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www.bedahradiologi.fkh.ipb.ac.id 1

Drh. Deni Noviana, PhD

Drh. R. Harry S, MAppSc, PhD

Bagian Bedah dan Radiologi

Departemen Klinik Reprod ksi dan Patologi

Drh. Deni Noviana, PhDhttp://deni.staff.ipb.ac.id/

Departemen Klinik, Reproduksi dan Patologi

Fakultas Kedokteran Hewan IPB

1. Patient monitoring system2 Peralatan resusitasi oksigen2. Peralatan resusitasi oksigen3. Peralatan heating therapy4. Peralatan fluid therapy5. Monitor listrik jantung6. Peralatan cardiac arrest7 Peralatan penanganan perdarahan7. Peralatan penanganan perdarahan8. Peralatan aspirator9. Peralatan anaestesi inhalasi

• Oxygen saturation (SpO2) pulse oxymetry

• Blood pressure, HR, RR, SpO2 sphygmomanometers + pulse oxymetry

• Esophageal sthetoscope

• Apnea monitor

• Oxygen saturation is a measurement of the amount of

h d hoxygen attached to the haemoglobin cell in the circulatory system.

• Also called SaO2, SpO2, pulse ox, and sat or sats (short for saturation)

• Put simpler it is the amount ofPut simpler it is the amount of oxygen being carried by the red blood cell in the blood.

• Normal range: 96‐99%



• Pulse oximetry is a non‐invasive method allowing the monitoring of the oxygenation of a patient's hemoglobin.

• SpO2 Is given in as a percentage, for example 96%.

d h• Sensors connected to the patients contain two parts –LEDs and photodetectors.

i h i h d l h d li h i h i f d l h i i ll d f id

Sensor is placed on a thin part of the patient's body (fingertip, earlobe, across a foot)

Animals need to clip the hair when the sensor is applied

Difference in color between oxygen‐bound (bright red) and oxygen‐unbound (dark red or blue, in severe cases) blood hemoglobin caused different ratio of absorbance

Light with red wavelengths and light with infrared wavelengths is sequentially passed from one side to a photodetector on the other side.

The percent of hemoglobin molecules bound with oxygen molecules (oxyhemoglobin) can be made SpO2

Changing absorbance of each of the two wavelengths is measured

• Between 96‐99%• One haemoglobin molecule can carry a g y

maximum of four molecules of oxygen• One hundred haemoglobin molecules

could together carry a maximum of 400 (100 x 4) oxygen molecules

• If these 100 haemoglobin molecules were carrying 380 oxygen molecules they would be carrying (380 / 400) x y y g ( / )100 = 95% of the maximum number of oxygen molecules that could carry and so together would be 95% saturated.



• Pulse oximetry is a simple, noninvasive method of

monitoring the percentage of hemoglobin (Hb) in the blood that is saturated with oxygen.

• Complete system pulse oxymetry

• Description: SpO2, ECG, Pulse rate, respiration rate. , p

• Waveforms: ECG Plethysmogram.

• Graphics trends: SpO2, Pulse rate, Pulse signal strength and respiration

• Blood is carried from the heart to all parts of your body in vessels called arteries.body in vessels called arteries.

• Blood pressure is the force of the blood pushing against the walls of the arteries.

• One of the principal vital signs. • Systolic pressure measures the maximum pressure in the arteries during the cardiac cycle, hi h h th h t t t b twhich occurs when the heart contracts, or beats,

to pump blood.• Diastolic pressure when the heart is at rest, between beats, your blood pressure falls.

• Blood pressure is always given as these two numbers, the systolic and diastolic pressuresdiastolic pressures.

• Both are important. Usually they are written one above or before the other, such as 120/80 mmHg.

• Systolic pressure is the highest pressure in the heart and ismeasured when the heart is contracting. Di t li th l t• Diastolic pressure, the lowest pressure in the heart, occurs when the heart is filling.

