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Ch. 26 Emergency & Critical Care Nursing

Terms in this set (189)

Borborygmi
a rumbling or gurgling noise made by the movement of fluid and gas in the intestines
Capillary Refill Time
The time it takes for the vessels in the mucous membranes to return to normal after being pressed
Eructation
belching
Stridor
A high pitched wheezing sound generated from partially obstructed air flow in the upper airway.
Syncope
fainting or sudden loss of consciousness caused by lack of blood flow to the brain
Tachycardia
Abnormally fast heart rate; can indicate compensation for shock state, pain, anemia, anxiety or any combo of thereof
Tachypnea
rapid breathing often shallow, can indicate asthma, lung disease, anxiety, obesity, pulmonary embolism, choking, heart failure, heat stroke, lung infections...
Tympany
A hollow drum-like sound that is produced when a gas-containing cavity is tapped sharply
Toxin
an organic poison made by plants and animals
Urethral Process
a very short, narrow tube-like structure on the tip of the penis and because of its location and size is the most common site for uroliths to obstruct
Uterine Prolapse
when the uterine folds inside-out through the cervix and the vulvar lips
Uterine Torsion
the gravid uterus twists in relation to the maternal pelvis; cause of dystocia in cattle and camelids, and may be corrected by rolling the animal
Endometrial
pertaining to the inner lining of the uterus
Jugular Vein
Vein that carries blood from the head to the superior vena cava
Perineal Area
the area of the body between the genitals and the anus
Abdominocentesis
Aspiration of fluid by inserting a needle in the peritoneal cavity
cardiopulmonary resuscitation (CPR)
the attempt to restore cardiac and pulmonary function
Chest Tube
a tube inserted into the pleural space
Defibrillation
the treatment for ventricular fibrillation
Electrocardiogram
a visual representation of the electrical activity of the heart
Fetatome
Device used to cut a deceased fetus into smaller parts that can be more easily extracted vaginally when fetotomy is performed.
Fetotomy
The cutting apart of a deceased fetus to enable removal from the uterus
pericardiocentesis
surgical puncture to aspirate fluid from the sac surrounding the heart
Pulse Oximeter
an external monitor placed on the patient's tongue or earlobe to measure the oxygen saturation of hemoglobin
Regional Nerve Block
Anesthetic agent is injected into and around a nerve or group of nerves causing desensitization of a larger area of the body.
Rumenostomy
Surgical procedure whereby a permanent hole is created from the skin into the rumen.
Thoracocentesis
surgical puncture to aspirate fluid from the pleural space
Tracheotomy
Creation of a temporary opening from the skin to the trachea
Tracheostomy
Surgical creation of a permanent opening into the trachea through the neck
Transfaunation
Transfer of beneficial microorganisms from the rumen of one individual to that of another.
Triage
The sorting of patients (as in an emergency room) according to the urgency of their need for care.
Urethrostomy
surgical creation of a permanent opening between the urethra and the skin
Restrictive Breathing
fast, short, and shallow breaths
Apneustic Breathing
Abnormal respiration marked by deep inspiration with an abnormally long pause before exhalation
Labored Breathing
Prolonged and deep respiration
Cheyne-Stokes Breathing
Alternating between tachypnea and bradypnea
Kussmaul Breathing
deep and labored breathing
Normal mentation
Patient is bright, alert and interactive
Dull Mentation
not eager to interact with the environment
Obtunded Mentation
reacts to stimuli more slowly than normal
Stuporous Mentation
Only reacts to noxious stimuli
Comatose Mentation
unresponsive to any stimuli
Fixed and dilated pupils
Irreversible midbrain lesion
Rigid forelimbs and flexed hindlimbs with normal mentation
Injury to the cerebellum
Anisocoria
unequal pupil size; injury of the cerebrum
Rigid forelimbs and flaccid hindlimbs when in lateral recumbency is typical
Schiff-Sherrington, associated with a T3 to L3 spinal lesion
Unresponsive midrange pupils
Lesion in the medulla supporting brain injury
Extreme rigidity of all four limbs with arching of the neck and back
A lack of connection between the forebrain and brainstem
Septic Shock
severe infection
Distributive Shock
Vasodilation and pooling of blood in the capillaries
Hypovolemic Shock
decreased circulating blood volume
Cardiogenic Shock
decreased cardiac output
Obstructive Shock
Impaired venous return to the heart
Drug(s) to treat Ventricular Tachycardia
lidocain (Xylocaine)
Drug(s) to treat Asystole
Epinephrine and Vasopressin
Drug(s) to treat PEA
Epinephrine and Vasopressin
Drug(s) to treat Bradycardia
Atropine
Drug(s) to treat Vagally mediated arrest of AV block
Atropine
Drug(s) to treat Refractory, unstable ventricular tachycardia
Magnesium sulfate and Amiodarone
Drug(s) to treat Hypotension
Dopamine and Vasopressin
Drug(s) to treat Pulmonary edema
Furosemide
Drug(s) to treat Cerebral edema
Mannitol
Drug(s) to treat Low cardiac output
Dobutamine
Drug(s) to treat Hyperkalemia
Calcium gluconate
P Wave
atrial depolarization
PR interval
time it takes for the impulse to conduct through the AV node
QRS complex
ventricular depolarization
ST segment
time interval from ventricular depolarization to repolarization
T wave
ventricular repolarization
T/F Orthopnea refers to a posture assumed by animals to ease breathing.
