I was assigned two patients to monitor today in ICU. Neither of them were really critical, but it was good experience to have some patients I was responsible for. One of my patients was the cutest little (ok little is more a term of endearment than an actual measure of size...he's a little tubby) bulldog puppy in the wide world. I'm going to call him Gus. Gus had surgery earlier this week to resect his soft palate and his alar fold which is cartilage inside his nose. A resection is a surgical removal of tissue, these particular resections allow our squish faced (aka brachycephalic) pals to breathe a little easier. The soft palate resection opens up the animal's airway by removing excess tissue that may cover a large portion of their epiglottis. The alar fold resection addresses the common issue of stenotic (narrowed) nasal passages, which also contribute to difficulty breathing. So, good 'ol Gus can breathe a little easier now...he still snorts a bit but he's adorable nonetheless. He had some issues with regurgitating kibble following surgery (even though he wasn't supposed to eat before surgery...naughty Gus!) but he made it through the day with no regurging. Woohoo! He did have some diarrhea in the morning but it started to improve by the end of my shift (everything is about poo, ok non-vet people? don't get all grossed out). A couple of IV meds and a catheter flush here and there and Gus was good to go.
My other patient was a standard Poodle. We'll call her Polly. Polly was in for some pretty vague symptoms of lethargy and coughing. Also, at her referring vet, her temp was 103 and they tested her PCV which was apparently 93%, 93!?!? That's craaaaaazy! As I said in yesterday's post, normal PCV for a dog is 37-55% so, when it's twice that, it's mildly concerning. However, when she came in to the Auburn ICU, her PCV was tested and it was 53%. On the high side, sure, but certainly nothing to get worked up over. We monitored her and she had an ultrasound performed on her abdomen which showed a hyperechoic spleen. Hyperechoic basically means that the tissue of the spleen appeared abnormal on the ultrasound. However, no other issues were found and no definitive diagnosis was made. So Polly is basically getting ready to go home and I decided to take her out to the yard to do her business and run around a bit. Me, being the genius that I am, decided to let Polly off the leash in the fenced in area (she was the first and last dog that I will ever do that with). Polly decided that she was going to prance around the yard and not allow me to catch her. After about ten minutes of having Polly make an idiot out of me, we corralled her in a smaller area near some outdoor runs. At this point, she really had no way out and I just had to get the leash on her and be done with it. She was none too pleased about being cornered which she made apparent by growling at me and trying to escape. I attempted a Poodle lasso with the slip lead I had but my forearm was a touch too close to her mouth, which I discovered as I felt her canine teeth clamping down on it. Fan-flippin-tastic. She bit me. I lassoed her nonetheless and we returned to the ICU. She apparently bit her tongue or gums or something because she had blood in her mouth that (thankfully) did not belong to me. She didn't get me too badly thankfully and I washed my arm with soap then scrubbed it with chlorhex, then one of the techs insisted on scrubbing it with Betadine and alcohol. It was a little ouchy and swollen around the lovely tooth marks but nothing too serious. We didn't have Polly's full record in ICU so we had to wait for the vet student on her case to find out when her last vaccinations were administered. Finally, she came back to let us know that Polly had received her 3 year rabies vaccination late last year...sweet! No foaming at the mouth and crazy times for me! Polly went home later that day but only because I said she could!! Apparently, if you're bitten by a dog, you get to decide if they need to stay at the clinic to be quarantined or if they should be euthanized. I understand why Polly flipped out and I know that it was my fault for letting her off the leash when I didn't know her that well, so off she went...with a muzzle for her walk up to the front.
All in all a good learning day. I even got to round on my cute little pal Gus! I am feeling oh so professional...minus the teeth marks on my forearm, for that, I just feel dumb. But hey, another tech was bitten by a cat yesterday (NOT up to date on Rabies) sooo it could be worse. Stacey at Bel-Rea was certainly pleased to find out it was a dog bit and not a cat bite.
Now, in what seems to be normal Alabama fashion, there is a fast approaching and widespread tornado warning so I'm going to go prepare for that without proofreading this entry. I apologize now for any glaring grammatical or spelling issues. Good night to all!
