Wednesday, February 27, 2013
Josh Project: End-of-the-Day Thoughts
Busy day of classes, but such a perfect ending visiting the children at the JNF General Hospital Pediatric Ward! I really wish that sometimes other students could see things through my eyes when it comes to St. Kitts. I have the best view ever! RUSVM's Josh Project (branch off of Josh and Friends) has really given me a whole new perspective and appreciation for those that I share this beautiful island with. These little ones that I meet at the hospital and their grateful parents/family members really fill my heart with an overwhelming sensation of joy and accomplishment. I can't get enough of them. I love sitting back in my chair in the playroom during our story time with them and watching them follow along as the story is narrated for them. I love watching them get a huge smile on their adorable faces as Josh comes to life with a little bit of their help (ie. wagging his tail). And I love the look of peace they have on their faces as our Josh Project group says our goodbyes and I know that they will be brave with their new friend Josh for whatever awaits them the next day whether that is surgery or the possibility of getting to go home after their hospital stay. I am so very thankful for all these memories that I get to make before my stay here is over. And I'm so very thankful for the way that these awesome children have made such a huge impact on my life while I've been here.
Tuesday, February 26, 2013
5th Semester: Time to Apply Your Knowledge!
5th semester is well underway and proving to be way more exciting and hands on than the last couple of semesters (1st and 2nd you have anatomy which allows for live animal handling and use, but beyond that it is books, books, books).
Several classes this semester are demanding my brain to reach into my vast storage of knowledge and apply it to live animals. In the Introduction to Clinics I class I have already had the majority of my labs. We have focused each lab on a different species and skill sets. These labs have really given us an opportunity to hone in on building consistent and thorough skills with each species.
My first lab was a phlebotomy, skin scraping, and halter tie lab. We practiced best-practice techniques with phlebotomies from simulation models for both cephalic veins and jugular veins. Then we were able to practice the proper techniques for superficial and deep skin scrapings as well as discussed when to use either approach. We were actually given cadaver skin to practice on that was stretched over a structure to simulate the actual animal (probably from those specimens that end up being utilized in the anatomy labs for 1st and 2nd semester). And the halter tie was extremely handy as we will be using this skill in future labs and semesters when working with the sheep, donkeys, or horses on campus.
There's the Canine Physical Examination lab. Using the wonderful kennel dogs we performed distance examinations and then the hands on nose-to-tail physical examinations. Getting into a routine in evaluating each system as well as taking into account the normal parameters for temperature, respiratory rate, heart rate, etc. The one thing that I really took from this examination was something I was not as familiar with nor had I done in the past, a good ole rectal palpation. It's actually really amazing what information you can get from this examination! From the ability to feel the urethra on the ventral aspect of the rectum to a general examination of the colon wall.
The suture lab provided information on a variety of suture patterns and situations that each pattern can be used in. To be honest we have had a great amount of practice with hand-ties since our 2nd semester, so now it was time to learn about the different suture patterns used in practice for the different tissues we will encounter. From tension relieving sutures such as the vertical mattress to the far-near-near-far, needless to say this skill set takes a lot of practice (many of my friends and I have had suturing parties where we study for a certain class together and then end the night practicing our suture patterns on our ROSSie models...this is acquired in your Clinical Skills course during 5th semester).
There's a Ovine Physical Examination lab. Not only did we get to learn how to properly restrain a sheep (please note that the video link is not the video we were provided with to study before the lab in preparation for this procedure), we got to understand the normal findings in this species. For me the best part of this lab was utilizing that same skill set during my examination with our kennel dog and transferring that to this species. We were able to estimate the age of our sheep (under 2 years of age) based on the eruption of certain teeth. By far the most interesting part of this lab was evaluating the testicles of our sheep for symmetry, pliability, and uniform temperature and then extruding the ram's penis to evaluate the urethral process at the end of it's penis.
There's an Equine Physical Examination lab. Again another opportunity to utilize our nose-to-tail hands on physical examination skills while looking at unique characteristics to this species such as the Purkinje reflections.
I have really only touched on the surface of these labs. They are full of amazing information for each species. From safe handling approaches to thorough evaluations of each system, these labs are awesome!
I have 2 labs to complete still for my Introduction to Clinics I course, one in communications and the other in emergency management.
Another hands-on course this semester has been Anesthesia. The lectures have really highlighted topics taught in previous semesters but what really makes you think about these topics is when you get to anesthetize a live animal. Under the supervision of our anesthesia professors and after weeks of becoming familiar with the anesthesia equipment, drugs and their side effects, etc etc, we are assigned to groups and perform a canine and sheep anesthesia (on separate occasions).
