Professional Documents
Culture Documents
Medical Nursing
Medical Nursing
Medical Nursing
for Veterinary
Technicians
By
Katie Samuelson, D.V.M.
All terms mentioned in this text that are known to be trademarks or service
marks have been appropriately capitalized. Use of a term in this text should not be
regarded as affecting the validity of any trademark or service mark.
LESSON ASSIGNMENTS
97
145
169
SELF-CHECK ANSWERS
271
Contents
INSTRUCTIONS TO STUDENTS
iii
YOUR COURSE
OBJECTIVES
When you complete this course, youll be able to
Instructions
COURSE MATERIALS
Your Medical Nursing for the Veterinary Technician course
provides you with the following materials:
1. This study guide, which includes
YOUR TEXTBOOK
Your textbook, Clinical Textbook for Veterinary Technicians,
contains the bulk of the material on which your examinations
will be based, so its important that you read it carefully and
completely. This study guide contains information and illustrations related to the topics in your lessons and important
points from your textbook.
Instructions to Students
A STUDY PLAN
This study guide divides the material to be covered into four
lessons. Each lesson is divided into multiple assignments to
make your learning more manageable. Each assignment
includes a reading from your textbooks and a supplementary
assignment in this study guide. After each assignment, there
are self-check questions to check your understanding of what
youve learned. Be sure to complete all of the work in each
lesson before moving on to the next. Youll find this easy to
do if you follow the study plan outlined below.
1. Read the instructions to each assignment in this study
guide. The instructions will tell you the pages in your
textbook that youll be reading.
2. Quickly read the assigned pages in your textbook. This
is called skimming, a learning technique you should use
to get a general idea of the topics covered in that part of
the text. You may find it helpful at this stage to read the
chapters straight through, rather than just reading the
pages on which the assignment focuses.
3. Go back and slowly read the assigned textbook pages
again. Pay careful attention to what youre reading.
4. Read the assigned pages in this study guide.
5. When youve finished the assignment, complete the selfcheck, which youll also find in this study guide. The
self-checks are based on both your textbook and this
study guide. The self-checks are for your use onlythey
arent graded. Dont send your answers to the school.
6. Once youve completed a self-check, turn to the answers
provided at the back of this study guide. The self-checks
are designed to show you how well you understand the
material, so test yourself honestly. Make every effort to
complete the questions before turning to the answers at
the back of this study guide. If you find any weak areas
in your knowledge, go back and review the relevant
material until you understand it.
7. Follow this procedure for all of the assignments, until
youve completed the lesson.
Instructions to Students
Instructions to Students
For:
Read in the
study guide:
Read in
the textbook:
Assignment 1
Pages 727
672681, 704705,
737744, 865878,
930931
Assignment 2
Pages 2840
787809
Assignment 3
Pages 4044
13551376
Assignment 4
Pages 4564
188190, 238239,
285, 588, 590591,
638639, 812823,
1221
Assignment 5
Pages 6496
586596, 598599,
620642
Examination 573460
Material in Lesson 1
Read in the
study guide:
Read in
the textbook:
Assignment 6
Pages 97106
599603, 642651
Assignment 7
Pages 107125
604609, 654657,
664669
Assignment 8
Pages 126144
Examination 573461
883895
Material in Lesson 2
Assignments
Read in the
study guide:
Read in
the textbook:
Assignment 9
Pages 145150
12991303
Assignment 10
Pages 151160
13211343
Assignment 11
Pages 161168
13031321, 13511354
Examination 573462
Material in Lesson 3
Read in the
study guide:
Read in
the textbook:
Assignment 12
Pages 169180
973981, 992993
Assignment 13
Pages 181205
981991, 9941003
Assignment 14
Pages 206218
908
Assignment 15
Pages 219270
908927, 931933,
944969
Examination 573463
Material in Lesson 4
Note: To access and complete any of the examinations for this study
guide, click on the appropriate Take Exam icon on your student portal.
You should not have to enter the examination numbers. These numbers
are for reference only if you have reason to contact Student Services.
Lesson Assignments
Introduction
The veterinary profession is one that involves many different
people working together to care for animals. Its much like
the human medical field, but without the participation of
the patient. Therefore, the people involvedveterinarians,
technicians, assistants, and ownersare all integral parts of
making sure an animal is healthy and well treated. The role
of the veterinary staff is to monitor and treat the animal
when it needs medical attention and to educate the owner
on the best care for the animal.
When an animal is admitted to a veterinary hospital, the
veterinary staff works as a team to care for the animal. The
veterinarian depends on the veterinary technician to aid him
or her in monitoring the animal and to perform diagnostics
that help the veterinarian make appropriate decisions on how
to treat the animal.
As a veterinary technician, your nursing responsibilities will
largely consist of routine care, feeding, and observation of
hospitalized patients. Youll often be an animals first line of
defense. Youll detect clinical problems that involve food and
water intake, elimination habits, and other behavioral changes.
These changes should be brought to the veterinarians attention,
as they may indicate a clinical problem.
Lesson 1
Lesson 1
Clean bedding
Thermometer, stethoscope, and other equipment for general examination of hospitalized and recumbent animals
10
Therapeutic Bathing
Bathing an animal once a month in the colder months of the
year and every other week during the warm season is sufficient unless the dog or cat has a skin problem that requires
more frequent attention with therapeutic baths. Always bathe
animals before theyre dipped for ectoparasites (parasites that
Lesson 1
11
live on the surface of their victims skin), such as fleas and ticks.
Care should be taken so that young puppies and kittens dont
become chilled.
Thoroughly rinse the animal with clean water to prevent
irritation of the skin from residual shampoo. The axillary and
scrotal regions of long-haired dogs are particularly vulnerable
to residual shampoo irritation. If a cage blow dryer is used,
caution must be exercised to prevent overheating of the
animal (hyperthermia).
Use shampoos containing insecticides only with approval
of the veterinarian because of possible toxicity or drug
interactions. Sponge-on insecticidal dipping solutions must
be diluted to avoid toxicity to the animal. Always read the
manufacturers instructions on the container before using
any dipping solution on an animal. If a complete immersion
bath is required, first remove fecal soiling from the animal
with a sponge bath.
Although theres no particular trick to bathing a dog or cat,
preparing both the animal and the bathing area makes the
chore safer and easier. Find an area large enough to accommodate the animal. Cover the floor of the bathing area with a
nonskid mat for traction.
Be sure that all hair mats and burrs have been combed out
of the coat. Place a small amount of lubricating ophthalmic
ointment into the animals eyes. This will protect the eyes from
irritating chemicals in shampoos or sponge-on insecticidal solutions. Place a small piece of cotton in each ear to protect
the external ear canals from excessive water. (Remember to
remove the cotton when the bath is done!) Monitor the water
temperature while the bath fills to prevent scalding.
Several bathing techniques ensure maximum effect with minimum difficulty. To keep fleas from running to the animals
head, always bathe an animal from nose to tail. Clean the
face, head, and ears with a sponge. Use small amounts of
shampoo. A little bit of shampoo can go a long way, and
too much shampoo is difficult to rinse off. Shampoo lathers
better if you dilute the measured amount with water before
application. Most therapeutic shampoos must remain on the
hair for at least 10 minutes before rinsing. Flea shampoos
generally do little to control fleas because they have limited
12
Dipping
The successful flea- and tick-control program eliminates these
pests from both the animal and its environment. Flea control
must be practiced on all animals in the household, but this
doesnt mean that all animals should be dipped. Dipping solution may be toxic to puppies and kittens under 3 months old.
Powders and sprays that contain either carbaryl or pyrethrins
can be used safely every five to seven days on a puppy or
kitten older than two months. Always read the products label
and follow the instructions carefully.
Sponge-on insecticidal dips are safe for healthy dogs and
cats over three months old. These dips, usually applied every 14
to 21 days, effectively kill fleas, ticks, and mange mites. Apply a
dipping solution after a shampoo by pouring and sponging the
premixed dipping solution over every part of the animals body.
Lesson 1
13
Dont towel or rinse. Allow the dip to dry on the dog or cat.
Always wear rubber gloves and protective eyewear when
applying any dip product.
Most dips are concentrates that are diluted with water just
before theyre applied. To avoid poisoning the animal, its crucial to mix dips exactly as described on the products label.
Dips usually contain chlorpyrifos, phosmet, permethrin, or
d-trans allethrin as their active ingredient.
Exercise
Moderate exercise benefits an animals general care. Its the
simplest, most basic form of physical therapy. It improves
muscle tone and strength and can help reduce fluid collecting under the skin (also called peripheral edema). To prevent
injury and death, exercise animals in a secure, controlled,
and safe environment. Animals with respiratory, cardiovascular, and musculoskeletal problems may need restricted
exercise. Exercise restrictions should be imposed by the
veterinarian. You should always check with the veterinarian
before exercising an animal.
Feeding
The most basic requirement for life is caloric intake. Animals
that are diseased in any way have a higher caloric need than
those that are healthy. Unfortunately, many times the hospitalized patient doesnt eat readily. Therefore, its very important
that the technician aid the animal in getting the calories it
needs each day. Some animals will readily eat on their own,
and for those patients, its necessary only to make sure that
they get the amount of food they require (the caloric intake
should be greater than the metabolic need). For hospitalized
animals that dont eat readily, more individualized attention
may be needed.
Depending on the individual animal, attention and encouragement (praise, saying good dog) may be the only thing
needed for the animal to eat. For others, a variety of foods
may be necessary to spark their appetite. In some cases,
more forceful methods may be necessary. For animals that
14
Medication Records
You, the veterinary technician, must record any medication
you administer (drug, dose, route of administration, and time
administered) completely and accurately in the animals medical
record. Record the notation immediately after administering the
medication, and sign or initial each entry. Follow this procedure
consistently to ensure that treatments are performed and not
repeated. A well-kept medical record improves the animals care
and protects the practice in the case of legal disputes. The
medical record is a legal document, and every treatment
should be recorded in case of subsequent litigation (Figure 2).
Lesson 1
15
Mr.
Miss
Ms.
X
Mrs.
Patient/Pets Name:
Patricia ONeil
Max
Address:
City/State/Zip
Scranton, PA 12345
Home Phone:
Business Phone:
555-1234
Patient/Pet Information
53
Chart #: ________________________
German Shepherd
Patient: Max
________________________ Species: ______________
Breed: ________________
Canine
Color: __________________________
Sex: F
Tan/Black
M
X
Rabies, Bordetella
lbs.
Vax History: ________________________________________________
Weight: 40
__________
Current Problems
Date
Time
Month
Day
Year
17
2004
SOAP
Format
Progress Notes
Fee
11
18
2005
16
Patient Monitoring
Depending on the severity of the patients clinical condition,
patient monitoring may occur anywhere from twice a day to
continuously. Animals that require only basic monitoring are
usually checked twice a day for temperature, heart rate (HR),
respiratory rate (RR), mucous membrane color (MM), capillary
refill time (CRT), and body weight. Theyre then exercised
according to the veterinarians instructions.
Patients that require more intense monitoring will have their
temperature, heart rate, respiratory rate, mucous membrane
evaluation, body weight, as well as the evaluation of other
specified parameters (e.g., blood pressure, oxygen saturation,
ECG) taken more frequently than twice a day. These animals
are generally assigned a form designed to track their vitals
and progress (Figure 3). By recording all of this information
on a form, the veterinarian will be able to assess the animals
recovery and recognize any improvements or setbacks. As the
veterinary technician, youre responsible for recording the
information obtained from the continuous monitoring as
specified on the animals treatment/monitoring form and
alerting the veterinarian to variances in the information.
Lesson 1
17
18
LABORATORY
SURGERY
RADIOLOGY
PROCEDURES
PERITONEAL FLUID
THORACIC FLUID/AIR
VOMIT/CHARACTER
STOOL/CHARACTER
URINE OUTPUT/COLOR
MENTATION
MM/CRT
RR/EFFORT
HR/SOUNDS
TEMPERATURE
MONITORING
5P 6P 7P 8P 9P 10P 11P 12A 1A 2A 3A 4A 5A 6A 7A 8A 9A 10A 11P 12P 1P 2P 3P
4P
FIGURE 3Patient Monitoring Chart (Mentation means mental abilitywhether the animal seems
confused, bright and alert, dull, sedated, and so on.)
Cleanliness
Cleanliness is extremely important and can be especially
challenging with recumbent animals, which may suffer
fecal and urinary incontinence. Much of your effort will
be to prevent decubital sores (bedsores) over prominent bony
regions of the animals body. Decubital sores heal very slowly
and can quickly become infected. Preventing and managing
decubital sores and scalding are extremely important aspects
of recumbent animal care.
Lesson 1
19
20
Soaking the affected area two to four times daily with a mild
astringent solution will help keep the decubital sore dry. One
part aluminum acetate to 40 parts water (Burrows solution)
provides the appropriate astringent. After soaking, apply a
thick, clinging ointment, such as zinc oxide, to protect the
area from irritation.
Ideally, the area of the decubital sore should be padded to
prevent further pressure injury, but the decubital sore itself
should remain exposed to the air so that it doesnt retain
moisture. One way of accomplishing this is to fashion a
donut from foam rubber and to affix this to the skin with
adhesive tape. Unfortunately, its difficult to maintain these
pads in the proper location for long periods of time. Topical
antibiotic agents should be applied judiciously.
Hydrotherapy
Hydrotherapy is the external use of water to treat an injury
or disease. Hydrotherapy improves a recumbent animals
general condition because it cleanses the animal, improves
circulation, decreases decubital sore development, and promotes healing of decubital sores. Make sure you dry the
animal completely after any bathing or whirlpool therapy.
Lesson 1
21
Nutrition
Good nutrition is essential for the recumbent animal. Forcefeeding and forced watering may be necessary if the animal
refuses or is unable to eat and drink.
22
Dispensing Medication
Always make sure that all medications, whether used in the
hospital or dispensed for use at home, are correctly labeled.
The dispensing label should include the following information:
Lesson 1
23
Routine hospital disinfectant and containers for disposing of animal waste, soiled bedding, and spent supplies
Medications (tablets, liquids, and capsules), a variety of sterile fluid solutions, and fluid and blood administration sets
24
25
Self-Check 1
At the end of each section of Medical Nursing for the Veterinary Technician, youll be asked
to pause and check your understanding of what youve just read by completing a SelfCheck exercise. Answering these questions will help you review what youve studied so
far. Please complete Self-Check 1 now.
c. Eating quickly
d. Pacing
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
(Continued)
26
Self-Check 1
3. Why are bathing and grooming an important aspect of nursing care?
__________________________________________________________
__________________________________________________________
4. A recumbent animal needs extra attention because it can get _______, which is skin
irritation caused by frequent wetting with urine.
