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Anesthesia -Scott Newman & Janet King > Test 4 Notes: Janet > Flashcards

Test 4 Notes: Janet Flashcards

1
Q

What 2 things do we pay attention to when a patient is under anesthesia?

A
  1. Maintaining adequate depth

2. Vitals stay within acceptable limits

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2
Q

What 3 things are used to monitor HR & Rhythm?

A
  1. Esophageal stethoscope- rate
  2. ECG- rhythm
  3. Pulse ox- pulse
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3
Q

If the systolic BP is ____ the ____ disappears.

A

<60bpm

Pulse

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4
Q

ECG measures ____ only.

A

Electrical activity only

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5
Q

Explain the electrical flow of the heart.

A

Pulse originates in the SA node, travels to the AV node (depolarization) then to the bundle of HIS & to right and left bundle branches and finally to the purkinje fibers creating a contraction.

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6
Q

P wave

A

atrial depolarization

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7
Q

The SA node ____ during the P wave

A

Contracts

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8
Q

QRS complex

A

ventricle depolarization

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9
Q

The SA node ____ & the AV valve ____ during the QRS complex.

A

Relaxes

Contracts

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10
Q

The SA node is also known as the ____.

A

Pace maker

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11
Q

What happens during the T wave?

A

Ventricle re-polarizes and relaxes

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12
Q

What could cause an interference with the ECG?

A

Cautery (60 cycle)
Circulating H2O blanket (60 cycle)
Leads drying out (flat line: use gel for long surgeries)

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13
Q

What is a Lead II?

A

The standard PQRST waves

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14
Q

What are the 4 leads?

A

Black- left axillary
Red- left inguinal
White- right axillary
Green- right inguinal

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15
Q

What would a complete ECG lead set up include?

A 
Lead I 
Lead II
Lead III 
AVR
AVL 
AVF

All of these leads have different polarities

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16
Q

Normal sinus rhythm general facts

A

Normal PQRST waves
Evenly spaced
Not missing anything

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17
Q

Respiratory sinus arrhythmia general facts

A

Regularly irregular
Must match respirations
Can be a normal finding

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18
Q

What happens with Respiratory sinus arrhythmias?

A

Heart rate increases with inhalation

and decreases with exhalation

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19
Q

Who can have a normal Respiratory sinus arrhythmia?

A

Dogs

NOT normal in cats!

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20
Q

What drug can make Respiratory sinus arrhythmias disappear?

A

Anticholinergics

more likely with atropine

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21
Q

Sinus Tachycardia would have a ____ cardiac output

A

poor

no time to fill

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22
Q

Sinus Tachycardia causes & interventions.

A

Too light- increase vaporizer
Drugs- nothing
Hypoxic- Increase flow meter and ventilate
Hypotension- Decrease vaporizer and give fluids or drugs
Hyperthyroid- Press on eyeball to stimulate vagus nerve
Anemia- Give fluids or blood transfusion
Cardiac dz- Drugs

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23
Q

Sinus Bradycardia drug of choice?

A

Atropine

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24
Q

Sinus Bradycardia values

A

Large dog= <100bpm

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25
Q

What can Sinus Bradycardia lead to if not treated?

A

Cardiac arrest

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26
Q

Sinus Bradycardia causes & interventions

A

Too deep- Turn down vaporizer
Alpha-2 Agonists- Give antagonist (Naloxone)
Vagal stimulation- Give Anticholinergics
Hypothermia- Keep warm
Hyperkalemia- Give IV fluids, Insulin/Dextrose

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27
Q

What could sinus tachycardia lead to if untreated?

A

Increased workload on the heart can lead to cardiac arrest

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28
Q

First degree A-V heart block basic facts

A

Prolonged P-R interval
Every P has QRS, but has a slow electrical flow
Difficult to see

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29
Q

If a first degree A-V block is not treated, what could it lead to?

A

2nd degree AV block

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30
Q

Second degree A-V block basic facts

A

Some P waves not followed by QRS

ventricle doesn’t contract for every atrium contraction

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31
Q

What is a second degree AV block also called?

