Midterm Review Flashcards
Typical emergency & critical care ceases presented in vet hospitals?
- Hit by by care (HBC) Trauma
- Traumatic Lacerations
- Vomiting
- Diarrhea
- Seizures
- Dyspnea
- Poisoning
- Urinary Tract Obstruction
- Cardiovascular Shock
Classification of emergency patients: Non Urgent
- Patient can wait
- Patient history & physical exam findings presented to DVM when available to see the pet
- Thorough exam & diagnostics are recommended
Classification of emergency patients; Urgent
- Patient taken to exam room for physical examination
- Treatment consent form is signed & CPR directive are discussed
- Thorough exam by DVM & discussion of treatment
Classification of emergency patients: Emergent
- Immediate medical stabilization is necessary
- Treatment consent acquired from owner verbally & form is signed
- CPR directive is discussed with owner
- Initial stabilization begins while medical history is collected
Classification of emergency patients: Life Threatening
- Immediate medical stabilization is necessary
- Treatment consent acquired from owner & form is signed
- CPR directive discussed with owner
- Initial stabilization begins while medical history is collected
An emergency &/or critical care patients arrives at the clinic what must the technician do first?
- Obtain patient history from the owner
- Perform an initial assessment by observing the patient
- Perform physical examination & obtain vital signs
3 main points to remember when fielding telephone calls?
- Limit medical advice to concert steps that the client can take to address the immediate problem prior/while transporting the animal to the veterinary hospital
- Difficult to provide accurate medical advice without examining the patient
- Always offer an exam
4 main points to remember when interacting with clients at the vet hospital?
- Greet Client
- Introduce yourself & explain your role
- Express concern & empathy about their animal condition
- Open-Ended questions & practice reflective listening when collecting medical history
Triage means & purpose?
To Sort
Purpose is to determine the priority with which patients need to be treated
True/False: Animals requiring immediate stabilization/hospitalization after initial assessment by a technician still require a thorough exam by a DVM
True
What forms must an owner sign prior to medical treatment?
- Treatment consent form
- Estimate of charges
Upon admittance of an ER/CC patient what must be created? & what should it include?
A medical record & should include:
- client contact information
- signed copy of estimate
- signed copy of treatment consent form
- CPR treatment directive
- Treatment sheets
What may be completed by a DVM indicating initial diagnostics & treatment to be performed?
A treatment order
*A monitoring/treatment flow sheet will also be created/attached to the patients cage for quick reference
What objective parameters should be assessed while monitoring ECC patients?
- MM Color
- CRT
- HR
- RR
- Temperature
What subjective parameters should be assessed when monitoring ECC patients?
- Attitude
- Character of Respiration
- Heart & Lung Sounds
- Pulse Intensity
- Comfort Level
What paraments should be used to monitor ECC patients?
- Periodic Hands on physical assessment
- Objective & Subjective parameters
- ECG Monitor
- Pulse Oximeter
- Blood Pressure Monitor
- End-Tidal Carbon Dioxide Monitor
What mechanical monitoring equipment is used to monitor ECC patients?
- ECG Monitor
- Pulse Oximeter
- Blood Pressure Monitor
- End-Tidal Carbon Dioxide Monitor
Cardiac arrhythmias may results from?
- Primary Cardiac Disease
- Trauma
- Shock
- Systemic Inflammatory Response Syndrome
Electrocardiograph Monitors are used to?
Monitor for cardiac arrhythmias
Pulse Oximeter are used to measure?
The percentage of hemoglobin saturated with oxygen
Pulse Oximeter can be used to diagnose?
Hypoxemia in patients with respiratory problems
End-Tidal Carbon Dioxide Monitor is use to measure?
The concentration of carbon dioxide in a single exhaled breath (Capnography)
End-Tidal Carbon Dioxide Monitor is used for?
Monitoring ventilation in animals under anesthesia, on a ventilator, or those undergoing CPR
What are common diagnostic tests performed on ECC patients?
