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Finals > Medical Nursing And Anaesthesia > Flashcards

Medical Nursing And Anaesthesia Flashcards

1
Q

Cutaneous Anthrax

A

95% human disease
Spores from soil, meat, tanning, hide
Horses and pigs
Painless lesion and dark crust

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2
Q

Septicaemic anthrax

A

Ingested from soil - horses and cattle
Ingested from protein supplements - pigs
Inhale spores - humans

Bacteria germinate, multiply uncontrollably and release toxins, using up the body’s O2 supply

Incubation 1-14days
Humans/horses 24hrs till death
Cattle 1-2hrs till death
Pigs death is rare

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3
Q

Symptoms of septicaemic anthrax

A 
Haemorrhage
Toxaemia
Enlarged spleen and LN inflammation
Capillary thrombosis
Blood vessel fluid loss
Pulmonary oedema
Septicaemia 
Circulatory collapse
Extreme hypoxia
Death

Pre death - dark blood from all orifices and increased ❤ and resp rate
Post death- dried dark blood round orifices and incomplete rigor mortis

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4
Q

What is Mycobacterium?

A

Gram +ve
Aerobic
Rods

M. Bovine
M. Tuberculosis
M. Avium- not psitticines

Spreads from all orifices
6mnths in faeces
1-4yrs in soil

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5
Q

How does Tb work

A 
Inhalation or ingestion
Local macrophages
Lymph nodes
Granuloma in lungs, liver and spleen - subclinical, military tb that is shedding
Granuloma bursts then spreads
Latent tb spread by coughing
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6
Q

Bovine Tb

A

XDRTb
Stock culls - restock after 1 monthbt surviving cows can sell pasteurised milk
Antibiotics not worth it for cattle
Vaccinations not available as current test looks for antibodies

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7
Q

Definition of a food allergy

A 
Immunological adverse reaction
Pruritis 
Genetic predisposition- defects of mucosal barrier or gut associated lymphoid tissue 
IgE type 1 hypersensitivity
Viruses can cause sensitisation
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8
Q

Symptoms of food allergy?

A 
V+
D+ 
Abdo pain
Weight loss
Haematemesis
Altered appetite 
Histological changes - villus atrophy, eosinophils infiltrate, lymphocyte infiltrate, intraepithelial infiltrate
Often mistaken for IBD
Intradermal skin tests not helpful
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9
Q

3 diets for food adversions

A

Restricted antigen diet- one novel protein
Hydrolysed - proteins broken down so do not elicit an antigen response however can expose antigen epitope - type 4 reaction possible. Expensive
Elemental diet - hydrolysed feather protein. All peptides <1kD

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10
Q

Symptoms of IBD

A 
Unknown cause
V+D+
Haematemesis 
Abdo pain
Weight loss
Small int - melana, watery, large vol
Large int - haematochezia, mucus, tenesmus, freq
Borborygmi
Flatus 
Polyphagia / anorexia
Hypoproteinaemia causing ascites in abdo
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11
Q

Diagnosis and treatment of IBD

A

Histological diagnosis - endoscopy and biopsy
Immunosuppression - preds or cyclosporine (not if anorexic)
Highly digestible restricted fat diet

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12
Q

Patient prep for endoscopy

A 
History
Physical exam
Faecal exam
Routine lab tests
Radiographs and ultrasound
12 hr fasting
Take biopsies when doing the endoscopy
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13
Q

Colonoscopy prep

A

24-36hr starvation
Enema 1litre arm water for up to 30kg
Lavage - Iso-osmotic solutions, 2-4 doses 25ml/kg, NG tube, last dose 12hrs pre colonoscopy

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14
Q

GA for endoscopy

A

No nitrous oxide as 3rd space effect will cause overdistension of the stomach
Cuffed et tube to prevent aspiration if regurge occurs
Mouth gag
L lateral recumbancy so gastroantrum and ileum on top
Standard GA monitoring, be aware of cardiorespiratory compromise with over inflation

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15
Q

Food intolerance

A

Predictable- eaten something they shouldn’t
Unpredictable- non-immunological reaction occurring in a susceptible individual as idiosyncratic reactions
- differences in intestinal flora, enzyme activity and permeability
- could be an underlying genetic predisposition

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16
Q

Leptospirosis

A

20 strains, vaccines are strain specific
Cycling between domestic and wild animals
Worse in stressed or immunocompromised animals
Spread by stagnant water and urine
BARRIER NURSE
50% mortality in unvaccinated dogs
Causes kidney probs and cold like symptoms
Serology and pcr to diagnose
Antibiotics if detected early
L4 in U.K. Against canicola and icterohaeorrhagiae

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17
Q

Absolute contraindications of endoscopy

A

Unfit for anaesthesia due to unstable cardiac arrhythmia, cardiac failure, non reversible hypoxaemia, bleeding disorder)
Bowel perforation

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18
Q

Relative contraindications from endoscopy

A

Poor cardiopulmonary reserve
Uraemia
Hypoproteinaemia
Inadequate prep and investigation

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19
Q

Complications of endoscopy

A

Acute bradycardia - small dogs, vago-vagal reflex, atropine
Bacteraemia - give antibiotics if GI bleeding
Haemorrhage - severe h+ is rare, usually malignancy
Perforation - rare usually due to disease or vigorous insufflation
Infection transmission - not cleaned properly. Do top before tail
⬇️ venous return from gastric over distension - increase antropyloric contractility, compression of the caudal vena cava, decreased venous return and bp, decreased tidal vol and diaphragmatic compression

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20
Q

Components of an endoscope

A

Light source made of incoherent glass fibres
Insufflation
Suction
Flexible endoscope

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21
Q

Pros and cons of fibre optic endoscope

A

Pros

  • portable
  • cheap
  • range of sizes

Cons

  • faceted image
  • smaller the size the lower the resolution
  • fragile as coherent glass fibres
  • hard to rotate
  • need a CCD camera attachment for video
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22
Q

Pros and cons of video endoscope

A

Pros

  • excellent quality
  • hygienic as don’t need to look through eye piece
  • assistant can also see the image

Cons

  • expensive
  • not easily portable
  • small diameters not available
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23
Q

What are the 3 types of bacillus?

