T5: Getting the Patient Ready for Theatre Flashcards

1
Q

What are some procedures that may need to be performed to stabilise an animal?

A
  • Clearing the airway
  • Administration of oxygen via mask
  • Intubation -may require lignocaine gel or spray
  • Control of haemorrhage -apply direct pressure
  • IV fluids
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2
Q

What is the aim of pre-operative stabilisation?

A

to reduce the patient’s anaesthetic risk so that their chances of surviving surgery are increased.

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3
Q

What is IPPV?

A

Intermittent Positive Pressure Ventilation

breaths performed manually by the nurse using the breathing bag or by a mechanical ventilator

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4
Q

Name some situations where the vet may require the veterinary nurse to assist with controlling the patient’s ventilation during anaesthesia

A
  • apnoea
  • hypoventilation
  • obesity
  • thoracotomy
  • muscle relaxant use
  • diaphragmatic hernia
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5
Q

What is hypoventilation?

A
  • abnormally low alveolar ventilation (i.e. the volume of gas delivered to the alveoli each minute is less than normal)
  • caused by a reduction in the tidal volume (size of breath) and/or a reduction in the respiratory rate.
  • Hypoventilation can lead to hypercapnia (an increase in expired carbon dioxide levels).
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6
Q

How may obesity cause breathing difficulties during anaesthesia?

A
  • Subcutaneous, intrathoracic and abdominal fat deposits may prevent adequate expansion of the chest and lungs
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7
Q

What type of ventilation is required during a thoracotomy?

A
  • PPV -ongoing ventilation, not intermitent
  • as the chest is opne, animal cannot breath for itself
  • mechanical ventilator often used
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8
Q

How may a diaphragmatic hernia interfere with a patients breathing during anaesthesia?

A
  • diaphragm contributes little to the expansion of the lungs and even very light anaesthesia may cause severe ventilatory depression
    *
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9
Q

When using manual IPPV, what is the maximum breath size?

A

not greater than 20cm H2O

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10
Q

What is the normal ventilatory rate for:
Cats?
Dogs?

Adult horses?

Foals?

A
  • 15 breaths/min (cats)
  • 8 breaths/min (large dogs)
  • 4-6 breaths/min (adult horses)
  • 8-10 breaths/min (foals)
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11
Q

Describe how you would place an IV catheter

A
  • In either cephalic, jugular and medial and lateral saphenous veins.
  • can be left for long periods of time (>72hrs) if properly maintained, and flushed w/ heparin saline every 4-6hrs.
  • Immobilsed and hold off vein
  • insert catheter w/ bevel up at 15degree angle
  • look for flash of blood, reduce angle of catheter to parallel w/ vein
  • advance, look for flash in chamber, advance fully
  • tape and plug
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12
Q

What is maintenance fluid rate?

A

2.5-3ml/kg/hr or 60ml/kg/day

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13
Q

For neonates or presence of massive tissue injury, fluids rates should be increased by a factor of…?

A

1.3

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14
Q

How quickly should a fluid deficit be replaced?

A
  • over 48 hours:

half in the first 6-8 hours

three quarters after 24 hours

and the remainder by 48 hours

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15
Q

Name the fluid used for routine fluid maintenance during surgery

A

Hartmann’s

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16
Q

What characteristics should a canine blood donor have?

A
  • current vaccinations
  • tested negative for heartworm microfilaria
  • be receiving heartworm prophylaxis
  • not have received a blood transfusion
  • PCV greater than 35% immediately prior to blood collection
17
Q

What characteristics should a feline blood donor have?

A
  • tested negative to feline leukaemia virus and feline immunodeficiency virus
  • be receiving heartworm prophylaxis.
18
Q

The volume of blood collected from the donor on each occasion should be limited to:

A
  • 16ml/kg for greyhounds
  • 12ml/kg for other dog breeds
  • 10ml/kg for cats
19
Q

Name the antcoagulant used in blood collection bags

A

Citrate Phosphate 2x Dextrose with Adenine (CP2D-A)

20
Q

How may collected blood be stored?

A
  • be stored for four weeks at temperatures of 2-6°C.
  • Gentle agitation of the pack every day or so to mix the red cells, will optimise its condition.
  • Blood for patients with thrombocytopenia should be stored at about 20°C and administered within 6 hours
  • Refrigeration inactivates platelets.
21
Q

Which canine blood type are universal blood recipients?

A

DEA 1.1

can receive a first transfusion of any type without developing a transfusion reaction

22
Q

Clinical signs of a transfusion reaction include:

A
  • pyrexia
  • vomiting
  • salivation
  • trembling
  • elevated heart rate
  • urticaria (raised itchy areas of skin)
  • hypotension (leading to shock)
23
Q

What does blood cross-matching involve?

A
  • separation and washing of red cells from the donor and recipient.
  • Donor cells are then mixed with the recipient’s plasma (“major cross-match”) and the recipient’s cells are mixed with the donor’s plasma (“minor cross match”).
  • Incompatibility is indicated by aggregation (clumping) of the red cells.
24
Q

At what rate should you administer a blood transfusion?

A
  • initial rate of transfusion is slow (0.2 ml/kg/minute for 20 minutes) and the patient is observed for signs of a transfusion reaction.
  • A normovolaemic animal should not receive blood at a rate greater than 1.5 ml/kg/hour.
25
Q

How may you transport a patient into the theatre?

A
  • manual carrying
  • trolley
  • stretcher
  • hydraulic winches

You may need to bring anaesthetic pump and fluids (clinic depending).

Be careful to:

  • not occlude breathing
  • not to contaminate surgical site
  • Keep animal warm
26
Q

A patient should be positioned in surgery so that:

A
  • the surgeon has ample access to the surgical region
  • the patient is comfortable
  • swelling (oedema) of the feet does not occur because of constriction by ties
  • leg ties are not placed in front of a venipuncture - because of the danger of producing a haematoma.
27
Q

What is dorsal recumbency?

A

animal placed on its back

28
Q

What is ventral recumbency?

A

animal placed on its abdomen/thorax

29
Q

What is lateral recumbency?

A

animal is placed on its side

30
Q

Name some positioning equipement

A
  • sand bags
  • ties
  • v troughs
31
Q

Explan the final clean of the surgical area before surgery

A
  • wash hands and gown/glove up
  • first solution applied is an alcohol-based antiseptic (strongly bactericidal) this is then removed with gauze swabs in an aseptic manner
  • final antiseptic to be applied is usually an iodophor or chlorhexidine solution (which is water based). These are not usually removed but left to dry on the skin