Recovery of a patient Flashcards
what do the following mucous membranes indicate
pale - shock
blue - lack of oxygen
yellow - liver failure
salmon pink - good health
brick red - infection or sepsis
4 cranial reflexes and what we should check for when monitoring anaesthesia
-Jaw Tone
-Eyes
-Pinch between the toes
- palpebral reflex
2 advantages and 2 disadvantages of a pulse oximeter
-works quickly - advantage
- non invasive - advantage
- temp and skin thickness can reduce accuracy
What is Recovery
reverse of induction, the patient goes from an unconscious state to a conscious state with all the associated planes in between
Recovery
safe and comfortable recovery is the final objective of anaesthesia
recovery remains the most overlooked phase of anaesthesia
optimal recovery requires consideration of the patients changing neurologic status
Monitoring in the post - op Period
- Just as essential
- speed of recovery depends upon
-breed
-existing illness - renal, hepatic, respiratory, cardiac
-Temp
- Duration and type of anaesthesia
- Route of Drug administration
What do you want in the recovery area?
-Thermometer
-Syringe
- warming matt
- stethescope
When to Extubate
Early
-risks inhalation of FBs
- Best for cats
- Not for brachycephalic dogs
-allows pollution of atmosphere
Late
- airway protected until gag response returns
-best for potential airway obstruction
-risk of largyneal spasm in cats
- less pollution of atmosphere
-prolonged 02 breathing
What to monitor
- position of patient
- pulse
- respiratory rate and pattern
Pale MM - Cyanosis - Red
pale
- sympathetic vasoconstriction
- haemorrhage
cyanosis
-poor oxygenation
- poor circulation
- peripheral vasoconstriction
red - Toxaemia or Hypercapnia
Other things to monitor
- Temp
-Pain - Hydration
- Wound management
- Drug Therapy
- Nutrition
Recovering from special procedures
- Ophthalmic procedures
- Abdominal surgery
- Thoracic surgery
- Orthopaedic procedures
- Myelography - dye injected into spinal cord for study of the nervous system
How can supplemental oxygen be given ?
- Flow - past
- Oxygen tent
-Mask
-intranasal catheter
anaesthetic complications
- cardiopulmonary arrest
- airway obstruction
- respiratory depression/ arrest
- circulatory insufficiency
- Hypothermia
Cardiopulmonary arrest
- most common cause is overdose of inhalation agent
- if monitoring is adequate you will spot the increasing anaesthetic depth
- respiratory changes occur before cardiac arrest
- electrical abnormalities will also be evident (if you are using ECG)
Signs of impending Arrest
- changes to respiratory rate, depth and pattern
- changes in pulse quality and rhythm
- unexplained changes in anaesthetic depth
- abnormal ECG rhythms
Signs of Arrest
- No heart sounds
- no pulse palpable
- no respiratory movements
- fixed and dilated pupils
- grey or cynanotic pupils
- dry cornea with loss of reflexes
- Arrhythmia on ECG
Causes of Arrest
- Anaesthetic overdose
- Hypoxia and hypercapnia
- Hypotension
-Dysrhythmias - pre existing heart disease
- hypothermia
Cardiopulmonary resuscitation
Airway
Breathing
Circulation
Drugs
Electrical defibrillation
Follow up
drugs which should be in your anaesthetic emergency box
Adrenaline
Atropine
Lidocaine
Furosemide
What do we need in a crash box/kit
- drugs
- laryngoscope
- IV equipment
airway obstruction during or after anaesthetic
- increased respiratory effort/noise
- paradoxical chest wall movement
- no movement of reservoir bag
- Cyanosis
How to Check ET tube is not blocked?
- squeeze resevoir bag and look for movement of chest wall
- remove and replace
- Or use suction to clear tube
causes of tracheotomy
- Anaesthetic or opioid overdose
- Chest wall movement inadequate
- respiratory movements unable to inflate lungs
- Tachypnoea
