W2 (1) Flashcards
What should be included in the patient assessment
- patient Identification
- patient History
- Signalment
- Physical exam
- Diagnostics
Why is body condition scoring important to Anesthesia?
Very thin patients:
- Underlying disease
- Prone to hypothermia
- Drugs may act quicker or stronger on these patients
Overweight patients:
- Underlying disease
- Dose to lean body weight
- Brain is the same size even if body isn’t
- Cardio-pulmonary may be compromised
Why is TPR important to Anesthesia?
Know what “normal values” are for dog, cat, horse, cow
Hyperthermia/hypothemia
Tachycardia/bradycardia
Panting”
Why is hydration important to Anesthesia?
- In general we want to anesthetize hydrated patients
- Exceptions in emergencies
- Dehydration will impair tissue perfusion -> Hypotension
How do you assess hydration?
skin turgor, postition of the eye in the orbit, mucous membrane moisture level, heart rate, pulse strength, and level of consciousness
What words are used to describe the level of consciousnes and temperament
Consciousness : BAR, QAR, Lethargic, Obtunded, Stuporous, Comatose
Temperament : Anxious, Friendly, calm, Aggressive, Excitable, Scared
What are the different values for Mucous membrane color?
Pink - normal color
White/pale - decreased perfusion from shock, vasoconstriction, hypotension, or a variety of other condictions, anemia
Blue - “cyanotic”, reduced oxygen saturation
Yellow - Iceteric
Red
What is a pain score?
- Affects how you interact with animal
- pain management plan
What is involved in a preanesthetic Diagnostic workup?
Test and Diagnostic Procedures: PCV/TP or Plasma Protein, CBC/Profile (Panel), Urinalysis, Serologic or Chemistry Panels, Coagulation Screen, ECG/EKG, Radiographs, Contrast studies, Ultrasound
- All completed tests must be reviewed by the veterinarian, record in the patient’s permanent record before the anesthesia plan/protocol is formed.
What factors influence the diagnostic tests chosen?
Different tests may be ordered based on:
- Facility standard policies
- Different patient groups: Pediatric, Geriatric, Trauma, Elective, Disease states
Other considerations: Financing
Diagnostic : CBC
Evaluation of blood cell numbers and morphology
- Packed cell volume (PCV), plasma protein (PP), hemoglobin,
- Total red blood cell (RBC), white blood cell (WBC), platelet, and absolute leukocyte counts.
Diagnostic : Elevated PCV or RBC
- Dehydration (associated fluid lost leads to decrease in blood volume)
- Decreased Blood volume lead to: Affecting cardiac output, Blood pressure, Tissue perfusion
Diagnostic : Decreased PVC/RBC
Anemia
- Decrease capacity to supply oxygen to the tissues
- Anesthesia increase risk: Tissue hypoxia
- PCV less than 25% in dog and 20% in cat, horse, cow should be reported immediately
Diagnostic : TP
(Proteins-albumin, gobulins, and fibrinogen)
- Hypoproteinemia
- Decreased protein production by the liver
- Protein loss in the GI tract, kidneys
- Blood loss
- Most anesthetics are partially protein bound and the other portion is unbound and free in the blood : Patients with low protein, less protein the anesthetic can bound to resulting in increasing drug potency.
- Less 4.0 g/dL in any patient should be reported immediately
Diagnostic : Total WBC and Leukocyte counts
- Measure the total number of leukocytes
- Measure the number of each type of leukocyte (neutrophils, lymphocytes, monocytes, eosinophils, basophils)
- Changes in counts and morphology may be associated with infection, parasitism, and other diseases
- These changes may influence preanesthetic patient management
Diagnostic : Platelet count
- Evaluate blood coagulation
- Patients with thrombocytopenia are at greater risk of intraoperative and postoperative bleeding
- May have to stabilize condition before surgery
- These changes May influence preanesthetic patient management
Diagnostic : Blood chemistries (panel/profile)
- Assess organ health and function
Kidney – which values Assess Kidney function?
Liver – which values Assess Liver function? - Screen For any diseases or conditions that May increase the patient risk under anesthesia
- Results of These test will aid to formulate an anesthetic plan
Diagnostic : urinalysis
- Information of urinary and non urinary systems
- Kidney function is important in regulating electrolyte and water balance, blood pressure, and elimination of anesthetic agents
- Protein in urine or specific gravity is less than: 1.030 in canine, 1.035 in feline
(Further test needed to assess kidney function) - Macroscopic exam finding (color, clarity odor, biochemical analysis) and Microscopic findings : May reveal diabetes, liver or kidney disease, other systemic disorder
Diagnostic : Blood coagulation tests/screens
- Blood coagulation screens evaluate the chemical, and sometimes mechanical, components of blood coagulation.