5. What are decubital sores?
__________________________________________________________
__________________________________________________________
6. List three ways to decrease decubital sore formation.
__________________________________________________________
__________________________________________________________
__________________________________________________________
Questions 79: Match the following terms with their definitions by placing the letter of the
best definition in the blank space next to each term.
______
7. Sterilization
______
8. Disinfectant
______
9. Antiseptic
Lesson 1
27
ASSIGNMENT 2CARE OF
PEDIATRIC ANIMALS
Read this assignment. Then read pages 787809 in Clinical
Textbook for Veterinary Technicians.
Introduction
Although every animal begins as a newborn, the vast majority
of newborns youll encounter in veterinary practice will be
puppies and kittens. Foals run a distant third. To prepare
you for the majority of situations youre likely to confront,
weve narrowed our discussion of pediatric animal health care
to the care of newborn puppies, kittens, and foals.
28
Raise the bottom of the box off the floor, which can get
cold. Put padded, disposable, washable flooring (such as
indoor-outdoor carpeting, disposable diapers, or cotton
towels) in the bottom in order to keep the boxs inhabitants as warm and dry as possible.
Lesson 1
29
30
Lesson 1
31
and quality of nutrients for different stages of growth; a regular schedule of feeding, sleeping, grooming, and exercise; and
the stimulus that provokes urination and defecation.
The most important consideration for an orphaned puppys or
kittens environment is stability. As mentioned earlier, newborn puppies and kittens are unable to effectively control
their body temperature. During their first four weeks of life,
they gradually change from having a variable body temperature to maintaining a uniform body temperature. This means
that during the first week of life, their body temperature is
directly related to the environmental temperature. Therefore,
the ambient temperature must be between 86 and 90F.
Over the next three weeks of life, the ambient temperature
can be gradually lowered to 75F. Humidity should be maintained at 55% to 60%. Stability extends beyond temperature
and humidity, however. Its equally important that sudden
changes of environmental conditions be avoided, and that
disturbances outside of socialization, exercise, and hygiene
activities be minimized.
Formula Feeding
Feeding orphaned puppies and kittens that still require mothers
milk can be rewarding, but any substitute for mothers milk
isnt as good as the real thing. If a foster mother is unavailable,
the puppies or kittens will have to be hand-fed a replacement
food formulated to meet the optimum nutritional requirements
of the puppy or kitten. Various modifications of homemade and
commercially prepared formulas simulating mothers milk have
been used with success. The following are several homemade or
commercially prepared formulas for rearing puppies and kittens.
32
Lesson 1
33
34
Never squeeze milk out of the bottle while the nipple is in the
animals mouth. Doing so may result in laryngotracheal aspiration of the milk into the lungs. Never attempt to nipple-feed
a puppy or kitten that lacks a strong sucking reflex.
Tube feeding is the fastest way to feed orphaned puppies and
kittens. A number 5 French infant feeding tube is appropriate
for puppies or kittens weighing less than 300 g, and a number 8 to 10 French infant feeding tube is appropriate for
puppies and kittens weighing over 300 g. (French refers to a
standard set of sizes for needles, catheters, and tubes.)
Mark the feeding tube clearly to indicate the depth of insertion to ensure gastric delivery; that is, the distance from the
last rib to the tip of the nose can be measured and marked
off on the feeding tube as a guide. This should be done
weekly to accommodate for the growth of the puppy or kitten.
Never feed into the distal esophagus, the part of the esophagus
from the heart to the diaphragm. If this happens, the food
will come right back up and be aspirated into the lungs.
When feeding, fill a syringe with warm formula and fit it to
the feeding tube, taking care to expel any air in the tube or
syringe. Open the animals mouth slightly, and with the
animals head held in the normal nursing position, gently
pass the feeding tube to the marked area. If the animal
coughs or you feel an obstruction before reaching the mark,
the feeding tube is in the trachea and needs to be reinserted.
Otherwise, slowly administer the prepared formula over a
two-minute period to allow sufficient time for slow filling of
the stomach. Regurgitation of formula rarely occurs, but if it
does, withdraw the feeding tube and interrupt feeding until
the next scheduled meal.
Lesson 1
35
36
Orphaned Foals
Accepted minimum nutritional requirements of the healthy foal
to 30 days of age are in the range of 130 to 150 kcal/kg/day.
The healthy foal should gain one to two kg/day. Some foals
require assistance or encouragement to nurse from their surrogate mare. Every effort should be made to feed foals from
their mare. Foals that are unable or unwilling to nurse from
their mare can be allowed to nurse from a bottle or bucket if
they maintain a suck reflex. Foals without a strong suck
reflex require an indwelling nasogastric tube for feeding.
The primary complication associated with tube feeding is
aspiration pneumonia. To avert this risk, the tubes position
within the stomach must be confirmed before each use of
a nasogastric tube. Recumbent foals must be placed in
sternal recumbency (sitting upright and resting on the chest
bone) during and for 20 minutes following feeding to prevent
regurgitation and aspiration of milk.
Mares milk is the best source of nutrition for the foal. When
available, mares milk should always be used. To prevent
mastitis (inflammation of the mares udder), the mares udder
and the hands must be cleaned before milking and a teat dip
(a commercial antiseptic product designed specifically for this
purpose) applied after milking.
Lesson 1
37
Several alternatives to mares milk are available. Milk preparations formulated for nutrition of other species generally
arent suitable for the foal. Goats milk is palatable but
causes some metabolic abnormalities and shouldnt be used
alone for extended periods. Goats milk has a caloric density
of 276 kcal/pint. Milk replacers are readily available and
inexpensive but are unpalatable and notorious for causing
gastrointestinal upsets. Goats milk can be added to milk
replacers to improve palatability. Milk replacers, when fed
per labeled directions, underestimate a foals caloric requirements by 50% to 70%. The amount to be fed to the foal
should be calculated daily based on caloric requirements
and the foals body weight.
Commercial Milk Replacers for Foals
Foal Lac (Pet-Ag Inc., Elgin, Illinois)
Mares Match (Land-o-Lakes, Fort Dodge, Iowa)
Nutri-Foal (Ross Laboratories, Columbus, Ohio)
38
Self-Check 2
1. How often should a puppy or kitten nurse from its mother in the first week of life?
a. 12 times a day
b. 24 times a day
c. 48 times a day
d. 1224 times a day
3. Total care of the puppy or kitten in the first six to eight weeks of life includes all of the
following, except
a. the correct quality and quantities of nutrition.
b. a regular schedule of sleeping, feeding, grooming, and exercise.
c. a frequently changing environment to make the animal adaptable to various situations and
to improve socialization.
d. a steady ambient temperature.
4. What is the range of caloric need for puppies and kittens, and how often should they be fed?
a.
b.
c.
d.
2226
2022
2226
2022
kcal/100
kcal/100
kcal/100
kcal/100
g
g
g
g
of
of
of
of
body
body
body
body
weight
weight
weight
weight
given
given
given
given
in
in
in
in
34
46
23
34
equal
equal
equal
equal
portions
portions
portions
portions
over
over
over
over
24
24
24
24
hours
hours
hours
hours
(Continued)
Lesson 1
39
Self-Check 2
5. When should the first dose of vaccines be administered to puppies and kittens?
a. 45 weeks of age
b. 68 weeks of age
ASSIGNMENT 3CARE OF
GERIATRIC ANIMALS
Read this assignment. Then read pages 13551376 of Clinical
Textbook for Veterinary Technicians.
40
Lesson 1
41
42
During the examination, discuss with the owner any agerelated changes that are occurring, such as hearing loss,
blindness, difficulty in rising and walking, and pre-existing
medical conditions. Toward the end of the exam, fill in the
annual health-care services record and provide the owner
with a copy. Before the owner and animal leave, dispense
once-a-month flea, tick, and heartworm preventive products.
Lesson 1
43
During the examination, discuss with the owner any agerelated changes that are occurring, such as hearing loss,
blindness, difficulty in rising and walking, and pre-existing
medical conditions. Toward the end of the exam, fill in the
annual health-care services record and provide the owner
with a copy. Before the owner and animal leave, dispense
once-a-month flea, tick, and heartworm preventive products.
Before proceeding to the next assignment, take a moment to
complete Self-Check 3. Remember that you can check your
answers by turning to the back of this study guide.
Self-Check 3
1. List the four factors that influence the aging process.
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
Questions 24: At what age range is an animal considered to be in each of the following
groups?
2. Pediatric:
______________________
3. Adult: __________________________
4. Geriatric:
______________________
5. What vaccine(s) should a geriatric cat receive during its annual visit to the veterinarian?
__________________________________________________________
__________________________________________________________
Check your answers with those on page 272.
44
ASSIGNMENT 4ROUTINE
ANIMAL CARE
Read this assignment. Then read pages 188190, 238239,
285, 588, 590591, 638639, 812823, and 1221 in your
Clinical Textbook Veterinary Technicians.
Introduction
Not every animal you encounter as a veterinary technician
will be hospitalized. Animals may be brought in for routine
checkups to ensure good health. During the examination,
discuss with the owner any changes that are occurring in the
animals health. The animal may need booster shots to keep
its vaccinations effective.
The following procedures should also be part of the annual
exam:
Lesson 1
45
Trimming Nails
Nail trimming, or pedicure, is an important part of general
care for dogs, cats, and birds (Figure 5). Excessive nail length
results in altered walking and the potential emphasis of
lameness problems. Long nails can even be traumatically
torn from their attachment site! Untrimmed nails can become
ingrown, usually into the animals footpads. Ingrown nails
can result in inflammation or abscess formation.
FIGURE 5Animals nails
must be trimmed regularly
to avoid traumatic
injuries.
46
FIGURE 6Different
Veterinary Nail Trimmers
Foals
Farriers (people who make, fit, and remodel horseshoes)
recommend that a foal receive its first trim at two weeks of
age and then every four weeks until its weaned at four to six
months. After that, a six- to eight-week trimming schedule
should be adequate depending on the foals needs.
A good farrier will round the toes during a trim, so the legs
straightness wont be hampered by the forceful twisting or
turning of the hoof that often results from pointed toes.
Very few foals are born with perfectly straight legs. Many
foals are born with angular deformities such as toed-out,
bowlegged, base narrow, knock-kneed, or pigeon-toed limbs
(Figure 7). Most of these deformities correct themselves in
two to four months. A knowledgeable farrier doesnt try to
correct things that nature handles quite well on its own.
Lesson 1
47
Ideal
Position
Toed
Out
Bowlegged
Base
Narrow
KnockKneed
PigeonToed
Adult Horses
Adult horses require regular trimming and shoeing. Hooves
that arent cared for regularly can affect the horses gait
(manner of walking) and result in injury to the horse. Although
most horses are trimmed by a farrier, there are times when
you might be expected to trim a horses hooves while its in the
hospital. Therefore, you should be familiar with the general
anatomy of the hoof.
Most parts of a horses hoof are made of horn, a fibrous material
made of the protein keratin. Horn is also the chief material that
comprises the horns of cattle and other animals and the
claws of some animals.
48
BarA ridge separating the frog and the sole that helps
the heel to spread
Heel
Bulb of
Heel
Frog
Buttress
Bar
White Line
Sole
Hoof Wall
Toe
Lesson 1
49
50
Hemostat (E)
Towel (G)
Culture medium
FIGURE 9Ear-Cleaning
Equipment
Lesson 1
51
52
Lesson 1
53
5. Flush the solution into the ear and gently massage the
ear canal (Figure 10E).
FIGURE 10EFlush the ear
and massage.
54
A helpful hint for preventing contamination: clean the lessinfected external ear canal thoroughly before cleaning the
external ear canal thats more infected!
Lesson 1
55
56
Lesson 1
57
Oil-based treatments and parasiticidal treatments must continue for at least three weeks. Both oil-based and ivermectin
treatments will fail unless all animals in a household are
treated at the same time.
Sterile eyewash
Cotton balls
58
Lesson 1
59
60
Lesson 1
61
Removing Sutures/Staples
The veterinary technician usually removes sutures once the
veterinarian has evaluated incision healing and determined that
they can come out. Most sutures are removed in 10 to 14 days.
Suture scissors remove the sutures with minimal discomfort
to the animal. Staples can be removed with a special tool that
is inserted between the staple and skin. When squeezed, the
edges of the staple lift out of the skin fairly painlessly (Figure
15). If you dont have a staple remover, a pair of hemostats
can be used. If hemostats are used, make sure to remove one
end of the staple and then the other, as trying to remove the
whole staple from the center will cause pain and damage to
the newly healed skin.
FIGURE 15Staple
Remover
62
Self-Check 4
1. List four complications of overgrown toenails.
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
2. What is the normal interval for hoof trimming in a foal?
a. 24 weeks
b. 68 weeks
c. 1214 weeks
d. 1012 weeks
(Continued)
Lesson 1
63
Self-Check 4
3. Why is it best to clean the less-infected ear first?
a.
b.
c.
d.
4. True or False? Its okay to gently touch the dropper tip of medication to the animals eye.
5. The anal sacs are located at _______ and _______ relative to the anus.
6. When using a hemostat to remove staples, the staple should be removed by
a.
b.
c.
d.
ASSIGNMENT 5ADMINISTERING
MEDICATION AND FOOD
Read this assignment. Then read pages 586596, 598599, and
620642 in your Clinical Textbook for Veterinary Technicians.
Oral Medications
Oral administration is one of the most convenient methods
for animal owners and veterinary personnel to administer
medications. Tablets and capsules are economical and provide accurate, uniform doses. Oral liquids are even more
convenient if the dose is accurately measured and the animal
accepts it. A syringe can be used to provide an accurate dose.
64
Lesson 1
65
66
Lesson 1
67
68
Lesson 1
69
70
Intubation Methods
Orogastric Intubation of Dogs and Cats
Orogastric intubation, also known as gastric gavage or stomach tube feeding, is the passing of a tube into an animals
mouth, down the esophagus, and into the stomach. It is used
to administer medication or food to an animal, or to remove
gas or toxins from the stomach. Note that cats generally need
to be sedated to pass a stomach tube successfully. Dogs are
more tolerant of the procedure. The equipment needed to perform orogastric intubation includes the following:
A syringe or funnel
Lesson 1
71
2. Mark the tube at the measured length with either adhesive tape or a permanent marking pen. This will ensure
you dont insert the tube too far (Figure 21B).
FIGURE 21BMark the
tubing with adhesive tape.
72
Lesson 1
73
7. Test the patency (accessibility or openness) and placement of the stomach tube by injecting sterile water into
the tube before administering any medication or food
(Figure 21G).
FIGURE 21GSterile water
or saline is injected into
the tube.
74
Lesson 1
75
A syringe
C. Butterfly Catheter
D. Adhesive Tape or
Marking Pen
E. Lubricating Gel
F. Topical Liquid
Anesthetic
D
E
G. Stockinette or Bandage
Material
C
D
A
76
77
6. Secure the tube behind the dogs head (Figure 23D). The
tube can remain in place for several days of feeding or medicating. The tube must be flushed with water after each use
to keep it patent (unobstructed).
