Day 3 - rest till lameness Flashcards
Wound management in standing position - sedation
Xylazine: 0.5 – 1.1 mg
Detomidine: 0.01 mg
Romifidine – mostly used or combinations with Butormidor Butormidor – long, good, stabile
LOCAL AND PERINEURAL ANESTHESIA
Lidocaine, marcain, mepivacain
WOUND MANAGEMENT IN GENERAL ANESTHESIA - sedation
-IV or inhalation anesthesia
-Premedication
-Induction
-Ketamine, diazepam – IV – move to operating room
-Isoflurane inhalations
-IV anesthesia (if other indication) ketamine, xylazine
Non-absorbable
skin
Absorbable
intestines, subcutaneous
Monophyl
on cut surface
polyphyl
if you see cut surface
pseudo monophyl
if you cover the polyphyl
Most used suture material
Natural or synthetic
Indication and types of drains
INDICATION:
-Foreign material / Contamination
-Reduce the accumulation of blood, serum, etc.
-Abscess cavity
-2-4 days inside – after 2 days with little fluid – take it out
TYPES:
-Passive / Active
-Bandage drains
-Tubular (semi regid fenestrated tube)
-Penrose
Septic joint info:
- WBC
- TP
- Cytology
Lameness
-Lameness 4/5
-Synovia: (take sample)
-WBC: more 40 g/l
-TP: more 2 g/dl
-Cytology: neutrophil granulocytes
Septic joing (open injury)
Tx
IV AB: gentamycin
IM AB: penicillin, amoxicillin + clavulan
Joint lavage: IA AB, isotonic infusion, Intra articular treatment
Joint drain
Regional limb perfusion with AB
Partial thickness wounds (2)
Erosion, abrasion
Full thickness wounds
3 coordinated phases: acute inflammation (starts when injury happens), cellular proliferation and matrix synthesis and remodeling with scar formation.
Acute inflammatory phase
- Bleed and Pain
- Vasoconstriction mediated by sympathomimetic amines and thromboxane.
- Vasodilatation
- increased capillary permeability mediated by: histamine, bradykin, prostaglandings E1 and E2 – pain
Leukotriene B4 - Cellular and noncellular blood components can enter into the wound by diapedesis.
Cellular components of healing
Lymphocytes, monocytes and neutrophiles
Cellular proliferation stage
-Presence of fibroblast
-Epithelialization
-formation of granulation tissue
-wound contraction: Begins when blood clots, necrotic tissue, debris, infection has been removed.
-fibroplasia (migration of fibroblasts, collagen formation 3-5 days)
-granulation tissue (vascular loops)
-wound contraction (myofibroblasts)
Connective tissue
Collagen fiber and ECM production
IC tropocollagen – EC fibrils – ECM binder – reticulin – argyrophilic fibers
- First fibroblast in 2-3 days
- First collagen 5-7 days
- First elastic fibers 4 weeks
The first 21 days are the same for all wounds and tissues.
Granulation tissue consists of .. ?
capillaries, fibroblast, macrophages, mast cells
Matrix synthesis
-Last stage
-Maturation of collagen scar
-Decrease in vascularity
-Decreased number of fibroblast and macrophages
Wound healing: Mineral deficiencies
Zinc – delayed wound
Cu – collagen synthesis important
Wound healing: vitamins
A-elasticity, collagen synthesis and epithelization
K- hemorrahe
C- epithet anigo and collagen
Wound healing: SAIDS
Stops wounds healing
Decrease collagen synthesis
Decrease angiogenesis
Decrease granulation tissue formation Decrease epithelization
Effects of local anaesthetics
Less leukocyte can adhere to the endothelium
Decreases blood vessel lumens
Common local anesthetics, paranasal or infiltrate surgical areas
Effects of local insulin
Protein synthesis, constriction,
Cell division can be better
Decrease edema
Effect of temperature and pH on wound healing
High temp (30)
Lower pH
Cold decrease elasticity
User bandage higher temperature
Steps off primary wound healing (7)
1.The incised space fills up immediately with blood and fibrin clots.
2.At the border of the wound neutrophil accumulation in 24 h present
3.Mitotic activation of the basal cells – present in 24-48 h
4.Macrophags on 3rd day – granulation tissue proliferation – collagen fibers – epithel expansion.
5.Angiogenesis on 5th day. Increased collagen mass which overbridge the incision.
6.Collagen and fibroblast proliferation on the 2nd week decreased edema, less leukocyte and vascularity.
7.No sign of inflammation after 1 month, avascularisated scab.
Steps off secondary wound healing (4)
1.Clean up wound – regressive process
2.Granulation tissue formation, fill up the wound
3.Constriction of the granulation tissue, scar tissues
4.Epithelization
Cases of no wound healing complications
-Sarcoid, tumor
-Tumor, another type
-Foreign body
Callus formation, periostal rupture
- Haematoma between broken ends
- After few days acute inflammation (neutrophils, monocytes, histocytes)
- from the periosteum, edosteum, granulation tissue formation (fibroblast and blood vessel proliferation) – temporary callus – fibroblasts differentiation = osteoblasts
- Temporary osteoid, cartilage callus. 5. Temporary bone callus (irregular structure)
- Regular lamellar bone callus
Lamellar bone calluses (3)
1.Intermediate callus
-Lamellar bone in the line of the cortex of fractured bone edges
2.Endocallus
-Forms in the previously bone marrow area
3.Ectocallus
-Extra bone formation around the fractured area
MRI general info
High or low-field MRI?
3D, soft tissue and bone tissue
High
CT - for what?
Traditionally for osseous lesions
-Fracture, preoperative planning
-Localised lameness not explained by radiography and ultrasonography
-Ataxia, neck pain
ADVANTAGES:
-Allows guided injections
-Pre-operative planning
CT or MRI?
MRI:
-In standing sedation
-Bone & soft tissue injuries
-Neck – only cranial aspect
-Time consuming
CT:
-General anaesthesia for limbs
-Fractures, planning
-Neck – standing, depending on the CT even C7
- Guided injections
- Very quick
Scintography
-Information about function of organs
-Mostly for osseous injuries
-Suspicion of stress fractures
Sinus rhytm
ATRIAL PREMATURE COMPLEX/DEPOLARIZATION
Atrial fibrillation
1ST AND 2ND DEGREE ATRIOVENTRICULAR BLOCK
2ND DEGREE ATRIOVENTRICULAR BLOCK
3RD DEGREE (COMPLETE) ATRIOVENTRICULAR BLOCK
VENTRICULAR PREMATURE COMPLEX/DEPOLARIZATION
VENTRICULAR TACHYCARDIA (UNIFORM)
VENTRICULAR TACHYCARDIA (MULTIFORM)
Abdomen: Left upper quadrant
small colon and small intestine
Abdomen: Left lower quadrant
left ventral large colon/pelvic flexure
Abdomen: Right upper quadrant
head of the caecum (ileocoecalis sound (thunder storm) + gas sound)
Abdomen: Right lower quadrant
right ventral large colon
Abdominal US: left side
- flank area – spleen, left kidney
- lower – large colon, spleen
- inguinal area – urinary bladder,
small intestinal loops - more cranial – stomach and
spleen - even more cranial: liver and
spleen
Abdominal US: Right side
- 17th – 16th IC: right kidney
- More cranial: lung, liver,
duodenum, colon - More caudal: colon,
ceacum - Inguinal ring: small
intestinal loops, bladder - Ventral: colon