A

Licheniform - abortion in cattle
Cereus - food poisoning in humans / mastitis in cattle
Anthracis- horses cattle and humans - lethal

Spores
Aerobic
Catalase +ve

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24
Q

Characteristics of a benign tumour

A 
Slow growth rate
Well defined boundary
Minimal impact on adjacent tissues
Minimal impact on host
No metastasis
Paraneoplastic effects can occur due to release of physiologically active components
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25
Q

Characteristics of a malignant tumour

A

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

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26
Q

When are tumours least susceptible to treatment

A

When first detectable as already began to slow down growth

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27
Q

Where do tumours metastasise to?

A

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

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28
Q

What are the paraneoplastic effects?

A

Haematological complications
Hyperhistaminaemia
By-stander immune mediated reactions
Hypercalcaemia

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29
Q

Haematological complications due to paraneoplastic effects

A 
Oestrogen producing cells are affected 
Bone marrow affected
Non regenerative anaemia - lethargy, weakness, dyspnoea
Thrombocytopenia - bleeding
Leukopenia - infection risk
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30
Q

Hyperhistaminaemia due to paraneoplastic effects

A

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

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31
Q

By-stander immune mediated reactions due to paraneoplastic effects

A

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

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32
Q

Hypercalcaemia due to paraneoplastic effects

A

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

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33
Q

Diagnosis of cancer

A 
History
Exam
Lab tests
Diagnostics
FNA 
Biopsy
Can only make accurate diagnosis by histological exam of the cells collected from the tumour
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34
Q

Cancer stage classification

A

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

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35
Q

Surgery to treat cancer

A

Most effective treatment option

Debulking a mass that can’t be removed completely increases cell turnover and improves the response to chemo

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36
Q

Radiotherapy as cancer treatment

A

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

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37
Q

Chemotherapy as cancer treatment

A

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

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38
Q

Types of chemo drugs

A

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

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39
Q

How is chemotherapy given?

A

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

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40
Q

Phases of chemo treatment

A

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

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41
Q

When to use chemotherapy

A

The tumour has to be systemic and have a high growth rate - lymphoma

Sarcoma, carcinoma and melanoma are resistant as too slow growing

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42
Q

Drug combo to treat lymphoma

A

Cyclophosamide
Oncovin
Prednisolone

+/- doxorubicin

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43
Q

Risks of cytotoxic drugs to patients

A

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

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44
Q

Treatment of GI toxicity from cytotoxic drugs

A

IVFT
Antiemetics
Gastroprotectants
Chlorhexidine mouthwash

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45
Q

What is myelosuppresion?

A

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

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46
Q

Phlebitis due to chemo

A

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

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47
Q

What to do if perivascular leakage of cytotoxic drugs

A 
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
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48
Q

Lymphoma

A

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

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49
Q

What is the Monroe Kelly Hypothesis?

A

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

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50
Q

Intracranial pressure

A

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

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51
Q

PaCO2 and PaO2

A

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

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52
Q

Anaesthetic considerations for neurodisease

A 
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
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53
Q

When doing a CIF tap what do you need to look out for

A

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

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54
Q

Drug considerations for neurodisease patients

A

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

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55
Q

GA considerations for hyperthyroidism

A

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

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56
Q

GA considerations for hypothyroidism

A 
Dogs
Megaoesophagus
Decreased GI motility
Obese and lethargic
Bradycardia and hypotension
Slow biotransformation of drugs
Hypothermia risk
Monitor cardiovascular system
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57
Q

GA considerations for hyperadrenocortism - Cushing’s

A 
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
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58
Q

GA considerations for Hypoadrenocortcism - Addisions

A 
Hyperkalaemia
Bradycardia
Dehydration
Weight loss
Lethargy
Stabilise before GA
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59
Q

GA considerations for Neuromuscular disorders

A

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

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60
Q

GA considerations for oesophageal foreign bodies

A 
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
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61
Q

GA considerations for GI foreign bodies

A 
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
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62
Q

GA considerations for GDV

A

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

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63
Q

GA considerations for equine colic

A

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

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64
Q

GA considerations for hepatic dysfunction

A

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

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65
Q

GA considerations for insulinoma

A 
BG checks
Hypoglycaemic - avoid hyperglycaemia pre op as stimulates insulin release - avoid dexmedetomidine
NMBA
Avoid nsaids 
Prednisolone post op
Post op pancreatitis risk
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66
Q

GA considerations for diabetes mellitus

A 
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
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67
Q

Explain the spontaneous breathing mechanisms

A

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

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68
Q

Minute volume calculation

A

Vt x resp rate

Vt = 10-15mL/kg

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69
Q

What is compliance?

A

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

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70
Q

How is ventilation controlled?

A 
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
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71
Q

Quantitative indications of using artificial ventilation

A

Failure to breathe - drugs ( opioids, NMBAs)

Control damage - cervical lesion or tetanus

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72
Q

Qualitative indications for artificial respiration

A 
Low O2, high CO2
Drug induced resp depression
Mechanical impairments - open thorax
V/q mismatch
Lung disease - asthma causing bronchospasm
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73
Q

Preventative indications for artificial ventilation

A

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

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74
Q

How does high frequency jet ventilation work?

A

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

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75
Q

How does IPPV work?

A

Inverse mechanism

Create +ve pressure on inhalation

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76
Q

Manual IPPV

A

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

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77
Q

Pros and cons of manual IPPV

A 
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

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78
Q

Pros and cons of ventilators?

A 
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

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79
Q

Types of controlled ventilation

A

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

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80
Q

Additional features of ventilators

A

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

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81
Q

Pressure controlled vs volume controlled IPPV

A

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

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82
Q

Risks of IPPV

A

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

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83
Q

What are the variables and settings on a ventilator?

A 
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
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84
Q

How to calculate minute ventilation?

