Exam 2 Flashcards
(241 cards)
1
Q
A
3000 mL/min
*VE = Minute Ventilation
1
Q
Airway Pressure at End Expiration is maintaned above Ambient Pressure. _____ is Applied when Positive Pressure is maintained between Inspirations that are Delivered by a Ventilator
A
Positive End-Expiratory Pressure (PEEP)
*Maintains some pressure in the airways, where the Pressure Guage does not return to Zero between Inspirations but Instead is maintained at the Chosen PEEP Value_- Holds the Alveoli Open_ to Prevent Atalectasis
1
Q
Local Anesthetics in the ____ Form Remain at Receptor Sites Longer, while Local Anesthetics in the ____ Form Rapidly Penetrate Membranes
A
Cationic (Charged)- Remains at Receptor Site Longer
Non Charged- Able to Rapidly Penetrate Membrane
*First you want the Drug in the Non-Charged Form so that it can Penetrate the Nerve Membrane, then Switch to the Cationic Form so that it can Remain at the Receptor Site Longer
*The Non- charged Form Penetrates the Membrane of the Nerve. In order for it to become Active it must convert itself to the Cationic Form. The Cationic Form cannot Penetrate the Membrane and therefore stays at the receptor site longer
1
Q
Onset is Dependent on the pKa of a Drug. As the pKa moves further Away from Tissue pH (7.4), it has a ____ Onset of Action
A
Slower
Ex. Procaine with a pKa of 8.9 has a very Slow Onset. Lidocaine with a pKa of 7.7 has a Very Fast Onset (Closer to tissue pH = 7.4)
*All Local Anesthetic pKa’s will be Above Tissue pH of 7.4. As pKa Increases Further from 7.4, you have a slower and slower Onset
*Photo: Most Important- Know the Top Four- On Exam
1
Q
True/False: Lidocaine and Bupivacaine are the Two most Commonly Used Local Anesthetics. Lidocaine has a Faster Onset than Bupivacaine
A
True
*The pKa of Lidocaine is Closer to Tissue pH (7.4), than Bupivicaine
1
Q
Highly Perfused Areas will have ____ Systemic Absorption, while Poorly Perfused Areas will have _____ Systemic Absorption
A
Faster Systemic Absorption- Highly Perfused
Slower Systemic Absorption- Poorly Perfused
*Duration of Action is also affected by Tissue Blood Flow
_*_Ex. Mucous Membranes and Intercostal Muscles have More Blood Flow to the Area, More Systemic Absorption, Less Likely to have an Effect Locally, and More Likely to have Side Effects
*Highly Perfused Areas have Faster Systemic Absorption, and Therefore Shorter Duration of Action
*Poorly Perfused Areas have a Much Longer Duration of Action
1
Q
______ Nerve Block Indications Include:
Extraction of Canine
Extraction of Incisor
Extration of Premolar
Removal of Small Nasal Mass
A
Infraorbital
*Contraindication: Extraction of Molar
1
Q
Peripheral Nerve Block that Provides Anesthesia to the Elbow and Distally that is Indicated in:
Radius/Ulna Fractures
Toe Amputations
Carpal Arthrodesis
A
Brachial Plexus Block
*If A Patient Fractured its Humerus, doing a Brachial Plexus Block does NOT Help. Only Desensitizes the Elbow and Distally- KNOW THIS
1
Q
True/False: When Performing Cranial Epidurals on Sheep and Goats, you tend to hit CSF Fluid commonly and therefore should Decrease your Epidural Dose by HALF
A
True
*In any Species, if you see CSF Fluid within your Epidermal Needle, Decrease the Dose by 1/2 to prevent the drug from traveling to the Brain
*If you get CSF Fluid and you are dosing for an Epidural Space, make sure to lower your Dose
1
Q
When Performing a Cranial Epidural, what do you do if you Puncture the Dural Sac?
A
Reduce the Dose by Half
1
Q
Disadvantages of Which Cardiovascular Drug:
SEVERE Vasoconstriction- Decrease Tissue Perfusion
Increase Oxygen Consumption
Tachyarrhythmias
Tissue Hypoxia
A
Epinephrine
1
Q
Cardiovascular Drug that is an Alpha 1,2 and Beta 1,2 Agonist that is used to Treat Routine Hypotension
A
Ephedrine
*Ephedrine, Dobutamine, Dopamine and Phenylephrine- Common Drugs that are used to Treat Routine Hypotensive Cases
1
Q
Two Indications for the Use of Colloids
A
Shock
Hypoproteinemia
1
Q
True/False: Be Cautious when Administering Fluids to Patients with Cardiac Disease or Renal Disease, because they cannot deal with a large volume of fluid quickly
A
True
1
Q
Cystalloid Fluid Replacement that is a Balanced Electrolyte Solution that Contains Calcium and is a Common Choice for Anesthetized Patients
A
Lactated Ringers Solution (LRS)
*Lactate as Alkalinizing Agent
*Contains Calcium- Caution if Transfusing Blood because the Calcium will Interfer with the Anticoagulants leading to Blood Clots
1
Q
Synthetic Colloid that is Pectin based and Metabolized by Amylase that Increases the Plasma Volume by at Least the Volume of Fluid Administered
A
Hetastarch (Vetstarch)
*Stays in the Intravascular Space a long time- we dont want to Overhydrate the Patients so we only give 2-5mL/kg/h
*When you give Hetastarch, the Patients Amylase will go through the Roof- Know this
1
Q
A
B. 1 Drop/2 Seconds
1
Q
At ____% Blood Loss, the Patients PCV will Be 20%. For Oxygen Carrying Capacity, we Need a Minimum Hemoglobin of _____mg/dL for Appropriate Delivery of Oxygen (DO2) to Tissues (PCV 21%)
A
20%
Hb 7 mg/dL
* 7mg/dL of Hemoglobin is the MINIMUM where you can still carrying oxygen to tissues. 7mg/dL is Equivalent to a PCV of 21% (7x3). If we have a Patient with acute blood Loss and PCV
1
Q
Balanced Electrolyte Solution that is made of Water, Electrolytes and an Alkalinizing Agent that Causes No Fluid Shifts between ICF and ECF
A
Crystalloid
*Redistribution Occurs!!!- How Much Stays in the Intravascular Space after 15 Minutes? 20-30%. For Every 1mL of Blood Loss you are going to give 3-4 mL of Cystalloid
1
Q
External Chest Compression Theory used for Cats and Dogs
where Arterial Flow is Caused by Direct Compression of the Ventricles
A
Cardiac Pump Theory
*In smaller patients if you compress their chest in the right place you will actually be able to compress their ventricles and move blood foward
1
Q
For External Chest Compressions in Medium to Large Dogs you Place 1 Hand on Top of Other Parallel at the ____ Part of the Chest and Apply Even Pressure using Palm of Hand
A
Widest
1
Q
When Monitoring the Effectiveness of CPCR, What is the Most Important Indicator of Survivability?
A
ETCO2
*Capnograph will be the most Effective Tool you can Have
*If you have Greater than 20mmHg at 20 Minutes of CPR, you have a Higher Likelyhood Return of Spontaneous Circulation (Patient is Coming Back to Life)
*If you have Less than 10mmHg at 20 Minutes of CPR Spontaneous Circulation is Unlikely to Occur (Patient Dies)
1
Q
Drugs that Provide Mild to Moderate Pain Relief that are Anti-Inflammatory, Analgesic, and Antipyretic
A
NSAIDS
1
Q
Review of Arachidonic Acid Cascade
A
NSAIDS Stop the Production of Prostaglandins from Arachidonic Acid (AA)- Most Important
*NSAIDS Block COX (Cyclooxygenases) therefore the Arachidonic Acid cannot turn into Prostaglandin
1
COX ___ Works on the **Mucosa to Prevent Erosions and Promote Healing and is Also an Anti-Inflammatory**
**2**
_**\***COX 2 Also has some Renal Protection Fuctions_
1
COX ___ is involved in **Fever Initiation**
**3**
1
**Cyclooxygenase** ____ is Responsible for:
_Vicero-Nociception_
_Thermal Stimulation_
_Involved in Constitutive Functions with COX 2_
**Cyclooxygenase 1 (COX 1)**
1
Most Commonly used **COX 2 Preferential NSAID** That is Used Widely in _Dogs_ that is Formulated as a Tablet or Parenteral with a Duration of 12-24 Hours with Side Effects Including Nephrotoxicity, Hepatoxicity, and GI Ulceration
**Carprofen**
**\***Great for Pre and Post Op Surgery because you can Administer the Parenteral Formulation prior to Surgery and send the Patient home with the Oral Chews
1
**COX 2 Selective NSAID** that is a Once a Day formulation (Duration 24 Hours) used in _Dogs and Horses_ with Side Effects Including Abdominal Pain, Diarrhea, Urticaria, and PU/PD
**Firocoxib**
1
Ventilatory Status was Assessed and there is **Increased PaCO2**. Is this Patient Hypoventilating or Hyperventilating?
