SaS Final Flashcards
What are the parts to Bone reconstruction of the Stifle?
Trochleoplasties
Tibial tuberosity transposition
Distal femoral osteotomy
Complications of The Lateral ear canal resection
Don’t prefer it on cockerspanials (otitis externa)
Don’t choose a patient that has otitis externa (it does not treat it)
What is the Gold standard for nasal disease diagnostics?
Computed tomography
How do you make the Fascia as clean as possible?
Cut where the subcutaneous tissue and fascia meet
Fifi just had contractions ended 20 minuets ago. Should medical treatment be started?
No. >30 minuets is the common practice.
When is arthroscopy a good option for potential diagnosis?
OCD and FMCP
What are some issues consistent with hepatic dysfunction?
Hypoglycemia
Hypoprotenemia
Decreased BUN
What does the TTA surgery aim for?
Extension of the tibial tuberosity to make the force of weight bearing parallel to patellar tendon
Jerry (dog) is an abdominal cryptorchid. What is the proper surgical procedure?
there are two;
Ventral midline
abdominal incision Laparoscopically
What are the indications for Complete/Partial Liver lobectomy?
Biopsy
Neoplasia
Trauma
Abscess
Cysts
How do you make a simple continuous closure the same risk of dehiscence from a simple interrupted?
IT IS HARD –6 throws at the beginning –8 throws at the end if everything is done properly
Advantages/Disadvatages to Tru-cut Biopsy
Minimally invasive
Ultrasound/CT guided
14-16 guage needles
Increased risk of bleeding
Cat presents open fracture with periosteal stripping and extensive ST loss. Classification?
Type III B
Extensive ST Loss, Bone exposure, stripped periosteum
You suspect a partial tear of the CCL. What do you expect?
Partial tear: commonly happens in the craniomedial band and instability in flexion
What can worsen the signs of hepatic encephalopathy?
Anything that taxes the liver:
High protein meals
NSAIDs
Benzodiazepines
GI Ulceration
Which procedures have a more rapid return of function with CCL rupture?
TPLO(tibial plateau leveling osteotomy)/ TTA
How do you treat non-surgically ear hematoma?
Drain;
IV cortisone
Dexamethasone/prednisalone- long term
In a C-section; where do you make the incision; Over the fetus or before/after the fetus?
C-section: Do not make the incision over the fetus “Milk” the fetuses to incision.
What are the main things we monitor after PSS surgery?
Portal hypertension, seizures
Treat with IV fluids until eating on own (offer food early post-op period)
Analgesia- Buprenophine
T/F Every graft with slits is to be expanded.
False; Slits can be primarily to prevent accumulation of fluid under the graft. Grafts do not always need to expand
A dog presents with 2.3 cm bone sticking out. Soft tissue does not seem to be damaged severly. No flaps or avulsions.
What classification?
Type II
>1 cm, Mild soft tissue trauma without extensive soft tissue damage. No flaps or avulsions
What Dietary chanes can be made to prevent GDV?
Egg, Fish, Plenty of water before meals, smaller volumes
What is the Ideal method to diagnosis pyometra?
Ultrasound- pyometra
What is a poor prognosticator with single congenital shunts?
Ascities
(copper colored irises)
Where does the left ovarian vein drain?
Left renal vein
What must you do for PSS surgery?
MEASURE PORTAL PRESSURES
You bridge the incision from this type of skin repair to the recipient site.
You commonly use a bridge incision on flap
What is important to remember duing the OHE of a torsed Uterus?
Do no derotate a torsed Uterus
what is the common closure of the feline castration?
Healing by second intention is the common closure of the feline castration
Why did you just Matrix-block the other vet from using prostaglandin (for whatever stupid reason) on a closed cervix pyometra?
Prostaglanding vs. Closed cervix = rupture
Which hormone level is usually low in a Retained ovary?
LH (hence; Cats may require lutenization first)
What is the normal Sulcular debth in Cats?
> 1mm
Sulcular debth in cats
You notice Vessel thrombosis in the spleen when fixing a GDV. What do you do?
Splenectomy- Vessel thrombosis in the spleen
What can happen if you are too far lateral on the Ventral midline incision?
