped scale and those under 1kg should be weighed on gram scale

*compare current weight with previous weights

*significantly overweight animals should be dosed at a lean body weight because fat increases total body mass but not the volume of nervous tissue on which anesthetics exert their effects

*LOC: BAR, QAR, lethargic, obtunded, stuporous, comatose

*temperature: dog, cow, and cat (100-102.5),horse (99-100.5), sheep/goat (102-104)

*heartrate: dog (60-180), cat (120-240), horse (30-45), cow (60-80), sheep/goats (60-90)

*respirations: dog (10-30, panting), cat (15-30), horses and cows (8-20), sheep/goats (16-24)

*sinus arrhythmia - heartrate cyclically increases during inspiration and decreases during expiration

*first degree atrioventricular heart block - conduction delay through the AV node, prolonged PR interval on ECG, causes no change in heart sound

*second degree atrioventricular heart block - caused by a periodic block of electrical conduction through the AV node, missing QRS complexes, periodic pauses on auscultation representing skipped beats.

3. laboratory results

*elevated PCV or RBC count most often caused by dehydration, causes a decrease in blood volume which affects cardiac output, blood pressure, and tissue perfusion

*decreased PCV or RBC count indicates anemia caused by decreased production, loss, or destruction of RBCs. Causes a decreased in oxygen carrying capacity. PCV less than 25% in dogs and 20% in cats, horses, and cows should be reported.

*TP measures blood proteins. Hyperproteinemia may be associated with dehydration. Hypoproteinemia results from decreased production by the liver or increased loss from the GI tract or kidneys or from blood loss. Many anesthetic drugs circulate in the blood partially bound to plasma proteins, only the portion that is free can exert an effect. With hypoproteinemia the unbound portion increases, increasing drug potency. TP less than 4.0 should be reported.

-physical status classification: P1 (minimal-healthy patient, elective procedures), P2 (low-patient with mild systemic disease, neonatals, geriatric, obese, mild dehydration, tumor removal), P3 (moderate- severe systemic disease, anemia, moderate dehydration, compensated major organ disease), P4 (high-severe systemic disease that is a constant threat to life, ruptured bladder, internal hemorrhage, pneumothorax, pyo), P5 (extreme-patient not expected to survive without sx, severe head trauma, pulmonary embolus, GDV, end-stage major organ failure), E-emergency

-Food withholding: Dogs and cats(food 8-12, water 2-4), horses (food 8-12, water 0-2), cattle (food 24-48, water 8-12), small ruminants (food 12-18, water 8-12), neonatal and peds (none)

-approx. 60% of body weight is water, 40% is intracellular fluid (ICF), 20% is extracellular fluid (ECF) where 15% is interstitial fluid and 5% is intravascular fluid.

-Blood volume is 8%-9% of body weight in dogs and large animals and 6%-7% of body weight in cats

-90ml/kg for dogs and large animals and 60ml/kg in cats are used to calculate blood volume

-electrolytes when dissolved separate in to cations (positive) and anions (negative), they provide osmotic pressure and are essential for blood clotting, heart function, and neuromuscular function.

-cations: sodium (majority found in extracellular space), potassium (majority found in the cells), magnesium, calcium

-anions: chloride, bicarbonate, phosphates, proteins

-proteins are essential for drug transport, regulation of blood pressure by providing oncotic pressure, and blood pressure.

-glucose provides energy

-ICF contains potassium, magnesium, protein and phosphate

-ECF contains sodium, chloride, bicarbonate

-electroneutrality is the state of electrical balance in any fluid compartment

-osmalarity (solute concentration) of approx. 300mOsm/L is maintained in all fluid compartments of healthy animals.

-solutes in each compartment provide osmotic pressure that draws water into the compartment in proportion to the number of particles present.

-colloids do not pass vascular endothelium freely, they provide oncotic pressure to draw water into the blood vessels

-plasma concentration of calcium and potassium must be kept in a very narrow range to maintain normal muscle and heart function

-fluids:

*replacement fluids have high concentrations of sodium and chloride like ECF

*maintenance fluids have lower concentrations of sodium and chloride, but higher concentrations of potassium

*balanced fluids have a similar profile to ECF

*isotonic fluids have an osmolarity near plasma (300mOsm/L)

*hypotonic fluids have an osmolarity lower than plasma

*hypertonic fluids have an osmolarity higher than plasma

*crystalloids are not used for patients with low TP, low RBC mass, or low platelet count

1. Isotonic polyionic replacement solutions include lactated ringers, normosol-r, plasma-lyte a and r, and isolyte s. Calcium containing products are not to be administered with blood because they can cause clotting.

2. Isotonic polyionic maintenance solutions include normosol-m in 5% dextrose and plasma-lyte 56 in 5% dextrose

3. normal saline solution 0.9% contains only sodium and chloride ions in water, is an unbalanced solution, used for Addison's disease, blood transfers, to bathe exposed tissues during sx, iv catheter flush, and body cavity flush. Can cause hypokalemia and is more acidic.

4. hypertonic saline solutions (3%, 5%, 7%, and 23.4%) given with isotonic crystalloid solutions to patients in acute care settings and to treat hypovolemic, traumatic, or endotoxic shock. Rapidly but temporarily draws water into the vasculature supporting blood pressure

5. Dextrose solutions

*Colloids do not diffuse freely across blood vessel membranes and are used to support expansion of blood volume and blood pressure

1. synthetic colloid solutions include dextran, pentastarch, hetastarch, or gelatin products.

2. Blood products (plasma and whole blood) contain albumin and other natural colloids.

*sx rate for crystalloid administration is 10ml/kg/hr for the first hour, the 5ml/kg/hr for the remainder of the procedure. These rates compensate for vasodilation, decreased cardiac output, and increase in insensible fluid loss occurring during anesthesia.

* patients with excessive hemorrhage or hypotension need higher rates, healthy young dogs can tolerate 40ml/kg/hr for the first hour with half of this given over the first 15 minutes. Cats are more susceptible to overhydration and should not exceed rates of 20ml/kg/hr.

*3ml of fluid should be given for every ml of blood loss because the interstitial fluid compartment is about twice the volume of the intravascular compartment. A saturated 3x3 gauze sponge holds about 3-6ml of blood and 4x4 gauze sponge holds about 5-10ml of blood.

*infusion rates for shock: 90ml/kg as rapidly as possible for dogs and 55ml/kg as rapidily as possible for cats.

*hypertonic saline rates for shock and blood loss 7% hypertonic saline is 3-4ml/kg slowly over 5 minutes followed by isotonic crystalloids. Side effects if given to quickly include bradycardia, hypotension, rapid, shallow breathing, and bronchoconstriction.

*synthetic colloids 10-20ml/kg/day for dogs and large animals and 5-10ml/kg/day for cats. administered as a slow bolus over 15-60 minutes in dogs and large animals and 30-60 minutes in cats. Also may be administered as a CRI of 1-2ml/kg/hr.

-signs for overhydration include ocular and nasal discharge, chemosis (edema and swelling of the conjunctiva, SQ edema, increased lung sounds, increased respiratory rate, dyspnea, coughing, restlessness.

-hemodilution may occur in patients with anemia, hypoproteinemia, and substantial blood oozing during sx.

-animals weighing less than 5kg, those with cardiac or renal disease are at greatest risk for volume overload and may need a slower infusion rate.