Surgery and Anesthesia – Flashcards
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What color is the oxygen tank?
answer
green
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what color is the nitrous oxide tank?
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blue
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what are 5 gasses commonly used in surgery?
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oxygen nitrous oxide isofluorine halothane cebofluorine
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PPM
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parts per million
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What does it mean if you can smell the gas?
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It is 15X more than it needs to be
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what are 6 short term effects of exposure to too much gas?
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Headache Nausea Depression Irritable Fatigue Drowsiness
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What are 5 long term effects of exposure to too much gas?
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Reproduction problems Liver problems Kidney problems bone marrow suppression Nervous system problems
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What gas is the least toxic?
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isofluorine
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How is isofluorine eliminated?
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Through lungs
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How are every other gas besides isofluorine eliminated?
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through liver and kidneys
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What gas is the worst for being hepatotoxic?
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Halothane
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what gas is hard on the kidneys?
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metaphane
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what are 2 neurologic symptoms one can experience when exposed to too much gas?
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decreased motor skills short term memory loss
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NIOSH
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National Institute for Occupational Safety and Health Recommend for no gas to exceed 2 ppm when used alone
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How many air exhanges should be made per hour for proper ventilation?
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15-20
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1 cc of anesthetic forms how much of waste?
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200 mL
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What are 2 ways to reduce exposure of waste of anesthetic gasses?
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scavenger system check for leaks
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What are 2 different scavenger systems?
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canister with charcoal (most common) hose that leads to outside
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What are 2 ways you can tell if there is a leak?
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hear it (Oxygen) smell it (gas)
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What should you do after giving an injection?
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wipe with alcohol
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What is the anesthesia form of ketamine?
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teletamine
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what kind of injectable anesthesia is used on elephants and is 10,000 X more potent than morphine?
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Etorphine
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Xylazine
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AKA Rompum injectable anesthesia used on large animals can cause 2nd degree heart block can absorb through skin
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What is a reversing agent for narcotics?
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naloxine
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What are some important safety tips on how to store and handle gas tanks?
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open tank slowly dont try to block leak with hand tanks should be secure and in upright position dont put tanks in heavy traffic area label tank (empty, in use, full etc)
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Where should an endotracheal tube reach if it is the right size?
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the thoracic inlet
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what are the two types of endotrachael tubes?
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Murphy Cole
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Murphy
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Endotrachael tube with cuff and side hole
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cole
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endotrachael tube with no cuff and no side hole commonly used on birds and reptiles
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what is the purpose of endotrachael tubes?
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bypasses oral, nasal cavities, pharynx, and larynx
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What can happen if the cuff on an endotrachael tube is too tight?
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can damage trachea
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What is the purpose of the side hole on an endotrachael tube?
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drains excessive mucus
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What are 3 advantages of a cuff on an endotrachael tube?
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1) decreases dead space 2) prevents animal from aspirating 3) decreases pollution in air
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What would happen if an endotrachael tube is too far in?
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could go in one lung and animal will not go to sleep as well
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What would happen if endotrachael tube is not in far enough?
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too much dead space
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What are 6 parts of an endotrachael tube?
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Murphy eye Machine end Connector - connects to machine Cuff Pilot balloon and valve Measurement of internal diameter and length
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what are 3 parts of a laryngoscopes?
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Handle Blade Light
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what are 2 types of blades for a laryngoscopes?
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Miller (straight) McIntosh (curved)
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What kind of animal are gas masks used on?
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Used mostly on older or fractuous animals
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What are 4 components of the anesthetic machine?
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Compressed gas supply Anesthetic vaporizer Breathing circuit Scavenger system
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What setting should gas be set on?
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2
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What if gas is set on 5?
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never leave machine!
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Non rebreathing circuit
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Used on small animals (3-7 kg) Not a lot of resistance
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E tank
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Small Need a wrench screws in on a 3 hole port
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H tank
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Large hand turn open fully when in use
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When should you change the gas?
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When the tank pressure gauge is below 500 psi or 150 mL of oxygen
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Flow meter
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How much oxygen is being delivered (Liters) (most on one or below = 1 L/minute)
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How do you check iso levels?
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make sure bubble of vaporizer is half full
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What are the 2 ways to change concentration?
