osce 2016 Flashcards
catheter locations equine
lateral thoracic v. jugular v cephalic saphenous (needle toward heart)
catheter locations SA
lateral saphenous (dog)
Medial saphenous (cat)
Jugular
auricular
arterial access SA
dorsal metatarsal a.
abdomniocentesis - sa
1 cm cranial the umbilicus off midline. 22G needle
abdominocentesis- equine
1-2 in caudal to xyphoid process right of midline. 18 G 1.5’’
Core Vaccinations- canine
Canine Distemper V (every 3-4 wks; between 6-16wk)
Canine parvovirus -2
Canine Adeno virus
Rabies (no earlier than 12wk)
Core Vx- Feline
Feline Panleukopenia
Feline Herpes
Feline Calicivirus
(every 3-4 wks; between 6-16wk)
Canine/ Feline Parasiticide
Heartworm; Flea; Tick; Round worms; Tape worms; whip worms; hook worms.
Puppies: Every 2 weeks until 3 months of age.
• Once/month from 3 to 6 months of age.
• Four time/year after 6 months of age.
Adults: Treat regularly considering potential exposure to parasites and prepatent periods.
Tapetal reflex using transilluminator
Stand 5-6 feet away from the dog’s eyes
Move eyes slightly lower than patient/ put dog on table; Shine transilluminator/penlight at dog’s pupil. Moving light from one pupil to another allows you to assess pupil size and symmetry.
a + tapetal reflex indicates
cornea, anterior chamber and lens are clear and that the retina is likely intact. DO IN DIM LIGHT!
if a dog has assymetric pupils how do you determine which is normal
if a miotic pupil does not dilate in darkness, it is abnormal
if a dilated pupil does not constrict under light stimulation it is abnormal
Menace Response
(CN II & VII; orbicularis oculi muscle) Blink is considered positive
Palpebral reflex
(CN V & VII)
Vestibulo-ocular (oculocephalic) reflex
(CN III, IV, VI, & VIII) move the head from side to side until you see nystagmus; when the motion stops the nystagmus stops. Then move head upwards and downwards to elicit veritical nystagmus
Pupillary Light Reflex: direct & consensual
(CN II & parasympathetic fibers of CN III; retina, iris constrictor/sphincter muscle, mid-brain)
Direct:in the eye the light is shown
indirect: the other eye
Dazzle Reflex
(CN II, VII, retina, rostral colliculus)
Shine a bright light in the eye- An involuntary aversion such as a blink, head/neck turn, or globe retraction is considered positive and
normal response in the visual patient
Maze Test
To asses blindness. Do in light and dark; tape over one eye
Schimer Tear Test
measurement of aqueous tear production
normal >15mm/min
Normal IOP
10-25 mm Hg
> 25mm Hg intraocular pressure
excessive restraint (pressure around head/neck), jugular occlusion, pushing on globe, glaucoma
uveitis. Decreased aqueous production due to inflammation
Equine physical exam: distance exam be sure to _____.
Observe respiratory patterns from a distance prior to interacting with the horse.
Never stand ______ of a horse
directly in front or behind of. Exc: equine stocks
Equine: evaluating head
Start at nares; asses color; moisture; airflow;
MM/CRT; (dentition- leave for end of exam)
Sinus evaluation: maxillary; left and right frontal
Eyes: determine lid tone by opening eyes; cornea; conjunctiva etc. menace; PLRs are slow in equine.
Ears: palpate external and internal pinna
Pupil in the horse
horizontal oval
corpora nigrins
dorsal or ventral proliferations of the iris into the pupil
palpable arteries of the face (equine)
transverse facial a.
facial a.
(also good loc for arterial blood draws)
HR equine
28-44 beat/min
palapable LN (equine)
submandibular (intermandibular surface mid mandible) Should be
Equine: evaluation of neck
- laryngeal palpation (hold both hands straight up 6in apart in throat latch region) “box like” feel. Dorsal surface / finger tips can evaluate arytenoids. Looking for laryngeal symmetry. squeezing may elicit cough.
