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Equine BCM > Lab > Flashcards

Lab Flashcards

1
Q

What is the onset and duration of lidocaine?

A

Rapid onset, 1.5-3 hr duration

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2
Q

What is the onset and duration of Mepivicaine?

A

Rapid onset, 2-3 hour duration

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3
Q

What is the onset and duration of Bupivicaine?

A

Intermediate onset, 3-6 hr duration
-used for therapeutics (ex after surgery)

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4
Q

What is the most important thing when injecting anything into a joint?

A

STERILITY

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5
Q

Which local anesthetic is typically used for diagnostic analgesia in horses?

A

Mepivicaine
-lidocaine not used as much as it can cause more soft tissue reaction

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6
Q

If trying to block inflamed tissue, how may the results of your test be affected?

A

Acidic environments interfere with the action of local anesthetic, so you may not see as much of a response

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7
Q

When do you not want to block limbs for diagnostic purposes?

A

Severe lameness cases

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8
Q

What are sources of articular pain?

A

Synovium, joint capsule, articular/periarticular ligaments, periosteum, subchondral bone
-note that cartilage is not on the list as it has no nerve endings (but cartilage breakdown can cause inflammation of these other structures)

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9
Q

What is the goal of diagnostic analgesia?

A

Ideally block out all lameness to better localize the source
-always start distally and work proximally

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10
Q

T/F: you can do intrasynovial blocks in any order

A

True- as there is no risk of the analgesic agent blocking out other areas

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11
Q

What are some indications for performing joint blocks?

A

Significant effusion in the joint, severe pain after flexion test

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12
Q

What level of patient prep is required for perineural blocks?

A

Clean, brief PI/alcohol scrub, never touch shaft or end of needle
-maybe want to be sterile if risk of entering synovial structure

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13
Q

What level of patient prep is required for intrasynovial blocks?

A

-Sterile prep: clip (if hair is dirty), 5-minute sterile scrub, wear sterile gloves

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14
Q

What needle size should you use for blocks when injecting subQ in small area?

A

22-25 ga

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15
Q

What needle size should you use for blocks when injecting into heavy fascia?

A

18 ga

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16
Q

T/F: Nerve blocks are typically done with the patients foot flat on the ground

A

F- legs should be lifted in most cases

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17
Q

In which anatomic direction should you direct your needle when doing blocks in the distal limb?

A

Distally to avoid the risk of the analgesic moving proximal

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18
Q

How should you judge improvement in diagnostic analgesia cases?

A

Very subjective. Make use of manipulation tests, circles
-aim for 100% improvement. baseline may switch to other side. Should always get 70% improvement or you need to block more to localize

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19
Q

What are some potential complications of perineural analgesia?

A

Perineural: Local swelling (hematoma, inflammation), regional swelling (cellulitis)
Intrasynovial: acute reactive synovitis (flare reaction), hematoma, infectious synovitis

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20
Q

What are some considerations for things to avoid when performing local anesthesia?

A

Blocked horses may be unsafe to ride during exam
-may unintentionally block the motor nerves (elbow, sacroiliac blocks)
-consider if there may be a fracture or incomplete fracture-Don’t block these horses. Image them first!

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21
Q

Describe the palmar digital block.

A

Blocks palmar digital nerves (medial and lateral)
-Blocks out 70-80% of the foot and the coffin joint (not blocking out coronary band)-includes heel, sole, and some of the soft tissue structures
-place needle just proximal to the heel bulbs
-use small volume
-to assess if block was affective, poke around heel bulbs and coronary band

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22
Q

Describe the dorsal ring block.

A

Targets the dorsal branches of the palmar digital nerves
-desensitized the entire foot and pastern
-may be more selective than the abaxial sesamoid block
-this block is not commonly done

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23
Q

Describe the basi-sesamoid and abaxial sesamoid block

A

Targets the palmar digital nerves proximal to their dorsal branching
-functionally similar to PD and dorsal ring block
- fetlock joint block possible with this -be sure not to go too high

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24
Q

Describe the low palmar/low 4 point block

A

Blocks the medial and lateral palmar digital nerves (subcutaneously) as well as the medial and lateral palmar metacarpal nerves (deep/axial)
-careful to avoid fletlock joint and digital flexor tendon sheath
-this block should completely desensitize the fetlock

25
Q

Describe the high palmar/high 4-point block

A

Blocks the medial and lateral palmar and palmar metacarpal nerves
-blocks the carpal-metacarpal joint

26
Q

What is an alternative to the high 4-point block?

A

Lateral Palmar/Wheat block
-requires medial palmar and dorsal ring blocks
-avoids the carpal joints but you are likely to enter carpal canal

27
Q

Describe the distal interphalangeal joint block.

