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vtt 117 - surgical tech > wks 8-11 > Flashcards

wks 8-11 Flashcards

1
Q

CPR

A

Cardiopulmonary Resuscitation

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2
Q

RECOVER

A

Reassessment Campaign on Veterinary Resuscitation

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3
Q

new CPR guidelines: CABD

A

compressions
airway
breathing
defribillation

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4
Q

BLS

A

basic life support
1. chest compressions
2. ventilation

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5
Q

ALS

A

advanced life support
3. Monitoring
4. Vascular Access
5. Administer Reversals and/or Medications

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6
Q

ROSC

A

Return of Spontaneous Circulation

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7
Q

cardiac compressions

A
  • Importance of high-quality chest compressions with minimal interruption
  • uninterrupted cycles of 2 minutes
  • rate of 100-120/min
  • depth of 1/3-1/2 the width of the chest
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8
Q

chest compressions

A

Use in cardiopulmonary arrest (CPA) to restart the heart; Will depend on thoracic conformation

cardiac pump theory and thoracic pump theory

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9
Q

cardiac pump theory

A

Ventricles are directly compressed between sternum and spine in dorsal recumbency or between the ribs in lateral recumbency

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10
Q

thoracic pump theory

A

Chest compressions increase the intrathoracic pressure; compresses the aorta & collapses the vena cava leading to blood flow out of thorax

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11
Q

Artificial Respiration

A

Early ventilation is very beneficial
Increases chance of success

  • ventilation rate of 10 breaths/minute
  • Inspiratory time of 1 second
  • Tidal volume of 10ml/kg
  • Delivered simultaneously with compressions
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12
Q

4 methods of artificial respiration

A
  1. ET tube + Anesthetic machine
  2. ET tube + Ambu Bag
  3. Mask + Ambu Bag
  4. Mouth to Snout
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13
Q

rapid intubation

A

can be accomplished while the animal is in lateral recumbancy and undergoing chest compressions

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14
Q

Mouth-to-Nose Resuscitation

A
  • Insure patient airway
  • Hold mouth tightly closed
  • Place your mouth over the animal’s nares and blow into the nares till you see the lungs expand
  • 30 compressions: 2 breaths
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15
Q

Cardiac Compressions + Artificial Respirations: Alone

A

30 compressions: 2 rapid breaths in 2-minute cycles

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16
Q

Cardiac Compressions + Artificial Respirations: assistance

A
  • Person performing compression should be rotated after each 2-minute cycle to prevent fatigue
  • Minimize chest compression interruptions
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17
Q

2-minute cycles of CPR

A

allow brief pause to:
◦ Rotate compressors
◦ Evaluate patient
◦ Evaluate ECG

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18
Q

Patients with no pulse but electrical activity

A
  • Treat with vasopressors and anticholinergic drugs
  • Administer every other cycle
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19
Q

Patients in ventricular fibrillation or pulseless ventricular tachycardia

A
  • Treat with electrical defibrillation
  • Mechanically defibrillation with a “precordial thump”
  • Blow to the chest with a clenched fist
  • Immediately start another 2-minute cycle
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20
Q

Medium, Large or Giant Breeds chest compressions

A
  • hands over widest portion of the chest
  • 30 compressions: 2 breaths if alone
  • 100-120/minute
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21
Q

Narrow, Deep-Chested Breeds chest compressions

A
  • hands directly over heart
  • 30 compressions: 2 breaths if alone
  • 100-120/minute
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22
Q

Barrel-Chested Breeds chest compressions

A
  • dorsal recumbency
  • hands over sternum directly over heart
  • 30 compressions: 2 breaths if alone
  • 100-120/minute
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23
Q

Small dogs & cats <10 kg with compliant chests for compressions

A
  • Use 1-handed technique with hand wrapped around sternum directly
    over heart
  • same rate
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24
Q

Small dogs & cats >10 kg or lower chest compliance or a fatigued compressor

A

Use the 2-handed technique directly over heart (similar to narrow-chested)

