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VIC
Veterinarian in charge
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What is minimum patient database?
Patient history, physical examination and diagnostic tests
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What is preinduction care of the patient
Medication administered, IV catherization, fluid administration and stabilization
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4 points to ask in regards to symptoms
- Duration
- Volume/severity
- Frequency
- Character/appearance
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What type of consent to get from owner before a procedure
Written and oral
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When confirming a surgical procedure check the following specifics
- If surgery on a limb confirm affected limb
- Removing tumor know exact location
- If removing tumor confirm owners request with histopathology or cytology
- Determine if client wishes doctor to use their judgement regarding unforeseen decisions during surgery
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Signalment is...
- Species
- Breed
- Age
- Sex
- Reproductive status
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Which species are sensitive to opioids
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Which species requires lower doses of lidocaine
Cats
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Which species is more resistant to the effect of phenothiazine
Cats
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Which species tend to have rougher recoveries from inhalant anesthetics
Horses
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Anticholinergics should be avoided in which species
Ruminants, can make their saliva thick and can lead to airway occlusion
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Ruminants are more sensitive to which drug that requires 1/10 the dose of horses
Xylazine
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Small pediatric animals are prone to what under anesthesia?
- Hypercarbia (elevated CO2 in blood)
- Hypoexmia
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Dead space
Breathing passages and tubes convey fresh O2 from the source to the alveoli but in which no gas exchange can occur
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Which species are prone to airway blockage
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Which species are prone to bloating
Ruminants
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Which breeds are sensitive to barbiturates because of their lack of body fat and slow metabolism
Sighthounds
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Which breed is more sensitive to acepromazine
Boxers
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Which breed is resistant to acepromazine
Terriers
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Which breeds are more difficult to intubate
Brachycephalic
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Which breeds of horses are sensitive to sedatives
Draft horses
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Which age of animals are less capable of metabolizing injectable drugs because the necessary liver metabolic pathways are not fully developed
- Neonates (up to 2 weeks old)
- Pediatric (2-8 weeks old)
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Which age of animals may not be able to tolerate normal drug doses because of poor hepatic or renal function
Geriatric
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Reproductive status refers to what..
Whether the patient has been spayed, neutered, intact or if being used for breeding purposes
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Why not to perform a spay when an animal is in heat
Uterus is enlarged and more extensive blood supply, can also bleed excessively due to effects of estrogen
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Which drug can cause penile prolapse in stallions
Acepromazine
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Which drug can cause uterine contractions in third trimester in sheep and cattle
Xylazine
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Epinephrine given with which drugs can cause cardiac arrhythmias
- Cyclohexamines
- Xylazine
- Barbiturates
- Halothane
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Antidepressants such as ___ and___ may cause cardiac arrhythmias and excessive responses to anticholinergics and CNS depressants
- Amitriptyline
- Clomipramine
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Which drug may decrease biotransformation of barbiturates and anesthetics, may also prolong propofol and ketamine
Chloramphenicol
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If given within 14 days of each other some monoamine oxidase inhibitors such as ___ and ___ may increase effects of morphine and other opioids
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May cause an increase in CNS and respiratory depression if given with opioids
Antihistamines
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Change in an animals behavior could indicate...
- CNS disease
- Pain
- Systemic illness
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Exercise intolerate could indicate...
- Heart disease
- Anemia
- Muscoskeletal pain
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Fainting could indicate...
- Hypoxemia
- Low blood pressure
- Cardiac disease
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Seizures may indicate..
- CNS disease
- Toxin ingestion
- Metabolic disorders
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CPCR
Cardiopulmonary cerebrovascular resuscitation
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Dehydration increases the risk for these anesthetic complications
- Hypotension (low blood pressure)
- Poor tissue perfusion
- Kidney damage
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Anemia decreases...
Oxygen carrying capacity of the blood and predisposes patient to hypoxemia
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Bruising lesions on the skin or mucous membranes indicate...
Clotting disorder
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Numeric assessment of patients weight compared with the ideal body weight
Body condition score
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Ideal body conditioning score in dogs
4 or 5
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Ideal body conditioning score in cats
5
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Body condition score of 1 indicates
Extreme cachexia
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Excessive thinness in patient may indicate
- Hyperthyroidism
- Parasite overload
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Parameters indicating hydration levels
- Skin turgor
- Position of eye in orbit
- Mucous membranes
- Refill and moisture level
- Heart rate
- Pulse strength
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LOC
Loss of consciousness
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EENT
Eyes, ears, throat, nose
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PLR
Pupillary light reflex
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Direct light reflex
Observe and compare pupil sizes, direct light into right eye and note size of pupil
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Pupil constriction
Miosis
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Consensual light reflex
While light shining in right eye observe the pupil size of the left eye, pupil should be the same size as the right
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Dog normal heart rate
60-180
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Cat normal heart rate
120-240
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Horse normal heart rate
30-45
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Cow normal heart rate
60-80
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Sheep/goat normal heart rate
60-90
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Regular rhythm with no irregularities to pause between beats is...
