Surgery II Lab Practical

The scenarios won't fit the narrow width of this blog, so you can see the it in a document format at:
https://docs.google.com/etc

Abscesses:

• result from wounds sustained at least 3 days ago
• Step 1: surgical debridement
• don gloves and face mask
• surgically prep the puncture site
• use scalpel blade or hypodermic needle to lance abscess usually where original puncture was
• empty the abscess
• lavage with 1:40 dilution of Chlorhexidine
• remove necrotic tissues
• suture edges of wound if it's large
• create 2 new holes for Penrose drain to enter and exit, keep gravity in mind when choosing the location
• insert drain and suture on both ends
• clean drain site daily
• remove drain within 3 days
• remove drain as you would sutures so that nothing that's been outside the wound gets drug back through the wound upon removal
• Step 2: medical treatment
•  antibiotics

 Caution Numbers:

• HR: below 80Bpm
• RR: below 12 bpm
• CRT: under 1sec or over 2sec
• T: under 99F or more than a 2 degree drop
• Doppler, Systolic: below 100mmHg
• Doppler, Oscillometric: below 80mmHg
• CVP: 8cmH2O
• ET CO2: less than 25mmHg or over 45mmHg
• SpO2: 90%

 Cleaning/autoclaving:

• Autoclave 121C/250F 15 PSI 15min
• Flash Autoclave 133C/272F 35PSI 1min
• Detergents:
• Ethylene Oxide 1-18hrs + 24-48hrs to vent
• NOT inactivated by organic materials: Phenols (Pine-Sol), Biguanides (Chlor-Hex)
• Sporicidal:  Chlorine (Bleach), Aldehydes (Cidex)
• Scrubbing:
• fingernails
• wash w/ soap
• scrub fingertips, fingers, then hand  on hand  #1 (20 strokes on each surface)
• scrub fingertips, fingers, then hand on hand and wrist area of hand #2
• scrub wrist area of arms, then elbow area of arm #1
• scrub elbow area of arm #2

CPR:

• start in right lateral recumbency
• do compressions about where the elbow rests
• at costochondral junction
• compress no more than 30% to avoid cracking ribs
• thoracic pump: do compressions in time with breaths
• in dorsal recumbency, compressions are done on caudal end of sternum and at an angle down and cranial
• never stop for more than 10sec for any reason
• compressions contraindicated with:
• rib fracture
• pleural effusion
• pneumothorax
• cardiac tamponade

Drugs:

• Analgesics:
• Ketamine/Telazol
• A2A's
• Butorphanol
• Controlled:
• Diazepam
• Torbutrol
• Butorphanol
• Morphine and derivatives
• Fentanyl
• Ketamine

Equipment:

• Manometer max for giving breath: 20cmH20/14mmHg
• Manometer max for regular use: 4cmH20/2-3mmHg
• F-tubes: blue inner tube = inspiration, clear outside = exhalation
• Staining:
• Black/White spots = minerals in water
• Corrosion = wet, dry time cut short?
• Rust deposits = hard water, corrosion
• Blue/Grey = reverse metal plating, in cold sterile too long, chlorhex residue, exposure to saline?
• Brown/Orange w/o pitting = iron in water, high pH detergent
• Dark Brown = dried blood
• Multi-color = excessive heat exposure
• Read flow meter at center of ball, or at top of bobbin.  If there are 2 balls, there should be 2 scales, the top ball will read on the smaller scale, the bottom on the larger scale.
• APM, Audio Patient Monitor: esophageal stethoscope w/ speaker to amplify the sound.
• Direct BP monitor(MAP, Mean Arterial Pressure -most accurate) inside body (uncommon),atrial or CVP which must be measured on expiration.
• Indirect BP monitor = Doppler or Sphagnometer: hold the part with the reading at the animal's heart level; the 1st sound is systolic, 2nd is diastolic; not accurate, so take 5 readings, eliminate the highest and lowest, then average the other 3.
• Ocillometer -gives digital readout, measures size change.  Cuff size: width more important than circumference, width should be 40% of the circumference of the limb it will be used on.
• Laser: Think of the laser workpiece as looking like a mechanical pencil.  If you take the lead out, the "lead" is the tip and the empty pencil is the laser handpiece.

Math:

• # of L of O2 left in an H tank:  psi x 3.3
• # of L of O2 left in an E tank:  psi x 0.3
• Reservoir bag:  5-6 x tidal volume, always round up
• Tidal volume: 10ml/kg minimum
• 2.5% = 25mg/mL
• 1:1000 = 1g/L? = 1mg/mL?
• max lidocaine for cats= 4mg/kg (3 spots per paw)
• fluid deficits =  % lost x kg (10% of 20kg = 2kg = 2L lost)
• Fluid rates
• shock in dogs = 60-90ml/kg/hr
• shock in cats = up to 60ml/kg/hr
• maintenance = 40-60ml/kg/day
• surgery = 10ml/kg/hr
• drip rate: (calibration x volume)/time
• max potassium rate =0.5meq/kg/hr

Oxygen supplementation:

• flow-by
• face mask
• nasal prongs
• tube pointed at nose/mouth
• oxygen tent
• zip-lock bag
• e-collar
• oxygen cage
• nasal catheter -for longer term administration
• numb nostril
• measure tube from nose to medial canthus
• mark tube w/ tape
• lube tube
• insert tube when at leats 4min have passed since numbing
• suture a loop next to the nose
• suture tape on tube to suture loop through skin
• secure tube above forehead with tape?, glue? or more suture

 Suture Patterns:

• simple interrupted -J-J-J-
• uninterrupted/continuous -/-/-/-
• horizontal mattress = = =
• vertical mattress -| -| -|-
• cruciate/cross mattress  -X-X-X-

Triage:

• Airway
• make sure patent
• clear obstructions
• place ET tube
• Heimlich?
• tracheostomy?
• Breathing
• O2 supplementation
• manual ventillation?
• mouth to snout?
• Circulation
• IV catheter, fluids
• hemorrhage control
• CPR
• Drugs
• bolus IV drugs with 10-20cc saline
• dilute intratracheal drugs with 5-10cc sterile water
• Exam/Electrical Defibrillation
• defibrillation is only for v-fib or v-tach
• Follow-up

• Immediate:
• airway obstruction
• cardiac or respiratory arrest
• DOA
• Critical:
• respiratory or cardiac distress (pulmonary edema, arrhythmias)
• shock
• active bleeding (arterial or venous)
• active seizuring
• Serious:
• large wounds, compound fractures, traumatic injury
• bloat (GDV)
• toxin ingestion
• blocked male cats
• puppy and kitten sickness/weakness
• Less Serious:
• fractured tooth, toenail injury, URI, etc

 Misc:

• MAC:  high MAC = high safety = less potent = more required to maintain anesthesia
• Methoxyflurane is nephrotoxic
• Halothane is hepatotoxic
• Intubation:
• size according to width of space between nares
• ready one size smaller as well just in case
• check for leaks
• measure to thoracic inlet on the animal
• lube
• push epiglottis down with ET tube
• push down while inserting tube between arytenoid cartilage/vocal folds and into trachea
• tie in
• verify it's in place:
• watch for fogging INSIDE the tube
• palpate neck, if you feel 2 tubes, it's in the esophagus
• watch for bag movement during breathing
• listen to lung sounds on both sides
• Prep:
• cat spay:  midway between umbilicus and pubis bone
• dog spay: 1/4 to 1/3 down from umbilicus
• Review nerve block sites
• Monofilament:
• less traumatic to tissues
• does not wick
• Multifilament:
• greater strength
• holds knots better
• less memory (easier to work with)
• Storage times for packs:  4w muslin, 6m paper, double if double-wrapped
• Black handled instruments are "extra sharp", but dull more quickly.
• Gold handled instruments hold their edge longer  and have stronger gripping surfaces
• Osteotome has a point at it's center, slices bone.
• Bone chisel has it's point off-center and is used to chip away bone.
• O2 flow by: connect O2 to flow meter to outlet to patient (ET tube, mask, etc)
• ECG:
• measuring mv: 10cm = 1mv  (at standard calibration)
• if not standard, squared off wave = 1mv
• complexes are measured in height (mv) and width (sec)?
• intervals are measured in width (sec) only ?
• lead placement
• front: just proximal to elbow (on the caudal aspect)
• rear: just proximal to stifle (on cranial aspect)
• precordial clip goes on end of sternum
• Tourniquet placement:
• front: proximal to elbow, metal clasp over tricep (caudal aspect, not medial or lateral)
• rear: proximal to knee, metal clasp lateral or medial (check) 
• Landmarks for Ortolani's sign:  ischium and greater trocanter
  

Euthanasia as treatment for behavior issues in shelters

I tend to root for the underdog.  In a shelter situation, that's usually a dog with medical or behavior problems.  Having been an employee and (currently) a volunteer in a "no-kill" shelter, I've fallen for many animals who never made it out despite the "no kill" label.  Some succumbed to disease or illness, but at least an equal number were euthanized for behavior problems that could not (or would not) be solved.

