Surgery
What surgery size is the smallest? the largest?
6-0 is the smallest through 0 (or 1) being the largest.
i.e. 6-0, 5-0, 4-0, 3-0, 2-0, 1-0, 0, 1, 2, etc. - we typically do not use anything larger than 0 (or "ought").
What is the most common dose of propofol for inducing anesthesia? Alfaxalone? Ketamine/Midazolam?
Propofol - 4-6 mg/kg IV slow TO EFFECT
Alfaxalone - (DOGS) 1.5-4.5 (commonly 3) mg/kg IV TO EFFECT; (CATS) 2.2-9.7 (commonly 3-4) mg/kg IV TO EFFECT
KET/Midaz - *DJ* 1mL of each per 20 pounds with a max dose of 3 mL of each. (i.e. a 40 pound dog would get 2 mL of each)
A blocked cat is hospitalized and you notice that in the last 2 hours there is no urine product in the bag. You alert the doctor but what trouble shooting steps should you take?
Make sure the line is not twisted and kinked preventing flow. Make sure the u-cath is still properly in place and not twisted/kinked. Palpate the patients bladder to ensure that bladder is not full and unable to be emptied. If doctor is OK, detach the line and flush u-cath with sterile saline to see if flows and then try to remove fluid.
Dr. Johnson wants you to pull up unasyn for a patient. What is her dose of this medication?
50 mg/kg (while AB and SA will be 30mg/kg)
Most recent recommendations for heat stroke.
Rapid cooling! Instead of using alcohol, it is recommended to place p on cool surface or wet towel, douse with cold water, and use fans for evaporation cooling. IVF. Monitor temp closing. Stop active cooling when temp is 103F!
What's the highest % Dextrose drip that can go into a peripheral IVC?
7.5% - 10% would need to be through a central line
The doctor is performing a c section and will be handing you puppies - what do you need to do?
Use a surgery towel to catch puppy and be sure not to touch the doctor's hands or sterile field when catching. Now you need to pass the puppy to another staff member to remove the sac (if still present), tie the cord, and "whelp" (i.e. stimulate, suck fluid out of mouth, etc.)
Most common side effect of propofol induction
Apnea
You have a pet with an NG tube. How do you give food/meds? What do you look out for?
Check tube placement first! Aspirate and record amount of fluid retrieved. Flush, give food/meds (flushing in between), and flush again (usually with 5-10 mL of lukewarm water depending on patient size). Administer body temperature food slowly (over 10-15 minutes). Thoroughly crush tablets so they do not clog the tube. If flushing becomes difficult, alert VOD. Often can try to dislodge a blockage with a small amount of cola.
Dr. Johnson would like you to pull up ket/mid for induction for anesthesia. What dose does she like to use?
KET/Midaz - *DJ* 1mL of each per 20 pounds with a max dose of 3 mL of each. (i.e. a 40 pound dog would get 2 mL of each)
Explain how to give a dextrose bolus and how make a 5% dextrose drip.
1 mL/kg diluted 1:4 IV slow over 1-3 minutes. Why avoid giving dextrose straight IV?
Take 100 mL out of a 1L bag and put in 100 mL of 50% Dextrose.
2.5% - 50 mL out; 50 mL in
7.5% - 150 mL out; 150 mL in.
When you need to check charges for a hospitalized patient, what are you checking?
- Injection prices are correct
- Charged for the correct number of bags of fluids
- Charged for any hemo filters used
- Initial PCV is $0 if done with a CBC
- Anesthesia time is charged correctly
- Making sure nothing else is missing
What do you need to set up for a general surgery?
You will need: table drape, the table drape clips, towels for patient, towel clamps, patient drape, surgery pack, lap sponges, sterile bowl, warmed fluids to put into bowl, scalpel blade, suture if VOD knows what they want already
You have a pet under anesthesia for surgery - they are asleep but they start moving as the doctor makes an incision and you note they have a palpebral reflex. What needs to be done?
They are too light - need to increase gas inhalant or even give another dose of induction. The key is to keep p at plane 2 of anesthesia using the least amount of inhaled gas needed.
1 - light - regular breathing and responsive to stimuli
2 - ventral eye rotation and loss of reflexes (IDEAL)
3 - shallow breathing; centrally fixed eyes
You have a cute puppy hospitalized for flea and hookworm anemia that is getting a blood transfusion. What is important about monitoring this patient during the transfusion? What size IVC do you want this p to have?
Monitoring for reaction. We have monitoring sheets to help guide you through this but typically we are taking vitals every 5 minutes for the first 15 minutes; every 15 minutes for the next 45 minutes; then every half an hour. The rate and timing of the transfusion will potentially be VOD dependent. (AB will use the QR code on the pRBCs for instructions).
Use filter! Initial rate will be slow (0.25-1ml/kg/hr) for 15 minutes then increased. The total volume should be administered over 4 hours after bag puncture.
