Unit quiz: The First Hours: Oxygen, Perfusion and the Monitored Number

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Question 1

A fictional 9 kg French bulldog, four days after airway surgery, rests in an oxygen cage set to deliver roughly 50 percent oxygen. The technician notes the SpO2 has fallen from 96 to 91 percent, the respiratory rate has risen from 28 to 46 breaths per minute, and the patient is increasingly reluctant to lie down. The cage door has been opened repeatedly for treatments. Which reading of the situation is most defensible?The fall in saturation together with the rising respiratory rate suggests the delivered oxygen fraction is no longer adequate for this patient, so the technician should check the cage seal, flow and door-closing discipline, record the trend, and escalate to the veterinarian for a decision on a higher-support technique such as a nasal line.A saturation of 91 percent is acceptable in a brachycephalic patient that has just had airway surgery, so the reading can be recorded and the next scheduled check can wait.

Question 2

A fictional 6 kg cat with a pyothorax is quiet and cold three days after a bite wound was cleaned. Temperature is 36.2 degrees Celsius, heart rate 118 beats per minute, respiratory rate 48 with open-mouth breathing, systolic pressure 104 mm Hg, lactate 3.9 mmol/L and urine output 0.4 mL/kg/h over two hours. A colleague says the cat cannot be septic because it is not febrile or tachycardic. Which response best applies the consensus definition?The colleague is correct that sepsis requires fever and tachycardia, so the findings should be recorded as a post-operative inflammatory response and monitored tomorrow.The cat has infection with hypothermia, hyperlactataemia, tachypnoea and oliguria, which are signs of organ dysfunction, so sepsis should be reported and escalated; the SIRS criteria are not the definition and were not supported in cats.

Question 3

A fictional 11-year-old cat has a systolic reading of 192 mm Hg taken once, immediately after being lifted from a carrier, with a size 1 cuff on the forelimb while two people hold the cat in lateral recumbency. The veterinarian is about to start an antihypertensive. What should the technician say?The reading cannot support a diagnosis: the cuff is likely too small for the limb, restraint and posture generate situational hypertension, and the ACVIM statement requires confirmation on more than two occasions unless target organ damage is present, so the measurement should be repeated under a standard protocol first.The value is in the severely hypertensive band, so treatment should start now and the protocol can be tightened at the next visit.

Question 4

A fictional 9-year-old dog with vomiting and weakness has a sodium of 129 mEq/L and a potassium of 6.9 mEq/L. The ECG shows a rate of 54 beats per minute with small P waves and a widened QRS. A colleague proposes correcting the sodium quickly to 140 mEq/L within four hours. What is the strongest objection?The objection is that sodium correction is irrelevant here, because the only dangerous finding is the potassium and the ECG, so the sodium can be corrected at any rate once the potassium is treated.Sodium should not be corrected faster than about 0.5 mEq/L per hour or 8 to 12 mEq/L per day because rapid change risks cerebral oedema, and the ECG changes and potassium also need veterinary assessment, so the plan should be escalated rather than accelerated.

Question 5

A fictional 4.6 kg cat in diabetic ketoacidosis is on an insulin infusion. At 14:00 the glucose is 402 mg/dL and at 15:00 it is 268 mg/dL. The technician is due to record the next value at 16:00. What is the best action at 15:00?Report the fall of 134 mg/dL in one hour immediately, because it exceeds the 50 to 100 mg/dL per hour limit intended to avoid cerebral oedema, and prepare to add dextrose as the veterinarian directs while continuing hourly glucose measurement.Record 268 mg/dL and continue the hourly schedule, because the value is still above the 250 mg/dL resolution target and no action is needed until it falls below that.

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