This is an incredibly difficult thing to deal with.  I can't tell you the number of hours I've spent trying to rehabilitate and socialize animals with behavior issues only to see them either euthanized in the shelter or shortly after adoption.  The reasons given are liability and adoptability, but in many cases I have to say I believe the real issues is not having the resources to identify and deal with the problem early and on the organizational (rather than the individual) level.

Our shelter used to have a behaviorist that would come in an volunteer her time testing and giving tips on working with the animals that had issues.  But, her advice was given to one person who was tasked with spreading the word on the training plan.  There was no consensus.  There was no way of asking the trainer questions or otherwise allowing volunteers (some of whom think they qualify as a behaviorist themselves) to buy into the plan.  So, everyone did what they thought was best which meant the dogs were confused and the trainer was frustrated, so I assume she got tired of wasting her time and no longer comes to the shelter.

But, when an animal has a medical issue, even in a shelter environment, it's usually treated.  If behavior issues can be fatal, why aren't they treated the same as a medical issue?  With professional advice and a structure in place for implementing the recommended training, I think we'd see a lot more animals surviving the shelter environment and getting adopted.

Of course, that touches on two main issues that are probably the reasons this isn't done.  1.  There are too many pets out there anyway and some might say that the loss of a dog with a behavior issue likely saves a dog without one.  That may be true.  And 2, behavior issues aren't as easily solved as many medical issues are.  It's not as easy as one pill twice a day or some salve to put on a wound.  Instead it requires time, training, and liability.  ...and the outcome you hope for is adaptability, but given their history they will never be as adoptable as most other dogs and will likely take up space on the adoption floor for awhile before the right adopter comes along.

That brings me to another issue -the selectivity of potential adopters by shelters.  They often won't adopt to you if you'll be gone more than 8 hours, you don't have a fenced-in yard, you've never owned that breed before, you have kids, you have a roommate, you or your child have a disability, etc.  Anything that sets off alarms to the particular counselor you are talking to is grounds to deny you the adoption even if the next counselor would have said yes.  Why are we being so picky (and in some cases discriminating based on race, age, sexual orientation, and/or disability) if so many pets are dying?  How can they not think that the adopter they turned down is just going to the pet store down the street to buy a puppy mill dog?  Is that ever weighed into the decision at all?

And maybe if we didn't make people go through an interrogation to adopt a shelter animal adoptions would go up and puppy mills would loose business and profitability?  Maybe if people felt they could answer the adoption counselor's questions truthfully they'd get better advice and more adoptions would be successful.

Then again, maybe I'm just naive.  Or maybe there's a middle ground.  And maybe other shelters are run better (I hope they are!).  But, all of this has sparked something in me.  I look forward to being a Vet Tech with my hands in the poop and my eyes throbbing from looking into a microscope too long for as long as possible, but when I'm too old and can't do it anymore I would really love to start a shelter.  I understand that I'd have to be the one to make the call on euthanizing a dog for aggression, but at least when I made that decision I'd understand and agree with it.  I'd have the time, ability, and resources to look for other options before that needle hit the vein and it was too late.

I hate being the victim of someone else's decision.  I hate nodding my head "yes" when they tell me they've done everything they could while knowing there were options that were not explored.  But I do because at the time it doesn't matter.  The decision is made.  My friend is dead.  But I do hold some hope that one day I can make a difference in some of these dogs' lives.

RIP Vixey, Mike, Boris, and the many others.

ECG Review

You can click on any of the photos in this article to see the Flickr page for it where you can leave notes on the images (ie circle a wave and ask "what's this wave?") and larger versions are available for viewing there as well.

1.

Is the P-wave to P-wave spacing consistent?  No
Is the QRS to QRS spacing consistent?  No?
Is there a P-wave for every QRS complex?  No.
The QRS complex is early = Ventricular issue = PVC

2. (top)


P-P consistent?  No.
QRS-QRS consistent?  No.
P for every QRS?  No.
PVC
Are there 3 in a row?  Yes.  = Ventricular Tachycardia
(bottom:  all QRS waves are bizarre except for the one with the arrow so this one is also Ventricular Tachycardia?)

3.

The T-wave can go down (below baseline) or above it and still be considered normal.
Here we have a double QRS with no P-wave.
There are 2 in a row,
The QRS complexes are weird, so this means it is a ventricular issue.
They are also early, so they are premature.
There are 2 abnormal QRS's in a row, but not 3, so it's PVC and you should note it as "2 PVC's seen" on your homework.

4. is missing, I don't know why.

5.

Remember that when given all the leads, lead II is the only one we read.

6.

(top image)
P-P distance consistent?  No
QRS-QRS distance consistent?  No
All P's and QRS's look normal, they just speed up and slow down.
=Sinus Arrhythmia

(bottom image)
Also sinus arrhythmia, it's just not as long of a readout.

7.

(top)
P-P distance consistent?  No
QRS-QRS distance consistent?  No
QRS's look bizarre, they have a Sigmoid curve look  (like an "S" laid on it's side).  This indicates a ventricular issue.
Is it premature or late?  Measure between two normal waves to the left and right of the weird one, and the weird one should be right in the middle.  This one was early/premature.
And there's only one, so it's a PVC.

(bottom)
The same thing, only this time there are more than 3 in a row, so it's Ventricular Tachycardia.

8.

Is the P-P interval consistent?  It's hard to tell.
The ventricles aren't as quick as the atria.
The ventricles are showing an escape beat.
This shows a 3rd degree AV block.
There are 3 P-waves without QRS complexes. 
It's like the P's are on their own cycle.

9.

Here the sizes of the QRS complexes are changing.
They aren't bizarre looking, though.
Is the P-P interval the same?  No?  It's hard to distinguish the P-waves.
Is the QRS-QRS interval the same?  No
Is there a P for every QRS and vice versa?  Don't know, hard to distinguish the P's.
The QRS's have no rhythm, they are randomly spaced.
This indicates an atrial issue.
It is atrial fibrillation (jungle drums).

10.

There is no way to get a rate from this lead.
P-P interval consistent?  No, can't identify the P-waves
QRS-QRS consistent?  No, can't identify the QRS complexes.
P for every QRS?  No, can't identify them.
=Ventricular fibrillation
(it could also be quivering or shaking)

11.

(top)
P-P interval is hard to see, but normal.
QRS-QRS interval is normal.
If the P-P and QRS-QRS is normal you can rule out arrhythmias.
The baseline is moving.  This indicate the patient is moving, this is not caused by the heart.
This is an artifact caused by tremor or purring.

12.

You can't identify anything in this ECG.
It's abnormal, but the same height and distance the whole way;  it's very predictable.
If you count the rate it'd be 3600Bpm.
This is an artifact caused by electrical interference.

13.


