Medical Nursing

Study Guide
Medical Nursing
for Veterinary
Technicians
By
Katie Samuelson, D.V.M.
About the Author

Katie Samuelson has worked in the veterinary field since 1987.
She began as kennel help, worked her way up to veterinary assistant and then to certified veterinary technician. She earned a
doctorate in veterinary medicine from Oregon State University in
2001. As a technician, she was in charge of the technical staff,
training, and aiding them in their continuing education. Currently,
she works in emergency medicine and is publishing a technician
manual that she began writing for her staff.
All terms mentioned in this text that are known to be trademarks or service
marks have been appropriately capitalized. Use of a term in this text should not be
regarded as affecting the validity of any trademark or service mark.
Copyright 2015 by Penn Foster, Inc.

All rights reserved. No part of the material protected by this copyright may be
reproduced or utilized in any form or by any means, electronic or mechanical,
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system, without permission in writing from the copyright owner.
Requests for permission to make copies of any part of the work should be
mailed to Copyright Permissions, Penn Foster, 925 Oak Street, Scranton,
Pennsylvania 18515.
Printed in the United States of America
01/28/16
LESSON ASSIGNMENTS
LESSON 1: ANIMAL NURSING CARE AND

ADMINISTRATION ROUTES
LESSON 2: SAMPLE COLLECTION AND

FLUID ADMINISTRATION
97
LESSON 3: DENTAL PROPHYLAXIS
145
LESSON 4: WOUNDS, BANDAGES, CASTS,

SLINGS, AND EMERGENCY CARE
169
SELF-CHECK ANSWERS
271
Contents
INSTRUCTIONS TO STUDENTS
iii
YOUR COURSE
Since veterinary technicians perform most of the routine

treatments for each animal, they typically spend more time
with the animal than the veterinarian does. Therefore, the
technician is crucial in bringing the veterinarians attention
to any potential problems the animal may be experiencing.
This being the case, its important that you, as the veterinary
technician, have a thorough knowledge of animal health care.
OBJECTIVES
When you complete this course, youll be able to
Explain the routine care, feeding, medication, and

observation procedures for hospitalized patients,
including pediatric and geriatric animals
Identify and describe the requirements, routes,

procedures, and safety and health concerns of fluid
administration
Identify and describe the most common procedures used

in veterinary sample collection
Explain the principles and procedures of dog and cat

dental prophylaxis
Describe wound care and how bandages play a part in

wound healing
Describe types and parts of bandages and specify the

appropriate bandaging techniques for various animals
Identify and describe the function of specialty bandages
Instructions
Welcome to Medical Nursing for the Veterinary Technician! This

study guide is designed to assist you with your study of veterinary medicine. Caring for animals, whether it be routine or more
specialized, is an exciting and challenging career. You, as a
veterinary technician, are a key player in the animals health
care. As you become more experienced, youll find that youll
be more and more involved in the intricacies of the care each
animal receives.
Explain the proper way to maintain, change, and remove

bandages, splints, casts, and slings
Identify emergency and critical patients via the telephone

and on presentation to the veterinary hospital
Recognize the signs of common emergency problems and

anticipate the needs of the veterinarian in stabilizing
those patients
Describe the general approach to the poisoned patient

and be familiar with the clinical signs and management
of commonly encountered toxins
Explain the steps involved to perform basic cardiopulmonary resuscitation
COURSE MATERIALS
Your Medical Nursing for the Veterinary Technician course
provides you with the following materials:
1. This study guide, which includes
A lesson assignments page that lists the schedule of

assigned readings in your textbook
Explanatory material on each assignment
Self-checks and answers that allow you to measure

your understanding of the course material
2. Your course textbook, Clinical Textbook for Veterinary

Technicians, Eighth Edition, by Joanna M. Bassert,
which contains your assigned readings
YOUR TEXTBOOK
Your textbook, Clinical Textbook for Veterinary Technicians,
contains the bulk of the material on which your examinations
will be based, so its important that you read it carefully and
completely. This study guide contains information and illustrations related to the topics in your lessons and important
points from your textbook.
Instructions to Students
A STUDY PLAN
This study guide divides the material to be covered into four
lessons. Each lesson is divided into multiple assignments to
make your learning more manageable. Each assignment
includes a reading from your textbooks and a supplementary
assignment in this study guide. After each assignment, there
are self-check questions to check your understanding of what
youve learned. Be sure to complete all of the work in each
lesson before moving on to the next. Youll find this easy to
do if you follow the study plan outlined below.
1. Read the instructions to each assignment in this study
guide. The instructions will tell you the pages in your
textbook that youll be reading.
2. Quickly read the assigned pages in your textbook. This
is called skimming, a learning technique you should use
to get a general idea of the topics covered in that part of
the text. You may find it helpful at this stage to read the
chapters straight through, rather than just reading the
pages on which the assignment focuses.
3. Go back and slowly read the assigned textbook pages
again. Pay careful attention to what youre reading.
4. Read the assigned pages in this study guide.
5. When youve finished the assignment, complete the selfcheck, which youll also find in this study guide. The
self-checks are based on both your textbook and this
study guide. The self-checks are for your use onlythey
arent graded. Dont send your answers to the school.
6. Once youve completed a self-check, turn to the answers
provided at the back of this study guide. The self-checks
are designed to show you how well you understand the
material, so test yourself honestly. Make every effort to
complete the questions before turning to the answers at
the back of this study guide. If you find any weak areas
in your knowledge, go back and review the relevant
material until you understand it.
7. Follow this procedure for all of the assignments, until
youve completed the lesson.
8. When youre confident that you understand all the

assigned material within a lesson, complete the lesson
examination. The examination is based on both your
textbook and this study guide.
9. Repeat steps 18 for the remaining lessons in this study
guide.
If you have any questions during your studies, email your
instructor for assistance.
Now review the description of lesson assignments provided
in the outline that follows, and then begin your study of
medical nursing with the first assignment of Lesson 1.
Enjoy your studies!
Remember to regularly check your student portal. Your instructor may

post additional resources that you can access to enhance your
learning experience.
For:
Read in the
study guide:
Read in
the textbook:
Assignment 1
Pages 727
672681, 704705,
737744, 865878,
930931
Assignment 2
Pages 2840
787809
Assignment 3
Pages 4044
13551376
Assignment 4
Pages 4564
188190, 238239,
285, 588, 590591,
638639, 812823,
1221
Assignment 5
Pages 6496
586596, 598599,
620642
Examination 573460
Material in Lesson 1
Lesson 2: Sample Collection and Fluid Administration

For:
Read in the
study guide:
Read in
the textbook:
Assignment 6
Pages 97106
599603, 642651
Assignment 7
Pages 107125
604609, 654657,
664669
Assignment 8
Pages 126144
Examination 573461
883895
Assignments
Lesson 1: Animal Nursing Care and

Administration Routes
Lesson 3: Dental Prophylaxis

For:
Read in the
study guide:
Read in
the textbook:
Assignment 9
Pages 145150
12991303
Assignment 10
Pages 151160
13211343
Assignment 11
Pages 161168
13031321, 13511354
Examination 573462
Lesson 4: Wounds, Bandages, Casts,

Slings, and Emergency Care
For:
Read in the
study guide:
Read in
the textbook:
Assignment 12
Pages 169180
973981, 992993
Assignment 13
Pages 181205
981991, 9941003
Assignment 14
Pages 206218
908
Assignment 15
Pages 219270
908927, 931933,
944969
Examination 573463
Note: To access and complete any of the examinations for this study
guide, click on the appropriate Take Exam icon on your student portal.
You should not have to enter the examination numbers. These numbers
are for reference only if you have reason to contact Student Services.
Lesson Assignments
ASSIGNMENT 1YOUR ROLE

IN ANIMAL NURSING CARE
Read this assignment. Then read pages 672681, 704705,
737744, 865878, and 930931 in Clinical Textbook for
Veterinary Technicians.
Introduction
The veterinary profession is one that involves many different
people working together to care for animals. Its much like
the human medical field, but without the participation of
the patient. Therefore, the people involvedveterinarians,
technicians, assistants, and ownersare all integral parts of
making sure an animal is healthy and well treated. The role
of the veterinary staff is to monitor and treat the animal
when it needs medical attention and to educate the owner
on the best care for the animal.
When an animal is admitted to a veterinary hospital, the
veterinary staff works as a team to care for the animal. The
veterinarian depends on the veterinary technician to aid him
or her in monitoring the animal and to perform diagnostics
that help the veterinarian make appropriate decisions on how
to treat the animal.
As a veterinary technician, your nursing responsibilities will
largely consist of routine care, feeding, and observation of
hospitalized patients. Youll often be an animals first line of
defense. Youll detect clinical problems that involve food and
water intake, elimination habits, and other behavioral changes.
These changes should be brought to the veterinarians attention,
as they may indicate a clinical problem.
Lesson 1
Animal Nursing Care and

Administration Routes
A clinical problem is anything that interferes with the animals

well-being or requires diagnostic evaluation or treatment.
Diarrhea, vomiting, complete or partial loss of appetite, restlessness (indicating discomfort), and difficulty in breathing are all
examples of clinical problems you must be able to recognize.
Remember that your observations are an important source of
information in the animals diagnostic and therapeutic care.
You should view your job as a form of problem solving. There
are four major steps to caring for animals:
1. Data collection
2. Interpretation
3. Implementation of a plan
4. Evaluation of that plan
For example, data collection might involve making an
observation that an animals water intake appears to have
increased (indicating possible polydipsia [excessive thirst]).
The interpretation of the data is recognizing the increased
intake as a potential clinical problem and documenting it.
In the case of increased water intake, it may be necessary
to actually measure the amount of water the animal is
drinking in a 24-hour period and then compare it with
normal daily intake.
A plan is implemented after the veterinarian has been
notified of the potential clinical problem, the problem has
been confirmed per the veterinarians instructions (such as
measuring water intake), and a plan has been formulated by
the veterinarian to try to correct the problem. The technician
may be the one to implement the plan, depending on the level
of training achieved. The plan is then evaluated by monitoring the treatment results. This is a very important component
of the technicians job, as the results may cause the plan
to be modified based on the animals response or a change
in the clinical situation. To maintain the baseline for observation
and protect the practice from legal difficulties, the veterinary
technician always must consult the veterinarian before making
any changes to an animals diagnostic or therapeutic care.
Never forget that the quantity and nature of nursing care an
animal receives will vary. One animal may readily accept a
diagnostic or therapeutic procedure, whereas another animal
Medical Nursing for Veterinary Technicians
may resist to the point that the intended benefit is lost.

Excessive intervention may be detrimental to some animals.
Other animals require a great deal of attention and affection
to maintain their will to live during the separation from their
owners.
The hospital staff should establish and maintain consistent
standards for nursing care. They have a professional and
moral obligation to every animal to provide the following:
An environment as clean, comfortable, and stress-free

as possible
Food and water at all times, unless restricted for medical

reasons
Adequate exercise and grooming care, unless restricted

for medical reasons
Prompt and humane pain relief
Humane treatment of every animal at all times
Individual cleaning to keep every animal dry and free of

urine and feces, unless cleaning is restricted for medical
reasons
Routine Care and Observation

of the Hospitalized Animal
Part of your role as a veterinary technician is to care for and
monitor the condition of animals in the veterinary hospital.
Activities such as bathing, grooming, and exercising hospitalized animals, as well as carefully maintaining their medical
records, all fall under the heading of routine care. Because
many hospitalized animals arent ambulatory, a separate
area of concern is caring for recumbent animals. Recumbent
animals are those lying down and unable to rise.
Lesson 1
Routine animal care requires the following equipment and

supplies:
Bathing and grooming areas for both small and large

animals (Figure 1)
Grooming and bathing equipment and supplies such as

combs, brushes, scissors, towels, electrical dryers, and
shampoos
Clean bedding
Clean water and food in accessible containers
Daily medication orders for all hospitalized and

recumbent animals
Adequate-sized kennels and exercise areas for small

animals
Adequate-sized pens or stalls and exercise areas for large

animals
Adequate supply of bandages, tape, and ointments for

general wound care
Thermometer, stethoscope, and other equipment for general examination of hospitalized and recumbent animals
FIGURE 1Grooming and

Bathing Area
10
Cleanliness and Animal Care

The best way to keep an ambulatory animal clean is through
the appropriate use of bedding and exercise areas. Large
animals are usually kept in stalls or pens that have rubber
matting and some form of shavings or straw lining in them
to aid in urine absorption. Several types of bedding are routinely
used for dogs and cats. They include puppy pads, blankets,
towels, and pet beds. Its important that the bedding material
selected be disposable or readily and effectively cleaned between
uses. Because animals occasionally ingest their bedding, its
also important that the material be safe and nontoxic.
Most dogs and cats are extremely reluctant to urinate or
defecate in their cages, so regular use of an exercise area will
help to keep both cage and animal clean. Generally, cats are
easier than dogs to keep clean during periods of hospitalization. Unless theyre seriously ill, cats use the litter pans and
groom and clean themselves. Litter should be changed daily,
and pans should be either disposable or constructed of
materials that allow thorough cleaning and disinfecting
between uses. It isnt necessary to place cats in exercise
areas unless the hospital stay is unusually long.
Grooming, bathing, and general cleanliness are important
aspects of routine animal care for several reasons. First, a
clean and well-groomed animal has an enhanced sense of
well-being and is likely to recover from an illness more
rapidly. Second, a clean and comfortable animal is much
less likely to develop skin problems or bedsores from urine
scalding and fecal soiling, which can become another clinical
problem. Third, grooming and medicated baths can prevent
or treat many skin diseases. Finally, discharging a clean
animal reflects well upon the practices overall health care.
Therapeutic Bathing
Bathing an animal once a month in the colder months of the
year and every other week during the warm season is sufficient unless the dog or cat has a skin problem that requires
more frequent attention with therapeutic baths. Always bathe
animals before theyre dipped for ectoparasites (parasites that
Lesson 1
11
live on the surface of their victims skin), such as fleas and ticks.
Care should be taken so that young puppies and kittens dont
become chilled.
Thoroughly rinse the animal with clean water to prevent
irritation of the skin from residual shampoo. The axillary and
scrotal regions of long-haired dogs are particularly vulnerable
to residual shampoo irritation. If a cage blow dryer is used,
caution must be exercised to prevent overheating of the
animal (hyperthermia).
Use shampoos containing insecticides only with approval
of the veterinarian because of possible toxicity or drug
interactions. Sponge-on insecticidal dipping solutions must
be diluted to avoid toxicity to the animal. Always read the
manufacturers instructions on the container before using
any dipping solution on an animal. If a complete immersion
bath is required, first remove fecal soiling from the animal
with a sponge bath.
Although theres no particular trick to bathing a dog or cat,
preparing both the animal and the bathing area makes the
chore safer and easier. Find an area large enough to accommodate the animal. Cover the floor of the bathing area with a
nonskid mat for traction.
Be sure that all hair mats and burrs have been combed out
of the coat. Place a small amount of lubricating ophthalmic
ointment into the animals eyes. This will protect the eyes from
irritating chemicals in shampoos or sponge-on insecticidal solutions. Place a small piece of cotton in each ear to protect
the external ear canals from excessive water. (Remember to
remove the cotton when the bath is done!) Monitor the water
temperature while the bath fills to prevent scalding.
Several bathing techniques ensure maximum effect with minimum difficulty. To keep fleas from running to the animals
head, always bathe an animal from nose to tail. Clean the
face, head, and ears with a sponge. Use small amounts of
shampoo. A little bit of shampoo can go a long way, and
too much shampoo is difficult to rinse off. Shampoo lathers
better if you dilute the measured amount with water before
application. Most therapeutic shampoos must remain on the
hair for at least 10 minutes before rinsing. Flea shampoos
generally do little to control fleas because they have limited
12
residual activity and just anesthetize the fleas. If the fleas

stay in the fur during the bath, theyll eventually wake up
and bite the animal again.
Basic Grooming Protocols

To prevent the spread of infections such as ringworm,
thoroughly cleanse all grooming equipment with hospital
disinfectant after each use. Whenever possible, get the
owners permission before clipping or removing hair from an
animal for medical reasons. This is especially important for
show animals. Some dog breedsfor example, the Afghan
houndhave extremely slow hair growth.
The main difference between grooming and bathing large
and small animals is that large animals take much more
time. As with small animals, an area should be designated
for grooming or bathing and stocked with the appropriate
combs, brushes, and shampoos. Its especially important to
the recovery of hospitalized large animals, particularly postoperative animals, to keep their pens and bedding areas
clean and free of fecal material.
Dipping
The successful flea- and tick-control program eliminates these
pests from both the animal and its environment. Flea control
must be practiced on all animals in the household, but this
doesnt mean that all animals should be dipped. Dipping solution may be toxic to puppies and kittens under 3 months old.
Powders and sprays that contain either carbaryl or pyrethrins
can be used safely every five to seven days on a puppy or
kitten older than two months. Always read the products label
and follow the instructions carefully.
Sponge-on insecticidal dips are safe for healthy dogs and
cats over three months old. These dips, usually applied every 14
to 21 days, effectively kill fleas, ticks, and mange mites. Apply a
dipping solution after a shampoo by pouring and sponging the
premixed dipping solution over every part of the animals body.
Lesson 1
13
Dont towel or rinse. Allow the dip to dry on the dog or cat.
Always wear rubber gloves and protective eyewear when
applying any dip product.
Most dips are concentrates that are diluted with water just
before theyre applied. To avoid poisoning the animal, its crucial to mix dips exactly as described on the products label.
Dips usually contain chlorpyrifos, phosmet, permethrin, or
d-trans allethrin as their active ingredient.
Exercise
Moderate exercise benefits an animals general care. Its the
simplest, most basic form of physical therapy. It improves
muscle tone and strength and can help reduce fluid collecting under the skin (also called peripheral edema). To prevent
injury and death, exercise animals in a secure, controlled,
and safe environment. Animals with respiratory, cardiovascular, and musculoskeletal problems may need restricted
exercise. Exercise restrictions should be imposed by the
veterinarian. You should always check with the veterinarian
before exercising an animal.
Feeding
The most basic requirement for life is caloric intake. Animals
that are diseased in any way have a higher caloric need than
those that are healthy. Unfortunately, many times the hospitalized patient doesnt eat readily. Therefore, its very important
that the technician aid the animal in getting the calories it
needs each day. Some animals will readily eat on their own,
and for those patients, its necessary only to make sure that
they get the amount of food they require (the caloric intake
should be greater than the metabolic need). For hospitalized
animals that dont eat readily, more individualized attention
may be needed.
Depending on the individual animal, attention and encouragement (praise, saying good dog) may be the only thing
needed for the animal to eat. For others, a variety of foods
may be necessary to spark their appetite. In some cases,
more forceful methods may be necessary. For animals that
14
require a variety of foods (picky eaters), its important to

make sure any foods you offer follow the veterinarians restrictions. For example, if the animal requires a kidney-friendly
diet, make sure everything youre offering is kidney-friendly.
Having the owner bring in the animals regular food from home
may also help in getting the animal to eat. For the animal that
refuses to eat on its own, syringe or force-feeding, gastric gavage, or other enteral tubes may be necessary.
Many times, force-feeding is only required for a short time
and can jump-start the animal into eating on its own. Forcefeeding can be accomplished by placing some of the food on
the animals nose, causing the animal to lick it off, placing
the food in the side of the mouth in the space between skin
and teeth, or by using a syringe to place food into the mouth.
Always try the least-invasive method first (placing food on the
nose); if that isnt successful, move on to other, more invasive
techniques. When syringe-feeding an animal, its imperative that
you give the food slowly enough that the animal can swallow
it. Otherwise, the animal may just let it drip out of its mouth
or aspirate some of the food into its lungs.
In general, large animals arent force-fed. However, a few
medical conditions require a variance in their normal diets.
For example, horses with sand impactions within the large
intestine may need Metamucil added to their diet. Ruminants
(cows, sheep, goats) suffering from grain overload (lactic acidosis)
will need to be restricted from eating grain. When the condition
has cleared up, you can introduce grains back into the diet.
Medication Records
You, the veterinary technician, must record any medication
you administer (drug, dose, route of administration, and time
administered) completely and accurately in the animals medical
record. Record the notation immediately after administering the
medication, and sign or initial each entry. Follow this procedure
consistently to ensure that treatments are performed and not
repeated. A well-kept medical record improves the animals care
and protects the practice in the case of legal disputes. The
medical record is a legal document, and every treatment
should be recorded in case of subsequent litigation (Figure 2).
Lesson 1
15
AnyCity Animal Hospital

Medical Record
Owner Information
Owner Name:
Mr.
Miss
Ms.
X
Mrs.
Patient/Pets Name:
Patricia ONeil
Max
Address:
City/State/Zip
444 Main Street
Scranton, PA 12345
Home Phone:
Business Phone:
555-1234
Patient/Pet Information
53
Chart #: ________________________
German Shepherd
Patient: Max
________________________ Species: ______________
Breed: ________________
Canine
Color: __________________________
Sex: F
Tan/Black
M
X
N Birth Date: ____________

02/27/2003
Rabies, Bordetella
lbs.
Vax History: ________________________________________________
Weight: 40
__________
Current Problems
Date
Time
Month
Day
Year
17
2004
SOAP
Format
Progress Notes
Fee
Hit by car 4/17/2004 10 A.M.

Panting, Limping, Depressed/Weak
Pale/Tacky Mucus Membranes
11
18
2005
Diagnosed with Osteoarthritis

Prescribed Rimadyl Chewable
Tablets 25mg #30 Tabs
1 Tab TID/PRN
FIGURE 2Medical Record
16
Patient Monitoring
Depending on the severity of the patients clinical condition,
patient monitoring may occur anywhere from twice a day to
continuously. Animals that require only basic monitoring are
usually checked twice a day for temperature, heart rate (HR),
respiratory rate (RR), mucous membrane color (MM), capillary
refill time (CRT), and body weight. Theyre then exercised
according to the veterinarians instructions.
Patients that require more intense monitoring will have their
temperature, heart rate, respiratory rate, mucous membrane
evaluation, body weight, as well as the evaluation of other
specified parameters (e.g., blood pressure, oxygen saturation,
ECG) taken more frequently than twice a day. These animals
are generally assigned a form designed to track their vitals
and progress (Figure 3). By recording all of this information
on a form, the veterinarian will be able to assess the animals
recovery and recognize any improvements or setbacks. As the
veterinary technician, youre responsible for recording the
information obtained from the continuous monitoring as
specified on the animals treatment/monitoring form and
alerting the veterinarian to variances in the information.
Routine Care and Observation

of the Recumbent Animal
The animal that will require the most of your attention is the
recumbent, cage-confined animal. This animals rehabilitation
or recovery depends on its individual care. Enthusiastic nursing
care and lots of love can make a real difference. Many animals
also have special rehabilitative needs. The veterinary technician
has the responsibility to recognize and attend to these needs.
A physical therapy program may be needed to expedite the
recovery period.
Lesson 1
17
18
LABORATORY
SURGERY
RADIOLOGY
PROCEDURES
PERITONEAL FLUID
THORACIC FLUID/AIR
VOMIT/CHARACTER
STOOL/CHARACTER
URINE OUTPUT/COLOR
TOTAL FLUID OUTPUT
TOTAL FLUID INPUT
MENTATION
MM/CRT
RR/EFFORT
HR/SOUNDS
TEMPERATURE
MONITORING
5P 6P 7P 8P 9P 10P 11P 12A 1A 2A 3A 4A 5A 6A 7A 8A 9A 10A 11P 12P 1P 2P 3P
4P
Date: ____________ Patient: __________________________ Case #: ____________
FIGURE 3Patient Monitoring Chart (Mentation means mental abilitywhether the animal seems
confused, bright and alert, dull, sedated, and so on.)
The Personal Touch

The first step in rehabilitation is to show interest in and compassion for the animal. Personal touching (with warm hands)
and talking to the animal are extremely important.
Always relate to the animal as a best friend. To establish this
relationship, address the animal by name, speaking in a
pleasant tone. The personal touch also extends to the animals exercise. Personally supervise the animals exercise
periods and, when possible, take the animal outdoors two to
three times daily to defecate and urinate. Animals that are
recumbent may need assistance in rising and walking. Words
of encouragement while exercising go a long way.
Urinary and Bowel Habits

Many recumbent animals retain excessive amounts of urine
in their urinary bladder. To prevent urine scalding (irritation
of the skin caused by frequent wetting with urine) and urinary
tract infections (UTIs), take careful notes on the animals
urinary habits.
The urinary bladder should be completely emptied three to four
times daily. Manual expression of the urinary bladder through
the abdominal wall works with most females. Manual expression
is using physical pressure on the bladder to stimulate urination.
Manual expression of the urinary bladder isnt as easily accomplished in males, who may require catheters. Concentrated,
bloody, or odorous urine should be brought to the veterinarians
attention so that it can be analyzed and cultured for bacteria.
Cleanliness
Cleanliness is extremely important and can be especially
challenging with recumbent animals, which may suffer
fecal and urinary incontinence. Much of your effort will
be to prevent decubital sores (bedsores) over prominent bony
regions of the animals body. Decubital sores heal very slowly
and can quickly become infected. Preventing and managing
decubital sores and scalding are extremely important aspects
of recumbent animal care.
Lesson 1
19
Animals suffering various neurologic or orthopedic problems

can be recumbent and require special care for long periods.
The longer an animal is recumbent, the greater the risk for
decubital sores and scalding. Both complicate recovery.
Fortunately, a light coating of petroleum jelly on susceptible
perineal or inguinal areas can prevent scalding.
Astringent helps remove moisture from the tissues, which
promotes healing. You shouldnt leave the astringent on for
too long, or it will become irritating.
Decubital sores develop over bony prominences as the result of continuous pressure
and damage to overlying skin. These sores
not only complicate recovery but also can
trigger systemic and life-threatening
bacterial infections. The best treatment for
decubital sores is prevention. Padded rings
or donut bandages protect the bony areas
most prone to decubital ulcers (Figure 4).
FIGURE 4Donut Bandage
Veterinary professionals advocate various

bedding materials to reduce the frequency
and severity of decubital sores: air mattresses, foam padding, synthetic fleeces,
grids or grates, and straw. The bedding
material should either be disposable or
have an impermeable surface that doesnt
retain moisture or bacteria and can be
thoroughly cleaned. Many impermeable
surfaces keep urine and moisture in contact with the skin,
which can increase the risk of decubital sores.
Other routine measures that help prevent decubital sores
include turning the animal frequently (every two to four
hours), using slings or carts intermittently to prevent continuous pressure over the bony prominences, and bathing the
animal to keep the skin clean.
Should decubital sores develop despite these efforts, clean
the sores thoroughly with surgical scrub solution and then
completely dry the area. Monitor and report the animals
condition to the veterinarian, who may find it necessary to
surgically remove necrotic (dead) tissue.
20
Soaking the affected area two to four times daily with a mild
astringent solution will help keep the decubital sore dry. One
part aluminum acetate to 40 parts water (Burrows solution)
provides the appropriate astringent. After soaking, apply a
thick, clinging ointment, such as zinc oxide, to protect the
area from irritation.
Ideally, the area of the decubital sore should be padded to
prevent further pressure injury, but the decubital sore itself
should remain exposed to the air so that it doesnt retain
moisture. One way of accomplishing this is to fashion a
donut from foam rubber and to affix this to the skin with
adhesive tape. Unfortunately, its difficult to maintain these
pads in the proper location for long periods of time. Topical
antibiotic agents should be applied judiciously.
Recumbent Large Animals

Recumbent large animals are also more prone to developing
clinical problems such as colic, decreased gut motility, and
the inability to empty their urinary bladder. Decubital sores
also develop very quickly on recumbent large animals. The
care outlined in the previous section should be used to prevent sores in these animals (change position every two to four
hours; pad stall with straw, waterbed, or padded mat). A
sling can be used in instances when a horse is able to stand
but is too uncoordinated to maintain a standing position.
However, the use of a sling on an animal thats unable to
support its own weight can lead to complications such as
breathing difficulties and the formation of pressure sores.
An animal thats unable to void urine should have a urinary
catheter in place.
Hydrotherapy
Hydrotherapy is the external use of water to treat an injury
or disease. Hydrotherapy improves a recumbent animals
general condition because it cleanses the animal, improves
circulation, decreases decubital sore development, and promotes healing of decubital sores. Make sure you dry the
animal completely after any bathing or whirlpool therapy.
Lesson 1
21
Other Types of Physical Therapy

Both large and small animals can benefit from other types of
physical therapy. Depending on the clinic you work in and
the animals needs, you may assist with these therapies or
perform them yourself. Some therapies require additional certifications or training. Others are fairly easy to master. These
therapies include, but are not limited to, massage, passive
range of motion exercises, neuromuscular stimulation, bioelectrical stimulation, magnetic stimulation, therapeutic
ultrasound, lasers, and thermal therapy.
The use of these therapies is determined by the veterinarian.
As a veterinary technician, you will assist, but youll also play
a role in monitoring the animals response to the therapy.
during and after treatment. The veterinarian will take your
record of the animals response into account, and may adjust
the therapy based on your observations.
Nutrition
Good nutrition is essential for the recumbent animal. Forcefeeding and forced watering may be necessary if the animal
refuses or is unable to eat and drink.
Discharging the Recumbent Small Animal

The veterinary technician plays a vital role in the rehabilitation
and recovery of recumbent animals by providing high-quality
nursing care, physical therapy, and owner education. The
animal should, however, be discharged from the hospital
as soon as possible. Familiar surroundings enhance the
animals sense of well-being and security, and thereby speed
its recovery. Demonstrate the animals therapy to its owner
to make sure that the owner understands how to administer
it. Stress to the owner that maintaining the treatment schedule is important to prevent a relapse. Provide the owner with
complete, written home-care instructions concerning diet,
exercise, medication, treatment schedule, and expected urinary and bowel habits. Call the owner frequently to monitor
the animals condition at home. Many animals will need to
return to the hospital for additional checkups and treatment.
22
Dispensing Medication
Always make sure that all medications, whether used in the
hospital or dispensed for use at home, are correctly labeled.
The dispensing label should include the following information:
Complete name of the medication
Size or concentration of the medication
Number of tablets, capsules, or milliliters of medication

dispensed
Dosage and frequency of administration
Name of the owner and the animal or, more commonly,

the name of the animal and the owners last name
(e.g., Fluffy Smith)
Name of the hospital
If potentially toxic drugs are dispensed, childproof containers

should be used, as determined by state and federal regulations.
The Isolation Ward

Sometimes animals with contagious diseases need to be hospitalizedfor example, a dog or horse with a viral or
bacterial diarrhea. An adequate isolation ward or designated
area should be available for such animals. The ideal isolation
ward affords the same quality of care an animal would
receive in an intensive care unit. It has one entrance and
exit and is equipped with proper hospital disinfectant and
clothing protection. Its ventilation system is separate from
the rest of the hospital, and the area is climate-controlled. Its
supplied much like the rest of the hospital, but all equipment
and supplies remain in the isolation ward and are considered
contaminated. To help contain the contagion, as few people as
possible should treat and handle a contagious animal. Barring
emergencies that require outside treatment, contagious animals
are kept and treated only in the isolation ward.
Lesson 1
23
Equipping the Isolation Ward

The following items are needed for the routine care of
isolation-ward animals:
A variety of high-quality foods in types and flavors

appropriate for the animal species in the isolation ward
(whether dogs, cats, birds, horses, ruminants, or swine)
Appropriate feeding and watering utensils
Measuring equipment and scales for daily weighing of

animals and food (to ensure correct feed amounts and
determine exact food intake)
Routine hospital disinfectant and containers for disposing of animal waste, soiled bedding, and spent supplies
Medications (tablets, liquids, and capsules), a variety of sterile fluid solutions, and fluid and blood administration sets
Plastic tubing in several sizes for gastric or nasogastric

intubation and assorted sizes of urinary catheters (tubes
inserted into the bladder to drain urine)
Various medicating equipment such as syringes and

needles, pilling forceps, balling guns, dose syringes,
speculum devices, and infusion fluid pumps
Stethoscope, thermometer, bandaging scissors, and

bandage equipment
Clothing in the Isolation Ward

To protect isolation ward personnel from contagious disease
and to confine the contagion, anyone entering the isolation
ward should be properly clothed. Proper clothing includes shoe
coverings that can be removed and dipped in disinfectant upon
exiting the isolation ward. Isolation ward personnel always
should wear a protective surgical gown or jumpsuit and disposable gloves. Protective gear should never leave the isolation ward
except for disposal or washing. Some contagious diseases may
warrant protective eyewear and a surgical mask.
24
Disinfectants, Sterilization, and

Antiseptics in the Isolation Ward
Disinfectants are agents that destroy disease-producing
microorganisms or inactivate viruses. Sterilization is the complete destruction of living organisms. Antiseptics are agents
that destroy most organisms but can be used on intact skin.
Not surprisingly, all three play a role in the isolation ward.
Disinfectants are chemical agents applied to inanimate objects
to destroy most bacteria (but not necessarily spore-forming
bacteria). Disinfectants capable of destroying bacteria and
viruses may be used as chemical sterilizers, but under no
circumstances should disinfectants be applied to human or
animal skin. You always should wear protective gloves and
clothing when you use disinfectants, which can irritate the
skin and be toxic to the body. Disinfectants are used to clean
cages, floors, walls, and the shoe coverings worn in the isolation
ward. (Prepare a dipping solution for shoe coverings daily by
mixing water and a commercial hospital disinfectant according
to the labels instructions.)
Antiseptics are used to prevent the spread of disease transmitted
by the hands. Make sure you wash your hands thoroughly with
a good antiseptic soap before you leave the isolation ward.
Sterilization destroys all disease-producing organisms and
their spores that may have contaminated equipment or materials. Methods of sterilization and disinfection can be divided
into two groups: physical and chemical. The most widely
used and accepted method of physical sterilization is the
use of saturated steam under pressure. This method is limited to use on materials, clothing, and equipment that arent
damaged by heat or moisture and are penetrable by steam.
Sterilizers that employ steam under pressure as the sterilizing
agent are called autoclaves. This method works only when
used properly. Materials must be thoroughly clean and free
from grease, oil, and protein materials (such as blood). The
practical and reliable way to ensure that sterilization has
occurred during the autoclaving process is through the use
of dependable sterilization indicators, such as autoclave tape
or chemical sterilization indicators. Chemical sterilization is
the use of liquid or gaseous chemicals to achieve sterilization.
Your surgery unit discusses the different methods of sterilization
in detail.
Lesson 1
25
The sterilization and disinfection methods used by a veterinarian

may depend on his or her past experience. Whatever the method,
contaminated clothing, equipment, bedding, and materials must
be properly disinfected and sterilized. If this is not possible, the
materials must be discarded. If they are washed, they must
always be washed separately from materials used in the rest of
the hospital.
Next, well examine an area of veterinary medicine thats
often a persons first veterinary experiencepediatric animal
care. But before proceeding to the next assignment, take a
moment to complete Self-Check 1. Check your answers by
turning to the back of this study guide.
Self-Check 1
At the end of each section of Medical Nursing for the Veterinary Technician, youll be asked
to pause and check your understanding of what youve just read by completing a SelfCheck exercise. Answering these questions will help you review what youve studied so
far. Please complete Self-Check 1 now.
1. Which of the following would not be considered a clinical problem?

a. Vomiting
b. Lethargy
c. Eating quickly
d. Pacing
2. List the four major steps in caring for an animal.
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
(Continued)
26
Self-Check 1
3. Why are bathing and grooming an important aspect of nursing care?
__________________________________________________________
__________________________________________________________
4. A recumbent animal needs extra attention because it can get _______, which is skin
irritation caused by frequent wetting with urine.
5. What are decubital sores?
__________________________________________________________
__________________________________________________________
6. List three ways to decrease decubital sore formation.
__________________________________________________________
__________________________________________________________
__________________________________________________________
Questions 79: Match the following terms with their definitions by placing the letter of the
best definition in the blank space next to each term.
______
7. Sterilization
a. Destroys most organisms but can be used on

intact skin
______
8. Disinfectant
b. Destroys disease-producing microorganisms
______
9. Antiseptic
c. Destroys all disease-producing organisms and

their spores
Check your answers with those on page 271.
Lesson 1
27
ASSIGNMENT 2CARE OF
PEDIATRIC ANIMALS
Read this assignment. Then read pages 787809 in Clinical
Textbook for Veterinary Technicians.
Introduction
Although every animal begins as a newborn, the vast majority
of newborns youll encounter in veterinary practice will be
puppies and kittens. Foals run a distant third. To prepare
you for the majority of situations youre likely to confront,
weve narrowed our discussion of pediatric animal health care
to the care of newborn puppies, kittens, and foals.
Care of Newborn Puppies and Kittens

Newborn puppies and kittens are completely helpless. They
rely on their mother for warmth, food, elimination, and cleanliness. Theyre incapable of thermal regulation for the first six
days of life and require an external heat source to stay warm
for the first one to three weeks of life. Immediately after birth,
they should begin nursing from the mother every two to four
hours. The mother licks their external genitalia both to stimulate urination and defecation and to clean them after every
feeding. Seven to 12 days after delivery, the puppies and kittens eyes open but have limited vision. At 14 to 16 days, their
external ear canals open. By 18 days, they begin to move
around and explore their environment.
Normal puppies and kittens are born without appreciable quantities of circulating protective immunoglobulins. The mothers
first milk is called colostrum, a thick, yellow mammary secretion
rich in maternal antibodies that the puppy or kitten must ingest
and absorb for adequate immunologic protection. Because the
gastrointestinal cells that allow absorption of these immunoglobulins are lost soon after birth, the newborn must ingest the
colostrum in its first 12 to 24 hours.
28
Sometimes your role in newborn care will consist of educating

clients about the optimal environment for the new litter.
Whether youre instructing a client or preparing a newborn
nursery yourself, the following guidelines apply:
Keep puppies and kittens in a small box with sides high

enough to keep the litter inside and drafts out.
Raise the bottom of the box off the floor, which can get
cold. Put padded, disposable, washable flooring (such as
indoor-outdoor carpeting, disposable diapers, or cotton
towels) in the bottom in order to keep the boxs inhabitants as warm and dry as possible.
Avoid bedding materials that become slippery when wet,

such as newspapers.
Covered hot-water bottles or an infrared lamp six feet

above the box may help to keep the area warm. Heating
pads are not recommended and should never be set on
higher settings (severe burns can result) or cover the
entire floor of the box (an overheated newborn must be
able to get away from the heat source). A puppys or
kittens rectal temperature should be maintained at
96 to 97F for the first week of life and 97 to 100F for
the second, third, and fourth weeks.
A ticking clock placed in the box may help to keep

puppies and kittens quiet.
Care of Newborn Foals

At birth, the foals umbilical cord should be allowed to tear
on its own. If needed, it can be stripped of blood and gently
broken close to the foals body. Apply a 1% iodine solution to
the umbilical cord stump. Continue this treatment four times
a day for two days. Foals from mares that werent vaccinated
with tetanus antitoxin in the last four to six weeks of gestation should receive 1,500 IU (international units) of tetanus
antitoxin intramuscularly.
After birth, the healthy foal exhibits a suck reflex in 20 minutes,
stands within one to two hours, and nurses within two to
three hours. Foals should urinate within 12 hours of birth
Lesson 1
29
and pass meconium, the yellow-orange mucilaginous (sticky or

gelatinous) material that constitutes a newborns first stool,
within 24 hours. Some horse owners routinely administer a
warm, soapy-water enema after birth to remove the retained
meconium. If the foal hasnt defecated within 24 hours or is
straining to defecate, the veterinarian may elect to administer
an enema. This should be done with great care and generous
lubrication, as a foals rectal mucosa is quite fragile.
The awake foal should be alert and easily aroused by environmental stimuli. The respiratory rate is 20 to 40 breaths
per minute at birth, and 60 to 80 per minute within one
hour. The respiratory rhythm is regular when the foal is
awake but may be irregular while the foal is sleeping. A foal
should develop a strong bond with its mare by one and a half
hours of age. Foals generally sleep within three hours after
birth and after each feeding. Foals nurse an average of seven
times per day. Head bobbing while searching for the udder is
normal. Within 24 hours of birth, the healthy foal should be
strong, alert, and capable of running.
The heart rate is 40 to 80 beats per minute within 5 minutes
after birth, increasing to 130 beats per minute from 6 to 60
minutes, and stabilizing at 90 to 100 beats per minute. The
heart rate increases to 130 beats per minute or higher upon
exertion, such as when the foal is standing.
Normal foals, like puppies and kittens, are born without appreciable quantities of immunoglobulins. The mares first milk
contains colostrum, which the foal must ingest and absorb for
adequate immunologic protection. Because the gastrointestinal
cells that allow absorption of these immunoglobulins are lost
soon after birth, the foal must ingest the colostrum in its
first 12 to 24 hours.
Inadequate absorption of colostrum is called failure of passive
transfer and is thought to be associated with increased susceptibility to infection. The immunoglobulin (Ig) levels are generally
30
measured 18 to 24 hours after birth to allow time for ingested

colostrum to be absorbed into the bloodstream. There are several commercial tests available for measuring the Ig level.
If the veterinarian detects an Ig deficit, he or she may choose
to replace it by one of two methods. The first, oral administration of donor colostrums, would be ideal, except that most
foals are too old to absorb colostrum by the time a deficit is
detected. Foals should receive 1 to 2 L of colostrum by 12
to 24 hours of age. Ig levels should then be measured 16
to 20 hours after administration.
Failure of passive transfer after 24 hours is treated with
intravenous administration of plasma from an appropriate
donor. Plasma is administered by way of an intravenous
catheter. A rule of thumb is that 1 L of plasma raises the Ig
level of the 45 kg foal by 200 mg/dl. These procedures arent
done in small animal medicine.
Principles of Orphaned Animal Care

