Surgery

1
Surgery Anesthesia

• An overview of the surgical process, patient
  safety, anesthesia, recovery, team guidelines and
  mentality.

Set to the tune of Shine On You Crazy Diamond
by Pink Floyd
?Click speaker to turn music off
2

• The following training presentation is designed
  for Rose City Vet Hospital,Inc. employees and is
  authorized for use as continuing education
• It has been designed as a general overview to
  benefit every level of knowledge

?Rose City Vet Hospital, Inc., Mike Jennings
3
Training Module Instructions

• The default slide rate is 20 seconds
• Press the S key to pause and restart
• Use the ? to review a slide
• Use the ? to move to next slide
• Once you have completed the slide show, to your
  satisfaction, take the test
• There is no time limit to complete
• You can repeat as many times as needed
• Email questions to mike.jennings_at_rcvh.net

To restart Hold down both mouse buttons for 2
seconds!
4
Training Topics

• Patient Triage
• Anesthesia Set Up
• Procedure Overview
• Anesthesia Agents
• Effective Monitoring
• Safe Recovery
• Status Report / Discharge

5
Patient Triage
Assessing Your Surgical Case
6
Patient Triage Overview

• Effective Triage
• Patient Considerations
• Fluid Support
• The Patient
• Pre-Anesthetic Diagnostics
• Client Expectations

7
Effective Triage

• Triage n., the sorting of patients (as in an
  emergency room) according to the urgency of their
  need for care.

Triage Begins at client check in and the first
person that greets the client is the initiator.
When we greet clients we should remember that
processing should be as fast as possible to
ensure the lobby is clear. Manage the patient
flow as best as you can. Put animals in the rooms
if needed. Enforce your decision and do not be
intimidated by our clients, just smile!

• Owners fear increases when there is a full lobby
• Panic induces fear in the animal as well
• Be prepared for crisis but treat each situation
  equally
• Nearly all of our situations are scheduled and
  non-emergency.

8
Effective Triage 2
Group your thoughts before speaking with
clients. Think about where you want the
conversation to go, you are in control of
gathering the required data for processing. Have
the gathering process laid out in your mind
before you initiate the conversation, that way
you complete the task efficiently.

• Introduce yourself, even if in a hurry, to take
  ownership of the client
• Immediately assess the situation and begin
  thinking of how it is going to play out. It
  helps, and comes with experience, to know how ask
  questions in logical successions.
• Always be through in what you do. It is even more
  important in a crisis situation to ensure all of
  the information is gathered. We do not want to
  waste time that a patient might not have.

9
Effective Triage 3

• Gather complete information. Scan the records to
  ensure all of the client information is complete.
  Ask clients for cell phone updates every time the
  drop off or ask for a number where they can be
  reached today.
• Have them sign all forms. If the situation is
  life threatening then they must sign an emergency
  estimate. If the animal stays an estimate must be
  signed.

Keep It Legal!
The burden of proof is on us when it comes to
medical records!
10
Effective Triage 4
Questions for Chief Complaint (Chief Complaint
is the reason for the visit) 1. What is the
reason for the visit? 2. When did you first
notice this problem? 3. Change in behavior? 4.
How is the attitude? 5. How is the appetite? 6.
Normal urination? Normal defecation? 7. Recent
lab tests and fecal? 8. Describe to me what is
occurring.
11
Effective Triage 5
Please Consider
Why the patient is here in the first place! Ask
questions pertaining to surgery for surgery
appointments, emergency questions for crisis
situations, and review medical and annual
services for patients that present for routine
exams. Consider if we have tested recently for
heartworm or an annual fecal. Look at the big
picture!
Examine The Chart
Examine The Situation
Examine The Client
Exceed All Expectations
12
Effective Triage 6
Remember that the patients life is in our hands
Work together to prevent accidents and mistakes
Take ownership of the animal and pass ownership
on to the next person
Meet with your co-workers to discuss our cases
and make time to get rounds
13
Patient Considerations
Consideration n., a matter weighed or taken into
account when formulating an opinion or plan
Always Ensure That the surgical patient has been
fasted for the previous 8 hours. As a group
ensure that the procedure is correct and all of
the orders have been approved by the owner.
Return any belongs to the owner before the animal
is taken to the treatment area. Double check
everything for the sake of the patient!
Address all of the clients questions and
concerns before the estimate is signed. It is
your responsibility to inform the client and
answer questions confidently and correctly
14
Patient Considerations 2
Assess patient age and surgical requirements for
senior patients
Inform clients regularly about the status of
their patient
Assess patient need for diagnostic profiles and
supportive care
Double check everything doses, name tags,
procedure type, etc.
Assess patient risk and modify client expectations
Gather complete information lump location,
procedure type, which tooth is the problem, etc.

