Test 2: 29 case discussion Flashcards
1 yo FS Lab for OVH
* PE & BW WNL
* Premedicated with 0.02mg/kg acepromazine & 0.05mg/kg
hydromorphone
* Induced with 3mg/kg propofol
* Started on isoflurane
what monitoring would you use on this pt.
measure HR:
* pulse ox
* EKG
measure BP
* NIBP- doppler or oscillometric
* IBP- pressure transducer (A line), simple aneroid gauge method
measure ventilation
* capnogrophy
temp
ASA physcial status levels
1: healthy
2: Mild systemic disease
3: Severe systemic disease
4: Severe life-threatening disease
5: Moribund (not expected to survive 24 hours)
6: Organ Donor
E: Emergent
First Reading Following Induction
* HR: 45 BP: 80/40 (50)
* ETCO2: 40
* SpO2: 100%
is pt hypotensive
yes < 60 MAP is bad
Hypotension (MAP < 60mmHg, SAP < 80mmHg) can compromise cerebral and coronary perfusion
* Ideally MAP> 80, SAP >100
Severe acute hypertension can cause edema and hemorrhage anywhere but worry most about brain and lungs
* MAP >140mmHg
* SAP > 180mmHg
what contributing to pts hypotension after induction for spay with ace, hydromorphone, propofol and iso
meds causing vasodilation and bradycardia
inhalants will decrease SVR
opiods will decrease HR
what is the 1st step to treat hypotension in surgery pt
check depth and decrease inhalant if possible
after decreasing inhalant
* HR: 50 * BP: 85/45 (55)
what is next step
anticholinergics (atropine or glycopyrrolates to increase HR)
fluid bolus:
after adjusting iso and giving glycopyrrolate
- HR: 120bpm * BP: 100/60 (70)
next step
nothing
pt no longer hypotensive- continue to monitor
5yo FS DSH for GI FB- Ex Lap
* PCV: 50 TP:7
* Lactate: 4
PE:
* T: 100 P:200 R: 20
* Pulses: snappy
* Abd: painful to palpation
* MM: tacky, CRT 2s
what monitoring would you use?
PCV high (normal 20) and Lactate high (normal 2) → dehydrated poor perfusion
measure HR:
* pulse ox
* EKG
measure BP
* NIBP- doppler or oscillometric
* IBP- pressure transducer (A line), simple aneroid gauge method
measure ventilation
* capnogrophy
temp
- HR: 200 Doppler: 60
is pt hypotensive
yes
doppler ≃ systemic pressure
advantages of doppler
Non-invasive
Continuous audible signal
Can detect arrhythmias
Loss of pulse waves can be correlated with ECG
what does doppler measure
?? maybe systolic or mean
intervene when
* Dogs doppler < 100mm Hg
* Cats doppler < 80 mm Hg
what is contributing to cats hypotension. FB exlap
↑lactate and PCV
post induction with fentanyl, midazolam, alfaxalone, iso
given fluids
inhalents, sepsis cause decrease SVR → drop BP
high lactate and PCV means pt is dehydrated. hypovolemia will decrease preload
after decreasing inhalant of exlab cat
* HR: 200 * Doppler: 70
next step
< 80 is hypotensive in cats
2nd step normally administer anticholinergic and bolus
this cat HR 200: no anticholinergic in this case
give bolus
cat ex lab
after decreasing iso and bolus
- HR 140 * Doppler: 78
next step
still hypotensive
give sympathomimetics- epi bolus or norepinephrine infusion
epi bolus for CPR
would start NE infusion→ (β1 and ⍺) will cause intense vasoconstriction (↑ BP), baroceptor ↓HR, minimal change in CO
10yo Mixed Breed Dog for Splenectomy
* Large cavitated splenic mass
* PCV 34 TP 6.8
* PE Unremarkable
* T: 100F P: 160bpm R: pant
what monitoring?
PCV high (normal 20) → dehydrated poor perfusion
measure HR:
* pulse ox
* EKG
measure BP
* NIBP- doppler or oscillometric
* IBP- pressure transducer (A line), simple aneroid gauge method
measure ventilation
* capnogrophy
temp
BP: 60/30 (40)
what?
V tach
how to treat
Vtach-
* lidocaine or amiodarone
* May require electrical conversion if pulseless
arterial pressure wave
dicrotic notch
what is Vtach
> 4 VPCs in a row, fast rate, no p-waves, wide QRS
