Read Vet&ExternCurriculum.Jun2010 text version

HUMANE ALLIANCE

Private Vet/Extern Curriculum

Introduction

Welcome to the Humane Alliance Veterinary Surgery Rotation. We are happy to have you join our team and look forward to working with you. We hope this rotation is a valuable learning experience. As a team member, we have the following expectations of you while you are on this rotation: 1. You must be prepared. You must read the procedures the day before the surgery. You will not be allowed to operate if you have not reviewed the procedure ahead of time. 2. You must provide the highest quality patient care. All animals must receive a physical examination. All animals must be adequately evaluated and treated with analgesics, as well as any other indicated medications. There is NO tolerance for leaving an animal in a soiled cage. Finally, all animals must be in excellent condition at the time of discharge. 3. You must assist the records technician to maintain accurate and complete medical records by informing them of the patient's status (i.e. normal, in heat, pregnant, etc.), and any additional concerns that should be noted. 4. You must maintain a positive attitude and have good teamwork on this rotation. We are a TEAM, and that includes everyone from lead veterinarian, to technician, to student. Everyone on the team is to be treated with equal respect, and you are expected to help the other team members whenever needed. This includes all areas from set-up to clean-up.

ROTATION OBJECTIVE: To teach basic skills and practical applications of high-quality, high-volume techniques used in anesthesia and surgery and to allow veterinary students the opportunity to become adept at performing these techniques.

HUMANE ALLIANCE

Private Vet/Extern Curriculum

Scheme of Studies

Courses: Patient Triage, Anesthesia Protocol, Surgical Protocol

Patient Triage:

Theory Review of general physical examination principles with emphasis on clinical signs of disease. Review of most likely disease processes which would pose a risk to the other patients. Review methods of determination (i.e. disqualifiers) regarding selection of surgical cases. Practical Perform evaluation of body system functions on individual patients including: 1. 2. 3. 4. 5. 6. 7. 8. 9. Mentation status Body condition Hydration status Mucous membrane color and capillary refill time R/O presence of ocular/nasal discharge Auscultation of heart and lungs Abdominal palpation Verify reproductive status (identify patients who have previously been sterilized) Utilize available knowledge from owner/agent to evaluate patient's medical history, NPO status, potential for allergies, current medications and any other variable that may affect the patient adversely during anesthesia and/or surgery.

Anesthesia Protocol:

Theory Review of general principles of anesthesia and analgesia routinely utilized in ovariohysterectomy and castration. Review of most likely complications which occur during anesthesia and methods to avoid those complications. Practical

HUMANE ALLIANCE

Private Vet/Extern Curriculum

1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11.

Perform pressure checks on the systems of an anesthetic machine and be able to trouble shoot problems as needed. Capable of properly restraining both dogs and cats for anesthetic induction. Understand the mechanism of action of routinely used drugs in anesthetic protocol including premedicants, induction drugs, and maintenance agents. Be able to assess and provide preemptive, intraoperative, and/ or post-operative analgesia. Perform IV catheterization. Selection of appropriate size endotracheal tube for successful intubation of a dog and a cat, cuff inflation and differentiation between tracheal and esophageal intubation. Induction, maintenance and recovery of dogs and cats from anesthesia. Determine an anesthetized animal's plane of anesthesia. Utilize anesthetic monitors (i.e. pulse oximeter) *Not to be used in place of hands-on patient evaluation* Recognize and treat hypotension. Be able to count and record, heart rate, respiratory rate, oxygen saturation. Be able to locate and assess pulse quality as well as capillary refill time and mucous membrane color.

12. 13.

Be able to set up, calculate and administer IV fluids. Understand the difference between rebreathing and nonrebreathing systems and how to select the proper system based on patient size.

Surgical Protocol:

Theory Review of general surgical principles and doctrine of appropriate tissue handling. Review of preop considerations and preparations. Review principles of surgical asepsis, sterilization and disinfection. Review appropriate OR conduct. Review post-op recovery and care, as well as wound healing and complications. Practical

HUMANE ALLIANCE

1.

