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Small Animal ECC > 1 Intro info > Flashcards

1 Intro info Flashcards

1
Q

What is a medical emergency?

A

an urgent or pressing need for medical attention

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2
Q

What is a critical care patient?

A

a patient whose condition can deteriorate rapidly

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3
Q

What is an intensive care unit (ICU)?

A

a facility for management for critical care patients

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4
Q

T/F: An intensive care unit (ICU) is the same thing as an emergency room.

A

FALSE

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5
Q

What are options for clinics that offer emergency services?

A
  • specifically an emergency clinic - 24 hour full service emergency and critical care facility; typically transfers patients to their usual vet on next working day
  • full service hospital with 24 hour service for its clientele
  • on-call rotation of area veterinarians
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6
Q

What are some ethical considerations in ECC?

A
  • obligation to patient
  • obligation to client
  • facilitation of client decision making
  • client disenchantment w previous veterinarian
  • indigent clients
  • stray animals
  • decision whether or not to treat
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7
Q

Some issues faced related to obligation to the patient?

A
  • alleviate / prevent pain
  • minimize stress, sufferring
  • attempt to correct dz or injury w reasonable prognosis
  • humane euthanasia when indicated
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8
Q

Some issues faced related to obligation to client?

A
  • honesty, courtesy, respect
  • protection of client confidences
  • reasonable fees
  • informed consent
  • competent and caring services
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9
Q

Some ideas about how to effectively facilitate client decision making?

A
  • avoid haste
  • consider emotions
  • empathetic third party may assist
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10
Q

Some guidelines when dealing with client disenchantment with the previous vet?

A
  • avoid criticism [you do not know condition of animal when other vet saw/treated it or the vet’s thought process/reasoning]
  • listen and allow client to calm
  • focus on animal’s present condition
  • consider consultation w previous vet for patient’s benefit
  • consider reporting misdeeds AFTER patient care, if there are misdeeds to report - via proper channels
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11
Q

What to remember when dealing with indigent clients?

A
  • patient must receive vet’s best services unless the client specifically consents to less extensive services
  • patient must be treated with same level of care as when client is paying full fees
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12
Q

Considerations when treating stray animals:

A
  • “Good Samaritan” rarely assumes the bill
  • obligation to animal dictates at least supportive care at minimum
  • the owner, once located, may refuse to pay the bill
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13
Q

When might the decision to NOT treat be made?

A
  • treatable or untreatable conditions that result in poor quality of life
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14
Q

What are ways to decide to not treat?

A
  • passive euthanasia

- orders to not resuscitate (no code, DNR, DNAR)

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15
Q

Alternative to passive euthanasia and deciding not to treat?

A

active euthanasia - performed by vet

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16
Q

Legal considerations when working in ECC?

A
  • negligence
  • contracted liability
  • emergency Tx communications
  • informed consent
  • emergency prescriptions
  • euthanasia in owner absence
  • client assisstance w treatment
  • communication bottom line
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17
Q

Why might a vet face negligence issues?

A
  • deviation from accepted standards
  • national locality rule
  • specialists held to higher standards
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18
Q

When does the vet-client relationship begin?

A

upon verbal or written agreement

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19
Q

When does the contract (VCPR) end?

A
  • Tx is complete
  • care is transferred to another veterinarian
  • the client decides to terminate the contract
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20
Q

If a client makes telephone contact with a vet, what is a potential liability issue?

A
  • vet liable if client is NOT advised to have animal examined
  • vet also liable is medication is prescribed w/o an examination
21
Q

What law is violated if medication is prescribed over the phone without an examination of the animal?

A

MO Practice Act

22
Q

When should decision be made for euthanasia if owner cannot be contacted?

A
  • based on good judgement

- defendable in court, if action is similar to what other veterinarians would do

23
Q

How can a vet show forsight and avoid liability for client injury?

A
  • offer to have vet or vet tech restrain animal, instead of the client
  • if client bitten by their animal and you did not offer this, you are liable
24
Q

One of the most important aspects of vet care, especially in the emergency setting?

A

COMMUNICATION

25
Q

How might a hospital maintain “readiness”?