Youve seen the importance of the mother in caring for newborns, yet some newborns have no mother to care for them.
How do veterinary practices deal with orphans?
Orphaned Puppies and Kittens

Hand-raising orphaned puppies and kittens requires a great
deal of time and effort. The ideal solution to the problem of
caring for a motherless puppy or kitten is to find a lactating
mother that will accept the puppy or kitten and raise it with
its own. When a foster mother isnt available, the orphan
puppy or kitten must be hand-fed until the animal is about
four to six weeks of age. The puppy or kitten should be kept
with its littermates between feedings. Doing so allows it to
learn appropriate social behavior.
If neither of the previous options is possible, the only remaining
option is total care of the puppy or kitten. As puppies and
kittens are usually mature enough to leave their mothers
between six and eight weeks of age, this is the interval of total
orphan care. During this crucial period, orphaned puppies and
kittens require a suitable environment; the correct quantities
Lesson 1
31
and quality of nutrients for different stages of growth; a regular schedule of feeding, sleeping, grooming, and exercise; and
the stimulus that provokes urination and defecation.
The most important consideration for an orphaned puppys or
kittens environment is stability. As mentioned earlier, newborn puppies and kittens are unable to effectively control
their body temperature. During their first four weeks of life,
they gradually change from having a variable body temperature to maintaining a uniform body temperature. This means
that during the first week of life, their body temperature is
directly related to the environmental temperature. Therefore,
the ambient temperature must be between 86 and 90F.
Over the next three weeks of life, the ambient temperature
can be gradually lowered to 75F. Humidity should be maintained at 55% to 60%. Stability extends beyond temperature
and humidity, however. Its equally important that sudden
changes of environmental conditions be avoided, and that
disturbances outside of socialization, exercise, and hygiene
activities be minimized.
Formula Feeding
Feeding orphaned puppies and kittens that still require mothers
milk can be rewarding, but any substitute for mothers milk
isnt as good as the real thing. If a foster mother is unavailable,
the puppies or kittens will have to be hand-fed a replacement
food formulated to meet the optimum nutritional requirements
of the puppy or kitten. Various modifications of homemade and
commercially prepared formulas simulating mothers milk have
been used with success. The following are several homemade or
commercially prepared formulas for rearing puppies and kittens.
32
Commercially Prepared Milk Formulas for Puppies or Kittens

Begin Milk Replacer for Puppies (Performer Brand,
St. Joseph, Missouri)
Begin Milk Replacer for Kittens (Performer Brand, St. Joseph,
Missouri)
Esbilac Powder for Puppies (Pet-Ag Inc., Elgin, Illinois)
Esbilac Liquid for Puppies (Pet-Ag Inc., Elgin, Illinois)
GME Powder for Puppies (a goat-milk formula; Pet-Ag Inc.,
Elgin, Illinois)
Kittylac: Powder for Kittens (Lander Corp., Post Falls, Idaho)
KMR Liquid for Kittens (Pet-Ag Inc., Elgin, Illinois)
KMR Powder for Kittens (Pet-Ag Inc., Elgin, Illinois)
Multi-Milk for Multi-Animals (milk replacer for animals with
lactose intolerance; Pet-Ag Inc., Elgin, Illinois)
Nurturall Liquid for Puppies (Veterinary Products
Laboratories, Phoenix, Arizona)
Nurturall Powder for Puppies (Veterinary Products
Nurturall Liquid for Kittens (Veterinary Products Laboratories,
Phoenix, Arizona)
Nurturall Powder for Kittens (Veterinary Products
Veta-Lac Powder for Puppies (Vet-A-Mix, Shenandoah, Iowa)
Veta-Lac Powder for Kittens (Vet-A-Mix, Shenandoah, Iowa)
Feeding Orphaned Puppies and Kittens

Commercially prepared milk formulas are preferable to home
recipes, as commercial formulas more closely compare to
mothers milk. These formulas generally provide 1 to 1.24
kcal (kilocalories) of metabolizable energy per ml (milliliter) of
formula. The caloric need for most nursing-age puppies and
kittens is 22 to 26 kcal per 100 g (grams) of body weight.
Therefore, the average puppy or kitten should receive 13 ml
of formula per 100 g of body weight a day during the first
week of life, 17 ml of formula per 100 g of body weight a day
Lesson 1
33
during the second week, 20 ml of formula per 100 g of body

weight a day during the third week, and 22 ml of formula per
100 g of body weight a day during the fourth week.
The amounts of formula should be given in equal portions
three or four times daily. For the first three weeks of life, the
formula should be warmed before each feeding to about
100F or to a temperature near the animals body temperature. Never feed chilled formula to a puppy or kitten.
After each feeding, the abdomen should be enlarged but not
overdistended. When a milk formula is used, less than the
prescribed amount should be given per feeding for the first
feedings. The amount then should be increased gradually to
the recommended feeding amount by the second or third day.
The amount of milk formula is increased accordingly as the
puppy or kitten gains weight and responds favorably to feeding.
Puppies should gain 1 to 2 g/day/lb (pound) (2 to 4
g/day/kg [kilogram]) of anticipated adult weight for the first
five months of their lives. The kitten should weigh 80 to 140
g at birth (most weigh around 100 to 120 g) and gain 50 to
100 g weekly.
When preparing the formula, always follow the manufacturers
directions and keep all feeding equipment scrupulously clean.
A good way of handling prepared formula is to prepare only
a 48-hour supply at a time and divide this into portions
required for each feeding. Once formula is prepared, its best
stored in the refrigerator at 4C.
The easiest and safest way of feeding prepared formula to
nursing-age puppies and kittens is by nipple bottle. However,
a dosing syringe or tube also can be used.
The best nipple bottles are made especially for feeding
orphan puppies or kittens. Second best are bottles equipped
with preemie infant nipples. When feeding with a nipple
bottle, hold the bottle so that the puppy or kitten doesnt
ingest air. The hole in the nipple should be such that when
the bottle is inverted, milk slowly oozes from the nipple. It
may be necessary to enlarge the nipple hole with a hot needle
to get milk to ooze from the bottle when inverted. Squeeze a
drop of milk onto the tip of the nipple and then insert the
nipple into the animals mouth.
34
Never squeeze milk out of the bottle while the nipple is in the
animals mouth. Doing so may result in laryngotracheal aspiration of the milk into the lungs. Never attempt to nipple-feed
a puppy or kitten that lacks a strong sucking reflex.
Tube feeding is the fastest way to feed orphaned puppies and
kittens. A number 5 French infant feeding tube is appropriate
for puppies or kittens weighing less than 300 g, and a number 8 to 10 French infant feeding tube is appropriate for
puppies and kittens weighing over 300 g. (French refers to a
standard set of sizes for needles, catheters, and tubes.)
Mark the feeding tube clearly to indicate the depth of insertion to ensure gastric delivery; that is, the distance from the
last rib to the tip of the nose can be measured and marked
off on the feeding tube as a guide. This should be done
weekly to accommodate for the growth of the puppy or kitten.
Never feed into the distal esophagus, the part of the esophagus
from the heart to the diaphragm. If this happens, the food
will come right back up and be aspirated into the lungs.
When feeding, fill a syringe with warm formula and fit it to
the feeding tube, taking care to expel any air in the tube or
syringe. Open the animals mouth slightly, and with the
animals head held in the normal nursing position, gently
pass the feeding tube to the marked area. If the animal
coughs or you feel an obstruction before reaching the mark,
the feeding tube is in the trachea and needs to be reinserted.
Otherwise, slowly administer the prepared formula over a
two-minute period to allow sufficient time for slow filling of
the stomach. Regurgitation of formula rarely occurs, but if it
does, withdraw the feeding tube and interrupt feeding until
the next scheduled meal.
Elimination, Exercise, Cleaning,

and Weaning Procedures
Its vital that after feeding, the orphaned puppy or kitten
receives a simulation of the mothers tongue action on the
anogenital area to provoke micturition (urination) and
defecation. Swab the anogenital area with moistened cotton
or dry, soft tissue paper until reflex elimination occurs.
Lesson 1
35
Sometimes you can get the same response simply by running

a forefinger along the abdominal wall. Provide this stimulation after each nipple-bottle feeding or tube feeding until the
orphan reaches about three weeks of age, after which puppies and kittens can usually relieve themselves without help.
Most puppies and kittens benefit from gentle handling before
feeding to allow for some exercise and to promote muscular
and circulatory development. In addition, the animal should
be washed at least once a week with a soft, moistened cloth
for general cleansing of the skin, simulating the cleansing
licks of the mothers tongue.
As discussed earlier, the orphaned puppy or kitten should be
encouraged to begin eating solid food at three or four weeks
of age, respectively. Once theyre eating satisfactorily from a
bowl, gradually reduce the amount of prepared formula until
the puppy or kitten is eating only food designed for growth at
least three times a day.
Vaccinating Puppies and Kittens

Puppies and kittens should be checked for gastrointestinal
parasites at three weeks of age, and then rechecked when
they return for their vaccinations. Heartworm-preventive
medication should be started at 6 to 8 weeks of age in areas
where heartworms are endemic.
The initial vaccination series consists of one injection of a
multivalent vaccine (a vaccine containing more than one
infectious-agent component) given at 6 to 8 weeks of age
and two boosters given at 10 to 12 weeks of age and 14 to
16 weeks of age. Puppies and kittens whose immune status
is uncertain may receive an additional injection of multivalent vaccine as early as 2 weeks of age. The rabies injection
is given at 3 months of age in most states.
The following are recommendations, but each clinic or area
may have different actual protocols:
36
Puppies should receive the DA2PLPC and, possibly,

kennel cough and canine borreliosis vaccines. DA2PLPC
is a vaccine that protects against canine distemper (D),
infectious canine hepatitis (A2; canine adenovirus type
2), canine parainfluenza (P), leptospirosis (L), canine
parvovirus type 2 (P), and canine coronavirus (C).
Kittens should receive the following vaccines: FVRCP,

chlamydia, feline leukemia virus (FLV), and rabies.
FVRCP is a vaccine that protects against feline viral
rhinotracheitis (FVR), feline calicivirus infection (C), and
feline panleukopenia (P).
Orphaned Foals
Accepted minimum nutritional requirements of the healthy foal
to 30 days of age are in the range of 130 to 150 kcal/kg/day.
The healthy foal should gain one to two kg/day. Some foals
require assistance or encouragement to nurse from their surrogate mare. Every effort should be made to feed foals from
their mare. Foals that are unable or unwilling to nurse from
their mare can be allowed to nurse from a bottle or bucket if
they maintain a suck reflex. Foals without a strong suck
reflex require an indwelling nasogastric tube for feeding.
The primary complication associated with tube feeding is
aspiration pneumonia. To avert this risk, the tubes position
within the stomach must be confirmed before each use of
a nasogastric tube. Recumbent foals must be placed in
sternal recumbency (sitting upright and resting on the chest
bone) during and for 20 minutes following feeding to prevent
regurgitation and aspiration of milk.
Mares milk is the best source of nutrition for the foal. When
available, mares milk should always be used. To prevent
mastitis (inflammation of the mares udder), the mares udder
and the hands must be cleaned before milking and a teat dip
(a commercial antiseptic product designed specifically for this
purpose) applied after milking.
Lesson 1
37
Several alternatives to mares milk are available. Milk preparations formulated for nutrition of other species generally
arent suitable for the foal. Goats milk is palatable but
causes some metabolic abnormalities and shouldnt be used
alone for extended periods. Goats milk has a caloric density
of 276 kcal/pint. Milk replacers are readily available and
inexpensive but are unpalatable and notorious for causing
gastrointestinal upsets. Goats milk can be added to milk
replacers to improve palatability. Milk replacers, when fed
per labeled directions, underestimate a foals caloric requirements by 50% to 70%. The amount to be fed to the foal
should be calculated daily based on caloric requirements
and the foals body weight.
Commercial Milk Replacers for Foals
Foal Lac (Pet-Ag Inc., Elgin, Illinois)
Mares Match (Land-o-Lakes, Fort Dodge, Iowa)
Nutri-Foal (Ross Laboratories, Columbus, Ohio)
Feeding Orphaned Foals

When feeding foals, thoroughly clean and disinfect all
utensils before and after use. Once milk preparations are
reconstituted, refrigerate or discard any leftover milk preparations after two hours at room temperature. Foals wont
nurse from commercial cow nipples but do quite well with a
lambs nipple.
Milk feeding should be started gradually. Begin at 50 to
100 ml every 30 to 60 minutes. If the foal tolerates these
feedings, the volume of milk may be gradually increased and
timing of feedings may be spaced to every two hours. Many
high-risk foals wont tolerate commercial milk products.
Feeding should be discontinued if regurgitation, abdominal
distention, colic, or severe diarrhea occur. Foals receiving
less than 100 kcal/kg/day should be considered candidates
for alternative feeding procedures, such as a stomach tube.
38
Feeling confident about your ability to care for a pediatric

animal? You should be. Youve covered the fundamentals
of pediatric animal care. Next its time to look at the other
extreme: geriatric animals. Before proceeding to the next
assignment, take a moment to complete Self-Check 2. Check
your answers by turning to the back of this study guide.
Self-Check 2
1. How often should a puppy or kitten nurse from its mother in the first week of life?
a. 12 times a day
b. 24 times a day
c. 48 times a day
d. 1224 times a day
2. Which of the following times is correct for the newborn foal?

a.
b.
c.
d.
Suck reflex within 120 minutes of birth

Urination within 10 hours of birth
Standing within 45 hours of birth
Passing of meconium within 12 hours of birth
3. Total care of the puppy or kitten in the first six to eight weeks of life includes all of the
following, except
a. the correct quality and quantities of nutrition.
b. a regular schedule of sleeping, feeding, grooming, and exercise.
c. a frequently changing environment to make the animal adaptable to various situations and
to improve socialization.
d. a steady ambient temperature.
4. What is the range of caloric need for puppies and kittens, and how often should they be fed?
a.
b.
c.
d.
2226
2022
2226
2022
kcal/100
kcal/100
kcal/100
kcal/100
g
g
g
g
of
of
of
of
body
body
body
body
weight
weight
weight
weight
given
given
given
given
in
in
in
in
34
46
23
34
equal
equal
equal
equal
portions
portions
portions
portions
over
over
over
over
24
24
24
24
hours
hours
hours
hours
(Continued)
Lesson 1
39
Self-Check 2
5. When should the first dose of vaccines be administered to puppies and kittens?
a. 45 weeks of age
b. 68 weeks of age
c. 1012 weeks of age

d. 1416 weeks of age
6. The primary complication associated with tube feeding a foal is _______.
ASSIGNMENT 3CARE OF
GERIATRIC ANIMALS
Read this assignment. Then read pages 13551376 of Clinical
Geriatric Health Care for

Dogs and Cats
Aging is a natural, normal life process for humans and animals.
Aging can be defined as a complex biological process that progressively reduces an animals ability to maintain a normal
body state. Affected by internal body factors and external environmental stresses, the aging process decreases the animals
ability to survive and increases its vulnerability to disease and
eventual death. The geriatric (some veterinarians use the term
senior) animals increased health problems, and owners typically
passionate attachment to these animals, have obligated veterinary practices to offer a considerable breadth of geriatric
health-care services.
Many factors may influence the aging process: genetic background, nutrition, internal disorders (such as metabolic
disease and cancer), and environmental factors (such as
40
traumatic injury or parasites). Aging isnt an actual disease.

Rather, accumulated wear and tear accounts for an older
animals fragile state.
The veterinary teams responsibility to the older animal is to
delay, or at least to minimize, the progressive deterioration
the aging process wreaks on body systems and to improve
the animals quality of life for the weeks or months ahead.
The teams primary goal, therefore, is to improve comprehensive health-care services with state-of-the-art medical and/or
surgical therapy and competent nutritional management.
Health care for the older dog and cat can be a natural extension of the health-care services already in place for the young
dog and cat. Pediatric health-care services treat dogs and
cats from birth to 1 year of age. Adult health-care services
begin at 1 year of age and continue until approximately 6
to 8 years. Because the effects of the aging process vary with
the dog and cat breeds and their lifestyles, so do general
guidelines for implementing geriatric health-care services.
The following list offers guidelines for when different types of
animals should begin to be considered geriatric:
Small dogs: less than 20 lb (9.07 kg)9 to 13 years
Medium dogs: 21 to 50 lb (9.52 to 22.68 kg)9 to

11.5 years
Large dogs: 51 to 90 lb (23.13 to 40.82 kg)6 to

9 years
Giant dogs: more than 90 lb (40.82 kg)6 to 9 years
Cats (most breeds): 11 to 14 years
The owners of dogs and cats older than 7 years should be

encouraged to have their animals examined at least biannually. Veterinary practices often furnish a checklist of annual
health-care services to ensure that older animals benefit from
the full range of available preventive health care.
The key to any biannual health-care visit, beyond obtaining
the history and performing the physical examination, is the
use of diagnostic and blood/urine screening tests. Regularly
performed diagnostic and laboratory tests allow the veterinarian
to screen for a spectrum of diseases we now know to be common
Lesson 1
41
in older dogs and cats. Veterinary practices recommend the

following routine annual health-care services for older dogs
and cats.
The Geriatric Dog

To perform routine health care on the geriatric dog, the veterinary team will conduct a general physical examination and
record the animals body weight. (Weight loss when there
shouldnt be weight loss is an indication that problems exist.)
The animal should also be checked for the following external
parasites and dermatophytes:
Fleas, ticks, and ear mites (Otodectes cynotis)
Mange mites, especially Demodex canis and Sarcoptes

scabiei
Dermatophytes, particularly Microsporum spp. and

Trichophyton mentagrophytes
If suggestive clinical signs are present, the appropriate

therapy should be initiated.
During this visit, the animal should receive boosters for the
DA2PLPC and rabies vaccines and, possibly, kennel cough
and canine borreliosis vaccines. The following procedures
should also be part of the geriatric dogs annual exam:
42
Fecal examination (fecal flotation test)
Administration of an appropriate anthelmintic if the fecal

examination is positive
Check for heartworm disease (occult antigen test)
Adjustment of the dosage of heartworm preventative

according to body weigh
Blood and urine health-screening tests
Adjustment of the diet according to health needs and,

if necessary, change in grooming procedures
Trimming the nails and cleaning the ear canals
During the examination, discuss with the owner any agerelated changes that are occurring, such as hearing loss,
blindness, difficulty in rising and walking, and pre-existing
medical conditions. Toward the end of the exam, fill in the
annual health-care services record and provide the owner
with a copy. Before the owner and animal leave, dispense
once-a-month flea, tick, and heartworm preventive products.
The Geriatric Cat

To perform routine health care on the geriatric cat, the
veterinary team will conduct a general physical examination
and record the animals body weight.
The animal should also be checked for the following external
parasites and dermatophytes:
Fleas and ear mites (Otodectes cynotis)
Mange mites, especially Notoedres cati, Demodex spp.,

and Cheyletiella spp.
Dermatophytes, particularly Microsporum spp. and

Trichophyton mentagrophytes
If suggestive clinical signs are present, the appropriate

therapy should be initiated.
During this visit, the animal should receive boosters for the
following vaccines to keep them effective: FVRCP, chlamydia,
feline leukemia virus (FLV), and rabies.
The following procedures also should be part of the geriatric
cats annual exam:
Deworming according to fecal examination results
Blood and urine health screening tests, including a total

T4 determination (used to indicate hyperthyroidism)
Adjustment of the animals diet and grooming procedures

as needed
Lesson 1
43
During the examination, discuss with the owner any agerelated changes that are occurring, such as hearing loss,
blindness, difficulty in rising and walking, and pre-existing
medical conditions. Toward the end of the exam, fill in the
annual health-care services record and provide the owner
with a copy. Before the owner and animal leave, dispense
once-a-month flea, tick, and heartworm preventive products.
Before proceeding to the next assignment, take a moment to
complete Self-Check 3. Remember that you can check your
answers by turning to the back of this study guide.
Self-Check 3
1. List the four factors that influence the aging process.
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
Questions 24: At what age range is an animal considered to be in each of the following
groups?
2. Pediatric:
______________________
3. Adult: __________________________
4. Geriatric:
______________________
5. What vaccine(s) should a geriatric cat receive during its annual visit to the veterinarian?
__________________________________________________________
__________________________________________________________
44
ASSIGNMENT 4ROUTINE
ANIMAL CARE
Read this assignment. Then read pages 188190, 238239,
285, 588, 590591, 638639, 812823, and 1221 in your
Clinical Textbook Veterinary Technicians.
Introduction
Not every animal you encounter as a veterinary technician
will be hospitalized. Animals may be brought in for routine
checkups to ensure good health. During the examination,
discuss with the owner any changes that are occurring in the
animals health. The animal may need booster shots to keep
its vaccinations effective.
The following procedures should also be part of the annual
exam:
Deworming, if necessary, according to fecal examination

results
Blood and urine health screening tests
Adjustment of the animals diet and grooming procedures

as needed
Toward the end of the exam, fill in the annual health-care

services record and provide the owner with a copy. Before
the owner and animal leave, dispense once-a-month flea,
tick, and heartworm preventive products.
Many veterinary procedures involve routine activities such
as trimming, cleaning, medicating, and follow-up care for
animals. But just because these procedures are routine
doesnt mean theyre unimportant. For example, lets look
first at a health-care practice that many might consider
purely cosmetic.
Lesson 1
45
Trimming Nails
Nail trimming, or pedicure, is an important part of general
care for dogs, cats, and birds (Figure 5). Excessive nail length
results in altered walking and the potential emphasis of
lameness problems. Long nails can even be traumatically
torn from their attachment site! Untrimmed nails can become
ingrown, usually into the animals footpads. Ingrown nails
can result in inflammation or abscess formation.
FIGURE 5Animals nails
must be trimmed regularly
to avoid traumatic
injuries.
Now that weve established its importance, lets look at the

fundamentals of nail trimming. The procedure requires a
sturdy, durable nail trimmer. Resco and Whites are popular
brands of veterinary nail trimmers (Figure 6). To avoid
cutting nails too short in dogs and birds, hold the cutting
surface of the nail trimmer parallel to the plantar (toward
the sole) surface of the digital footpads. Cut the nail in that
plane. In cats, expose the nails by grasping the paw between
the thumb and index finger and sliding the skin on the back
of the paw away from the nails. Once exposed, trim the cats
nails as described for dogs. If the blood vessel or quick of the
nail is cut, quick stop sticks made of silver nitrate will stop
the bleeding by chemically cauterizing the wound.
Special dremels have also become commonplace for use on
some dogs, and especially for the claws and beaks of birds.
Dremels use a rough surface like a nail file to wear down the
nail. They are fast, accurate, and there is very little risk of
injuring the quick. Before use, pull any hair or feathers away
46
FIGURE 6Different
Veterinary Nail Trimmers
from the toe to prevent injury. Using very light pressure,

move the tool around the nail tip. Unfortunately, some animals dont like the sound or feeling of vibration against their
sensitive feet. They may require slow introduction to the tool.
As many animals dont like to have their feet handled, its a
good practice to routinely give a pedicure to any animal anesthetized or tranquilized for any procedure.
Offer the owner some instructions on proper trimming technique so that this important task can be done at home.
Foals
Farriers (people who make, fit, and remodel horseshoes)
recommend that a foal receive its first trim at two weeks of
age and then every four weeks until its weaned at four to six
months. After that, a six- to eight-week trimming schedule
should be adequate depending on the foals needs.
A good farrier will round the toes during a trim, so the legs
straightness wont be hampered by the forceful twisting or
turning of the hoof that often results from pointed toes.
Very few foals are born with perfectly straight legs. Many
foals are born with angular deformities such as toed-out,
bowlegged, base narrow, knock-kneed, or pigeon-toed limbs
(Figure 7). Most of these deformities correct themselves in
two to four months. A knowledgeable farrier doesnt try to
correct things that nature handles quite well on its own.
Lesson 1
47
Ideal
Position
Toed
Out
Bowlegged
Base
Narrow
KnockKneed
PigeonToed
FIGURE 7Angular Limb Deformities in Foals
If a foal does require corrective work, the farrier and the

veterinarian should work as a team to correct any problems.
The best results are usually achieved between 2 and 9 months
of age. Early inspection and close monitoring of the foal are
essential. As the foal develops, its requirements change and
must be continually monitored.
Adult Horses
Adult horses require regular trimming and shoeing. Hooves
that arent cared for regularly can affect the horses gait
(manner of walking) and result in injury to the horse. Although
most horses are trimmed by a farrier, there are times when
you might be expected to trim a horses hooves while its in the
hospital. Therefore, you should be familiar with the general
anatomy of the hoof.
Most parts of a horses hoof are made of horn, a fibrous material
made of the protein keratin. Horn is also the chief material that
comprises the horns of cattle and other animals and the
claws of some animals.
48
Horn can grow in several degrees of firmness. Some sections

are stronger than others to provide support. Some sections
are more elastic to provide flexibility. The parts of a horses
hoof are shown in Figure 8.
The parts of a horses hoof include the following:
Heel bulbA soft, rounded structure located at the back

of the heel
FrogA triangular mass of elastic horn located toward

the back of the hoof
BarA ridge separating the frog and the sole that helps
the heel to spread
ButtressThe site where the bar meets the hoof wall
Hoof wallThe outermost layers of tough horn that

protect and retain moisture in the foot
White lineThe inside edge of the hoof wall where it joins

with the sole
SoleA concave plate of flaky horn that covers most of

the bottom surface of the hoof and protects the inside
structures of the foot
FIGURE 8Parts of a
Horses Hoof
Heel
Bulb of
Heel
Frog
Buttress
Bar
White Line
Sole
Hoof Wall
Toe
Lesson 1
49
Most trimming and shoeing will be done by a farrier. If an

injury or disease is present, the horse should be treated by a
veterinarian. Several conditions of the hoof may require treatment by a veterinarian. Hooves may suffer cracks from being
left untrimmed or exposed to excessive moisture. Some
cracks are more severe than others. Treatment may be required
to keep the crack from getting larger and to prevent lameness.
Laminae are plates of tissue that attach the hoof to the fleshy
part of the horses foot. These tissues can become inflamed,
resulting in laminitis, a painful condition that requires a
veterinarians treatment. Left untreated, laminitis may result
in permanent lameness.
Thrush is a bacterial infection of the frog. It can be caused by
improper cleaning of the hooves. Excessive mud and manure
can keep air from reaching the frog, resulting in infection.
Thrush is painful and requires treatment by a veterinarian.
These are just a few conditions that may affect a horses
hooves. There are many others, and quite a few can be
prevented with proper care, trimming, and shoeing.
Cleaning and Medicating Ears and Eyes

Ears and eyes have one important thing in commonboth
must be cleaned with extreme care. Because these organs are
so delicate, theyre easily irritated and damaged. Improper
cleaning can also spread an infection from one ear or eye to
the other.
Cleaning the External Ear Canal

Animals may accumulate cerumen (wax), exudate (clear cellular fluid), or debris in the external ear canal. This could be
due otitis externa (outer ear inflammation), a wound, or just
being outside. It generally requires cleaning. Certain dog
breeds, particularly cocker spaniels, poodles, Bedlington terriers, and Kerry blue terriers, may also accumulate excessive
hair in the external ear canal. The first step in treating any
external ear problem is complete and thorough cleaning of
the entire external ear canal. Note that an examination by the
veterinarian is always performed first to ensure that the
50
eardrum is intact. If there is any doubt of the eardrums status,

use only sterile saline to very gently flush the ear. Normally, the
following equipment is used to clean the external ear (Figure 9):
Wax-softening agent (A)
Bowl containing a warm, dilute antiseptic solution (B)
Microscope slides (C)
Prescribed medication (D)
Hemostat (E)
Soft-rubber-bulb syringe (F)
Towel (G)
Cotton applicator sticks (H)
Cotton balls (I)
Culture medium
FIGURE 9Ear-Cleaning
Equipment
Thorough cleaning often requires the administration of a

short-acting general anesthetic or heavy tranquilization.
You or the veterinarian will administer the tranquilizer or
anesthetize the animal according to the protocol specified
by the veterinarian.
Lesson 1
51
The veterinary technician is often responsible for cleaning an

animals ears and instilling medication. The following procedure
details how to clean an animals ears:
1. Using extreme care, place a cotton-tipped applicator
stick into the ear canal and roll it around to collect some
of the debris found in the ear. Then roll the applicator on
a microscope slide, making sure the debris is spread
onto the slide. The slide can then be looked at using a
microscope. It will first be looked at for ear mites and
then stained to look for yeast and bacteria (Figure 10A).
FIGURE 10AObtain a
sample that can be
tested for infection and
parasites.
2. If the ear has excessive wax, instill a wax-softening (or

cerumenolytic) agent such as dioctyl sodium succinate
(DSS) (Figure 10B).
FIGURE 10BInstill a
wax-softening agent.
52
3. Gently massage the ear canal to soften the wax

(Figure 10C).
FIGURE 10CMassage the
ear to soften the wax.
4. To remove excessive wax and debris, perform lavage

of the external ear canal with a soft-rubber-bulb
syringe and a diluted antiseptic solution (Figure 10D).
Sometimes sedation is needed for this step.
FIGURE 10DUse a soft rubberbulb syringe to lavage the
external ear canal.
Lesson 1
53
5. Flush the solution into the ear and gently massage the
ear canal (Figure 10E).
FIGURE 10EFlush the ear
and massage.
6. Use cotton balls, cotton applicator sticks, and extreme

care to wipe the wax from the external ear canal
(Figure 10F).
FIGURE 10FWipe the
wax from the external ear
canal using cotton balls
and cotton applicator
sticks.
54
7. Gently clean the horizontal ear canal with extreme

caution to prevent damage to the eardrum (tympanic
membrane) and to avoid deeper packing of debris
(Figure 10G).
FIGURE 10GClean the
horizontal ear canal.
8. Use a clean towel to dry the animals ears (Figure 10H).

FIGURE 10HDry the ears
with a clean towel.
A helpful hint for preventing contamination: clean the lessinfected external ear canal thoroughly before cleaning the
external ear canal thats more infected!
Lesson 1
55
Some veterinarians prefer to use pulsating streams of water

from a dental hygiene apparatus to clean the external ear
canal, as described here:
1. Add approximately 5 ml of povidone-iodine or chlorhexidine solution to approximately 236 to 384 ml of warm
water.
2. Apply the stream of water in a rotating motion directed
parallel to the external ear canal.
3. Catch the excess water and debris in an ear irrigation
basin or similar vessel.
An inexpensive alternative to a dental hygiene apparatus is
a rubber-bulb syringe, which can be used to loosen debris
manually and help flush the ear canal. Veterinarians will
avoid these techniques if the tympanic membrane isnt intact.
Regardless of the cleaning technique, the last step in the
process is another ear canal examination to evaluate the
external ear canals cleanliness and the state of the eardrum.
Once the ear canal is sufficiently clean, carefully dry the
canal with clean cotton swabs and instill the initial dose of
prescribed ear medication.
Applying Topical Medications in Ear Canals

A number of medications go into an animals ear. Most topical
ear preparations contain various combinations of antibiotic,
anti-inflammatory, fungicidal, and parasiticidal agents. Topical
antibiotics such as enrofloxacin, chloramphenicol, neomycin,
polymyxin, and gentamicin treat bacterial infections. Antiinflammatory corticosteroids decrease inflammation and
exudative discharge buildup (minimizing ear scratching).
Topical antifungals such as thiabendazole and miconazole
treat dermatophytes and yeast organisms such as Malassezia.
Oil-based parasiticides kill ear mites, which can also be
treated with ivermectin in animals older than three months.
Other treatments, such as acetic acid (a dilute vinegar solution),
alter the pH in the external ear canal. However, veterinarians
avoid combining pH-lowering drugs with gentamicin, whose
potency suffers in an acid environment.
56
Use the following procedure to administer medication to the

ear:
1. Straighten the external ear canal by pulling the earflap
upward and laterally.
2. Insert the nozzle or tube of the ear medication slightly
downward and medially a short distance into the ear canal
(Figure 11A). The distance inserted will vary with the size
of the dog and its ears.
FIGURE 11AInsert the
nozzle downward a short
distance into the ear
canal.
3. Administer the medication.

4. Gently massage the base of the ear to spread the medication over the entire lining of the horizontal and
vertical ear canal (Figure 11B).
FIGURE 11BMassage the
ear.
Lesson 1
57
Oil-based treatments and parasiticidal treatments must continue for at least three weeks. Both oil-based and ivermectin
treatments will fail unless all animals in a household are
treated at the same time.
Cleaning the Eye

Eyes should always be cleaned and medicated with extreme
care. This care includes using the proper eyewash. Most companies that dispense ophthalmic (eye) medications manufacture an
eyewash solution, usually a combination of sodium chloride,
potassium chloride, boric acid, and a preservative. These
sterile, isotonic, and relatively inexpensive solutions are
specifically made for ophthalmic irrigation and should be
used in place of homemade brews. Never use eyewash or
other topical ophthalmic medications directly from the
refrigerator. Cold solutions tend to irritate the eye. Cotton
balls are preferred for cleaning around the eye.
Equipment needed to clean and
medicate the eye includes the
following (Figure 12):
Sterile eyewash
Ophthalmic ointment or drops
Cotton balls
FIGURE 12Eye-Cleaning and -Medicating

Equipment: (A) Sterile Eyewash, (B) Ophthalmic
Drops, (C) Ophthalmic Ointment
58
To clean the eyelids, use the following procedure:

1. Moisten the cotton balls with eyewash (Figure 13A).
FIGURE 13AMoisten
cotton balls with eyewash.
2. Gently pull the lid up or down against the eyes bony

orbit. Holding the eyelid in this position, wipe it with the
moistened cotton ball (Figure 13B). Never apply pressure
to the eyeball itself.
FIGURE 13BPull the eyelid up or down and wipe
with the moistened cotton
ball.
3. To irrigate the eye, simply apply eyewash directly onto

the eyeball or into the surrounding conjunctival sac
(Figure 13C). Avoid touching the tip of the eyewash bottle
to any part of the animal. This will contaminate the
entire bottle of solution.
Lesson 1
59
FIGURE 13CApply eyewash directly to the

eyeball to irrigate.
Applying Topical Medications in the Eye

When administering ophthalmic drops to an animals eye,
rest the hand holding the dropper bottle on the animals
head. Evert the lower eyelid with the other hand and place
the drops in the conjunctival sac without touching the dropper tip to the eyeball. Apply ophthalmic ointment to the eye
in a 3-mm-wide strip on the lower eyelid border. Again, be
very careful not to touch the tip of the tube to any part of the
animals eye. (Figure 14).
FIGURE 14Apply ointment to the lower eyelid.
60
Expressing Anal Sacs

The anal sacs are paired structures, about 1 cm in diameter,
that lie between the internal and external anal sphincter
muscles on either side of the anal canal. Each sac opens into
the lateral margin of the anus by a single duct, at approximately the four- and eight-oclock positions of the anus. The
anal sacs hold secretions produced by the anal glands. The
anal glands line the walls of the anal sacs and produce a
foul-smelling fluid, serous to pasty in consistency and brown
to off-white in color.
Like the colon, the anal sacs can become impacted. Signs of
impacted anal sacs include excessive licking of the perineum;
scooting, or dragging the perineum on the floor; abnormal
carriage of the tail; or vague indications of pain or discomfort
in the anal region.
There are two main ways to express anal sacs. For cats,
generally only the external expression is used, whereas with
dogs, either the external or internal method can be used. Use
the following procedure for external expression of dog or cat
anal sacs:
1. Put on latex gloves.
2. Lift the animals tail out of the way. Holding a paper
towel in the one hand, put the pointer finger and thumb
on the outer portion of the perianal region at about the
four- and eight-oclock positions, respectively.
3. Apply gentle pressure to squeeze the finger and thumb
together, causing the anal glands to express themselves.
If this doesnt produce any secretions, check to make sure
the openings of the sacs can be seen and that theyre not
plugged. If unsure, check with the veterinarian, as the anal
sacs could be abscessed or plugged to where more invasive
attention is needed.
Use the following procedure to internally express a dogs anal
sacs:
1. Put on latex gloves.
2. Lubricate the forefinger of one gloved hand.
3. Gently insert the forefinger into the dogs rectum.
Lesson 1
61
4. Locate and immobilize the distended anal sacs between

the forefinger and the thumb (which remains external to
the anus). The anal sacs are generally found in a ventrolateral location.
5. Gently apply pressure until the sac secretions are forced
through the ducts.
This technique can occasionally compress the ducts as well
as the anal sacs. If gentle pressure doesnt express the sacs,
reposition the finger and thumb and reapply pressure.
Following anal expression, place paper toweling or cotton
over the anus to prevent the extremely unpleasant liquid
from soiling the animal, the environment, or yourself.
Removing Sutures/Staples
The veterinary technician usually removes sutures once the
veterinarian has evaluated incision healing and determined that
they can come out. Most sutures are removed in 10 to 14 days.
Suture scissors remove the sutures with minimal discomfort
to the animal. Staples can be removed with a special tool that
is inserted between the staple and skin. When squeezed, the
edges of the staple lift out of the skin fairly painlessly (Figure
15). If you dont have a staple remover, a pair of hemostats
can be used. If hemostats are used, make sure to remove one
end of the staple and then the other, as trying to remove the
whole staple from the center will cause pain and damage to
the newly healed skin.
FIGURE 15Staple
Remover
62
Before proceeding to the next assignment, take a moment to

complete Self-Check 4. Remember that you can check your
answers by turning to the back of this study guide.
Self-Check 4
1. List four complications of overgrown toenails.
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
2. What is the normal interval for hoof trimming in a foal?
a. 24 weeks
b. 68 weeks
c. 1214 weeks
d. 1012 weeks
(Continued)
Lesson 1
63
Self-Check 4
3. Why is it best to clean the less-infected ear first?
a.
b.
c.
d.
It can be cleaned more quickly.

