When the machines don’t beep…

Vet student in surgery

Today’s Diary Entry is sponsored by Pet Webinars

Today was another spent in clinic, it’s a good balance for me as I can study when there are no patients, and then learn when there are. This morning a puppy with multiple fractures in a front leg was presented to us, the radius and ulna both were fractured however there was some callus formation here so it was healing ok alone. However the humerus was also fractured however the bone here was displaced and so it needed to be realigned and supported for healing. The doctor here decided to do surgery to insert a plate onto the fracture of the humerus.

So I actually did a lot of the prep for the surgery which was new to me so was pretty cool, and then was given the option of assisting or doing anaesthesia. As there was a final year with me I let them assist on the surgery and took on anaesthesia as I am wholly behind the philosophy of being able to do a good anaesthesia before starting to learn surgery.

Now one of the upsides of studying here in Slovakia is that we don’t have all the latest equipment, and our monitor in the main operating theatre is probably past retirement age, and about as reliable as the England football team. The reason however this is a upside is because it means I get to learn the hard way, so thanks to our broken monitor I had a working temperature probe, and a pulse oximeter that worked only some of the time.

In addition as it was a puppy the entire body was covered by the surgical drape, the surgery being on the humerus prevented me even trying to use the ECG (though it probably wouldn’t have worked anyways). So how do you monitor a patient you cannot see, with little equipment?

Well my approach today was to use the eye position and reflex, coupled with the respiration rate and mucus membranes. Generally if a patient is breathing it means the heart is still beating – though a patient can still have a heartbeat when not breathing – and the rate and depth of respiration indicate their state. Pain for example would be indicated by rapid shallow breathing, whilst deep sleep is by steady deep breathing.

The eye position is interesting as it varies within different species, in dogs however the eyes rotate down and towards the middle at surgical levels of anaesthesia, however if it goes too deep the eye will center again. There are two reflexes associated with the eye, the palpebral reflex which is from touching the corners of the eyelids and then the corneal reflex which occurs when touching the cornea. Now I used the palpebral reflex in combination with the eye position today to help keep my anaesthesia at a surgical level.

At the end as we needed to do xrays to check the position of the plate and our xray room is not equipped for gas anaesthesia I moved over to using injectable anaesthetics for this.

Now in total the anaesthesia was around 2 hours long so I managed to maintain confidence that the patient was fine, and keep the surgical levels of anaesthesia using just these parameters. It’s not the perfect way to do anaesthesia and if I could I would use a capnography and ECG however you can only use what you have. However when it came time for the patient to recover the patient was awake within 10 minutes, and alert sitting up within 30 minutes which I think is pretty impressive for this lowly vet student.

2 thoughts on “When the machines don’t beep…

  1. That’s excellent that you got to experience monitoring like that – while I was in school we had the fanciest machines and monitoring basically involved filling in the chart from the numbers on a screen…
    ….then I get into general practice and there is no monitoring equipment. Just my nurse and her stethescope! (we have since upgraded to a pulse ox & blood pressure. had ecg but we have given up on it because it never seemed to work….)

    • I really don’t like pulse ox, you should try it on a patient during euthanasia and see how long after the heart stops the numbers stay good for. Ecg is just fiddly to get good connections, alcohol works sometimes, otherwise if you really want it you can use needles into skin and the ecg leads onto them. 🙂

      Machines are good, but they break so I think its good to learn the basics as the only way is up 🙂

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