This site is 100% ad supported. Please add an exception to adblock for this site.

Vet Anes Test 2: Cardiovascular dz

Terms

undefined, object
copy deck
No epiglottis or diaphragm in reptiles like in?
birds.
most common acq dz cardiac in horses?
conduction disturbances, valvular dz
Conventional lab tests don't measure liver function. ALP is a sign of?
biliary obstruction.
Masking animals down increases?
myocardial oxygen demand
What sort of resp changes do you need to account for during pregnancy?
while be induced faster b/c incr O2 consumption by 20% and desaturation occurs quickly w/o supplemental O2
What question should you ask to det heart dz?
duration of ownership, pervious mention of murmur, cough (more common in dogs), collapse, lethargy, seizures, current meds
FMD break out. What do you do?
euthanize/depopulate all infecteds w/i 24 hrs, all contigouas farms w/i 48 hrs
You are euthanizing a horse. What method do you use?
pentobarbital 100mls in jugular catherter
What gas should you not use with pneumothorax?
NO
What aer obj analyses of heart dz?
ECGs (rhythm, chest enlargement), chest rads, ECHOCARDIOGRAPHY, chemistery, CBC
During a c-section your dog begins to bleed out. What do you use to maintain blood pressure?
colloids
Liver dysfunction will affect things like:
glucose homeostasis will decrease, fat metab will decrease, protein syn will decrease, decrease formation of urea from ammonia, decrease albumin. Drug and hormone metab will be decreased b/c dependent on blood flow and microsomal activity in the liver. Bilirubin formation and excretion- incr in conjugated form of bilirubin but also incr in unconjugated bilirubin because of hemolysis.
What drugs increase CBF?
all inhaled, iso least, halo most, cycloheaxmines incr CMR and CBF
Why does ICP incr during anes?
as CBF incr so does ICP, CBF related to cerebral metabolic rate (CMF)
You are anesthetizing a pregnant dog. Why should you reduce the anesthetic req by 25-40%?
incr prog modluates type A GABA receptors, hormonal antinociception dure to incr E and prog, and the epidural/CSFspaces anesthetic need decr by 30-50%
You are euthanizing an animal by disruption of brain funtion. What methods can you use?
bullet, electrocution (follow w/ second method to insure death)
Explain fetal ion trapping?
highly lipid soluble drugs cross easily, opiods and local anesthetics are weak bases and cross easily b/c lipid soluble, only non-ionized durgs will transfer. In an acidotic fetus, weak bases are in an ionized form and get trapped and accumulate
What is the cushings reflex?
systemic hypertension to maintain CBF in the face of incr ICP accompanied by bradycardia is not a good sign
A yorkie with a history of cough and resp distress comes in. What syndrome are you expecting to see?
tracheal collapse
Centrilobular hepatic necrosis is seen w/?
induced liver damage. Low o2 avail to liver incr it.
In food animals what is the most common acquired cardiac dz?
myocardial, inflammatory, valves
Crocodiles have a?
gular fold.
What drugs do not increase CBF?
benzodiazepines, a2 agonists, thio, propofol, etomidate, opiods, phenothiazines, butyrophenones
IV fluids in CP?
don't overload patient(2-3 ml/kg/hr or if in failure don't use any)! avoid hypertonic saline!, avoid colloids unless hypoproteinemic or hypoalbunemic
Do blood work. Opiates in birds-?
butorphanal, kappa agonists, bensodiazepenes w/ opiates are safe. Diazapam compounded w/ propylene glycol...dissociatives on bigger birds. For inhalants, it is preferred. Period. Fast recovery, tight control. Mask can induce and maintain anesthesia.
What is the best way to anes a patient in acute postrenal failure?
dialysis, isotonic saline or colloid in trauma cases, tables 1 and 2
What drugs do you use to treat interstitial volume increases in ICP patients?
mannitol unless there is an obstruction, loop diurectics, corticosteroids
What are the signs of hepatobiliary disease?
It's nebulopathic. Can have about any sign but classics are hepatomegaly, ascites, jaundice, coagulopathies.
this is not usually a problem following opiod administration?
hypoventilation in incr ICP patients
21% of dogs are likely to have this happen when having a myelo?
seizures, also >20kg and more contrast incr risk
What is the rx for acute hyperK?