Its less painful.
To avoid contamination
To see how much the animal will object to the other ear being cleaned
4. True or False? Its okay to gently touch the dropper tip of medication to the animals eye.
5. The anal sacs are located at _______ and _______ relative to the anus.
6. When using a hemostat to remove staples, the staple should be removed by
a.
b.
c.
d.
pulling at the middle of the staple.

cutting the staple in half and then removing each side.
removing one end of the staple and then the other.
tapping the staple with the blunt end of the hemostat.
ASSIGNMENT 5ADMINISTERING
MEDICATION AND FOOD
Read this assignment. Then read pages 586596, 598599, and
620642 in your Clinical Textbook for Veterinary Technicians.
Oral Medications
Oral administration is one of the most convenient methods
for animal owners and veterinary personnel to administer
medications. Tablets and capsules are economical and provide accurate, uniform doses. Oral liquids are even more
convenient if the dose is accurately measured and the animal
accepts it. A syringe can be used to provide an accurate dose.
64
Oral administration offers the additional advantage of reduced

risk of infection or abscess caused by a faulty injection technique. Disadvantages of the oral route include the potential
for inhaling liquid medications into the lungs and the potential
for the animal to spit out the medication so that the prescribed
dose isnt absorbed. In addition, its contraindicated in animals
that are vomiting, for the obvious reason that the medication
may be regurgitated before it can be absorbed. Various digestive
factors mean that even accurately dosed medication may be
inadequately absorbed in the small intestine, altering the
expected therapeutic response.
To have all oral administration options at its disposal, a
veterinary practice needs three forms of oral medications:
liquids, tablets, and capsules. The practice also requires
special equipment for delivery of the medication, such as
regular syringes, pilling forceps, balling guns, dose syringes,
eyedroppers, and speculum devices.
The easiest technique to learn and to teach owners is oral
administration of liquid medication, as shown in Figures 16A
and B. The following are guidelines for administering oral
medications:
1. Use a syringe or small prescription bottle to measure an
accurate dose.
2. Once the dose is ready, form a pocket by gently pulling
out the animals lower lip at the corner of the mouth
(Figure 16A). Pour small amounts of liquid into this
pocket.
For large animals, the easiest and most convenient delivery
method is oral pastegranules and powders that can be
mixed with something sweet like molasses. Least desirable
are drugs formulated for mixing in the animals drinking
water, because water consumption is highly variable and
unpredictable. Water mixes, however, may be the only economically feasible method for treating large numbers of sick animals
in flocks or herds. Medicated drinking water also has proven to
be the least stressful method of medicating small birds.
Lesson 1
65
FIGURE 16ATo administer liquid medications

orally, first squirt the dose
into a pocket formed
between the animals
lip and gum.
FIGURE 16BTilt the

animals head slightly to
encourage swallowing.
Hand-Pilling for Dogs and Cats

Hand-pilling is the placement of a tablet or capsule in an
animals mouth in a way that makes the animal swallow it.
To hand-pill a dog or cat, use the following procedure
(see Figures 17A17D):
1. Hold the tablet between the thumb and fingers of your
right hand (Figure 17A). Or, hold the tablet or capsule
between the second and third fingers of the right hand.
Use the left hand to open the animals mouth (reverse
hand placements if youre left-handed).
66
FIGURE 17AHold the

tablet between the thumb
and fingers of the right
hand.
2. Grasp the upper jaw with the thumb on one side

and fingers on the other and press the lips over the
upper teeth. Using your right thumb, press downward
on the lower jaw in the space behind the incisors to
open the animals mouth. Or, hold the tablet or capsule
between the thumb and second finger and use the third
finger to open the animals mouth (Figure 17B).
FIGURE 17BUse the third
finger to open the animals
mouth while holding the
pill between the first two
fingers.
Lesson 1
67
3. Place the tablet or capsule in the center of the tongue as

far back in the mouth as possible (Figure 17C).
FIGURE 17CPlace the pill
in the center of the
tongue.
4. Close the animals mouth and gently tap the animal on

its nose or stroke under its chin to startle it into swallowing the medication (Figure 17D).
FIGURE 17DClose the
animals mouth and gently
tap its nose or stroke
under its chin.
68
The same technique to hand-pill can be used to bolus-feed an

animal. Small amounts of food can be placed in the mouth as
a pill would, or you can use a pilling gun (Figure 18).
FIGURE 18A pilling gun
can be used to give medication to aggressive animals.
Using a Balling Gun for Ruminants

A bolus is a rounded mass of food or medicine ready to be
swallowed or passed through the gastrointestinal tract. You
may administer lubricated boluses to ruminants with a balling
gun. A balling gun consists of a short cylinder large enough to
contain the average bolus, a hollow stem containing the rod
that connects the handle with the plunger in the cylinder,
and the handle (Figure 19). The end of the balling gun should
be smooth and preferably made of soft plastic.
FIGURE 19Balling Guns
Lesson 1
69
The following describes the correct use of a balling gun:

1. Secure the animals head and neck to stabilize it. (Its
often best to restrain the animal in a corner or a head
catch to keep it from backing away.)
2. Pry open the side of the mouth.
3. Carefully slide the balling gun into the mouth and over
the base of the tongue.
4. Release the lubricated bolus.
Boluses are usually passed into cattle with
a balling gun. Multiple-delivery balling guns
can safely administer a number of boluses
in a short amount of time. An alternative
method in cattle is to grasp the nose by
its septum with the thumb and first finger
of one hand and then gently but firmly pull
upward (Figure 20). This usually causes the
animal to open its mouth so that the bolus
can be introduced.
Using a Dose Syringe on

Ruminants, Swine, and Horses
FIGURE 20An alternative to using a balling
gun is to pull on the animals nasal septum to
make it open its mouth.
Ruminants, swine, and horses often receive

oral liquid medication from a dose syringe,
dosing bottle, or stomach tube. The following procedure describes how to use a dose syringe:
1. Stabilize the animals head and hold it horizontally.
2. Introduce the tip of the dose syringe into the mouth and
over the base of the tongue, or place the tip into the side
of the mouth in the pocket formed between the animals
teeth and skin.
3. Deliver the medication.
If the animal coughs, lower its head to prevent aspiration of
the medication into the lungs.
70
Intubation Methods
Orogastric Intubation of Dogs and Cats
Orogastric intubation, also known as gastric gavage or stomach tube feeding, is the passing of a tube into an animals
mouth, down the esophagus, and into the stomach. It is used
to administer medication or food to an animal, or to remove
gas or toxins from the stomach. Note that cats generally need
to be sedated to pass a stomach tube successfully. Dogs are
more tolerant of the procedure. The equipment needed to perform orogastric intubation includes the following:
Adhesive tape or a permanent marking pen
A roll of adhesive tape or a wooden spacer block
Water-soluble lubricating gel or tap water
Plastic tubing in several sizes or rubber urinary

catheters (22 French, 75 cm long for dogs; 12 French to
16 French, 40 cm long for cats).
A syringe or funnel
The following procedure describes the proper placement of an

orogastric tube:
1. To pass a stomach tube, place the dog/cat in a sternal
position (on its chest). Measure the tube for appropriate
length by extending it alongside the animals body. The
tube should reach from the animals incisor teeth to the
level of the eighth or ninth rib (Figure 21A).
FIGURE 21AThe distance
is measured from the animals mouth to the eighth
or ninth rib.
Lesson 1
71
2. Mark the tube at the measured length with either adhesive tape or a permanent marking pen. This will ensure
you dont insert the tube too far (Figure 21B).
FIGURE 21BMark the
tubing with adhesive tape.
3. Place a partially used roll of adhesive tape or a wooden

spacer block behind the canine teeth to hold the
animals mouth open (Figure 21C).
FIGURE 21CA roll of
adhesive tape placed
behind the teeth will hold
the mouth open.
4. Lubricate the stomach end of the tube with a sterile

lubricating gel or tap water and then insert the tube into
the animals mouth through the central hole in the tape
roll or spacer block (Figure 21D).
72
FIGURE 21DThe end of

the stomach tube is lubricated with sterile gel.
5. Gently push the tube into the pharynx as the animal

swallows (Figure 21E). The tube is advanced slowly to
the level previously marked by the adhesive tape. If the
animal coughs, remove the stomach tube, as the tube
may have been pushed into the trachea.
FIGURE 21EInsert the
tube into the pharynx.
Lesson 1
73
6. Palpate the animals neck to ensure that the tubing can

be felt in the esophagus (Figure 21F).
FIGURE 21FPalpate the
neck to make sure the
tube is placed properly.
7. Test the patency (accessibility or openness) and placement of the stomach tube by injecting sterile water into
the tube before administering any medication or food
(Figure 21G).
FIGURE 21GSterile water
or saline is injected into
the tube.
8. Attach the syringe or funnel to the end of the stomach tube.

The medication or liquefied food is slowly administered
through the funnel using the syringe or gravity flow.
74
9. Kink the stomach tube to prevent liquid contents from

being withdrawn and inhaled. Remove the tube.
10. After the stomach tube is removed, clean it thoroughly
with tap water.
Orogastric Intubation of Ruminants and Horses

A stomach tube can easily be passed into a restrained sheep
or goat by using a tape roll or appropriately sized syringe
case with its end smoothed. Caregivers pass a lubricated
9.5-mm-diameter rubber tube through the speculum device
and over the base of the animals tongue into the esophagus.
This process requires visualization or palpation of the tube
as it passes through the esophagus to ensure placement of
medication in the rumen. If in doubt of the tubes placement,
either pass it again or blow air into the tube. This allows an
assistant listening with a stethoscope over the paralumbar
fossa (the area just behind and at the top of the left ribs) to
hear air bubbling through the rumen contents.
A sheep or goat may sometimes regurgitate stomach contents
if the volume of liquid medication is large. When this occurs,
the tube is removed and the animals head is lowered from
the horizontal position to prevent fluid from being aspirated
into the lungs. Skip the regurgitated dose and resume dosing
at the next scheduled time.
In cattle, a metal speculum or wooden block can be used for
passing a stomach tube into the rumen. Veterinarians often
find it best to place the stomach end of the tube into the speculum before introducing the tube into the mouth. The tube can
then be rapidly passed once the speculum is properly placed.
Once again, make sure that the tube has reached the rumen
before administering any medication.
Nasogastric Intubation of Dogs and Cats

Nasogastric intubation is the passing of a small-diameter,
soft plastic or rubber tube (a nasogastric tube) into the
stomach through the nostril and nasal passage. Nasogastric
intubation isnt as practical as stomach tubing through the
mouth. The nostrils and nasal passages are smaller and
restrict the types of solutions that can pass through the tube
Lesson 1
75
(e.g., pureed food cant pass through a nasogastric tube).

Many veterinarians, however, prefer nasogastric intubation
for short-term nutritional support. The technique is easy,
inexpensive, and well tolerated by animals for short periods.
The equipment needed to place a nasogastric tube (Figure 22)
includes the following:
Soft rubber feeding tubes (French sizes 310)
A syringe
19- or 20-gauge butterfly catheter tubing
Adhesive tape or permanent marking pen
Water-soluble lubricating gel
Topical liquid anesthetic
Stockinette or bandage material
FIGURE 22Equipment for

Nasogastric Intubation:
A. Soft Rubber Feeding
Tube
B. Syringe
C. Butterfly Catheter
D. Adhesive Tape or
Marking Pen
E. Lubricating Gel
F. Topical Liquid
Anesthetic
D
E
G. Stockinette or Bandage
Material
C
D
A
Smaller cats may require size 3 or 5 French tubes. Tubing

from a 19- or 20-gauge butterfly catheter may be used in
smaller cats, kittens, and puppies.
76
The following steps describe the procedure for placement of

a nasogastric tube:
1. To pass a nasogastric tube, place the animal in a sternal
position. Several drops of topical liquid anesthetic can be
placed into the nares of the animal to minimize irritation
and sneezing (Figure 23A).
FIGURE 23AAnesthetic
drops are placed in the
dogs nares.
2. Measure the distance the tube should be inserted by

measuring the distance from the level of the eighth or
ninth rib to the end of the animals nose (Figure 23B)
FIGURE 23BThe distance
to the animals eighth or
ninth rib is measured.
3. Mark the tubing with adhesive tape or permanent

marking pen. There should be enough length left to
secure the tubing to the animals head.
Lesson 1
77
4. Lubricate the tip of the tube with sterile lubricant.

5. While the animals head is maintained in a steady,
normal position, advance the tube slowly into the
nose to the level previously marked (Figure 23C).
FIGURE 23CThe tube is

advanced slowly into the
nose.
6. Secure the tube behind the dogs head (Figure 23D). The
tube can remain in place for several days of feeding or medicating. The tube must be flushed with water after each use
to keep it patent (unobstructed).
FIGURE 23DThe end of
the tube is secured behind
the dogs head.
78
Nasogastric Intubation of Horses

A well-placed nasogastric tube in a horse has many uses. A
nasogastric tube can relieve gas accumulation that may accompany an attack of colic or postoperative colic management.
(Colic describes severe, recurring pain in the abdomen often
caused by disease or infection.) A nasogastric tube can also
feed or medicate a horse with a painful oral condition or an
inability to grasp food (e.g., because of a fractured mandible).
Figure 24 shows the correct placement of a nasogastric tube.
Notice that the tube travels behind the liver in this view, as
indicated by the dotted lines. The nasogastric tube can be left
in place temporarily by taping it to a halter. This allows the
horse to be fed or medicated frequently without the trauma of
repeatedly passing the nasogastric tube.
FIGURE 24Nasogastric
Tube Placement in the
Horse
Tube
Spleen
Kidney
Stomach
Rectum
Liver
Esophagus
Cecum
Bladder
Duodenum
Even a correctly placed nasogastric tube can give horses a

profuse nosebleed. A tube accidentally passed into another
organ can cause real damage. The most serious problems
result from a tube passed through the trachea and into the
lungs. Any substance administered into a tube accidentally
placed in the lungs can lead to severe pneumonia and death.
Therefore, nasogastric tubes are generally placed by a veterinarian and then maintained by a technician.
Lesson 1
79
Administering Parenteral Injections

Parenteral injections offer two advantages over the oral route:
rapid absorption and accurate dosing. Veterinary medicine
routinely employs the subcutaneous, intramuscular, and
intravenous routes of parenteral injections. Intradermal and
intraperitoneal (within the abdominal cavity) routes are less
frequently used.
What factors determine the administration route? First, the
medications pharmacological properties. Some medications
arent adequately absorbed or may produce severe tissue
reactions when administered by a particular route. Second,
different routes produce different absorption rates. A critically
ill animal needs the route that produces the fastest action.
An animal suffering a severe, overwhelming infection, for
instance, should receive an antibiotic via the quicker intravenous route rather than the slower oral route.
The animals condition, temperament, and owner may also
determine the appropriate route. Veterinarians generally
avoid giving oral medications to a vomiting animal or one
with severe respiratory problems. Aggressive or irritable
animals may eliminate the options of topical, oral, or intravenous administration routes, leaving only subcutaneous or
intramuscular routes. If the animals owner will be doing the
medicating, topical and oral routes are the obvious choices
over parenteral injection.
Routine animal parenteral injections require the following
equipment:
80
Assorted sizes of hypodermic needles and syringes
Cotton balls moistened in 70% isopropyl rubbing alcohol
Saline solution
Subcutaneous Injections
If the medication is nonirritating, it can be injected
subcutaneously, or just under the skin. Subcutaneous injections allow quick systemic activity because the medication is
readily absorbed into the lymph and blood systems.
Dogs and Cats

Veterinarians use subcutaneous injections to vaccinate dogs
and cats. A 22- or 25-gauge needle is adequate for vaccinations (and most other subcutaneous injections) in dogs and
cats. An ideal subcutaneous injection site in dogs and cats
is the dorsolateral area from the shoulder to the rump.
The following steps describe how to provide a subcutaneous
injection to a dog or cat:
1. Prepare the injection site by parting the hair and
cleansing the skin with 70% isopropyl rubbing alcohol
(Figure 25A).
FIGURE 25AThe injection
site is prepared and
cleaned.
2. Pick up the prepared fold of skin and pinch the skin

between the fingers (Figure 25B). Place the needle
beneath the skin. The syringe is aspirated to make
sure the needle is subcutaneous.
Lesson 1
81
FIGURE 25BA fold of

skin is pinched between
the fingers.
3. Inject the medication into the fold of skin (Figure 25C).

FIGURE 25CMedication is
administered.
4. Remove the needle and gently massage the area to

help the body absorb and distribute the medication
(Figure 25D). This also gives you the opportunity to
reassure your patient that youre still friends!
82
FIGURE 25DThe area is

massaged.
Ruminants and Horses

The optimal site for subcutaneous injection of small quantities
in ruminants and horses is the middle area of the neck between
the scapula (shoulder blade) and the ramus (vertical, elongated
extension) of the mandible. This area is easily accessible and
requires minimal restraint (Figure 26). The injection technique
is the same as that for a dog or cat, except that an 18- or 20gauge, 2.5 to 3.75 cm needle is used.
The medication may not be easily absorbed in the area just
over or behind the spine of the scapula, but this site uses
the animals movement to help distribute the medication
and prevent abscesses from forming. This is also a popular
FIGURE 26Subcutaneous
Injection Site in the Horse
Lesson 1
83
site for administering large quantities of fluids, such as the

second 500 ml bottle of calcium solution to a cow with milk
fever. Show animals, whose appearance is important, typically receive injections that may irritate or blemish the skin
in the axillary (armpit) or flank (area between the ribs and
the hip bone) fold areas.
Pigs
Swine may be confined in a farrowing crate or crowded with
a panel. A farrowing crate is a cage large enough to hold the
swine but too narrow to allow it to turn around. When subcutaneously injecting swine, the area just behind the base of
the ear is often used. A 16- to 18-gauge, 2.5 to 5 cm needle
is directed ventrally. The injection is completed as quickly as
possible before the animal can move. The axillary space or
flank fold can be used on small pigs held by their hind legs.
Llamas, Goats, and Sheep

Llamas, goats, and sheep can receive subcutaneous injections
just behind the elbow. The axillary region where the forearm
meets the body is also used in goats and sheep. Because
sheep must receive subcutaneous injections in an area where
there is no wool present, the inguinal region is also used.
Intramuscular Injections
Slightly more irritating medications should be injected intramuscularly. Because muscle tissue cant expand readily,
medications injected intramuscularly are generally smaller in
volume, usually less than 5 ml per injection site.
Dogs and Cats

One injection site in dogs and cats is the semimembranosus
and semitendinosus muscle mass (hamstring muscles) in
the hind leg. The site is approached laterally with the needle
angled in a slightly caudal direction to avoid damaging the
sciatic nerve. (The sciatic nerve is the longest, widest nerve
in the body. It extends down the thigh and into the lower leg
84
and foot.) The site for injection is selected by placing the fingers on the wings of the ileum and allowing the thumb to
fall naturally. The injection goes at the point where the
thumb lands. A 22- or 25-gauge needle is adequate for most
dogs and cats.
Use the following procedure to administer an intramuscular
injection to a dog or cat:
1. Prepare the injection site by parting the hair and
cleansing the skin with cotton balls moistened in 70%
isopropyl rubbing alcohol.
2. Maintain the animal in a standing or reclining position.
3. Grasp the muscle between the thumb and fingers
(Figure 27).
FIGURE 27Intramuscular
Injection Technique for
Small Animals
4. Insert the needle perpendicular to the muscle and

slightly retract the plunger to ensure that the needle
hasnt entered a vein. Inject the medication, and
withdraw the needle.
5. As with subcutaneous injections, once the injection has
been completed, massage the area gently to help the
body absorb and distribute the medication and to relieve
pain from the injection.
Lesson 1
85
The lumbosacral musculature, located along the animals

spine, is also a popular intramuscular injection site in dogs
and cats. Unless the animal is extremely thin or small, you
may elect to inject the lumbosacral musculature.
Cattle
Intramuscular injections are not commonly performed in cattle
due to the potential muscle damage that can occur. Most cattle,
even dairy cattle, are eventually eaten, so muscle damage will
limit profitability. If intramuscular injections are necessary, the
neck muscles are used.
Horses
Horses receive intramuscular injections in several locations,
including the brachiocephalicus muscle of the neck, the pectoral
muscles, and the semimembranosus or semitendinosus
muscles. The gluteal muscles are generally not used, as any
abcesses forming after the injection are very difficult to drain.
The procedure is performed as follows:
1. Restrain the horse as necessary based on the injection
site being used. Stocks are recommended, but the horse
should at least be restrained with a halter and lead.
2. Clean the injection site with 70% isopropyl alcohol.
3. Firmly tap the injection site with the flat of the fist or
rub it firmly with alcohol-soaked cotton. (This lessens
the animals awareness of the needle prick.)
4. Insert the detached needle into the muscle, all the way to
the hub in a single, firm motion.
5. Attach the syringe to the needle and aspirate the syringe.
6. Inject the medication firmly, but not too quickly.
7. Withdraw the needle and syringe. Massage the area gently to decrease discomfort and to help distribute the
medication.
86
The brachiocephalicus muscle in the neck is easily accessible

and requires a minimum of restraint. However, this site is
rarely used for large quantities of medication (more than
10 ml), as most horses arent heavily muscled in this area.
The pectoral muscle is used minimally. This is due to the
potential for horses to jump or strike out, which is dangerous
to the technician. It is also known to be a painful injection
site which causes swelling.
For repeated intramuscular injections, the semitendinosus
muscle is usually the muscle of choice (Figure 28). The two
sides can be used in an alternating fashion so as not to
cause soreness in one side. Again, avoid being kicked by
standing on the side opposite the leg youre injecting! If this
is not possible, pressing your body up against the animals
hip may reduce the impact of a kick.
FIGURE 28Site for
Semitendinosus Muscle
Injection in the Horse
Lesson 1
87
Racehorses, whose performance may suffer because of medication-induced inflammation, never receive intramuscular
injections in the hindquarters, nor do they receive more than
20 ml at any one site. The common injection sites for intramuscular injection in horses are shown in Figure 29.
Gluteal Muscles
Brachiocephalicus
Pectoral
Semitendinosus
FIGURE 29Intramuscular
Injection Sites in the
Horse
Swine
The dorsal neck muscles are a common intramuscular injection site in swine. Its usually one of the cleanest areas for
injection and is easily accessible in animals confined in a
farrowing crate or crowded with a dividing panel. Swine also
seem to be less sensitive to pain in this area. Use a 16- to
18-gauge, 2.5 to 3.75 cm needle, inserting and injecting in
one motion. Once again, the procedure must be quick to
avoid excessive movement by the animal.
88
The medial (toward the midline) side of the ham is often used
in giving medication to small pigs that can be restrained by
holding the hind legs. This is a common site for injecting
young pigs with iron. An 18- to 19-gauge, 1.25 to 2.5 cm
needle is used in small pigs. The posterior ham area is also a
possibility for injecting a standing adult pig intramuscularly
(with a 16- to 18-gauge, 3.75 to 5 cm needle). However, try to
avoid this area for injection; its a choice meat cut and is
often dirty.
Sheep and Goats

Sheep and goats usually receive intramuscular injections in
the neck muscles. Few goats have enough muscle mass in
other parts of their bodies for safe intramuscular injections.
Intramuscular injections in sheep are sometimes given in the
gluteal and triceps muscles as well.
Intravenous Injections
You already know that intravenous injection is the fastest
way to get drugs into circulation and tissues. It may also be
the method of choice for medications that irritate the tissues.
Note, however, that veins run close to arteries, and injecting
medication into an artery would send a concentrated dose
to the extremities or the head, where venous injections go
back to the heart and are distributed systematically. Also,
this large quantity to one area can cause a severe reaction.
Dogs and Cats

Intravenous injection sites in dogs are generally the cephalic
and lateral saphenous veins; in cats, the cephalic, medial
saphenous, and femoral veins (Figure 30). Dogs and cats
rarely have medications injected into the jugular veins, but
they can be used in some instances, and the procedure is the
same as for other animals.
Lesson 1
89
FIGURE 30This cat is

being restrained for an
injection in the medial
saphenous vein.
The following is the general procedure for intravenous

injection into the cephalic or saphenous veins:
1. Have the patient restrained in sternal recumbency, or a
sitting position, for cephalic veins and in lateral recumbency, or a standing position, for saphenous veins.
2. Have the assistant restraining the animal hold the vein off
by applying pressure on the vein above the injection site.
3. Clean the area to be injected with 70% isopropyl alcohol.
4. Insert the needle at a 30-degree angle into the skin and
then into the vein. You may need to stabilize the vein
by placing your thumb from the hand holding the leg
alongside the vein.
5. Aspirate a small amount of blood into the syringe to
verify proper positioning of the needle.
6. Have the assistant release the digital pressure or tourniquet on the vein (but still hold the limb immobile) and
inject the medication slowly into the vein.
7. Withdraw the needle and syringe and have the assistant
apply prompt digital pressure to the injection site.
If you notice small air bubbles in the syringe, hold it so that
the air bubbles float to the plunger end, leaving the air bubbles and a small amount of liquid in the syringe. In the event
of accidentally injecting an irritating medication into the
tissues surrounding the vein, alert the veterinarian and, if
directed, instill large volumes of physiologic saline solution
into the area to dilute the medication.
90
Cattle
Cattle typically receive intravenous medication in the external
jugular vein as follows:
1. Have an assistant restrain the animal in a head catch
with head drawn upward and to the side opposite the
injection site.
2. Cleanse the injection site with
70% isopropyl rubbing alcohol.
3. Occlude the vein by applying digital
pressure in the lower jugular groove
(Figure 31).
4. Push a 16- or 18-gauge, 5 to 7.5 cm
needle sharply into the vein at a 45- to
90-degree angle to the skin.
5. Keeping the vein occluded, thread the
needle into the vein to the hub and
attach the syringe (if isnt already
attachedsome people feel that the
syringe should not be attached to the
needle; others feel it should be).
FIGURE 31Procedure for Intravenous

Injection in Cattle
6. Once the syringe is attached, its best to verify the position of the needle by aspirating a small amount of blood
into the syringe, as the needle can sometimes be moved
during attachment of the syringe. Blood should flow from
the needle if its in the vein.
7. Release the digital pressure on the jugular groove and
inject the medication.
8. Withdraw the needle and syringe and place pressure on
the injection site.
Veterinarians administering medication with a simple administration set can lower the bottle of fluids below the injection
site to observe blood flowing back into the administration set.
Once the blood flow shows that the needles position is correct, they release digital pressure on the jugular groove and
raise the fluid bottle above the injection site. This procedure
administers the medication without blood flowing into the
administration set.
Lesson 1
91
The tail (coccygeal) vein is used for small quantities (35 mls)
of medications and for blood collection. Cattle are tolerant of
the use of this vessel, but theres an increased risk of actual
injury from the cow kicking. Another drawback of this vessel
is that it rolls easily under the skin, and a second person is
usually needed to help restrain the animal.
In dairy cattle, the subcutaneous abdominal vein (milk vein)
can be used for administering small quantities of medication
while the cow is confined in the milking parlor (a room used
for milking cows). This technique requires tail restraint. Take
special care with this site, as a large hematoma may result
because of the areas ventral location and loose skin covering.
Pinching the skin for several minutes after withdrawing the
needle from the vein helps to prevent hematoma formation.
Horses
Horses receive intravenous medication in the external jugular
vein. Because the esophagus of a horse runs near the jugular
groove in the left side, the right jugular vein is used whenever
possible.
An 18-gauge, 5 cm needle suffices for most injections, though
a 14- or 16-gauge, 5 to 7.5 cm needle may be used for large
quantities of medication.
Most important in this procedure is that the needle is placed
first, and then the syringe is attached to the needle. This is to
ensure that the needle is in the vein and not an artery. Blood
flow is monitored: if the needle is in a vein, blood will drip consistently; if its in an artery, the blood will spurt. Also, the
needle needs to be at least an 18-gauge, or the flow will be
compromised and it will be more difficult to distinguish vein
from artery. Looking at the color of the blood is not a good
way to determine which vessel the needle is in!
For single injections, perform the procedure as follows:
1. Dont use a head catch on a horse. An assistant should
hold the horses halter and reins to keep it steady (a
twitch may also be needed for anxious horses).
2. Cleanse the injection site with 70% isopropyl alcohol.
3. Occlude the vein to see where it distends, and then
insert the needle toward the head at a very slight angle.
92
4. Watch the blood coming from the needle. Dripping

means the needle is in the vein; spurting means its
in the artery. Aspirate the needle to reconfirm.
5. Once its confirmed that the needle is in the vein and not
the artery, attach the syringe and slowly inject the
medication.
6. Inject the medication according to its specifications.
Some medications can be given quickly, but many must
be given slowly.
7. Remove the needle and syringe and hold off the vein.
Sheep and Goats

The external jugular vein is the site of
choice for intravenous therapy in sheep and
goats. The same procedure for intravenous
injections in the horse applies to sheep and
goats, except that the animal is generally
backed into a corner or held against the
assistants body while the head is held
extended up to expose the neck and jugular
veins (Figure 32). Other vessels used
include the cephalic and femoral veins.
With these vessels, its more difficult to
restrain the animal.
Pigs
The ear (auricular) veins are commonly
used for blood collection in the pig, specifically the lateral vein. The cephalic vein can
be used in adult pigs, but restraint can be
extremely challenging. The jugular vein
may be used in piglets, but its difficult to
locate in adults. Pigs can bite, so restraint
is particularly important.
FIGURE 32Intravenous Injection in a Goat
The procedure is performed as follows:

1. Properly restrain the animal.
2. Clean the injection site with 70% isopropyl alcohol.
3. Occlude the base of the ear using digital pressure.
Lesson 1
93
4. Using a needle already attached to a syringe, insert the

needle at a very shallow angle.
5. Aspirate the syringe to ensure the needle is in the vessel.
6. Release the digital pressure and inject the medication.
7. Remove the needle and syringe. Apply pressure to the
injection site.
Intradermal Injections
The small volume of medication that can be injected with
intradermal injectionsinjections within the layers of skin
makes them unsuitable for administering medications.
Veterinarians use the intradermal route to diagnose atopy
(systemic hypersensitivity to allergic reactions), to test for
tuberculosis in ruminants, or to provide sensitizing medications such as tetanus antitoxin or snake venom. Intradermal
skin testing for atopy or tuberculosis uses a 25- to 27-gauge,
1/ -inch needle attached to a 1 ml disposable syringe. The
8
veterinarian carefully introduces the needle between the layers
of the skin and then injects 0.05 to 0.1 ml of the test material. If the animal is sensitive to the medication, the test site
should develop welts, heat, swelling, redness, and/or pain.
Intraperitoneal Injections
Veterinary professionals generally avoid the intraperitoneal
injection route (except in some exotic species). This method
of administration may cause peritonitis or an intra-abdominal
abscess. The absorption rate of intraperitoneal fluids is more
rapid than the absorption rate of subcutaneous fluids, but
not as rapid as the intravascular route. Medications may be
administered by the intraperitoneal route in neonatal ruminants and swine, as long-term intravenous therapy is often
impractical.
Intraperitoneal solutions should be warm and isotonic. Isotonic
solutions are equal in electrolyte concentration to the animals
circulating blood. Isotonic medications minimize inflammation.
In standing adult animals, the paralumbar fossa should be
used. Often, a 16- to 18-gauge, 7.5 cm needle is required to
94
penetrate the thick muscle and fat into the peritoneum. In

baby pigs held by their hind legs, a 16-gauge, 1.25 to 2.5 cm
needle is inserted halfway between the midline and the flank.
Whenever the intraperitoneal route is used, the skin should be
properly cleansed and disinfected prior to insertion of the needle.
Congratulations! Youve completed Lesson 1. Now, review the
material youve learned in this study guide as well as the
assigned pages in your textbook for Assignments 15. Once you
feel you understand the material, complete Self-Check 5. Then
check your answers with those provided at the end of this study
guide. If youve missed any answers, or you feel unsure of the
material, review the assigned pages in your textbook and this
study guide. When youre sure that you completely understand
the information presented in Assignments 15, complete your
examination for Lesson 1.
Lesson 1
95
Self-Check 5
1. List the three possible forms of oral medications.
__________________________________________________________
__________________________________________________________
__________________________________________________________
2. Which of the following is the least desirable way to administer oral medications to large
animals?
a. An oral paste
b. Mixed in the water trough
c. Granules in the feed

d. None of the above
3. How do medications administered subcutaneously enter the animals system?
__________________________________________________________
__________________________________________________________
4. Briefly describe how to find the correct injection site for an intramuscular injection when using
the back leg muscles on a dog.
__________________________________________________________
__________________________________________________________
5. When giving an intramuscular injection in the semimembraneous muscles in a dog, you need
to be careful to avoid the _______ nerve.
a. femoral.
b. brachial.
c. sciatic.
d. anal.
96
ASSIGNMENT 6VENIPUNCTURE
FOR TREATMENT OR BLOOD
SAMPLING
Read this assignment. Then read pages 599603 and 642651
in Clinical Textbook for Veterinary Technicians.
Introduction
For animals to be diagnosed and treated effectively, veterinary professionals need to take samples of body fluids such
as blood, urine, and milk. They also perform many diagnostic
procedures, some of which you, the veterinary technician,
can do yourself. This section prepares you to play a role in
many different kinds of sample collection and diagnostic
procedures.
Venipuncture is exactly what it sounds like: the puncture of a
vein. Veterinarians and veterinary technicians routinely perform venipuncture to administer medications and take blood
samples. Venipuncture employs the following equipment and
supplies:
Assorted sizes of needles, and either syringes or

vacutainers
Sponges or cotton balls moistened in 70% isopropyl

rubbing alcohol
Although the equipment is uncomplicated, locating and

placing needles in venipuncture sites can be a challenge.
Lets look at the most popular venipuncture sites for each
species and the demands that accompany each site, species,
and procedure.
Lesson 2
Sample Collection and

Fluid Administration
97
Cephalic Venipuncture for

Dogs and Cats
Veterinary professionals use the cephalic vein, which is located
on the front surface of the front leg, to collect blood samples
from dogs and cats. Figure 33 shows the location of this vein.
One advantage of this site is the ease of locating and using
it. A long-haired animal may require some clipping over the
venipuncture site to see the cephalic vein. However, its usually
sufficient to wet and cleanse the site thoroughly with 70%
isopropyl alcohol, part the hair, and introduce the needle
directly through the skin.
FIGURE 33Location for
Cephalic Venipuncture
If the venipuncture site is the cephalic or saphenous vein,

proceed as follows:
1. Have an assistant restrain the animal and occlude the
vein throughout the blood draw.
2. Prepare a syringe equipped with a small-gauge needle.
Use a 12.7 mm, 22- to 25-gauge needle for small dogs
and cats; a 19.05-mm, 22-gauge for medium dogs and
cats; or a 2.5 cm, 20- or 21-gauge for large dogs.
3. Palpate the vein with the index finger. With the syringe
in the opposite hand, insert the needle bevel upwards at
a 30-degree angle and into the vein in one motion.
4. Gently pull the syringe plunger to allow blood to flow
into the syringe.
98
5. When the necessary amount of blood has been collected,

have the assistant stop occluding the vein.
6. Quickly withdraw the needle and immediately have the
assistant apply digital pressure to the venipuncture site
to prevent bleeding or hematoma formation. Usually,
light pressure held over the venipuncture site for at least
30 seconds allows a clot to form, causing the bleeding
to stop.
If an assistant is unavailable, venipuncture may be done by
occluding the vein with a tourniquet. A light wrap is then
placed to help stop the bleeding.
The cephalic vein can be used in horses, sheep, goats, swine,
and camelids. For these animals, insert the needle before
attaching it to the syringe. Most animals react to the needle
puncture, and if the syringe is attached, its likely to come
out of the vessel. The syringe should be attached only after
the animal has calmed down.
Jugular Venipuncture
Another popular site for taking blood samples from dogs,
cats, horses, and ruminants is the external jugular vein
(Figure 34). This site is especially suitable for short-haired
animals, whose jugular veins are usually easy to spot.
Typically, you can obtain a greater volume of blood from
the jugular vein than the cephalic vein.
FIGURE 34Location for
Jugular Venipuncture
Lesson 2
99
Dogs and Cats

When performing jugular venipuncture in a dog or cat, have
an assistant restrain the animal and extend its head and
neck. With cats, it may be helpful to have the assistant
extend the head and neck with one hand while using the
other to grasp the front feet and extend them over the edge of
the examination table. Unruly cats may require a cat bag or a
large towel wrapped over both front and hind legs.
Rotating the animals head slightly often makes the vein easier
to see, as does distending the vein by placing a thumb in the
jugular furrow at the chest inlet. Insert the needle toward the
head into the external jugular vein. Needle sizes are 12.7
mm, 22-gauge for small dogs and cats; 19.05 mm, 20-gauge
for medium dogs and cats; and 2.5 cm, 18- or 20-gauge for
large dogs.
Ruminants
Whether a ruminants external jugular vein is a suitable
venipuncture site depends on the available restraint and the
size of the sample to be taken. Have an assistant restrain a
bovine undergoing external jugular venipuncture with a halter or a halter and nose lead. Nose tongs may be used for
additional restraint. Whenever possible, restrain the ruminant in a chute or tie it to a stanchion. The following steps
describe jugular venipuncture for cattle:
1. Have an assistant draw the head upward and to the side
opposite the venipuncture site and secure the head in
this position by tying the restraint rope or ropes to a
solid area, such as the top bar of the stanchion.
2. Cleanse the venipuncture site with 70% isopropyl
rubbing alcohol.
3. Occlude the vein by applying digital pressure in the
jugular furrow, making it easier to see the vein. The
jugular vein in most cattle is very large, so you may need
to use the palm of your hand to occlude the vessel.
4. Use your opposite hand to push a 16- to 18-gauge, 5
to 7.5 cm needle through the skin at a 45- to 90-degree
angle with one sharp motion.
100
5. When a flow of blood from the needle signals that the

vein has been entered, thread the needle is either
upward or downward to the hub.
6. Keep the vein occluded, and attach a syringe to the
needle. Aspirate the necessary amount of blood.
7. Release the pressure on the vein, and withdraw the
needle.
8. Apply pressure to the site to prevent bleeding and
hematoma formation.
One of the most frustrating ruminants from which to collect
blood is sheep, who often have thick wool covering the
venipuncture site. As its often impossible to see a sheeps
external jugular vein, its especially important to stretch
the neck to one side. One method, described here, requires
the sheep to be seated on its rump.
1. Have an assistant stand behind the sheep and pull it by
its forelegs into their shins until the sheep plops back on
its rump. Then have him or her place one knee on the
ground and stretch the sheeps neck over the thigh of the
other leg, holding the sheeps head firmly.
2. Occlude the external jugular vein as with other animals.
3. Direct an 18- or 20-gauge, 2.5 cm needle into the jugular
furrow at a 20-degree angle to the skin.
If repeated attempts fail, small pieces of wool can be plucked
from the skin over the jugular furrow until the vein becomes
visible. This method is satisfactory for sheep that can be
successfully placed on their rump. The same venipuncture
method can be employed on sheep in a standing position
simply by backing the sheep into a corner and keeping it
forced against one side of the pen. The assistant stretches
the neck by holding the head of the sheep to the side opposite where the venipuncture is to be performed.
The procedure described previously for venipuncture of the
external jugular vein in the bovine can be applied to the goat.
An alternative location for collection of blood in the goat is
the cephalic vein. The previously described procedure for
cephalic venipuncture in the dog and cat may be adjusted
for the goat.
Lesson 2
101
Horses
Routine blood samples are collected from horses from the
external jugular vein as outlined for the bovine. The animals
temperament will determine the restraint needed. An assistant may occlude the vein if needed, but youll usually do
that yourself. Use a 20- to 25-gauge, 3.75 cm needle, and
attach the syringe after the needle is in place. The right
external jugular vein (the horses right) is used whenever possible to avoid hitting the esophagus, which runs near the
jugular groove on the horses left side. Turning the head away
from the side of the venipuncture ensures that the vein is
stretched and more easily identified.
Swine
Jugular venipuncture may be used, but poses risks of injury
and even death to swine. This site is not used in pet pigs, but
may be used in the commercial setting.
Camelids
The lack of a jugular groove, thick skin, and lots of fur make
jugular venipuncture of camelids difficult. Jugular venipuncture is done either high up or low down on the neck, but not
in the center. The venipuncture itself is performed as
described for other animals.
Ear Venipuncture for Swine

