Term
Name the ideal pre-med, induction and maintenance drugs for a c-section in a dog |
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Definition
Atropine (anticholinergic)
Midazolam (benzodiazepine tranquilizer)
Butorphanol (opioid/analgesic)
Propofol (induction)
Isoflurane (gas inhalent)
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Term
Give 2 reasons why atropine is the anticholinergic of choice for c-sections. |
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Definition
1. Has a short onset and duration
2. Can cross the placental barrier |
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Term
Why give metaclopramide or cimetidine (famotidine) to a c-section patient? |
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Definition
Give acid blockers to inhibit reflux due to increased intra- abdominal pressure from the fetuses |
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Term
Why do we pre-oxygenate c-section patients and what is the duration? |
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Definition
Duration 5 minutes pre-induction.
We give to prevent hypoxia and poor tissue perfusion due to pressure on the diaphragm |
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Term
Name a disadvantage to mask inhalant induction vs. injectable induction for c-section? |
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Definition
Mask induction does not provide airway protection and her increased risk of reflux means increase risk of vomit aspiration. |
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Term
List 2 strategies for reviving an unresponsive puppy delivered via c-section. |
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Definition
1. rub vigorously with a towel
2. place 1 drop of doxapram under the tongue to initiate a breath and increase respiration |
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Term
Name the reversal agent for opiods, alpha 2 agonists and benzodiazepines |
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Definition
opioids-naloxone
benzodiazepines-flumazenil
alpha 2s- yohimbine for most |
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Term
Name 4 parameters that affect the CO2 laser's effect on tissue |
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Definition
1.power setting
2. spot size/tissue area
3. tip to tissue distance
4. hand speed |
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Term
List 4 surgeries where lasers may be beneficial |
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Definition
1. spay
2. neuter
3. cat declaw
4. mass removal |
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Term
List 2 distinct advantages to laser surgery |
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Definition
1. cauterizes the vessels and causes hemostasis
2. should be less painful/traumatic to tissues if done properly, esp. w/ declaws |
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Term
What are 2 disadvantages of using a laser in surgery |
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Definition
1. cost-very expensive
2.steep learning curve, can do more damage than good if not done properly. |
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Term
List 4 safety precautions for when lasers are in use |
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Definition
1. protect the skin, don't scrub w/ alcohol, use saline instead
2. protect your eyes, wear safety glasses
3. protect yourself from fumes. use a plume scavenger and face mask
4. prevent fire hazzard- wet down flammable objects (i.e. ET tube)and beware laser near O2 tanks |
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Term
Name some key differences between lidocaine and bupivicaine |
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Definition
Lidocaine- 15 min. onset
4-6 hour duration
Bupivicaine- less than 5 min. onset
1-2 hour duration
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Term
What should you be aware of if you choose to mix lidocaine and bupivicaine for maximum benefit |
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Definition
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Term
Name 4 important differences between the lidocaine patch and fentanyl patch |
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Definition
Mode of Action- lidocaine topical absorption, fentanyl systemic transdermal absorption
Application- lidocaine must be applied near site of pain for local analgesia, fentanyl can be applied anywhere, because drugs are released systemically
cost- lidocaine is cheaper
Fentanyl is a controlled drug, lidocaine is not |
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Term
Why can you cut a lidocaine patch to size, but not a fentanyl patch? How do we reduce the dose of fentanyl for a small patient |
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Definition
If a fentanyl patch is cut, drugs will be delivered uncontrollably throughout the system, while lidocaine only provides local analgesia. To reduce the dose of fentanyl, only remove part of the protective backing. You can use the rest later. |
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Term
Describe opioids as analgesics. List some and their receptors. |
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Definition
Opioids are good, potent somatic and visceral analgesics, w/ mild sedation
i.e.
