Week 5

 An enLIGHTening week! (foreshadowing..)

Day 23: Entire Border Collie family spay/neuter day! Placed IV catheter, induced with Alfaxalone, and placed ET tube on spay patient. Monitored anesthesia (uneventful) and recovery, as well as prepared the bill and take-home oral Metacam for the patient. Assisted with surgical prep, and anesthesia monitoring for castration/bandage change of patient with moist dermatitis due to poor bandage care. 

Day 24: Assisted with surgical prep, anesthetic monitoring, and recovery for a Cavoodle spay and Chihuahua castration. Restrained DLH cat for euthanasia by DVM, and attended to the stitch-up recovery of a Whippet who presented with a R hind leg laceration (of unknown cause). 

Day 25: Power Outage (oh no)! Monitored anesthesia for a Staffy spay with limited blood pressure readings due to a malfunction. Utilized pedal pulses to estimate blood pressure and pulse quality  alongside capillary refill time, anesthesia was luckily relatively uneventful. Assisted with surgical prep and holding lights for DVM to help proceed with a second spay. Accompanied DVM and Head Nurse to other clinic site to perform TTA surgery on a Kelpie. Laid out necessary orthopedic tools, completed quarter shave and full surgical prep of the leg, and passed orthopedic drill and saw using aseptic technique to DVM. 

Day 26: Hospital support day. Assisted with restraints for procedures, cleaning up the surgery suite, walking and feeding recovery patients, and scrubbing instruments and preparing packs.

Day 27: Emergency walk-in Maltese with distended and extremely bloated abdomen noted to have developed over the past 4 days by owner. Thoracic and abdominal radiographs revealed fluid filled stomach, lobulated lung lobes, and enlarged heart. Physical exam further revealed a grade 5 heart murmur with increased respiratory effort. Abdominal fluid was retrieved using a syringe by DVM, which came out pink/red. DVM diagnosed patient with congestive heart failure with pulmonary effusion. Euthanasia was decided upon by family due to rapid decline of patient on table. Flow-by oxygen was delivered with Butorphanol and Furosemide injections while waiting for family members. 

Dachshund spay induced with IM Alfaxalone and mask-down isoflurane (due to difficult veins), with needed top-up for ET tube placement. Topped up with Alfaxalone due to pain response from the pulling of the uterine horns. Rough anesthetic monitoring due to the induction effects, with hypercapnia, apnea, high blood pressure, and low SPO2. Decreased ISO to 1.5 and increased flow rate to 2.5, saw gradual decrease in ETCO2 and Blood Pressure, with SPO2 increasing. Uneventful recovery :)!

What did you enjoy in the week and why?

I enjoyed having the ability to experience how to prepare for and witness how TTAs are done! As orthopedic surgeries are not commonplace in most clinics, having the ability to recognize which tools are needed, and what is done during the procedure, helps create a foundational base for me to build off of!

What were your achievements and why?

My achievement this week was being able to flow smoothly from IV catheter placement, induction, and ET tube placement! Through guidance and practice the weeks prior, I was able to create a flow that matched my abilities and comfortability which lead me to better my efficiency.

What were your challenges and why?

The challenge I experienced this week was finding a good balance of anesthetic that will provide my patient with analgesia and anesthesia against blood pressure, SPO2, and ETCO2. I felt quite worried of my numbers and my patient, but thanks to constant communication with the DVM (on where the surgery is and how the previous drugs may be acting towards the readings), I was able to find a point where the readings improved.

What skills will you be focusing on (continued or next)?  What are your steps for succeeding in these skills?

I will be focusing on getting comfortable with uncomfortable anesthesia. I will do this by watching others in their anesthetic monitoring, communicating with the DVMs, and recognizing normal "abnormals" for each patient by consistent practice.

What are some tips and tricks you learned during the week?

Saline or any intravenous fluid is drawn up in a large syringe and dispensed aseptically onto the site when a saw is being used on the bone to minimize heat!