T
T/F When evaluating mucous membrane color, blue means something is wrong, whereas mottled pink means things are fine.
F- mottled pink means possible carbon monoxide poisoning, heat stroke, or sepsis.
T/F Animals that are 3% to 4% dehydrated have decreased skin turgor.
F- 7% to get clinical signs
T/F Kussmaul breathing indicates respiratory compensation for a metabolic acidosis, such as diabetic ketoacidosis.
T
T/F When blood is aspirated during abdominocentesis, abdominal bleeding can be differentiated from fresh blood by looking at the color.
F- by observing clotting factors (clots=fresh blood)
T/F The ventral neck should be aseptically prepared when performing a tracheostomy tube placement.
T
T/F Animals with respiratory distress should have chest radiographs taken immediately upon presentation to diagnose the cause quickly.
F- Stabilize the patient first to not cause more stress
T/F Animals with hypoxia caused by severe anemia can have normal pulse oximeter readings.
T
T/F The partial pressure of oxygen in arterial blood (PaO2) can be used to assess pulmonary function.
T
T/F An ECG tracing is a reliable method of determining cardiac activity following cardiopulmonary arrest.
F- NOT a reliable method
T/F An ambu bag is used to provide ventilatory support.
T
T/F When performing defibrillation, electrical conduction should be enhanced by wetting the hair with 70% isopropyl alcohol.
F- alcohol can cause a fire; use conducting gel or saline
T/F The overall survival rate for all causes of witnessed in-hospital cardiopulmonary arrest patients is good, as long as treatment is initiated quickly.
F- only 4-9% survival rate
T/F A single increased central venous pressure (CVP) measurement is an accurate indicator of fluid overload.
F- needs multiple measurements needed to monitor trends
T/F Doppler blood pressure monitoring is only reliable for detecting systolic arterial blood pressure.
T
T/F The life-threating condition gastric dilation volvulus (GDV) can be readily ruled out as long as the patient doesn't have visible abdominal distention.
F- Long thorax may not display detention; stomach remains in thoracic cage
T/F The "P" wave on an ECG tracing corresponds to propagation of the electrical impulse through the atrial heart muscle.
T
T/F The horizontal axis on an ECG tracing represents the strength of the electrical impulse measured in mV.
F= the vertical axis
T/F NSR is a normal rhythm in both the dog and cat.
T
T/F Atrial standstill is a cardiac arrhythmia that has hyperkalemia as its most common cause.
T
T/F A second- degree AV block is a rhythm characterized by a prolonged PR interval on the ECG.
F- by a intermittent disruption of AV nodal.
T/F Horses that have colic can be divided into two main categories: a small number that resolve with minimal or no treatment, and many more that require aggressive treatment.
F- LARGER number that resolves with minimal or no treatment and many LESS that require aggressive treatment
T/F Abrasions around the head and the presence of dirt, mud, and hay in the hair coat of a horse experiencing colic are signs that it was in severe pain prior to arrival at the hospital.
