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157 Cards in this Set
- Front
- Back
What are the 4 purposes of monitoring anesthesia?
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1) Assess depth of anesthesia
2) Assess response to anesthesia 3) Verify performance of equipment 4) Improve safety |
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In general, what variables of anesthesia do you want to monitor?
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Variables that respond quickly to change in anesthetic depth
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When monitoring you are assessing normal VS abnormal values for what 2 things?
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1) Vital signs in that specie
2) Responses to anesthetic drug administration |
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What are the 3 organ systems being monitored during anesthesia? What do you assess for each system?
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1) CNS
-assess depth of anesthesia 2) Cardiovascular -assess adequacy of perfusion 3) Respiratory -Assess ventilation/ oxygenation |
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How do we assess ventilation?
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By monitoring how well the animal is eliminating CO2
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What are 10 parameters that we monitor during anesthesia regarding the cardiovascular system?
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1) HR
2) ECG 3) Pulse rate 4) Pulse pressure 5) Membrane color 6) Perfusion time 7) BP 8) Pulse oximetry 9) Central venous pressure 10) CO |
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What are 3 methods used to monitor the HR?
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1) Auscultation w/ stethescope, if thorax accessible, or esophageal stethoscope
2) Palpate peripheral pulse 3) Monitor ECG -lets you know rate & rhythm |
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What are 2 types of leads used to monitor the ECG?
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Lead II
Base-apex lead |
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Compare the heart rate of larger breeds and smaller breeds.
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Larger breeds are slower
Smaller breeds are faster |
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Do juveniles have a faster or slower heart rate?
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Faster
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True or false. Heart rate is usually unaffected by premedication and anesthesia depth during small animal surgery.
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False, affected by premedicants used and depth of anesthesia can affect HR (insufficient anesthesia= increased HR)
e.g. Dexmetatomidine & opioids slow HR |
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What are 6 arteries that can be paplpated to measure the pulse in canine/felines?
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1) Dorsal pedal
2) Femoral 3) Lingual 4) Coccygeal 5) Metacarpal 6) Metatarsal |
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What is the normal heart rate of dogs under anesthesia?
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65-180 beats / minute
-alpha2 will slow HR to 40 or 50 so he'll use a lower dose |
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What is the normal heart rate of a cat under anesthesia?
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100-220 beats/minute
-alpha2 will slow HR to 40 or 50 so he'll use a lower dose |
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When does the depth of anesthesia affect HR in SMALL ANIMALS?
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Usually won't decrease as depth of anesthesia increases, but can increase if depth of anesthesia is insufficient
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Out of horses, ruminants, camelids and swine, which has the slowest HR?
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Horses
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How does the HR fluctuate with anesthesia in LARGE ANIMAL surgery?
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HR may decrease as depth increases (except in horses)
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What are 6 arteries that can be palpated to measure the pulse in a horse?
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1) Facial
2) Digital 3) Radial 4) Dorsal metatarsal 5) Transverse facial 6) Caudal auricular |
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What is the normal heart rate of an adult horse under anesthesia? Juveniles?
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Adults: 30-50 beats/min
Juveniles: 50-70 beats/min |
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What are 4 arteries that can be palpated to measure the HR in ruminants?
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1) Common digital
2) Caudal auricular 3) Saphenous 4) Radial |
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What is the normal HR of an adult ruminant under anesthesia? Juvenile?
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Adult: 70-100 beats/min
Juveniles: 80-120 beats/min |
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What are 4 arteries you can palpate to measure the HR in a camelid?
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1) Common digital
2) Caudal auricular 3) Radial 4) Saphenous *Same as ruminants |
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What is the normal HR for an adult camelid under anesthesia? Juveniles?
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Adults: 60-90 beats/min (w/ atropine)
28-40 beats/min (w/ alpha2) Juveniles: 90-125 beats/min |
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What are the 3 arteries that can be palpated to measure the heart rate in swine?
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1) Radial
2) Caudal auricular 3) Saphenous |
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What is the normal HR for adult swine under anesthesia? Juveniles?
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Adults: 60-90 beats/min
Juveniles: 90-125 beats/min |
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What are the 3 characteristics of the pulse that you should analyze?
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Strength, rate, rhythm
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What determines the pulse pressure?
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Difference b/w systolic and diastolic pressure
e.g. 120/90 mmHg palpates similar to 90/60 mmHg |
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True or false. Pulse strength gives a pretty accurate quantitative estimate of BP.
