Lab Midterm Flashcards
What method of ventilation use requires us to provide more extensive monitoring and nursing care for our patients
Mechanical ventilation
What is the true first step of resuscitation
Alerting other team members to the crisis and move the patient to a centralized area where the crash cart and oxygen are accessible
What can be used as a good indicator of effective chest compressions
End tidal carbon dioxide (ETCO2) and it should be above 10-15 mmHg
T/F it is acceptable to pause chest compressions for catherization and intubation
FALSE chest compressions should not be stopped for any reason
What does excessive ventilation of the patient during cardiopulmonary resuscitation cause
Cerebral vasoconstriction and decreased blood flow to the brain
What drugs are safe to administer via the endotracheal tube
Naloxone, atropine, vasopressin, epinephrine, lidocaine (NAVEL)
What should be monitored in patients that survived CPR
Assessments for neurologic signs and for developing organ failure
Why should patients be monitored more closely when anesthizied w/ sevoflurane
It can cause hypotension and it has a more rapid response time
What are general rules of thumb when handling compressed gas cylinders
Never leave an unattended compressed gas cylinder unsupported or lying on its side, never attempt to remove the valve or index pins, keep skin and eyes clear of the valve port when opening a tank, and do not use oxygen near any ignition source
How much liquid anesthetic should be in the vaporizer for the vaporizer to function properly
The quantity of the liquid anesthetic should fill between the upper and lower lines of the window but should be at min 1/2 full at all times
What will overfilling the vaporizer w/ liquid anesthetic result in
Anesthetic overdose
What will underfilling the vaporizer w/ liquid anesthetic result in
The inability to keep the patient anesthetized
What should be checked if there is a sudden elevation in the patients ETCO2
The unidirectional valves
What should be checked prior to placing an ET tube
The length, diameter, cuff, if the connector is loose, if the tube is damaged, or blocked w/ dried mucus
What is anesthesia used for in most veterinary practices
To provide anxiolysis, sedation, tranquilization, immobility, muscle relaxation, unconsciousness, and pain control
What are the benefits of balanced anesthesia
Minimizes adverse effects and gives the anesthetist the ability to produce anesthesia w/ the degree of CNS depression, muscle relaxation, analgesia, and immobilization
What must an anesthetist approach every anesthetic procedure w/
A genuine willingness to take personal responsibility for the well being of the patient
What can decrease unforseen problems during anesthetic procedures
Scheduling an appointment several days before the procedure to accumulate a patient database so problems can be addressed before hand
What type of questions are the most important when obtaining a patient history
Open ended questions
WHat are the 4 questions that should be asked when gathering historical information about signs of illness
The duration, the volume/severity, the frequency, and the character/appearance
What should you always confirm when checking in a patient undergoing an anesthetic procedure
The nature of the scheduled procedure
What type of patients respond differently to anesthetic procedures
Very large, very small, <8 weeks old, or older patients that are >75% of their lifespan
What should be collected from every owner prior to the anesthetic event occurs
A written estimate of the expected charges and signed consent for the procedure
What are the 2 reasons for monitoring our patients under anesthesia
To keep the patient safe and to regulate anesthetic depth
What is anesthetic monitoring based off of
That in the average patient there is a parameter for what is expected to show to predict the response at any given anesthetic depth
What marks the border between anesthetic stages 1 and 2
Loss of consciousness
What marks the border between anesthetic stages 2 and 3
Loss of spontaneous muscle movement
What marks stage 4 of anesthesia
Loss of all reflexes, widely dilated pupils, flaccid muscle tone, and cardiopulmonary collapse
What is stage 1 of anesthesia
The period of voluntary movement
What is stage 2 of anesthesia
Period of involuntary movement
What is stage 3 of anesthesia
Period of surgical anesthesia
What is stage 4 of anesthesia
Period of anesthetic overdose
What are the 3 subdivied stages of the 3rd anesthetic stage
Light, surgical, and deep
What words are used to describe the status of reflexes verbally or written
Present, decreased, depressed, and absent
What is the main indicator of determining when it is safe to remove the ET tube
The swallowing reflex (response to the presence of saliva or food in the pharynx
What reflex should be absent in small animals under surgical anesthesia
The palpebral reflex (blink in response to a light tap on the medial or lateral canthus)
What reflex is present during light stage 3 anesthesia