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Increase oxygen rate Change dial
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pg 114 blue book
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check list
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What are 2 factors that affect vaporizer?
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temperature: hot - move faster The lower the oxygen, the more gas you will need (oxygen flow rate)
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pg 123, 128, 130, 135 blue book
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pics and tables
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What 9 things should be included in the preanesthetic evaluation?
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Why they are needing anesthesia history: med history, adverse rxns physical exam age breed temperament type of procedure heavy sedation or general anesthesia experience of surgeon
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What the 5 categories of patients?
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normal mild systemic disease severe systemic disease severe systemic disease with constant threat to die moribund patient (will not live unless operated on)
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What should you do once a puppy is born?
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clean out air ways (rough up) tie off umbilical cord
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How long does a patient have to fast before surgery?
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requires 4 hours unless older then should be overnight
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What 8 things are needed for an anesthetic plan?
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staff equipment needed drugs analgesia pre and post sedation induction and maintenance monitoring emergency protocol
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What are 3 types of drugs used for pain management in surgery?
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local blocks post operative intra operative
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what drugs can be used post operative and intraoperative?
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NSAIDS
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What are 2 NSAIDS that can be used post or intraoperative?
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Rimadyl Metacam
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Dopram
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stimulates respiration can put a drop under tounge of a puppy
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what gland does oxytocin come from?
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posterior pituitary gland
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What are the 4 major diseases that go through kidneys?
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Diabetes Renal Disease Cardiac Disease Liver Disease
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How should diabetic animals fast before surgery?
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Just cut food intake and insulin by half
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What is one thing that is important when doing surgery on diabetic dogs?
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they heal slow
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What should be monitored with animals with renal disease going into surgery?
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Kreatinine and BUN
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Diarese
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urinate a lot
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What should you make sure of when performing surgery on an animal with cardiac disease?
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make sure animal has enough oxygen moniter blood pressure
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90% of all drugs go through what?
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the liver
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Do you use premeds on critical patients?
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no
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What are the advantages of premeds?
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relaxes animal decreases stress decreases anesthesia
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What are the disadvantages of premeds?
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reaction longer wake up bradycardia
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Does acepromazine increase the risk of seizures in epileptics?
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there is no evidence
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What premed is yellow in color and a tranquilizer?
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acepromazine
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What may atropine and glycopyrrolate cause?
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tachycardia and myocardial hypoxemia
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what premed is short acting and reduces saliva?
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atropine
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What are 3 premeds?
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atropine acepromazine torbegesic
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which premed is a controlled substance?
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torbegesic
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myocardial hypoxemia
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low oxygen in blood in the heart muscle
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what is the trade name for glycopyrrolate?
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Robinal
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What does atropine cause in horses?
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twisting of intestines
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What are 4 inhalants for anesthesia?
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Cevofluorine isofluorine halothane metaphane
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When do you change soda lime?
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color of white turns blue
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soda lime
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what is in the waste container of a scavenger system to absorb expired gasses
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What are 3 emergency supplies for anesthesia and surgery?
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suction lighting crash cart
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suction
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canister that pulls fluid
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crash cart
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emergency drugs and protocols
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If the heart stops, what emergency drug should be given?
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epinephrine
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What should be recorded every 5 or 10 minutes?
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temp pulse respiration
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What are 6 things considered for patient prep?
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IV catheter and fluids Anesthesia monitoring tools Stabilize unstable patients first Manage arrythmias Is blood needed? Pre-oxygenation by mask before induce
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How do you manage arrythmias?
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lidocaine
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Who do you pre oxygenate before inducing?
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older animals
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What does a capnometer check?
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Carbon Dioxide
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What are 8 anesthesia monitoring tools?
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Stethoscope ECG BP thermometer esophageal stethoscope capnometer pulse ox
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What does a pulse ox check?
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oxygen
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What are 3 things considered as crucial surgery?
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old animals young animals invasive surgeries
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What must you do for crucial surgeries? why?
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start on IV for emergency drugs keeps circulation going through organs
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If you need to turn an animal, how should it be done?
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turn animal towards stomach, not towards their back. dont want ET tube to turn in trachaea
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When do you know its time to remove the endotrachael tube?
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when they start swallowing
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When should you remove the endotrachael tube in brachycephalic animals?
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wait until their up walking around
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How do you remove the endotrachael tube?