Ca salts to stabilize HR, table 4
How do you restore urine prod in an oliguric pt?
if prerenal use isotonic fluids, if dt low CO, restore circulating vol then use ionotropes, diuretics should not be used in hypovolemic pts
A dog has dystocia w/o c-section. 15.6% of the puppies DOA with 7.9% dead soon after birth. Why did this happen?
mom's dehydration, hypovolemia, sepsis, stress, exhaustion, hypocalcemia pup's hyypoxia, acidosis, hypercapena, distress
Heart rate is slow, down in the teens. The Doppler can be useful on the?
thoracic inlet to hear sounds.
CBC will tell you if the animal is?
hypoproteinemic, anemic, affects fluid choice
Decreased ICP measuremens in neurologically normal patients is observed with all drugs, including?
ket, fentanyl, iso
how are perfusion pressure and renal output regulated?
decr perfusion pressure reduces hydrostatic pressure in the glomerular capillaries and decr filtration, SymNS stim due to surgery causes renal aretery vasoconstriont, decr RBF and glomerular filtration rate despite maintenance of persion pressure w/i the range of autoreg, hemmorhage, hypovolemia, dehydration, all decr filtration P through icr plasma oncontic pressure, any decr in RBF wil initiate renin rlz, which w/ catecholamines decr RBF
Where can you give naloxone to a neonate if you think it has had an opiate overdose?
sublingually o rinto umbilical vein
Can have failure w/o?
murmur
Puppy neurological reflex depression rankings (least to most) with an epidural, prop/enflurane, thio/enflurane, midazolam/ket/enflurane?
epi highest resp rate, prop/en lowest rate, mid/ket/enf lowest rate
To test the dogs heart, what should you do?
is the animal more comfortable lying down (good) or sitting up (bad), run animal up and down the hall
Use drugs w/ a specific antagonist so
if we get in trouble can get out of it.
cardiac 2:
MOD DZ, receiving drugs
how is renal blood flow regulated?
autoreg at 60-160mmHG MAP
What else does the kidney do besides make urine?
target for PTH, aldosterone, ADH, metabolize and secrete insulin, renin, PGs, erythropoietin
When euthanizing a wild animal, what should you consider?
what will happen to scavengers wo heat the carcass. Use IV KCl or head shot
Can I use an ECG to est plasma K conc?
mild K incr causes T waves to be TALL AND PEAKED w/ HR and P waves normal, mod K incr causes HR to slow and P waves to flatten, high K incr causes bradycardia atrial standstill T wave +/- large, Pts w/ K >5.5-6 should not be anes for elective procedures
What CV changes do you need to account for during pregnancy?
incr maternal plasma volume and incr CO (40%), utero-placental perfusion is pressure dependent b/c fetal blood flow not autoregulated, uterine perfusion maintained b/c bicornuate uterus
You are euthanizing an animal by hypoxia. What methods can you use?
CO2, N2, Argon, CO, exsanguination after unconsciousness
What is the principal function of the kidneys?
regulate water and E balance, excrete H and nitrogenous waste, 25% of CO, GFR= 20% renal plasma flow, .5-1 ml urine/hr
in teh small geriatric what is teh most common?
valve dz
If we have incr prothrombin time, incr plasma bilirubin, or decrease in albumin, or ascites they're all ass w/?
worsened prognosis. Albumin and ascites are linked, remember? Albumin holds fluid w/in the vasculature. If the bilirubin is high then is a sign of bad prognosis, but can have it low and still have bad prog.
Birds don't have diaphragms so if compress sternum?
they die. Gloves aren't so good b/c not very protective. NO PRESSURE ON CHEST.
Have complete tracheal rings so be careful w/?
cuff inflation.
How should you support CP?
inotropes (esp if poor contractility), inotropes not a good idea in hypertrophic pts, use much catuin w/ drugs that cause vasoconstriction
How do you improve puppy survival after a c-section?
when surgery not emergent, dam was not braachy cephalic, less than 4 pups in litter, no natural delivered or deformed pups, no METHOXYFLURANE or XYLAZINE used, Iso and propofol ass/ with better 7d survival
Bradycardia can be treated with what in a pregnant dog?
atropine or glycopyrrolate (ineffective in fetus)
Ventilate 1-2x per min. Can get an ECG in these guys by putting needles in skin and hooking it in. Give fluids in skin under?
scales subq.
How do you calculate CPP?
