Monitoring a patient

Question 1

Stethoscope

Answer 1

allow measurement and rate of rhythm

Normal heart rate for dogs - 60 - 100bpm

normal heart rate for cats - 160 - 200bpm

normal respiratory rate for dogs - 10-30 bpm

normal respiratory rate for cats - 20-30 bpm

Question 2

oesphogeal stethoscopes

Answer 2

used to measure heart rate

manually check heart rate and rhythm

Question 3

Electrocardiogram - ECG

Answer 3

allows us to understand the electrical activity of the heart

electrical activity starts at the sino atrial node

an ecg is a visual representation of the hearts electrical activity and quality/ rate of the contraction of the myocardium

Question 4

Disatole

Answer 4

point of relaxing

Question 5

ECG Wave (P)

Answer 5

P Wave - contraction of the atria

Question 6

ECG wave (PR Interval)

Answer 6

AV node stimulated and slowly conducts from atria to ventricles to allow a coordinated ventricular contraction

Question 7

ECG wave ( QRS Complex)

Answer 7

contraction of ventricles

Question 8

ECG Wave ( T Wave)

Answer 8

repolarisation for next contraction

Question 9

ECG Placement

Answer 9

red - right forelimb
yellow - left forelimb
green - left hind limb
black - right hind limb
white - general placement on the side

Question 10

ECG Considerations

Answer 10

ECG describes electrical activity of the heart

rhythm can be traced on the graph and any abnormalities certain systemic abnormalities and cardiac pathology

Question 11

Capnography

Answer 11

Based on the measurement of exhaled CO2 (end tidal carbon dioxide)

measured by gas withdrawn from small tube between the circuit and ET tube

Normal end tidal co2 vollumes are 40 - 55 mm Hg

Question 12

Pulse Oximetry

Answer 12

Non invasive technique which monitors the degree to which Hb is saturated with oxygen

displays animals heart rate

attached to multiple points of the body
- tongue
-non pigmented skin

Question 13

Pulse oximetry

Answer 13

threshold for hypoxaemia is usually at an arterial oxygen tension of 60mm Hg

this corresponds to a Hb oxygen saturation of 90%

during anaesthesia oxygen needs to be above 90%

Question 14

pulse oximetry considerations

Answer 14

gives no indication of available haemoglobin

lack of perfusion will prevent a signal being obtained e.g. tissue compression of the probe

light interference from surgical lights can cause inaccuracies

Question 15

Blood pressure

Answer 15

systolic
dog - 110 - 190
cat - 120-170

diastolic
dog - 55-110
cat - 70 - 120

in general anaesthesia, we aim to maintain arterial blood pressure above 70 - 80 mm

Question 16

direct blood pressure monitoring

Answer 16

invasive and is one of the most useful indicators of cardiovascular function

central venous pressure is measured in the central veins close to the heart
indicates mean right atrial pressure and is frequently used as an estimate of right ventricular preload

measured in the thoracic vena cava using a long IV catheter

risks of introducing infection and haematoma formation

Question 17

Indirect blood pressure monitoring

Answer 17

a doppler probe contains two piezoelectric crystals which should sit at a right angle to a peripheal artery

Common arteries used include the metacarpal, dorsal metatarsal, planter metatarsal and coccygeal artery

probe can be taped into place over the artery before turning on loudspeaker, and minor adjustments made to the positioning as necessary to obtain best quality sound.

headphones may be used to reduce theatre noise levels

Question 18

oscilometer blood pressure monitoring

Answer 18

can be obtained with the use of an inflatable cuff around limb or tail base,k which is attached to monitor

measurement is automatic and allows detection of oscillations produced by the artery wall as the cuff deflates

meaures thr systolic mean and diastolic pressure

Question 19

digital thermometer

Answer 19

a thermometer is used to monitor patient temperature

the tip of the thermometer is lubricated placed into rectum of the patient

normal range for a dog should be 38.3 - 38.7

normal range for a cat - 38 - 38.5

Question 20

Blood Gas Analysis

Answer 20

measures PH

should contain no air bubbles

2 types of blood gas analyser
oxygenation
ventilation

the acid base status of the patient

Question 21

Cranial nerve reflexes

Answer 21

caused by the cranial nerves

cranial reflexes are checked on anaesthetised patients

measures depth of anaesthesia, to consider if a patient is too light, or deep in depth of anaesthesia

Question 22

palpebral reflex

Answer 22

tapping the corner of the eye will result in blinking, indicates light anaesthetic, no blinking indicates a good depth of anaesthesia

Question 23

Eye position and Pulpillary diameter

Answer 23

when eyes are positioned in the corners this is adequate, but a central position with small pupil indicates light anaesthetic and central with dilated pupil indiactes deep anaesthetic. Some drugs may affect the accuracy of this reading however, such as Ketamine

Question 24

Jaw Tone

Answer 24

when the jaws are loose and slack, the patient is adequately anaesthetised. tight jaws which are difficult to open indicate light anaesthetic

Question 25

Pedal reflex

Answer 25

lightly pinching between the toes will cause the patient to move their paw away if they are not sufficiently anaesthetised

Question 26

Monitoring MM and CRT

Answer 26

Salmon pink - good health] pale - shock yellow - jaundice/ liver failure blue/purple - lack of oxygen, hypoxia red - infection/sepsis

Question 27

CRT Capillary refill time

Answer 27

press gum will whiten them, when finger is removed they should return to colour in 1-2 seconds, a slower CRT can indicate poor circulation or shock

Question 28

Hypothermia anaesthesia complication

Answer 28

abnormally low body temp which can be caused by anaesthetic drugs and surgery prep. may occur due to the vasodilation during anaesthesia and the heat loss which may occur during evaporation of water from hibi scrub

Question 29

Tachycardia anaesthesia complications

Answer 29

increased heart rate. could mean propofol may need increasing or more pain relief need to be given, increased heart rate could be when the animal is feeling more pain during surgery

Question 30

hypoxia anaesthesia

Answer 30

lack of oxygen to certain area, may be indicated by blue/purple MM or skin colour , and indicates the tissues are not oxygenating properly.

Question 31

Bradycardia and bradypnoea

Answer 31

slow heart rate and resp. rate could mean that the patient is too deep under anaesthetic, could lead to heart failure and crash kit will be needed to administer drugs

Question 32

Monitoring Charts

Answer 32

monitoring patient should be continual and a written record should be completed should be started when the pre anaesthetic is given it allows for harmful trends to be recognised and allows for timely and appropriate action to be taken most will write a reading every 5 minutes medical legal document