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deflate cuff just enough to get it out so no foreign material goes into lungs but can come out without damaging trachaea
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What does monitoring include?
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evaluation of oxygen, ventilation, cardiac rate and rhythm, adequate depth of anesthesia, muscle relaxation, BT, and analgesia
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Use a high oxygen rate when what changes?
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when rapid changes in anesthetic depth are needed
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what is the maintenance typically for oxygen when rapid changes in anesthetic depth are needed?
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200-500 mL
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Why should you keep the pop off valve all the way open?
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to prevent popping a lung
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What are 4 anesthetic complications?
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hypoventilation hypotension arrhythmia death
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how can you tell if an animal is going into hypoventilation under anesthesia?
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cyanosis
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cyanosis
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blue gums
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hypotension
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low blood pressure
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what are 3 ways to detect an arrhythmia?
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auscultate ECG pulse, HR, doppler ultrasound
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How can you tell if an animal has low blood pressure when under anesthesia?
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low heart rate pale gums
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When does recovery start?
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when the gas is turned off
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when do most surgery related deaths occur?
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3 hours after surgery
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What do you record every 5 minutes during recovery?
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HR Rhythm RR MMC eye position muscle tone reflexes
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How often should you check temperature during recovery?
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15 minutes
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What is the most reliable tool when checking vitals?
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personal direct contact (stethoscope, pulse, BP, MMC, CRT, smell)
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SFT
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see it feel it trust it
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What are the 4 places to check pulse?
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femoral artery (inside flank area) lingual artery (uner tongue) digital artery (below carpus) heart rate
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What is the best way to check pulse?
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heart rate
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When should you tell the veterinarian the heart rate is too slow in a large dog?
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lower than 50 BPM
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When should you tell the veterinarian the heart rate is too slow in a small dog?
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lower than 70 BPM
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When should you tell the veterinarian the heart rate is too slow in a cat?
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lower than 100 BPM
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Pulse defecit
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HR doesnt match up with pulse blood is not getting to back legs
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what causes a pulse defecit in cats?
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thromboembolis
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How do you treat a pulse deficit?
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treat with blood thinners ex: heparin
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How do you calculate respiratory rate?
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count breaths for 15 sec then x4
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What is the behavior of stage I of anesthesia?
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Disoriented
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What is the respiration in stage I of anesthesia?
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normal 20 - 30 breaths/min
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What is the cardiovascular function in stage I of anesthesia?
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heart rate unchanged
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What would the response be to surgery in stage I or II of anesthesia?
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struggle
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What is the depth of anesthesia in stage I or II of anesthesia?
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not anesthetized
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What is the eye position in stage I, II or III of anesthesia?
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central may be nystagmus note: stage III might have eye rotated
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nystagmus
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eye clicking back and forth
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what is the pupil size in stage I and III of anesthesia?
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Normal
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Does the pupil respond to light in stage I, II or III of anesthesia?
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yes
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how is the muscle tone in stage I, II and III of anesthesia?
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good
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Is there reflex response in stage I and II of anesthesia
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all present may be exaggerated in stage II
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What is stage II of anesthesia?
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Excitement stage
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What is the behavior of stage II of anesthesia?
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Excitement struggling vocalization paddling chewing yawning
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What is the respiration in stage II of anesthesia?
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Irregular may hyperventilate
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What is the cardiovascular function in stage II of anesthesia?
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Heart rate may increase
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what is the pupil size in stage II of anesthesia?
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may be dilated
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What is stage III: plane 1 of anesthesia?
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Light anesthesia
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What is the behavior of stage III of anesthesia?
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Anesthetized
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What is the respiration in stage III - plane 1 of anesthesia?
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Regular 12-20 breaths/min
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What is the cardiovascular function in stage III - plane 1 and plane 2 of anesthesia?
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pulse strong HR > 90 BPM
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What would the response be to surgery in stage III - plane 1 of anesthesia?
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may respond with movement
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What is the depth of anesthesia in stage III - plane 1 of anesthesia?
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light
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Is there reflex response in stage III - plane 1 of anesthesia
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swallowing poor or absent other reflexes present but diminished
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What stage of anesthesia do we want to be at for surgery?
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stage III - plane 2
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What is stage III - plane 2 of anesthesia?