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False, not accurate
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When examining a pressure wave, what is a dicrotic notch? Is it a good thing?
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Blood is ejected from aorta and then blood starts to flow backwards towards the heart, then the valves closes and blood hits the valve and squirts forward again
-it appears as the second bump on graph |
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What is the only difference b/w the arteries palpated to estimate HR and pulse strength among all the species (as in which arteries can be palpated)?
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All of them are the same, but in swine you can also palpate the dorsal pedal artery to estimate pulse strength
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What color should mucous membranes be?
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Pink, not pale or cyanotic
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What is required for an animal to be ABLE to have cyanotic mucous membranes?
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Requires AT LEAST 5 g of hemoglobin
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Perfusion time is an indicator of ______.
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Blood pressure
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When you blanche a gum, what is a normal capillary refill time?
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<2 seconds
-be careful, "perfusion time" can be close to normal after death bc just squish blood out and it flows back |
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What instrumentation is used to assess the electrical activity of the heart?
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Electrocardiography (ECG)
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Electrocardiography allows continuous audible assessment of the _____ and _____ of the heart.
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Rate & rhythm
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What are 2 downfalls of electrocardiography?
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1) May not correlate w/ mechanical activity
2) Artifacts can be common |
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What type of leads are most commonly used for electrocardiography?
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Lead II
Modified base-apex lead |
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What are 2 locations where you can put the left arm lead of an ECG?
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Left thorax
Base of heart |
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Where do you put the right arm lead when using electrocardiography in animals?
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Right thorax
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Where do you put the left leg lead when performing electrocardiography?
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Patient's head or throat
-Change lead selector to find one that will be accurate |
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What are 2 measuring devices used for arterial catheterization?
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1) Aneroid manometer
-instrument used to measure pressure 2) Long fluid administration set |
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What are the 4 electrical instruments used for direct blood pressure?
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1) Transducer
2) Amplifier 3) Display 4) Anderoid manometer -or long fluid administration set |
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When directly measuring blood pressure with arterial catheterization is is ________, continuous and inaudible.
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Accurate
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Direct blood pressure measurements can be altered by position of the ________.
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Transducer
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What are 4 sites used for arterial catheterization?
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1) Dorsal pedal
2) Coccygeal 3) Femoral 4) Lingual -All these are also used to check pulse |
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What are 5 sites used for arterial catheterization in horses?
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1) Facial
2) Transverse facial 3) Dorsal metatarsal 4) Digital 5) Caudal auricular -All these are also used to check pulse |
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What are 4 sites used for arterial catheterization in ruminants and camelids?
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1) Common digital
2) Caudal auricular 3) Saphenous 4) Radial |
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What are 3 sites used for arterial catheterization in swine?
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1) Caudal auricular
2) Saphenous 3) Radial |
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What are 2 methods used to indirectly measure blood pressure?
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1) Doppler
-Return to flow principle 2) Oscillometric technic -Cardell series & others OR petmap |
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What does the Doppler measure?
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Determines blood flow & determines systolic pressure
-Value nearer mean pressure in cats/small dogs |
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Dopplers produce a continuous audible signal of ______ and ______, but not ________.
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Continuous audible signal of RATE and RHYTHM, but not PRESSURE.
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What are 3 parameters that we can control that can cause errors in a Doppler reading?
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1) Faulty probe placement
2) Incorrect cuff size 3) Rapid cuff deflation |
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What are 4 physiologic parameters of the patient that can result in errors in a Doppler reading?
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1) Hypotension
2) Hypovolemia 3) Bradycardia 4) Hypothermia |
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What are 4 arteries that the crystal can be placed on when using a Doppler?
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1) Metacarpal
2) Metatarsal 3) Dorsal pedal 4) Tail (less often) |
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What does the Doppler measure?
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Determines blood flow & determines systolic pressure
-Value nearer mean pressure in cats/small dogs |
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Dopplers produce a continuous audible signal of ______ and ______, but not ________.
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Continuous audible signal of RATE and RHYTHM, but not PRESSURE.
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What are 3 parameters that we can control that can cause errors in a Doppler reading?
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1) Faulty probe placement
2) Incorrect cuff size 3) Rapid cuff deflation |
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What are 4 physiologic parameters of the patient that can result in errors in a Doppler reading?