A

Incomplete heart block

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32
Q

If there is a consistent 2nd degree AV block, the patient will have ____ cardiac output and low ____.

A

Bad cardiac output

Low pulse/heart rate

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33
Q

What is a third degree AV block also called?

A

Complete heart block

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34
Q

Third degree AV block basic facts

A

Prolonged QRS

Atrial and ventricular contractions are not in sync

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35
Q

Third degree AV blocks have ____ cardiac output and the QRS complex looks ____ & ____

A

Horrible

Wide & bizarre

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36
Q

What is the treatment for a 3rd degree AV block?

A

Pacemaker

resets electrical activity of the heart

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37
Q

If you have an abnormal ECG what are the first 2 things you should do?

A

Turn down the vaporizer

increase ventilations

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38
Q

Drug of choice for 2nd and 3rd degree AV blocks

A

Atropine

may or may not work for 3rd degree

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39
Q

Causes & interventions of 2nd & 3rd degree AV blocks

A 
Too deep- turn down vaporizer
Drugs (Alpha-2)- give antagonist 
Electrolyte imbalance (^K)- give fluids
Acid/base imbalance- give fluids 
Myocardia Hypoxia- ventilate 
Cardiac Dz.- medical intervention
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40
Q

If your patient has respiratory acidosis to do hypercapnia what should you do?

A

Ventilate

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41
Q

PVC basic facts

A

Premature Ventricular Contractions
Originates somewhere in the ventricle
Ventricle contracting too rapidly
Wide and bizarre QRS complexes

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42
Q

What is a common cause of a pulse deficit

A

PVCs

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43
Q

PVCs have bad ____ due to ____

A

Cardiac output

the ventricles contracting too quickly- doesn’t get a chance to fill

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44
Q

What would an excessive PVC look like?

A

3 or more PVCs in a row- may need treatment

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45
Q

Ventricular tachycardia basic facts

A

Multiple VPCs in a row

Looks like ghosts holding hands

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46
Q

V-Tach causes a high ____

A

Heart rate

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47
Q

What is the drug of choice for V-Tach and PVCs?

A

Lidocaine-

CRI in fluids or IV injection

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48
Q

Causes and interventions of V-Tach & PVCs?

A 
Too deep- decrease vaporizer
Drugs (barbiturates)- no intervention
Electrolyte imbalance- fluids
Acid/base imbalance- fluids
Myocardial hypoxia- ventilation
Cardiac dz.- medical intervention
Stress/pain- opioids or tranquilizers
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49
Q

V-Tach is common in ___ & ___ patients

A

GDV & HBC

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50
Q

Ventricular fibrillation basic facts

A

Irregular line
no PQRSTs
Heart is quivering

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51
Q

V-Fib patients have ____ cardiac output & could lead to ____ if untreated

A

little to no

cardiac arrest

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52
Q

V.fib treatments

A

Turn off vaporizer
Defibrillation
ABCDs of resuscitation

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53
Q

Hyperkalemia can cause ____ T waves and ____

A

Tall, spiked T waves

& bradycardia

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54
Q

What could tall and wide T waves indicate?

A

Myocardial hypoxia or hypothermia

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55
Q

Asystole basic facts/treatment

A

Flat line
Turn off vaporizer
ABCDs of resuscitation

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56
Q

What 2 things are pale MM & increased CRT caused by?

A

Peripheral vasoconstriction

Decreased tissue perfusion

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57
Q

What 3 things can cause Peripheral Vasoconstriction?

A

Hypothermia
Alpha-2 agonists
Pain

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58
Q

What 3 things can cause Decreased Tissue Perfusion?

A

Patient is too deep- decrease vaporizer
Bradycardia- give atropine
Hypotension- decrease vaporizer, give fluids, or drugs

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59
Q

What is cyanosis and what are the first 2 things you should do if your patient has this?

A

Hypoxia
Increase in the amount of unsaturated hemoglobin

  • Ventilate
  • Decrease vaporizer
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60
Q

When observing respirations what 3 things should you pay attention to?

A

Respiration Rate
Tidal Volume
Effort

61
Q

What is the formula for choosing a res. bag?