- Palpate and squeeze trachea
- evaluate Jugular furrow
- asses dehydration (skin tent
Jugular vein assesment; normal filling time
Hold off in distal 1/3 of neck; less than 30-60 sec
Strum vein to asses wall
Causes of jugular pulse
physiologic- no proximal than middle/ distal 1/3 of neck.
pathologic
Heart auscultation Horse; audible heart sounds; most common physiologic arrythmia; most common physiologic MUMUR
PAM; 3rd, 4th, 5th (left side) Apex beat (5th lower than mitral valve) Tricuspid 4th ICS (right side)
2-4 audible (bah-lub-dub-ah) S4-S1-S2-S3
mobitz 1 2nd degree av block (wenkebach)
grade 3 left heart base systolic ejection murmur
equine RR
8-20 bpm
equine: upper airway sounds can be heard
at nostril; over trachea
types of breath sounds
bronchiol: generated at trachea/large broncus loud/harsh. Insp louder (hilus/ trachea)
bronchovesicular: softer; softer exp (hilus)
vesicular: softer (lung periphery)
In general: greater sounds more ventrally than dorsally, more cranially than caudally
When releasing horse in the stall NEVER
have the horse between you and the door
what is auscultated in the RD quadrant of the horse
Cecum (2-3 contraction/1-2 min)
Left Dorsal Quadrant?
small colon; small intestine
Ventral Quadrants?
Large Colon
Equine Normal Temp
99-101 F
Clinical evaluation of the respiratory tract involves
depth (ventilation), frequency (rate) , character (effort)
Thoracocentesis Location
pnuemothorax- 7th and 9th ICS dorsal 1/3
Fluid- 7th and 8th ICS ventral 1/3
AVOID: Internal thoracic artery (near costo chondral junc)
S1 is asso with
closure of AV valves
S2
end of systole- closure of aortic and pulmonic valves
S3
rapid filling of ventricles
S4
atrial contraction (actually blood rushing into the atrium immidietly following atrial systole)
3 things that promote blood turbulence
decreased viscosity; high velocity; large vessels
CPR compression rates for small animals
100-120 cpm
Limit compression pauses to _____.
1 every 2 min for no longer than 10 sec
Ventilation rate for emergency cases
ventilation rate of 10 breaths/min, with an inspiratory
time of 1 second and a peak pressure of 20 cm
H2O
What End-tidal partial pressure of carbon dioxide needs to be obtained for Return of spontaneous circulation
if Petco2 does not increase to ≥ 15 mm Hg in dogs or cats despite optimal CPR technique after 2 to 3 minutes, consider a different CPR method, such as open-chest CPR (depending upon the clinical situation); and if Petco2 remains ≤ 10 mm Hg despite maximal effort and the ECG is not showing electrical activity, discontinuation of the resuscitation attempt can be considered.
Cardio pulmonary arrest drug tx
low-dose epinephrine, followed by vasopressin
and then another low dose of epinephrine, with 2 minutes of CPR in between drug administrations.
atropine can be administered at initiation of CPR and
repeated every 3 to 5 minutes in small animals with
pulseless electrical activity or asystole arrest rhythms
tx ventricular tachycardia
lidocaine
tx ventricular fibbrillation
defibrillation (CLEAR)
tx asystole
CCPR+ epinephrine +/- vasopressin; +/- atropine every other cycle (2min)
chest compression depth in dogs and cats
between 1/3 and 1/2 the width of the
chest
Shock fluid dose cat
40-60 ml/kg/
Shock fluid dose dog
60-90 ml/kg
Superficial Skin Scraping for
Sarcoptes mites (ears/ ventrum) dorsum is often scraped for Cheyletiella mites. Scrape lightly
Deep Skin Scraping
Demodex - live in the hair follicle. areas of alopecia
scrape until bleeding observed
Wood’s Lamp procedure
In 50% of all infections with the dermatophyte, Microsporum canis, apple-green fluorescences is seen on the hair shafts.
