Medical Nursing And Anaesthesia Flashcards

Question

Characteristics of a malignant tumour

Answer 1

Fast growth rate Undefined boundaries and may spread to adjacent tissues Metastasis Often life threatening due to destructive nature and metastasis into vital organs Growth and invasion into adjacent tissues or destruction of bone Paraneoplastic effects due to release of physiologically active components

Answer 2

When first detectable as already began to slow down growth

Answer 3

Blood -> liver and lungs Lymphatics -> local then regional lymph nodes Transcoelomic -> across pleural of peritoneal space Iatrogenic -> seeding during FNA or trucut

Answer 4

Haematological complications Hyperhistaminaemia By-stander immune mediated reactions Hypercalcaemia

Answer 5

``` Oestrogen producing cells are affected Bone marrow affected Non regenerative anaemia - lethargy, weakness, dyspnoea Thrombocytopenia - bleeding Leukopenia - infection risk ```

Answer 6

Mast cells produce: Histamine to stomach - anaphylactic shock Proteases which prevent healing - delayed wound healing post sx Heparin which prevents clotting - localised bleeding Vasoactive amines - excess acid production and ulcers leading to peritonitis Oedematous swelling with erythema and pruritis

Answer 7

IMHA - secondary - fragmentation causing shistocytes, neuropathic so, myasthenia gravis Skin disease - cats with pancreatic cancer lose hair and go shiny

Answer 8

Tumours release parathyroid hormone related peptide (PTHrp) which increases calcium conc -lymphosarcoma, anal sac adenocarcinoma, multiple myeloma

Answer 9

``` History Exam Lab tests Diagnostics FNA Biopsy Can only make accurate diagnosis by histological exam of the cells collected from the tumour ```

Answer 10

T - tumour size and invasiveness N- spread to lymph nodes? M - metastasis

Answer 11

Most effective treatment option | Debulking a mass that can't be removed completely increases cell turnover and improves the response to chemo

Answer 12

Limited availability and expensive Gamma or beta rays emitted close to tumour - brachytherapy Radiation from external bea, directed at the tissue from a fixed distance - teletherapy May need repeating Side effects - neural necrosis, osteonecrosis, skin reddening, dermatitis, localised hair loss, dermal fibrosis

Answer 13

Cytotoxic drugs kill a fixed % of cells Use highest possible dose that is safe to use Not effective in advanced disease Combination chemo Dangerous drugs to people - risk assessments

Answer 14

Anti-metabolites Alkylating agents Anti-tumour antibiotics - damage nucleic acids Vinca alkaloids - damage microtubules Tyrosine kinase inhibitors - stop cell signals Platinum compounds Enzymes

Answer 15

Repeated intervals to allow normal tissue to recover 3 week cycles Doses done by surface area rather than body weight so large animals aren't overdosed

Answer 16

Induction- decrease tumour burden to undetectable levels Maintenance - maintain remission after induction but debatable if necessary Rescue - if does not respond or relapses give more aggressive therapy. Second remission is harder to achieve and animal eventually becomes resistant to the drugs

Answer 17

The tumour has to be systemic and have a high growth rate - lymphoma Sarcoma, carcinoma and melanoma are resistant as too slow growing

Answer 18

Cyclophosamide Oncovin Prednisolone +/- doxorubicin

Answer 19

GI toxicity Myelosuppression Phlebitis Cyclophosphamide - sterile haemorrhagic cystitis Doxorubicin - cardiotoxicity, maximum cumulative dose is 240mg/m2 Cisplatin - nephrotoxicity

Answer 20

IVFT Antiemetics Gastroprotectants Chlorhexidine mouthwash

Answer 21

Bone marrow suppression Can lead to neutropenia and life threatening sepsis Routine haematology needs to be done before each chemo treatment

Answer 22

Many dugs are irritant or vesicant Check IV catheter first Place IV catheter first stick so no holes for drugs to move out of veins and go subcut

Answer 23

``` Stop giving drugs Aspirate drug and flush with saline to dilute Draw back blood and remove IV IV hydrocortisone Cold compress Antidote for some drugs but is expensive ```

Answer 24

Most common in dogs Multicentric lymphoma Can't treat with sx as systemic Chemo

Answer 25

Intracranial cavity is 80% brain, 10% CSF, 10% blood If any increase, pressure increase causing seizures, papilloedema and depressed state Blood brain barrier disrupted by trauma, inflammation and hypertension Brain gets 15% cardiac output

Answer 26

Influenced by cerebral perfusion pressure, PaO2, PaCO2 and cerebral metabolic activity Cushing reflex - decreased heart rate and increased Bp Cerebral perfusion pressure - pressure gradient between MAP and ICP Cerebral blood flow autoregulated MAP 50-150mmHg Coughing, v+, occluded jugular vein increase venous outflow pressure

Answer 27

4% increase of cerebral blood flow for 1mmHg increase of PaCO2 Intracerebral steal - vasodilation of undamaged vessels shunts blood away from damaged area as the damaged areas can't autoregulate Inverse steal - vasoconstriction of undamaged blood vessels shunts blood to damaged areas Hypoxia can cause vasodilation

Answer 28

``` Elevate head at 35 degree angle Mannitol - osmotic diuresis but can cause dehydration. Increases Blood flow so pressure decreases IPPV ETCO2 should be 30mmHg - capnography 100 O2 gas Preoxygenate and O2 on recovery Seizure watch - plans on kennel Anticonvulsants Bp ```

Answer 29

Watch the airway to make sure when neck is bent ET tube is not kinked and airway is not occluded

Answer 30

Dexmedetomidine, sevo and ket have cerebral protectant effects ACP - vasodilator so can increase ICP by increasing venous outflow Barbiturates and hypothermia can decrease cerebral pressure Potassium bromide can cause electrolyte imbalances

Answer 31

Multi organ dysfunction PuPd Muscle weakness Hypertrophic cardiomyelopathy - avoid stress ECG IVFT Thermoregulation Opioid with ACP Avoid ket as increases cardiac contractility and predisposes to arrhythmias Avoid Dexmedetomidine as causes bradycardia Monitor ca2+, laryngeal paralysis and hypocalcaemia common post op

Answer 32

``` Dogs Megaoesophagus Decreased GI motility Obese and lethargic Bradycardia and hypotension Slow biotransformation of drugs Hypothermia risk Monitor cardiovascular system ```

Answer 33

``` Pituitary tumour Overweight and lethargic Poor thermoregulation Bruising Risk of pulmonary thromboembolism - hypercoagulability - extreme clotting PuPd - Na retention and K excretion Risk of wound infection May or may not be on medical tx ```

Answer 34

``` Hyperkalaemia Bradycardia Dehydration Weight loss Lethargy Stabilise before GA ```

Answer 35

Aspiration and regurgitation pre disposition Check gag reflex Resp muscles may be affected - IPPV Check capnography Paradoxical breathing, low sao2, hypercapnia Sternal recumbancy and elevated head on recovery Myasthenia gravis so exaggerated response to NMBAs

Answer 36

``` Stabilise Dehydration a concern - IVFT Possible regurg Avoid morphine as causes v+ Cuff ET tube to prevent aspiration if regurg Pre GA radiographs to check for rupture Elevate head Suction for intubation Don't give but/bup incase of pneumothorax Analgesia ```

Answer 37

``` Stabilise Avoid morphine Cuff ET tube Dehydration, hypovolaemia and acid base disturbances - IVFT Slow release of fluid from abdo, too fast will decrease blood pressure, but too much fluid puts pressure on diaphragm Monitor resp system Avoid nitrous oxide as fills dead space Heat loss ```

Answer 38

Emergency Shocked patient IVFT in large vol to support cardiovascular system Decompress stomach to relieve pressure on diaphragm Sx Arrhythmia - pre op from pain and hypovolaemia - post op from release of inflammatory components and potassium Watch for h+ as usually clotting abnormalities BG checks Bp usually okay but perfusion poor Intensive post op care

Answer 39

Endotoxaemia Fluid and electrolyte abnormalities Distended viscera - ventilation compromise NSAIDS, xylazine, opioids Hartmanns Decompress stomach Ippv - decreases cardiac output so not good if low Bp

Answer 40

Portosystemic shunt, biliary obstruction, trauma Liver produces a large amount of heat so when slow metabolism, prone to hypothermia Albumin binds to GA drugs so decreased albumin means more free fraction so lower doses needed Decreased clotting factor so h+ risk Decreased hepatic clearance of drugs - use short acting ones BG checks - predisposed to hypoglycaemia Pre GA blood tests - plasma proteins, glucose, bile acid, liver enzymes, clotting, urea Medical management of encephalopathy Monitor inbalances and blood loss - water and na retention, k excretion CVP BP Thermoregulation Avoid hypoxia and hypercapnia Ga drugs cause hypotension, hepatotoxicity and enzyme induction

Answer 41