• Blood pressure typically is reported as a two‐number ratio, systolic “over” diastolic pressure.

• The most common noninvasive blood pressure (NIBP) measurement methodinvolves a blood pressure cuff and ainvolves a blood pressure cuff and a stethoscope

• The cuff is connected to a gauge that displays pressure in the cuff.

• The cuff and gauge together are termed a sphygmomanometer.

• The blood pressure cuff is usuallyThe blood pressure cuff is usually placed around the arm and inflated to pressures displayed on the gauge.



• The manual technique involves a person who plistens using thestethoscope to Korotkoff sounds.

• Sphygmomanometers can use air or mercury (Hg) within the gauge to determine the pressure.

• The pressures are reported in millimeters of mercury (mm Hg),

Average canine blood pressure: 133/75

Breed Systolic Pressure (mmHg) Diastolic Pressure (mmHg) Pulse RateLabrador Retriever 118±17 66 ± 13 99 ± 19Golden Retriever 122 ±14 70 ±11 95 ± 15Great Pyrenees 120 ± 16 66 ± 6 95 ± 15Yorkshire Terrier 121 ± 12 69 ± 13 120 ± 14West Highland 126 ± 6 83 ± 7 112 ± 13Border Collie 131 ± 14 75 ± 12 101 ± 21

King Charles Spaniel 131 ± 16 72 ±14 124 ± 24German Shepherd 132 ± 13 75 ±10 108 ± 23

Terrier 136 ± 16 76 ±12 104 ± 16Bullterrier 134 ± 12 77 ±17 122 ± 6Chihuahua 134 ± 9 84 ± 12 109 ± 12Chihuahua 134 ± 9 84 ± 12 109 ± 12

Miniature Breeds 136 ± 13 74 ± 17 117 ± 13Pomeranian 136 ± 12 76 ± 13 131 ± 14

Beagle 140 ± 15 79 ± 13 104 ± 16Dachshound 142 ± 10 85 ± 15 98 ± 17

Saluki 143 + 16 88 ± 10 98 ± 22Greyhound 149 ±20 87 ± 16 114 ± 28Pointer 145 ± 17 83 ± 15 102 ± 14

CatCatThe blood pressure values for cats are not breed‐specific.

Normal feline blood pressure: 124/84

118/84 Kobayashi, 1990

125 ±1 1/89 ± 9 Brown et al., 1997

123 ± 14/88 + 15 Curtet, 2001123 ± 14/88 15 Curtet, 2001

125 ± 12/86 ± 15 Weber et al., 2002



Pulse Oxymetry with Blood Pressure measurement Magnatek 1400

• This monitor can function asa stand‐alone Non‐invasive Blood Pressure Monitors/NIPB monitorMonitors/NIPB monitor (Systolic/Diastolic/Mean Arterial Pressure)

• Complete system pulse oxymetry• Description: SpO2, ECG, Pulse rate,

respiration. • Waveforms: ECG Plethysmogram. • Graphics trends: SpO2, Pulse rate, Pulse

signal strength and respirationg g p• NIBP MONITOR) or can be configured with

SpO2, TEMP and printer as an independent vital signs monitor. Combine with the magnaTek 1300 or 1500 to add parameters.

• An instrument passed into the esophagus ith th ti iti d t th l l f thwith the tip positioned at the level of the

heart.

• It provides an excellent means of monitoring heart sounds and respiration (lung) while the animal is anesthetized.( g)

• Usually use the battery as power supply

OESOPHAGEAL STHETOSCOPE

• Transmit heart and lung d t thsounds to the

anesthesiologist’s earpiece

• Smooth, heat‐bonded cuff to tube transition minimizes potential for esophageal irritation.

• Definition is a medical equipment that records an animal’s heart rate and breathing patternan animal s heart rate and breathing pattern, and alarms if an animal’s heart rate slows down (bradycardia) or if he or she stops breathing for a period of time (apnea).