(top)
P-P consistent?  Yes?
QRS-QRS consistent?  No
P for every QRS?  No, not in between beats.
QRS's are not bizarre looking.
The P's are weird, though, so this indicates an atrial issue.
Are the P's premature?  Yes
APC if less than 3 in a row, atrial fibrillation if 3 or more in a row.

14.

P-P consistent?  Can't tell, they can't be identified for sure.
QRS-QRS consistent?  No
P for every QRS?  No, can't identify the P-waves.
=Atrial fibrillation.  You can't identify normal P-waves and there are random QRS's.

Sophomore year, 1st semester flashcards

My flashcards are available on StudyDroid here:
http://www.studydroid.com/index.php?page=search&search=muddyboots2&x=19&y=16

If you own an Android phone (Droids and many other phones) you can download the StudyDroid app and put these flashcards on your phone.  If you do not own an Android phone you can use the web interface to study them.


No guarantee the info is correct.  Information provided under a Creative Commons Attribution, Non-Commercial, Share-Alike license.

What's to eat?

So, I'm into my Sophomore year, first semester, and we had Exotics class for the first time with Eileen yesterday.  She's very much into ecology and the interconnectedness of politics, the environment, and animals.

This lead to an interesting discussion yesterday between my classmates and I about trying to eat with some consciousness about supporting or not supporting the various places that our meat comes from.  Or, the alternative, becoming vegetarian.

This was on my mind before I even entered school.  I saw Food, Inc. and other documentaries and I read books on corporate farming and, as a result, have been trying to source my meat from smaller farms or going "semi-veg" where you try to eat vegetarian a few days a week to make some sort of an impact without feeling completely deprived.

So, last year in large animal class we went over the raising of beef cattle, dairy cows, pigs, and chickens and, while I was afraid it'd turn my "semi veg" into a "full veg", it did not.  It did, however, further my resolve to try to purchase from non-corporate farms.  We got to see small farms in our labs and it was obvious that the farmers really cared for their animals, so it definitely strengthened my resolve that I wanted to continue to support smaller farming operations.

But, in a fit of documentary watching based on some recommendations by Eileen, I just watched "End of the Line" about overfishing and how big of an issue it is.  All over the world the populations of many of our primary food fish are dropping at an alarming rate and, while limits are put in place globally, many times they are higher than what the scientists recommend for sustainability (and to be clear, that's sustaining an already extremely low population), so the number scientists recommend for allowing the species to recover their numbers was MUCH higher.  And, even though they agreed upon the setting the fishing limit higher than the scientists recommended, many countries exceed the limits anyway.

Fish used to be my "go to" food.  In restaurants where the meat sources are unknown I'd order fish.  I mean, they swam free in the ocean, got caught, and ended up on my table, right?  Chances are that was a better life than the cattle, pig, or chicken had?  Well, yes, but no.  If they were wild, they were likely caught with troll lines that arbitrarily catch everything in their path.  The coral, plants, and other fish that get caught are killed and their bodies are simply tossed overboard.  Only the profitable fish are kept.  Uncool.  And I learned that farmed fish are no better.  They use trolling lines to catch fish to feed to the farmed fish.  Great!

I'm left with a feeling of frustration that I should have to work so hard to not support the global trend of abusing our protein sources so we can get more (profit) out of less (humanity/responsibility).  I know the average person doesn't want to think about a pork chop as once having been a pig, but it's those blinders that are standing in the way of us fixing this mess.

Corporations don't want to abuse animals, they just want to make a profit.  And the meat-consuming customer doesn't want to support the abuse of the animals they eat, they just want to buy hamburger for $3/lb so they can afford to put gas in their car to get to work for another week.  But it's that drive to lower prices that has driven the farming industry to do some pretty horrible things.  But, how would the consumer know?  After all, the packaging on their meat products show peaceful farm scenes and the average person has no reason to look into it any further.

I think this is where our government comes in.  More and more the laws are changing so that dogs and cats are no longer just considered property in the eyes of the law, but they are considered as living things which should not be abused and should be given some level of basic care and comfort.  Where are these laws for our food animals?  I hope they are coming.

And with fish too.  The average consumer is too busy working and raising a family to know what species to buy and which not to.  Or whether to buy farmed or wild and how they were caught.  And worse yet, i think we'd all agree that endangered species should not be on any menu, but in "End of the Line" they showed that they often are.  As they said in the documentary, if a restaurant put tiger or gorilla on their menu you'd hear about it on the news, they'd be shut down or at least protested against.  We just aren't as aware of fish.  We assume it's regulated but it appears (from this one documentary, mind you) that it is not.


That's it.  I have no answers.  I'm just using this blog as a vent for my frustration although I will throw a plug in here for Certified Humane.  I have yet to find any meat in stores that's Certified Humane, but I have found eggs in stores like Whole Foods and Caputo's in Naperville, IL if you are interested in supporting them.  They have their requirements for eggs, beef, dairy, poultry, etc all up online so you can read through them.  Their standards seem to jive with what we learned in large animal class Freshman year.  I very much support their efforts in giving consumers who are aware of the problems of factory farming a clear way to judge whether or not their animal products were raised and handled humanely.

That's it.  I'm stepping down from the soapbox now.  More to come as the semester advances I'm sure.

My externship site review

The place where I did my externship will remain anonymous unless you are in the JJC Vet Tech program.

The good:
  * I got to see a lot.  This is a busy walk-in clinic that has a separate emergency clinic that operates in the same building overnight.  Advertising for the emergency clinic, I suspect, means that this clinic sees a lot of emergencies regardless of the time of day.
  * The Tech supervisor graduated from JJC so she knows what to expect out of JJC students and can relate on a personal level to the experience of being an extern.
  * The other Assistants/Techs are very nice and helpful.
  * They pay $100/week. 
  * Shifts are 6:30am to 1:30pm, so the possibility to work a second job or do things after your shift is there.  I chose to work the afternoon shift on Mondays and Tuesdays which I liked (1:30pm to 8:30pm) and putting in extra time in addition to your shift is no problem if you want to get your hours done more quickly.

The bad:
  * The doctors are always very busy juggling rooms and don't have a lot of time to answer questions.  Teaching time with doctors is very rare.
  * There are 10 or so doctors and sometimes a Veterinary intern on staff here.  It's hard to get to know them and to get them to remember that you are an extern looking to learn things so that if/when they do have time or something interesting they might let you know about it.
  * The Techs/Assistants, while helpful, will generally give newbies the easy jobs just to keep up with the pace, so if you want to try a catheter, jugular blood draw, etc you have to either wait till everyone else is busy and you are the only one available or speak up!
  * Techs/Assistants are not well utilized.  Doctors do most of their own blood draws, injections, radiographs, etc. so much of your time is spent restraining.  This leaves few opportunities to practice, so again you have to jump on opportunities when they arise.  (Techs/assistants are mainly responsible for surgery and hospitalized patients, though, so these are your best opportunities to get practice!)
  * I had to buy a uniform from them.  For 2 sets of scrubs it was about $100. 

The indifferent:
  * There is no structure at this clinic.  You aren't assigned to any job or vet, everyone just jumps in and does what needs to be done.  You go from prepping for surgery, to cutting nails, cleaning cages, drawing blood, mopping the floor, washing surgical instruments, shuttling animals around -whatever needs to be done at the moment.  There is little to no down time, but you aren't stuck with one task or one doctor all day either.

