wk 13 Flashcards
open fracture
penetrated skin
closed fracture
skin is intact
fracture types
- transverse
- oblique
- spiral
- comminuted (reducible and nonreducible)
orthopedic surgery
bring opposite ends of fracture and joints back into alignment
internal fixation
form of rigid fixation placed under the skin and muscle directly on or in the bone surface or medullary cavity to regain stability
- bone plates, screws, nails, pins, wire
external fixation
fixation is applied through the exterior surface of the limb to the interior surface cavity to help with stability
- casts, splints
orthopedic surgical prep
- clip from joint above and joint below
- tie the limb up
- surgical scrub
- stockinette and paw wrapped with vet wrap
post-op orthopedic surgery
- restrict exercise
- antibiotics and analgesics
femoral head osteotomy (FHO)
excision arthroplasty of femoral head - removal of head of femur
indications for FHO
- hip dysplasia
- subluxations and luxations of femoral heads
- avascular necrosis
surgical prep for FHO
- clip entire hip from dorsal midline to stifle
- clip entire circumference of upper thigh
- surgical scrub
- stockinette
post-op for FHO
- exercise restricted
- physical therapy
- analgesics
recovery period
end of anesthesia until vital signs and consciousness are normal
post-op period
time between end of procedure and when animal is released to the owners care
recovery area
- separate and quiet
- constantly staffed
- fully stocked
monitoring
- 5-10 minutes
- check reflexes
- HR RR mm color CRT
- inspect incision
monitoring recovery
- extubation
- animal can’t control actions
- observation
brachycephalic breeds
- prone to complications
- insufficient airflow
- long soft palates
- delay extubation
- closely monitor for dyspnea and cyanosis
cage
- large
- well padded
- animal face outwards towards cage door
- no food or water - empty dish in ring
- watch for suffocation in bedding or falling from top cage
large animal recovery
- padded stall
- open area
post-op complications
-hypothermia
-emergence delirium
-prolonged recovery
maintain body temp
- neonates, lean animals, geriatrics = most prone to hypothermia
5 factors that lead to hypothermia
- evaporation of surgical scrub solutions
- infusion of room temp fluids
- contact with cold surgical table
- evaporation of surface fluid from exposed body cavity
- inhaled anesthetic gases are cold
how to warm patients
*avoid aggressing surface warming and heating pads
- warm air blankets
- circulating warm water blankets
- conductive fabric warming
- rice bag warmers
- warm fluids
- wrapping paws in socks
emergence delirium
- exaggerated movements
- uncontrolled movements
- excitement
- thrash around
- paddle
- cry out
- try to bite
results of emergence delirium
- can injure itself
- can damage surgical sites
- toes caught in bars of crate
- fractured teeth
prolonged recovery treatment
-physical stimulation
- ventilation
- fluid therapy
- reversal agents
- warming measures
- dextrose (pediatric patients)
surgery complications
- hemorrhage
- seroma (pocket of serum)
- dehiscence
- self-trauma
- infection
causes of hemorrhage
- von willebrand disease
- chronic liver disease
- toxins
- surgical ligature dislodged
- small arteries begin bleeding
treatment for hemorrhage
- direct pressure for 5-10 minutes
- bandage
- warm, moist compress
causes of seroma
- dead space
- area of excessive movement
- irritation from sutures
treatment for seroma
- warm, moist compress
- draining of fluid
- surgical drainage and Penrose drains
causes of dehiscence
- self-trauma
- blunt trauma
- activity
- improper suture placement
- infection
treatment for dehiscence
- clean with antiseptic
- antibiotic
- surgical debridement
- resuture
- e collar
self-trauma consequences
- delayed wound healing
- infection
- dehiscence (reopening wounds)
preventing self-trauma
- collars
- bandaging
- muzzle
- foul tasting product
- sedation
- stainless steel suture or staples
- pain management
infection consequences
- delayed healing
- pain
- fever
- dehiscence
infection treatments
antibiotics
compress
surgical debridement
resuturing
when to notify DVM
- Prolonged Recovery
- Prolonged Hypothermia
- Hemorrhage
- Pale mucous membranes
- Weak, rapid pulse
- Rapid, shallow breathing
- Wound dehiscence
- When in doubt, notify the doctor
common ways to lose a client
- Bill is more than expected and client was not notified ahead of time
- Animal is discharged dirty, bloody and/or smelly
- Animal is discharged and in pain
specific instructions for confinement, feeding, surgical site, medications, suture removal
- Confinement – for routine OHE’s and castrations, most pets should have limited exercise for 7-14 days
- Feeding – introduce only water to begin with and then slowly allow food and in small amounts. If no vomiting – can increase.
