Student Manual

Year 4 Instructional Program

Class of 2024

June 12, 2023 – June 16,

2024

Dr. Susan J. Tornquist

Lois Bates Acheson Dean

Dr. Stacy Semevolos

Associate Dean for Academic Affairs and Graduate Programs

Dr. Joe Klopfenstein Associate Dean for Student Success

Dr. Luiz Bermudez

Head, Department of Biomedical Sciences

Dr. Chris Cebra

Chair, Department of Clinical Sciences

Dr. Helio de Morais

Director, Lois Bates Acheson Veterinary Teaching Hospital

Dr. Kurt Williams

Director, Oregon Veterinary Diagnostic Laboratory

Table of Contents

Year 4 Instruction Block Schedule ...............................................................................................5

Student Policies ............................................................................................................................7

VTH Overview ...............................................................................................................................9

Large Animal Services

VTH Guidelines and Procedures ................................................................................................15

Clinic After Hours Responsibilities ............................................................................................20

Large Animal Clinical Medicine I and II (VMC 732/752) .........................................................26

Surgery I and II (VMC 734/754) ................................................................................................39

Rural Veterinary Practice I and II (VMC 735/755) ....................................................................44

Clinical Theriogenology (VMC 729) ...........................................................................................49

Emergency Care (VMC 782) .......................................................................................................51

Small Animal Services

VTH Guidelines and Procedures ................................................................................................53

After Hours Responsibilities.......................................................................................................56

Intensive Care Unit Policies and Procedures .............................................................................58

Internal Medicine I and II (VMC 791/792) ................................................................................72

Critical Care (VMC 797) ............................................................................................................120

Clinical Cardiology (VMC 719) ..................................................................................................136

Clinical Oncology (VMC 753) ......

..............................................................................................143

Core Services

VTH Pharmacy ..........................................................................................................................151

Veterinary Anesthesiology (VMC 737) ......................................................................................169

Clinical Imaging (796) ...............................................................................................................172

OVDL

Guidelines and Procedures .....................................................................................................185

Diagnostic Clinical Pathology (VMB 736) ...

.............................................................................194

Diagnostic Services (VMB 795) ................................................................................................197

Additional Courses

OHS Small Animal Primary Care (VMC 794) ..........................................................................205

Veterinary Preceptorship (VMC 780) .......................................................................................209

Small Animal Surgery (VMC 793).............................................................................................131

Approved Outside Electives.........................................................................................................212

Graduation Requirements..................................................................................215

For additional policies, procedures, and forms, visit:

https://vetmed.oregonstate.edu/students/current

Year 4 Instruction Block Schedule

The final year of the professional educational program is scheduled in 13 blocks of 4

weeks each. All rotations start on Monday and end on Sunday, with the exception of

Large Animal Emergency Care. This course starts on Sunday at 8pm and ends Monday

morning. All students that have a course scheduled for the end of the year (13, 13b,

13b2 or 13a- 3 week) will stay on this last rotation until Wednesday, June 12, 2023 at

noon.

Blocks for the academic year 2022-2023 will be as follows:

Block 1: June 19, 2023 – Jul

16, 2023

Tuesday, July 4 (1b, 1b1)

Independence Day

Block 2: July 17, 2023 – August 13, 2023

Block 3: August 14, 2023 – September 10, 2023

Block 4: September 11, 2023 – October 8, 2023

Monday, September 4 (3b, 3b2) Labor Day

Block 5: October 9, 2023 – November 5, 2023

Block 6: November 6, 2023 – December 3, 2023

Block 7: December 4, 2023 – December 31, 2022

Block 8: January 1, 2024 – January 28, 2024

Monday, January 15 (8b, 8b1) Martin Luther King Day

Block 9: January 29, 2024 – February 25, 2024

Block 10: February 26, 2024 – March 24, 2024

Block 11: March 25, 2024 – April 21, 2024

Block 12: April 22, 2024 – May 19, 2024

Block 13: May 20, 2024 – June 16, 2024 (released Wednesday, June 12)

Monday, May 27 (13a, 13a2)

Memorial Da

Monday holiday rule: Students stay on an extra day to cover Monday holidays.

The next block starts on Tuesday instead of the normal Monday. Please note this

when making any plans.

Schedule Changes: Changes are not permitted without the approval of the course

coordinator. If you need to be absent during a block for any reason you must fill out

the standard absence form in advance and have it signed by the Associate Dean for

Student and Academic Affairs. If you have an emergency or become ill, you need to

notify the appropriate people of your absence as soon as possible. You are

responsible for contacting Jason Tanenbaum to schedule make up days of rotations

if needed.

CCVM Student Policies

Absence Policy- Year 4

This policy is also listed on the CCVM website.

http://vetmed.oregonstate.edu/students/current/absences

Students in both elective and required clinical rotations are allowed to have no more than

0.5 days of excused absence per 1-week block, with a maximum of 5 excused days of

absence during the senior year. The following are considered EXCUSED absences:

Job interviews

National or State licensing boards

A medical or family emergency

Scheduled medical appointments

Military or legal obligation such as subpoena or jury duty

Other personal circumstances necessitating absence from the block will be considered

UNEXCUSED, unless the course leader and duty clinician to which the student is assigned

deem it appropriate to classify as an EXCUSED absence. Except for emergencies, students

must complete a Request to be Absent Form (available in the dean’s office) for ALL

anticipated absences. The form should be completed and returned to the Associate Dean

for Student and Academic Affairs. Except in emergencies, if not submitted at least 1 week

prior to the absence, the absence will automatically be considered UNEXCUSED.

When a student has greater than 0.5 days of excused absence/1 week of block time or ANY

unexcused absence the student will be expected to make up that time along with any after-

hours emergency time associated with the block. If, in the opinion of the course leader,

absences were such that the student’s learning opportunities were sufficiently reduced by

the absences, the student may be required to repeat the entire block. Until absenteeism is

made up, the student shall receive a grade of INCOMPLETE.

Grading

Students will receive “Pass” or “No Pass” for all rotations and electives in senior year.

Instructors will establish criteria to evaluate student performance, and students will

need to achieve a minimum score of 70% to pass. If a student does not perform

satisfactorily, they will need to repeat the block, following the Academic Standards

policy. The instructor may require a student to retake part or all of a block if they are

repeatedly tardy or absent without an excused absence. Students must pass all core

rotations to be allowed to graduate from the DVM program. Additional details about the

year four academic process can be found in the Academic Standards Policy.

Pet policy

Dogs, cats, and other pets, by University rules, are not allowed in buildings unless they are

part of the teaching program, or here as a patient. Animals here for teaching purposes

and appointments must be properly housed within the Teaching Laboratory or Veterinary

Teaching Hospital. Please leave your pets at home. Pets are not allowed to be kept in

vehicles in the College’s parking lots.

Pregnancy, Disabled and Seriously Ill Students

The veterinary curriculum is both mentally and physically rigorous. Veterinary students

are potentially exposed to materials and procedures that may result in physical or

psychological injury. Traumatic injuries are an inherent risk of your chosen profession

whether it be by direct contact with animals or equipment necessary to diagnose and treat

disease or as a result of exposure to potentially hazardous chemicals or agents. Physical,

academic and emotional stressors are also present that may lead to psychological distress.

Injury may be increased when a student is pregnant, trying to become pregnant, disabled

and/or seriously ill.

The CCVM realizes that individuals, who are pregnant, may become pregnant, are

disabled or seriously ill have the right and responsibility to make decisions for themselves

concerning their condition. The CCVM may not discriminate against these individuals

based on their condition and the student should expect appropriate consideration from

fellow students, staff and faculty.

The CCVM will provide reasonable accommodations to all students regardless of

disabilities to the extent possible in classes and clinical rotations consistent with Oregon

State University policies, state and federal law unless their presence constitutes a risk to

the health and well-being of fellow classmates, staff, house officers or faculty. This risk will

be determined by the Associate Dean of Student Success and Department of Clinical

Sciences Chair. The following recommendations are for students who are pregnant,

attempting to become pregnant, disabled (temporarily or permanently) or seriously ill:

1. The student should notify his/her healthcare provider of their condition and of

the curricular requirements to develop a plan that is appropriate for the

student’s condition. The healthcare provider may contact the Associate Dean or

Department Chair to assist in this assessment

2. The student should provide the Associate Dean with a signed statement from the

healthcare provider that defines the risks that the student is exposed to

3. The student should notify the Associate Dean of his/her pregnancy, disability or

illness as early as possible so steps can be taken to decide the best course of

action for the student

The student will work with their healthcare provider and the Associate Dean of students

then may elect one of the following:

1. Continuation as a student with no change in schedule or activities and a

written acknowledgement of the risks involved

2. Continue as a student with schedule and/or activity changes and a written

acknowledgement that program completion may be delayed, and hazards may

still exist

3. Withdraw from the DVM program permanently or request readmission

through the Student’s Progress Committee

Lois Bates Acheson Veterinary Teaching Hospital

Dr. Helio de Morais

Director, Lois Bates Acheson Veterinary Teaching Hospital

Hospital Mission

The mission of the Oregon State University, Lois Bates Acheson Veterinary Teaching

Hospital (VTH) is to provide superior clinical instruction as part of a professional

veterinary curriculum; to provide high quality patient care and customer service; to serve

as a referral and consultation center for veterinary practitioners as well as governmental

and non-governmental agencies; to conduct original clinical research on emerging animal

and human health concerns; and to offer an intellectual and academic atmosphere that

supports the practice of innovative veterinary medicine.

