Preoperative Assessment and Prep LA
In what situations do equine veterinarians need to communicate with the insurance company?
emergency anesthesia
euthanasia
What direction should surgical incisions be made in relation to tension lines and why?
parallel to tension lines
-perpendicular or oblique incisions gape and require more sutures for closures than incisions that parallel tension lines
Why was a change in assessment from ABC to M2ARCH2E needed?
Everything ABC assessed had to do with transporting oxygen to red blood cells. If there are not sufficient red blood cells to transport enough oxygen to keep cells alive, ABC is irrelevant.
What are the major areas addressed in the preoperative assessment of a surgical patient?
patient history
physical exam
laboratory data
associated underlying disease
patient stabilzation
You are on a clinical rotation and are in the OR with your preceptor to fix a degloving injury. You ask your preceptor if she is going to use vacuum assisted closure to close the wound. She wants to know why you think this is the best course of action for this patient. (What are the benefits of vacuum assisted closure?)
What are the basic factors considered when performing a pre-op risk assessment on a horse?
inherent vs variable risk
inherent factors: signalment, medical history
variable factors: primary disease (physical and cardiovascular status), elective vs emergency surgery, extent of procedure
What are the methods of reducing tension when closing a surgical wound?
-undermining wound edges
-selecting appropriate suture patterns
-using relief incisions
-skin stretching
What does M2ARCH2E stand for?
M: massive hemorrhage and muzzle
A: airway
R: respiration
C: circulation
H: head injury and hypothermia
E: evacuate/pain management/abx
What location of a wound would generally be a compressible hemorrhage?
Wound of an extremity where direct pressure can be applied to it.
"Poppy" is an 8 year old GSD that was just diagnosed with a CCL tear. The owner wants to do the gold standard treatment which she read online was TPLO. What are you going to discuss with her prior to the surgery?
I would discuss ASA score and risk of anesthesia as the dog is a little bit older.
The quality of life of the patient with/without the procedure- is it medically necessary at the patient's stage of life? There are nonsurgical options.
The risk of surgery and the recovery time/care it requires.
If the O still wants to go through with it, I would discuss the cost and provide an estimate, get a signed consent form for anesthesia, tell her poppy needs to be fasted for 12 hours but can still drink water and tell the owner to stick by her phone for any updates while in the OR if something were to go wrong.
What type of surgery is the best for an abdominal approach in cattle?
standing surgery
What are the methods for recruiting skin to close wounds under tension?
-presuturing
-adjustable sutures
-skin stretchers
-skin expanders
What are the landmarks for performing a needle decompression of the thoracic cavity?
7th to 10th intercostal space
Make a u with your hands having your cranial hand sit at the caudal aspect of the scapula and poke in the center of the U your hands make
What are the different types of SSIs as classified by the CDC?
Incisional SSI: infection of the actual site of the surgical incision -Can be superficial: involving the skin and subcutaneous tissue or deep: involving deep soft tissue layers such as incisional fascia and muscle
Organ/space SSI: infection of an anatomic part that was manipulated during the operation
You are a new veterinarian at an urgent care clinic that also does general practice. You have two surgeries for the day, one is a OVH on a 1 year old healthy poodle, the other is a mass removal on an 8 year old chihuahua with a heart murmur. What is their ASA status? What lab work are you ordering for each of them?
young healthy animal: ASA 1
Big 4 or quats
-PCV, TP, blood glucose, BUN
Old chihuahua: ASA 3
minimum data base
-CBC and differential
-serum biochemical profile
-urinalysis
List one procedure that falls into each category: clean, clean contaminated, contaminated, and dirty
clean: arthroscopy
clean contaminated: colic surgery
contaminated: fresh traumatic wound less than 4 hours after trauma
dirty: older laceration with purulent material present
In your clinical year, your preceptor is doing a mass removal in a high tension area and asks what pattern she should use for closing the skin to relieve pressure. What is the standard tension relieving suture for the skin?
vertical mattress
A patient presents with a soup bone stuck over lower canines. What segment of M2ARCH2E does this fall under and how do you fix it?
pull tongue straight out between lower canines and gently pull bone up from chin to dislodge
If you have an emergency case that has no time to become stabilized before needing to be rushed into surgery, what is justified to do as "stabilization" before it is induced.
replacing fluid deficits and correcting acid base and electrolyte abnormalities
You are working at an emergency clinic and a possible HBC comes in. You are at the R portion of the MARCH scheme and listen to the patient’s breaths. Shallow, rapid breathing is occurring. What does this suggest?
What type of patient prep would be done for a bovine LDA procedure?
semi-emergency, no withholding feed
Walk me through the considerations to be taken if you were planning a surgical mass removal.
-skin tension and elasticity should be assessed while avoiding excess tumor manipulation
-direction of skin tension lines, shape of excision, and method of closure should all be planned before hand
-a larger area should be clipped and prepped
-excision should include tumor, previous biopsy sites, and wide margins of normal tissue in three dimensions
-benign: remove tumor and 1 cm of normal tissue
-malignant: remove more than 2-3 cm in all dimensions
Explain step by step how to do a tracheotomy.
1. Make a transverse incision between the annular ligament between the 3rd and 4th or the 4th and 5th tracheal cartilages.
2. Facilitate tube placement by depressing the proximal cartilages with a hemostat.
3. Elevate the distal cartilages with an encircling suture. Insert a tracheotomy tube that does not completely fill the lumen.
4. Appose the sternohyoid muscles, subcutaneous tissue, and skin cranial and caudal to the tube.
5. Secure the tube by tying it with gauze or umbilical tape around the neck.
What are the normal or resident organisms living in the skin's superficial cornified layers and the outer hair follicles of dogs and why is that important?
-Staphylococcus epidermidis
-Corynebacterium spp
-Pityrosporym spp.
SSIs lead to increased mortality rates in surgical patients and it is important to be aware of what flora is present on the patient to begin with in order to mitigate infection.
A patient presents to your urgent care clinic with a long wound along its dorsum. The lesion has localized erythema with areas of hyperpigmentation and potential blistering. It shows signs of edema and possible superficial epidermal necrosis, accompanied by mild to moderate swelling. What are your immediate concerns for the patient and what antimicrobial would you use to treat this?