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Medium surgical anesthesia
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What is the respiration in stage III - plane 2 of anesthesia?
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Regular, may be shallow 12-16 breaths/min
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What would the response be to surgery in stage III - plane 2 of anesthesia?
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Heart and respiration rates may increase
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What is the depth of anesthesia in stage III - plane 2 of anesthesia?
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moderate
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What is the eye position in stage III - plane 2 of anesthesia?
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Often rotated vetrally
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what is the pupil size in stage III - plane 2 of anesthesia?
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slightly dilated
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Does the pupil respond to light in stage III - plane 2 of anesthesia?
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sluggishly
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how is the muscle tone in stage III - plane 2 of anesthesia?
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relaxed
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Is there reflex response in stage III - plane 2 of anesthesia
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patellar, ear flick, palpebral and corneal may be present others absent
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what is stage III - plane 3 of anesthesia?
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Deep anesthesia
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What is the respiration in stage III - plane 3 of anesthesia?
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Shallow < 12 breaths/min
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What is the cardiovascular function in stage III - plane 3 of anesthesia?
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HR 60 - 90 BPM CRT increased pulse less strong
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What would the response be to surgery in stage III - plane 3 or plane 4 or stage IV of anesthesia?
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none
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What is the depth of anesthesia in stage III - plane 3 of anesthesia?
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deep
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What is the eye position in stage III - plane 3 of anesthesia?
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usually central may rotate ventrally
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what is the pupil size in stage III - plane 3 of anesthesia?
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moderately dilated
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Does the pupil respond to light in stage III - plane 3 of anesthesia?
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very sluggishly or absent
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how is the muscle tone in stage III - plane 3 of anesthesia?
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greatly reduced
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Is there reflex response in stage III - plane 3 of anesthesia
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all reflexes diminished or absent
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What is the respiration in stage III - plane 4 of anesthesia?
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Jerky
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What is the cardiovascular function in stage III - plane 4 of anesthesia?
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HR < 60 BPM prolonged CRT pale mucous membranes
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What is the depth of anesthesia in stage III - plane 4 of anesthesia?
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Overdose
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What is the eye position in stage III - plane 4 and stage IV of anesthesia?
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central
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what is the pupil size in stage III - plane 4 and stage IV of anesthesia?
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widely dilated
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Does the pupil respond to light in stage III - plane 4 and stage IV of anesthesia?
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unresponsive
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how is the muscle tone in stage III - plane 4 and stage IV of anesthesia?
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flaccid
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Is there reflex response in stage III - plane 4 and stage IV of anesthesia
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No reflex activity
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What is the behavior of stage IV of anesthesia?
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Moribund
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What is the respiration in stage IV of anesthesia?
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Apnea
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What is the cardiovascular function in stage IV of anesthesia?
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cardiovascular collapse
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What is the depth of anesthesia in stage IV of anesthesia?
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dying
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What are 2 anticholinergic drugs?
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atropine glycopyrrolate
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Atropine
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increase heart rate decreases salivation
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glycopyrrolate is also known as...
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Robinul
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what are 4 causes of increased heart rate?
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anticholinergic drugs ketamine and tiletamine shock pain
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ketamine
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increases heart rate nystagmus
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what are ketamine and tiletamine considered?
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halucinagens
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when is glycopyrrolate used?
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in c-sections last longer
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how does the blood flow through the heart?
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pre cava -> right atrium -> tricuspid valve -> right ventricle -> pulmonary artery -> lungs -> pulmonary vein -> left atrium -> mitral valve -> left ventricle -> body
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sepsis
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dark gums
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cyanosis
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blue gums
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how do you correct high CRT?
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correct by volume of fluids
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What are 4 causes of hypotension?
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hypovolemia cardiac insufficiency excessive vasodilitation (drugs) too deep anesthetic wise
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what should RR be during anesthesia?
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8-20 breaths/min
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How big of a blood pressure cuff do you use?
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40% of circumfrence of arm
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What happens when their is right sided heart failure?
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ascites
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What happens when there is left sided heart failure?
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will affect the lungs
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What are 5 reflexes that can be checked during anesthesia?
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auricular pedal palpebral corneal laryngeal
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auricular refelx
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ear twitch
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pedal reflex
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pinch foot
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palpebral reflex
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medial canthus of eye
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corneal reflex
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touch eyeball
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Where should muscle tone be checked?
