I’m trying to recall the last time I pulled an all-nighter. It was the night before an anesthesia test, if I recall correctly. I was sitting on the couch with a stack of cards trying desperately to remember the effects on the respiratory system of propofol versus ket-val.I remembered it for a while, kind of.
We spend a ridiculous amount of time in vet school memorizing facts, but there is nothing- and I do mean nothing- like experience to drive that point home.
For example: We are taught that when you anesthetize a patient, they should have an intravenous catheter. They just should. There are too many things on that chart of stuff I had to memorize that can go wrong, and if they do you want quick access to the veins to try and fix it.
You learn this, and say OK, then you get out into the real world and perhaps you have a boss who scoffs at this idea. Too expensive! he says, and hands you a syringe with some drugs in it. He offered the owners a catheter, after all, and they said no. He tried and that is all he can do.
There are choices. You can say no, I’m not comfortable with that, and walk away. Or you can do it.
Either way you’ll learn something. One way you find out your limits- and that of your boss. The other way, you learn that propoflo does indeed cause significant respiratory depression, which could perhaps cause arrest when given too fast. And then when the blood pressure plummets and you can’t get a catheter in, your boss will be certain to blame you for screwing up although it was his crummy protocol that made it happen in the first place.
This happened to me one night early in my career. I chose route number one. My colleague, 2 months out of vet school and too needful of a job to say anything, took route 2. She learned lotsandlotsandlots that night.
The dog survived. She quit a month later.
No IV, no anesthetic is my rule for my animals. Same as pre op blood work. These should be basic. Most clinics when I live don’t use IV’s on a regular basis, telling you it really is not necessary for routine procedures. It’s all routine until it isn’t. Or you hear it is only a dental.. right…. Not using an IV is a deal breaker for me.
Are we the only ones up??
Dr. V says
Me too. We’re not the cheapest place in town, but I’m very proud of our protocol. Safest one we can come up with and aggressive pain management from cruciates to cat neuters, no opting out.
I believe we might be the only ones up.
no opting out, I like that.. The clinic I go to they now use a form and you opt out of what you don’t want… there was even one to opt of of pain meds.. WTF .. sorry but what’s with that.. My boy was having a small tumor removed from his leg last Aug and the tech actually asked me if I wanted him to have pain meds.. I asked if she was kidding me, she then went on to tell me that clients get upset about paying for them without being asked..
She also asked if I wanted it sent for diagnostics becaue I didn’t have to she said… hmmm yes that’s why its coming off.. we don’t know what it is.
There was no IV listed on the opt out so I asked and she said well it’s not major surgery he proably doesn’t need it.. YES he does.
The tumor was a haemangiopericytoma.. We didn’t get clear margins ( not possible ) but it’s one of the better cancers to have so we wait and see.
There are just some things worth the money.
I’m still awake! I run into the catheter issue at work a lot, actually. If I’m doing a short procedure with reversible anesthesia, I might be ok with it, depending on the patient’s age and health status. If an owner declines an IV catheter, I make darn sure they understand what they are declining and that their pet has a higher risk of complications, including death. I refuse to use propofol without some form of IV access and intubation supplies at the ready. My anesthesiology prof drilled that one intio my brain on that rotation. Unfortunately in my area, my ER clinic does service some lower income areas, and not everyone can do the ‘ideal’ thing for their pet, like the HBC chihuahua with a fractured pelvis and tail that I had to send home the other night with a single shot of hydromorphone, a few days of oral buprenorphine and a script for tramadol. She had $300 total to fix her dog. She spent over $200 of it with me. She said her regular vet takes payment plans (which we don’t). I would have loved to monitor her for contusions, internal bleeding, and shock on an IV, but the owner couldn’t afford it. I am liberal with AMA (against medical advice) forms when I need them. ER medicine can be frustrating sometimes (which is why I wrote the guest blog for everyone!)