Test 3: 42 emerg Flashcards
10 year old maltese ate sock 2 days ago
tense abdomen
3/6 left sided apical systolic murmur
what diagnostics prior to anesthesia
EKG
echo- for mumur
ultrasound
Xray
BP
bloodwork
systolic murmur is normally
mitral valve disease- most common heart disease in dogs
what does it mean to have B2 mitral valve disease
asymptomatic, but echo/xray shows changes to the heart, Needs treatment with pimobenden
hemodynamic goals for CV pts
maintain O2 delivery
- preoxygenate
- keep MAP >60
Prevent exacerbation of cardiac disease
- careful using fluids
- minimize stress
rapid intervention to maintain hemodynamic stability
- maintain normal HR
- prevent/treat arrhythmias
- prevent/treat hypotension
hemodynamic goals for MV disease pts
maintain HR- avoid ↓HR
maintain contractility
Maintain BP- avoid increased afterload
if you ↓BP, then more blood into heart then more blood regurg in atria → LA enlargment and Left side CHF
which premed is contraindicated for MVD
dexmed
methadone
fentanyl
midazolam
dexmedetomidine
⍺2 agonist
cause ↑afterload and reflex ↓HR →↓CO
do not give to pts with decreased systolic function
* may be good for cats with HOCM
* reversible with atopamezole
protocol for MVD
premed/co induce with opioid and benzo
- minimize propofol or alfaxalone dose
- minimize inhalant
- ↑ use of atropine to prevent ↓HR
- careful using fluids
- support BP with dopamine/dobutamine
2 yo male DSH straining, HR 140, RR 32, distended bladder, no murmurs
what are your initial concerns
urinary obstruction- ↑ potassium
urinary obstruction can lead to
↑pressure →↓GFR
azotemia, acidemia, hyperkalemia
EKG changes with ↑potassium
tall tented T waves
shortened QT interval
prolonged PR interval and widened QRS
short and widened P wave
absence of P wave and ↓HR with sinoventricular rhythm
sine wave, Vfib, ventricular asystole
how to stabilize urinary obstruction
calcium decrease threshold for action potential
increase K into cells
* glucose and insulin
* sodium bicarbonate
* β2 agonist- albuterol, terbutaline
promote excretion/ removal of potassium
* diuresis
* dialysis
how to sedate cat for urinary obstruction
methadone
midazolam
alfaxalone
sacrococcygeal epidural
8 yo yorkie, goose honk cough, narrow trachea, 140 bpm, panting, very excited. how would you premed?
0.01 acepromazine, 0.4 butorphanol (anticough)
how to induce dog for tracheal stent after premed with ace and butorphanol
propofol + midazolam
how to maintain anesthesia for collapsing trachea if premeded with ace and butorphanol, induced with propofol and midazolam
TIVA- propofol CRI or alfazalone CRI
can add butorphanol CRI to reduce amount of propofol or alfazalone needed