Organization

The Veterinary Teaching Hospital is organized into service & support areas:

Clinical Service Areas

Anesthesiology

Diagnostic Imaging

Large Animal Internal

Medicine Large Animal Surgery

Rural Veterinary Practice

Large Animal & Small Animal

Theriogenology

Small Animal Internal Medicine

Small Animal Surgery

Cardiology

Oncology

Small Animal Emergency & Critical Care

Hospital Support Areas

Central Sterile

Client Services

• Medical Aide Supervisor

• Medical Aide Receptionists

• Process Improvement Manager

• Client Advocates

• Student Workers

Farm/Ranch Services

• Farm/Ranch Supervisor

• Animal Attendants

• Student Workers

Financial Services

Patient Services

• Patient Service Coordinators

• Certified Veterinary Technicians

• Veterinary Assistants

• Animal Attendants

• Student Workers

Pharmacy

Hospital Hours of Business

Large Animal Hospital Office Hours

Monday - Friday 8am to 5pm

541-737-2858 (Phone)

541-737-8651 (Fax)

Large Animal Emergency Service

541-737-2858 (Phone)

Available 24-hours/day, 7 days/week

Call the number; listen to instructions; leave a message; and a doctor will return call

within minutes.

Small Animal Hospital Office Hours

Monday – Friday 8am to 6pm

541-737-4812 (Phone)

541-737-4818 (Fax)

Support Staff

Client Services

The Medical Aide Supervisor oversees the reception areas and the Medical Aide

Receptionists. The Reception staff is responsible for client scheduling, patient receiving

and discharging, billing, and maintaining medical records.

Farm Services

The Large Animal Farm/Ranch Supervisor is responsible for the entire Large Animal

physical plant, including the surrounding CVM-managed property. The Farm/Ranch

Supervisor is also responsible for husbandry and care of the CVM-owned animals. The

Farm/Ranch Supervisor supervises Large Animal Attendants and Student Worker

Attendants.

Financial Services

The Hospital’s financial support is provided by the Process Improvement Manager and

the VTH Accounting team.

Patient Services

The Patient Services Coordinators supervise the technical and patient care staff as well as

coordinate safety and accident reporting.

General Technician, Animal Attendant, & Assistant Duties

Technicians in the Hospital are responsible for the complete organization of their assigned

area, including patient care, student supervision, client communication, inventory and

equipment maintenance, and assisting faculty with teaching and research. Animal

attendants and assistants are responsible for maintaining the hospital’s facility,

equipment and supplies, in addition to assisting with patient care (feeding, walking, etc.)

and restraint. While working in the clinic, technicians, animal attendants and assistants

are required to follow all approved VTH and university policies and procedures, as well as

to follow direction provided by the Patient Services Coordinators and/or work leaders and

clinicians on their particular service.

The following duties apply to Technicians in all areas of the hospital:

• Provide basic and advanced patient care (blood draws, catheter placement, patient

monitoring and critical care, administration of medications, etc.)

• Prepare for and assist clinicians with medical and surgical procedures

• Admit patients, perform physical examinations and take patient histories when

necessary

• Oversee and instruct students in general and specialized patient care and techniques

• Provide student orientation for individual service areas

• Provide safety instruction for students and monitor student safety

• Monitor and encourage compliance of all hospital rules and policies

• Coordinate and assist in scheduling daily patient receiving and diagnostic procedures

• Coordinate patient care with core services (Anesthesia and Imaging), reception desk

and, at times, the Large Animal Hospital

• Maintain organization and cleanliness of service area

• Maintain specialized service area supply inventory

• Operate and maintain specialty area equipment

• Communicate with clients over the phone, in person or via email, regarding patient

care, procedure estimates and medication refills

• Keep accurate patient medical records and drug logs

• Prepare patient estimates for diagnostics, procedures and hospitalization

• Enter charges for all hospitalization, diagnostic testing, and medical, surgical and

diagnostic procedures

• Assist in developing and maintaining hospital protocols, forms, logs and teaching

materials

• Assist clinicians with research projects, student labs and student grading

General Animal Attendant duties may include the following:

• Maintain and stock general supplies and laundry throughout the hospital, including

the ICU and Main Treatment areas

• Maintain and follow daily, weekly and monthly hospital cleaning schedules

• Coordinate maintenance and repairs for hospital equipment

• Coordinate cleaning schedules with outside services

• Maintain and order all hospital bagged and canned food

• Direct animal attendant student workers

• Provide patient care following direction from technicians or clinicians, including

walking and feeding

• Assist with restraint for basic procedures, including venipuncture or bandage

changes

In addition to the duties listed for Animal Attendants, Animal Assistant duties may also

include:

• Provide additional patient care, such as icing incision sites, administering oral

medications, etc.

• Assist with and perform selected rehabilitation procedures.

Safety

The OSU VTH realizes the importance of a safe work environment. The training for and

practice of veterinary medicine is associated with physical and emotional hazards.

Individuals who are pregnant, anticipate a pregnancy, are disabled or seriously ill should

review recommendations under the previous CVM Student Policy section. Policies are in

place to minimize injury to our students. In the event of a life-threatening injury

involving students, staff or clients, emergency services (9- 911) should be called

immediately. Someone should stay with the injured person until emergency services arrive.

Some specific, relatively common, injuries are discussed below. Any accident or injury

occurring at the VTH should be reported as soon as possible to service personnel and/or a

supervisor, so that the appropriate paperwork can be completed (OSU Accident Reporting,

Benton County Health).

Bites: It is important to remember that all bites should be reported to a service

veterinary technician who will aid in completing necessary paperwork (see above) and

mark the patient’s file with Caution alerts. A policy on animal bites, as well as bite report

form, is available in the Appendices. Immediately, all bites should be washed with soap

and water for a minimum of 5 minutes and encouraged to bleed. Do not massage the

wound. It is recommended that students see their healthcare provider or Student Health

Services for further recommendations. The appendix also contains material students

should read on rabies.

Sharps: Needle stick and other sharp injuries are common in veterinary practice.

Students should read the Sharps Injury policy in the appendix. For life-threatening

injuries see above. For non-life-threatening injuries wash it with warm soap and water for

five minutes, encouraging bleeding. Do not massage the wound. Wrap and dress as

appropriate. Seek medical care as previously directed.

Infectious Disease: As veterinary students, you will be exposed to or potentially

exposed to many infectious and zoonotic agents. A comprehensive infectious disease

policy for the hospital is in the appendix that covers personal safety as well as individual

diseases. Students should

read up on cryptosporidiosis, Salmonella ssp. Campylobacter, Giardia, Yersinia,

hookworms, roundworms, rabies, tetanus, bartonellosis (cat scratch disease),

toxoplasmosis, leptospirosis, brucellosis, Q fever, tuberculosis, anthrax, Lymes Disease,

equine encephalitis, West Nile fever, and Herpes B virus (primate contact) as they may

come into contact with patients that are or potentially are infected with these zoonotic

organisms.

Radiologic Risks: Students may be exposed to several radiologic risks including

radiation (radiograph, CT, MRI, fluoroscopy) and radionuclides. Students should adhere to

the principles of ALARA. Students who are pregnant or may be pregnant are referred to an

earlier section on safety for pregnant persons in the CCVM Student Policies. Additional

safety information will be obtained during your diagnostic imaging rotation and

orientation. The Appendix contains additional information regarding radiation exposure

and ALARA.

Chemicals: Chemicals are used for a variety of tasks around the VTH Students should

familiarize themselves with the risks of exposure to chemicals in their environment. MSDS

sheets are available in the VTH for all chemicals used and can be found in the hospital

laboratory area (Tech Station). If you have questions regarding chemical exposure, please

ask a service technician or clinician.

