Tuesday, 1 June 2010

Dog Crash

In UK you do not have to be qualified to do anaesthetics on a patient. The rcvs say that the vet is able to direct things.
This system means that vets can continue to pay poor wages so qualified veterinary nurses do not stay in the profession, and there is a lack of qualified nurses so unqualified are used.
You can pack shelves at Tesco one day and the next start at a vet and be put in charge of an anaesthetic; this is not unusual in many practices. In fact a lot of them do not even have a qualified veterinary nurse on the premises.
To be fair some unqualified auxiliary have been in the profession for years and are very good but it is still an excuse for bad wages and lax rules.

The following is an event that happened to me recently when l was working with a locum vet and shows exactly why A) This system is so dangerous and B) Why the vet should listen to the anaesthetist because they are at the sharp end not rumbling round in the animal’s guts doing a different job.

We had a small dog on the table having an operation. I had had to go and find some instruments for the vet so had left my patient unattended for a few minutes. I got back and he had started to puff a bit. I did a quick check on him and was about to turn my patient down slightly as he was going too deep.

Vet: Turn him up he is puffing.
Me: No he is going to deep l am lightening him.
Vet: “No l said turn him up he is getting puffy”
Me: “He has no jaw tone and his eyes are…”
Vet: Snapping “I want him up”
Me “Suit yourself” so l turn him up to 3
Vet: A couple of minutes later “He is still too light he is puffing worse”
Me “Yes l know he is too deep”
Vet “No he isn’t deepen him up to 4.5”
Me: Getting ready for the animal to crash and debating internal odds on how long this will take “Fine” turning patient’s anaesthetic gas up to 4.5

Within a couple of minutes he had crashed and stopped breathing. I was waiting for this little side trip under GA to begin. I smacked off the gas just left him on pure oxygen and started to breathe for him. It took 10 minutes until he was stable enough to breathe on his own. I also had to re-stabilise him back under anaesthetic.

The vets comment when she saw me start to do ippv on the dog stopped breathing “Oh has he stopped breathing?” She did not see it stop breathing as she was busy with her operation, happy the dog was not puffing. What would have happened with the shelf stacker?
I ignored her and just got on with my side of things. WW3 did not need to be brought in at this point and l was chewing my tongue.

So if you have a pet that is going to have a general anaesthetic, ask if it is a qualified nurse or a second year vn student (you do anaesthetics in second year) who will do the anaesthetic. Things can and do happen, l have had patients crash and been unable to do anything to bring them back, but it is less likely and circumstances like the above one are a lot more correctable because l knew what was about to happen.


Elizabeth said...

I am surprised you didn't bite your tongue off...
nothing replaces "training"....

Anonymous said...

Really poor communication there, glad you knew what was going on.