Private Vet/Extern Curriculum

Demonstrate understanding of asepsis by utilizing appropriate code of behavior in OR (i.e. cap, mask, gloves, scrubs), as well as verification of proper surgical preparation of patient by support staff, draping of patient for surgery and address any break in sterility immediately.

2. 3.

Exhibit ability to consistently monitor patient during surgical procedure (i.e. verify anesthesia machine settings and patient status {HR, RR, Color}). Provide direction to support staff to ensure necessary ancillary care for patient during surgery (i.e. direct the administration of IV or SQ fluids, required intra-operative drugs, etc.).

4. 5. 6. 7. 8. 9. 10. 11.

Be able to perform a routine ovariohysterectomy and castration in a dog or cat. Be able to perform an ovariohysterectomy in a pregnant dog or cat. Be able to perform an ovariohysterectomy in an estrous dog or cat. Be able to perform a castration on a cryptorchid dog or cat. Be able to perform routine surgical repair of umbilical hernia in a dog or cat. Learn and apply high-volume techniques taught by the NSNRT veterinarians. Be able to identify any patient in recovery that is having a prolonged or abnormal recovery period and address as needed. Pursue the standard course of action for prolonged recovery: Initial assessment = assess peripheral pulses, take temperature, inspect mucous membrane color and CRT. Further assessment = PCV, abdominocentesis and attend to as needed.

12.

Perform re-checks of patients after surgery (time frame will vary up to weeks after procedure), determine if any additional care should be provided, and provide that service.

13. 14. 15. 16.

Make certain to get the entire ovary out. Be familiar with common reasons for dehiscence. Be able to evaluate the advantages & disadvantages of open vs. closed castration. Be prepared to participate in weekly morbidity rounds in which selected cases are discussed.

HUMANE ALLIANCE

Surgery Clinic Assignments (Veterinarians)

Monday Surgeon Tech Assistant(s) FD = 2 MD = 6 FC = 6 MC = 6 20 Tuesday FD = 3 MD = 5 FC = 7 MC = 5 20

Private Vet/Extern Curriculum

Wednesday FD = 4 MD = 5 FC = 7 MC = 4 20

Thursday FD = 4 MD = 5 FC = 8 MC = 3 20

Surgeon Tech Assistant(s)

FD = 5 MD = 5 FC = 9 MC = 2 21

FD = 6 MD = 4 FC = 10 MC = 2 22

FD = 6 MD = 3 FC = 11 MC = 3 23

FD = 6 MD = 3 FC = 12 MC = 4 25

Surgeon Tech Assistant(s)

FD = 7 MD = 3 FC = 13 MC = 4 27

FD = 8 MD = 2 FC = 15 MC = 5 30

FD = 8 MD = 4 FC = 15 MC = 5 32

FD = 8 MD = 5 FC = 15 MC = 7 35

HUMANE ALLIANCE

Surgery Clinics Assignments (Veterinary Students)

Private Vet/Extern Curriculum

Monday Surgeon Tech Assistant(s) FD = 1 MD = 1 FC = 3 MC = 1 6

Tuesday FD = 2 MD = 2 FC = 3 MC = 1 8

Wednesday FD = 2 MD = 2 FC = 3 MC = 2 9

Thursday FD = 3 MD = 2 FC = 3 MC = 2 10

Surgeon Tech Assistant(s)

FD = 3 MD = 2 FC = 3 MC = 2 10

FD = 3 MD = 2 FC = 3 MC = 4 12

FD = 3 MD = 2 FC = 3 MC = 4 12

FD = 3 MD = 2 FC = 3 MC = 4 12

Surgeon Tech Assistant(s)

FD = 3 MD = 2 FC = 4 MC = 5 14

FD = 3 MD = 2 FC = 4 MC = 5 14

FD = 3 MD = 3 FC = 4 MC = 5 15

FD = 3 MD = 3 FC = 4 MC = 5 15

HUMANE ALLIANCE

Private Vet/Extern Curriculum

Veterinary Extern Student Surgical Evaluation Form

STUDENT: ____________________________________________ DATE: _______________________________________________ EVALUATOR(S): ______________________________________