CPP = MAP-ICP
Check ECGs for?
a p, q, r, s, t waves
what congenital defects are most commmon?
patent ductus arteriosus, septal defects, stenotic valves
Can you use low-doses of dopamine to stimulate renal dopaminergic receptors adn imp renal output?
low dose dopamine has no evidence for to rx or prevetn ARF
Serum albumin is a sign of chronic liver dys b/c it takes?
14-21d to be made. Albumin binds to some drugs and lessens the effect, making inactive forms. Albumin makes most of the plasma oncotic P.
Three basic mechanisms for euthanasia are?
depression of neurons necessary for life, hypoxia, disruption of brain activity
Monitoring- have someone always monitoring. Resp is vital, monitored by?
heel movement. Don't want to rest anything on keel! Monitor same things you would monitor in other species (withdrawal, etc).
what is most common in boxers?
conduction
If you tie beack w/ waterfowl will cause?
dive response= bradycardia. Mask waterfowl down. Birds with long pointy beaks can attack you when you try to mask them.
What are your best choices for induction for c-section?
propofol (single-dose only), etomidate + fentanyl,
An older lab comes in with upper airway noise. What do you do to anesthetize it?
sedate, pre-ox, propofol
What is the best lab test for clinical eval of renal function?
when 70% of nephrons are nonfunctional, HCT, acid base status, Na and K levels
the cardiac council classification takes into account what only?
severity, not the cause of dz, we must know the cause to give drugs
Breath holding in reptiles is?
common.
Why does the risk of pulmonary aspiration increase during pregnancy?
incr prog- decr gastric emptying- incr gastric vol- decr gastroesophageal sphincter tone
Why does lung vol decr during pregnancy?
uterus displaces pylorus
Things that do predict liver function well are things made by the liver itself like?
bile, BSP retention (a dye) that is administered and watch how fast is cleared to determine liver function. Transaminase enzymes of variable use for function, but can be a flag for problems
Jiggly line on an ECG is?
atrial fibrillation
Idiosyncratic drug induced hepatitis is caused by
analgesics, antibx, tranquilizers, etc. Signs start 2-6 wks after therapy but can occur earlier. Pathology is centrilobular necrosis.
When both live and dead pups were delivered before surgery, what method of anesthesia gives the best survival?
epidural (71%), prop/iso (68%), thio (7%) w/ initial 24 hr mortality highest w/ thio (20%), iso/prop (6%), lidocaine epidural ( 4%)
Recovery- w/ inhalants is?
rapid. Gently restrain until upright. Give butorphanol and NSAIDS for pain.
Etomidate is good for?
induction drug of choice in anis w/ significnt cardiac dysfunction
cardiac 4:
moribund
Opiods are good for waht in cardiac pts?
brady cardia but can be dealt with
You are euthanizing an animal by anesthetic overdose. What method is best to cause resp/cardiac arrest?
inhaled anesthetics or injectables (better)
benzodiazepines are good for what in cardiac patients?
wide safety margin, reversible, no effects on the heart, combinations w/ opiods good
what kinds of renal failure patients am I likely to anes?
anis w/ acute postrenal problems where anesthesia and surgery are emergently req, anis w/ chronic renal dz where anes is req to do an unrelated sx
inhalants in CP are good for?
dose dependent reductions in CO and BP, use other durgs to decr use of these
What is the difference between flow and capacity-dependent metabolism?
Flow-dependent is the amount of drug being presented for metabolism. Perfusion will be directly and indirectly affected by anesthetics and surgery.
Anticholinergics ar good for?
pediatrics or cats (patients whose cardiac output is rate dependent), bradyarrhythimias, cardiac arrest, may cause tachycardia that will not be tolerated by cardiac patient
Sensitive skin. As they go to sleep relax from?
head to tail. Recover tail to head. Cloacal tone, tail pinch, used for depth monitoring. RR and HR slow. Recovery is slow.
what is most common in large giant breeds?
dilated cardiomyopathy
For a diaphragmatic hernia, what should you do to anes?
pre-ox, RAPID INDUCTION, shock may occur after viscera removal, check for atelectasis before closure
Barotrauma is caused by?
excess airway pressure, closed p relief valve, pneumothorax, sq emphysema, pneumomediastinum
ASA 2:
mild diz, no failure, no drugs
Dogs that are on heart meds are also on?
diurectics with messes w/ ACE inhibitors and can mess with electrolytes and cause anes probs
What are you checking for in physical exams to indicate heart problems?
jugular pulses (distended, pulsing, Right sided heart failure), edema, ascites, wide forelimb stance
AsA 1:
healthy
Fasting- empty crop out to prevent?
aspiration.