Wednesday, April 27, 2011
Tuesday, April 26, 2011
Week 5- ICU
This week I'm working in the small animal ICU. It's very different from the other services in the hospital because there are all kinds of patients there and they have varying levels of treatments/care required. It can be a little rough at times-- we've already had 4 animals euthanized this week (it's only TUESDAY!) and there are a few others with poor prognoses. On the other hand, we've also discharged several patients that have recovered and are going home with a good prognosis. Wahoo!
Some of the patients that come to ICU are not emergencies but have just come out of surgery, so they require closer monitoring than what they would get on a regular ward. They are monitored for signs of pain and signs of surgery related complications (signs of internal bleeding, dehiscence of an incision, regurgitation before the patient is fully recovered, etc, etc). Often, these patients are also continuing to potent pain medication intravenously along with regular fluids. All of these things have to be monitored along with the standard stuff like temperature, pulse, respiration rate, catheter patency, whether the catheter is still properly placed, urination, defecation and apparent mental/emotional status. That's just for a standard post-op recovery patient! Patients that have critical conditions often require a lot more attention.
All ICU patients, post-op or otherwise, have a specific chart that shows what treatments need to be given or diagnostics need to be done each hour. So, for example, we have a dog that's been in the ICU for a few weeks who has been getting regular blood transfusions due to severe anemia. We'll call her Gertie. Gertie is on a plethora of medications that are given at various intervals, one may be every 8 hours, every 12 hours, once a day and so on. Also, because we are concerned about her anemia, we need to do regular blood tests to evaluate how effective the blood transfusions are and how/if her body is making an effort to counteract the anemia. We run a group of tests called "quats", this is a group of four tests that can be done from a single blood sample of only about 1 ml or so. The four tests are blood glucose, packed cell volume (PCV), total protein/total solids and lactate. With Gertie, we are most concerned about her PCV because it tells us the percentage of red blood cells that make up the blood and therefore can indicate the severity of her anemia. For a dog, the normal range is 37-55%. Gertie's PCV when I did it this morning was 18%, which is about where it's been hanging out. The blood transfusion are being given in an attempt to keep her PCV up as high as possible while it is determined what exactly is causing the anemia. At this point, it is believed that she has some form of cancer that is causing a lack of red blood cells in her body, but we won't know for sure what the cause is until some diagnostic tests come back. My point here is, it's important for Gertie's quats to be done at regular intervals in order to monitor her status and it's also important for her vital signs to be monitored at regular intervals and medications administered at the appropriate times so we know if her status is becoming more severe. So, every hour, an ICU tech specifically assigned to her goes through her chart and ensures that every thing that needs to be done that hour is done. It's imperative to note any changes or trends that are occurring with critical patients because it may aid in determining a definitive diagnosis or be a sign of deterioration...or improvement!
ICU is definitely a hands on kind of rotation. There's plenty of med administration, fluid administration, physical examination, blood and other body fluid evaluation, catheterization and beeping fluid pump aggravation! (and so returns the nerdiness...) Anyway, it's been great experience so far. I shall keep all of you in my ever growing audience up to date as the week progresses.
PS- Good luck to all my pre-clin pals on your first mini-CPE next week! You'll do greaaaaaat!
Some of the patients that come to ICU are not emergencies but have just come out of surgery, so they require closer monitoring than what they would get on a regular ward. They are monitored for signs of pain and signs of surgery related complications (signs of internal bleeding, dehiscence of an incision, regurgitation before the patient is fully recovered, etc, etc). Often, these patients are also continuing to potent pain medication intravenously along with regular fluids. All of these things have to be monitored along with the standard stuff like temperature, pulse, respiration rate, catheter patency, whether the catheter is still properly placed, urination, defecation and apparent mental/emotional status. That's just for a standard post-op recovery patient! Patients that have critical conditions often require a lot more attention.
