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VT 260 ER & CC > Midterm Review > Flashcards

Midterm Review Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

Typical emergency & critical care ceases presented in vet hospitals?

A
  1. Hit by by care (HBC) Trauma
  2. Traumatic Lacerations
  3. Vomiting
  4. Diarrhea
  5. Seizures
  6. Dyspnea
  7. Poisoning
  8. Urinary Tract Obstruction
  9. Cardiovascular Shock
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2
Q

Classification of emergency patients: Non Urgent

A
  • Patient can wait
  • Patient history & physical exam findings presented to DVM when available to see the pet
  • Thorough exam & diagnostics are recommended
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3
Q

Classification of emergency patients; Urgent

A
  • Patient taken to exam room for physical examination
  • Treatment consent form is signed & CPR directive are discussed
  • Thorough exam by DVM & discussion of treatment
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4
Q

Classification of emergency patients: Emergent

A
  • 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
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5
Q

Classification of emergency patients: Life Threatening

A
  • 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
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6
Q

An emergency &/or critical care patients arrives at the clinic what must the technician do first?

A
  1. Obtain patient history from the owner
  2. Perform an initial assessment by observing the patient
  3. Perform physical examination & obtain vital signs
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7
Q

3 main points to remember when fielding telephone calls?

A
  1. 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
  2. Difficult to provide accurate medical advice without examining the patient
  3. Always offer an exam
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8
Q

4 main points to remember when interacting with clients at the vet hospital?

A
  1. Greet Client
  2. Introduce yourself & explain your role
  3. Express concern & empathy about their animal condition
  4. Open-Ended questions & practice reflective listening when collecting medical history
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9
Q

Triage means & purpose?

A

To Sort
Purpose is to determine the priority with which patients need to be treated

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10
Q

True/False: Animals requiring immediate stabilization/hospitalization after initial assessment by a technician still require a thorough exam by a DVM

A

True

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11
Q

What forms must an owner sign prior to medical treatment?

A
  1. Treatment consent form
  2. Estimate of charges
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12
Q

Upon admittance of an ER/CC patient what must be created? & what should it include?

A

A medical record & should include:
- client contact information
- signed copy of estimate
- signed copy of treatment consent form
- CPR treatment directive
- Treatment sheets

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13
Q

What may be completed by a DVM indicating initial diagnostics & treatment to be performed?

A

A treatment order
*A monitoring/treatment flow sheet will also be created/attached to the patients cage for quick reference

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14
Q

What objective parameters should be assessed while monitoring ECC patients?

A
  1. MM Color
  2. CRT
  3. HR
  4. RR
  5. Temperature
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15
Q

What subjective parameters should be assessed when monitoring ECC patients?

A
  1. Attitude
  2. Character of Respiration
  3. Heart & Lung Sounds
  4. Pulse Intensity
  5. Comfort Level
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16
Q

What paraments should be used to monitor ECC patients?

A
  1. Periodic Hands on physical assessment
  2. Objective & Subjective parameters
  3. ECG Monitor
  4. Pulse Oximeter
  5. Blood Pressure Monitor
  6. End-Tidal Carbon Dioxide Monitor
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17
Q

What mechanical monitoring equipment is used to monitor ECC patients?

A
  1. ECG Monitor
  2. Pulse Oximeter
  3. Blood Pressure Monitor
  4. End-Tidal Carbon Dioxide Monitor
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18
Q

Cardiac arrhythmias may results from?

A
  1. Primary Cardiac Disease
  2. Trauma
  3. Shock
  4. Systemic Inflammatory Response Syndrome
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19
Q

Electrocardiograph Monitors are used to?

A

Monitor for cardiac arrhythmias

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20
Q

Pulse Oximeter are used to measure?

A

The percentage of hemoglobin saturated with oxygen

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21
Q

Pulse Oximeter can be used to diagnose?

A

Hypoxemia in patients with respiratory problems

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22
Q

End-Tidal Carbon Dioxide Monitor is use to measure?

