Helpful hints?

Re: Helpful hints?

Noweia — Mon, 25 Aug 2014 19:48:08 GMT

Intubeaze is great on RTA wounds - stings when sprayed on but then numbs the whole area. Works wonders for road rash and large open areas.

Re: Helpful hints?

Julian Earl — Fri, 22 Aug 2014 22:50:56 GMT

[quote user="Evelyn Barbour-Hill"]

[quote user="Anthony Todd"]

[quote user="Julian Earl"]Believe it or not inject through the open surface of the exposed tissue, not through the skin adjacent[/quote]

Wow, at last someone states this, and not the dogma that you will introduce infection into sterile tissue. How can we get doctors to realise it though!?

Bloody 'ell it hurts when they stick the [22G!] needle into the hypersensitive area a centimeter from the edge of the cut!

I don't think I ever had to twitch a horse with a cut if I squirted a bit of local on the open wound point of entry, waited, and then started the infiltration from that point.

[/quote]

I genuinely thought that this what was what everybody did, and I wondered why it was offerred as a tip.

[/quote]

Well I certainly wasn't taught this and learnt from experience after trying it on a traumatised patient, and continued because it was so much better. The fact that I wasn't taught it is precisely why I put the idea in this thread. By the way, the local anaesthetic itself still stings but my suggestion is to avoid puncturing the adjacent skin with the needle, sensitive as has been pointed out. The tissue of an open wound surface is not sensitive to the needle itself, that is my main point[ no puns intended!]

Regarding having yourself stitched without local , fair enough, a colleague suture my scalp after banging my head, but years ago I had my lip sutured and if you think fingertips are sensitive, try your lip! It felt like a knitting needle albeit a sharp one. The doc told me the local would hurt more but I'm not sure I believe him.

Re: Helpful hints?

katja wagner — Fri, 22 Aug 2014 20:14:32 GMT

proxymetacaine minims works well as local to place iv catheter or void blood,also good for plucking eyebrows!

Re: Helpful hints?

Hannah Wynne Richards — Fri, 22 Aug 2014 16:24:42 GMT

I'm just waiting for some uni person to condemn all these hints - because practitioner observations are automatically invalid!

Wynne

Re: Helpful hints?

Anthony Dennison — Fri, 22 Aug 2014 15:46:06 GMT

[quote user="Neil Wheadon"] In one practice I've worked in they squirt intubease and the nurses swear by it (everything is catherterised)[/quote]

I've done this before, works for animals that jump off the needle when trying to take a jugular blood sample too. Just think it works quicker than EMLA cream, though you have to give a liberal spray.

Re: Helpful hints?

Neil Wheadon — Fri, 22 Aug 2014 14:23:56 GMT

Seems to be a local anaesthesia thread so here goes

Analgesia for catheters - Clip, then rub spirit reasonably hard onto the area with cotton wool, then apply the EMLA, this seems to really help. In one practice I've worked in they squirt intubease and the nurses swear by it (everything is catherterised)

Neil

Re: Helpful hints?

Anne Seawright — Fri, 22 Aug 2014 10:00:14 GMT

[quote user="Marie Kubiak"]

[quote user="Anthony Todd"]

Am I right in thinking medicos never ever do it, always in the hypersensitive area beside the cut?

[/quote]

Not sure how widely it is done but some certainly do. My mother, when feeling sympathetic, used to inject local through wounds before stitching me back together and it definitely did still sting. The rest of the time she just did it without local, mistakenly hoping I'd learn my lesson!

Marie

[/quote] I thought it was the ph of the local that made it sting so while placing it on the open wound rather than injecting it would obviously remove the pain from the needle prick, it will still sting. I have heard of medical specialists adding sodium bicarbonate to neutralise the acidity before using local.

Re: Helpful hints?

Marie Kubiak — Fri, 22 Aug 2014 08:06:44 GMT

[quote user="Anthony Todd"]

Am I right in thinking medicos never ever do it, always in the hypersensitive area beside the cut?

[/quote]

Marie

Re: Helpful hints?

Anthony Todd — Thu, 21 Aug 2014 22:58:27 GMT

[quote user="mariette asselbergs"]

To be fair to the younger generation vets Anthony: in a CPD course on Emergency stuff I was told that it was a good thing to cover fresh wounds of RTA victims with a swab soaked in local anaesthetic. Have done that ever since and seems a kind thing to do.

Mariette

[/quote]

Never heard of that one either but what a good thing to do!

Re: Helpful hints?

Michael Woodhouse — Thu, 21 Aug 2014 22:55:19 GMT

[quote user="Anthony Todd"]Bloody 'ell it hurts when they stick the [22G!] needle into the hypersensitive area a centimeter from the edge of the cut![/quote]

Be a man like me and refuse local - the doctor didn't like that.

Re: Helpful hints?

mariette asselbergs — Thu, 21 Aug 2014 22:26:50 GMT

Mariette

Re: Helpful hints?

