ER Flashcards
When performing phone triage, what info should you always obtain?
Obtain a client name and phone number, then determine if patient is in a life-threatening situation
Student #11 ML
McCurnin 10th ed pg 775
How do you perform an initial triage?
Collect a brief history, perform a quick PE, then get information about resuscitation status and initial treatments
Student #11 ML
McCurnin 10th ed pg 775
What are the ABCs of a primary survey?
A: airway/attitude
B: breathing/bleeding
C. cardiovascular/circulation
Student #11 ML
McCurnin 10th ed pg 775
What are common conditions associated with abnormal MM color?
blue/purple=cyanotic: hypoxia
brick red=injected, hyperemic: carbon monoxide toxicity, heat stroke, sepsis
yellow=icteric: high levels of bilirubin
white=pale: anemia
Student #11 ML
McCurnin 10th ed pg 776
What is the typical appearance of an orthopneic patient?
Orthopneic patients will extend their neck while standing/crouching with their elbows away from their body in an attempt to continue breathing
Student #11 ML
McCurnin 10th ed pg 776
What are common causes of dehydration in veterinary patients?
Vomiting, diarrhea, excessive panting, polyuria, and decreased water intake
Student #6, AF, McCurnin 10th ed. pg. 777
What is the normal blood pH for veterinary patients?
7.4
Student #6, AF, McCurnin 10th ed. pg. 778
A crash cart must contain which items?
Emergency medications, needles, syringes, a laryngoscope, various endotracheal tubes, and an ambubag. Larger carts should also contain instrument packs for procedures such as a tracheostomy or open-chest CPR.
Student #6, AF, McCurnin 10th ed. pg. 779
What does increased ETCO2 readings indicate? What does decreased ETCO2 readings indicate?
Increased = The patient may be hypoventilating, or is rebreathing CO2 in an anesthesia circuit with exhausted soda lime
Decreased = The patient may be hyperventilating or has decreased cardiac output
Student #6, AF, McCurnin 10th ed. pg. 783
How many breaths per minute should be delivered to the patient when attempting cardiopulmonary resuscitation (CPR)?
10 breaths/minute
Student #6, AF, McCurnin 10th ed. pg. 784
What is Flail chest?
Is when a part of the ribs are broken in more than one place and they move the oposite way that the chest.
Student #10 AJ
McCurnin 9th edition page 842
Define borborygmi
Is a rumbling noise caused by the propulsion of gas and ingesta through the intestine
Student #10 AJ
McCurnin 9th edition page 843
Define azotemia
blood has increased concentrations of nitrogenous wastes.
Student #10 AJ
McCurnin 9th edition page 844
What is SIRS?
systemic inflammatory response syndrome
Student #10 AJ
McCurnin 9th edition page 857
What is SIRS do in the body?
SIRS causes widespread inflammation due to an underlying disease.
Student #10 AJ
McCurnin 9th edition page 847
What is atrial fibrillation and what is it caused by?
A rapid, irregularly irregular rhythm with supraventricular morphology QRS complex, no identifiable P waves, and fibrillatory waves.
Caused by left atrial enlargement secondary to underlying structural cardiac disease.
Student #8 KH, McCurnin 10th ed. pg. 798
A rapid ventricular tachycardia requires which emergency treatment drug to suppress the arrythmia due to high risk of sudden death?
Lidocaine
Student #8 KH, McCurnin 10th ed. pg. 799
Normal QRS width interval for canine and feline?
Small breed: 0.05 sec
Large breed: 0.06 sec
Feline: Max 0.04 sec
Student #8 KH, McCurnin 10th ed. pg. 795
Indications for Epinephrine and adverse effects?
Asystole and PEA.
Arrythmia and hypertension
Student #8 KH, McCurnin 10th ed. pg. 787
What are potential risks after CPR?
Pulmonary edema, atelectasis, pulmonary thromboembolism, and acute respiratory syndrome, as well as injuries from the CPR itself.
Student #8 KH, McCurnin 10th ed. pg. 787
What should you do if you suspect any raspatory distress at all?
Give your pt supplemental o2
Student #20
McCurnin 10th ed. pg. 776
What percent of dehydration are the signs noticeable?
5% is when you start noticing signs of dehydration
Student #20
McCurnin 10th ed. pg. 778
What does MODS stand for?
Multiple organ disfunction syndrome: This includes kidney, brain, lungs, liver and heart disfunctions.
Student #20
McCurnin 10th ed. pg. 781
What is a sinus rhythm
This is a normal rhythm in dogs and cats and is counted as the SA node. When you put sinus in front of something than that means that its a normal irregular (sinus bradycardia/ sinus tachycardia)
Student #20
McCurnin 10th ed. pg. 781
Pneumothorax
If Pneumothorax is the result of a laceration of the thoracic wall. The wound should be repaired and all the air should be taken out to restore the intrathoracic pressure.