A

The concentration of carbon dioxide in a single exhaled breath (Capnography)

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23
Q

End-Tidal Carbon Dioxide Monitor is used for?

A

Monitoring ventilation in animals under anesthesia, on a ventilator, or those undergoing CPR

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24
Q

What are common diagnostic tests performed on ECC patients?

A
  1. Hematocrit (PCV) & Total Plasma Protein
  2. Blood Chemistry Analyzers / Electrolyte Panels
  3. Complete Blood Count (CBC)
  4. Urine volume & Specific Gravity
  5. Urine Output
  6. Blood Gas Analysis
  7. Lactate Concentration
  8. Coagulation Test
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25
Q

Hematocrit (PCV) & Total Plasma Protein are used to help diagnose?

A
  1. Dehydration
  2. Anemia
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26
Q

What diagnostic tests are performed to diagnose dehydration?

A

PCV, TP, & Urine Specific Gravity

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27
Q

What diagnostic tests are performed to diagnose anemia?

A

Hematocrit (PCV) & Total Plasma Protein

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28
Q

High values of TP & PCV indicate?

A

Dehydration

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29
Q

Low Values of PCV & TP indicate?

A

Over Fluid Hydration

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30
Q

Blood chemistry analyzers / Electrolyte panels measure?

A

Multiple electrolytes & provide vital information to guide immediate therapy

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31
Q

Blood chemistry analyzers / Electrolyte panels abnormalities are often observed in animals experiencing?

A
  1. Vomiting/Diarrhea
  2. Diabetes Mellitus
  3. Urinary Tract Disease
  4. Eclampsia
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32
Q

CBC is a useful diagnostic test when treating CBC by?

A

Helping to identify & manage animals with anemia, thrombocytopenia, infectious or inflammatory conditions

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33
Q

Urine Specific Gravity is used to measure?

A

Dehydration

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34
Q

What specific gravity indicated dehydration?

A

Greater than 1.060

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35
Q

Normal values for urine specific gravity?

A

Dogs: 1.025 - 1.055
Cats: 1.035

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36
Q

Low levels of urine specific gravity indicate ?

A

That the kidney are not able to concentrate the urine therefore something is wrong

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37
Q

Urine volume provides information on? & is used to assess?

A

Renal profusion & function
Used to assess hydration status during fluid administration

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38
Q

Fluid volumes in the body or those coming out of the body can be estimated using what weight scale?

A

1mL fluid = 1g of weight
1L fluid = 1kg of weight

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39
Q

Urine output indicates?

A

Decreased urine outputs indicate kidney failure which results in the lack of urine output which can lead to fluid overload

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40
Q

Blood Gas Analysis is ran with?

A

An ISTAT machine

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41
Q

Blood gas analysis is used to?

A
  • Reveal acid-vase & oxygenation abnormalities in animals
  • Helpful in identifying & determining severity of respiratory problems & metabolic abnormalities
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42
Q

Blood gas analysis reveal what potential respiratory problems?

A

Pneumonia & CHF

43
Q

Blood gas analysis is helpful in identifying what metabolic abnormalities?

A
  • Urineary tract obstruction
  • Diabetic keto acidosis
44
Q

Lactate concentration diagnostic test is used to measure?

A

Lactic acid levels within the body.
- Lactic acid is produced when the body is not getting enough oxygen

45
Q

increase lactic acid concentrations indicate?

A

Inadequate blood flow/oxygen delivery to the tissues

46
Q

Increased lactate concentration is seen in patients with?

A
  • Shock
  • GDV
  • Crushing Traumatic Injuries
47
Q

Lactate concentration is a good useful in ECC patients?

A

It’s a good prognostic indicator
* Increased lactate concentration have poor prognosis

48
Q

Coagulation tests are used to?

A

Evaluate coagulation abnormalities which can develope in patients w/:
- anticoagulant rodenticide toxicity
- thrombocytopenia
- sepsis

49
Q

What are the different coagulation tests?

A
  • Buccal Mucosal Bleeding Time
  • Prothrombin Time
  • Activated Partial Thromboplastin Time
  • Activated Clotting Time
  • Platelet Count
  • Sodium Citrate / Light Blue Tube
50
Q

What are possible causes of cardiopulmonary arrest (CPA)?