• Together we can achieve the desired results
• Working as a team will save lives
• We will commit less mistakes
• Increase customer satisfaction
• Secure client base and prevent loss

15
Fluid Support

• Intravenous adj., situated, performed, or
  occurring within or entering by way of a vein
  also used in or using intravenous procedures

Intravenous Fluids help maintain blood pressure
in the anesthetized patient and will replace lost
fluids (during surgery, fluids are lost through
evaporation from body cavity surfaces, through
bleeding, and in any tissues that are being
removed). Upon completion of the procedure,
intravenous fluid therapy speeds the recovery
process by diluting the anesthetic agents
circulating in the blood stream and by enhancing
their metabolism and elimination through the
liver and kidneys. Patients that receive IV fluid
therapy generally wake up faster than those that
do not.
16
Fluid Support 2

• Additionally, studies have shown that 0.9 - 2 of
  all patients that receive general anesthesia will
  develop kidney dysfunction or failure 7-14 days
  after anesthesia. This risk is almost completely
  eliminated in patients that receive
  peri-operative intravenous fluid therapy. Sure,
  98 of all pets will have no problem, but your
  veterinarians goal is to eliminate that

unknown 2. For these reasons, all surgery
patients should receive intravenous
catheterization and fluid therapy. When making
recommendations to our clients please consider
all of these facts as well as the clients
financial ability.
Do what the Safety bee says!
Bee Smart!
Bee Safe!
17
The Patient

• Patient n., an individual awaiting or under
  medical care and treatment

As We Talked About earlier in this presentation
each animal must be looked at on an individual
basis. Assess the age first. Make sure that in
either extreme, puppy or senior, that you
recommend the best available care to our clients.
The best practices are those who have team
members that address
clients and patients on a first name basis.
Look into both of their eyes

• Be confident in the services that you recommend
• Understand the procedure you are discussing
• Take ownership of the patient

18
Pre-Anesthetic Diagnostics

• Anesthesia n., loss of sensation with or without
  loss of consciousness

Patient Assessment begins with the surgical
examination. During this brief physical the
doctor evaluates the patients vitals and overall
appearance. However, what may look normal on the
outside maybe completely abnormal on the inside.
That is why pre-anesthetic blood tests are
mandatory for our senior patients. This is the
only way we can really see what is going on
inside the patient.
Many technologies that help humans live longer,
healthier lives are available to our patients. By
performing a few basic tests our veterinarians
are able to gather a wealth of information
concerning the well-being of the patient.
19
Pre-Anesthetic Diagnostics 2

• There are four basic wellness tests your
  veterinarian will use to diagnose the health of
  your pet
• Complete Blood Count (CBC)This tests for anemia,
  infection, inflammation and the healthiness of
  blood cells.
• Chemistry TestsThese panels survey many of the
  organ systems of the body to make sure they are
  working properly.
• Thyroid Function TestsThese tests are useful in
  diagnosing increased (hyper) or decreased (hypo)
  functions of the thyroid gland.

20
Pre-Anesthetic Diagnostics 3

• UrinalysisThis test assesses the health and
  function of the urinary system. This is
  especially important in older animals to help
  with the early detection of kidney disease.

The results of laboratory tests on a patient are
compared to reference ranges established by
measuring the laboratory parameters in a group of
normal animals. The reference ranges for each
laboratory test differ between laboratories and
across species. Keep in mind that sometimes
laboratory tests need to be repeated to evaluate
trends, which may provide more information than
measurement of a single test
21
Client Expectations

• Client n., a person who engages the professional
  advice or services of another

Look at the client/patient bond

• Use reassurance and empathy in voice
• Establish trust and expectations
• Take ownership of the task
• Follow through until the end
• Update frequently
• Team communication is critical

Remember what these animals mean to the owners.
To most of our clients they are members of the
family. We are the other family doctor and we
need to practice professionalism every step of
the way.
22
Client expectations
2
Animals are like children for many people

• They fill emotional voids
• They are innocent and kind
• They provide companionship
• They increase our joy
• They listen when no one else will

Imagine this at your door!
23
Anesthesia Set Up Overview

• Catheterization
• E-tubes and Cuffs
• Drug Considerations
• The Machine
• Breathing Circuits
• Monitoring
• Equipment
• The Procedure

care
skill
life
risk
safe
value
trust
support
team
24
Procedure Overview

• Simple Wounds and Lacerations
• Elective Surgery
• Non-Elective Surgery
• Emergency Surgery
• The Crisis
• The Surgeon
• The Nurse

care
skill
life
risk
safe
value
trust
support
team
25
Anesthesia Agents Overview

• Pre-Surgical Medications
• Induction Agents
• Maintenance
• Analgesics
• Local Blocks
• Sedatives
• Chemical Restraint

care
skill
life
risk
safe
value
trust
support
team
26
Monitoring Overview

• Patient Systems / Vitals
• Calculating Fluid Rates
• Hypoventilation
• Hyperventilation
• The Sigh
• Machine Values
• Charting
• Crisis

care
skill
life
risk
safe
value
trust
support
team
27
Recovery Overview

• Procedure Completion
• Patient Transport
• Extubation
• Hypoventilation
• Patient Safety
• Excitatory Phase
• Comforting

care
skill
life
risk
safe
value
trust
support
team
28
Update/Discharge Overview

• Client Expectations
• Surgical Callback
• Charting
• Invoicing
• Go Home Instructions
• Medications
• Discharge

care
skill
life
risk
safe
value
trust
support
team
29
Vocabulary

• Glossary of terms
• Define the terms as used in this subject

30
Summary

• State what has been learned
• Define ways to apply training
• Request feedback of training session

31
Where to Get More Information

• Other training sessions
• List books, articles, electronic sources
• Consulting services, other sources