A patient fails to respond to rx, or there is no effective rx and the animal has a poor quality of life. Rx?
euthanasia
What premeds should you not use in a c-section?
alpha-2s, benzos
cardia 3:
ani in heart failure and needs drugs to survive
how long do anes agents affect renal function?
transiently, limited to anes period, attenuated by perioperative fluids
Murmurs indicate?
chamber size and enlargment
A pot-bellied pig with resp distress comes in. What problems should you be on the lookout for?
stenotic nares, hypoplastic trachea, brachycephalic syndrome
ASA 3:
mod dz, receiving drugs
Cardiac 1:
mild dz, no failure, no drugs
Rules of thumb for animals with resp problems are?
minimize stress, pre-oxygenate, intubate, ventilate, monitor closely
Alpha-2s are good for what in cardiac pts?
not recommended in cardiac pts exced in HCM cats and horses (xylazine, detomidine, medetomidine), increases preload so good for HCMs
in dogs what is the most common?
PDA
CBF varies directly and linearly with?
PaCO2
Hyperventilation transiently decr CBF in patients suspected of having?
ICP (target PaCO2 is 30-35, ET CO2 25-30)
Can ketamine be safely used in neurologically impaired patients?
yes
the same drugs that are best for maintaining balance of CMR and CBF are also best for?
CSF dynamics
Hepatic arterial blood flow is autoregulated. Basically, if we have this autoregulation halothane tends to preserve autoreg when used at less than 1 MAC. So what?
The point is light levels of anesthesia we can maintain this autoregulation. Isoflurane tends to preserve it better than halothane but if we get them too deep or the BP is too low it won't be preserved. Try to maintain blood flow and lightness. Surgery can cause a reduction in hepatic blood through from release of vasoconstricting purposes and blockage of blood flow. If you have a drug that depends on high hepatic clearance rates and flow is reduced then amt of drug being presented is reduced then we have a prolonged effect.
reptils Have a 3-chambered heart, except the?
crocodile.
can anes agents cause delayed nephrotoxicity?
2o to biotransformation of fluoride containing inhaled anes methoxyflurane to oxalate and free inorganic fluoride ion, methoxyflurane enhances nephrotoxic effect of other drugsincluding flunixin meglumine and aminoglycoside antibiotics
What about nephrotoxicity with other fluoride containing anes?
sevo is transformed in the presence of Sodasorb or baralyme into compound A, unlikely to be toxic in semi-closed system
Puppy vigor is reduced by?
using inhaled anesthetic, ketamine, thiobarbituates, did not influence 7d survival
What are the anes rules of thumb?
avoid incr myocardial oxygen demand, avoid fluid overload, maintain adequate o2 delivery, maintain HR near awake level, inotropes are great for poor contractility (dilated cardiomyopathy), do not suddenly change cardiac meds, correct arrhythmias if possible, pre-oxygenate
Reptiles areTolerant of moderate?
hypoxemia.
Horse most common congenital defect is?
ventral septal defect
DO NOT USE TELAZOL IN TIGERS BECAUSE
IT CAUSES SEIZURES. Okay in lions.
Blood loss- don't tolerate blood loss well. Trky to give fluids through?
the wing veins or veins in the legs. Keep them warm. Use ECG. Needles under the skin and clip right onto the needles. Sensor over the sternum or ches for Doppler.
What drug qualities are desirable when anesthetizing a pregnant dog?
drugs w/ short duration, antagonists available, use lowest dose, use local techniques when possible
Restraint is easy unless they're venomous or a crocodile. Ketamine works well in?
healthy reptiles. Ketamine plus other stuff works well in sick reptiles.
When faced with a dog that has hypertension and ICP, which should you take care of first?
ICP
edema, pneumonia, atelactasis, neoplasia, contusions, asthma, COPD, and torsions are all examples of?
intrapulmonary probs
Acepromazine is useful for what?
low doses in animals with dilated cardiomyopathy, combination with opiods, not great in animals with HCM or congestive heart failure, good for calming patient
How should you monitor a CP?