Anthony Todd — Thu, 21 Aug 2014 18:48:23 GMT

[quote user="Evelyn Barbour-Hill"]I genuinely thought that this what was what everybody did, and I wondered why it was offerred as a tip.[/quote]

gosh no, we were taught it was a capital crime and septicaemia in the patient was the inevitable result. i never saw the slightest reaction in the tissue in my stitch-ups.

Am I right in thinking medicos never ever do it, always in the hypersensitive area beside the cut?

Re: Helpful hints?

Evelyn Barbour-Hill — Thu, 21 Aug 2014 17:45:53 GMT

[quote user="Anthony Todd"]

[quote user="Julian Earl"]Believe it or not inject through the open surface of the exposed tissue, not through the skin adjacent[/quote]

Wow, at last someone states this, and not the dogma that you will introduce infection into sterile tissue. How can we get doctors to realise it though!?

Bloody 'ell it hurts when they stick the [22G!] needle into the hypersensitive area a centimeter from the edge of the cut!

I don't think I ever had to twitch a horse with a cut if I squirted a bit of local on the open wound point of entry, waited, and then started the infiltration from that point.

[/quote]

I genuinely thought that this what was what everybody did, and I wondered why it was offerred as a tip.

Re: Helpful hints?

Anthony Todd — Thu, 21 Aug 2014 16:42:02 GMT

[quote user="Julian Earl"]Believe it or not inject through the open surface of the exposed tissue, not through the skin adjacent[/quote]

Wow, at last someone states this, and not the dogma that you will introduce infection into sterile tissue. How can we get doctors to realise it though!?

Bloody 'ell it hurts when they stick the [22G!] needle into the hypersensitive area a centimeter from the edge of the cut!

I don't think I ever had to twitch a horse with a cut if I squirted a bit of local on the open wound point of entry, waited, and then started the infiltration from that point.

Re: Helpful hints?

Miriam Lodewyks — Wed, 20 Aug 2014 23:15:17 GMT

Good idea Julian. One helpful tip for anxious dogs in the consult room: I always ask clients to let them off the leash, then ignore the dog for a couple minutes while I take the history. It allows me to assess their general demeanour and anxiety level and it really helps the dogs relax. The worst thing is when owners drag them through the door and plonk them right on the table, must be terrifying for the poor animal.

Re: Helpful hints?

Julian Earl — Wed, 20 Aug 2014 19:16:42 GMT

@lo Bob,

No I haven't seen those but will approach the VBF to see if I can offer anything. I don't work now but don't like not being a proper vet anymore.

Re: Helpful hints?

bob lehner — Tue, 19 Aug 2014 11:21:21 GMT

All good tips.

Have you seen the VBF 'Veterinary Tips' booklets - Vols 1 and just recently 2 ? Feature some of the things you have discussed - plus others.

Re: Helpful hints?

Julian Earl — Mon, 18 Aug 2014 21:35:28 GMT

[quote user="Martin Atkinson"]

Sorry to hear you've given up getting back to work but hopefully you can still get out on your bike which is of course much more important!

[/quote]

Thanks Martin, Yes I had got back on my bike last year, completing a local sportive in a decent time for which my club gave me an honorary award for not quitting despite my injuries. I rode another modest sportive this spring then managed to break my right arm last month so stopping my progress back to fitness. This chornic pain from new injuries is no fun,I can promise you! I doubt I'll work again but hopefully despite my fractured skull, most of the useful information there hasn't all leaked out and I can make helpful suggestions?

also, yes I would be willing to mentor folk, that's partly why I started the thread.

Re: Helpful hints?

Nicola Cole — Mon, 18 Aug 2014 20:36:46 GMT

Mentoring/clinical experience roles: I'm not sure how you get these jobs and whether you have already looked in to it-but what about final year students when they're doing their 'preparing for practice' course or whatever it's called these days? All the points you've mentioned are the really useful practical things that you need when you graduate....that you wish someone had mentioned but the course didn't cover!

Re: Helpful hints?

Martin Atkinson — Mon, 18 Aug 2014 14:14:46 GMT

[quote user="katja wagner"]

I would have loved somebody to give me tips and hints when i was a new graduate,also somewhere were i could have asked "silly" questions without made to feel like a moron.

[/quote] Don't worry Katja I still ask silly questions even 39 years after graduation and I probably am a moron but the trick is to ask difficult ones no-one can answer which makes you sound intelligent!!

Re: Helpful hints?

katja wagner — Mon, 18 Aug 2014 13:43:39 GMT

I would have loved somebody to give me tips and hints when i was a new graduate,also somewhere were i could have asked "silly" questions without made to feel like a moron.

maybe Arlo could set up a new graduate section with a mentor like yourself ?

katja

Re: Helpful hints?

Martin Atkinson — Mon, 18 Aug 2014 12:53:22 GMT

Sorry to hear you've given up getting back to work but hopefully you can still get out on your bike which is of course much more important!