What I got to do:
Daily to several times a week:
  * restraining
  * cleaning cages, dishes, surgical instruments, the treatment area, etc
  * drawing up vaccines
  * TPR's for hospitalized cases
  * giving medication to boarding and hospitalized patients
  * prep animal for surgery (restrain for induction and intubation, then you shave, scrub the surgical site, and open the pack for the vet)
  * nail trims with or without dremel
  * cephalic blood draws on dogs
  * putting in IV catheters (almost always in dogs)
  * SQ injections
  * IV pump use

Weekly or so:
  * jugular blood draw(s)
  * putting drugs away (cabinets by type of drug, helped w/ re-learning drugs)
  * run in-house blood tests (PCV, Pre-surgical or Chems, rarely CBC's, or electrolytes)
  * nebulization(s)
  * giving subcutaneous fluids
  * monitor patients' anesthesia level

Rarely:
  * scrub in on a surgery (once, foreign body)
  * take x-rays yourself
  * dentals
  * calculate and/or give premed
  * induce anesthesia (once)
  * intubate (once)
  * anal glands, fecal collection
  * microscope work, mostly earmite checks (a couple aspiration biopsies and skin scraping results always because I asked to look at it)
  * run EKGs (done over the phone)
  * use esophageal stethoscope
  * set up suction and/or cautery for surgery
  * wing clipping
  * microchipping

Never:
  * fecals -always sent out
  * urinalysis -sent out
  * blood smears -sent out
  * physical exam -doctors do, although techs do TPR's on hospitalized cases
  * interact with customers by phone
  * needle aspiration biopsy -doctors do
  * skin scraping -doctors do
  * FDT/STT -doctors do
  * otoscope/ophthalmoscope use -doctors do
  * take histories-doctors do
  * bandaging -techs do, I just never did it
  * calculating fluid rates, estimating dehydration -doctors do
  * dental radiographs -not available except w/ regular x-ray machine
  * blood pressure, ETCO2 -BP available, ETCO2 not available

What I got to see:
  * oxytocin use, puppies being born (got to stimulate puppies to potty)
  * eclampsia
  * hit by cars
  * respiratory arrests and other emergencies
  * collapsed tracheas
  * toxin ingestions (Decon, Aleve, marijuana, transmission fluid, unknowns)
  * saddle thrombus
  * GDV
  * HGE
  * severe anemia
  * hepatic lipidosis in a cat
  * compound fracture in cat
  * lacerations, abcesses, necrotic wounds
  * an impalement
  * glucose curves
  * ACTH stim tests
  * acute and chronic renal disease
  * acute and chronic liver disease
  * acute and chronic heart disease
  * cardiac arrests
  * splenic, liver, skin, and other tumors
  * two eye removals  (dog and cat)
  * heat stroke (dogs and a chinchilla)
  * severe dry eye
Surgeries:
  * limb, tail, toe amputation
  * declaws
  * spays, neuters
  * foreign bodies/gastrotomies (rocks, blankets, rubber toys, etc)
  * cystotomies
  * blocked cat
  * CCL's
  * tight ropes
  * TPO's
  * patellar luxation correction
  * lumpectomies
  * aural hematomas
  * kidney removal (HBC)