Normal sinus arrhythmia
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Rhythm in which the heart rate cyclically increase during inspiration and decreases during expiration
Sinus arrhythmia
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First degree heart block is caused by what
Conduction delay through the AV node and prolonged PR interval
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Second degree heart block caused by what
Periodic block of electrical conduction through the AV node and missing QRS complex
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Where to palpate pulse
- Femoral artery
- Medial side of rear leg
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Cyanotic mucous membranes indicates
Reduced oxygen saturation
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Dyspneic patients show signs of..
- Mouth breathing
- Flared nostrils
- Excessive panting
- Exaggerated chest or abdominal movements on inspiration
- Wheezing
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Complete blood cell count consists of
- PCV
- Plasma protein (PP)
- Hemoglobin
- RBC count
- WBC count
- Platelet count
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Elevated PCV or RBC count is often caused by ___ and may cause...
- Dehydration
- Decrease in blood volume
- Affect cardiac output, blood pressure, and tissue perfusion
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PP is measurement of blood protein including...
Albumin, globulins, fibrinogen
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Hypoproteinemia results from...
Decreased protein production by the liver or increased loss from GI tract, kidneys or blood loss
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PP with less than ___ should be reported
4
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Changes in WBC counts can be associated with...
- Infection
- Parasitism
- Leukemia
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Kidneys regulate...
- Electrolyte and water balance
- Blood pressure
- Elimination of anesthetics
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Specific gravity for a dog
1.030
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Specific gravity for a cat
1.035
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Specific gravity for large animals
1.025
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Color, clarity, odor and biochemistry of a urinalysis can indicate...
- Diabetes
- Liver/Renal disease
- Systemic disorders
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Blood chemistry test asses...
- Circulating enzymes
- Electrolytes
- Proteins
- Metabolites
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Which tests should be performed on patients that have preexisting coagulation disorders
- Prothrombin time (PT)
- Activated partial thromboplastin time (APTT)
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Which breeds might have hereditary coagulation disorders
- Dobermans
- Rottweilers
- Scottish terriers
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Records electrical activity of the heart
Electrocardiogram
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P1
Normal, healthy, minimal risk
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P2
Mild systemic disease, neonatal geriatric or obese patients, low risk
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P3
Severe systemic disease, anemia, moderate dehydration, compensated major organ disease, moderate risk
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P4
Severe systemic disease that is a constant threat to life, high risk
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P5
Moribund, not going to survive without operation, extreme risk
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Which gases require precision vaporizer
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Active expulsion of stomach contents that occurs in conscious patients
Vomiting
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Passive process that may occur in an unconscious or conscious patient, results in flow of stomach contents into esophagus and mouth
Regurgitation
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Fluid administration helps maintain __ and ___
Blood volume and blood pressure
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CRI
Constant rate infusion
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2 types of catheters
- Through the needle
- Over the needle
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What size catheter for small animals
16-24 gauge 3/4-2 inch
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Air embolism
Air going into catheter and vein
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Almost all anesthetic drugs decrease ___ and cause ____, in turn decreasing flow of blood from heart
- Force of heart muscle contractions (inotropy)
- Bradycardia
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Increase in intravascular volume
Vasodilatation
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Fluids aid in oxygen delivery by___ and ___
- Increasing blood volume and cardiac output
- AKA blood pressure and tissue perfusion
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What percentage of body weight in adult animals is water
60%
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What percent of body weight is intracellular fluid
40%
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Extracellular fluid is broken down into two different types...
- 15% interstitial
- 5% intravascular
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What percent of body weight is extracellular fluid
20%
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Solutes important in fluid therapy
- Ions
- Colloids
- Glucose
- Small proteins
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Proteins are important in what 3 things
- Drug transport
- Oncotic pressure
- Blood clotting
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Anions
- Cl-
- HCO3-
- Phosphates
- Proteins
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Constant state within the body created and maintained by normal physiologic processes
Homeostasis
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Small ions and particles diffuse ____ until ___ ____
- Freely
- Equilibrium balanced
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Colloids dont diffuse and act to increase ___ ___ and draws fluids into __ ___.
