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Tag: Ears

  • Triage, pt 2: secondary survey

    Triage, pt 2: secondary survey

    Secondary survey refers to the detailed physical examination performed after the primary survey, and should only be performed once the patient has been adequately stabilised.

    It is always important to perform physical examinations systematically to avoid overlooking organ systems. This could be difficult in a stressful emergency situation, so one way to remind yourself is with the following acronym:

    A CRASH PLAN

    A – Airway

    • respiratory pattern
    • airway patency

    C – Cardiovascular

    • circulation
    • heart sounds
    • pulses
    • capillary refill time

    R – Respiratory

    • respiratory sounds
    • bruising
    • external wounds to chest

    A – Abdomen

    • palpation
    • bruising
    • external wounds
    • fast ultrasound:
      • abdomen:
        • free fluid (diaphragmatic-hepatic site, splenorenal site, cysto-colic site, hepatorenal site)
        • bladder integrity
      • thorax (do this at the same time as assessing the abdominal cavity):
        • ensure you do both left and right sides
        • chest tube site
        • pericardial site
        • wet/dry/third space

    S – Spine and tail

    • gait and posture
    • pain sensation
    • crepitus

    H – Head

    • mentation
    • cognitive function
    • cranial nerves
    • external wounds/bruising
    • eyes – including symmetry, third eyelids, eye position, haemorrhage and detailed ophthalmological examination
    • ears
    • nose
    CPR
    The secondary survey will help identify any concurrent problems not seen on the primary survey.

    P – Pelvis

    • wounds
    • bruising
    • pain
    • cepitus
    • perineum
    • external genitalia

    L – Limbs

    • deformities
    • fractures
    • pain
    • bruising
    • wounds
    • weight bearing vs non-weight bearing

    A – Arteries

    • all accessible superficial arteries – pulses and pressure

    N – Nerves

    • mentation
    • cranial nerves
    • conscious proprioception
    • postural reflexes
    • peripheral spinal reflexes
    • withdrawal reflexes
    • deep pain
    • cutaneous trunci reflex
    • anal tone

    Stable patient

    By following the primary and secondary triage processes consistently, you should be able to quickly determine the order of criticalness of patients, institute appropriate resuscitative measures and manage life-threatening injuries. Then, with your thorough physical examination, identify any other concurrent problems not seen on the primary survey.

    Overall, you have a stable patient, and are able to formulate an appropriate diagnostic and treatment plan.

  • The revision roller coaster

    The revision roller coaster

    At this stage of the year, it’s hard for me to write about anything but revision. So, for those of you reading this as a means to escape, I can only apologise. At the same time, if your idea of time off from studying is reading my work-related articles, then I think we need to have a little sit down and a talk about healthy revision outlets…

    With my last ever university exams (yeah, like, ever!) rearing their heads, I’m finding my own is a bit of a jumble.

    The last several weeks before the big day can often feel, at least for me, like a bit of a roller coaster ride. There are ups and downs; terrifying “grip the handlebar” kind of moments; and occasional points where you reach the top, clear the clouds and see everything below you with level-headed clarity – and then the whole thing starts again from the beginning.

    Happy birthday to me?

    First of all there’s the build-up. Personally, I think the build-up to exams can be worse than actually taking the things.

    As somebody with a birthday plonked squarely in early May, this has led to the anniversary of my birth becoming somewhat bittersweet over my past 20 (yes, 20) years of education. I’ve even had friends and classmates willing me not to age, just to fend off the dreaded exams.

    If you’re lucky, it will have been a good year since your last exams, so it’s almost easy to tell yourself it can’t really be as bad as you remember it, and sure, you’re here to tell the tale!

    So what’s all the fuss about? Besides, it’s months away, right… right?

    Then the realisation hits you that those months have melted away into a measly finger-countable number of weeks. This is the feeling akin to the hard “thunk” of that metal seat belt bar strapping you in before the roller coaster ride. You’re locked in now, and the only way is onwards.