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1) Hypotension
2) Hypovolemia 3) Bradycardia 4) Hypothermia |
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What are 4 arteries that the crystal can be placed on when using a Doppler?
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1) Metacarpal
2) Metatarsal 3) Dorsal pedal 4) Tail (less often) |
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What are 4 arteries the crystal can be placed on when using a doppler on a horse?
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1) Tail
2) Dorsal metatarsal 3) Digital 4) Radial |
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What are 3 arterial the crystal probe of a Doppler can be placed on in a camelid, ruminant or swine?
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1) Tail
2) Common digital 3) Radial |
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Do you want to place the crystal distal or proximal to the cuff when using a Doppler?
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Proximal to crystal
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How do you know what size of a cuff to use when measuring blood pressure with a Doppler?
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Cuff diameter should be 40% of circumference of limb
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What are the benefits of the Cardell series and others?
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Accurate over a wider range of heart rates and patient sizes.
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What are 5 errors/physiologic changes that can result in inaccurate blood pressure measurements when using a Cardell series?
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1) Hypotension
2) Hypovolemia 3) Hypothermia 4) Bradycardia 5) Wrong cuff |
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**What does the cardell measure?
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Determines mean arterial pressure and calculates systolic and diastolic pressure and HR
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When does the cardell take measurements (at what intervals)?
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Some will cycle at user-determined intervals, automated, very convenient and usually accurate
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True or false. Non-invasive blood pressure is a continuous method, that is not audible and can be inaccurate.
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False, It is inaudible and can be inaccurate, but not continuous
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What are 3 locations that the cardell series can be used on to take the blood pressure of a small animal?
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1) Metatarsus
2) Antebrachium 3) Tail |
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What are 4 sites you can use for a Cardell series to measure blood pressure in a horse?
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1) Tail
2) Dorsal metatarsal 3) Digital 4) Radial |
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What are 3 sites blood pressure can be taken using a Cardell series in a ruminant, camelid and swine?
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1) Tail
2) Common digital 3) Radial |
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What is the normal blood pressure (systolic, diastolic and MAP) of a dog?
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Systolic: 80-120 mmHg
Diastolic: 40-80 mmHg Mean: 60-100 mmHg |
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What is the normal blood pressure of a cat?
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Systolic: 80-150 mmHg
Diastolic: 40-80 mmHg Mean: 60-120 mmHg |
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What is the normal blood pressure a horse?
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Systolic: 95-120 mmHg
Diastolic: 65-90 mmHg Mean: 75-100 mmHg |
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Why do horses require a higher mean arterial pressure compared to other species?
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When animal is down and putting weight on the muscles and if too deep then the driving pressure to force open those capillaries is diminished so get areas of ischemia and if get enough muscle damage then horse can't stand afterward
-Keep MAP> 75 to prevent myopathy |
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What is the normal blood pressure of sheep, goat, camelids and swine?
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Systolic: 80-100 mmHg
Diastolic: 50-70 mmHg Mean: 60-80 mmHg |
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What is the normal blood pressure of cattle?
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Systolic: 120-150 mmHg
Diastolic: 75-100 mmHg Mean: 90-120 mmHg |
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Why are indirect blood pressure readings inaccurate with camelids?
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Because on cannon bone its just bone so the algorithms aren't designed for this
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Is pulse oximetry invasive? continuous? audible?
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Noninvasive
Continuous Audible |
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How does pulse oximetry measure hemoglobin saturation?
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Utilizes red & infrared light to determine hemoglobin saturation
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What does pulse oximetry display?
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Waveform & heart rate
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What is the normal percent saturation of hemoglobin?
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SpO2> 95%
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Why is pulse oximetry useful during anesthesia?
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Detects hypoxemia before cyanosis is present
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What are 4 sources of error when using pulse oximetry?
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1) Motion
2) Ambient light 3) Vasoconstriction -hypothermia, hypovolemia, drug induced 4) Dyshemoglobinemia |
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What is the primary site used to get pulse oximetry readings?
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Tongue
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What are some alternate sites used for pulse oximetry (not tongue)?
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Nares in some species, paw, ear, prepuce, vulva
-*alternate locations need white skin -achilles tendon less dependable |
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What does the central venous pressure assess?
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Venous return to right atrium/ heart's ability to pump
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What is a normal central venous pressure?