First was our canine anesthesia. We were given a specific protocol to follow for the pre-meds, induction, and maintenance drugs. So my group got together one night and discussed dosages based on our patient's weight as well as decided who would take on which tasks for the procedure. One individual would place the IV catheter, someone would give the pre-meds, someone would give the induction meds, someone would place the endotracheal tube (ETT), and everyone seemed to take on placing the various monitoring equipment (capnograph, pulse oximetry, doppler, EKG, etc etc). Really awesome aspect of this procedure (other than the entire thing!) was that all of us took turns monitoring and recording our patient's vitals. Our patient had respiratory depression (probably a result of the induction medication utilized) so initially we had to breathe for our patient to make sure that the inhalant was taken in. We also ran into hypotension with our patient but were able to discuss with our instructor what should be done to correct the hypotension. Before we knew it our patient was breathing on it's own and the hypotension was resolved! We also took our patient from a non-rebreathing system to a rebreathing system after a set amount of time. What lasted for about 3 hours (from setting up our equipment, preparing our station for IV catheter/ETT/etc, the physical exam, having our protocol approved and a discussion with the professor about complications/etc., acquiring the drugs from the pharmacy in the veterinary teaching hospital, etc etc.), felt like it flew by! Before we knew it we were waking our patient back up and cleaning up our lab space and equipment, making sure to leave everything the way we found it (just as important as the rest of the procedure!).
And last but not least is our Diagnostic Imaging course. We have used a kennel dog on separate occasions to learn about our digital radiograph machine in our teaching hospital as well as to become familiar with the ultrasound equipment. For our radiograph machine lab we discussed proper positioning, how to take measurements of our patient for the settings when taking a radiograph, how the image can be adjusted after it is taken, etc. all while discussing the basics of the x-ray machine (anode, cathode, mAs, kVp, and so on). We talked about very important safety measures to take when performing a radiograph (measures that I have seen not taken seriously by clinic employees...so important to know the dangers of radiation from x-rays and how you can protect yourself and staff). During the ultrasound lab we focused on the abdominal structures such as the liver, spleen, kidneys, bladder, stomach, intestines, etc. while applying knowledge that we have gathered from class such as artifacts on an ultrasound image (each of us in the group took turns finding the big ones: liver, spleen, kidneys, bladder). In the classroom, learning about ultrasounds, the equipment, and the images that the machine gives you did not come easily for me. It was like a foreign language! The only thing that really helped me were some YouTube videos that a fellow colleague shared with me. It really helped me to put together what I was learning in class. I absolutely love this class and you are taught by the very man that wrote the book you use for this class (and that other veterinary schools utilize!), Dr. Donald Thrall.
I'm extremely thankful for the learning experiences all of these labs have given me. I am also so thrilled to finally be putting my classroom knowledge to use in clinical situations. This semester has definitely been a change in pace for me. Semesters in the past have felt like an uphill battle at times. Where last semester (my 4th semester) had a marathon of exams from like the 3rd week to the 13th week of the semester, this semester is much more relaxed and not overwhelming. The professors are wonderful and all the classes have been so very informative (not to say previous semesters are any less). I feel like this semester is the beginning of the semesters that are meant to teach us students how to take our classroom knowledge and apply it to clinically relevant situations and really understand that knowledge to its fullest.
Several classes this semester are demanding my brain to reach into my vast storage of knowledge and apply it to live animals. In the Introduction to Clinics I class I have already had the majority of my labs. We have focused each lab on a different species and skill sets. These labs have really given us an opportunity to hone in on building consistent and thorough skills with each species.
My first lab was a phlebotomy, skin scraping, and halter tie lab. We practiced best-practice techniques with phlebotomies from simulation models for both cephalic veins and jugular veins. Then we were able to practice the proper techniques for superficial and deep skin scrapings as well as discussed when to use either approach. We were actually given cadaver skin to practice on that was stretched over a structure to simulate the actual animal (probably from those specimens that end up being utilized in the anatomy labs for 1st and 2nd semester). And the halter tie was extremely handy as we will be using this skill in future labs and semesters when working with the sheep, donkeys, or horses on campus.
There's the Canine Physical Examination lab. Using the wonderful kennel dogs we performed distance examinations and then the hands on nose-to-tail physical examinations. Getting into a routine in evaluating each system as well as taking into account the normal parameters for temperature, respiratory rate, heart rate, etc. The one thing that I really took from this examination was something I was not as familiar with nor had I done in the past, a good ole rectal palpation. It's actually really amazing what information you can get from this examination! From the ability to feel the urethra on the ventral aspect of the rectum to a general examination of the colon wall.
The suture lab provided information on a variety of suture patterns and situations that each pattern can be used in. To be honest we have had a great amount of practice with hand-ties since our 2nd semester, so now it was time to learn about the different suture patterns used in practice for the different tissues we will encounter. From tension relieving sutures such as the vertical mattress to the far-near-near-far, needless to say this skill set takes a lot of practice (many of my friends and I have had suturing parties where we study for a certain class together and then end the night practicing our suture patterns on our ROSSie models...this is acquired in your Clinical Skills course during 5th semester).