Controlled Substances

Controlled substances are those substances that fall under the jurisdiction of the Drug

Enforcement Agency (DEA), which is part of the U.S. Department of Justice, who enforces

the Controlled Substance Act, and therefore depict Federal regulations surrounding the

use and accountability of. Controlled substances carry diversion and abuse potential, with

different scheduling of the substances, which make them high-priority to many

regulations in healthcare practices. The primary goal of the DEA is to prevent diversion

and abuse of these substances while ensuring adequate supply of controlled substances are

met for the country’s legitimate medical, scientific, and research needs.

All employees and students within the Veterinary Teaching Hospital, which fall under the

DEA registration of the Acheson Teaching Hospital Pharmacy, are subject to Title 21

United States Code (USC) Federal Controlled Substances Act. All definitions, rules, and

regulations can be found at the following website:

http://www.deadiversion.usdoj.gov/21cfr/21usc/index.html.

Therefore, all employees and students must maintain appropriate scope of practice in

veterinary medicine when using controlled substances. This means that appropriate

protocol and use of controlled substances are warranted in patient therapy, in terms of

prescribing, administering, and dispensing for legitimate medical purposes.

Controlled substances will require strict accountability, security, and documentation in all

areas of the hospital, therefore a “closed-system” concept is warranted. This means that all

records must be accurate and a reflection of secure physical inventory for all audit

purposes. Students will, at times, be handling controlled substances and will be granted

this authority under their respective VTH clinical practitioner and under their direct

supervision. Students, in this regard, will be held responsible in abiding by all measures

that fall under the Controlled Substance Act. Students are not allowed to access areas that

contain controlled substances within the VTH, veloped positive-will help in maintaining

compliance for accountability and accuracy of, for example, serving as witnesses to

controlled substance transactions from the Cubex® machines or preparing written

prescription orders for controlled substances signed by the VTH practitioner.

If diversion is suspected, severe penalties can follow per Federal regulations, such as civil,

criminal, or loss of licensure and in turn, punishments around the veterinary collegiate

program as deemed necessary.

Controlled substances are divided into five schedules, determined by current accepted

medical use in the U.S. and relative abuse potential and likelihood to cause dependence.

Please familiarize yourself with the following examples (definitions are paraphrased):

• C I: high potential for abuse, lack of safety

o Example: heroin

• C II: high potential for abuse and may lead to severe psychological or physical

dependence

o Examples: hydromorphone, morphine, fentanyl

• C III: have potential for abuse less than C I / C II, may lead to moderate or low

physical dependence / high psychological dependence

o Examples: buprenorphine, ketamine, APAP-codeine

• C IV: have a lower potential for abuse relative to C III

o Examples: butorphanol, midazolam, diazepam

• C V: have a lower potential for abuse relative to C IV

o Example: codeine syrup

Large Animal Services

Veterinary Teaching Hospital

Guidelines and Procedures

Introduction

The primary mission of faculty, staff, and students is quality patient care. The provision of

excellent service is fundamental to the Veterinary Teaching Hospital (VTH). The VTH is

expected to function and provide services in a manner similar to a successful private

practice and this requires the attention of everyone to all aspects from patient care, client

relations, and general order and cleanliness. The workload and schedule is demanding at

times. Your performance under stressful situations will help you develop necessary skills

and habits.

Hospital Hours

Regular business hours:

Monday through Friday 8:00 am - 5:00 pm

After-hours:

Monday through Thursday 5:00 pm - 8:00 am Friday 5:00 pm - Monday 8:00 am

Holidays: (Hospital closed for regular receiving):

Martin Luther King, Jr. Day

Memorial Day

Juneteenth

Independence Day

Labor Day

Veteran’s Day

Thanksgiving

Christmas Eve

Christmas Day

New Year’s Day

General Guidelines and Hospital Procedures

Dress Code: Clean and appropriately worn clothes are required at all times. Nametags

are to be worn in the VTH at all times. You are required to carry a stethoscope,

thermometer, pen light, a watch (digital or second hand) and bandage scissors in the

VTH.

It is your responsibility to purchase and launder purchased clothing. We ask that each of

you procure two pair of green duck bib overalls or coveralls (e.g. from Pella Products).

Pella Products offers group discounts if, as a class, you want to coordinate your order.

Shoes should be of a type that can be dipped into antiseptic solutions and sufficient to

reduce injury if stepped on by an animal.

Scrubs are required in surgery. Surgery scrub suits will be worn in the operating rooms

together with shoe covers at all times. Caps and masks will be worn as required. Surgical

scrub suits are not to be worn out of the operating room unless under coveralls or lab

coats. For field service you will need coveralls and boots (spare coveralls should be

available to replace dirty ones). Upon return from a field service call, students must

change their clothes and sanitize or change boots before working in the VTH. This dress

code requirement is designed to present students as professionals. No other type of

clothing will be allowed for 4

year students in the hospital.

Professionalism and Conduct: Be punctual and dress and behave in a professional

manner. Address all Veterinary Teaching Hospital Clinicians as Doctor; and if you have a

preference for the way you would like to be addressed (e.g., Mr. Smith, Ms. Jones, etc.,)

tell people.

Discussions regarding cases in the presence of the owner or client are encouraged only

when prompted by the clinician in charge.

Medical Records: Because our program is concerned with detailed case material,

extensive records and information are required. Fill out the required forms completely

and with the information required. Clearly record all procedures on the daily progress

sheet so that the staff may see that relevant charges are made. Any supplies used should

be recorded on appropriate forms. Completion of the medical record is the responsibility

of the student, veterinary technician and clinician overseeing the case so be sure you are

familiar with the portions of the medical record that are your responsibility.

Client Confidentiality: Information regarding clients and their animals is confidential

and available only to the owner or his/her designated agent, or referring veterinarian.

Patient information is to be released only by a clinician or by written order of the same.

Any photographs or video taken must be approved by the owner/agent on the

Authorization and Release form.

Patient Care: Students are required to participate in the full regimen of treatments for

assigned patients. This includes after-hours care as necessary. All patients should be

handled with care, and if aggressive behavior is noted, please call attention to this so that

injuries to oneself and others can be prevented. Clinicians should be called to assist you

with handling unruly cases. If you ever feel uncomfortable handling a patient or

performing a procedure, notify a clinician immediately. Halters are to be left with the

patients, but lead ropes, blankets, bandages, etc., should be returned to the owner or

carrier when the patient arrives. All animals should be weighed on admission and

discharge and details recorded. If owners require “blanketing” of their animals, we will be

responsible for returning this equipment to them at discharge. We are in the animal care

profession, but do receive requests to accept animal donations for teaching uses. Any

person asking to donate animals should be directed to Large Animal Reception.

Procedures: Certain diagnostic or treatment procedures, e.g. rectal examinations,

intravenous injections, and the passage of nasogastric tubes, should be performed only in

the presence of a clinician. If you have any questions regarding the procedures you are

performing as a clinical student, stop and ask a clinician.

Hospital Equipment: All equipment should be cleaned and broken equipment is

replaced by a veterinary technician before storing. Return all equipment, supplies, and

drugs, to their correct locations when you have finished using them. It is VTH policy that

no equipment or supplies be used by students for personal reasons. This policy applies to

evenings and weekends. There are no exceptions to this policy.

Facilities: The Hospital reception area, student computer area, and student break rooms

are the designated places for students to remain unless busy with patient care. Please

respect others by leaving these areas clean.

Safety Procedures

Your safety is our primary concern. There are numerous opportunities for injury in the

VTH.

Animal Handling Risks: When dealing with animals, anything can happen, and you

should be alert and prepared at all times. If you are unfamiliar with the demeanor of any

specific animal, work in pairs or talk to the clinician-in-charge before doing anything.

Animals are not to be left unattended while restrained in stocks, chutes, or when tied up.

They react differently to restraint. Be alert. Always be aware of an avenue of escape. Keep

the stall door closed enough so as not to encourage bolting by your patient. Do not

completely close or lock the stall door when working inside stalls with animals. Never

enter a bull or stallion’s stall alone. Veterinary technicians and clinicians (not stall

cleaners) are available to help. You should make sure that you have had proper

instruction before working with unfamiliar animals. Do not hesitate to ask. If utilizing an

assistant, make sure your assistant is aware of the potential hazard and knows how to

restrain the animal.

Environment and Equipment: Do not shout or make loud noises in the hospital, as it

frightens animals. Avoid running in the hospital. Remove debris from floors to prevent

accidents. When spraying water in the VTH be aware of electrocution risks. Do not spray

water on electrical outlets, light sockets, or electrical insect/fly killers. Human food and

drink are not permitted in the hospital animal areas.