T
T/F Nasogastric intubation in colic patients is important, because horses with excessive accumulation of stomach gas and fluid will often vomit and aspirate.
F- will NOT vomit and aspirate
T/F After passing a nasogastric tube in a colic patient, the tube should be removed immediately if no fluid is obtained to avoid further damage to the stomach.
F- do not remove tube, introduction to various therapeutic agents (mineral oil, water, or electrolytes) should be the next step
T/F When managing a colic patient, the body temp should always be taken prior to performing a rectal examination.
T
T/F Endoscopic examination of the airways can be used to evaluate the pharynx, guttural pouches, and trachea in horses, but cannot be used to evaluate deeper structures like the bifurcation of the bronchi.
F- can be used
T/F When performing a thoracentesis, the caudal aspect of the rib should be avoided with the needle.
T
T/F The location most often used to perform a tracheotomy in an equine patient is the ventral midline between the middle and caudal third of the neck.
F- cranial & middle 3rd of the neck
T/F Splint stabilization of an equine elbow fracture is not necessary if the patient can extend, plant, and move the leg.
T
T/F A scapula plantar splint is applied up to the point of the calcaneus to stabilize a distal to mid-hindlimb fracture.
T
T/F The size of the area around a wound that should be clipped is most closely associated with the presence or absence of infection.
F- location; joint or tendon sheath involvement needs clipped also
T/F When checking a wound for joint involvement by tapping the joint, the needle should always be introduced at a site distant from the wound.
T
T/F Food animals seldom need emergency care because, with few exceptions, their value is seen as economic.
F- often need 911 care
T/F Farm animals are frequently presented to emergency services because of complications of gastrointestinal parasitism.
F- parasitism in farm animals is more common and doesn't need emergency services normally
T/F Choke is a gastrointestinal condition commonly seen in camelids.
T
T/F The ruminal contents of a cow can be used to perform ruminal transfaunation of a goat.
T
T/F A vet can usually diagnose urethral obstruction form a good history and physical examination.
T
T/F The rapidity with which joint luxations are treated is an important determinant of the likelihood of success.
T
T/F Sheep and goats that are targets of dog attacks often suffer puncture wounds, which, although potentially serious, usually involve only superficial structures.
F- usually involve deeper structures
T/F By using proper equipment, dystocias of food animals can usually be management by the vet without additional help.
F- usually takes 2 or more people
T/F When replacing a prolapsed uterus, a large plastic bag can be used to prevent further contamination and trauma of the prolapsed organ.
T
T/F When faced with a small ruminant with an inability to urinate, urethral stones can easily be ruled out by taking radiographs.
F- urethral stones are not always radiopaque
T/F General anesthesia is required to perform a urethrostomy in a goat.
F- Not required
Laryngeal paralysis and other extrathoracic airway obstructions are characterized by
long, slow inspirations and short exhalations.
Increased bronchovesicular sounds indicate
pulmonary edema.
A weak, thread arterial pulse usually indicates
decompensated shock.
A patient with pronounced loss of skin turgor, dry mucous membranes, tachycardia, weak pulses, and sunken eyes, but not in shock or comatose, is approximately ___ dehydrated.
10%
An elevated blood lactate indicates
poor tissue perfusion.
Which of the following is a sign of compensated shock, but not a sign of decompensated shock? Pale mucous membrane color, tachycardia, hypotension, or increased pulse pressure?
Increased pulse pressure
A complication of shock that is characterized by widespread inflammation of tissues resulting from lack of oxygen is known as
SIRS
When performing a thoracentesis to diagnose or treat pneumothorax, prepare the area around the
7th to 9th intercoastal space between the top 1/3 and bottom 2/3 of the thorax
Cats with asthma will usually have
Increased respiratory effort and wheezing
Increased end-tidal carbon dioxide levels occur with
hypoventilation.
PaO2 is measured with
arterial blood-gas monitoring
The first priority when preforming CPCR is considered by many critical care veterinarians to be
chest compressions
During cardiopulmonary arrest and subsequent CPCR, which of the following end-tidal carbon dioxide monitor values indicate that chest compressions are adequate?
10 to 15 mm Hg
Closed-chest compressions are often not effective in
animals with pneumothorax.