A

Breathing rate x tidal volume

Breathing rate =60/(inspiratory time + expiratory time)

Tidal volume = inspiratory time x inspiratory flow rate

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85
Q

Breathing phases controlled by triggering

A

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

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86
Q

Breathing phases controlled by cycling

A

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

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87
Q

Breathing phases controlled by limiting

A

Safety, set maximum value of either pressure, volume, flow

Can stop inspiration prematurely if max pressure is reached

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88
Q

Features of a bag squeezer ventilator

A

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

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89
Q

Features of a mechanical thumb ventilator

A

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

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90
Q

Features of an intermittent blower ventilator

A

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

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91
Q

Features of a minute volume ventilator

A

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

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92
Q

What must be done when setting up a ventilator?

A

Close APL valve

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93
Q

What should the inspiration:expiration ratio be when using a ventilator

A

1:2

Short inspiration of 1 second

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94
Q

What needs to be monitored when ventilating

A

Spirometry
Capnography
Blood gas analysis

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95
Q

How do you stop IPPV?

A

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

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96
Q 
Lacey
Racial and ulnar fractures
Cardiovascularly stable
Long sx
Significant post op pain expected
A 
Pre-med - alpha 2 and methadone
Induce propofol or alfaxalone
Radial ulnar musculocutaneous nerve blocks or brachial plexus nerve blocks
NSAIDs
Methadone post op
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97
Q

Bertha

Ovariohysterectomy

A

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

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98
Q

Benson
Castration
Cardiovascular dx- mitral valve dx will increase regurg or blood loss when slowing heart rate

A 
ACP and bup
Propofol or alfaxalone
Sevo for quick recovery
NSAID post op
Intratesticular nerve block
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99
Q

Gracie

Bilateral sacro iliac luxation

A 
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
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100
Q

One year old colt

Standing castration

A 
Alpha 2 ( xylazine, rimifadine, dexmed) and opioid (but/bup)
Intratesticular nerve block - lidocaine
NSAID
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101
Q

Why use capnography?

A

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

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102
Q

Low V/Q

A

Low ventilation but there is perfusion
Atelectasis
Mucous plugging

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103
Q

High v/q

A

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

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104
Q

What should ETCO2 be and what is it?

A

30-43 mmHg due to V/Q mismatch

It is the highest level of excreted CO2 which is closest to CO2 in the blood

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105
Q

Draw a capnograph trace and explain what each component means

A

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

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106
Q

What does it mean when the beta angle on a capnograph is not 90 degrees?

A

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

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107
Q

What is the difference between ETCO2 and PaCO2?

A

5mmHg

Greater than this and means alveolar dead space

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108
Q

When will ETCO2 increase?

A 
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
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109
Q

When will ETCO2 decrease?

A

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

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110
Q

Draw a capnography trace for inspiratory obstruction

A

Check notes

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111
Q

Draw a capnograph for leaking ET tube

A

Check notes

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112
Q

Draw a capnograph for heart oscillations

A

Check notes

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113
Q

Draw a capnograph for surgeon leaning on chest

A

Check notes

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114
Q

Draw a capnograph for dilution of expired gases by fresh gas flow

A

Check notes

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115
Q

Draw a capnograph to show fighting IPPV and a leak in the sampling

A

Check notes

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116
Q

Draw capnograph to show cardiac arrest then cpr

A

Check notes

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117
Q

Limitations of pulse oximetry

A

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

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118
Q

ECG

A

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.

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119
Q

When are there alterations of the ECG during GA

A 
Pain
Artefact
Diathermy
Hypoxaemia
Hypercapnia
Hypotension
Hypo/hyperthermia
Electrolyte abnormalities
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120
Q

What does sinus bradycardia look like

A

Appropriate PQRST wave with each beat

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121
Q

What does AV block 2nd degree look like?

A

P waves with a few normal PQRST complexes.

Treat with atropine

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122
Q

What does AV block 3rd degree look like?

A

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

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123
Q

What does ventricular extra systole look like?

A

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

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124
Q

What does bigeminy look like

A

One normal complex then one ventricular extra systole

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125
Q

What does ventricular fibrillation look like

A

No normal complexes

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126
Q

What does atelectasis mean

A

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

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127
Q

Why is thoracic surgery painful?

A

Skin incision
Nerve damage
Retraction is extremely painful
Inflammation

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128
Q

Preanaethesia prep for thoracic surgery

A

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

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129
Q

Anaesthetic protocol for thoracic surgery - cardiovascular

A

Minimise cardiovascular depression
No alpha 2 agonists
Multimodal approach
Cardiovascular drugs

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130
Q

Anaesthetic protocol for thoracic surgery - respiratory

A 
Minimise respiratory depression
Premed opioid and ACP
Rapid intubation
Propofol / alfaxalone / ketamine 
Etomidate
Use volatile agents for rapid recovery
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131
Q

Mechanical or manual ventilation in thoracic surgery?

A

Mechanical less demanding

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

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132
Q

Do you need NMBAs when starting IPPV?

A

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

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133
Q

Risks of ventilation during thoracic surgery

A

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

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134
Q

When to stop ventilation

A

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

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135
Q

Basic life support for thoracic surgery

A

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

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136
Q

Analgesic management for thoracic surgery

A 
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
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137
Q

Recovery of thoracic surgery

A

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

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138
Q

Analgesia for orthopaedic or spinal patients

A 
Multimodal is best
NSAIDs
Opioids
Local nerve blocks
Epidural

Local blocks enable a lighter plane of anaesthesia as sensation is abolished

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139
Q

Anaesthetic considerations for trauma patients

A

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

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140
Q

What happens if there is a splenic rupture?

A

Don’t touch

Allow a few days to heal

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141
Q

GA considerations for paediatric patients needing orthopaedic surgery

A

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

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142
Q

Surgical fluid rate

A

5ml/kg/hr

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143
Q

Complications of orthopaedic surgery

A

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

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144
Q

Recovery of orthopaedic patients

A

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

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145
Q

What is base excess?

A

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

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146
Q

What is the anion gap?