FIGURE 23DThe end of
the tube is secured behind
the dogs head.
78
FIGURE 24Nasogastric
Tube Placement in the
Horse
Tube
Spleen
Kidney
Stomach
Rectum
Liver
Esophagus
Cecum
Bladder
Duodenum
Lesson 1
79
80
Saline solution
Subcutaneous Injections
If the medication is nonirritating, it can be injected
subcutaneously, or just under the skin. Subcutaneous injections allow quick systemic activity because the medication is
readily absorbed into the lymph and blood systems.
Lesson 1
81
82
Lesson 1
83
Pigs
Swine may be confined in a farrowing crate or crowded with
a panel. A farrowing crate is a cage large enough to hold the
swine but too narrow to allow it to turn around. When subcutaneously injecting swine, the area just behind the base of
the ear is often used. A 16- to 18-gauge, 2.5 to 5 cm needle
is directed ventrally. The injection is completed as quickly as
possible before the animal can move. The axillary space or
flank fold can be used on small pigs held by their hind legs.
Intramuscular Injections
Slightly more irritating medications should be injected intramuscularly. Because muscle tissue cant expand readily,
medications injected intramuscularly are generally smaller in
volume, usually less than 5 ml per injection site.
84
and foot.) The site for injection is selected by placing the fingers on the wings of the ileum and allowing the thumb to
fall naturally. The injection goes at the point where the
thumb lands. A 22- or 25-gauge needle is adequate for most
dogs and cats.
Use the following procedure to administer an intramuscular
injection to a dog or cat:
1. Prepare the injection site by parting the hair and
cleansing the skin with cotton balls moistened in 70%
isopropyl rubbing alcohol.
2. Maintain the animal in a standing or reclining position.
3. Grasp the muscle between the thumb and fingers
(Figure 27).
FIGURE 27Intramuscular
Injection Technique for
Small Animals
Lesson 1
85
Cattle
Intramuscular injections are not commonly performed in cattle
due to the potential muscle damage that can occur. Most cattle,
even dairy cattle, are eventually eaten, so muscle damage will
limit profitability. If intramuscular injections are necessary, the
neck muscles are used.
Horses
Horses receive intramuscular injections in several locations,
including the brachiocephalicus muscle of the neck, the pectoral
muscles, and the semimembranosus or semitendinosus
muscles. The gluteal muscles are generally not used, as any
abcesses forming after the injection are very difficult to drain.
The procedure is performed as follows:
1. Restrain the horse as necessary based on the injection
site being used. Stocks are recommended, but the horse
should at least be restrained with a halter and lead.
2. Clean the injection site with 70% isopropyl alcohol.
3. Firmly tap the injection site with the flat of the fist or
rub it firmly with alcohol-soaked cotton. (This lessens
the animals awareness of the needle prick.)
4. Insert the detached needle into the muscle, all the way to
the hub in a single, firm motion.
5. Attach the syringe to the needle and aspirate the syringe.
6. Inject the medication firmly, but not too quickly.
7. Withdraw the needle and syringe. Massage the area gently to decrease discomfort and to help distribute the
medication.
86
Lesson 1
87
Racehorses, whose performance may suffer because of medication-induced inflammation, never receive intramuscular
injections in the hindquarters, nor do they receive more than
20 ml at any one site. The common injection sites for intramuscular injection in horses are shown in Figure 29.
Gluteal Muscles
Brachiocephalicus
Pectoral
Semitendinosus
FIGURE 29Intramuscular
Injection Sites in the
Horse
Swine
The dorsal neck muscles are a common intramuscular injection site in swine. Its usually one of the cleanest areas for
injection and is easily accessible in animals confined in a
farrowing crate or crowded with a dividing panel. Swine also
seem to be less sensitive to pain in this area. Use a 16- to
18-gauge, 2.5 to 3.75 cm needle, inserting and injecting in
one motion. Once again, the procedure must be quick to
avoid excessive movement by the animal.
88
The medial (toward the midline) side of the ham is often used
in giving medication to small pigs that can be restrained by
holding the hind legs. This is a common site for injecting
young pigs with iron. An 18- to 19-gauge, 1.25 to 2.5 cm
needle is used in small pigs. The posterior ham area is also a
possibility for injecting a standing adult pig intramuscularly
(with a 16- to 18-gauge, 3.75 to 5 cm needle). However, try to
avoid this area for injection; its a choice meat cut and is
often dirty.
Intravenous Injections
You already know that intravenous injection is the fastest
way to get drugs into circulation and tissues. It may also be
the method of choice for medications that irritate the tissues.
Note, however, that veins run close to arteries, and injecting
medication into an artery would send a concentrated dose
to the extremities or the head, where venous injections go
back to the heart and are distributed systematically. Also,
this large quantity to one area can cause a severe reaction.
Lesson 1
89
Cattle
Cattle typically receive intravenous medication in the external
jugular vein as follows:
1. Have an assistant restrain the animal in a head catch
with head drawn upward and to the side opposite the
injection site.
2. Cleanse the injection site with
70% isopropyl rubbing alcohol.
3. Occlude the vein by applying digital
pressure in the lower jugular groove
(Figure 31).
4. Push a 16- or 18-gauge, 5 to 7.5 cm
needle sharply into the vein at a 45- to
90-degree angle to the skin.
5. Keeping the vein occluded, thread the
needle into the vein to the hub and
attach the syringe (if isnt already
attachedsome people feel that the
syringe should not be attached to the
needle; others feel it should be).
6. Once the syringe is attached, its best to verify the position of the needle by aspirating a small amount of blood
into the syringe, as the needle can sometimes be moved
during attachment of the syringe. Blood should flow from
the needle if its in the vein.
7. Release the digital pressure on the jugular groove and
inject the medication.
8. Withdraw the needle and syringe and place pressure on
the injection site.
Veterinarians administering medication with a simple administration set can lower the bottle of fluids below the injection
site to observe blood flowing back into the administration set.
Once the blood flow shows that the needles position is correct, they release digital pressure on the jugular groove and
raise the fluid bottle above the injection site. This procedure
administers the medication without blood flowing into the
administration set.
Lesson 1
91
The tail (coccygeal) vein is used for small quantities (35 mls)
of medications and for blood collection. Cattle are tolerant of
the use of this vessel, but theres an increased risk of actual
injury from the cow kicking. Another drawback of this vessel
is that it rolls easily under the skin, and a second person is
usually needed to help restrain the animal.
In dairy cattle, the subcutaneous abdominal vein (milk vein)
can be used for administering small quantities of medication
while the cow is confined in the milking parlor (a room used
for milking cows). This technique requires tail restraint. Take
special care with this site, as a large hematoma may result
because of the areas ventral location and loose skin covering.
Pinching the skin for several minutes after withdrawing the
needle from the vein helps to prevent hematoma formation.
Horses
Horses receive intravenous medication in the external jugular
vein. Because the esophagus of a horse runs near the jugular
groove in the left side, the right jugular vein is used whenever
possible.
An 18-gauge, 5 cm needle suffices for most injections, though
a 14- or 16-gauge, 5 to 7.5 cm needle may be used for large
quantities of medication.
Most important in this procedure is that the needle is placed
first, and then the syringe is attached to the needle. This is to
ensure that the needle is in the vein and not an artery. Blood
flow is monitored: if the needle is in a vein, blood will drip consistently; if its in an artery, the blood will spurt. Also, the
needle needs to be at least an 18-gauge, or the flow will be
compromised and it will be more difficult to distinguish vein
from artery. Looking at the color of the blood is not a good
way to determine which vessel the needle is in!
For single injections, perform the procedure as follows:
1. Dont use a head catch on a horse. An assistant should
hold the horses halter and reins to keep it steady (a
twitch may also be needed for anxious horses).
2. Cleanse the injection site with 70% isopropyl alcohol.
3. Occlude the vein to see where it distends, and then
insert the needle toward the head at a very slight angle.
92
Pigs
The ear (auricular) veins are commonly
used for blood collection in the pig, specifically the lateral vein. The cephalic vein can
be used in adult pigs, but restraint can be
extremely challenging. The jugular vein
may be used in piglets, but its difficult to
locate in adults. Pigs can bite, so restraint
is particularly important.
Lesson 1
93
Intradermal Injections
The small volume of medication that can be injected with
intradermal injectionsinjections within the layers of skin
makes them unsuitable for administering medications.
Veterinarians use the intradermal route to diagnose atopy
(systemic hypersensitivity to allergic reactions), to test for
tuberculosis in ruminants, or to provide sensitizing medications such as tetanus antitoxin or snake venom. Intradermal
skin testing for atopy or tuberculosis uses a 25- to 27-gauge,
1/ -inch needle attached to a 1 ml disposable syringe. The
8
veterinarian carefully introduces the needle between the layers
of the skin and then injects 0.05 to 0.1 ml of the test material. If the animal is sensitive to the medication, the test site
should develop welts, heat, swelling, redness, and/or pain.
Intraperitoneal Injections
Veterinary professionals generally avoid the intraperitoneal
injection route (except in some exotic species). This method
of administration may cause peritonitis or an intra-abdominal
abscess. The absorption rate of intraperitoneal fluids is more
rapid than the absorption rate of subcutaneous fluids, but
not as rapid as the intravascular route. Medications may be
administered by the intraperitoneal route in neonatal ruminants and swine, as long-term intravenous therapy is often
impractical.
Intraperitoneal solutions should be warm and isotonic. Isotonic
solutions are equal in electrolyte concentration to the animals
circulating blood. Isotonic medications minimize inflammation.
In standing adult animals, the paralumbar fossa should be
used. Often, a 16- to 18-gauge, 7.5 cm needle is required to
94
Lesson 1
95
Self-Check 5
1. List the three possible forms of oral medications.
__________________________________________________________
__________________________________________________________
__________________________________________________________
2. Which of the following is the least desirable way to administer oral medications to large
animals?
a. An oral paste
b. Mixed in the water trough
__________________________________________________________
__________________________________________________________
4. Briefly describe how to find the correct injection site for an intramuscular injection when using
the back leg muscles on a dog.
__________________________________________________________
__________________________________________________________
5. When giving an intramuscular injection in the semimembraneous muscles in a dog, you need
to be careful to avoid the _______ nerve.
a. femoral.
b. brachial.
c. sciatic.
d. anal.
96
ASSIGNMENT 6VENIPUNCTURE
FOR TREATMENT OR BLOOD
SAMPLING
Read this assignment. Then read pages 599603 and 642651
in Clinical Textbook for Veterinary Technicians.
Introduction
For animals to be diagnosed and treated effectively, veterinary professionals need to take samples of body fluids such
as blood, urine, and milk. They also perform many diagnostic
procedures, some of which you, the veterinary technician,
can do yourself. This section prepares you to play a role in
many different kinds of sample collection and diagnostic
procedures.
Venipuncture is exactly what it sounds like: the puncture of a
vein. Veterinarians and veterinary technicians routinely perform venipuncture to administer medications and take blood
samples. Venipuncture employs the following equipment and
supplies:
Lesson 2
97
98
Jugular Venipuncture
Another popular site for taking blood samples from dogs,
cats, horses, and ruminants is the external jugular vein
(Figure 34). This site is especially suitable for short-haired
animals, whose jugular veins are usually easy to spot.
Typically, you can obtain a greater volume of blood from
the jugular vein than the cephalic vein.
FIGURE 34Location for
Jugular Venipuncture
Lesson 2
99
Ruminants
Whether a ruminants external jugular vein is a suitable
venipuncture site depends on the available restraint and the
size of the sample to be taken. Have an assistant restrain a
bovine undergoing external jugular venipuncture with a halter or a halter and nose lead. Nose tongs may be used for
additional restraint. Whenever possible, restrain the ruminant in a chute or tie it to a stanchion. The following steps
describe jugular venipuncture for cattle:
1. Have an assistant draw the head upward and to the side
opposite the venipuncture site and secure the head in
this position by tying the restraint rope or ropes to a
solid area, such as the top bar of the stanchion.
2. Cleanse the venipuncture site with 70% isopropyl
rubbing alcohol.
3. Occlude the vein by applying digital pressure in the
jugular furrow, making it easier to see the vein. The
jugular vein in most cattle is very large, so you may need
to use the palm of your hand to occlude the vessel.
4. Use your opposite hand to push a 16- to 18-gauge, 5
to 7.5 cm needle through the skin at a 45- to 90-degree
angle with one sharp motion.
100
Lesson 2
101
Horses
Routine blood samples are collected from horses from the
external jugular vein as outlined for the bovine. The animals
temperament will determine the restraint needed. An assistant may occlude the vein if needed, but youll usually do
that yourself. Use a 20- to 25-gauge, 3.75 cm needle, and
attach the syringe after the needle is in place. The right
external jugular vein (the horses right) is used whenever possible to avoid hitting the esophagus, which runs near the
jugular groove on the horses left side. Turning the head away
from the side of the venipuncture ensures that the vein is
stretched and more easily identified.
Swine
Jugular venipuncture may be used, but poses risks of injury
and even death to swine. This site is not used in pet pigs, but
may be used in the commercial setting.
Camelids
The lack of a jugular groove, thick skin, and lots of fur make
jugular venipuncture of camelids difficult. Jugular venipuncture is done either high up or low down on the neck, but not
in the center. The venipuncture itself is performed as
described for other animals.
102
Other Animals
The ear vein is used commonly in camelids and is done as
described for the swine.
For cats, the marginal ear vein is used to collect very small
samples of blood, such as to measure blood glucose levels.
This results in very little pain and restraint for the patient.
Lesson 2
103
104
Coccygeal Venipuncture
for Bovines
The ventral coccygeal, or tail vein, is a common site for bovine
venipuncture (Figure 35). The animal must be confined to an
area that prevents sideways motion. Once confinement is
accomplished, the procedure is as follows:
1. Apply tail restraint with one hand by
bending the tail directly forward at the
base.
2. Cleanse the venipuncture site with 70%
isopropyl rubbing alcohol.
3. Hold the syringe with an 18- to 20gauge, 2.5 to 3.75 cm needle in the
opposite hand and insert it at a 90degree angle to the skin on the midline
between the hemal arches of the fourth
to seventh coccygeal vertebrae.
The ventral coccygeal vein can be used for the
administration of small quantities of nonirritating medication. Caustic medications
injected into this region can cause vascular
damage and sloughing of the tail.
Other Animals
The coccygeal vein can also be used in camelids and swine. It
is not used in goats, sheep, horses, dogs or cats.
Lesson 2
105
Horses
The saphenous and transverse facial veins are also used in the
horse. The saphenous vein is not used in awake horses due to
the risk of injury to the technician. This site is used in neonates
and anesthetized patients.