A
  • have a ready area
  • wall chart/s w quick dose reference
  • training, drill sessions
  • maintenance of equipment and supplies - check lists
26
Q

Suggested order of assessment for primary survey and triage of individual patient?

A
  • RAPID - one minute evaluation
  • level of consciousness
  • airway, breathing status
  • cardiovascular assessment
  • nervous and musculoskeletal assessment
27
Q

Triage of multiple patients:

What is class 1?

A

most urgent, catastrophic

immediate treatment required - will die if not treated ASAP

28
Q

Triage of multiple patients:

What is class 2?

A

severe, critical

action needed in minutes to an hour

29
Q

Triage of multiple patients:

What is class 3?

A

Serious

action needed in a few hours

acute injury - in a lot of pain, but not in jeopardy of dying at that moment

30
Q

Triage of multiple patients:

What is class 4?

A

less serious but pressing

needs treatment w/in 24 hours, but cannot ‘wait until Monday’

31
Q

Triage of multiple patients:

What is the status of a patient who is not classified?

A

emergency b/c of owner’s concern or convenience

action after classified patients are under control

32
Q

Minimum data base of emergency laboratory?

A
  • PCV and TP
  • blood glucose via reagent strip glucose meter
  • BUN (azostix)
  • urine specific gravity

often added in:
CBC
blood chem and electrolytes and lactate
urinalysis

33
Q

common diagnostic capabilities in emergency laboratory?

A
  • hematology
  • cytology
  • microbiology
  • hemostasis
  • blood gases
34
Q

What test assesses coagulation cascade?

A

Clotting times
PT
PTT

35
Q

What test evaluates extrinsic clotting pathway?

And intrinsic pathway?

A

extrinsic: prothrombin time
intrinsic: partial prothrombin time

36
Q

What is most important aspect of your evaluation of patient?

A

your physical exam - what you see/feel/hear/smell/etc

do NOT rely too heavily on machines to tell you everything

examine patient with your own senses very carefully then follow up with selected laboratory tests

37
Q

What is a central venous pressure test used to evaluate?

A
  • reflection of right atrial pressure

- used for early detection of fluid overload during intravenous fluid therapy

38
Q

What materials do you need for central venous pressure monitoring?

A
  • catheter [jugular often]
  • IV extension tubing
  • 3 way stop cock
  • IV infusion set and fluids
  • second IV extension tubing w catheter cap and cm ruler OR commercially available manometer
39
Q

What are normal central venous pressure values?

A

0 to 5 cm H20

varies with position of catheter tip so establish zero point and monitor variations from that point

40
Q

Invasive methods to monitor patient status?

A

CVP
direct arterial blood pressure
pulmonary artery catheter
intra-abdominal pressure

41
Q

What does low CVP indicate?

A

hypovolemia

vasodilation

42
Q

What does high CVP indicate?

A

artifactual elevations: if peripheral instead of central location or catheter tip OR if catheter is obstructed with kinks or blood clots

physiological alterations

43
Q

What physiologic alterations may be present when monitoring high CVP, after r/o artifacts?

A
  • hypervolemia
  • normovolemia or hypovolemia w cardiac decompensation
  • cardiopressaant anesthesiaa or cardiopulmonary dz
  • inc intrathoracic pressure [due to mechanical ventilation or pleural space dz]
44
Q

What can you do for a patient wiht high CVP?

A
  • always do something!
  • check for artifactual causes
  • slow or stop IV fluids
45
Q

What can you do for patient w low or normal CVP?

A
  • continue or inc IV fluid administration rate
46
Q

T/F: CVP is a reflection of left heart pressures, therefore, with a normal CVP, pulmonary edema will not occur.

A

FALSE - CVP does NOT reflect left heart pressures - therefore pulmonary edema can result in face of normal CVP

47
Q

How can direct arterial blood pressure be monitored?

A
  • dorsal pedal artery

- transducer and monitor

48
Q

How can intra abdominal pressure be monitored?

A
  • foley urinary catheter

- water monitor

49
Q

What info is included on standard medical record forms?

A
  • Hx and PE
  • estimate / consent for Tx
  • progress notes
  • anesthesia and Sx reports
  • dismissal (instructions for owners)

Small Animal ECC (5 decks)

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