A

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

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147
Q

PaO2

A

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%

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148
Q

Respiratory alkalosis

A

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

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149
Q

Metabolic acidosis

A

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

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150
Q

Metabolic acidosis and respiratory alkalosis

A 
Base excess low
Hypocapnic
pH normal
Anion gap low
HCO3 low
Mixed acid base disturbance
Give bicarbonate but don't mix with hartmanns
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151
Q

Observation of animals in respiratory distress

A

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

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152
Q

Auscultation of animals in respiratory distress

A 
Normal lung sounds barely audible
Crackles - fluid
Wheezes - airways narrowing
No lung sounds - pleural space disease
Stertorous or strider - upper airways
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153
Q

Upper airway disorder causes in cats

A

Foreign body
Nasopharyngeal polyps
Laryngeal tumours

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154
Q

Lower airway disorders in cats

A

Feline lower respiratory tract disease

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155
Q

Parenchymal lung disease causes in cats

A

Pulmonary oedema
Haemorrhage
Infection

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156
Q

Pleural space disease causes in cats

A

Pneumothorax

Pleural effusion

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157
Q

How to stabilise a cat in resp distress

A

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

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158
Q

What do you need to set up for thoracocentesis

A 
19g butterfly needle
3 way tap
Syringe
Skin prep
Sterile gloves
Ultrasound machine
Tubes for sampling

Clip hair over 7-8th intercostal space

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159
Q

In an emergency how would you give drugs to a distressed cat

A

I/M

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160
Q

Name a bronchodilator

A

Terbutaline is a B-2 agonist

0.05mg/kg I/M in cats

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161
Q

What corticosteroid can you give to a cat in resp distress

A

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

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162
Q

Which problem can thoracocentesis not help

A

Diaphragmatic hernia

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163
Q

What can cause pneumothorax

A

Chronic bronchitis and asthma

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164
Q

How do you intubate a cat with laryngeal paralysis

A

Using a dog urinary catheter through an ET tube

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165
Q

What are hypothermia and hypotension signs of in cats

A

Sepsis or infection

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166
Q

Why is anaemia a problem in cats

A

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

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167
Q

Clinical signs of anaemia in cats

A

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

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168
Q

Why perform a haematological examination when investigating anaemia

A

Confirms presence and type of anaemia

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169
Q

Features that suggest regenerative anaemia in cats

A

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

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170
Q

What reticulocytes occur in cats

A

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

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171
Q

Which reticulocyte is rarely seen in non anaemia cats

A

Aggregate form

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172
Q

When can regenerative anaemia become non regenerative anaemia

A

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

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173
Q

Two main causes of regenerative anaemia

A

Blood loss

Haemolysis

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174
Q

Causes of haemolytic anaemia

A 
FeLV
Parasites
Primary or secondary immune mediated haemolytic anaemia
Heinz body anaemia
Severe hypophosphataemia
Incompatible blood transfusions
Neonatal isoerythrolysis
Inherited defects
How well did you know this?
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4
5
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175
Q

How does mycoplasma haemofelis cause feline infectious anaemia

A

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

176
Q

Symptoms of feline infectious anaemia

A 
Pallor
Lethargy
Weight loss
Anorexia
Pyrexia
Dehydration
177
Q

Diagnosis of feline infectious anaemia

A

Polymerase chain reaction

178
Q

Treatment of feline infectious anaemia

A

Doxycycline antibiotic pill with food or water to prevent oesophageal stricture

179
Q

What do you know about Heinz body anaemia

A

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

180
Q

Neonatal isoerythrolysis

A

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

181
Q

Non regenerative anaemia causes

A

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

182
Q

Bone marrow disorders

A

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

183
Q

How do you treat anaemia

A

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

184
Q

When to give a blood transfusion in a cat suffering from anaemia

A

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

185
Q

How can you stimulate the bone marrow

A

Anabolic steroids stimulate erythroid precursors via EPO activation
Prednisolone therapy

186
Q

What is erythropoietin

A

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

187
Q

What is a bleeding disorder

A

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

188
Q

What is primary haemastasis

A

Reflex constriction of blood vessels

Platelet plug

189
Q

What is secondary haemastasis

A

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

190
Q

Which clotting factor helps platelet adhesion

A

Von wilebrands factor

191
Q

Primary haemostatic disorders

A

Qualitative and quantitative platelet disorders

Vessel wall defects so can’t vasoconstrict

192
Q

Which coagulation factors are in the intrinsic pathway

A

XII, IX, XI, VIII

Ca2

193
Q

Which coagulation factors are in the extrinsic pathways

A

VII, III,

Ca2

194
Q

Which coagulation factors are in the common pathway

A

V, X

Ca2

195
Q

Where are coagulation factors synthesised

A

Liver

196
Q

Which coagulation factors require the liver to use vitamin k

A

II, VII, IV, X

197
Q

What is tertiary haemastasis

A

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

198
Q

Clinical signs of primary haemostatic disorders

A 
Petechiae and ecchymotic haemorrhages
Multiple sights of bleeding
Prolonged bleeding
Venepuncture bleeding
Surface bleeding from mm
199
Q

Clinical signs of secondary haemostatic disorders

A

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

200
Q

Screening tests for primary haemostatic disorders

A

Platelet count

Buccal mucosal bleeding time

201
Q

Lab tests for secondary haemostatic disorders

A

Activated clotting time
Activated partial thromboplastin time
Prothrombin time

202
Q

What does the buccal mucosal bleeding time test look for

A

Platelet function or number

203
Q

What does activated clotting time test for

A

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

204
Q

What does activated partial thromboplastin time and prothrombin time test for

A

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

205
Q

What is chronic kidney disease

A

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

206
Q

Causes of chronic kidney disease

A 
Chronic interstitial nephritis 
Glomerulonephropathies
Infection
Nephrotoxins and drugs e.g. Ethylene glycol
Neoplasia
Inherited or congenital disease
207
Q

Clinical signs of CKD

A

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

208
Q

How do you test for CKD

A 
SG will be low
Sediment
Dipstick
Culture and sensitivity 
Urinanalysis will show azotaemia
Biochem and haem
Blood pressure
Ultrasound
209
Q