A
  • Trauma: Hemorrhage &/or Hypovolemic
  • Hypoxia
  • Infection
  • Anesthetic Drug Administration
  • Vagal Stimulation
  • Hypothermia or Hyperthermia
  • Metabolic disorders
51
Q

What is the purpose of CPR?

A

To provide the patient with adequate ventilation & circulation until spontaneous cardiopulmonary function is restored

52
Q

What is the CPR recovery percentage?

A

1-3%

53
Q

CPR has a higher success rate if?

A

Due to an anesthesia overdose, vagal nerve stimulation, &/or during routine surgical procedures

54
Q

CPR must be started within?

A

3 minutes of the cardiac arrest

55
Q

CPR Preparation should include?

A
  • 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
56
Q

What is the first thing todo prior to performing CPR?

A

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

57
Q

What are the ABC of CPR?

A

A: Establish Airway
B: Breath for the patient / Ventilation
C: Chest Compressions / Circulation
D: Diagnose the cause
E: Emergency Drug administration &/or defibrillation

58
Q

How to confirm cardiopulmonary arrest (CPA) prior to beginning CPR?

A
  • Unconsciousness
  • Absence of respiration
  • Absence of a heartbeat &/or pulse
  • Fixed/Dilated Pupils
  • Pale or Bluish mucous membranes
59
Q

What are the three phases of CPR?

A

Phase 1: Basic Life Support
Phase 2: Advances Life Support
Phase 3: Prolonged Life Support

60
Q

What are the 3 steps within phase 1 of CPR?

A
  1. (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
  2. (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
61
Q

How can effectiveness of phase 1 of CPR/Basic Life Support can be assessed by observing?

A
  • Mucous membrane color
  • Palpating peripheral pulse
  • Direct arterial pressure
  • End-Tidal Carbon Dioxide monitor
    *Should be greater than 15 mmHg with effective chest compressions
62
Q

How to perform CPR on medium to large breed dogs?

A
  • Position in lateral recumbency
  • Compress at the widest part of the thorax
63
Q

How to perform CPR for keel chested dogs? Or dogs less than 10kgs/22lbs?

A
  • Position in lateral recumbency
  • Compress at the 4th to 5th intercostal space at the costochondral junction
64
Q

How to perform CPR for barrel chested dogs?

A
  • Position on their back or ventral recumbency
  • Compress at the caudal 3rd rib portion over the sternum
65
Q

How to perform CPR on smalls dogs & cats?

A

One hand compressions:
- Lateral recumbency
- Compress at the central aspect of the sternum between the lower 3rd & middle 3rd rib

66
Q

How to perform two hand chest compression CPR? & why?

A
  • 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
67
Q

What is phase 2 of CPR?

A

Advanced life support?

68
Q

What are the 2 steps within phase 2 of CPR?

A
  1. Diagnose the cause of ineffective cardiovascular (CV) function by the cue of EG monitor
  2. Administer emergency drugs or defibrillation performed to establish cardiovascular function
69
Q

Aystole heart rhythm

A
  • No electrical activity
  • Treat w/ epinephrine/Vasopressin & Atropine
  • 22% common
70
Q

Pulseless Electrical Activity (PEA) cardiac arrhythmias

A
  • Wide, Bizarre QRS Complexes
  • Treat w/ epinephrine/vasopressin & Atropine
71
Q

Ventricular fibrillation cardiac arrhythmias

A
  • 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
72
Q

Rapid chaotic electrical activity with no identifiable waves or pattern is treated with?

A

Defibrillation

73
Q

Pulseless ventricular tachycardia

A
  • Rapid, wide & bizarre QRS complexes
  • Treat with defibrillation
74
Q

Common emergency drugs used?

A
  • Epinephrine / Vasopressin
  • Atropine
  • 2% Lidocaine / Amiodarone
  • Sodium Bicarbonate
75
Q

Epinephrine / Vasopressin is used in ECC patients for?