    Image © Anna / Adobe Stock

    Highs and lows

    Like with any good roller coaster, the journey of revision is marked by a series of highs and lows. You can sometimes spend a day or two feeling really very good about yourself, quite smug actually, especially in the early swathes of revision while your brain juices are still flowing nicely.

    “Wow”, you think to yourself. “I remember everything I read today. It may have taken 13 years of exam practice, but I think I’m getting the hang of this revision malarkey after all”.

    Then a day comes when you wake up and it feels as though everything you once knew has fallen out of your ears overnight. Your brain feels like a clogged artery and the juices just can’t quite make their way round the bends. Paragraphs, facts and figures can start to swim together. Do horses lay eggs? Do chickens neigh?

    It can feel like five years’ worth of content is trying to make it’s way to the forefront of your mind all at once, with no polite or mannerly order.

    Image © Jacob Lund / Adobe Stock

    Stay in control

    The important thing, I find, in order not to let the roller coaster get the better of you, is to make everything else in your life as smooth a ride as possible. Obviously, this is easier said than done, I’m no fool. Life will always throw things at you, especially when you feel like you already have enough on your plate, but start by controlling the things you can.

    Remember the basics:

    • Sleep.
    • Eat.
    • Hydrate.
    • Practice self-care.

    Treat yourself to that leftover easter chocolate, keep making plans with friends as something to look forward to, and let yourself clock off for a couple of hours before bed.

    It all matters

    It has been scientifically proven that increased levels of stress actually reduce our ability to take in new information – which is, ironically, something on this year’s syllabus – as do lack of sleep, under-eating, dehydration and depression.

    Trying to revise under any of these conditions is like fighting with one arm behind your back, so never forget that what you do outside of your revision schedule is just as important as what’s in it.

  • The pen is mightier than the scalpel

    The pen is mightier than the scalpel

    For some, my past A-level choices of biology, chemistry and English literature may seem an odd mixture.

    At first glance, the arts and the sciences don’t seem go hand in hand, and are often viewed as polar opposites. I even remember being asked during one of my veterinary interviews if my decision to study English lit was an indication that I valued the arts above the sciences…

    As someone who had endured a considerable wealth of hours endeavouring to make it into vet school (and was, in fact, at an interview for vet school), it took me a couple of blinks before I could bring myself to answer that question.

    Words, words, words

    Since then, I am still yet to find another vet student or graduated vet who took English as their third A-level choice – perhaps because, until recently, most vet schools wouldn’t accept anything other than physics, maths or maybe economics at a push.

    With three years of the vet course down, and a master’s dissertation currently weighing on my shoulders, this truly baffles me, given that writing is such an inherent part of the scientific process.

    Whether it’s animal welfare, physiology, psychology or behaviour, almost everything we know and practice today can be attributed to some budding young scientist who did the research, wrote it up very eloquently, and had other scientists read over it diligently before they decided to write about it, too (otherwise known as a peer review).

    Similar principles

    Today, it does not matter how big of a breakthrough you make; if your grammar isn’t on point, nobody is going to publish it and your discovery may well fall on deaf ears. If you don’t know at least five different words for “furthermore” and can’t tell your colons from your semi-colons then are you even a scientist?

    I have personally always loved writing (couldn’t you tell?) and being able to combine my affinities for that with veterinary medicine sometimes feels a bit too good to be true.

    I also feel incredibly grateful for the skills my background in English have taught me. I may no longer be comparing the works of Mary Shelley and Thomas Hardy, but strangely, the same principles can be applied to literature reviews and grant proposals.

    Do what you love

    I would strongly encourage any wannabe vets not to shy away from exploring interests outside of the sciences, if that’s what you really enjoy.

    For me, an artier A-level was a really useful way to switch off the science part of my brain and recharge after a day of balancing equations – almost like my right and left brain taking turns at the wheel while the other had a little lie down.

    And who knows, if more medical schools required an A at English A-level, doctors might be know for better handwriting.

     

  • A different kind of exam

    A different kind of exam

    A veterinary career and examinations go hand in hand. I can’t count the number of papers I’ve sat over the last quarter of my life that have opened the doors to where I am now.