Staging of CKD

A

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

210
Q

Aims of treatment for CKD

A

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

211
Q

Why do you need to correct and maintain fluid balance of patients with CKD

A

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

212
Q

How do you manage the clinical signs of CKD with diet

A

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

213
Q

Treatment of vomiting and nausea

A

Gastroprotectants
Sucralfate
Antiemetics

214
Q

Management of inappetance or anorexia

A

Control nausea
Smelly foods
Mirtazapine
Enteral feeding if severe

215
Q

Treatment of constipation

A

Oral lactulose

Fluid therapy

216
Q

Correction of hypokalaemia

A

Potassium supplementation oral potassium gluconate if eating

Potassium chloride IV

217
Q

Management of hyperphosphataemia

A

Diet

Oral phosphate binding drugs with food

218
Q

Management of systemic hypertension

A

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

219
Q

Management of proteinuria

A

Telmisartin

Benazepril

220
Q

Anaesthetic considerations for rhinoscopy and bronchoscopy

A

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

221
Q

GA considerations for BOAS

A

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

222
Q

GA considerations for laryngeal surgery

A

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

223
Q

GA considerations of dental procedures

A

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

224
Q

GA considerations of ocular procedures

A

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

225
Q

Locoregional techniques for the eye

A

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

226
Q

What to prepare for BOAS sx

A

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

227
Q

Components of the BOAS

A 
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
228
Q

What other signs are present in BOAS patients and how are they managed

A 
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
229
Q

Surgical considerations of aural and nasopharyngeal polyps

A 
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
230
Q

What is the anion gap?

A

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

231
Q

PaO2

A

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%

232
Q

Respiratory alkalosis

A

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

233
Q

Metabolic acidosis

A

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

234
Q

Metabolic acidosis and respiratory alkalosis

A 
Base excess low
Hypocapnic
pH normal
Anion gap low
HCO3 low
Mixed acid base disturbance
Give bicarbonate but don't mix with hartmanns
235
Q

Observation of animals in respiratory distress

A

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

236
Q

Auscultation of animals in respiratory distress

A 
Normal lung sounds barely audible
Crackles - fluid
Wheezes - airways narrowing
No lung sounds - pleural space disease
Stertorous or strider - upper airways
237
Q

Upper airway disorder causes in cats

A

Foreign body
Nasopharyngeal polyps
Laryngeal tumours

238
Q

Lower airway disorders in cats

A

Feline lower respiratory tract disease

239
Q

Parenchymal lung disease causes in cats

A

Pulmonary oedema
Haemorrhage
Infection

240
Q

Pleural space disease causes in cats

A

Pneumothorax

Pleural effusion

241
Q

How to stabilise a cat in resp distress

A

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

242
Q

What do you need to set up for thoracocentesis

A 
19g butterfly needle
3 way tap
Syringe
Skin prep
Sterile gloves
Ultrasound machine
Tubes for sampling

Clip hair over 7-8th intercostal space

243
Q

In an emergency how would you give drugs to a distressed cat

A

I/M

244
Q

Name a bronchodilator

A

Terbutaline is a B-2 agonist

0.05mg/kg I/M in cats

245
Q

What corticosteroid can you give to a cat in resp distress

A

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

246
Q

Which problem can thoracocentesis not help

A

Diaphragmatic hernia

247
Q

What can cause pneumothorax

A

Chronic bronchitis and asthma

248
Q

How do you intubate a cat with laryngeal paralysis

A

Using a dog urinary catheter through an ET tube

249
Q

What are hypothermia and hypotension signs of in cats

A

Sepsis or infection

250
Q

Why is anaemia a problem in cats

A

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

251
Q

Clinical signs of anaemia in cats

A

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

252
Q

Why perform a haematological examination when investigating anaemia

A

Confirms presence and type of anaemia

253
Q

Features that suggest regenerative anaemia in cats

A

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

254
Q

What reticulocytes occur in cats

A

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

255
Q

Which reticulocyte is rarely seen in non anaemia cats

A

Aggregate form

256
Q

When can regenerative anaemia become non regenerative anaemia

A

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

257
Q

Two main causes of regenerative anaemia

A

Blood loss

Haemolysis

258
Q

Causes of haemolytic anaemia

A 
FeLV
Parasites
Primary or secondary immune mediated haemolytic anaemia
Heinz body anaemia
Severe hypophosphataemia
Incompatible blood transfusions
Neonatal isoerythrolysis
Inherited defects
259
Q

How does mycoplasma haemofelis cause feline infectious anaemia

A

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

260
Q

Symptoms of feline infectious anaemia

A 
Pallor
Lethargy
Weight loss
Anorexia
Pyrexia
Dehydration
261
Q

Diagnosis of feline infectious anaemia

A

Polymerase chain reaction

262
Q

Treatment of feline infectious anaemia

A

Doxycycline antibiotic pill with food or water to prevent oesophageal stricture

263
Q

What do you know about Heinz body anaemia

A

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

264
Q

Neonatal isoerythrolysis

A

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

265
Q

Non regenerative anaemia causes

A

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

266
Q

Bone marrow disorders

A

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

267
Q

How do you treat anaemia

A

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

268
Q

When to give a blood transfusion in a cat suffering from anaemia

A

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

269
Q

How can you stimulate the bone marrow

A

Anabolic steroids stimulate erythroid precursors via EPO activation
Prednisolone therapy