All ICU patients, post-op or otherwise, have a specific chart that shows what treatments need to be given or diagnostics need to be done each hour. So, for example, we have a dog that's been in the ICU for a few weeks who has been getting regular blood transfusions due to severe anemia. We'll call her Gertie. Gertie is on a plethora of medications that are given at various intervals, one may be every 8 hours, every 12 hours, once a day and so on. Also, because we are concerned about her anemia, we need to do regular blood tests to evaluate how effective the blood transfusions are and how/if her body is making an effort to counteract the anemia. We run a group of tests called "quats", this is a group of four tests that can be done from a single blood sample of only about 1 ml or so. The four tests are blood glucose, packed cell volume (PCV), total protein/total solids and lactate. With Gertie, we are most concerned about her PCV because it tells us the percentage of red blood cells that make up the blood and therefore can indicate the severity of her anemia. For a dog, the normal range is 37-55%. Gertie's PCV when I did it this morning was 18%, which is about where it's been hanging out. The blood transfusion are being given in an attempt to keep her PCV up as high as possible while it is determined what exactly is causing the anemia. At this point, it is believed that she has some form of cancer that is causing a lack of red blood cells in her body, but we won't know for sure what the cause is until some diagnostic tests come back. My point here is, it's important for Gertie's quats to be done at regular intervals in order to monitor her status and it's also important for her vital signs to be monitored at regular intervals and medications administered at the appropriate times so we know if her status is becoming more severe. So, every hour, an ICU tech specifically assigned to her goes through her chart and ensures that every thing that needs to be done that hour is done. It's imperative to note any changes or trends that are occurring with critical patients because it may aid in determining a definitive diagnosis or be a sign of deterioration...or improvement!
ICU is definitely a hands on kind of rotation. There's plenty of med administration, fluid administration, physical examination, blood and other body fluid evaluation, catheterization and beeping fluid pump aggravation! (and so returns the nerdiness...) Anyway, it's been great experience so far. I shall keep all of you in my ever growing audience up to date as the week progresses.
PS- Good luck to all my pre-clin pals on your first mini-CPE next week! You'll do greaaaaaat!
Sunday, April 24, 2011
End of week 4
Friday was another busy day in the Ortho department. First, we had an overflow TPLO surgery that we didn't get to on Thursday. I was the circulator/anesthesia tech wannabe. I helped get all her monitoring equipment hooked up and set up her fluids, Cefazolin and Morphine CRI. Then the anesthesia tech pretty much left me to assist the vet student who was monitoring anesthesia which made me feel like a cool kid. The student had been on food animal rotations for the past few weeks and was mildly freaking out about monitoring anesthesia for small animals. Fortunately, we had a really smooth anesthesia and I utilized my jedi-like calming vibes to assure the student she was doing a great job and that everything was peachy keen.
Towards the end of the surgery, the vet let the vet intern and resident take over so that he could go do surgery on an owl. An OWL! It was a Barred Owl with a fractured wing. I didn't get to see the whole procedure because I was still in the TPLO surgery but I got a few pictures of the owl when he was intubated (had an ET tube in) and when he was recovering. The owl came from the Raptor Rescue that is part of Auburn. I'll be doing a rotation there in a few weeks and I can post pictures of those kids because they aren't owned by private clients. So basically they use a mask to gas down the birds instead of using an IV induction agent like Propofol that we traditionally use in small animal procedures. The bird is then intubated with an itty bitty super flexible ET tube. The only monitoring that was done was tracking the respiratory rate and using a stethoscope to monitor the heart rate (i.e. auscultation). Their normal resting heart rate is over 200 beats per minute which is uber fast. A dog usually runs somewhere from 60-160 bpm depending on size. Anyway, here is a picture of Mr. Owl. The blue thing is the ET tube and the orange stuff is the remnants of his bandage.