• Also called a cardiorespiratory monitor.Th it ill b t d f• The apnea monitor will be turned on for a certain amount of time, usually while animals inconcious/anaesthetized.



• A box with knobs, wires, TV‐like screens (depend on ( ptype), and a power cord

• They may stick to the skin, or be held on with a lightweight belt.

• There may also be other attachments that measure air flow through the nose or mouth.

• The electrodes have wires coming from them which are attached to the device.

• Tracheostomy: A ytracheostomy is a hole created in the neck to help animals breathe more easily.

• D ring operation• During operation anaesthetized animals

• Air flow: This shows how much air flows from nose or mouth to the lungs.

• Apnea: This shows how many times animal had apnea and how long theyApnea: This shows how many times animal had apnea, and how long they stopped breathing each time.

• Breathing pattern: This shows if animal breathe evenly and regularly.

• Breathing rate: This shows how many times you breathe in one minute.

• Chest movement: This shows how often your chest rises and falls*

• Electrocardiogram: This measures the electrical activity in your heart*• Electrocardiogram: This measures the electrical activity in your heart

• Oxygen level: This shows how much oxygen is in your blood*

* Depend on the type of apnoe monitor



• Resusitasi merupakan sebuah upayadi k k i k t k j t dmenyediakan oksigen ke otak, jantung dan

organ‐organ vital lainnya melalui sebuahtindakan medis

• Mechanical ventilation Resucitator

• Oxygen Chamber/tankOxygen Chamber/tank

• Other respiratory equipment Nebulizer

• Mechanical ventilation devices – air is pushed i t th linto the lungs

• This does not mimic actual breathing. In normal breathing, air is sucked into the lungs by moving the diaphragm.

• A device using positive pressure to inflate the lungs of an unconscious animal who is not breathing, in order to keep them oxygenated and alive.

• There are three basic types:• There are three basic types:

1. Manual version (bag valve mask) consisting of a mask and a large hand‐squeezed plastic bulb using ambient air, or with supplemental oxygen from a high‐pressure tank.



2. The second type is a pulmonary or breath powered resuscitator.

3. The third type is an oxygen powered resuscitator. These are driven by pressurized gas delivered by a regulator, and can either be automatic or manually controlled.

Resuscitator :A device using positive pressure to inflate the lungs of an unconscious animal who is

not breathing, in order to keep them oxygenated and alive.

• Infant manual resuscitator

• Mask

O i b (1700

• Adult manual resuscitator

• Mask

• Oxygen reservoir bag (2500• Oxygen reservoir bag (1700 ml)

• Oxygen tubing 60‐80 mm

• Oxygen reservoir bag (2500 ml)

• Oxygen tubing 200 cm

• Oxygen therapy purpose

• Equipped with thermo and hygrometer

• Nebulizer – This device is able to create a di ti i t th t b dd d t i t bmedication mist that can be added to air to be

inhaled by a patient.



• Principle for all nebulizers is to either use oxygen, compressed i l i b kair or ultrasonic power to break up medical solutions/suspensions into small aerosol droplets, for direct inhalation from the mouthpiece of the device.

• Important to note that inhaled aerosol droplets can onlyaerosol droplets can only penetrate into the narrow branches of the lower airways if they have a small diameter of 1‐5 micrometers.

use a piston‐style air compressor use high‐frequency vibrations to turn the medicine into a mist

the animal inhales mist through a device that inserts into the mouth

k

this air pressure sprays the medication out into a mist form

the mist they produce has more consistent, uniform and smaller

the animal inhales mist through a device that inserts into the mouth

or mask

or mask particle size

• AC power supply

• Power consumption 60 pwatt

• Ultrasonic frequency : 1.7 Mhz

• Max. Atomizing flow rate : Approx. 4mL / minpp /

• Aerosol particle size : 1 ~ 5 µ

• Solution bottle capacity : 150mL

• Infra red lampp

• Heating pad



• Infrared lamps have many uses but aremany uses, but are most commonly used in communication and heating.