ROSSie spay simulator. Use this to practice your suture patterns as well as working with the various "tissue layers" you'll encounter during a spay (in 6th semester you learn to "spay" your ROSSie)
Don't mind that it looks a little beat up...this is what happens when your island pup discovers your ROSSie and uses it as a chew toy :) But wanted to give a side view to show the layers of the ROSSie that are present (the tubes you see sticking out are simulating the uterine horns...but these ones have been a little damaged from said island dog)
There's a Ovine Physical Examination lab. Not only did we get to learn how to properly restrain a sheep (please note that the video link is not the video we were provided with to study before the lab in preparation for this procedure), we got to understand the normal findings in this species. For me the best part of this lab was utilizing that same skill set during my examination with our kennel dog and transferring that to this species. We were able to estimate the age of our sheep (under 2 years of age) based on the eruption of certain teeth. By far the most interesting part of this lab was evaluating the testicles of our sheep for symmetry, pliability, and uniform temperature and then extruding the ram's penis to evaluate the urethral process at the end of it's penis.
There's an Equine Physical Examination lab. Again another opportunity to utilize our nose-to-tail hands on physical examination skills while looking at unique characteristics to this species such as the Purkinje reflections.
I have really only touched on the surface of these labs. They are full of amazing information for each species. From safe handling approaches to thorough evaluations of each system, these labs are awesome!
I have 2 labs to complete still for my Introduction to Clinics I course, one in communications and the other in emergency management.
Another hands-on course this semester has been Anesthesia. The lectures have really highlighted topics taught in previous semesters but what really makes you think about these topics is when you get to anesthetize a live animal. Under the supervision of our anesthesia professors and after weeks of becoming familiar with the anesthesia equipment, drugs and their side effects, etc etc, we are assigned to groups and perform a canine and sheep anesthesia (on separate occasions).
First was our canine anesthesia. We were given a specific protocol to follow for the pre-meds, induction, and maintenance drugs. So my group got together one night and discussed dosages based on our patient's weight as well as decided who would take on which tasks for the procedure. One individual would place the IV catheter, someone would give the pre-meds, someone would give the induction meds, someone would place the endotracheal tube (ETT), and everyone seemed to take on placing the various monitoring equipment (capnograph, pulse oximetry, doppler, EKG, etc etc). Really awesome aspect of this procedure (other than the entire thing!) was that all of us took turns monitoring and recording our patient's vitals. Our patient had respiratory depression (probably a result of the induction medication utilized) so initially we had to breathe for our patient to make sure that the inhalant was taken in. We also ran into hypotension with our patient but were able to discuss with our instructor what should be done to correct the hypotension. Before we knew it our patient was breathing on it's own and the hypotension was resolved! We also took our patient from a non-rebreathing system to a rebreathing system after a set amount of time. What lasted for about 3 hours (from setting up our equipment, preparing our station for IV catheter/ETT/etc, the physical exam, having our protocol approved and a discussion with the professor about complications/etc., acquiring the drugs from the pharmacy in the veterinary teaching hospital, etc etc.), felt like it flew by! Before we knew it we were waking our patient back up and cleaning up our lab space and equipment, making sure to leave everything the way we found it (just as important as the rest of the procedure!).
And last but not least is our Diagnostic Imaging course. We have used a kennel dog on separate occasions to learn about our digital radiograph machine in our teaching hospital as well as to become familiar with the ultrasound equipment. For our radiograph machine lab we discussed proper positioning, how to take measurements of our patient for the settings when taking a radiograph, how the image can be adjusted after it is taken, etc. all while discussing the basics of the x-ray machine (anode, cathode, mAs, kVp, and so on). We talked about very important safety measures to take when performing a radiograph (measures that I have seen not taken seriously by clinic employees...so important to know the dangers of radiation from x-rays and how you can protect yourself and staff). During the ultrasound lab we focused on the abdominal structures such as the liver, spleen, kidneys, bladder, stomach, intestines, etc. while applying knowledge that we have gathered from class such as artifacts on an ultrasound image (each of us in the group took turns finding the big ones: liver, spleen, kidneys, bladder). In the classroom, learning about ultrasounds, the equipment, and the images that the machine gives you did not come easily for me. It was like a foreign language! The only thing that really helped me were some YouTube videos that a fellow colleague shared with me. It really helped me to put together what I was learning in class. I absolutely love this class and you are taught by the very man that wrote the book you use for this class (and that other veterinary schools utilize!), Dr. Donald Thrall.
I'm extremely thankful for the learning experiences all of these labs have given me. I am also so thrilled to finally be putting my classroom knowledge to use in clinical situations. This semester has definitely been a change in pace for me. Semesters in the past have felt like an uphill battle at times. Where last semester (my 4th semester) had a marathon of exams from like the 3rd week to the 13th week of the semester, this semester is much more relaxed and not overwhelming. The professors are wonderful and all the classes have been so very informative (not to say previous semesters are any less). I feel like this semester is the beginning of the semesters that are meant to teach us students how to take our classroom knowledge and apply it to clinically relevant situations and really understand that knowledge to its fullest.
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