I added two arrows that point to the major issues for those of you who haven't spent much time looking at radiographs. The top arrow points to the space where two vertebrae have been forcefully separated. Just like our spine, a dog's spine should be connected from the skull all the way down to the end of their tail. Damage similar to what this dog suffered would most likely cause a loss of control of the ability to urinate and defecate and, potentially, some other neurological issues related to spinal cord damage. The bottom arrow points to the damaged pelvis. The pelvis is made up of a few bones that are all fused together: the ilium is the uppermost portion that forms little wings that flank the spine, the pubis is the middle portion and the ischium is what makes up our "sit bones" and is the lower part that is sticking out behind the femurs (leg bones). In this animal, all three of those bones were shattered on one side. Orthopedic surgery is not always done to repair a pelvic fracture, whether or not it is done depends on where the fracture is located. If the ilium or the acetabulum (remember that one? the part that makes up the socket of the hip joint...see, learning is fun!) then surgery will most likely be done. In this animal, surgery would definitely be indicated. However, following radiographs, epidural pain medications were administered and we were attempting to place a urinary catheter. During this procedure, the dog went in to cardiac arrest. CPCR (that's the new term for CPR) was administered until we received confirmation from the owner to stop, we weren't able to save the dog. That was the first time I had seen CPCR done on a real animal and it was difficult to watch. I know we did everything we could for that dog and that this is all part of being a vet tech and life in general but it's still hard to see an animal die right in front of you. In the long run, it's probably for the best that the dog didn't make it. Her quality of life would have been less than desirable even if surgery had been as successful as can be imagined. We just have to take comfort in knowing that we are doing our best to improve the lives of as many animals as we can. We are bound to lose some along the way, but hopefully there is more good than bad in the long run.
Towards the end of the surgery, the vet let the vet intern and resident take over so that he could go do surgery on an owl. An OWL! It was a Barred Owl with a fractured wing. I didn't get to see the whole procedure because I was still in the TPLO surgery but I got a few pictures of the owl when he was intubated (had an ET tube in) and when he was recovering. The owl came from the Raptor Rescue that is part of Auburn. I'll be doing a rotation there in a few weeks and I can post pictures of those kids because they aren't owned by private clients. So basically they use a mask to gas down the birds instead of using an IV induction agent like Propofol that we traditionally use in small animal procedures. The bird is then intubated with an itty bitty super flexible ET tube. The only monitoring that was done was tracking the respiratory rate and using a stethoscope to monitor the heart rate (i.e. auscultation). Their normal resting heart rate is over 200 beats per minute which is uber fast. A dog usually runs somewhere from 60-160 bpm depending on size. Anyway, here is a picture of Mr. Owl. The blue thing is the ET tube and the orange stuff is the remnants of his bandage.
And this is one of him after the procedure when he is recovering, isn't he cute??
After the owl, we had an emergency come in. The dog had been out on a walk with her owner when a neighbor drove by and accidentally hit the dog with the car. Her right hip and pelvis were crushed and the vertebrae (bones of the spine) in her tail were completely separated at one point of her spine. Below is a lateral radiograph of her pelvis and caudal (towards the hind end) spine.
Thursday, April 21, 2011
Ortho surgery extravaganza!
I spent some quality time with the orthopedics crew today. They do surgeries on Tuesdays and Thursdays so today was full of orthopedic fantasticness.
First up was a bilateral FHO or Femoral Head Osteotomy. Let's break that down- Femoral head= rounded head of the femur that is supposed to fit ever so nicely into the acetabulum or "hip socket" to form the hip joint, Osteotomy= surgical removal of a bone (in this case, chunk of a bone). FHO's are really pretty amazing because the head of the femur that forms the hip joint with the pelvis is literally removed so there is nothing in the hip joint, the musculature surrounding the hip area and the eventual development of scar/cartilagenous tissue forms a joint-like connection to support the area. Here is a link to a blog that has before and after radiographs(x-rays) of an FHO performed on one side--> Rads . Our patient today had both femoral heads removed, isn't that cool that the body can handle something like that??? No femoral heads? Awesome! Anyway, that was a nerdy outburst, sorry. So the reason for the surgery was hip pain caused by arthritis in the hip joints. Just looking at the pre-operative radiographs was painful. The head of the femur should be smooth and round and articulate wonderously with the (say it with me...) acetabulum. This dog's femoral heads were all uneven and rough and ouchy. So we got the dog anesthetized and I helped hook her up to all of our diagnostic goodies once we transferred her to the surgery suite (ECG leads, pulse ox, temperature probe down the esophagus, ETCO2, blood pressure cuff and fluids). I think I am finally getting the hand of hooking all of that stuff up in a timely manner. The dog was on fluids as well as a Cefazolin CRI and Morphine CRI (CRI= constant rate infusion, so it's flowing at a specific rate along with regular fluids during the surgery). Cefazolin is an antibiotic to prevent infection, we give about 100 mls during the first hour of surgery then stop it. Morphine is an analgesic (pain reliever) and is given throughout the surgery. It can also be given as a bolus or a larger amount given all at once if the animal is showing signs of pain during surgery. Prior to surgery, the dog was also given an epidural of pain medication which helps to stop pain before it starts and allows us to use less anesthetic gas to keep the dog anesthetized during surgery (for a safe-ER anesthesia right Janet?). All of these medications together worked beautifully and we had a pretty stellar anesthesia.