Above Below Average Average Unsatisfactory

EVALUATION OF SPECIFIC AREAS: Knowledge of surgical principles and diseases Knowledge of anesthetic principles & diseases Rounds Presentation (professional communication) Diagnostic Skills Patient Care Manipulative Skills Interaction with clients/staff/colleagues Attendance & Punctuality Acceptance of Responsibility Enthusiasm/Attitude Professional Appearance OVERALL PERFORMANCE: Letter Grade

Superior

Average

A

B

C

D

F

HUMANE ALLIANCE

Outline for Veterinarian Training

Private Vet/Extern Curriculum

Introduction: Attributes to look for in potential spay/neuter veterinarians · · · · · · · Passion for the mission Ability to multi-task Ability and flexibility to work as a team member Ability to focus and complete tasks Constructive, competitive attitude Physical ability to complete surgery and other duties as dictated by protocol Capable of staff and client interaction and effective communication

I. General Orientation A. Explanation of expectations 1. Ensure quality care of all patients 2. Represent organization professionally and ethically 3. Perform physical examinations on surgical candidates 4. Training and supervision of support staff 5. Be willing to perform needed duties even if outside your job description 6. Perform surgical sterilizations 7. Complete client communication per protocol 8. Ensure compliance with regulatory institutions such as DEA, OSHA, MSDS and state vet boards 9. Comply with the organization's mission B. Overview of daily operations 1. Be familiar with daily clinic flow, policies and procedures 2. Be familiar with responsibilities and limitations of support staff 3. Be familiar with facility operations II. Daily Veterinary Tasks A. Punctual arrival B. Confer with tech staff regarding post-op condition of inpatients C. Initiate drug logs and set up surgical suite D. Supervise intake of new patients

HUMANE ALLIANCE

1. Perform physical exams 2. Verify patient ID

Private Vet/Extern Curriculum

3. Calculate drug dosages and administer premeds E. Preparation for surgical procedures. 1. Don surgical cap and mask 2. Complete surgical scrub to elbows 3. Tip sutures in a sterile manner 4. Verify the patient's anesthetic level and settings 5. Verify surgical area set-up 6. Glove utilizing sterile technique F. Performance of surgical procedures using sterile technique. 1. Drape 2. Incise skin 3. Remove SQ adipose tissue to expose linea 4. Incise linea 5. Utilize spay hook to locate and exteriorize first ovary and report status of uterus 6. Break suspensory ligament 7. Isolate ovary and place ligature on pedicle, remove 8. Tear away broad ligament 9. Follow uterine horn to bifurcation and isolate opposite horn. 10. Repeat steps # 6-8 11. Locate uterine body in such a way to ensure complete removal of both uterine horns 12. Place ligature on mid-uterine body 13. Remove 14. Complete visual sweep of the abdomen 15. Perform closure of linea 16. Perform closure of SQ and SC 17. Close skin with glue 18. Perform tattoo 19. Ensure patient has been removed from inhalation anesthetic and administer any vaccines intended for that patient

HUMANE ALLIANCE

20. Re-glove and proceed to the next surgery G. Attending to patients in recovery 1. Monitor timely extubation

Private Vet/Extern Curriculum

2. Supervise support staff care of the recovery area 3. Require support staff to report prolonged or abnormal recovery periods to surgeons H. Determine the need for ancillary care/medications I. Completion of any re-checks or client communications by end of shift 1. Obtain medical record and re-check form from the support staff 2. Complete assessment and finalize re-check form J. Final assessment of post-op patients 1. Visually inspect all post-op patients individually 2. Verify all patients have been given a post-op snack, and instruct staff to water appropriate patients 3. Verify cage doors are secure K. Compliance with shift-end or facility exit procedures

Recommended Reference Texts

Bojrab, MJ. 1998. Current Techniques in Small Animal Surgery. 4 Ed. Lea & Febiger, Philadelphia, USA. Plumb, D.C. 2005. Veterinary Drug Handbook. 5 Ed. Blackwell Publishing Professional. Slatter, D.H. 2002. Textbook of Small Animal Surgery. 3 Ed. Saunders.

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