The pedal reflex (flexion or withdrawal of the limb in response to vigorous squeezing and twisting or pinching of a digit or pad)
When is monitoring for the pedal reflex important
In patients undergoing masked induction
What reflex is lost when the anesthetic depth is excessive but is unreliable in small animals
The corneal reflex (retraction of the eyeball w/in the orbit and/or blink in response to stimulation of the cornea)
What is the laryngeal reflex
Immediate closure of the epiglottis and vocal cords when the larynx is touched
What is the pupillary light reflex
The PLR is a constriction of the pupils in response to shining a bright light onto one of the retinas
What is the dazzle reflex
A blink response to shining a bright light on the retinas
How can an anesthetist falsely interpret the muscle tone of an induced patient
If the open the patients mouth too wide causing a force of resistance
What is the position of the patients eye during light stage 3 anesthesia
Central
What is the position of the patients eye during surgical anesthesia
Ventromedial
What is the position of the patients eye during deep stage 3 anesthesia
Central
T/F HR, RR, Vt, and BP are NOT accurate indications that their is a conscious perception of pain in my patient
True other signs have to be present to indicate a perception of pain
What are the objectives of surgical anesthesia
The patient does not move, is not aware, does not feel pain, has no memory of the procedure afterward, and does not have dangerous depression of the cardiovascular and respiratory systems
What are the major effects and adverse effects of halogenated inhalation anesthetics
Dose related CNS depression, hypothermia, paddling, excitement, and muscle fasciculations during recovery, variable effect on HR, vasodilation, hypotension, decreased cardiac output, tissue perfusion, dose dependent respiratory depression, hypoventilation, retention of CO2, respiratory arrest, adequate to good muscle relaxation, depression of respiration in neonates, and production of CO when exposed to desiccation CO2 absorbent
What type of anesthetics are generally considered safe to give most patients
Halogenated
What does the safety of anesthetics depend on
The degree of the care at which the agents are administered and the vigilance in the monitoring of the patient
What is vapor pressure
A measure of the tendency of a liquid anesthetic to evaporate in the vaporizer
What does the vapor pressure level (number) mean
The higher the vapor pressure the more easily the liquid evaporates the lower the pressure the harder it is for the liquid to evaporate
What is the blood gas coefficient
A measure of the solubility of an inhalant anesthetic in the blood as compared w/ alveolar gas
What does the blood gas coefficient valuse (number) represent
The lower the blood gas partition coefficient the faster the patients induction and recovery the higher the number the slower their induction and recovery
What does MAC stand for
Minimum alveolar concentration
What is MAC
The lowest concentration at which 50% of patient show no response to a painul stimulus such as a surgical incision
What is MAC useful for
Meausring the potency of the agent used and to determine the average vaporizer setting that must be used to produce surgical anesthesia
Why is isoflurane the inhalation agent of choice for patients w/ heart disease
Because it has the fewest adverse cardiovascular effects
Why is sevoflurane the inhalant agent of choice for mask and chamber inductions
Because of its high controllability of anesthetic depth
Why is desflurane considered the one breath anesthesia
Because the blood gas parition coefficient is significantly lower than other anesthetic agents used it appears the patient becomes anesthetized or wakes up after taking one breath
What does 1 drop of doxapram equal
1 mg
What quantity of doxapram is required to stimulate respiration from a neonate
1-5 drops under the tongue of a puppy and 1-2 drops under the tongue of a kitten depending of the size of the patient and the degree of depression
What should be done at the beginning of the day by the anesthetist
The primary and secondary oxygen tanks should be evaluated to ensure they are full, operational, and turned on
What are things to remember when handling compressed gas cylinders
Avoid contact w/ flames, sparks, or other sources of iginition, turn the tank on only when it is attached to the yoke or pressure regulator, store tanks only attached to a yoke, secured in a cart, or rack (specified for this), or chained to a wall, never attempt to attach a tank to a yoke that does not fit, and never tamper w/ the safety system on a tank, line, or pressure reducing valve
How can the volume of an oxygen tank be calculated
By multiply the psi of an E tank by 0.3 and an H/J tank by 3
How should one turn off a flowmeter
Turn the knob until the bobbin or ball reaches 0
What should occur if a bottle of liquid anesthetic accidentally breaks
Vacate the room until it has completely evapoated
What is important to do after using a non rebreathing system