Abbreviations in Veterinary Medicine

• AAFCO:  Association of American Feed Control Officials  -set standards for feed and it's labelling
• ACE:  angiotensin-converting enzyme
• ACT:  activated clotting time
• ACTH:  adrenocorticotropic hormone
• ADH:  antidiuretic hormone
• ADR:  Ain't Doin' Right 
• AD:  right ear
• AI:  artificial insemination
• ALARA:  as low as reasonably attainable  -what you want your x-ray exposure to be
• ALP:  alkaline phosphatases
• ALT:  alanine aminotransferase
• APPT:  activated partial thromboplastin time
• ARF:  acute renal failure  -sudden onset, kidneys appear swollen
• AS:  left ear
• AST:  Aspartate aminotransferase
• AU:  both ears
• AVMA:  American Veterinary Medical Association
• BID:  twice a day
• BM:  bowel movement, poop
• Bpm:  beats or breaths per minute (measure of heart or respiratory rate)
• C  calculus/tartar (on dental chart, graded C/H, C/M, C/S)
• C1, C2, etc:  cervical vertebrae -they are numbered with C1 being the closest to the skull
• cc:  cubic centimeters  -same as a mL
• CCD:  canine cognitive disorder  -doggie alzheimer's
• C/H:  calculus heavy (on dental chart)
• CHF:  congestive heart failure
• CL:  corpus luteum  -produces progesterone and maintains pregnancy
• C/M:  calculus moderate (on dental chart)
• cm:  centimeter  -metric system unit of measurement, 2.5 cm = 1 inch
• CNS:  central nervous system  -the brain and spinal cord
• CP:  corporal proprioception  -a test of the nervous system; one test is to pick up a dog's foot and put it down so the toes are under the foot, a normal response would be for the dog to immediately turn his foot back to a natural position
• CRF:  chronic renal failure  -slow onset, kidneys appear lumpy and shrunken
• CRI:  constant rate infusion  -administration of a drug in little bits over a long period of time, usually done via an IV drip
• CRT:  capillary refill time  -a test of perfusion where pressure is applied to an area like the gums and then released; the skin should blanch and then return to pink within 2 seconds
• C/S:  calculus slight (on dental chart)
• CVP:  central venous pressure  -measurement of blood pressure at a central vessel such as the vena cava, usually done through the jugular
• D:  diarrhea 
• DA2PP:  distemper, adenovirus (two types), parvovirus, and parainfluenza  -common multi-vaccination for dogs
• DER:  daily energy requirement  -much like BMR for humans, its the calories required to sustain life at rest, helps in determining amount of feed to give
• DMSO:  dimethyl sulfoxide  -a nonsteroidal anti-inflammatory drug (NSAID)
• DTM:  dermatophyte test media  -a culture test used to diagnose ringworm
• Dz:  disease
• EDTA:  ethylenediaminetetraacetic acid  -an anticoagulant added to some blood collection tubes, usually those with a puple top
• EEE:  Eastern Equine Encephelitis
• EH:  enamel hypoplasia/hypocalcification  -when the enamel doesn't form properly on the teeth such as in dogs exposed to high fever (esp. Distemper) as puppies when the enamel is forming
• ELISA:  enzyme-linked immunosorbent assay  -a type of rapid test that a vet can often do in the office and have the result in 10 to 15 minutes
• EOD:  every other day
• EPO:  erythropoetin  -a chemical released by the kidneys that spurs new red blood cell growth
• ETCO2:  end tidal carbon dioxide  -a measurement of the amount of carbon dioxide being breathed out by an animal, usually under anesthesia
• F:  female
• F1:  furcation detected (on dental chart)
• F2:  probe passes into furcation (on dental chart)
• F3:  probe passes through furcation (on dental chart)
• FAD:  flea allergy dermatitis or foreign animal disease  -allergic reaction to a flea bite, or an animal disease that is not usually encountered in the area where it was found, could be a vector for terrorism
• FDT:  fluoroscein dye test -used to find ulcers or wounds on the eye
• FE:  furcation exposure (on dental chart, graded F1, F2. F3) 
• FeLV:  feline leukemia virus vaccine
• FFD:  focal film distance  -the distance from the x-ray source to the film
• FIA:  feline infectious anemia 
• FIP:  feline infectious peritonitis  
• FIV:  feline immunodeficiency virus  -kitty AIDS
• FLUTD:  feline lower urinary tract disease  -conditions of the lower urinary tract in cats such as bladder infections, blocking, etc
• FORL:  feline odontoclastic resporptive lesion  -condition in cats where the tooth is absorbed by the body
• FRL:  feline resorptive lesion  -condition in cats where the tooth is absorbed by the body
• Fx:  fracture
• g:  gram  -unit of weight, roughly equal to that of a small paperclip
• GDV:  gastric dilatation and volvulus  -a life-threatening condition where a dog's stomach fills with gas and then twists around, cutting off circulation and causing tissue death
• GH:  gingival hyperplasia (on dental chart, graded H1, H2, etc)
• GI:  gastrointestinal  -the organs of digestion from the stomach to the anus
• GR:  gingival recession  (on dental chart)
• gr:  grain  -a unit of measuring weight, there are about 60mg in a grain
• H1:  gingival hyperplasia, 1mm
• H2:  gingival hyperplasia, 2mm, etc
• Hb:   hemoglobin  -the chemical in the blood that carries the oxygen
• HCT:  hematocrit -same as PCV. measures what percent of the blood is RBC's
• HR:  heart rate (number of beats per minute)
• Hx:  history
• IACUS:  Institutional Animal Care and Use Committee  -oversees animal welfare issues in research facilities
• ID:  intradermal  -(injections) made directly into the skin (as opposed to under it), usually for allergy testing or administration of a pain blocking agent
• IM:  intramuscular  -(injections) made into the muscle, usually the tricep (upper arm), quadricep or hamstring (upper leg), or epaxial (back)
• IMHA:  immune mediated hemolytic anemia  -an anemia caused by the body attacking it's own red blood cells (RBC's)
• IO:  intraosseus  -(injections) into bone such as the hip, femur (upper leg), or tibia (lower leg)
• IP:  intraperitoneal  -(injections) into the abdominal cavity
• Iso:  isoflurane  -a type of gas anesthetic
• IV:  intravenous  -in a vein or vessel
• kg:  kilogram  -a measure of weight, there are 2.2 pounds in 1 kilogram
• kVp:  kilovoltage peak  -a setting used for taking radiographs, effects the contrast in the resulting image
• L:  liter  -one-thousand mL, about the same as a quart 
• L1, L2, etc:  vertebrae of the lower back, numbered
• lb:  pound  -a measurement of weight, there are 2.2lbs in a kg
• LH:  luteinizing hormone -promotes ovulation and corpus luteum conversion in females and stimulates testosterone production in males
• LI:  large intestine
• LRS:  lactated ringers solution  -a type of fluid used both subcutaneous (under the skin) and IV
• M:  mobility (on dental chart, graded M1, M2, M3) 
• M:  male
• MAC:  minimum alveolar concentration  -a measure of the amount of an anesthetic gas that's required to render an animal unconscious
• MCHC:  mean corpuscular hemoglobin concentration  -the average amount of hemoglobin contained in the red blood cells, tells you if the RBC's arepale in color or not; light cells have less hemoglobin and are often indicative of young RBC's
• MCV:  mean corpuscular volume  -the average size of the red blood cells in a sample, large cells indicate more young RBC's
• mg:  milligram  -one one-thousandth of a gram (g) 
• MIC:  the lowest concentration of an antibiotic that is effective, usually in laboratory conditions, used to determine dosage requirements
• mL:  milliliter  -one one-thousandth of a liter (L), a milliliter of water weighs about a gram (g)
• mm:  millimeter -a tenth of a centimeter (cm)
• mm:  mucus membranes  -often the areas on animals where color can be observed or a CRT can be taken such as the gums, tongue, prepuce, conjunctiva, etc
• MPD:  maximum permissible dose  -max amount of radiation a person should be exposed to in a year, 5 REM for occupationally exposed persons, 0.5 REM for everyone else
• MREM:  millirem  -one one-thousandth of a REM
• MSDS:  Material Safety Data Sheet  -the safety information about chemicals used in a workplace that must legally be accessible to anyone who uses the chemical as part of their job
• NM:  neutered male
• NSAID:  non-steroidal anti-inflammatory drug  -like Tylenol or aspirin in human medicine
• O:  missing (on dental chart)
• o:  owner
• OCD:  osteochondritis dissecans  -a condition where a piece of cartilage in a joint (usually the knee) tears and floats around causing pain
• OD:  right eye
• OS:  left eye
• OSHA:  Occupational Safety and Health Act -a set of laws designed to provide a safe workplace for employees
• OTC:  over the counter  -a medication or other product that's available in stores without the need for a prescription
• OU:  both eyes
• oz:  ounce  -equal to 2 tablespoons or 30mL
• p:  patient 
• P1:  the most proximal phalanx (bone of the finger/toe/digit)
• P2:  the middle phalanx (bone of the finger/toe/digit)
• P3:  the most distal phalanx (bone of the finger/toe digit)
• PCV:  packed cell volume  -a test to find out what percentage of the blood is red blood cells, it can help diagnose anemia among other things
• PDA:  patent ductus arteriosis  -a condition where a hole in the heart that's normal in fetuses persists in an infant or adult; usually results in a "washing machine" type of heart murmur
• PLR:  pupillary light reflex  -a test of the nervous system; a light is shined in the eye and the pupil is observed for contraction
• PO:  per os  -by mouth 
• PNS:  peripheral nervous system  -nerves that come after the brain and spinal cord
• prn:  as needed
• PSS:  portosystemic shunt  -a condition where a blood vessel allows blood to detour around the liver so that it does not get filtered and toxins build up in the blood
• pu/pd:  increased urination, increased thirst 
• q4h:  every four hours
• q8h:  every eight hours
• QID:  four times a day 
• Qt:  quart  -a measure of volume that's about the same as a liter (L)
• RBC:  red blood cell  -carries oxygen to tissues and carbon dioxide away from them
• RE:  root exposure (on dental chart)
• REM:  Roentgen equivalent man  -used to express dosage of radiation exposure
• RER:  resting energy requirement  -similar to BMR for humans, it tells you the number of calories an animal would need to survive (not including any exercise); used to determine amount to feed
• RR:  respiratory rate (number of breaths in a minute)
• Rv:  rabies (virus)  -often refers to the vaccine
• SC:  subcutaneous  -(injection) under the skin
• SE:  side effects
• SF:  spayed female
• SG:  specific gravity  -a measurement of how diluted or concentrated a liquid is such as in urine or blood
• SI:  small intestine
• SID:  once a day
• SQ:  subcutaneous  -(injection) under the skin
• STT:  Schirmer Tear Test  -a test for dry eye
• Sx:  surgery
• T:  temperature
• T1, T2, etc:  thoracic vertebrae  -the vertebrae with ribs attached, numbered with the one closest to the neck being T1
• TBW:  total body water  -the total amount of water in the body
• TID:  three times a day
• TPN:  total parentral nutrition  -providing nutrients to hospitalized patients intravenously when they cannot take it in through the digestive tract
• TPR:  temperature, pulse, and respiration  -vital signs
• Tx:  treatment
• UA:  urinalysis  -a test to look for crystals, bacteria, and other indications of disease
• URI:  upper respiratory infection  -a cold
• UTI:  urinary tract infection
• V:  vomiting
• VC:  vena cava  -the largest vein in the body, it drains into the heart
• VEE:  Venezuelan equine encephalitis  -zoonotic
• VI:  volume infused  -amount of fluids administered by a fluid pump
• Vx:  vaccinate/vaccination/vaccine
• VTBI:  volume to be infused  -amount of fluid set on a pump to be administered to the patient
• W:  wear (on dental chart)
• WBC:  white blood cell(s)  -the cells involved in protecting the body from infection
• WEE:  Western  Equine Encephalitis
• WNL:  within normal limits
• X:  extraction (on dental chart)

This is a radiograph of a one and a half year old female terrier mix who ingested rat poison. It came in as a referral from another vet. The initial complaint from the owners was that the dog was having difficulty breathing. We did a blood test and found out that she was severely anemic and on physical examination we found a huge hematoma on her neck where the referring vet drew blood from her.

The owners had no money for a blood transfusion so we gave her vitamin K (to treat the rat poison toxicity) and balanced fluid therapy with diluting her blood to the point where her difficulty breathing grew even worse.

The radiograph shows that her entire left lung was filled with fluid. The fluid is probably blood because rat poison affects blood's ability to clot and dogs who ingest rat poison often bleed into their lungs. She's lucky only one lung was affected!

After a couple days of hospitalization she went from a dog who couldn't lay down due to her difficulty breathing and having severely pale mucous membranes and no appetite despite her hip bones showing to a dog who'd wag her tail as you approached her cage and had fairly pink mucous membranes (almost normal), and who'd devour any food put in front of her.

I did her TPR's while she was hospitalized with us and by listening to her lung sounds you could easily tell which side was affected -the left lung was silent while you could hear breathing on the right side. Just before she was released, I could start to hear a little bit of air flow on the left side which was a sign that the amount of fluid was starting to go down in that lung.