Smallest IVC - 22g - ideally 18/20. Smaller than this (i.e. 24g) will cause lysis of RBCs.
What do you dilute a lasix CRI with?
0.9% NaCl
Why do you need to check electrolytes when giving toxiban?
Toxiban can elevate the sodium levels and cause significant hypernatremia
The doctor is closing a skin incision and askes you for 2-0 suture. What type of needle would they want to skin?
Reverse cutting - this type of needle damages the tissue as it pushes through but is needed for tough tissue like skin
You have a patient under anesthesia for surgery. The doctor is in the middle of removing a bladder stone and p is breathing shallowly and infrequently. You note that they have centrally placed eye position. What needs to be done?
The patient is too deep under anesthesia - lighten the anesthesia. The key is to keep them on the least amount of gas needed to maintain anesthesia. Never leave a pet on a high level of anesthesia for long! See planes of anesthesia:
1 - light - regular breathing and responsive to stimuli
2 - ventral eye rotation and loss of reflexes (IDEAL)
3 - shallow breathing; centrally fixed eyes
You have a CHF patient on a lasix CRI. What is an important part of monitoring this patient every hour?
Monitor RR and RE of course, but monitoring the AMOUNT in the syringe pump, as it is supposed to be 1mL an hour and even when the pump is set appropriately, we need to monitor the syringe as well. Do not forget that the line attached the pump had to be filled prior to starting, and the line is usually ~6 mL itself. It is important to also attach flush once the syringe is empty so the p receives all the medication within the line.
A dog with Sago Palm toxicity needs NAC q 6 hours for 7 doses total. How do you give N-Acetyl Cysteine ?
If giving IV dilute 1:4 with 0.9% NaCl or sterile water and use filter. Ask VOD if they want you to dilute to give orally but typically no.
What is the maximum mEq/L of KCL that can go through a peripheral IV catheter?
Do not exceed 80 mEq/L in a peripheral vein according to VetGirl - in my opinion, do not exceed 60 - anything about should be through a central line
The doctor is performing an R&A and askes for 4-0 suture. What type of needle would they want for this delicate type of procedure?
Taper needle - this type of needle does much less damage to the tissue but would be very difficult to use on tough tissue like skin.
You have a pet under anesthesia and are taking their vitals. You note their blood pressure is low. What needs to be done?
Check to see if they pet is too deep under anesthesia and lighten if needed. If that is not the issue, p may need a bolus of IVF or a higher rate - ask your VOD. If p's HR is also persistently low, your VOD may also want you to give a dose of what medication?
You have a hypoglycemic puppy with a central line. How do you draw samples from the central line?
Use the at-dove 3 syringe method:
Stop infusion for 1-2 minutes
Clean port
Flush then pull blood; push back in (1 syringe)
Pull sample (2nd syringe)
Flush (3rd syringe)
What is Dr. B's son's full name?
Dean Walter Beers
In what ways may you need to assist with a cystotomy? Splenectomy? GDV? R&A?
Cystotomy - you may need to help pass a u-cath retrograde and flush (from urethra back to bladder) to check for stones
Splenectomy - you will likely need suction; you also may need to glove in to help hold the spleen if it is very large while the doctor ligates vessels
GDV - you will likely need to pass an orogastric tube through the mouth and esophagus into the stomach while the doctor rotates the stomach to help remove gas/fluid; you may need to glove in to help hold the body wall up while the doctor performs the gastropexy
R&A - you may need to glove in to help hold the R&A site while doctor performs the surgery; you will need to also help lavage the abdomen and have suction ready
You are monitoring anesthesia on a pet having a splenectomy. The p goes into cardiac arrest and no longer has a pulse. What is the FIRST THING YOU DO before starting CPR?
TURN OFF ANESTHESIA! Reverse any medications if needed.
You have a DKA patient that you are treating in hospital. Name some of the many things that are important to monitor and perform on this patient throughout their stay.
Monitor BG and tailor the insulin CRI based on results
Change the insulin CRI bag and line every 24 hours. Agitate hourly.
Monitor electrolytes and supplement as needed. Ensure p is on the correct type of IVF and supplementation that the VOD wants and agitate the bag hourly.
Monitor ketones and alert VOD of results as the goal is to have NEGATIVE
Offer food as instructed and alert VOD when p is eating multiple times in a row as when p's ketones are negative and is eating, can switch off of insulin CRI onto q12h insulin.
Monitor and care for central line. Monitor site, keep clean, and draw samples accordingly.
A puppy presents acting super strange - disoriented, agitated, vocalizing repeatedly, dazed/out of it, drooling. Watch video Dr. B has. The VOD wants to know if the owners have a specific medication at home. What medication?
Baclofen! A human muscle relaxer that is very toxic to dogs - symptoms can be severe and prolonged - some patients end up comatose and even on a ventilator.