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60 Cards in this Set
- Front
- Back
A/S anesthetic emergencies
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A/S anesthetic emergencies
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What is the tech role in an anesthetic emergency?
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Recognize signs of crisis and alert DVM, aticipate needed supplies, assist DVM
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Define geriatric
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has met 75% of life expectancy
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define pediatric
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3 months of age or younger
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What are some patient factors that increase chance of anesthetic emergencies?
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geriatric, pediatric, brachycephalic, sighthounds, obese, c-section
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By how much should you reduce anesthesic doses in geriatric pt?
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30-50%
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Will the recovery time be prolonged or shortened in a geriatric pt?
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prolonged
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Why should you avoid prolonged fasting in a pediatric pt?
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hypoglycemia could occur
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What anesthetic method is preferred in a pediatric pt?
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inhalation
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What is a major concern when anesthetizing a brachycephalic pt?
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airway obstruction
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What drug should not be given to sighthounds?
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Barbiturates
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What dose rate should you use in an obese pt?
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Dose according to ideal weight
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What dose rate should you use w/ a c-section? What drugs should be voided?
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lowest effective dose
avoid ketamine/diazepam and barbiturates |
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What a condition caused by inadeuate tissue perfusion leading to cellular hypoxia, metabolic acidosis, and ultimaely death?
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Shock
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What are 4 types of shock?
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hypovolemic, vasculogenic, cardiogenic, obstructive
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What is hypovolemic shock? Causes?
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decrease in circulating blood volume due to loss of fluid - hemorrhage, v/d, diuresis, burns
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What is vasculogenic shock? Causes?
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vascular space is increased leading to decrease in blood pressure - sepsis, anaphalaxsis, drug overdose
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What is cardiogenic shock? Causes?
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failure of cardiac output - dysrhythmias, valvular insufficiency, congenital defects, heart muscle problems
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What is obstructive shock? Causes?
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restriction in blood flow - GDV, pneumothorax
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What are some signs of shock?
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tachycardia, hypotension, tachypnea, hypothermia, weakness, restlessness, depression, decr urine output, coma and pupil dilation, leads to cardiopulmonary arrest
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When tx shock, __ & __ medsare not absorbed since perfusion is poor Therefore it is a good idea to place an IV catheter before anesthesia.
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IM &/or SC
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What meds are given in a shock situation?
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rapid IV fluids, Dopamine/dobutamine (incr contraction of heart muscle), lidocaine/propranolol(arrythmias), glucocorticoids, antibiotics (sepsis), diuretics (oliguria/anuria)
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What are some things to check w/ the trach tube when the pt won't stay anesthetized?
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in traches? lg enough? cuff inflated? kinked? firmly attached to machine?
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What are some things to check w/ the vaporizer when the pt won't stay anesthetized?
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connected to O2? connected to delivery system? correctly set? filled?
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What are some things to check w/ the delivery system when the pt won't stay anesthetized?
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leaks? O2 flow adequate?
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What are some things to check w/ the O2 tank when the pt won't stay anesthetized?
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On? adequate supply in tank?
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What are some steps to take to avoid common errors that cause the pt to not remain anesthetized?
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proper checkout of machine, premeasure trach tube, check cuff, confirm correct placement of trach tube
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What are some signs that a pt is too deep?
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dilated pupils, no reflexes, bradycardia, delayed CRT, hypoventilation, no muscle tone
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What are some possible equipment errors that could cause a pt to be too deep?
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incorrect vaporizer setting or calibration, incorrect anesthetic in the machine
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What are some possible pt factors that could cause a pt to be too deep?
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hypothermia, shock, pre-ex dz, drug dosages or interactions
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What are some signs of resp depression?
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reduced resp rate (< 10 rpm), reduced tidal volume, +/- cyanosis
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What are some causes of resp depression?
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too deep, anesthetic drugs, surgical positioning (pressure on chest or diaphgragm), CNS/metabolic dz
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How do you tx resp depression?
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lighten plane, bag, correct surgical positioning, can use doxapram if above not effective
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ALL uncorrected cases of inadeuate ventilation can lead to ___-> ___->___->
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resp arrest -> cardiac arrest -> death
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What are some signs of abnormal breathing patterns?