Student #20
McCurnin 10th ed. pg. 781
What does the initial diagnostics include?
Packed Cell Volume (PCV), Total Protein (TP), Blood Glucose, Blood Gas Analysis, Blood Pressure, Pulse Oximetry, ECG, and FAST scan.
Student #3, S.C
McCurnin 10th Edition Page:778
Shock is a complex syndrome resulting from what?
Altered blood flow or impaired oxygen delivery to tissue.
Student #3, S.C
McCurnin 10th Edition Page:779
What is FAST used for?
To quickly assess body cavities for fluid.
Student #3, S.C
McCurnin 10th Edition Page:779
When should a thoracic drain be placed?
If more than two thoracocenteses are needed within a few hours.
Student #3, S.C
McCurnin 10th Edition Page:782
What can MM color be a sign of?
Respiratory function.
Student #3, S.C
McCurnin 10th Edition Page:782
What type of crystalloid IV fluid is most commonly used for resuscitation, re-hydration, and replacement of ongoing hydration losses?
Isotonic crystalloids, such as
1. Normosol R
2. Lactated Ringer Solution (LRS)
3. 0.9% NaCL (normal saline)
Student #18 BKS
McCurnin 9th ed. pg.820
When is it more appropriate to use a colloid IV fluid versus a crystalloid IV fluid?
Resuscitation/reversing hypovolemia
Colloids contain high-molecular-weight molecules, which remain within the vascular space more effectively than crystalloids; therefore, making them well suited for use in resuscitation.
Student #18
McCurnin 9th ed. pg. 821
Replacement fluid rate?
% dehydrated + number of losses + maintenance (30*kg+70)
Student #4, BE, Pg 822
To prevent adverse cardiac effects when administering potassium intravenously, the rate should not exceed what?
-0.5mEq/kg/hr
Student #4 BE, Pg 828
Hydration parameters during physical exam?
-Skin turgor, tackiness of mucous membranes, sunken eyes, cardiovascular compromise, body weight.
Student #4, BE, Pg 829
Laboratory parameters evaluated to asses hydration status?
PCV, TP, Urine output, urine specific gravity, hypernatremia
Student #4, BE, Pg. 829
What does minor vs. major cross-matching detect?
-Minor: Detects agglutination reaction between donors’ plasma and the recipients RBC’s.
-Major: Detects agglutination reaction between donors RBC’s and recipients plasma.
Student #4, BE, Pg 833
When looking at pupils what does the term anisocoria mean and what may it indicate?
Anisocoria means asymmetry in pupil size which may indicate an acute cerebral injury like blood clot, hemorrhage, or brain injury
Student #14, S.P.
McCurnin 10th Edition Page:777
What is done during secondary survey?
There is a more detailed physical examination, and non-life threatening problems are addressed.
Student #14, S.P.
McCurnin 10th Edition Page:779
What is the maintenance of a crash cart?
A crash cart should be inspected a minimum of once a month for proper function and expiration. After inspection or use, the crash cart should be restocked.
Student #14, S.P.
McCurnin 10th Edition Page:779
Bright Red MM, and bounding pulses may indicate?
A septic animal
Student #14, S.P.
McCurnin 10th Edition Page:780
What is equipment needed for a thoracocentesis?
Needle, butterfly or IV catheter, collection tubing, 3-way stopcock, and a syringe of appropriate size (60 ml)
Student #14, S.P.
McCurnin 10th Edition Page:782
What are the clinical signs of SIRS?
Vasodilation that leads to hypotension, tachycardia, tachypnea, fever, and marked increases or decreases in white blood cell count
Student #16 ER
McCurnin 10th Edition pg 781
What would hearing a borborygmi on auscultation of the thorax indicate?
Diaphragmatic hernia
Student #16 ER
McCurnin 10th Edition pg 776
When performing cardiopulmonary resuscitation, what is the chest compression rate?
100-120 compressions per minute
Student #16 ER
McCurnin 10th Edition pg 785
A rhythm in which every other beat is a VPC is referred to as what?
Bigeminy
Student #16 ER
McCurnin 10th Edition pg 799
If the femoral pulse in dogs or cats cannot be palpated, this indicates that the mean arterial blood pressure is likely less than what?
60 mmHg
Student #16 ER
McCurnin 10th Edition pg 776
How can you confirm proper placement of an IO catheter?
Aspiration of bone marrow or radiographs can help confirm proper placement
Student #18 BKS
McCurnin 9th ed. pg 827
What are the blood types in cats and which is the most common?
The blood types for cats are A,B, and AB. Type A is most common for domestic short-hair and domestic long-hair breeds.
Student #18 BKS
McCurnin 9th ed. pg 832
What is TACO?
transfusion-associated circulatory overload
Student #18 BKS
McCurnin 9th ed. pg. 837
How do cats differ from dogs when it comes to shock?