I was basically the circulator during surgery. The circulator (brace yourself Jessie, here comes a definition straight from your manual) is the mediator between sterile and non-sterile fields. What that means is that the circulator can pass instruments and supplies in a sterile manner to the people that are scrubbed in and must remain sterile. Instruments and other things are sterilized in packs, the outer layer can be peeled back by the circulator and the sterile person can remove the item to use in the surgery without introducing any type of contamination to the surgery site. Maintaining a sterile surgical site and sterile fields for the surgeon to work in is extremely important in preventing infection in the patient.
Anyway, one of the coolest circulator duties I performed today was catching the femoral head that the surgeon dropped into my open hands! COOOOOOOOOL! I could see all the remnants of connective tissue on it and the spongy bone part and the goo all over the bone and it was so neat! (Another nerdy outburst, sorry again) The anesthesia tech that was in there with us was not nearly as excited about the anatomical awesomeness that I held in my hands but everyone's nerdiness is brought out by different things so I'm ok with that.
The surgery went well and the dog recovered nicely. She will most likely not be able to be as active as she was at her peak, but she will be able to move relatively normally and do many of the things she did before. A major concern for post-op FHO patients is ensuring that they maintain a healthy but lean weight so as not to overstress the hip area that has been compromised. Pretty cool stuff if you ask me.
We did a few TPLO's today as well, which I believe I have mentioned before so I won't get back in to that. Surgery is pretty awesome and I'm constantly amazed at what the body can handle and recover from.
First up was a bilateral FHO or Femoral Head Osteotomy. Let's break that down- Femoral head= rounded head of the femur that is supposed to fit ever so nicely into the acetabulum or "hip socket" to form the hip joint, Osteotomy= surgical removal of a bone (in this case, chunk of a bone). FHO's are really pretty amazing because the head of the femur that forms the hip joint with the pelvis is literally removed so there is nothing in the hip joint, the musculature surrounding the hip area and the eventual development of scar/cartilagenous tissue forms a joint-like connection to support the area. Here is a link to a blog that has before and after radiographs(x-rays) of an FHO performed on one side--> Rads . Our patient today had both femoral heads removed, isn't that cool that the body can handle something like that??? No femoral heads? Awesome! Anyway, that was a nerdy outburst, sorry. So the reason for the surgery was hip pain caused by arthritis in the hip joints. Just looking at the pre-operative radiographs was painful. The head of the femur should be smooth and round and articulate wonderously with the (say it with me...) acetabulum. This dog's femoral heads were all uneven and rough and ouchy. So we got the dog anesthetized and I helped hook her up to all of our diagnostic goodies once we transferred her to the surgery suite (ECG leads, pulse ox, temperature probe down the esophagus, ETCO2, blood pressure cuff and fluids). I think I am finally getting the hand of hooking all of that stuff up in a timely manner. The dog was on fluids as well as a Cefazolin CRI and Morphine CRI (CRI= constant rate infusion, so it's flowing at a specific rate along with regular fluids during the surgery). Cefazolin is an antibiotic to prevent infection, we give about 100 mls during the first hour of surgery then stop it. Morphine is an analgesic (pain reliever) and is given throughout the surgery. It can also be given as a bolus or a larger amount given all at once if the animal is showing signs of pain during surgery. Prior to surgery, the dog was also given an epidural of pain medication which helps to stop pain before it starts and allows us to use less anesthetic gas to keep the dog anesthetized during surgery (for a safe-ER anesthesia right Janet?). All of these medications together worked beautifully and we had a pretty stellar anesthesia.