A

60mls/kg

always round up to next liter

62
Q

What could happen if your res. bag is too small?

A

Pneumothorax
Could be too inflated to accurately observe resps.
May show an increase on the pressure manometer

63
Q

If your res. bag is too big it would ____.

A

Be too difficult to monitor respirations

64
Q

Normal anesthesia RR = ____.

A

8-30rpm

65
Q

Hypoventilation is ____rpm and has what 3 effects?

A

<8rpm
Decreased RR
Decreased TV
Increase in CO2 (hypercapnia/resp.acidosis)

66
Q

What are 4 causes and interventions of hypoventilation?

A

Patient too deep– decrease vaporizer, ventilate
Obese patient– ventilate
Patient position– ventilate
Open thorax sx.– machine/manual ventilations

67
Q

Hyperventilation may cause a decrease in ____ leading to respiratory ____.

A

CO2

Alkalosis

68
Q

Hypoventilation may cause a ____ in CO2, leading to respiratory ____.

A

Increase

Acidosis

69
Q

What are 3 causes and interventions of hyperventilation?

A

Patient too light– ventilate and maybe increase vaporizer
Metabolic acidosis– take over ventilations
Respiratory dz.– ventilate

70
Q

When a patient is _____, less GA is needed due to it causing the MAC to be more potent.

A

Hypothermic

71
Q

What are 4 complications of hypothermia?

A

Prolonged recovery
Prolonged clotting time
Delayed wound healing
Shivering increases O2 demands by 600%

72
Q

What are 4 causes of hypothermia?

A 
Decreased metabolic rate
Drugs that cause vasodilation
Neonates/Geriatrics/Emaciated pts. 
Open body cavity 
Shaving and scrubbing (alcohol)
73
Q

How would you obtain the temperature during surgery?

A

Thermometer in nostril +1degree F

Feel ears/paws

74
Q

What are some ways to prevent hypothermia?

A 
Blankets
Circulating H2O blanket
Warmies- disk 
Fluid bag- be careful! 
Rice bag
Warm IV fluids 
Bair Hugger 
Wrap feet
75
Q

What are the 3 things that make up blood pressure?

A

Cardiac Output– “pump”
Vascular Resistance– “tubes”
Blood Vol.– “fluid”

76
Q

What is the cardiac output equation?

A

Stroke Vol. X Heart Rate= CO (in mls/min)

77
Q

What 3 values make up the arterial blood pressure?

A

Systolic– top #
Diastolic– bottom #
MAP– mean arterial pressure

78
Q

What is the best indicator of tissue perfusion?

A

MAP= the average pressure in the arteries through a cycle

79
Q

Hypotension systolic value=

A

<80mmhg

80
Q

Hypotension MAP value=

A

<60mmhg

81
Q

Systolic is an indication of when the ventricles are ____.

A

contracting

82
Q

Diastolic is an indication of when the ventricles are ____.

A

relaxing

83
Q

What are the 3 most important organs that need good perfusion?

A
  1. Kidneys
  2. Heart
  3. Brain
84
Q

What are 3 causes of Hypotension?

A
  1. Excessive depth
    • vasodilation
    • bradycardia
    • decreased CO
  2. Drugs
    • Inhalant anesthetics
    • Acepromazine
    • Alpha-2s
  3. Blood loss
    • hemorrhage
    • hypovolemia
85
Q

What are the first 3 interventions of Hypotension?

A

Decrease vaporizer
Bolus/Change fluid
Drugs

86
Q

You should always anticipate fluid loss and ____ before surgery

A

Bolus fluids

87
Q

What type of fluids are normally administered during surgery? At what rate?

A

Crystalloids

10mls/kg/hr

88
Q

What are the 2 options when a bolus is needed?

A

3-5mls/kg (can be done twice)

double surgery fluids and run for 15min. (20mls/kg/hr)

89
Q

What would be another option of fluids if your patient is having difficulty maintaining fluids?

A

Colloids

90
Q

What are a few examples of Colloids?

A

Hetastarch
Dextran
RBCs

91
Q

What do Inotrope drugs do?

A

Increase the force of cardiac contraction (pump)

92
Q

What do Chronotropes do?