Many of the restraining chutes have hard projections that are at head height; look where

you are going and watch what you, the animal, and other people are doing. Equipment

used for treatment or restraint of large animals may also break, malfunction, or simply be

inadequate at times, and you should never use equipment unless you are fully aware of its

proper operation and limitations. Wear ear protection when using noisy equipment. Wear

ear protection when using noisy equipment.

Injuries: If a life-threatening injury occurs, dial 9-911 and send someone to meet the

emergency vehicle. In addition, if you are injured during the assigned time in the hospital

this must be reported immediately to the attending clinician, service area supervisor,

Hospital Director and Chair of the Department of Clinical Sciences.

Sharp objects (needles, scalpel blades) should be carefully handled and discarded in

designated disposal containers. Do not to recap needles. For sharps, injuries and animal

bites the wounds should be immediately cleaned with warm running water and soap for

several minutes followed by an antiseptic solution such as povidone-iodine or

chlorhexidine. A bandage should be applied as necessary. Students should contact the

Student Health Services at (541) 737-9355. An Accident and Illness Form needs to be

completed and is located in the small animal hospital outside small animal reception. A

technician supervisor (Robyn Panico or Dave Meyer) can assist in completing the

paperwork. Specific information on sharps injury and reporting can be found in the

appendices Sharps Safety Plan and Sharps Injury Log. Animal bites follow the procedure

above. Animal bites should also be reported to the Benton County Health Department

(541) 766-6835. For additional information on animal bite injuries and rabies, please read

appendices Animal Bite Procedure, Animal Bite Reporting Form, Compendium of

Animal Rabies, and Human Rabies Prevention Program. Appropriate paperwork must be

completed. You may refer to the appendix on Accident Reporting Procedures and

Accident and Illness Form.

Infectious Disease: See the Large Animal Infectious Disease Protocol in the

appendices for a full discussion of infectious disease and risks in the large animal hospital.

Consider the infectious agent(s) that are a concern and avoid contaminating yourself, the

patient or other patients with that agent. Consider things like keeping the stall clean and

clear of manure, avoid walking in manure, and avoid tracking manure into feed.

Thoroughly clean shoes with a brush and disinfectant when you accidentally get fecal

matter on shoes or where required in the facility. Wear appropriate personal protective

equipment as indicated by the risk of exposure and transmission of infectious agents. This

may include gloves, a gown, mask/goggles and boot covers/plastic booties. Exam gloves

should be worn when working with all patients. Wash Your Hands between patients.

Frequent hand washing has been proven to be the most important component to prevent

the spread of infectious diseases. Hands should be scrubbed for at least 15 seconds, when

treating animals with known infectious diseases, remove soiled garments and plastic

booties. Do not share equipment between animals unless it has been cleaned and

disinfected.

Patient Admission

Patients are admitted only by prior arrangement with the clinician or VTH reception staff.

Admission (or discharge) of patients after-hours is not encouraged unless prior

arrangements have been made or an emergency situation exists. Do so only when

authorized by the clinician- in-charge. All required forms to be filled out and signed are in

the reception area. Make sure that these forms are completely filled out. Weigh animals

on admission and record the time and date of admission. Take as much history as possible

from the owner or agent, or as directed by clinicians. With emergencies, common sense

takes precedence over paperwork, which can be postponed until emergency treatment is

instituted. Remember to complete the paperwork as soon as time permits. Do not allow a

client or agent to leave before signing the required forms, especially the Authorization and

Release form. Deposits are required for treatment. Clinicians and reception personnel will

provide this function during office hours. Clinicians or technicians perform this duty

overnight or during weekends.

Unloading (or loading) patients is the responsibility of the owner/hauler. Responsibility

for animals or people injured during unloading or loading may be placed upon a volunteer

helper. If help is requested by the owner/hauler, contact the clinician. Many animals

behave badly when being unloaded or loaded from trailers. You may show the client the

entrance but they must unload their animal themselves.

Keep the halter on the animal and give owner the lead shank and any other tack not

required. Any tack kept should be clearly identified with the owner's name, stall number,

and case number. Patient’s tack is hung on the stall door

Assign stalls after the clinician has ascertained that no infectious disease is present. In the

latter case, the animal will be placed in an isolation stall. If in doubt, confer with the

clinician or technician. Each animal should be clearly identified on admission to ensure

proper treatment.

Food and water should be given according to the clinician’s instructions. Place a stall card

and necessary instructions on the stall door.

Patient Discharge

No patients will be discharged unless specifically authorized by a clinician. All documents

and invoices must be completed and signed before discharging the patient. Clinicians

(clinical fellows, residents, faculty) must review discharges prior to their distribution to

owners or referring veterinarians. When discharging patients, make sure that the written

discharge instructions concerning the patient are clearly understood by the client as well

as signed by the clinician and client. The date and time of discharge and patient current

weight should be recorded in the medical record. A copy of the signed discharge should

accompany the owner.

Patients slated for discharge should be ready to go home, i.e., they are to be groomed, and

are to look presentable. Make sure the client is given any tack, shoes or equipment that

belongs to them. Check the front of the stall, feed room and large animal reception for any

belongings. Be sure that any medications to be dispensed are labeled properly and given

to the client.

Mark the stall with a card that says ‘Clean and Disinfect’ or alternatively turn the stall card

and write on it.

Additional Information

VTH Policies, Procedures Organizational Charts, and SOPS are available on the

Veterinary Teaching Hospital intranet site. http://128.193.215.68:12469/vth-

policies/_policies_main.htm.

Large Animal Clinic

After-Hours Responsibilities

After-Hours Student’s Role

The after-hours students play a crucial role in maintaining client services and patient care

outside of regular hours. The duties of these students are to monitor and treat patients,

identify and report patient status changes, and assist in emergency cases. Students are

expected to be punctual and available in Magruder Hall during their entire assigned

periods. Remember that after hours provides valuable learning experiences in medication

administration, patient assessment and monitoring, organization and teamwork. You are a

valued member of the team and we appreciate your help.

After-Hours Schedule

There will always be one or more in-hospital clinicians and one field service (RVP)

clinician on call. The hospital typically has a House Officer scheduled as primary on-call

with a Senior Clinician available as back up. You should be aware of their intended

whereabouts and of any required treatments, admissions, discharges, before the clinicians

depart each day. The clinician and House Officer on duty may be reached by telephone if

needed. A roster of on-duty emergency House Officers is located on the reception area

bulletin boards. There are lists of clinician phone numbers in the reception area as well

as in strategic locations in the hospital.

Remember the doors are locked outside of business hours so keep your access badge

with you.

Duties

Telephone Responsibilities: After-hours students and technicians are responsible for

answering the hospital “back” telephone line (541-737-6845) when on duty. When the

VTH reception area closes, phone calls from clients and referring veterinarians are routed

through the primary veterinary clinician (house officer) on duty. If that clinician needs to

contact the hospital, he/she will phone on the back line. This hospital number may be

answered on the phones in the hospital and communication room telephones by punching

*7.

Please answer clearly, “OSU Veterinary Teaching Hospital. This is (your name) speaking.

May I help you?” A clinician will notify you about the case, its estimated time of arrival,

and will let you know about any special requirements or equipment to have on hand. In

addition to preparing yourself to receive this case, please also notify the duty technician as

soon as possible so that they may prepare for the patient’s arrival.

Non-business and non-emergency calls are not to be made from VTH business

telephones. Personal calls may be placed from lines other than 737-6845. When using the

telephone, please be as brief as possible. Do not give out individual office numbers or

clinician cell phone numbers to clients or referring veterinarians. When placing calls

remember the following:

For on-campus calls dial: 7 + the 4 digit number.

For local calls dial 9-541+ the 7 digit number.

For 1-800 calls dial 9-1-800+ the 7 digit number.

For long distance calls dial 9-1- + the 7 digit number and then the approved long

distance code.

After-hours call boxes are mounted on the wall outside the VDL reception area and at the

north gate by the small animal hospital. If either box is used, it rings on the hospital

“back-line” at 7- 6845. You can then look at the live feed of the camera monitoring the

north large animal hospital entrance and determine if the North or South gate should be

opened. The gates now also have a sign on them labeling them as “North” or “South” so

you can ask the client which gate they are at. The North gate button is located within the

communications room and the South gate button is located next to the bovine scale.

The reception at the call boxes is less than ideal. This means the telephone will often ring

and there appears to be no one at the other end, or you may simply hear a vehicle

running. The client may also be unable to hear you in some circumstances. Be aware that

even if you don’t hear a voice, there is likely someone waiting at the gate. The back line will

also ring with clients bringing specimens/animals to the VDL/necropsy after hours. If you

are unsure of how to deal with this, please notify the technician who will meet the client by

VDL and complete the appropriate paperwork, prior to placing the specimen in the correct

location in the VDL.