Many of the vets and techs thought she was a gonner when she came in and we learned that a blood transfusion wasn't an option for her, but we were all super happy she pulled through. She was such a cute and affectionate little dog! <3

Guess the diagnosis #2

2 year old Lhasa mix came in with the owner complaining of vomiting for the last 2 days, and the dog's now refusing to eat as well. Can you tell why from the radiograph above?

Highlight here for answer: Foreign body. See the chicken bone in the stomach?

Guess the diagnosis #1

A 6 year old Sheltie mix came in having difficulty breathing, especially after exercise. Can you tell why by the radiograph above?

Highlight here for the answer: Collapsed trachea -see the dark tube leading from the head and following the path of the spine? That's the trachea. See how narrow it gets near the area of the front legs? It should be about the same diameter all the way down!

Week 6 of externship

I've gradually been able to do more and more at my externship. I'm now routinely drawing blood, putting IV catheters in, helping prep for surgery, giving vaccines, doing TPR's, etc. I learned how to do EKG's over the phone today and a few weeks ago I actually got to scrub in on a surgery! I've been practicing reading radiographs and anticipate the tests the doctors will run after looking at the animal and/or their chart. I collected some extra urine the other day and looked at it under the microscope, then I compared what I saw to what Antec reported and I was able to explain the discrepancies. In short, I'm pretty happy with my progress!

Of course, there are some frustrations as well. Techs get treated like poop by some doctors while others are happy to teach you things or even quiz you about certain topics. And just like any job there are things you'd rather not do: cleaning cages, sweeping, mopping, etc. It hasn't been a perfect experience, but it has been interesting and I think that's pretty much what it's all about.

Pharmacology math examples

Here's a typical pharmacology math problem:

1. A 30 pound Cocker Spaniel comes into your clinic needing amoxicillin for an infection. Your vet asks you to dispense the Amoxicillin based on a dosage of 11mg per kg. How much amoxicillin should the dog receive per dose?

Before getting into the problem let's approach pharmacology math by thinking about it in terms we are more familiar with. How about we temporarily change the problem as follows:
You have 30 eggs that cost $11 per dozen how much are all the eggs worth?

First, we'd figure out how many dozen we have by converting eggs to dozens of eggs. This is done by dividing the number of eggs by 12 because there are 12 eggs in a dozen. So, 30/12=2.5doz.

Since we know they cost $11 per dozen and we know we have 2.5 dozen, we just multiply 2.5x11=$27.50 right? See, you know how to do this!

With that in mind let's now attach our actual problem:

1. A 30 pound Cocker Spaniel comes into your clinic needing amoxicillin for an infection. Your vet asks you to dispense the Amoxicillin based on a dosage of 11mg per kg. How much amoxicillin should the dog receive per dose?

First you need to convert pounds to kilograms. You need to memorize the fact that there are 2.2 pounds in a kilogram. It's something you'll use a lot. So, for 30lbs you need to divide 30 by 2.2 to get 13.64kg as your answer.

This part of the problem is just like the previous problem where there were 12 eggs in a dozen. 30 eggs divided by 12 eggs per dozen was 2.5 dozen eggs.

Second part: you have a dose of 11mg per kg. You have 13.64kgs. 11mg per kg means that for every kg you need 11mg. This should tell you that you need to multiply 13.64 by 11. 13.64x11=150.04mg per dose.

This works just like the eggs costing $11 per dozen. 3 dozen would cost $33 because $11 times 3 dozen = $33.

2. The next day the owner of this Cocker Spaniel comes back to the clinic saying they can't get the dog to swallow the pills. Your vet asks that you give them liquid amoxicillin instead. The liquid you have contains 62.5mg of amoxicillin per milliliter. How many milliliters should be given per dose?

Well, we figured out before that the dosage is 150.04mg. And we have a solution that contains 62.5mg per ml or for every milliliter there are 62.5mg. So, we need to know how many 62.5's are in 150.04. We do this by dividing 150.04mg by 62.5mg and we get 2.4ml.

If you have a hard time following that we can try once again to use something more familiar to understand how to work it out: Coffee has 100mg of caffeine per cup. You need at least 300mg to get through your next Keller test. How many cups of coffee do you need? 300mg (needed) divided by 100mg (per cup) = 3 cups.

Now try a few on your own before peeking at the answers:

3. A 10lb cat comes into your clinic with a cold. The vet asks you to prepare doxycycline using 5mg per kg as the dose. How much doxycycline should be given per dose?

Invisible answer: (highlight to see)
Pound to kilogram conversion: 10lbs/2.2kg per lb = 4.5kg
Dose: 5mg x 4.5kg =22.7mg

4. You have doxycycline available in liquid form that contains 10mg per ml. How much of this solution should be given per dose?

Dose: 22.7mg/10mg per ml = 2.27ml

5. A 5lb puppy comes into your clinic and is diagnosed with roundworms. The vet asks you to draw up a dose of Strongid to give to the puppy based on 8mg/kg. The Strongid you have is 50mg/ml. How much Strongid should you prepare?

Pound to kilogram conversion: 5/2.2=2.27kg
Number of mg: 8mgx2.27kg=18.16mg
Number of ml: 18.16mg/50mg per ml=0.36ml

Day 2 at externship -kinda slow

Today started with a dog who's owners brought him in with a bone stuck on his lower jaw. Last night they had given him one of those cross-sections of a femur bone that you can buy in the pet store that was about 3 inches long and this morning they found him with the bone stuck around his mandible. It had somehow slipped past the canine teeth and could not be removed. The doctors sedated him with DexDomitor and used bone cutting foreceps to split the bone apart and remove it.

The Rott from last night ended up having 9 live pups (11 total) between 6am yesterday and 12:15 this morning. Their tails and dewclaws were docked today.

There was a growth removal on a dog's rear paw. The growth was a little larger than a marble and was growing on the medial aspect of one of the middle digits. I got to shave it (which wasn't easy). And I got to monitor during surgery. The growth was removed by cautery and I learned how to set up the machine.

There was an ACTH stim test in today. A dental with deciduous canine extractions and I got to watch as the vet trained one of the long-term techs there how to remove them.

One of the techs brought in her Great Dane. I found out from one of the vets that this is her third Great Dane in a short period of time. The first died within months of a bone infection, the second died of bloat shortly after she got it. This one was in for some swelling from it's recent gastropexy. It makes me think I need to try again to warn my brother about bloat with his Great Dane.

There was a lot of downtime, though. Aside from monitoring during the one surgery I just held a few dogs and worked on my packet for school. I want a medium day!!!

First day at my first externship!

I chose to go to Animal Care Center in Plainfield, IL as my summer externship site and today was my first day on the job. I walked in and we immediately got in a collapsed dog who was having trouble breathing. The head tech intubated him and a vet worked to save him, but he ended up dying on the table.

Then there was a hospitalized cat that the overnight Emergency Center people were worried about. He was lethargic and although he'd flop himself around it was clear he wasn't really aware. He died about an hour later.

Then there was a female Rott from a rescue group who was pregnant. She had had one pup before we arrived and was still working on having the others. It was said that there were 12 pups total in her, but she didn't have another until 8:30am and then she had two a couple hours later. One of those suffocated because she didn't rip the sack off (maybe she didn't notice there were two?). She did great with the others!?! The weird thing was that the puppy was left for hours on the counter and it didn't turn blue. No one wanted to bag it until we were absolutely sure it was gone. The doctors and the head tech all took turns listening with their stethoscopes, then the head tech got out the Doppler and tried with that. Nothing. It was weird.

Around 10am we had a hit by car come in that had a broken pelvis and pneumothorax, but the owners wanted to take it to their vet so all we were able to do is stabilize it.

Of course, in between, there were dentals, spays, vaccines, x-rays, a glucose curve dog, a sedated grooming cat, a lot of manual fecal pulls, some monitoring of anesthesia, and many cages to clean and sweeping to do. All-in-all it was fun. I didn't get to do too much tech work today -a couple blood draws, but I'm sure that once I get the hang of how things work and where things are that will change. All-in-all it was very busy, but fun.