- Hematocrit (PCV) & Total Plasma Protein
- Blood Chemistry Analyzers / Electrolyte Panels
- Complete Blood Count (CBC)
- Urine volume & Specific Gravity
- Urine Output
- Blood Gas Analysis
- Lactate Concentration
- Coagulation Test
Hematocrit (PCV) & Total Plasma Protein are used to help diagnose?
- Dehydration
- Anemia
What diagnostic tests are performed to diagnose dehydration?
PCV, TP, & Urine Specific Gravity
What diagnostic tests are performed to diagnose anemia?
Hematocrit (PCV) & Total Plasma Protein
High values of TP & PCV indicate?
Dehydration
Low Values of PCV & TP indicate?
Over Fluid Hydration
Blood chemistry analyzers / Electrolyte panels measure?
Multiple electrolytes & provide vital information to guide immediate therapy
Blood chemistry analyzers / Electrolyte panels abnormalities are often observed in animals experiencing?
- Vomiting/Diarrhea
- Diabetes Mellitus
- Urinary Tract Disease
- Eclampsia
CBC is a useful diagnostic test when treating CBC by?
Helping to identify & manage animals with anemia, thrombocytopenia, infectious or inflammatory conditions
Urine Specific Gravity is used to measure?
Dehydration
What specific gravity indicated dehydration?
Greater than 1.060
Normal values for urine specific gravity?
Dogs: 1.025 - 1.055
Cats: 1.035
Low levels of urine specific gravity indicate ?
That the kidney are not able to concentrate the urine therefore something is wrong
Urine volume provides information on? & is used to assess?
Renal profusion & function
Used to assess hydration status during fluid administration
Fluid volumes in the body or those coming out of the body can be estimated using what weight scale?
1mL fluid = 1g of weight
1L fluid = 1kg of weight
Urine output indicates?
Decreased urine outputs indicate kidney failure which results in the lack of urine output which can lead to fluid overload
Blood Gas Analysis is ran with?
An ISTAT machine
Blood gas analysis is used to?
- Reveal acid-vase & oxygenation abnormalities in animals
- Helpful in identifying & determining severity of respiratory problems & metabolic abnormalities
Blood gas analysis reveal what potential respiratory problems?
Pneumonia & CHF
Blood gas analysis is helpful in identifying what metabolic abnormalities?
- Urineary tract obstruction
- Diabetic keto acidosis
Lactate concentration diagnostic test is used to measure?
Lactic acid levels within the body.
- Lactic acid is produced when the body is not getting enough oxygen
increase lactic acid concentrations indicate?
Inadequate blood flow/oxygen delivery to the tissues
Increased lactate concentration is seen in patients with?
- Shock
- GDV
- Crushing Traumatic Injuries
Lactate concentration is a good useful in ECC patients?
It’s a good prognostic indicator
* Increased lactate concentration have poor prognosis
Coagulation tests are used to?
Evaluate coagulation abnormalities which can develope in patients w/:
- anticoagulant rodenticide toxicity
- thrombocytopenia
- sepsis
What are the different coagulation tests?
- Buccal Mucosal Bleeding Time
- Prothrombin Time
- Activated Partial Thromboplastin Time
- Activated Clotting Time
- Platelet Count
- Sodium Citrate / Light Blue Tube
What are possible causes of cardiopulmonary arrest (CPA)?
- Trauma: Hemorrhage &/or Hypovolemic
- Hypoxia
- Infection
- Anesthetic Drug Administration
- Vagal Stimulation
- Hypothermia or Hyperthermia
- Metabolic disorders
What is the purpose of CPR?
To provide the patient with adequate ventilation & circulation until spontaneous cardiopulmonary function is restored
What is the CPR recovery percentage?
1-3%
CPR has a higher success rate if?
Due to an anesthesia overdose, vagal nerve stimulation, &/or during routine surgical procedures
CPR must be started within?
3 minutes of the cardiac arrest
CPR Preparation should include?
- A team of 3-5 people is ideal
- Large enough space to accommodate entire CPR team where CPR takes place
- Oxygen Source
- Good Lighting
- Solid Surface on which to place the patient
What is the first thing todo prior to performing CPR?