**Hypoventilation**
**\***_PaCO2 \> 45mmHg_ is Increased = Hypoventilation
_\*PaCO2 is Decreased = Hyperventilation_
1
**Descending Inhibitory Pathway** that is an Important Relay for Descending Facilitative and Inhibitory Modulation of Nociceptive Input
**Periaqueductal Gray Matter (PAG)**
1
Central Sensitization is Fundamentally Different from Peripheral Sensitization because it Allows Low Intensity Stimuli and Low Threshold **A Delta** Fibers to Cause Pain as a Result of ____ in the Spinal Cord
**Neuroplasticity**
**\***Know for Exam! In Central Sensitization the Low Intensity Stimuli are Now suddenly causing pain due to Neuroplasticity- Very hard to Recover
1
Four Anticipated Complications of **Ruminant Anesthesia**
**Hypersalivation**- Adults Produce a lot of Saliva
**Bloat-** Leads to Decreased Venous Return and Hypoventilation
**Hypoventilation-** Be Prepared to Give IPPV
**Regurgitation/Aspiration Pnuemonia-** Secure the Airway Quickly to Prevent Aspiration Pneumonia- Intubate Swiftly and Inflate Cuff after Induction. _Keep Head Elevated with Nose Pointed Down during Sedation and Recovery_
1
Three _Cardiovascular_ Pathologies that are Common and Generally Normal During **Equine** Anesthesia
**2 Degree AV Block**- Horses have Inherently High Vagal Tone
**Wandering Pacemaker-** Equine have Large SA Node
**Biphasic P Wave**
1
Drugs used for _Premedication_ in **Horses**
**Alpha 2 Agonists (Xylazine, Detomidine)-** Most commonly used for Sedation, Muscle Relaxation and Analgesic Properties (_Most Common Premedication for Horses_). _Detomidine has a Longer Onset but has a Longer Duration Duration as well_
**Acepromazine-** Typically only Given in Excited Horses to Help with Sedation
_\***Opioids** are Not commonly Administered as Premedication in Horses because we are getting Sedation from the Alpha 2 Agonists. Opioids can cause Excitment and COLIC in Horses_
1
Drugs used for IV _Induction_ in **Horses**
**Ketamine + Benzodiazepine**
1
Drugs used for _Maintenance_ in **Equine** Anesthesia
In Hospital- **Isoflurane/Sevoflurane**
In Field**- TIVA (Triple Drip)- Guaifenesin, Ketamine, Xylazine**
**\***_What Happens if Guaifenesin is Given With a Concentration Higher than 15%? Hemolysis_ will Occur (Moreso in Cattle- Greater than 6% Guafinesen will cause Hemolysis in Cattle)
1
Normal **Heart Rate** in BPM for **Horses** under General Anesthesia
**30-45 BPM**
1
Complication of **Equine** Anesthesia that can be caused by:
_Decreased FiO2_
_Hypoventilation_
_V/Q Mismatch_
_Right to Left Shunt_
_Diffusion Impairment_
**Hypoxemia**
**\***5 Causes of Hypoxemia Listed Above
_\*V/Q Mismatch is Very Common in Equine Species_
1
Endotracheal Intubation is Difficult in **Pigs** because the Laryngotracheal Junction is at an _____ and the ETT can become Caught on the Floor of the Larynx
**Angle**
**\***Rotate the Tube 180 Degrees when it meets Resistance
1
Two **Neuromuscular Blocking Agents** can cause ____ Release leading to Vasodilation and Hypotension
**Histamine**
_**\***Ex. Atracurium, Mivacurium_
1
When Administering **Neuromuscular Blocking Agents** you must be certain to Provide ____ because Paralysis of Muscles of Respiration is Possible
**Ventilation**
1
**Nondepolarizing** Neuromuscular Blocking Agent that is Described Below:
**Pancuronium**
**\***Often leads to Tachycardia
2
Most Susceptible Nerves to **Local Anesthetics**
**C Fibers, B Fibers, and A Delta Fibers**
**\***_A Delta and C Fibers are where Pain Transmission Occurs_- They are Two of the Most susceptible Nerves to Local Anesthetics
\*Least Susceptible- Motor FIbers. By Lowering the Concentration of Local Anesthetic we can Block Sensory but still Provide Adequate Motor Function
2
Oral **NSAIDS** Must be Given with ____ to Avoid Contact of NSAID Directly with Gastric Mucosa
**Food**
_**\***With Food is a Must!! NSAID that Touches the Gastric Mucosa will cause Gastric Ulcers_
3
Cardiovascular Drug that can be Used in the Treatment of **Cardiopulmonary Arrest or Vasodilatory Shock**
**Vasopressin**
**\***_Decreases Tissue Perfusion- Significant Vasoconstriction_
4
Which of these is _Incorrect_ about Administering **NSAIDS:**
A. Select Patient Wisely
B. Use Highest Effective Dose
C. Monitor Patients Regularly with Long-Term Use
D. Avoid Concurrent NSAID or Corticosteroid Use
**B. Use Highest Effective Dose**
**\***NSAIDS- Use LOWEST Effective Dose
4
Did we Get an Artery? **Yes** (SO2 \> 88%)
pH \> 7.45 therefore **Alkalosis**
**pCO2 is Low (Primary)**
**HCO3 is Low (Compensatory)**
**_\*Respiratory Alkalosis_**
**PO2 is Low** (Should be around 400-500 on 100% Oxygen)
**BE- Normal** (0 +/- 4)
4
Common _Induction Drugs_ used in **Ruminant Anesthesia**
**Telazol**
**Ketamine**- Great for Cattle Inductions. Combine with Muscle Relaxant- _Combine with Benzodiazepine or with Guafenisin ("Double Drip")_
**Propofol-** Used for Smaller Ruminants and Sheep
\*_Ketofol- Ketamine + Propofol IV Works well in Small Ruminants_
4
During **Ruminant Anesthesia** Recovery, Leave ET Tube in Place until Strong Laryngeal Reflex Returns and Patient is able to remain \_\_\_\_. Immediately Check for Airway Patency after Extubation
**Sternal**
**\*In Ruminants- Pull the Endotracheal Tube INFLATED- DO NOT DEFLATE CUFF**
**\***Check for Airway Patency- Obligate Nasal Breathers. Put Hands over Nostrils to feel Airflow
5
**External Chest Compression Theory** for Medium-Large Size Dogs where you _Position your hands at the Widest Part of the Thorax_ where you use a Pressure Gradient to move Drugs forward
**Thoracic Pump Theory**
5
Part of the **Pain Pathway** where Sensory and Motor Action Potentials to and From the Spinal Cord are Carried by Peripheral Nerves, which are Categorized according to Size, Myelination, and Conduction Velocity
**Transmission**
**\***Afferent- Travelling Away from the Receptor towards the CNS
\*Efferent- Signal Travelling back from the CNS to Create an Action (Ex. Move your Hand off Hot Plate)
6
We Cannot Give ____ Containing Fluid (Ex. Lactated Ringers) In the Same line as a Transfusion Product because it interferes with Anticoagulant and will make the Product Clot
**Calcium**
**\***We Also don't want to Transfuse _Hypotonic Fluid_ with our Transfusion Product because it will cause _Hemolysis_
6
Sally is a 1 y.o Intact Female Labrador Retriever that you are Perfoming an Ovariohysterectomy on at 8am and she will Stay in your Clinic Overnight. You will Check on her around 10pm for a walk and to Administer Pain Medications. **What is your Preemptive Analgesia Plan?**
\*Always want to Make sure that if we are having a Painful Procedure you will Want an Opioid as part of the Neuroleptanalgesia Combination
\*Used a Pure Mu (Morphine, Hydromorphone) because they are Much stronger Opioids
\*Can an NSAID be administered before Surgery? Most Commonly only Given Post-operatively because you don't want to compromise Kidney Blood Flow during Surgery
7
Which of the Following is Important when _Selecting Patients_ for **NSAIDS** Administration?