A

Increase the heart rate (pump)

93
Q

What do Vasopressors do?

A

Cause vasoconstriction– increases BP (tube)

94
Q

What are 3 common drugs to treat hypotension?

A

Dopamine
Dobutamine
Ephedrine

95
Q

Dopamine is a ____ & ____ so it increases ____ and ____ output.

A

+ inotrope & + chronotrope

Increases renal perfusion and urine output

96
Q

How is Dopamine administered?

A

It is diluted in fluids and given in micrograms/kg/min.

IV drip CRI

97
Q

Dobutamine is a + ____ & lower + ____

A

+inotrope & lower +chronotrope

increases force of cardiac contractions and heart rate

98
Q

Ephedrine is a +____, lower +____ & ____.

A

+Vasopressor, lower chronotrope & inotrope

99
Q

How is dobutamine given?

A

Diluted in fluids -IV drip CRI

100
Q

How is Ephedrine given?

A

IV injection

101
Q

What are 4 benefits of Ephedrine?

A

Cheap
Easy to give
Can give 2 injections
Has a 20min. duration

102
Q

With Ephedrine, you may see an increase in ____, but its main action is ____.

A

Heart rate

Vasoconstriction

103
Q

What hypotension drug would you use for a shorter surgery?

A

Ephedrine

104
Q

What hypotension drug would you use for a longer surgery?

A

Dobutamine or Dopamine drip

105
Q

What are the 2 ways to measure BP?

A

Indirect- Doppler or Oscillometer

Direct- Direct Arterial Pressure

106
Q

Doppler BP monitor measures?

A

Systolic BP and pulse

107
Q

With a doppler the crystal (probe) should be placed ____ to the cuff

A

distal

108
Q

How should the cuff of the doppler be measured?

A

The width of the cuff should cover 40% of the circumference of the limb or tail

109
Q

How does the probe of a doppler work?

A

You place ultrasound gel on the probe and place it on the artery, it will emit high frequency sound waves and when the waves encounter the pulsating artery, it will create a whooshing sound (the pulse)

110
Q

What are some problems with the doppler?

A

Not very accurate in cats
Probes are fragile
Cuff size must fit accurately
Works best on long, straight legged, hairless dogs

111
Q

How does the Oscillometer blood pressure monitor work?

A

Machine automatically inflates cuff and reads Systolic, Diastolic and Mean arterial pressure, some also display a pulse
Also has a cat setting

112
Q

Direct arterial pressure info.

A

Common in equine anesthesia
More accurate, but invasive
Indwelling catheter is placed in an artery and connected to a monitor

113
Q

What does a Capnograph measure?

A

ETCO2 Insp.C02, and Respiratory Rate

114
Q

What is the most common type of capnograph?

A

Side stream- monitors samples of gas from small tube attached between the ET tube and the breathing system

115
Q

Inspiration CO2 should fall into what range?

A

0-5mmHg

116
Q

End Tidal CO2 should fall into what range?

A

35-45mmHg

117
Q

Normal Capnographs show ____ on the monitor and represent the ____.

A

Square wavelengths, RR

118
Q

What are some causes of decreased ETCO2?

A

Increased RR
ET tube in esophagus
Respiratory arrest/cardiopulm. arrest

119
Q

What can a decreased ETCO2 lead to?

A

Respiratory alkalosis

120
Q

2 reasons for increased ETCO2

A

Decreased rate and tidal volume

121
Q

What can increased ETCO2 lead to?

A

Respiratory acidosis

122
Q

How do you correct increased ETCO2?

A

Increase ventilations!

you may also need to decrease the gas %

123
Q

If you have increased Insp.CO2 that could mean ____ or the ____.

A

The soda lime granules are exhausted and need to be changed.
O2 flowrate is not high enough

124
Q

What does a Pulse Ox measure?

A

% of Hgb saturated with Oxygen & Pulse

125
Q

How does the Pulse Ox work?

A

By using 2 different lengths of light

126
Q

Pulse Ox:
Red light measures ______.
Infrared light measured ______.

