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Small animal medicine - Clinical day tests > Day 2 - 2. Oxygen therapy, reanimation, euthanasia. > Flashcards

Day 2 - 2. Oxygen therapy, reanimation, euthanasia. Flashcards

1
Q

What does oxygen delivery depend on?

A
  • Hemoglobin conc -> Anemia
  • Oxygenisation of the arterial blood (PaO2) -> hypoxaemia
  • Cardiac output -> hemodynamic disturbance
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2
Q

what is the goal of oxygen delivery?

A

Increase the inspired O2 concentration (FiO2)

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3
Q

What are the values of hypoxia?

A

Hypoxia (PaO2 < 80 Hgmm, Sa O2 <90%)

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4
Q

Clinical signs of hypoxia:

A 
• Restlessness
• Dyspnoe
• Increased respiratiory rate (> 32-40/min)
• Labial breathing
• Open mouth breathing (cats)
• Abnormal respiratory sounds
– Upper airway stridor
– Crepitaion
– Respiration 0 (pleural effusion, pneumothorax)
• Cyanosis
• Gasping
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5
Q

Which sedation is used during hypoxia?

A

Acepromazin
Butorphanol
Midazolam

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6
Q

What are the common causes of hypoxia?

A
  1. Upper respiratory obstruction
  2. Pulmonary diseases
  3. Congestive heart failure
  4. Pleural effusion
  5. Thoracic trauma (pneumothorax, lung contusion)
  6. Inhalation of toxic gases (smoke, CO)
  7. Severe anaemia
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7
Q

What are some Upper respiratory obstructions?

A

– Brachycephal syndroma
– laryngeal collapse
– Laryngeal paralysis
– Tracheal collapse

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8
Q

Give some pulmonary diseases:

A

– Pneumonia

– Pulmonary edema/ARDS

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9
Q

What are used for the arterial blood gas analysis?

A
  1. Femoral or metatarsal arteries
  2. PaO2
  3. SatO2
  4. PaCO2
  5. A-a gradient
  6. „Rule of 120”
  7. PaO2/FiO2 ratio
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10
Q

Explain A-a gradient:

A

difference between alveolar O2 pressure and PaO2 (<10-15)

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11
Q

Explain rule of 120:

A

PaO2 + PaCO2, if < 120→V/Q-mismatch

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12
Q

What is the normal , acute lung injury and ARDS values of : PaO2/FiO2 ratio

A
  • Normal: > 400 Hypoxaemia: 300-400
  • Acute Lung Injury: 200-300
  • Acute Respiratory Distress Syndrome < 200
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13
Q

Oxygen sources:

A
  1. Bottle or concentrator
  2. „Flow by” oxygen
  3. Oxygen hood / collar
  4. Nasal oxygen catheter
  5. Oxygene cage
  6. Endotracheal tube
  7. Mechanical ventilation
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14
Q

Explain „Flow by” oxygen:

A

„Flow by” oxygen

  • Small diameter tube held to the nose of the patient
  • Through mask→some animals don’t tolerate
  • 2-3 liter/min→FiO2: 25-40%
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15
Q

Explain Oxygen hood / collar:

A

Oxygen hood / collar
• Elisabeth collar ventral 50-75% covered by plastic folia
• 1 liter/10 kg/min→FiO2: 40-60%
• CAVE: some dogs do not tolerate it – panting→ increased humidity → hyperthermia

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16
Q

Explain Nasal oxygen catheter:

A

Nasal oxygen catheter
Thin (6-9Fr) plastic tube placed in the ventral meatus of the nose
Well tolerated on long term management
50-100 ml/kg/min→FiO2: 40-50%

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17
Q

Explain oxygen cage:

A 
Oxygene cage
• Floading over 20 minutes
• FiO2: 30-50%
• Safe use in long term management
• Lack of stress
• CAVE panting → increased humidity → hyperthermia, CO2 
• Expensive!!
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18
Q

Explain Endotracheal tube:

A

Endotracheal tube
Primarily in upper respiratory tract obstructions perioperatively
Anesthesia required
FiO2: 21-100%

19
Q

What are the mechanical ventilation – indications:

A

Mechanical ventilation – indications:

  • Severe hypoxia (PO2<60 mmHg)
  • Sever hypercapnia (PCO2 >60 mmHg)
  • Excessive work of breathing
20
Q

CPCR =

A

Cardiopulmonary cerebral resuscitation

21
Q

When is CPCR performed?

A

cardiorespiratory arrest (CPA)

22
Q

Clinical signs of CPA

A 
– Gasping / agonial breathing pattern 
– unconciousness
– Lack of spontaneous breathing
– Lack of palpable pulse
– Lack of cardiac sounds
23
Q

When is the prognosis poor?