Seroma from the dead space
“Doc, it’s been 3 hours since the first puppy!?” -you reply-?
This can be normal. Continue to watch closely. If it goes on for 4 hours or more please bring them in.
You notice diffuse arragnment of adenocarcinomas in the liver. Where should you look for metastiasis?
Lymph nodes, peritoneum and lungs
Adenocarcinomas Diffuse
What kind of samples can you gain from a Laparoscopy?
Multiple relatively small tissue samples;
Cup biopsy forceps
Tru-cut needle
Gillotine (performed with suture loops)
A young dog presents with oral tumors. What are our two differentials?
odontomas
Undifferentiated Malignant oral tumor
What are the advantages of open castration?
Decreased risk of ligature slipping Decreased risk of abdominal hemorrhage Useful for large, bulky pedicles
What are commonly the most malignant oral tumors?
Oral melanomas are more commonly malignant
“Bunny hopping” is a sign of what?
CCL degeneration/failure
Describe the common Arteriovenous malformations of the Liver
Intrahepatic
multiple high pressure arterial to low pressure venous malformations
What do you need to do prior to an orthopedic exam?
a regular PE!
T/F Intraabdominal hemorrhage can be life threatening
True
What are indications for a lateral ear canal resection?
Moist environment predisposing to re-infection
Difficulty administering treatments
It’s been 24 hours since the temperature drop on a poodle. Problem?
No problem. Iz common
Name some things that happen with a patients Blood work who has a PSS;
Microcytic anemia, Pokilocytes (cats), Decreased bun, increased liver enzymes, INcreased pre and post-prandial bile acids, Increased ammonia, Decreased protein C activity.
T/F
Suture ligation is possible for all extra hepatic portosystemic shunts.
False
Suture ligation <50% of patients
T/F All uterine ruptures present as septic peritonitis
False; Sterile, pregnant uterus- minimal sings
Where is the fixation point, on the stomach, for a gastroplexy? (commonly)
Fixation point is at the base of the greater curvature
What osteotomy related complication can you see with TTA?
Iatrogenic patellar luxation TTA
“Kidra’ has been trying to make a ‘nest’ for the past 33 hours”
Please bring ‘Kidra’ in. Most likely dystocia
What is one signifying feature to look for to know that you are not too far lateral in the Ventril Midline incision?
“Pop” in to the SubQ
Cat presents with
Deep pocket formation (3mm), Gingival recession with abnormal topography and moderatly mobile incisors.
What stage of periodontal disease?
Stage 3
What are the indications of Choledochtomy?
Choledocholithiasis
Biliary sludge
(not commonly performed)
Describe the Midline approach
1)Sharply incise the Subcutaneous in the same plane as the skin 2) Identify linea alba
What are the indications for medical treatment of CEH?
Cystic endometerial hyperplasia: Valuable breeding animal no vaginal bleeding
Which suture distributes tension the best?
Monofilament distributes tension the best
What does a radiograph have to be in order to diagnose UAP?
The limb has to be in flexed lateral and not just a simple neutral lateral view.
You notice Venous congestion when fixing a GDV; What do you do?
Nothing; Congestion is self limiting
What is the holding layer of the body wall?
Body wall holding later; External rectus sheath.
How many Molars do cats have? Mandible and maxilary?
1 on each (total 4)
Is vaginal cytology helpful in metritis diagnosis?
No; Degenerative neutrophils, intracelular bacteria. Both of which are normal postpartum findings.
What are the qualifications for medical management of Pyometra?
Not systemically ill OPEN PYOMETRA only Owner highly motivated and aware of risks
How much porisity does cortical bone have?
Cortical bone porisity 5-10%
What analgesia do we use with PSS?
Buprenorphine
What is the standard treatment for CEH?
OHE is the default treatment for cystic endometrial hyperplasia
What is the advantage/time-to-use Flank approach?
Ovariohysterctomy Cats Risk of evisceration eliminated
T/F Ovarian neoplasms are commonly metastatic
False; Metastatic disease is uncommon overall
What is Biliary Mucoceles?
