ER Study Guide Exam 1 PDF

**ER Study Guide Exam 1** **Summarize chapter 2** **Chapter 2 of *Small Animal Emergency and Critical Care for Veterinary Technicians*** delves into the critical role of accurate and thorough monitoring for managing sick or injured animals. The chapter highlights physical examinations, clinical pa...

**ER Study Guide Exam 1** **Summarize chapter 2** **Chapter 2 of *Small Animal Emergency and Critical Care for Veterinary Technicians*** delves into the critical role of accurate and thorough monitoring for managing sick or injured animals. The chapter highlights physical examinations, clinical pathologic tests, and device-based monitoring as essential tools to assess and manage patient health. Below is an expanded overview: **Physical Examination** - **Hands-on Monitoring:** Techniques like inspection, palpation, auscultation, percussion, and olfaction provide valuable real-time data. - **Key Parameters:** Respiratory rate, depth, effort, mucous membrane color, capillary refill time (CRT), and pain level are vital. Trends over time are as important as individual readings. - **Tools:** Utilize visual observation and equipment like stethoscopes to identify subtle signs of deterioration. **Clinical Pathologic Monitoring** This includes various laboratory tests and their interpretation: 1. **Blood Gas Analysis** - **Assesses oxygenation, ventilation, and acid-base balance.** - **Key indicators:** - **pH:** Reflects overall acid-base status. - **PaCO2:** High levels indicate hypoventilation (respiratory acidosis); low levels suggest hyperventilation (respiratory alkalosis). - **HCO3⁻:** Reflects metabolic compensation (low in acidosis, high in alkalosis). - **Management:** - For **acidosis**, ensure adequate ventilation or address metabolic causes (e.g., bicarbonate supplementation for metabolic acidosis). - For **alkalosis**, identify the cause (e.g., hypochloremia or overventilation) and correct accordingly. 2. **Packed Cell Volume (PCV) and Total Plasma Solids (TS)** - **PCV evaluates red blood cell mass, indicating dehydration or anemia.** - **TS** assesses protein levels and oncotic pressure, with high levels suggesting dehydration or inflammation and low levels indicating protein loss (e.g., through urine or gastrointestinal losses). 3. **Electrolytes** - **Sodium:** Critical for fluid balance. Hypernatremia often indicates dehydration; hyponatremia can suggest excessive fluid retention or losses. - **Potassium:** Essential for neuromuscular function. Hypokalemia can lead to weakness, while hyperkalemia poses cardiac risks. - **Chloride:** Altered levels often indicate acid-base imbalances. 4. **Chemistry Panel** - Evaluates organ function, especially liver and kidney health. - Provides data on glucose, proteins, liver enzymes (ALT, AST), kidney markers (BUN, creatinine), and electrolytes. 5. **Clotting Panel** - Includes prothrombin time (PT) and activated partial thromboplastin time (aPTT) to assess clotting efficiency. - Extended times suggest clotting factor deficiencies or anticoagulant toxicity. **Sampling Techniques** - Use correct containers for blood and urine samples to prevent contamination or clotting. - Avoid excessive blood draws, especially in small patients. Limit to 5--7% of total blood volume per week. - Properly label and handle samples to avoid errors, ensuring centrifugation and separation of plasma or serum when needed. **Device-Based Monitoring** 1. **Pulse Oximetry** - Measures oxygen saturation (SpO2). Low values (\103°F or 39.4°C): - **Heatstroke: Animals exposed to high temperatures, humidity, or exercise.** - **Seizures or status epilepticus:** Prolonged muscle activity generates excessive heat. - **Toxins or drugs:** Substances like metaldehyde or amphetamines can increase metabolic rate. **5. Diagnosing Metabolic or Endocrine Disorders** - Repeated temperature readings are useful for: - **Hypothyroidism:** Often associated with mild hypothermia. - **Hyperthyroidism or Cushing's disease:** May present with hyperthermia. **6. Postoperative and Critical Care Monitoring** - Use a thermometer in critical care patients to detect complications such as: - Postoperative hypothermia (common in small or elderly animals). - Fever from postoperative infections or complications. - Monitoring temperature in ventilated or anesthetized patients for hypothermia or hyperthermia. **7. Assessing Response to Therapy** - Recheck temperatures when treating: - **Infections:** To evaluate the effectiveness of antibiotics. - **Heatstroke or hypothermia:** To ensure temperature is returning to normal gradually and safely. - **Shock resuscitation:** As an indicator of improved perfusion and metabolism. **8. Emergency Situations** - Always measure temperature in emergencies like: - **Poisoning:** For substances causing hyperthermia (e.g., chocolate toxicity, organophosphates). - **Septic shock:** Hypothermia can indicate severe progression of the disease. - **Cardiac arrest recovery:** Hypothermia is a