5705 Module 2

SOAP Format

• Owner reports not acting normally, stumbling occasionally, vacant look, still wants to play, and enjoying the park
• Interacting less with family at home, eating/toileting normally, no history of seizures, doesn't usually eat things he isn't supposed to
• Proprioception slow, no nystagmus, rest of neuro exam NAD, weight stable, T=N, no obvious pain, walking normally in carpark
• Diagnosis: Cushings, brain tumor, toxicity, dementia
• Plan: Bloods/ACTH stim/US/UA/xrays/MRI/pain relief trial
• Pain relief trial, monitor for changes, bloods and UA initially, consider MRI if all results normal

Injection Sites and Routes

• Subcutaneous (SQ/SC)
• Intraosseous (IO)
• Intrathecal (into the fluid in the spinal canal/Cerebrospinal Fluid)
• Intradermal (into the dermis of the skin)
• Intra-articular (into the articular space of a joint)
• Intraperitoneal (IP) (into the peritoneal cavity/abdominal cavity)
• Intra-arterial (into an artery)
• Intracardiac (IC) (into the heart/chambers of the heart)

Importance of Proper Injection Technique

• Injection is the only or best method of administration for many medicines and most vaccines
• Medications given via the wrong route can cause skin or vein necrosis, seizures, and even death
• Poor injection technique can cause animal pain, abscesses, and scarring
• Proper technique requires considering the drug, route, and animal's needs

Preparing to Inject a Medication

• Read the label to ensure correct drug, amount, method, and site
• Choose clean, dry skin, correct needle and syringe size, and appropriate needle length and gauge
• Use the smallest needle and syringe reasonable to minimize tissue damage
• Change the needle and syringe between animals, never reuse them

Subcutaneous Injection (SQ/SC)

• Subcutaneous injections involve administering medication into the "subcutaneous space" under the skin.
• Common sites for SQ/SC injections in cats and dogs: scruff of the neck, side of the chest, and flank.
• Common sites for SQ/SC injections in cattle, sheep, and horses: neck.
• Advantages: large volumes can be administered, generally less painful, and well-tolerated.
• Disadvantages: slow absorption due to lack of large blood vessels, not suitable for fluid administration in emergency situations.

Technique for SQ/SC Injection

• Lift the skin over the scruff of the neck to form a tent.
• Insert the needle at the tent base, avoiding directing the needle at fingers.
• Hold the needle parallel to the animal's body to avoid puncturing underlying structures.
• Aspirate to ensure the needle has not entered a blood vessel.
• Inject the full volume at a moderate rate.
• Withdraw the needle and press the skin to seal the exit hole and prevent fluid from leaking out.
• Check the animal for any bleeding.

Intramuscular (IM) Injection

• Common sites for IM injections in cattle, sheep, and horses: neck muscle.
• IM injection in horses: into the neck muscle.

Intravenous (IV) Injection

• Common sites for IV injections in cats, dogs, and rabbits: cephalic vein (front-leg), medial saphenous vein (hind-leg), and marginal ear vein (rabbits).
• Common sites for IV injections in large animals: jugular vein (cattle, sheep, and horses), and tail (coccygeal vein) in cattle.
• Advantages: drugs administered IV are delivered directly to the bloodstream and quickly reach effective concentrations.
• Disadvantages: requires aseptic technique, drugs must be administered slowly to reduce the chance of heart/brain reaction.

Other Injection Routes

• Intradermal (into the dermis of the skin)
• Intra-articular (into the articular space of a joint)
• Intraperitoneal (IP) (into the peritoneal cavity or abdominal cavity)
• Intra-arterial (into an artery)
• Intracardiac (IC) (into the heart or the chambers of the heart)

Importance of Injection Routes

• The route of administration depends on the medication being given.
• Medications given via the wrong route can cause skin or vein necrosis, seizures, and even death.
• Poor injection technique can cause animal pain, abscesses, and scarring.
• Consideration of the drug, its purpose, and the animal's welfare is crucial when choosing an injection route.

Clinical Records

• Veterinarians must maintain clear and accurate clinical records that can be easily understood by another veterinarian taking over the case.
• Records must be detailed, retained for statutory periods or until they remain relevant, and not altered retrospectively without marking changes chronologically.
• Records must be accessible to clients on request, unless there are justifiable legal reasons to withhold them.

Record Keeping Acronyms

• S.O.A.P (Subjective, Objective, Assessment, Plan) is a standard record keeping acronym used for veterinary medical records.
• HEAP (History, Examination, Assessment, Plan) is another acronym used, with History equivalent to Subjective, and Examination equivalent to Objective.

Medication Administration

• General principle: Read the label, ensure correct drug, amount, method, and site.
• Choose the correct needle and syringe size for the job, using the smallest needle and syringe reasonable for the product and injection site.
• Use the appropriate needle length and gauge for the animal, injection site, and drug.

Injection Techniques

• Subcutaneous (SQ) injection: administer medication into the subcutaneous tissue, just beneath the skin.
• Intramuscular (IM) injection: administer medication into a large muscle, with common sites including proximal hind-leg muscles and back muscles.
• IM advantages: faster absorption, but can be more painful and has a risk of accidental IV administration.
• IM technique: fill syringe, eject air bubbles, give injection deep into muscle, and check for blood flow.

Packaging and Storage

• Unopened manufacturer's packages normally meet safety requirements.
• Loose tablets or capsules must be put in Child Resistant Safety Containers (CRSCs).
• Check client has necessary equipment and understands storage and handling requirements, such as refrigeration or sensitivity to light.

Client Communication

• Ensure owners understand what to give, when to give, and how to administer medication.
• Never assume owner understanding and use clear, simple language.
• Use standardization, clarification, and double-checking to ensure client comprehension.

Bandaging

• Check bandages for slippage, tightness, odor, edema, discharge, skin irritation, wetness, strikethrough, patient soiling, and patient interference.
• Increasing mental stimulation can help minimize patient interference with bandages.
• Different types of Elizabeth collars and pet shirts can be used to assist with bandage management.

Surgical Wound Bandaging

• Often, surgical wounds are left without a dressing, but a simple non-adherent dressing may be applied as a primary layer.
• The dressing is usually removed after 24 hours, and additional padding may be required for adsorption or stabilization of the surgical site.