- Various disorders may adversely affect blood coagulation and put surgery patients at high risk for intraoperative and postoperative hemorrhage
- A coagulation panel: prothrombin time (PT), activated partial thromboplastin time (APTT)
- Should be performed on any patient that may have a preexisting coagulation disorder (end stage liver disease, hereditary disorders – e.g. Von Willebrand’s)(Doberman, Rottweilers, Scottish terriers)
- In house screen tests : Buccal mucosal bleed time (see page 26 in the textbook)
Diagnostic : EKG/ECG
- Records the electrical activity of the heart
- Assess heat rhythm
-Recommended in patients with known or suspected:
Heart disease (Patent ductus arteriosus (PDA)), Chest trauma, Gastric dilation volvulus (GDV), Splenic disease, Electrolyte disturbances, Medications that may affect heart rhythm
- Because most anesthetic agents alter heart rate, cardiac output, and oxygen consumption to some degree, patients with heart disease are at much greater risk for anesthetic complications.
Diagnostic : Radiography
Thoracic and abdominal radiographs (heart disease, traumas, suspected foreign bodies, diaphragmatic hernia, pneumothorax, pleural effusion, etc.)
Diagnostic : Ultrasound
Masses, heart blood flow, foreign bodies, bladder stones, etc.
TPR Normal Values (dog, cat, horse, cow
Dog -
Cat -
Horse -
Cow -
What are the physiological needs of Fluid administration?
- We all need a constant source of oxygen delivered to all body tissues! (Necessary to perform basic metabolic functions)
- Absence of oxygen will damage any tissue resulting in cell death in the brain and heart muscle
- This can happen within minutes
what are the primary functions to take into consideration when administering fluids?
Cardio and Respiratory systems is to: Supply the oxygen need to the body, Extracting oxygen from the air and distributing it to every cell in the body
- All anesthetic agents affect these systems decreasing oxygen delivery!
- These systems need constant attention!
How do anesthetic agents affect cardiopulmonary function?
Most decrease heart contractions (force) and cause a slowing of heart rate (bradycardia)
-Decreased blood flow from the heart
Most relax the muscle tone of blood vessels
-Increases vessel dilation (vasodilation)
-Decrease cardiac output and vasodilation causes hypotension and decreased perfusion of tissue with blood!
How to prevent hypotension and maintain tissue perfusion
Administration of IV fluids to support oxygen delivery**
- Fluids will increase circulating blood volume –> Improving cardiac output, Supporting blood pressure and tissue perfusion
What are important aspects of the body’s composition to take into consideration when administering fluids
60% of adult animal body weight is water!
- Body composition, age, disease can affect the body percentage weight of water
interstitial fluid
Bathes cells and tissues
Plasma
Liquid portion of blood which consititutes most of the intravascular volume
Transcellular fluid
Synovial joint fluid, Cerebrospinal fluid, Bile, Lining of the peritoneal cavity, pericardium, and pleural space
What is the rule of thumb to simplify the distribution of fluid in the body
60: 40:20 rule
- 60% patient weight is water
- 40% patient weight is intracellular fluid (ICF)
- 20% patient weight is extracellular fluid (ECF)
Body fluids
consist of water and solutes (atoms /molecules dissolved in body water)
Electrolytes
- When dissolved change into :Cations (positively charged ions) + Anions (negatively charged ions)
- Sodium Chloride is electrolyte – when dissolved Sodium is the cation and Chloride is the anion
- provide osmotic pressure
Essential for: blood clotting, cardiac function, neuromuscular function
Important Cations/Anions
Important cations found in body fluids : Sodium, potassium, magnesium, calcium
Important anions found in body fluids : Chloride, bicarbonate, phosphates, proteins
Proteins
Essential for drug transport, blood pressure regulation (oncotic pressure), and blood clotting
Glucose
provides energy to the cells
Homeostasis
Constant state with the body
Maintained by normal physiologic processes
Dynamic process is constant:
- Water and solutes move through cell membranes to maintain balance
- Some solutes move though the body along gradients (High concentration gradients to low concentration gradients)
- Some solutes are confined to or concentrate in a particular space
This is depend on size and chemistry
- Albumin – large size, does not travel freely, tend to stay within the intravascular space
- Potassium – active transport through cell membranes is concentrated in the cells
Balance principles (Equilibrium of body fluids)
the number of negative and positive charged particles in any fluid compartment Must be equal : Equilibrium
- to be healthy and maintain equilibrium the solute concentration or osmolarity Must be maintained in all body fluids
- Increased osmolarity Is due to water loss : Dehydration, exercise, heat stroke, vomiting, diarrhea
- Congestive heart failure where large quantities of solutes are lost
Osmotic pressure
Solutes in each compartment provide osmotic pressure
- Pressure that draws water into the compartment in proportion to the number particles present
- Example: Vascular space increases or decreases, water will follow, increasing or decreasing blood volume
Small particle solutes such as ions diffuse freely through vascular endothelium, taking water with them.
- The ions equilibrate relatively quickly between the intravascular and interstitial fluid spaces.
- The interstitial fluid compartment is about three times the size of the intravascular compartment
Therefore only about one quarter of fluid administered intravenously remains in the vascular space after equilibration.