Reattaching the port in the common gas outlet
What happens to the pop off valve before and after giving a manual breath
Before giving a breath it is closed and is opened immediately after giving a breath
How full should the reservoir bag be during a procedure
3/4 of the way full at peak expiration
What are the signs of needing to change CO2 granules
Hard/brittle granules, color change to 1/3 to 1/2 of the granules, CO2 level greater than 0 during peak inspiration (measured w/ a capnograph), after 6-8 hrs of use, after 14-30 days, and if oxygen flowmeter was left on overnight or for any equivalent period of time
What are the maximum measurements on a pressure manometer that are considered safe
0-3 cm H20 when the patient is breathing spontaneously and 20 cm H2O in small animal swhen positive pressure ventilation is provided
When are pediatric tubes recommended for use on a rebreathng system
When the patient weights 15-30 lbs
What does the patients body weight determine when setting up the anesthetic machine
The choice of machine, reservoir bag size, breathing tubes, oxygen flow rates, and breathing circuit
Why do we increase the flow rate when changing the anesthetic depth w/ a partial or minimal rebreathign system
Do change the depth quicker
How often should a qualified repair professional examine all of the parts on an anesthetic machine
Every 4-12 months
Why should technicians double check their CRI calculations regardless of how they were obtained w/ either the CRI calculator provided by the VAPM via website or app
Due to the high risk associated w/ giving drugs via CRI incorrectly
Why should a patients ET tube be temporarily disconnected when turning the patient
Because rollowing or twisting the animal while it is still connected may cause the endotracheal tube to twist or collapse resulting in an airway obstruction, or traumatizing/lacerating the trachea
How often should a technician administer artifical tear solution to the cornea of a patient
Every 2-4 hrs because general anesthesia decrease tear secretion for up to 24 hrs post op
When is the most dangerous period for complicaitons for animals that experienced no problems during induction or maintenance
During recovery
Why should a recovering patient be watched continuously at close range
Because they may develop hypoxemia, cardiac arrhythmias, or other complications w/o any signs
When should recovering patients be supplemented w/ oxygen
If shivering occurs
Why should a patients head be positioned w/ the nose slightly lower than the neck
When the patient is undergoing a COHAT or other oral surgery in which blood or fluids are present in the oral cavity to prevent any from draining in the trachea
How often should a recovering patient be turned
Every 10-15 mins to prevent hypostatic congestion
What is hypostatic congestion
Pooling of blood in dependent lung and tissues
What is the goal of inhalant anesthesia
To deliver a safe concentration of an anesthetic agent w/ oxygen to the patient along w/ providng a method for assisting ventilation
What are the different oxygen tank sizes
E tank (660 liters) and H/K tanks (6,600 liters)
What color represents oxygen
Green
What color represents nitrous oxide
Blue
What is the direct safety soure used for compressed gas sources
The pin index safety system that only allows one type of tank to be attached to the yoke
What is the central safety source for gas lines
The diameter index safety system only allows for a certain plug shape and diameter to be entered into the wall
What is the pressure regulator
Attached to the compressed gas source it reduces pressure from the tank to constant pressure of 50 PSI
What is the pressure gauge
It reflects the amount of gas remaining in the tank
What is the flowmeter
It controls the rate the oxygen or nitrous is being delivered to the patient’s breathing system, takes the pressure from 50 PSI to 15 PSI, is meausred by a bobbin or ball, and is also color coded
What is specially about the knob on the flowmeter
It is very sensitive so turn it carefully and ONLY until the bobbin/ball reaches 0 when turning it off
What is the oxygen flush valve
It delivers fresh oxygen into the system at 35-75 L/min bypassing the vaporizer and delivers the oxygen directly to the common gas outlet
What must happen prior to using the oxygen flush valve
The patient HAS to be detached from the breathing circuit
What is the vaporizer
It holds liquid anesthetic and coverts it into a breathable gas these are also color coded (purple = iso and yellow = sevo)
What is the difference between a precision and non precision vaporizer
A precision vaporizer has a dial to give a consistent anesthetic rate to the patient while a non precision vaporizer functions based on the patients breathing so it is not consistent
How often should a vaporizer have maintenance done
Yearly
What is the common gas outlet
The fresh gas outlet is the point of exit from the oxygen and anesthetic gas to enter the patient breathing circuit this is where a non rebreathing system is attached
What comprises the breathing circuit