morphine- pure mu agonist
oxymorphone-pure mu agonist
hydromorphone- pure mu agonist
fentanyl- pure mu agonist
buprenorphine-partial mu agonist
butorphanol-mu antagonist, kappa agonist |
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Term
Which opioid has the longest onset and duration? |
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Definition
The fentanyl patch- 6-12 hour onset, w/ 72 hour duration |
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Term
Which opioid has the shortest onset and duration? |
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Definition
butorphanol- onset 15 mins IM/SQ, duration 1-2 hours. Also least potent opioid analgesic |
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Term
Which opioids are bad to combine? |
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Definition
butorphanol w/ mu agonists. Will cancel each other out. |
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Term
What is the only oral, synthetic opioid we have in veterinary medicine? |
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Definition
Tramadol- 1-2 hour onset, lasts 8-12 hours given PO |
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Term
What is the most profound side effect of giving opioids, besides analgesia? |
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Definition
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Term
List some alpha 2 agonists that provide analgesia |
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Definition
xylazine (horses usually)
dexmedetomidine
medetomidine
detomidine (horses only)
ramifidine (horses only) |
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Term
Which drugs can be used as emetics in dogs and cats? |
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Definition
xylazine- cats
apomorphine-dogs |
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Term
Name some NSAIDs commonly used for analgesia |
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Definition
carprofen- injectable or oral
meloxicam- injectable or oral
etodolac-oral
deracoxib-oral
tepoxalin-oral
firocoxib (Previcox)-oral |
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Term
Which NSAID as of 2010 is no longer approved in cats for post-op analgesia? What is our only post-op alternative as a result? |
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Definition
Oral meloxicam, though some vets may continue to use it off label
buprenorphine is the only approved alternative. |
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Term
What is our biggest concern when it comes to giving NSAIDs...especially perisurgically? |
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Definition
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Term
What can we do to help increase renal profusion during surgery where NSAIDs are part of the protocol? |
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Definition
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Term
Which drugs commonly used for surgery, are NOT analgesics? |
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Definition
anticholinergics (atropine and glyco)
Phenothiazines (acepromazine)
benzodiazepines (diazepam, midazolam, zolazepam, etc.)
propofol
gas inhalents |
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Term
Which class of drugs is commonly used in combination with analgesics and sedatives? What are their common side effects? |
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Definition
NMDA antagonists, i.e. ketamine and tiletamine. Hallucinations, and muscle rigidity. |
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Term
Define neurolept analgesia |
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Definition
The combination of an opioid and a sedative to reach maximum potentiation of each drug to relax and reduce pain in the patient. |
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Term
What is our main goal w/ analgesic protocols? |
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Definition
To prevent pain, not to chase it. |
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Term
What drugs are commonly used for ring blocks? What nerves do we numb for a routine declaw? |
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Definition
lidocaine, bupivicaine, or mepivicaine (horses)
block the radial, ulnar and and median metacarpal nerves |
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Term
What are the cellular components of a stress leukogram? What is the hallmark of chronic stress vs. acute stress? |
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Definition
See overall leukocytosis
neutrophilia
lymphopenia
eosinopenia
monocytosis
Will see significant increase in cortisol levels in chronic stress. |
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Term
What will we see chemically in a stressed animal's bloodwork? |
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Definition
Increased glucose levels
increased platelets
increased RBCs
Increased cortisol |
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Term
What is a marginal pool and how do peripheral blood changes occur during times of stress? |
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Definition
The marginal pool is where blood cells made in the bonemarrow are stored until needed. In times of stress, HR and BP increase, flooding the marginal pool into the peripheral blood, thus leading t neutrophilia |
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Term
What is the formula for blood pressure? |
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Definition
BP=HR X SV X TPR
CO=HR X SV, so...
