Test 3: 41: emerg

Question 1

asa levels

Answer 1

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

Question 2

how to optimize emergency pt

Answer 2

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

Question 3

IV access for emergency

Answer 3

2 large bore peripheral catheters
central line may be needed
give fluids before surgery

Question 4

goals of premed

Answer 4

• Reduce pain and anxiety
• Reduce induction dose and MAC sparing
• May not need to be administered IM prior to IV catheter

Question 5

why use opioids in emergency

Answer 5

• Excellent analgesia
• Minimal effect on BP
• May cause bradycardia
• Typically easily treated with anticholinergics
• Moderate-profound sedation in debilitated patients
• May cause respiratory depression

Question 6

benzo will cause excitement except in

Answer 6

Less likely in very young, very old or very sick patients

Question 7

can you use dexmedetomidine in emergency

Answer 7

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

Question 8

can you use acepromazine in emergency?

Answer 8

try to avoid

can cause vasodilation, ↓BP, no pain relief, and is NOT reversible

Question 9

small animal is IV in place how to induce for emergency

Answer 9

fentanyl (full μ opioid), midazolam (benzo)

Question 10

small animal IV not in place what premed for emergency

Answer 10

methadone IM, alfaxalone

Question 11

small animal premed for emergency that is painful and needs stabilization

Answer 11

methadone IV

Question 12

why use propofol

Answer 12

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

Question 13

when to use propofol for emergency induction

Answer 13

• Increased ICP→ Seizures
• Renal/hepatic insufficiency
• Pulmonary disease
• Fast endoctracheal intubation

Question 14

why use alfaxalone

Answer 14

• Dose dependent CV & Respiratory depression
• Slightly less than propofol
• Short duration of action
• Does not accumulate
• IV or IM

Question 15

indications to use alfaxalone

Answer 15

• Increased ICP
• Seizures
• Fast tracheal intubation
• Renal insufficiency
• Pulmonary disease

avoid large doses in unstable CV or septic pts

Question 16

good or bad things about ketamine

Answer 16

• ↑SYM= Blood pressure & heart rate increases
• No muscle relaxation
• Good somatic analgesia
• Minimal/moderate impact on respiratory function
• IM/IV/PO

Question 17

when to not use ketamine

Answer 17

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

Question 18

indications to use ketamine

Answer 18

• Mildly CV unstable (bradycardia/hypotension)
• Fast endotracheal intubation
• Maintain respiratory drive
• Somatic pain
• Lack of IV access

Question 19

pros and cons of etomidate

Answer 19

• No significant myocardial depression
• Mild respiratory depression
• Short duration of action
• Decreases ICP
• Myoclonus(muscle spams, excitability)→ Combine with benzodiazepines
• Suppression of cortisol production

Question 20

indications to use etomidate

Answer 20

• Myocardial disease
• CV unstable/shock
• Increased ICP
• Seizures
• Fast endotracheal intubation

Question 21

cats or dogs tolerate lidocaine during emergency surgery

Answer 21

dogs

lidocaine: used for Mac sparing effects, antiinflammatory

Question 22

monitoring for emergency

Answer 22

• Pulse oximetry
• Capnography
• ECG
• Blood pressure (invasive ideal, oscillometric, doppler)
• Arterial blood gases
• Temperature

Question 23

how to treat GDV

Answer 23

• 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

Question 24

how to rapid induce a horse for emergency

Answer 24

Horses typically require alpha-2 agonist for premedication (try to reduce dose)

• Not as many options for induction
• Typically ketamine/midazolam or ketamine/GG

Question 25

equine maintenance during colic emergency

Answer 25

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