``` BG checks Hypoglycaemic - avoid hyperglycaemia pre op as stimulates insulin release - avoid dexmedetomidine NMBA Avoid nsaids Prednisolone post op Post op pancreatitis risk ```

Answer 42

``` Stabilise 1/2 dose insulin as starved 1st sx of day BG checks Needs to eat post op so find out fav food Give second half of insulin after eaten Quick recovery so short acting drugs Avoid medetomidine - hyperglycaemia IVFT incl glucose ```

Answer 43

During inspiration Pa > Palv Air moves in and alveoli create a -ve inspiratory pressure as e alveolar volume increases Diaphragm contracts and thorax expands During expiration Palv > Pa Thorax recoils and diaphragm relaxes creating positive pressure in the alveoli and air moves out

Answer 44

Vt x resp rate | Vt = 10-15mL/kg

Answer 45

Change in volume for any given pressure The ability to stretch Pressure for a small cat will cause lungs to expand too much whereas the same pressure in an obese dog will cause barely any movement in the lungs

Answer 46

``` Higher brain centres - cerebral cortex Respiratory centres - medulla and pons Peripheral and central chemoreceptors Stretch receptors in lungs Irritant receptors Receptors in muscles and joints ```

Answer 47

Failure to breathe - drugs ( opioids, NMBAs) | Control damage - cervical lesion or tetanus

Answer 48

``` Low O2, high CO2 Drug induced resp depression Mechanical impairments - open thorax V/q mismatch Lung disease - asthma causing bronchospasm ```

Answer 49

Prevent respiratory exhaustion Icu cases Poor ability to breathe - aspiration pneumonia

Answer 50

Oscillating of lungs 400-500/minute O2 passively diffuses in lungs

Answer 51

Inverse mechanism | Create +ve pressure on inhalation

Answer 52

Rebreathing bag / ambu bag Demand valve Short inspiration Assess thoracic movements

Answer 53

``` Pros Easy, economic Less harmful Easier to adapt to patients Not dependant on conditions ``` Cons Depends on operator - hard to be consistent Irregularity of breaths Poor control of ventilatory parameters

Answer 54

``` Pros Automatic Regular breaths Ventilatory parameters controlled Allows different types of ventilation Additional features - PEEP to prevent lung collapse at the end of expiration ``` Cons Requires equipment and power supply Complicated to operate Injury risk

Answer 55

Continuous mandatory Intermittent mandatory - if patient stops breathing then it takes over Synchronised intermittent mandatory - will try to mimic normal breathing pattern of patient

Answer 56

PEEP - positive end expiration pressure PSV - pressure support ventilation CPAP - continuous positive airway pressure

Answer 57

Pressure controlled is used when risk of volume trauma e.g. Open thorax Lots of pressure immediately causing lungs to expand quickly at first and then progressively

Answer 58

Decreased cardiac output decreased venous return causing a direct effect on the heart Poor perfusion of organs - use higher resp rate but careful with Vt as increase pressure of venous system Increased sympathetic, RAa system and ADH Acute trauma to the parenchyma - barotrauma Shear stress effect - volutrauma ventilator induced lung injury (VILI). If ventilated for long period of time causes alveolar inflammation Oxygen effects - ideally 100% for less than 6hrs to avoid radical issues Acid base disturbances High pressure won't cause injury but high volume will

Answer 59

``` Breathing frequency Tidal vol / minute vol I:E ratio Inspiratory time or expiratory time Inspiratory flow rate - amount of vol/unit of time Peek inspiratory pressure Positive end expiratory pressure ```

Answer 60

Breathing rate x tidal volume Breathing rate =60/(inspiratory time + expiratory time) Tidal volume = inspiratory time x inspiratory flow rate

Answer 61

Time triggered - set expiratory time Pressure triggered - negative pressure generated by patient causes expiration Volume triggered - set expiratory volume Flow triggered - detection of a decrease in expiratory flow

Answer 62

Time cycled - set inspiratory time Pressure cycled - changeover when predetermined pressure reached Volume cycled - changeover when predetermined volume reached Flow cycled - changeover when flow decreased to predetermined value

Answer 63

Safety, set maximum value of either pressure, volume, flow | Can stop inspiration prematurely if max pressure is reached

Answer 64

Bellow connected to bag port Ascending bellow - detection of air leak if does not go fully up PEEP Time cycled or pressure limited Equine - pressure cycled or pressure limited

Answer 65

Newton valve Action depends of flow from ventilator Associated with ventilator Tidal vol depends on fresh gas flow and time of occlusion of thumb Blocks flow - changing the flow rate will have an impact on vol and pressure in the airways

Answer 66

Proportional flow valve - electronically timed and activated Or has a pneumatically timed oscillator Divides the driving gas up into tidal volumes of a set size and rate

Answer 67

Collect continuous flow of gas into a pressurised reservoir Delivery to patient under positive pressure Fresh gas flow is the intended minute volume Expensive in terms of fresh gas flow

Answer 68

Close APL valve

Answer 69

1:2 | Short inspiration of 1 second

Answer 70

Spirometry Capnography Blood gas analysis

Answer 71

Need to make sure spontaneous breathing is possible Antagonise NMBA Decrease respiratory depressant drugs like opioids Allow co2 to increase, decrease ventilation from ventilator

Answer 72

``` Pre-med - alpha 2 and methadone Induce propofol or alfaxalone Radial ulnar musculocutaneous nerve blocks or brachial plexus nerve blocks NSAIDs Methadone post op ```

Answer 73

Premed - alpha 2 or ACP and methadone Propofol or alfaxlone induction ISO NSAID with premed as not expecting lots of blood loss - if worried about perfusion give post op

Answer 74

``` ACP and bup Propofol or alfaxalone Sevo for quick recovery NSAID post op Intratesticular nerve block ```

Answer 75

``` Alpha 2 and methadone Epidural of bupivicaine and morphine lasts for 6 hours - beware of skin infections and clotting abnormalities Morphine can cause urine retention Propofol or alfaxalone ISO Methadone post op or fentanyl cri ```

Answer 76

``` Alpha 2 ( xylazine, rimifadine, dexmed) and opioid (but/bup) Intratesticular nerve block - lidocaine NSAID ```

Answer 77

Level of gas in blood Tells you if there's an obstruction or leak How adequate the ventilation is Cardiac output - decrease CO, decrease ECO2 Rebreathing V/q mismatch Alveolar dead space - mismatch between blood and alveolar co2 Equipment failure

Answer 78

Low ventilation but there is perfusion Atelectasis Mucous plugging

Answer 79

High ventilation but poor perfusion Pulmonary embolism Hypovolaemia, low cardiac output - cardiac arrest

Answer 80

30-43 mmHg due to V/Q mismatch | It is the highest level of excreted CO2 which is closest to CO2 in the blood

Answer 81

Expiratory upstroke - gas from alveoli breathed out Alveolar plateau - slanted. CO2 continuously excreted into alveoli so as they get smaller the CO2 conc increases Inspiratory limb- inspiration Alpha angle - increases as slope of plateau increases. Function of the degree of v/q mismatching Beta angle - should be 90 degrees

Answer 82

Phase IV Obese patients Poor thoracic compliance Fast alveoli empty quickly at beginning so have high conc of CO2 at the end