270
Q

What is erythropoietin

A

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

271
Q

What is a bleeding disorder

A

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

272
Q

What is primary haemastasis

A

Reflex constriction of blood vessels

Platelet plug

273
Q

What is secondary haemastasis

A

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

274
Q

Which clotting factor helps platelet adhesion

A

Von wilebrands factor

275
Q

Primary haemostatic disorders

A

Qualitative and quantitative platelet disorders

Vessel wall defects so can’t vasoconstrict

276
Q

Which coagulation factors are in the intrinsic pathway

A

XII, IX, XI, VIII

Ca2

277
Q

Which coagulation factors are in the extrinsic pathways

A

VII, III,

Ca2

278
Q

Which coagulation factors are in the common pathway

A

V, X

Ca2

279
Q

Where are coagulation factors synthesised

A

Liver

280
Q

Which coagulation factors require the liver to use vitamin k

A

II, VII, IV, X

281
Q

What is tertiary haemastasis

A

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

282
Q

Clinical signs of primary haemostatic disorders

A 
Petechiae and ecchymotic haemorrhages
Multiple sights of bleeding
Prolonged bleeding
Venepuncture bleeding
Surface bleeding from mm
283
Q

Clinical signs of secondary haemostatic disorders

A

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

284
Q

Screening tests for primary haemostatic disorders

A

Platelet count

Buccal mucosal bleeding time

285
Q

Lab tests for secondary haemostatic disorders

A

Activated clotting time
Activated partial thromboplastin time
Prothrombin time

286
Q

What does the buccal mucosal bleeding time test look for

A

Platelet function or number

287
Q

What does activated clotting time test for

A

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

288
Q

What does activated partial thromboplastin time and prothrombin time test for

A

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

289
Q

What is chronic kidney disease

A

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

290
Q

Causes of chronic kidney disease

A 
Chronic interstitial nephritis 
Glomerulonephropathies
Infection
Nephrotoxins and drugs e.g. Ethylene glycol
Neoplasia
Inherited or congenital disease
291
Q

Clinical signs of CKD

A

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

292
Q

How do you test for CKD

A 
SG will be low
Sediment
Dipstick
Culture and sensitivity 
Urinanalysis will show azotaemia
Biochem and haem
Blood pressure
Ultrasound
293
Q

Staging of CKD

A

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

294
Q

Aims of treatment for CKD

A

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

295
Q

Why do you need to correct and maintain fluid balance of patients with CKD

A

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

296
Q

How do you manage the clinical signs of CKD with diet

A

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

297
Q

Treatment of vomiting and nausea

A

Gastroprotectants
Sucralfate
Antiemetics

298
Q

Management of inappetance or anorexia

A

Control nausea
Smelly foods
Mirtazapine
Enteral feeding if severe

299
Q

Treatment of constipation

A

Oral lactulose

Fluid therapy

300
Q

Correction of hypokalaemia

A

Potassium supplementation oral potassium gluconate if eating

Potassium chloride IV

301
Q

Management of hyperphosphataemia

A

Diet

Oral phosphate binding drugs with food

302
Q

Management of systemic hypertension

A

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

303
Q

Management of proteinuria

A

Telmisartin

Benazepril

304
Q

Anaesthetic considerations for rhinoscopy and bronchoscopy

A

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

305
Q

GA considerations for BOAS

A

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

306
Q

GA considerations for laryngeal surgery

A

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

307
Q

GA considerations of dental procedures

A

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

308
Q

What is normal resp rate

A

< 35bpm

309
Q

Features of pleural space disease

A

Restrictive breathing pattern

Increased rate but reduced depth

310
Q

Features of lung parenchyma disease

A

Inspiratory and expiratory dyspnoea

Lung tissue affected

311
Q

Why is monitoring patients in resp distress important

A

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%

312
Q

What physical exam should be performed on patients in resp distress

A 
Resp rate and effort
Anxiety levels
HR and pulse quality
Mm
Arterial blood gas for PaO2
Pulse ox
313
Q

What should Pa02 be

A

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

314
Q

When has a patient got hypoxaemia

A

PaO2 <80mmHg

SaO2 <95%

315
Q

Diagnosis and stabilisation of pleural effusion or pneumothorax

A 
X rays
Ultrasound
Physical exam
Thoracocentesis
Samples for cytology, culture, biochem
316
Q

Signs of left sided heart failure

A 
Pulmonary oedema
Tachypnoea
Dyspnoea
Cough
Pulmonary crackles
317
Q

Signs of right sided heart failure

A

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

318
Q

What do cats with heart failure present with in general

A 
Tachycardia
Weak pulses
Pale mm
Slow CRT
Cats can present with hypothermia and bradycardia
319
Q

Why is the emergency stabilisation of a dog with congestive heart failure

A 
Minimise stress
Oxygen
Furosemide 2mg/kg IV
Record an ECG
If in myocardial failure then pimobendan 0.15mg/kg IV
320
Q

What should you monitor when a dog has congestive heart failure

A

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

321
Q

What further investigations should you do if a patient has CHF

A

Haematology
Biochem
Echocardiography
Thoracic radiographs

322
Q

When a patient with CHF has been stabilised, what are the next steps

A

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

323
Q

What should normal systolic blood pressure be

A

120-140mmHg

324
Q

What are the signs of pericardial effusion

A 
Right sided heart failure
Distended jug veins
Pulsating hug veins
Ascites
Tachycardia
Weak pulses
325
Q

What is the diagnosis and treatment of pericardial effusion

A 
Physical exam and echocardiography 
Pericardiocentesis 
IVFT
No furosemide
Hospital for 24-48hrs
Can recur - if no marked improvement then neoplasia possible
326
Q

What are the signs of hypertrophic cardiomyopathy

A

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

327
Q

What is the emergency stabilisation for cats with hypertrophic cardiomyopathy

A 
No stress
Furosemide
Oxygen
Thoracocentesis if pleural effusion 
Treat hypothermia
Pain meds
328
Q

Once stable what is the treatment for hypertrophic cardiomyopathy

A

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

329
Q

What is a bradyarrhythmia

A 
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
330
Q

What is a tachyarrhythmia

A

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

331
Q

What diseases are associated with Right sided Heart Failure

A

Pericardial effusion

Congenital cardiac disease

332
Q

What diseases are associated with left sided heart failure

A

Degenerative valvular disease

Dilated cardiomyopathy

333
Q

Lost the potential adverse side effects that could occur during anaesthesia of:

A

12 yr JRT dental and potential extractions

16yr old DSH full extraction

334
Q

What are the potential adverse effects of NMBA. What will you see clinically and what you should do.

