Exam 1: Lecture 2: Patient Evaluation Flashcards
Who should perform the pre-anesthetic evaluation on the patient
ultimatley the responsibility of the veternarian in charge of the patient
What do you always start with during the pre-anesthetic evaluation?
Signalment
What are the part to giving a doctor or another team member signalment
Species, breed, age, sex, and reproductive status
What should be done or checked during a pre-anesthetic evaluation?
- Signalment
- History (including anesthesia events or if the patient is currently ill)
- Physical exam (Body weight and body condition score)
- Blood and urine sample
- Temperment / mentation and level of pain
- Advances diagnositics if done
What patients should receive a routine ECG screening?
- Patients with evidence of CV disease
- Geriatic patients
- underlying diseases that may lead to arrythmais
What are some underlying diseases that may lead to arrhythmias
hyperkalemia
GDV
splenomegaly
traumatic myocarditis
What should you look for/ give during a physical exam findings
- Temperature
- Pulse
- Respiration
- MM / CRT
- Body weight
What percent dehydration describes the following?
- Not detectable
Less than 5
What percent dehydration describes the following?
- Not detectable
Less than 5
What percent dehydration describes the following?
- Subtle loss of skin elasticity
5-6
What percent dehydration describes the following?
- Definite delay in return to skin to normal position
6-8
What percent dehydration describes the following?
- Slight prolongation of CRT
- Possible dry MM
6-8
What percent dehydration describes the following?
- Eyes possible sunken in orbits
6-8
What percent dehydration describes the following?
- tented skin stays in place
- eyes sunken in orbit
10-12
What percent dehydration describes the following?
- Definite prolongation of CRT
- Possible signs of shock
- Dry MM
10-12
What percent dehydration describes the following?
- Definite signs of shock
(Tachycardia, cool extremities, rapid and weak pulse)
12-15
What percent dehydration describes the following?
- Death Imminent
12-15
What systems are important when preforming a physical exam?
- integument (skin)
- Lymph nodes
- GI tract / abdominal palpation / gut sounds
- Genitourinary tract
- Central nervous system
What lab work should be preformed on an animal that is less than 5 years old (young) having an elective procedure with no abnormal history?
PCV
Glucose
BUN
What lab work should be preformed on an animal that is older having an elective or non-electice procedure
- any history of recent illness
- Screening for suspected infectious disease in endemic regions
- All patients included in a research study
CBC
Chemistry Profile
UA
+/- the following:
- ECG
- blood pressure
- thoracic rads
- echocardiogram
- blood gas analysis
- coag profile
- liver function testing
- 4Dx
Where is the pre-anesthetic evaluation performed?
Typically in the clinic, but also done during farm calls
Find a quite place so you can better auscultate the heart and lungs
What happens if you cannot approach the animal because it is fractious or is a zoo or wild animal patient?
Be cautious and use drugs if needed
When should you perform the pre-anesthetic evaluation on a normal procedure?
- usually the day before or up to 1 week before the planned procedure
- make sure to do another short exam on the day of anesthesia
When should you perform the pre-anesthetic evaluation on an emergency case?
Done immediately before the procedure
What questions should be asked of the owner when doing the pre-anesthetic exam for an emergency?
drugs given, diet, home life, etc.
Why should pre-anesthetic evaluation be done on all patients?
- safety
- organ function and risk
- To see if the client is willing to take the risk
(this conversation should take place and be documented prior to sedating or anesthetizing any patient)
What category does the following fall under?
- Normal healthy patient
I
What category does the following fall under?
- OVH
- casteration
- ear/tail docking
- declaw
I
What category does the following fall under?
- patients with mild systemic disease
II
What category does the following fall under?
- skin tumor
- fracture
- local infection
- compensated cardiac disease
II
What category does the following fall under?
- well controlled diabeties
- uncomplicated hernia
- pregnancy
- obesity
II
What category does the following fall under?
- patient with severe systemic disease
III
What category does the following fall under?
- fever
- dehydration
- anemia
- cachexia
III
What category does the following fall under?
- uncontrolled DM
- COPD
- renal failure
III
What category does the following fall under?
- Patient with severe systemic disease that is a constant threat to life
IV
What category does the following fall under?
- Uremia
- toxemia
- sepsis
- shock
- severe dehydration
IV
What category does the following fall under?
- cardiac decompensation or failure
- emaciation
- high fever
IV
What category does the following fall under?
- moribund patients not expected to survive without operation
V
What category does the following fall under?
- extreme shock and dehydration
- terminal malignancy or infection
- severe trauma
V
When should the ASA PS be assigned?
- after the PE is complete and the lab work or diagnostic tests have been interrupted
Case Example:
A 3-year-old intact beagle presents to your clinic in an emergency for a laceration over the right flank region after getting tangled in barbed wire. The laceration is about 4 inches long and will require cleaning the wound, placing a Penrose drain, and surgical closure of the remainder of the wound. The remainder of the PE is WNL. The owner says the dog is UTD on vaccines, flea/tick prevention, and HW medication. What ASA level is this?
ASA level 2
- no severe signs, but tear in integument
Case Study:
Molly a 12 year old QH mare referred to the University teaching hospital for colic of 12 hour duration. Trainer gave a dose of banamine
- she is 9 months pregnant
- pawing and rolling intermittently
PE
- tachycardia
- tachypnea and increased effort
- distended abdomen - no gut sounds
- MM are dark pink
what is the ASA level?
ASA level 4 or 5
Why is ASA’s physical status important?
- Used to assess anesthetic risk of a case
- physical status effects the PK and PD and aids in the selection of drugs and or techniques for a patient
- Important criteria used in selection of patients in research studies
- Can also be used from a legal standpoint (retrospectively)
Give examples of considerations that are important for dosing drugs?
- Age
- disease
- obesity
- SA vs LA
- size
- pregnancy
Give some examples of patient preparation which are important
- Fasting recommendations
- Hygiene and patient comfort
- correct dehydration and electrolyte imbalance
- Preoperative antibiotics
What species of animals do not require fasting before surgery
rodents and rabbits
birds less than 200 grams
neonates
What species of animals do not require water deprivation before surgery
Canine
feline
equine
Do you know why a patient is fasted prior to general anesthesia?
- decreased food and fluid in the stomach
- decrease risk of aspiration
- distended stomach or rumen impairs ventilation and could lead to hypoxemia and hypercapnia
What consequence could happen in horses if their stomach is full
Rupture at induction
Why is it not necessary for neonates, small birds, and some mammals to fast before surgery
- prone to hypoglycemia within a few hours of starvation
- increased metabolic rate in birds and small mammals
What about depriving water from patients with increased fluid requirements
- renal insufficiency
- febrile
- diabetes
- hot environment
What are the 4 H’s of General anesthetic concern
hypotension
hypoventilation
hypothermia
hypoxemia
What are other concerns are species, age, disease or procedure specific for general anesthetic concerns
hemorrhage
pain
delayed recovery
regurgitation
laryngeal spasms
difficult intubation
dysphoria
arrythmisa
myopathy
What do you always want to do and never forget regarding surgery
ALWAYS get a signed consent form by the owner
- can get a verbal consent over the phone, but best to have a 2nd person to confirm the owners decision