I was basically the circulator during surgery. The circulator (brace yourself Jessie, here comes a definition straight from your manual) is the mediator between sterile and non-sterile fields. What that means is that the circulator can pass instruments and supplies in a sterile manner to the people that are scrubbed in and must remain sterile. Instruments and other things are sterilized in packs, the outer layer can be peeled back by the circulator and the sterile person can remove the item to use in the surgery without introducing any type of contamination to the surgery site. Maintaining a sterile surgical site and sterile fields for the surgeon to work in is extremely important in preventing infection in the patient.
Anyway, one of the coolest circulator duties I performed today was catching the femoral head that the surgeon dropped into my open hands! COOOOOOOOOL! I could see all the remnants of connective tissue on it and the spongy bone part and the goo all over the bone and it was so neat! (Another nerdy outburst, sorry again) The anesthesia tech that was in there with us was not nearly as excited about the anatomical awesomeness that I held in my hands but everyone's nerdiness is brought out by different things so I'm ok with that.
The surgery went well and the dog recovered nicely. She will most likely not be able to be as active as she was at her peak, but she will be able to move relatively normally and do many of the things she did before. A major concern for post-op FHO patients is ensuring that they maintain a healthy but lean weight so as not to overstress the hip area that has been compromised. Pretty cool stuff if you ask me.
We did a few TPLO's today as well, which I believe I have mentioned before so I won't get back in to that. Surgery is pretty awesome and I'm constantly amazed at what the body can handle and recover from.
Tuesday, April 19, 2011
Week 4, yeah!
Today was a crazy, long, hectic yet fun day. Orthopedics had two surgeries, one of which was my little buddy from yesterday with the fractured femur and the other was a Tibial Plateau Leveling Osteotomy (lovingly known as a TPLO). The TPLO dog came in yesterday with hind leg lameness and underwent an orthopedic exam. The dog was very tense during the exam and the veterinarian didn't feel that he got an accurate sense of what was going on with the injured leg. Once the dog was sedated for x-rays, the vet re-examined the leg and determined through a drawer sign test that the dog had torn a ligament in its stifle ("knee"). A positive drawer sign test is when the two major bones of the hind limb that form the stifle joint can be moved forward and backward past each other (not normal!!) to indicate that the ligament(s) that usually support the joint are damaged and no longer doing their uber-important job. So, the TPLO surgery was set up for today. TPLO surgery involves removing part of the tibia (lower leg bone) and placing various plates and screws and other fun stuff on/in the bone to stabilize the joint. Cool! However, the ortho group had ample help so I joined up with the neuro kids.
The initial plan in neuro was to do diagnostics on two different dogs, which included MRI. Unfortunately, the MRI was not in the mood to function properly for the majority of the day so we ran a CT scan on dog #1 and had to hold off on diagnostics for dog #2 since the owners would not approve a myelogram and CT in lieu of MRI. Dog #2's (we'll call him Hal) owners came by to see him later in the day. Hal has significant weakness in his hind end and the vet felt that he may have lumbo-sacral disease. Lumbo-sacral disease is basically a general name for degenerative changes that occur in the spine of the lumbar/sacral regions (equivalent to the lower back). Hal's owners were very concerned about him but they were incredibly grateful for the care that he was receiving. We were able to wheel Hal out on a gurney and then assist him with a sling while he walked around the pet exercise area with his owners. A HUGE part of vet med is communicating and interacting with owners. Not all owners are fantastically awesome, but when you come across owners that want to do everything they can for their pet and truly appreciate the effort that we, as medical professionals are putting forth, it's motivating and makes you want to be a more caring, knowledgeable tech.