BP=CO X TPR |
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Term
What is the ideal stage and plane of anesthesia for a routine spay or neuter? |
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Definition
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Term
Name some of the MOST reliable signs of depth of anesthesia |
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Definition
1. gross, purposeful, spontaneous movement
2. reflex movement,less reflex present, deeper they are
3. transient hemodynamic- increase or decrease in HR or Respiration (minus surgical stimulation)
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Term
Name some reliable signs of anesthetic depth |
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Definition
1. Vaporizer setting history
2. muscle tone
3. palpebral reflex
4. pupillary response
5. tear production, very dry=very deep
6. eyeball position |
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Term
Name some of the LESS reliable signs of anesthetic depth |
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Definition
1. HR alone
2. Resp. rate alone
3. BP |
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Term
Name some UNRELIABLE signs of anesthetic depth |
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Definition
1. pupil size
2. shivering in response to hypothermia |
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Term
Opioids cause what in cats? |
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Definition
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Term
What's important to remember when determining anesthetic depth? |
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Definition
A positive response provides much more info than a negative one. Also, never make a determination of depth on one parameter alone |
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Term
List 3 signs that a patient may display when in pain? |
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Definition
1. may vocalize
2. may not eat
3. may favor the affected area or hide |
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Term
Define multimodal analgesia |
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Definition
An approach to pain management that involves using analgesics from different categories...i.e. an opioid and an NSAID |
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Term
What is the term for a pain response to a normally innocuous stimulus? |
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Definition
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Term
What is defined as an increased pain response as a result of local inflammation? |
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Definition
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Term
What is the term for the absence of pain sensation in the skin and musculoskeletal system? |
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Definition
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Term
What is the term for absence of pain or stimulation to the internal organs? |
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Definition
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Term
Which lasts longer, the sedative or analgesia effects of butorphanol? |
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Definition
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Term
Which intervertebral space do we administer an epidural? |
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Definition
Lumbosacral joint-between L7 and S1 |
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Term
Which complex is associated with ventricular depolarization on an EKG? |
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Definition
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Term
What is associated with atrial depolarization on an EKG? |
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Definition
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Term
What is associated with ventricular re-polarization on the EKG? |
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Definition
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Term
What is associated with the time required for an impulse to travel from the SA node to the ventricle on an EKG? |
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Definition
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Term
What class of drugs is most likely to cause profound bradycardia or an AV block? |
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Definition
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Term
Which class of drugs would you most likely use to TREAT an AV block or sinus bradycardia |
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Definition
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Term
Which drug is most likely used to treat VPCs? |
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Definition
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Term
When do we consider a large breed dog to be bradycardic? |
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Definition
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|
Term
When do you consider a cat to be bradycardic? |
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Definition
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Term
Describe a 2nd degree AV block: Mobitz type 1 |
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Definition
An arrhythmia when the PR interval gradually gets longer and longer, until it skips a QRS complex/T wave and resets itself |
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Term
What is going on if you see a wide QRS complex appearing early on the rhythm strip? |
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Definition
VPCs- ventricular premature contractions |
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Term
How do you calculate a HR based on a EKG rythm strip? |
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Definition
1.Determine paper speed
2. count 5 large blocks to equal 1 second
3. count the number of complete complexes in 10 (5 block) spaces
4. Multiply that number by 6
i.e. paper speed is 25 mm/sec. you count 6 complexes in 10 seconds. Multipy that by 6 and get 36 BPM.