A
  • To help stimulate the heart muscle to contract
  • Vasoconstriction = Increase blood pressure
  • Helps w/ shock patients
76
Q

Atropine is given to ECC patients to help?

A
  • Increase heart rate
  • Blocks the parasympathetic nervous system
77
Q

2% Lidocaine / Amiodarone is used in ECC patients for?

A

To treat heart rhythm/atrial fibrillation problems where the heart is often beating a rapid rate that commonly causes poor blood flow

78
Q

Sodium Bicarbonate is used in ECC patients to?

A

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

79
Q

Drugs given IV can expect what time delay?

A

1-2 minutes delay for onset of drug effect

80
Q

Peripheral catheters used to give drugs should be flushed with how much saline?

A

10-30 mL of Saline

81
Q

Giving drugs intratracheal should be?

A
  • 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
82
Q

What drugs are commonly given intratracheal?

A
  • Epinephrine / Vasopressin
  • Atropine
  • Lidocaine
83
Q

Intraosseous drug administration?

A
  • 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
84
Q

What are the steps of phase 3 of CPR (Prolonged Life Support)?

A
  • 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
85
Q

What breeds are predisposed to arrhythmias?

A
  • Doberman
  • Boxer
  • Main Coon
  • Persians
86
Q

Normal Sinus Rhythm

A

Normal Heart Rate/Rhythm

87
Q

Sinus Arrhythmia

A

Heart rate speeds up & slows down

88
Q

Second Degree Atrioventricular Block

A

Lack of P wave with every WRS crave due to a blockage of the depolarization signal in the AV node

89
Q

Ventricular Premature Contractions (VPC’s)

A

Ventricular depolarization signal is generated in the ventricle which doesn’t come from the sinus node

90
Q

Ventricular Tachycardia

A

A series of VPC’s caused by abnormal rapid depolarization of the ventricles

91
Q

Shock

A

Is a life threatening condition characterized by inadequate blood flow to body tissue which can be the end results of many disease processes

92
Q

What are the four different shock mechanisms?

A
  1. Hypovolemic Shock
  2. Cardiogenic Shock
  3. distributive Shock
    4.Obstructive Shock
93
Q

Hypovolemic shock

A
  • due to decreased intravascular volume/fluid
  • Caused by hemorrhage, GI loss, Burns, Skin loss
94
Q

Cardiogenic Shock

A

Due to cardiac pump failure

95
Q

Distributive shock

A

Maldistribution of intravascular volume/fluid resulting in decreased blood pressure/ loss of blood volume
- Septic shock, Anaphylactic shock, & Neurogenic shock

96
Q

Obstructive shock

A

Due to mechanical obstruction of blood flow in the cardiovascular system

97
Q

Clinical signs of shock?

A
  • Obtunded (Decreased level of mentation)
  • Pale, Cold, Dry Mucous Membranes
  • Prolonged CRT
  • Tachycardia
  • Decreased pulse strength
  • Decrease heart sounds
  • Cold skin & extremities
  • Weakness
98
Q

Shock treatment?

A
  • Treat underlying cause
  • Provide supplemental oxygen
  • IV fluids
  • Sympathomimetic drugs (Dopamine / Dobutamine)
99
Q

Distributive shock treatment

A

Epinephrine & steroids

100
Q

Hypovolemic Shock

A
  • Hypertonic saline administered in small doses
  • Crystalloid fluids
  • 7.5% NaCl
101
Q

Monitoring patient in shock?

A
  • Physical parameters: Respiration & Cardiovascular Function
  • Physiologic Parameters: Oxygen saturation & Blood pressure
  • Laboratory Parameters: PCV, TP, Electrolytes, Blood Gases, Lactate
102
Q

Emergency treatment area should be equipped with:

A
  • Oxygen deliver devices
  • IV Fluid administration supplies
  • Suction Apparatus
  • Monitoring equipment
  • Defibrillator
  • Ventilator
103
Q

Crash Cart should include?

A
  • 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

VT 260 ER & CC (3 decks)

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