The ear vein (auricular vein) is a common venipuncture site
in swine. Again, teamwork is needed for this technique to be
successful. The ear vein is generally used for collecting small
samples only (25 mls). Sustained negative pressure on the
syringe will collapse the ear vein wall. The following procedure is used for ear venipuncture of swine:
1. Have an assistant restrain the animal with a hog snare.
2. Occlude the ear vein by placing a strong rubber band or
digital pressure around the base of the ear.
102
3. Grasp the tip of the ear in one hand while holding a

syringe attached to an 18- to 20-gauge, 2.5 to 3.75 cm
needle in the other. (A butterfly catheter can be used
here as well.)
4. Insert the needle into the ear vein while maintaining a
slight negative pressure on the syringe. Draw the appropriate quantity of blood. Blood can also be collected
simply by puncturing the vein with the needle and allowing blood to drip into a container.
The ear vein is also commonly used for intravenous administration of medication.
Other Animals
The ear vein is used commonly in camelids and is done as
described for the swine.
For cats, the marginal ear vein is used to collect very small
samples of blood, such as to measure blood glucose levels.
This results in very little pain and restraint for the patient.
Sublingual Venipuncture for Dogs

The sublingual veins are located superficially under the
tongue. Although veterinarians rarely use a dogs sublingual
vein to collect blood samples, its accessibility makes it appropriate for obtaining a quick blood sample during surgery or
for emergency purposes. Youll note that the following steps
omit the rubbing alcohol. Thats because the sublingual vein
is one of the few veins that doesnt need to be moistened with
70% isopropyl alcohol before obtaining a blood sample. To
obtain a blood sample from a dog, proceed as follows:
1. Have an assistant occlude the sublingual vein at the
base of the tongue.
2. Ensure that the syringe is equipped with a small-gauge
needle, such as a 12.7 mm, 25-gauge needle for small
dogs or a 19.05 mm, 22-gauge needle for medium and
large dogs.
3. Insert the needle through the tongue lining beside
the visualized sublingual vein and then directly into
the sublingual vein, in one motion.
Lesson 2
103
4. Gently pull the syringe plunger to allow blood to flow

into the syringe.
5. Rotate the needle 180 degrees and quickly withdraw it.
Because of the shape of the needle and the proximity
of the vein to the surface, rotating the needle before
removing it helps to minimize blood loss at the site.
6. Immediately apply digital pressure to the venipuncture
site to prevent bleeding or hematoma formation. Hematoma
formation is quite likely in the sublingual venipuncture site,
so its very important to apply adequate pressure.
Brachiocephalic or External Jugular

Venipuncture for Swine
Collecting blood from the brachiocephalic, or external jugular,
vein has become common for swine. For simplicity, the following description will refer only to the brachiocephalic vein.
The actual venipuncture may be performed through one of
the jugular veins (because the venipuncture site is close to
the point where the internal and external jugular veins join
to become the brachiocephalic vein). To collect blood from
the brachiocephalic vein, proceed as follows:
1. Have an assistant restrain the animal.
2. Find the deepest part of the right jugular fossa, and then
visualize a transverse line through the manubrium sterni
and shoulders parallel to the ground.
3. Visualize a second line from the manubrium sterni toward
the right scapula at a 45-degree angle to the transverse
line. The venipuncture site falls where the second line
crosses the deepest part of the right jugular fossa.
4. Insert the needle perpendicular to the ventral surface of
the extended neck and collect the blood sample.
Veterinary professionals prefer the right side for this venipuncture to avoid hitting the phrenic nerve or the thoracic duct,
which are near the external jugular vein. For pigs that weigh
up to 90 kg, a 16- or 18-gauge, 3.75 cm needle is appropriate.
Larger swine may require a 16- or 18-gauge, 5.0 cm needle.
104
Coccygeal Venipuncture
for Bovines
The ventral coccygeal, or tail vein, is a common site for bovine
venipuncture (Figure 35). The animal must be confined to an
area that prevents sideways motion. Once confinement is
accomplished, the procedure is as follows:
1. Apply tail restraint with one hand by
bending the tail directly forward at the
base.
2. Cleanse the venipuncture site with 70%
isopropyl rubbing alcohol.
3. Hold the syringe with an 18- to 20gauge, 2.5 to 3.75 cm needle in the
opposite hand and insert it at a 90degree angle to the skin on the midline
between the hemal arches of the fourth
to seventh coccygeal vertebrae.
The ventral coccygeal vein can be used for the
administration of small quantities of nonirritating medication. Caustic medications
injected into this region can cause vascular
damage and sloughing of the tail.
FIGURE 35Coccygeal Venipuncture in the

Bovine
Other Animals
The coccygeal vein can also be used in camelids and swine. It
is not used in goats, sheep, horses, dogs or cats.
Cranial Vena Cava

Venipuncture for Swine
The most popular site for obtaining blood samples from commercial swine is the cranial vena cava. In pet pigs this site
should not be used, as there is a risk of complication and
death. Veterinarians prefer the right side for cranial vena
cava swine venipuncture to avoid the phrenic nerve and thoracic ducts near the left exterior jugular vein. The animals
size determines the required needle.
Lesson 2
105
Small hogs should be restrained in dorsal recumbency with the

head fully extended and front legs pulled caudally. Mature animals
are restrained by a hog snare, in which the head is held in a
straight line with the body and slightly elevated. To perform cranial
vena cava venipuncture on swine, use the following procedure:
1. Locate the right jugular fossa in a depression just lateral to
the anterior projection of the sternum.
2. Cleanse the venipuncture site with 70% isopropyl alcohol.
3. Insert the needle attached to a syringe perpendicular to the
plane of the neck and toward the left shoulder. Withdrawal
must be slow to allow time for the blood to travel through
the long needle into the syringe.
Other Venipuncture Sites

Dogs and cats
The femoral vein can be used in both dogs and cats for small
sample collections. Both the dog and cat are placed in lateral
recumbency and the vein is occluded high on the inner thigh.
For dogs, the lateral saphenous vein can be used routinely much
like the cephalic vein. It tends to roll more than the cephalic
vein. The procedure is much like that for the cephalic vein, but
the dog may be in a standing or lateral position for the draw.
For cats, the medial saphenous vein is also routinely used.
Again, this is done with the cat in lateral recumbency. Occlude
the vein by applying pressure high up on the thigh. Then, you
can perform the venipuncture as for the cephalic vein.
Horses
The saphenous and transverse facial veins are also used in the
horse. The saphenous vein is not used in awake horses due to
the risk of injury to the technician. This site is used in neonates
and anesthetized patients.
The transverse facial vein is used to collect small samples in the
nonfractious horse. This is a site that horses rarely object to the
needle insertion but there is the risk of damaging the eye with
the needle if the horse becomes agitated.
106
Cattle
The subcutaneous abdominal (milk) vein was used in the past
but has become a last resort due to the complications that
occur. The vein becomes infected easily, tends to bleed, and
can form hematomas that occlude blood flow to the teat
(causes thrombosis).
Lets see how well youre doing! Complete Self-Check 6 before
proceeding to the next assignment. Check your answers by
Self-Check 6
1. Venipuncture is used for _______ and _______.
2. Where is the cephalic vein located?
a. Neck
b. Back leg
c. Front leg
d. Tongue
3. An assistant or a/an _______ can be used to occlude a vein.

4. Which vein should you use to draw blood from a sheep or goat?
a. Cephalic
b. Ear
c. Jugular
d. Milk
5. In swine, which side of the neck is preferred for cranial vena cava and jugular
venipuncture? What is the reason for this preference?
a.
b.
c.
d.
The
The
The
The
right side because of the esophagus on the left side

right side because of the phrenic nerve or thoracic duct on the left side
left side because of the esophagus on the right side
left side because of the phrenic nerve or thoracic duct on the right side
6. What is a common site for bovine venipuncture?

a. Cephalic vein
b. Ear vein
c. Tail vein
d. Milk vein
Check your answers with those on page 273
Lesson 2
107
ASSIGNMENT 7URINARY
CATHETERIZATION AND URINE
COLLECTION TECHNIQUES
664669 in Clinical Textbook for Veterinary Technicians.
Introduction
You already know that a urinary catheter is inserted into the
bladder to drain urine or to monitor urine production. Its
important to have an in-depth understanding of whats
involved with placing and maintaining a urinary catheter.
Several types of urinary catheters are available, as shown in
Figure 36. The figure also shows a syringe used to aspirate
urine from the bladder. Stainless-steel catheters, called bitch
catheters, are used only in female dogs. These catheters are
used to empty urine from the bladder and for abdomenocentesis. They cant be placed for long-term urine monitoring.
A Foley catheter has a bulb at the end that fills with air or
fluid to keep the tip of the catheter in the bladder of a female
dog. Theyre available in 3 French to 10
French diameter and range from 40 to
75 cm in length. They can be sutured
to the animal for extended urine monitoring. Foley catheters are too short to
D
reach the bladder of male dogs.
C
C
FIGURE 36Different Urinary Catheters: (A) Flexible

Rubber; (B) Stainless Steel; (C) Semirigid Plastic;
(D) Syringe (used with catheters); (E) Foley
108
The semirigid plastic (polypropylene)

catheter, also called a tomcat catheter,
can be used in cats of either sex. It can
be sutured to the animal for extended
urine monitoring.
Flexible rubber catheters (also used as
feeding tubes) can be used on male and
female dogs and cats. Sizes range from
3 French to 22 French diameter and 40
to 75 cm in length. They can also be
sutured to the animal.
In addition to a variety of urinary catheters, veterinary practices keep the following equipment and supplies on hand for
urinary catheterization (Figure 37):
A sterile speculum with a light source
Assorted regular syringes and urine containers
Hair clippers and surgical scrub disinfectants
Sterile gloves
Sterile lubricating gel
Cotton balls
FIGURE 37Equipment
Needed for Urinary
Catheterization: (A) Urine
Collection Containers;
(B) Sterile Gloves;
(C) Speculum with Light
Source; (D) Speculum;
(E) Lubricating Gel;
(F) Syringe; (G) Light
Source; (H) Hair Clippers;
(I) Cotton Balls
F
C
G
D
B
E
Urinary Catheter Care

Even under optimal conditions, urinary catheterization runs
the risk of trauma and/or infection. Therefore, only sterile
catheters in good condition should even be considered for
use. If urinary catheters are reused, you must adhere to the
following standard urinary catheter care guidelines:
Rinse the urinary catheter immediately after use to prevent debris, blood, or protein from congealing in the tip.
Check the tip of the urinary catheter for sharp edges,

especially around the openings. Discard the catheter at
the first sign of damage.
Lesson 2
109
Use a large syringe to rinse the urinary catheter with a

mild soap solution.
Rinse the soap solution from the urinary catheter three

or four times with water (to prevent residual soap from
interfering with urine evaluations).
Use another large syringe to blow any remaining water

out of the urinary catheter.
Individually package and label each urinary catheter.
Sterilize urinary catheters in an autoclave or with ethylene

oxide gas.
Chemical sterilization of urinary catheters should be avoided for

two reasons. First, a chemical solution thats strong enough to
sterilize a urinary catheter will also irritate the animals mucous
membranes. Second, residual chemicals on the urinary catheter
may inhibit bacterial growth in urine cultures, interfering with
urine evaluations.
Urine Collection in Dogs and Cats

Male-Dog Catheterization
Passing a urinary catheter to obtain a urine sample isnt
difficult in most male dogs, but it does require a veterinary
assistant to aid in preparing and restraining the animal.
The following procedure, illustrated in Figure 38, is used to
place a urinary catheter in a male dog:
1. If the dog has long hair, trim the hair at the tip of the
prepuce.
2. Place the dog in lateral recumbency. Pull forward and
flex the hind top leg.
110
3. Retract the sheath of the penis enough to allow the end

of the penis to protrude (Figure 38A).
FIGURE 38ARetract the
sheath of the penis.
4. Cleanse the glans penis with antiseptic soap (Figure

38B). Rinse well to remove every trace of soap residue
(which may cause the sample to appear cloudy, inhibit
bacterial growth in the urine specimen, or destroy cells).
5. Open the sterile package of the appropriately sized
urinary catheter (size 4 to 10 French, 45 cm long with
the opposite end adapted to fit a syringe) to expose
only the catheter tip. Use sterile lubricating gel to lubricate the distal 2 to 3 cm of the catheter.
FIGURE 38BClean the
glans penis with antiseptic
soap.
Lesson 2
111
6. Insert the lubricated end of the catheter into the urethra

(Figure 38C). Keep most of the urinary catheter in its
package so it can be handled without contamination.
(The urinary catheter may also be passed with sterile
gloved hands or a sterile hemostat.) Gently thread the
catheter into the urethra.
FIGURE 38CThe lubricated end of the catheter
is inserted into the
urethra.
7. Steady, gentle pressure will overcome any resistance

(caused by flexure of the urethral canal or crystals) when
the urinary catheter reaches the caudal end of the penis.
FIGURE 38DSix to 12 ml
of urine are collected by
aspiration.
112
8. Watch for a flow of urine at the catheters end. This flow

indicates that the catheter is passing the sphincter of the
urinary bladder. The first few milliliters of urine are discarded. Then, 6 to 12 ml of urine can be collected in a
sterile syringe by aspiration from the end of the urinary
catheter (Figure 38D).
9. If the catheter will remain in place for extended monitoring of urine production, place a tab of tape around the
end of the catheter (Figure 38E) and suture the tape to
the prepuce.
FIGURE 38EA tab of
adhesive tape is placed
around the catheter.
10. Attach a sterile urinary collection bag to the external end

of the catheter (Figure 38F).
FIGURE 38FA urinary
collection bag is attached
to the external end of the
catheter.
Lesson 2
113
If no urine flows once the catheter has been inserted as far as

the mark that represents the estimated required length, attach
the syringe and aspirate the urine. You can attempt to exert
very mild pressure on the urinary bladder, but this may cause
the urinary catheter to traumatize the bladder wall.
Female-Dog Catheterization
The positioning of the female dogs urethral orifice makes it difficult to catheterize. This procedure is also a two-person
operation. Female dog catheterization requires a vaginoscope or
otoscope fitted with a sterile speculum equipped with a light to
visualize the urethral orifice. If the speculum was stored in a
cold-sterilization tray, rinse it with warm sterile water. If the
speculum has been wrapped and sterilized in an autoclave,
place sterile lubricating gel on its tip prior to insertion.
Use this procedure to catheterize a female dog:
1. If the animal has long hair, trim some of the hair from the
vulva so that it doesnt contaminate the urinary catheter
on insertion.
2. Have the animal restrained in a standing position or, if
anesthetized, position the animal so that the tail region is
raised higher than the head.
3. Cleanse the lips of the vulva and the surrounding hair
with antiseptic scrub (Figure 39A) and make sure to rinse
the solution from the dog thoroughly.
FIGURE 39AThe lips of
the vulva and surrounding
area are cleansed.
114
4. Open and discard the sterile package of the appropriately

sized urinary catheter and lubricate the insertion end of
the catheter with sterile lubricating gel. When catheterizing female dogs, its easier to wear gloves than to pass
the catheter through the packaging.
5. Use a speculum to visually locate the urethral orifice on
the ventral floor of the vagina, approximately 3 to 5 cm
(1.5 to 2 inches) inside of it.
6. Pass the urinary catheter along the
vaginal floor until it passes through
the urethral opening and into the
urinary bladder, approximately 6 to
12 cm (3 to 6 inches) (Figure 39B).
Rectum
Vagina
Catheter
7. Remove the speculum, and maintain the catheter in place (Figure

Urethra
39C). Allow the first 2 to 3 ml of
urine to flow from the urinary
Urinary Bladder
catheter; then attach a sterile
syringe to collect 6 to 12 ml of
FIGURE 39BCorrect Placement of Urinary Catheter
in the Female Dog
urine. If no urine flows (and the
catheter is definitely in place), urine
can be aspirated into a syringe. As
with male dogs, avoid manual compression on the
urinary bladder; it may cause the catheter to traumatize
the urinary bladder wall.
FIGURE 39CThe catheter

is maintained in place.
Lesson 2
115
The Finger Identification Technique

An alternative to using a speculum to visualize the urethral orifice
is the finger identification technique. This technique works best for
large-breed dogs. Although finger identification does take some
practice, some find it easier than trying to manage a speculum and a
urinary catheter at the same time. This technique requires teamwork
to be successful.
The finger identification technique is performed as follows:
1. If the animal has long hair, trim some of the hair from the vulva
so that it doesnt contaminate the urinary catheter on insertion.
2. Restrain the animal in a standing position.
3. Cleanse the vulva and surrounding area with antiseptic scrub.
4. Rinse the scrub very well.
5. Open the package of an appropriately sized sterile
urinary catheter.
6. Thoroughly wash your hands and put on sterile gloves.
7. Lubricate the tip of the catheter with sterile lubricating gel.
8. Use a lubricated index finger to gently palpate the urethral
papilla and pass the urinary catheter into the urinary bladder.
9. Allow the first 2 to 3 ml of urine to flow from the catheter. Then
attach a sterile syringe to collect 6 to 12 ml of urine. If no urine
flows (and the catheter is definitely in place), aspirate the urine.
Male-Cat Catheterization
Catheterization of the male cat may require anesthetic, either an
injectable short-acting agent or a rapidly-cleared gas agent. This
technique is therefore used only on obstructed cats or those in surgery. Severely ill cats under anesthesia must be handled with
extreme care. In many cases, sedating the ill cat is sufficient to
accomplish urinary catheterization.
Use the following procedure to catheterize a male cat:
1. Have an assistant place the anesthetized or sedated animal on
its back, with the hind legs pulled forward.
2. Draw the penis from the sheath and gently backward.
116
3. Pass a sterile, flexible, plastic or polyethylene urinary

catheter (the tomcat catheter) through the urethral
opening and into the urinary bladder.
Accumulated urethral material may cause an obstruction. It
may be necessary to inject 3 to 5 ml of sterile water or sterile
saline to flush out an obstruction and pass the catheter.
Female-Cat Catheterization
Female cats are catheterized by a plastic, blunt-ended tomcat
catheter. Its often necessary to use an injectable short-acting
anesthetic agent or a rapidly cleared gas anesthetic agent. As
with males, this technique is used only for obstructed cats or
those in surgery. Female cats are very difficult to catheterize.
Use this procedure to catheterize a female cat:
1. Cleanse the lips of the vulva. Restrain the cat in a sternal
position with the hind legs hanging over the edge of a
table. Hold the tail away from the vulva.
2. Wear sterile gloves to grasp the vulva and pull it caudally.
Pass the lubricated urinary catheter along the floor of
the vaginal vestibule into the urethral orifice.
Maintaining Indwelling
Urinary Catheters
There are several reasons a veterinarian may wish to install
and maintain (for several days) a flexible indwelling urinary
catheter in the urethra and urinary bladder. These reasons
include a poor urine stream following repeated urethral
flushing, some forms of kidney failure, urinary bladders with
poor muscle tone, or to measure urinary output. For these
animals, the appropriately sized urinary catheter is passed
aseptically and then secured to the skin by sutures attached
either to the catheter or to adhesive tape holding the catheter
in place. The urinary catheter needs to be secure enough that
it wont be dislodged or removed by the animals movements.
Once the catheter is secure, firmly attach its external end to a
sterile intravenous infusion line and a fluid bag or a closed
urine collection system. This shields the urinary tract from
Lesson 2
117
environmental bacteria that could enter the urinary bladder.

Small animals should wear an Elizabethan collar to prevent
them from removing or disturbing the urinary catheter.
In a cooperative animal, this closed system can be maintained
for four to five days. Periodically empty or change the fluid
bag. This closed method allows you to measure the amount
of urine the animal produces in a given time period.
Urinary Bladder Expression

Never exert excessive manual pressure on a catheterized urinary
bladder. If the catheter is absent, urine can be collected by
expressing the urinary bladder. This procedure must be
done with great care, especially if theres an obstruction in the
urethra. Excessive pressure on the urinary bladder may
cause it to rupture.
The urinary bladder is located by palpating the abdomen with
gentle, steady pressure. Use one hand to express the urinary
bladder of cats and small dogs. In larger animals, use both
hands to exert gentle pressure on either side of the urinary bladder. If pressure is applied to the urinary bladder and no urine
flows, urethral blockage may exist. In this case, another
method of urine collection should be considered.
Cystocentesis in Dogs and Cats

Veterinarians and veterinary technicians frequently obtain
urine specimens from dogs and cats with cystocentesis, a
procedure that removes urine directly from the urinary bladder
through the abdominal wall. This enables the sample to be
free from any contamination (sterile). This technique is performed only when the urinary bladder is sufficiently firm
to be easily palpable or by using ultrasound to guide the needle into the bladder. The aid of the veterinary assistant is
required for this technique.
Use this procedure to perform cystocentesis on a dog or cat:
1. Position the animal on its back, its side, or in a standing
position, depending on the animals disposition and your
own preference.
118
2. Aseptically prepare the skin with 70% isopropyl alcohol.

3. Manually immobilize the urinary bladder by abdominal
palpation. A 5 to 20 ml syringe with a 22- to 25-gauge,
3.75 to 5 cm needle is inserted through the abdominal
wall and directly into the urinary bladder lumen.
4. Remove the urine sample by gentle suction. Some veterinarians prefer to remove as much urine as possible at
this time. The thinking is that a very full bladder may
rupture. However, others feel that the time required to
do this increases the risk of injury. If the animal moves
during cystocentesis, the bladder can easily tear. Your
veterinarian will instruct you as to the preferred method.
A three-way stopcock may be attached to the syringe and needle
to aid in the removal of extremely large amounts of urine. Care
is taken not to leave a large amount of urine in the urinary bladder. The intrabladder pressure may cause urine to leak through
the puncture site and into the abdominal cavity.
Free-Flow Urine Collection

for Dogs and Cats
Urine can be collected from dogs and cats during the normal
voiding process, a technique called free-flow, voided sample,
or free-catch collection. Dogs frequently void when taken outside for a walk. Fashion a cup holder from a straightened
wire coat hanger or a small-diameter aluminum rod bent into
a circle at one end. Place a urine cup in the circle. As the
animal begins to void, slip the cup into place to obtain the
urine sample.
A metabolic cage (a cage on a wire platform over a floor that
slopes to a central funnel) can also serve as a urine collection
device. Place the animal in the cage and then place a clean
container under the funnel to collect voided urine.
Because cats like to void in the same place, free-flow urine
can be collected from them without sample cups or metabolic
cages. Place a solid plastic sheet or plastic beads instead of
litter in their litter box. The urine can then be collected easily.
Lesson 2
119
Urine Collection for Cattle

Various stimuli can help you collect urine samples from
cattle. This reflects the fact that individual animals seem to
respond to different types of stimulation. A frequently successful method of stimulating a cow to urinate is to stroke
repeatedly beneath the area of the vulva. Avoid holding the
tail with the other handit may distract the animal. Some
cows will urinate if the vulva is stroked with several pieces of
hay or straw. If these methods fail, the lips of the vulva can
be flapped together repeatedly to stimulate urination. Its best
to collect a midstream urine sample to avoid contamination
from either the vestibule or the vulva.
Urinary catheterization can be easily performed by the veterinarian or veterinary technician with a bent metal catheter
or an artificial insemination pipette thats been slightly bent
approximately 2.5 cm from the tip.
Use this procedure to catheterize a cow:
1. Prepare the cow by scrubbing the skin around the vulva
and the lips of the vulva with an antiseptic solution.
2. Rinse the area at least three times with water containing
an antiseptic solution.
3. Introduce a sterile gloved hand into the vulva and slide
the fingers along the ventral shelf of the vestibule to find
the urethral orifice. The urinary catheter is directed into
the urethral orifice by guiding it with one of the fingers of
the other hand.
4. Gently advance the urinary catheter until urine flow
indicates that it has entered the urinary bladder.
Because of the size of bulls and the danger involved, a bull
must be anesthetized to pass the catheter. Bulls should not
be catheterized by a veterinary technician.
Urine Collection for Horses

Urine can be collected from a mare as from a cow. Wrap the tail
prior to the procedure to prevent hair from entering the vulva.
The hair will contaminate the area and irritate the sensitive
mucous membranes.
120
Male horses are catheterized to collect urine. The animal must

be sedated in order to pass the catheter. Clean the penis using
the same procedure as that for male dog catheterization. The
male horses urethral diverticulum accumulates smegma; take
extra care to clean this area well. A flexible urinary catheter
is lubricated with sterile saline and inserted into the urethra
while the penis is held by an assistant. There may be some
resistance felt at the ischial arch, so some force may be needed
to overcome this area. The horse will generally raise its tail
once you pass the ischial arch. The catheter is advanced
until the premeasured distance. If urine doesnt flow freely, it
can be collected by aspiration.
Urine Collection for Sheep and Goats

The procedure for catheterizing female sheep and goats is the
same as that for the female dog. Inserting a catheter in male
goats and sheep is difficult and not recommended because of
the animals specific anatomy.
Interestingly, urine can be collected from the ewe by holding
its nostrils and mouth closed. After no more than 45 seconds,
the ewe struggles to get air and will urinate at the same time.
Urine is also collected from both male and female sheep and
goats just by waiting until they stand up. These animals have
a tendency to void after switching position from lying down to
standing up.
Urine Collection for Other Animals

Urine collection via catheterization is not possible in male
camelids. Collection must be obtained by free catch. Females
can be catheterized as described for cattle.
Samples from female swine are usually collected by free
catch. Male swine are not catheterized. Females can be
catheterized, but this is not routine.
Lesson 2
121
Abdomenocentesis in Large Animals

Large animals routinely require abdomenocentesis to collect
fluid from the abdomen for analysis. This procedure is used
mostly in large animals with colic, unexplained weight loss, a
fever of unknown origin, an abdominal infection, or chronic
diarrhea. This is not a routine procedure for dogs and cats.
Figures 40A to 40F demonstrate this procedure.
Use this procedure to perform abdomenocentesis on a horse:
1. Restrain the horse in a chute or stanchion (Figure 40A).
FIGURE 40AThe horse is
restrained in a chute or
stanchion.
FIGURE 40BThe site is

clipped and cleaned.
122
2. Clip and clean

the site (be aware
of the horses feet
at all times to avoid
being kicked). The
site used is the
lowest point of the
abdomen just to
the right or left of
midline (Figure
40B). Avoid blood
vessels to minimize
bleeding.
3. Prepare the area by scrubbing with povidone-iodine

followed by alcohol three separate times (Figure 41C).
FIGURE 40CThe abdomenocentesis site is
scrubbed with iodine.
4. Inject approximately 2 ml of 2% lidocaine starting in the

subcutaneous tissue and pulling out to reach the skin
(Figure 40D). This provides local anesthesia to the site.
5. Put on sterile gloves. Using a sterile No. 15 scalpel blade,
make a stab incision into the skin (Figure 40E).
FIGURE 40DLidocaine is injected.
Lesson 2
FIGURE 40EIncise the skin with a scalpel.
123
6. Insert a 9 cm, sterile, blunt-ended teat cannula into the

hole made by the scalpel blade and push it through the
subcutaneous space (Figure 40F). You should feel a pop,
and fluid will generally flow out of the cannula if youve
made it into the abdominal cavity. Its helpful to have
some sterile 4.4 gauze on the end of the cannula to collect any blood that may be leaking and to keep it from
contaminating the sample.
FIGURE 40FA sterile,
blunt-ended teat cannula
is inserted into the subcutaneous space, and fluid
is collected.
7. Collect the sample into blood tubes for analysis. Try not
to collect the first few drops of fluid, as these are normally contaminated with blood. If fluid isnt flowing well,
the cannula may need to be rotated a bit to allow better
access to fluid. Once the sample has been collected,
withdraw the cannula and hold 4.4 gauze over the puncture site to decrease blood dripping from the site.
In cattle, camelids, sheep, and goats, the technique is the same
as that for the horse. There are other sites that can be used. In
the camelid, for example, the most common site is the right
paracostal.
Abdomenocentesis is not routinely performed for either pet or
commercial pigs.
Now that youve learned about urine collection and catheterization, lets check your progress. Before proceeding to the next
assignment, take a moment to complete Self-Check 7.
Remember that you can check your answers by turning to
the back of this study guide.
124
Self-Check 7
1. A Foley catheter is a/an
a.
b.
c.
d.
stainless-steel catheter.
catheter with a bulb on the end.
flexible polypropylene catheter.
inflexible plastic catheter.
2. What are two reasons that chemical sterilization of catheters should be avoided?
__________________________________________________________
__________________________________________________________
Questions 35: Indicate whether each statement is True or False.
______
3. The urinary catheter should be placed in the most sterile way possible.
______
4. If you meet resistance when placing the catheter, make sure to apply firm pressure
to force it through.
______
5. A male dog is easier to catheterize than a female.
6. List four different ways that urine can be collected.
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
7. Collecting urine from a ewe is most similar to
a. male-dog catheterization.
b. female-dog catheterization.
c. cow catheterization.
d. mare catheterization.
8. Abdomenocentesis is most commonly used in

a. dogs.
b. cats.
c. horses.
d. pigs.
Lesson 2
125
ASSIGNMENT 8FLUID
ADMINISTRATION
Types of Fluid Solutions

Many medical and surgical situations require sterile fluid
solutions to be administered. Veterinary medicine is no
exception. Veterinary practices routinely use several basic
types of sterile fluid solutions. Although you wont be required
to determine which type of fluid is best for the patient, its
important that youre familiar with each type of fluid, as
youll be setting up the fluid administration and may be
adding other medications/additives to the fluids.
These fluids (also known as crystalloids) can be classified
as hypotonic, isotonic, or hypertonic. Hypotonic fluids have
a lower osmotic pressure than that of the blood in a healthy
animal. (Osmotic pressure is a measurement of the components that make up blood.) An example of this type of fluid
would be 0.45% saline. (Note: Saline often is abbreviated as
NaCl.) Isotonic fluids are those that have the same osmotic
pressure as blood. Examples of isotonic fluids include physiologic (0.9%) saline solution, which conforms to the bodys
normal salinity; 5% dextrose in water solution; Normosol-R;
and extracellular (lying outside the cells) fluid replacement
solutions such as Ringers solution or lactated Ringers solution (LRS). Ringers solution is a sterile solution of sodium
chloride, potassium chloride, and calcium chloride in purified
water. Hypertonic fluids are fluids with a greater osmotic
pressure than that of blood and generally come only in the
form of 7% saline. Figure 41 lists the ingredients found in
the various types of crystalloids.
126
Solution
Na+
K+
Ca+
MG+
Cl
Base
Glucose
LRS
130
109
28 (lactate)
Ringers
147
156
Normosol-R
140
98
27 (lactate)
0.9% NaCl
154
154
1200
1200
5% Dextrose
7% NaCl
FIGURE 41Fluid Types and Compositions
Other types of fluids may be administered to patients, but

these are used only in very specific situations. Colloids are
one type of fluid used in very specific situations. Colloids are
any fluid substance that acts as a volume expander by
adding only to plasma, not both plasma and the interstitial
fluid. Colloids include substances such as blood products,
dextran, VetStarch, and hetastarch.
The other major class of fluids is TPN, which stands for total
parenteral nutrition. This type of fluid contains electrolytes,
water, and supportive nutrition such as calories, nitrogen
sources, vitamins, and trace minerals.
Based on the specific clinical situation, the veterinarian will
recommend combinations of these basic fluid types. These
fluids can also be supplemented with concentrated solutions
of electrolytes and dextrose. To prepare and administer these
solutions, a veterinary practice should have the following
materials on hand:
Fluid solutions and assorted sizes of fluid administration sets
Cotton balls moistened in 70% isopropyl rubbing alcohol
A bottle of sterile saline-heparin solution for flushing the

intravenous indwelling catheter
Lesson 2
127
Special equipment such as regular syringes, adhesive

tape, bandaging material, antiseptic ointment, and
assorted intravenous indwelling catheters and needles
A commercial fluid infusion pump
A sterile three-way stopcock (a valve that regulates the

flow of fluid through a tube)
A manometer (an instrument for ascertaining the pressure of liquids or gases) for central venous pressure
measurements
Veterinarians frequently add antibiotics and other medications to fluid solutions. As a rule, however, veterinarians
avoid mixing multiple medications either in a syringe or in
fluid solutions. Some combinations may inactivate one of the
medications, as carbenicillin does to gentamicin when the
two are combined. The interaction may or may not be visible
upon mixing. Even when medications arent mixed, some are
incompatible with fluid solutions, as Table 1 summarizes.
Table 1
PHYSICAL INCOMPATIBILITIES OF MEDICATIONS IN FLUID SOLUTIONS
Medication
Incompatible with
Amphotericin B
0.9% saline solution
Cephalothin sodium
Lactated Ringers solution, calcium gluconate,

calcium chloride
Chloramphenicol sodium succinate
Vitamin B complex with vitamin C
Chlortetracycline hydrochloride, tetracycline

hydrochloride, oxytetracycline hydrochloride
Lactated Ringers solution, sodium bicarbonate,

calcium chloride
Penicillins
Dextrose-containing solutions with pH greater

than 8 (made by adding sodium bicarbonate)
Penicillin G potassium
Vitamin B complex with vitamin C
128
Fluid Administration Routes

Fluid administration sets are collections of vessels that give
a choice of fluid drip rates (Figure 42). These sets are used to
deliver fluids through the various fluid administration routes.
Sterile fluids can be administered via several routes: under
the skin, in the mouth, into a vein, into the stomach, or even
into a bone. What are the recommended conditions for each
of these routes? What are the advantages and disadvantages
of each? Lets examine each route in turn.
FIGURE 42Fluid
Administration Sets:
(A) Administration Set;
(B) Extension or
Secondary Set
A
B
The Subcutaneous Route

Although its fairly easy to administer fluid subcutaneously,
its also relatively slow. It shouldnt be used for conditions
that require prompt action, such as severe dehydration or
electrolyte deficiencies. Fluids administered subcutaneously
should be warmed to body temperature and be isotonic with
the bodys extracellular fluid. Remember that isotonic fluids
have an osmotic pressure approximately equal to that of
extracellular fluid and include fluids such as Ringers,
Normosol, and 0.9% saline. Dextrose solutions shouldnt be
administered under the skin, as they can cause sloughing of
skin and abscess formation.
Lesson 2
129
Animals can take various rates and volumes of subcutaneous

fluids. A rough guideline for total daily volume in dogs and
cats is approximately 30 to 60 ml/kg. It takes six to eight
hours for the body to absorb subcutaneous fluids. Therefore,
the total daily dose can be divided and given every six to
eight hours, preferably in as many sites as possible.
The subcutaneous route is not used in large animals, as the
amount of fluid required exceeds the administration limit.
The Oral Route

Veterinarians often elect oral fluid administration (via rapid
bolus techniques) because its inexpensive, safe, and easy.
They avoid oral fluid administration, however, if the animal
is vomiting or has severe, life-threatening dehydration or
electrolyte imbalances that require immediate correction.
The Intravenous Route

Intravenous fluid administration through an indwelling
catheter is the quickest method of getting body water and
electrolytes into the general circulation and tissues. The best
candidates for this route, therefore, are severely ill animals,
severely dehydrated animals, and rapidly dehydrated animals. Intravenous fluid administration is also routinely used,
along with general anesthesia, to maintain renal blood flow
and thus vascular access during emergencies. The intravenous
fluid administration process requires close monitoring to
avoid complications such as overhydration, infection, thrombosis (obstruction of a blood vessel by blood clots), phlebitis,
embolism (obstruction of a blood vessel due to abnormal
particles, such as air bubbles), and impaired fluid delivery
should the animal change positions and obstruct the intravenous catheter.
The most common sites for intravenous fluid administration
in dogs and cats are the cephalic vein, lateral or medial
saphenous vein, and the external jugular vein. Small puppies
and large kittens are infused in the cephalic or external
jugular veins using a 22- or 23-gauge indwelling catheter.
130
Ruminants and horses typically receive intravenous fluids

through larger-gauge indwelling catheters in the external
jugular vein.
The Intraperitoneal Route

Although its possible to administer fluids into the abdominal
cavity, veterinarians generally avoid this route. Intraperitoneal
administration may cause peritonitis (inflammation of the
membranes lining the abdominal cavity) and intra-abdominal
abscess formation. The rate of absorption of intraperitoneal
fluid solutions is nearly equivalent to the rate of absorption
of subcutaneous fluids.
The Intraosseous Route

Hypothermic animals, severely-dehydrated puppies and kittens,
and other animals that cant receive venipuncture benefit
from the intraosseous (within the long-bone center) route
of fluid administration. The intraosseous route offers high
absorption rates, approximately 95% within five minutes,
and flow rates up to 11 ml/min with gravity flow. Any intravenous medication can be given into the marrow cavity
without any complications. Appropriate needle size and length
vary with the size and age of the animal. The site is generally
the femur or humerus, bones with large marrow cavities.
The intraosseous route offers its fair share of potential
complications, such as infection that can cause cellulitis,
subcutaneous abscesses, bone inflammation, and leaking
around the needle puncture site. Other common problems
include misplacement of the needle or catheter, bending or
dotting of the needle, through-and-through puncture of the
bone, and replacement of the marrow cavity with fat or fibrous
tissue. Intraosseous infusions can be painful as well, usually
because the solution is too cold or irritating. Pain may also
result from placing too much weight on the needle inserted in
the marrow cavity or administering too much fluid at once.
Lesson 2
131
Determining and Maintaining

