Sick Patients SDL Flashcards
Wookie has been admitted for a lateral antebrachial mass removal and nail clip under general anaesthesia. On physical examination she has a heart rate of 124bpm, a grade 3/6 systolic murmur audible over the left apex, a respiratory rate of 24bpm, mild upper respiratory tract stertor, normal lung sounds, strong and synchronous pulses, pink and moist mucous membranes and a capillary refill time of 2 seconds. She weighs 2.8kgs, body condition score 4/9. She is friendly but nervous.
Are there any further questions you’d like to ask the owner to help you decide on an anaesthetic plan?
You might also want to ask about exercise tolerance, any episodes of coughing, any syncopal or pre-syncopal episodes, any episodes of increased respiratory rate and effort
Wookie has been admitted for a lateral antebrachial mass removal and nail clip under general anaesthesia. On physical examination she has a heart rate of 124bpm, a grade 3/6 systolic murmur audible over the left apex, a respiratory rate of 24bpm, mild upper respiratory tract stertor, normal lung sounds, strong and synchronous pulses, pink and moist mucous membranes and a capillary refill time of 2 seconds. She weighs 2.8kgs, body condition score 4/9. She is friendly but nervous.
Are there any other diagnostic tests you want to discuss with Wookie’s owner before you proceed?
Echocardiography - stage the disease and take accurate measurements
Haematology and biochemistry - Assess organ function
PCV and TS (total solids)
POCUS (point of care ultrasound) - assessing for gross cardiac disease and the presence of pulmonary oedema
Why would you avoid using acepromazine in a patient with systemic heart disease?
It causes vasodilation so can lead to hypotension and reduced tissue perfusion
What is the purpose of pre-oxygenation?
Pre-oxygenation increases the fraction of inspired oxygen (FiO2) and oxygen therefore displaces nitrogen in the alveoli.
Essentially, pre-oxygenation buys us time at induction when the patient is likely to experience respiratory depression or apnoea.
Why should a low IVFT flow rate be used in patients with cardiac disease?
intravenous fluid therapy should be used cautiously as an increase in preload can more easily result in pulmonary oedema
When you make the first skin incision, you notice this on the multiparameter monitor. What is the likely cause of this?
sympathetic stimulation/ nociception.
What local anaesthetic technique could you use to clean, debride and suture this tail?
Epidural coccygeal 1-1
Epidural sacrococcygeal
Which local anaesthetics are licensed in horses?
lidocaine
mepivacaine
Duchess is a brachycephalic cat in for an enucleation. What potential complications might you anticipate being more likely to encounter as a result?
Increased risk of dyspnoea and airway obstruction following sedation
potential for difficult intubation leading to hypoxaemia
increased risk of regurgitation and therefore oesophagitis/ stricture formation and aspiration pneumonia
corneal abrasions of the normal eye due to exopthalamus
airway obstruction on extubation
Which blocks would be suitable for an enucleation in a cat?
Retrobulbar
Peribulbar
Whilst manipulating the stomach and spleen you look at the multiparameter monitor and notice a couple of unusual complexes on the ECG. What are these?
Ventricular premature complexes
How would you describe this arrythmia?
Ventricular tachycardia
Whilst injecting the local anaesthetic into the retrobulbar space you notice the following on the multiparameter monitor. What is the likely cause of this?
An oculocardiac reflex can be caused by pressure or traction on the globe. This happens because the ophthalmic nerve is a branch of the trigeminal nerve. Nuclei of the trigeminal and vagus nerve are anatomically connected. Vagal stimulation may lead to bradycardia and atrioventricular block. This cat has a second degree AV block
What drug can you give to treat ventricular tachycardia?
Lidocaine is an antiarrhythmic drug which decreases permeability to sodium. This decreases the rate of ventricular firing, action potential duration and increases the relative refractory period.