• Infrared heating uses infrared lamps to ptransmit infrared radiation to the body that is being heated.

• Has been proven to effectively relieve aches an pains caused by muscular pains and stiff joins

• Comfortable warmth penetrates deep into the skin, stimulates blood circulation and warms the muscles.

• The muscles automatically yloosen up and relax

• The tissue became more pliable warms also reduces stiffness and makes joins more flexible

“Infra red lamp specifications”

• Has been proven to effectively relieve aches an pains caused by

l i d iff j imuscular pains and stiff joins• Output: 100‐150Watt infrared

warmth • Penetrates deep into skin,

improving blood circulation thereby giving relief for one areas

• Concentric rings help to focus on specific spots

• Adjustable angle

• Heating pads are useful for providing warmth for youngproviding warmth for young puppies/kittens, for dogs/cats during cold weather, post parturation or for older dogs with arthritis and joint problems.

• A heating pad is a safe way to increase your dog's comfort when used properly.



• Infusion cuff

• Infusion pump

• Syringe pump

• Alat yang digunakan untukb t dmembantu mendorong

cairan di dalam botal infusakan keluar lebih cepatdiperlukan untukmelakukan flushing dalamjumlah banyak dan periodewaktu yang singkat

Introduction• Bottles of fluids used gravity flow g y

to “drip” fluids into a patient. • As technology expanded into

health care, the bottles were replaced with plastic bags and gravity was no longer medically adequate.

• Electromechnical pumps are p pmore reliable and provide constant monitoring of fluid delivery.

• Also called intravenous pump, IVAC, and IV pump

• Delivers medication, blood, or fluid into the patient over a specific period of time at a particular rate.

• The pump ensures an accurate rate and, therefore, an exact dose.

• IV bags, filled with fluid, are connected through tubing to theg gpump, and then through the pump to the veins of the patient.



• Syringe pumps deliver medication from a syringe by i i d i h b kusing a piston to drive the back

of a standard syringe. • This device is usually used for

very small amounts of medication delivered veryaccurately.

• As with IV pumps, the di i i ll d li dmedication is usually delivered

to patients through their veins. Dosing instructions (time andamount) are programmed by the clinical staff.

• Electrocardiography

• Electrocardiograph/Elektrokardiogramm (Germany) A transthoracici i f h l i linterpretation of the electrical activity of the heart over time captured and externally recorded by skin electrodes.

• It is a noninvasive recording produced by an electrocardiographic device.W k l b d i d• Works mostly by detecting and amplifying the tiny electrical changes on the skin that are caused when the heart muscle "depolarizes‐repolarizes" during each heart beat.

• Fibrillation – the fluttering of the heart, which is essentially randomized electrical signals that result in chaotic and ineffective contractions.

• Asystole – no electrical activity of the heart, “flat line.” Patients in this condition are clinically dead.condition are clinically dead.

• Conduction abnormalities disruption of the electrical pathways of the heart.



• Only two connections are required to measure the electrical activity of the heartthe electrical activity of the heart.

• For example, a very basic ECG can readily be seen by holding a lead in each hand and using some simple signal processing amplifiers.

• There are three connections to the patient in a th l d ECGthree‐lead ECG.

• The connections are most often labeled RA (right arm), LA (left arm), and LL (left leg).

• Lead I – LA (positive) and(positive) and RA (negative)

• Lead II – LL (positive) and RA (negative)L d III LL• Lead III – LL (positive) and LA (negative)

• Each lead graphically shows the voltage ( t ti l diff ) b t t f th(potential difference) between two of the electrodes.

• A three‐lead ECG illustrates the electrical activity of the heart in three different ways using the three electrical wires connected to gthe patient.



• Defibrilator

• Fairly simple device that delivers a large amount of energy across a patient’s chestamount of energy across a patient s chest when the heart is not beating properly.