Confirm cardiopulmonary arrest (CPA) through a list of clinical signs:
- Unconsciousness
- Absence of respiration
- Absence of a heartbeat &/or pulse
- Fixed/Dilated Pupils
- Pale or Bluish Mucous Membranes
What are the ABC of CPR?
A: Establish Airway
B: Breath for the patient / Ventilation
C: Chest Compressions / Circulation
D: Diagnose the cause
E: Emergency Drug administration &/or defibrillation
How to confirm cardiopulmonary arrest (CPA) prior to beginning CPR?
- Unconsciousness
- Absence of respiration
- Absence of a heartbeat &/or pulse
- Fixed/Dilated Pupils
- Pale or Bluish mucous membranes
What are the three phases of CPR?
Phase 1: Basic Life Support
Phase 2: Advances Life Support
Phase 3: Prolonged Life Support
What are the 3 steps within phase 1 of CPR?
- (A) Establish Airway
- Endotracheal tube &/or Tracheostomy tube
2: (B) Breath for the patient - Endotracheal tube: Ventilate for the patient every 6 seconds
- Attach to a pure oxygen source
- Mouth to south breathing if ET tube is not an option
- Endotracheal tube &/or Tracheostomy tube
- (C) Chest Compressions / Restore effective circulation
- Perform external chest compressions at a rate of 100 - 120 beats per minute
- Thorax must be compressed by 1/3 - 1/2 of its normal diameter with each compression
How can effectiveness of phase 1 of CPR/Basic Life Support can be assessed by observing?
- Mucous membrane color
- Palpating peripheral pulse
- Direct arterial pressure
- End-Tidal Carbon Dioxide monitor
*Should be greater than 15 mmHg with effective chest compressions
How to perform CPR on medium to large breed dogs?
- Position in lateral recumbency
- Compress at the widest part of the thorax
How to perform CPR for keel chested dogs? Or dogs less than 10kgs/22lbs?
- Position in lateral recumbency
- Compress at the 4th to 5th intercostal space at the costochondral junction
How to perform CPR for barrel chested dogs?
- Position on their back or ventral recumbency
- Compress at the caudal 3rd rib portion over the sternum
How to perform CPR on smalls dogs & cats?
One hand compressions:
- Lateral recumbency
- Compress at the central aspect of the sternum between the lower 3rd & middle 3rd rib
How to perform two hand chest compression CPR? & why?
- Two hand compression techniques for large cats & small dogs whose chest is hard to compress
- Lateral recumbency
- Compress central aspect of sternum between lower 3rd & middle 3rd rib
What is phase 2 of CPR?
Advanced life support?
What are the 2 steps within phase 2 of CPR?
- Diagnose the cause of ineffective cardiovascular (CV) function by the cue of EG monitor
- Administer emergency drugs or defibrillation performed to establish cardiovascular function
Aystole heart rhythm
- No electrical activity
- Treat w/ epinephrine/Vasopressin & Atropine
- 22% common
Pulseless Electrical Activity (PEA) cardiac arrhythmias
- Wide, Bizarre QRS Complexes
- Treat w/ epinephrine/vasopressin & Atropine
Ventricular fibrillation cardiac arrhythmias
- Rapid chaotic electrical activity with no identifiable waves or patterns
- Treat with defibrillation
- If defibrillation is not an option you can give Lidocaine IV but than defibrillation is not an option
Rapid chaotic electrical activity with no identifiable waves or pattern is treated with?
Defibrillation
Pulseless ventricular tachycardia
- Rapid, wide & bizarre QRS complexes
- Treat with defibrillation
Common emergency drugs used?
- Epinephrine / Vasopressin
- Atropine
- 2% Lidocaine / Amiodarone
- Sodium Bicarbonate
Epinephrine / Vasopressin is used in ECC patients for?
- To help stimulate the heart muscle to contract
- Vasoconstriction = Increase blood pressure
- Helps w/ shock patients
Atropine is given to ECC patients to help?
- Increase heart rate
- Blocks the parasympathetic nervous system
2% Lidocaine / Amiodarone is used in ECC patients for?