A. \> 6 Weeks Old
B. Well-Hydrated
C. Normal Hemostatic Function
D. No Concern or Evidence of GI Ulceration
E. Making Sure No Other NSAID has been given within 7 Days
F. All of the Above are important in Patient Selction for NSAIDS
**F. All the Above are important in Patient Selection for NSAIDS**
\*Well-Hydrated- If we block Prostaglandin Production the kidneys cannot Autoregulate Blood Flow
8
**Cystalloid** Therapy that can be used in Patients with Emergency Acute Blood Loss that _Draws fluid into the Intravascular Space_ and Improves Cardiovascular Function, however the Effects are SHORT-TERM
**Hypertonic Saline (7.5% NaCl)**
_**\***With Every 1mL of Hypertonic Saline, Plasma Volume will Increase by 2-4mL_
9
**Bupivacaine**
**\***Question on Exam
9
\_\_\_\_\_\_ are Inidicated in Procedures such as:
_Hind Limb Procedures_
_Femur Fractures_
_Pelvic Procedures_
_Stifle Procedures_
_Thoracotamy_
**Cranial Epidurals**
_**\***As you Inject More Volume of Epidural, the Drug can Move Further Cranially and Block areas of the Abdomen_
\*Don't want the drug to Travel to far Cranially because it can Impair Diaphramatic Movements or cause Seizures in the Brain
9
**Resuscitation** Crystalloid Fluid that is used in Special Circumstances when your patient needs Increased Circulating Volume Quickly (Ex. Hemorrhage)
**Hypertonic Saline**
_\*Draws Fluid INTO Intravascular Space- Very Good for Emergency Situation where you need to Increase Circulating Volume_
9
**Nonselective COX Inhibitor** Drug that Blocks COX 1 and COX 2 that is Formulated as a Tablet and can Lead to Side Effects such as GI Ulceration and Decreased Platelet Activity
**Aspirin**
9
Sally is a 1 y.o Intact Female Labrador Retriever that you are Perfoming an Ovariohysterectomy on at 8am and she will Stay in your Clinic Overnight. You will Check on her around 10pm for a walk and to Administer Pain Medications. **What Type of Pain is Sally Experiencing Post-Op?**
10
**B. Epinephrine**
12
Which **Cardiovascular Drug** has these Characteristics:
_Non Specific Beta Agnoist_
_Increases Heart Contractility_
_Increases Heart Rate_
**Dobutamine**
13
Peripheral Nerve Block that is Indicated in:
_Declaws_
_Toe Amputations_
**Forefoot Block**
_**\***Injected into the Medial and Lateral Aspect of the Palmar and Dorsal Aspect of Each Limb, Just proximal to the Carpus_
13
Technique for Eye Enucleation in Large Animals that Desensitizes the _Oculomotor, Trochlear, Abducens and Trigeminal Nerves_
**Petersons Technique**
**\***_Peterson Technique Blocks the Eye but does not Block the Eyelids_
13
Three Volume Replacement Options for Patients with **Blood Loss**
**Crystalloid (**
**Colloid (10-20% Blood Loss)**
**Blood Products (\> 20% Blood Loss)**
**\***After 20% Blood Loss there is not enough Red Cells To Carry Oxygen to Tissues so we must use a Blood Product, usually either _Packed Red Cells or Whole Blood- Carry Oxygen_
13
Where are the ECG Leads Placed during **Ruminant Anesthesia**?
**Base-Apex**
15
Review of **Four Primary Disturbances** and Expected Compensatory Responses
_Primaries are in Red!_
_Think of Bicarb (HCO3) as a Base causing Alkalosis_
_Think of CO2 as an Acid causing Acidosis_
**Metabolic Acidosis- Decreased pH, Decreased Bicarbonate, Compensatory Decrease in CO2**
**Metabolic Alkalosis- Increased pH, Increased Bicarbonate, Compensatory Increased CO2**
**Respiratory Acidosis- Decreased pH, Increased CO2, Compensatory Increased Bicarbonate (_common in Anesthetized Patients_)**
**Respiratory Alkalosis- Increased pH, Decreased CO2, Compensatory Decreased Bicarbonate**
16
**Nonselective COX Inhibitor** Drug that is used in _Horses and Cattle_ and Can be Formulated as a Powder, Paste or Parenteral that has a Duration of 12 Hours but there is a _HIGH Risk of GI Ulceration_
**Phenylbutazone**
**\***High Risk of GI Ulceration and Nephrotoxicity
17
Peripheral Nerve Block in **Large Animals** that Provides Anesthesia of the Upper Lip and Nose for Suturing of Nasal Laceration or Placement of Nose Ring in Cattle
**Infraorbital Nerve Block**
**\***Desensitizes the Area that you Inject and **Rostrally**
18
True/False: In an Animal with Infectious Disease you should Avoid Administering Local Anesthetics
**True**
**\***Infections create more _Acidic Environments_, causing the pH of Drugs to Drop Dramatically. The Local Anesthetics pH will be Further from Tissue pH leading to a longer onset of action
\*Less Drug will be able to Penetrate into the Nerve due to Slower Onset, leading to **Higher Systemic Absorption**- _Be cautious when Injecting a Local Anesthetic into an Area that is Infected because you may see more Systemic Absorption and Toxic Side Effects_
18
**A. pKa 7.5**
18
Indications for ____ Transfusion:
## Footnote
**Coagulopathies**
**Fresh Frozen Plasma**
**\***If you have a _Patient that Needs Clotting Factors_- Ex. Rodenticide Toxicity, Hepatic Failure, or DIC
19
Patient is Experiencing Supraventricular Tachycardia. What Drugs can be Used to **Slow Down the Heart**?
**Beta-Blockers (Ex. Esmolol or Diltiazem)**
**\***Esmolol is Commonly used to Slow Down the Heart!
20
**Motor Fibers- Least Susceptable to Local Anesthetics- Last to be Blocked**
**\*By Using a Lower Concentration of Local Anesthetics you are less likely to Impair Motor Function**
21
Examples of Replacement _____ Include:
_Normal Saline_
_LRS_
_Normasol- R_
Pl-A
Pl-128
**Crystalloids**
22
During **Equine** Anesthesia Recovery the patient should be Discouraged from Standing when ____ is still Present
**Nystagmus**
**\***Nystagmus occurs in Stage II Anesthesia
23
Blood Volume = _____ + Erythrocytes
**Plasma**
**\*_Need to Know these Numbers on Exam_**
_Ex. 20 kg Dog. What is its Total Blood Volume? (20 x 90 = 1800)_
24
Cardiovascular Drug that is a _Beta Agonist_ for the **Treatment of Hypotension in Equine Patients**
**Dobutamine**
24
**Fasting** is Controversial in _____ and Generally you Withhold Food _3-6 Hours_ so the Patient is not Overly Stressed
**Equines**
**\***Do NOT Fast Foals
_\*When Preping Horses for Anesthesia we Flush Food Debris out of the Mouth because when we Intubate we don't want to Push anything down into the Lungs_
25
**Arterial** Samples are used to Evaluate _____ Gas Exchange and the Patients Oxygenation Status
**Respiratory**
_**\***Arterial Blood Gas- Determine Oxygenation Status_
\*Venous Sample- Deoxygenated Blood so it Cannot tell you anything about the Patients Oxygenation Status
26
During **Ruminant Anesthesia**, Keep the Head and Neck Elevated and Patient in ____ Recumbancy after a Premedication is Given
**Sternal**
27
\_\_\_\_\_ Can be Given in Large Volumes to Expand Extracellular Fluid Volume Without Changes in Electrolyte Composition, Thus _Does NOT Induce Fluid Shifts between ICF and ECF_
**Cystalloids**
28
Two Peripheral Nerve Blocks that can be Used for _TPLO's and Crutiate Repairs_
**Femoral Nerve Block**
**Sciatic Nerve Block**
29
Part of the **Pain Pathway** with Integration, Processing and Recognition of Sensory Input that Occurs in Multiple Areas of the Brain, which Communicate by Interneurons to produce a coordinated Response in the Body
**Perception**
30
The Peri-anesthetic Fluid Rate is \_\_\_\_\_mL/kg/h for Most Cases. For _Cats_, the Peri-anesthetic Fluid Rate is ____ mL/kg/h
**10 mL/kg/h**
**5 mL/kg/h**
\*Cats have a Smaller Blood Volume so they don't require as much fluid and they are more Prone Over Hydration
31
**Cyclocoxygenase** ____ is:
_INDUCIBLE_
_Upregulated during Inflammation_ (20x's Normal Concentration)
_Key Role in Nociception_
_Involved in Constitutive Functions with COX 1_
**Cyclooxygenase 2 (COX 2)**
_\*COX 2 is and INDUCIBLE Situation. During inflammation there is 20x's more COX 2 in the Tissue than you would in a normal State_
32
The Following are Commonly used\_\_\_\_\_ Fluids:
_Hetastarch_ (Hydroxy-ethyl Startches)
_Albumin_
_Dextrans_
**Colloid**
33
Is this **Arterial? Yes** (SO2 \> 88%)
pH is **Acidemic**
**pCO2 is High (Primary)**
**PO2- Normal**
_**\*Respiratory Acidosis- Severely Hypoventilating**_
**HCO3 (Bicarb)- High (Compensatory)**
**BE- Normal**
34
_Premedications_ used for **Pig Anesthesia**
**Alpha 2 Agonists (Xylazine)**- Effective when Combined with Ketamine +/- Opioid
35
True/False: **Neuromuscular Blocking Agents** Provide _No Sedation, Anesthesia or Analgesia,_ therefore Adequate Anesthesia and Analgesia must be provided when Administering Neuromuscular Blockers