• When the heart is not beating with a pattern, all cells are contracting at different times; this is known as fibrillation. D fib ( th ft ll d) i t d• Defibs (as they are often called) in use today send about 3,000 volts (V) – up to 20 amperes (A) – across a patient’s chest.



• This large amount of energy causes all cells in the heartcauses all cells in the heart to depolarize at once.

• This action may allow the SA node to resume function and generate a normal electrical pattern. p

• Sometimes the SA node can recover, but sometimes it cannot.

• One paddle is placed on the p pright side of the patient, near the clavicle. This paddle is often labeled “sternum.”

• The other paddle is placed on the left side of the patient near the ribs, below the breast. This paddle is often labeled “apex.”

• Electrocauter

• Cauterization is an ancient medical practice by ti b th ti t ith lcreating burns on the tissue to either close

wounds or stop bleeding, or to remove part of the body.

• This practice would close wounds and stop bleeding because the heat would make the gblood clot.

• Cauterization is used with great frequency



• Burning of the tissue is usually accomplished i f t t ith b th fvia one of two routes, either by the use of electricity or with chemicals.

• When electrical pulses are used, this is called electrocauterization, and it’s often used to destroy tissues and make sure that small yarteries or veins don’t bleed excessively from removal of tissues.

In monopolar electrosurgery the current flows from the generator to the active electrode, in the hand of the surgeon, at the surgical site. The current passes through the patient’s body to a dispersive pad, which is the ground electrode, and back to the generator.

In bipolar electrosurgery current flows from the generator to the instrument, typically forceps. One tine of the forceps t th ti l t d d di tacts as the active electrode and directs

the current through the patient tissue to the other tine, which acts as the return electrode and enables the flow to return to the generator to complete the circuit.



Unipolar Electrosurgery

BipolarBipolar Electrosurgery

Electro‐cauterization (Bipolar)

• Aspirator surgery



• For First Aid Emergency • Suction pump for post‐Suction pump for posttracheotomy and minor surgery

• Light and easy to clean.• One jar type flow rate 15 lt/min – 25 lt/min

• Power source: AC and/ DC /(Battery)

• Antibacterial & hidrofobicfilter (opt)

• Masker

• Laryngoscope

• Endotracheal Tube (ETT)

• Ukuran bervariasi• Disambungkan denganmesin anesthesi inhalasiuntuk mengirimkanoksigen dan inhalan• Disambungkan denganresuscitator untukmembantu pengirimanoksigen• Disambungkan dengan• Disambungkan dengannebulizer untukmembantu pengiriman“mist” tertentu



• A laryngoscope is used to guide the insertion f th d t h l t bof the endotracheal tube.

• These devices are very common in hospitals.

• Ventilators are most commonly connected to the patient via an endotracheal tube through the mouth.

• The tube is curved to match animals/human anatomy.The tube is curved to match animals/human anatomy. • Many endotracheal tubes contain an inflatable cuff at the end to make a seal against the sides of the trachea.

• The cuff is inflated with air from a syringe.

• Berfungsi untuk mengalirkan gas inhalan danoksigenoksigen

• Intubasi dilakukan segera setelah induksianestesi oleh preparat yang bersifatmenghilangkan reflek menelan (ketamine, tiletamine/zaolazepam)Si l t ETT• Single use atau re‐use ETT

• Perhatikan ukuran ETT



HewanHewan BeratBerat (kg)(kg) Diameter ETT Diameter ETT (mm)(mm)(mm)(mm)

AnjingAnjing 33--77 3.03.0--5.05.0

77--1515 5.05.0--7.57.5

1515--3030 7.57.5--9.59.5

>30>30 9.59.5--1212

KucingKucing 2.52.5--4.04.0



Endotracheal Intubation

References

• Barbara L. Christe. 2009. Introduction to Bi di l I t t ti (Th T h lBiomedical Instrumentation (The Technology of Patient Care). Indiana University Purdue University Indianapolis. Cambridge University Press.

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