The transverse facial vein is used to collect small samples in the
nonfractious horse. This is a site that horses rarely object to the
needle insertion but there is the risk of damaging the eye with
the needle if the horse becomes agitated.
106
Cattle
The subcutaneous abdominal (milk) vein was used in the past
but has become a last resort due to the complications that
occur. The vein becomes infected easily, tends to bleed, and
can form hematomas that occlude blood flow to the teat
(causes thrombosis).
Lets see how well youre doing! Complete Self-Check 6 before
proceeding to the next assignment. Check your answers by
turning to the back of this study guide.
Self-Check 6
1. Venipuncture is used for _______ and _______.
2. Where is the cephalic vein located?
a. Neck
b. Back leg
c. Front leg
d. Tongue
c. Jugular
d. Milk
5. In swine, which side of the neck is preferred for cranial vena cava and jugular
venipuncture? What is the reason for this preference?
a.
b.
c.
d.
The
The
The
The
c. Tail vein
d. Milk vein
Lesson 2
107
ASSIGNMENT 7URINARY
CATHETERIZATION AND URINE
COLLECTION TECHNIQUES
Read this assignment. Then read pages 604609, 654657, and
664669 in Clinical Textbook for Veterinary Technicians.
Introduction
You already know that a urinary catheter is inserted into the
bladder to drain urine or to monitor urine production. Its
important to have an in-depth understanding of whats
involved with placing and maintaining a urinary catheter.
Several types of urinary catheters are available, as shown in
Figure 36. The figure also shows a syringe used to aspirate
urine from the bladder. Stainless-steel catheters, called bitch
catheters, are used only in female dogs. These catheters are
used to empty urine from the bladder and for abdomenocentesis. They cant be placed for long-term urine monitoring.
A Foley catheter has a bulb at the end that fills with air or
fluid to keep the tip of the catheter in the bladder of a female
dog. Theyre available in 3 French to 10
French diameter and range from 40 to
75 cm in length. They can be sutured
to the animal for extended urine monitoring. Foley catheters are too short to
D
reach the bladder of male dogs.
C
C
108
In addition to a variety of urinary catheters, veterinary practices keep the following equipment and supplies on hand for
urinary catheterization (Figure 37):
Sterile gloves
Cotton balls
FIGURE 37Equipment
Needed for Urinary
Catheterization: (A) Urine
Collection Containers;
(B) Sterile Gloves;
(C) Speculum with Light
Source; (D) Speculum;
(E) Lubricating Gel;
(F) Syringe; (G) Light
Source; (H) Hair Clippers;
(I) Cotton Balls
F
C
G
D
B
E
Rinse the urinary catheter immediately after use to prevent debris, blood, or protein from congealing in the tip.
Lesson 2
109
110
Lesson 2
111
FIGURE 38DSix to 12 ml
of urine are collected by
aspiration.
112
Lesson 2
113
Female-Dog Catheterization
The positioning of the female dogs urethral orifice makes it difficult to catheterize. This procedure is also a two-person
operation. Female dog catheterization requires a vaginoscope or
otoscope fitted with a sterile speculum equipped with a light to
visualize the urethral orifice. If the speculum was stored in a
cold-sterilization tray, rinse it with warm sterile water. If the
speculum has been wrapped and sterilized in an autoclave,
place sterile lubricating gel on its tip prior to insertion.
Use this procedure to catheterize a female dog:
1. If the animal has long hair, trim some of the hair from the
vulva so that it doesnt contaminate the urinary catheter
on insertion.
2. Have the animal restrained in a standing position or, if
anesthetized, position the animal so that the tail region is
raised higher than the head.
3. Cleanse the lips of the vulva and the surrounding hair
with antiseptic scrub (Figure 39A) and make sure to rinse
the solution from the dog thoroughly.
FIGURE 39AThe lips of
the vulva and surrounding
area are cleansed.
114
Rectum
Vagina
Catheter
Lesson 2
115
Male-Cat Catheterization
Catheterization of the male cat may require anesthetic, either an
injectable short-acting agent or a rapidly-cleared gas agent. This
technique is therefore used only on obstructed cats or those in surgery. Severely ill cats under anesthesia must be handled with
extreme care. In many cases, sedating the ill cat is sufficient to
accomplish urinary catheterization.
Use the following procedure to catheterize a male cat:
1. Have an assistant place the anesthetized or sedated animal on
its back, with the hind legs pulled forward.
2. Draw the penis from the sheath and gently backward.
116
Female-Cat Catheterization
Female cats are catheterized by a plastic, blunt-ended tomcat
catheter. Its often necessary to use an injectable short-acting
anesthetic agent or a rapidly cleared gas anesthetic agent. As
with males, this technique is used only for obstructed cats or
those in surgery. Female cats are very difficult to catheterize.
Use this procedure to catheterize a female cat:
1. Cleanse the lips of the vulva. Restrain the cat in a sternal
position with the hind legs hanging over the edge of a
table. Hold the tail away from the vulva.
2. Wear sterile gloves to grasp the vulva and pull it caudally.
Pass the lubricated urinary catheter along the floor of
the vaginal vestibule into the urethral orifice.
Maintaining Indwelling
Urinary Catheters
There are several reasons a veterinarian may wish to install
and maintain (for several days) a flexible indwelling urinary
catheter in the urethra and urinary bladder. These reasons
include a poor urine stream following repeated urethral
flushing, some forms of kidney failure, urinary bladders with
poor muscle tone, or to measure urinary output. For these
animals, the appropriately sized urinary catheter is passed
aseptically and then secured to the skin by sutures attached
either to the catheter or to adhesive tape holding the catheter
in place. The urinary catheter needs to be secure enough that
it wont be dislodged or removed by the animals movements.
Once the catheter is secure, firmly attach its external end to a
sterile intravenous infusion line and a fluid bag or a closed
urine collection system. This shields the urinary tract from
Lesson 2
117
118
Lesson 2
119
120
Lesson 2
121
122
Lesson 2
123
7. Collect the sample into blood tubes for analysis. Try not
to collect the first few drops of fluid, as these are normally contaminated with blood. If fluid isnt flowing well,
the cannula may need to be rotated a bit to allow better
access to fluid. Once the sample has been collected,
withdraw the cannula and hold 4.4 gauze over the puncture site to decrease blood dripping from the site.
In cattle, camelids, sheep, and goats, the technique is the same
as that for the horse. There are other sites that can be used. In
the camelid, for example, the most common site is the right
paracostal.
Abdomenocentesis is not routinely performed for either pet or
commercial pigs.
Now that youve learned about urine collection and catheterization, lets check your progress. Before proceeding to the next
assignment, take a moment to complete Self-Check 7.
Remember that you can check your answers by turning to
the back of this study guide.
124
Self-Check 7
1. A Foley catheter is a/an
a.
b.
c.
d.
stainless-steel catheter.
catheter with a bulb on the end.
flexible polypropylene catheter.
inflexible plastic catheter.
2. What are two reasons that chemical sterilization of catheters should be avoided?
__________________________________________________________
__________________________________________________________
Questions 35: Indicate whether each statement is True or False.
______
3. The urinary catheter should be placed in the most sterile way possible.
______
4. If you meet resistance when placing the catheter, make sure to apply firm pressure
to force it through.
______
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
7. Collecting urine from a ewe is most similar to
a. male-dog catheterization.
b. female-dog catheterization.
c. cow catheterization.
d. mare catheterization.
c. horses.
d. pigs.
Lesson 2
125
ASSIGNMENT 8FLUID
ADMINISTRATION
Read this assignment. Then read pages 883895 in Clinical
Textbook for Veterinary Technicians.
126
Solution
Na+
K+
Ca+
MG+
Cl
Base
Glucose
LRS
130
109
28 (lactate)
Ringers
147
156
Normosol-R
140
98
27 (lactate)
0.9% NaCl
154
154
1200
1200
5% Dextrose
7% NaCl
Lesson 2
127
A manometer (an instrument for ascertaining the pressure of liquids or gases) for central venous pressure
measurements
Veterinarians frequently add antibiotics and other medications to fluid solutions. As a rule, however, veterinarians
avoid mixing multiple medications either in a syringe or in
fluid solutions. Some combinations may inactivate one of the
medications, as carbenicillin does to gentamicin when the
two are combined. The interaction may or may not be visible
upon mixing. Even when medications arent mixed, some are
incompatible with fluid solutions, as Table 1 summarizes.
Table 1
PHYSICAL INCOMPATIBILITIES OF MEDICATIONS IN FLUID SOLUTIONS
Medication
Incompatible with
Amphotericin B
Cephalothin sodium
Penicillins
Penicillin G potassium
128
A
B
Lesson 2
129
130
Lesson 2
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132
Lesson 2
133
Monitor renal function in dehydrated dogs or cats by measuring or approximating urine output volume. Normal urine output
volume is 2 ml/kg/hr. If urine production is questionable, the
veterinarian may request that the urinary bladder be catheterized. Urine production is then checked every one to four hours
for the amount produced versus the amount of intravenous
fluid put in via the catheter.
To monitor the fluid level, a piece of 1-inch white tape with
the starting date and time can be placed on the fluid solution
bag (Figure 43). This tape should be marked in sections that
denote where the fluid solution should be at given times during the day. For example, if it has been determined that these
fluids should be delivered at 50 ml per hour, the date and
time is marked on the bag at the start of therapy. The tape
is marked off at 50 ml increments to represent the amount
of fluid delivered hourly.
FIGURE 43Marked Fluid
Solution Bag
134
FIGURE 44Commercial
Fluid Infusion Pump
Intravenous fluids
Three-way stopcock
Heparin-saline solution
Lesson 2
135
136
Lesson 2
137
138
Lesson 2
139
Attach extension
venotubing to port
of intravenous
catheter.
140
Turn off
stopcock to
fluid bag.
Measure the
drop in fluid
level in the
manometer.
Lesson 2
141
142
Self-Check 8
1. Which of the following are crystalloids?
a.
b.
c.
d.
c. 0.45% saline
d. 7% saline
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
4. What are two common complications of intraperitoneal fluid administration?
__________________________________________________________
__________________________________________________________
(Continued)
Lesson 2
143
Self-Check 8
5. Which of the following animals (if severely dehydrated) benefit the most from intraosseous
administration?
a. Cows
b. Adult cats
c. Kittens
d. Sheep
6. What is a manometer?
__________________________________________________________
__________________________________________________________
7. What is a complication of too much fluid in an animal with heart disease?
a.
b.
c.
d.
Painful abdomen
Subcutaneous fluid accumulation
Pulmonary edema
Lameness
__________________________________________________________
10. Which of these will falsely increase CVP?
a.
b.
c.
d.
144
Dental Prophylaxis
Introduction
Dental prophylaxis, the management and prevention of periodontal
disease (diseases of the tissues around the tooth below the
gums), isnt just for people. Dogs and cats middle-aged and
older should have their teeth professionally cleaned at least
once a year. Some animals, especially those on moist diets,
require dental prophylaxis twice a year. (Toy breeds are prone
to tooth crowding because of their shortened skulls.)
Dental prophylaxis removes the plaque and dental calculus
that accumulate on the teeth at the gum line and cause
gingivitis (gum inflammation) and periodontal diseases such
as periodontitis, an inflammatory reaction of the tissues surrounding a tooth below the gums. Dental calculus is calcium
phosphate and carbonate with organic matter deposited on
tooth surfaces; its also known as tartar. The general goal of
dental prophylaxis is to relieve oral pain, restore the mouth
to a healthy condition, and maintain a healthy mouth following
dental prophylaxis.
You, the veterinary technician, will play a key role in dental
prophylaxis, as youll be performing the dental prophylaxis
on the animal and helping the owner learn to care for the
animals teeth at home. To be able to perform the dental
prophylaxis, youll need to know a bit about the anatomy
of the teeth, the type of equipment needed, and, of course,
the steps involved in the process.
Lesson 3
ASSIGNMENT 9TOOTH
ANATOMY, FORMULAS, AND
DIRECTIONAL TERMS
145
146
Oral mucosaThis isnt technically part of the periodontium. The oral mucosa is actually the tissue found
throughout the mouth that enables the cheeks and lips
to stretch and open the mouth as full as possible.
The terms for all of these different structures can be confusing, but over time youll become more familiar with the most
common of them.
Lesson 3
147
148
Directional Terms
Lastly, its advantageous to know some of the descriptive
directional terms for the teeth and the mouth. The following
are some of the descriptors you should know:
Now that weve covered some of the basic terms and anatomy
needed for veterinary dentistry, lets see how well youre
doing. Before proceeding to the next assignment, complete
Self-Check 9. Remember that you can check your answers by
turning to the back of this study guide.
Lesson 3
149
Self-Check 9
1. The two basic parts of the tooth are the _______ and the _______.
2. The three layers of the tooth are the _______, _______, and the _______.
3. Which of the following is the correct anatomical nomenclature for an adult dog?
a. I
,C
b. I
,P
,C
,M
,P
4
4
c. i
,M
,c
d. I
3
3
,p
,C
3
3
,P
,M
2
3
c. Lower left
d. Lower right
c. premolars.
d. maxillary teeth.
150
ASSIGNMENT 10DENTAL
EQUIPMENT, DENTAL
PROPHYLAXIS, AND TOOTH
EXTRACTION
Read this assignment. Then read pages 13211343 in Clinical
Textbook for Veterinary Technicians.
Dental Equipment
The equipment necessary to perform a dental prophylaxis
ranges from the very simple and minimal to the very involved,
depending on the expertise and focus of the clinic. The basic
equipment needed for a dental prophylaxis includes a table of
some fashion, hand instruments, and a polisher. Yet, even if
a clinic doesnt specialize in dental work, they generally have
more specialized equipment on hand.
Hand instruments are a necessity, but additional equipment
is required if money is to be made from doing dental prophies
(prophylaxis procedures). Hand instruments are time-consuming, require that animals stay under anesthesia for long
periods, and can quickly tire the technician. Therefore, most
veterinary hospitals now have dental air units (usually
referred to as dental machines) that incorporate at least an
ultrasonic scaler, a drill, and a polisher.
The dental machine makes dental prophylaxis quick and
helps the technician clean the teeth thoroughly. Dental
machines do need special attention to work properly, and
therefore its advisable to follow the manufacturers instructions
and perform routine maintenance on them. Make sure to test
the equipment routinely to keep it working properly. Its also
important to care for the hand instruments and keep them
sharp or they wont work correctly and will damage the teeth.
Lesson 3
151
152
FIGURE 46Equipment
and Supplies for Dental
Prophylaxis: (A) Scalers;
(B) Extraction Forceps;
(C) Root Elevator;
(D) Curette; (E) Dental
Gag; (F) Polishing Paste;
(G) Power-Driven Dental
Unit; (H) High- and LowSpeed Handpieces
H
G
Lesson 3
153
154
FIGURE 47BCotton
towels are placed under
the animals head. (Setting
courtesy of VCA Lewis Animal
Hospital, Columbia, Maryland)
Lesson 3
155
156
Lesson 3
157
Tooth Extraction
Tooth extractions usually are performed by the veterinarian,
but you, as the technician, may be asked to assist. There are
three main types of extractions: simple, sectioned, and surgical.