Hyperplasia of mucus-secreting cells and excessive mucus secretion;
Associated wtih hypothyroidism
What happens when you dissect too caudaly during a lateral ear canal resection?
Hit the parotid gland
It’s been 38 hours since the temperature drop on a pregnant beagle. Problem?
Yes, possibly dystocia.
Describe a grade IV MPL.
IV MPL: “out-out” –Patella is fixed in luxation –Manual reduction is not possible –hypoplastic patella
You are attempting an Ovariohysterectomy. The uterus is distended; what do you do?
Distended uterus; Enlarge the incision
Explain the cardiovascular effects of DGV;
Poor venous return; Decreased preload, perfusion, and CO and BP
Hypotension ontop of Hypoxemia
Vasoconstriction; Catecholamines, decreased perfusion, renal shutdown, loss of GIT mucosa, Shock and death.
What is anisotropicy?
Elastic modulus dependent upon direction of loading application.
T/F You can not skip subcutaneous closure
False You may skip if there is minimal Subcutaneous tissue
Dog presents with;
Gingival tissue is firm and pink. Some defined stipling and minimal sulcular debth (2.2mm)
What stage of periodontal disease?
Stage Zero- or Normal
What do you tell Joe about his dog who just came out of a TTA surgery?
Restrict exercise till radiographic healing (8-12 weeks) Expect 6 months of recovery following surgery compression bandage 24-48 hours.
What are the renal effects of GDV?
Poor perfusino leads to Oliguria/ Anuria
if you can’t perform a cholecystoduodenostomy, what should you perform?
Cholecystojejunostomy
T/F The horners associated with TEKA can be present before.
True!
Horners syndrome can be caused before the surgery takes place
(E.g. caused by the pre-existing diseased state)
What do you normally have with portal vein hypoplasia?
Portal hypertension
or
Microvascular Dysplasia
What do you incise through for a closed feline castration?
Spermatic fascia
The Gold standard for diagnosing PSS;
CT angiography
(Ultrasound is next best)
What are some DDx for the blood pannle seen with pyometras?
Sepsis SIRS (neutrophilia w/ left shift, Mild thrombocytopenia- inflammation, hypoalbuminemia, mild cholestasis {bilirubin, liver enzymes])
Kitty with suspect middle ear polyps. Has neuronal signs. What does this tell you?
Within the tympanic bulla
What marker do you position next to for near complete resectino of the lobe during a partial/complete lobectomay?
Hilus of the liver
Which components are ligated with an Open castration?
Separately ligated Vascular components( artery, nerve, plexus) Parietal tunic, cremaster, ductus deferens
Which radiograph angle is the most diagnostic?
Right lateral ; GDV most diagnostic
What do you do if the pedicle starts bleeding?
Extend the Incision
How can you tell if CCL rupture is chronic?
DJD on the physical exam and radio-graphs can confirm chronicity.
What is the main thing we worry about in the surgery on the mandible/jaw?
Occlusion;
not if the bones are lined up nice and pretty
Where do the ovarian arteries branch from?
Directly off the aorta
When do you use the scrotal approach in Castration?
Mature patients
What is the lateral patellar luxation signalment
Large breeds
What’s the common ‘medical treatment’ of dystocia?
Monitor calcium and glucose (supplement as needed) Oxytocin
Describe the Tibial thrust test
Puts the limb in a normal weight bearing scneario
What are most of the bacteria once sub-gingival plaque has “set in”?
Once there is presence of sub-gingival plauqe most Bacteria are:
Anaerobic
Trixy (dog) is diagnosed with Inguinal cryptorchid. Surgical approach?
Skin and SQ tissue incised over the testicle
How do people commonly treat liver fracture?
Conservative managment:
IV fluids
+/- Transfusion.
What are the Indications for LIgature tecnique of the liver?
Should Only be used for left lateral and left medial liver lobectomies in small dogs and cats
Where is the proper ligament located?
Urterine horn to caudal pole
Describe Cholecystectomy
Ligate the cystic duct and cystic argery
Do not ligated/damage the common bile duct
What is the indication of perineal castration?
Patient is already in perineal position
What does furture distention of GDV cause in the dog?