Surgery I, 2nd Lab Practical

Identify the pictures/answer the questions. Answers are at the end.

1.)














2.)














3.)





















4.)

















5.)



























6.)
























7.)


















8. Without looking at the gas specified on the vaporizer, how can you tell if it uses Sevoflurane or Isoflurane?
9. How do you connect the EtCO2 monitor up?
10. What is the disadvantage of using the red rubber ET tube?
11. What is the optional hole in the patient-end of the endotracheal tube called?
12. You are monitoring a dog under anesthesia. His jaw tone is moderately tense, what does this mean?
13. How do you measure how far to insert an ET tube?
14. Order of scrubbing if you start with the left hand?
15. What do you do before scrubbing?
16. What do you do after scrubbing?
17. Trace an oxygen molecule through the anesthesia machine for a rebreathing circuit.
18. What are the 3 connections on a non-rebreather connected to?
19. Trace an oxygen molecule through the anesthesia machine when the O2 flush valve is pressed.
20. Pressure on manometer for normal patient breathing (unassisted)?
21. Pressure on manometer when manually ventilating?
22. What is the line that runs down the entire length of the endotracheal tube for?
23. An endotracheal tube has "7.0" on it in large numbers, what does that mean?
24. When intubating a patient, what is the thing you have to push down in order to see the area where the tube goes?
25. What structures (2 of them) do you aim between to get the endotracheal tube into the trachea?
26. What is the hole where the endotracheal tube is pushed down called?
27. More to come!

-------------
ANSWERS
----------------

1. Coles endotracheal tubes
2. Pulse oximeter
3. Laryngoscope
4. ECG
5. Doppler blood pressure monitor
6. Esophageal stethoscope
7. Audio Patient Monitor
8. Iso will go up to 5%, Sevo up to 7 or 8%
9. It goes between the endotracheal tube and the tube from the anesthesia machine
10. If bent it kinks, which would cut off the animal's air supply
11. Murphy eye
12. Nothing unless you have checked it previously and it was more or less tense. Jaw tone can be different for each animal and is only meaningful when you have a previous jaw tone to compare it to.
13. From the nose to the thoracic inlet
14. Left fingertips, left fingers (including thumb), left hand, right fingertips, right fingers (including thumb), right hand, right wrist, left wrist, left forearm, right forearm.
15. Clean under fingernails and wash hands and arms with soap and water.
16. Drop brush in sink, rinse arms fingertips to elbows making sure hands stay above elbows, pick up towel (keep hands above elbows while doing so!), dry left hand, then left wrist and forearm on one half of one side of the sterile towel, then dry right hand, etc on other side and other half of towel.
17. Oxygen tank > pressure regulator > oxygen flow meter > vaporizer > common gas outlet > patient > CO2 absorbent > rebreathed or exhausted out the scavenger or f/air filter.
18. patient, fresh gases, exhaust/scavenger/f/air filter
19. Oxygen tank > pressure regulator > patient
20. 2-3mmHg/4cm H2O
21. 14mmHg, 20cmH20
22. radiopaque marker, allows tube to show up on x-ray in case of swallowing, etc
23. inside diameter is 7.0mm
24. epiglottis
25. vocal folds, arytenoid cartilage
26. glottis
27.

Things to practice:
__ Gloving (open/closed)
__ Suturing (interrupted, uninterrupted/continuous, horizontal mattress, vertical mattress, cruciate/cross mattress)
__ Suture types (absorbable, non-absorbable, mono/multifilament, sizes)
__ Needle types (sizes, shapes, cutting, reverse cutting, tapered)
__ Removing sutures
__ Putting a blade on a scalpel handle/removing it
__ Intubation
__ Charting
__ Cautions
__ Anesthesia planes
__ Audio Patient Monitor
__ Esophageal stethoscope
__ ECG
__ Blood pressure measurements (direct/indirect)
__ Instrument care
__ Endoscope
__ Pulse Oximeter
__ Capnography
__ Coles endotracheal tube
__ Red rubber endotracheal tube
__ Miguel endotracheal tube
__ Murphy-type endotracheal tube
__ Anesthesia machine (VIC, VOC)
__ Non-rebreathing circuit vs rebreathing circuit
__ Laryngoscope
__ Patient monitoring (jaw tone, CRT, mm, HR, RR, femoral/lingual pulse)
__ Reflexes (swallow/gag, pedal, palpebral, corneal)
__ Scrubbing
__ Surgical assisting (handing surgeon instruments, pouring liquid aseptically, handing surgeon syringe w/ needle)
__ Packing (wrapping, labelling, indicator/integrator)
__ Folding (Huck towel, non-fenestrated/fenestrated drape, instruments, gown)

Advice for incoming Freshmen of the JJC Vet Tech program

1. Attend orientation or visit with an adviser after being accepted.
You'll get a handbook, your schedule, a list of supplies that you'll need, and notice of a quiz that'll occur on your first day. Then remember about that quiz and read the handbook over before your start date. There really is a quiz. It really does count toward your grade.

2. Be prepared to work hard!
This program is not easy. I got my Associates in Biology about 15 years before starting the program and this program was 100% more difficult. If you can get your prerequisites done before starting the program, it'll really help. It'll also help if you aren't working or if you can reduce your hours as much as possible. Also, get organized because there are many long-term projects to keep track of on top of upcoming tests, practicals, quizzes etc. A good planner is a good idea, so is a buddy so that you can make sure each other stay up to date on what's coming up. Making study buddies and/or study groups can be a big help too.

3. School supplies:

A. Don't cheap out on your stethoscope, but don't spend a ton of money either.
Sure the drug store sells $10 stethoscope, but you can't hear much through them. To hear respiratory sounds or sounds in a noisy treatment area or barn you'll really want something better. But, that being said, you'll also be lugging that stethoscope through manure covered barns and if you're like me you'll also drop it on the floor several times, so now might not be the time for the top of the line model either. Get something middle of the road. I got an ADC Adscope 6XX series and it worked beautifully.

B. Buy the yellow boots.
Some of my fellow students bought boots that differed from the ones we were shown at orientation and Dr Stein warned that they should get the yellow ones. He'll let you use about anything but porous materials, laces, or lots of buckles are really hard to get clean and you really don't want to bring stuff home from the farm (enough of the stink will soak into your clothes and hair!). But, the yellow boots are really the easiest ones to work with out on the farms, so do yourself a favor and get those.

C. School supplies they don't tell you about.
All of your teachers will give you handouts and most will give you printouts of Powerpoint slides or outlines to take notes on, so a notebook for each class may not be necessary, but a 3-ring binder for each one will be. Dr. Stein will give you a TON of handouts -get a 2" binder for his class. Oh yeah, and Dr Stein's handouts don't really have room for notes, so you may need a notebook or some paper for his class as well.

A voice recorder is a good idea. None of the teachers mind being recorded (you should still ask). You may not find it necessary in all the classes, but I found it helpful in Dr Keller's class because his tests are so in-depth that you can't miss anything and really have to understand everything he says. The recorder is also useful in Dr Stein's class because at times he'll lecture instead of having lab which can mean 4 hour lectures. No one can be 100% attentive for that long.

3x5 cards. You are allowed to write (not type!) notes on one for each Pharmacology test and many of my fellow students used thousands and thousands of them to make flashcards out of as well. The thriftier of us cut them in half which meant they were easier to carry too. I used StudyDroid which is a program for Android phones that allows you to make flashcards on a website, then sync them to your phone where you can practice them whenever you find downtime. It also means a lot less to carry. By the end of each semester one classmate of mine had a whole portable file box full of flashcards that she'd carry around. I was happy to not have to do that.

If you want to view my flashcards you can search for "muddyboots" on the StudyDroid website you'll find my flashcards! You can copy them to your Android device or review them online if you don't have an Android phone. I'll warn you, though, I didn't enter all my notes into those cards. Anything I already knew I skipped, so don't use it as your only source of studying!

