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Applied Clinical Veterinary Nursing > GA Accidents and Emergencies > Flashcards

GA Accidents and Emergencies Flashcards

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1
Q

What is the CEPSAF enquiry?

A

a study to estimate the risks of anaesthetic and sedation-related mortality in companion animals in the UK

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2
Q

what is the overall risk of mortality under sedation/GA for dogs?

A

0.17%

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3
Q

what is the overall risk of mortality under sedation/GA for cats?

A

0.24%

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4
Q

what is the overall risk of mortality under sedation/GA for rabbits?

A

1.39%

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5
Q

for what duration did the CEPSAF study look at post-op complications?

A

48 hours

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6
Q

does sedation or GA carry higher risks?

A

GA

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7
Q

within what timeframe did 50% of deaths occur?

A

within 3 hours of recovery

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8
Q

how does ET intubation affect mortality of cats during GA?

A

increased mortality in cats (not dogs)

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9
Q

what is the risk factor of inhalational anaesthesia?

A

6 times more likely to die compared to injectable

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10
Q

what is one of the limitation of the of CEPSAF study?

A

only looked at mortality within 48 hours - some issues take longer to arise

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11
Q

what is a significant patient factor in GA/sedation risk?

A

poor health - dogs with asa grades 3-5

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12
Q

what types of procedures carry the highest risk for GA/sedation related death?

A

urgent procedures

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13
Q

how does patient age affect risk of GA/sedation-related death?

A

older dogs (largest >9 years)

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14
Q

what type of facial conformation carries a higher risk of GA/sedation-related death?

A

dolichocephalic breeds - 3.7x the risk compared to mesocephalic breeds

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15
Q

why is it thought that dolichocephalic breeds have a higher GA/sedation-related risk?

A

increased attention/vigilance towards brachycephalic breeds may reduce our concern towards other breeds

possible additional risk pathway that is specific to dolichocephalic dogs that we do not fully understand

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16
Q

what are some of the main factors which contribute to anaesthetic accidents?

A

unwell patients

equipment failure

inadequate preparation

inadequate monitoring

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17
Q

what is the difference between a complication and an error?

A

a complication is an event that develops but is not due to human error whereas an error is an avoidable event

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18
Q

give some examples of anaesthetic complications

A

hypotension
haemorrhage
drug reaction

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19
Q

give an example of an anaesthetic error

A

APL valve left shut
patient given wrong dose of drug

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20
Q

what are some of the human errors that can occur during anaesthesia?

A

drug administration errors

incomplete clinical assessment

inadequate knowledge of equipment/protocols

failure to appropriately monitor the patient

closed APL valve

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21
Q

what types of equipment error/failure can occur during anaesthesia?

A

inability to deliver an appropriate oxygen supply

lack of oxygen in cylinder/source

disconnection of piped oxygen

stuck or missing one way valve

leaks in the machine/breathing system

ventilator failure

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22
Q

what are the benefits of using checklists during anaesthesia?

A

ensures safety critical steps are performed, as well as improving teamwork and communication

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23
Q

what are the complications that can arise during IV catheterisation?

A

trauma during insertion

extravascular placement

infection/inflammation

phlebitis

air embolism

pain/discomfort

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24
Q

how can we prevent IV catheter complications?

A

aseptic technique

start lower down on limb

chose correct catheter type (length/gauge)

prevent patient interference

daily/twice daily observation and dressing change

regularly flush

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25
Q

what are the possible drug administration errors?

A

incorrect drug/dose/concentration/route used

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26
Q

why do drug administration errors usually occur?

A

miscommunication

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27
Q

how can we avoid drug administration errors?

A

double-check all calculations, doses, bottles, route of admin

have an accurate patient weight

always label syringes

understand pharmacology of drug given

check hospital form before and administration

record all drugs given on hospital sheet

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28
Q

what should we do if we spot a drug admin error?

A

tell the vet immediately

stop giving the drug if not all given

carefully monitor patient

check drug bottle/data sheet for info

contact poison service if necessary

inform owner of mistake

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29
Q

how can we reduce the incidence of drug admin errors?