TRICHOGRAM
is the microscopic examination of plucked hairs
If arthrospores and hyphae are found, dermatophytosis is likely; Demodex; if alopecia is caused by pruritic(broken hairs) vs. non-pruritic etiologies.
Cytology of Skin (Acetate tape preparation)
bacterial (often Staphylococcus sp). and yeast (Malassezia sp.) infections of the skin and ears
When applying a bandage always push the digital flexor tendons _____.
medially (lateral to medial , right limb clockwise)
Sheep PE - Temp
102-104
ruminal contractions (sheep pe)
1-2/min
Pulse Sheep
70-90 bpm
RR Sheep
12-20 pm
Sheep PE: Why examine lips/ gums
Look for vesicles, pustules or scabs on the lips, nostrils, face and eyelids which are common sites for contagious ecthyma.
unilateral nasal discharge in a sheep?
Nasal Bot
SHeep Pe: Lung Auscultation
Cranial ventral border at 6th rib, mid thorax at 7th rib, caudal border at 11th rib. Sounds heard best in the
trachea and at the base of the lungs. Inspiratory breath sounds are normally louder than expiratory
sounds.
SHeep Pe: Heart Auscultation
Heart sounds best heard in axilla between 2nd and sixth rib. Heart Sounds: S1 and S2.
Take pulse in sheep?
femoral artery on the medial aspect of the thigh
MM/ CRT eval in sheep
buccal, conjunctival or vaginal membranes
Palpable LN Sheep
Sub-mandibular, pre-scapular and pre-femoral nodes should be palpated
Why do you smell Sheep feet
Foot Rot - Fusobacterium necrophorum
Bovine Venipuncture sites
coccygeal v. 1/2 inch deep and perpendicular to the tail
at the underside, midline and at about 3 to 6 inches from the base of
the tail.
Small animal Venipuncture sites
Jugular v.
Cephalic v.
Small Animal IM Location
Lumbar muscles (caudal to last rib cranial to wing of ilium, lateral to dorsal spinus processes.) Thigh (SemiMembranosus/ semitendinosus) Behind femur; needle pointed CAUDALLY to avoid sciatic.
Small Animal SQ inj
Tent btwn shoulder blades (needle perpindicular to tent)
Ovine IM inj
Neck - triangle. Cranial to shoulder ventral to nuchal lig dorsal to cerv vert. Remove needle from syringe when inserting.
Ovine SQ inj
over triangle, or just behind triceps/ elbow
Equine IM inj
Neck (jus like sheepy) Caudal Thigh (semimemand semi tend) Ventral to tuber ischia, dorsal to gastroc tendon, axial to lateral thigh. (remove needle while placing)
Bovine IM inj
triangle of neck (remove needle)
Bovine SQ inj
Neck, or just behind elbow
Normal canine temperature
100.4 – 102.2°F
Normal feline temp
101.3‐102.2°F
Pulse Canine
60-120
RR Canine
10-30
Palpable structures canine mandible
mandibular lymph nodes and the parotid salivary glands. There are a chain of mandibular lymph nodes (2‐5) which are 4 pea‐sized and lose in the skin at the angle of the mandible. They are freely moveable
structures
LN canine caudal to ear
the submandibular or parotid salivary glands found caudal to the ear and firmly fixed / lobulated
LN canine at point of shoulder
The superficial cervical (prescapular) lymph nodes are palpated between the thumb and index finger
The _______ is palpated on the caudal surface of
the gastrocnemius muscle
popliteal lymph node
Max fluid rate for potassium
.5meq/kg/hr or body weight in kg/2 =meq max
maintenance rate for fluids dog and cat
40-60 ml/ kg/ day (cat 40, dog 60)
5 types of shock
Hypovolemic: loss of 3 ‘types’ of fluid:
• Hemorrhagic: loss of blood
• Non-hemorrhagic: loss of plasma from dehydration
• Redistribution of fluid: edema, third-spacing
• Cardiogenic: failure of pump
• Vasodilatory or distributive: failure of ‘tubing’ because of
inflammatory substances in ‘tubing’ like bacteria/sepsis.
