Clinical Skills III OSCE

Purpose of a cystocentesis

to obtain urine for bacterial culture, to decompress the bladder

Benefits of cystocentesis compared to free catch urine sample

avoiding contamination

Cysto needle size for small dog or cat

22g 1"

Cysto needle size for medium and large dog

22g 1.5"

Cysto needle size for giant dog / obese dog

22g 3" spinal needle

Best position of a cat for cystocentesis

lateral recumbency

Best position of a dog for cystocentesis

dorsal recumbency

Should you redirect the cysto needle?

No you can damage or traumatize internal organs

If you are doing a decompressive cysto, where should you insert your needle?

towards the bladder neck

Ultrasound guided cysto

utilizes US to visualize the urinary bladder

When to attempt a blind technique cysto?

no US available

If you need to poke 2x for a cysto, should you insert it into the same spot?

No. Go cranial or caudal

Is cysto a "benign" procedure?

No. aortic laceration vs. bladder rupture vs. iatrogenic bacterial infection.

When should you NOT cysto your patient?

struggling patient, thrombocytopenia, emphysematous cystitis, pyometra, bladder neoplasia

Purpose of decompressive cystocentesis

providing relief of pressure within the urinary bladder when the patient has a urethral obstruction

Equipment needed to u-cath a dog

sterile u-cath (red rubber or foley if indwelling), lube, speculum if female, sterile gloves

U-cath of choice for a 10-25kg dog

8-10 fr

Restraint for a dog u-cath placement

lateral

Male u-cath placement boundaries

distal end off penis to neck of urinary bladder

Why is it important to place the u-cath in the right spot?

avoid looping of the u-cath / damaging the mucosa

Male u-cath resistance may occur when

passing os penis, passing ischial arch

Digital technique for female u-cath placement

one hand: lubricated (sterile) gloved finger into vagina , other hand inserts catheter ventrally

Iatrogenic UTI is more common in what sex of dog during a u-cath placement

female

Why are male cats predisposed to a UO?

length and narrow diameter of the urethra

Name some causes of a UO

inflammation, spasm, urolith, urethral plugs

Polypropylene "tom cat" catheterr

irritating to urethra, rigid, use when trying to relieve obstruction. NOT AN INDWELLING CATHETER

Most common size of feline u-cath

3.5-5 fr

Once u-cath is inserted into male cat, pull prepuce how?

caudal, dorsal. helps to straighten urethra

Why is female cat u-cath relatively straighforward?

short, straight, wide urethra

Plucking of the surgical site is common for what procedure?

feline castration

Do skin scrubs sterilize the skin?

No

How should skin be scrubbed for surgery?

center --> periphery in circular or linear motion

Benefits of Povidine / Betadine as a surgical scrub

broad spectrum, economical, must contact x 2 mins

Benefits of Chlorhex as a surgical scrub

works well with alcohol, blood, organic debris. > iodine

Benefits of Alcohol as a surgical scrub

highest and rapid kill rates. enhances effectiveness of iodine and chlorhex

When would you use open gloving?

final prep of surgical site, minor surgical procedures

What drape is placed first when quarter draping?

cranial drape

Steps of tying a patient into sx

1- form a loop with the rope

2- loop placed proximal to hock

3- make a 1/2 hitch around metatarsals

4- secure to table

Appropriate capillary tube to run a PCV on blood samples collected in a no additive tube

use heparinized capillary tubes

Appropriate capillary tube to run a PCV on blood samples collected in a EDTA tube

plain capillary tubes

38%

What is the PCV?

QATs

quick assessment tests

Name the QATs we run before anesthesia

PCV, TS, BG, BUN, Lactate

Why is recording hepatic function important on anesthetic record?

can interfere with pK

Small animal surgery surgical handle

#3

Large animal surgery surgical handle

#4

Handle used in neurosx

#7

Standard SA Blade #10

Fine point blade #11

#12

Beaver Handle

precise cutting

#15 for entering viscous organs

Standard LA Blade #20

Mayo scissor

Cut thick tissues

Fingertip scalpel grip

index finger rests on and stabilizes blade

Pencil scalpel grip

using hand rather than arm. short precise incisions

Advanced neurologic diagnostic procedures

CSF tap, CT/MRI, Myelogram, Infectious dz PCR

Tenotomy scissors

delicate surgery and small structures (think ophtho)

Bandage (Lister) scissors

blunt ends to prevent trauma. DO NOT use on tissues

Adson-Brown forceps

holding and manipulating delicate tissues.

Adson forceps

fine instrument used to manipulate tissues NOT organs

Debakey Forceps

used on delicate tissues and viscera

Allis Tissue Forceps

use on tissue leaving patient

Doyen Tissue Forceps

use on tissue remaining in patient. non traumatic

Kern Bone holding forceps

heavy duty, self retaining forceps used to hold bone during surgery

Backhaus Towel Clamps

penetrating. secure DRAPE to SKIN

edna-lorna towel clamp

NON penetrating. secure TOP to BOTTOM drape or attach instruments to drape

Gelpi Retractor

maintain wound exposure during general, orthopedic and neurosurgery - retract tissues

Weitlaner Retractor

retract tissues

Finochietto Rib Spreader

To hold the ribs apart during thoracic surgery

Balfour Retractor

Provides increased exposure of abdominal cavity.

Miller senn retractor

sharp / blunt. retract skin and superficial tissues

Army-Navy Retractor

Double-ended, smooth blade used to retract skin, fat, and muscle.

Malleable Retractor

"Ribbon"; retracting deep wounds; handheld; may be bent to desire shapes

Hohmann retractor

single blade and a handle used to lever tissues out of the way- orthopedic surgery (FHO)

Mosquito forceps

small surgical forceps with delicate tips for clamping small vessels and tissues

Kelly Forceps

Used to clamp small to medium- sized blood vessels. "Kelly only goes half way"

Crile Hemostatic Forceps

-Provides hemostasis (teeth run length of jaws)

Rochester Carmalt Forceps

Used to clamp tissue bundles that contain blood vessels. Longitudinal grooves and cross grooves at the tip. Good for large pedicles, etc.

Poole suction tip

remove large amounts of fluid (ie. viscera)

Yankhauer Suction Tip

Only allows fluid to be suctioned, not tissue

Frazier suction tip

remove fluid from smaller areas, brain and spinal surgery

Mayo-Hegar Needle Holder

To drive suture needles through tissue that requires suturing and to assist in tying sutures (MOST COMMON)

Olsen-Hegar Needle Holder

Needle holder + scissor combo. NOT used at AVC

Mathieu Needle Holder

used in LA

Castroviejo Needle Holder

commonly used in eye surgery and microsurgery

Babcock Tissue Forceps

use on tissue remaining in patient

Normal mentation

interacts with the environment and is alert

Disorientation agitation arises from the

prosencephalon

Obtunded

lethargic, limited responsiveness

Stupor

asleep when undisturbed but can be aroused

Coma

state of profound unconsciousness

Decerebellate rigiditiy

opisthotonos. acute cerebellar lesion

Decerebrate rigidity

extensor rigidity of limbs and trunk. rostral brainstem lesion.

Schiff Sherrington

increased tone TL, flaccid HL. acute spinal cord lesion T2-L4

Vestibular ataxia

leaning or falling to one side, circling, drunken gait

Cerebellar ataxia

staggering, wide-based gait; difficulty with turns; uncoordinated movement

paresis

partial paralysis

paralysis (-plegia)

loss of motor function

CN I

Olfactory (smell)