Answer 83

5mmHg | Greater than this and means alveolar dead space

Answer 84

``` Heart rate, Bp, temp increases Ga too light Inadequate ventilation Increased cardiac output increases transfer of CO2 from periphery to lungs Increase body temp or metabolic rate ```

Answer 85

Heart rate or Bp decreases as will reduce O2 production Excessive ventilation Decreased cardiac output or metabolic rate Pulmonary embolism Leak in machine or circuit

Answer 86

Check notes

Answer 87

Check notes

Answer 88

Check notes

Answer 89

Check notes

Answer 90

Check notes

Answer 91

Check notes

Answer 92

Check notes

Answer 93

Can give false high reading if carbon monoxide or paracetamol toxicity Doesn't tell you how many rbc there are just how effective they are Vasoconstriction, movement and dark mm give false readings

Answer 94

Does not give cardiac output or pulse quality | Heart rate variability is the interval between the R-R waves. Indicator of nocioception - becomes less variable.

Answer 95

``` Pain Artefact Diathermy Hypoxaemia Hypercapnia Hypotension Hypo/hyperthermia Electrolyte abnormalities ```

Answer 96

Appropriate PQRST wave with each beat

Answer 97

P waves with a few normal PQRST complexes. Treat with atropine

Answer 98

P waves with an abnormal QRS complex every so often as myocardium is firing without a signal

Answer 99

No P wave Ventricular premature contractions caused by stimulation of the myocardium No mitral valve closure Lidocaine cri as sodium channel blocker

Answer 100

One normal complex then one ventricular extra systole

Answer 101

No normal complexes

Answer 102

No alveolar space Usually from opening of the thorax Increased risk of hypoxaemia

Answer 103

Skin incision Nerve damage Retraction is extremely painful Inflammation

Answer 104

Blood type and availablity as bleeding probable Fluids and drugs to combat hypotension O2 and IPPV equipment for hypovemtilation Check all equipment Stabilise patient - chest drain if needed Pre oxygenation especially if cardiac output isn't optimal

Answer 105

Minimise cardiovascular depression No alpha 2 agonists Multimodal approach Cardiovascular drugs

Answer 106

``` Minimise respiratory depression Premed opioid and ACP Rapid intubation Propofol / alfaxalone / ketamine Etomidate Use volatile agents for rapid recovery ```

Answer 107

Mechanical less demanding | Manual if atelectasis at end of sx as can assess how much pressure there is in lungs

Answer 108

Not compulsory but if NMBA still active use antagonists to reverse on recovery as will have severe resp depression

Answer 109

Cardiovascular depression due to compromised venous return Baro/volutrauma Reexpansion of pulmonary oedema

Answer 110

End of sx Pulmonary reexpansion - useful in lavage atelectasis when lung is collapsed and rinsed - do not do if lung has been collapsed for more than 12 hours as risk of oedema and the amount of pressure, volume and stress on lungs can be detrimental. Can aid with some O2 but don't push it

Answer 111

Fluid therapy Blood transfusion? Management of hypothermia - classic ways - warm fluids for lavage

Answer 112

``` Opioids but may be contraindicated NSAIDs if no contraindication - hypovolaemia Ketamine - bolus or cri - antihyperalgesic - supports CV system Lidocaine - cri - anaesthetic sparing effect so better stability - antiinflammatory effects Intercostal block - bupivacaine Epidural - morphine ```

Answer 113

Pulse ox with FIO2 Be ready to induce again O2 - try to decrease aid asap Fluid therapy - keep an eye on chest drain so losses accounted for TlC - bladder, heat loss, pain assessments

Answer 114

``` Multimodal is best NSAIDs Opioids Local nerve blocks Epidural ``` Local blocks enable a lighter plane of anaesthesia as sensation is abolished

Answer 115

Gas exchange affected - pulmonary contusions Arrhythmias - heart contusion Pneumothorax Increased intracranial pressure Shock Blood loss Bladder rupture - hyperkalaemia - cardiac arrest Cerebral, spinal cord and peripheral nerve rupture

Answer 116

Don't touch | Allow a few days to heal

Answer 117

Prone to hypoglycaemia so don't starve as long as adults Blood loss - small amounts can be critical Immature renal and hepatic clearance of drugs Incomplete blood brain barrier Increased risk of hypothermia High metabolic rate so high O2 consumption

Answer 118

Haemorrhage Pneumothorax - thoracic spinal column sx Air or pulmonary embolism - all sx Impaired ventilation - high cervical spine sx or use of NMBA

Answer 119

Slow non excited recovery - sedate if necessary Orthopaedic mattress Residual motor block - 24hrs until full recovery Challenge in horses for smooth recovery - incidence of refractive is high

Answer 120

Amount of acid required to titrate 1 litre of blood to a pH of 7.4 at 37 degrees and a PaCO2 of 40mmHg Result can be positive - alkalosis Negative - acidosis

Answer 121

Normally 15-25mmol/l Increases - lactic acidosis ( shock, GDV, severe tissue perfusion) - ketoacidosis (uncontrolled diabetes) Decreased - hypoproteinaemia (portosystemic shunt, kidney dx, GI dx) Can appear normal if GI carbonate loss

Answer 122

Should be x5 higher than inspired O2 - room air is 21% so PaO2 is 105mmHg There needs to be a big drop in PaO2 before you see a drop in SaO2 so SaO2 is a late indicator of hypoxia - should worry if drops below 95%

Answer 123

Compensating to the left as system is trying to replace CO2 Usually hypocapnoeic but oxygenating well Blood pH is higher than norm - alkalaemia

Answer 124

Drop in base excess Hco3 will increase as H increases because compensation has shifted right to get rid of CO2 Hypercapnia

Answer 125

``` Base excess low Hypocapnic pH normal Anion gap low HCO3 low Mixed acid base disturbance Give bicarbonate but don't mix with hartmanns ```

Answer 126

Hands off approach Body position to maximise tidal vol - neck extended and elbows abducted in sternal Inspiratory dyspnoea - upper airway obstruction Expiratory dyspnoea - lower airway obstruction Slow laboured pattern - parenchyma disease Rapid shallow pattern - pleural space disease Paradoxical breathing - severe resp disease

Answer 127

``` Normal lung sounds barely audible Crackles - fluid Wheezes - airways narrowing No lung sounds - pleural space disease Stertorous or strider - upper airways ```

Answer 128

Foreign body Nasopharyngeal polyps Laryngeal tumours

Answer 129

Feline lower respiratory tract disease

Answer 130

Pulmonary oedema Haemorrhage Infection

Answer 131

Pneumothorax | Pleural effusion

Answer 132

Hands off - oxygen cage for a while Calm quiet environment where they feel safe Keep an eye on them If any emergency procedures need to be undertaken do so gently and with minimal stress

Answer 133

``` 19g butterfly needle 3 way tap Syringe Skin prep Sterile gloves Ultrasound machine Tubes for sampling ``` Clip hair over 7-8th intercostal space

Answer 134

Terbutaline is a B-2 agonist | 0.05mg/kg I/M in cats

Answer 135

Dexamethasone 0.25-0.5mg/kg Im or IV Deals with acute inflammation

Answer 136

Diaphragmatic hernia

Answer 137

Chronic bronchitis and asthma

Answer 138

Using a dog urinary catheter through an ET tube

Answer 139

Sepsis or infection

Answer 140

Cats able to adjust their lifestyle to compensate so by the time symptoms show it's quite profound Rbc lifespan in cats is 70 days Feline haemoglobin has a low affinity for o2 so can tolerate anaemia well

Answer 141

Pale mms - check nose and pads if unpigmented Lethargy and exercise intolerance Tachycardia Tachypnoea Signs associated with the underlying cause Pica - lick concrete or eat soil Lymphadenopathy and splenomegaly

Answer 142

Confirms presence and type of anaemia

Answer 143

Increased mean cell vol Presence of significant anisocytosis and polychromasia Increased reticulocyte count

Answer 144

Aggregate form that is the only type seen in dogs - tells you what's happening in the bone marrow and last 24hrs Punctate form- can last a very long time. Don't count these when doing a reticulocyte count

Answer 145

Aggregate form

Answer 146

When chronic blood loss causes iron deficiency which impairs rbc formation - rarely seen FeLV Chronic disease Infectious and inflammatory diseases

Answer 147

Blood loss | Haemolysis

Answer 148

``` FeLV Parasites Primary or secondary immune mediated haemolytic anaemia Heinz body anaemia Severe hypophosphataemia Incompatible blood transfusions Neonatal isoerythrolysis Inherited defects ```

Answer 149

Attaches to rbc so body recognises it as foreign and destroys it

Answer 150