• Obstructive: Flow is obstructed. Ex: Gastric dilation
volvulus, pericardial effusion, venous thrombosis, tension
pneumothorax.
• Combination of above
3 Classifications of shock
Hypovolemic
Cardiogenic
Septic/ Vasodilatory
How to correct fluid DEFICITS in dehydrated patient
%dehydrated * kg (10% dehydrated in 20 kg dog = 2000 ml deficit)
3 factors to consider when calculating fluid plan
Deficit
Maintenance
On going losses
isotonic crystalloids - how much will remain in vasculature after equilibration?
They are freely permeable to cell membranes
– After about ½ hr of equilibration, only about 1/3 will still be within intravascular space.
LARGE VOL CAN LEAD TO EDEMA
Examples of Replacement Crystalloids
Ringers, LRS, Normosol R, 0.9 % saline, PlasmaLyte A
• Designed to replace fluid loss.
• Can give rapidly (shock, dehydration)!
• Have K conc similar to that of plasma
• If used for maintenance fluid therapy, must monitor serum Na as patient can become hypernatremic. Must also add K if used as maintenance.
Exammples of Maintenance crystalloids
Normosol M, 0.45 % NaCl + 2.5 % dextrose, PlasmaLyte
56
• Designed to replace daily Na losses without Na overload.
• Don’t give rapidly!
• Some do not have K, so have to add it.
• Used for maintenance fluid therapy. Lower-Na fluids do not stay in vascular space & are poor at expanding blood vol., so often combined with colloids in patients with low albumin
When do I use hypertonic saline & what are potential
side effects?
• Indications:
– Cases of hypovolemic shock that do not have dehydration or hypernatremia
– Head trauma cases
• Contraindications
– Dehydration
– Hypernatremia
• Side effects
– Rapid administration may cause bronchoconstriction,
bradycardia & hypotension
• Dose: Over a 20-minute period, dogs should receive 4
to 7 ml/kg; cats ½ this dose.
When are colloids used?
used when goal is to restore RBCs, clotting factors, AT III, or albumin
Bolus: 5-10 ml/kg over 5-10 min for hypovolemia
(CRI): 10-20 ml/kg/day. This is maximum daily dose.
REMEMBER:Colloids are not used to replace dehydration deficits. Colloids are helpful to keep fluids in intravascular space so they are used in cases with low albumin or vasculitis or those with peripheral edema or ascites
How do I determine how much K+ to give?
- Look at the patient’s K Meq/L
- Compare to Sliding Scale of Scott to determine how much would be desired
- Calculate patient’s K max. (1/2 BW in kg)
- If Kmax
Perfusion parameters
HR, CRT, MM, Pulse pressure, temperature, blood pressure
Dog Abdominal Palpation…what can you feel?
Normal animal - liver, stomach portion of spleen in rib cage, not palpated. Normal spleen not palpated beyond ribs
● Small intestines - thin walled, flattened, slip easily through fingers as indistinct structures w/omentum, mesentery, associated vessels & lymph nodes
● Colon- presence of feces will make it palpable in caudal dorsal abdomen
● Kidney - not routinely palpable. (are in cats, have “floating kidneys”)- Left kidney more caudal than right. In dorso-cranial abdomen. Just ventral
● Bladder- palpable in caudal abdomen, size varies w/amount of urine (duh). Palpate in cranial to caudal fashion, allow bladder to slip between fingers to epaxial muscles behind ribs, apply pressure dorsally
Indirect vs direct optho exam
Indirect- w/focal light & lens, ● View at arm’s length, Inverted view, compare regions of fundus
Direct- use ophthalmoscope head, View close to dog’s eye● Highly magnified, upright image of one small region of fundus.Peripheral retina not examined
Gram + Cocci
Streptococcus, Staphalococcus
Gram + rods
Cornybacterium, clostridium
Gram - coccobaccilla
brucella, pasturella
gram - rods
Escherichia, Pseudomonas , Proteus, Salmonella