A

issues should be discussed regularly at clinical governance meetings

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30
Q

what is the difference between vomiting and regurgutation?

A

vomiting = active process

regurgitation = passive process, no GI contraction

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31
Q

what is reflux?

A

regurgitation in an anaesthetised patient

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32
Q

what are the danger periods for vomiting/regurgutation?

A

induction and recovery

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33
Q

what is GOR?

A

gastro-oesophageal reflux

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34
Q

what are the risk factors for GOR?

A

excessive/inadequate pre-op fasting

drug choices

abdominal pressure

abdo surgery/long ops

orthopaedic surgery

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35
Q

why is regurgitation sometimes missed?

A

some regurgitation is silent

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36
Q

what are the signs in recovery that a patient might have GOR?

A

may vomit blood-tinged fluid, appear unable to swallow, appear distressedw

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37
Q

name some drugs which might make a patient more likely to have GOR

A

ACP, diazepam, opioids

38
Q

why do some opioids make patients at risk of GOR?

A

Mu agonists relax the oesophageal sphincter

39
Q

why might GOR be more common in ortho procedures?

A

usually use a Mu agonist

patient often moved multiple times under GA

40
Q

how can we lower the risk of GOR?

A

appropriate pre-op fasting times

identify at-risk patients

pre-op GI protectants?

head up/swift induction

cuffed ET tube

have suction readily available

41
Q

describe the steps you should take if you notice regurgitation

A

tell vet, patient head down

suction/swab out pharynx

record on anaesthetic record

42
Q

which drug might vets give to patients at risk of GOR?

A

omeprazole IV

43
Q

why do patients develop corneal ulceration under sedation/GA?

A

anaesthesia/sedation/opioids reduced tear formation

trauma from external sources can contribute (heat/masks/liquid)

44
Q

why is it important to prevent corneal ulceration?

A

corneal ulceration is incredibly painful

45
Q

how can ocular damage be prevented under GA?

A

regular use of ophthalmic ointment/lubrication

care with warming devices

careful positioning

be aware of placement of face masks

avoid droplet/liquids around face area

avoid trauma

46
Q

what should we do if we notice an ulcer forming under GA?

A

prevent rubbing/scratching

inform vet

potentially start eye ointments to continue at home

try to identify the reason

inform owner

47
Q

what can hypothermia result in?

A

cardiac arrhythmias

bradycardia

impaired coagulation and wound healing

shivering –> increased oxygen demand

48
Q

at what body temperature is atrial fibrillation likely to occur?

A

30 degrees

49
Q

at what body temperature is ventricular fibrillation likely to occur?

A

24-28 degrees

50
Q

how does hypothermia impact anaesthesia?

A

drugs have prolonged duration of action

decreased renal plasma flow

decreased oxygen delivery to tissues

lower anaesthetic requirement

51
Q

how can we prevent hypothermia under GA?

A

insulate patient

warm from point of premed - don’t leave unsupervised

HME breathing system

care with clip and scrub

use of external heat sources, warm environmental temperature

avoid excessive length of anaesthesia

52
Q

what is the effect of hyperthermia on BMR?

A

increased BMR - 13% for every degree above normal

53
Q

what are the effects of hyperthermia under GA?

A

increased BMR

increased oxygen requirement

parenchymal cell damage

54
Q

what occurs at body temperatures >41 degrees?

A

irreversible brain damage

55
Q

what occurs at body temperatures >43 degrees?

A

death

56
Q

which breeds are at risk of hyperthermia?

A

brachys

overweight patients

57
Q

how can we avoid hyperthermia under GA?

A

close observation of patient warming

identify at-risk animals

provide cooling if required - fan/wet towels/cold water lavage

58
Q

how can we avoid heat burns under GA?

A

never leave patient on heat source they are unable to move away from

avoid microwave heat sources - they do not distribute heat evenly

59
Q

what are possible causes of respiratory failure/restriciton under GA?

A

depression of respiratory centres in brain

impaired movement of thorax - sandbags, abdo pressure (surgeons hands)

impaired lung movement e.g. pleural effusion

airway obstruction

60
Q

what are some of the possible signs of respiratory tract obstruction?

