Ch. 2 Patient Preparation Flashcards
MPD stands for
Minimum patient database
MPD must include
Hx, PE, labs
What does confirming the scheduled procedure prevent
-anesthetizing the wrong patient
-performing an unnecessary procedure
-not performing a scheduled procedure
What specifics should be known for confirming the procedure
-exact location of tumors
-o’s wishes regarding cytology or histology
-o’s wishes regarding decisions during procedure
What breed is sensitive to barbiturates
sighthounds
what breeds are sensitive to acepromazine
boxers and giant breeds
what breed is resistant to acepromazine
terriers
what breed is difficult to intubate
brachiocephalic dogs
what horses are sensitive to sedatives
draft horses
Past adverse reactions to anesthetic agents
Cats- prolonged ketamine recovery
Dogs- behavioral change after acepromazine sedation
Preventative care
vaccines
fecal and parasite control
hw status- dogs
FIV and FLV testing- cats
Tetanus toxoid- horses
Sick patients must be _ prior to anesthesia
stabilized
What are the most affected systems by anesthetic agents
cardiovascular, nervous, pulmonary
When should animals be weighed
immediately before anesthetic procedure
What scale should be used for <5kg patient
pediatric scale
what scale should be used for a patient <1kg
gram scale
How to estimate weight for horses in kg
heart girth (cm)2 x length (cm) / 11880
Elevated temperature indicates
inflammation
decreased temperature indicates
numerous systemic disorders
What heart rhythm is described
-heart rate increases w/ inspiration and decreases with expiration
-dogs, horses, ruminants
-heart rate affected by respiration
sinus arrhythmia (SA)
What heart block is described?
-delayed conduction through the AV node
-Detected only on ECG tracing
First degree atrioventricular (AV) heart block
What heart block is described?
-Periodic block of conduction through the AV node
-Results in skipped heartbeats
Second degree AV heart block
More than _ skipped heartbeat in a row is abnormal and must be reported
one
AV blocks are not associated with _ rhythms
breathing
How to know the difference between SA and AV block
watch P breathe while auscultating the heart
Where should you listen for murmurs
over each valve; cranial most aspect of left axilla-PDA
What is a pulse deficit
more heartbeats the pulses
What does pulse help determine about blood pressure
strong or weak pulse indicates high or low BP
Crackles are _ sounds
discontinuous
Wheezes are _sounds
continuous
What is a patient work up based on
age, history, PE, and financial considerations
Preanesthetic diagnostic tests and procedures
CBC, UA, Chem, Coagulation screens, ECG, x-rays, etc.
Class P1 is _ anesthetic risk
minimal
Class P5 is _ anesthetic risk
extreme
What anesthetic protocol does class P1 and P2 use
standard
Classes P3 and P5 need
special protocols and stabilization
Complications of not withholding food prior to induction
esophageal reflux, vomiting, regurgitation, pulmonary aspiration, pneumonia
What are the following?
-Fluid admin.
-Rapid IV access in an emergency
-CRI of drugs and anesthetic agents
-Admin. of vesicants
-Sequential admin. of incompatible drugs
reasons for placing an IV catheter
Fluid administration allows the anesthetist to
increase circulating blood volume, increasing CO and tissue perfusion
Plasma is _% of body weight
5%
Blood volume in dogs and large animals is -% of body weight
8-9%
Blood volume in cats is -% of body weight
6-7%
How to calculate blood volume in dogs and large animals
90ml/kg lean body weight
How to calculate blood volume in cats
60ml/kg lean body weight
Colloids are _ molecular weight plasma proteins
large
Ions are small molecular weight and _ charged
electrically
Two types of electrolytes
Cations and Anions
What are the following
-Sodium
-Potassium
-Magnesium
-Calcium
cations
Solute concentration (osmolarity) in any fluid compartment must be
300 mOms/L
Solutes must provide osmotic pressure to
pull water into a compartment
_ of IV fluids administered will stay in the intravascular space
1/3
_ of IV fluids will diffuse into the interstitial space
2/3
Some solute concentrations (_ and _) must be kept within a narrow range to maintain normal heart and muscle function
Ca2+, K+
Perioperative hemorrhage is a loss from the
intravascular space
What should be administered for preoperative hemorrhage
hypertonic saline or colloid solutions
what should be administered for significant perioperative hemorrhage
blood products
What should be administered for low albumin
blood plasma or colloid solutions
The following are _ fluids
-Similar to ECF
-LRS
-Normosol-R
-Plasma-lyte A and R
-Isolyte S
Isotonic, polytonic crystalloids
Lactated ringers solution (LR) and Plasma-lyte R (PR) contain calcium and cannot be administered with
blood products
_ _ is used to
-bath tissues during surgery
-to flush IVC
-to flush body cavities
Normal saline (NS)
Hypertonic saline solutions are used to treat
acute shock, acute blood loss in absence of colloid, BUT should be followed w/ colloid if P needs long-term volume expansion
Hypertonicity results in fluid being draw into the intravascular space to maintain
blood pressure
Dextrose solutions are used to support
blood sugar levels
D5W is used to replace fluid loss due to
dehydration or heat stroke
Colloids are used to support
blood volumes and blood pressure
Fluid rate for routine anesthesia and surgery
10ml/kg/hr during first hour
5ml/kg/hr during remainder of the procedure
Fluid rate for drop in BP
Bolus 10ml/kg, repeat if needed
Colloid if 2 boluses unsuccessful
Adverse effects of fluid administration
volume overload and over hydration
What is used for infusion rates
patient weight and prescribed rate
What is used for drip rate
infusion rate, delivery rate, conversion factors
Preanesthetic/ preoperative medications
antibiotics, preemptive analgesia, antiemetics, anticonvulsants, anti-inflammatory drugs