ECP, BP, central venous pressure, pulse oximeter, capnograph
Handling not unusual for birds to die when you try to grab them so
don't handle them or use towels. Nets not so good.
Thio is good for?
not rec in anis w/ sig cardiac dysfunction b/c causes tachycardia and tachyarrhythmias
what acq dzs are most common?
valvular dysfuntion, myocardial failure, conduction disturbances
When is mechanical pressure indicated?
if ani is apneic, if spontaneous ventilation not allowed by procedure
What is the best way to anes a pt in chr renal failure?
maintain RBF, avoid hypovolemia, hypotension, FLUID ADMIN most imp!, tables 1 and 2
A dog presents with headache, nausea, vomiting, and seizures in adult animal who has never had them before. What are the dynamics of the presumed process?
parenchymal tissue inflamed or neoplasia (80%), incr in blood flow (10%), CSF (10%) reduced outflow, increase in any of these causes a change in the other (monro-kellie doctorine)
Which anesthetic drugs cross the placenta?
all (drugs w/ mol wt < 500 daltons cross easily
You have a choice of using an epidural, propofal/iso, or thio to do a c-section. Which one gives teh highest survival?
propofol/iso (89%), epidural (83%), thio (56%)
pneumothorax, hydrothorax, diaphragmatic hernia, chest wall injury, obesity, abdominal distention, and neurological abnormalities are all examples off?
extra-pulmonary probs
DOes surgery time matter in puppy survival?
no
How does anes and surgery affect glomerular filtration?
rlz neurohumoral substances, changes in arterial BP, catcholamine rlz, ADH, endothelin, NO, PGs, aldosterone-renin-angiotensin system
Prehepatic dysfunction has an incr in?
unconjugated bilirubin, normal ALT and ALP. From hemolysis, bilirubin overload from whole blood transfusion.
Not all murmurs indicate?
failure
When you do your physical exam for cardiac probs, what should you do?
do in a quiet room, listen to both sides of the heart, listen tolungs, feel pulses,
Where can you do acupuncture to stimulate breathing?
gov vessel 26
ECG abnormalities may or may not indicate?
failure
Capacity dependent- is
the ability of the organ to metab the drug and depends on the functionality of Microsomal CYP and you cannot predict this based on leakage enzymes. Microsomal function is usually a fraction of its total capacity
dissociatives use in cardiac patients?
increase cardiac consumption and heart rate, useful in low doses EXCEPT IN CATS W/ HCM (don't ever use for them)
Incr CBF can be temporarily offset by?
IV benzos and mod hyperventilation
Both active inspiration and expiration as far as the parabronchi are concerned. If stop breathing are in trouble b/c
continous breathers.
IN cats what is the most common thing seen?
hypertrophic cardiomyopathy, idiopathic and hyperthryroidism (in older cats, skinny but eating well, gallop rhythm, thyroid slip) factors
Post-op care for CP?
oxygen! esp if shivering
Sometimes see post anesthesia hepatid dysfunction.
Catecholamine, etomidate, sepsis, bilirbuinemia, drug induced hemolysis all can cause problems. Anything formulated w/ propylene glycol can be a prob! Alos rule out intraop hypotension, hypoxemia, hypoventilation, hypovolemia. Also rule out extrahepatic causes like CHF, and benign post-op stuff.
What local anesthetic techniques can you use for a c-section?
line block, inhalant, epidural (but ass w/ maternal hypotension, fetal acidosis
Intrahepatic or hepatocellular disease incr?
conj bili, big incr in ALT and kinda normal ALP. From sepsis, hypoxemia, shunts, cirrhosis.
How do you euthanize a pet dog?
IV injection of DEA II, III, IC ONLY on comatose-like animals
local anesthetics are good in cardiac pts for?
regional use (epidural), lidocaine
how do inhalant anes agents acutely affect renal function?
no direct effect on autoreg of GFR or RBF, indirectly reduce GFR and RBF through their depressant effects on cardiac function and BP, effects can be attenuated by perioperative fluid admin and reducing the inhaled anes
Can I admin an NSAID for analgesia during anes and sx w/ renal pts?
perioperative pain control, OK to use in clincally normal dogs, limit to well hydrated pts w/ normal renal function receiving IV fluids
The portal vein drains the intestines and comes back to the liver. It provides?
55% of the oxygen to the liver, and other half is from the hepatic artery.

Deck Info

158

permalink