Flipping dogs....

RE: Flipping dogs....

Beats — Fri, 13 Oct 2017 07:19:52 GMT

[quote user="bevs2251"]I have instituted a surgical IV fluids rate of 2.5-5mls/kg/hour rather than the standard 10mls/kg/hour currently taught to vet nurses and young vets. No-one could give me a scientific reason for this figure. Another e-vet forum I'm on advised that the figure of 10mls/kg/hour is too high, rather should be 2.5-5mls/kg/hour. Once again, dogma that's caught on with no real rational explanation.[/quote]

current dogma can be found at:

https://www.aaha.org/public_documents/professional/guidelines/fluid_therapy_guidelines.pdf

you'll find the standard surgical fluid rates match your own intuition

RE: Flipping dogs....

bevs2251 — Fri, 13 Oct 2017 04:03:02 GMT

I haven't been bitten yet when flipping back a glottis. That was more likely to happen in the bad old days of ACP/atropine premed & thiopentone inductions ! We now use ACP/narcotic premeds + Alfaxan IV for induction of cats and dogs. I much prefer Alfaxan to Propofol - much less volume and no apnoea.

The teacher at vet school who taught us to intubate Greyhounds without using a laryngoscope did not advocate this for all dogs or cats. Just that we should be proficient in this technique as a lot of veterinary practices (at that time mid-1980s) did not have a laryngoscope. I find that I rarely need to use one.

I have instituted a surgical IV fluids rate of 2.5-5mls/kg/hour rather than the standard 10mls/kg/hour currently taught to vet nurses and young vets. No-one could give me a scientific reason for this figure. Another e-vet forum I'm on advised that the figure of 10mls/kg/hour is too high, rather should be 2.5-5mls/kg/hour. Once again, dogma that's caught on with no real rational explanation.

RE: Flipping dogs....

Mark Hedberg — Tue, 10 Oct 2017 09:08:44 GMT

[quote user="robloxley"]

Are they sufficiently taught to question dogma, or the difference between correlation and causation?

[/quote]

Are vets taught the above either? (yes, bit of a tongue in cheek question here!) :)

RE: Flipping dogs....

Minnie — Sun, 08 Oct 2017 10:13:09 GMT

agreed but would very much depend on relevancy of the small group of experts

A lot of the problems we have now with nursing are a result of 'expert' opinion and input

RE: Flipping dogs....

Beats — Sun, 08 Oct 2017 08:31:32 GMT

Re both GDV and laryngoscopes: I esophageally intubated a Bulldog once and bagged it a few times and it GDV'd - I've used laryngoscope on these since.

Re nurse training: there is a problem with a circular loop system based on students needing to pass exams:

The colleges teach what is in the exams/syllabus.
The textbooks are written to include the information that is in the exams/syllabus.
The exam questions and syllabus, when actually updated, are based on the textbooks...

Someone needs to jump first, either the colleges, the textbook authors or the exams to get out of this silly loop. I think the drive needs to come from the examination questions / syllabus. Personally, I think one option is that City and Guilds should ditch their current database and crowd-source MCQs from the profession at large and then have these vetted for accuracy, currency and relevance by a small group of experts allowing the black-balling of silly questions. Fix the exams/syllabus and the textbooks and colleges will follow. I've posted this before, but it's still there years on, and yes... I've brought it up with City and Guilds and RCVS:

http://cdn.cityandguilds.com/ProductDocuments/Land_Based_Services/Animal_Management/7457/7457_Level_3/Assessment_materials/7457_Veterinary_Nursing_sample_questions_v3.pdf

RE: Flipping dogs....

Minnie — Sat, 07 Oct 2017 15:09:09 GMT

[quote user="David Mills"]

Quick straw poll of nurses here - all were taught it at college. Including in cats.

[/quote]

This one wasn't (qualified 1996) but think I may be able to narrow down a little when this particular 'rule' came in. I noticed some of the nurse students coming back from Telford around 2003-4 were very insistent that rolling dogs should always be legs under rather than legs over. Had never come across it before that. The only reasoning they could give was - 'it causes GDV' and 'its what we were taught'. I have never seen any actual evidence to support this either, but then a lot of what they are taught now leaves me mystified so who am I to say.

RE: Flipping dogs....

Evelyn Barbour-Hill — Fri, 06 Oct 2017 13:26:22 GMT

[quote user="bevs2251"] I have seen swab/sponge packs left behind. Happened to another vet with a cat post-extubation almost dying from suffocation before the nurse called me to check on it. Blue & gasping. Saw the swabs still in the throat & yanked out before disaster.[/quote]

All proper throat packs have strings on. Never ever put anything into the throat without a string or something to the outside.

[quote user="bevs2251"] Use no name brands so probably works out cheaper than swabs or sponge packs ! [/quote]

But jeepers, it's only a few pennies involved anyway!

