Clinical Skills 1a

How to Pass Surgical Instruments

passed sharp end away from receiver and positioned in the surgeon’s hand ready to use

What are the three scalpel grips

pencil, fingertip, palm

How to put on scalpel blade

Grasp back side of the blade using needle holders, hold scalpel away from face and pointed down, don’t apply blade with fingers

Fingertip scapel hold is useful for

long straight incisions

Pencil scalpel blade grips is useful for

short and precise cuts

Palm scalpel grip is useful for

most power but is the least precise (tough tissue)

Press cutting is used for

stab incisions into hollow organs

Tripod grip of needle holders provides

max control, best for precise

The palm grip of needle drives is used for

application with speed and power

Hold the needle ___ of the distance from the needle tip

3/4

Introduce the needle at ____ to the incision

90 degrees

Removal of needle from tissue is optimally performed with

needle holders

Tripod grip for scissors allows for

max movement and control of scissors

Two hand tie is best for

precision but slower

One hand tie is best for

speed

Animal Component - Historical experiences

How do they do normally at the vet? What has caused concern for the animal in the past?

Animal Component - Comfort Level

illness/injury, aging and other body changes

Animal Component - Situtational Changes

New owner, changes in environment

Triage Component

what is the patient here for or what is the level of urgency for care? You need to consider both the needs of the patient and the needs of the owner

Veterinary Impact

Interpreting and understanding the behavior in your patients, quiet environment, quiet demeanor, treats, pheromones, medicines

Cattle Working Systems

Halters, squeeze chutes, head lock gates, tilt tables, ropes

Understanding Horse Language

ears, lips, nostrils, teeth/tongue movement, head and body position, tail position and movement

Equine interaction tools and techniques

halter and lead rope, hand distraction/hand twitch, mechanical twitch, stanchions/stocks, chemical support

Muzles are used to

not stop the patient from biting but to minizme damage and control the animal

What gauge needle do you generally use for large/medium animals

20g

What gauge do you generally need for smaller patients

22g

Lavender top - Additive

EDTA

Green top- Additive

Heparin

Blue top - Additive

Citrate

Red Top - Tests

Chem, serology, vit e, most endocrinology

Tiger top - Tests

can relplace red top for most chem and serologies, avoid with some endocrine/chem

Lavender top - Tests

EDTA Plasma - ACTH Endogenous/ Actch and insulin

EDTA Whole Blood - Hemogram, lead, selenium, knott’s heartworm, PCR tests

Green top - Tests

Heprinized Plasma - most chems, toxicology (cu, fe, nitrate/ite, zinc)

Heprain whole blood - Knott’s heartworm, toxiciolgy

Blue Top - Tests

Most comparative coagulation tests

Blood Culture Vials

first in order of draw,

Additives : Media to encourage growth of microbes + anticoagulant

Centrifugation: No

Blue Top

second in order of draw

Additive: Citrate

Centrifugation: Yes if you want citrate plasma

Used for: Coagulation testing

Red Top Tube

Third in order of draw

Additives : None

Centrifugation: Yes after clot has fully fromed

Used for: Chem, serologies, Vit E, Endocrine

What test can you not use red tops for

Endogenous ACTH/ACTH stimulation tests/insulin

Tiger top

third in order of draw

Additives: Serum separator

Centrifugation: Yes, after clot has fully formed

Used for: Interchangable with the red top

Green top

Fourth in order of draw

Additive: Lithium Heparin

Centriguation: Yes if you want heparinized plasms

Used for: Chem, toxicology, heartworm

Purple top

Fifth in order of draw

Additives : Postassium EDTA

Centrifugation: yes if you want plasma

Used for: CBC, insulin, endogenous ACTH, ACTH stim test, heartworm, PCRs, lead/selenium

Gray top tube

Sixth in order of draw

Additive: Sodium Fluoride (preservative) and Potassium Oxalate(Anticoagulant)

Centrifugation: Yes if you want plasma

Used for: Plasma glucose and lactic acid

Coccygeal Venipuncture

Done gloves, stand behidn teh cow and slightly to one side of the tail, hold the tail approximately a 3rd of the way from the base and with your non-dominant hand raise the tail vertically until it is horizontal to the ground, locate the groove lying in the ventral midline of the tail, midway along the body of a coccygeal vertebra, with you dominant hand insert the needle perpendicualy to the surface of the skin slwoly to a depth of a few milimetters (you may hit bone), back the need out very slowly about 1 mm and pull back on plunger, get blood and reove needle from tail, apply pressure to site for 20-30 seconds

Equine Jugular Veinpuncture

Don gloves, stand on the side of the horse you plan to use, with you non-dominant hand distend the jugular vein by compressing the proximal third of the neck (You should be able to visualize the vein now), with your dominant hand, match the angle of the vein with your syringe and needle, insert the needle completly into the vein and pull back on plunger, remove needle and apply pressure to site for 20-30 seconds

Recumency for canine jugular

seated, standing or dorsal recumbency

Recumbency of Feline Jugular

Sternal, lateral, or ventral recumbency

Canine and feline Jugular Venipuncture

Don gloves, cclude jugular with non dominant hand, with dominatn hand insert the needle into the vein at 45 angle and to a depth of a few mm, pul back, remove needle and apply pressure for 20-30 seconds

Cephalic Venipuncture

Don gloves, hold thoracic limb with non-dominant handm with dominant hand insert the needle in the vein at a 25 angle and to a depth of a few milimeters, pull back, remove needle, apply pressure for 20-30 seconds

Lateral and Medial Saphenous Veinpuncture

Don gloves, hold pelvic limb with non-dominant hand, with dominant hand insert the needle at 25 angle and to a depth of a few mm, pul back, remove needle and apply pressure for 20-30 seconds

Facial Sinus Venipuncture

Don gloves, stand on the side of the horse you plan to use, with you dominant hand insert the needle at an upwar 60 through the skin and muscle toward the base of the facial crest, the needle tip will make contact with the bone , back the needle out very slwoly 1-3 mm to enure placement of the needle and pull back, remove needle and apply presure to site for 20-30 seconds