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85 Cards in this Set
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- Back
Monitoring of anesthetic equipment (5)
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Check for leaks
C02 absorbent is not exhausted Varify power sources Verify monitoring device readings MM color, CPR, pulse |
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Perfusion
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passage of oxygenated blood through body tissues
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Shock
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inadequate perfusion
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Hypoxemia
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Insufficient oxygenation of blood
(Pa02 < 60 mm Hg) |
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Hypoventilation
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Reduced ventilation
Determined by increase of arterial CO2 levels PaCO2 > 45mm Hg |
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Hypercarbia / hypercapnia
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Increased arterial CO2 levels
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Hypotension
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Inadequate arterial blood pressure
Common sign of cardiovascular depression |
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Hypovolemia
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Insufficient circulating blood volume.
Common cause of hypotension. Fluid administration used as supportive measure. |
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Hypothermia
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Abnormally low body temperature
2 - 3 degrees below normal Sign of nervous system & cardiovascular depression |
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Ways to evaluate respiratory function (6)
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respiratory rate
tidal volume breathing patterns Hb concentration end-tidal CO2 arterial blood gases |
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What does pulse oximeter measure
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% of Hb that is saturated with O2
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What does the capnometer measure?
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end-tidal carbon dioxide (ETCO2)
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Manual ways of monitoring respiration (3)
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esophageal stethascope
reservoir bag movement - observe movement, feel for resistance MM, arterial blood @ sx site |
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Ways to evaluate cardiovascular function (7)
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hr, heart sounds
temp pulse quality and rate mm color CRT blood pressure urine output |
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Ways to monitor cardiovascular function (3)
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ausculation
ECG Pulse |
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Pulse quality
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how pulse feels when palpated
strong, moderate, weak, thready |
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Pulse pressure
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difference between systolic and diastolic arterial pressures
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What do cherry red mm indicate?
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Carbon monoxide poisoning
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Response to hypothermia
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decrease anesthetic concentration
decrease fresh gas flow to minimum requirements ensure adequate circulation insulate from cold surfaces; dry the body surface apply warm blankets, pads |
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Response to tachycardia (4)
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decrease anesthetic concentration
increase oxygen flow increase rate of IV fluids support ventilation |
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Response to bradycardia (4)
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anticholiergics or alpha antagonist
decrease anesthetic concentration support with 02 and fluids may be transient |
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Response to hypotension (3)
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lower anesthesia
administer fluids keep warm |
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Response to hypercarbia / hypercapnia
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increase ventilation
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Reasons for hypercarbia / hypercapnia
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1) Rebreathing circuits: expired soda lime or faulty unidirectional valves
2) Non-rebreathing circuits: inadequate flow rate 3) Excessive dead space, long ET tube |
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Response to hypoxemia
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increase inspired O2 concentration and ensure adequate ventilation
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Reasons for hypoxemia (2)
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kinked/plugged ET tube
empty O2 tank |
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Response to excessive depth (3)
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decrease vaporizer setting
increase O2 flow rate ensure ventilation and circulatory support |
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Reasons for inadequate depth (5)
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insufficient delivery of anesthetic to avleoli
breathing around ET tube/mask vaporizer is empty, overfilled, malfunctioning inadequate flow rate and vaporizer settings inadequate uptake of anesthetic from alveoli into bloodstream |
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Reasons for excessive circuit pressure
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closed pop-off valve
excessive O2 flow rate occlusion of scavanger system |
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Checklist for inspection of anesthetic equipment (8)
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1) sufficient O2 available
2) vaporizer filled 3) gas lines correctly connected 4) sufficient CO2 absorbent time available 5) scavenger system properly connected / functioning 6) cuff syringe available 7) attach breathing circuit, tubes, reservoir bag 8) check for leaks |
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How do you check for leaks? (8)
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1) close pop-off valve
2) occlude patient end of breathing circuit 3) fill circuit w/ O2 to a pressure of 20cm H2O 4) turn O2 flow to 100ml/min (0.1 L/min) 5) if pressure increases, leaks are withing acceptable limits 6) if pressure drops, increase flow rate until pressure remains stable 7) Leaks exceeding 200ml/min (0.2L/min) should be corrected via machine maintenance 8) open pop-off valve while occluding Y-piece; pressure should drop to 0cm H2O |
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Why do anesthetic problems occur? (4)
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human error
equipment failure adverse effects of anesthetics patient related factors |
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Which breeds are at highest risk? (5)
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bulldog
pekingese brachycephalics weimaraner jack russel |
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Types of human error (4)
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failure to get good history
lack of knowledge of drugs/machines used incorrect drug administration personell in hurry, fatigue, careless |
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Problems with geriatric patients (4)
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reduced organ function
poor response to stress degenerative disorders increased risk of hypothermia and overhydration |
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Ways to decrease risk in geriatric patients
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IV fluids at reduced rate
select agents with minimal cardiovascular effect allow longer time for preanesthetics preoxygenate reduce anesthesia keep warm |
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Problems with pediatric patients (3)
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increased risk of hypothermia and overhydration
inefficient secretion of drugs difficult intubation and IV catheterization |
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Ways to decrease risk in pediatrics (6)
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keep warm
careful w/ pre-op fasting IV dextrose in LRS cut ET tubes dilute injectable drugs lower doses inhalent agents over IV ket/val, no barbiturates |
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Problems with brachycephalics (2)
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tendency toward airway obstruction
high vagal tone |
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Reducing risk in brachycephalics (5)
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anticholinergics
preoxygenate rapid IV induction delay extubation observe closely during recovery |
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Which anesthetic cannot be used on sighthounds?