``` Pallor Lethargy Weight loss Anorexia Pyrexia Dehydration ```

Answer 151

Polymerase chain reaction

Answer 152

Doxycycline antibiotic pill with food or water to prevent oesophageal stricture

Answer 153

Irreversibly denatured oxidised haemoglobin Small portion normal in cats as sensitive to oxidative damage Paracetamol toxicity Onions Lymphoma Diabetic ketoacidosis Rbc conraining Heinz body is destroyed

Answer 154

Gives birth to young that are a different blood type Mothers agglutinating antibodies are passed through colostrum These cause haemolysis of the youngs rbcs Common in Persian, British shorthair or Birman cats as type B

Answer 155

Bone marrow disorders Suppression of bone marrow due to systemic disease Most anaemia cats have non regenerative anaemia

Answer 156

Myeloproliferative disease - abnormal proliferation of rbc Melodysplastic disease - abnormal production rbc in bone marrow Marrow failure - failure of stem cell production Toxins - chemotherapeutic agents, chloramphenicol

Answer 157

Diagnose the underlying cause Treat the cause Supportive treatment such as blood transfusions, EPO and androgenic hormones

Answer 158

PCV less then 10- above and cat has coping mechanism Moderate acute anaemia rather than profound chronic anaemia as clinically more severe Tachycardia Lethargy Pale mm Slow crt

Answer 159

Anabolic steroids stimulate erythroid precursors via EPO activation Prednisolone therapy

Answer 160

Hormone release by kidneys that increases the rate of production of rbcs in response to falling levels of oxygen in the tissues

Answer 161

Abnormal condition allowing blood to escape from injured vessels or interfering with haemastasis

Answer 162

Reflex constriction of blood vessels | Platelet plug

Answer 163

Stabilisation of platelet plug by fibrin which is a result of activation of the clotting cascade

Answer 164

Von wilebrands factor

Answer 165

Qualitative and quantitative platelet disorders | Vessel wall defects so can't vasoconstrict

Answer 166

XII, IX, XI, VIII | Ca2

Answer 167

VII, III, | Ca2

Answer 168

V, X | Ca2

Answer 169

II, VII, IV, X

Answer 170

Limiting reactions to ensure clotting is localised to injured area Prostacyclin, proteins C and S Antithrombin binds to heparin to inactivate many factors

Answer 171

``` Petechiae and ecchymotic haemorrhages Multiple sights of bleeding Prolonged bleeding Venepuncture bleeding Surface bleeding from mm ```

Answer 172

Haematomas Localised sight of bleeding Delayed bleeding or rebleeding from cuts Single large bleed that's deep or from a cavity

Answer 173

Platelet count | Buccal mucosal bleeding time

Answer 174

Activated clotting time Activated partial thromboplastin time Prothrombin time

Answer 175

Platelet function or number

Answer 176

Evaluates intrinsic and extrinsic pathways Will be prolonged in haemophilia, deficiencies in factors of the intrinsic and common pathways, Disseminated intravascular coagulation Rodenticide toxicity Liver dysfunction Normal < 165sec

Answer 177

Sodium citrate tubes tested in lab APTT looks at intrinsic and common pathways PT looks at extrinsic and common pathways - very sensitive to vit k deficiencies and rodenticide toxicities as factor VII has shortest half life

Answer 178

Gradual loss of functional nephrons and deterioration in renal function Older dogs and cats Cause often hard to determine

Answer 179

``` Chronic interstitial nephritis Glomerulonephropathies Infection Nephrotoxins and drugs e.g. Ethylene glycol Neoplasia Inherited or congenital disease ```

Answer 180

PUPD Dehydration Anorexia Halitosis Hypertension Hypokalaemia due to decreased intake and increased urinary loss Anaemia due to uraemic toxins, reduced rbc lifespan and erythropoietin deficiency Proteinuria Hyperphosphataemia as not excreted in urine Renal secondary hyperparathyroidism Uti

Answer 181

``` SG will be low Sediment Dipstick Culture and sensitivity Urinanalysis will show azotaemia Biochem and haem Blood pressure Ultrasound ```

Answer 182

Called IRIS Based on serum creatinine levels when rehydrated Additional substaging based on proteinuria and hypertension Recognises that CKD is progressive

Answer 183

Treat underlying dx Correct and maintain fluid balance Manage clinical signs Delay the progression

Answer 184

Dehydration spdecreases renal perfusion and renal function Acute decompensation - IV fluids x2 maintenance and correct over 24hrs. Measure urea and creatinine when rehydrated to assess degree of azotaemia Chronic underlying dehydration - ongoing fluid support at home, moist food with additional water, broths, multiple water bowls. Subcut fluids. Prevent acute decompensation

Answer 185

Diet Restricted phosphate and protein diet as improves survival time High fat to maintain weight Omega 3 PUFAs Increased potassium and vit B, E Fermentable fibre Decrease sodium to decrease risk of hypertension

Answer 186

Gastroprotectants Sucralfate Antiemetics

Answer 187

Control nausea Smelly foods Mirtazapine Enteral feeding if severe

Answer 188

Oral lactulose | Fluid therapy

Answer 189

Potassium supplementation oral potassium gluconate if eating | Potassium chloride IV

Answer 190

Diet | Oral phosphate binding drugs with food

Answer 191

Amlodipine decreases Bp Angiotensin converting enzyme inhibitor decreases pressure in glomerulus so decreases proteinuria Telmisartin Restricted sodium diet

Answer 192

Telmisartin | Benazepril

Answer 193

Painful - deep plane anaesthesia Anti tussives to prevent coughing reflex May involve extubation - flow by oxygen and TIVA or use a laryngeal mask Cats usually have reflex bronchoconstriction - anticholinergic, salbutamol or terbutaline sub cut an hour before scope to prevent acute asthma crisis Monitor in recovery

Answer 194

Pre oxygenate before intubation Don't leave unattended once pre med given as upper airway obstruction due to muscles relaxing Intubation difficult due to laryngeal collapse, narrow trachea Risk of aspiration so elevate head on recovery and keep in sternal in sx. Cuff tube Risk of tube kinking in sx so use reinforced tube Soft tissue swelling can cause breathing difficulty in recovery - extubate late, hang by upper canines on cage door May need to do tracheostomy Calm down with sedative but can lose control of airway so careful

Answer 195

Emergency tracheostomy or calm down with sedative May need to extubate so oxygen flow by and use TIVA tube cuff may be in the surgical field Blood from surgery in upper airway so extubate with mildly inflated cuff

Answer 196

Reinforced tubes to prevent kinking Mouth gag - end of syringe as can cause blindness in cats Cuffed tube Pack throat Heat pad and towels and foil to keep patient warm Locoregional nerve blocks for pain relief as can be quite painful

Answer 197

Et tube can kink Torsion of tube can cause laryngeal laceration in cats Accessibility to patient is limited - can't see palpebral reflex or eye position Catheter in back leg Eye may need to be central - stay sutures, sub tenons injection with local anaesthetic, NMBA High intraocular pressure should be avoided - keep ETCO2 low and ventilate, avoid jug vein obstruction Quiet recovery to prevent thrashing - empty bladder, pain relief, sedate if necessary, buster collar - get used to it prior to sx

Answer 198

Enucleatio - sub tenons Ocular procedures in standing horses - auriculo palpebral nerve only blocks motor so no sensation loss - retrobulbar block for enucleation - four point block of supra orbital nerve, lacrimal nerve, infratrochlear nerve and zygomatic nerve gives loss of sensation - local infiltration of eyelids

Answer 199

May need setting camera and endoscope Laryngoscopes with 2 blades - one to pull down tongue and one to pull up soft palate Long Q tips Good light source Sternal positioning with head up and ET tube ventrally

Answer 200

``` Stenotic nares Aberrant turbinates Overlong soft palate Naso-pharyngeal hyperplasia and macroglossia Saccule inside the larynx protrude Tonsillitis enlargement Hypoplastic trachea - thin and small Bronchial collapse Same amount of soft tissue in smaller space so more resistance to air flow ```

Answer 201

``` Gastrointestinal signs Improve after airway sx Can be as bad as resp signs Cardiac sphincter remains open causing regurg, v+ and acid reflux Metoclopramide CRI pre and post op Sucralfate, omeprazole, ranitidine ```

Answer 202