During CPCR, stimulation of the Governor Vessel 26 acupuncture point is used to
stimulate respirations
The drug most commonly used to treat asystole during CPCR is
Epinephrine
When administering advanced life support during CPCR, some drugs may be given via the endotracheal tube. Which drug cannot be given this way?
Sodium bicarbonate
Marked increased central venous pressure (CVP) is caused by
heart failure.
Hyperkalemia is often a feature of which emergency disease?
Urethral obstruction
The ECG electrode that should be placed on the right rear limb is
green.
Arrhythmias that originate from below the AV node are classified as
ventricular arrhythmias.
A sinus arrhythmia is
normal in the dog, but not the cat.
Which of the following cardiac rhythms commonly occurs in normal animals as a response to pain, excitement, stress, or anxiety? Sinus arrhythmia, atrial fibrillation, sinus tachycardia, or atrial tachycardia?
Sinus tachycardia
Which of the following is a QRS complex that occurs too soon and is of identical or nearly identical shape as normal QRS complex? Atrial premature complex, junctional escape beat, ventricular premature complex, or ventricular escape beat?
Atrial premature complex
A cardiac arrhythmia that appears on an ECG tracing as a flat line is called
ventricular asystole
In equine medicine, emergencies involving three major organ systems make up a large part of the caseload. Which organ system is typically not involved?
Genitourinary system
The 10-cm X 10-cm location that should be clipped and surgically prepared prior to performing an abdominocentesis in colic patients is usually located
3cm-5cm caudal to the xiphoid and 3cm-5cm to the right of the midline.
The most common reason for surgical intervention in a colic patient is to
investigate pain that is unresponsive to sedation.
An upper respiratory tract obstruction in an equine patient is generally characterized by
severe distress, inspiratory stridor, and normal lungs sounds.
Effective treatment of equine pneumonia may require a bacterial culture and cytologic evaluation of respiratory secretions. Samples for these tests are best obtained by
transtracheal wash.
A bandage designed to stabilize a fracture of the proximal metacarpus of the horse must extend from the coronary band to the
highest point of the elbow.
Equine patients with _____ should always be assessed for blood loss, which is commonly associated with this condition.
a wound
A nonviable segment of bone that acts as a foreign body and frequently prevents full wound healing until it is removed is called a(n)
sequestrum
A cow in hypovolemic shock should receive a rapid 1L IV infusion of
hypertonic (7%) saline.
The area that must be prepared prior to abdominal surgery in cattle to correct GI abnormalities such as an abomasal volvulus or cecal volvulus is typically
the right paralumbar fossa.
A large-bore tube used to remove ingesta, liquid, and gas from the rumen of a cow is called a
Kingman tube.
The term down animal or downer is usually used to describe
animals that cannot stand.
The best option for supporting cows that can't stand for long periods of time is
hydroflotation.
A Krey hook is a device used to
perform a fetotomy
A "breech" presentation of a fetus during parturition is one in which
the rump presents first.
The "plank-in-the-flank" method is a technique is used to correct a
uterine torsion in a cow.
Urolithiasis is a condition most often seen in
Male sheep and goats
The most common place for a urinary stone to lodge in a goat is the
urethral process.
The procedure used to create a permanent opening from the skin into the bladder is called a
bladder marsupialization
To minimize the likelihood of development of urolithiasis in goats, it is most important to
eliminate grain from the diet.
During an initial triage examination, the ___, ___, and ___ organ systems should be systemically and carefully evaluated.
The respiratory, cardiovascular, and neurologic system
Dogs that in shock often have an abnormally fast heart rate (HR), also known as __ whereas cats often have an abnormally slow HR, also known as ___.
Tachycardia; bradycardia
A nonpalpable dorsal metatarsal arterial pulse in a dog indicates a mean arterial pressure (MAP) lower than ___________ mm Hg, whereas a nonpalpable femoral pulse in a dog or cat indicates a MAP lower than ___________ mm Hg.
80; 60
The clip-like probe of a pulse oximeter is designed to attach to a ______, poorly haired area.
vascular
Shock occurs as a result of altered blood flow, and ultimately impaired delivery of _____ to the tissues.
oxygen
Normal arterial blood pressure values for dogs and cats are in the range of ____ - ___ mmHG systolic and ___ - ___ mmHg (diastolic).