A

Provides analgesia to coffin joint, navicular bursa and toe of sole

28
Q

Describe the navicular bursa block (podotrochlear)

A

Most specific block for navicular problems. Also blocks out toe of sole
-can use radiography to confirm positioning

29
Q

Describe the proximal interphalangeal joint block

A

AKA pastern
Uncommonly performed
-synovial fluid is not commonly retrieved
-use up to 10 mL local anesthetic

30
Q

Describe the proximal metacarprophalangeal joint bock (AKA fetlock)

A

lots of different approaches (dorsal, proximal palmar, collateral sesamoidean ligament)
- 10 mL, evaluate at 10 min

31
Q

Describe the dorsal approach to the carpal joint block

A

Flex leg, can easily palpate joint
- can block proximal and middle (will also block out the distal)
-5-10 mL per joint

32
Q

Describe the low plantar and distal blocks

A

Similar to forelimb counterparts
-action of reciprocal apparatus makes the flexed block more difficult

33
Q

Describe the high plantar block

A

Blocks medial and lateral plantar and plantar metatarsal nerves
-dorsal ring block may be added to abolish dorsal cannon bone pain
-may be used to diagnose proximal suspensory desmitis
-must worry about blocking distal intertarsal joint

34
Q

Describe blockage of the tarsometatarsal joint (hock)

A

Lateral approach
-insert needle just proximal to head of MT IV
-usually does not communicate with distal intertarsal joint

35
Q

Distal intertarsal joint block

A

Difficult
-medial approach
-cunean tendon is marker
-stand on opposite side of horse
-fluid not usually obtained

36
Q

Tarsocrural joint block

A

Communicates with the proximal intertarsal joint
-the saphenous vein overlies the dorsomedial pouch-avoid this

37
Q

How do you inject the stifle?

A

Must inject all 3 joints separately (inconsistent which communicate from horse to horse)

38
Q

What does the image created by a radiograph depend on?

A

Total number of xrays produced -mAs

Film focal distance- FFD (distance of tube to target)

Ability of Xray to penetrate the tissue- kVP

39
Q

What are the main applications of radiography and what are its limitations?

A

Applications: evaluation of bone, some soft tissue

Limitations; 2D image of 3 D object leading to superimposition (take multiple views)
-30-50% change in bone density required for detection of radiographic changes
-superimposition of structures common

40
Q

How should you prepare a horse for radiography?

A

They have to be weight bearing, clean area of interest, use proper restrain (often sedation), center machine on area of interest, be sure to take sufficient views

41
Q

How should you evaluate a radiographic image?

A

Make sure its of adequate quality, the positioning is proper, there are no artifacts
-first evaluate from distance, then follow bone margins
-be sure to recognize breed and discipline differences

42
Q

How can you age a lesion on a radiograph?

A

Difficult!
-new bone growth starts to occur 14 days before radiographic detection
-non-displaced fractures can take 10-14 days to become visible

43
Q

What are some causes of focal demineralization?

A

Infection, osseous cyst-like lesion, chronic pressure, OC defect, neoplasia (not common in horses)

44
Q

Define sclerosis

A

Increased radioopacity of bone
-Response to chronic mechanical stress of inflammation, walling off of infection, protection of weak areas of bone

45
Q

What can contrast radiography be used for?

A

Used to highlight various structures
-can be used to estimate prognosis for a horse with laminitis (venogram)-poor contrast=poor prognosis

46
Q

What are the advantages and disadvantages to using ultrasound?

A

Advantage: excellent soft tissue imaging, can see bone surfaces
Disadvantages: cant penetrate bone or gas

47
Q

What are the main applications for using ultrasound?

A

Assessing tendons and ligaments, menisci, joints (capsule, cartilage surface, fluid), bursae, tendon sheaths, any soft tissue!
-diagnosing lung consolidation in pneumonia cases

48
Q

How should you prep horses for ultrasound?

A

Clean area to be scanned, clip the hair, apply acoustic gel, make sure patient is weight bearing

49
Q

T/F: smaller transducers are best for assessing superficial tissues?

A

False- these get deeper

50
Q

How does nuclear scintigraphy work?

A

Radioisotope is ingested into the animal and it is tagged onto something to get incorporated into tissue of interest
-in the case of horses, we usually do this with bone by tagging it onto phosphorus
-the radioisotopes travel to areas of high metabolic activity
-gamma rays detect radiation

51
Q

What are the indications for using nuclear scintigraphy?

A

Obscure or multifocal lameness
-to assess healing over time

52
Q

What are the phases of the nuclear scintigraphy scan?

A

Vascular phase: image occurs immediately-what you see depends on local blood flow
Soft tissue: image 2-3 minutes post injection when bone uptake is beginning
BoneL 2-3 hours post injection-image depends on blood flow, permeability and the metabolic activity of the bone

53
Q

What are you actually measuring during nuclear scintigraphy?

A

local bone metabolism

54
Q

What are the advantages to nuclear scintigraphy?

A

Very specific for detecting early disease (but not specific), can scan entire body (but not cheap), can be used to monitor healing

55
Q

Describe what CT scanning is?

A

Cross-sectional slices and 3D image reconstructed with computer (eliminates superimposition)
-results in better resolution of bone and soft tissues than radiographs, GA usually required

56
Q

What are CT scans the most useful for?

A

Bone lesions, 3D fracture reconstruction, skull imaging (teeth and sinuses)

57
Q

How are MRI images created?

A

Through excitation of hydrogen nuclei in body by a magnetic field. Energy is released during relaxation of the nuclei
-water and fat have the most hydrogen (high signal shows up white, low=black)

58
Q

Name the advantages and disadvantages to MRI?

A

Advantages: superior to CT for soft tissues, can examine all tissues, excellent anatomical and physiologic info

Disadvantages: cost and size of patient, takes a long time, often have to be anesthetized, need to know where lameness is and if animal has implants

59
Q

What are the main uses for MRI in horses?

A

Imaging from carpus and tarsus distally as well as head and cranial neck

Equine BCM (13 decks)

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