Once you let a client through the gate, remember that reception is locked, and someone

will need to meet them at the reception door to let them in.

Admissions and Discharges: Please refer to the LA VTH Guidelines and Procedures

for general information on patient admission and discharge. In most instances, a clinician

will be present at the time of client arrival. If the clinician has not arrived, have the owner

unload the animal only if the clinician has said to do so. If not, utilize this time to obtain

a good history. This is the client's first impression of OSU-VTH so ensure that you are

dressed appropriately and act professionally. The usual rules about giving opinions,

criticizing treatments, or giving advice also apply here. Many clients will not know if you

are student, staff, or faculty. Identify yourself before proceeding with collecting a history

or performing a physical examination.

After-hours, a veterinary technician or clinician will generate a case number, complete a

financial estimate and collect a deposit for services. The student will aid in filling out the

Client Information form as well as the Authorization and Release form. Alert the on-call

clinician of any ‘walk-in’ emergencies.

In the event an animal arrives dead, the on-call clinician is still called for instructions. If

he/she feels it is necessary, they will contact the pathologist or instruct you to do so. The

details regarding the pathologist on call are posted inside the front VDL door and in

hospital Reception. The number for the emergency cell phone carried by the on-call

pathologist is located on the door to the necropsy cooler and on the white board in the

hall outside of the Equine Minor Treatment room. The pathologists must be notified of

every specimen placed in the cooler; however, the clinician present will typically do this.

Medical Records: SOAPs are required for cases admitted to the emergency service at the

end of your shift and until the case is transferred to another service. You are responsible to

write records, SOAP's, and treatment sheets. Remember to have a clinician check the

treatment sheet prior to administering medications. You are also responsible to turn in any

requests or lab work between 7:30 and 8:30 am. In most cases, if a patient goes to

surgery, the student who received the case will go to surgery with them and scrub in. In

some instances, when it is close to the end of a shift, the emergency student starting at

10pm weekdays/8pm weeknights may scrub in instead. This decision is at the discretion

of the clinician on duty; however, it is okay to remind the clinician that it is nearing the

end of your shift as sometimes they lose track of time. Every effort will be made to ensure

you have adequate time away from the hospital as long as patient care is not

compromised. The student who scrubs into the case is responsible to have a surgery report

in the record within 24 hours of the completion of the surgery. Final surgery reports are to

be submitted electronically. Ensure you also provide the new student a full description of

the case, and ensure records are complete for your involvement prior to leaving. Record

all medications used and all medications and supplies checked out of pharmacy.

Remember that the SOAP is the medical record. Everything from the examination,

diagnostic test results, medications etc., must be accurately recorded here. Please ask your

house officer or clinician if you are unsure of specific details.

Patient Care: If you admit a case, you are the student responsible for the case during

your duty hours or until the case is officially transferred to another service. This will

usually occur at transfer rounds the following morning. The primary on-call clinician

(resident or clinical fellow) and the emergency clinician or surgeon will challenge you to

take an active role in these cases. If you demonstrate you are prepared before case arrival,

you will be more likely to be given more responsibility. However, if time is of the essence,

and the clinician takes charge of the case, make sure you understand the whys in the case

management and ask questions at an appropriate time. If a case requires emergency

surgical care, the 5-10 pm or emergency student scrubs in for the surgery and the on-call

backup student will provide support. You also should not leave the following morning

until you have discussed the case with the house officer/emergency clinician in person,

your paperwork is completed, medications for the day have been made, and the flow sheet

has been approved by the house officer. If you do not have a patient, please assist other

students with their 8 am treatments and do not leave until you have received permission

from the house officer/emergency clinician on duty.

Critical care cases are your primary responsibility and the on-duty clinician, resident or

clinical fellow is primarily responsible for decisions regarding their care. Always call the

clinician designated if the parameters (written on the stall-side treatment

sheet) for clinician contact are met or if there are other patient changes that

concern you. Remember to use your best judgment and call earlier if you have questions

or concerns even if the parameters have not been reached. Clinicians would rather that you

call too early, than too late. If you are uncertain whether to call a clinician, the duty

technician is a valuable resource in making this decision.

Never underestimate the value of a physical examination and consider the information a

clinician may need when on the phone with you (i.e. always perform a physical

examination prior to calling unless the situation is emergent or dangerous).

The clinician/house officer to call is the person listed on the treatment sheet. If you do

not get an answer, leave a voicemail, and call again. Keep calling. If the house officer does

not respond, or you need an immediate response in an emergency, call the senior clinician

on the case. If neither one can be reached, you may call the emergency clinician on duty.

As with other cases, treatment should not be instigated, altered, or discontinued without

consultation with a clinician unless you are dealing with a life-threatening emergency. This

is the time in your clinical training to take initiative, however, please do so under the

guidance of the clinician in charge if at all possible. The location and use of emergency

medical kits will be shown to you during orientation. Large animal emergencies can be

dramatic, and your safety is always top priority. Take care not to get yourself into a

situation where your safety may be at risk, and do not hesitate to call for help

(clinician/technician) prior to entering a stall.

Treatment sheets and flow charts are set up by the daytime service and are to be followed

exactly unless instructions change. Complete regularly scheduled BID treatments. These

are the responsibility of medicine or surgery students assigned to the case, but may be

performed by the ER and backup students or technicians as a courtesy. After-hours duty

students may relieve block students of this responsibility but only with mutual agreement

among concerned parties. A walk through and visual examination should be performed on

all hospitalized patients by the ER student at regular hourly intervals. Investigate all

concerns by reading the medical record.

Weekend treatments are given in the same schedule as weekdays. The time at which you

begin morning treatments on weekdays will depend on your caseload. However, you

should begin treatments early enough, with SOAPs completed, to be free to participate in

rounds by 8:00 am. When you are present in the hospital after hours, you need to be able

to hear changes with patients such as fluid pumps beeping. As such, while you may use

personal electronics for entertainment during quiet times, headphones are not to be worn,

and any sound must be quiet enough that you can hear noises from patient stalls.

Remember that late night/early morning is the most common time for medication errors

to be made. Double-check everything before you administer it, and always ask a

technician or clinician if you are uncertain. Remember that nothing opaque goes into a

vein. If a medication is not prepared and ready for a patient, double check with the

technician/other students that they have not given it and forgotten to sign. If not, contact

the student on the case to ask if they drew the medication up. Only once these avenues are

exhausted, should you prepare the medication/get a medication from pharmacy.

Rounds: Attend clinic rounds and be prepared to discuss any cases under your care. This

essentially means all hospitalized cases. To be prepared, read the medical records for all

cases and understand the case management decisions that have been made. Use the

veterinary literature, colleagues, faculty, and internet in your quest to learn from these

cases. Use discretion and judgment when discussing these cases with faculty. Remember,

owner information is strictly confidential and not to be shared with other owners and

non-VTH veterinarians. Pay attention to presentations during rounds of all hospitalized

patients. If the reasons behind the management of the case are not apparent, challenge

yourself to discover them by reading the record and the literature, and by having

constructive discussions with colleagues and faculty or the emergency clinician. Be

organized and ready for rounds presentations if you are transferring a case. You should

have your SOAP, and all laboratory results available. Present the case in a logical manner-

Signalment, history, physical examination findings. After this it is usually logical to present

in the order tests were done; i.e. blood gas analysis/CBC/serum chemistry results, then per

rectum findings, belly tap results etc. Update on surgical findings even if you were not

scrubbed into the procedure. Summarize medications administered (dose in mg/kg, route

of administration, frequency) and know WHY you are giving these. Summarize how the

patient progressed overnight, and your morning physical examination findings. Be

prepared with your plan for the day.

Professionalism: Give the after-hours duty technician your full cooperation. The after-

hours duty technician reduces your overnight stays by 50%. Regarding client questions,

do not get trapped into trying to answer questions that you do not feel confident about. It

is better to refer questions than to speculate. Please take time to locate the duty technician

at the start of your shift. They can update you on any special considerations such as

patients to discharge, emergencies coming in, or critical cases that need extra attention.

They may direct you to divide the cases so that one person deals with isolation cases and

one with hospital cases. At the end of your shift, please check in with the technician again.

This is the time to update them on any patient concerns that have arisen recently, let

them know which treatments you finished/did not finish, and make sure they are aware

you are leaving. Your knowledge of the cases is valuable- take a few minutes to update the

emergency student taking over from you.

Sleeping Quarters

During large animal rotations, students may spend long shifts in the hospital. This may

put them at risk during the commute home. The sleeping quarters are intended to provide

a safe alternative for students and house officers who may be too tired to commute home.