A 
Reduced Hgb (unsaturated)
Oxygenanted Hgb.
127
Q

Pulse Ox:

What is a Plethysmograph & what does it indicate?

A

a pulse waveform
It indicates the pulse strength
Tall wave= strong
Short wave= weak

128
Q

How do you place the Pulse Ox probe on the tongue?

A

With the sensor side ON TOP and the light side BELOW the tongue (light from above may interfere with readings)

129
Q

Where can a pulse ox probe be placed?

A

Thin, hairless, non-pigmented area

Best & most common placement= tongue

130
Q

The Pulse Ox probe cannot be placed on ___ some other places it will work are ____.

A

A black tongue (the pigment will absorb the light)
Lip, Pinna, Toe web, Achilles tendon, Vulvular fold
Rectal probes are also available (reflective probe) usually used for dentals

131
Q

Pulse Ox readings should be ____ under anesthesia

A

> 95%

132
Q

Pulse Ox:
Borderline Hypoxia=
Hypoxia=
Cyanosis=

A

(O2 Saturation)

Borderline= 90-95%
Hypoxic= <85% patient is BLUE!
133
Q

Pulse Oximeters can detect ____ before it is visually evident

A

Hypoxia

before it is Cyanotic

134
Q

2 Probe reasons for decreased Pulse Ox readings

A

Probe placement- may be on pigmented skin, dry tongue, patient movement, overhead light
Probe pinching- can cause decreased perfusion to tongue

135
Q

Perfusion issues for decreased Pulse Ox readings

A

Poor perfusion caused by hypotension, cradycardia, peripheral vasoconstriction,
Alpha-2 agonists!
Cold tongue = crappy readings!

136
Q

Oxygen reasons for decreased Pulse Ox readings

A

ET tube may be disconnected, kinked, or in esophagus

O2 flow rate too low

137
Q

Lung reasons for decreased Pulse Ox readings

A

Respiratory failure, inadequate ventilation
V/Q mismatch= alveolar ventilation/pulmonary perfusion ratio determines adequacy of gas exchange in lungs (see chart on worksheet)
Lung Dz.

138
Q

What are 2 examples of V/Q mismatch & what is the result of both?

A

Pulmonary thromboembolism: V is okay, Q has bad pulmonary perfusion

Collapsed lungs: V has poor alveolar perfusion, Q is fine

End result= NO OXYGEN

139
Q

What does the V & Q stand for in a V/Q mismatch?

A 
V= alveolar ventilation
Q= pulmonary perfusion
140
Q

Heart reasons for poor Pulse Ox readings?

A

Poor perfusion due to bradycardia, arrhythmias, V/Q mismatch

141
Q

How do you improve O2 Saturation?

A

Ventilate!!!! and maybe increase O2 flow rate

142
Q

What are the most important things to continue monitoring post-op?

A

Respirations
MM color & CRT
Palpate pulse

143
Q

What are 6 common post op complications?

A 
Respiratory distress (esp. brachys)
Hypothermia
Vomiting
Chewing/licking
Hemorrhage 
Analgesics wearing off
144
Q

What should you do if your patient is in respiratory distress Post-Op

A 
Reposition- sternal 
Extend head & neck 
Pull tongue out 
Give O2 (mask or flow-by)
Re-intubate if nothing works
145
Q

If your patient is vomiting, how can you prevent them from aspirating

A

Lift butt up and put their face down

146
Q

What are some signs of post op hemorrhage?

A 
Prolonged hypothermia
Pale MM, increased CRT
Slow recovery
Increase HR & RR 
Decreased BP
147
Q

What should you do if you think your patient is hemorrhaging before getting the Dr?

A

Get PCV & TP

Do a centesis or ultrasound

148
Q

What are 4 issues with brachycephalics

A

elongated soft pallet
narrow trachea
narrow nares
increased sympathetic tone

149
Q

How to decrease risk of brachys

A 
Decrease stress- tranq/sedatives 
Anticholinergics- glyco/atropine
Pre Oxygenate- increase O2Sat.Hgb 
IV induction- faster 
Leave ET in longer

Anesthesia -Scott Newman & Janet King (13 decks)

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