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25
Q

if the heart stopped what is the preferred emergency drug

A

epinephrine
- stimulates heart
- higher dose if administering through ET tube

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26
Q

CPR summary

A
  1. Determine the animal is apneic and/or no heartbeat
  2. Shout for help
  3. Begin cardiac compressions-give 30
  4. Assess airway-check for obstructions-provide mouth to snout (Swipe mouth, If obstructed: Heimlich Maneuver, Give 2 breaths)
  5. Intubate if help arrives; provide artificial
    respiration simultaneously as compressions
    1. Ventilation rate of 10 breaths/minute
    2. Tidal volume of 10ml/kg
    3. Inspiratory time of 1 second
  6. 100-120 compressions per minute
  7. Monitor with ECG
  8. Place IV catheter
  9. Administer medications
  10. Assess patient every 2 minutes for spontaneous
    breathing and heart rate
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27
Q

proper monitoring

A

key to preventing anesthetic emergencies and to a successful outcome when they occur

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28
Q

when to stop CPR

A
  1. The animal recovers
  2. You are relieved by someone else
  3. You are physically exhausted
  4. The DVM calls time of death
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29
Q

DNR

A

do not resuscitate

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30
Q

apnea

A

no breathing

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31
Q

respiratory arrest

A

cessation of respiratory effort

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32
Q

dyspnea

A

difficult breathing

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33
Q

tachypnea

A

rapid respirations

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34
Q

cardiac arrest

A

cessation of circulation due to failure of heart to contract; always includes respiratory arrest

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35
Q

causes of anesthetic problems and emergencies

A
  • human error
  • equipment failure
  • adverse effects of anesthetic agents
  • patient related factors
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36
Q

human errors

A

1.Failure to obtain adequate history & examination
2.Inadequate experience with anesthetic machine
3.Incorrect administration of drugs
4.Failure to monitor properly
5.Failure to recognize and respond promptly to earlysigns of patient difficulty
6.Errors caused by being in a hurry or fatigued

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37
Q

Hypercapnea

A

can lead to respiratory acidosis = decreased blood pH

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38
Q

most serious and most preventable

A

empty o2 tank

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39
Q

patient related factors

A
  1. Geriatric patients
  2. Pediatric patients
  3. Brachycephalic dogs
  4. Sighthounds
  5. Obese animals
  6. C-section
  7. Trauma patients
  8. Patients with organ disease
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40
Q

anesthetic problems and emergencies

A
  • animals that will not stay anesthetized
  • animals that are too deeply anesthetized
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41
Q

animals that are too deeply anesthetized

A
  • Respiratory rate of 6 bpm or less
  • Shallow respirations
  • Dyspneic
  • Pale or cyanotic mucous membranes
  • CRT > 2 seconds
  • Bradycardia
  • Weak pulse
  • Cold extremities
  • Absent reflexes
  • Flaccid muscle tone
  • Dilated pupils
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42
Q

temporary apnea

A

no breathing

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43
Q

anesthetic duties

A
  • Set up & check out the anesthetic machine
  • You can do this by yourself, but you will be expected to also go through the 7 steps for the instructor
  • Place a mayo stand by the front of the surgery table to place the supplies
  • Choose 2 ET tubes and gather all the supplies needed for induction & intubation (see anesthetic supplies check list)
  • Administer all medications
  • Intubate the patient
  • Help with monitoring and adjusting anesthesia
  • Bagging the patient
  • Extubate
  • Return patient to cage
  • Bleed out machine
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44
Q

monitor duties

A
  • Set up the monitor (including alarms, hi and low
    parameters) and gather any supplies associated with
    monitor
  • Start the white anesthesia record
  • Assist circulator with physical exam
  • Set up monitoring equipment prior to induction
  • Measure blood pressure cuff
  • Apply blood pressure cuff when patient is sedated – if able
  • Hook up the patient to the monitoring equipment
  • Monitor the patient throughout anesthesia
  • 5 – 10 minute vital checks
45
Q

circulator

A
  • Perform the Set up hot water blanket & towel
  • Pre-surgical examination
  • Restrain patient for induction/intubation
  • Patient record
  • The circulator should gather the patient record and is
    responsible for making sure all the paperwork is filled out (including the SOAP) record.
  • The circulator must work closely with the anesthetist to obtain the drug dosages given
  • Enter controlled substance log info
  • Enter stick log info
  • Clean table after anesthesia
  • Clean & return hot water blanket to cabinet
  • Dispose of trash
46
Q

no circulator

A
  • Monitor should do the patient SOAP record
  • Anesthetist should set up the hot water blanket and towel
  • Monitor should perform the physical examination
  • Monitor should enter the controlled substance log
  • Monitor should enter the stick log info
  • Anesthetist should clean table
  • Anesthetist should clean & return hot water blanket
  • Anesthetist should dispose of trash
47
Q