A

< 10% ROSC

<1% survive to discharge

24
Q

Potentially reversible causes of CPA:

A

5 H, 5T

25
Q

Give the 5 H

A
  1. Hypovolaemia/haemorrhage
  2. Hypoxia/hypoventilation
  3. Hydrogen ions –> acidosis
  4. Hyperkalaemia/hypokalaemia
  5. Hypoglycaemia
26
Q

Give the 5 T

A
  1. Toxina
  2. Tension pneumothorax
  3. Thromboembolism
  4. Tamponade (pericardial)
  5. Trauma
27
Q

Parameters of monitoring a critically ill patient:

A

T,P,RR,CRT, BG

28
Q

Common causes of critical patients:

A 
– SIRS (systemic inflammatory response syndrome)
– septikaemia
– Congestiveheartfailure
– Severe respiratory disease, ARDS
– Cerebraldiseases(seizures),
– Multipletrauma
–coagulopathia, toxicosis, anaesthesia
– Ill puppies BW< 2 kg!!!
29
Q

Things to consider before CRCP…

A
  • Underlying disease…
  • Owners will
  • Timing – within 3-5 minutes after CPA
  • Equipment
  • Trained staff (3+n)
30
Q

The ABC of cardiopulmonary resuscitation

A

Airways
Breathing
Circulation

Drugs
ECG
Fluids

31
Q

Airways

A

– Clean the airways (mucose, FB)

– Endotracheal intubation

32
Q

Breathing

A

with AMBU-ballon 10-12/min rate

33
Q

Circulation

A

Thoracic compressions
Right lateral recumbency
Position of the hands:
– Medium- large breed: both hands on the widest points of the thorax
– Medium breeds: one handover the heart(4-6. intercostal space)
– Small breeds and cats: 1 handover the cardiac area, thumb on the other side of the chest

34
Q

Drugs

A

• Drug applications
– Intravenous
– Intratracheal
• safe: atropin, epinephrine/adrenalin, lidokain, naloxon, vazopressin
• 2-2,5x dose is necessary (epinephrine: 3-10x IV dosage!)
• Drug should be solved in 5-10 ml sterile water or saline
• CAVE: severe pulmonary disease (edema)

35
Q

ECG

A 
Background – Asystole
– Electric activity without pulse
– Ventricular tachycardia
Ventricular fibrillation
Severe sinusbradycardia
36
Q

Fluids

A

• Patients with hypovolaemia: shock dosis
– crystalloids: dog: 90 ml/kg, cat: 45 ml/kg
– Colloids (HAES) dog: 5 ml/kg cat: 2-3 ml/kg
– Hypertonic saline: NaCl (3%)

  • Patients with euvolemia: crystalloids in bolus with maximum speed
  • dog: 20 ml/kg bolus
  • cat: 10 ml/kg bolus
37
Q

Commonly used drugs (ABC)

A

Adrenalin (Tonogen inj)
• mainly alpha2 adrenergic stimulatory effect:
peripheral arteriolar vasoconstriction increase → cerebral and coronarial perfusion pressure increase
• 0,01mg/kgIV
• Dosage can be repeated in 3-5 min (max: 0.1 mg/kg IV)

Atropin (Atropin inj.)
– Heart rate increase, vascular resistance increase, blood pressure increase
– Most effective in case of vagotonia induced asystole
– 0,04 mg/kg IV
– Can be repeated in 3-5 minutes 3x

38
Q

When is it allowed to use euthanasia?

A

-Incurable disease or injury
– Control of infectious diseases – Unavertable attack
– Scientific research
– (high treatment costs)

39
Q

Parameters of quality of life:

A 
• Pain (1-10)
• Appetite (1-10)
• Hydration (1-10)
• Hygine (1-10)
• Mood (1-10)
• Locomotion (1-10)
• More „good than bad days”(1-10)
>35: acceptable QOL
40
Q

Describe the procedure of euthanasia:

A
  • Place i.v. catheter
  • General anesthesia – (acepromazin/ ketamin+diazepam/ propofol) i.v.
  • Drugs for euthanasia – Pentobarbital60-100mg/ttkg:
  • Release inj (1 ml/5ttkg)
  • Euthasol 40 % inj. – T-61inj.0,3ml/ttkg(?)
41
Q

What can be done if the iv catheterisation is not possible in case of euthanasia?

A

→ induce anesthesia i.m. →apply euthanasia medication i.c.

• Monitor heart, respiration, corneal reflexes

42
Q

Mistakes of euthanasia :

A
  • Let the patient wait for long in the waiting room
  • Leave the cadaver alone in the treatment room
  • Handle the body without respect
  • Underestimate the grief of the owner
  • Recommend to buy/get a new animal
43
Q

As a vet, how should you act when performing an euthanasia?

A

Circumstances: empathy, empathy, empathy
• Quiet room (turn off cell phones!)

• According to the wish of the owner:
– Wish to say goodbye? (left few minutes alone)
– Wish to be present?
– What happens with the

• Prepare what will happen… describe the procedure
– i.v. catheter
– Induce anesthesia
– Apply drug for euthanasia
– May void urine or feces
– Possible unvoluntary muscle constrictions

Small animal medicine - Clinical day tests (3 decks)

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