**True**
_**\***Inhumane when used as Sole Agent_
36
Which Vein is Used when Placing an IV Catheter for **Ruminant Anesthesia?**
**Jugular Vein**
**\***Accessed Most Easily during Surgery- Use a Large Gauge Catheter!
37
**Impedence Device**
**\***Creates Negative Pressure in the Thorax
38
\_\_\_\_ of Extra Cellular Fluid is INTRAVASCULAR
**1/4**
_**\***Interstitial Fluid makes up 3/4 of ECF_
_\*Intravascular Fluid makes up 1/4 of ECF_
Most of the ECF is in the Intersitial Compartment or Intravascular Space. _The Only Place we can Affect Quickly is the Intravascular Space_
39
Treatment of Anesthetic Induced **Hypotension**
**5-10 mL/kg over 15 Minutes**
_\*Give Hourly Crystalloid as Rapid Bolus. When we Give a Fluid Bolus Under Anesthesia, we give our Hourly Rate in 15 Minutes_
\*You DO NOT give the Shock Rate fluid Bolus in this Situation
40
**Topical Anesthetic** Sprayed on Arytenoids to Prevent Laryngeal Spasm during Intubation
**Lidocaine Spray**
41
Peri-Anesthetic Fluid Type used in these Situations:
_Correct Hypovolemia_
_Hypoproteinemic Patients_
_Support Colloid Osmotic Pressure_
**Colloids**
\*Corrects Hypovolemia- Colloids stay in the Intravascular Space
Hypoproteinemic Patients- Colloids Prevent Edema and Fluid Shifts
_If you have a Patient with Total Protein_
41
**Cyclooxygenase**\_\_\_\_ is Involved in:
_Pyrexia (Fever)_
_Analgesia_
_Poorer Anti-Inflammatory_
**Cyclooxygenase 3 (COX 3)**
42
Part of the **Pain Pathway** where Noxious Stimuli are Converted into an Electrical Action Potential by the Terminal ends of Sensory Nerve Fibers
**Transduction**
**\***Noxious Stimuli can be Mechanical, Chemical, Thermal or Electrical
43
**External Chest Compressions** must be _____ and _____ where Pauses Must be Less than 10 Seconds
**Continuous**
**Uninterrupted**
**\***We don't stop for anything- We don't stop for Intubation or Catheter Placement
_\*Even with Chest Compressions your Cardiac Output will only be 25-40% of the Prearrest Cardiac Output_
44
Modified Alphabet Guide for _Basic Life Support_ in **Cardiopulmonary Arrest**
**C = Chest Compressions (_Continuous Uninterrupted Chest Compressions)- Most Important thing for the Patient_**
**A = Airway**
**B = Breathing**
**C = Circulation**
**D = Drugs**
**E = ECG**
**F = Fluid Therapy**
45
Indications for ______ during **Cardiopulmonary Arrest** Include:
_Penetrating Chest Wounds_
_Thoracic Trauma with Rib Fractures_
_Diaphragmatic Hernia_
**_Pericardial Effusion_**
**Internal Cardiac Massage**
**\***Only Reason to Open the Chest is if the Patient has a Condition where you are unable to Move Blood through External Chest Compressions
\*Pericardial Effusion- If the Pericardial Sac is full of Fluid then you can't squeeze the heart to pump blood forward with External Compressions
46
**Nondepolarizing** Neuromuscular Blocking Agent that is Described Below:
**Vecuronium**
48
**COX Preferential NSAID** Drug that is used in Dogs, Cats, Horses and Cattle with a Duration of Action between 12-48 Hours with Side Effects Including Vomiting, Diarrhea, Hepatic and Renal Issues
**Meloxicam**
49
In Patients that are **Hypoalbuminemic**, Which Product would we Give to Increase Colloid Oncotic Pressure (COP)?
**Hetastarch**
50
**Normal Heart and Pulse Rate** in _Adult Cattle_ and _Calves, sheep, and Goats_
51
Commonly used Opioid given for Analgesia in **Ruminant Anesthesia**
**Butorphanol**
52
True/False: **Local Anesthetics** that are more Likely to have Protein Binding tend to Increase the Duration of Action of the Drug
**True**
**\***Bupivacaine has 95% Protein Binding- More Likely to have Longer Duration of Action
55
**NSAIDS** Are most Commonly Given as \_\_\_\_- Operative Administration for Pain Relief
**Post**
**\*NSAIDS-** Takes \> 45 Minutes for Therapeutic Effects Despite Route of Administration
56
**COX 3 Preferential NSAID** that is NOT approved for Veterinary Patients, but is used in _Dogs_, with Side Effects Including HEPATIC Damage
**Acetaminophen**
\*NOT FOR USE IN CATS- Heinz Body Anemia
57
Two Nerve Blocks used in **Large Animals** for Enucleation of Eyeballs and Removal of Tumors from Eye and Eyelids
**Peterson**
**Retrobulbar**
58
Peripheral Nerve Block that _Desensitizes Ipsilateral Incisors, Canine Tooth, Premolars and Molars_ as well as the Skin and Mucosa of the Chin and Lower Lip
**Mandibular Nerve Block**
60
Review of **Lung Volume and Capacity**
\*Understand these Different Lung Volumes and Capacities- KNOW
**Tidal Volume**- Normal Breath In and Out
\*Tidal Volume + Inspiratory Reserve Volume = **Inspiratory Capacity**
**\***Tidal Volume + Expiration Reserve Volume = **Expiration Capacity**
**\***Tidal Volume + Inspiratory Reserve + Expiratory Reserve = **Vital Capacity**
61
\_\_\_\_\_ Occurs with **Rapid, Continous Firing of Primary Nociceptive Afferents,** Especially C Fibers, which Stimulates the Release of Increased Amounts of Glutamate, Substance P, and BDNF leading Upregulation
**Windup**
_**\***General Anesthesia does NOT prevent Windup since it does not prevent the Generation of Action Potientials in the Primary Afferents_
63
When Performing **Cranial Epidurals** in _Felines_, the ____ ends Close to **L7-S1** and we are More likely to Penetrate the \_\_\_\_
**Dural Sac**
**\***The Cats Dural Sac may end closer to L7-S1 and if you accidently Puncture that Dural Sac, the Drug will Travel straight to the Cats Brain
_\*Decrease Dose by 1/2 if CSF is Obtained_
64
Sensory Nerves that Have a _____ Firing Rate are More Susceptible to **Local Anesthetics**
**Higher**
66
In Large Animals, Local Anesthesia of the ____ can be done by:
_Inverted L Block_
_Incisional Block_
_Epidural_
_Proximal Paravertebral Block_
_Distal Peravertebral Block_
**Flank**
\*Incisional Block- Giving Local Anesthetic in the Area of Incision
\*Epidural- Can be used for Abdominal Procedures so long as you give enough Volume
\*Nerve Roots that Come Directly out from the Spinal Cord you can Desensitize them either Proximally or Distally to provide adequate Analgesia to the side that is being Innervated
67
Peripheral Nerve Block that Desensitizes _Rostral Mandible and Ipsilateral Canine and Incisors_
**Mental Nerve Block**
68
True/False: Highly Perfused Areas have a Shorter Duration of Action with **Local Anesthetics**, and Poorly Perfused Areas have a Much Longer Duration of Action with Local Anesthetics
**True**
_\*Highly Perfused Areas have Faster Systemic Absorption, and Therefore Shorter Duration of Action_
_\*Poorly Perfused Areas have a Much Longer Duration of Action_
70
Fluid Therapy used in Patients that have _Massive Hemorrhage and you need to Move Fluid into the Intravascular Space_, where Results are Short-Term and must be follwed by either Cystalloid or Colloid if Hypovolemic
**Hypertonic Saline**
71
Best Place to do _IM Injections_ for **Pig Anesthesia**
**Neck Area Caudal to the Ear**
**\***Do Not want to Place IM Injections in the Hind Area of Pigs
72
Peripheral Nerve Block that is Used in Horses and Cattle for Examination of the Eye, that DOES NOT Desensitize the Eyelids
**Auriculopalpebral Block**
**\***Stops the Animal from Blinking when you are doing the exam (Paralysis), but _does not_ Desensitize the Eyelids
73
