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FCP Week 3 > Monitoring > Flashcards

Monitoring Flashcards

1
Q

Why monitor (3)

A
  1. Prevent patient response to surgical stimulation (nociception)
  2. Maintain tissue perfusion and oxygenation so we can improve patient outcome and prevent worsening of subclinical disease
  3. Detect abnormalities before they turn into major complication
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2
Q

Responses to pain under anaesthesia

A

Increased HR and resp. rate

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3
Q

Tissue perfusion

A

Process in which an adequate supple of oxygenated blood and nutrients are delivered to tissues and carbon dioxide and waste products are removed

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4
Q

Purpose of Anaesthesia monitoring chart (3)

A
  1. Legal record of surgery
  2. important tool in handover
  3. Allow trends to be spotted
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5
Q

Components of monitoring chart (5)

A
  1. Time of recording
  2. Amount of oxygen being delivered to the patient in l/min
  3. % volatile agent being delivered
  4. Heart rate
  5. Temperature
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6
Q

Effect of volatile agents (3)

A
  1. Cardiac depression
  2. Respiratory depression
  3. Decreased homeostasis
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7
Q

Causes of poor tissue perfusion (7)

A

Anything that affects blood flow
1. blood pressure
2. Reduced Heart Rate
3. Haemorrhaging
4. Anaemia
Decreased oxygen delivery due to
1. Equipment failure
2. Pulmonary disease
3. An obese patient lying on its back

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8
Q

Brain and Anaesthesia

A

Want to depress cerebral conscious perception areas but maintain hind brain functions

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9
Q

3 hypos

A
  1. Hypotension
  2. Hypothermia
  3. Hypoventilation
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10
Q

How to establish depth of anesthesia

A

Jaw tone- loose
Palpebral Reflex
Eye Position
Capnography

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11
Q

Monitoring depth of anaesthesia with ketamine

A

Increases muscle tone
Eyes won’t be rotated
Jaw tone won’t be loose

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12
Q

Palpebral reflex

A

can inadvertently desensitise the animal to your touch

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13
Q

Monitoring temperature

A

Hypothermia causes slow recovery and post op wound infections
Monitor temperature with simple rectal thermometer or oesophageal thermometer

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14
Q

Oesophageal Thermometer

A

Measured from incisors to scapular

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15
Q

Patient warming

A

Easier to keep patient warm than bring temperature back up

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16
Q

Key factors in monitoring anaesthesia (4)

A
  1. preventing response to surgical stimulation
  2. Detecting abnormalities early on by identifying trends
  3. Minimising decreased tissue perfusion
  4. Minimising the ‘three hypos’
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17
Q

Impact of maintaining patients close to physiological norm

A

Lower morbidity
Lower mortality
Lower infection rates
Faster wound healing
Faster recoveries

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18
Q

How to monitor cardiovascular system (6)

A
  1. HR and rhythm (stethoscope and pulse palpation)
  2. Mucous membrane colour and capillary refill time
  3. Bleeding from surgical site
  4. Measure Blood pressure
  5. Measure haemoglobin oxygen saturation
  6. Detect arrhthmias
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19
Q

Anaesthetised dog/cat HR

A

60-120

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20
Q

Dachshund HR under anaesthesia

A

can be 50-60 due to increased vagal tone

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21
Q

Oesophageal stethoscope

A

useful if patient is draped
measure, insert alongside ETT

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22
Q

Pulse Palpation

A

Important to feel pulse along side auscultation of the heart
identify pulse defecits

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23
Q

Capillary Refill time

A

Assessment of peripheral perfusion and oxygenation
Should be 1.5-2 s

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24
Q

very pink/ red mucous membranes

A

Vasodilation
- sepsis
- anaesthetic drugs (e.g. anaphylaxis)
- low MAP

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25
Q

Dry/tacky mm

A

dehydration/ hypovolaemia

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26
Q

Wet mm

A

over infusion, nausea, risk of regurg/ gastric reflux, aspriation

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27
Q

Very pale mm + slow CRT

A

Vasoconstriction
- anaemia
- inadequate blood flow
- alpha 2 agonist

28
Q

Cyanosis

A

Bluish/ purple discolouration of skin or mm due to low O2 saturation near skin
indicates severe hypoxaemia
Animal is close to death

29
Q

Weighing swabs after intraoperative bleeding

A

1g=1ml of blood lost

30
Q

BP cuff width

A

40% of circumference of area of the limb you are placing it on
very important to get right

31
Q

Doppler- what odes it show in cat vs dog

A

MAP in Cats
Systolic in dogs

32
Q

BP cuff too large

A

reading too low compared to true value

33
Q

BP cuff too small

A

reading too high compared to true value

34
Q

Normal bp ranges for healthy non anesthetised animals

A

Systolic- 100-160 mmHg
Diastolic- 80-120 mmHg
Mean- 60-100mmHg

35
Q

minimum MAP to perfuse heart, kidneys and brain

A

60mmHg (>90mmHg systolic)

36
Q

Possible consequences of MAP <60mmHg for over 30 mins

A

Renal Failure
Delayed recovery
Neuromuscular complications
Decreased hepatic metabolism of drugs
CNS abnormalities such as blindness

37
Q

How to take BP using Doppler

A

Place cuff on shaved area of patient
Place sensor over pulse and turn volume up
Listen to pulse, sounds like flushes
Inflate cuff until you occlude the limb enough that the sound disappears
Slowly release pump until the sound comes back
The point where the sound comes back is the animals blood pressure
Repeat 5-6 times and take average

38
Q

SpO2

A

% of haemoglobin that is saturated with oxygen

39
Q

Healthy SpO2

A

> 95%

40
Q

What does pulse oximetry tell us?