Cats in shock often present with bradycardia rather than tachycardia.
Student #2 vc
McCurnin 10th ed. pg 776
What occurs in the body during septic shock?
Translocation of bacteria from the GI tract into the bloodstream transports them to damaged organs. This can occur during any form of shock and is difficult to treat as altered blood flow may impair antibiotic delivery to the damaged organ.
Student #2 vc
McCurnin 10th ed. pg 780
What is the most common cause of atrial standstill?
Hyperkalemia associated with systemic disease.
Student #2 vc
McCurnin 10th ed. pg 800
Upper vs lower respiratory tract emergencies?
Upper- the most common, almost always result of obstruction of airflow to lungs and present with severe distress, anxiety, and loud noise on inspiration.
Lower- usually caused by lung disease or failure to inflate lungs.
Student #2 vc
McCurnin 10th ed. pg 806
In Equine care, what are the goals of stabilization in a fracture?
To decrease pain, minimize/eliminate further injury, minimize damage to soft tissues and vasculature, minimize swelling and enable some degree of weight bearing.
Student #2 vc
McCurnin 10th ed. pg 810
Which acupuncture point can be used to help stimulate respirations and where is it located?
Governing Vessel 26, located at the nasal philtrum at the ventral edge of the nares. It can be stimulated with a 25g needle.
#13 KM
McCurnin 10th ed. pg. 786
Which piece of monitoring equipment is the best indicator to gauge the success of chest compressions?
ETCO2 monitor (capnograph). As chest compressions restore perfusion, ETCO2 should rise to 15mmHg or higher.
#13 KM
McCurnin 10th ed. pg. 785
What should be checked at least hourly after successful CPR?
Evaluation of neurologic function like pupillary light response, pupil size and symmetry, spontaneous respiratory efforts, stimulus response and motor response.
#13 KM
McCurnin 10th ed. pg. 788
Second degree AV block vs third degree AV block?
Second degree is characterized by some P waves that are not followed by a QRS complex and third degree is when there a complete dissociation of P waves and QRS complexes.
#13 KM
McCurnin 10th ed. pg. 801
Basic life support vs advanced life support?
Basic: chest compressions and ventilation
Advanced: medications, defibrillation, and/or open chest procedures
#13 KM
McCurnin 10th ed. pg. 784
When is the remainder of the initial exam completed?
Once it is determined that the patient does not require emergency treatment or after stabilization has occurred.
#1, MA
McCurnin 10th ed. pg 776
What does paO2 stand for?
Partial pressure of oxygen in arterial blood
#9 KJ
McCurnin 10th ed. pg 778
What should a patient’s paO2 be when breathing room air?
80-100mmHg
#9 KJ
McCurnin 10th ed. pg 778
What should lactate levels be below when analyzing blood gases?
2mg/dL
Levels higher than this can indicate poor perfusion, and we should further evaluate the patient’s fluid status.
#9 KJ
McCurnin 10th ed. pg 779
Normal arterial blood pressure values for dogs and cats?
Systolic: 100-140mmHg
Diastolic: 60-80mmHg
MAP: 70-100mmHg
#9 KJ
McCurnin 10th ed. pg 779
Are pulse oximeters reliable on patients with CO poisoning or on patients who inhaled smoke?
No.
Carbon monoxide (CO) can bind to hemoglobin which registers as oxygen saturation on pulse oximetry.
#9 KJ
McCurnin 10th ed. pg 779
What type of shock is most commonly seen in dogs and cats?
Hypovolemic Shock
Student #12 JL, McCurnin 10th ed. pg. 780
What causes hypovolemic shock?
Decreased intravascular fluid volume
Student #12 JL, McCurnin 10th ed. pg. 780
Define Distributive Shock
Maldistribution of blood flow
Student #12 JL, McCurnin 10th ed. pg. 780
When do you usually see distributive shock?
Anaphylaxis, sepsis, heat stroke, and envenomation
Student #12 JL, McCurnin 10th ed. pg. 780
Define Obstructive Shock
Venous return to the heart is impaired.
Student #12 JL, McCurnin 10th ed. pg. 780
What should be administered if a blocked cat is hyperkalemic?
Calcium gluconate
#19 MW
McCurnin 10th ed. pg. 790
What dose the term “acute abdomen” mean?
Sudden onset of pain in the abdomen that is severe and of an unknown cause
#19 MW
McCurnin 10th ed. pg. 790
Define Sinus Rhythm
Each beat is initiated by SA nodal discharge.
#19 MW
McCurnin 10th ed. pg. 796
What are atrial premature complexes (APC’s)?
Impulses originating from the atrial myocardium rather than the SA node.
#19 MW
McCurnin 10th ed. pg. 797
What is a rumen trochar used for?