To treat heart rhythm/atrial fibrillation problems where the heart is often beating a rapid rate that commonly causes poor blood flow
Sodium Bicarbonate is used in ECC patients to?
used when CPR has been going on for at least 20 minutes which negatively affects the bodies PH levels and sodium bicarbonate counteracts the acidosis within the body
Drugs given IV can expect what time delay?
1-2 minutes delay for onset of drug effect
Peripheral catheters used to give drugs should be flushed with how much saline?
10-30 mL of Saline
Giving drugs intratracheal should be?
- Drug dose should be doubled & mixed w/ 5-10 mL of saline to increase the volume since your trying to get into the lower airway mucosa
- Flush the drug through an Endotracheal tube using a red rubber catheter
- Give 3-4 breaths in a row afterwards
What drugs are commonly given intratracheal?
- Epinephrine / Vasopressin
- Atropine
- Lidocaine
Intraosseous drug administration?
- Injecting into the bone marrow into a long bone using a catheter
- Easier to do in a neonate than in mature animals
- Not very common
What are the steps of phase 3 of CPR (Prolonged Life Support)?
- Post cardiac arrest period
- There is a high risk that the animal will reearrest
- Close monitoring is necessary to make sure cardiovascular, respiratory, and central nervous system function is adequate
What breeds are predisposed to arrhythmias?
- Doberman
- Boxer
- Main Coon
- Persians
Normal Sinus Rhythm
Normal Heart Rate/Rhythm
Sinus Arrhythmia
Heart rate speeds up & slows down
Second Degree Atrioventricular Block
Lack of P wave with every WRS crave due to a blockage of the depolarization signal in the AV node
Ventricular Premature Contractions (VPC’s)
Ventricular depolarization signal is generated in the ventricle which doesn’t come from the sinus node
Ventricular Tachycardia
A series of VPC’s caused by abnormal rapid depolarization of the ventricles
Shock
Is a life threatening condition characterized by inadequate blood flow to body tissue which can be the end results of many disease processes
What are the four different shock mechanisms?
- Hypovolemic Shock
- Cardiogenic Shock
- distributive Shock
4.Obstructive Shock
Hypovolemic shock
- due to decreased intravascular volume/fluid
- Caused by hemorrhage, GI loss, Burns, Skin loss
Cardiogenic Shock
Due to cardiac pump failure
Distributive shock
Maldistribution of intravascular volume/fluid resulting in decreased blood pressure/ loss of blood volume
- Septic shock, Anaphylactic shock, & Neurogenic shock
Obstructive shock
Due to mechanical obstruction of blood flow in the cardiovascular system
Clinical signs of shock?
- Obtunded (Decreased level of mentation)
- Pale, Cold, Dry Mucous Membranes
- Prolonged CRT
- Tachycardia
- Decreased pulse strength
- Decrease heart sounds
- Cold skin & extremities
- Weakness
Shock treatment?
- Treat underlying cause
- Provide supplemental oxygen
- IV fluids
- Sympathomimetic drugs (Dopamine / Dobutamine)
Distributive shock treatment
Epinephrine & steroids
Hypovolemic Shock
- Hypertonic saline administered in small doses
- Crystalloid fluids
- 7.5% NaCl
Monitoring patient in shock?
- Physical parameters: Respiration & Cardiovascular Function
- Physiologic Parameters: Oxygen saturation & Blood pressure
- Laboratory Parameters: PCV, TP, Electrolytes, Blood Gases, Lactate
Emergency treatment area should be equipped with:
- Oxygen deliver devices
- IV Fluid administration supplies
- Suction Apparatus
- Monitoring equipment
- Defibrillator
- Ventilator
Crash Cart should include?
- Airway Access Supplies
- laryngoscope, ET tube, Lube, Roll Guaze
- Venous Access Supplies
- Butterfly cath, IV cath, Syryines, Needles, Tape, IV drop set, Tourniquet
- Emergency Drugs
- Atropine, Epinephine/Vasopressin, 2% Lidocaine w/out EPI, Sodium Bicarbonate, Calcium Chloride/Gluconate, Doxapam, Mannitol
- Miscellaneous Supplies
- Guaze, Stethoscope, Surgery pack, Suture material, Scalpel blades, sterile gloves