Correct Fluid Rate
Now that you know the various routes of fluid administration,
how do you determine and maintain the correct fluid rate?
Determining Fluid Rate

Fluid administration sets in various sizes are required because
animals in different conditions require different rates of fluid.
For animals that are severely dehydrated or in shock, its nearly
impossible to give the fluid solution too quickly. Otherwise, the
rate is generally based on normal fluid use plus replacement
of abnormal losses. Normal fluid turnover is 65 ml/kg/day
for mature animals and 130 ml/kg/day for immature animals.
An intravenous fluid administration rate of 10 to 16 ml/kg/hr
during the first hour of therapy is adequate. Veterinarians
reduce the chance of inadvertently giving too much fluid solution
by favoring indwelling intravenous catheters and prolonged
administration periods over rapid bolus techniques.
Fluid administration sets are available in sets that provide
10, 15, 20, and 60 drops/ml (60 drops/ml is the minidrip, or
microdrip, set). Cats and small dogs usually get the minidrip
set or a burette. A burette is a glass tube with a stockcock
attachment and a capacity of 150 ml.
Veterinary hospitals use commercial fluid infusion pumps
and syringe pumps (the same ones most human hospitals
use) to administer fluid solutions intravenously to all sizes
of hospitalized animals. Burettes or syringe pumps ensure
precise delivery of small quantities of fluid solution to small
puppies and kittens.
The veterinarian chooses a set and administration method
that allows maximum rehydration without adding stress
to the animal. Animals that weigh less than 7 kg (15 lbs),
like the aforementioned cats and small dogs, get minidrip sets.
Animals that weigh more than 7 kg get the administration set
that rehydrates adequately without overloading the animals
circulatory system. Animals with heart disease, pulmonary
132
edema (excessive fluid in the lungs), or ascites (accumulation

of free fluid in the abdominal cavity) require careful monitoring of the quantity of fluid solutions they receive.
To determine the rate of fluid administration, the veterinarian
performs several calculations. The first of these is the drop
factor. The drop factor is equal to the number 60 divided by
drops per ml of the administration set to be used. The drop
factor then becomes part of a second calculation, the rate of
fluid administration in drops per minute. This rate is equal to
the desired ml per hour divided by the drop factor.
For example, a 15 kg dog needs to receive 750 ml of fluids
over 24 hours, or 250 ml three times daily (every eight
hours). At what rate should the fluid solution be administered for an eight-hour period if an administration set that
delivers 10 drops/ml is used?
1. Determine the fluid requirement in ml per hour:
250 ml per 8 hours = about 31 ml per hour
2. Determine the drop factor:
Drop factor = 60 divided by 10 drops/ml = 6
3. Determine the drip rate in drops per minute:
Drops/min = 31 ml/hr divided by 6 = about 5
Thus, the fluid solution should be set at a rate of 5 drops/min
to deliver 250 ml of fluid over an eight-hour period.
Maintaining Fluid Rate

Monitoring both animal and fluid is essential to maintaining
the proper fluid rate in animals receiving fluid administration.
Readings vital to fluid rate maintenance are the animals
packed-cell volume (PCV), its total plasma protein heart rate,
mucus membrane color, mentation, warmth of extremeties,
and its body weight. PCV describes the percentage of the volume of whole, unclotted blood occupied by the red blood cells
in milliliters per 100 ml of blood. Weigh the animal on the
same scale every day if possible. A gain or loss of 0.5 kilograms reflects a gain or loss of 500 ml of fluid.
Lesson 2
133
Monitor renal function in dehydrated dogs or cats by measuring or approximating urine output volume. Normal urine output
volume is 2 ml/kg/hr. If urine production is questionable, the
veterinarian may request that the urinary bladder be catheterized. Urine production is then checked every one to four hours
for the amount produced versus the amount of intravenous
fluid put in via the catheter.
To monitor the fluid level, a piece of 1-inch white tape with
the starting date and time can be placed on the fluid solution
bag (Figure 43). This tape should be marked in sections that
denote where the fluid solution should be at given times during the day. For example, if it has been determined that these
fluids should be delivered at 50 ml per hour, the date and
time is marked on the bag at the start of therapy. The tape
is marked off at 50 ml increments to represent the amount
of fluid delivered hourly.
FIGURE 43Marked Fluid
Solution Bag
This monitoring method is satisfactory, but it allows for

errors, such as improper rate setting or occlusion of the
vein caused by bending of the animals leg. A commercial
fluid infusion pump is the preferred method of administering
fluids over long periods or when precise amounts must be delivered (Figure 44). Such infusion pumps can be programmed to
deliver fluids accurately regardless of how the animal rests
in the cage.
134
FIGURE 44Commercial
Fluid Infusion Pump
Measuring Central Venous Pressure

The measurement of central venous pressure (CVP), the
amount of blood pressure in the vein and right side of the
heart, also helps in evaluating the fluid status of an animal.
When used and interpreted properly, the CVP measurement
can substantially reduce the likelihood of excessive fluid
administration. Measurement of CVP is a simple technique
that can be performed in all veterinary practices. The following equipment is needed to monitor CVP:
Over-the-needle indwelling catheter
Needles and syringes
12- to 16-inch extension venotubing
Intravenous fluids
Three-way stopcock
Bandages and tape
Manometer or length of extension venotubing and ruler
Heparin-saline solution
Lesson 2
135
To measure CVP, place an indwelling intravenous catheter in

the cranial vena cava by way of the external jugular vein, at
the level of the hearts right atrium. Once the catheter has
been placed, CVP can be monitored using a sterile manometer.
A manometer is a slender tube with calibrations printed on it
for measuring. If a manometer isnt accessible, you can use a
length of sterile extension venotubing and a yardstick or
ruler as a makeshift manometer, as shown in Figure 45.
To measure CVP, use the following procedure:
1. Attach a sterile manometer, if available, or a 12- to 16inch length of sterile extension venotubing to the center
port of a three-way stopcock. With the animal in lateral
recumbency, position the zero point of the manometer at
the level of the animals sternum (Figure 45A).
FIGURE 45AThe
manometer should be
level with the animals
sternum.
136
2. Tape the manometer or venotubing and stopcock to a

stationary object close to the animal, such as a wall
(Figure 45B).
FIGURE 45BTape the
manometer to a wall near
the animal.
3. Maintain a constant position of the animal and the

manometer or venotubing to obtain an accurate
evaluation (Figure 45C).
FIGURE 45CPlace a ruler

alongside the tube to
measure the fluid levels.
Lesson 2
137
4. Attach a bag of saline and a regular administration set to

one of the side ports of the stopcock. Hang the bag of
fluids above the animal and manometer (Figure 45D).
FIGURE 45DHang the
bag of fluids above the
animal and the manometer.
5. Attach a 12- to 16-inch length of extension venotubing to

the other side port of the stopcock (Figure 45E).
FIGURE 45EAttach
extension venotubing
to the other side port of
the stopcock.
6. Allow the fluids to fill all venotubing and the manometer

(Figure 45F).
138
FIGURE 45FAllow the

venotubing and manometer
to fill with fluid, letting
excess fluid run out to
remove any air in the
tube.
Turn stopcock off

to dog to fill venotubing
and manometer.
Lesson 2
Turn stopcock off

to manometer to fill
extension venotubing.
139
7. Attach the extension length of venotubing to the port of

the intravenous catheter (Figure 45G).
FIGURE 45GAttach
extension venotubing to
the intravenous catheter.
Attach extension
venotubing to port
of intravenous
catheter.
8. Turn the stopcock off to the bag of fluids. The level of

fluid in the manometer will fall (Figure 45H). The CVP
is equal to the level of the fluid in the manometer once
equilibrium has been established and the fluid level
stops decreasing.
9. To improve accuracy, repeat steps 6 through 8 three
times.
Its important to perform all CVP measurements with the
same zero point and with the animal in the same position. A
clotted or kinked intravenous catheter will falsely increase
the CVP reading. Obstruction is the likely culprit if the level
of the manometer doesnt fluctuate with respiration. The
140
Turn off
stopcock to
fluid bag.
Measure the
drop in fluid
level in the
manometer.
FIGURE 45HTurn the

stopcock off to the bag
of fluid and measure the
drop in fluid level.
catheter should be flushed with a heparin-saline solution

after each reading to maintain catheter patency. If a catheter
is patent, it is open and unobstructed.
The veterinarian will watch the trends in the central venous
pressure and determine whether to increase or decrease the
intravenous fluid therapy.
As its impossible to record them continuously, central
venous pressure measurements are made intermittently. If
intravenous fluids arent being administered between CVP
measurements, the intravenous catheter should be flushed
with the saline-heparin solution. Otherwise, a blood clot
might form in the catheter. (If fluids are being given, theyll
automatically flush the catheter and keep things moving, so
the heparin solution is unnecessary.) Veterinarians favor
Lesson 2
141
trends over single measurements when evaluating CVP.

Changes of less than 3 cm of water arent significant. Using
the animals sternum as the zero point, normal CVP in the
dog and cat varies between 0 and 5 cm of intravenous fluid.
If CVP is consistently greater than 8 to 10 cm of intravenous
fluid, veterinary professionals suspect volume overload and
slow down or stop fluid administration.
Congratulations! Youve completed Lesson 2. Now its time to
review the material youve learned in this study guide as well as
the assigned pages in your textbook for Assignments 68. Once
you feel you understand the material, complete Self-Check 8.
Then check your answers with those provided at the end of this
study guide. If youve missed any answers, or you feel unsure of
the material, review the assigned pages in your textbook and
this study guide. When youre sure that you completely understand the information presented in Assignments 68, complete
your examination for Lesson 2.
142
Self-Check 8
1. Which of the following are crystalloids?
a.
b.
c.
d.
Hypotonic fluid, TPN, and blood

Hypertonic fluid, hypotonic fluid, and TPN
Hypotonic fluid, TPN, and isotonic fluids
Hypotonic, isotonic, and hypertonic fluids
2. Which of the following is an example of an isotonic fluid?

a. 0.9% saline
b. Blood
c. 0.45% saline
d. 7% saline
3. List the five different routes of fluids administration.
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
4. What are two common complications of intraperitoneal fluid administration?
__________________________________________________________
__________________________________________________________
(Continued)
Lesson 2
143
Self-Check 8
5. Which of the following animals (if severely dehydrated) benefit the most from intraosseous
administration?
a. Cows
b. Adult cats
c. Kittens
d. Sheep
6. What is a manometer?
__________________________________________________________
__________________________________________________________
7. What is a complication of too much fluid in an animal with heart disease?
a.
b.
c.
d.
Painful abdomen
Subcutaneous fluid accumulation
Pulmonary edema
Lameness
8. What is normal output volume for a dog/cat?

9. Define central venous pressure.
__________________________________________________________
10. Which of these will falsely increase CVP?
a.
b.
c.
d.
The false placement of the catheter

Obstruction of the manometer
Clotted or kinked IV catheter
Intermittent measurements
144
Dental Prophylaxis
Read this assignment. Then read pages 12991303 in your

Clinical Textbook for Veterinary Technicians.
Introduction
Dental prophylaxis, the management and prevention of periodontal
disease (diseases of the tissues around the tooth below the
gums), isnt just for people. Dogs and cats middle-aged and
older should have their teeth professionally cleaned at least
once a year. Some animals, especially those on moist diets,
require dental prophylaxis twice a year. (Toy breeds are prone
to tooth crowding because of their shortened skulls.)
Dental prophylaxis removes the plaque and dental calculus
that accumulate on the teeth at the gum line and cause
gingivitis (gum inflammation) and periodontal diseases such
as periodontitis, an inflammatory reaction of the tissues surrounding a tooth below the gums. Dental calculus is calcium
phosphate and carbonate with organic matter deposited on
tooth surfaces; its also known as tartar. The general goal of
dental prophylaxis is to relieve oral pain, restore the mouth
to a healthy condition, and maintain a healthy mouth following
dental prophylaxis.
You, the veterinary technician, will play a key role in dental
prophylaxis, as youll be performing the dental prophylaxis
on the animal and helping the owner learn to care for the
animals teeth at home. To be able to perform the dental
prophylaxis, youll need to know a bit about the anatomy
of the teeth, the type of equipment needed, and, of course,
the steps involved in the process.
Lesson 3
ASSIGNMENT 9TOOTH
ANATOMY, FORMULAS, AND
DIRECTIONAL TERMS
145
Anatomy of the Teeth

The teeth, like the rest of the body, are formed from the three
primitive tissues: mesoderm, endoderm, and ectoderm. The
tooth is formed from the outside infrom the crown first to
the root last. Unlike most other parts of the body, a tooth is
actually composed of more than one type of tissue.
The tooth can be divided into two parts: the root and the
crown. The root is what it sounds likeit holds the tooth in
place in the jaw. It can be singular; however, some teeth have
two or three roots. The crown is the portion of the tooth seen
above the gum line.
So what actually makes up the tooth? Enamelthe hardest
tissue produced by the bodyis a protective covering made
of minerals, not cells, found only on the crown of a tooth.
Dentin, a living tissue, is a bonelike structure that helps protect
the pulp cavity. Pulpthe blood vessels, lymph vessels, and
nerve tissuemakes up the sensory portion of the tooth.
The structures surrounding the teeth are collectively known as
the periodontium. The periodontium consists of the following:
146
Periodontal ligamentThe ligament that connects the

tooth to the socket and functions in cushioning forces
to the tooth
Alveolar crestThe bone that supports the upper teeth
Gingiva (gums)Attached to the periodontal ligament,

the gingiva protects the ligament from oral bacteria.
Oral mucosaThis isnt technically part of the periodontium. The oral mucosa is actually the tissue found
throughout the mouth that enables the cheeks and lips
to stretch and open the mouth as full as possible.
Mucogingival line (MGL)The line that divides the gingiva

from the oral mucosa
Free gingival marginThe portion of the gingiva that

overlaps the tooth
Gingival sulcusThe space between the free gingival

margin and the tooth
Cemento-enamel junction (CEJ)The bottom of the

gingival sulcus
The terms for all of these different structures can be confusing, but over time youll become more familiar with the most
common of them.
Tooth Designations and

Dental Formulas
What else do you need to know before starting dental prophylaxis on an animal? You need to know the number of teeth
each species has and how to accurately record changes to the
teeth. The dental formula is shorthand for the type and number of teeth in a species.
Teeth can be designated in two ways. The first is an anatomic
nomenclature thats put forth as a formula of sorts. It has
the following designations for each tooth type:
I = incisorThe incisors are the teeth found at the front

of the mouth that are all similar in shape and size.
Incisors have one root each. Theyre used to gnaw (chew
meat off a bone), snip grass, or bite at an itch.
C = canineThe canines are the very long teeth found on

either side of the incisors. In carnivores, these teeth are
used to grab and tear the flesh of prey.
P = premolarThe premolars are pointed and have a

crown with a triangular shape. These teeth have one
to three roots and are used mostly for mastication
(chewing) of food.
M = molarThe molars can be either flat (as in the dog)

or pointed (as in the cat). Theyre used to grind food.
Herbivores have large, flat molars for grinding plants.
The dental formula lists these teeth with a fractional number

the top number correlates with the maxillary teeth of the
upper jaw, and the bottom number correlates with the
mandibular teeth of the bottom jaw. The formula accounts
for only one side of the mouth, as the two sides should
be identical.
Lesson 3
147
The formula for the adult dog is

3
1
4
2
I
,C
,P
,M
3
1
4
3
From this formula, you should be able to tell that the total
number of teeth found in an adult dogs mouth is 42.
For the adult cat, the formula is
3
1
3
1
I
,C
,P
,M
3
1
2
1
From this formula, you should be able to tell that the total
number of teeth found in an adult cats mouth is 30.
For an adult horse, the formula is
3
1
3 4
3
I
,C
,P
,M
3
1
3
3
From this formula, you can tell that the number of premolars
is variable in horses.
The formula is slightly different for young animals, as they
dont have any permanent teeth (i.e., molars). Young animals
have teeth that are deciduous; that is, theyll all fall out and
be replaced by permanent teeth. Tooth designations are written in lowercase to signify that the formula pertains to a
young animal.
For the puppy, the formula is
3
1
3
i
,c
,p
3
1
3
This formula indicates that puppies have a total of 28 teeth.
For the kitten, the formula is
3
1
3
i
,c
,p
3
1
2
This formula indicates that kittens have a total of 26 teeth.
Lastly, a few of the teeth are called carnassial (meat-eating)
teeth. The carnassial teeth are the fourth premolar and first
molar. These teeth are often the easiest to identify, and therefore are used as landmarks to help you figure out which
tooth youre looking at depending on the tooths location
relative to the carnassials.
The other dental formula commonly used when recording
information about the teeth is the Modified Tridan System.
This system actually assigns numbers to each tooth. With
this system, each tooth has a three-digit number. The first
148
digit designates the section of the mouth youre referring to

(1 = upper right, 2 = upper left, 3 = lower left, 4 = lower
right). The second two numbers refer to the actual tooth (the
first incisor on the upper-right side would be 1, which
means the tooths three-digit number would be 101).
Directional Terms
Lastly, its advantageous to know some of the descriptive
directional terms for the teeth and the mouth. The following
are some of the descriptors you should know:
DistalThe direction moving from the incisors to the

molars
MesialThe direction moving from the molars to the

incisors
LabialAlso called buccal or vestibular. The surface of

the tooth that faces the lips.
Rostral Closer to the front of the head, in comparison

to another tooth. The opposite of rostral is caudal.
PalatalPertaining to the upper teeth (maxillary teeth)
LingualPertaining to the lower teeth (mandibular teeth)
Occlusal surfacePertaining to the area of the upper and

lower teeth that contact each other
ApicalPertaining to the area toward the root tip
CoronalPertaining to the area toward the crown
CervicalPertaining to the area found at the cementoenamel junction
Now that weve covered some of the basic terms and anatomy
needed for veterinary dentistry, lets see how well youre
doing. Before proceeding to the next assignment, complete
Self-Check 9. Remember that you can check your answers by
Lesson 3
149
Self-Check 9
1. The two basic parts of the tooth are the _______ and the _______.
2. The three layers of the tooth are the _______, _______, and the _______.
3. Which of the following is the correct anatomical nomenclature for an adult dog?
a. I
,C
b. I
,P
,C
,M
,P
4
4
c. i
,M
,c
d. I
3
3
,p
,C
3
3
,P
,M
2
3
4. If a tooth is numbered 301, what is its location?

a. Upper right
b. Upper left
c. Lower left
d. Lower right
5. The term labial is generally used to refer to the

a. molars.
b. incisors.
c. premolars.
d. maxillary teeth.
150
ASSIGNMENT 10DENTAL
EQUIPMENT, DENTAL
PROPHYLAXIS, AND TOOTH
EXTRACTION
Dental Equipment
The equipment necessary to perform a dental prophylaxis
ranges from the very simple and minimal to the very involved,
depending on the expertise and focus of the clinic. The basic
equipment needed for a dental prophylaxis includes a table of
some fashion, hand instruments, and a polisher. Yet, even if
a clinic doesnt specialize in dental work, they generally have
more specialized equipment on hand.
Hand instruments are a necessity, but additional equipment
is required if money is to be made from doing dental prophies
(prophylaxis procedures). Hand instruments are time-consuming, require that animals stay under anesthesia for long
periods, and can quickly tire the technician. Therefore, most
veterinary hospitals now have dental air units (usually
referred to as dental machines) that incorporate at least an
ultrasonic scaler, a drill, and a polisher.
The dental machine makes dental prophylaxis quick and
helps the technician clean the teeth thoroughly. Dental
machines do need special attention to work properly, and
therefore its advisable to follow the manufacturers instructions
and perform routine maintenance on them. Make sure to test
the equipment routinely to keep it working properly. Its also
important to care for the hand instruments and keep them
sharp or they wont work correctly and will damage the teeth.
Lesson 3
151
So, what are these instruments? The powered equipment

includes ultrasonic scalers, drills, and polishers. The ultrasonic
scaler is used to remove calculus through the oscillating action
of its head. The scaler is accompanied by a water source thats
used to cool the tip, as the oscillations generate immense heat
that can damage the tooth surface. The scaler has two different
tips: the curved, blunted point and the curved, sharp chisel tip.
The chisel tip is used to remove large areas of calculus from
the teeth. The blunted tip is used to remove smaller areas of
calculus. Never push either tip into the surface of the tooth;
they must be placed flat against the tooth.
The drill is generally a high-speed dental drill that has an
attached water source much like the ultrasonic scalers.
Remember that the high speed generates immense heat that
can damage teeth. Water is necessary to keep the tooth cool
and to help remove debris. There are many different tips that
attach to the drill depending on the type of drilling needed.
Most states dont allow veterinary technicians to remove
teeth, so we wont cover tooth extraction here.
The polisher is used at the end of the dental prophylaxis to
smooth out the teeth. During the prophylaxis (even when
performed correctly), the teeth are microscopically damaged.
If the teeth are left in that condition, theyre more prone to
developing tartar and calculus. This means that if the teeth
arent polished, the dental work will have caused more harm
than good!
As for the hand instruments, the most important one is the
periodontal probe (also referred to as the periodontal explorer).
This probe is used to check for gingival pockets (areas separating the tooth from the gingiva) and depth of tooth decay.
The periodontal probe has two ends. One is a straight, blunt
end with incremental lines used to measure the gingival
pocket depth. The other end is a curved, sharp tip that can
be used to explore tooth decay.
Other hand instruments include scalers, curettes, dental
extractors, and dental elevators. Scalers and curettes are
used to remove calculus not removed by the ultrasonic scaler
and to remove all calculus found below the gum line. Dental
extractors and elevators are used in tooth extraction.
152
Dental Prophylaxis in the

Veterinary Practice
Providing an animal with good dental prophylaxis requires
teamwork. The veterinary technician will want to maintain
the dental equipment and supplies, shown in Figure 46:
Power equipment such as an electric or air-driven dental unit
Dental handpieces, including high-speed and low-speed

handpieces
Rotary scaler burrs
Various hand instruments, such as probe, scaler,

curette, sharpening stone, extraction forceps, and root
tip pick. Its important to keep these instruments sharp.
Polishing paste or pumice
FIGURE 46Equipment
and Supplies for Dental
Prophylaxis: (A) Scalers;
(B) Extraction Forceps;
(C) Root Elevator;
(D) Curette; (E) Dental
Gag; (F) Polishing Paste;
(G) Power-Driven Dental
Unit; (H) High- and LowSpeed Handpieces
H
G
The animal receiving dental prophylaxis should consume only

water the night before treatment. When the animal arrives at
the veterinary practice, its owner should complete a dental
record. This aids dialogue between owner and clinic, helps
the veterinarian evaluate periodontal disease progression,
Lesson 3
153
and affords the practice some legal protection. The form

should also disclose if an aged animal is predisposed to
endocarditis (inflammation of the inner lining of the heart)
or other immune disorders. These animals should receive
antibiotics before dental procedures because veterinarians
usually elect to extract teeth from geriatric cats and dogs
with moderate to severe periodontitis rather than subject
these patients to serial dental treatments requiring repeated
anesthetization.
Predental antibiotics are administered by subcutaneous, intramuscular, or intravenous injection with predental medications,
or orally 24 hours before cleaning. The antibiotic course may
continue for up to seven days following dental prophylaxis,
depending upon the severity of periodontal or oral disease.
Veterinarians recommend complete dental prophylaxis when
the animal displays gingivitis, plaque, and dental calculus.
Dental prophylaxis resolves these problems if the dental
disease hasnt progressed beyond gingivitis.
Complete dental prophylaxis includes supragingival (above
the gum line) and subgingival (below the gum line) scaling to
remove all plaque and calculus, polishing of the teeth, and
rinsing of the gingival sulcus, the groove between the surface
of the tooth and the epithelium lining the free gingiva.
Veterinary technicians are responsible for removing plaque
and calculus deposits from an animals teeth. The veterinarian or the veterinary technician (depending on the state
regulations) will extract any teeth that are loose or diseased.
Lets look at the steps involved in giving an animal a clean,
healthy mouth.
1. Anesthetize and intubate the animal (Figure 47A).
2. Position the animals head with the nose slightly downhill to allow fluids to drain from the mouth. Place cotton
towels under the head to soak up water and keep the
animals head dry. Wear a mask, gloves, and eye protection when cleaning the animals teeth and mouth. This
reduces inhalation of aerosolized bacteria (Figure 47B).
154
FIGURE 47AThe animal

is anesthetized and intubated. (Setting courtesy of
VCA Lewis Animal Hospital,
Columbia, Maryland)
FIGURE 47BCotton
towels are placed under
the animals head. (Setting
courtesy of VCA Lewis Animal
Hospital, Columbia, Maryland)
3. Remove large deposits of calculus with dental hand

scalers (Figure 47C). This step may be skipped, depending on the technicians training.
4. Scale the teeth with a combination of mechanical and
hand instruments.
The entire scaling procedure can actually be done with hand
instruments, but this method takes much longer. When
using hand instruments, make sure to pull down toward the
crown of the tooth when trying to remove calculus.
Lesson 3
155
FIGURE 47CLarge calculus deposits are removed

with hand scalers. (Setting
Mechanical scaling instruments (ultrasonic scalers) are used

primarily on the crown of the tooth to remove the majority of
plaque and calculus deposits (Figure 47D). Used with care,
mechanical instruments can also work subgingivally. With
the mechanical scalers, its important to remember that they
produce heat and, if left for long periods on a portion of a
tooth, can actually damage the tooth, making it more susceptible to cavities, plaque buildup, and/or cracking. Make sure
to continually move the scalers around the teeth and not to
spend more than three seconds in one spot. If necessary,
return to the affected tooth later.
FIGURE 47DMechanical
scalers are used to
remove the remaining
plaque and calculus.
(Setting courtesy of VCA Lewis
Animal Hospital, Columbia,
Maryland)
156
After mechanical scaling, hand instruments are used to

remove the remaining plaque and calculus deposits on the
crown and to scale subgingivally. Scalers are used supragingivally. Curettes are used supragingivally and subgingivally.
5. Polish the teeth after scaling (Figure 47E). Although the
idea of polishing sounds cosmetic, in dentistry it
decreases the rate of subsequent plaque accumulation
by smoothing the irregular tooth surface left by scaling.
A soft, rubber prophylaxis cup and fine prophylaxis
paste or flour pumice is used to polish the teeth. Hand
polishing isnt recommended, as it doesnt sufficiently
smooth the tooth surface.
FIGURE 47EThe teeth
are polished. (Setting courtesy of VCA Lewis Animal
6. After polishing, irrigate the gingival sulcus. The gingival

sulcus is the groove between the surface of the tooth and
the lining of the free gingiva. Irrigation removes polishing
paste and debris that may have accumulated during the
procedure (Figure 47F). Use a 0.1 to 0.2% chlorhexidine
solution for irrigation. This may be followed by a fluoride
treatment of the teeth.
Lesson 3
157
FIGURE 47FThe gingival

sulcus is irrigated. (Setting
7. After irrigation, check the teeth for pockets using the

periodontal probe. The normal depth of the dental sulcus
is 3 mm in the dog and 1 mm in the cat. Excess depth
is generally associated with periodontitis. Established
periodontitis requires additional treatment planning
beyond a routine dental prophylaxis. When periodontitis
is present and periodontal pocket depths are less than
4 to 5 mm, closed subgingival plaque and calculus
removal and root planing can be performed, meaning
that the gums dont have to be surgically opened. The
veterinarian may determine that the periodontal pockets
are greater than 5 mm in depth and are difficult to treat
conservatively (without surgical intervention). If advanced
periodontitis is present, with periodontal pockets exceeding
9 mm in depth and with tooth socket or alveolar bone loss
of 70% or greater, the tooth is best treated by extraction.
Tooth Extraction
Tooth extractions usually are performed by the veterinarian,
but you, as the technician, may be asked to assist. There are
three main types of extractions: simple, sectioned, and surgical.
158
Simple extractions are extractions of teeth that dont have

more than one root. These extractions dont generally require
more than the dental elevator (used to break down the periodontal ligament attachment) and dental extractors (used to
grasp the tooth and pull it out).
Sectioned extractions are extractions of teeth with more than
one root. These extractions are so named because the tooth
is generally sectioned to enable each root to be removed as a
simple extraction. The dental elevator and extractor are used
in this procedure, as is a drill. The drill cuts the tooth into
sections for easy removal and decreases the chance of fracturing a root by trying to remove multiple roots as one unit.
Surgical extractions require bone to be cut to remove a tooth.
These are necessary when the tooth root isnt accessible,
when theres danger to the adjacent structures, or when
theres damage to the root. These extractions are much more
involved, but they generally dont require much more instrumentation than sectioned extractions.
All three types of extractions may require suturing of the gingiva once the tooth is removed, depending on the size of the
pocket left. It may also be helpful to pack powdered antibiotic
into the tooth pocket to aid in fighting potential infection.
Make sure to note if sutures are placed, as they may need to
be removed later.
Lets take a moment to check your understanding of the
material presented thus far. Take a moment to complete
Self-Check 10 before proceeding to the next assignment.
Lesson 3
159
Self-Check 10
Questions 14: Match the following terms with their definitions by placing the letter of the
best definition in the blank space next to each term.
______
1. Drill
______
2. Ultrasonic scaler
______
3. Polisher
______
4. Periodontal probe
a. An instrument with two different ends: a straight, blunt

end with incremental lines and a curved sharp tip
b. An instrument used at the end of the dental prophylaxis
to smooth out the teeth
c. A high-speed dental instrument with an attached water
source thats used to split teeth or remove portions of
teeth that are decayed
d. An instrument used to remove calculus through the
oscillating action of its head
5. Which animals should receive antibiotics before a dental prophylaxis?

a.
b.
c.
d.
Every animal
No animal
Those predisposed to tartar buildup
Those predisposed to endocarditis
6. When is a complete dental prophylaxis usually recommended by a veterinarian?

a.
b.
c.
d.
When an animal has gingivitis and plaque

When an animal has gingivitis, plaque, and dental calculus
Yearly, regardless of tooth condition
Only when the animal seems to eat irregularly, indicating a problem
7. Why should you wear a mask when performing a dental prophylaxis?

a.
b.
c.
d.
To
To
To
To
keep the instruments sterile

not have to smell the animals bad breath
prevent inhalation of aerosolized bacteria
prevent water from being sprayed on your face
8. The three types of tooth extractions are _______, _______, and _______.
160
ASSIGNMENT 11CHARTING
DENTAL WORK AND DENTAL
RADIOLOGY
Read this assignment. Then read pages 13031321 and
Charting Dental Work

Charting dental work can be very confusing. It generally involves
a specific dental form where findings and various procedures
can be noted. Most dental charts contain pictures of the teeth in
one or more forms: open-mouth occlusal view, buccal/labial
with roots, and lingual/palatal view of the crowns.
Regardless of the views on the form, there are two ways to
record the information: (1) by the person performing the
dental and (2) by dictating the information to a second
person. The second way can be more efficient as long as the
person writing down the information understands what the
person performing the dental is saying (i.e., he or she needs
to know the tooth names/numbers and the abbreviations for
the various conditions of the teeth).
Twelve basic things are routinely recorded in a dental chart,
with other procedures recorded if theyre performed or necessary. The following lists routine charting information and the
abbreviations used to chart them (note that when there are
numerical abbreviations, a 0 is normal and not generally
recorded):
1. Calculus index (CI)A rating of the severity of calculus
coverage
CI0No calculus (not generally recorded)
CI1Calculus covering less than one-half the crown

of any tooth
CI2More than one-half of the crown is covered

(but not all of it).
CI3The entire crown is covered with calculus, and

the calculus continues under the gingiva.
Lesson 3
161
2. Missing teethNoted by circling the tooth thats missing.

If a portion of the root system is still present, it can be
signified by RtR (retained root).
3. Malformed and malpositioned teethThe tooth is generally
represented by a drawing of either the tooth itself or its
location. The abnormal tooth may be drawn in a different
color, or the normal shape or position may be whited out
so that the abnormal one can then be drawn.
4. Supernumerary teethExtra teeth are drawn in where
theyre found.
5. Traumatized teethThese are generally fractured teeth
(Fx). A fracture is documented according to whether its
open (FxO) or closed (FxC). Open fractures are then
further documented as to whether the pulp is alive (in
medical jargon, vital) (V), or dead (nonvital) (NV).
6. Gingival index (GI)A rating of the color and shape of the
gingiva
GI0Normal gingiva, which should be pink (or in

some cases black due to pigmentation) and have
nice flat margins. This generally isnt recorded.
GI1Reddened, swollen, and/or rounded margins
GI2Reddening, swelling, and gingival bleeding

when probed
GI3Spontaneous bleeding, ulceration, severe

inflammation (stomatitis) or gingival hyperplasia
7. Stomatitis and kissing ulcersNoted by either outlining

the extent of the lesions or by shading the area using
cross-hatching
8. Tooth mobility (M)The movement of a tooth. Movement
can occur for numerous reasons, including trauma, fractured roots, lack of alveolar bone, and periodontitis.
162
M0No movement; not normally recorded
M1Very slight movement (1 mm)
M2Obvious movement, but tooth has firm roots
M3Obvious movement with potential to extract

just by pushing it in the right direction
9. Probing depthThe depth a probe can be inserted into

the sulcus of a tooth. Normal depth in dogs is 4 mm or
less; for cats its 1 mm or less. The depth is generally
noted next to the tooth.
10. Gingival recession and hyperplasiaNormal gingiva
should overlap the crown of the tooth by about 2 mm.
Hyperplasia is documented by placing a (+) and the
amount next to the tooth. Recession is noted with a ()
and the number. The area thats recessed should also
be drawn in for future reference (i.e., is the recession
the same or increasing across the whole tooth?).
11. Furcation lesionsThe loss of alveolar bone in the space
between the roots (called the furcation)
F1Depression extends less than halfway under the

crown.
F2Depression is more than halfway but not the

full length.
F3All of the bone and gingiva are missing.
12. Periodontal index (PDI)Rating that incorporates the

presence of stomatitis, probing depth measurements
and gingivitis, and the degree of tissue infection. This
can be subjective.
PDI1Gingivitis only
PDI2Gingivitis, and loss of the cemento-enamel

junction (CEJ) attachment is 25% or less.
PDI3Gingivitis, and CEJ attachment loss is

2550%. Gingival hyperplasia can be seen, and
there may be bone loss on radiographs.
PDI4Severe periodontitis with over 50% CEJ

attachment loss. Teeth are usually falling out
in this stage.
Lesson 3
163
Other procedures are generally noted on the chart as needed.

The most common procedure done in general practice is the
extraction of teeth. This is generally noted by placing an X
over the tooth extracted. The type of extraction performed is
noted by XS for a simple extraction or XSS for a surgical
extraction. Also make sure to note if a pocket was sutured
in this area.
Dental Radiology
Dental radiology has come a long way in veterinary medicine.
There are now many very lightweight, handheld X-ray units
with automatic processors available in an attainable price
range. The regular diagnostic X-ray unit found in most veterinary clinics can be used for dental diagnosis. However, its
somewhat difficult to get the correct positioning, as the animal will need to be manipulated instead of the machine. The
small self-developing units are easier to place in the mouth
and process; in fact, they self-process!
Digital radiography also includes digital dental radiographs.
These machines are usually stand-alone, but may be part of
a unit. A sensor placed in the mouth projects a picture to the
computer. The sensor takes views much like the older film,
but can take more in-depth views if necessary. Digital dental
radiographs can be less expensive in the long run because
there is very little waste produced to get the desired pictures.
Regardless of the machine and cassettes being used, there
are a number of basic radiographs that are obtained when
looking at an animals teeth. Survey radiographs are the set
of X-rays that show the entire mouth. This set generally has
at least 6 views for the cat and 10 views for the dog. These
views look at each tooth (sometimes more than once). In
taking the views, its important to go in a stepwise fashion so
as not to forget a view. The survey radiographs highlight each
side of the mouth, the front teeth, and the upper and lower
164
arcades of each. Its important to note that proper radiographing

of teeth requires anesthesia, as animals wont hold still for
these films!
Some helpful hints for radiographing the teeth include the
following:
Place the film/sensor in such a way that moving the animal doesnt result in movement in the film/sensor. A
triangular block or foam curler can be used to aid in
holding the film/sensor in place. Make sure that any
placement aid doesnt go between the film/sensor and
machine.
Use sandbags around the animals head to keep the body

in place while working around the head.
Have a skull nearby so you can evaluate where the film

should be placed and which teeth youve captured in a
certain X-ray.
The following are the standard dental radiograph techniques:
Paralleling techniqueThis technique allows for

evaluation of the mandibular teeth that are caudal to
the second premolars. Paralleling requires the film or
sensor to be placed parallel to the long axis of the tooth.
Bisecting angle techniqueThis technique allows for

evaluation of the front part of the mouth, both the rostral mandible and maxilla. The beam directs via a series
of angles that start with the tooth angle in relation to the
film or sensor.
Occlusal techniqueThis technique allows for evaluation

of the maxilla and nasal cavity. The beam is positioned
at a right angle to the film or sensor.
Other views may be necessary depending on the affected

tooth. But, for the most part, the views just presented will be
inclusive enough for the veterinarian to be able to evaluate
root systems. Exact positioning and angles vary depending on
the animal and type of equipment to be used. Please refer to
your textbook for more specifics.
Lesson 3
165
Dental Prophylaxis at Home

For optimal plaque control, the animals owner must perform
dental prophylaxis at home. The success of home care depends
on the owners schedule and commitment and the animals
cooperation. Many veterinary hospitals depend on the veterinary
technician to provide training in dental prophylaxis to owners.
Daily plaque removal is ideal, but every two days is adequate.
Its best to start early with young animals so they learn to
accept the procedure, but older animals may be trained to
allow home care. The training process should be gradual,
acclimating the animal so it eventually allows dental prophylaxis at home.
Suitable products for home care include childrens or infants
soft toothbrushes, veterinary toothbrushes, finger toothbrushes (devices that fit over the finger), gauze pads, and
other products designed for plaque removal. Oral hygiene
products are available as pastes, liquids, gels, and sprays.
Animals tend to swallow the products, so avoid any oral
hygiene product not specifically designed for veterinary use.
While hard food and soft rubber chew toys do help remove
plaque, these approaches tend to be less successful in aged
animals who may be missing teeth and are settled in their
dietary and chewing habits. Animals shouldnt be allowed to
chew on hard objects, as this may result in tooth fracture.
Weve now covered the essentials of dental prophylaxis for
dogs and cats. Lets move on to horses.
Dental Care for Horses

Remember that horses have two sets of teeth. The first set
are deciduous teeth, commonly called caps. They erupt
around six months of age. The diduous teeth are only milk
incisors and premolars. At about two and a half years of age
the permanent teeth begin to replace the decuduous teeth.
Complete replacement is usually by five years of age.
The dental formula for horses varies from male to female.
Most adult males have 44 permanent teeth, while female
have 36-44 permanent teeth (females generally do not have
canines and may be missing the first premolar). All horses
166
start with 24 deciduous caps. There are common designations of some of the teeth that are helpful to know when
talking with owners.
Wolf teeth are the permanent first premolars. They are generally smaller than the other premolars. These teeth may be
extracted to prevent discomfort if the horse wears a bit.
Cheek teeth are premolars and molars, not including the wolf
teeth. These six teeth are anatomically very close together
and are considered a single unit. The horse therefore has
four units of cheek teeth: two on the maxilla and two on the
mandible. Cheek teeth have many grooves and ridges that
are made up of cementum, enamel, and dentin.
Equine teeth are hypsodont, meaning the crown extends
below the gingiva. The root structure allows the teeth to grow
throughout the horses life. The teeth wear down by chewing,
which leads to sharp points, waves, or other abnormalities.
This is generally the focus of equine dental care.
Plaque and calculus formation is not as common in horses as
small animals, so it is not routinely performed. However, the
examination of these teeth and any work that needs to be
done is very physical and can be time consuming.
Initial examination is performed with the horse fully awake.
This is necessary to evaluate the muscles associated with
chewing. Any facial swelling, ulcers along the lips, or discharge from the eyes, nose, or mouth is noted. The stall must
be examined for partially chewed food. Check the feces for
particle size.
The horse is then sedated to better evaluate the oral cavity. A
speculum is placed in the mouth, and the horses head is
placed on a stand or the shoulder of an assistant. The veterinarian generally performs the teeth floating by using various
grades of dental floats, or metal files. The teeth are examined
for waves, undergrown or overgrown teeth, sharp edges, fractures, and abcesses. The instruments used for the actual
dental work can be electric or hand powered. As a technician,
youll help sedate and restrain the animal, pass floats to the
veterinarian, and document any problem teeth.
Lesson 3
167
Congratulations! Youve now completed the dental lesson!