A

increased respiratory effort

paradoxical ventilation

no air movement through nose/mouth

cyanotic mucous membranes

capnography changes

61
Q

why might we see apnoea/respiratory arrest under GA?

A

depth i.e. too light (breath-holding) or too deep

unnoticed respiratory tract obstruction

drug-related e.g. fentanyl/NMB/post-induction apnoea

62
Q

why might we see cyanosis under GA?

A

may be due to inadequate oxygen supply

may be due to very low cardiac output

63
Q

what should you do if you notice respiratory tract obstruction and the patient isn’t intubated?

A

inform surgeon/vet

straighten neck, pull tongue forward, check mouth/pharynx and suction if needed

check equipment, turn on oxygen and intubate

64
Q

how can we reduce chances os desaturation during intubation?

A

pre-oxygenate, esp if potentially difficult intubation

65
Q

what should you do if you notice respiratory tract obstruction and the patient is intubated?

A

check ET tube isn’t kinked/obstructed/too long/faulty

check breathing system

check oxygen supply

try giving breath and feel for resistance in the bag

66
Q

what should you do if the patient is apnoeic and cyanotic?

A

confirm heartbeat

check depth of anaesthesia, check for obstruction/obvious causes

ensure 100% oxygen is given (minute volume)

manual ventilation, check breathing system/tube/chest wall movement

antagonise drugs and turn off volatile agent if necessary

67
Q

what is cardiac arrest?

A

cessation of an effective circulation

68
Q

what can cause cardiac arrest under GA?

A

pre-existing CVS disease

anaesthetic overdose

hypovolaemia

electrolye/acid-base abnormalities

vagal reflex

undetected respiratory arrest

69
Q

what improves chances of success for a cardiopulmonary arrest?

A

earliest detection possible

70
Q

what should we do if the patient is in cardiac arrest?

A

call for help - establish team

start cardiac compressions

turn off anaesthetic agent and begin ventilating, check breathing system, tube, confirm chest wall movement

71
Q

which type of cells in the heart have the ability to contract?

A

working myocardial cells

72
Q

which cells in the heart have the ability to generate an impulse?

A

self-excitatory cells

73
Q

what is automaticity?

A

the property of cardiac cells to generate spontaneous action potentials

74
Q
A
75
Q

what heart rate does impulse via the atrioventricular node achieve?

A

40-60bpm

76
Q

what heart rate does impulse via the bundle of His achieve?

A

40-60bpm

77
Q

what heart rate does impulse via the bundle branches/purkinje fibres achieve?

A

20-40bpm

78
Q

what is an arrhythmia?

A

a change in rate, rhythm or origin that differs from the normal cardiac cycle

79
Q

what happens in first degree block?

A

electrical signal is ‘held up’ - struggles to get through each time

80
Q

what does 1st degree block look like on ECG trace?

A

prolonged distance between P and R

gap between P and QRS complex is larger than that between QRS and T wave

81
Q

what are the 2 types of 2nd degree block?

A

wenckebach and mobitz

82
Q

what occurs in Wenckeback 2nd degree block?

A

progressive lengthening of the PR interval until the gap is so large that beats are lost - gradual

83
Q

what occurs in Mobitz 2nd degree block?

A

intermittent passage through the AV node, but no progressive development - beats just drop

84
Q

what is 3rd degree block?

A

complete heart block - electrical signal cannot get past the AV node

85
Q

why does 3rd degree block not instantly result in cardiac arrest?

A

body has safety mechanisms that allow other parts of the heart to generate a beat - these are often weaker and slower

86
Q

why is the trace in 3rd degree block so irregular?

A

different induction of beats being given from different parts of the heart at irregular times

87
Q

what is ventricular tachycardia?

A

very rapid heart rate caused by abnormal complexes generated by the ventricles

88
Q

what is the heart rate during ventricular tachycardia?

A

> 160bpm

89
Q

what should you do if you notice abnormalities in the ECG trace?

A

try to get printed/video/screenshot ECG trace

inform vet immediately

90
Q
A

Applied Clinical Veterinary Nursing (31 decks)

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