``` Young cats Originate from middle ear epithelium Sneezing, URT obstruction, stertor Diagnose with oral exam, rhinoscopy and CT resection with bulla osteotomy Good results post sx and with steroids ```

Answer 203

Normally 15-25mmol/l Increases - lactic acidosis ( shock, GDV, severe tissue perfusion) - ketoacidosis (uncontrolled diabetes) Decreased - hypoproteinaemia (portosystemic shunt, kidney dx, GI dx) Can appear normal if GI carbonate loss

Answer 204

Should be x5 higher than inspired O2 - room air is 21% so PaO2 is 105mmHg There needs to be a big drop in PaO2 before you see a drop in SaO2 so SaO2 is a late indicator of hypoxia - should worry if drops below 95%

Answer 205

Compensating to the left as system is trying to replace CO2 Usually hypocapnoeic but oxygenating well Blood pH is higher than norm - alkalaemia

Answer 206

Drop in base excess Hco3 will increase as H increases because compensation has shifted right to get rid of CO2 Hypercapnia

Answer 207

``` Base excess low Hypocapnic pH normal Anion gap low HCO3 low Mixed acid base disturbance Give bicarbonate but don't mix with hartmanns ```

Answer 208

Hands off approach Body position to maximise tidal vol - neck extended and elbows abducted in sternal Inspiratory dyspnoea - upper airway obstruction Expiratory dyspnoea - lower airway obstruction Slow laboured pattern - parenchyma disease Rapid shallow pattern - pleural space disease Paradoxical breathing - severe resp disease

Answer 209

``` Normal lung sounds barely audible Crackles - fluid Wheezes - airways narrowing No lung sounds - pleural space disease Stertorous or strider - upper airways ```

Answer 210

Foreign body Nasopharyngeal polyps Laryngeal tumours

Answer 211

Feline lower respiratory tract disease

Answer 212

Pulmonary oedema Haemorrhage Infection

Answer 213

Pneumothorax | Pleural effusion

Answer 214

Hands off - oxygen cage for a while Calm quiet environment where they feel safe Keep an eye on them If any emergency procedures need to be undertaken do so gently and with minimal stress

Answer 215

``` 19g butterfly needle 3 way tap Syringe Skin prep Sterile gloves Ultrasound machine Tubes for sampling ``` Clip hair over 7-8th intercostal space

Answer 216

Terbutaline is a B-2 agonist | 0.05mg/kg I/M in cats

Answer 217

Dexamethasone 0.25-0.5mg/kg Im or IV Deals with acute inflammation

Answer 218

Diaphragmatic hernia

Answer 219

Chronic bronchitis and asthma

Answer 220

Using a dog urinary catheter through an ET tube

Answer 221

Sepsis or infection

Answer 222

Cats able to adjust their lifestyle to compensate so by the time symptoms show it's quite profound Rbc lifespan in cats is 70 days Feline haemoglobin has a low affinity for o2 so can tolerate anaemia well

Answer 223

Pale mms - check nose and pads if unpigmented Lethargy and exercise intolerance Tachycardia Tachypnoea Signs associated with the underlying cause Pica - lick concrete or eat soil Lymphadenopathy and splenomegaly

Answer 224

Confirms presence and type of anaemia

Answer 225

Increased mean cell vol Presence of significant anisocytosis and polychromasia Increased reticulocyte count

Answer 226

Aggregate form that is the only type seen in dogs - tells you what's happening in the bone marrow and last 24hrs Punctate form- can last a very long time. Don't count these when doing a reticulocyte count

Answer 227

Aggregate form

Answer 228

When chronic blood loss causes iron deficiency which impairs rbc formation - rarely seen FeLV Chronic disease Infectious and inflammatory diseases

Answer 229

Blood loss | Haemolysis

Answer 230

``` FeLV Parasites Primary or secondary immune mediated haemolytic anaemia Heinz body anaemia Severe hypophosphataemia Incompatible blood transfusions Neonatal isoerythrolysis Inherited defects ```

Answer 231

Attaches to rbc so body recognises it as foreign and destroys it

Answer 232

``` Pallor Lethargy Weight loss Anorexia Pyrexia Dehydration ```

Answer 233

Polymerase chain reaction

Answer 234

Doxycycline antibiotic pill with food or water to prevent oesophageal stricture

Answer 235

Irreversibly denatured oxidised haemoglobin Small portion normal in cats as sensitive to oxidative damage Paracetamol toxicity Onions Lymphoma Diabetic ketoacidosis Rbc conraining Heinz body is destroyed

Answer 236

Gives birth to young that are a different blood type Mothers agglutinating antibodies are passed through colostrum These cause haemolysis of the youngs rbcs Common in Persian, British shorthair or Birman cats as type B

Answer 237

Bone marrow disorders Suppression of bone marrow due to systemic disease Most anaemia cats have non regenerative anaemia

Answer 238

Myeloproliferative disease - abnormal proliferation of rbc Melodysplastic disease - abnormal production rbc in bone marrow Marrow failure - failure of stem cell production Toxins - chemotherapeutic agents, chloramphenicol

Answer 239

Diagnose the underlying cause Treat the cause Supportive treatment such as blood transfusions, EPO and androgenic hormones

Answer 240

PCV less then 10- above and cat has coping mechanism Moderate acute anaemia rather than profound chronic anaemia as clinically more severe Tachycardia Lethargy Pale mm Slow crt

Answer 241

Anabolic steroids stimulate erythroid precursors via EPO activation Prednisolone therapy

Answer 242

Hormone release by kidneys that increases the rate of production of rbcs in response to falling levels of oxygen in the tissues

Answer 243

Abnormal condition allowing blood to escape from injured vessels or interfering with haemastasis

Answer 244

Reflex constriction of blood vessels | Platelet plug

Answer 245

Stabilisation of platelet plug by fibrin which is a result of activation of the clotting cascade

Answer 246

Von wilebrands factor

Answer 247

Qualitative and quantitative platelet disorders | Vessel wall defects so can't vasoconstrict

Answer 248

XII, IX, XI, VIII | Ca2

Answer 249

VII, III, | Ca2

Answer 250

V, X | Ca2

Answer 251

II, VII, IV, X

Answer 252

Limiting reactions to ensure clotting is localised to injured area Prostacyclin, proteins C and S Antithrombin binds to heparin to inactivate many factors

Answer 253

``` Petechiae and ecchymotic haemorrhages Multiple sights of bleeding Prolonged bleeding Venepuncture bleeding Surface bleeding from mm ```

Answer 254

Haematomas Localised sight of bleeding Delayed bleeding or rebleeding from cuts Single large bleed that's deep or from a cavity

Answer 255

Platelet count | Buccal mucosal bleeding time

Answer 256

Activated clotting time Activated partial thromboplastin time Prothrombin time

Answer 257

Platelet function or number

Answer 258

Evaluates intrinsic and extrinsic pathways Will be prolonged in haemophilia, deficiencies in factors of the intrinsic and common pathways, Disseminated intravascular coagulation Rodenticide toxicity Liver dysfunction Normal < 165sec

Answer 259

Sodium citrate tubes tested in lab APTT looks at intrinsic and common pathways PT looks at extrinsic and common pathways - very sensitive to vit k deficiencies and rodenticide toxicities as factor VII has shortest half life

Answer 260

Gradual loss of functional nephrons and deterioration in renal function Older dogs and cats Cause often hard to determine

Answer 261

``` Chronic interstitial nephritis Glomerulonephropathies Infection Nephrotoxins and drugs e.g. Ethylene glycol Neoplasia Inherited or congenital disease ```

Answer 262

PUPD Dehydration Anorexia Halitosis Hypertension Hypokalaemia due to decreased intake and increased urinary loss Anaemia due to uraemic toxins, reduced rbc lifespan and erythropoietin deficiency Proteinuria Hyperphosphataemia as not excreted in urine Renal secondary hyperparathyroidism Uti

Answer 263

``` SG will be low Sediment Dipstick Culture and sensitivity Urinanalysis will show azotaemia Biochem and haem Blood pressure Ultrasound ```

Answer 264

Called IRIS Based on serum creatinine levels when rehydrated Additional substaging based on proteinuria and hypertension Recognises that CKD is progressive

Answer 265

Treat underlying dx Correct and maintain fluid balance Manage clinical signs Delay the progression