I never tie anything to the endotracheal tube. Routine at end of procedure: we put three things in, we need to pull three things out. Inspect and wipe out mouth. Pull out oesophageal stethoscope. Make sure you can see string of sponge all the way back (it often gets wrapped round things including the tongue) then pull that out. Inspect again and then deflate cuff, pull tube out. In cat, use point of paper towel to hook out the big gob of mucus that often accumulates in the nasopharynx. Nurse checks she has seen throat pack , just as after a surgical operation she checks she has seen all the needles.

I have laryngoscopes, never used them. Never found a need. Decent light down the throat is necessary though.

RE: Flipping dogs....

Thomas Johnson — Fri, 06 Oct 2017 09:35:02 GMT

[quote user="Gillian Mostyn"]

[quote user="bevs2251"]I often get the nurse to hold both jaws open & use my fingers to flip the glottis then pass the tube.[/quote]

And you've never been bitten?

Genuinely confused why anyone would instruct that the use of laryngoscopes is bad. Odd. Obviously any instrument can be used badly, but I use them occasionally for brachys and very large dogs where the larynx is in the back of a big black hole....

[/quote]

I would also be very reluctant to put my hand in a dog's mouth immediately after anaesthetic induction, they're sometimes not as anaesthetised as you think!

I occasionally use laryngoscopes in dogs, particularly brachycephalic breeds, but also find that I am using them more and more frequently in cats as I find I can often place a larger diameter ET tube when I do.

RE: Flipping dogs....

Gillian Mostyn — Fri, 06 Oct 2017 07:33:43 GMT

[quote user="bevs2251"]I often get the nurse to hold both jaws open & use my fingers to flip the glottis then pass the tube.[/quote]

And you've never been bitten?

RE: Flipping dogs....

bevs2251 — Fri, 06 Oct 2017 06:33:07 GMT

I always rolled dogs legs over body for dentals until last 3 years or so when all the new young vets & nurses said it should be body over legs ! Never had a problem the old way.

I use tampons down the throat for dentals. I have seen swab/sponge packs left behind. Happened to another vet with a cat post-extubation almost dying from suffocation before the nurse called me to check on it. Blue & gasping. Saw the swabs still in the throat & yanked out before disaster.

Tampons have that nice string(s) that you cut at the knot distally so you have two strings which you tie around the E-T tube as far down as possible (below where the cuff comes off). Tampon comes out with the E-T tube. No chance of being left behind ! Tip in our Control and Therapy magazine from at least 15-20 years ago ! I use mini size for small cats, regular size for cats/small dogs, super/jumbo for big dogs. Use no name brands so probably works out cheaper than swabs or sponge packs !

I don't use laryngoscopes either. At Uni, when intubating GreyHounds, our vet teacher refused to let us use them. We had to learn to intubate without. Never needed to use one for cats. For dolichocephalic breeds, or if need to flip epiglottis back, I often get the nurse to hold both jaws open & use my fingers to flip the glottis then pass the tube. Specialists do recommend using laryngoscopes for the brachiocephalics but I haven't had to so far.

RE: Flipping dogs....

Rob Loxley — Thu, 05 Oct 2017 17:15:43 GMT

[quote user="David Mills"]Quick straw poll of nurses here - all were taught it at college. Including in cats.[/quote]

Are nurse training colleges teaching the principles behind EBVM? We still get nurses being taught - mostly by the previous generations of nurses - to never to give ACP to epileptics or boxers, to roll all animals one way, assessing the pressure in the little balloon on the et cuff to see if it's not leaking etc. Are they sufficiently taught to question dogma, or the difference between correlation and causation?

RE: Flipping dogs....

David Mills — Thu, 05 Oct 2017 16:00:12 GMT

I did a literature search on this last night and there is...nothing.

I even looked at some of the papers on GDVs - hospitalisation and stress of panting is the only risk factor identified.

The way I see it, dogs roll about all the time and don't develop GDVs.

Quick straw poll of nurses here - all were taught it at college. Including in cats.

RE: Flipping dogs....

Thomas Johnson — Mon, 25 Sep 2017 12:26:31 GMT

[quote user="Niall Taylor"]

The theory is utter claptrap. I've been asking for years for evidence and I have never heard anything other than 'I heard someone say'.

Closely related to the idea that no dog or cat should be intubated without the aid of a laryngoscope - also claptrap!

It's like a massive weight off my shoulders hearing someone else bring up the subject !

[/quote]

I had exactly the same feeling when I read through the thread! It does seem to be a very entrenched opinion in some circles though.

RE: Flipping dogs....