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increased effort/abdominal breathing, decr movement of chest or reservoir bag, cyanosis, unusual sounds (rales, crackles, muffled)
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What are some causes of unusual breathing patterns?
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too deep, misplaced trach tube, obstruction w/i resp system (aspirated material, mucus), obstruction w/i equipment, dz of resp system
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How do you tx abnormal breathing patterns?
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*Check popoff and bag first*, lighten plane, ventilate and watch (if resistance, probably an obstruction, disconnect & aspirate trach tube
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At what bpm is considered bradycardia in dogs? cats?
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<60 bpm in dogs, <100 bpm in cats
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What are some possible causes of bradycardia?
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too deep, increased vagal tone, hypothermia, metabolic problems, late stages of hypoxia
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What are some tx for bradycardia?
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lighten plane, support ventilation, keep pt warm, admin of anticholinergic (atropine)
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What bpm are considered tachycardia in lg, med, and sm dogs? In cats?
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>120 bpm in large dogs
>140 bpm in med dogs >150 bpm in sm dogs >200 bpm in cats |
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What are some causes of tachycardia?
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too light? hypotension, shock, inadequate ventilation, drug induced (ketamine,anticholinergics), hyperthermia
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How is tachycardia tx?
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adj plane, fluid support, support ventilation, check temp/maintain normothermia
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What are some signs of cardiac dysrhythmias?
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irreg pulse rate & pressure, pulse deficits, irreg heart sounds, prolonged CRT, weak pulse, apllor, cyanosis, abnormal ECG tracings
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What are some causes of cardiac dysrhythmias?
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too light ot deep, drugs sensitized heart to effects of epinephrine (halothane, barbiturates), anesthetic drugs, hypoxia, surgical manipulation
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What are some steps to take to prevent cardiac arythymias?
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pre-surg PE and labs, correct hydration & metabolic imbalances beforehand, knowledge of drug interactions & proper protocols, fluids for cardiac support, proper anesthetic depth monitoring
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Tx for cardiac arythymias?
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asses & adj plane, ventilation, fluid therapy
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What are some signs of cardiac arrest?
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resp arrest, no pulse, no heart sounds, dilated/fixed pupils, lack of bleeding at surg sites, blue/gray tissue color, ECG changes
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What are some causes of cardiac arrest?
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inadequate ventilation -> resp arrest, anesthetic overdose, hypothermia, metabolic problems, cardioascular disturbances
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Tx for cardiac arrest?
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CPR, epinephrine, after resuscitation dopamine/dobutamine, evaluate CNS status
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What are some causes of vomitting/aspiration/regurgitation?
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drugs, light anesthesia (stage 2), feeding before anesthesia, stress, excitement, surgical manipulation
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What are some signs of aspiration?
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cyanosis, bronchospasm (wheezing, can't breathe in), apnea, tachypnea, pneumonia or pulmonary edema
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How can you prevent vomiting/regurgitation/aspiration?
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fast 12 hours before anesthesia, avoid stress & excitement, acepromazine (antiemetic), rapid intubation
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Tx for vomitting?
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place in sternal recumbency, keep mouth open & tongue out, tilt table downward, afterward examine and cleanse pharynx
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Tx for aspiration?
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suction airway/lavage w/ sterile saline, administer O2, admin of aminophylline & steroids if bronchospasm occurs, broad spectrun ABs, steam or mist, coupage
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What is metabolic hyperthermia?
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hypermetabolic state induced by drugs that leads to uncontrolled incr in temp, metabolic crisis, and may lead to death
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What are some predisposingfactors for malignant hyperthermia?
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genetic, infection, drugs, environmental stress & excietment
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What are some early signs of malignant hyperthermia?
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hyperventilation, tachypnea, incr body temp, skin nd mm flushed, tachycardia nad dysrhythmias, BP first incr then dramatically decr, muscle rigidity
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What are some late signs of malignant hyperthermia?
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muscle rigidity, core body temp 108-110, hemolysis, acuteremal failure, hypoglycemia, cerebral edema, death
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Tx for malignant hyperthermia?
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remove triggering agent ifpossible, IV fluids, cool body, O2, diuretics, corticosteroids
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