Hello again from Michigan State University's Large Animal Hospital! I am currently in my third week of working the night shift, and things are a little different than when I was working during the days. The hospital is much quieter, and unless there are emergency patients, it is just myself and two to three technicians in the hospital. The biggest portion of my duties is hourly treatments, which includes monitoring vital signs, feeding, cleaning stalls, and administering medications. I also do some cleaning and restocking of supplies.
When an emergency comes in, I am often responsible for restraining the patient while the doctor and student on the case take a history, do a physical exam and any other testing or procedures that may need to be done before the patient is admitted and put into a stall. I also run blood work, such as a packed cell volume/total solids, and a venous blood gas. These basic tests allow the doctor to asses the patients hydration, acid-base status, oxygenation levels, and can give an indication if sepsis is a concern. During colic emergencies, I also restrain the horse during an abdominal ultrasound, rectal exam, and while the nasogastric tube is passed.
My first two weeks on the night shift were very quiet, with few to no emergencies coming in each night, and very few patients in the hospital. Last night, however, we made up for two slow weeks! A mare and foal, a colic, an alpaca, a calf, and a potbelly pig all came in on emergency, along with quite a few patients already in the hospital. The foal was a two day old Belgian filly that presented for being dull and poor nursing. On admission, the foal was found to be dehydrated with entropion in both eyelids. Entropion is a condition that causes the eyelid to roll in towards the eyeball, and the eyelashes can cause corneal ulceration. This was thought to be due to the dehydration, and not a congenital defect. The foal also had injected, tacky mucus membranes, was tachycardic, bloated with decreased gut sounds and loose manure on the tail. Initial blood work showed that the foal was hypoglycemic and dehydrated. An IV catheter was placed an a 10% dextrose drip was started to correct for the hypoglycemia while additional diagnostics were performed. A venous blood gas indicated that the foal had a decreased bicarbonate, increased lactate and creatinine, and decreased white blood cell count. These results indicated toxic changes and that sepsis was a possibility for this foal. An abdominal ultrasound was performed, which showed loops of distended small intestine. A nasogastric tube was passed and the foal produced 1 liter of reflux. Due to this, feeding was not started last night. We continued to check for reflux and a dextrose CRI was started to support the foal's blood glucose through the night. The entropion was corrected with a few sutures in the lower eyelid to hold the eyelashes away from the cornea until the condition corrects itself with adequate hydration.
Today, I am happy to report that the filly is doing much better. She is able to rise on her own and run circles around me in the stall! The reflux has resolved, and we have been feeding her 100ml of her dam's milk via the tube every two hours. IV antibiotics were started last night, and continue today. She remains on IV fluids, dextrose, and total parenteral nutrition.Her eyes look much better, and she is quite spunky. The only negative change is that she has developed some loose, foul smelling manure. If this gets any worse she will have to be moved to the Pegasus Center to our isolation unit.
This week and next week will both be short weeks for me. I leave early Friday morning for an AAEP Conference in North Carolina. I won't be back to work until Thursday evening next week. The AAEP Summer Focus Conference is offering a student track that offers dry labs in radiography, podiatry, and ophthalmology. For the remainder of the conference, students can either attend sessions on ambulatory equine medicine or lameness. I hope to use this time to review my equine limb anatomy and radiography skills. My in-laws live about an hour away from where the conference is, my wife and I are also using this trip as a mini-family vacation.
No comments:
Post a Comment