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Applied Clinical Veterinary Nursing > GA Accidents and Emergencies > Flashcards

GA Accidents and Emergencies Flashcards

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
what are the possible drug administration errors?
incorrect drug/dose/concentration/route used
26
why do drug administration errors usually occur?
miscommunication
27
how can we avoid drug administration errors?
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
28
what should we do if we spot a drug admin error?
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
29
how can we reduce the incidence of drug admin errors?
issues should be discussed regularly at clinical governance meetings
30
what is the difference between vomiting and regurgutation?
vomiting = active process regurgitation = passive process, no GI contraction
31
what is reflux?
regurgitation in an anaesthetised patient
32
what are the danger periods for vomiting/regurgutation?
induction and recovery
33
what is GOR?
gastro-oesophageal reflux
34
what are the risk factors for GOR?
excessive/inadequate pre-op fasting drug choices abdominal pressure abdo surgery/long ops orthopaedic surgery
35
why is regurgitation sometimes missed?
some regurgitation is silent
36
what are the signs in recovery that a patient might have GOR?
may vomit blood-tinged fluid, appear unable to swallow, appear distressedw
37
name some drugs which might make a patient more likely to have GOR
ACP, diazepam, opioids
38
why do some opioids make patients at risk of GOR?
Mu agonists relax the oesophageal sphincter
39
why might GOR be more common in ortho procedures?
usually use a Mu agonist patient often moved multiple times under GA
40
how can we lower the risk of GOR?
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
describe the steps you should take if you notice regurgitation
tell vet, patient head down suction/swab out pharynx record on anaesthetic record
42
which drug might vets give to patients at risk of GOR?
omeprazole IV
43
why do patients develop corneal ulceration under sedation/GA?
anaesthesia/sedation/opioids reduced tear formation trauma from external sources can contribute (heat/masks/liquid)
44
why is it important to prevent corneal ulceration?
corneal ulceration is incredibly painful
45
how can ocular damage be prevented under GA?
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
what should we do if we notice an ulcer forming under GA?
prevent rubbing/scratching inform vet potentially start eye ointments to continue at home try to identify the reason inform owner
47
what can hypothermia result in?
cardiac arrhythmias bradycardia impaired coagulation and wound healing shivering --> increased oxygen demand
48
at what body temperature is atrial fibrillation likely to occur?
30 degrees
49
at what body temperature is ventricular fibrillation likely to occur?
24-28 degrees
50
how does hypothermia impact anaesthesia?
drugs have prolonged duration of action decreased renal plasma flow decreased oxygen delivery to tissues lower anaesthetic requirement
51
how can we prevent hypothermia under GA?
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
what is the effect of hyperthermia on BMR?
increased BMR - 13% for every degree above normal
53
what are the effects of hyperthermia under GA?
increased BMR increased oxygen requirement parenchymal cell damage
54
what occurs at body temperatures >41 degrees?
irreversible brain damage
55
what occurs at body temperatures >43 degrees?
death
56
which breeds are at risk of hyperthermia?
brachys overweight patients
57
how can we avoid hyperthermia under GA?
close observation of patient warming identify at-risk animals provide cooling if required - fan/wet towels/cold water lavage
58
how can we avoid heat burns under GA?
never leave patient on heat source they are unable to move away from avoid microwave heat sources - they do not distribute heat evenly
59
what are possible causes of respiratory failure/restriciton under GA?
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
what are some of the possible signs of respiratory tract obstruction?
increased respiratory effort paradoxical ventilation no air movement through nose/mouth cyanotic mucous membranes capnography changes
61
why might we see apnoea/respiratory arrest under GA?
depth i.e. too light (breath-holding) or too deep unnoticed respiratory tract obstruction drug-related e.g. fentanyl/NMB/post-induction apnoea
62
why might we see cyanosis under GA?
may be due to inadequate oxygen supply may be due to very low cardiac output
63
what should you do if you notice respiratory tract obstruction and the patient isn't intubated?
inform surgeon/vet straighten neck, pull tongue forward, check mouth/pharynx and suction if needed check equipment, turn on oxygen and intubate
64
how can we reduce chances os desaturation during intubation?
pre-oxygenate, esp if potentially difficult intubation
65
what should you do if you notice respiratory tract obstruction and the patient is intubated?
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
what should you do if the patient is apnoeic and cyanotic?
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
what is cardiac arrest?
cessation of an effective circulation
68
what can cause cardiac arrest under GA?
pre-existing CVS disease anaesthetic overdose hypovolaemia electrolye/acid-base abnormalities vagal reflex undetected respiratory arrest
69
what improves chances of success for a cardiopulmonary arrest?
earliest detection possible
70
what should we do if the patient is in cardiac arrest?
call for help - establish team start cardiac compressions turn off anaesthetic agent and begin ventilating, check breathing system, tube, confirm chest wall movement
71
which type of cells in the heart have the ability to contract?
working myocardial cells
72
which cells in the heart have the ability to generate an impulse?
self-excitatory cells
73
what is automaticity?
the property of cardiac cells to generate spontaneous action potentials
74
75
what heart rate does impulse via the atrioventricular node achieve?
40-60bpm
76
what heart rate does impulse via the bundle of His achieve?
40-60bpm
77
what heart rate does impulse via the bundle branches/purkinje fibres achieve?
20-40bpm
78
what is an arrhythmia?
a change in rate, rhythm or origin that differs from the normal cardiac cycle
79
what happens in first degree block?
electrical signal is 'held up' - struggles to get through each time
80
what does 1st degree block look like on ECG trace?
prolonged distance between P and R gap between P and QRS complex is larger than that between QRS and T wave
81
what are the 2 types of 2nd degree block?
wenckebach and mobitz
82
what occurs in Wenckeback 2nd degree block?
progressive lengthening of the PR interval until the gap is so large that beats are lost - gradual
83
what occurs in Mobitz 2nd degree block?
intermittent passage through the AV node, but no progressive development - beats just drop
84
what is 3rd degree block?
complete heart block - electrical signal cannot get past the AV node
85
why does 3rd degree block not instantly result in cardiac arrest?
body has safety mechanisms that allow other parts of the heart to generate a beat - these are often weaker and slower
86
why is the trace in 3rd degree block so irregular?
different induction of beats being given from different parts of the heart at irregular times
87
what is ventricular tachycardia?
very rapid heart rate caused by abnormal complexes generated by the ventricles
88
what is the heart rate during ventricular tachycardia?
>160bpm
89
what should you do if you notice abnormalities in the ECG trace?
try to get printed/video/screenshot ECG trace inform vet immediately
90

Applied Clinical Veterinary Nursing (31 decks)

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