Inital: Rotation along the mesenteric axis
Prolonged: Clockwise rotation of the stomach
A cat comes into your clinic in labor. All the kittens come out fine but the last. Of corse the mom prolapses. You try manual reduction but it does not work. What is the next treatment??
OHE is indicated when manual reduction is not possible of uterine prolapse.
What is the normal Sulcular debth in the dog?
< 3mm
Sulcular debth
T/F You are not entering the abdominal cavity with open castration when you exteriorize the testicle
False: You are technically entering the abdominal cavity.
What is the ‘colonic maneuver’?
Retraction of the colon medially –mesocolon will retract jejunum
What is the external force applied to any cross sectional area?
Sterss: external force applied to any cross setional area
What should you try before choledochotomy?
Attempt to flush stones back into gall bladder
What is important to remember about Exteral tracheal ring implants?
Only good for the cergical regions
What does TPLO surgery aim for?
Rotation of the proximal tibia to make the Force of weight bearing perpendicular to tibial axis.
What are some complications seen commonly after PSS surgery?
Hyovolemic shock
hypothermia, weak pulses, Abdominal pain, Vomiting/Diarrhea, Seizures
A dog walk in bright and alert; breeder presenting for failure to conceive. They have noticed vaginal discharge and drinking a lot. Top DDx?
Cystic endometrial hyperplasia
What’s the order of what to do for open fractures?
1) stablize patient 2) asses tissue damge 3) assess neurovascular status 4) imaging 5) clean wound, collect culture, start with Cefazolin
Describe Grade II patellar luxation
Grade II: “In-Out” –Patella luxates with lateral pressure or on flexion of stifle, remains luxated until reduced manually or when animal extends –Spontaneous luxation and reduction occurs, with intermittent lameness
Where is a common place to find osteophytes in joint injuries?
Patella and trochelar ridges
T/F Crepitus confirms osteophyte
False: Crepitus can be caused by other factors mal-formed joints arthritis.
When Do you see Ascites with PSS?
Secondary to portal hypertension
Describe the prescrotal approach;
Routine elective castration Shave, prep, drape (testicles out of field) Stand on ‘wrong’ side advance testicle to prescrotal position Incise over testicle on midline (expose parietal vaginal tunic)
what are the advantages to closed castration?
Decreased risk of scrotal hematoma Decreased postoperative swelling Slightly quicker
Which is the ‘grade’ of the various repairs of the CCL rupture repair?
In order: Lateral suture
TPLO
TTA,
Tightrope
How do you check the right pedicle?
Retract the duodenum
Name the anatomical location of the Ovaries
–Ovaries are located at the caudal pole of the kidneys –Uterine horns are dorsolateral –Uterine body is located between urinary bladder and colon, adjacent to ureters.
Where is the attachment of the CCL?
Caudomedial aspect of the lateral condyle Cranial intercondyloid area of the tibia
Dog presents with Pain on flexion and supination of the Elbow. DDx?
MCD (medial compartment disease)
T/F
Incongruities are always static
False;
The Radius shifts during weightbearing- Dynamic
Dogs or Cats are more prone to honers syndrome from ear surgery?
True
Nerves run superficially in ventromedial area
What needle type should you use on a hysterotomy?
Taper needle (Less traumatic)
What is it important to do post-PSS surgery?
Recheck 4-8 weeks
Serum chimstry, Liver function tests
(BW values may never normalize)
Describe high porosity;
High porosity:
Long elastic phase
Lower yeild point
T/F
Prognosis of cats after Permanent tracheostomy is good.
False
Cats do not do well, either subcoming to original problem or developing a secondary with Laryngeal paralysis
How do you treat a laceration of the Pinna that involves two skin surfaces and/or cartilage?
Must do a primary closure
Vertical mattress- deep bites align cartilage, superficial alligns skin
Fidoa is brought back in because there is bleeding near her abdominal incision from an ovarinhysterectomy 12 days ago. Is this likely?
No; Commonly postoperative dehescience is within 7 days.
What is special a bout the Multi-loblar-osteochondro-sarcoma?
It’s essentially a low grade malignant tumor in most cases
Occurs on flatbones-skull
&
Vertical rhamus of the mandible
What side does the menisofemoral ligament reside on?