Condition in Pigs that is most Prevalent in Individuals with **High Ratio of Muscle to Total Body Mass** caused by a mutation in the Porcine Ryanodine Receptor 1 gene that leads to _Rapidly Increasing ETCO2_
**Malignant Hyperthermia**
**\***Most Diagnostic Clinical Sign- _Rapidly Increasing ETCO2_
\*100% Mortality Rate- If occurs during Anesthesia then Rapid Termination of Inhalant and Body Cooling may be helpful
75
First Three Signs that Occur with **Local Anesthetic Toxicity**
**1. CNS Signs**- Sedation, Seizures, Coma
**2. Respiratory System Depression**
**3. Cardiovascular-** Bradycardia
_**\***Signs are Seen in this Order_
_\*Exception- **Bupivacaine causes Cardiovascular Depression 1st**_
79
Which **Cardiovascular Drug** has these Effects Below
**Epinephrine**
**\***May decrease Renal Blood Flow because it causes such Massive Vasoconstriction
80
**A. Methadone**
81
True/False: **IPPV** may Physically Impede Venous Return to the Right Side of the Heart leading to Decreased Stroke Volume, Cardiac Output, and Arterial Blood Pressure
**True**
**\***Venous Return to the Heart is _Decreased_ with IPPV- Negative Cardiovascular Effect of IPPV
\*These Cardiovascular Effects can be Overcome with Expansion of Extracellular Fluid Volume (_Give Fluids) and Inotropic Drugs_
82
**C. Cardiovascular Depression**
84
**NSAIDS** Have a Very ____ Safety Margin, therefore we _NEVER Exceed the Upper Dose Limit_
**Narrow**
**\***One of the Most common Drugs we Perscribe but one of the Least Safe
_\*Use the Lowest Effective Dose_
_\*You Must Wash Out NSAIDS- Discontinue with no NSAIDS for a 7 day Period of Time before you restart a new NSAID- WE DO NO MIX NSAIDS WITHIN 7 DAYS- KNOW THIS_
86
Where do we want to put IV Access (Circulation) in a Patient that is in **Cardiopulmonary Arrest?**
**Cephalic**
**\***Cephalic is Close to the Heart- _Use the Largest Catheter you can Find- Lots of Fluids Quickly_
_\*What if you are Unable to Get IV Acces, how would you administer Drugs? Put Drugs down the Endotracheal Tube- Alveoli are very Vascular Structures_
88
Treatment of Choice for **Malignant Hyperthermia** in Pigs
**Dantrolene**
**\***Also try to Reduce Stress in the Pigs
89
Treatment of **Hyperkalemia** in Equine Patients
**Calcium Gluconate**- _Does not Lower Serum Potassium Level, it just Stabilizes the Myocardium_
**0.9%NaCl** (Saline)- Dilutes Down the Potassium Level
90
**Neuromuscular Blocking Agents** are used for _____ in patients that are Difficult to Intubate, _Intraocular Surgeries_, and for Delicate Procedures where Movement would be Detrimental
**Muscle Relaxation**
\*NMBAs are used in procedures where you need Significant muscle Relaxation
91
All of the Following are Contraindication to ____ Use:
**_Acute Renal Insufficiency_**
_Hepatic Insufficiency_
_Dehydration_
_Hypotension/Hypovolemia_
_Coagulopathies_
_GI Ulceration_
**NSAIDS**
_**\***The Use of Other NSAIDS or Corticosteroids are also Contraindications- If the Patient is On Other NSAIDS or Corticosteroids you CANNOT Give them a different NSAID for 7 days!!!_
**_\*Acute Renal Insufficiency- If you inhibit Prostaglandins the Kidneys cannot Autoregulate Blood flow and Nephrons will Die!_**
_\*Hepatic Insufficiency- NSAIDS are Metabolized by the Liver_
94
Review of **Nerve Fibers**
Two Fibers Involved in Pain- **C Fibers and A Delta**
_**\***C Fibers are Unmyelinated- Slow Conduction Velocity_
Degree of Myelination shows how fast the Conduction Velocity is- More Myelination, means Faster Velocity
95
Sub-Anesthetic Doses of **Ketamine** can be used to help Prevent Wind-Up in the Spinal Cord by Blocking Glutamate effects at the _____ Receptor
**NMDA**
_**\***Ketamine- NMDA Antagonist_
97
**Cats** have Naturally Occurring Preformed ____ whether or not ever Having a Transfusion
**Alloantibodies**
**\***Type A Cats have the Alloantibodies against Type B Cells and Vice Versa
_\*ALL CATS MUST BE TYPED AND CROSSMATCHED PRIOR TO TRANSFUSION_
98
Which Of these is Matched _Incorrectly_ about **Sample Accuracy**?
A. Air Bubbles = Increase PaO2 and Decrease PaCO2
B. Excess Heparin = Decreased pH
C. Delay in Analysis = Decreased PaO2 and pH
**All of these are Correct**
99
Which One of these is _Incorrect_ for Performing **Chest Compressions:**
A. Place Patient on Soft Surface
B. R,L Lateral Recumbancy
C. Change People Every 2 Minutes
D. 80-100 Compressions per Minute
E. Compress Chest 30%, Allow Full Recoil
F. CONTINOUS compressions
**A. Place Patient on Soft Surface**
_**\***We want to Place the Patient on a Firm Surface because you don't want any give_
\*Change People every 2 Minutes- Providing good Chest Compressions is Physically Exhausting
\*Compress Chest 30%, then allow full Recoil- During Recoil is when Venous Return Occurs so you don't want any pressure on the chest during Recoil
100
True/False: **Type and Crossmatch** must be Performed prior to Every Whole Blood, RBC, or Plasma Transfusion in **Felines**
**True**
102
In What Ruminant Species does **Xylazine** cause Pulmonary Hemorrhage and Edema leading to Hypoxemia and is _Not Recommended for use_
**Sheep**
_**\***Alpha 2 Agonists NOT Recommended in Sheep!_
103
Many Anesthetic Drugs are Highly Protein Bound. If a Patient has ______ the Anesthetic Drugs will have a more Profound Effect
**Hypoproteinemia**
**\***_We Cut Down our Drug Doses in Hypoproteinemic Animals if we know the Drug is Highly Protein Bound- More Free Drug when Proteins Levels are Low = More Profound Effects_
\*Without Proteins in the Vascular Space pulling Water in, the Vessels will become Leaky and lead to Edema and Hypotension
105
What is the Most Common Pathologic Arrhythmia in **Horses**
**Atrial Fibrillation**
_**\***Atrial Fibrillation is Irregularly Irregular- Nothing Matches up_
_\*Oral Medication that can be Given to Horses for Treatment of Atrial Fibrillation- Quinodine_
108
**Infraorbital** Nerve Block Desensitizes _______ Adjacent to Injection and _Rostrally_
**Upper Dental Arcade**
**\***Blocks Nerve Fibers where you Inject and then **_Rostrally_**
_\*Anything Behind where you Inject Local Anesthetics in the Infraorbital Foramen will NOT be Desensitized_
_\*Infraorbital Nerve Block- Not Useful for Molar Extraction- Molars are Behind the Infraorbital Foramen_
109
**Cardiovascular Drug** that is Characterized by:
_Increased Heart Rate_
_Vasoconstriction_
_Bronchodilation_ (Allergic Reactions)
_Administration during Cardiopulmonary Arrest_
_Strongest Vasopressor_
**Epinephrine**
_**\***Potent Vasoconstrictor- Strongest Vasopresso_r
\*Epinephrine can also be used to Treat _NON-RESPONSIVE Hypotension_ (Last Resort Drug)
111
**Pain Scale** based on Specific Behavoiral Signs believed to Represent Pain in the Dog that has One Physiologic and Seven Behavoiral Categories
**The Glasgow Composite Measure Pain Score (GCMPS)**
_**\***Better Scale- Has been Validated by Statistical Method_s
112
\_\_\_\_\_ are Not Used in Ruminants because Salivary Secretions will become more Viscous and Could Obstruct the Airway
**Anticholinergics**
113
Maintenance Drugs used in **Pig Anesthesia**