158
Lesson 3
159
Self-Check 10
Questions 14: Match the following terms with their definitions by placing the letter of the
best definition in the blank space next to each term.
______
1. Drill
______
2. Ultrasonic scaler
______
3. Polisher
______
4. Periodontal probe
Every animal
No animal
Those predisposed to tartar buildup
Those predisposed to endocarditis
To
To
To
To
8. The three types of tooth extractions are _______, _______, and _______.
Check your answers with those on page 270.
160
ASSIGNMENT 11CHARTING
DENTAL WORK AND DENTAL
RADIOLOGY
Read this assignment. Then read pages 13031321 and
13511354 in Clinical Textbook for Veterinary Technicians.
Lesson 3
161
162
PDI1Gingivitis only
Lesson 3
163
Dental Radiology
Dental radiology has come a long way in veterinary medicine.
There are now many very lightweight, handheld X-ray units
with automatic processors available in an attainable price
range. The regular diagnostic X-ray unit found in most veterinary clinics can be used for dental diagnosis. However, its
somewhat difficult to get the correct positioning, as the animal will need to be manipulated instead of the machine. The
small self-developing units are easier to place in the mouth
and process; in fact, they self-process!
Digital radiography also includes digital dental radiographs.
These machines are usually stand-alone, but may be part of
a unit. A sensor placed in the mouth projects a picture to the
computer. The sensor takes views much like the older film,
but can take more in-depth views if necessary. Digital dental
radiographs can be less expensive in the long run because
there is very little waste produced to get the desired pictures.
Regardless of the machine and cassettes being used, there
are a number of basic radiographs that are obtained when
looking at an animals teeth. Survey radiographs are the set
of X-rays that show the entire mouth. This set generally has
at least 6 views for the cat and 10 views for the dog. These
views look at each tooth (sometimes more than once). In
taking the views, its important to go in a stepwise fashion so
as not to forget a view. The survey radiographs highlight each
side of the mouth, the front teeth, and the upper and lower
164
Place the film/sensor in such a way that moving the animal doesnt result in movement in the film/sensor. A
triangular block or foam curler can be used to aid in
holding the film/sensor in place. Make sure that any
placement aid doesnt go between the film/sensor and
machine.
Lesson 3
165
166
start with 24 deciduous caps. There are common designations of some of the teeth that are helpful to know when
talking with owners.
Wolf teeth are the permanent first premolars. They are generally smaller than the other premolars. These teeth may be
extracted to prevent discomfort if the horse wears a bit.
Cheek teeth are premolars and molars, not including the wolf
teeth. These six teeth are anatomically very close together
and are considered a single unit. The horse therefore has
four units of cheek teeth: two on the maxilla and two on the
mandible. Cheek teeth have many grooves and ridges that
are made up of cementum, enamel, and dentin.
Equine teeth are hypsodont, meaning the crown extends
below the gingiva. The root structure allows the teeth to grow
throughout the horses life. The teeth wear down by chewing,
which leads to sharp points, waves, or other abnormalities.
This is generally the focus of equine dental care.
Plaque and calculus formation is not as common in horses as
small animals, so it is not routinely performed. However, the
examination of these teeth and any work that needs to be
done is very physical and can be time consuming.
Initial examination is performed with the horse fully awake.
This is necessary to evaluate the muscles associated with
chewing. Any facial swelling, ulcers along the lips, or discharge from the eyes, nose, or mouth is noted. The stall must
be examined for partially chewed food. Check the feces for
particle size.
The horse is then sedated to better evaluate the oral cavity. A
speculum is placed in the mouth, and the horses head is
placed on a stand or the shoulder of an assistant. The veterinarian generally performs the teeth floating by using various
grades of dental floats, or metal files. The teeth are examined
for waves, undergrown or overgrown teeth, sharp edges, fractures, and abcesses. The instruments used for the actual
dental work can be electric or hand powered. As a technician,
youll help sedate and restrain the animal, pass floats to the
veterinarian, and document any problem teeth.
Lesson 3
167
Self-Check 11
1. What are two ways a dental prophy can be recorded?
__________________________________________________________
__________________________________________________________
2. List 4 of the 12 basics that are routinely recorded in a dental chart.
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
Questions 3 and 4: Indicate whether each of the following statements is True or False.
______
3. Its generally recommended that animals chew on hard objects to remove plaque.
______
168
Types of Wounds
Everyone knows what a wound is, but most people dont know
one wound from another. All injured tissues have similarities.
Much of what well discuss here applies to internal wounds
as well, but this assignment focuses on skin and underlying
tissue wounds. These wounds are either open or closed. Open
wounds are injuries that cut and destroy skin. Closed wounds
are crushes and contusions (bruises). There are six kinds of
open wounds:
1. Abrasions
2. Avulsions or bite wounds
3. Degloving injuries
4. Lacerations
5. Burns
6. Ulcers or pressure sores
Animals usually suffer abrasions when theyre hit by a car
and skid along the ground. An abrasion is a shearing or
rubbing wound that damages and destroys the skins outer
layer (epidermis) and parts of the tissue under it (dermis).
This is the most superficial open wound. An abrasion usually
appears red and raw. Its surface oozes blood and serum. It
may be contaminated by debris.
Lesson 4
Wounds, Bandages,
Casts, Slings, and
Emergency Care
169
Wound Healing
The healing of any injured tissue is a complex process. The
actual process of wound healing is covered in the Animal
Diseases, Pathology, and Immunology study guide. But, as
a quick review, remember that healing starts immediately
following the injury and continues for many months. Wounds
heal in an orderly sequence. Although these events overlap
considerably, it helps to think of healing as a sequence of three
phases: the inflammatory phase, the proliferative phase, and the
maturation phase.
170
Lesson 4
171
Wound Care
Initial Presentation
The first thing to remember about an injured animals wound
is that wounds often result from significant trauma that creates
other serious problems. Placing a clean bandage over the
wound will aid in decreasing contamination and, potentially,
bleeding, but a clean and dressed wound does little good to
an animal dying of shock or experiencing breathing difficulties
or serious blood loss. You first must assist the veterinarian
in treating the injured animals life-threatening problems.
Once the animal is stabilized, its wounds can be evaluated
and treated.
The veterinarian first checks to see if the wound is bleeding;
he or she then slows or stops any bleeding by applying pressure directly to the bleeding vessel. A visible vessel can be
clamped or tied with suture material. The veterinarian
assesses the extent of the injury by asking the following
questions:
172
Lavage
Lavage is the flushing (irrigation) of a wound. Lavage dilutes
and rinses bacteria, foreign material, and blood clots from the
wound. The ideal lavage fluid is warm, sterile, and similar in
composition to body fluids. Normal saline (0.9% sodium chloride) is a good lavage solution. Tap water isnt as good a choice,
but you might use it if the wound is heavily contaminated or
when theres no other fluid available. Antiseptic solutions such
as chlorhexidine and povidone-iodine are used in most instances
to help clean out the wound. However, these can damage tissue
if used in too high concentration. Hydrogen peroxide is not routinely used, as the hydrogen content damages internal tissue.
Apply the lavage with a large injection syringe (60 mls) and a
19-gauge needle to flush the wound. Do not use a pulsing
tool such as a Water Pik to apply the lavage solution! The
pressure will drive debris and bacteria deeper into the wound.
Successful lavage requires plenty of fluid. Some wounds require
several liters or more. The lavage should remove as much foreign matter as possible. Dirt, hair, and wood are all highly
inflammatory, so take special care to remove them.
Debridement
Debridement is the surgical removal of diseased or damaged
tissue and foreign matter from a wound. Its typically done at
the same time as lavage. Debridement can turn a traumatic
wound into a clean wound with healthy tissue and a good
blood supply.
The extent of debridement depends on the injury. The veterinarian attempts to remove all dead tissue and foreign matter while
preserving as much skin as possible. Fat and muscle can be
excised (cut out) more freely if necessary. A remarkable amount
of tissue can be removed from some sites without affecting
function. Dead tissue in a wound can lead to serious problems
Lesson 4
173
174
Lesson 4
175
Wound location
176
Lesson 4
177
Bandaging Materials
Several materials are required to properly place a bandage.
These materials usually are placed in the following order,
and include
Adhesive tape
Gauze
Vet wrap
Elastikon tape
178
Lesson 4
179
Self-Check 12
1. List the six types of open wounds.
__________________________________________________________
__________________________________________________________
2. List the three phases of wound healing.
__________________________________________________________
__________________________________________________________
3. True or False? The wound is the most important thing to address when an animal first
presents to the clinic.
4. An easily cleaned, uncontaminated wound is usually closed by
a.
b.
c.
d.
primary closure.
delayed primary closure.
second-intention healing.
open primary healing.
To
To
To
To
__________________________________________________________
__________________________________________________________
7. Of the three layers you listed in the previous question, which layer is not always necessary in
bandaging?
__________________________________________________________
__________________________________________________________
Check your answers with those on page 275.
180
ASSIGNMENT 13BANDAGING
SMALL AND LARGE ANIMALS
Read this assignment. Then read pages 981991 and 9941003
in Clinical Textbook for Veterinary Technicians,
Cast padding
Gauze
Lesson 4
181
When bandaging a limb, the middle two toes are left exposed,
enabling assessment of color, swelling, and heatall of which
can be indications of a bandage thats been placed too tightly.
The procedure to place a bandage on the leg of a small animal
is shown in Figure 49 and described in the following steps:
1. Place adhesive tape stirrups on the foot. Stirrups hold
the bandage to the leg and are almost always an
absolute requirement (Figure 49A).
FIGURE 49AAdhesive
tape stirrups are placed
on the leg to secure the
bandage. (Setting courtesy of
Airpark Animal Hospital,
Westminster, Maryland)
182
Lesson 4
183
184
Lesson 4
185
186
Lesson 4
187
Re-dressing a Wound
When re-dressing a wound, its probably most important to
know which primary bandage material best suits the wounds
stage of healing. A petroleum-impregnated gauze, for
instance, may suit the earliest stages of open-wound healing
because its nonadherent and nonocclusive. However, petroleum can slow down epithelialization, so a Telfa pad
better suits a wound with fully formed granulation tissue.
The primary layer of the bandage may vary, but most times
veterinarians reapply a bandage with the same bandaging
technique they used previously, following the same bandaging principles (apply tape stirrups to the foot and then apply
the three component layers of the bandage). The bandage
must be properly placed. A bandage placed too tightly will cut
off the legs blood supply. A loose bandage may slip.
188
Special Bandages
Weve come a long way from that basic strip of fabric, and
were not done yet! Veterinary medicine employs a variety of
specialty bandages for some of its more unusual situations.
Adhesive tape
Cotton padding
Gauze
Vet wrap
Elastikon tape
Lesson 4
189
190
4. Add a support to the bandage, such as the fiberglass support shown in the figure (Figure 55D).
Lesson 4
191
FIGURE 56Mason-Meta
Splints
192
Casts
While internal injuries are beyond the scope of this unit, the
casts and slings that help heal some of them arent. When an
injury needs a high degree of immobilization for an extended
period, a wrap or specialty bandage can be impractical and
insufficient. And while bandages exert pressure, some problems need weight-bearing pressure removed or a particular
alignment maintained. In such cases, veterinarians use casts
and slings.
Casts, which are made of fiberglass or plaster of paris, stabilize some limb fractures by immobilizing the joints above and
below the fractured bone. The materials needed to cast a leg
are as follows (Figure 57):
Adhesive tape
Gauze
Exam gloves
Hot water
FIGURE 57Cast Materials
Lesson 4
193
194
Lesson 4
195
Slings
The Ehmer Sling
The Ehmer sling is a figure eight made from tape and gauze.
This type of sling keeps an animals weight off an injured
hind leg. The sling holds the hip in an internally rotated and
abducted (leg moved out and away from the body) position.
Small animals wear the Ehmer sling after relocation of a
dorsally dislocated hip. (Most hip dislocations move dorsally,
or toward the back.) Ehmer slings are also worn after
surgical repair of some fractures.
To apply the sling, flex the animals ankle and knee and then
wrap gauze in a figure-eight pattern. To maintain blood
supply, take care not to wrap and tighten the gauze directly
around the leg or foot. The gauze is held in place with tape.
To further abduct the hip, place tape from the bandaged leg
up and over the abdomen. Animals wear the Ehmer sling for
an average of 10 to 14 days.
The following steps are used to apply an Ehmer sling
(Figure 59):
1. Pad the injury and wrap the leg with gauze (A).
2. Flex the leg and wrap the sling around the knee and
ankle (B).
3. While holding the leg at maximum flexion, pass the sling
over and wrap it behind the knee (C).
4. Wrap the sling forward around the front of the leg (D).
196
A
B
E
D
FIGURE 59An Ehmer sling is a figure-eight pattern of tape and gauze.
Lesson 4
197
198
FIGURE 60A Velpeau sling keeps an animals weight off its front leg.
Lesson 4
199
FIGURE 61The carpal flexion sling provides some mobility but prevents the animal from putting
weight on the injured leg.
The Hobble
A hobble is a tape sling that holds the hind legs a fixed
distance from each other. This sling allows the animal to
walk but prevents the legs from abducting. Though usually
used after hip relocation, the hobble helps dogs prone to
splaying because of weakness or a neurological problem.
Veterinarians make the hobble from two lengths of white
adhesive tape, each long enough to loop around the dogs
hind legs at tarsus (ankle) level. They press the sticky side of
each length to the other so that the nonsticky sides face out.
This tape is looped and placed around both of the hind feet
at tarsus level. By binding together this central portion of the
loop (between the legs) with more white tape, veterinarians create a short loop of tape around each foot with a section of bound
tape in between, holding the feet in the position of a normal
standing dog. Figure 62 shows the placement of the hobble.
200
B
FIGURE 62The hobble allows an animal to
walk but keeps the hind limbs from abducting.
Lesson 4
201
Are the toes swelling? If you can see only the toenails,
are they spreading apart from each other? Spreading
toenails likely mean the toes are swelling.
202
Removing Bandages
A conscientious owner can remove a bandage, but the job is
best left to veterinary professionals with the knowledge and
equipment to do a better job. Plus, the veterinarian often
needs to reassess how the wound is healing and if another
bandage should be placed. Lister bandage scissors work best
to remove bandages (Figure 64). These scissors have a blunt
tip that makes it easier to avoid skin while cutting the bandage.
FIGURE 64Lister
Bandage Scissors
Lesson 4
203
Self-Check 13
1. List the two most common reasons to bandage a small animals leg.
__________________________________________________________
__________________________________________________________
2. Which of the following is not a reason to expose the middle two toes when placing a bandage
on the leg of a small animal?
a.
b.
c.
d.