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5-10 cm H2O for most species
-Normal can be 20-30 cm H20 in equines in lateral recumbency |
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True or false. Central venous pressure can be a big help during anesthesia.
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False, little use during anesthesia
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What are 4 ways to monitor/measure cardiac output?
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1) Thermodilution
2) Dye dilution 3) Lithium dilution 4) Ultrasound techniques |
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True or false. Cardiac output is not commonly monitored in clinical cases.
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True
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What is dye dilution?
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Inject dye into right atrium or anterior vena cava and then measure concentration and calculate out dilution
-but background concentrations kept increasing w/ time |
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What is thermodilution?
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Inject saline and then measure temperature, use pulmonary arterial catheter
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What is lithium dilution?
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Don't need a pulmonary arterial catheter like you do w/ thermodilution, just inject lithium and then push button and blood is aspirated out of artery and then computer tells you concentration and CO
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What are 3 ways to monitor the respiratory system (without electronic equipment)?
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1) Auscultation
2) Observation of chest excursions 3) Observe breathing pattern -movement of rebreathing bag, chest wall, abdomen |
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What are 4 parameters that are measured to monitor the respiratory system?
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1) Tidal volume
2) Capnography 3) Blood gas analysis 4) Rate |
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Abdominal breathing is common in what 3 situations/animals?
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1) large animals
2) Neonates 3) When obstruction or lung disease is present |
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How is respiratory rate affected by anesthetic depth?
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Rate tends to decrease as anesthetic depth increases
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What is the normal respiratory rate in a dog?
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8-15 breaths/min
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What is the normal respiratory rate of a cat?
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10-20 breaths/min
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How does panting affect anesthesia intake?
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results in less effective ventilation
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What is the normal respiratory rate of horses?
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6-8 breaths/ min
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What is the normal respiratory rate of a ruminant?
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25-40 breaths/min
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What is the normal respiratory rate of a camelid?
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10-20 breaths/min
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What is the normal respiratory of swine?
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10-20 breaths/min
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______ "pant" under anesthesia.
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Ruminants
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How do you assess tidal volume?
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Watching rebreathing bag, not very precise
-rebreathing bag should move in sync with chest |
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How is tidal volume affected by anesthetic depth?
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Tends to decrease as anesthetic depth increases
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How do you measure tidal volume?
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Spirometer
- but tidal volume changes rapidly so can't really measure it |
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What is the normal tidal volume in canines/felines?
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8-10 mL/kg
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What is the normal tidal volume of a horse?
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8-12 mL/kg
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What is the tidal volume of a ruminant?
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5-8 mL/kg
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How does the tidal volume vary between the ventilator and the volume the animal naturally breathes in?
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Ventilator is higher amount
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What is one way to assess ventilation during anesthesia?
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Capnography- measures CO2 in expired gas
-CO2 goes up the less the animal breathes |
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How does the depth of anesthesia affect CO2 levels?
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PCo2 will increase as depth of anesthesia increases or with increased doses of opioids
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What can be used to detect equipment malfunction? what types of malfunction?
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Capnography
-Recognizes airway disconnection, apnea, abnormal breathing patterns and cardiac arrest (blood flow ceases and no CO2 returns to lungs so decreases very quickly) |
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How does partial pressure of end tidal carbon dioxide vary from partial pressures of arterial CO2?
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PetCO2 < PaCO2 by 10-15 torr
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What is the normal partial pressure of end tidal CO2?
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40-75 torr (spon Vent)
30-35 torr (IPPV) |
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What is the normal fractional concentration of inspired O2? inspired CO2?
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FIO2= 50-90%
FICO2< 2 torr |
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What does it mean if the fractional concentration of inspired CO2 increases?
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Sodalyme is running out
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What are 3 things that can be analyzed using blood gas analysis?
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1) Acid-base status
2) Adequacy of ventilation & oxygenation 3) Many assess electrolytes, lactate, glucose |
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What is the normal PaCO2 for large animals using Spon Vent? Small animals?
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Large animals: 60-75 torr
Small animals: 40-60 torr -both using spon vent |
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What is the normal PaCO2 using IPPV ?
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40-45 torr
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What is the normal PaO2 in small animals? Large animals?
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Small animals: 400-500 torr
Large animals: > 200 torr |
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What is a normal pH?
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7.35-7.45
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What are 6 ways to check the CNS status of a patient under anesthesia?
