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!!!
Tuesday, May 24, 2011
Monday, May 23, 2011
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.
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.
Wednesday, May 4, 2011
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)
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)
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