    If you manage to make it even half way through the vet course it can be assumed you have mastered the art of taking tests.

    But third year, I’m coming to realise, is a game changer.

    The same, but different

    I don’t think it properly dawned on me until our first day back during an afternoon practical. We were going over a routine canine examination, mimicking the role of any vet when a fresh patient comes through their doors; travelling from nose to tail, searching for abnormalities, checking mucous membranes, smelling inside the ears – the works.

    We also covered various injection sites along with their pros and cons, how and where to auscultate the lungs, and even how to wash our hands – which, it turns out, is far more complex than life up until now had led us to believe.

    Now don’t get me wrong, they hadn’t waited until third year to teach us all of this (a lot of it was basic stuff; the habits general practice workers could do in their sleep). No, the difference was that, in these practicals, we actually had real dogs.

    New experiences

    It sounds childish given our future line of work, but as any vet student will confirm, when we see an animal, any animal, but especially dogs, we get very excited. It’s not just the fact it’s a cute dog (although, I won’t lie to you, that’s also a big part of it, too), but getting to practice something you’ve spent hours, if not days, learning about in the classroom on an actual patient – even a volunteer one who’s really just there for the treats and attention is such a breath of fresh air and an experience to be jumped on.

    Palpating lymph nodes that aren’t sewn into stuffed animals, palpating an abdomen that isn’t lying on your dissection table – all these things are akin to luxury for new third years.

    But, with this rush of this new kind of learning, came to realisation of what they were preparing us for: the dreaded OSCEs – a whole new kind of exam.

    Image © stokkete/ Adobe Stock
    “Before long, we won’t be able to pass every test they throw at us by last-minute reading and flash cards” – Eleanor Goad. Image © stokkete/ Adobe Stock

    Growing up

    It’s always difficult having to start over or break out of an old routine into a new one, but when you go from pre-clinical to clinical you pretty much have to do just that. As you and your cohorts shuffle ever closer to becoming real full-fledged vets, it shouldn’t come as a surprise that you get treated more and more like one, and are expected to act a little more like one.

    Before long, we won’t be able to pass every test they throw at us by last-minute reading and flash cards. Attention to detail, compassion, patience and professionalism will begin to carry the same weight as memorising words from a page.

    In my mind, this can only be a good thing; a little scary, perhaps, but it’s also a nice reminder of where we’re headed. Working with real animals, working on problem solving – it all helps to make the future a little more tangible and less of an abstract concept.

    I don’t know how I’m going to shape up with this new style of assessment coming my way, but I’ll certainly give it my best.

  • New year, new us

    New year, new us

    With the Christmas festivities over and 2017 already upon us, many of you will have taken the time to make a new year’s resolution you won’t keep.

    new-year-quote-crop_Fotolia_chrisberic
    Image © chrisberic / fotolia.

    It is estimated only 8% of people succeed in achieving or keeping their new year’s resolution (so the odds are against you), but if you feel this is your year to make a difference, why not incorporate your four-legged friend into that lifestyle change?

    Fat cats and dumpy dogs

    A lot of resolutions will be along the lines of trying to lose weight or get fitter, and while the human population has a weight problem, obesity is also rife in the UK pet population.

    Headlines and statistics are forever telling us our pets are overweight, and my parents are sick of me enforcing a diet every time I go home to find my cats a little rounder than a few months previously. However, it wasn’t until I spent a few days consulting in first opinion small animal practice, as part of one of our final year rotations, that the problem really hit me.

    I’m used to seeing overweight pets in the consult room while on placement with other vets and I’ve witnessed the weight loss conversation more times than I can count. But on one particular morning, when I had similar conversations myself with four out of five clients, I saw the future of my veterinary career flash before me: overweight dog after overweight dog coming through the door.

    Cruel is the new kind

    Despite sounding like a broken record, I can only hope my words did not fall on deaf ears. So many owners didn’t even realise their animals were overweight – “that’s just his shape”. And yet others are fully aware, but just can’t ignore their pets’ begging.

    Dog with carrot
    Why not substitute pet treats with a healthy alternative such as carrots, Jordan suggests.