Answer 266

Dehydration spdecreases renal perfusion and renal function Acute decompensation - IV fluids x2 maintenance and correct over 24hrs. Measure urea and creatinine when rehydrated to assess degree of azotaemia Chronic underlying dehydration - ongoing fluid support at home, moist food with additional water, broths, multiple water bowls. Subcut fluids. Prevent acute decompensation

Answer 267

Diet Restricted phosphate and protein diet as improves survival time High fat to maintain weight Omega 3 PUFAs Increased potassium and vit B, E Fermentable fibre Decrease sodium to decrease risk of hypertension

Answer 268

Gastroprotectants Sucralfate Antiemetics

Answer 269

Control nausea Smelly foods Mirtazapine Enteral feeding if severe

Answer 270

Oral lactulose | Fluid therapy

Answer 271

Potassium supplementation oral potassium gluconate if eating | Potassium chloride IV

Answer 272

Diet | Oral phosphate binding drugs with food

Answer 273

Amlodipine decreases Bp Angiotensin converting enzyme inhibitor decreases pressure in glomerulus so decreases proteinuria Telmisartin Restricted sodium diet

Answer 274

Telmisartin | Benazepril

Answer 275

Painful - deep plane anaesthesia Anti tussives to prevent coughing reflex May involve extubation - flow by oxygen and TIVA or use a laryngeal mask Cats usually have reflex bronchoconstriction - anticholinergic, salbutamol or terbutaline sub cut an hour before scope to prevent acute asthma crisis Monitor in recovery

Answer 276

Pre oxygenate before intubation Don't leave unattended once pre med given as upper airway obstruction due to muscles relaxing Intubation difficult due to laryngeal collapse, narrow trachea Risk of aspiration so elevate head on recovery and keep in sternal in sx. Cuff tube Risk of tube kinking in sx so use reinforced tube Soft tissue swelling can cause breathing difficulty in recovery - extubate late, hang by upper canines on cage door May need to do tracheostomy Calm down with sedative but can lose control of airway so careful

Answer 277

Emergency tracheostomy or calm down with sedative May need to extubate so oxygen flow by and use TIVA tube cuff may be in the surgical field Blood from surgery in upper airway so extubate with mildly inflated cuff

Answer 278

Reinforced tubes to prevent kinking Mouth gag - end of syringe as can cause blindness in cats Cuffed tube Pack throat Heat pad and towels and foil to keep patient warm Locoregional nerve blocks for pain relief as can be quite painful

Answer 279

Restrictive breathing pattern | Increased rate but reduced depth

Answer 280

Inspiratory and expiratory dyspnoea | Lung tissue affected

Answer 281

Need to receive enough oxygen to treat hypoxia and distress Can't have too much oxygen or will develop oxygen toxicity Need lowest oxygen level patient can tolerate Long term should be less than 60%

Answer 282

``` Resp rate and effort Anxiety levels HR and pulse quality Mm Arterial blood gas for PaO2 Pulse ox ```

Answer 283

On room air 100mmHg On 100% oxygen 500mmHg Depends on oxygen and barometric pressure

Answer 284

PaO2 <80mmHg | SaO2 <95%

Answer 285

``` X rays Ultrasound Physical exam Thoracocentesis Samples for cytology, culture, biochem ```

Answer 286

``` Pulmonary oedema Tachypnoea Dyspnoea Cough Pulmonary crackles ```

Answer 287

Distended peripheral veins Pulsation of jugular veins Ascites Pleural effusion in cats

Answer 288

``` Tachycardia Weak pulses Pale mm Slow CRT Cats can present with hypothermia and bradycardia ```

Answer 289

``` Minimise stress Oxygen Furosemide 2mg/kg IV Record an ECG If in myocardial failure then pimobendan 0.15mg/kg IV ```

Answer 290

Resp rate needs to be below 40 Blood pressure needs to be over 80 systolic If the patient improves then HR, RR reduces, pulses and CRT improves and patient will look brighter

Answer 291

Haematology Biochem Echocardiography Thoracic radiographs

Answer 292

Get eating asap Life long treatment of furosemide, pimobendan, ACE inhibitor, spironolactone Home asap

Answer 293

120-140mmHg

Answer 294

``` Right sided heart failure Distended jug veins Pulsating hug veins Ascites Tachycardia Weak pulses ```

Answer 295

``` Physical exam and echocardiography Pericardiocentesis IVFT No furosemide Hospital for 24-48hrs Can recur - if no marked improvement then neoplasia possible ```

Answer 296

Cats Tachypnoea, dyspnoea, open mouthed breathing Heart murmur or gallop Tachy or bradycardia Hypothermia Aortic thromboembolism - sudden onset paresis, cold legs, painful and stiff muscles, pale and blue foot pads and nail beds

Answer 297

``` No stress Furosemide Oxygen Thoracocentesis if pleural effusion Treat hypothermia Pain meds ```

Answer 298

Furosemide ACE inhibitor If aortic thromboembolism- aspirin, clopidogrel, low molecular weight heparin

Answer 299

``` 3rd degree atrioventricular block Complete and sustained interruption of conduction from the atria to the ventricles in the atrioventricular node No P wave P and QRS not associated Wide and bizarre complexes Need a pacemaker ```

Answer 300

Supraventricular tachycardia - regular tachycardia originating from one place in atria. Narrow QRS but regular Atrial fibrillation - tachycardia from multiple places in atria. Chaotic rhythm. Irregular R-R distances. No P waves Ventricular tachycardia - tachycardia from ventricles. Regular with wide and bizarre QRS

Answer 301

Pericardial effusion | Congenital cardiac disease

Answer 302

Degenerative valvular disease | Dilated cardiomyopathy

Answer 303

12 yr JRT dental and potential extractions | 16yr old DSH full extraction

Answer 304

What other analgesics can be used

Answer 305

Measurement of CO2 concentrations in respired gases and a numerical display of the expired conc

Answer 306

Measurement of CO2 concentrations in respired gases and graphical display of CO2 waveform

Answer 307

Display of CO2 waveform

Answer 308

``` Adequacy of respiration Info on cardiac output Can inform on presence of rebreathing Can provide info on v/q matching Can provide info on alveolar dead space when combined with PaO2 Detect equipment errors ```

Answer 309

Infrared light absorbed by molecules that have two or more different atoms Amount of infrared light absorbed is proportional to the the absorbing substance - Beers law

Answer 310

Can be used in non intubated patients Resilient Easy to connect Easy to disinfect Slow response time Water vapour can condense in line Line can become kinked Water vapour pressure changes CO2 concentrations - need a water trap

Answer 311

No sampling line so rapid response No effect of water pressure as cuvette is heated No scavenging needed No obstruction Sensors add drag to breathing system Vulnerable to damage Difficult to clean and disinfect Only intubated patients

Answer 312

Mucous plugging of bronchioles Et tube in a main bronchus Atelectasis

Answer 313

Pulmonary embolism Hypovolaemia Low cardiac output Cardiac arrest

Answer 314

PaCO2 - 35-45 | ETCO2 - 30-43

Answer 315

Faulty expiratory valve on a circle Exhausted soda lime Inadequate inspiratory flow on a non rebreathing circuit Insufficient expiratory time

Answer 316

Effect on overall CVS function Associated with pulse deficit Each ventricular extra systole looks different Effect on cardiac output signalled by low ETCO2 or MABP

Answer 317

``` Alpha 2s Benzodiazepines Acepromazine Propofol Alfaxalone Thiopental Volatiles ```

Answer 318

Opioids - methanol, fentanyl | Dissociative - ketamine

Answer 319

Guaiphenesine - equine | Inhibits interneurons at spinal level

Answer 320

Post synaptic nicotinic Ach receptors on the neuromuscular junction Two Ach need to bind to the two alpha sub units on the receptors Clearance from synaptic cleft by acetylcholine esterase Non depolarising blocks compete with Ach Depolarising activates receptor and keeps it activated making it insensitive to natural Ach

Answer 321

Respiratory failure | Behavioural and physical signs of anaesthetic depth are gone

Answer 322

Ocular surgery - central eye position Mechanical ventilation, mainly ICU ventilation case Reposition of fracture or dislocated joint Better surgical access to abdominal or thoracic cavity Mydriasis in birds Intubation

Answer 323

``` Non depolarising Binds to Ach receptor but is inactive Only one site of receptor needs to be bound Intermediate acting 30-40mins Ideal for renal/hepatic patient Minimal to no cardiovascular response Might cause histamine release ```

Answer 324

``` Aminosteroid Non depolarising 20mins Excreted unchanged via bile so unsuitable for hepatic patient No cardiovascular side effects ```

Answer 325

``` Depolarising 2 Ach molecules joined together so mimics natural Ach and leads to depolarisation - contraction before relaxation Degraded by plasmacholinesterase Cardiovascular responses, arrhythmia, hypertension Increased ICP Increased intragastric pressure Increased intracranial pressure Malignant hyperthermia Non reversible ```

Answer 326

Respiration unreliable - IPPV Peripheral motor nerve stimulation - stimulate a peripheral nerve. Train of 4 electrical impulses applied over 2 sec period. Loss of T1 100% blocked. Block worn off when T4/T1 is back to 0.9. Only possible for non depolarising block.