There is one room provided for living quarters to be shared between after-hours students

and house officers. There are four beds located in these quarters. The room is equipped

with a bed, bedding, and a washbasin. Showering and bathroom facilities are the student

locker rooms across the hall from the living quarters. This is a shared space so please

respect others and keep the area clean.

Linens can be placed in the provided bins in the student/faculty locker rooms for

washing. All belongings must be removed from the room at the end of occupancy. Dogs,

cats, or other pets are not allowed. Flip the sign on the door to “occupied” when you enter

so anyone else entering knows to be respectful. The sleeping quarters are to be utilized only

at the end of your shift.

While you are on duty in the hospital, you are expected to be awake and present in the

hospital at all times, for patient and personnel safety.

Grades

After-hours duties are incorporated into your other grade rotations. Grading is based on

attendance and professionalism as well as performance during rounds, quizzes and

discussions with faculty and staff. Perfect attendance is mandatory. Absences that are not

preauthorized will result in a failing grade. Tardiness can result in a heavy grading penalty.

The after-hours schedule is made by Garland Burdock, Large Animal Technician

Supervisor. Students may swap shifts, however they must be changed on the posted after-

hours schedule. When switching shifts, it is vital that you consider your schedule in full.

The large animal hospital is busy after hours and frequently takes in emergencies, often

more than one per night. Expect to be called in when you are on back up. Therefore, do

not make alterations that leave you with multiple shifts and back up shifts consecutively.

Whenever possible, inform the on-duty house officers and clinicians of changes,

difficulties and absences.

VMC 732 & VMC 752

Large Animal Clinical Medicine I and II

Guidelines and Procedures

Course Coordinator: Dr. Erica McKenzie

Course Instructors: Dr. Ana Pacheco, Dr. Erica McKenzie, Dr. Kelly Sears

Objective

To expose students to Large Animal Internal Medicine cases, many of which are received

on a referral basis. Phone numbers relevant to operations in the large animal hospital are

found in the General Information After-hours Duty sections of this manual.

Operation of the Medicine Service

The medicine service handles out-patient and in-hospital cases requiring primarily

medical management.

Cases may be referred or transferred to other services as appropriate.

Cases requiring surgical procedures or evaluation for lameness disorders will be

addressed by the surgical service.

Reproductive cases will be addressed by the theriogenology service, in conjunction

with the medicine service, unless surgery is required. If these patients require

hospitalization, they will typically be managed by the medicine service with close

consultation with the theriogenology service.

Some cases may involve one or more services, and the medicine service may also

consult with other services on specific cases as appropriate.

Students assigned to medicine are permitted to observe theriogenology or surgery

cases if there is no conflict with medicine cases and if clinician approval is given.

We interact extensively with other services in the hospital as listed below. Requisite

forms or electronic submissions should be filled out completely at the time of

sample submission or request and a copy left in the Hospital record.

Pharmacy: Please see the pharmacy section of the manual

Radiology and ultrasound: Imaging requests are submitted via the VetHosp

program for radiography, fluoroscopy, contrast exams (barium, myelogram),

computed tomography, and MRI. Where necessary (e.g. equine CT or

myelogram, or small ruminant MRI), anesthesia requests may also be required.

Ultrasonography is typically performed by the medicine service and does not

require a request form.

Endoscopy: Will be performed by the medicine service, typically with standing

sedation. No request form is needed unless general anesthesia is involved.

Clinical pathology and Diagnostic Services: Requests are submitted via the

VetHosp program. Requests should be submitted before 4.00 pm to avoid

additional charges. Specific samples (fecal enteric panels, Potomac horse fever

serology, equine respiratory PCR panel) must be submitted by 10 am as stats if

results are desired that day. Send out samples to other labs should be submitted

by midday. Take the appropriately protected sample(s) directly to veterinary

diagnostic laboratory receiving. Special and outside laboratory tests may be

submitted via the VetHosp program. Some may require additional forms but

should be routed through VDL receiving. Ask the clinician or technician for help

submitting uncommon “outside lab” samples. Some tests including blood gas

analysis, glucose or lactate measurement, ketones, PCV and refractometry total

protein measurement can be performed by students in the ‘technician lab’. You

will be shown how to use this equipment at orientation, but do not hesitate to ask

for help if needed.

Necropsy service:

Take carcass to cooler or necropsy floor as required by VDL personnel.

Identify carcass with appropriately colored tag and client details, and

intended purpose i.e. necropsy/teaching necropsy/disposal.

Submit information with a complete and thorough history to VDL receiving

after confirming adequate completion of the form with the house officer and

faculty member on service. Incomplete history is a common problem on

these forms which is detrimental to the necropsy process, and every effort

should be made to provide as complete a history as possible. DO NOT click the

“import case history” button. Try and attend necropsies on patients that you

were involved with-this is an excellent learning opportunity.

At present:

This service handles all internal medicine cases including:

Gastroenterology (nonsurgical), including colic cases presenting in-hours

until diagnosed as requiring surgical intervention. Colic cases presenting

after-hours are currently received by the surgical service.

Respiratory diseases (until or unless identified as surgical in nature)

Neurologic diseases

Urinary tract diseases (until or unless identified as surgical in nature)

Dermatological disorders

Endocrine disorders

Metabolic/nutritional diseases

Toxic diseases

Infectious diseases

Miscellaneous undiagnosed conditions

Almost all neonatal animals under two weeks of age

The medicine service provides basic assessment of cardiology cases and requests

an in-hospital consult from the cardiology service for echocardiography. The

medicine service can perform procedures including resting ECG, exercising or

overnight ECG, and conversion of atrial fibrillation.

The medicine service commonly provides assessment and management of

ophthalmology cases. Where necessary, we can request an in-hospital consult

from Dr. Maxwell, a practicing veterinary ophthalmologist currently located in

Corvallis.

II.

Procedures and Policies of Medicine Service

Attendance and duty

Students are expected to be present and properly attired on all weekdays from

8:00 a.m. to 5:00 p.m. or until casework is complete. Earlier attendance is

frequently required to ensure cases are appropriately assessed before hospital

receiving commences. Appropriate footwear is essential and students should wear

coveralls. Sleeveless shirts and baseball caps are not appropriate. Fingernails

should be clipped short and jewelry removed. False nails are not acceptable on

this rotation. You should be prepared to perform a per rectum examination on

any day, and nails that are not clipped will result in you being unable to take

part in this exercise. Clothing and personal appearance are not only important

for the impression we have on our clients, but also for safely performing

procedures on client and teaching animals as well as avoiding loss of valuable

personal items.

Treatments must be completed and charts filled in before 8:00 a.m., unless

otherwise instructed. All treatment sheets must be prepared by rounds the night

before, and signed by a clinician PRIOR to any treatments being performed.

Night care, if necessary for cases requiring close and constant observation such as

critically ill foals, may be assigned to students on the service on a rotating basis.

This is rare.

After hours scheduling is arranged by Garland Burdock (head technician) and

involves the emergency rotation students in combination with the medicine and

surgery rotation students into shifts. Students will be scheduled for primary or

back up duty and called upon as needed based on number and type of

emergencies presenting afterhours. The large animal hospital is frequently busy

after hours, and back up students should be prepared for the fact that they are

often called in. If you have been in the clinic overnight, please notify your clinician

the following day. If deemed appropriate and if it will not compromise patient

care, you will be sent home for self-care; however, this cannot happen if clinicians

are unaware that you were present overnight.

Equipment to be carried

Vocera

Stethoscope

Watch with a second hand or digital equivalent

Thermometer

Bright light source (LED preferred)

Scissors (bandage ± suture scissors)

A cell phone should be carried after hours for safety reasons

Records

All records for each case will be completed by the student assigned. These will be

examined by the clinicians and house officers. Discharge reports will be examined

by the house officers and the clinician in charge, so please ensure they are

completed with sufficient time prior to discharge for them to be looked at by both

parties. Daily updates should be made to the content of this document in Vet Hosp

Relations with clients

Students should not discuss diagnosis, treatment, or prognosis with the owner or

their representative, unless given permission for this to occur or with a house

officer or clinician being present. Please do not give clients your personal cell

phone number. If a client contacts you through your personal phone, notify your

House Officer or Clinician immediately.

Do not argue with a clinician about a diagnosis or treatment in front of a client;

please discuss it in a private fashion at an appropriate time.

Do not take photos of cases without client consent, and do NOT post any

photos of any client or their animal on social networking sites or

blogs. Consent for photography can be obtained on the Authorization and

Release document. The hospital also has signs requesting that clients do not take

photos within the hospital to protect staff/student/patient confidentiality. If a

client asks to take your photo and you are not comfortable with this, politely

decline. If a client takes your photo without permission, politely request they

delete it, or speak to a clinician who will arrange this for you.