A

SpO2
Detects hypoxaemia
measures pulse rate
Displays Photoplethysmography (used to detect volumetric changes in blood in peripheral circulation) within multiparameter

41
Q

PPG

A

Photoplethysmography waveform

42
Q

Limitations of pulse oximetry

A

may be showing normal SPO2 but animal is hypoxic (low oxygen in tissues) not hypoxeamic (low oxygen in blood)
The blood is well oxygenated but the circulation is insuffient to distribute the oxygenated blood

43
Q

Causes of inaccurate pulse ox readings

A

vasoconstriction (aplha 2 agonists, hypothermia, shock)
Hypoperfusion
Movement
Hyppothermia
Bright lights overhead
Smoke inhalation (abnormal haemoglobin)
Pigmented skin
Anaemia
Shock

44
Q

Hypoxia

A

Low oxygen content in bodily tissues

45
Q

Hypoxaemia

A

Low blood oxygen content

46
Q

ECG Cords (Red, yellow, green)

A

Yellow-left & cranial
Green- Left and caudal (grass under sun)
Red- right & cranial

47
Q

Monitoring Respiratory system under anaesthesia

A

You can monitor
- Resp rate, rhythm and effort
With equipment you can
- assess adequacy of respiration (EtCO2)
Check or estimate blood gases

48
Q

Listening to lung sounds

A

Identify breath sounds
Compare both sides of the chest
Compare ventral to dorsal
Change?
Inspiratory/ expiratory sounds

49
Q

Limitation of resp. rate

A

Does not provide information on the quality of ventilation
Same number of breaths could have different volumes and therefore provide different degrees of ventilation

50
Q

What is capnography

A

Non-invasive, continuous measurement of inhaled and exhaled carbon dioxide over time

51
Q

What is EtCO2

A

End tidal carbon dioxide, usually measured in mmHg

High= HYPOventilation or increased CO2 production/cardiac output
low= hyperventilation or decreased CO2 production/cardiac output

52
Q

Capnography and IPPV

A

Give breaths based on capnogrpah-> aiming to keep EtC02 as close to normal as possible

53
Q

What does capnography tell us

A

A change in ETCO2 value suggests an alteration in one or more of these parameters:
Tissue metabolism (CO2 metabolism)
Perfusion (blood flow carryign carbon dioxide from tissue via the heart to the pulmonary capillaries)
Ventilation (carrying carbon dioxide from alveoli in exhaled breath)

54
Q

Why look at CO2

A

Gives an easy way of assessing state of respiratory and cardiovascular system

55
Q

Normal EtCO2 for dogs

A

35-45 mmHg

56
Q

Normal EtCO2 for cats

A

28 to 45 mmHg

57
Q

What does blood gas analysis measure

A

PaCO2
PaO2
Blood pH
Electrolytes
Lactate

58
Q

Lurcher HR under anaesthesia

A

Will be lower than expected as they are fit dogs-> not worrying

59
Q

Invasive/ Non-Invasive Blood Pressure

A

Invasive is more accurate

60
Q

What is nociception

A

physiological response to noxious stimuli
the processes leading to sensitisation of the spinal and medullary dorsal horn neurones is still present under anaesthesia

61
Q

What is neuroleptanalgesia

A

combination of an opioid and a tranquilizer or sedative and reduces the amount of each required and results in improved sedation.

62
Q

What is a noxious stimuli

A

A stimulus that is damaging or threatens damage to normal tissues

63
Q

What is central sensitisation

A

Increased responsiveness of nociceptive neurons in the central nervous system to their normal or subthreshold afferent input

64
Q

What is somatic/visceral/neuropathic pain

A

Somatic Pain:
Pain experienced from skin, muscle, bone damage/disease
Visceral pain:
Pain experienced because of organ pain (abdominal or thoracic)
Neuropathic pain:
Pain caused by a lesion or disease of the somatosensory nervous system (in contrast to nociceptive pain)

65
Q

hypoxia vs hypoxaemia

A

While hypoxemia refers to low oxygen levels in your blood, hypoxia refers to low levels of oxygen in the tissues of your body.

The two can sometimes, but not always, occur together. For example, hypoxia can happen in the absence of hypoxemia if blood flow to an organ or tissue is disrupted. In this case, the blood may have normal levels of oxygen, but it can’t reach the affected area.

66
Q

What is blood paO2

A

partial pressure of oxygen in the blood
Can be related to spO2 (oxygen saturation) which can be shown from pulse oximetry
should be about 80-100 mmHg
can be measured directly by blood gas analysis

FCP Week 3 (9 decks)

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