Now, review the material youve learned in this study
guide as well as the assigned pages in your textbook for
Assignments 911. Once you feel you understand the material, complete Self-Check 11. Then check your answers with
those provided at the end of this study guide. If youve
missed any answers, or you feel unsure of the material,
review the assigned pages in your textbook and this study
guide. When youre sure that you completely understand the
information presented in Assignments 911, complete your
Self-Check 11
1. What are two ways a dental prophy can be recorded?
__________________________________________________________
__________________________________________________________
2. List 4 of the 12 basics that are routinely recorded in a dental chart.
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
Questions 3 and 4: Indicate whether each of the following statements is True or False.
______
3. Its generally recommended that animals chew on hard objects to remove plaque.
______
4. A horse is usually anesthetized to perform a floating of the teeth.
168
ASSIGNMENT 12WOUND CARE

AND MANAGEMENT
in Clinical Textbook for Veterinary Technicians.
Types of Wounds
Everyone knows what a wound is, but most people dont know
one wound from another. All injured tissues have similarities.
Much of what well discuss here applies to internal wounds
as well, but this assignment focuses on skin and underlying
tissue wounds. These wounds are either open or closed. Open
wounds are injuries that cut and destroy skin. Closed wounds
are crushes and contusions (bruises). There are six kinds of
open wounds:
1. Abrasions
2. Avulsions or bite wounds
3. Degloving injuries
4. Lacerations
5. Burns
6. Ulcers or pressure sores
Animals usually suffer abrasions when theyre hit by a car
and skid along the ground. An abrasion is a shearing or
rubbing wound that damages and destroys the skins outer
layer (epidermis) and parts of the tissue under it (dermis).
This is the most superficial open wound. An abrasion usually
appears red and raw. Its surface oozes blood and serum. It
may be contaminated by debris.
Lesson 4
Wounds, Bandages,
Casts, Slings, and
Emergency Care
169
An avulsion results when tissue is torn from its underlying

attachments. Dog bites often cause avulsion injuries. The
dogs tooth gets hooked into the skin and rips it from the
subcutaneous tissues. Sometimes the skin looks only bruised,
but other avulsions leave a very large and obvious skin flap.
Degloving occurs when a large area of skin is separated from
the underlying tissue, much like a glove being removed from
a hand. These are seen mostly in dogs that have jumped
from a car and are dragged along pavement.
A laceration has irregular edges and damage to the surrounding and deeper tissues. Lacerations are usually caused by
dull objects that tear tissue.
A burn is due to fire or a hot substance making contact with
the skin. Burns are classified by their depth into the skin.
Decubital ulcers or pressure sores form due to heavy pressure
on a bony body part. They are usually found in obese pets
and animals with orthopedic or neurological problems. They
are common if an animal has been placed in a bandage for
too long, or if the bandage was placed inappropriately. Ulcers
often form along the elbow, but can form on the hips and
hocks. Ulcers start with reddened skin and then progress to
white, purple, and black discolorations and skin sloughing.
Wound Healing
The healing of any injured tissue is a complex process. The
actual process of wound healing is covered in the Animal
Diseases, Pathology, and Immunology study guide. But, as
a quick review, remember that healing starts immediately
following the injury and continues for many months. Wounds
heal in an orderly sequence. Although these events overlap
considerably, it helps to think of healing as a sequence of three
phases: the inflammatory phase, the proliferative phase, and the
maturation phase.
170
Factors That Can Affect Wound Healing

Wound healing proceeds through the inflammatory, proliferative, and maturation phases. The rate of this progress can be
affected by age, diet, and blood deficiencies. The presence of
bacteria, foreign bodies, or significant anti-inflammatory drugs
can also influence the rate of healing. All of the following
factors affect an animals ability to heal.
Age. By itself, age doesnt affect wound healing, but older
animals sometimes exhibit health changes that might impair
wound-healing ability. A lifetime of poor nutrition can affect
an older animals healing ability. Organ failure and diseases
that present as animals age can also affect the speed with
which an animal heals.
Protein deficiency. Low protein levels delay fibroplasia.
Animals with protein-deficient diets or a protein-loss disease
may have poor wound-healing abilities.
Anemia. This is a condition in which the blood is deficient
in red blood cells, hemoglobin, or total volume. Anemia by
itself doesnt delay wound healing. However, significant blood
loss can lead to shock, which can inhibit wound healing.
Dehydration. Dehydration is an abnormal depletion of bodily
fluids. Dehydrated animals may suffer delayed wound healing.
Infection and foreign bodies. Bacteria produce collagenases,
enzymes that break down collagen and delay wound healing.
Foreign material in a wound increases susceptibility to infection,
and the resulting bacteria can delay wound healing. Some
extremely irritating foreign materials, such as hair, cloth, and
wood, may cause inflammation and affect wound healing.
Corticosteroids and nonsteroidal anti-inflammatory
drugs. Anti-inflammatory corticosteroid compounds, such as
cortisone, in high doses can significantly inhibit wound healing. Large amounts of steroids can inhibit fibrin deposition,
phagocyte migration, capillary and fibroblast multiplication,
and collagen production and growth. Animals treated with
small amounts of steroids (the dose for allergy control) in a
clinical setting shouldnt suffer these effects. At-risk animals
are those on high-dose steroid therapy or those with diseases
that produce high concentrations of natural corticosteroids
Lesson 4
171
(such as Cushings syndrome). Therapeutic amounts of

nonsteroidal, anti-inflammatory drugs, such as carpofen and
meloxicam, dont significantly affect wound healing.
Radiation therapy and chemotherapeutic drugs. These
treatment regimes can delay healing depending on the drug
used, when the drug was used, and how the drug causes cell
death. Most of these regimes target rapidly-dividing cells, which
means that theyre targeting not only cancer cells but also
the cells used in healing wounds.
Wound Care
Initial Presentation
The first thing to remember about an injured animals wound
is that wounds often result from significant trauma that creates
other serious problems. Placing a clean bandage over the
wound will aid in decreasing contamination and, potentially,
bleeding, but a clean and dressed wound does little good to
an animal dying of shock or experiencing breathing difficulties
or serious blood loss. You first must assist the veterinarian
in treating the injured animals life-threatening problems.
Once the animal is stabilized, its wounds can be evaluated
and treated.
The veterinarian first checks to see if the wound is bleeding;
he or she then slows or stops any bleeding by applying pressure directly to the bleeding vessel. A visible vessel can be
clamped or tied with suture material. The veterinarian
assesses the extent of the injury by asking the following
questions:
172
Has the wound damaged just the skin or also the

underlying muscle, tendons, or bone?
How contaminated is the wound?
Are the contaminants hair, dirt, stones, or other foreign

materials?
How old is the wound?
If the wound is older, does it reveal any signs of

infection?
After the initial evaluation, the veterinarian begins wound

treatment. Keeping the animal calm and still through this
stage usually requires anesthesia. Local anesthesia may be
enough, but some animals and injuries require sedation or
general anesthesia.
Lavage
Lavage is the flushing (irrigation) of a wound. Lavage dilutes
and rinses bacteria, foreign material, and blood clots from the
wound. The ideal lavage fluid is warm, sterile, and similar in
composition to body fluids. Normal saline (0.9% sodium chloride) is a good lavage solution. Tap water isnt as good a choice,
but you might use it if the wound is heavily contaminated or
when theres no other fluid available. Antiseptic solutions such
as chlorhexidine and povidone-iodine are used in most instances
to help clean out the wound. However, these can damage tissue
if used in too high concentration. Hydrogen peroxide is not routinely used, as the hydrogen content damages internal tissue.
Apply the lavage with a large injection syringe (60 mls) and a
19-gauge needle to flush the wound. Do not use a pulsing
tool such as a Water Pik to apply the lavage solution! The
pressure will drive debris and bacteria deeper into the wound.
Successful lavage requires plenty of fluid. Some wounds require
several liters or more. The lavage should remove as much foreign matter as possible. Dirt, hair, and wood are all highly
inflammatory, so take special care to remove them.
Debridement
Debridement is the surgical removal of diseased or damaged
tissue and foreign matter from a wound. Its typically done at
the same time as lavage. Debridement can turn a traumatic
wound into a clean wound with healthy tissue and a good
blood supply.
The extent of debridement depends on the injury. The veterinarian attempts to remove all dead tissue and foreign matter while
preserving as much skin as possible. Fat and muscle can be
excised (cut out) more freely if necessary. A remarkable amount
of tissue can be removed from some sites without affecting
function. Dead tissue in a wound can lead to serious problems
Lesson 4
173
and must be removed. The veterinarian will try to preserve

damaged tendons and ligaments and larger bony fragments
from a broken bone until definitive fracture repair.
There are three other methods of debridement: enzyme,
mechanical, and bandage debridement. Enzyme debridement
uses chemical agents to remove dead tissue from the skin.
Enzyme debridement is done in combination with surgical
debridement, and should be done only on small wounds.
Mechanical debridement employs either a wet-to-dry bandage
or a nonadherent bandage. When using a wet-to-dry bandage,
the wet bandage is applied as the primary layer to the wound,
followed by dry bandaging on the outside. As the bandage
dries, it clings to dead tissue and debris. Debridement occurs
when the bandage is removed. Bandage debridement has three
drawbacks. First, it can be painful. It may require sedation
or anesthesia for each bandage change. Second, it requires
several bandage changes to debride the wound well. Third, it
does not remove only contaminated or dead tissue. It will also
remove healthy tissue that is trying to heal.
Nonadherent primary layer bandages are becoming common
due to the problems associated with wet-to-dry bandages.
They are composed of a primary layer that comes in contact
with the wound but does not actually adhere to the wound.
This maintains the moisture needed to promote healing while
protecting new tissue.
Cleaning and Closing a Wound

Veterinarians always handle a wound gently. Granulation
tissue and new epithelium are initially very delicate and easy
to traumatize. When cleaning a wound, veterinarians follow
aseptic (infection-preventing) techniques whenever possible.
Lavage is the least traumatic way to clean a wound. Lavage
removes secretions and foreign materials loosely attached to
the wound surface. It may not remove firmly attached or
deeply embedded materials. Some of these materials can
be removed by blotting, not rubbing, the wound with a wet
gauze sponge. Rubbing, especially vigorous rubbing, can
remove new epithelium and damage the granulation tissue.
174
If lavage or a wet sponge cant remove a piece of dead tissue

or foreign body from the wound, a surgical instrument, such
as forceps, may be used. Forceps may be either straight or
curved and come in varying sizes. The size of forceps needed
depends on the size of the wound. More serious wounds with
bigger debris require larger, heavier forceps. Smaller wounds
require more delicate forceps.
Its important to treat any abscess that forms. An abscess is
an enclosed collection of pus surrounded by inflamed tissue.
Drainage is vital to the treatment of abscesses. Drainage
allows removal of the collected pus so that the bodys defense
mechanisms can fight the infection more effectively. The
easiest and quickest way to treat a superficial (near the
surface) abscess is to lance it. Veterinarians thrust a scalpel
blade into the lowest part of the abscess to create a drainage
hole for the pus. They may need to massage the abscess
gently to help push out the pus.
If the abscess cavity is small, lancing may
be all thats necessary to treat it. However,
if the abscess is large or deep, the veterinarian may need to do more to maintain
the drainage hole. In these situations, the
veterinarian usually places a surgical rubber or plastic drain in the abscess cavity.
The drain runs from the abscess cavity
through the skin below or at the cavitys
bottom. This enables the pus to move along
the drain and out of the body. The drain
stays in place until drainage has stopped or
the infection is under controlusually no
more than three to five days (Figure 48).
Rubber drains are also used in noninfected wounds to decrease the risk of
infection if there is space surrounding the
wound, due to skin pulling away from the
underlying tissue, as in degloving.
Lesson 4
FIGURE 48Cat with an Abscess
175
A wound can be closed directly with sutures if the wound is

simple and clean or if the wound is more complex but has
been completely cleaned with lavage and debridement. This
direct suturing is called primary-closure, or first-intention,
healing. Primary-closure suturing usually uses absorbable
sutures to bring the subcutaneous wound edges together and
nonabsorbable sutures or staples to bring the epithelium
together. The wound may need drains for wound leakage or
open space under the skin.
A wound thats too contaminated to be closed immediately
can be left open for several days of lavage and debridement.
This process is called delayed primary closure. Some large
wounds are never sutured but are allowed to contract and
epithelialize. Such wounds usually need bandages to protect
them while they heal. This is second-intention healing.
Factors that a veterinarian evaluates when deciding the type
of closure for a wound include the following:
Time since injury
Amount of contamination of the wound
Size of the wound
Debridement (how aggressive it was)
Blood supply to the wound
Amount of tension and/or dead space resulting from

the closure
Wound location
Animals current health status
Steps to Promote Healing

Currently, no agents have been proven to accelerate wound
healing. Scientists have performed many experiments in
hopes of finding ways to promote faster wound healing.
Oxygen chambers, tissue transfers, and healing ointments
such as vitamin E have all demonstrated positive effects on
wound healing, but many experimental results are debatable.
176
The best ways to encourage wound healing are to debride

the wound, keep it clean and protected, and avoid large doses
of anti-inflammatory drugs such as corticosteroids. These
drugs slow the healing process and increase the chance of
wound infection. Its also important to make sure the animal
is well-nourished.
Bandages and Bandaging Techniques

Bandaging is generally the veterinarians role, but you may
occasionally be called upon to bandage a wound. Your role as
a veterinary technician is to understand the theory behind
bandaging, know what materials are required, and aid the
veterinarian in bandaging an animal.
Once an injured animal is stabilized, the wound is cleaned,
debrided, and sutured. Why does it need a bandage? A
bandage, in its simplest form, is a strip of fabric used to
dress and bind a wound. Veterinary medicine has refined
and elaborated upon this basic form, combining it with casts,
slings, and splints to heal all kinds of injuries. These variations,
however, all perform a bandages four basic healing functions:
To protect the wound from environmental bacteria and

additional trauma
To absorb wound secretions
To immobilize the wound
To exert gentle pressure to prevent swelling or bleeding
The Parts of a Bandage

You can see from looking at the four healing functions of a
bandage that you may need more than a simple strip of
fabric to keep out bacteria, absorb secretions, exert pressure,
and immobilize the wound. Bandages that cover open
wounds have three layers:
The primary (contact) layer
The secondary (padded conforming) layer
The tertiary (holding and protective) layer
Lesson 4
177
The primary layer, which touches and protects the wounds

surface, is the wound dressing. Closed wounds, such as a
broken bone that doesnt penetrate the skin, dont require
a wound dressing. The secondary layer absorbs fluid and
harmful materials from the wound surface and also helps
to pad the wound. The tertiary (outer) layer holds the other
bandage layers in place.
Bandaging Materials
Several materials are required to properly place a bandage.
These materials usually are placed in the following order,
and include
Adhesive tape
Sterile pads (if an open wound exists)
Gauze
Cotton cast padding
Vet wrap
Elastikon tape
Adhesive tape, which is sticky on one side, comes in rolls.

White, porous adhesive tape is most often used to form
the stirrups to which a bandage will attach. Unlike other
adhesive tapes, white adhesive tape isnt stretchable.
Elastikon tape is a stretchable tape applied as the tertiary
layer of a bandage. Its stretchability allows it to be placed
with variable degrees of compression.
A sterile pad often serves as a bandages primary layer.
An open wound requires a primary layer over the wound.
Injuries that dont involve open wounds dont require a
primary layer. This layer is either adherent (sticks to the
wound, such as a wet-to-dry bandage) or nonadherent. This
layer is also either occlusive (water resistant) or nonocclusive.
Most dressings, such as petroleum-impregnated gauze or
Telfa pads, are nonadherent. Theyre also nonocclusive,
allowing fluid from the wound to drain into the absorbent
secondary layer. These dressings are appropriate for clean,
open wounds without established granulation tissue.
178
Occlusive dressings, which keep outside moisture out and

wound fluid in, are for wounds with established granulation
tissue. Most prepared occlusive dressings are hydrocolloidal,
meaning they combine with fluid (in this case wound fluid) to
form a gel. Tests have proven that hydrocolloidal dressing
speeds wound epithelialization, though it also diminishes
wound contraction.
Cotton is the major material of a bandages secondary layer
because its flexible, compressible, and highly absorbent. It
comes in small, thin rolls (2, 3, or 4 inches wide and about
1/ - to 1/ -inch thick) and in thicker rolls of sheet cotton.
32
16
The thin-rolled cotton is called cast padding. The thicker
sheet cotton comes in a 1 lb roll. Cotton is excellent for leg
bandages because its easy to shape to the leg.
Gauze comes in rolls or square pads. Rolled gauze covers,
compresses, and secures the cotton layer. Rolled gauze
comes in a variety of textures and sizes. The most common
sizes for small animals are 2-, 3-, and 4-inch widths. Large
animals usually require the 6-inch width. Veterinarians occasionally use square pad gauze in bandages, but they use it
far more often as absorbent surgical sponges.
An antiseptic is a substance that stops the growth and
action of bacteria in living tissue (not to be confused with
disinfectants, which are for inanimate objects such as an
examination table). Antiseptics function both as lavage
solutions and as germicides for a healing wound. The two
most popular antiseptics among veterinarians are chlorhexidine and povidone-iodine. Both solutions work against many
bacteria and harmful organisms. Used properly, neither
hampers wound healing. Another popular antiseptic is
triple-antibiotic ointment. This type of ointment contains the
antibiotics bacitracin, neomycin, and polymyxin. Large animal wounds are often treated with the antiseptic nitrofuracin.
Now that you know what bandages are, what they do, and
what theyre made of, turn your attention to where they go
and how to put them there. But first, test your knowledge
of the material presented here by completing Self-Check 12.
Lesson 4
179
Self-Check 12
1. List the six types of open wounds.
__________________________________________________________
__________________________________________________________
2. List the three phases of wound healing.
__________________________________________________________
__________________________________________________________
3. True or False? The wound is the most important thing to address when an animal first
presents to the clinic.
4. An easily cleaned, uncontaminated wound is usually closed by
a.
b.
c.
d.
primary closure.
delayed primary closure.
second-intention healing.
open primary healing.
5. Which of the following is not a basic function of a bandage?

a.
b.
c.
d.
To
To
To
To
keep helpful bacteria in contact with the wound

absorb wound secretions
immobilize the wound
exert pressure that helps prevent swelling or bleeding
6. List the three layers of a bandage.
__________________________________________________________
__________________________________________________________
7. Of the three layers you listed in the previous question, which layer is not always necessary in
bandaging?
__________________________________________________________
__________________________________________________________
180
ASSIGNMENT 13BANDAGING
SMALL AND LARGE ANIMALS
in Clinical Textbook for Veterinary Technicians,
General Bandage Application

Most bandages require the following:
Anchoring stirrups (adhesive tape strips) (This pertains

only to extremities.)
Sterile padding (if open wound)
Cast padding
Gauze
A splint (This is omitted from some bandages.)
Vet wrap and/or Elastikon to make up an outer

protective layer
Bandaging Small Animals

Bandaging the Limbs of Small Animals
The most common bandage sites in small animals are the
front and hind limbs. The two most common reasons to
bandage a small animals leg are to protect wounds or to
support the leg (for example, providing temporary support for
a broken leg).
A leg bandage always extends from above the target site all
the way down to and including the toes. A bandage that
doesnt extend to the toes could slip or twist and constrict
the leg, which would interfere with the foots blood flow.
Constriction can cause the foot to swell if blood isnt able to
circulate out of the area. It can also cause the foot to die if
blood cant reach it. A bandage placed down to the toenails of
the outer two toes helps avoid this complication.
Lesson 4
181
When bandaging a limb, the middle two toes are left exposed,
enabling assessment of color, swelling, and heatall of which
can be indications of a bandage thats been placed too tightly.
The procedure to place a bandage on the leg of a small animal
is shown in Figure 49 and described in the following steps:
1. Place adhesive tape stirrups on the foot. Stirrups hold
the bandage to the leg and are almost always an
absolute requirement (Figure 49A).
FIGURE 49AAdhesive
tape stirrups are placed
on the leg to secure the
bandage. (Setting courtesy of
Airpark Animal Hospital,
Westminster, Maryland)
2. Apply a sterile pad (the primary layer) over the wound

(Figure 49B).
FIGURE 49BA sterile pad
covers and protects the
wound. (Setting courtesy of
182
3. Wrap the leg snugly and evenly with cotton padding

(Figure 49C). There should be two to three layers of cotton overlapping by about 50%.
FIGURE 49CCotton
padding is wrapped
thickly around the leg.
(Setting courtesy of Airpark
Animal Hospital, Westminster,
Maryland)
4. Apply gauze over the cotton padding to compress and

secure the bandage (Figure 49D). The gauze can be
wrapped fairly tightly around the cotton, causing it to
compress; however, the cotton should inhibit the gauze
from being too tight and cutting off blood supply. At this
time, the stirrups should be folded back over the gauze
to secure it.
FIGURE 49DGauze is
applied over the cotton
padding to compress and
secure the bandage.
Maryland)
Lesson 4
183
5. Wrap Elastikon tape around the entire bandage to serve

as the tertiary layer (Figure 49E). Some veterinarians
prefer to use Vet wrap to cover the entire bandage.
Elastikon is then used to secure the ends of the bandage
to the animal.
FIGURE 49EThe entire
bandage is wrapped with
Elastikon tape. (Setting
courtesy of Airpark Animal
Hospital, Westminster,
Maryland)
6. Adhesive tape is placed so that it overlaps the Elastikon

and the animals skin, to hold the bandage securely and
prevent slippage (Figure 49F).
Bandaging Cat and Dog Tails

Tails often need bandages after surgical
repair or tumor removal. A dog or cat may
wag off a poorly secured tail bandage. To
prevent this, the veterinarian makes sure
the final tape layer sticks directly to the
skin. Another trick used by some veterinarians is to place a syringe casing over the
first layer of wrap, protecting the wound
from further damage.
FIGURE 49FThe Final Product
184
Bandaging the Ears of Small Animals

The ears of small animals most often need bandages to protect wounds or surgical incisions. Veterinarians bandage
animals with floppy ears by pulling up the ear, laying it flat
on the surface of the head, and placing a bandage over the
whole head (behind the eyes and in front of the neck) to
include the ear. For animals whose ears stick up, veterinarians place a roll or wad of gauze on the inner side of the ear
and secure it with adhesive tape.
Bandaging the Eyes

of Small Animals
Eyes can be difficult to bandage. Most
veterinarians use other means, such as an Elizabethan collar, to
prevent animals from scratching eye injuries. An Elizabethan collar is a stiff cardboard or plastic cone-shaped structure that
goes around the animals neck (Figure 50). The collar extends
beyond the animals nose, keeping its mouth from body
injuries and its claws from head injuries. If an eye does need
to be bandaged, veterinarians place the bandage over the
head to include the affected eye.
FIGURE 50An Elizabethan Collar in Place
Lesson 4
185
Bandaging Dog and Cat Torsos
FIGURE 51An Abdominal Bandage
Some animals require bandages over the

abdomen or chest to protect surgical sites
or to secure structures such as chest tubes
and abdominal drains (Figure 51). These
bandages are simply made of thin cotton,
gauze, and tape. Apply torso bandages by
wrapping rolled cotton around the chest or
abdomen. Cover the cotton with rolled
gauze and secure the gauze with tape. To
prevent the bandage from sliding, apply the
tape directly to the skin in front of or
behind it. Make sure the bandage isnt so
tight that the animal strains to breathe.
Watch an animal carefully after bandaging
the torso for straining to breathe or any
discomfort. Alert the veterinarian if it
appears the animal isnt breathing well.
Bandaging Large Animals

Bandaging the Limbs of Large Animals
In large animals, lower-limb bandages are used on wounds
located below the carpus or tarsus. Horses most commonly
receive lower-limb bandages. These bandages are used on
lower-leg injuries. In addition, lower-limb bandages are used
on horses confined to stalls to prevent stocking up (fluid
accumulation in the leg), which comes with inactivity.
To bandage or not to bandage is usually left to the veterinarians discretion, as leaving a wound open can result in a
condition known as proud flesh (exuberant granulation
tissue). When bandaging the leg, always wrap toward the
inside of the leg, which will decrease potential damage to the
tendons. Use the following procedure to bandage the limb of
a large animal:
1. Apply nonadhering dressing (Telfa pad) over the wound.
186
2. Place a light layer of conforming gauze over the dressing

to hold it in place. Make sure this layer and all other
layers are free of wrinkles, as wrinkles can cause pressure lines that will lead to skin damage and sloughing.
3. Apply sheet cotton to the limb. This layer is usually
composed of five layers of sheet cotton.
4. Wrap the cotton with gauze roll to conform it to the
legs shape.
5. Secure the layers with elastic tape or
Vet wrap. This bandage extends down
to the hoof and as far up the limb as
necessary.
Bandaging Horse Tails

Horses usually need tail bandages to keep
their long tail hair clean or, if the hair is
already dirty, to keep it from contaminating
other body sites.
The wrap is done in the following manner:
1. Wrap gauze around the bulk of the tail
hair (Figure 52A).
FIGURE 52AStep 1 in Wrapping the Tail of a

Horse
2. Fold the remaining hair forward

over the tail, and then wrap gauze
over it to hold up and cover the hair
(Figure 52B).
3. Hold the gauze in place with tape.
Bandaging the Ears

of Large Animals
To bandage the ears of large animals, follow
the same procedure as that for bandaging
small animals with upright ears.
FIGURE 52BStep 2 in Wrapping the Tail of a

Horse
Lesson 4
187
Bandaging the Eyes and Head

Wounds of Large Animals
The orthopedic stockinette, a tube-shaped
stretchable bandage, is a popular means of
covering and protecting a large animals
eye. Measure and cut an appropriate length
of stockinette, open the tube, and place the
animals muzzle through it. Pull the stockinette up over the head and cut holes to
expose the ears and the unaffected eye. The
stockinette is held in place with tape. An
orthopedic stockinette is also used to cover
other head wounds (Figure 53)).
FIGURE 53A stockinette is used to cover head
wounds.
Bandaging Large Animal Torsos

Some surgeons use bandages to cover incisions following
abdominal surgery. The procedure is the same as that for
bandaging small animals, but with thicker sheet
cotton in place of roll cotton.
Re-dressing a Wound
When re-dressing a wound, its probably most important to
know which primary bandage material best suits the wounds
stage of healing. A petroleum-impregnated gauze, for
instance, may suit the earliest stages of open-wound healing
because its nonadherent and nonocclusive. However, petroleum can slow down epithelialization, so a Telfa pad
better suits a wound with fully formed granulation tissue.
The primary layer of the bandage may vary, but most times
veterinarians reapply a bandage with the same bandaging
technique they used previously, following the same bandaging principles (apply tape stirrups to the foot and then apply
the three component layers of the bandage). The bandage
must be properly placed. A bandage placed too tightly will cut
off the legs blood supply. A loose bandage may slip.
188
Special Bandages
Weve come a long way from that basic strip of fabric, and
were not done yet! Veterinary medicine employs a variety of
specialty bandages for some of its more unusual situations.
The Robert Jones Bandage

A Robert Jones bandage is a heavily padded compression
bandage whose primary role is to support a limb. The Robert
Jones bandage temporarily stabilizes a broken leg before
surgery and then supports the limb and reduces swelling
after surgery. The following materials are needed to place a
Robert Jones bandage (Figure 54):
Adhesive tape
One more sterile pad (if an open wound exists)
Cotton padding
Gauze
Vet wrap
Elastikon tape
Fiberglass support (This is sometimes optional.)

FIGURE 54The Robert
Jones bandage materials
pictured here are as follows (clockwise from top
left): cotton padding,
gauze, Elastikon tape,
sterile pad, adhesive tape,
and fiberglass support.
Maryland)
Lesson 4
189
To apply a Robert Jones bandage, use the following

procedure:
1.As with a regular bandage, apply adhesive tape stirrups to
secure the bandage to the leg (Figure 55A).
FIGURE 55AAdhesive
tape stirrups secure the
bandage. (Setting courtesy of
2. Apply a sterile pad to protect the wound and absorb

fluids (Figure 55B).
FIGURE 55BA sterile pad
is placed to protect the
wound if necessary.
Maryland)
3. Place a large amount of cotton (sometimes a pound or

more for small animals, 4 to 5 pounds for horses) for the
secondary layer of bandage (Figure 55C).
190
FIGURE 55CThe sterile

pad is covered with cotton
padding. (Setting courtesy of
4. Add a support to the bandage, such as the fiberglass support shown in the figure (Figure 55D).
FIGURE 55DA fiberglass

support is added to
strengthen the bandage
and support the leg.
Maryland)
5. Tightly compress and secure the cotton padding and

fiberglass support with a layer of gauze. Again, fold
back the stirrups over the gauze layer to secure it.
6. Secure the entire bandage with a layer of Vet wrap or
Elastikon tape.
Lesson 4
191
Its important to remind the owner that the Robert Jones is

only a temporary support bandage, not a definitive bandage
for treating fractures.
Modified Robert Jones bandages are applied in the same way
as the regular Robert Jones, except that they omit the roll
cotton, making it a lighter bandage. The modified Robert
Jones bandage is used to reduce swelling after surgery, and
has become more popular than the traditional Robert Jones.
Distal Limb Splints

A distal limb splint, also known as a Mason-meta splint, is
a simple padded bandage that uses a rigid plastic splint to
support the limb below the elbow or hock (ankle). This splint
may be either plastic or aluminum and is curved lengthwise
to fit around the leg. For some fractures, distal limb splints
are a definitive repair method. They also help support fractures
that have been surgically repaired. The splint goes behind the
hind foot or forearm and extends down to the toes. You can
buy Mason-meta splints or make your own from fiberglass
casting material or moldable plastics (Figure 56).
FIGURE 56Mason-Meta
Splints
192
Casts
While internal injuries are beyond the scope of this unit, the
casts and slings that help heal some of them arent. When an
injury needs a high degree of immobilization for an extended
period, a wrap or specialty bandage can be impractical and
insufficient. And while bandages exert pressure, some problems need weight-bearing pressure removed or a particular
alignment maintained. In such cases, veterinarians use casts
and slings.
Casts, which are made of fiberglass or plaster of paris, stabilize some limb fractures by immobilizing the joints above and
below the fractured bone. The materials needed to cast a leg
are as follows (Figure 57):
Adhesive tape
A sterile pad (if an open wound exists)
A stockinette or cotton padding
Gauze
Exam gloves
Fiberglass or plaster of paris casting material
Hot water
FIGURE 57Cast Materials
Lesson 4
193
Veterinarians generally place these types of bandages, but

in many cases, youll assist them. The following procedure,
shown in Figure 58, is used to place a cast on an injured leg:
1. The veterinarian first applies adhesive tape stirrups
to secure the bandage material to the animals leg. A
sterile bandage is applied to the wound if necessary
(Figure 58A).
FIGURE 58AThe sterile
pad and adhesive tape
stirrups are placed on the
injured leg. (Setting courtesy
of Airpark Animal Hospital,
2. The leg is then wrapped with stockinette material or a

thin layer of cotton padding (Figure 58B).
FIGURE 58BStockinette
material is placed on the
leg over the sterile pad
and stirrups. (Setting courtesy of Airpark Animal
Hospital, Westminster,
Maryland)
194
3. The stockinette material or cotton padding is covered

with a layer of gauze conforming to the legs shape
(Figure 58C).
FIGURE 58CThe bandage
is wrapped with a layer of
gauze. (Setting courtesy of
4. Optional: Wire placed in IV tubing and then taped

to the last layer of gauze before placing the cast material
can be used as an aid in removing the bandage. When
its time to remove the cast, the wire is moved back and
forth, causing friction and cutting through the cast
material.
5. Wearing exam gloves, the veterinarian wets the casting
material and rolls it over the gauze, completely encircling
the leg (Figure 58D). Both fiberglass and plaster become
rigid when dry. Most small animal casts extend only to
the elbow or knee, but they can go higher if necessary.
FIGURE 58DWet fiberglass cast material or

plaster of paris is applied
over the gauze and
allowed to dry into the
cast. (Setting courtesy of
Lesson 4
195
Though animals usually tolerate them well, casts do require

some care and maintenance. Its crucial to monitor a casted
leg for any sign of swelling. Because the cast surrounds the
leg, a swollen leg in a cast may suffer skin damage or seriously impeded blood supply. Because open wounds under a
cast are difficult to manage properly, a fractured leg with an
open wound may be bandaged. Veterinarians change or
remove a cast by cutting it off with an oscillating saw, which
cuts the cast without cutting the skin beneath it.
Slings
The Ehmer Sling
The Ehmer sling is a figure eight made from tape and gauze.
This type of sling keeps an animals weight off an injured
hind leg. The sling holds the hip in an internally rotated and
abducted (leg moved out and away from the body) position.
Small animals wear the Ehmer sling after relocation of a
dorsally dislocated hip. (Most hip dislocations move dorsally,
or toward the back.) Ehmer slings are also worn after
surgical repair of some fractures.
To apply the sling, flex the animals ankle and knee and then
wrap gauze in a figure-eight pattern. To maintain blood
supply, take care not to wrap and tighten the gauze directly
around the leg or foot. The gauze is held in place with tape.
To further abduct the hip, place tape from the bandaged leg
up and over the abdomen. Animals wear the Ehmer sling for
an average of 10 to 14 days.
The following steps are used to apply an Ehmer sling
(Figure 59):
1. Pad the injury and wrap the leg with gauze (A).
2. Flex the leg and wrap the sling around the knee and
ankle (B).
3. While holding the leg at maximum flexion, pass the sling
over and wrap it behind the knee (C).
4. Wrap the sling forward around the front of the leg (D).
196
5. Repeat the wrapping three or four times and then secure

it with adhesive tape (E).
A
B
E
D
FIGURE 59An Ehmer sling is a figure-eight pattern of tape and gauze.
Lesson 4
197
The 90-90 Flexion Sling

The 90-90 flexion sling is used in young animals that have a
distal femoral fracture or other hind-limb surgery requiring
the animal to avoid bearing weight on the back limb. This
bandage is a variation of Ehmer sling.
The Velpeau Sling

The Velpeau sling is a shoulder bandage that keeps an animals
weight off an injured front leg. A Velpeau sling holds a relocated
shoulder in place. It can also be used to immobilize some
scapula (shoulder-blade) fractures. To apply the Velpeau sling,
follow the steps described here and shown in Figure 60.
1. Wrap the animals forelimb in a flexed position with cast
padding (A).
2. Extend the cast padding to the chest cavity (B).
3. Secure the sling with Vet wrap or Elastikon (C).
The Carpal Flexion Sling

The carpal flexion sling prevents an animal from putting
weight on an injured leg but doesnt immobilize all of the legs
joints. The carpal flexion sling does this by holding the carpus
(wrist) in a flexed position. Veterinarians sometimes use the
carpal flexion sling after surgically repairing elbow fractures.
To apply the sling, follow the steps described here and illustrated in Figure 61:
1. Flex and bandage the carpus (A).
2. Apply adhesive tape in a figure-eight pattern (B).
3. Secure the tape behind the carpus, forming a web that
keeps the carpus flexed (C).
198
FIGURE 60A Velpeau sling keeps an animals weight off its front leg.
Lesson 4
199
FIGURE 61The carpal flexion sling provides some mobility but prevents the animal from putting
weight on the injured leg.
The Hobble
A hobble is a tape sling that holds the hind legs a fixed
distance from each other. This sling allows the animal to
walk but prevents the legs from abducting. Though usually
used after hip relocation, the hobble helps dogs prone to
splaying because of weakness or a neurological problem.
Veterinarians make the hobble from two lengths of white
adhesive tape, each long enough to loop around the dogs
hind legs at tarsus (ankle) level. They press the sticky side of
each length to the other so that the nonsticky sides face out.
This tape is looped and placed around both of the hind feet
at tarsus level. By binding together this central portion of the
loop (between the legs) with more white tape, veterinarians create a short loop of tape around each foot with a section of bound
tape in between, holding the feet in the position of a normal
standing dog. Figure 62 shows the placement of the hobble.
200
Caring for Bandages,

Casts, and Slings
Its important to understand how to care for bandages and
how to treat problems that may arise as a wounded animal
heals. A poorly maintained bandage can be worse than no
bandage at all!
Keeping Bandages Dry

One of the most important rules of bandage
care is to keep the bandage dry. A bandage
soaked with water, the animals urine, or
wound discharge can harm the wound and
the healthy skin around it. A wet bandage
may also lose its form and do its job less
efficiently. Therefore, whether the bandaged
animal is in the veterinary hospital or at
home, its caretakers must make sure the
bandage stays dry. A wet bandage needs
prompt attention and will usually need to
be changed. To help avoid this situation,
veterinarians instruct the owner to secure a
sturdy plastic bag over the bandaged leg
before walking the animal outside and to
remove the bag when the animal comes
back in (Figure 63). Owners should not
bathe their bandaged animal.
B
FIGURE 62The hobble allows an animal to
walk but keeps the hind limbs from abducting.
What to Check For

You and the owner should monitor the animals bandage so
that any problems can be quickly resolved. Questions that
need to be considered when evaluating the bandage include
the following:
How does the bandage look? Is it dirty? Is it coming

apart?
Has the bandage slipped or twisted? (If you could see

the ends of the toes just after you bandaged the
animals foot, make sure you can still see them.)
Lesson 4
201
FIGURE 63A sturdy plastic

bag placed over a cast will
keep the cast clean and
dry if the animal must go
outside. (Setting courtesy of
Are the toes swelling? If you can see only the toenails,
are they spreading apart from each other? Spreading
toenails likely mean the toes are swelling.
Are there signs of rub sores between the toes or skin

irritation along the bandages top?
Does the bandage feel wet or smell bad? This may

indicate an infection or an ulcer under the bandage.
How is the animal reacting to the bandage? As most

animals accept properly placed bandages and splints,
pay attention if an animal starts licking or chewing a
bandage. The animal might be telling you theres a
problem, such as a pressure sore, under the bandage.
Preventing a Dog or Cat from

Chewing on a Bandage
Though most animals wont disturb well-placed bandages,
some just wont leave them alone. If a dog or cat is chewing
or licking a bandage, make it impossible to reach or unpleasant to lick. The best way to prevent an animal from licking or
chewing a bandage is to place an Elizabethan collar on the
animal. Although some animals take a few days to get used
to the collar, they generally tolerate it well. If a collar is
202
ineffective or impractical, spray the bandage lightly with Bitter

Apple or Obtundia. Most animals dont like these bitter solutions
and will avoid them once theyve smelled or tasted them.
Removing Bandages
A conscientious owner can remove a bandage, but the job is
best left to veterinary professionals with the knowledge and
equipment to do a better job. Plus, the veterinarian often
needs to reassess how the wound is healing and if another
bandage should be placed. Lister bandage scissors work best
to remove bandages (Figure 64). These scissors have a blunt
tip that makes it easier to avoid skin while cutting the bandage.
FIGURE 64Lister
Bandage Scissors
When removing the bandage, take care to remember where

the wound is located to avoid damaging it while removing the
bandage. Cut the bandage sequentially, starting with the
outer tape layer and moving to the deeper layers. Although
the bandage can be cut from either the top down or the
bottom up, the top down is usually easier and safer.
The removed bandage is checked for the presence and nature
of any discharge. Is the discharge pus, or is it normal wound
secretions? If the bandage uses a splint, check its condition.
A splint thats in good shape can be cleaned and used for the
animals next bandage.
Lesson 4
203
Now that weve covered the basics of bandaging and some of

the specific bandages youll see in practice, lets review your
understanding of these topics with Self-Check 13. Remember
that you can check your answers by turning to the back of
this study guide.
Self-Check 13
1. List the two most common reasons to bandage a small animals leg.
__________________________________________________________
__________________________________________________________
2. Which of the following is not a reason to expose the middle two toes when placing a bandage
on the leg of a small animal?
a.
b.
c.
d.
To
To
To
To
allow the animal to walk and maintain its balance

enable assessment of color
look for swelling
assess for heat
3. What is the function of stirrups in bandaging the leg of a small animal?