Answer 327

Anticholinesterases inhibit Ach breakdown in cleft so can compete with NMBA. Only antagonise when block wears off. Neostigmine - slow onset, longer acting Edrophonium - fast onset, shorter acting Cardiovascular consequences so use atropine with edrophonium and glycopyrrolate for neostigmine

Answer 328

Phase II block after more than one dose

Answer 329

``` Volatile agent Hypothermia Hepatic/ renal insufficiency Electrolyte acid base abnormalities Muscle diseases Aminoglycoside antibiotics Dose administered ```

Answer 330

``` Schedule first Keep calm Careful monitoring Corticosteroids Hydration Thermoregulation Recovery is critical ```

Answer 331

``` Elderly dogs Hyperthermia Dehydration Do not stress Give oxygen Sedation of ACP, opioid and corticosteroid helps breathing ```

Answer 332

``` Rapid calm recovery Extubate late Give oxygen Monitor carefully Avoid barking or excitement - analgesia ```

Answer 333

``` Avoid stress Use harness Avoid profound sedation as can suffocate Oxygen Gentle intubation Suction as saliva pre intubation and blood post surgery Corticosteroids Rapid smooth recovery ```

Answer 334

``` Pre existing respiratory compromise Anticholinergic Pre oxygenate In cats can't always pass bronchoscope through et tube Risk of environmental pollution Pneumothorax ```

Answer 335

``` Prevent pressure on jug veins Stop coughing, retching or vomiting No hypertension Prevent hypoxia or hypercapnia Don't put pressure on the globe Don't use ketamine or atropine ```

Answer 336

Sympathomimetics - epinephrine causes hypertension and arrhthmias Parasympatholytics - atropine and tropicamide can cause tachycardia and arrhythmias Parasympathomimetics - Ach can cause bradycardia and hypotension Mannitol - initial increase in circulating blood flow followed by diuresis so causes haemodynamic instability CAI - causes metabolic acidosis

Answer 337

``` Ketamine Stay sutures Correct depth of anaesthesia Ophthalmic nerve block Muscle relaxant ```

Answer 338

Oesophageal stethoscope Difficult to monitor Calm recovery - analgesia and sedation Monitor temp

Answer 339

Dexmedetomidine and bup NSAID Local block Induction and maintenance requirements reduced

Answer 340

Pethidine and nsaid Pre oxygenate Propofol Iso or sevo

Answer 341

``` Control IOP ACP and pethidine sedation Hindlimb catheter Avoid ketamine for induction Avoid hypoxia or hypercapnia NSAID Stay sutures or NMBA - IPPV ```

Answer 342

ACP and methadone NSAID Retrobulbar block Blood loss

Answer 343

``` Low dose ACP and bup IVFT Control IOP IPPV ECG Capnography Pulse ox Central eye - atracurium or vecurium Direct blood pressure Peripheral nerve stimulator NMBA antagonist Ensure spontaneous breathing before end anaesthetic Keep quiet NSAIDs ```

Answer 344

For healthy cats Monitoring clinics Maximise our involvement and skills

Answer 345

Who will run it Where will it be held Time management How will you promote the clinic and recruit cats

Answer 346

``` Newsletters Social media Word of mouth - vets and receptionists Post op checks Vaccination or flea checks Obesity clinics Dental clinics Client open evenings ```

Answer 347

``` Kidney disease Hyperthyroidism Dental disease IBD Hypertension Degenerative joint disease ```

Answer 348

``` History Weigh Blood pressure Discuss findings Clinical exam Discuss findings Diagnostic tests if needed Summarise and arrange a revisit ```

Answer 349

Reduced energy Reduced fat Reduced calcium and phosphorus Increased fibre

Answer 350

Only able to breathe standing or sitting up

Answer 351

Increased depth of breathing

Answer 352

Sedate or induce patient Jet ventilate with any tube you can get into the airway eg urinary catheter Placed between the larynx and thoracic inlet Wide bore IV catheter or tracheostomy tube Blade cuts 50% of trachea in circumference Clippers Attach oxygen Stay sutures on upper and lower tracheal ring that are labelled

Answer 353

ACP or butorphanol sedation May need intubation or emergency tracheostomy Oxygen therapy IV access If temp is >40.9 then cool down to 39.9 by continuously pouring tap water over them and place fan

Answer 354

Crackles caudally - pulmonary oedema Crackles cranially - aspiration pneumonia Dull lung sounds dorsal - pneumothorax Dull lung sounds ventrally - pleural effusion

Answer 355

Dorsal metatarsal | Femoral

Answer 356

Barometric pressure at sea level - 760mmHg Inspired air has 47mmHg of water vapour PO2 = 0.21 x (760-47) = 150mmHg

Answer 357

If there is efficient gas exchange If the ratio is less than 300 then there is lung disease or inflammatory process The A-A gradient should be as low as possible 150xFIO2-(PaCO2/0.8) - PaO2

Answer 358

``` Oxygen Hands off approach Resp rate, pattern and effort Mm colour and CRT Pulse quality and HR SpO2 Sternal recumbency ETCO2 PaO2 Temp espesh in oxygen cage Ventilation if needed Nebulisation Postulated feeding ```

Answer 359

Tricuspid valve disease Pulmonic stenosis Pericardial effusion

Answer 360

``` Dilated cardiomyopathy Congenital defects Hypertrophic cardiomyopathy Endocarditis Ventricular tachycardia Atrial fibrillation Ventricular fibrillation Sick sinus syndrome 3rd degree AV block ```

Answer 361

Mitral valve degenerative disease

Answer 362

Volume of blood in left ventricle before contraction

Answer 363

Resistance in the left ventricle wall when blood is ejected

Answer 364

Blood pressure decreases | Renin-angiotensin system activated

Answer 365

``` Auscultation History Echo ECG Thoracic radiographs Bloods - haem, biochem, electrolytes, proBNP ```

Answer 366

Systolic dysfunction Large dogs Atrial fibrillation Causes can be idiopathic, viral infection or taurine deficiency Decrease in contractility so decrease in cardiac output Renin-angiotensin system activated to increase preload and increase pressure in ventricles Dilation of ventricles and enlargement of atrium

Answer 367

``` Cats Diastolic dysfunction so decreased preload Tissue fibrosis of ventricles Atrial enlargement Diltazem to increase coronary blood flow Nitroglycerin to dilate coronary arteries Furosemide causes pulmonary oedema Aim to reduce systemic resistance ```

Answer 368

``` Pericardial effusion Right side Compresses and effects CO Obstructive shock Electrical alternans Pericardiocentesis Cause usually neoplasia NO FUROSEMIDE ```

Answer 369

``` Clip and prep over apex of heart Long 21G needle Ultrasound guided Monitor ECG as many have VPCs Check fluid drained isn't clotting as then in heart Culture and cytology Mild sedation needed ```

Answer 370

``` Bacterial infection Mitral and aortic valves affected Blood culture IVFT Ventricular tachycardia, idioventricular ventricular arrhythmias Antibiotics and supportive care ```