Client visitation: Please meet the client promptly in the waiting room when you

are paged and take them back to their patient. Explain that they need to stay with

their animal and are not to wander the hospital or look at other animal’s records.

You do not have to stay with the client for the entire visit, but be available and

walk by them frequently. Notify a clinician of their arrival. If you have concerns

(i.e. a client visiting other patients or looking through treatment sheets of

patients that are not their own), please notify a clinician. Do not discuss another

patient- if asked, politely answer that you are unfortunately not allowed to discuss

another case due to client and patient confidentiality rules.

Emergency situations

‘Emergency’ refers to a situation which demands immediate action. These situations

are usually unforeseen and, unfortunately, often come at inconvenient times. As

veterinarians and veterinary students, it is our obligation to treat emergency

situations whenever they arise.

With emergency cases, if you are the first person to greet the client, please instruct

them to unload their patient and to bring them immediately to the designated area

for that patient’s triage. Also, alert a technician and/or clinician of their arrival

immediately. If the client indicates it might not be safe to unload the patient due to

fractures, aberrant behavior, or neurologic disease, please wait for appropriate

assistance.

There is always room for controversy as to what constitutes the true emergency

situation. Several broad categories can be classified as true emergencies: 1) severe

respiratory compromise; 2) cardiac arrest; 3) massive hemorrhage or trauma; 4)

rapid-acting poisons; 5) anaphylaxis; 6) penetrating wounds of the thorax or

abdomen; 7) acute overwhelming bacteremia or toxemia; 8) massive or compound

musculoskeletal injuries; 9) coma and loss of consciousness; 10) severe GI signs (i.e.

colic); 11) continuous seizures; 12) multi- animal involvement.

III.

Procedures with Each Case

If you wish to have an Entrustable Professional Activity (EPA) performed, you

MUST notify/request this from the clinician/house officer prior to the case

arrival. If this is not done, your request will later be declined.

New case: Clients must initiate admission of patients at the reception area to

complete admission documents/releases, etc.

Take a history from the client under the supervision of a house officer and/or

clinician; record on case report form. In emergent situations- take a brief,

pertinent history and collect the full history at a later time, or assign a second

student to complete the history while you assist with immediate patient triage and

stabilization.

Perform a physical examination under the supervision of a house officer and/or

clinician; record on physical examination and physical diagnosis form.

Discuss findings; determine a problem list.

Discuss each problem in regard to differential diagnosis and pathophysiology.

List differential diagnoses. Keep physical diagnosis form in the case record.

Discuss diagnostic procedures and rule-outs or confirmation tests for each

differential diagnosis.

Perform tests or take samples under the supervision of the house officer and/or

clinician. Fill out necessary laboratory or procedure request forms.

Discuss possible further action or immediate treatment with the clinician and

house officers.

Administer treatment under supervision; record on daily progress notes.

10.

When test values are available, discuss the meaning and implications of each

result.

11.

Reach primary diagnosis; record.

12.

Discuss treatment regimen.

13.

Administer treatment.

14.

Discuss cost of care and prognosis with clinicians.

Hospitalized cases

Each morning:

Examine the animal.

Record temperature, pulse and respiratory rate and perform a full physical

examination.

(1)

Appetite and water consumption

(2)

Amount and character of manure

(3)

Any changes in the case, especially related to the problem the animal

presented for

(4)

Other subjective observations for each system

(5)

Other objective findings for each system

(6)

Assessment of case

(7)

Plan for the day's treatment

Administer medication.

Record any supplies/pharmaceuticals employed on the red sheets, and

medications given on the treatment sheet and initial.

At other times:

Monitor as predetermined in discussion.

Administer drugs as prescribed by clinician and record.

At discharge:

Return any medications or supplies for client credit to pharmacy or supplies.

Be sure the animal is cleaned and groomed; and reweigh the animal.

Prior to arrival, discuss instructions for owner with clinician.

Create a document (well in advance of the discharge time) encompassing

discharge instructions, or a case summary in the event of euthanasia of a

hospitalized patient, for the owner and/or referring veterinarian, which should

be reviewed and approved by the clinician. Ensure reception knows the day

and approximate time that the animal will be discharged. Keep the document

updated daily in case the animal leaves earlier than anticipated.

Give instructions to owner in presence of clinician, or listen to instructions as

given by the clinician.

Reports and discussion with the referring veterinarian will be made by the

senior clinician or house officers but students should be involved in these

discussions.

Turn the stall card over and write C/D on it to notify animal attendants of

departure

Take the treatment sheets, place in patient binder and put it on top of the binder

carts in the "Discharged Medicine Patients" section – the technicians will review the

file for billing completion prior to it being given to reception.

Restraint and handling of patients:

Most animals admitted to the VTH have good temperaments and can be

easily handled. However, good judgment and caution should be used when

handling any animal, and proper restraint methods should always be used.

This may include the use of appropriate sedation. In animals with

questionable temperaments, consult a senior clinician or house officer and

never handle such animals alone. Never assume cattle are safe to be in a stall

with - consult with a clinician to decide an appropriate handling plan. This

also applies to unusual species such as camels. Compassion and empathy for

the patient's condition are mandatory! NEVER strike an animal for

disciplinary reasons, and be aware of your position relative to theirs in a stall

at all times. Label the stall of any patient that has a difficult temperament so

everyone is alerted. Ask for assistance before entering these stalls. Do not get

between a mother and its offspring regardless of species.

Some animals require special equipment for safe restraint. This equipment

can cause injury if not properly used, so if not completely familiar with it you

should ask a clinician or caretaker for assistance. Such equipment includes:

squeeze chute, hydraulic chute, tilt table, head gates, bull leads, transporter

chute, equine stocks and cross ties, twitch, hog holder, etc. Animals should

never be left unattended when confined in any chutes or stocks, or

when tied, and should not have halters and lead ropes left on them

in stalls when unattended.

When handling adult horses, a halter and lead must be used at all times. Do

not ever tie a horse and never exit the stall (no matter how briefly) without

removing the lead rope, as both situations can result in significant patient

injury. Also, please ensure that the stall door is completely shut and latched

when exiting the stall (again, no matter how briefly).

Never assume a foal is halter trained, even if it is wearing a halter. Please

speak with a technician/clinician regarding proper handling tips for foals.

Please ensure a ‘foal handling sheet’ is placed on the front of any stall

containing a foal. Footbaths should also be placed in front of all foal stalls and

changed at least twice daily, more often if they become unclean.

IV.

Equipment and Drugs

All equipment must be cleaned and returned to its proper place after use.

The student is responsible for cleaning up the treatment area after use.

Clean up manure, blood and discharge.

Used instruments should be returned to central services for re-sterilization.

Instruments from cold trays should be cleaned up and returned to the tray.

Pharmaceuticals and supplies for each case will be checked out of the Pharmacy or

from ward stock, depending on the item needed. Ensure that the appropriate

paperwork is completed so the owner can be charged appropriately i.e. complete the

“red sheet” for ward supplies that do not come from Cubex or the pharmacy

At each treatment area there should be:

Diagnostic equipment, including sample containers.

Diagnostic drugs, including local anesthetics.

Sedatives and drugs used for restraint.

Emergency treatment drugs and resuscitation equipment are available in the

green ‘crash cart’ in the foal crib room. This should accompany sedated patients

to the CT room when possible.

General care of the equipment:

Within our clinical areas, there is a great deal of specialized medical and surgical

equipment. Like all equipment, it is expensive, and yearly costs for replacement

from breakage and abuse continue to grow. When handling equipment, we

suggest that you:

Handle it as if it were your own (WITH CARE!).

Clean all soiled equipment before replacing it. If equipment needs to be

sterilized or ultrasonically cleaned, take it to central services and make sure

that it will be returned to correct area. Ensure that the long metal teat

cannulas used for abdominocentesis procedures are not

discarded; they must be kept for sterilization.

Replace all equipment following use.

Clean and disinfect examination tables, counters, and carts following use.

Report defective or broken pieces of equipment to the senior clinician so that it

may be taken to Central Services for repair.

Please ask a staff member for instructions before attempting to utilize any

equipment with which you may not be familiar.

Place trash in appropriate receptacles, even if it is not your trash.

Clean up the surrounding area when vacated! Place manure in the

appropriate can; hose the floor to ensure that the area is clean and ready for

the next client.

Avoid spilling lubricant or mineral oil on the floor as it makes the floor slick

and dangerous for horses and humans; clean up immediately if a spill

occurs.