100-140; 60-80
The heart, lungs, _______, and ______ are the organs most often affected by MODS.
kidneys and liver
A pulse oximeter measures the percentage of hemoglobin that is saturated with ___, as well as the ____ rate.
oxygen; heart
During CPCR, when performing chest compressions and interposed abdominal compressions, the abdomen is compressed during the __________ phase of the chest compression.
recoil
When providing ventilation during CPCR with an anesthetic machine, a rate of approximately ___ to ___ respirations per minute should be used.
8-12
Central venous pressure (CVP) is the pressure in the cranial ____ _____. In normal dogs, CVP ___ to ___ cm H2O.
vena cava, 0-5
Regarding arterial blood pressure; in dogs and cats, normal ___________ pressure is 80 to 140 mm Hg, normal _________ pressure is 60 to 100 mm Hg, and normal _________ pressure is 50 to 80 mm Hg.
mean; diastolic
A blood pressure cuff is properly sized if the ___ of the cuff is approximately 40% of the ___ of the limb.
width; circumference
Patients with emergency respiratory disease are often treated with particular drugs related to the primary problem. For instance, patients in respiratory distress benefit from sedation with an opioid drug such as ___, cats suspected to have asthma should receive the drug ___ by inhalation, and patients suspected to be in heart failure should receive ____.
butorphanol; albuterol; furosemide.
The most commonly used electrocardiographic leads are 1,2,3, aVR, aVL, and aVF. 1, 2, and 3 are known as ____ leads, and a aVR, aVL, and aVF are known as ___ leads.
bipolar; augmented
When acquiring an ECG, the tracing should be recorded at a paper speed of ___ or __ mm/sec, and a calibration of ___ mm/mV.
25-50; 10
On a diagnostic ECG tracing, the QRS wave is made up of three separate waveforms. The first negative deflection represents the ___ wave, the first positive deflection represents the ___ wave, and the first negative wave following the first positive wave is the __ wave.
Q; R; S
When a QRS complex is normal in shape, this suggests that it is _______________ in origin, but if it is wide and bizarre in shape, this suggests that it is ____________ in origin.
supraventricular; ventricular
In a patient with a sinus arrhythmia, the HR typically increases during ___ and decreases during ___.
inspiration; expiration
Ventricular premature complexes (VPCs) may occur in groups of 2,3,4, or more and may occur in patterns. A group of two sequential VPCs is called a ____, and a group of three sequential VPCs is called a ___. A ___ is a rhythm in which every other beat is a VPC, and a ___ is a rhythm in which every 3rd beat is a VPC.
couplet; triplet; Bigeminy; trigeminy
Nasogastric intubation is typically performed in colic patients to remove excess gas and fluid from the stomach. This excess fluid is called ___ ____.
gastric reflux
On a physical examination, mucous membrane color is an important indicator of various conditions. For instance, an animal that presents with blue mucous membranes, also known as ____, should immediately be provided with ____.
supplemental; oxygen
In horses, thoracic problems, such as diaphragmatic hernia and pneumothorax, can lead to signs of respiratory distress or ___ (a disease of the gastrointestinal system)
colic
_____ supplementation is required in patients with respiratory distress when the PaO2 is less than 100 mm Hg.
Oxygen
When supplementing oxygen to an adult equine patient, a flow rate of at least ___ L/min should be used, whereas foals and miniature horses may require as little as ___ L/min.
15; 5
Bovine patients with bloat may have respiratory compromise because the rumen becomes distended and pushes on the ___________.
diaphragm
Microbial function of the ruminal contents can be determined by a methylene blue reduction test. If rumen flora is normal, the ruminal contents will change from a ___________ color to a ____________ color within 5 minutes.
blue; natural
In a ruminant, the incision for a C-section is usually made in the ___ ____ with the animal awake.
left flank
Cattle with metritis and mastitis can develop endotoxemia and may present with signs of _______ ______, which include tachycardia and tachypnea.
toxic shock
Animals with urinary obstructions frequently have serious electrolyte abnormalities. The most dangerous of these is ____________ because it may lead to fatal ________ _______________.
hyperkalemia; cardiac arrhythmias
The surgical procedure performed to create an opening in the urethra proximal to an obstruction is called a
urethrostomy
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