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What are the roles of the VT in anesthesia?
- Preparing, operating, and maintaining anesthetic equip
- Admin of anesthetic agents
- ET intubation
- Patient monitoring
- Understanding of physical parameters and machine data
- Perform quick and effective corrective interventions
- High standard anesthetic monitoring and understanding of interventions
What are important pre-op procedures are performed to determine a patients health status?
Obtaining patient history, performing PE and diagnostic tests
What is included in patient care?
IV catheter, med admin, etc
What may be done to prep for an upcoming procedure?
Maintaining anesthesia machine and sx room, preping surgical equipment (packs, sutures, blades, heating beds, towels, etc) required for the procedure
When may a VT induce anesthesia?
Upon DVM instruction
What is a scrub nurse?
Sterile nurse who assists the vet in retraction, stabilization, hemostasis and so on
What does the non-sterile assistant do in sx?
Includes monitoring anesthesia and the patient, opening surgical packs, drapes, sutures, etc in sterile manners; lavage & suction; admin of medication
What are the post-op roles of the VT?
- Cleaning patient of blood, feces, urine
- Placing bandages
- Recovering patient thru extubating and waiting until patient calms
- Keeping patient calm & admin of any Rx meds until discharge
- Discharging patient & informing owner of instruction for care
- Cleaning sx room & equipment, making sx packs & autoclaving them
What is the minimal information that should be retrieve from the client upon arrival?
- Complete PE
- Diagnostic testing ordered by DVM
- Confirmation of sx procedure to be done
- Determination of physical status & anesthetic risk
What type of questions should be asked when gaining a hx on a patient?
Give examples of questions to ask a client if a problem is indicated.
- How long has the problem been occuring?
- How often does the problem occur?
- What is the patients stool character?
- Have they tried intervening the problem?
- Did they get any results from the intervention?
What might be confirmed before a procedure?
- Confirm all procedures to be performed
- Confirmation of limb
- Confirm location of masses & if histopathology will be performed after removal
- Receive current contact information before client leaves
It is important to receive signalment. What does signalment entail?
- Repro status (know if intact or used for breeding)
Why is it important to know about any medications that the pet is on?
Drug interactions may occur and may cause increased bleeding of profound sedation
What type of drug should always be asked about when talking to a client about current medications?
Why is it important to ask a client about patient allergies?
- Anaphylaxis may occur (penicillins)
- Previous adverse interactions with anesthetics
What might be asked about preventative measures the client uses for the patient?
- When and what were previous vaccines given?
- Are they on HW &/or flea & tick prevention?
Why is it important to know about previous medical problems?
Anesthetic protocol may need to be altered
What may need to be done in signs of illness?
- Additional diagnostic testing
- Delay in anesthesia
What actions are performed with the written consent form?
- Provided the client with estimates for expected charges
- Thoroughly review w/ owner & describe procedures
- Explain why mandatory procedures are required (IVC, bldwk)
- Discuss optional procedures (microchips, gastropexy, etc)
- Confirm owners understanding that anesthesia is NEVER w/o risk
- Answer last minute questions
The PE is the responsibility of the _______, but the VT can use PE findings to _________________, _________________, and ___________________________.
Veterinarian; provide effective patient care, respond to patient needs, alert vet to changes in patient condition
What would be examined during a routine PE?
- EENT (ears, eyes, nose, mouth)
- H/L (cardiovascular/pulmonary)
- Abd (GI & abd)
- MSI (musculoskeletal/integ)
- Neuro (neurologic)
- U/G (Urogenital)
What is always to be received before any procedure is performed, and typically is done before the patient enters the exam room?
What is the BCS? What are the two scales used and how do the ranges work?
- Body condition score is a numeric assessment of the patient's body composition compared to the ideal body weight
- 1-5 & 1-9; 1 being cachexia, 5 or 9 being morbidly obese
How can hydration be assessed?
- Skin turgor
- MM color/moisture
- Heart rate
- Pulse rate
What diagnostic tests can assess hydration?
What are the levels of consciousness?
- Obtunded (dull mental state requiring vigorous stimulation to react)
- Stuporous (low consciousness)
When should body temperature be taken?
After all other vital signs
When examining a patients gait, what are you looking for?
- Manner in which they walk
- Equal weight bearing on all four limbs
When examining the skin, what are you looking for?
- External parasites
- Redness, flaking, parasite debris, wounds
What lymph nodes are palpated in PLS?
What is the ratio of benign cancers to malignant cancers in dogs and cats?
- 50:50 in dogs
- 5:95 in cats
What does it mean for anisocoria to occur?
Different sized pupils
What is normal rxn when testing PLR?
Direct and consensual constriction
Yeast smells _________, while bacteria smells ____________
What is a bacteria commonly found in the ear?
What do pale MM indicate? Cyanotic MM?
- Anemia or poor perfusion
- Hypoxia or poor perfusion
What causes methemoglobinemia and muddy gums? What is it treated with?
Acetominophen; Mucomyst® (Acetylcysteine)
What is a sinus arrhythmia? Is it normal?
- HR increases with inspiration and decreases with expiration
What is a pulse deficit?
When there is a difference in HR and pulse
What is the Flehmen response?
When the cat breathes open mouth due to a smell in urine or pheromones
What format is used when writing in the medical record? What does each letter stand for? Give examples.
- Subjective: things open to interpretation (CC, BCS, lvl of consciousness)
- Objective: more concrete facts (HR, RR, temp, etc)
- Assessment: determined by vet (anesthetic risk categories, DDx, etc)
- Plan: what is being done (diagnostic testing, sx, etc)
What does PAP stand for? What does it consist of?
Preanesthetic panel consists of BUN, Cr, Alk Phos, ALT, Gluc, TP
What is the GHP? What does it consist of?
General health panel consists of BUN, Cr, Alk Phos, Gluc, ALT, TP, Amyl, T-bili, Phos, Alb, Ca, Chol
What is involoved in a CBC?
- WBC differential
- Platelet count
What do blood chemistries assess?
Enzymes, electrolytes, proteins and metablolites
What are some indications of kidney fxn?
What causes glucosuria?
Stress, renal dz, diabetes mellitus
Urobilinogen is indicative of what?
What might be seen with a urinary tract infection?
Describe classes I - V when talking about anesthetic risk.
- Class I: minimal risk, normal & healthy (OVH & neuter)
- Class II: slight risk, minor dz present (neonates, geriatrics, obese, local infection)
- Class III: moderate risk, obvious dz (anemia, fever, low grade heart dz)
- Class IV: high risk, significant dz (shock, uremia, toxemia, uncompensated heart dz)
- Class V: extreme risk, moribund (HBC, KBH, blocked tom, advanced metabolic dz)
What sx may be performed on a blocked tom?
Perineal urethrostomy (PU sx)
Fasting prior to anesthesia can help prevent what?
Aspiration pneumonia or esophageal inflam.