Common gas outlet, inhalation valve, inhlation hose, ET tube, exhalation hose, exhalation valve, reservoir bag, poop off valve, and scavenging
What are the parts of the 3 way stop
Pop off valve/scavenging, CO2 absorbent cainster, and reservoir bag
What is the pop off valve
The pressure releasing valve allows for the release of excess pressure from the system into the scavenging system this is for our safety
What are the 2 types of scavenging systems
Passive and active
What is the passive scavenging system
Uses gravity/pressure of gas in the system by using F-air canisters that are filled w/ charcoal and it is the most common type
What is the active scavenging system
A vacuum system that pulls the air outside it is significantly more expensive
What is the CO2 absorbent canister
It removes the CO2 from the exhaled gases before returing it to the patient and it contains soda lime granules
How do we calculate the reservoir bag size
Weight in lbs x 30 = amount in mls then convert to liters
What is the pressure manometer
Monitors the pressure w/in the breathing system this is very useful when giving positive pressure
What is the PPV range
15-30 average is 20 mmHg to prevent barotrauma
What is the rebreathing system
Used for 15+ lb patients it allows for safe rebreathing of exhaled gases, it is more common yet more complicated, it utilizes unidirectional valves, contains more dead space, but is better at maintaining a patient’s temperature
How do we calculate the oxygen requirement of patients when using a rebreathing system
20ml/lb/min + 250 mls
How do we calculate the oxygen requirement of patients using a non rebreathing system
100mls/lb/min
What is the non rebreathing system
recommend for patients 15lbs and under, no rebreathing of gases, utilizes a higher oxygen rate, minimizes dead space, allows for a rapid change in depth, wastes more oxygen and anesthetic agent, and has a higher rate of drying out the mucosa and respiratory tract
What prevents the risk of increase CO2 in patients using an NRS
A high oxygen flow rate
Why is the non rebreathing system better for smaller patients
Because there is a lower resistance of breathing and less effort for the animal to get gas exchange
What are the differences between having a pop off valve open or closed
An open pop off valve is more expensive using more oxygen but is safer while a closed pop off valve only uses enough oxygen to meet the patients needs, it is cheaper, but risks an unsafe build up of nitrogen leading ot hypoxia
What is the difference between the VOC and VIC system
The vaporizer out of cicle uses a precision vaporizer that is more expensive but much more common while an vaporizer in circle uses a non precision vaporizer which is more dangerous but inexpensive
What things on an anesthetic machine should be checked prior to anesthetizing a patient
Flow meter, quantity of iso, oxygen, and soda lime
What do you multiple the MAC by to find the approximate vaporizer setting
1.5-2 but things like age, premeds, and body condition can affect this
What are the typical properties of isoflurane
Higher vapor pressure, lower solubility, and medium MAC
How does isofluarne tend to affect the patients body
Causes vasodilation leading to hypotension, can be irritating causing dry mm (respiratory depression, and metabolisim occurs in the respiratory system so it is safest for liver patients
What are the properties of sevoflurane
Higher vapor pressure, lower solubility, and highest MAC
What is the primary difference w/ how sevoflurane affects the patients body
It does not typically dry out/irritate the mm
How can nitrous gas affect our patient
It doesn’t irritate the respiratory tract, can provide analgesic effects, and can cause CO2 poisoning
What is the weight range for a pediatric y tube
30-13 kgs
What are signs of compensatory shock
Increase HR, inrease in RR/depth, decrease in BP, vasoconstriction, bounding pulse, CRT >1sec, and red mm
What are signs of decompensatory shock signs
Pale mm, weak threading pulse, decrease in HR, decrease in RR, and vasodilation
Which comes first respiratory arrest or cardiac arrest
Respiratory arrest
What are signs of respiratory arrest
Dyspnea, apnea, abnormal CRT, abnormal HR, abnormal pulses, and cyanosis
What are signs of cardiac arrest
No palpable pulse, no palpable or audible heartbeat, no muscle tone, dilated pupils, lack of PLR, cyanosis or pale mm, and prolonged CRT
What is the equation for a patient needing compression
Unresponsive + apneic = compression
What is the difference between BLS and ALS
ALS involves drugs and electrical cardioversion
What things can be monitored during CPR
ECG, doppler BP, ETCO2, and blood gas analysis
How are you positioned when giving CPR to cats
Fingers on the down side and thumb on the up side
What is different about giving a large dog CPR
You compress at the widest portion of chest
What is different about giving a barrel chested dog CPR
They are in dorsal recumbency, the anatomy limits the direct effect of compressions, and place your hands 1-2” above the xiphoid process