Rounds

Combined rounds (transfer rounds) will be held on certain days with students from

the surgery and medicine services, usually to address emergency cases that have

arrived out of hours and which need to be assigned to another service. Students

assigned to each case should be prepared to discuss them briefly and succinctly. Any

daily changes in the case should receive particular emphasis.

Other mornings, or following combined rounds, the medicine service will hold their

own rounds with a more in-depth discussion of their cases.

Senior papers are on Thursdays at 8:00 am for one hour and include in depth topics

that are researched and prepared by your peers. Senior papers will be followed by

medicine rounds.

‘Grand rounds’ are held each Friday morning at 8.00 am after case transfers, and

three or more interesting cases are presented by medicine and surgery students,

and an in-depth discussion is held. Discussion with clinicians/house officers in

advance regarding what might be an appropriate case or topic to present is advised.

A PowerPoint template is available for presentations on the student drive. Please see

the following instructions regarding organizing grand rounds with the schedule

determined by the students on the block:

All medicine and surgery students should complete a proposed grand rounds

schedule prior to the rotation commencing – see example on CANVAS

Ensure a mix of surgery and medicine cases or topics each week

Ensure the number of presenters are evenly scheduled across the block including

in the first week

Ensure that two-week students transitioning from surgery to medicine or vice

versa do not have to present two weeks consecutively

On weeks when Friday is not an option for presenting (such as thanksgiving for

example) plan to present Wednesday morning that week unless otherwise

instructed.

A fair system (such as a coin flip) might be required to determine students to take

presentations the first week if self-selection is challenging.

Provide a copy of the draft schedule to Dr. Holder and Dr. McKenzie no later

than the first Wednesday of the block for review and final approval.

VI.

Instruction In Addition To Casework

Discussions will be held in all blocks at the discretion of the clinicians and based on

the students' request and time. Feel free to ask if you have a particular topic you

would like to learn about, every effort will be made to accommodate this.

Students should work with their clinician to complete any necessary documents

related to their training such as RTA’s and procedures lists or booklets.

VII.

Non-case Related Time will be Spent in a Productive, Educational

Manner

Complete procedures required for graduation.

Special short seminars with clinicians on selected problems.

Practice examination skills and common procedures on normal animals.

Review cases on other services, i.e., surgery, theriogenology.

Observe necropsy of cases or pathology rounds.

Auto-tutorial programs in the library or on CANVAS.

Library study- notify clinicians of your whereabouts if you intend to go to the library

Special assignments may be made if necessary.

VIII.

Preparation

Review of common medical conditions in large animals and their treatment prior to this

rotation is highly recommended. Knowledge of the principles of fluid therapy and

antimicrobial use is critical. Throughout your rotation, you can expect to be constantly

questioned regarding large animal medicine and physiology, especially relevant to a case

you are managing. Therefore additional or review reading during your rotation is

strongly recommended. A student library containing relevant internal medicine texts is

located in the computer room to provide you ready access to applicable texts. Texts must

not be removed from that room. Large animal medicine notes and lecture slides are

available on the student share drive (T drive) in folder named “Clinical Course Handouts”.

ADDENDA

How to write a SOAP for LA Medicine

S (Subjective): On day 1: You write your SOAP to cover the intake. This is where you

write your history on the patient. On subsequent days: TAKE HISTORY OUT! The same

information does not need to be revisited multiple days in a row. Now you write your

subjective thoughts on the patient (attitude, appetite, behavior, etc.) and how the patient

progressed overnight. Also include here how much manure was produced and how much

water was consumed (in liters) over the previous 24 hours.

O (Objective): This is where you write all your physical examination data. Please divide

it into separate systems categories as follows:

VITAL SIGNS: T P R EENT:

CV:

RESP:

GIT:

UG:

MS:

INTEG:

NEURO:

LN:

Then you write the significant results of any diagnostics that have been performed that

morning: CBC/chemistry:

PCV/TP:

Venous blood gas:

A (Assessment): This is where you can provide a 4-5 (or more if needed) sentence

paragraph (NO lists) on your assessment of how the patient is progressing today. You can

describe laboratory results and how they have improved or declined and how they relate

to patient progress to demonstrate your understanding of disease processes and what the

important concerns are AT THIS POINT IN TIME.

P (Plan): This is where you write the plan for the day. Again, things should be written in

lists in a sensible manner. Usually as follows:

MONITORING:

PE q X hours

Any additional monitoring

MEDICATIONS: (list in ORDER: IV, IM, SQ, PO, Topical)

Drug A (concentration): dose (in mg/kg), frequency, route

Drug B (concentration): dose (in mg/kg), frequency, route

DIAGNOSTICS:

Test A

Test B

THERAPIES/TREATMENTS/PROCEDURES:

Ultrasound A

Flush B, etc.

ADDENDUM:

This is written at the end of the day. This is where you discuss the results of any tests that

come back AFTER the 8 am SOAP and any significant occurrences that have happened

throughout the current day.

How to write a discharge statement for LA Medicine

Complete the listed sections below as instructed for animals discharged

alive.

Chief Complaint: Write the main complaint the animal is presenting for according to

the client, e.g. ‘Irregular cardiac rhythm’ or ‘acute colic’

History: Describe the signalment of the animal in question (name, age, species, breed)

and the circumstances about why they presented. Prior information from referring

veterinarians such as their examination or diagnostic findings, any medications given by

the client or vet and other specifics about the current condition should be written here.

You can also report the status of other animals on the property and the current diet and

management conditions for this patient.

Physical Findings: Describe the initial assessment – attitude, body condition score

and weight if available, vital signs, relevant normal findings of examination (heart and

lung sounds, GI sounds, digital pulses etc.) and any abnormalities on examination.

Diagnostic Tests: These are usually best listed in order of occurrence. We do not want

long lists of terms and numbers that clients will not recognize or understand. For example,

indicate that ‘a complete blood count was performed, and changes were identified including

a high fibrinogen (an inflammatory protein) and a high neutrophil (white cell) count,

consistent with chronic inflammation or infection’. Write only clinically significant

findings of laboratory work and diagnostic procedures and attribute the meaning to them

in a manner that the client can understand.

Diagnosis: List one or more final diagnoses that were achieved during the visit and

indicate if the problem was resolved. e.g. ‘Acute colic, resolved with medical management’

Case Assessment: Do not reiterate the entire history. Restate why the animal presented

and the major findings of the examination and diagnostic procedures that culminated in

the specific diagnosis. Then describe how the case was managed including what

treatments were given and why (details such as doses are usually excluded). Then

summarize how the animal responded to treatments and if the problems resolved or are

continuing at this time. A segment educating the owner about specific disease conditions,

such as recurrent airway obstruction, pigeon fever, colic or other disorders and methods

of preventing them is usually relevant to finish up the case summary.

Treatment Recommendations: individually list ALL medications that the animal is

to receive at home, including dose (in tablets or mls), route and frequency of

administration, and how long the medications are to be given for. Also, indicate possible

side effects that the owner should monitor for in this section.

Dietary and exercise recommendations can also be made in this section, as can

recommendations for quarantine.

Follow up: indicate if re-evaluation is needed by OSU or the owner’s veterinarian, and

what specific tests or procedures are needed and approximately when they should be

scheduled. Also, instruct the client to call with any questions or concerns. If results are

not expected to be available for some tests or procedures at the time of writing, indicate

that they will be transmitted at some point when they are available.

Finish by thanking them for bringing their animal into the hospital,

How to write a case summary for LA Medicine (for animals that are not

discharged)

Complete the listed sections below as instructed for animals that do not

survive their visit. Ensure that the words ‘Discharge Statement’ at the top of

the template document are replaced with ‘Case Summary’

Chief Complaint: Write the main complaint the animal is presenting for according to

the client,

e.g. ‘Irregular cardiac rhythm’ or ‘acute colic’

History: Describe the signalment of the animal in question (name, age, species, breed)

and the circumstances about why they presented. Prior information from referring

veterinarians such as their examination or diagnostic findings, any medications given by

the client or vet and other specifics about the current condition should be written here.

You can also report the status of other animals on the property and the current diet and

management conditions for this patient.

Physical Findings: Describe the initial assessment – attitude, body condition score

and weight if available, vital signs, relevant normal findings of examination (heart and

lung sounds, GI sounds, digital pulses etc.) and any abnormalities on examination.

Diagnostic Tests: These are usually best listed in order of occurrence. We do not want

long lists of terms and numbers that clients will not recognize or understand. For

example, indicate that ‘a complete blood count was performed, and changes were

identified including a high fibrinogen (an inflammatory protein) and a high neutrophil

(white cell) count, consistent with chronic inflammation or infection’. Write only

clinically significant findings of laboratory work and diagnostic procedures and

attribute the meaning to them in a manner that the client can understand.