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