Test 3: 41: emerg Flashcards
asa levels
1: Healthy Patient
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
how to optimize emergency pt
Always try to stabilize patient prior to induction
- Hypovolemia
- Anemia
- Electrolyte disturbances
- Treat pain
- Administer oxygen
- If applicable stabilize surgical problem → Decompress GDV, apply pressure to bleeding wound
IV access for emergency
2 large bore peripheral catheters
central line may be needed
give fluids before surgery
goals of premed
- Reduce pain and anxiety
- Reduce induction dose and MAC sparing
- May not need to be administered IM prior to IV catheter
why use opioids in emergency
- Excellent analgesia
- Minimal effect on BP
- May cause bradycardia
- Typically easily treated with anticholinergics
- Moderate-profound sedation in debilitated patients
- May cause respiratory depression
benzo will cause excitement except in
Less likely in very young, very old or very sick patients
can you use dexmedetomidine in emergency
yes if CV stable
can increased SVR → reflex bradycardia → decreased CO
try to give low dose
excellent sedation, good pain relief
dexmed is an ⍺2agonist
can you use acepromazine in emergency?
try to avoid
can cause vasodilation, ↓BP, no pain relief, and is NOT reversible
small animal is IV in place how to induce for emergency
fentanyl (full μ opioid), midazolam (benzo)
small animal IV not in place what premed for emergency
methadone IM, alfaxalone
small animal premed for emergency that is painful and needs stabilization
methadone IV
why use propofol
Bad thing:
- Dose & rate dependent CV & respiratory depression →do not use in unstable CV or septic pts
Good things
- Short duration of action
- Dosen’t accumulate
- Extra-hepatic metabolism
- Clearance not altered by renal insufficiency
- Decreases ICP
when to use propofol for emergency induction
- Increased ICP→ Seizures
- Renal/hepatic insufficiency
- Pulmonary disease
- Fast endoctracheal intubation
why use alfaxalone
- Dose dependent CV & Respiratory depression
- Slightly less than propofol
- Short duration of action
- Does not accumulate
- IV or IM
indications to use alfaxalone
- Increased ICP
- Seizures
- Fast tracheal intubation
- Renal insufficiency
- Pulmonary disease
avoid large doses in unstable CV or septic pts
good or bad things about ketamine
- ↑SYM= Blood pressure & heart rate increases
- No muscle relaxation
- Good somatic analgesia
- Minimal/moderate impact on respiratory function
- IM/IV/PO
when to not use ketamine
Catecholamine depleted patients (indirect ↑ BP by ↑SYM, if no catecholamines can unmask low BP by direct negative ionotopic effects)
Controversial for head trauma patients
* May increase cerebral metabolic rate
* Reduces secondary brain injury cause by glutamate release
indications to use ketamine
- Mildly CV unstable (bradycardia/hypotension)
- Fast endotracheal intubation
- Maintain respiratory drive
- Somatic pain
- Lack of IV access
pros and cons of etomidate
- No significant myocardial depression
- Mild respiratory depression
- Short duration of action
- Decreases ICP
- Myoclonus(muscle spams, excitability)→ Combine with benzodiazepines
- Suppression of cortisol production
indications to use etomidate
- Myocardial disease
- CV unstable/shock
- Increased ICP
- Seizures
- Fast endotracheal intubation
cats or dogs tolerate lidocaine during emergency surgery
dogs
lidocaine: used for Mac sparing effects, antiinflammatory
monitoring for emergency
- Pulse oximetry
- Capnography
- ECG
- Blood pressure (invasive ideal, oscillometric, doppler)
- Arterial blood gases
- Temperature
how to treat GDV
- If possible: relieve stomach distension prior to induction
- Correct and fluid & electrolyte losses
- two IV catheters
- Prone to arrhythmias: include lidocaine in protocol
- Induce with fentanyl, midazolam, lidocaine
- Maintain with isoflurane
- Fentanyl & lidocaine CRIs
- Be prepared to treat hypotension/hemorrhage
- TAP block
how to rapid induce a horse for emergency
Horses typically require alpha-2 agonist for premedication (try to reduce dose)
- Not as many options for induction
- Typically ketamine/midazolam or ketamine/GG
equine maintenance during colic emergency
Colic → abdominal distension → reduced lung volume
* Typically require mechanical ventilation
* Worsens hypotension
Be prepared for rapid fluid infusion & vasopressor use
Opioids do not reduce MAC as much as small animal
* Can use lidocaine infusion as adjunct
* Locoregional blocks being investigated