To
To
To
To
204
Self-Check 13
7. What is the most important thing to remember when removing a bandage?
a.
b.
c.
d.
Questions 812: Match the following terms with their definitions by placing the letter of
the best definition in the blank space next to each term.
______
______
9. Ehmer sling
13. Which of the following is not something that needs to be relayed to an owner about caring for
a cast or sling?
a.
b.
c.
d.
The
The
The
If it
Lesson 4
205
ASSIGNMENT 14TELEPHONE
ASSESSMENT AND OWNER FIRST
AID BEFORE AND DURING
TRANSPORT
Read this assignment. Then read page 908 in Clinical Textbook
for Veterinary Technicians.
Introduction
Emergency medicine has recently become a more recognized
area of expertise for both veterinarians and technicians alike.
More and more clinics are offering emergency care after the
daytime practice has closed. These clinics are more versed in
the correct way to handle emergency cases and therefore are
better prepared for them. However, emergencies are also seen
by the regular day practice, whether they be animals presenting to the clinic with a problem requiring immediate medical
attention or an animal already in the clinic who is developing
a serious problem, such as during an anesthetic procedure.
Therefore, its extremely important that you, as a technician,
recognize these emergencies and work with the other staff as
a team to remedy the animals crisis.
Teamwork, training, and practice are all important factors in
successfully managing a critical animal. The presentation of
a critical animal can be very stressful to all involved, so
having a standard operating procedure is helpful in reducing
the stress and increasing the efficiency (and thus success) of
dealing with these patients. Each team member should be
assigned a specific job, and the emergency scenario should
be practiced on a regular basis.
206
Veterinary technicians are vital in the triage process of identifying animals with life-threatening problems, notifying the
veterinarian, and assisting in treatment.
Telephone Triage
The triage process often begins over the telephone. A pet
owner notices a problem with his or her pet and calls the
veterinary hospital for advice. The receptionist (or, in some
cases, you as the veterinary technician) must determine the
seriousness of the problem and give advice based on that
determination. Important initial questions include the clients
name and telephone number and the pets age, breed, and
sex. Its also important to ask if the pet has been spayed or
neutered. A brief description of the pets problem should then
be obtained.
Owners of pets with obviously serious problems should
always be advised to seek veterinary attention. A variety of
conditions are considered to be serious. Other problems will
require further investigation. Those conditions that require
immediate evaluation include
Loss of consciousness
Labored breathing
Seizures
Straining to urinate
Poisoning or snakebite
Prolapse of organs
Eye injuries
Lesson 4
207
When determining the severity of a problem over the telephone, its important to ask questions about four major
organ systems: the respiratory, the cardiovascular, the
urogenital, and the central nervous system. A review of your
study units on these systems will be helpful.
To evaluate the animals respiratory system, first ask the
owner if the pet is having difficulty breathing. Animals that
are dyspneic (having difficulty breathing) should always be
seen immediately by the veterinarian. If the owner is unsure,
you should ask questions about the pets breathing pattern
and body posture. Normal breathing is quiet, regular, and
effortless. You should be concerned if the owner reports the
development of noisy breathing.
Animals having difficulty breathing are often anxious, reluctant
to lie down, and will stand with their neck extended and their
elbows held away from the chest wall. If the owner has observed
any of these signs, advise the owner that a veterinarian should
see the pet immediately.
The cardiovascular system can be assessed by checking the
animals mucous membrane color, capillary refill time (CRT),
and heart rate and/or the pulse rate. Its often difficult for
the owner to evaluate the animals vital statistics. However,
most owners are able to evaluate mucous membrane color
and CRT.
To have the owner evaluate the mucous
membrane, ask the owner to evaluate the
color of the pets gums. Normal gums are
pink. Pale pink or white gums suggest
blood loss or shock. Blue discoloration
(cyanosis) of the gums can be an indication
of lack of oxygen or poor perfusion. Bright
red membranes are seen with some toxins
and with early stages of shock. CRT can
be evaluated with the following technique
(Figure 65):
208
Lesson 4
209
210
Mouth-to-Nose Resuscitation
If the animal isnt breathing, you can instruct the owner to
provide mouth-to-nose resuscitation as follows:
1. Ensure that the airway is clear of mucous, dirt, vomit,
or other foreign material. To clear the airway, have the
owner gently extend the head and neck. If head or neck
injuries are suspected, movements of the head should be
kept to a minimum. Pull the tongue forward and sweep
the material out of the mouth with one or two fingers.
2. Pull the tongue forward and close the mouth, holding
the tongue between the incisor teeth.
3. The rescuer should place his or her mouth over the
animals nose. In small dogs and cats, cover both the
animals mouth and nose.
4. Blow a steady stream of air into the animals nostrils for
two to three seconds. Hold the lips of the animal closed
so that the air wont escape from the sides of the mouth
(Figure 67).
Lesson 4
211
Chest Compressions
If no pulse or heartbeat can be detected, chest compressions
should be started in addition to mouth-to-nose resuscitation.
You can feel a beating heart when you place your hand on
the chest wall over the heart. The heart is located in the
lower part of the chest cavity just behind the elbow. You can
detect the pulse by lightly placing your index and middle
fingers on any part of the body where an artery crosses bone
or firm tissue. Common sites to check pulses on cats and
dogs are the same and are illustrated in Figure 68. Common
arteries to check include the femoral, brachial, and dorsal
pedal arteries. The femoral pulse is the easiest pulse for
owners to feel.
FIGURE 68Pulse Points
for Dogs and Cats
Brachial Artery
Femoral Artery
212
Hemorrhaging
Hemorrhaging (active bleeding) should be controlled with
either direct pressure or a pressure wrap applied to the
wound. If the bleeding is from the distal (lower) part of the
leg, elevating the limb will also decrease bleeding. Bandages
can be made of gauze or any clean material and tape. Its
virtually impossible to apply a pressure wrap too tightly on a
short-term basis.
A tourniquet is a device used to control severe bleeding by
compressing the blood vessels supplying blood to a limb.
Improper use of a tourniquet by untrained, inexperienced
persons can cause severe damage to a limb that may
necessitate amputation. Tourniquets are rarely needed to
control bleeding and should be considered only if lifethreatening bleeding cant be controlled by any other means.
Arterial bleeding (blood from a damaged artery) is more serious
than bleeding from a vein or a capillary. Arterial bleeding
can be identified by its bright red color and because it spurts
from the wound with each beat of the heart. Bleeding from
a damaged vein is dark red and flows from the wound in a
steady stream. Damaged capillaries cause small amounts of
blood to ooze from the wound and usually arent serious. The
following steps should be used to control external bleeding:
1. Place gauze (or the cleanest material available) against
the bleeding wound. If no clean material is available, use
your bare hand to apply pressure to the wound.
2. Maintain firm pressure for three to five minutes.
Lesson 4
213
Choking
If an owner calls with a choking animal, you should be
prepared to explain how to try removing the object before
coming to the hospital. If the object is too far back to be
removed manually, the Heimlich maneuver can be attempted.
You should, however, advise owners not to waste valuable
time. If initial attempts to dislodge the object arent successful, the owner should quickly seek veterinary assistance.
Figure 69 outlines how to perform the Heimlich maneuver on
dogs and cats.
If the animal is small and can be lifted, the following procedure should be used:
1. Hold the animal vertically. Place its head up, with
the animals spine against your chest and your arms
wrapped around the animal underneath its rib cage.
2. Forcibly push inward and lift upward with quick motions
to dislodge the object.
If the animal is too heavy to lift, use the following procedure:
1. Lay the animal on its side on a firm floor surface or on
hard ground.
2. Extend the head and neck into a neutral position.
3. Place your arms around the animals body below its ribs
and give short, quick compressions directed inward and
toward the diaphragm (Figure 70).
214
FIGURE 69Performing
the Heimlich Maneuver on
a Small Dog
Lesson 4
215
FIGURE 70Performing
the Heimlich Maneuver on
a Large Dog
Broken Leg
If you suspect an animal has a broken leg, you can instruct the
owner to immobilize the leg. A temporary support splint can
be made with rolled newspaper and tape (Figure 71). A muzzle should be applied before attempting splint placement. If
splinting isnt possible, confinement in
a box or carrier will prevent movement and further damage
to the limb. The following steps should be followed when
applying a temporary splint:
1. Apply a muzzle.
2. Place rolled newspaper on both the inside and outside of
the affected leg. Include the joint above and the joint
below the injury.
3. Secure the splint with tape or cloth strips. Dont tie the
strips directly over the fracture site.
216
Burns
Burns should be covered with a cool, not cold, compress. The
compress should be changed as it warms during transport.
Lesson 4
217
Self-Check 14
1. Which of these is not an important factor in successfully managing a critical animal?
a. Teamwork
b. Training
c. Animal cooperation
d. Practice
__________________________________________________________
__________________________________________________________
3. About what four organ systems should you ask when determining the severity of a problem
over the telephone?
__________________________________________________________
__________________________________________________________
4. What should be a primary concern when talking to a client about transporting an injured/ill
animal?
a.
b.
c.
d.
__________________________________________________________
__________________________________________________________
6. True or False? When an animal is hemorrhaging, blood-soaked bandages should be removed
and replaced with clean ones.
Check your answers with those on page 276.
218
ASSIGNMENT 15
WAITING-ROOM TRIAGE
Read this assignment. Then read pages 908927, 931933, and
944969 in Clinical Textbook for Veterinary Technicians.
Introduction
The triage process continues when the animal arrives at the
hospital. Triage will allow you to differentiate between critical
and stable patients. The triage nurse should evaluate each
emergency patient within minutes of its arrival. The veterinary technician may have the responsibility of triage nurse,
assessing emergency patients in the waiting room.
Initial Examination
If the animals history hasnt already been determined over
the telephone, a brief capsule history should be obtained
from the owner. You should approach the owner in a friendly,
professional manner and explain what youre going to do.
You should ask about the problem and when it occurred. Its
important for you to control the conversation and prevent the
owner from giving a lengthy, detailed history at this time. Ask
the owner about the pets normal temperament and behavior
with strangers. You may need a muzzle to evaluate an animal
thats frightened or in pain.
The triage examination should focus on the same body
systems that were evaluated over the telephone: respiratory,
cardiovascular, urogenital, and central nervous systems. The
triage evaluation should include assessment of the level of
consciousness (LOC), breathing pattern and effort, and
cardiovascular status.
You should observe the animal as you approach and speak
with the owner. Observe the animals breathing pattern. A
veterinarian should evaluate animals with noisy breathing
or open-mouth breathing immediately. Body posture may
suggest a serious respiratory problem. Animals that stand
Lesson 4
219
220
Parameter
Abnormal Findings
Heart/pulse rate
Pulse quality
Lesson 4
221
222
FIGURE 73Endotracheal
tubes come in a variety of
sizes.
FIGURE 74Laryngoscopes
also come in different sizes.
Lesson 4
223
clamped to the skin over the elbows and stifles (knee joints).
Good electric contact between the animals skin and the clips is
essential for transmission of the electrical impulse. Wetting the
skin with alcohol, water, or electrode jelly in the area where the
clips are attached can enhance contact (Figures 76A and 76B).
FIGURE 76AElectrode
jelly is being used here to
enhance the electrical
contact. (Setting courtesy of
VCA Lewis Animal Hospital,
Columbia, Maryland)
224
A large percentage of animals that experience a cardiopulmonary arrest die in spite of resuscitation efforts, but many
animals have been saved by CPR. The best chance of success
comes with early recognition of cardiopulmonary arrest. If
more than 10 minutes have passed between cardiopulmonary
arrest and the initiation of CPR, its very unlikely that there
will be a successful outcome. You should be familiar with the
signs of cardiopulmonary arrest or of animals that are near
arrest, and you should be mentally prepared to participate in
resuscitative efforts.
Signs of impending cardiopulmonary arrest include decreased
mentation, cyanotic membranes, and/or a labored, irregular
breathing pattern. An animal thats suffered a cardiopulmonary
arrest will show the following signs:
Dilated pupils
Loss of consciousness
If you see signs of a near arrest, you should notify the veterinarian and begin gathering the necessary equipment. If you
encounter an animal that has arrested, call for assistance,
Lesson 4
225
CCirculation
AAirway
BBreathing
Circulation
Start by listening for a heartbeat. The presence or absence of
a heartbeat tells you what to do next.
If the heart is beating but the animal isnt breathing, start to
breathe for the patient. Clear any vomit or foreign material
from the mouth, and make sure the airway is clear.
Breathing is usually done for the patient via an endotracheal
tube. After placement, the cuff should be inflated and the tube
secured to the upper jaw with a gauze strip. 100% oxygen is
delivered if possible. Manual breaths can be delivered through
an anesthesia machine or an ambu bag. If you must breathe for
the patient, make sure the chest cavity expands with each
breath. Its important to completely release the pressure on the
ambu bag between breaths. This allows the animal to exhale.
If theres no heartbeat present, begin chest compressions before
establishing an airway. Once chest compressions have started,
another person can try to establish an airway. Check the effectiveness of your chest compressions by using a Doppler blood
pressure probe on the globe of the eye or measuring the endtidal carbon dioxide (etCO2) levels.
When a cardiac arrest occurs in a veterinary hospital, advanced
life-support techniques are used. Advanced life support adds
D (drugs and defibrillation) and E (ECG) to the CABs of basic
life support.
Drugs
All of the drugs commonly used during CPR should be stocked
and readily available. A predesignated drawer is used in many
veterinary hospitals. You should familiarize yourself with the
drugs kept in this area. You may be asked to administer drugs
226
Indication
Dose
Route
10
15
20
30
40
50
60
70
80
90
100
Dosage in mls
Epinephrine
1:1000 1mg/ml
Sinus
arrest
0.1
mg/lb
IV,
IT,
IC
0.5
1.5
10
Atropine
0.5mg/ml
Vagally
induced
sinus arrest
Bradycardia
0.0125
mg/lb
IV,
IT
0.125
0.25
0.375
0.5
0.75
1.25
1.5
1.75
2.25
2.5
Lidocaine 2%
20mg/ml
Ventricular
arrhythmias
1
mg/lb
IV
0.25
0.5
0.75
1.5
2.5
3.5
4.5
Dexamethasone,
NaPO4
Shock
4mg/ml
2
mg/lb
IV
2.5
7.5
10
15
20
25
30
35
40
45
50
Solu Delta
Cortef 10mg/ml
10
mg/lb
IV
10
15
20
30
40
50
60
70
80
90
100
0.5
mEq/lb
repeat
every
5 min.
