Week 11: April 6-12, 2015
The highlight of this week is that I intubated my first patient! We were preparing a dog for spay and the technician handed me the ET tube and said, “You place it.” I was so excited because I have never done this before even though I had observed and assisted in the procedure hundreds of times. The technician told me that I should learn how to do the one handed technique because there might come a time when I either don’t have help or it’s an emergency and I won’t have time to wait. She showed me how to pull the tongue out, “like you’re going to rip it out of the dog’s head.” (Not really; it was a strong pull, but not enough to injure the dog). I held the dog’s tongue in the last three fingers of my left hand and then placed my index finger behind the canine tooth and used my hand as an elevator to pry open the mouth. She showed me the epiglottis at the back of the throat and used the end of the trach tube to gently lower it to reveal the larynx. She said, “ You see that V? You want to hold the tube slightly on its side and place it between the V into the trachea.” I placed it on the first try! She showed me the dog’s breath coming through the end of the ET tube and explained that if I felt the throat, I should only feel one hard tube. If I felt two, the ET tube was most likely in the esophagus. Since we determined the tube was placed correctly, I inflated the cuff and tied the strings behind the dog’s head in a bow to help keep it in place before hooking up the anesthesia machine. A technician told me never to hook an animal up to a dead machine, so I turned on the oxygen first, hooked up the rebreather, and then turned on the iso anesthesia. She later explained that cats sometimes are more difficult than dogs because their larynx is easily reactive, so you oftentimes have to “spear” the larynx really quickly or use a tiny drop of lidocaine to relax the throat. It was really exciting to learn a new technique that I can use to assist the doctors and technicians on future procedures.
This has been another week in trying to work out the kinks of going paperless. One of the doctor’s in particular is having trouble adjusting because she relies so much on writing things down. She also admitted she’s not computer friendly in general, so having to work with the computer system at work was frustrating. She dreaded seeing appointments because of the stress, so my job became to hold her hand and make the process as easy as possible. The hospital manager instructed the receptionist to schedule all her Saturday appointments for 30 min instead of her usual 15 so she wouldn’t fall so far behind trying to figure out a system that worked for her. I had to channel my mom patience, but we made it through Saturday, and at the end of the day, she was excited and on board with going paperless! There are a lot of aspects I like about going paperless, namely that everything is recorded where anyone can look up information without having to find a file. Every communication with the client is at hand, every test, drug administered, and prescription can easily be accessed. The next step is to get scanners for things that have to stay papered, such as consent forms. I hear there’s talk of a new xray machine that will allows us to transfer radiographs into AviMark. I’m just excited about the prospect of having an xray machine/program that won’t randomly decide to die on us.
Thursday I had the most exciting fecal sample of my life. And I think its awesome I get to say that in my line of work. We had a client drop off a fecal sample for a patient that kept having horrible bloody diarrhea and they couldn’t find out the answer. The dog was on metronidazole and the doctor suspected the food might be the culprit. I set up the fecal sample as usual, took a sample and mixed it with Fecasol, spun it in the centrifuge for 5 minutes, then allowed it to sit with a microscope cover slip over the top for 3 minutes. I placed the cover slip on a slide and placed it under the microscope. I usually start on the lowest objective, but in the interest of time I went straight for the 10x. Immediately I saw hookworm eggs, a heavy load of hookworms, up to 15 in a field at least! Then I saw this strange critter that looked like a mite. I pointed it out to the technician and she thought perhaps it was something that had crawled on the pooped when it was on the ground. But there were several! I excitedly showed the doctor and he theorized they were grain storage mites. We decided to send the rest of the fecal sample to an outside lab to find out exactly what they are. I can’t wait for the results!
The oval shape is a hookworm egg. The eight legged creepy thing? STAY TUNED!