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jaw anal
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What do the eyes do before an animal dies?
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they dilate
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what should be done if the animal stops feeling their foot?
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intubate
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What 3 things can we check to see if we can pass the tube?
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jaw tone laryngeal reflex pedal reflex
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what is normal on a pulse ox?
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95-99%
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where should the sensors go for a pulse ox?
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lingual or rectum or under tail
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what are 4 anesthesia monitoring devices?
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pulse ox captometer BP monitor ECG
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anesthesia monitoring devices
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measures how much available hemoglobin saturates oxygen
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what is normal on a captometer?
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35-45 mmHg
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where does the captometer attach?
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endotrachael tube
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What are 2 uses for a BP monitor?
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indirect (USE) direct
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where do you attach the BP monitor for indirect?
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coccygeal dorsal pedal digital arteries
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where do you attach the BP monitor for direct?
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catheter in artery
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What 3 things do the ECG detect?
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PVCs atrial dysfunction (change in P waves) Electrolyte imbalance (change in T waves)
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PVCs
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premature ventricular contractions
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What 5 breeds have problems with anesthesia?
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bulldogs pekinese brachycephalics weimaraners jack russel terriers
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In america, how many deaths per 1000 dogs and cats occur due to anesthesia?
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4.3 deaths/1000 dogs and cats
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what are 4 reasons for anesthesia related deaths?
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#1 human error equipment failure adverse rxns to drugs patient factors
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what are 6 human erros in anesthetic problems?
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no history lack of knowledge of machine incorrect drugs/dosage hurried or preoccupied fatigue inattentive - CRT, RR
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What are 5 equipment issues that could lead to problems with anesthesia?
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CO2 absorbent exhaustion - turns blue No O2 Misassembly of machine ET problems Vaporizer problems - wasnt filled properly
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What are adverse effects of acepromazine?
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decreases BP, HR sluggish ataxia 15 min to take effect
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what color is ace and what is it considered?
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yellow tranquilizer
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what is an adverse reaction to halothane?
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hepatotoxic
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what is an adverse reaction to xylazine?
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2nd degree heart block
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what might be safer when giving anesthetic agents and why?
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multidrug usage because of less concentration of gas used
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what is a side effect to NO2?
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bone marrow suppression
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What are 2 tests to check for liver disease?
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ALT AST
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What are 8 things to consider when putting geriatric patients under anesthesia?
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pre-op tests urinalysis chest x-rays ECG IV fluids need less drugs have longer recovery hypothermia
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what must you have with a pediatric who is going under anesthesia?
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accurate weight
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what are 4 things to watch when dealing with pediatric patients going under anesthesia?
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hypoglycemia dehydration usually 1/2 dose of meds temperature
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what are 2 types of IV tubes?
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micro macro
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micro IV tube
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60 drops/1 mL
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macro IV tube
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15 drops / 1 mL
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what are 4 things to consider when putting brachycephalic breeds under anesthesia?
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alot bradycardia - give atropine pre-oxygenate for 5 mins propofol or ketamine - valium combo leave ET in as long as possible
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what is one thing to consider with sighthounds going under anesthesia?
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increased sensitivity to thiobarbiturates (thiopental)
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what is 3 things to consider when putting obese animals under anesthesia?
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dose - 1/2 between normal and actual (3/4 of normal dose) pre oxygenate bag every 5 seconds, have respiratory difficulty - fat around lungs and heart
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propofol
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can become apneaic wake up fast
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ketamine
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1 cc / 20#
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what are 8 things to be considered when performing c-sections?
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start IVs Use minimal doses - all cross placental barrier clip and prep before sedate if possible decrease general anesthesia by 40% opiods are reversible do not use valium premeds decrease vomiting recover in sternal position
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what does dopram do in puppies?
answer
stimulates respiration
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what are 5 things you should or should not do after a puppy is delivered via c-section?
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suction blow nose doxapram - dopram dilute atropine do not put back with bitch too quickly
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HBC
answer
hit by car
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what 3 things are common in an HBC?
answer
pneumothorax hemorrhage diagphragmatic hernia
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pneumothorax
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collapsed lung
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diagphragmatic hernia
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hole in diaphragm
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what are 2 drugs you can give for low BP and what do they do?
answer
dopamine - increases HR dobutamine - increases BP
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what are 4 signs of fluid overload?
answer
crackles in lungs nasal discharge bulging eyes coughing
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where do you perform a thoracocentesis?