A

What other analgesics can be used

335
Q

What does capnometry mean

A

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

336
Q

What is capnography

A

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

337
Q

What is a capnograph

A

Display of CO2 waveform

338
Q

Why is measurement of respired gases helpful in anaesthesia

A 
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
339
Q

How does a capnograph measure CO2

A

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

340
Q

Advantages and disadvantages of side stream capnography

A

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

341
Q

Advantages and disadvantages of main stream capnography

A

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

342
Q

What causes low V/Q

A

Mucous plugging of bronchioles
Et tube in a main bronchus
Atelectasis

343
Q

Causes of high V/Q

A

Pulmonary embolism
Hypovolaemia
Low cardiac output
Cardiac arrest

344
Q

Normal PaCO2 and ETCO2

A

PaCO2 - 35-45

ETCO2 - 30-43

345
Q

Why would inspiratory CO2 not be zero

A

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

346
Q

When is treatment indicated for arrhythmias

A

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

347
Q

What anaesthetic drugs cause muscle relaxation

A 
Alpha 2s
Benzodiazepines 
Acepromazine
Propofol
Alfaxalone
Thiopental
Volatiles
348
Q

What anaesthetic drugs do not provide muscle relaxation

A

Opioids - methanol, fentanyl

Dissociative - ketamine

349
Q

Name a central acting muscle relaxant

A

Guaiphenesine - equine

Inhibits interneurons at spinal level

350
Q

Mechanism of action of neuromuscular blocking agents

A

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

351
Q

What are the consequences of full neuromuscular block

A

Respiratory failure

Behavioural and physical signs of anaesthetic depth are gone

352
Q

Indications for the use of NMBA

A

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

353
Q

Pharmacology of atracurium

A 
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
354
Q

What is the pharmacology of vecuronium

A 
Aminosteroid
Non depolarising
20mins
Excreted unchanged via bile so unsuitable for hepatic patient
No cardiovascular side effects
355
Q

Pharmacology of suxamethonium

A 
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
356
Q

How do you monitor a NMB

A

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.

357
Q

How do you antagonise a neuromuscular block

A

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

358
Q

Why do you only give one dose of NMBAs

A

Phase II block after more than one dose

359
Q

What factors influence the duration of the neuromuscular blockade

A 
Volatile agent
Hypothermia
Hepatic/ renal insufficiency
Electrolyte acid base abnormalities
Muscle diseases
Aminoglycoside antibiotics
Dose administered
360
Q

What are the general anaesthetic principles of airway surgery

A 
Schedule first
Keep calm
Careful monitoring
Corticosteroids
Hydration
Thermoregulation 
Recovery is critical
361
Q

What are the features of laryngeal paralysis

A 
Elderly dogs
Hyperthermia
Dehydration
Do not stress
Give oxygen
Sedation of ACP, opioid and corticosteroid helps breathing
362
Q

What is the recovery plan for dogs with laryngeal recovery

A 
Rapid calm recovery
Extubate late
Give oxygen
Monitor carefully
Avoid barking or excitement - analgesia
363
Q

What are the anaesthetic considerations for BOAS

A 
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
364
Q

Anaesthetic considerations for bronchoscopy or tracheal foreign bodies

A 
Pre existing respiratory compromise
Anticholinergic
Pre oxygenate
In cats can't always pass bronchoscope through et tube
Risk of environmental pollution
Pneumothorax
365
Q

How do you control intraocular eye pressure during ophthalmology surgery

A 
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
366
Q

What drugs are used in ophthalmology that can cause issues during anaesthetic

A

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

367
Q

How is a central eye maintained during anaesthesia for ocular surgery

A 
Ketamine
Stay sutures
Correct depth of anaesthesia
Ophthalmic nerve block
Muscle relaxant
368
Q

What is the maintenance and recovery of GA from ocular surgery

A

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

369
Q

Excitable 6yr lab
Eyelid tumour
Anaesthetic plan

A

Dexmedetomidine and bup
NSAID
Local block
Induction and maintenance requirements reduced

370
Q

Bulldog
BOAS
surgery to correct entropion
Anaesthetic plan

A

Pethidine and nsaid
Pre oxygenate
Propofol
Iso or sevo

371
Q

Cat
Ocular trauma
Anaesthetic plan

A 
Control IOP
ACP and pethidine sedation
Hindlimb catheter
Avoid ketamine for induction
Avoid hypoxia or hypercapnia
NSAID
Stay sutures or NMBA - IPPV
372
Q

Dog
Enucleation due to glaucoma
Anaesthetic plan

A

ACP and methadone
NSAID
Retrobulbar block
Blood loss

373
Q 
Dog
Cataract sx
Elderly
Possible diabetetic
Anaesthetic plan
A 
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
374
Q

How can you make feline senior clinics a success

A

For healthy cats
Monitoring clinics
Maximise our involvement and skills

375
Q

What needs to be considered when setting up a senior clinic

A

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

376
Q

How do you promote senior pet clinics

A 
Newsletters
Social media
Word of mouth - vets and receptionists
Post op checks
Vaccination or flea checks
Obesity clinics
Dental clinics 
Client open evenings
377
Q

What age is senior for a cat

A

7-8years

378
Q

Common conditions of senior cats

A 
Kidney disease
Hyperthyroidism
Dental disease
IBD
Hypertension
Degenerative joint disease
379
Q

Consultation structure for senior cat clinic

A 
History
Weigh
Blood pressure
Discuss findings
Clinical exam
Discuss findings
Diagnostic tests if needed
Summarise and arrange a revisit
380
Q