The MRI got over it's hissy fit around 3pm so we got Hal ready for diagnostics. This is where I learned the importance of ensuring that endotracheal tubes have been properly placed (yeah, really). I administered Propofol in order to induce Hal for spinal radiographs and his MRI and one of the vet students placed the endotracheal tube. Over the next minute or so (seemed like waaaaay longer), Hal began to turn progressively more purple, indicating that his tube was not properly placed...it was most likely in the esophagus (BAD). One of the vets stepped in, placed the tube properly and we began ventilating the patient until he returned to a nice pink color. He then took his dear sweet time to start breathing on his own, but once we got down to radiology, everything was a-ok. It's a little scary to think how many terrible things can happen during a "routine" procedure. One simple thing can be overlooked and an animal can die as a result. Maybe I'm getting all "made for TV movie" cheesy, but people, this is teamwork kind of stuff. Everyone has to be focused on the care and welfare of the patient first and foremost. Those few minutes of insanity when our patient was PURPLE were scary and I don't care to repeat them on a regular basis, thank you very much!
Alright so key points for the day: 1) Grateful people are great! 2) Intubating the esophagus is bad!
3) Teamwork is awesome and beneficial for all involved :)
The initial plan in neuro was to do diagnostics on two different dogs, which included MRI. Unfortunately, the MRI was not in the mood to function properly for the majority of the day so we ran a CT scan on dog #1 and had to hold off on diagnostics for dog #2 since the owners would not approve a myelogram and CT in lieu of MRI. Dog #2's (we'll call him Hal) owners came by to see him later in the day. Hal has significant weakness in his hind end and the vet felt that he may have lumbo-sacral disease. Lumbo-sacral disease is basically a general name for degenerative changes that occur in the spine of the lumbar/sacral regions (equivalent to the lower back). Hal's owners were very concerned about him but they were incredibly grateful for the care that he was receiving. We were able to wheel Hal out on a gurney and then assist him with a sling while he walked around the pet exercise area with his owners. A HUGE part of vet med is communicating and interacting with owners. Not all owners are fantastically awesome, but when you come across owners that want to do everything they can for their pet and truly appreciate the effort that we, as medical professionals are putting forth, it's motivating and makes you want to be a more caring, knowledgeable tech.
The MRI got over it's hissy fit around 3pm so we got Hal ready for diagnostics. This is where I learned the importance of ensuring that endotracheal tubes have been properly placed (yeah, really). I administered Propofol in order to induce Hal for spinal radiographs and his MRI and one of the vet students placed the endotracheal tube. Over the next minute or so (seemed like waaaaay longer), Hal began to turn progressively more purple, indicating that his tube was not properly placed...it was most likely in the esophagus (BAD). One of the vets stepped in, placed the tube properly and we began ventilating the patient until he returned to a nice pink color. He then took his dear sweet time to start breathing on his own, but once we got down to radiology, everything was a-ok. It's a little scary to think how many terrible things can happen during a "routine" procedure. One simple thing can be overlooked and an animal can die as a result. Maybe I'm getting all "made for TV movie" cheesy, but people, this is teamwork kind of stuff. Everyone has to be focused on the care and welfare of the patient first and foremost. Those few minutes of insanity when our patient was PURPLE were scary and I don't care to repeat them on a regular basis, thank you very much!
Alright so key points for the day: 1) Grateful people are great! 2) Intubating the esophagus is bad!
3) Teamwork is awesome and beneficial for all involved :)
Monday, April 18, 2011
Summing up end of week 3, begin week 4!!
So, I've been told that I got slack on my blog towards the end of the week so here's a quick run down on the fun stuff that happened Thursday and Friday.
On Thursday, we had a visit from the kids down at the Raptor Rescue. They brought in a Barred Owl and a Red Tailed Hawk, both of which had injuries to one of their wings. The birds were brought in for a test called an electromyograph (EMG) which test the electrical activity of skeletal (voluntary) muscles. The bird is anesthetized (nap time!) and small needles are inserted in to the affected muscles. The needles are connected to a monitor that displays the electrical activity of the muscles where the needles are placed. A normal skeletal muscle should not emit any electrical activity when it's not being voluntarily constricted. If there is electrical activity in a relaxed muscle it can be a sign of neuropathy (disease associated with the nerves/nervous system) and can happen when nerve fibers begin to reinnervate a damaged muscle fiber. Both birds had significant abnormal electrical activity in the muscles of their damaged wings and some muscle atrophy could be felt on both of them as well. We are hoping that they will improve with more rest and restriction on their activity.