Lateral side only
What surgical technique do we generally use with mandibular
Skin flaps and other techniques to alleviate tension
What is caracteristic of a Grade 1 patellar luxation?
Grade I: –Patella can be manually luxated but spontaneously returns to normal position –Spontaneous luxation is rare –Flexion and extesion of the joint are normal
What happens if you don’t perform the Bulla of the TEKA treatment?
Chronic discharge from the damaged epithelium
What side does the meniscotibial ligament reside on?
Lateral and medial
You diagnose cryptorchidisum. What is the surgical approach to rectify this?
Inguinal or Abdominal
What kind of clamps do you use for a OHE?
Non-crushing (Doyen)
Patients patella comes in luxated. You can manually reduce it but it reluxates spontaneously. What other signs do you expect to see and what grade of patellar luxation is this?
Grade III: “Out-In” –Medial displacement of quadriceps –Deformities of femur and tibia may be grossly apparent
What is in the maxilary recess?
Lateral nasal gland; can be large and gelatinous
and
parotid duct
What’s the gold standard for diagnosis Biliary Mucoceles?
Imaging;
mineralization, Hepatomegaly
Ultrasongraphy- enlarged gallbladder with immobile ecogenic bile, Striated or stellate pattern “Kiwi” sign. Pericholecystic hyperechoic fat or fluid may indicate rupture
which is the most common type of luxation (hip)
Craniodorsal
Larry (dog) has scrotal bruising. How do you treat?
Conservative management Cold then warm compress
What is one hormone produced by the Ovary?
Progesterone- important in pyometra
A cat is presented with 2.5cm margins from a SCC on it’s ear. Tx?
Total pinnectomy
>1-2 cm margins from visible lesion
T/F
Cats
Adeomas > Adenocarcinomas
(which do they have more?)
True:
Cats have more ademonmas than Adeoncarcinomas
Ortolani sign; what is it and what do we use it for
We used for DHD –hip subluxates when limb adducts –reduces when limb abducts
Describe the location/function of the Round ligament
It is a remnant of the gubernaculum. –uterine horn to vaginal process –free border of laterla fold of mesometrium
Where is the suspensory ligament located?
Cranial pole to body wall
what is one important thing to remember on the closure of metritis?
Do no penetrate the mucosa
Where does the right ovarian vein drain?
Vena cava
How do you harvest skini graphs?
1)Dissect graft from donor site Deep to cutaneous trunci 2) remove cutaneous trunci muscle and superficial subcutaneous tissue prior to applying graft
On an exploratory you notice a uterine neoplasia in Fifi (a poodle). What is a good assumption?
A good assumption would be to declare it a benign leiomyoma (90% of canines). Would not hurt to biopsy.
What do you incise through for an open feline castration?
Parietal tunic
Name some things that happen to the urine of an animal with a PSS.
Decreased USG
ammonium biurate crystals/calculi
Sediment consistent with UTI
Fido is brought in for routine elective castration. Best surgical approach?
Pre-scrotal
What should you make sure to do before cholecystectomy?
confirm patency prior to removing the gallbladder
On Radiographs you notice what appears to be a neoplasia in Nala’s uterus. Prognosis?
Until you biopsy; Guarded Likely malignant/metastatic in cats.
You see splenic torsion of the spleen when fixing a GDV. What do?
Splenectomy= splenic torsion
Prognosis of Extrahepatic PSS?
Good-excellent 78-94% of patients
T/F
Dogs usually present with something that leads to Cholangiocellular tumors.
False:
88% of cholangiocellular tumors are discovered at time of necropsy. Mostly intrahepatic
What is an example of Extracapuslar stabilization?
Lateral suture, Lateral fabellotibial suture, “Extracap”, TightRope
What are some symptoms seen on the physical exam of suspected pyometra?
Tachycardia, Tachypenea Vaginal discharge
How do you check the left pedicle?
Retract the descending colon
Do presents with enlarged Parotid/retropharngeal lymph nodes and painful temporomandibular joint. DDx?
Otitis Media
Ovariectomy is only acceptable for what?
