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PERI-OPERATIVE ACCIDENTS AND EMERGENCIES (TERMINOLOGY (EMERGENCIES,…
PERI-OPERATIVE ACCIDENTS AND EMERGENCIES
TERMINOLOGY
EMERGENCIES
PROBLEMS
EMERGENCIES
Respiratory arrest
apnoea
occurs in 3 circumstances
de novo
acute event
sign of cardiac arrest
terminal hypoventilation
caused by
neural unresponsiveness
severe CNS depression
Concussion
Intracranial hypertension
Hypothermia
Hypocapnia
Anaesthetic overdose
Normal dose of super-opiods
fentanyl
alfentanil
Treatment
ventilation
if hyperventilated
reduce resp. rate to 2 breaths/minute
reduce anaesthesia
maintain temperature
Mechanical obstruction
restricted gas flow
ineffective ventilation
Causes
Soft tissue
Brachycephalic breeds
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Blood
Dental. nasal surgery debris
Vomit
position head-down
Fluid
Bronchospasm
common in cats
Endotracheal tube
overinflated cuffs and lumenal collapse
neck flexion causing kinking
chest wall fixation
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Bizarre 'diaphragmatic' or paradoxical breathing pattern
Overinflated reservoir bag
gurgling from upper airway
impossible to sigh animal
Treatment
clear obstruction
bypass obstruction
tracheostomy
maintain head elevation
Endobronchial suction and lavage
Cardiopulmonary arrest
Causes
Myocardial hypoxia
Systemic
atmospheric hypoxia
tidal hypoxia
alveolar hypoxia
Haemoglobulinaemic hypoxia
stagnant hypoxia
Local
Qt too low
tachycardia
treat if
trend is dangerous and unchanging
rate is of haemodynamic significance
ECG shows signs of myocardia hypoxia
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causes
inadequate anaesthesia
hypotension
gases
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hyperthermia
drugs
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hypoglycaemia
phaeochromocytoma
idiopathic
hypotension
bradycardia
Arrhythmias
causes
SNS activation
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drugs
electrolyte abnormalities
certain surgical procedures
pre-existing heart disease
medical conditions
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Toxaemia
causes
azotemia
renal disease
endotoxaemia
canine pyometra
lactacidaemia
hypovolaemic shock
diabetic keto-acidosis
Electrolyte and pH imbalance
Hyperkalaemia
major burns
renal disease
Addison's disease
acidaemia
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iatrogenic
Treatment
resolve initiating cause
hyperventilation
HCO3-
fluids
insulin+glucose
Hypothermia
clinical effects
reduced alveolar ventilation
reduced HR and Qt
Left-shifted oxyhaemoglobin dissociation curve
increased blood velocity
shivering increases oxygen consumption and plasma catecholamines
arrhythmias
consequences
prolonged recovery
reduced drug redistribution
reduced elimination
cardiac arrest