Surgery Midterm (Instruments, anesthesia, dental, PE, behavior)

what are the directional terms for teeth?

Mesial - towards midline

distal - away from midline

labial - lips

lingual - tongue

buccal - cheek

occlusal - chewing surface

where does the crown meet the cementum?

cementoenamel junction

what pathology occurs at the CEJ

periodontal disease, FORLs

Job for incisors

cutting, nibbling

job for canines

holding, tearing

job for the premolars

cutting, shearing, holding

job for the molars

grinding

canine dental formula

3142, 3134

feline dental formula

3131, 3121

sickle scaler

purpose of sickle scaler

curved or straight, triangular head tapers to a sharp point, removes calculus above gumline and in between teeth, always pull away from the gumline

curette

purpose of the curette

U shaped, removes calculus under the gumline

periodontal probe

purpose of the periodontal probe

used to measure pockets, tiny little ruler

explorer

purpose of the explorer

used to detect subgingival calculus, tooth mobility, FORLs, enamel defects

dental elevator

purpose of the dental elevator

use to break down periodontal ligament, regular and winged, need to be sharp

periosteal elevator

purpose of the periosteal elevator

used to make gingival flaps, must be sharp

extraction forceps

purpose of the extraction forceps

used for extractions

tartar removal forceps

purpose of tartar removal forceps

used for removal of heavy calculus

mechanical scalers

COHAT

comprehensive oral health assessment and treatment

what does COHAT include

• PE and work up

• general anesthesia

• complete sedated oral exam

• record all findings before proceeding

• remove supragingival calculus with scaler

• remove subgingival calculus with a curette

• dental radiography

• extractions

• dental rads of extraction sites

  • polish and fluoride

how is safety and infection controlled

• sterile instruments

• appropriate sized mouth gags

• appropriate sized cuffed ET tube

• gauze in back of throat

• keep patient head tipped

• cover eyes and catheter

• PPE

• comfortable position

• light

• support hands while working

• be careful not to injure yourself

dental radiography reading

• top/bottom

• left or right

• find landmark tooth

• label teeth

• bottom - air on both sides of jaw bone

• left - lower 300s

• landmark - big fat tooth (309)

• label teeth - 307, 308, 309, 310

• top - sinuses

• right - 100s

• landmark - big fat tooth - 108

• label teeth - 110, 109, 108, 107, 106, 105

what type of tooth is the arrow pointing at

FORL

what is required for a diagnostic radiograph

• entire root

• surrounding alveolar bone

• landmark teeth

• be able to fix bad shot

what are the two dental radiograph techniques

• parallel

• bisecting

mayo scissors - dense tissue dissection

metzenbaum - delicate tissue dissection

iris scissors

suture removal scissors

lister bandage scissors

rat tooth - 3 giant teeth

adson - 3 tiny teeth

brown-adson - sideways teeth

dressing - transverse grooves, no teeth

Allis tissue forceps

sponge forceps - holds gauze and lap sponges

Doyen Forceps - has a gap to hold intestines, GENTLE

Ferguson Angiotribe - gigantic and terrifying, CRUSHES and DESTROYS

Backhaus Towel Clamp - sterility breaker

purpose of hemostats

stop bleeding

halstead mosquito - so tiny

Kelly - regular size, transverse grooves at tips

Crile - regular size, transverse grooves all the way up

Rochester-Pean - Larger

Rochester-Carmalt - double grooved at tip

Olsen-hager needle holders - scissors

mayo-hager needle holders

surgical needle rack

Spay hook

Groove director

Gallipot

What are tips for a good PE

• consistent - same procedure for every pt

• thorough

• efficient - should be quick and easy

• appropriate documentation - legal, SOAP

first step in PE

history

what is included in the history

• reason for exam

• vaccines

• previous dx

• current meds

• diet

• relevant medical hx

what is the second step in a PE

physical examination

what are the vitals during a PE

• HR/pulse

• RR

• temp

• hydration

• perfusion

• mentation

• BCS

• FAS

what should the eye be examined for?

• d/c

• chemosis

• hyperemia

• blepharedema

• ulcer

• neovascularization

• corneal opacity

• lens opacity

what should the ear be examined for

• d/c

• stenosis

• pain/pruritis

• erythema

what should the nares be examined for

• d/c

• stenosis

how should the cardiovascular system be examined

• murmur - grade and location

• arrhythmia - abnormal beats

how should the resp system be examined

• effort

• auscultation - sound

how is the GI examined?

• mouth - periodontal dz

• abdomen - palpation, distention, pain

• anus - appearance

how should the integument be examined?

• coat condition

• ectoparasites

• pruritis

• alopecia

• lesions

• peripheral lymphnodes

how should the urogenital system?

male - testicles, prepuce, penis

female - vulva, mammary glands

how should the musculoskeletal system be examined

• gait - lameness

• posture

• range of motion - normal, reduced, limited

how is the neurological system examined

• cranial nerves - pupillary light reflex, vision, hearing

• peripheral nerves - conscious proprioception

how should the behavior be examined

• in kennel/cage - cage aggressive, difficult to leash

• on exam - difficult to restrain, reactive to treatments

what is the third step in performing a PE

list all problems found on physical exam; DO NOT DIAGNOSE

what is the fourth step in PE

exam presentation

what is the flow of the heart

superior vena cave —> rigth atrium —>tricupsid valve —> right ventricle —> pulmonary valve —> pulmonary artery —> pulmonary veins —>left atrium —> mitral valve —> left ventricle —> aortic valve —> aorta

how does the electricity flow through the heart

SA node, AV node, Bundle of His, R/L bundle branches, Purkinje Fibers

Where should the electrodes be placed for ecg?

LA - black

RA - white

LL - red

RL - green

What does each part of the wave mean

P - Atria

QRS - ventricles

T - repolarization

Regular sinus rhythm

sinus tachycardia

Sinus bradycardia

sinus arrhythmia

1st degree AV block - PQ interval elongated

2nd degree AV block - occasional P wave w/o QRS, can occur due to high vagal tone

3rd degree AV block - P waves and QRS waves are no longer coordinated; MUST be treated due to low cardiac output

ventricular tachycardia - must be treated

Ventricular Premature Contractions - ventricles create QRS complex before the next p wave

atrial fibrillation

atrial flutter

ventricular fibrillation

What are the expectations of the anesthetist

know patient, know your protocol, know your team

how should you know your patient

signalment, PE and diagnostic workup

how should you know your protocol

drugs being used (class/mechanism, timing and expected effects, route, side effects), machine and equipment setup

what and why are the pre-op analgesics given to cat/dog before a procedure

prevent central sensitization, start night before procedure

canine - rimadyl/meloxicam

feline - onsior

why are premedications given

sedation, relax the patient