Cystic disease is the only acceptable time to use Ovariectomy
Where does gastric necrosis normally occur ?
Greater curvature; Where most gastric necrosis
T/F Closed castration has better prognosis that Open.
False; there is no data to support either.
How many ligatures are placed on a closed castration?
two; commonly millers and transfixation
which method is best to detect early Otitis media?
MRI
(don’t see radiographic changes till later)
What are common surgical procedures to fix MPL and LPL?
Soft tissue reconstruction and Bone reconstruction/realignment
When do multiple acquired porotosystemic shunts happen
Commonly secondary to portal hypertension
(macrovascular shunt ligation, chirrhosis, idiopathic, hepatic AV malformation)
What diseases do you reduce with Castration?
Androgen-related diseases; Prostatic disease Perianal adenoma perineal hernia Testicular disease
What are common congenital etiologies of MPL?
Medial displacement of tibial tuberosity Abnormal (shallow) trochelar groove Hypoplasia of medial condylar ridge
What is a suggested order to open fracture stablization?
Assess tissue damage
Assess neurovascular status
Imaging
Clean wound, culture
Treat with Cefazolin
What do we worry about with Oral melanomas specifically?
They metastasize early to regional lymph nodes and lungs early compared to other cancers
What are two etiologies to Pyometra?
Pyometra: Hormonal- progesterone-> uterine secretions Bacterial: Gram neg (E.Coli
Where do you make the circular incision for the Vertical ear canal resection?
at the level of the anhelix
What osteotomy related complication can you see with TPLO?
Iatrogenic angular limb deformities; Complication of TPLO
Signalment for Middle ear polyps
Younger
Felines
A dog comes in with severe exposure of bone. What’s one method to speed granulation tissue formation over the exposed bone?
‘Forage’-ing –Drilling holes through near cortex into medullary cavity
Cholecystectomy indications?
Necrotizing cholecystitis
Chronic cholecystitis
Biliary mucocele- thick biliary sludge
Cholelithiasis
Neoplasia
Trauma
What is a draining tract assocaited with teeth?
Parulis- Draining tract associated with teeth
Which veins are compressed with GDV?
Caudal vena cava
Portal vein
Splenic veins
What is an Arthrogram?
Contrast injected into a join space in efforts to find disruption of structures; not used anymore because we have MRI
What are some GI signs of PSS.
Hypermotlity of intestinal loops
pale/ashen discolration of intestines
increased mesenteric arterial puslation
Cyanosis of pancrease
You open a dog that presents with GDV but you do not see the greater omentum. What does this mean?
The greater omentum will not be visible if it is a counterclockwise torsion.
What kind of margins do you want to take with oral tumors?
1-2 cm
Which is is more prone to having metastatic disease of the Ovaries? Cats/Dogs
Cats
T/F Punch (seed) graphs are split thickness graphs
False Punch Graphs are full thickness
T/F
Liver tumors are more common in the cat than in the dog.
False:
Liver tumors are more common in dogs than cats.
Describe Cholangiocellular tumors
Mostly intrahepatic
High metastatic rate
Second most common primary malignancy of the liver in dogs
Most common primary hepatobiliar tumor in cats
What is the treatment of choice for Uterine Torsion?
Tx: uterine torsion= OHE
Describe the breakdown of the Broad ligament;
Broad ligament breakdown starts caudally and goes laterally away from the vessels
What is the classification for long oblique. Length of fracture > 2.0 diameter of diaphysis
What are the parts to Soft tissue reconstruction in MPL/LPL repair?
Medial release Lateral imbrication
How do you medically treat PSS?
Lactulose (traps ammonia)
Reduced protein diet
Antibitics
intrahepatic PSS
T/F
Squamous cell carcinomas of the pinna in the cat are highly/commonly metastatic
False
A dog presents from an other non-skilled veterinarian with Otitis externa that ‘cannot be treated medically (with Rx)’. Your Tx?
TEKA
Total ear canal ablation with lateral bulla osteotomy
Why do we not use the Lateral Ear canal resection much anymore?
Otitis externa does not limit itself to the external canal.
What is recomended to do with a partial and total mandibulectomy?