- Oncotic pressure
- Vascular space
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Blood volume of dogs
90 mL/kg
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Blood volume of cats
60 mL/kg
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Increase in K+ causes
Heart to stop
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Osmolarity solute concentration
300 mOsm/L
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What increases water loss
Dehydration, exercise, heat stroke, vomiting, diarrhea
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What decreases osmolarity
Chronic heart failure
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Increase in Ca++ will cause
Arrhythmias
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Naturally occurring form of glucose
Dextrose
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Fluids are classified into two different types
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Fluids subdivided by mix and quantity of solutes as..
- Replacement
- Balanced/Unbalanced
- Isotonic
- Hypotonic
- Hypertonic
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Contain water and small molecular weight solutes such as electrolytes
Crystalloids
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Isotnic, polyionic replacement solution
Contains ions such as sodium, potassium and chloride, is some cases magnesium and/or calcium
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Examples of isotonic, polyionic replacement solutions
- Lactated ringers (LR)
- Normosol-R (NR)
- Plasma-Lyte A (PA and PR)
- Isolyte (IS)
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Examples of isotonic, polyionic maintenance solution
- Normosol-M in 5% dextrose (NM5)
- Plasma Lyte 56 in 5% dextrose
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Normal saline solution AKA physiologic saline examples
- 0.9% saline
- Sodium chloride 0.9%
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Hypertonic saline solutions
Concentrated saline solution given with isotonic crystalloids to treat patients with shock
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Dextrose solutions
Rapidly metabolized to CO2 and water and most of the plain water diffuse into the interstital compartment
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Contain large molecular weight solutes that cont freely diffuse across vascular endothelium and stay in intravascular space
Colloid solutions
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2 types of colloid solutions
- Synthetic colloids
- Blood products
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Synthetic colloid solutions
Contain Dextran, pentastarch, hetastarch or gelatin products. 30-60% stays in plasma after 24 hours and smaller amount remains for as long as days to week
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Dose of synthetic colloids
- Dogs: 10-20 mL/kg/day
- Cats: 5-10 mL/kg/day
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Blood products
- Plasma and whole blood contain albumin and other natural colloids.
- Plasma used to support expansion of blood volume or treat hypoproteinemia
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IV fluid flow rate
10 mL/kg/hr during first hour and 5 mL/kg/hr for maintenance
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Shock doses old school way
- Dogs: 90 mL/kg/lb
- Cats: 55 mL/kg/lb
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Shock doses new way
- Dogs: 10-20 mL/kg/15 mins
- Cats: 5-10 mL/kg/15 mins
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Maintenance fluid rates
- Dogs: 3-6 mL/kg/hr
- Cats: 2-3 mL/kg/hr
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Signs of overhydration
- Ocular/nasal discharge
- Chemosis
- Edema of conjunctiva
- SQ edema
- Increased lung sounds
- Increased respiratory rate
- Dyspnea
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Macrodrip used for patients __kg or more
10
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Microdrip used for patients less than __ kg
10
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Pain medicine administered before a procedure
Preemptive analgesia
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No signs detectable for dehydration
< 5
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Mild loss of skin elasticity
5-6
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Definite loss of skin elasticity, may have dry mucous membranes, may have depressed globes within orbits
6-8
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Persistent skin ten with slow return because of loss of skin elasticity
8-10
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Persistent skin tent because of loss of skin elasticity, depressed globes within orbits, dry mucous membranes, CRT > 2 seconds
10-12
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Signs of shock , death
12-15
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Fully conscious, alert, engaged and interested in enviornment
BAR
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Fully conscious and alert but not engaged, owing to fear, pain, illness. Subdued or quiet
QAR
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Mildly depressed, aware of surroundings. Can be aroused with minimal difficulty
Lethargic
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Very depressed. Uninterested in surroundings. Responds to but cannot be fully aroused by a verbal or tactile stimulus
Obtunded
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Sleeplike state, nonresponsive to a verbal stimulus. Can be aroused by a painful stimulus
Stuporous
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Sleeplike state. Cannot be aroused by any means.
Comatose
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Anesthetic protocol that uses anesthetic drugs to maximize benefits and minimize risk
Balanced anesthesia
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Abnormal heart rhythms can be differentiated from sinus arrhythmia by observing ___ while auscultating heart
Respirations
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Healthy dogs and cats should withhold food for ___ and water for ___ before anesthesia
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