4. A/An _______ is a cone that prevents an animal from licking, scratching, or otherwise causing
harm to itself.
5. _______ is a condition that can occur in a horse that has a wound left unbandaged.
6. Which type of bandage is used to reduce swelling after surgery?
a. Modified Robert Jones
b. Robert Jones
c. Distal limb splint

d. Mason-meta splint
(Continued)
204
Self-Check 13
7. What is the most important thing to remember when removing a bandage?
a.
b.
c.
d.
Check whether the bandage is clean and dry.

Avoid damaging the wound.
Sedate the animal to prevent other trauma.
The owners should remove it and return only if theres a problem.
Questions 812: Match the following terms with their definitions by placing the letter of
the best definition in the blank space next to each term.
______
8. 90-90 Flexion sling
______
9. Ehmer sling
______ 10. Velpeau sling

______ 11. Carpal flexion sling
______ 12. Hobble
a. A tape sling that holds the hind legs a fixed

distance from each other; allows the animal to
walk on its hind legs but prevents the legs from
abducting
b. A shoulder bandage that keeps an animals
weight off an injured front leg
c. A sling that prevents an animal from putting
weight on an injured leg but doesnt immobilize
all of the legs joints
d. A sling used in young animals that have distal
femoral fractures or other hind limb surgery
requiring the animal to avoid bearing weight
on the back limb
e. A figure eight made from tape and gauze that
keeps an animals weight off an injured hind leg;
holds the hip in an internally rotated and
abducted position
13. Which of the following is not something that needs to be relayed to an owner about caring for
a cast or sling?
a.
b.
c.
d.
The
The
The
If it
cast should be kept clean and dry.

bandage should be checked frequently for placement.
bandage should be checked for foul smells.
gets wet or dirty during bathing, remove the bandage and dry it out.
Lesson 4
205
ASSIGNMENT 14TELEPHONE
ASSESSMENT AND OWNER FIRST
AID BEFORE AND DURING
TRANSPORT
Read this assignment. Then read page 908 in Clinical Textbook
for Veterinary Technicians.
Introduction
Emergency medicine has recently become a more recognized
area of expertise for both veterinarians and technicians alike.
More and more clinics are offering emergency care after the
daytime practice has closed. These clinics are more versed in
the correct way to handle emergency cases and therefore are
better prepared for them. However, emergencies are also seen
by the regular day practice, whether they be animals presenting to the clinic with a problem requiring immediate medical
attention or an animal already in the clinic who is developing
a serious problem, such as during an anesthetic procedure.
Therefore, its extremely important that you, as a technician,
recognize these emergencies and work with the other staff as
a team to remedy the animals crisis.
Teamwork, training, and practice are all important factors in
successfully managing a critical animal. The presentation of
a critical animal can be very stressful to all involved, so
having a standard operating procedure is helpful in reducing
the stress and increasing the efficiency (and thus success) of
dealing with these patients. Each team member should be
assigned a specific job, and the emergency scenario should
be practiced on a regular basis.
Triage and Readiness

Emergencies are often managed based on triage. Triage is a
French word that means to sort. In veterinary medicine,
the term is applied to the identification of patients with lifethreatening problems in need of immediate care.
206
Veterinary technicians are vital in the triage process of identifying animals with life-threatening problems, notifying the
veterinarian, and assisting in treatment.
Telephone Triage
The triage process often begins over the telephone. A pet
owner notices a problem with his or her pet and calls the
veterinary hospital for advice. The receptionist (or, in some
cases, you as the veterinary technician) must determine the
seriousness of the problem and give advice based on that
determination. Important initial questions include the clients
name and telephone number and the pets age, breed, and
sex. Its also important to ask if the pet has been spayed or
neutered. A brief description of the pets problem should then
be obtained.
Owners of pets with obviously serious problems should
always be advised to seek veterinary attention. A variety of
conditions are considered to be serious. Other problems will
require further investigation. Those conditions that require
immediate evaluation include
Loss of consciousness
Trauma, open fractures, excessive bleeding
Penetrating wounds to the thorax or abdomen

(e.g., from gunshots, arrows)
Labored breathing
Seizures
Straining to urinate
Poisoning or snakebite
Prolapse of organs
Profuse diarrhea or vomiting
Eye injuries
Lesson 4
207
When determining the severity of a problem over the telephone, its important to ask questions about four major
organ systems: the respiratory, the cardiovascular, the
urogenital, and the central nervous system. A review of your
study units on these systems will be helpful.
To evaluate the animals respiratory system, first ask the
owner if the pet is having difficulty breathing. Animals that
are dyspneic (having difficulty breathing) should always be
seen immediately by the veterinarian. If the owner is unsure,
you should ask questions about the pets breathing pattern
and body posture. Normal breathing is quiet, regular, and
effortless. You should be concerned if the owner reports the
development of noisy breathing.
Animals having difficulty breathing are often anxious, reluctant
to lie down, and will stand with their neck extended and their
elbows held away from the chest wall. If the owner has observed
any of these signs, advise the owner that a veterinarian should
see the pet immediately.
The cardiovascular system can be assessed by checking the
animals mucous membrane color, capillary refill time (CRT),
and heart rate and/or the pulse rate. Its often difficult for
the owner to evaluate the animals vital statistics. However,
most owners are able to evaluate mucous membrane color
and CRT.
To have the owner evaluate the mucous
membrane, ask the owner to evaluate the
color of the pets gums. Normal gums are
pink. Pale pink or white gums suggest
blood loss or shock. Blue discoloration
(cyanosis) of the gums can be an indication
of lack of oxygen or poor perfusion. Bright
red membranes are seen with some toxins
and with early stages of shock. CRT can
be evaluated with the following technique
(Figure 65):
FIGURE 65A veterinarian is performing CRT

evaluation on a dog.
208
1. Use your index finger to press on a

nonpigmented area of the gums or on
the inner surface of the lip to blanch
the membrane.
2. Release the pressure and observe how quickly the color

returns to the area. The time required for the color to
return to the area is recorded as the CRT. The CRT rate
should be one to two seconds.
Most owners cant provide reliable evaluation of heart or
pulse rates, and its usually best not to waste time or cause
frustration by asking them to do so. You should ask the
owner to feel the pets extremities. Cold extremities may indicate decreased blood flow associated with shock. If the owner
reports any abnormalities in mucous membrane color, CRT,
or cold extremities, the pet should be seen immediately by
the veterinarian.
The most immediate life-threatening problem associated with
the urogenital system is urethral obstruction. A blockage of
the urethra that causes an inability to urinate results in the
accumulation of waste products and quickly can become
fatal. Any animal thats frequently straining to urinate but
isnt producing urine should be seen immediately.
Abnormalities of the central nervous system requiring immediate
evaluation include head trauma, paralysis (inability to walk),
and prolonged seizures. You should ask about the pets mentation (mental activity). Animals that are mentally depressed
or abnormally hyperactive should be evaluated. Seizures are
a common emergency presentation and will be discussed in
more detail later in this study guide. A seizure that lasts two
to four minutes, stops, and has the animal quickly return to
normal activity isnt necessarily an emergency situation. If an
animal has multiple seizures or a seizure that lasts longer
than five minutes, it should be seen immediately.
Developing an appreciation of some of the common emergency
problems will be helpful in evaluating what constitutes an
emergency. If youre unsure about the severity of the problem,
the call should be referred to the veterinarian. It can sometimes be very difficult to determine a pets stability over the
telephone. If theres a possibility that an emergency exists,
the animal should be seen. Its always better to be cautious.
Lesson 4
209
Transport and First Aid

If the pet has a problem requiring immediate care, youll need
to instruct the owner on how to provide appropriate first aid
and how to transport the pet to the hospital without causing
further injury. Pet owners are often very upset in a crisis. Its
important for you to deliver this information to the owners in
a concise and calming manner. If the pet owner hasnt been
to the hospital previously, youll need to be prepared to give
precise directions to the hospital or to the nearest emergency
facility. Reading from prepared directions is a good idea.
The owners safety should always be of primary concern. An
animal in pain may bite its owner. Long pieces of material
such as leashes, neckties, belts, or pantyhose can be used as
a muzzle, if needed, to manipulate and transport injured animals in extreme pain (Figure 66). A muzzle shouldnt be used
if the animal is bleeding from the nose or mouth or is having
difficulty breathing. Covering the animal with a blanket can
be another protective barrier for the person trying to handle
the animal. A blanket can also help to prevent heat loss and
can be calming to the injured animal.
FIGURE 66Muzzles minimize the possibility of
injury by a fractious dog.
Maryland)
210
Mouth-to-Nose Resuscitation
If the animal isnt breathing, you can instruct the owner to
provide mouth-to-nose resuscitation as follows:
1. Ensure that the airway is clear of mucous, dirt, vomit,
or other foreign material. To clear the airway, have the
owner gently extend the head and neck. If head or neck
injuries are suspected, movements of the head should be
kept to a minimum. Pull the tongue forward and sweep
the material out of the mouth with one or two fingers.
2. Pull the tongue forward and close the mouth, holding
the tongue between the incisor teeth.
3. The rescuer should place his or her mouth over the
animals nose. In small dogs and cats, cover both the
animals mouth and nose.
4. Blow a steady stream of air into the animals nostrils for
two to three seconds. Hold the lips of the animal closed
so that the air wont escape from the sides of the mouth
(Figure 67).
FIGURE 67Mouth-toNose Resuscitation: Blow a

steady stream of air into
the animals nostrils while
holding the lips closed to
prevent air from escaping.
Lesson 4
211
5. Observe for movement of the chest wall to indicate the

effectiveness of the technique.
6. Repeat every three to five seconds until the animal starts
to breathe or until arrival at the hospital.
Chest Compressions
If no pulse or heartbeat can be detected, chest compressions
should be started in addition to mouth-to-nose resuscitation.
You can feel a beating heart when you place your hand on
the chest wall over the heart. The heart is located in the
lower part of the chest cavity just behind the elbow. You can
detect the pulse by lightly placing your index and middle
fingers on any part of the body where an artery crosses bone
or firm tissue. Common sites to check pulses on cats and
dogs are the same and are illustrated in Figure 68. Common
arteries to check include the femoral, brachial, and dorsal
pedal arteries. The femoral pulse is the easiest pulse for
owners to feel.
FIGURE 68Pulse Points
for Dogs and Cats
Brachial Artery
Femoral Artery
Dorsal Pedal Artery
212
The recommended rate of chest compressions is about 120 per

minute, or 2 every second. The recommended breathing is every
six seconds. In large dogs, you should instruct the owner to
apply compressions over the widest part of the chest. This position increases the amount of blood flow created with each
compression. Mouth-to-nose breathing and chest compressions
are minimally effective in resuscitation. They shouldnt be considered as at-home treatment, but rather a stopgap measure to
be used while the animal is being transported to the hospital.
Hemorrhaging
Hemorrhaging (active bleeding) should be controlled with
either direct pressure or a pressure wrap applied to the
wound. If the bleeding is from the distal (lower) part of the
leg, elevating the limb will also decrease bleeding. Bandages
can be made of gauze or any clean material and tape. Its
virtually impossible to apply a pressure wrap too tightly on a
short-term basis.
A tourniquet is a device used to control severe bleeding by
compressing the blood vessels supplying blood to a limb.
Improper use of a tourniquet by untrained, inexperienced
persons can cause severe damage to a limb that may
necessitate amputation. Tourniquets are rarely needed to
control bleeding and should be considered only if lifethreatening bleeding cant be controlled by any other means.
Arterial bleeding (blood from a damaged artery) is more serious
than bleeding from a vein or a capillary. Arterial bleeding
can be identified by its bright red color and because it spurts
from the wound with each beat of the heart. Bleeding from
a damaged vein is dark red and flows from the wound in a
steady stream. Damaged capillaries cause small amounts of
blood to ooze from the wound and usually arent serious. The
following steps should be used to control external bleeding:
1. Place gauze (or the cleanest material available) against
the bleeding wound. If no clean material is available, use
your bare hand to apply pressure to the wound.
2. Maintain firm pressure for three to five minutes.
Lesson 4
213
3. Inspect the wound after three to five minutes. If the

bleeding continues, reapply pressure and place a
pressure bandage on the wound.
4. If the bandage becomes blood-soaked, it shouldnt be
removed. Instead, apply additional bandage material over
the original bandage. This additional material will prevent
disturbing a clot that may be forming and provides continuous pressure to the wound.
Choking
If an owner calls with a choking animal, you should be
prepared to explain how to try removing the object before
coming to the hospital. If the object is too far back to be
removed manually, the Heimlich maneuver can be attempted.
You should, however, advise owners not to waste valuable
time. If initial attempts to dislodge the object arent successful, the owner should quickly seek veterinary assistance.
Figure 69 outlines how to perform the Heimlich maneuver on
dogs and cats.
If the animal is small and can be lifted, the following procedure should be used:
1. Hold the animal vertically. Place its head up, with
the animals spine against your chest and your arms
wrapped around the animal underneath its rib cage.
2. Forcibly push inward and lift upward with quick motions
to dislodge the object.
If the animal is too heavy to lift, use the following procedure:
1. Lay the animal on its side on a firm floor surface or on
hard ground.
2. Extend the head and neck into a neutral position.
3. Place your arms around the animals body below its ribs
and give short, quick compressions directed inward and
toward the diaphragm (Figure 70).
214
FIGURE 69Performing
the Heimlich Maneuver on
a Small Dog
Carriers and Stretchers

When transporting any animal with a breathing difficulty,
owners should minimize stress. They should keep the environment as cool as possible to prevent panting. Cats often
struggle against any restraint and are best transported in a
dark, well-ventilated carrier. Dogs shouldnt be allowed to
walk, but whenever possible, they should be carried or
transported on a stretcher. An emergency stretcher can be
made from wood or stiff cardboard, or a large blanket can
be used in a hammock fashion.
Lesson 4
215
FIGURE 70Performing
the Heimlich Maneuver on
a Large Dog
Broken Leg
If you suspect an animal has a broken leg, you can instruct the
owner to immobilize the leg. A temporary support splint can
be made with rolled newspaper and tape (Figure 71). A muzzle should be applied before attempting splint placement. If
splinting isnt possible, confinement in
a box or carrier will prevent movement and further damage
to the limb. The following steps should be followed when
applying a temporary splint:
1. Apply a muzzle.
2. Place rolled newspaper on both the inside and outside of
the affected leg. Include the joint above and the joint
below the injury.
3. Secure the splint with tape or cloth strips. Dont tie the
strips directly over the fracture site.
216
FIGURE 71A Temporary Splint
Injuries from Penetrating Objects

If an animal has been injured with a penetrating object,
such as a knife, arrow, or bullet, the owner should be told to
try to prevent movement or further penetration but shouldnt
attempt to remove the object. Large penetration wounds
should be covered with clean towels or cloth.
Burns
Burns should be covered with a cool, not cold, compress. The
compress should be changed as it warms during transport.
Spinal Cord Injuries and Head Trauma

If theres any concern for trauma to the spinal cord, the
animal should be transported on an improvised backboard
of wood or stiff cardboard to prevent further damage. If head
injury is suspected, the animal should be transported with
the head elevated approximately 30 degrees, with no pressure
placed on the neck.
Lesson 4
217
Lets review what youve learned about telephone triage

and first aid. Take a moment to complete Self-Check 14.
Self-Check 14
1. Which of these is not an important factor in successfully managing a critical animal?
a. Teamwork
b. Training
c. Animal cooperation
d. Practice
2. List four conditions that require immediate evaluation.
__________________________________________________________
__________________________________________________________
3. About what four organ systems should you ask when determining the severity of a problem
over the telephone?
__________________________________________________________
__________________________________________________________
4. What should be a primary concern when talking to a client about transporting an injured/ill
animal?
a.
b.
c.
d.
The animals disposition

The owners safety
The means by which they plan to get to the clinic
How long it will take to get to the clinic
5. Where should chest compressions be performed in small- and medium-sized dogs?
__________________________________________________________
__________________________________________________________
6. True or False? When an animal is hemorrhaging, blood-soaked bandages should be removed
and replaced with clean ones.
218
ASSIGNMENT 15
WAITING-ROOM TRIAGE
Introduction
The triage process continues when the animal arrives at the
hospital. Triage will allow you to differentiate between critical
and stable patients. The triage nurse should evaluate each
emergency patient within minutes of its arrival. The veterinary technician may have the responsibility of triage nurse,
assessing emergency patients in the waiting room.
Initial Examination
If the animals history hasnt already been determined over
the telephone, a brief capsule history should be obtained
from the owner. You should approach the owner in a friendly,
professional manner and explain what youre going to do.
You should ask about the problem and when it occurred. Its
important for you to control the conversation and prevent the
owner from giving a lengthy, detailed history at this time. Ask
the owner about the pets normal temperament and behavior
with strangers. You may need a muzzle to evaluate an animal
thats frightened or in pain.
The triage examination should focus on the same body
systems that were evaluated over the telephone: respiratory,
cardiovascular, urogenital, and central nervous systems. The
triage evaluation should include assessment of the level of
consciousness (LOC), breathing pattern and effort, and
cardiovascular status.
You should observe the animal as you approach and speak
with the owner. Observe the animals breathing pattern. A
veterinarian should evaluate animals with noisy breathing
or open-mouth breathing immediately. Body posture may
suggest a serious respiratory problem. Animals that stand
Lesson 4
219
with their necks extended or with their elbows held away

from the body should be considered to be in respiratory
distress and evaluated immediately.
Cyanotic mucous membranes indicate a severe respiratory
problem that should be evaluated immediately. Cyanotic
refers to a blue or purple discoloration of the tongue and
mucous membranes due to a decrease in the amount of
oxygen in the blood. You also should observe the patients
mentation and level of consciousness. How does the pet
respond when you approach and greet it? Exposure to toxins,
such as chocolate and caffeine, can cause hyperexcitability.
Mental depression can be seen with pain, fever, and infectious and metabolic disease.
Next, evaluate the animals cardiovascular status by checking
the mucous membrane color, capillary refill time, and the pulse
rate and quality. The veterinarian should evaluate animals with
either brick-red or very pale gums immediately. The capillary
refill time should be determined as described in the section
on telephone triage. The capillary refill time should be
between one and two seconds.
Evaluation of the animals pulse rate and quality is the next
step. You already know that a pulse is created in the artery
by the expansion and contraction of the vessel wall with each
heartbeat. A change in either the character or rate of the pulse
indicates a difference in heart function or blood volume. The
femoral pulse is most often evaluated. In addition to determining the pulse rate, you should evaluate the quality of the
pulses. Pulses normally feel firm and regular. Pulses that are
soft and difficult to detect suggest shock or an abnormality in
the strength of the hearts contraction.
Pulse frequency is easy to evaluate; pulse character is more
difficult to assess. Youll need to spend time feeling the
pulses in many animals to develop this skill. You should
consider the animal unstable if the pulse rate is greater
than 160 or less than 70 for a dog and greater than 250
or less than 150 for a cat. The veterinarian should be notified
if values are found to be outside of these ranges. Figure 72
summarizes the cardiovascular parameters evaluated at triage
and the abnormal findings that should be brought to the
veterinarians attention.
220
Parameter
Abnormal Findings
Mucous membrane color
White, cyanotic (blue), brick red, or yellow
Capillary refill time
Less than 1 second or greater than 2 seconds
Heart/pulse rate
Dog: Less than 70 or greater than 160

Cat: Less than 150 or greater than 220
Pulse quality
Weak, thready, bounding, or irregular
FIGURE 72Cardiovascular Triage Parameters
If theres suspicion of a urinary blockage, you should palpate

the abdomen for the presence of a large urinary bladder. A
distended urinary bladder will feel like an oval, firm, fluid-filled
structure in the mid- to caudal abdomen. If the urinary bladder
can be palpated in any animal presenting for straining to
urinate, it should be evaluated immediately.
When youve identified a critical patient, that animal should
be taken immediately to the area of the hospital designated
for initial evaluation and stabilization (usually the treatment
room), and the veterinarian should be advised immediately
of the patients status. The owner should be assured that
the animal is being looked after and that someone will be
updating him or her on the animals condition when possible.
Permission to perform emergency treatment (IV catheter,
fluids, oxygen, CPR) should be obtained at this time, enabling
the staff to start stabilizing the animal immediately.
Any patient suspected of a contagious disease, such as parvovirus, should be taken to the assigned isolation area to
prevent infection of other patients. For the consideration of
the owners and other patients in the waiting room, animals
that are bleeding, have unpleasant-looking injuries, or have
died should be taken immediately from the waiting room to
the treatment area.
Youll often be asked to provide important client communication
during the period of initial stabilization. When pets have been
taken immediately to the treatment area, their owners are apprehensive. Periodic updates on the status of the pet from the triage
nurse can help keep the clients calm until the veterinarian is
available to discuss the pets condition at length.
Lesson 4
221
Facility and Personnel Readiness

The successful management of emergency patients requires
the hospital and its team of veterinary professionals to be
ready to deliver life-saving care at all times. This type of care
requires advanced preparation of both the hospital facility
and its personnel. Effective communication between veterinarians, veterinary technicians, and veterinary assistants is
essential to optimize the chances of a positive outcome.
The clinic should have a predetermined area for the treatment
of unstable emergency patients. All resuscitation equipment
and drugs in this area should be organized and ready to use.
The ready area should have good lighting and a treatment
table that can be approached from at least two sides. The
area should be set up so that all necessary equipment is
readily available. Consistent stocking and frequent noting
of equipment locations prevents confusion and wasted time
when dealing with a critical patient.
The anesthesia induction area is often chosen as the
emergency treatment area because of the ready access to
oxygen and essential pieces of equipment such as endotracheal tubes, electrocardiogram, and so forth. A checklist of
all instruments and drugs should be made and periodically
reviewed. The area should be checked regularly to see that
all drugs and equipment are present and that equipment is
working properly.
Equipment Used in Resuscitation

You need to be familiar with the equipment used in resuscitation. Endotracheal tubes (Figure 73) are used to provide a
connection between the patients airway and the anesthesia
equipment. The tube is passed through the oral cavity and
down the trachea. An inflatable cuff at the end of the tube
provides an effective seal within the trachea to prevent stomach
fluid from entering the lungs. Inflation of the cuff also aids
in effective ventilation. A laryngoscope (Figure 74) is used to
facilitate intubation (placement of an endotracheal tube). The
lighted blades are available in a variety of sizes.
222
FIGURE 73Endotracheal
tubes come in a variety of
sizes.
FIGURE 74Laryngoscopes
also come in different sizes.
Oxygen may be delivered through the anesthesia machine,

but an ambu bag also can be used. As shown in Figure 75,
the ambu bag is a resuscitation device with a one-way valve.
The face mask can be removed. The bag is attached to the
endotracheal tube and squeezed to deliver a breath to the
patient. It can be used to deliver room air or may be attached
by tubing to an oxygen source to deliver 100% oxygen.
An electrocardiogram (ECG) is used to evaluate the heart
rhythm. The ECG machine consists of wires (called leads)
that attach to the animal, a terminal that interprets the
electrical impulses, and a device that displays the impulse
on paper or on a screen. The ECG leads are color-coded:
green for the right hind leg; red for the left hind leg; black
for the left foreleg; white for the right foreleg. The leads are
Lesson 4
223
FIGURE 75An Ambu Bag
clamped to the skin over the elbows and stifles (knee joints).
Good electric contact between the animals skin and the clips is
essential for transmission of the electrical impulse. Wetting the
skin with alcohol, water, or electrode jelly in the area where the
clips are attached can enhance contact (Figures 76A and 76B).
FIGURE 76AElectrode
jelly is being used here to
enhance the electrical
contact. (Setting courtesy of
VCA Lewis Animal Hospital,
Columbia, Maryland)
The ultimate test of the readiness of the hospital personnel is

the response to an animal thats suffered a cardiopulmonary
arrest. Cardiopulmonary arrest means that the animal has
stopped breathing and the heart has stopped pumping blood
to the body. Cardiopulmonary arrest may occur secondary to
issues such as trauma or severe metabolic disease. Whatever
the underlying cause, the process must be reversed or death
will rapidly occur. Cardiopulmonary cerebral resuscitation
(CPCR) is a means to temporarily restore breathing and blood
flow until the body can again take over those functions.
224
FIGURE 76BECG leads

are clamped to the skin.
(Setting courtesy of VCA Lewis
Animal Hospital, Columbia,
Maryland)
A large percentage of animals that experience a cardiopulmonary arrest die in spite of resuscitation efforts, but many
animals have been saved by CPR. The best chance of success
comes with early recognition of cardiopulmonary arrest. If
more than 10 minutes have passed between cardiopulmonary
arrest and the initiation of CPR, its very unlikely that there
will be a successful outcome. You should be familiar with the
signs of cardiopulmonary arrest or of animals that are near
arrest, and you should be mentally prepared to participate in
resuscitative efforts.
Signs of impending cardiopulmonary arrest include decreased
mentation, cyanotic membranes, and/or a labored, irregular
breathing pattern. An animal thats suffered a cardiopulmonary
arrest will show the following signs:
Apnea (lack of breathing)
Absence of pulses or a palpable heartbeat
Dilated pupils
Loss of consciousness
If you see signs of a near arrest, you should notify the veterinarian and begin gathering the necessary equipment. If you
encounter an animal that has arrested, call for assistance,
Lesson 4
225
move the animal to the predetermined resuscitation area, and

be prepared to participate in CPR. Basic life support
consists of the CABs:
CCirculation
AAirway
BBreathing
Circulation
Start by listening for a heartbeat. The presence or absence of
a heartbeat tells you what to do next.
If the heart is beating but the animal isnt breathing, start to
breathe for the patient. Clear any vomit or foreign material
from the mouth, and make sure the airway is clear.
Breathing is usually done for the patient via an endotracheal
tube. After placement, the cuff should be inflated and the tube
secured to the upper jaw with a gauze strip. 100% oxygen is
delivered if possible. Manual breaths can be delivered through
an anesthesia machine or an ambu bag. If you must breathe for
the patient, make sure the chest cavity expands with each
breath. Its important to completely release the pressure on the
ambu bag between breaths. This allows the animal to exhale.
If theres no heartbeat present, begin chest compressions before
establishing an airway. Once chest compressions have started,
another person can try to establish an airway. Check the effectiveness of your chest compressions by using a Doppler blood
pressure probe on the globe of the eye or measuring the endtidal carbon dioxide (etCO2) levels.
When a cardiac arrest occurs in a veterinary hospital, advanced
life-support techniques are used. Advanced life support adds
D (drugs and defibrillation) and E (ECG) to the CABs of basic
life support.
Drugs
All of the drugs commonly used during CPR should be stocked
and readily available. A predesignated drawer is used in many
veterinary hospitals. You should familiarize yourself with the
drugs kept in this area. You may be asked to administer drugs
226
during an attempted resuscitation. An easy-to-read wall chart

of emergency drug dosages per body weight, as given in Table 3,
can be a valuable reference during cardiopulmonary resuscitation. Drugs can be given intravenously if an intravenous
catheter has been placed, or they can be administered via
the endotracheal tube.
Table 3
DOSE SCHEDULE IN CARDIOPULMONARY RESUSCITATION
Body Weight in Pounds
Drug/
Concentration
Indication
Dose
Route
10
15
20
30
40
50
60
70
80
90
100
Dosage in mls
Epinephrine
1:1000 1mg/ml
Sinus
arrest
0.1
mg/lb
IV,
IT,
IC
0.5
1.5
10
Atropine
0.5mg/ml
Vagally
induced
sinus arrest
Bradycardia
0.0125
mg/lb
IV,
IT
0.125
0.25
0.375
0.5
0.75
1.25
1.5
1.75
2.25
2.5
Lidocaine 2%
20mg/ml
Ventricular
arrhythmias
1
mg/lb
IV
0.25
0.5
0.75
1.5
2.5
3.5
4.5
Dexamethasone,
NaPO4
Shock
4mg/ml
2
mg/lb
IV
2.5
7.5
10
15
20
25
30
35
40
45
50
Solu Delta
Cortef 10mg/ml
10
mg/lb
IV
10
15
20
30
40
50
60
70
80
90
100
0.5
mEq/lb
repeat
every
5 min.
IV
2.5
7.5
10
15
20
25
30
35
40
45
50
Bicarbonate
1mEq/ml
Shock
Metabolic
acidosis
ECG
ECGs are generally attached to the patient as soon as possible,
in the manner described earlier. The heart rhythm shown by the
ECG will determine which drugs should be given, and if defibrillation should be used. The veterinarian will be responsible for
assigning tasks such as delivering breaths, chest compression,
delivery of drugs, or establishing an airway. In order to be prepared in an emergency, familiarize yourself with the equipment
and drugs used during CPR.
Lesson 4
227
Examination
At this point, an initial examination has been done, so this is
basically re-examination. This is looking at the body as a
whole and assessing the extent of other injurieswounds,
exterior bleeding, evidence of internal bleeding, fractures.
Examination is done to look at the body and make sure other
things besides the cardiac arrest are being addressed, as they
may be contributing to why the animal went into arrest in
the first place.
Note that if an animal presents in shock leading to or already in
cardiac arrest, you may also be assigned the task of getting intravenous access to the animalplacing an intravenous catheter
as intravenous access is the best route for emergency drugs.
Common Emergency Presentations

Its impossible to discuss every emergency condition that may
be seen. However, in the following sections, youll be introduced to some of the most frequently encountered emergency
problems. Knowledge of these common emergency conditions
will help you recognize animals with these problems and give
their owners appropriate information about first aid and the
need to seek veterinary care. Also, your understanding of the
problem will enable you to anticipate the veterinarians needs
in treating the patient. For example, you can set up for and
place an intravenous catheter when you anticipate the need
for fluid therapy.
Shock
Shock isnt a disease but a condition brought about by a
variety of different causes. It can be caused by trauma, blood
loss, severe infections, or heart disease. It represents a failure
of the cardiovascular system. As you know, the purpose of
the cardiovascular system is to supply oxygen and other
nutrients to every cell in the body. When the cardiovascular
system is unable to perform this function, cells begin to die.
228
If the condition isnt quickly identified and treated, the animal

will die. Shock can be identified by evaluation of the following
parameters:
Mentation
Mucus membrane color
Heart rate
Pulse quality
Capillary refill time
Temperature
In the very early stages of shock, the heart rate increases

and the mucous membranes become bright pink, with a
shortened capillary refill time. The pulses are bounding, or
becoming stronger.
As shock becomes more severe, the animal becomes mentally
depressed. The heart rate remains elevated, but the pulses
become weak or cant be palpated. Mucus membranes become
pale, with a prolonged capillary refill time. Often, the rectal
temperature is low, and the extremities feel cold.
Its important for you to be able to recognize the clinical signs
of shock in veterinary patients. Prompt recognition of shock
and the initiation of therapy to correct it may be instrumental
in saving a patients life. All cases of shock, except for shock
caused by heart disease, are treated with aggressive fluid
therapy. Blood or blood substitutes may be given in addition
to the commonly used electrolyte solutions. You should
anticipate the need for one or possibly several large-gauge
intravenous catheters. Shock caused by heart disease is
treated with cardiac drugs that improve the strength of the
heartbeat and allow the heart to pump more effectively.
Multiple Trauma
Animals are often presented after sustaining whole-body
trauma. Dogs and cats may be hit by automobiles, fall from a
height (high-rise syndrome), or be attacked by other animals.
The concept of triage is again used in the management of
patients with multiple injuries. Immediately life-threatening
Lesson 4
229
injuries such as labored breathing or severe shock need to

be identified and treated before addressing other problems.
Injuries to the abdominal organs or broken bones may be
serious but arent likely to cause immediate death.
Animals having respiratory distress after a traumatic episode
should be suspected of having a pneumothorax (the presence
of air in the pleural space) or a hemothorax (the presence of
blood in the pleural space). Animals with either air or fluid in
their pleural space will have a rapid, shallow respiratory
pattern. When the thorax is auscultated (listened to with a
stethoscope), the lung sounds will be decreased.
Emergency management may include oxygen via a special
cage (Figure 77) or mask (Figure 78) and/or a thoracocentesis. Thoracocentesis involves the insertion of a needle into the
pleural cavity to remove the air or fluid accumulated there.
The equipment used for the procedure consists of a needle,
extension tubing, a three-way stopcock, and a syringe.
FIGURE 77An Oxygen
Cage
Thoracocentesis allows a substantial amount of air or fluid to

be removed from the pleural space without repositioning the
needle and with minimal stress to the patient. You should be
prepared to set up for and assist the veterinarian performing
thoracocentesis. This procedure may be required in dogs and
cats with heart disease and infections or neoplasia involving
the thorax.
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FIGURE 78An Oxygen

Mask
Cardiopulmonary Diseases
Aside from trauma to the animal that may affect the heart of
a dog or cat, various cardiopulmonary diseases may cause
emergencies. Fortunately, animals in heart failure can be
treated, but you must be able to definitively evaluate a patient
presented in this type of emergency situation. You could save
an animals life by recognizing the signs of cardiac distress.
Congestive Heart Failure

Congestive heart failure (CHF) is a common emergency presentation in dogs and cats. In cats, the cause of the heart failure is
often cardiomyopathy, a disease of the heart muscle. In dogs, it
can be caused either by cardiomyopathy or, more commonly,
by damaged, leaking heart valves.
When the heart fails, fluid accumulates in the lungs, in the
pleural space, or in the abdomen. Animals in heart failure
usually will present with labored breathing and coughing.
Mucus membranes may be cyanotic. Often, a heart murmur
or irregular heart rate may be detected when the thorax is
auscultated.
Animals in heart failure are unstable. Their fragile condition
requires immediate care, but they must be handled with
minimal stress. Initial treatment will depend on the severity
of the problem but may include oxygen or diuretics (drugs
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231
that cause increased production of urine, such as furosemide)

and cardiac drugs. Small doses of a sedative may be given
to reduce anxiety in very stressed patients. Further diagnostics may include chest radiographs and a cardiac ultrasound.
Aortic Thromboembolism
Cats with cardiomyopathy will sometimes present with aortic
thromboembolism. This condition is usually caused by a clot
that forms in the abnormal heart and then travels down the
aorta and lodges in a peripheral artery. It often lodges in the
terminal portion of the aorta, stopping all blood flow to the
hind legs. The clot can also affect a front leg, the kidneys, or
the intestines.
Cats with a clot in the terminal aorta, or a saddle thrombus,
will be in severe pain and often cry out. Theyre unable to use
their hind legs. The muscles in the legs will be firm, and the
footpads on the hind feet will be cold and pale. The femoral
pulses will not be palpable. Signs of heart failure may be seen at
the time of presentation or may occur soon afterward. In addition to treatment for heart failure, cats with aortic thromboembolism can be treated with anticoagulant drugs (drugs that
hinder blood clotting) such as heparin and warfarin. The
main treatment involves treating the existing heart disease,
managing pain, and preventing further clots from forming.
Feline Asthma
Feline asthma is another common cause of acute respiratory
distress in cats. During an asthma attack, the small airways
in the lungs are constricted, making it difficult for the cat to
exhale. An affected cat will have labored breathing, especially
on expiration. The disease is controlled with drugs to dilate
the airways and reduce inflammation. Oxygen may be given
during a severe episode.
Central Nervous System