Extend the closure of comisure
level of the second premolar
What is this?
Copper colored Irises of a cat
Ascities, PSS
What are two things to look for when choosing when to start grafting?
1) Granulation tissue; pink/glistening 2) Wound contacting and epithelial migration visible at wound margin
What does osteotomy eliminate?
In CCL rupture treatment Eliminates tibial thrust (active) Does not eliminate cranial drawer (passive)
When can you expect dogs to start eating again after complete mandibulaectomy?
1-2 days
Name some things that can be seen with degenerative joint disease;
–Medial buttressing- fiberous tissue develops –Joint edema
T/F OHE affects milk production
False: OHE does not affect milk production
Dog presents with pan on extension of the fore limb (specifically at the elbow). DDx?
Un-united Anconeal process
Pain on extension of the elbow
What bone reconstruction do you use for a Grade IV luxation?
Distal femoral osteotomy (DFO)
What are emergency indications for the use of Temporary tracheostomy?
Brachycephalic airway disease
Laryngeal paralysis
Mass (treatable) cusing obstruction the upper airway
Oropharyngeal or laryngeal foreign body
&
Patients undergoing mechanical ventilation
How do you close around the temporary tracheostomy?
Use umbilical tape to secure tube around neck
Remove obturator and replace with inner cannula
If incision is excessively long, partially close muscle, SQ and skin
How do you replace a temporary tracheostomy?
- remove inner cannula and replace with new (clean with 0.05% chlorhexidine
- Pre-oxygenate for 3-5 min
- Suction trachea with sterile suction tip to level of carina (<10 sec) repeat 2-4x
- Clean skin around tracheostomy incision
- Replace tube every 24 horus
Name some complications of Temporary tracheostomy;
Tube occlusion
Pneumomediastinum
Vagally mediated bradycardia and collapse
You have successfully cleaned out a patient with Hemothorax. What should you place to allowed continued protection?
Thoracostomy tube
T/F
Thoracostomy tubes are only used for egress drains
False:
Ingress or egress
You have a patient that is constantly producing suppurative effusion into the thorax. What kind of tube should you use for Thoracostomy?
Wider tube for suppurative effusion in thoracostomy tubes
FiFi is constantly leaking air into her thorax. What kind of tube should you use on thoracostomy?
Smaller tube
How do you measure a thoracostomy tube?
Start; Dorsal 1/3r of thoracic wall at 7-9 IC space
End: Point of the elbow
Where is the idea place for Thoracostomy tubes?
7-9 intercostal space
When is it safe to remove thoracostomy tubes?
abscence of pneumothorax for 12-24 hours.
Fluid production down to 2 mls/kg/day
What is cardiac tamponade?
Intrapericardial pressure is higher than end diastolic pressure.
(limited RV filling, Increased systemic venous pressure, Decrease in CO)
What is Pulsus paradoxus?
Happens during Cardiac tamponade:
Exaggerated fall in arterial pressure with inspiration due to decreased left sided heart filling
Pulses feel weak to absent on inpiration.
What should always be done during/after pericardiocentesis?
Fluid kept
What are the landmarks for the Pericardiocentesis?
5-6 intercostal space- mid ventral
PDS lenght?
4-6 months
What is the approach to Thoracic Duct Ligation?
Transdiaphragmatic
10th IC space- cat
Dog- 10th IC space
Where do you ligate the Thoracic Duct?
As close to the diaphragm as possible
What is the most common cause of Chylothorax?
Idiopathic
What does the Diagnosis of Chylothorax normally look like?
Triglycerides of fluid > serum
Serium > Cholesterol of Fluids
Modified transudate, lymphocytic effusion
what surgerys can help with a Chylothorax?
Thoracic duct Ligation
Cysterna Chyli ablation
+/- omentalization
+/- Pleuralport placment
What’s the clamp time on the kidney? (how long to keep it occluded)
Not over 20 mins!!
How do you close the kidney?
Suture less closure; Hold for 5 mins, forms a fibrin seal
Suture capsule closed
What are the advantages to Pyelolithotomy?
Does not require occlusion of blood supply
Does not damage nephrons