- Surgical site – should be monitored 2x daily.
- Medications – will depend on procedures. Must make sure client understands how to administer.
- Signs of adverse reactions.
- Suture removal – usually 7-14 days
discharge consideration
- Schedule a discharge time.
- Have discharge instructions and medications ready when the client arrives.
- Review with client and answer any questions or concerns.
- Review estimate/charges.
- Finalize record charting, place record in callback folder.
- Callback next day to check on patient.
controlled ventilation
- Positive pressure – gas is delivered under positive pressure into airway not to exceed 20 cmH2O
- Pressure into ET tube is higher than pressure in lungs
- Can be performed intermittently or continuously
- Can be performed with or without anesthetic gas
controlled ventilation uses
*Form of Artificial Respiration during CPR
*IPPV – Intermittent Positive Pressure Ventilation (Check for proper inflation of the ET cuff-Remove excess CO2 in hypercapnea-Prevent atelectasis)
*Speed up induction (when gas is on) or recovery from gas anesthetic (when gas isturned off) by bringing in fresh O2.
*Help eliminate N2O at the end of surgery
ventilation in the awake animal - inhalation
active phase
1. Increased levels of CO2 stimulates the respiratory center
2. Diaphragm and intercostal muscles contract
3. Increase the volume of thorax
4. Connective tissue pulls open alveoli which creates a negative pressure vacuum
5. Air from the outside (high pressure) is pulled into alveoli(low pressure)
*Should last 1/3 of the respiratory cycle
ventilation in the awake animal - exhalation
passive phase
1.Intercostal muscles and diaphragm relax
2.Chest recoils
3.Alveoli collapse
4.Air flows out of alveoli
*Should last 2/3 of the respiratory cycle
ventilation in anesthetized animal
*Respiratory center– under the influence of anesthesia (Less responsive to CO2)
*Intercostal muscles & diaphragm– also under anesthesia (Less expansion- Rebreathing bag collapses less)
problems with ventilation in the anesthetized animal
- hypercapnea
- hypoxemia
- decreased tidal volume
quality of ventilation
respiratory rate and tidal volume
controlled respiration (manual ventilation)
- Constant – CPPV – constant positive pressure ventilation
- Intermittent - IPPV - intermittent positive pressure ventilation
- Anesthetist squeezes the reservoir bag with the pop-off valve closed to expand lungs.
- Exhalation passive
controlled respiration (mechanical ventilation)
Exhalation can be active by applying negative pressure
targets for controlled ventilation
- Target rate- 6-12 breaths per minute
- Depth-slightly deeper than normal
- Must allow pressure to return to zero during expiration (Allows venous return of blood to heart, increases stroke volume, cardiac output - Keeps blood flow to alveoli)
short inspiration
inspiration should only occur for about 1/3 of the respiratory cycle
long expiratory phase
allows lungs to deflate and the pressure in the lungs to fall - allows heart and major blood vessels to fill
steps to bagging
- Close pop-off valve
- Fill rebreathing bag if necessary using O2 flow meter
- Quickly (1-1.5 seconds) squeeze bag while watching lungs inflate - Do NOT exceed 20 cmH2O
- Release bag
- Open pop-off valve
- Squeeze bag slightly to make sure pop-off is open
risks of bagging
- Excessive airway pressure may rupture alveoli
- Cardiac output may be decreased if PPV is maintained throughout expiration
- If ventilation rate too high-too much CO2 is exhaled resulting in a respiratory alkalosis
- Can cause excessive delivery of the anesthetic
under ventilation
- Generalized depression of most body systems
- Retained CO2 Respiratory acidosis
- Brain damage and death if severe
over ventilation
less harmful
1. Decreases animal’s tendency to breath independently (Removes CO2 more rapidly-Can result in apnea)
2. Respiratory alkalosis
Controlled Ventilation Can Affect Anesthesia Depth
If rate is higher or if breaths (tidal volume) are deeper, than the animal would breathe on its own - the animal may get deeper than you would expect
anesthetic related hazards
inhalation of gases
surgical room pollution - side effects of prolonged gas exposure
- Spontaneous abortion
- Congenital abnormalities
- Cancer
- Hepatic disease
- Renal disease
Inhalation of Soda Lime Dust
- Fine dust from fresh soda lime will form a caustic alkaline substance in combination with water.
- The mucous membranes of nose and throat are normally moist and also easily damaged by caustic substances.
injectable drugs
- loaded syringes should not be carried in pockets
- used for chemical restraint - can affect humans
autoclave related injuries
steam burns
- wear insulated gloves
explosions
oxygen related injuries
- combustion
- pressure release (sudden release)
- cylinder weight (can crush fingers)