**Isoflurane/Sevoflurane (**Most Common)
## Footnote
**Propofol CRI**
**Triple Drip**
114
**135mL**
(15kg x 90ml/kg) x .10 = 135mL
116
Review Card
\*Aceytlcholine Binding is Competitive and Reversible
\*If you have more Ach than NMBA, then Muscle Contraction will Occur
\*If you have More NMBA than Ach, then Muscle Paralysis will Occur
117
Two **Shock-able Rhythms** seen on Electrocardiogram
**Pulse-less Ventricular Tachycardia**
**Ventricular Fibrillation**
118
Review of **Ocular Rotation** under _Cattle_ Anesthesia (KNOW THIS)
**Light Anesthesia-** Palpebral Reflex Disappears
**Induction**- Eye Rotates Ventrally and Partially Obscured Cornea
**Deepening Anesthesia**- Pupil Hidden by Lower Lid
**Deeper Anesthesia**- Dorsal Rotation of Eyelid (Too Deep)
_\*Rotation of Globe does NOT occur Under Anesthesia in Sheep and Goats_
120
**Electric Shock** that Depolarizes Myocardial Cells used Only on Patients with _Ventricular Fibrillation and Pulse-less Ventricular Tachycardia_
**Defibrillation**
**\***After Defibrillation you have to Restart Compressions for At least 2 more Minutes. You're Depolarizing the Heart and it takes time to Repolarize
121
**Direct Blood Pressure** Monitoring is Commonly done in the ____ Artery during **Ruminant Anesthesia**
**Auricular**
_**\***Where do you Measure Indirect (Doppler) Blood Pressure? Median Artery_
122
\_\_\_\_\_ can be Performed by Closing the Pop-off Valve and Squeezing the Reservoir Bag until _10-20 cm H20_ is Reached and then the Pop-off Valve is Reopened so the Patient can Passively Exhale
**IPPV**
**\***AKA- Giving a Patient a Breath/ Manual IPPV
\*Must close Pop-off Valve- Just squeezing the Reservoir bag will not Deliver Effective Ventilation
123
Lipid Solubility is Positvely Related to Potency of Local Anesthetics. As Lipid Solubility \_\_\_\_\_\_, Potency Increases
**Increases**
**\***Drugs that are **More Lipid Soluble** Facilitate Nerve Penetration more Readily and _Absorbs into the Myelin Sheath_ leading to a **Slower Onset and Longer Duration of Action**
**\***Highly Lipid Soluble drugs are Absorbed into the Myelin Sheath, which does not Block the Nerve, Leading to Slower Onset and Longer Duration
126
**COX 2 Selective NSAID** that is used in Dogs and Formulated as a Tablet with a Duration of 24 Hours and Side Effects including Vomiting/Diarrhea, Hematochezia, and Melena
**Deracoxib**
128
**Reversal for Rocurium and Vecuronium** NMBA's that Does NOT Rely on Ach Esterase Inhibition
**Sugammadex**
**\***Gobbles up Neurmuscular Blocking agent and prevents it from binding
129
**Local Anesthetic** Duration of Action is based on _Protein Binding._ The Greater the Protein Binding, the _____ the Duration of Action
**Longer**
130
**Topical Anesthetic** that is a Eutetic Mixture of Lidocaine and Prilocaine that you _Apply 1 Hour Prior to Attended Use_ and Wrap the Area in Sarane Wrap
**EMLA Cream**
**\***Useful for Numbing an Area prior to _Catheter Placement_
131
Drug Only Indicated in **Ventricular Arrhythmias**
**Lidocaine**
132
Sally is a 1 y.o Intact Female Labrador Retriever that you are Perfoming an Ovariohysterectomy on at 8am and she will Stay in your Clinic Overnight. You will Check on her around 10pm for a walk and to Administer Pain Medications. **What is your Postoperative Analgesia Plan?**
\*Carprofen- NSAID given for post operative Pain Managment
\*Buprenorphine (Opioid) can be Given for Moderate Pain- Less Side Effects with Buprenorphine than Morphine
133
**Calculate the Drip Rate** in Drops/Second
**1 Drop/Second**
**\*(**20 kg x 10 mL/kg/h x 20 Drops/mL)/ 60 Seconds
135
We _____ Ruminants during Anesthesia to Prevent Aspiration of Salivary Secretions or Rumen Contents if Regurgitation Occurs
**Intubate**
136
Review of _Adrenergic Agonists (Cardiovascular Drugs)_
\*Drugs that Act on **Beta 1** will I_ncrease Contractility_
\*Drugs that act on **Alpha** will _Increase Vasoconstriction_
\*Drugs that Act on **Beta 2** will I_ncrease Vasodilation_
An adrenergic agonist is a drug that stimulates a response from the adrenergic receptors. The five main categories of adrenergic receptors are: α1, α2, β1, β2,
138
Commonly used Premedications for **Ruminant Anesthesia**
**Acepromazine-** Administered IM in Neck
**Xylazine-** _More Potent in Ruminants (Use 1/10th of the Equine IV Dose)_
_\*These Drugs are Not approved for use in Food Animals but they are used Off Label_
140
**Sensory Nerves** have a ____ Diameter with a Higher Firing Rate, Therefore they _Block Earlier and with a Lower Concentration of Local Anesthetics_
**Smaller**
**\***If the Surgeon is Concerned with Motor Function, you can Find ways to Provide Adequate Motor Function while Blocking Sensory Nerves because Sensory Nerves are More Sensitive to Local Anesthetics and will be Blocked before Motor Nerves
143
Technique for Local Anesthesia of the **Flank** where you Administer the Local Anesthetic Between T13-L1, L1-L2, and L2-L3
**Proximal Paravertebral**
**\***Desensitizes the Entire Flank
_\*Advantages: Wide and Uniform Area of Analgesia and Muscle Relaxation, Faster Technique_
_\*Disadvantages: Difficult in Obese Cattle, Possible Scoliosis, Risk of Hitting Aorta or Vena Cava_
146
The Percentage of all Available Heme-Binding Sites Saturated with Oxygen from an Arterial Sample is a Calculated Value based on the Position on the Oxygen Hemoglobin Dissociation Curve and PaO2
**SaO2 (Saturated Oxygen)**
**\***At 80mmHg and 95% SaO2 - Mild Hypoxemia
\*At 60mmHg and 90% SaO2- Severly Hypoxemic
148
Which **Cardiovascular Drug** is Described Below?
**Dopamine**
\*Increased Contractility- Beta 1 Agonist
\*_Only when Using High Dose of Dopamine, will cause Vasoconstriction_
150
Important Complication of **Equine Anesthesia**
**Hypotension**
_\*Hypotension can lead to Postanesthetic Myopathies in Horses_
_**\***If the **MAP is Kept \> 70mmHg** Post Anesthetic Myopathies do not commonly occur. **Keep MAP \> 70 mmHg**_
151
Review of **Plasma Volumes and Blood Volumes** in Species
**\*Know the Blood Volume by Species**- So that you can Calculate How Significant Blood Losses are going to be and how aggressive your Treatment needs to be
152
Some _Local Anesthetics_ can be used as Anti-arrhythmic Agents (Lidocaine) , while Others, such as ______ may Cause **Lethal Arrhythmias** when High Doses are used
**Bupivacaine**
153
Blood Sample was Taken and the **pH is 7.23 Is this Patient Acidemic or Alkalemic?**
**Acidemia**
**\***Normal pH = 7.4
155
Indicated Peripheral Nerve Block used for _Extraction of an Incisor, Canine, and Molar all on the Same Side_
**Maxillary Nerve Block**
156
Review Card
**Arterial: (Rule of 4's)**
**pH- 7.4**
**PaCO2- 40mmHg**
**PaO2- 100mmHg** (Room Air); 400-500mmHg (100% Oxygen)
**HCO3- 24 mmol/L**
**BE- 0 +/- 4 mmol/L** (Ideal BE is Zero)
**SaO2- 95-100%**
**Lactate**
157
**Neuromucular Blocking Agent** that is _2 Acetylcholine Molecules Bound Together_ leading to:
Phase 1: Depolarization and Muscle Fasciculations (Rigid Paralysis)
Phase 2: Flaccid Paralysis
**Succinylcholine**
159
You Overdose a Patient on **Epinephrine** and the Patient is in _Ventricular Tachycardia_. What Would you give to treat the Ventriclar Tachyarrhythmias?