    Unfortunately, sometimes you have to be “cruel to be kind” and ignore those big round eyes that are trying to melt your heart – your dog will be better off long term being denied those extra treats, but having a healthier lifestyle.

    If you think your pet may be on the larger side of normal, vets will often run free weight clinics with the veterinary nurses to allow accurate monitoring and adjustment to diet and exercise.

    Everyday changes

    General advice would be to cut down on meal sizes and cut out treats, or at least substitute them with a healthy alternative such as carrots. Exercise should be determined on an individual basis, dependent on any existing health conditions (such as joint problems), breed and lifestyle.

    There may be a medical reason for retaining weight, so if the aforementioned doesn’t seem to be working, seek veterinary advice.

    This new year, even if you can’t keep your own resolution, why not make one for your pet and help them achieve the lifestyle they deserve? Or if you’re trying to lose weight or gain fitness yourself, why don’t you and your pet do it together?

  • Routine ear cleaning in chronically waxy ears

    Ear drops
    Consider routine ear cleaning in chronically waxy ears.

    When I attended the North American Veterinary Conference back in January, I was surprised to hear one of the dermatologists say he did not recommend cleaning ears [in chronic cases].

    That being said, I’ve heard other specialists espouse the virtues of routine cleaning from upon high.

    I’m a great believer in the rule of “if it ain’t broke, don’t fix it”, but I do see atopic dogs that develop significant build up of wax – and routine cleaning with my favorite ear cleaner twice weekly just keeps the use of prescription drugs to a minimum and increases the interval between flare ups.

    So, my tip for this week would be to consider this in certain cases.

  • The power of the food trial

    "Dog food 203365" by Anne Hornyak - Flickr: Fromm 203/365. Licensed under CC BY-SA 2.0 via Wikimedia Commons.
    Image courtesy Anne Hornyak via Flickr. Licensed under CC BY-SA 2.0 via Wikimedia Commons.

    A very itchy, erythematous young boxer with very sore ears came in to my consult room.

    A normally very docile chap, it really resented having topical treatments applied to its ear canals.

    It turned out he was passing stools three to four times a day (two is more normal) and showed signs of gastrointestinal disturbance on an intermittent basis.

    Thinking we were heading in the direction of atopic disease, I instigated a food trial, with my personal favourite, Purina HA. Three weeks later, we had a different (much better) dog.

    Amazing – particularly given only 25% of cases respond within the first three weeks of a trial. Now I have to persuade the owners we should do a re-challenge to confirm our diagnosis.

  • Five tips for your job search

     

    Image ©iStockphoto.com/scyther5

    Searching for a new job can seem like a daunting task, but there are some smart ways you can improve your hunt and bag that dream career move. Here are five top tips to help turn your job hunt into a smashing success:

    Keep your ear to the ground

    Not all employers will advertise their jobs publicly, looking to fill these vacancies by other means, such as word of mouth, recruiting internally, or headhunting. Being pro-active and sending out letters on-spec, or networking (more about that below) can provide unexpected opportunities.

    Be visible to potential employers

    There are plenty of websites these days that allow you to post your CV online. Think of it as an opportunity to put your details out to thousands of potential employers, giving them the opportunity to come to you.

    Target the right companies

    Do your research, and find the right companies for you. Think about whether you’d like to work for a small or large organisation, and spend time applying for the roles you want the most. Of course, not everyone can be too picky, but it doesn’t hurt to know the history of a company and why you’d like to work there – it shows initiative that will put you ahead of the game at interview stage.

    Network, network, network!

    Networking is essential for meeting people who might be able to help you with career prospects. You can do this in a variety of ways, from going to networking events to just signing up on LinkedIn and adding people to your online pool of acquaintances. Just remember to keep your eyes and ears open, and you might stumble across information that could help you obtain your new job.

    Stay positive

    Rejections can be very disheartening, but it’s important not to let this get you down. Persistence is key, and is one of the main attributes of any successful person, regardless of what they do for a living. Stay in the game, get back on that horse, dust yourself off and keep going!

    And lastly, we wish you the best of luck with your job search.