What is the thoracic pump method
When you increase intrathoracic pressure during compression results in forward blood flow
How do you evaluate the effectiviness of compressions
Palpable pulse and doppler placed on the cornea
What is the preferred method for administer medication during a code
Central line
How many tubes should you have ready for intubation
At least 3
How do you measure the length of the ET tube
From the tip of the nose to the thoracic inlet
What are indications that a patient is ready for intubation
Unconsciciouness, lack of voluntary movement, absent pedal reflex, sufficient muscle tone relaxation to allow the mouth to be held open, and no swallowing reflex
What can placing the ET tube in the esophagus and not catching it potentially lead to
Inability to keep the patient anesthetized, airway blockage, and hypoxemia
How do you inflate the cuff w/ cats
Use a 3 ml syringe and add air in 0.5mls increments until no leak is heard
Why are we extra careful when intubating cats
They have a narrower glottis and random laryngospasms when the larynx is irritated
What are tips to intubating a cat successfully
Ensure that the patient is adequately anesthetized, wait for the glottis to open before attempting placement, and try to get it in the first time
What are life threatening complications that can occur in a cat if you try and force an intubation
Tracheal rupture, pneumothorax, and pneumomediastinum
Why should owners be informed that it is not uncommon for animals to cough 1-2 days post intubation
Because some patients will always develop minor irritation of the trachea or larynx
What could happen if a patient is intubated w/ an ET tube that is too long
They could be oxygenated w/ only one lung or the mechanical dead space could be increased both leading to hypoxemia
What can be used during the recovery period if an animal is caught chewing or traumatizing various areas
parethesia or e collars
What route can bupivacaine not be given
IV
What is the max dose of 2% iso given to a 4 kg cat SQ or IV
0.8 mls SQ and 0.1 IV
What is the max dose of 0.5% bupivacaine to a 4 kg cat SQ
0.8 mls
What is the respiratory volume
The amount of air that moves in and out of the lungs in one minute
How can you roughly find the respiratory volume
By taking the Vt and multiplying it by the RR
Why do some alveoli in dependent regions of the patients lungs completely or partially collapse
Due to a decreased Vt
How can we keep alveoli expanded during a procedure
Giving sighs or manual ventilation every 2-10 minutes
What are the principles of patient monitoring
Monitor the patient frequently using your hands, eyes, and ears, always check multiple parameters, never depend on an instrument alone, and do not try to determine the plane of anesthesia based on the drug dose
Why do we intubate patients
To maintain an open airway, decrease anatomic deadspace, transportation of the gas to the patient to prevent WAG, prevent aspiration of foreign material into pulmonary system, and monitor and control respiration during anesthesia
What are the different things to take into considering when choosing a tube
Clean and dry, cracks, flexibility, cuff or no cuff, sizing, diameter, and construction
What are the different materials ET tubes are made of allowing for varying flexibility
PVC (most common), red rubber tubes (most prone to kinking), and silicone (most expensive)
What is the ID on the ET tube
The internal diameter is referred to as oral this is the larger bolder of the too numbers
What is the OD on the ET tube
The outer diameter is referred to as the nasal this is the small of the too numbers
What is the very tip of the ET tube that goes into the patient called
The bevel
What piece of the tube greatly makes up the ET tube
The radiopaque line
What is the one way valve
Where you screw in the syringe to inflate the cuff
What follows the one way valve on the ET tube
The pilot balloon
What transports the air from the pilot balloon to the cuff
The pilot line
How do you determine the diameter of the ET tube
It should fill the area below the nares w/ the whole of the connector of the tube
What are characteristics of the murphys ET tube
Beveled end, side hole known as the murphys eye, and +/- cuff
What are the characteristics of the cole ET tube
No side hole, decreased diameter at the patient end, and used in animals that have complete tracheal rings such as birds
What are the steps of intubating
Open mouth to visualize the larynx, located the epiglottis, insert tube through the larynx and trachea, tie the tube in place, inflate the cuff, connect to anesthetic machine, and verify placement by auscultation
What is the maximum amount of air to place in the cuff of a dog or cat
5 cc for dog and 3 cc for cat
What are operator error complications of intubation
Trauma, laryngospasm, and over inflation of cuff
What are the steps for extubation
Discontinue inhalant, leave on oxygen for 5 mins, loosen gauze tie, deflate cuff immediately before extubation, remove the tube once the swallow reflex has returned, and inspect tube