subjective

A
  • evaluation of animal
  • Mentation/Status of animal: BAR, QAR, bright, alert, responsive; depressed, improving, getting worse
  • Description/history: Fluffy has a 3 day history of diarrhea. He is known to eat things he is not supposed to. Has also vomited twice with toy stuffing in vomit.
  • Presenting complaint/reason for visit
48
Q

objective

A
  • measurable data
  • Physical exam findings
  • Diagnostics test findings: Bloodwork, Fecal, etc
49
Q

assessment

A

*analysis of S and O
- differential diagnosis: vet responsible

50
Q

plan

A
  • treatments
  • client communication
  • prognosis
  • procedures
51
Q

day before anesthesia

A
  • animal weighed
  • no food for 12 hours
52
Q

night before anesthesia

A
  • remove food
  • cats in individual cage
  • NPO tags
  • water bowls can be left in cages
53
Q

morning of anesthesia

A
  • water removed
  • double check for correct animals
  • complete physical exam before
54
Q

sutures removed

A

7-14 days

55
Q

-tome

A

cutting instrument

56
Q

-otomy

A

to cut into
incise

57
Q

-ectomy

A

to cut out
excise

58
Q

-ostomy

A

to form a new opening
surgical

59
Q

reproductive surgery

A

Ovariohysterectomy (OHE, OVH): Spay
Cesarean section (C-section)
Mastectomy (mammary glands)
Orchiectomy: Neuter or Castration

60
Q

Penrose Drain

A

Soft rubber tubing placed in a wound to prevent
build up of fluid

61
Q

testicular implants

A

neuticles

62
Q

abdominal surgery

A

Exploratory Laparotomy
Gastrotomy
Enterotomy
Intestinal Anastomosis (remove part of intestinal tract)
Splenectomy
Anal Sac Ablation (removal of anal glands)

63
Q

Pre-Operative Preparation

A

Patient History at Check in
Client Communication at Check in
Physical Examination
Patient Preparation

64
Q

surgical prep

A
  • surgical clipping
  • surgical scrub
65
Q

antiseptics

A

iodophor scrubs
chlorohexidine scrub
alcohol

66
Q

pattern of surgical scrub

A

centered and moved in a circular motion outward from initial site - remove sponge and begin rinse in same motion

67
Q

positioning on surgery table with ropes

A

front legs - one loop above carpus and one below
hind legs - both loops below he hock

68
Q

other tasks before surgery

A

Position surgery table for height of surgeon, tilt table depending on position
Direct lights at incision site
Regulate intravenous fluids
Open surgical packs, hand suture materials to surgical team
Monitor anesthesia

69
Q

endotracheal intubation

A

flexible tube is placed inside the trachea of an
anesthetized patient; anesthetic gases are delivered directly from anesthetic machine into patients lung

70
Q

why ET tube is used

A
  • maintain airway
  • prevent aspiration pneumonia
  • provide pathway for gases
  • decrease dead space
  • provide an avenue for controlled respiration
  • provide an avenue for resuscitative measures in an emergency
71
Q

equipment needed for ET intubation

A
  • appropriate tube size
  • orange ties
  • gauze sponge
  • air syringe
  • laryngoscope
  • sterile lube
  • stylet
  • lidocaine for cats
72
Q

murphy type

A
  • most common
  • beveled end and side hole
  • diameter less than trachea
  • cuff to seal trachea
73
Q

Cole type

A
  • no cuff or hole
  • fitted to trachea
  • more common in pediatric and exotics
74
Q

types of ET tube material

A

polyvinyl chloride
red rubber
silicone

75
Q

PVC

A
  • stiffer
  • can damage trachea
  • cannot autoclave
76
Q

red rubber

A
  • more flexible and less traumatic
  • kinks
  • not transparent
77
Q

silicone

A
  • more expensive
  • can be autoclaved and reused
  • strength and flexibility
78
Q

reinforced ET tubes

A

embedded with coil of metal to prevent kinking while also bends

79
Q

how ET tubes are sized

A

sized by the internal diameter and length

80
Q

how to choose proper diameter of ET tube

A
  • adult cats: 3.0mm, 3.5mm, 4.0mm
  • small dogs: 3.0mm-5.0 mm
  • medium dogs: 5.0mm-7.0mm
  • big dogs: 7.0mm+
  • use largest tube that will fit the airway
81
Q