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barbiturates
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Problems with obese animals (3)
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accurate dosing difficult
poor anesthetic distribution respiratory difficulties shallow breathing results in hypercapnia |
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Decreasing risk in obese patients
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dose according to ideal weight
rapid induction preoxygenate may need to bag delay extubation observe closely during recovery |
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Problems encountered in dam during cesarean
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increased workload on heart
compromised respiration tendency to vomit risk of hemorrhage |
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Problems encountered with offspring during cesearian
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Anesthetics may cross placenta, causing reduced respiratory and cardiovascular funciton.
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Stragedies to decrease risk in cesarian sx - dam (5)
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IV fluids
clip before induction preoxygenate lowest effective dose of anes avoid pentobarbital, ket/val |
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Stragedies to decrease risk in cesarian sx - offspring
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reversing agents, doxapram
administer O2 by face mask atropine (bradycardia) |
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Problems with trauma patients (4)
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cardiac arrhythmias, 12-72hrs post trauma, often cause of cardiac arrest after HBC
respiratory distress shock & hemorrhage internal injuries |
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Decreasing risk of trauma patients
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thorough exam
thoracic xrays & ECG stabilize before anes |
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Problems with cardiovascular disease (4)
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compromised circulation
risk of overhydration pulmonary edema tendency to develop arrhythmias and tachycardia |
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Decreasing risk for patients with cardiovascular disease (4)
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preoxygenate
avoid agents that effect heart (halothane, xylazine) avoid overhydration diuretics - alleviate pulmonary edema |
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Problems encountered in patients with respiratory disease (3)
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poor oxygenation
respiratory arrest patients anxious/difficult to restrain |
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Decreasing risk for patients with respiratory disease (7)
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avoid stress
preoxygenate no nitrous oxide induce with IV anes rapid intubation control ventilation if needed monitor closely during recovery |
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Problems encountered in patients with hepatic disease
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delayed metabolism
decreased blood clotting hypoproteinemia dehydration anemic / icteric |
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Decreasing risk in pateints with hepatic disease
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pre anes blood tests
omit preanes meds induce with iso or propofol expect prolonged recovery |
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Problems in patients with renal disease (3)
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delayed excretion of anes agents
electrolyte imbalances: hyperkalemia, hyperphosphatemia, metabolic acidosis dehydration |
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Decreasing risk in patients with renal disease (5)
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rehydrate before sx, keep H2O till last moment
reduce anes dosage obtain renal function tests & electrolyte values caution with carprofen, acepromazine, xylazine, diazepam, etamine and barbiturates. IV fluids during sx (urinary obstructions are special cases) |
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Problems in patients with urinary obstruction (5)
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dehydration
acidosis azotemia hyperkalemia bradycardia |
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Decreasing risk in patients with urinary obstruction (3)
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avoid barbiturates & IV ket
treat hyperkalemia if present |
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Brachycephalic breeds (8)
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Bulldogs
Pugs Pekingese Shih Tzu Boxer Shar-Pei Boston Terrier Bull Terrier |
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Brachycephalic syndrome (3)
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hypoplastic trachea
elongated soft palate stenotic nares (small lumen) |
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normal RR
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dog 8-15 bpm
cat 12-18 bpm |
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normal HR
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dog 70-120 bpm
cat 130-170 bpm |
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normal arterial blood pressure
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dog 100 mm Hg (mean)
cat 120 mm Hg (systolic) |
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normal temp
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100-102 F
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RR requires tx
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dog <8
cat <10 |
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HR requires tx
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dog <60 or >140
cat <110 or >200 |
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blood pressure requires tx
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dog <60
cat <100 |
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temp requires tx
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<98 or >103 F
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critical rr
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dog <4
cat <6 |
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critical hr
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dog <40 or >175
cat <100 or >225 |
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critical blood pressure
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dog <50
cat <80 |
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critical temp
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<95 or >104
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If the pop-off valve is inadvertently left shut it will...
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cause a significant rise of pressure within circuit
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Brain damage may occur when there is inadequate oxygenation of the tissues for longer than ____ min
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4
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When a technician is performing CPR alone, the ratio of cardiac compressions to ventilation should be:
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10:2
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CPR should not be discontinued for longer than:
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30 seconds
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Signs that ET tube is malfunctioning (4)
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reservoir bag is not moving
compression of reservoir bag does not result in the raising of the chest animal is dyspneic animal cannot be kept at adequate level of anesthesia |
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Signs that pop-off valve is closed or malfunctioning
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reservoir bag distended with gas
patient has difficulty exhaling |
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Which patients are at risk of overhydration
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cardiac disease & pediatrics
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Why are brachycephalic dogs under anesthetic risk
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excess tissure around oropharynx
increased vagal tone disproportionally small trachea |
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Drugs that should be avoided with cardiovascular disease patients
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halothane & xylazine
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How much barbiturate does an animal with liver dysfunction & hypoprotenemia require for induction compared with normal dog
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less barbiturate
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Reasons for light plane of anesthesia
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ET tube cuff not inflated
incorrect vaporizer setting incorrect placement of ET tube use of anesthetic w/ low MAC |
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Causes of tachypnea
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Increased levels of arterial CO2
Light anesthesia |