Niall Taylor — Sat, 23 Sep 2017 22:10:28 GMT

[quote user="bob lehner"]

There is an entrenched view in the VN community that if you have a dog in lateral recumbency and you want to turn it over onto its other side you should do so by rolling the body over the legs and absolutely NOT by flipping the legs over the body. The theory is that the latter option may lead to a gastric volvulus.

Just curious as to whether this theory has any substance to it - e.b.m - or is it a myth that has become embedded in veterinary folklore?

Anyone had any personal experience or opinions?

[/quote]

The theory is utter claptrap. I've been asking for years for evidence and I have never heard anything other than 'I heard someone say'.

Closely related to the idea that no dog or cat should be intubated without the aid of a laryngoscope - also claptrap!

It's like a massive weight off my shoulders hearing someone else bring up the subject !

Niall

RE: Flipping dogs....

Evelyn Barbour-Hill — Fri, 22 Sep 2017 15:34:31 GMT

[quote user="Joyce Whitehead"]Do you have a recommendation for throat packs Evelyn? I find they vary a lot in quality. We currently are using some that I'm not that keen on, they seem a bit small/not absorbent enough. [/quote]

Metro-packs (sponge) for everything, except cats and dogs too small to fit them in.

DEHP throat packs (we call them the teabags) 5x5 cm for everything too small for a sponge; they work very well in cats if, after moistening as usual, you roll it into a sort of tapering plug.

I also have some 6x6cm teabags for dogs that are betwixt and between, but I don't really need them.

Don't improvise with swabs or cotton wool or anything like that.

And for those with tight-fisted employers: never re-use them

RE: Flipping dogs....

Joyce Whitehead — Fri, 22 Sep 2017 14:47:46 GMT

[quote user="Evelyn Barbour-Hill"]

If they witter, point out that:

a) you do of course clear the mouth of visible fluids and solids before you turn..... don't you?

b) if there is a proper throat pack in place it will stop anything

[/quote]

Do you have a recommendation for throat packs Evelyn? I find they vary a lot in quality. We currently are using some that I'm not that keen on, they seem a bit small/not absorbent enough.

RE: Flipping dogs....

Evelyn Barbour-Hill — Fri, 22 Sep 2017 11:44:45 GMT

[quote user="Joyce Whitehead"]

Excellent Evelyn, I can start doing that during my dental procedures () and not bother if the nurses tell me off!

[/quote]

If they witter, point out that:

a) you do of course clear the mouth of visible fluids and solids before you turn..... don't you?

b) if there is a proper throat pack in place it will stop anything

RE: Flipping dogs....

Joyce Whitehead — Fri, 22 Sep 2017 09:03:37 GMT

Excellent Evelyn, I can start doing that during my dental procedures () and not bother if the nurses tell me off!

RE: Flipping dogs....

Evelyn Barbour-Hill — Thu, 21 Sep 2017 21:44:29 GMT

[quote user="Joyce Whitehead"]

I also tend to go legs over body mostly but the opposite for dentals as i feel there is less likelihood of rolling crud toward the back of the throat (even if it is into the throat pack).

[/quote]

I do, um, quite a lot of dental procedures (let us not get into that "a dental" business ) which often involve turning the patient over several times, and I have never ever turned the patient over "body over legs".

RE: Flipping dogs....

Joyce Whitehead — Thu, 21 Sep 2017 21:25:22 GMT

I also tend to go legs over body mostly but the opposite for dentals as i feel there is less likelihood of rolling crud toward the back of the throat (even if it is into the throat pack).

RE: Flipping dogs....

Nicola Cole — Thu, 21 Sep 2017 21:01:45 GMT

[quote user="Robin Grimmer"]

Always wondered why the nurses do this and then get stroppy when I flip the legs over - which is much easier! Thought it was horse****. I wonder who/where it came from?

[/quote]

No idea where it came from but I do remember being told this by someone who wasn't a nurse!

RE: Flipping dogs....

Rob Loxley — Thu, 21 Sep 2017 18:51:32 GMT

[quote user="Robin Grimmer"]I wonder who/where it came from?[/quote]

GDVs do happen in the postoperative period and people then want to put it down to something specific?

RE: Flipping dogs....

Robin Grimmer — Thu, 21 Sep 2017 18:44:21 GMT

Always wondered why the nurses do this and then get stroppy when I flip the legs over - which is much easier! Thought it was horse****. I wonder who/where it came from?

RE: Flipping dogs....

Bob Russell — Thu, 21 Sep 2017 17:21:04 GMT

We roll legs over body as a routine but body over legs for dental treatments!

Really not at all sure whether this has any basis in science or just a habit we have got into!

Some science/EBM would be rather nice.

RE: Flipping dogs....

Rob Loxley — Thu, 21 Sep 2017 17:06:44 GMT

[quote user="bob lehner"]is it a myth that has become embedded in veterinary folklore[/quote]

No evidence, is an embedded myth that many are vehemently attached to