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between 7th and 9th rib
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why do you do a thoracocentesis cranially?
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caudal has vessels and nerves
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what is the most common cardiovascular problem from anesthesia?
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bradycardia
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what is the only way to determine arrythmias?
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Run an ECG
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Preload
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Blood returning to heart
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Afterload
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Blood after left heart
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pg 148-150 in blue book
answer
...
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PVC
answer
premature ventricular contractions
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AF
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atrial fibrilation no p waves
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VF
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ventricular fibrilation no qrs complexes
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what drug do you use for 2nd degree heart block?
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atropine
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what drug do you use for V Tachycardia?
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lidocaine
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what drug do you use for sinus arrest?
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epinephrine
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Pleural effusion
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fluid between lung and lining of pleural cavity
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pneumonia
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inflammatory condition of lung, especially the air sacs
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pulmonary edema
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abnormal build up of fluid in air sacs of lungs
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what gas do you not use for respiratory disease?
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NO2
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what is the difference between pneumonia and congestive heart failure?
answer
pneumonia : fluid in lungs congestive heart failure : fluid outside lungs
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what 5 things should be done with an animal with a diaphragmatic hernia?
answer
PreO2 Head up Rapid induction Intubate rapidly Manual bagging
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what is a complication with a diaphragmatic hernia?
answer
pneumothorax
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what 3 things should be done with an animal with renal problems?
answer
Offer water up to 1 hour before surgery IV fluids Reduce drug doses
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why do you want to reduce drug doses with an animal that has renal problems?
answer
To make sure kidneys excrete
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what 6 things should be done if animal will not stay anesthetized?
answer
check vaporizer Check ET Is patient apneic? too shallow breathing? check machine, O2 flow rate is patient agonal? Increased RR
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what should you do if the ET has a leak, if the patient is apneic or if the animal has shallow breathing and they wont stay anesthetized?
answer
bag
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what should be given if patient is agonal?
answer
dopram
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what are 11 signs that the patient is too deep?
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2 sec bradycardia weak pulse BP < 80 mm HG arrythmias too cold no reflexes flaccid muscle tone dilated pupils
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what are 13 emergency drugs?
answer
atropine dexamethasone diazepam dobutamine dopamine doxapram epinephrine lidocaine naloxone prednisolone sodium succinate sodium bicarbonate vasopressin yohimbine
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what are 6 CPR drugs?
answer
atropine epinephrine lidocaine prednisolone sodium succinate sodium bicarbonate vasopressin
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what are 3 drugs mainly used in practice?
answer
atropine dexamethasone epinephrine
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what is diazepam for?
answer
seizures
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what is dobutamine for?
answer
increases BP
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what is doxapram for?
answer
increases RR
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what is prednisolone sodium succinate for?
answer
shock
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what is sodium bicarbonate for?
answer
respiratory acidosis
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respiratory acidosis
answer
breathing too fast
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what is vasopressin for?
answer
increases BP
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what is yohimbine for?
answer
reverses rompum/xylazine
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how many minutes do you have to CPR an animal?
answer
4 minutes
question
how many people are needed for CPR?
answer
5 needed, 3 minimum
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what does each person do for CPR?
answer
1 on chest 1 on bag 1 on pulse 1 adm. drugs 1 keeps records
question
what are the ABCDE of CPR?
answer
A - airway B - Breathing C - circulation D - drugs E - ECG
question
what is the most important during CPR?
answer
circulation
question
how often do you do chest compressions for CPR?
answer
every 1-2 seconds
question
how often do you bag during CPR?
answer
every 10-12 seconds
question
what 4 problems can occur during anesthesia recovery?
answer
regurgitation, vomiting, aspiration seizures dyspneic prolonged recovery
question
what are 3 causes of seizures?
answer
ketamine epilepsy hypoglycemia
question
pg 345-347 blue book
answer
...
question
what is the #1 drug for pulmonary edema?
answer
lasix
question
lasix
answer
draws fluid out of kidneys
question
what are the 2 side effects of lasix?
answer
polydipsia polyuria