D. School supplies you shouldn't stress about.
My first day I had my car full of my overalls, boots, scrubs, everything. Don't do that. You need to wear your scrubs and your nametag for Small Animal and Radiology lab. The overalls and boots are needed only for Large Animal labs. The stethoscope, thermometer, bandage scissors, etc should find a permanent home in your bag -you'll be expected to have them at all times. I never used the scrub jacket my first semester, but it can be nice for the times when short sleeve scrubs are too cold or when you're working with a really dirty animal and you want to keep your scrubs clean.

4. The low-down on Dr. Keller.
A lot of people will tell you all kinds of things about Dr. Keller. Some of it is true. His tests are insanely hard. He rubs people the wrong way at times. He generally won't give you a break for late assignments or missed points. But, as long as his office door is open he's very willing to go over something from class or answer your questions. If you aren't understanding something don't hesitate to ask him. He's very approachable and helpful if you just ask.

What to expect on your first test? First, take your time and READ the questions. Read them three times before you answer. Underline the word "not" whenever you see it. Read every word on the true/false questions. If you miss a word while reading, chances are you'll miss points as a result. Be VERY CAREFUL! He can be very tricky with his questions, so this will save you more points than any other tip I can give you. Other stuff? Know your vocabulary, know the terms just as he tells you or just as the reading states. He sometimes won't accept dictionary answers. Also don't add any extra information that's not specifically asked for on the test, it's just an opportunity to lose points.

Understand that an A in your previous classes probably equals a C in Dr Keller's class. You should learn to be happy with a C, very happy with a B, and know that A's are pretty rare.

5. The facility managers.
These are the people you'll ask when you need to know where something is, how to do something to your animal, how to write in the medical record, whenever you encounter anything weird or have any problems during kennels, and they'll oversee the IM injections that you'll do as well. They are awesome. They'll drop whatever they are doing to help you and they'll never make you feel stupid for whatever questions you ask. Just please remember to treat them well in return!

6. Want to get a head start?
Before I started the program I ordered a bunch of random Vet Tech textbooks and tried to read as much as I could to get a head start. None of what I randomly read helped me at all. Then I got my book list and I started reading those. The stuff I chose to read didn't help either. Here's the stuff that's really useful to study if you want to get a head start for your 1st semester Freshmen year:

For Small Animal class:

• The path of blood flow through the heart.
• How heartworm is contracted and prevented. ELISA/occult vs microfilaria tets.
  
• The basics about all the diseases that routine vaccines are intended to prevent.
• Memorize the 10 body systems: Respiratory, Ears, Lymph nodes, Urogenital, Nervous, Gastrointestinal, Musculoskeletal, Integument, Cardiovascular, Eyes
• Know what tests these abbreviations are for: CP (conscious proprioception), PLR (pupillary light response), CRT (capillary refill time), MM (mucous membranes), STT (Schirmer tear test), FDT (fluorescein dye test) , DTM (Dermatophyte Test Medium).
• Learn how to solve insulin problems like this one: If Fluffy is on 4U of U-100 insulin, but you ran out of U-100 syringes. How many U of insulin would you need to draw up for Fluffy if all you had were U-40 syringes? (Be able to solve the reverse problem as well where an animal is on U-40 insulin and needs to draw it up in a U-100 syringe.)
  

For Large Animal class:

• Know your conversions. How many cc's in a teaspoon? How many cups in a gallon? How many ounces in a liter? He'll test you on this through many of your quizzes and all of the exams and into your Clinical Pathology class your second semester. It'll help in first semester Pharmacology as well.
• The parts of the rumen.
  
• Memorize the normal values for temperature, heart rate, respiratory rate and gestation time for: sheep, goats, beef cattle, dairy cows, horses, and pigs.
  
• Know the genus and species names plus the terminology for an intact vs castrated male, immature vs mature female, a baby, and what they are called as a group for: ovine, caprine, bovine, swine, and equine.
  
• The bones and joints of the horse's leg. (femur, humerus, radius, ulna, tibia, patella, sesamoids, metacarpals/metatarsals (#'s II, III, and IV), phalanges (proximal, middle, distal), pasterns (short, long), coffin bone, navicular bone, etc). Note that horses have lost many bones if you compare their legs to dogs/cats or humans. They actually stand on one finger (the middle finger)!
  
• You can try to get a really basic overview of hormones of reproduction (follicles, graffian follicle, estrogen, FSH, progesterone, and how they all work during estrus and pregnancy as well as the equivalent in males -making sperm and the course they travel). How sperm are supported and directed within the uterus.

For Radiology class:

• All the bones in the human/animal skeleton (but not the individual skull bones, carpals/tarsals, metacarpals/metatarsals, or phalanges).
• Directional terms (dorsal, ventral, cranial lateral, medial, palmar, plantar, proximal, distal). Make sure to study them as they apply to animals and not humans!

Pharmacology:

• Abbreviations like SID (once a day), BID (twice a day), TID (three times a day), q4h (every 4 hours), eod (every other day), prn (as needed), OD (right eye), OS (left eye), OU (both eyes), AD (right ear), AS (left ear), AU (both ears), IM (intramuscular), IP (intraperitoneal), IO (intraosseus), PO (by mouth).
  
• Practice writing really small for the 3x5 notecard you're allowed to use on the tests. ;-)
• Study up on basic math. If a 25lb dog is supposed to get 5ml per pound of drugX, how much would he get? (25x5=125ml) If drugX comes in a concentration of 5mg/ml and a 10lb cat is supposed to get 2mg per pound, how many ml's should it get? 10lbx2=20mg 20mg/5mg per ml = 4ml. You'll be doing this a LOT!
  

Kennels:

• Kennels is your easiest class by far. There's no reason to try to prepare for this class. If you show up for kennel duty you'll be most of the way to passing this class.

7. Bring a garbage bag to off-site Large Animal labs!

Keeping your boots and overalls in a garbage bag after labs where you go out to the farms will dramatically improve the smell on the way home in the van AND the smell of your car on your way home as well. Spread the word to the rest of your lab group!

For the pig labs, just know that while I'm sure the garbage bag helps, you and your car will reek for a couple days after your lab. It just clings to your hair and skin.

8. Your classmates.
Your first week or two may be awkward, but try to get over it as soon as possible. You'll be with these same 30 or so people for the next two years and believe it or not, by the end of the semester you'll end up being really close friends with them. They'll help you with your injections, help you study, and cheer you on when you're doing your first rectal exam on a dairy cow.

9. Be prepared to gain weight!
First there's the stress and lack of time, but then there's also candy bowls in many of your classes and Dr Stein's wife's amazing homemade breads, spreads, and other goodies.

10. Have more questions?
Email me or Facebook me. I'd be happy to answer your questions and/or give you advice. My address is: erica at muddyboots.org -if you want to add me as a friend on Facebook, just mention the JJC Vet Tech program so I know who you are.

I'll be a Sophomore as of Fall 2011, so if you'll be a Freshmen starting that semester, contact me! I'll be up for study sessions as my time allows. Helping you will allow me to keep the info I learned in my first semester fresh for my Boards, so don't feel bad about asking!

Normal stats for large animals

Horse:
Temperature: 99.1-100.8
Respiration: 12/min
Heart Rate: 25-70/min
Gestation: 336

Goat:
Temperature: 101.5-103.5
Respiration: 15/min
Heart Rate: 70-135
Gestation: 150

Sheep:
Temperature: 100.8-103.8
Respiration: 19/min
Heart Rate: 60-120
Gestation: 148

Pigs:
Temperature: 101.5-103.5
Respiration: 16/min
Heart Rate: 55-85/min
Gestation: 115 (3 months, 3 weeks, 3 days)

Cows:
Temperature: 101.5-102.5
Respiration: 30/min
Heart Rate: 40-70/min
Gestation: 283