On Friday, an upper GI endoscopy (little camera inserted through the mouth to explore the goodies that lie within!) was performed on a patient that had undergone neurosurgery earlier in the week. She had vomited up blood and pieces of mucosal tissue from her GI tract (either esophagus or stomach). There was inflammation and some sloughing of tissue in many areas of the esophagus and stomach and biopsies were taken (biting off little chunks of tissue for further examination).
We then observed a necropsy on a dog that had come in to us for severe ataxia and also seizures I believe, the second day that she was in ICU she also began having corneal edema in her right eye. On MRI they found some areas in the cerebellum and in the frontal/parietal regions of her brain that were abnormal. She was an older dog and euthanasia was probably the best option. The necropsy was a little rough to watch after working with the dog and loving on her the day before. They had to remove her head in order to dissect and get samples of her brain tissue, that was the hardest part to see. Otherwise, the dissection of the tissues and organs itself was interesting. Oddly enough, there was nothing to be seen in the brain tissue as far as gross evidence of what was seen on MRI. The doctor doing the necropsy said that it may show up once the tissue is fixed.
This week is Orthopedics/Neuro week.
Ortho had a little 4 month old puppy come in with a broken femur. The x-ray that had been done at the referring veterinarian showed that the femur was completely broken into two pieces. We did more x-rays and will most likely do surgery later this week to repair the fracture. The puppy was ridiculously adorable by the way.
I also rocked the socks off of a jugular blood draw and IV catheter placement on a neuro dog. Practice, practice, practice!
Ok hopefully this satisfies everyone's blog withdrawal (Dad!), I will try to be better in the future.
On Thursday, we had a visit from the kids down at the Raptor Rescue. They brought in a Barred Owl and a Red Tailed Hawk, both of which had injuries to one of their wings. The birds were brought in for a test called an electromyograph (EMG) which test the electrical activity of skeletal (voluntary) muscles. The bird is anesthetized (nap time!) and small needles are inserted in to the affected muscles. The needles are connected to a monitor that displays the electrical activity of the muscles where the needles are placed. A normal skeletal muscle should not emit any electrical activity when it's not being voluntarily constricted. If there is electrical activity in a relaxed muscle it can be a sign of neuropathy (disease associated with the nerves/nervous system) and can happen when nerve fibers begin to reinnervate a damaged muscle fiber. Both birds had significant abnormal electrical activity in the muscles of their damaged wings and some muscle atrophy could be felt on both of them as well. We are hoping that they will improve with more rest and restriction on their activity.
On Friday, an upper GI endoscopy (little camera inserted through the mouth to explore the goodies that lie within!) was performed on a patient that had undergone neurosurgery earlier in the week. She had vomited up blood and pieces of mucosal tissue from her GI tract (either esophagus or stomach). There was inflammation and some sloughing of tissue in many areas of the esophagus and stomach and biopsies were taken (biting off little chunks of tissue for further examination).
We then observed a necropsy on a dog that had come in to us for severe ataxia and also seizures I believe, the second day that she was in ICU she also began having corneal edema in her right eye. On MRI they found some areas in the cerebellum and in the frontal/parietal regions of her brain that were abnormal. She was an older dog and euthanasia was probably the best option. The necropsy was a little rough to watch after working with the dog and loving on her the day before. They had to remove her head in order to dissect and get samples of her brain tissue, that was the hardest part to see. Otherwise, the dissection of the tissues and organs itself was interesting. Oddly enough, there was nothing to be seen in the brain tissue as far as gross evidence of what was seen on MRI. The doctor doing the necropsy said that it may show up once the tissue is fixed.
This week is Orthopedics/Neuro week.
Ortho had a little 4 month old puppy come in with a broken femur. The x-ray that had been done at the referring veterinarian showed that the femur was completely broken into two pieces. We did more x-rays and will most likely do surgery later this week to repair the fracture. The puppy was ridiculously adorable by the way.
I also rocked the socks off of a jugular blood draw and IV catheter placement on a neuro dog. Practice, practice, practice!
Ok hopefully this satisfies everyone's blog withdrawal (Dad!), I will try to be better in the future.
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