clin pro 2

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Author:
mery9
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142664
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clin pro 2
Updated:
2012-03-21 17:09:17
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Anesthetic problems emergencies
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  1. What are some causes why animals won't stay anesthetized?
    • vaporizer
    • Endotracheal tube
    • Oxygen
    • Respirations
    • Connections
  2. What causes the vaporizer to keep the patient awake?
    • setting too low or turned off
    • Check anesthetic level in fill window
    • Malfunction-does iso vaporizer need to maintained at 3-4% for surgical plane
  3. What can go wrong with the endotracheal tube that would cause the patient to wake up?
    • the placement of the tube
    • not in esophagus
    • Bronchus
    • Cuff blow by
  4. How can oxygen cause problems under anesthesia?
    • Flow rate too low: not getting enough anesthetic
    • Excessive use of flush valve (dilution of anesthetic)
  5. Respirations
    • Apnea
    • Ketamine/diazepam
    • Thiopental
    • Propofol
    • Too shallow
  6. Connections
    • Correct assembly
    • Tight connections
  7. What are the causes of that a patient would be too deeply anesthetized?
    • Vaporizer setting too high for the patient
    • Dose of injectable too high (induced)
    • pre-existing problem
    • A.shock
    • B. anemia
  8. What are some signs of patient being too deep?
    • Resp<8/min may be shallow or dyspneic
    • Mucous membranes pale, may be cyanotic
    • CRT>2
    • Bradycardia
    • Pulse weak, hypotension(<80mmHg)
    • Cardiac arrhythimias
    • Cold extremities ears hypothermia
    • Reflexes absent: PLR, Corneal reflexes
    • Muscle tone flaccid
    • Pupils dilated
  9. How would you treat a patient who is too deeply anesthezied?
    • Decrease vaporizer setting (possibly turn off)
    • Bag with 100% O2 every 5 sec. until signs of recovery
    • Increased heart rate
    • Stonger pulse
    • improved color and crt
    • consider iv fluids, external heat, drugs, reversal agents
  10. What are the causes of pale mucous membranes?
    • Preexisting anemias
    • Intraoperative blood loss
    • Drugs causing vasodilation and hypotension
    • Hypothermia
    • Pain
  11. What are the preexisting anemias?
    • Feline leukemia virus
    • Hemolytic anemias
    • coagulopathy
    • Neoplasia
    • Chronic Renal failure
  12. What are the drugs that cause vasodilation and hypotension?
    • Inhalation agents (halothane)
    • Xylazine
    • Acepromazine (hypotension)
  13. Treatment for pale mucous membrane?
    • Determine anesthetic depth lighten if too deep
    • Monitor vital signs- heart/ rep. rate pulse CRT
    • Consider fluid therapy, transfusion (on DVM's orders)
    • Warm patients
    • Pain relief
  14. What causes prolonged CRT?
    Hypotension
  15. Hypotension
    • Preexisting shock
    • bloodloss intraoperatively
    • Excessive anesthetic depth
    • Drug related
  16. What drugs cause Hypotension?
    • Acepromazine
    • Inhalation anesthetic
  17. How would you treat hypotension?
    • Immediately check pulse and blood pressure, absence of femoral pulse indicates pressure <40mmHg
    • IV fluids- crystalloids, Colloids
    • Reduce anesthetic depth if possible
    • Administer 100% O2
    • Keep warm
    • Drugs
  18. What drugs would you use for hypotension?
    • corticosteroids:commonly used
    • cardiac inotropes(increase force of contraction)
    • dopamine
    • dobutamine
  19. What causes dyspnea and/ or cyanosis?
    • Unable to obtain oxygen
    • Unable to breathe normally
    • Anesthetic too deep
  20. Why is the patient unable to obtain oxygen?
    • No oxygen in tank
    • Flowmeter off
    • Endotracheal tube blocked
  21. What are some reasons why the airway might be obstructed?
    • ET tube blocked
    • Excessive flexion of neck
    • Laryngospasm: especially on untubating patient
    • Bronchoconstriction
    • Brachycephalic conformation
    • aspiration (if not intubated)
  22. What are some respiratory pathology?
    • Pneumothorax
    • Pulmonary edema
    • Diaphragmatic hernia
    • Pleural effusion
  23. What would you see when a patient is in dyspnea and or cyanosis?
    • Exaggerated chest or abdominal movements on inspiration
    • Blue purple mucous membranes
  24. How would you treat dyspnea and cyanosis?
    • Determine oxygen source adequate
    • Bag with 100% Oxygen (vaporizer off) and observe chest wall for movement.continue until pulse oximeter is 90-95% or mucous membrane color improves
    • If unable to intubate consider tracheostomy or 14 g IV cath into cricothyroid ligament w/3cc syringe attached to Y piece.
    • IV fluids drugs (doxapram)
    • Monitor closely cardiac arrest may follow
    • Post operative supplemental oxygen may be necessary
  25. What causes tachypnea?
    • surgical stimulation
    • Inadequate anesthetic depth
    • Opiod (panting)esp. oxymorphone
    • Paradoxical response to hypoxia and hpercapnia in excessively deep anesthesia
    • Hypethermia
  26. How do you treat tachypnea?
    • If normal anesthetic depth, temp, and vital signs dont change vaporizer setting usually self corrects within 1-2min
    • Consider analgesia if pain induced
    • Tend to see i obese and toy breeds. May need to assist or control ventilation.
  27. What causes Tachycardia?
    • Drugs
    • Preexinsiting condition
    • surgical stimulation
    • hyperthermia
  28. What drugs cause tachycardia?
    • Atropine
    • Ketamine
    • Epinephrine
  29. What are the preexisitng condition that causes tachycardia?
    • hyperthyroid
    • shock
    • congestive heart failure
    • anemia
  30. When do you see tachycardia?
    • In stage III of anesthesia
    • Heart rate>160 (large dog)
    • Heart rate >180 (small dog)
    • Heart rate >240 (cat)
  31. How can you treat tachycardia?
    • Checkdepth may need to increase if heart
    • If cause is shock treat hypotension
  32. What causes bradycardia?
    • Drugs
    • stimulation of vagus nerve
    • Deep anesthesia
    • Hyperkalemia
    • Hypotermia
    • Hypoxia
  33. What drugs cause bradycardia?
    • xylazine or medetomidine
    • Opioids
  34. What causes stimulation of vagus nerve?
    • Brachycephalic
    • Endotracheal intubation
    • Ocular surgery
    • Handling of viscera
  35. In what rate is consider bradycardia?
    <60in dogs