IV
2.5
7.5
10
15
20
25
30
35
40
45
50
Bicarbonate
1mEq/ml
Shock
Metabolic
acidosis
ECG
ECGs are generally attached to the patient as soon as possible,
in the manner described earlier. The heart rhythm shown by the
ECG will determine which drugs should be given, and if defibrillation should be used. The veterinarian will be responsible for
assigning tasks such as delivering breaths, chest compression,
delivery of drugs, or establishing an airway. In order to be prepared in an emergency, familiarize yourself with the equipment
and drugs used during CPR.
Lesson 4
227
Examination
At this point, an initial examination has been done, so this is
basically re-examination. This is looking at the body as a
whole and assessing the extent of other injurieswounds,
exterior bleeding, evidence of internal bleeding, fractures.
Examination is done to look at the body and make sure other
things besides the cardiac arrest are being addressed, as they
may be contributing to why the animal went into arrest in
the first place.
Note that if an animal presents in shock leading to or already in
cardiac arrest, you may also be assigned the task of getting intravenous access to the animalplacing an intravenous catheter
as intravenous access is the best route for emergency drugs.
Shock
Shock isnt a disease but a condition brought about by a
variety of different causes. It can be caused by trauma, blood
loss, severe infections, or heart disease. It represents a failure
of the cardiovascular system. As you know, the purpose of
the cardiovascular system is to supply oxygen and other
nutrients to every cell in the body. When the cardiovascular
system is unable to perform this function, cells begin to die.
228
Mentation
Heart rate
Pulse quality
Temperature
Multiple Trauma
Animals are often presented after sustaining whole-body
trauma. Dogs and cats may be hit by automobiles, fall from a
height (high-rise syndrome), or be attacked by other animals.
The concept of triage is again used in the management of
patients with multiple injuries. Immediately life-threatening
Lesson 4
229
230
Cardiopulmonary Diseases
Aside from trauma to the animal that may affect the heart of
a dog or cat, various cardiopulmonary diseases may cause
emergencies. Fortunately, animals in heart failure can be
treated, but you must be able to definitively evaluate a patient
presented in this type of emergency situation. You could save
an animals life by recognizing the signs of cardiac distress.
Lesson 4
231
Aortic Thromboembolism
Cats with cardiomyopathy will sometimes present with aortic
thromboembolism. This condition is usually caused by a clot
that forms in the abnormal heart and then travels down the
aorta and lodges in a peripheral artery. It often lodges in the
terminal portion of the aorta, stopping all blood flow to the
hind legs. The clot can also affect a front leg, the kidneys, or
the intestines.
Cats with a clot in the terminal aorta, or a saddle thrombus,
will be in severe pain and often cry out. Theyre unable to use
their hind legs. The muscles in the legs will be firm, and the
footpads on the hind feet will be cold and pale. The femoral
pulses will not be palpable. Signs of heart failure may be seen at
the time of presentation or may occur soon afterward. In addition to treatment for heart failure, cats with aortic thromboembolism can be treated with anticoagulant drugs (drugs that
hinder blood clotting) such as heparin and warfarin. The
main treatment involves treating the existing heart disease,
managing pain, and preventing further clots from forming.
Feline Asthma
Feline asthma is another common cause of acute respiratory
distress in cats. During an asthma attack, the small airways
in the lungs are constricted, making it difficult for the cat to
exhale. An affected cat will have labored breathing, especially
on expiration. The disease is controlled with drugs to dilate
the airways and reduce inflammation. Oxygen may be given
during a severe episode.
232
Seizures
Seizures, convulsions, or fits are caused by transient, abnormal
brain activity. Seizures can result from a number of different
causes. Here are some of the many possible causes of seizures:
ToxicityLead, organophosphate
Trauma
Idiopathic epilepsy
Lesson 4
233
Acute Paresis/Paralysis
Dogs and, less commonly, cats will be presented because of
injury to their spinal cords. Depending on the severity of the
problem, they may be paretic (weak in the limbs) or paralyzed. Injury to the spinal cord in the neck causes loss of use
of all four limbs. If the spinal cord is injured along the back,
234
the front legs will be normal, but the animal will be unable to
use its back legs. A sudden onset of paresis or paralysis is
most commonly caused by intervertebral disk disease. Injury
due to trauma, infarct, or neoplasia can have similar signs.
The intervertebral disk is a fibrocartilaginous (thick cartilage)
structure positioned between vertebrae in the spinal column.
As seen in Figure 79, its composed of an outer fibrous layer
called the annulus and a gelatinous inner portion called the
nucleus. The purpose of the disk is to cushion shock, allow
movement, and unite the vertebral segments.
FIGURE 79Intervertebral
Disk
Annulus
Nucleus
Lesson 4
235
Musculoskeletal Presentations
Injuries of the musculoskeletal system include abnormalities
involving the bones, the joints, and the soft tissues (tendons,
ligaments and muscles, and skin).
Fractures
A fracture is a broken bone. Fractures are often suspected
from physical examination findings such as localized swelling,
pain, or unnatural positions of the limb, but they must be
confirmed by taking a radiograph. If the skin over the fracture
site is intact, the fracture is classified as a closed fracture.
In open fractures, the skin has been disrupted, exposing the
underlying muscle and bone. Open fractures are considered
more serious because of the possibility of infection. Figure 80
illustrates the differences between open and closed fractures.
Closed
Open
236
Luxation
A luxation is a displacement or dislocation of a joint from its
normal position. Trauma is the most common cause of a
luxation. The hip, the shoulder, and the elbow are the joints
most often affected. Figure 81 illustrates a luxated hip joint
as it would appear on a radiograph. In addition to causing
loss of function of the joint, the dislocation also causes injury
to the ligaments and muscles around it. Soon after the injury
occurs, the abnormal joint can often be manipulated back into
normal position, but may also require surgical repair if it cannot
be replaced or if the hip continues to pop out.
Normal
Hip Joint
Luxated
Hip Joint
Radiograph
Area
Restraints
Lesson 4
237
Soft-Tissue Wounds
Injuries to the skin and the underlying muscles, nerves, and
blood vessels are a common occurrence in veterinary medicine.
When dealing with skin wounds, you need to be concerned not
only about the damaged tissue, but also about blood loss and
infection. Intact skin is an important barrier against infection.
When that barrier is broken, the underlying tissues are susceptible to the invasion of bacteria.
Further classification of wounds based on the mechanism of
injury will help you to understand the management and anticipated complications of each type of wound. As discussed, there
are five categories of wounds: abrasion, avulsion, incision,
laceration, and puncture. Review the wound section of the
study guide for further differentiation.
Gastrointestinal Presentations
Vomiting, diarrhea, and inappetence (lack of appetite) are the
most common signs seen in animals with disease affecting
the gastrointestinal tract. In the following section, youll be
introduced to several gastrointestinal diseases causing vomiting
and/or diarrhea commonly seen on an emergency basis. Its
important to remember that vomiting also is seen with a large
number of nongastrointestinal problems. Several causes of
vomiting in animals arent associated with primary gastrointestinal tract disease. These causes are
238
Pain
Toxins
Drugs
Neurological disease
Motion sickness
Acute Gastroenteritis
One of the most common causes of acute onset vomiting
and/or diarrhea is irritation of the stomach and intestine
from dietary causes. This condition is known as acute
gastroenteritis.
The intestine may become irritated from a sudden change in diet
or when animals get into garbage or other foreign material. If
bones or other large objects have been consumed, abdominal
radiographs should be taken to determine if theres foreign
material in the intestine.
If no foreign material remains in the intestine, the vomiting and
diarrhea will often resolve with supportive care. The intestine
should be rested by fasting the animal or feeding it a bland diet
thats very easy to digest. If theres some kind of foreign material
in the intestine, the veterinarian will need to decide if the material can safely pass through the intestine without causing
injury to the bowel. If it may obstruct the bowel, it will need
to be removed surgically. The severity of dehydration from the
condition may warrant hospitalization with IV fluids.
Parvovirus Enteritis
Vomiting, diarrhea, inappetence, and depression can be seen
secondary to viral infection. A number of viruses affect the
gastrointestinal system. The most serious and potentially
fatal is parvovirus. Affected animals will present with vomiting, lethargy, and severe bloody diarrhea, and will often be
dehydrated. In severe cases, an animal will be in shock.
Enteritis (inflammation of the intestine) caused by parvovirus
infection is most commonly seen in dogs less than 6 months
of age and in dogs that havent received vaccination to protect
them from the disease. The diagnosis is often suspected when a
young, unvaccinated dog is presented with the typical clinical
signs. Finding a low number of white blood cells on a complete
Lesson 4
239
Pancreatitis
Inflammation of the pancreas, or pancreatitis, is a serious,
potentially fatal condition of dogs and, less commonly, cats.
The pancreas is a large glandular structure located behind the
stomach between the spleen and duodenum. The pancreas is
responsible for the production of insulin. It also aids in the
digestion of food. The presence of food in the stomach causes
pancreatic juice to be secreted into the small intestine.
Pancreatic juice contains enzymes such as trypsin, amylase,
and lipase, which are vital to the digestion of carbohydrates,
proteins, and fats. In patients with pancreatitis, these
enzymes are released within the pancreas, causing an
autodigestive process. The cause of the disease isnt known,
but its often associated with the ingestion of a fatty meal,
such as from table scraps or other human foods.
240
Gastric Dilatation-Volvulus
Gastric dilatation-volvulus (GDV) is a life-threatening emergency that without prompt attention will lead to circulatory
collapse and death. The condition is commonly referred to as
bloat. Bloat occurs when a dogs stomach becomes distended
with food, liquid, and air. The stomach then twists or rotates
around the distal esophagus, preventing fluid or air from
leaving the stomach. The rapidly distending stomach prevents blood flow back to the heart, and the dog begins to go
into shock. The stomach wall begins to die because of lack
of blood flow. The problem is seen most commonly in large,
deep-chested breeds of dogs such as Great Danes, Doberman
Pinschers, and Standard Poodles.
The cause of this condition isnt known. Ingestion of a large
meal, ingestion of large quantities of water, and active exercise
after eating are thought to be inciting causes of the condition.
Clinical signs of GDV include restlessness, nonproductive retching, increased salivation, difficulty breathing, depression, and
distention of the abdomen. The diagnosis is usually made
Lesson 4
241
242
FIGURE 83Decompression
of a distended stomach
resulting from GDV is often
achieved through the passing of a stomach tube.
Urogenital Disorders
Urogenital disorders are disorders that affect the urinary
or reproductive systems. Renal failure and renal disease
account for many of the emergencies youll see involving the
urinary system. Female dogs and cats will often be presented
for emergency care because of difficulty in delivering their
kittens or puppies; the general term for this is dystocia. Three
common presentations related to the female reproductive tract
are eclampsia, pyometra, and dystocia.
Renal Failure
The kidneys are responsible for filtering waste products from
the blood. When the kidneys dont function properly, waste
products accumulate in the blood, causing renal failure.
Lesson 4
243
Urethral Obstruction
A common cause of acute renal disease, especially in cats, is
blockage or obstruction of the urethra. Urethral obstruction
is one of the group of clinical signs known as feline lower
urinary tract disease (FLUTD). The cause hasnt been clearly
established, but numerous factors have been considered,
including litter box hygiene, viruses, bacteria, and dietary
considerations.
Affected cats will have episodes of hematuria (blood in the
urine) or stranguria (difficult urination) when the urethra
is partially blocked. During an episode, cats will often pass
mineral crystals in their urine. During an episode of abnormal
urination, a plug of mucous and crystals can form, lodge in
the urethra, and block the flow of urine. Obstruction of the
urethra is much more common in male cats, but, although
rare, it can occur in female cats.
If urine is unable to pass because of complete blockage, the
cat first becomes uncomfortable and then quickly becomes
toxic from the buildup of electrolytes and waste products.
Potassium is the primary electrolyte, and it can cause severe
and potentially fatal irregularities in the heart rhythm.
Owners will report that their cat is making frequent trips to
the litter box, assuming the posture of urination without
producing urine, or that the cat is attempting to urinate in
strange places. The owner may mistakenly believe that the
cat is constipated. Affected cats can be identified upon arrival
at the veterinary hospital by palpating a large, firm, painful
urinary bladder.
244
Eclampsia
Eclampsia is a condition caused by an abnormally low level
of calcium in the blood. Its most commonly seen in dogs
nursing puppies. The condition often occurs in the first three
weeks after parturition (delivery of puppies). Toy breeds of
dogs such as the Chihuahua are most often affected. Affected
dogs will pant and act restless. Theyll then develop muscle
tremors and a stiff gait. The increased muscle activity will
cause an elevated rectal temperature. The signs will quickly
progress to collapse and death if left untreated.
The diagnosis of eclampsia often is suspected based on
history and clinical signs and is confirmed by checking the
blood-calcium level. The signs can be reversed quickly by
the intravenous administration of calcium. Its important to
remember that if rapidly given intravenously, calcium can
cause a slow or irregular heart rate. You may be asked to
monitor the heart rate or ECG tracing while calcium is being
administered. To maintain a normal blood-calcium level, the
dog may be placed on an oral calcium supplement. In addition, the puppies should be prevented from nursing and
instead be fed a milk-replacement formula.
Pyometra
Pyometra is an infection of the uterus. The disease generally
occurs in middle-aged to older unspayed females and often
occurs within four to six weeks of the previous heat cycle.
Lesson 4
245
246
Inappetence
Yawning
Frequent urination
Stamping of feet
Profuse sweating
Twisted intestine
Feed impaction
Foreign-body impaction
Intestinal displacement
Gas distention
Parasitic infections
Urinary obstruction
Lesson 4
247
Owners often will call with a suspicion that their pet has been
poisoned. The clinical signs of many common metabolic problems are similar to those seen secondary to toxicity. Owners
often mistakenly assume that their sick pet has been poisoned.
Its important for you to question them about the possibility of
exposure to a possible toxin. If exposure to a toxin is a possibility, the owner should be instructed to have the pet evaluated
immediately. The owner should bring along the label or packaging from any compound suspected to be the offending toxin.
248
Lesson 4
249
3% hydrogen peroxide
Laxatives
Abrasives
Lipstick
Antacids
Lubricant
Antibiotics
Magic markers
Ballpoint pens
Matches
Mercury thermometers
Mineral oil
Modeling clay
Body conditioners
Newspaper
Bubble bath
Calamine lotion
Perfumes
Play-Doh
Colognes
Cosmetics
Rubber cement
Deodorants
Shampoos (liquid)
Elmers glue
Shaving cream/lotion
Etch-A-Sketch
ExLax
Soaps (detergents)
Fabric softeners
Spray deodorizers
Fishbowl additives
Suntan preparations
Fluoride
Vitamins
Incense
Watercolors
Indelible markers
Zinc oxide
Zirconium oxide
250
Medical Nursing for Veterinary Technicians
Is a rodent or rabbit
Lesson 4
251
252
Common Toxins
Although many pet owners believe that their homes are safe
environments for their pets, there are a variety of household
products that are hazardous to an animals health. Common
household products can have severe adverse effects on a pet.