risk in post-resuscitation care **9. When Addressing Digestive Issues** - Use a thermometer for patients presenting with: - Vomiting and diarrhea, as hypothermia or hyperthermia can indicate the severity of illness (e.g., parvovirus). - Suspected gastrointestinal infections or sepsis. **10. In Neonates and Young Animals** - Frequent temperature checks are essential because: - Neonates have immature thermoregulatory systems. - Hypothermia can occur rapidly due to environmental exposure or poor nursing. **11. Specific Situations to Avoid Rectal Temperature** - While rectal temperatures are the gold standard, alternative methods (e.g., axillary or auricular) should be used: - Patients with severe trauma or pain near the rectum. - Critically ill patients where rectal stimulation may induce vagal-mediated arrest. - Small patients (e.g., neonates or kittens): To prevent distress or harm. **Monitoring Frequency** - Stable patients: Every 4--6 hours or as needed. - Critically ill or recovering patients: Every 1--2 hours, or continuously via esophageal or rectal probes. **By understanding the specific scenarios for using a thermometer, you can better ensure patient safety and effective care.** **\ How much blood can be drawn from a patient in a week.** **FROM companion animal book** - The book provides a calculation specific to avian patients: - The **average total blood volume** in birds is **6--13% of their body weight**, using 8% as a standard value. - Up to **10% of the total blood volume** can safely be collected at one time for hematological testing​​. - If a bird weighs 500 grams (0.5 kg), its total blood volume is approximately: - While specific weekly guidelines are not mentioned for other species, the principles of blood volume limits can be extended with similar caution. **\ What IV catheter to place and where** **IV Catheter Placement** - Peripheral veins (e.g., cephalic, saphenous) for short-term use. - Central veins (e.g., jugular) for long-term access, blood sampling, or fluid administration​ **Information from *Common Diseases of Companion Animals, 4th Edition*:** - Recommended size: **14--16 gauge** for large dogs to allow rapid fluid administration​. - Aseptic technique is crucial to prevent complications such as **thrombophlebitis**. - Particularly common with jugular vein catheters. - Proper selection of materials, aseptic placement, and regular maintenance minimize risks​. **\ Fluid: how much to give, what to look for , calculation and evaluation of the case.** **1. Fluid Therapy Volume Calculations** Fluid therapy involves three components: replacement, maintenance, and ongoing losses. The total fluid volume is the sum of these components. **A. Replacement Fluids** Replacement fluids address existing dehydration. **Calculation for Dehydration:** Volume to replace (mL) = Body weight (kg) x % dehydration (in decimal) x 1000 - **% Dehydration Estimates:** - **Mild dehydration:** 5% body weight (e.g., subtle skin tenting). - **Moderate dehydration:** 6--8% (e.g., prolonged skin tenting, dry mucous membranes). - **Severe dehydration:** \>10% (e.g., sunken eyes, shock). **Example: A 10 kg dog estimated to be 7% dehydrated: Volume to replace**=10 kg×0.07×1000=700 mL **Replacement fluid is typically given over 4--24 hours depending on severity and concurrent conditions.** **B. Maintenance Fluids** Maintenance fluids address normal daily fluid needs. **Calculation for Maintenance Fluids:** - **Cats:** 60 mL/kg/day - **Dogs:** 40--60 mL/kg/day - **For a 10 kg dog**: Maintenance Volume=50 mL/kg/day×10 kg=500 mL **C. Ongoing Losses** Ongoing losses include fluids lost through vomiting, diarrhea, wounds, or excessive urination. **Estimation:** - Measure output (e.g., vomit, diarrhea) or estimate based on severity (e.g., 1--5 mL/kg per episode). - Replace measured losses hourly or as they occur. **D. Total Daily Fluid Volume** **The total fluid volume is:** Total Volume (mL/day)=Replacement+Maintenance+Ongoing Losses **2. Monitoring During Fluid Therapy** Proper monitoring is essential to avoid complications such as overhydration or inadequate resuscitation. **A. Key Parameters to Monitor** 1. **Physical Signs:** - **Hydration Status:** Check skin turgor, mucous membrane moisture, and capillary refill time (CRT). - **Body Weight:** Monitor daily; rapid weight gain can indicate fluid overload. 2. **Urine Output:** - **Normal urine output:** 1--2 mL/kg/hour - Use urinary catheters to monitor output in critical cases. 3. **Cardiovascular Signs:** - Heart rate and pulse quality. - Monitor for tachycardia (dehydration or hypovolemia) or bradycardia (overhydration). 4. **Respiratory Rate and Effort:** - Increased respiratory rate or effort can indicate pulmonary edema from overhydration. 5. **Body Temperature:** - Hypothermia or hyperthermia may affect fluid needs. 6. **Central Venous Pressure (CVP):** - Normal CVP: 0--5 cm H2O - Elevated CVP suggests fluid overload or impaired cardiac function. 7. **Blood Pressure:** - Hypotension (\