Thought I’d do a quick summary review of my first ever rotation week! To serve as an educational/ sentimental purpose for the future when I look back and see how far we’ve come.
I cannot believe it is the end of the week already! (well, not quite, as I still have to go in tomorrow eve for a hospital treatments shift heh) This week was pretty intense but super fun yet rewarding!
Day 1 consisted of our introduction, it felt a little bit chaotic at first because we weren’t familiar with using the system to look up hospital records, (thank you kind intern J for helping us out!) who to refer to for things etc.. I also felt a little bit bad for asking lots of questions to the clinicians/ interns (thanks for your patience! heh) because I was double-triple checking myself to make sure I did the right thing (from asking history, where to bring patient, which sheet to fill in…)
Notes from day 1:
- When taking history, quantify the degree of inappetence, dehydration or lethargy using scales or percentages. (eg % of weight loss *measured in records* over a specific period of time or ask ”on a scale of 1-10 how would you rate Poppy’s change in appetite in [insert window of time’]”) This is important to quantify so it’s not entirely subjective!
- Always ask if their pet has travelled abroad!!
- Presenting on rounds: Summarise your case with succinct points (significant findings instead of every single test you did), have a list of differentials ready and be prepared to answer the questions ‘what is your plan/ what is the next step’ ! (talking with all eyes on you can be daunting, but with practice it can only get better!!! back yourself!!
Day 2 was a little bit busy for me because I was juggling 3 cases at one point and had a quick lunch – the combination of stress and eating quickly didn’t go well with my stomach, ended up with cramps throughout the day haha! But I got to practice taking bloods and putting in IV catheters so that was good, note to self to learn how to be more confident/ back myself when doing things under time pressure next time.
Notes for day 2
- Use the correct sheets to SOAP your patients! (Orange for first admit, blue for the next day sheet) Remember to double check the assessment and plan with your clinician, as it can get a bit busy at times!
- Need to work on taking succinct history notes while balancing a conversation with the owner, any tips of advice would be welcomed please!
- Learn to ask more detailed questions to differentiate between the conditions and terms, eg. if pet is having a urinary issue, ask questions to dfx dysuria, stranguria, incontinence, pollakiuria etc (same for vomit/regurg/coughing)
- extra note: could quickly look up differentials for potential conditions of your patient to impress clinician 😉
Day 3 and 4 somehow blurred into one but overall I think our group got into the swing of things and (somewhat) knew what we were doing. I found that making phone calls to owners was quite daunting, but hey like everything it takes practice! We also had differential rounds in the morning where the clinician comes and goes through the differentials of a condition which was pretty useful.
Struggled with IV catheter placement and got some pretty neat tips from the intern 🙂 !
- Loosen everything when you open your packet- give the hub and stylet a wiggle, give the bung a wiggle, so that when you’re in the vein you don’t struggle to remove those components
- Steady the vein with your non-dominant hand (dominant hand is holding the catheter) by getting a firm grip and using thumb to ‘steady’ the vein parallel-y *veins can be very mobile*
- Using your thumb and forefinger to pinch the wing holder- so u can use the other hand holding the stylet piece to flick off the hub – ADVANCE THE HUB AND NOT pull out the stylet – I never use to understand it when they tell me this but I think I understand now- the reason is simple, because if u remove the stylet before advancing the catheter it will kink 😅
- It is ok to make a mistake when presenting on rounds (like mixing up the gender heh) the team is really supportive and it makes for a good laugh sometimes.
- Still learning how to balance the importance of taking a TPR and trying not to stress your patient out. Sometimes when you have a non compliant patient, you have to persevere (ask for help as well!) and take a temperature for example if you are worried about pyrexia for the patient.
Day 5 started out with some seminars by the clinicians, followed by a clinical pathology case discussion where we were given practice cases (blood results, short hx) to work on. I found the clin path seminar super useful because amongst other things I finally understood the mysterious anion gap (that no one really talks about x)!)
In a nut shell, your blood contains a balance of positive and negative ions, with your main positive ions (Na+, K+) commonly measured on biochem test and your negative ions (Cl-, HCO3-) less commonly measured. The anion gap consists of the unmeasured ions, to simplify, anion gap = (Na+ + K+) – (Cl- + HCO3-) Examples of unmeasured ions are urea, lactate, phosphate, ethylene glycol, albumin.. etc. Low anion gap can occur if you have more negative ions, conversely high anion gap if you have more positive ions. The key takeaways in terms of interpreting your blood sample is:
- Low anion gap can be caused by low albumin levels
- High anion gap can be caused by increase in lactate (if bacteria producing them/septic), ketone bodies (if diabetic for eg), ethylene glycol (if toxicity), phosphate, urea
This is how I understood it anyway, please correct me if not! x
❤️Grateful for an amazing medicine team who were so kind + patient to guide us this past week !