Please enable JavaScript.
Coggle requires JavaScript to display documents.
Patient Care During Surgery (Prevention of musculoskeletal damage (When an…
Patient Care During Surgery
Observations during surgery
Urine output
Monitoring urine output enables an assessment to be made of renal function, particularly important in critical care patients
Most effective when a urinary catheter is placed and collected in a bag
Normal urine output is 1-2ml/kg/hr
Torniquets
A strip of material that when applied to a limb, reduces the internal blood flow and consequently controls a bleed
Usually applied to the upper extremities in order to occlude major arteries
On the forelimb
: brachial artery, medial side of the humerus
On the hindlimb
: femoral artery on the medial side of the femur
On the tail
: coccygeal artery found at the base of the tail
Can save lives but are potentially dangerous for if they cut of blood supply for too long it can cause tissue death, therefore they should only be used if methods to control the bleeding have failed
Should only be placed for 15 minutes maximum
Never cover with a bandage
Blood loss
When blood is lost, the first step is to stop further blood loss. The second step is to replace the lost volume. In any surgery where there is a risk of blood loss, the amount needs to be quantified in order to be replaced. The measurement used is primarily determined by the nature of the operation as well as:
Weighing swabs: subtract the weight of dry swabs from the weight of soaked swabs. 1g = 1ml of blood.
Measuring the amount of fluid in a suction vessel
Estimating the volume of blood on drapes, surgical attire and the floor by weight - this is unreliable
The total circulating volume of blood can be calculated as:
Dogs = 80-90ml/kg of body weight
Cats = 60-70 ml/kg of body weight
The % of blood lost can be calculated as
Measured volume of blood lost / total circulating volume x 100 = % of blood lost
The following action should be taken:
Crystalloids >10% of blood volume lost (3x the blood lost)
Blood transfusion or oxyglobin >20% of blood volume lost
Routine care of the anaesthetised animal
Maintaining body temperature
Unable to regulate its own body temperature and hypothermia increases anaesthetic risk and prolongs recovery time
Measure the rectal temperature before and during the anaesthetic, evert 5 minutes
Number of ways to maintain body temperature, but is far better to prevent heat loss than to warm up an animal, methods include
Avoiding over-wetting the patient during the surgical scrub
Use of a rebreathing circuit, reducing heat loss through the airways
Insulation - place on a padded matting rather than the operating table and covering the areas of the animal which are not being operated on
Ambient temperature of 15-28 degrees in the operating theatre
Actively providing warmth such as heat pads, bare hugger
Warm IV fluids and fluids needed for lavage
Short surgery time
Prevention of corneal ulcers
Animals under GA are unable to blink, combined with the reduced tear production results in eyes that are susceptible to drying out, which can lead to corneal ulceration
Can be prevented by providing synthetic lubrication to the eye during surgical procedures which should be applied after induction and at regular intervals during the GA
Prevention of musculoskeletal damage
When an animal maintains one position for a prolonged period of time, there is a danger of musculoskeletal damage
Large animals such as horses are particularly vulnerable
Pressure on an area of muscle can lead to pressure necrosis, whereby the wright pressing on the muscle leads to reduced blood flow and tissue death
Pressure necrosis can be prevented by careful positioning of the animal and providing support with cushioning
Pressure on important nerves must be avoided as it can lead to paralysis and loss of function