**Lidocaine (1-2mg/kg)**
**\***Lidocaine- Treatment of Ventricular Tachyarrhythmias
160
**Nonselective COX 1 and COX 2 Inhibitor** Drug used in _Horses and Ruminants_ that can be formulated as Granules, Paste or Parenteral with Side Effects Including Local Swelling and GI Ulceration
**Flunixin Meglumine**
161
COX ___ is Responsible for **Mucosal Defense and Platelet Function**
**1**
**\***If You give an NSAID that Blocks COX 1 then you may have Increased Bleeding Times
162
Cystalloid Fluid that is a **Balanced Electrolyte Solution** where _Acetate is the Alkalinizing Agent,_ that may cause Vasolidation with Very Rapid Administration
**Normosol- R and Plasmalyte 148**
163
Two Types of Cardiopumonary Cerebral Resuscitation (**CPCR)** used in **Cardiopulmonary Arrest**
**External CPCR** (External Chest Compressions with IV Access and Drugs)
**Internal CPCR (**Thoracotamy with Internal Cardiac Massage)
**_\*Internal CPCR DOES NOT improve Survivability_**
_\*The Most Successful CPCR- the ONE AVOIDED_
165
**Review Card-** Will be on Exam
\*Guidelines for **IPPV**
Tidal Volume- Know **10-20 mL/kg in Small Animals**
**\***I:E Ratio- **1:2-1:3.** Ex. If you spent 2 Seconds in Inspiration, how many Seconds would you want to spend in Expiration? 4-6 Seconds
_You want to Spend LONGER in the Expiration Phase than the Inspiration Phase-_ Want to give the body time to have the venous Return
\*Peak Inspiratory Pressure (PIP)- When you Deliver a Breath, you want the Pressure Guage to stay around **20 cm H20** in small animals
166
Inhalant Anesthetics Alter the Distribution of Pulmonary Blood Flow in **Horses**, Resulting in Areas that are Perfused but not well Ventilated, which Worsens Hypoxemia by Contributing to \_\_\_\_\_\_
**V/Q Mismatch**
**\***V = Ventilation
Q = Perfusion
167
Commonly Used **Nondepolarizing** Neuromuscular Blocking Agent that is Described Below:
**Atracurium**
_**\***Repeated Doses are Not Cumulative_
_\*Hofmann Eliminiation- Spontaneous Molecular Decomposition_
\*Good for Patients with Renal and Hepatic Disease because half of it has Breakdown that doesn't Rely on Functioning Kidney or Liver
_\*Atracurium = Histamine Release_
168
**Acute Blood Loss \> 20%** Means the Patients **PCV** will be
**\***Need a Minimum Hemoglobin of 7mg/dL (PCV 21%) for Oxygen to be Delivered to Tissues. If PCV is Below 21%, Oxygen will not be Delivered to Tissues- Consider a Blood Transfusion
170
Cardiovascular Drug that is an _Alpha 1,2 and Beta 1,2 Agonist_ which is the **Strongest Vasopressor** and Administered during **Cardiopulmonary Arrest**
**Epinephrine**
**\*I_ncreases Heart Rate_** due to Strong Beta effects
\*Generally Causes **_Vasoconstriction_**- If a Drug has Alpha Effects, generally the Alpha Effects will Predominate the Beta Effects, in this case causing Vasoconstriction
172
Name the 5 Parts of the **Pain Pathway (Nociception)**
**1. Transduction**
**2. Transmission**
**3. Modulation**
**4. Projection**
**5. Perception**
**\***Ex. We get a Cut and we Transduce that Signal. The Signal will be Transmitted along those Nerve Fibers to the Grey Matter Dorsal Horn. Modulation Occurs in the Dorsal Horn and is Projected up to our Brain, which is able to Perceive the Signal
174
Local Anesthetic with the **Highest Protein Binding and Highest Lipid Solubility (Potency)** and therefore the Longest Duration of Action
**Bupivacaine**
175
One of the Most Telling Indicators of how your **Cardiopulmonary Arrest Resuscitation** is Going
**ETCO2**
176
Drug that works on V1A and V2 Receptors to cause Significant _Vasoconstriction and is Effective in Acidic Environments_
**Vasopressin**
_\*Effective in Acidic Environments._ Epinephrine does not work once your patients become Acidemic. If we are Worried the Patient is Acidemic, we will Start with Vasopressin rather than Epinephrine
177
Part of the **Pain Pathway** when Nociceptive Information is Sent to the Brain by Nerve Tracts that Originate in the Laminae of the Dorsal Horn
**Projection**
178
Indications for ____ Transfusion:
**Acute Blood Loss/Hemorrhage**
**Anemia**
**Whole Blood**
180
Cardiovascular Drug that is an _Alpha 1,2 and Beta 1,2 Agonist_ that is mainly used for **Significant Non-Responsive Hypotension**
**Norepinephrine**
_\*Norepinephrine- Does not have as severe Tachycardia as you will see with Epinephrine_
182
**Nondepolarizing** Neuromuscular Blocking Agents that Bind NAchR withOUT Activating it leading to _FLACID Paralysis_
These Drugs lead to _FLACID_ Paralysis
183
**Local Anesthetic** with the _Longest Duration of Action_
**Bupivacaine**
**\***Bupivacaine is 95% Protein Bound
More Protein Bound = Longer Duration of Action
_\*Lidocaine has the Fastest Onset of Action, while Bupivacaine has the Longest Duration of Action!_
\*He Prefers Bupivacaine for Procedures because he wants the Local Anesthetic to Last longer and Provide more Analgesia
184
In **Arterial** Samples the PaO2 will be \_\_\_\_\_mmHg on Room Air or ______ if on 100% Oxygen (Anesthetized Patients)
**80-110 mmHg**
**500 mmHg**
\*SaO2 (Saturated Oxygen) \> 88%
_\*Arterial Sample- Pulsatile Flow_
185
If Using a DEA (\_\_\_) Donor, Type and Crossmatch is NOT Performed on **1st Transfusion**
**(–)**
_**\***Type and Crossmatch Any Transfusion given \> 5 Days after Initial Transfusion_
186
_1st Priority Resuscitation Drug_ in a Full **Cardiopulmonary Arrest**
**Epinephrine**
**\***Acts on Alpha and Beta Receptors- Causes _Intense Peripheral Vascoconstriction_ that Centralizes our Blood Volume
_\*Dose to use: 0.01 mg/kg IV_
188
99% of **Felines** in the US are Type \_\_\_
**A**
**\***Still Safest to Type and Crossmatch every Feline prior to Blood Transfusion
189
Common Nerve block for Eye Enucleation in Large Animals where you Aspirate Local Anesthetics into the Back of the Eye
**Retrobulbar Block**
191
_Number 1 Priority_ in Cases of **Cardiopulmonary Arrest** that is Done to Pump Blood from the Chest to Vital Organs in order to Maximize Cerebral and Myocardial Perfusion
**Continuous Uninterrupted Chest Compressions**
**\***Even if only 1 Person is There- Do not Try to get an Airway, start Chest Compressions immediately and DO NOT STOP
\*Venous Return occurs during Relaxation
192
**Nociceptor** that is _High Threshold_, takes a stronger stimulus to Activate, that Responds to Cold Temperature, Burning and Freezing ("Slow Pain")
**C-Fiber**
\*_C Fibers- Unmyelinated_- Takes Longer to Transmit the Pain Signals
193
Which **Cardiovascular Drug** does this Describe?