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Term
What is the term for the amount of blood ejected during one cardiac cycle? |
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Definition
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Term
What happens to blood pressure if the HR drops? |
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Definition
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Term
What happens to BP if the TPR drops? |
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Definition
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Term
Acepromazine causes profound vasodilation. Which part of the BP formula is most affected by this? |
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Definition
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|
Term
True or Fals
Normal pulses= Normotension |
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Definition
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Term
What are 2 indications for monitoring BP in veterinary patients? |
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Definition
1. monitoring geriatrics
2. monitoring patients on cardiac meds |
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Term
What are the 2 most common technologies for measuring INDIRECT BP in animals? |
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Definition
1. oscillometry
2.doppler |
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Term
List the most common locations to place a BP cuff on dogs and cats |
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Definition
proximal to the carpus and proximal to the tarsus |
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Term
What is the most common lead used in EKG? |
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Definition
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Term
What rarely if ever causes perianesthetic arrhythmias? |
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Definition
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Term
What are some common issues we see w/doppler BP measurements? |
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Definition
Tendency to underestimate systolic, usually a better reflection of MAP
Poor representation of diastolic BP
<100 readings consider MAP
>100 readings consider systolic |
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Term
What are the 3 steps seen on an EKG preceding death of the patient? |
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Definition
1. ventricular tachycardia- a bunch of VPCs in succesion
2. Ventricular Fibrillation- low amplitude chaotic electrical activity
3. asystole-flat line- no electrical or mechanical activity-DEATH |
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Term
What are 2 places to palpate a PERIPHERAL pulse |
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Definition
metacarpal palmar artery
metatarsal dorsal artery |
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Term
When do we become concerned about inspiratory CO2 being registered on a capnograph? |
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Definition
When it reaches or exceeds 5 mmHG |
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Term
What are 2 common causes for excessive inspiratory CO2? |
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Definition
1. CO2 absorber, whether a leak or expired soda lime
2. A communication between the inhalation and exhalation tubes in an F circuit causing the patient to rebreathe excess CO2 |
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Term
What is the Normal awake value for ETCO2 in both dogs and cats? |
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Definition
dog-35-45 mmHG
cat- 30-40 mmhg |
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Term
List 4 causes of increased ETCO2 |
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Definition
1. hypoventilation
2. fresh gas flow too low
3. malignant hyperthermia
4. problem w/breathing circuit |
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Term
List 4 causes of decreased ETCO2 |
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Definition
1. Hyperventilation
2.hypothermia
3. apnea
4. asthma |
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Term
List the normal canine values for the following: |
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Definition
MAP: >70 mmHG
ETCO2: 35-45 mmHG
InCO2: 0-8 mmHG
PaCO2: 38-38 mmHG
SpO2: >95%
PaO2: >110 mmHG
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Term
What might you do to correct a high ETCO2 and PaCO2 if you see the patient is hypoventilating? |
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Definition
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Term
What are 2 indications for anticholinergics? |
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Definition
reduce salivary secretions and increase HR |
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Term
What are 2 possible complications associated w/ acepromazine? |
|
Definition
could lower the seizure threshold, could cause possible bradycardia |
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Term
What are some possible immediate side effects of propofol induction? |
|
Definition
going slowly through the excitement phase and apnea |
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Term
List some things that decrease pulmonary performance under anesthesia. |
|
Definition
drugs like opioids and inhalants
recumbancy
head down position
lung pathology |
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|
Term
What is the term for a collapsed state of the lung/alveoli? |
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Definition
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|
Term
What are 2 indications for complete controlled ventilation of a patient? |
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Definition
1. elective for a patient that is very difficult to keep at a steady rate
2. open chest surgeries |
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Term
At what pressure do we provide a regular breath to patients? |
|
Definition
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|
Term
What pressure do we provide a sigh or deep breath? |
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Definition
Depends on patient size, but never more than 30 cmH2O |
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Term
Why do we sigh our patients? |
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Definition
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Term
How often do we sigh, spontaneous ventilated patients vs. controlled ventilated patients? |
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Definition
spontaneous=every 5 mins
controlled=every 15 mins |
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Term
What is the unit we have to monitor vitals at BRCC? |
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Definition
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|
Term
List some artifacts that can occur when taking an EKG |
|
Definition
60 cycle interference- electrical
wandering baseline-result of panting or purring
patient movement, etc. |
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Term
What is the difference between a Mobitz Type 1 and Mobitz Type 2 arrhythmia? |
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Definition
Mobitz type 1 will gradually extend time between complexes, until a beat is skipped entirely andthen it resets
Mobitz Type 2 has a consistant rhythm, then randomly drops a beat and resets-more dangerous and more related to pathology |
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Term
Why might we see low ETCO2 on a non-rebreathing system |
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Definition
Because the patient is only taking in fresh gasflow. It is not unusual to see an ETCO2 in the 20s. |
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Term
Which is more helpful and accurate to monitor the patient, ETCO2 or SpO2? |
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Definition
ETCO2, SpO2 is rarely accurate |
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