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1) Muscle relaxation/ jaw tone
2) Ocular reflexes/ eye position 3) Lacrimation 4) Laryngeal/ swallowing reflex 5) Response to pain/ pedal reflex (to assess response to pain or surgical stimulus) 6) Ear flick/ whisker reflex |
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How do you assess muscle relaxation? What animals is it useful in?
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By jaw tone
-Useful reflex in dogs and cats -some tone should be present |
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What does a lack of jaw tone in a dog or cat imply?
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Depth of anesthesia can be decreased
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How can you monitor the ocular reflexes in a dog?
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Globe begins centrally then as gets deeper in anesthesia the eye moves rostral-ventral ("rolled in")
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How do you monitor the ocular reflexes in a bovine?
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As depth of anesthesia increases the globe roles ventrally, then as anesthesia levels out the globe moves dorsally to the center
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What is the palpebral reflex?
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Lids close when touched or lid margins brushed
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Palpebral reflexes are slow to absent in what animal?
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Horses
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What does it mean if the palpebral reflex is present in any animal other than a horse?
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Means insufficient anesthesia
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What is the corneal reflex? Should it be present during anesthesia?
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Lids should close when cornea is touched, should be present
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What is a nystagmus?
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Medial-lateral oscillations of eye
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What does the presence of nystagmus in a HORSE imply?
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Anesthesia is too light
-best accuracy in horses, other species not dependable |
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How is pupillary dilation/ constriction affected by anesthesia?
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-Pupil may dilate slightly during induction (excitement) then may constrict
-pupils dilate at increasing depth |
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Lacrimation is an indirect indicator of _______ pressure, which is useful in horses.
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Perfusion pressure
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When is the swallowing reflex present during anesthesia?
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Lost early and regained just prior to return of consciousness
-can be present in ruminants at adequate depth of anesthesia |
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Why should the swallowing reflex be present at the time of extubation?
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To prevent aspiration
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What is the laryngeal reflex?
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Closure of arytenoid cartilages due to tactile stimulation
-can make intubation difficult |
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Laryngeal reflex is more common in what 4 animals?
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Cats, goats, sheep & swine
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What is the cause of laryngospasm in cats?
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A sustained laryngeal reflex
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How do we assess an animal's response to pain? How is this helpful for monitoring anesthesia?
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Pedal reflex: pinch pad or digit, lack of withdrawal when depth adequate
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What does the ear flick/ whisker reflex indicate?
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Inadequate anesthetic depth
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What does increased heart rate, respiratory rate, and blood pressure indicate?
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Insufficient depth
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How do we perform anesthetic agent analysis?
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Measures end tidal agent concentration to provide an estimate of dose, interpretation affected by premedication, local anesthesia
|
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Most surgeries are done at _____-_____ MAC, if the animal is premedicated ____-_____ MAC is used and if an epidural is in place _____-____ MAC is usually required.
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1.25-1.5 MAC
1.0-1.25 (w/ premed) <1 MAC (epidural) |
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What are 5 ways to asses fluid balance?
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1) Hematocrit or hemoglobin
2) Electrolytes (Na, K, Cl, Ca) 3) Plasma total solids or serum total protein 4) Glucose, lactate 5) Urine production |
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What are 2 ways to monitor body temperature during surgery?
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1) Clinical thermometer
2) Esophageal or rectal probe |
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What does increased heart rate, respiratory rate, and blood pressure indicate?
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Insufficient depth
|
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How do we perform anesthetic agent analysis?
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Measures end tidal agent concentration to provide an estimate of dose, interpretation affected by premedication, local anesthesia
|
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Most surgeries are done at _____-_____ MAC, if the animal is premedicated ____-_____ MAC is used and if an epidural is in place _____-____ MAC is usually required.
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1.25-1.5 MAC
1.0-1.25 (w/ premed) <1 MAC (epidural) |
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What are 5 ways to asses fluid balance?
|
1) Hematocrit or hemoglobin
2) Electrolytes (Na, K, Cl, Ca) 3) Plasma total solids or serum total protein 4) Glucose, lactate 5) Urine production |
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What are 2 ways to monitor body temperature during surgery?
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1) Clinical thermometer
2) Esophageal or rectal probe |
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What are 4 risks that increase in a patient that's hypothermic?
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1) Arrhythmias
2) Blunts response to chronotropes 3) Delays recovery 4) Increases risk of infection at surgical site |