    <100 in cats
  36. How to treat bradycardia?
    • Not all require treatment, check anesthetic depth: remember.
    • Decrease vaporizer setting if needed
    • 100% oxygen (bag)
    • If caused by drugs or excess vagal stimulation- atropine or glycopyrrolate IV consider the use of epinephrine
  37. What causes cardiac arrhytmia?
    • Drugs
    • Preexisting heart disease
    • Gastric dilation and volvulus
    • Hypoxia
    • Hypercapnia
    • electrolyte abnormalities
    • Myocardial contusion (bruse heart cause by trauma)
    • PVC barbiturate, halothane hypoxia, cardiac disease trauma, acid base electrolyte abnormality epinephrine.
  38. What do you see during cardiac arrhythmias?
    • Dropped beats on auscultation
    • Pulse deficit
    • ECG abnormalities
  39. Treatment for cardiac arrythmias
    • R/O inadequate oxygen flow or CO2 accumulation
    • Ventilate with oxygen 100% oxygen
    • drugs lidocaine (local anesthesia)
    • If injected IV corrects arrhytmias
  40. What drugs cause respiratory arrest?
    • IV ketamine
    • Barbiturates
    • Propofol
    • Opiods
  41. True or false: Prolonged bagging with oxygen cause respiratory arrest?
    True
  42. What are causes of respiratory arrest?
    • Drugs
    • prolonged bagging with O2
    • anesthetic overdose
    • lack of oxygen flow
    • preexisting respiratory disease
  43. How do you treat respiratory arrest?
    • If from drugs or bagging- give 1 breath every 30 sec while continuing to monitor
    • Otherwise inform DVM, Intubate (if not already) administer 100% oxygen
    • Check heart to r/o cardiac arrest
    • Turn off vaporizer
    • Ensure oxygen flow
    • R/O airway obstruction
    • Bag every 3-5sec until vital signs improve
    • IV cath, fluids at shock rates
    • Drugs: doxapram: respiratory stimulant, reversing agents
    • keep warm
    • discontinue bagging for 15-30 seconds, observe for breathing
  44. What do you do during cardiac arrest?
    Check for airway, breathing, start compression, give drugs
  45. Airway
    • Intubate administer 100% oxygen
    • Make sure no obstruction of airway (chest movement)
  46. Breathing
    • One breath per 2 compressions
    • One breath every 3-5 sec
    • Alternate 2 breaths with 10 compression if solo
  47. Compression
    • 1-2 compressions per second
    • Theories
    • acupunture nose
    • Cardiac pump-small animals: manually compressing the heart
    • Thoracic pump-large animals:changing the in the thorax
    • Palpable femoral pulse should occur with each compression
    • Defibrillate for ventricular fibrillation
  48. Drugs
    • IV fluids
    • Route
    • IT a 2x dose for atropine, epinephrine, Lidocaine
    • IV central line if possible
    • IC lest preferable: can cause more damage if needle is in wrong chamber

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