To relieve bloat in emergency situations in cattle
#19 MW
McCurnin 10th ed. pg. 814
Pulse Pressure vs Pulse Quality?
Pulse Pressure refers to the difference between systolic and diastolic pressures
VS
Pulse Quality refers to a “description” of how quickly pulse pressure changes and how long each pulse lasts
#1, MA
McCurnin 10th ed. pg 777
Findings that support traumatic brain injury?
Changes in mentation, responsiveness, gait, posture, proprioception, and pupil size/symmetry/responsiveness,
McCurnin 10th edition page 777
Student #17, TAS-R
How does treatment of hypovolemia differ from treatment of dehydration?
5 SF
Hypovolemia: rapid IV fluid therapy plus treatment of what caused it
Dehydration: fluid therapy over several hours
McCurnin 9th ed. pg 844-845
Define Ventricular Tachycardia and its treatment
5 SF
Ventricular tachycardia is a run of 4 or more VPCs in a row at a rate greater than 180bpm. It is treated with rapid administration of lidocaine.
McCurnin 9th ed. pg 869
What is reperfusion injury?
5 SF
When blood flow and oxygen delivery are restored after and event of shock or CPA, lactate and free radicals are released into circulation. Damaged tissues attract WBCs, which activate and release more inflammatory mediators, leading to an increase in free radicals. This results in tissue/cellular damage. All shock patients have a risk of developing SIRS after being treated.
McCurnin 9th ed. pg 848
Why must extra care be taken when handling patients experiencing dyspnea?
5 SF
Dyspneic patients are extremely stressed, so even basic procedures such as restraint, IVC placement, and taking x-rays can be enough to trigger cardiac arrest.
McCurnin 9th ed. pg 850
What is lidocaine used for and what is the typical method of administration.
5 SF
Lidocaine is used to treat ventricular arrhythmias. It is typically given as an IV bolus initially, then continued as a CRI.
McCurnin 9th ed. pg 855
The primary survey does not require the veterinary technician to measure what?
RR and HR, auscultation is to only determine whether it is abnormal (fast or slow) or normal
#1, MA
McCurnin 10th ed. pg 775
For cats/dogs, what is the length of chest compressions cycles during CPR?
2 minutes.
McCurnin 10th edition page 785
Student #17, TAS-R
What is the process of triaging?
It is the process of sorting ill or injured animals into groups based on their need for or likely benefit from immediate medical treatment
#1, MA
McCurnin 10th ed. pg 775
What is the term to describe the condition of maintaining a specific posture to ease breathing?
Orthopnea
#1, MA
McCurnin 10th ed. pg 776
Percent survival rate for cats/dogs that experience cardiopulmonary arrest (CPA)?
4-9%.
McCurnin 10th edition page 787
Student #17, TAS-R
Drugs that are safe to administer through the ET tube?
Naloxone, Atropine, vasopressin, epinephrine, and lidocaine (NAVEL).
McCurnin 10th edition page 787
Student #17, TAS-R
What is a common cause of atrial flutter?
Severe left atrial enlargement.
McCurnin 10th edition page 798
Student #17, TAS-R
What intercostal spaces should the needle be inserted into when performing a thoracocentesis?
Between the 7th and 9th intercostal space
McCurnin 9th ed. pg 848
Student #15, HP
When the diaphragm is paralyzed, this leads to what condition?
Paradoxical abdominal breathing
McCurnin 9th ed. pg 842
Student #15, HP
If a patient’s CVP rises more than 8 - 10 cm H2o, this can indicate _______, ________, or _________.
cardiac disease, heart failure, or fluid overload
McCurnin 9th ed. pg 856
Student #15, HP
On an ECG, a tall P wave indicates what?
A tall P wave can indicate atrial enlargement
McCurnin 9th ed. pg 864
Student #15, HP
Mydriatic, or unresponsive fixed and dilated pupils indicate what brain injury?
An irreversible midbrain lesion
McCurnin 9th ed. pg 843
Student #15, HP
When assessing the abdomen during triage, what are you looking for?
Pain, tympany, or fluid waves.
Student #7, HHS
McCurnin 10th edition, pg:777
Common clinical signs of hypovolemia?
Delayed CRT, pale mm, weak pulses, altered mentation
Student #7, HHS
McCurnin 10th edition, pg:780
Causes of obstructive shock?
GDV and pericardial tamponade
Student #7, HHS
McCurnin 10th edition, pg:780
Treatment focus for MODS?
Fluid therapy, antibiotics, vasopressors, mechanical ventilation, and administration of blood products.
Student #7, HHS
McCurnin 10th edition, pg:781
What is the thoracic pump technique?
When hands are placed and compressions are given to the widest portion of the chest in round-chested dogs.
Student #7, HHS
McCurnin 10th edition, pg:785