What should feline senior diets contain

A

Reduced energy
Reduced fat
Reduced calcium and phosphorus
Increased fibre

381
Q

What does orthpnoea mean

A

Only able to breathe standing or sitting up

382
Q

What does hyperpnoea mean

A

Increased depth of breathing

383
Q

How do you do a temporary tracheostomy

A

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

384
Q

What do you do if a BOAS patient is stressed

A

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

385
Q

When auscultating the lungs, what can each quadrant tell you

A

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

386
Q

Which arteries do you measure arterial blood gas from

A

Dorsal metatarsal

Femoral

387
Q

How do you calculate the partial pressure of inspired o2

A

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

388
Q

What can the PAO2/FIO2 ratio and A-A gradient tell us

A

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

389
Q

How should you approach a patient in cardiorespiratory distress

A 
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
390
Q

What are right sided cardiac emergencies

A

Tricuspid valve disease
Pulmonic stenosis
Pericardial effusion

391
Q

What are whole heart emergencies

A 
Dilated cardiomyopathy
Congenital defects
Hypertrophic cardiomyopathy 
Endocarditis
Ventricular tachycardia 
Atrial fibrillation
Ventricular fibrillation 
Sick sinus syndrome
3rd degree AV block
392
Q

What is a left sided heart emergency

A

Mitral valve degenerative disease

393
Q

What is preload of the heart

A

Volume of blood in left ventricle before contraction

394
Q

What is afterload of the heart

A

Resistance in the left ventricle wall when blood is ejected

395
Q

What happens when cardia output decreases

A

Blood pressure decreases

Renin-angiotensin system activated

396
Q

How do you diagnose heart disease

A 
Auscultation
History
Echo
ECG
Thoracic radiographs
Bloods - haem, biochem, electrolytes, proBNP
397
Q

What is dilated cardiomyopathy

A

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

398
Q

What is hypertrophic cardiomyopathy

A 
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
399
Q

What is cardiac tamponade

A 
Pericardial effusion
Right side
Compresses and effects CO
Obstructive shock
Electrical alternans
Pericardiocentesis
Cause usually neoplasia
NO FUROSEMIDE
400
Q

How do you do a pericardiocentesis

A 
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
401
Q

What is endocarditis

A 
Bacterial infection
Mitral and aortic valves affected
Blood culture
IVFT
Ventricular tachycardia, idioventricular ventricular arrhythmias 
Antibiotics and supportive care
402
Q

What is degenerative heart disease

A 
Mitral valve LCHF 
Tricuspid RCHF
Small dogs
Nodular and thick
Regurgitation 
Give furosemide, ACE inhibitors and dilazem
403
Q

When should you be worried with arrhythmias and how should they be treated

A

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

404
Q

What types of ECG monitors are there

A

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

405
Q

When obtaining an ECG what position should your patient be in

A

Right lateral

406
Q

How do you prevent problems with an ECG

A

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

407
Q

When are ECGs used

A

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

408
Q

What heart rate do you see with hyperkalaemia

A

Bradycardia

No P spikey T

409
Q

What is the conduction system of the heart

A

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

410
Q

What are the cell types in the heart

A

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.

411
Q

ECG

A

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

412
Q

How do you interpret an ECG

A 
Rate
Rhythm - regular, regularly irregular, irregularly irregular
Is there a p wave for every QRS
Sinus or ventricular arrhythmias 
Intermittent or continuous
413
Q

What is an ectopic beat

A 
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
414
Q

What are escape beats

A

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

415
Q

Av blocks

A

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.

416
Q

Hyperkalaemia arrhythmias

A

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

417
Q

Sick sinus syndrome

A 
Abnormal SA node function
Bradycardia, tachycardia and periods of arrest
Can get failure of escape beats
Need pacemaker 
WHWT common
418
Q

Features of pacemakers

A 
Treat bradycardia
Last 5-10years
Expensive
Care with neck restraint
No jugular samples
Remove when animal is euthanised
419
Q

Risks of pacemakers

A 
Infection
Lead dislodgement
Failure
GA related issues
Lead fracture
Venous thrombosis
420
Q

Blood gas and acid base values

A

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

421
Q

Acid base imbalances

A

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

422
Q 
6yr bulldog
He hypoplastic trachea and mitral valve insufficiency 
pH 7.063
PaCO2 106.7mmHg
HCO3 28.4
BE 4.2
A

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

423
Q 
7yr lab
Hx pancreatic duct adenocarcinoma and peritonitis
pH 7.202
PaCO2 19.8mmHg
HCO3 7.4mEq/L
BE -18.5
A

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

424
Q 
6yr Boston terrier
pH 7.49
PaCO2 47mmHg
HCO3 34.8mEq/L
BE 10.2
A

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

425
Q

Causes of metabolic acidosis

A 
Diarrhoea
Diabetic ketoacidosis
Renal failure
Addison's disease
Lactic acidosis (sepsis)
426
Q

Causes of respiratory alkalosis

A

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

427
Q

What is Kirby’s rule of 20

A

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!!!!!!!

428
Q

How can you correct hypoalbuminaemia

A

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

429
Q

When is potassium low in patients

A

Renal disease
GI losses
Sepsis

430
Q

What can high potassium cause

A

Bradycardia

Caused by Addison’s or urinary obstruction

431
Q

What can low and high levels of sodium cause

A

CNS signs

432
Q

What can low phosphate cause

A

RBC haemolysis

Usually due to anorexia

433
Q

What can cause a loss of consciousness or mentation

A

Hypotension
Hypoglycaemia
Hyperammonaemia

434
Q 
3yr MN huntaway
Ascending paralysis
Cranial nerve deficits - no blink or gag
Impaired respiration - aspiration pneumonia
SpO2 90%
RR 84
HR 124-158
Mm red CRT 1s
Bp 100mmHg
Corneal melting ulcers
Suspect toxin ingestion - botulism
Nursing considerations?
A 
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
435
Q 
10yr female JRT
Brain tumour removal sx
Propofol coma 24 hours
HR95
RR 18
Bp 135mmHg
Paralysis / semicomatose - gag present
20% blood loss in sx
SpO2 100%
Blind
Nursing considerations?
A

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

436
Q 
2yr MN DLH
Status epilepticus
HR 240
RR 60
Bp sys 60mmHg
Ventilator for 3 days
HE, PSS
Nursing considerations?
A

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

437
Q

How should you nurse the ventilator patient

A 
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

Finals (3 decks)

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