**Norepinephrine**
**\***Does not as Significantly Increase the Heart Rate compared to Epinephrine
194
_**Crystalloids Redistribute Quickly**,_ where Only \_\_\_\_\_% Remains Intravascular 15 Minutes after Infusion
**20-30%**
**\***15 Minutes After Injection, 2/3rds to 3/4ths of the Cystalloid you gave is gone from the Intravascular space and Moved into the Interstitium
_\*For Every 1mL of Blood Loss you're going to give 3-4mL of Crystalloid because only 20-30% of it stays in the Vascular Space_
195
Technique for Local Anesthesia of the **Flank,** where you Administer Two Injections (Dorsal and Ventral) of Local Anesthetic at _L1, L2, and L4_
**Distal Paravertebral**
**\***Don't Inject at L3
\*Advantages: Lack of Scoliosis, Lack of Risk of Penetrating Major Blood Vessels
\*Disadvantages: Larger Doses of Anesthetic
196
**Respiratory Acidosis**
198
What Two Factors Affect the **Duration of Action** of Local Anesthetics
**Lipid Solubility**
**Protein Binding**
**\***_The Higher the Lipid Solubility and Protein Binding, the LONGER the Duration of Action_
200
True/False: Rotation of the Globe Occurs Under Anesthesia in **Sheep and Goats**
**False**
202
In **Canine** Blood Transfusions, Only DEA (\_\_\_) Dogs should receive DEA (\_\_\_) Donor Blood to Prevent DEA Sensitization of a DEA (–) Dog
**(+)**
_**\***DEA = Dog Erythrocyte Antigen. It Important that if you have a DEA (+) Dog they can get a DEA (+) or (-) Transfusion. If you have a DEA (–) Dog, They can Only Recieve DEA (–) Blood- You don't want to introduce them to the Antigen_
**_Use DEA (–) Donors- Can Donate to Both DEA (+) and (-) Dogs_**
No Need to Test for Plasma Tranfusions, Just Whole Blood and RBC if not a "Transfusion Virgin"
203
\_\_\_\_ Epidurals are used for Surgical Procedures in Horses and Cattle that involve the Tail, Perineum, Anus, Rectum, Vulva, Prepuce and Skin of Scrotum
**Caudal**
**\***Gray Areas show where Desensitization will Occur. _Caudal Epidurals do not affect the Hind Legs and most of the time you will do and Epidural in a Standing Horse_
204
Dose of Cystalloids used when Giving Fluid Therapy to a Patient in Cardiopulmonary Arrest that is **Hypovolemic**
**Shock Doses: 90 ml/kg in Dogs, 45 ml/kg in Cats**
205
Drug that is Indicated for use in a VAGALLY Induced **Cardiopulmonary Arrest**
**Atropine**
**\***_Under Anesthesia, almost all Anesthesia Arrests Get Atropine because the Patients have High Vagal tone under Anesthesia_
206
Peripheral Nerve Block that Desensitizes _Ipsilateral Upper Dental Arcarde and Maxilla_
**Maxillary Nerve Block**
_**\***Desensitizes All the Teeth in the Upper Arcarde on the Side of Injection_
_\*Indications- Molar Extraction_
208
When Assessing the Anesthetic Depth in **Horses** the _____ Signs are Very Important- Palpebral and Corneal Reflexes, Lacrimation, Nystagmus, and Position of the Eyeball
**Eye Signs**
_\*Blinking, Lacrimation (Watery Eyes) and Nystagmus are all Signs that the Horse is Too Light_
_\*Drug that makes the Reflexes Less Reliable- Ketamine_
209
Which **Cardiovascular Drug** has these Effects:
_Increases Heart Rate_
**_Treatment for Hypotension_**
_Increases Vascular Resistance_
_Increases Contractility_
_Increases Cardiac Output_
**_Fast Onset_**
**Ephedrine**
**\*Fast Onset**- Ex. If Multiple Patients in the Clinic are Hypotensive you can give Boluses of Ephedrine
210
**Nociceptor** that has _Low and High Threshold_ that Responds to Hot Temperature, Sharp, Pricking, Burning, and Freezing ("Fast Pain")
**A Delta Fibers**
212
**Hypercapnia** _____ _Increases Circulating Catecholamines_ , which can lead to Tachycardia, Arrhythmias and Increased Myocardial Contractility
**Indirectly**
213
**Vasodilation**
**Contractility**
**Bradycardia**
214
Best _Induction_ Drugs used in **Pig Anesthesia**
**Dexmetatomidine-Ketamine-Butorphanol Combination**
215
Infiltration Technique used for a **Flank Approach in Cattle**, where we Desensitive the Nerve Fibers against the _Caudal Border of Rib 13_, just Ventral to the Lateral Processes of the Lumbar Vertebrae
**Inverted L**
216
During Respiratory Arrest when **Breathing** for the Patient you give ___ Breaths every 1-2 Seconds with 100% Oxygen
**2**
**\***_Acupuncture- GV26_ ( Upside down T on Nose). Jab needle at Junction of the T, which may stimulate the Patient to breathe if they are in Respiratory Arrest but still have Pulses
_\*If Patient is Only in Respiratory Arrest but still has Pulses then Begin Intubation and Breathing for the Patient as well as Acupuncture of the GV26 Area. If Patient is in Full Cardiopulmonary Arrest (CPA) then Immediatly start Chest Compressions_
217
Peripheral Nerve Block that Desensitizes:
_Upper Dental Arcade (Adjacent to Injection and **Rostrally**)_
_Upper Lip and Nose_
_Dorsal Aspect of Nasal Cavity_
_Soft and Hard Palates_
**Infraorbital Nerve Block**
**\***Does NOT Desensitize Anything Behind the Infraorbital Foramen
218
Most Common Arteries to Obtain Blood Gas Samples in **Large Animals**
219
\_\_\_\_\_ Fluids Exerts its Effects mainly on the _Interstitium and Intracellular Fluid Compartments_
**Crystalloids**
**\***Crystalloids leave the Intravascular Space Quickly
220
Blood Sample was Taken and the **SaO2 is \> 88%**. Is this a Venous or Arterial Sample?
**Arterial**
221
Main **Depolarizing** Neuromuscular Blocking Agent that Binds to NAchR Resulting in Activation (Depolarization)
**Succinylcholine**
**\***_Leads to a RIGID Paralysis_
222
Peripheral Nerve Block used in Large Animals to _Desensitize the Eye_ and Allow for Sufficient Opthalmic Examination
**Supraorbital Nerve Block**
**\***Anesthesia to the Upper Eyelid- Desensitizes
_\*If you have a Laceration to the Upper Eyelid you should do an Auriculopalpebral Block to Stop Blinking and a Supraorbital Block to Desensitize the Eyelid_
223
Two Main **Nerve Fibers** that are Involved with Pain
**A Delta**
**C Fibers**
224
Three Drugs that can be Given to Reverse **Nondepolarizing** Neuromuscular Blocking Agents
**Anticholinesterase Drugs:**
_Edrophonium_
_Neostigmine_
_Pyridostigmine_
\*These Three Drugs Increase Acetylcholine at the Neuromuscular Junction
225
Cardiovascular Drug that is an _Alpha 1 Agonist_ that Causes:
**_Significant Vasoconstriction_**
_Splenic Contraction_
_Decrease Epistaxis_
_Decrease Nasal Edema (Nasal Decongestant)_
**Phenylephrine**
**\***Allows Patients to Breath much better through their Nose- Nasal Decongestant
\*Phenylephrine may be Useful in Patients in Shock with Severe Vasodilation. Phenylephrine can be Given to Help bring Blood Vessels back to a normal Size
227
Indications for _____ Nerve Blocks:
_Procedures from Stifle Distally_
_Crutiate Repairs_
_TPLO's_
_Fractured Tibia/Fibula_
**Hindlimb (Femoral and Sciatic Nerve Blocks)**
228
For Patients in **Cardiopulmonary Arrest** that has Lost Greater than 10% of its Blood Volume, Which Fluid should we use in Fluid Therapy?
**Colloids**
229
What **Oxygen Flow Rates** are used during Ruminant Anesthesia? Which Inhalant Anesthetic is most Cost Effective in Ruminant Anesthesia?
**10-20 ml/kg/min**
**Isoflurane**
230
Two Sensory Nerves Targeted by **Local Anesthetics**
**A (Delta) and C Fibers**
231
Cardiovascular Drug that is a Beta 1,2 and Alpha 1 Agonist that is used in the **Treatment of Hypotension** and Increase Urine Output
**Dopamine**
**\***One of the First Options for Treating Hypotension
232
**Nondepolarizing** Neuromuscular Blocking Agents Do Not Activate when Binding Receptor leading to ____ Paralysis
**Flaccid**
233
True/False: In a **Cow** you need to Block _One_ Nerve for Dehorning, while in a **Goat** you need to block _Two_ Nerves for Dehorning
**True**
**\***Cattle- Block Cornual Branch of Zygomaticotemporal
\*Goat- Block Cornual branch of Infratrochlear and Cornual Branch of Zygomaticotemporal
234
**Hypercapnia** ____ causes _Vasodilation and Myocardial Depression_ that can lead to Cardiac Arrest and Increased Intracranial Pressure
**Directly**
235
IV Access in **Equines** is done with a _____ Catheter placed in the Side of the Neck that will be "up" if Placed in Lateral Position
**Jugular**
236
**Neuromuscular Blocking Agents (NMBAs)** lead to Short Term, Reversible ____ Paralysis
**Flaccid**