In this section, well discuss some common household toxins.
As the veterinary technician, your ability to identify common
toxins and their dangerous effects will be invaluable to the
veterinary practice and the clients that you serve.
Lesson 4
253
Ethylene Glycol
Toxicity from ingestion of ethylene glycol usually occurs when
dogs and cats drink automobile antifreeze. Antifreeze has a
sweet taste, and animals will readily drink it. Animals can
become poisoned after consuming only a small amount of
antifreeze. The toxic dose is 4.2 to 6.6 ml/kg in the dog and
1.5 ml/kg in the cat. Toxic amounts of ethylene glycol are
also found in some photographic processing chemicals.
The serious consequences of ethylene glycol ingestion are
caused not by the compound itself, but by metabolites.
Metabolites are compounds produced as the body breaks
down the product for elimination. Ethylene glycol is broken
down by the body into several metabolic products, including
oxalic acid. Calcium combines with oxalic acid to form crystals in the renal tubules, causing obstruction of the tubules
and renal failure.
Within one to two hours of ingesting a toxic dose, the animal
will show gastrointestinal and central nervous signs. The
animal will become dull or depressed or may act drunk,
displaying a staggering, unsteady gait. It will often vomit.
The owner also may notice increased thirst and urination.
If untreated, the animals condition will progress to coma
and death if a large amount of antifreeze was consumed.
If a toxic but nonlethal dose was consumed, the animal
may appear to get better over the next 6 to 12 hours, but
then again begin to appear ill with signs of depression, weakness, and vomiting as the toxic metabolites are produced
and cause renal failure.
An animal ingesting ethylene glycol should receive veterinary
care as soon as possible. The goal of therapy is to prevent the
formation of toxic metabolites. If given soon after exposure,
antidotes such as ethanol or 4-methylprazole are effective in
preventing the metabolism of ethylene glycol and the formation of the toxic oxalate crystals. (4-methylprazole is available
only for use in dogsdont use it in cats.)
If the animal is presented for treatment after the toxic metabolites have been formed and caused damage to the kidneys,
the veterinarian can provide only supportive care, and the
patient will most likely die. You should advise owners of the
254
Anticoagulant Rodenticides
Many animals are presented for emergency care following the
ingestion of rodenticide products (products designed to kill
rodents such as rats and mice). The active ingredient in most
rat poisons is warfarin or one of many newer, more potent
warfarin-like drugs. These products are often referred to as
anticoagulant rodenticides because they kill rats (or other animals that ingest the product) by causing abnormal bleeding.
Within a few days of ingesting a toxic dose of an anticoagulant
rodenticide, the animal will have a decreased ability to form a
blood clot. Minimal trauma, such as might occur when playing
Lesson 4
255
Chocolate
Dogs may show signs of toxicity after eating chocolate. Ingestion
of toxic amounts of chocolate causes excessive stimulation of
both the cardiac and central nervous systems. Clinical signs
may be seen up to four to five hours after ingestion. Affected
dogs will be anxious and restless. They may have muscle
tremors. Seizures may be seen in severe cases. The heart
rate will be rapid, and an irregular rhythm may be detected.
The dog will often vomit and have diarrhea.
256
Poisonous Plants
Many house and garden plants contain chemicals that can
produce toxic effects if ingested in sufficient quantities. Dogs
and cats arent strict herbivores (plant eaters), so they rarely
consume large quantities of plant material. Pets are most
likely to consume plants when theyre bored or after changes
in their environment. Table 4 lists some common plants
that may cause toxic signs in cats and dogs if ingested in
sufficient quantities. Dogs or cats that have consumed toxic
quantities of plants are treated by gut decontamination
followed by symptomatic/supportive care.
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Table 4
POTENTIALLY POISONOUS COMMON PLANTS
Common
Name
Scientific
Name
Poisonous
Portion of Plant
Indication
of Poisoning
Autumn crocus
Colchicum autumnale
Leaves
Vomiting, CNS*
stimulation
Castor bean
Ricinus communis
Leaves, beans
Diarrhea, shock
Daffodil
Narcissus spp.
Bulbs
Vomiting, diarrhea
Daphne
Daphne spp.
Vomiting, CNS
stimulation,
depression
Dumb cane
Dieffenbachia seguine
Stems
Salivation,
laryngitis
English ivy
Hedera helix
Leaves, berries
Vomiting, diarrhea
Foxglove
Digitalis purpurea
Leaves
Heart irregularities
Golden chain
Cytisus laburnum
Leaves, seeds
CNS stimulation
Larkspur
Delphinium spp.
Leaves, seeds
Paralysis, CNS
stimulation
Convallaria majalis
Leaves, flowers
Heart irregularities
Oleander
Nerium oleander
All parts
Heart irregularities
Philodendron
Philodendron spp.
Stems, leaves
Salivation
Poinsettia
Euphorbia spp.
Leaves
Heart irregularities
Privet
Ligustrum vilgare
Leaves, berries
Vomiting, diarrhea
Rhododendron
Rhododendron spp.
Leaves
Vomiting, diarrhea
Tobacco
Nicotianna spp.
Leaves
CNS stimulation
258
Heat Stroke
Heat stroke is a condition of extreme overheating of the body
caused by high environmental temperature. Unlike people, cats
and dogs are incapable of sweating. They get rid of excessive
body heat by panting. When extra body heat exceeds their ability
to lose heat by panting, the body temperature begins to rise.
Animals with heat stroke often will have rectal temperatures
above 105F. Heat stroke often occurs when high environmental
temperatures are coupled with factors such as confinement,
lack of proper ventilation, or excessive exercise. Dogs left
in closed cars on a hot day are particularly at risk. Animals
with heat stroke can present with one or more of the following
clinical signs:
Panting
Collapse
Coma
Lesson 4
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260
Lethargy
Lack of coordination
Stupor
Shivering
Collapse
Coma
Burns
Burn injuries occur when intense heat damages the skin and
underlying tissues. The nature of the heat source and the
duration of the exposure determine the severity of the injury.
Burn injuries may occur by friction, such as when an animal
is dragged by a car. Less commonly, animals are exposed to
flames or scalding liquids. Puppies and kittens will often bite
or chew on electric cords, causing burns on the tongue and
lips. Pieces of equipment commonly used in a veterinary hospital, such as clippers, heating pads, and heating lamps, are
capable of burning patients. Always use these tools with the
proper caution.
Burns are classified as partial thickness or full thickness. In
partial-thickness burns, damage is limited to the superficial
layers of skin. Full-thickness burns involve all layers of the
skin, as well as the underlying tissues. Table 5 compares
the clinical features of the two types of injuries.
Lesson 4
261
Table 5
CLINICAL COMPARISON OF BURN TYPES
Partial Thickness
Full Thickness
Very painful
Not painful
Bleeding
No bleeding
Red, edematous
262
Snakes
There are only a few species of poisonous snakes in the
United States. Rattlesnakes, copperheads, water moccasins,
and coral snakes are responsible for the majority of poisonous
snakebites in animals, with rattlesnake bites accounting for
80% of all animal deaths from snakebites.
Animals rapidly develop paralysis following a coral snake
bite. The clinical signs following a bite from any other major
species of snake are local necrosis and effects on red blood
cells and blood clotting. A snakebite is often suspected by the
typical appearance of the bite wound. Most snakebites occur
around the head, neck, or extremities. There will be marked
local swelling, bruising, and pain associated with the wound.
The appearance of the wound cant be used to reliably distinguish between a poisonous and nonpoisonous bite.
Animals bitten by a poisonous snake (other than a coral snake)
may show both a local reaction and a systemic reaction to the
bite. The local reaction consists of pain, swelling, and bruising
around the area that was bitten. Systemic reactions include
shock and abnormal bleeding. When a snake bites, its venom
is released from the fangs into the area of the wound.
Enzymes in the venom are designed to destroy tissue in the
bite area, so the affected tissue will often become necrotic
(dead). If toxic amounts of venom are in the area of the bite
and spread through the body, there will be a generalized or
systemic reaction.
The first goal in treatment of a patient thats been bitten is to
prevent spread of the venom. This can best be accomplished by
keeping the animal quiet. Physical activity increases the uptake
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263
264
Flying Insects
Dogs and cats may have adverse reactions to stings from
bees, yellow jackets, wasps, and hornets. The animals dense
fur helps to protect pets from most stings. Theyre most
often stung on the exposed areas of the head and paws. Pets
usually wont be presented for emergency for the insect bite
itself, but rather for the allergic reaction to it. The local
reaction to an insect bitetransient redness, swelling, and
painwill usually resolve without treatment. An ice pack or
topical analgesics may help to relieve some of the discomfort.
A systemic allergic reaction to the bite will cause a diffuse
swelling of the face or of a limb. The swelling will often be
pruritic (itchy). The allergic reaction is treated with antihistamines
and steroids. Any pet with facial swelling should be seen by
the veterinarian, as the throat may begin to close. Animals
can also have anaphylactic reasons. The animal may vomit
and collapse, or go into a coma. These require immediate veterinary care, or the animal will die
Lesson 4
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266
Lesson 4
267
Reproductive Emergencies
Dystocia refers to any difficult birth. Its not common in the
horse but is fairly common in cattle, sheep, and goats. Dystocia
requires quick diagnosis and treatment to save the mother and
the offspring. In some instances, the offspring cant be saved
and may be cut into pieces so it can be removed without the
need for surgery.
Dystocia can occur due to uterine torsion or malpositioning of
the fetus. A Caesarean section can be performed to remove the
fetus, but the veterinarian must determine if this poses excessive risk to the mother. The veterinary technician normally helps
with the removal of the fetus. If surgery is performed, the technician will also be required to assist. Reproductive emergencies
can be particularly emotional, so its important to take your time
becoming comfortable with the procedures. If youre confident
that youre performing your job to the best of your ability, youll
be better able to manage the stress of these types of situations.
Uterine prolapse generally occurs in association with pregnancy.
The uterus can fold out of the body through the cervix, leading
to tears. If the uterine artery is torn, the animal may bleed to
death. Most uterine prolapses start off mildly, meaning the
uterus is not entirely outside the body. These prolapses can
usually be managed medically. Some cases, as with an artery
tear, require surgery to prevent death. Most animals whove
experienced uterine prolapse once wont be used for breeding a
second time.
Most other emergencies found in large animals are treated similarly to those found in small animals. Open wounds, fractures,
and muscle trauma are the more common emergencies seen in
large animals.
Youve now covered some of the basic emergencies you might
encounter as a veterinary technician. Our discussion in no way
covered all emergency situations, and not every veterinarian
treats emergencies the same way, but you should now have
enough information to be able to participate in emergency
animal care.
268
Lesson 4
269
Self-Check 15
1. List four potential causes of shock.
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
2. Describe what happens to the mucous membranes during shock.
__________________________________________________________
__________________________________________________________
3. What is the initial therapy for congestive heart failure?
a. Radiographs
b. Diuretics and fluid therapy
__________________________________________________________
__________________________________________________________
5. What are the three parts to a seizure (in order of occurrence)?
a. Aura, postictus, ictus
b. Ictus, postictus, aura
270
Self-Check 1
1. c
Self-Check 2
1. d
2. b
3. c
4. a
5. b
6. aspiration pneumonia
Answers
271
Self-Check 3
1. Genetic background, nutrition, internal disorders,
environmental factors
2. From birth to 1 year of age
3. 1 year of age and until approximately 6 to 8 years
4. 6 to 8 years and older
5. Chlamydia, feline leukemia virus (FLV), rabies, feline
infectious peritonitis (FIP), and FVRCP (feline viral
rhinotracheitis, feline calicivirus infection, and feline
panleukopenia)
Self-Check 4
1. Altered walking, lameness, traumatic tearing (easier to
get caught if long), ingrown nail, abscess formation
2. b
3. c
4. False
5. four, eight oclock
6. c
Self-Check 5
1. Liquid, tablet, capsule
2. b
3. Through the lymph and blood system
4. The injection site is located by placing the fingers on the
wings of the ileum and allowing the thumb to fall naturally. The injection goes at the point where the thumb
lands.
5. c
272
Self-Check Answers
Self-Check 6
1. medication administration, blood sampling
2. c
3. tourniquet
4. c
5. b
6. c
Self-Check 7
1. b
2. The chemical solutions can irritate the animals mucous
membranes, and the solutions may inhibit bacterial
growth when urine is collected for culture.
3. True
4. False
5. True
6. Catheterization, bladder expression, free catch,
cystocentesis
7. b
8. c
Self-Check Answers
273
Self-Check 8
1. d
2. a
3. Subcutaneous, oral, intraperitoneal, intraosseous,
intravenous
4. Abscess and peritonitis
5. c
6. An instrument for ascertaining the pressure of liquids or
gases
7. c
8. 12 ml/kg/hr
9. The blood pressure in the vein and right side of the heart
10. c
Self-Check 9
1. root, crown
2. enamel, dentin, pulp
3. d
4. c
5. b
Self-Check 10
1. c
2. d
3. b
4. a
5. d
6. b
7. c
8. simple, sectioned, surgical
274
Self-Check Answers
Self-Check 11
1. By the person performing the dental, or by dictating the
information to a second person
2. Calculus index, missing teeth, malformed and malpositioned teeth, supernumerary teeth, traumatized teeth,
gingival index, stomatitis and kissing ulcers, tooth
mobility, gingival recession and hyperplasia, probing
depth, furcation, periodontal index
3. False
4. False
Self-Check 12
1. Abrasions, avulsions, incisions, lacerations, punctures
2. Inflammatory phase, proliferative phase, maturation
phase
3. False
4. a
5. a
6. Primary (contact), secondary (padded conforming),
tertiary (holding and protective)
7. Primary
Self-Check 13
1. Protect wounds, support the leg
2. a
3. To help hold the bandage in place
4. Elizabethan collar
5. Proud flesh/Exuberant granulation tissue
6. a
7. b
8. d
Self-Check Answers
275
9. e
10. b
11. c
12. a
13. d
Self-Check 14
1. c
2. Loss of consciousness, trauma, open fractures, excessive
bleeding, penetrating wounds to the thorax or abdomen
(gunshots, arrows), labored breathing, seizures, straining
to urinate, poisoning or snakebite, prolapse of organs,
profuse diarrhea or vomiting, eye injuries
3. Respiratory, cardiovascular, urogenital, and CNS
4. b
5. Over the heart
6. False
Self-Check 15
1. Trauma, blood loss, severe infections, and heart disease
2. In the very early stages of shock, the heart rate increases
and the mucous membranes become bright pink, with a
shortened capillary refill time. As shock becomes more
severe, mucous membranes become pale, with a prolonged
capillary refill time.
3. c
4. A clot in the terminal aorta
5. d
276
Self-Check Answers