Answer 371

``` Mitral valve LCHF Tricuspid RCHF Small dogs Nodular and thick Regurgitation Give furosemide, ACE inhibitors and dilazem ```

Answer 372

Ventricular tachycardia - HR>180, syncope -lidocaine Supra ventricular tachycardia- HR>180, syncope - diltiazem 3rd degree AV block - syncope, bradycardia - pacemaker Atrial fibrillation- lethargy, syncope, HR>180 -pimobendan Ventricular fibrillation - now. - defibrillation Sick sinus syndrome - multiple syncope, bradycardia - pacemaker

Answer 373

Mulitparameter monitors - continuous monitoring Paper trace recording machine - diagnostic value Holter monitoring - monitoring over longer period, manually noting events. Pads on chest (1 left, 2 right) and body pack Telemetry - monitoring patients from a distance

Answer 374

Right lateral

Answer 375

Make sure leads on correct legs Check settings on machine Make sure leads don't cross over patients chest Minimise movement Stop panting or purring Check contact of electrodes against skin and ensure they haven't dried out Remove interference

Answer 376

Diagnostic work up Triage Anaesthesia Monitoring inpatients with known arrhythmias Critical patients Newly identified pulse deficits CPR metabolic or electrolyte abnormalities During pericardiocentesis or jugular catheter placement Hands off method of monitoring eg blood transfusions

Answer 377

Bradycardia | No P spikey T

Answer 378

Sinoatrial note - pacemaker. p wave Atrioventricular node - slows impulse down Atrioventricular ring - depolarisation of atrium Bundle of His -'spread depolarisation wave towards ventricles Right and left bundle fibres - depolarise right and left ventricles Prukinje fibres - depolarisation of myocardium Then repolarisation

Answer 379

Electrical cells - conduction system of the heart. Orderly distribution. Spontaneously generate electrical impulses to the next cell and receive them Myocardial cells - make up the wall. Contractility and stretchability Cells at rest are polarised.

Answer 380

P wave - SAN to AVN. Depolarisation in atria. Travelling to +vet electrode so positive spike. Width is time taken P-R interval - complete depolarisation of atria. Return to baseline. AVN depolarised QRS - contraction of ventricles Q wave - depolarisation of septum. Travels away from positive electrode so negative spike R wave - ventricles depolarised. Big wave as larger muscle mass S wave - finishing depolarisation ventricles. Negative T waves- repolarisation. Can be positive or negative

Answer 381

``` Rate Rhythm - regular, regularly irregular, irregularly irregular Is there a p wave for every QRS Sinus or ventricular arrhythmias Intermittent or continuous ```

Answer 382

``` Out of place beat Did not originate from SAN Originate in atria or ventricles VPC - wide and bizarre QRS with no P wave APC, JPC- narrow with no P wave SVT ```

Answer 383

Ectopic beats due to SAN failure with bradycardia Rescue for the heart by generating an impulse before cardiac standstill Wide and bizarre with no P wave

Answer 384

Affect PR interval 1st degree prolonged PR interval 2nd degree type 1 - PR gets longer and longer then snaps back Type 2 - PR interval the same. Occasional p waves with no QRS 3rd degree - p waves sometimes followed by an escape beat or tall QRS-T. P waves occur faster. Actual heart rate is slow.

Answer 385

Tall T wave gets higher Long PR interval and wide QRS duration Eventually absent P wave and sinusoidal wave Treat with insulin and glucose May then need to redose with potassium after

Answer 386

``` Abnormal SA node function Bradycardia, tachycardia and periods of arrest Can get failure of escape beats Need pacemaker WHWT common ```

Answer 387

``` Treat bradycardia Last 5-10years Expensive Care with neck restraint No jugular samples Remove when animal is euthanised ```

Answer 388

``` Infection Lead dislodgement Failure GA related issues Lead fracture Venous thrombosis ```

Answer 389

pH 7.35-7.45 PaO2 80-100mmHg PaCO2 35-45mmHg HCO3 21-24 bicarbonate buffer BE +2 or -2mEq H ions needed to return the pH back to normal Anion gap dogs 12-24mEq/L cats 13-27mEq/L

Answer 390

Metabolic acidosis pH <7.35 acidaemia -compensatory factors pH in normal limits but HCO3 very low and PaCO2 is also low Metabolic alkalosis pH >7.45 alkalaemia -compensatory factors pH within normal limits but HCO3 very high and PaCO2 also high Increase in lactate can also cause metabolic acidosis Respiratory alkalosis PaCO2 <35mmHg so body hyperventilates to get rid of CO2 Respiratory acidosis PaCO2 >45mmHg so body will hypoventilate to retain CO2 to bring the pH down

Answer 391

Metabolic acidosis Respiratory acidosis Primary respiratory acidosis with a partial compensatory metabolic alkalosis

Answer 392

Acidaemia Respiratory alkalosis Metabolic acidosis from HCO3 and BE Metabolic acidosis with a compensatory respiratory alkalosis

Answer 393

Metabolic alkalosis from HCO3 and BE Respiratory acidosis Metabolic alkalosis with compensatory respiratory acidosis

Answer 394

``` Diarrhoea Diabetic ketoacidosis Renal failure Addison's disease Lactic acidosis (sepsis) ```

Answer 395

Vomiting - loss of H ions Hypoalbuminaemia - weak acid. Should not be less than 50 Upper GI obstruction (vomiting)

Answer 396

Critical parameters to be checked in critical care patients Fluid balance - assess hydration and replace fluid loss like for like eg blood with blood Albumin levels - keep above 20. Measure TS. Glucose - hypotensive, septic, anorexic and puppy patients. Electrolytes and acidbase - acidaemia seen in sepsis. Low magnesium can cause potassium to stay low. Everything has a knock on effect Oxygenation and ventilation Level of consciousness and mentation Blood pressure HR, rhythm, contractility and pulse quality Temperature Coagulation - risk of developing DIC and thrombocytopaenia PCV - haematocrit x3 = PCV Renal function - urine output 1-2ml/kg/hr Immune status, AB choice and WBC count - neutropenic patients barrier nursed GI motility - due to stress and opioids Drug doses and metabolism - calculate daily. Consider drug accumulation Nutrition - cats need arginine and taurine. Calculate RER daily. Feeding tube? Pain management - pain score. Multimodal analgesia Patient mobilisation and nursing care - minimal restraint. Recumbent patients. Physio. Prevent scalding Wound care TLC!!!!!!!

Answer 397

Plasma - hard to get hold of Blood transfusion Food - best way to increase

Answer 398

Renal disease GI losses Sepsis

Answer 399

Bradycardia | Caused by Addison's or urinary obstruction

Answer 400

RBC haemolysis | Usually due to anorexia

Answer 401

Hypotension Hypoglycaemia Hyperammonaemia

Answer 402

``` Recumbent - turn every 4 hours Oxygen therapy Feeding tube Eye drops every 15 mins Keep upright- propped up Inco sheets and barrier cream ECG IVFT Pain score Temp Monitor mentation Check Bp daily Check glucose, electrolytes and coags at admit Nebulisation and coupage Urinary catheter and monitor output Physio IV catheter and urinary catheter care ```

Answer 403

ECG and HR - decrease could mean raised ICP. Check pulses for change as risk of thromboembolism Bp measured every 2-4hrs - monitor for increase as could be raised ICP Blood loss during sx so hypertonic saline (oncotic pull) IVFT and syringe water Glasgow coma score and painscore Analgesia - opioids at high dose to encourage sedation Move slowly and ensure she's aware Urinary catheter - monitor output and care for it Barrier cream Turn every 4 hours Keep head elevated Bloods - monitor twice daily Monitor RR for aspiration pneumonia and thromboembolism PCV - blood transfusion? NPO for 24hrs post coma - feeding tube Quiet environment with minimal handling and padded bed. TLC

Answer 404

IVFT to support Bp Hypotension despite fluids so given vassopressors Bloods x4 day Bp monitor is response to fluids, ventilation and vasopressors HR and ECG - monitor for decrease as could be raised ICP and monitor for changes relating to ventilation, fluids and drugs Coags - monitor for bleeding as PSS prone to reduced clotting factors Monitor U+ Drugs - accumulation Feeding tube Analgesia CRI Turn every 4 hours Faecal scald Quiet environment with minimal stimuli. Gentql handling and padded bed

Answer 405

``` Eye care Mouth care Airway Humidification Physio and repositioning Lines, drains, tubes Urination/ defecation Drugs Treat underlying dx Communication Record keeping Acid base, blood gases and electrolytes ```