how to measure proper length to insert ET tube

A

thoracic inlet to tip of nose

82
Q

how to check and ET tube prior to use

A
  • damage
  • debris
  • hold up to light to check for lumen obstruction
  • cuff leaks (air or water)
83
Q

laryngoscope

A

device used to increase visibility of larynx
- handle, blade, light source

84
Q

arytenoids

A

two white, barlike cartilage structures located at opening to trachea

85
Q

glottis

A

contains vocal chords

86
Q

epiglottis

A

leaf shaped cartilage that covers the glottis during swallowing

87
Q

how do dogs and cats differ in their larynx

A

cats tongue is more rough

88
Q

positioning for ET intubation

A

sternal recumbency

89
Q

6 steps to ET intubation

A
  1. visualize the et tube pass between the arytenoids
  2. confirm et tube is in the trachea
  3. advance tube to predetermined length
  4. tie the tube in
  5. inflate the cuff
  6. check for proper inflation of the cuff
90
Q

laryngospasm

A

reflex closure of the glottis &
arytenoids

91
Q

6 ways to confirm an ET tube is in the trachea

A
  1. see if go between arytenoids - best way to confirm
  2. cough
  3. fogging in the et tube
  4. watch flutter valve “flutter”
  5. feel air
  6. check capnograph……
    **if you hear whining noises, it is in the esophagus
92
Q

when should patient be extubated

A

after 2-3 good swallows

93
Q

how to clean ET tube

A
  • always clean the tube inside and out with a brush and disinfectant
  • inflate the cuff when cleaning to be sure no secretions are caught in the folds
  • soak in disinfectant (chlorhexidine) and rinse well
  • hang to dry
94
Q

what to also tell clients when discharging pet that has been intubated

A

it is not unusual for an animal to cough for several days after being intubated due to tracheal irritation; dry cough not a wet cough - wet cough is indication of something more serious

95
Q

cuff not inflated or under inflated

A
  • inability to create a seal between cuff & trachea
  • difficulty or inability to keep the patient anesthetized
  • aspiration of stomach contents
  • aspiration of foreign material and fluid during dental cleaning
  • pollution of work space with anesthetic gas
96
Q

tube diameter too small

A
  • inability to create a seal between cuff & trachea
  • small tubes are more likely to block with mucus
  • increased resistance to breathin
97
Q

cuff overinflated or tube diameter too large

A
  • necrosis of tracheal mucosa
  • big concern in cats
  • possibility of tracheal rupture
98
Q

tube too long

A

if tube is too deep:
* intubation of one main bronchus = hypoxemia
* difficulty keeping patient anesthetized
if extends beyond mouth = increased mechanical
dead space, hypoventilation & hypoxemia

99
Q

tube too short

A
  • inability to intubate
  • changes patients position and may dislodge tube
100
Q

overzealous intubation

A
  • tracheal irritation = tracheitis & postoperative cough
  • trauma or tracheal rupture = pneumomediastinum and/or pneumothora
101
Q

tube kinked or obstructed

A
  • dyspnea & hypoxemia
  • cyanosis!
  • asphyxia = cardiac arrest if not corrected!
102
Q

tube not removed before return to consciousness

A
  • damage from chewing
  • blockage of airway
  • severed portion of tube and may be aspirated or swallowed
103
Q

tube not cleaned and disinfected

A
  • transmission of infectious agents
  • blockage of tube with dried mucus or other foreign material
104
Q

steps if patients vomits when intubated

A
  • lower head
  • can tilt table
  • do not extubate!
  • pull tongue anteriorly
  • remove secretions/vomitus
  • notify veterinarian
  • monitor by ausculating lungs
  • get in sternal recumbency asap
105
Q

anesthetic masks

A
  • cone shaped devices used to administer oxygen and anesthetic gases to non-intubated patients
  • used for anesthetic induction and maintenance
106
Q

main intubation procedure before

A
  1. premeds
  2. wait 15 minutes
  3. IV catheter to sedate
  4. induction IV to anesthetize
  5. then place tube to maintain anesthesia
107
Q

size syringe for cats and dogs

A

cats: 3cc
dogs: 6cc

108
Q

main extubation procedure

A
  1. shut of anesthetic gas but leave on o2 for 5 minutes
  2. deflate cuff
  3. untie at one good swallow
  4. wait till 2-3 good swallows to take out tube

vtt 117 - surgical tech (8 decks)

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