Disorders of the central nervous system (CNS) often present as
emergencies. The central nervous system is the portion of the
nervous system consisting of the brain and the spinal cord.
The cases youll see may present due to trauma, diseases, or
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congenital disorders. As a veterinary technician, your role

to assist with CNS disorders may prevent additional injuries
to an animal or may aid in diagnosis by readily identifying
the signs of a disorder.
Seizures
Seizures, convulsions, or fits are caused by transient, abnormal
brain activity. Seizures can result from a number of different
causes. Here are some of the many possible causes of seizures:
Congenital defectsHydrocephalus (enlargement of

the cranium), lysosomal storage disorders (enzyme
deficiencies)
Infectious diseaseDistemper, FIP (feline infectious

peritonitis)
ToxicityLead, organophosphate
Trauma
Metabolic disordersHypoglycemia (low blood sugar),

hepatic encephalopathy (ammonia accumulation), and
thiamine deficiency
NeoplasiaUncontrolled tumor growth
Idiopathic epilepsy
A seizure is composed of three parts: the aura, the ictus, and

the postictus. The aura occurs just before the actual seizure.
The animal seems to sense that something is about to happen. It may become restless, nervous, or more affectionate.
This phase may not be detected in all animals.
The ictus is the period of the actual seizure. The animal will
collapse onto its side, violently thrashing its head and limbs.
Theres often involuntary chomping of the jaws. The animal
will often salivate, urinate, and defecate uncontrollably. The
animal will be unconscious; the eyes will be open and in a
fixed stare. The animal will be unresponsive. Dogs are generally not violent during seizures. However, it has no control of
its jaw muscles and could damage anything near its mouth.
No attempt should be made to muzzle, administer oral medications, or restrain a dog during a seizure. The ictal phase
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233
usually lasts between one and three minutes. A prolonged,

continuous seizure where the ictal phase lasts longer than
five to ten minutes is called status epilepticus. Status epilepticus
is a medical emergency. It will result in death if not treated
immediately.
The postictus begins immediately after the ictus and can be
thought of as a recovery period. The dog will often wander
aimlessly with a staggering, unsteady gait. It will often act
confused and will be temporarily blind. The animal will usually return to normal within an hour.
If an animal has a single seizure and then quickly returns to
normal, no immediate treatment is required. A diagnostic
workup should be done to determine the cause of the seizure.
If an animal is having frequent seizures or is in status
epilepticus, it needs immediate therapy to stop the seizure in
conjunction with a diagnostic search for the cause.
When presented with a patient having a seizure, an intravenous
catheter should be placed if possible, and blood should be
collected to determine the blood glucose. The animal should
be given a drug such as midazolam as soon as possible to stop
the seizure. If the seizure isnt controlled after midazolam has
been given, other drugs such as pentobarbital, phenobarbital,
or thiopental may be given.
You should check the rectal temperature on any patient
experiencing seizures. Animals that are in status epilepticus
will rapidly elevate their body temperature. Temperatures of
105F and higher arent uncommon. The animal should be
cooled to a temperature of 103F with cool, wet towels. Stop
active cooling efforts when the increased muscle activity
associated with the seizure has been controlled and the
temperature has decreased to 103F; this prevents the
temperature from falling below normal.
Acute Paresis/Paralysis
Dogs and, less commonly, cats will be presented because of
injury to their spinal cords. Depending on the severity of the
problem, they may be paretic (weak in the limbs) or paralyzed. Injury to the spinal cord in the neck causes loss of use
of all four limbs. If the spinal cord is injured along the back,
234
the front legs will be normal, but the animal will be unable to
use its back legs. A sudden onset of paresis or paralysis is
most commonly caused by intervertebral disk disease. Injury
due to trauma, infarct, or neoplasia can have similar signs.
The intervertebral disk is a fibrocartilaginous (thick cartilage)
structure positioned between vertebrae in the spinal column.
As seen in Figure 79, its composed of an outer fibrous layer
called the annulus and a gelatinous inner portion called the
nucleus. The purpose of the disk is to cushion shock, allow
movement, and unite the vertebral segments.
FIGURE 79Intervertebral
Disk
Annulus
Nucleus
Disk degeneration occurs with aging. As the disk degenerates,

the nucleus becomes calcified, and the fibers of the annulus
weaken. Eventually, the weakened annulus can rupture, and
material from the nucleus protrudes into the spinal canal,
putting pressure on the spinal cord.
In some breeds, degeneration begins earlier and progresses
faster, making them predisposed to problems associated with
intervertebral disk disease. Predisposed breeds include the
Dachshund, Cocker Spaniel, Basset Hound, Poodle, Beagle,
German Shepherd, and Labrador Retriever.
Clinical signs of disk disease vary depending on the severity
of the problem. Mildly-affected animals will seem to be in pain
and reluctant to move. Severely-affected animals may become
acutely paralyzed. When the presenting signs are mild, the animal will be treated with drugs to reduce inflammation and pain
and limited to strict cage rest. Animals with severe signs or with
chronic disk disease may require surgery.
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Musculoskeletal Presentations
Injuries of the musculoskeletal system include abnormalities
involving the bones, the joints, and the soft tissues (tendons,
ligaments and muscles, and skin).
Fractures
A fracture is a broken bone. Fractures are often suspected
from physical examination findings such as localized swelling,
pain, or unnatural positions of the limb, but they must be
confirmed by taking a radiograph. If the skin over the fracture
site is intact, the fracture is classified as a closed fracture.
In open fractures, the skin has been disrupted, exposing the
underlying muscle and bone. Open fractures are considered
more serious because of the possibility of infection. Figure 80
illustrates the differences between open and closed fractures.
FIGURE 80Open and

Closed Fractures
Closed
Open
A simple fracture is a single break in the bone; a compound

fracture has multiple breaks in the same bone.
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Initial management of most fractures involves immobilization

with a bandage or splint. Bandages are applied to limit movement, prevent further swelling, decrease pain, and hold the
bones in proper alignment. A splint or cast may be the definitive
repair for some fractures, whereas others may require surgery
involving repair with metal pins, wires, or bone plates.
Luxation
A luxation is a displacement or dislocation of a joint from its
normal position. Trauma is the most common cause of a
luxation. The hip, the shoulder, and the elbow are the joints
most often affected. Figure 81 illustrates a luxated hip joint
as it would appear on a radiograph. In addition to causing
loss of function of the joint, the dislocation also causes injury
to the ligaments and muscles around it. Soon after the injury
occurs, the abnormal joint can often be manipulated back into
normal position, but may also require surgical repair if it cannot
be replaced or if the hip continues to pop out.
Normal
Hip Joint
Luxated
Hip Joint
Radiograph
Area
Restraints
FIGURE 81Luxated Hip Joint of a Dog
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237
Soft-Tissue Wounds
Injuries to the skin and the underlying muscles, nerves, and
blood vessels are a common occurrence in veterinary medicine.
When dealing with skin wounds, you need to be concerned not
only about the damaged tissue, but also about blood loss and
infection. Intact skin is an important barrier against infection.
When that barrier is broken, the underlying tissues are susceptible to the invasion of bacteria.
Further classification of wounds based on the mechanism of
injury will help you to understand the management and anticipated complications of each type of wound. As discussed, there
are five categories of wounds: abrasion, avulsion, incision,
laceration, and puncture. Review the wound section of the
study guide for further differentiation.
Gastrointestinal Presentations
Vomiting, diarrhea, and inappetence (lack of appetite) are the
most common signs seen in animals with disease affecting
the gastrointestinal tract. In the following section, youll be
introduced to several gastrointestinal diseases causing vomiting
and/or diarrhea commonly seen on an emergency basis. Its
important to remember that vomiting also is seen with a large
number of nongastrointestinal problems. Several causes of
vomiting in animals arent associated with primary gastrointestinal tract disease. These causes are
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Pain
Toxins
Drugs
Foul tastes and odors
Metabolic diseasekidney disease, diabetes, and liver

disease
Neurological disease
Motion sickness
History, physical examination, and diagnostic testing often are

needed to determine if vomiting is caused by a problem with
the gastrointestinal tract or with some other body system.
Acute Gastroenteritis
One of the most common causes of acute onset vomiting
and/or diarrhea is irritation of the stomach and intestine
from dietary causes. This condition is known as acute
gastroenteritis.
The intestine may become irritated from a sudden change in diet
or when animals get into garbage or other foreign material. If
bones or other large objects have been consumed, abdominal
radiographs should be taken to determine if theres foreign
material in the intestine.
If no foreign material remains in the intestine, the vomiting and
diarrhea will often resolve with supportive care. The intestine
should be rested by fasting the animal or feeding it a bland diet
thats very easy to digest. If theres some kind of foreign material
in the intestine, the veterinarian will need to decide if the material can safely pass through the intestine without causing
injury to the bowel. If it may obstruct the bowel, it will need
to be removed surgically. The severity of dehydration from the
condition may warrant hospitalization with IV fluids.
Parvovirus Enteritis
Vomiting, diarrhea, inappetence, and depression can be seen
secondary to viral infection. A number of viruses affect the
gastrointestinal system. The most serious and potentially
fatal is parvovirus. Affected animals will present with vomiting, lethargy, and severe bloody diarrhea, and will often be
dehydrated. In severe cases, an animal will be in shock.
Enteritis (inflammation of the intestine) caused by parvovirus
infection is most commonly seen in dogs less than 6 months
of age and in dogs that havent received vaccination to protect
them from the disease. The diagnosis is often suspected when a
young, unvaccinated dog is presented with the typical clinical
signs. Finding a low number of white blood cells on a complete
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239
blood count supports a diagnosis of parvovirus infection. The

diagnosis is confirmed by demonstrating the presence of
parvovirus in the feces.
Easy-to-use, rapid, in-hospital test kits for the detection of
parvovirus in feces are available. Mildly-affected animals can
be treated with subcutaneous fluids, and antibiotics to guard
against secondary bacterial infections. Severely-affected animals
will need to be hospitalized for intravenous fluids, plasma
transfusions, antibiotics, and antiemetics (drugs to control
vomiting). The disease is often fatal if not treated, and some
animals die in spite of appropriate therapy.
Because the disease is so contagious, when an animal infected
with parvovirus is in the hospital, its important to protect
other patients from infection. Infected animals should be kept
in an isolated area. The virus is resistant to inactivation and
may remain infectious outside the animal for several months.
Most commercial detergents and disinfectants dont inactivate
the virus. Chlorine bleach (diluted 1:32 with water) effectively
inactivates parvovirus. A diluted bleach solution should be
used to clean cages, floors, tables, and pieces of equipment
that have been exposed to the infected individual. You should
rinse your hands in a diluted bleach solution after handling a
patient with parvovirus infection.
Pancreatitis
Inflammation of the pancreas, or pancreatitis, is a serious,
potentially fatal condition of dogs and, less commonly, cats.
The pancreas is a large glandular structure located behind the
stomach between the spleen and duodenum. The pancreas is
responsible for the production of insulin. It also aids in the
digestion of food. The presence of food in the stomach causes
pancreatic juice to be secreted into the small intestine.
Pancreatic juice contains enzymes such as trypsin, amylase,
and lipase, which are vital to the digestion of carbohydrates,
proteins, and fats. In patients with pancreatitis, these
enzymes are released within the pancreas, causing an
autodigestive process. The cause of the disease isnt known,
but its often associated with the ingestion of a fatty meal,
such as from table scraps or other human foods.
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Overweight, middle-aged female dogs appear more likely to

be affected by pancreatitis. Clinical signs in mildly affected
individuals will include vomiting, lack of appetite, and
depression. A physical examination may also demonstrate
abdominal pain and an elevated rectal temperature. More
severely affected animals will present in shock. The diagnosis
is often suspected based on history and examination findings.
Additional diagnostics, including blood tests, abdominal
radiographs, and abdominal ultrasound, are often used to
confirm the diagnosis.
The treatment will depend on the severity of the problem, but
the basic goal of therapy is to allow the pancreas to rest and
stop the autodigestive process. Because the presence of food
in the stomach will stimulate further secretion of enzymes,
the animal must not be given any food or water orally. Most
patients receive intravenous fluids and antibiotics for several
days. Pain medications are often needed to make the animal
more comfortable.
Gastric Dilatation-Volvulus
Gastric dilatation-volvulus (GDV) is a life-threatening emergency that without prompt attention will lead to circulatory
collapse and death. The condition is commonly referred to as
bloat. Bloat occurs when a dogs stomach becomes distended
with food, liquid, and air. The stomach then twists or rotates
around the distal esophagus, preventing fluid or air from
leaving the stomach. The rapidly distending stomach prevents blood flow back to the heart, and the dog begins to go
into shock. The stomach wall begins to die because of lack
of blood flow. The problem is seen most commonly in large,
deep-chested breeds of dogs such as Great Danes, Doberman
Pinschers, and Standard Poodles.
The cause of this condition isnt known. Ingestion of a large
meal, ingestion of large quantities of water, and active exercise
after eating are thought to be inciting causes of the condition.
Clinical signs of GDV include restlessness, nonproductive retching, increased salivation, difficulty breathing, depression, and
distention of the abdomen. The diagnosis is usually made
Lesson 4
241
based on history and physical examination. An abdominal

radiograph will confirm the large, abnormally positioned
stomach (Figure 82). An irregular heart rhythm (known as
ventricular premature contractionVPC) may be detected on
physical examination or by an electrocardiogram.
FIGURE 82This X-ray
shows a patient with gastric dilatation-volvulus, or
bloat.
There are three major therapeutic goals in the initial

management of patients with GDV:
1. Address the shock.
2. Decompress the stomach (reduce the pressure on the
stomach wall by removing some of the air trapped
within).
3. Surgically reposition the stomach.
The initial goal of therapy is to treat the shock. Affected individuals are given large volumes of intravenous fluids. Often,
two or more intravenous catheters are needed to deliver the
fluids more rapidly.
The second goal is to decompress the stomach. Decompression
can be achieved by passing a stiff plastic tube either through
the mouth, down the esophagus, and into the stomach, or
by needle paracentesis. Figure 83 illustrates the passing of a
stomach tube. Needle paracentesis involves placing a needle
or catheter across the body wall and into the distended stomach.
The final goal of treatment is to surgically return the stomach
to its normal position. Depending on the availability of staffing
and the condition of the patient, the surgery may be done
242
FIGURE 83Decompression
of a distended stomach
resulting from GDV is often
achieved through the passing of a stomach tube.
immediately or postponed for a few hours. If the surgery isnt

done immediately, the dog should be sedated and its stomach
should be lavaged with lots of room temperature water.
At the time of surgery, the stomach will be carefully
inspected. Portions of the stomach wall that have become
necrotic (i.e., dead, nonviable) from lack of blood flow will
need to be removed. A gastropexy (a procedure to attach
the stomach to the abdominal wall) is done to prevent a
recurrence of the problem.
Urogenital Disorders
Urogenital disorders are disorders that affect the urinary
or reproductive systems. Renal failure and renal disease
account for many of the emergencies youll see involving the
urinary system. Female dogs and cats will often be presented
for emergency care because of difficulty in delivering their
kittens or puppies; the general term for this is dystocia. Three
common presentations related to the female reproductive tract
are eclampsia, pyometra, and dystocia.
Renal Failure
The kidneys are responsible for filtering waste products from
the blood. When the kidneys dont function properly, waste
products accumulate in the blood, causing renal failure.
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243
Clinical signs seen in animals with renal failure include

increased thirst and urination, decreased appetite, vomiting,
and decreased activity level. An unpleasant fruity odor is
often detected on the breath.
The kidneys may fail from a slowly progressive disease process.
Chronic renal failure is a common problem in older cats and
dogs. Acute or sudden failure of the kidneys can result from
decreased blood flow during shock states, from infectious
agents such as leptospirosis, or from toxins such as ethylene
glycol, the main ingredient in antifreeze.
Urethral Obstruction
A common cause of acute renal disease, especially in cats, is
blockage or obstruction of the urethra. Urethral obstruction
is one of the group of clinical signs known as feline lower
urinary tract disease (FLUTD). The cause hasnt been clearly
established, but numerous factors have been considered,
including litter box hygiene, viruses, bacteria, and dietary
considerations.
Affected cats will have episodes of hematuria (blood in the
urine) or stranguria (difficult urination) when the urethra
is partially blocked. During an episode, cats will often pass
mineral crystals in their urine. During an episode of abnormal
urination, a plug of mucous and crystals can form, lodge in
the urethra, and block the flow of urine. Obstruction of the
urethra is much more common in male cats, but, although
rare, it can occur in female cats.
If urine is unable to pass because of complete blockage, the
cat first becomes uncomfortable and then quickly becomes
toxic from the buildup of electrolytes and waste products.
Potassium is the primary electrolyte, and it can cause severe
and potentially fatal irregularities in the heart rhythm.
Owners will report that their cat is making frequent trips to
the litter box, assuming the posture of urination without
producing urine, or that the cat is attempting to urinate in
strange places. The owner may mistakenly believe that the
cat is constipated. Affected cats can be identified upon arrival
at the veterinary hospital by palpating a large, firm, painful
urinary bladder.
244
Treatment will depend on the stage of the disease. If cats are

seen soon after the blockage has occurred, before high levels
of toxins have accumulated, they can be sedated and have
the urethral obstruction relieved by passage of a sterile
lubricated catheter. The bladder and urethra should be irrigated
with saline. The catheter may be left in place for 12 to 36
hours. If the cat has become toxic from the accumulated
waste products, it will require intravenous fluids and drugs
to reduce the high potassium levels, in addition to management
of the obstructed urethra.
Eclampsia
Eclampsia is a condition caused by an abnormally low level
of calcium in the blood. Its most commonly seen in dogs
nursing puppies. The condition often occurs in the first three
weeks after parturition (delivery of puppies). Toy breeds of
dogs such as the Chihuahua are most often affected. Affected
dogs will pant and act restless. Theyll then develop muscle
tremors and a stiff gait. The increased muscle activity will
cause an elevated rectal temperature. The signs will quickly
progress to collapse and death if left untreated.
The diagnosis of eclampsia often is suspected based on
history and clinical signs and is confirmed by checking the
blood-calcium level. The signs can be reversed quickly by
the intravenous administration of calcium. Its important to
remember that if rapidly given intravenously, calcium can
cause a slow or irregular heart rate. You may be asked to
monitor the heart rate or ECG tracing while calcium is being
administered. To maintain a normal blood-calcium level, the
dog may be placed on an oral calcium supplement. In addition, the puppies should be prevented from nursing and
instead be fed a milk-replacement formula.
Pyometra
Pyometra is an infection of the uterus. The disease generally
occurs in middle-aged to older unspayed females and often
occurs within four to six weeks of the previous heat cycle.
Lesson 4
245
The animal often presents with signs of shock. Less severely

affected individuals may show nonspecific signs of illness:
decreased appetite, weakness, or vomiting. The owner may
report increased thirst and urination. A mucoid or bloody
vaginal discharge may or may not be seen. An enlarged
uterus often can be found on physical examination, on radiographs of the abdomen, or through abdominal ultrasound.
The best treatment option is surgical removal of the infected
uterus as soon as the animal can be stabilized with intravenous fluids and antibiotics.
Colic in the Horse

Most emergency conditions are the same in large animals
as in small animals, with only small variations in treatment
regimes. However, one condition thats seen on a regular
basis in horses more than in any other animal is colic. Colic
refers to any presentation of abdominal pain. Signs that are
generally associated with abdominal pain include
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Inappetence
More frequent stretching than normal
Yawning
Looking at its sides/stomach region
Frequent urination
Pawing at the ground
Stamping of feet
Constant pacing of the stall
Kicking at the abdomen
Rolling violently on the ground
Profuse sweating
Increased heart and respiratory rates
Congested (very red) mucous membranes
Abdominal pain can be truly abdominal, or it can be another

disorder that mimics abdominal pain. The cause needs to be
quickly determined and addressed by the veterinarian, as
more serious causes can lead to death. The various causes of
colic include
Twisted intestine
Feed impaction
Foreign-body impaction
Intestinal displacement
Gas distention
Parasitic infections
Uterine contractions (pregnancy related)
Urinary obstruction
Inflammatory bowel disease
The typical order of treatment is to first try to medically manage

the horse; then, if that doesnt resolve the problem, surgery
may be indicated. The veterinarian will start with a physical
exam of the horse, including a rectal exam, looking for potential
causes of the colic. Next, a few diagnostic procedures are performed to aid in diagnosis. These include nasogastric intubation,
abdomenocentesis (including analysis of the fluid obtained), and
blood collection. Other procedures may be warranted depending
on the initial findings.
Once the horse has been worked up for the colic, medical
treatment involves drugs to control the pain and frequent
nasogastric flushes to alleviate the distention. The horse is
held off feed until the signs of colic are completely resolved.
Feed is then introduced in a very slow fashion, usually starting with a handful of wet grass hay every couple of hours,
gradually working back up to the normal amount consumed
before the colic. The veterinary technician is vital in the
management of a colic case, as the technician may be asked
to perform some of the diagnostics, monitor the patient for
improving or worsening, and assist in reintroducing the horse
to normal diet and activity.
Lesson 4
247
Chemical and Physical Disorders

In the practice of emergency medicine, youll encounter many
animals that have sustained chemical or physical injuries.
These injuries may be caused by extremes of the environment,
bye snake or insect envenomizations (poisonings caused by a
bite or sting), or by one of the many toxic substances in the
environment. Dogs and cats are curious by nature and will
often encounter substances that can cause harm. This section
provides you with a general approach to management of these
problems. It briefly describes the clinical signs and therapeutic
approaches to some of the most commonly seen toxicities.
General Approach for

Poisoned Patients
Dogs and cats have potential exposure to a large number of
poisonous substances in their environment. A poison is any
substance that through chemical action can produce harmful
effects on normal body processes. Animals can be exposed to
poisons or toxins by a number of different routes, including
Ingestion through the mouth
Inhalation in the form of noxious gases, fumes, dusts,

or mists
Injection into the body tissues or blood by hypodermic

needles or poisonous bites
Absorption through the skin by contact with poisonous

substances
Owners often will call with a suspicion that their pet has been
poisoned. The clinical signs of many common metabolic problems are similar to those seen secondary to toxicity. Owners
often mistakenly assume that their sick pet has been poisoned.
Its important for you to question them about the possibility of
exposure to a possible toxin. If exposure to a toxin is a possibility, the owner should be instructed to have the pet evaluated
immediately. The owner should bring along the label or packaging from any compound suspected to be the offending toxin.
248
If the animal has vomited, the owner should bring a sample of

the vomit in a clear plastic bag or glass container. The sample
may be useful in diagnosing the toxin.
If the owner calls because the pet has consumed or been
exposed to a known substance, youll need to help determine
if the substance is potentially toxic to the animal. Figure 84
contains a list of agents generally assumed to be nontoxic to
cats and dogs. Animal poison control centers, such as the
National Animal Poison Control or Pet Poison Hotline, can
also provide valuable information. Its important to have these
numbers readily available. You should confer with the veterinarian to make a final determination on what is or isnt toxic.
Before speaking with the veterinarian, its important that you
gather some information about the potentially toxic exposure.
Find out the following from the owner:
The active ingredient in the substance
The amount ingested
When the exposure or ingestion occurred
The approximate weight of the animal
What signs, if any, the pet is currently demonstrating
There are four general steps to the management of a poisoned

patient regardless of the toxic substance or the route of
exposure:
1. Prevent further absorption.
2. Hasten elimination of the absorbed toxin.
3. Determine specific antidotes.
4. Give supportive care.
Prevent Further Absorption

Its important to remove the animal from the affected environment. In cases of poisonous gases and fumes, this will mean
moving the animal to a different location.
Lesson 4
249
3% hydrogen peroxide
Laxatives
Abrasives
Lipstick
Antacids
Lubricant
Antibiotics
Magic markers
Ballpoint pens
Makeup (eye, liquid, facial)
Bath oil (castor oil and perfume)
Matches
Bathtub floating toys
Mercury thermometers
Birth control pills
Mineral oil
Bleachless than 5% sodium hypochlorite
Modeling clay
Body conditioners
Newspaper
Bubble bath
Pencil (graphite lead, coloring)
Calamine lotion
Perfumes
Candy (beeswax or paraffin)
Petroleum jelly (Vaseline)
Chalk (calcium carbonate)
Play-Doh
Colognes
Porous-tip marking pens
Cosmetics
Putty (less than 2 oz)
Crayons marked AP, CP
Rubber cement
Dehumidifying packets (silica or charcoal)
Sachets (essential oils, powder)
Deodorants
Shampoos (liquid)
Elmers glue
Shaving cream/lotion
Etch-A-Sketch
Soap and soap products
ExLax
Soaps (detergents)
Fabric softeners
Spray deodorizers
Fishbowl additives
Suntan preparations
Fluoride
Sweetening agents (saccharin)
Glues and pastes
Teething rings (water sterility)
Hair dyes, sprays, tonics
Toothpaste, with or without fluoride
Hand lotions and creams
Vitamins
Incense
Watercolors
Indelible markers
Zinc oxide
Ink (black, blue)
Zirconium oxide
FIGURE 84Generally Nontoxic Household Agents
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A common route of exposure is from products or substances

applied to the hair coat and then absorbed through the skin.
If a pet has been poisoned by topical exposure, the product
should be removed from the hair coat. This is usually best
accomplished by bathing the animal in a mild pet shampoo or a
liquid dishwashing detergent. If the toxic substance is a powder,
vacuuming the hair coat is an effective means of removal.
The owners should be instructed to wear protective clothing
and eye wear when handling and bathing their pets and to
keep their pets warm and dry following bathing.
Ingestion is the most common route of toxin exposure. In the
case of ingestion, efforts should be made to decontaminate
the gastrointestinal tract. Decontamination is an attempt to
remove the toxin from the stomach and intestine before its
absorbed into the bloodstream. Because of its grooming
habits, any animal that has been topically exposed to a toxin
probably also has ingested some of the toxin.
Gastrointestinal decontamination should be considered in
addition to bathing these patients. Toxic material can be
removed from the stomach either by inducing emesis
(making the animal vomit) or by gastric lavage. If the animal
has ingested the material within the past four hours and
there are no contraindications to vomiting, the owner may
induce vomiting at home. Its important that emesis not be
induced if the animal is depressed, having a seizure, or is
nonresponsive. Emesis isnt recommended if the animal
Ingested a caustic material
Ingested a petroleum product
Is experiencing difficulty breathing
Is experiencing a seizure or exhibiting signs of

hyperactivity
Appears depressed or is unconscious
Is a rodent or rabbit
Its important to note that rabbits and rodents dont have

the ability to vomit. Attempts to produce vomiting in these
species can cause the stomach to rupture.
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An emetic is a drug used to produce vomiting. At home,

owners can use 3% hydrogen peroxide to induce vomiting in
their pets. Peroxide works by causing mild irritation in the
stomach. It is given orally at 1 teaspoon per 10 pounds of
body weight. If this does not cause the animal to vomit, the
owner should not repeat the treatment. Emetics available at
the hospital are more reliable, especially in cats. Other home
remedies, such as table salt, are not recommended. If the
owner lives close to the hospital, its better to have the owner
come directly to the hospital than to attempt emesis at home.
The veterinarian will make the decision if the owner should
attempt to induce vomiting.
When emesis isnt an option, gastric lavage may be used to
remove toxic material from the stomach. To perform gastric
lavage, the animal is anesthetized, and an endotracheal tube
is placed. A large-bore stomach tube is passed into the stomach.
Five to 10 ml/kg of lukewarm water is lavaged in and out of
the stomach 10 to 15 times or until all the stomach contents
are removed. After either emesis or gastric lavage has emptied
the stomach, an adsorbent can be given to bind any toxin
remaining in the gastrointestinal tract.
Activated charcoal is the most commonly administered
adsorbent. Activated charcoal is given either orally or by
stomach tube. Repeated doses of charcoal are recommended
for those toxins that are slowly eliminated from the body.
Cathartics are often given in combination with activated
charcoal. A cathartic is a drug that causes active movement
of the bowels. This speeds the movement of both the unbound
toxin and toxin bound to charcoal through the gastrointestinal
tract and decreases time for absorption. Commonly-used
cathartics include sorbital, sodium sulfate, magnesium
sulfate, and magnesium citrate.
Hasten Elimination of Absorbed Toxin

If a toxin is excreted or cleared from the body by the kidneys,
treatment with intravenous fluids to promote increased urine
production will speed the elimination of the drug from the
animal. Altering the pH of the urine can also be used to
hasten the elimination of some toxins.
252
Specific Antidotes/Supportive Care

A small number of toxins have a specific antidote. An antidote
is a compound that neutralizes a poison or counteracts its
effects. As will be discussed later in this section, vitamin K
can prevent the effects on blood clotting caused by rat poison,
and ethanol (alcohol) is given to prevent the conversion of
antifreeze to toxic substances that cause kidney failure. In
most cases of poisoning, there isnt a specific antidote, and
the proper treatment of the animal is to provide supportive
care until the toxin is cleared from the body.
Many toxins cause stimulation of the central nervous system,
resulting in hyperactivity, muscle tremors, or seizures. These
signs can be controlled with sedatives such as midazolam.
Cardiac arrhythmias (abnormal heart rhythms) are seen with a
number of poisonings. Animals poisoned with insecticide products may have an abnormally slow heart rate. The ingredients in
many over-the-counter cold medications can cause dangerously
rapid or irregular heart rates. If the cardiac arrhythmia is
severe and adversely affecting the patient, drugs such as
atropine and propranolol can be given to normalize the heart
rate. Fluid and electrolyte imbalances are managed with
intravenous fluid therapy.
Poisoned animals are often temporarily unable to control their
body temperatures. Rectal temperature should be carefully monitored and external warming or cooling provided to maintain
a normal body temperature.
Common Toxins
Although many pet owners believe that their homes are safe
environments for their pets, there are a variety of household
products that are hazardous to an animals health. Common
household products can have severe adverse effects on a pet.
In this section, well discuss some common household toxins.
As the veterinary technician, your ability to identify common
toxins and their dangerous effects will be invaluable to the
veterinary practice and the clients that you serve.
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253
Ethylene Glycol
Toxicity from ingestion of ethylene glycol usually occurs when
dogs and cats drink automobile antifreeze. Antifreeze has a
sweet taste, and animals will readily drink it. Animals can
become poisoned after consuming only a small amount of
antifreeze. The toxic dose is 4.2 to 6.6 ml/kg in the dog and
1.5 ml/kg in the cat. Toxic amounts of ethylene glycol are
also found in some photographic processing chemicals.
The serious consequences of ethylene glycol ingestion are
caused not by the compound itself, but by metabolites.
Metabolites are compounds produced as the body breaks
down the product for elimination. Ethylene glycol is broken
down by the body into several metabolic products, including
oxalic acid. Calcium combines with oxalic acid to form crystals in the renal tubules, causing obstruction of the tubules
and renal failure.
Within one to two hours of ingesting a toxic dose, the animal
will show gastrointestinal and central nervous signs. The
animal will become dull or depressed or may act drunk,
displaying a staggering, unsteady gait. It will often vomit.
The owner also may notice increased thirst and urination.
If untreated, the animals condition will progress to coma
and death if a large amount of antifreeze was consumed.
If a toxic but nonlethal dose was consumed, the animal
may appear to get better over the next 6 to 12 hours, but
then again begin to appear ill with signs of depression, weakness, and vomiting as the toxic metabolites are produced
and cause renal failure.
An animal ingesting ethylene glycol should receive veterinary
care as soon as possible. The goal of therapy is to prevent the
formation of toxic metabolites. If given soon after exposure,
antidotes such as ethanol or 4-methylprazole are effective in
preventing the metabolism of ethylene glycol and the formation of the toxic oxalate crystals. (4-methylprazole is available
only for use in dogsdont use it in cats.)
If the animal is presented for treatment after the toxic metabolites have been formed and caused damage to the kidneys,
the veterinarian can provide only supportive care, and the
patient will most likely die. You should advise owners of the
254
potential toxicity of antifreeze and other products containing

ethylene glycol, and that they should seek immediate veterinary
care if they witness or even suspect their pet may have
consumed one of these products.
Organophosphates and Carbamates

Two groups of chemical substances commonly found in
insecticide products that can cause toxicity to cats and dogs
are organophosphates and carbamates. Theyre found in a
variety of flea products, including powders, collars, sprays,
and dips.
Toxicity occurs most commonly by absorption of toxins
through the skin or by ingestion. Clinical signs include
constricted pupils, excessive salivation, vomiting, diarrhea,
muscle tremors, and labored breathing. Bathing to remove
the product from the hair coat and decontamination of the
gastrointestinal tract are important in treating these patients.
Atropine sulfate is the antidote given for both carbamate and
organophosphate toxicity. Protopam chloride (2-PAM) is also
given in the case of organophosphate toxicity.
History of exposure to flea products and the patients clinical
signs should make you suspect that a patient is experiencing
a toxic reaction to a flea product. If you believe this to be the
case, advise the owner to seek immediate veterinary care.
Anticoagulant Rodenticides
Many animals are presented for emergency care following the
ingestion of rodenticide products (products designed to kill
rodents such as rats and mice). The active ingredient in most
rat poisons is warfarin or one of many newer, more potent
warfarin-like drugs. These products are often referred to as
anticoagulant rodenticides because they kill rats (or other animals that ingest the product) by causing abnormal bleeding.
Within a few days of ingesting a toxic dose of an anticoagulant
rodenticide, the animal will have a decreased ability to form a
blood clot. Minimal trauma, such as might occur when playing
Lesson 4
255
with another dog, will cause serious bleeding. The bleeding

can occur in the skin and muscles. It also commonly occurs
in the lungs, chest cavity, and the abdomen.
If animals are presented within a few hours of ingesting rat
poison, the gastrointestinal tract should be decontaminated
by inducing vomiting and administering activated charcoal.
Rodenticides are often bright blue-green in color and easy to
identify in the vomitus. Even if the dog or cat vomits a large
amount of the poison, you must be concerned about any
product that could have been absorbed.
To determine if a toxic amount of the product has been
absorbed into the bloodstream, the blood clotting function
can be monitored over the next 72 hours. The prothrombin
time (PT) test is the most sensitive test to monitor for the
presence of a toxic amount of an anticoagulant rodenticide.
If the PT is normal 72 hours after ingestion, the animal didnt
absorb a toxic dose and no further treatment is required.
If the PT test shows prolongation of the time required for
the blood to clot, the animal should be considered to have
ingested a toxic dose and be given Vitamin K1, the antidote
for this group of toxins. In theory, it would be better to test
the blood for levels of the rodenticide product, but these tests
arent readily available.
If an animal presents with unexplained bleeding, toxicity
from a rodenticide product should be considered. The owner
should be questioned about possible exposure to rat poison.
If the animal is bleeding, it should be treated with blood or
plasma transfusions in addition to Vitamin K1.
Chocolate
Dogs may show signs of toxicity after eating chocolate. Ingestion
of toxic amounts of chocolate causes excessive stimulation of
both the cardiac and central nervous systems. Clinical signs
may be seen up to four to five hours after ingestion. Affected
dogs will be anxious and restless. They may have muscle
tremors. Seizures may be seen in severe cases. The heart
rate will be rapid, and an irregular rhythm may be detected.
The dog will often vomit and have diarrhea.
256
Theobromine is the ingredient in chocolate thats responsible

for the toxic reaction thats seen. Dogs are extremely sensitive
to the stimulatory effects of theobromine. As compared to
humans, dogs show toxic signs at lower blood levels, and the
effects of the drug are more prolonged because its cleared
from the body more slowly. A 20-pound dog will show signs
of toxicity after eating 23 ounces of milk chocolate or 21/2
ounces of baking chocolate.
If the animal is presented before clinical signs are seen,
decontamination of the gastrointestinal tract usually will
prevent any toxic signs. When presented after the chocolate
has been absorbed into the bloodstream and clinical signs
are seen, the treatment is symptomatic. Putting the animal
on intravenous fluids will accelerate the clearance of the
toxin and shorten the duration of clinical signs.
Poisonous Plants
Many house and garden plants contain chemicals that can
produce toxic effects if ingested in sufficient quantities. Dogs
and cats arent strict herbivores (plant eaters), so they rarely
consume large quantities of plant material. Pets are most
likely to consume plants when theyre bored or after changes
in their environment. Table 4 lists some common plants
that may cause toxic signs in cats and dogs if ingested in
sufficient quantities. Dogs or cats that have consumed toxic
quantities of plants are treated by gut decontamination
followed by symptomatic/supportive care.
Lesson 4
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Table 4
POTENTIALLY POISONOUS COMMON PLANTS
Common
Name
Scientific
Name
Poisonous
Portion of Plant
Indication
of Poisoning
Autumn crocus
Colchicum autumnale
Leaves
Vomiting, CNS*
stimulation
Castor bean
Ricinus communis
Leaves, beans
Diarrhea, shock
Daffodil
Narcissus spp.
Bulbs
Vomiting, diarrhea
Daphne
Daphne spp.
Bark, leaves, fruit
Vomiting, CNS
stimulation,
depression
Dumb cane
Dieffenbachia seguine
Stems
Salivation,
laryngitis
English ivy
Hedera helix
Leaves, berries
Vomiting, diarrhea
Foxglove
Digitalis purpurea
Leaves
Heart irregularities
Golden chain
Cytisus laburnum
Leaves, seeds
CNS stimulation
Larkspur
Delphinium spp.
Leaves, seeds
Paralysis, CNS
stimulation
Lily of the valley
Convallaria majalis
Leaves, flowers
Oleander
Nerium oleander
All parts
Philodendron
Philodendron spp.
Stems, leaves
Salivation
Poinsettia
Euphorbia spp.
Leaves
Privet
Ligustrum vilgare
Leaves, berries
Vomiting, diarrhea
Rhododendron
Rhododendron spp.
Leaves
Vomiting, diarrhea
Tobacco
Nicotianna spp.
Leaves
CNS stimulation
*CNS = Central nervous system
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Physical and Environmental Injuries

Toxic products arent the only potential threat to household
pets. Daily activities also can be hazardous to an animal thats
exposed to extreme weather conditions. Encounters with the
natural environment, part of an animals normal routine, can
also prove potentially life-threatening. The veterinary technicians task is to educate clients about potential physical
and environmental injuries, and to identify these symptoms
should an unfortunate accident occur.
Heat Stroke
Heat stroke is a condition of extreme overheating of the body
caused by high environmental temperature. Unlike people, cats
and dogs are incapable of sweating. They get rid of excessive
body heat by panting. When extra body heat exceeds their ability
to lose heat by panting, the body temperature begins to rise.
Animals with heat stroke often will have rectal temperatures
above 105F. Heat stroke often occurs when high environmental
temperatures are coupled with factors such as confinement,
lack of proper ventilation, or excessive exercise. Dogs left
in closed cars on a hot day are particularly at risk. Animals
with heat stroke can present with one or more of the following
clinical signs:
Panting
Rapid heart rate
Bright red mucus membranes
Increased rectal temperature
Collapse
Coma
Lesson 4
259
Initial treatment is to gently cool the animal. While traveling

to the hospital, the owner should cover the animal with cool,
wet towels. The owner shouldnt apply ice packs or immerse
the pet in cold water because the animal could go into shock.
Upon arrival at the hospital, the cooling process should be
continued with cool, wet towels and room-temperature intravenous fluids. Active cooling should be stopped when the
rectal temperature reaches 103F. The temperature should be
checked frequently to prevent overcooling.
After an episode of heat stroke, animals are at risk of
developing a number of serious problems, including kidney
failure, decreased blood platelet formation, and blood-clotting
abnormalities. These animals need to be carefully monitored
for the development of secondary problems.
If the animals temperature is extremely high (over 110F) or
stays elevated for an extended amount of time, the animal
may not survive despite aggressive therapy. The best treatment
for heat stroke is prevention. Its important that owners be
educated about proper management of their pets during
the summer.
Hypothermia and Frostbite

Animals can suffer from hypothermia (low body temperature)
or frostbite after exposure to extreme cold or immersion in
cold water. Clinical signs of hypothermic animals include
260
Low rectal temperature
Lethargy
Lack of coordination
Stupor
Shivering
Collapse
Coma
Frostbite occurs when the skin, usually on the feet, ears, or

tail, freezes from exposure to severe cold. The frozen, dead
tissue can be recognized by its dark color. The dead tissue
will be hard to the touch. The affected animal should be
placed in a warm, dry environment. Warm intravenous fluids
should be used to slowly rewarm the patient. The ECG
should be monitored during rewarming to watch for
irregularities in the heart rhythm. In severe cases, warm
fluids may be flushed in and out of the chest and abdominal
cavities to help in the rewarming process.
Frostbitten extremities should be thawed in warm water. The
frozen tissue should be massaged during warming. The animal
should be placed on antibiotics and the area protected to prevent self-mutilation. Some of the frozen tissue may survive,
but any tissue thats been irreparably damaged will need to
be surgically removed.
Burns
Burn injuries occur when intense heat damages the skin and
underlying tissues. The nature of the heat source and the
duration of the exposure determine the severity of the injury.
Burn injuries may occur by friction, such as when an animal
is dragged by a car. Less commonly, animals are exposed to
flames or scalding liquids. Puppies and kittens will often bite
or chew on electric cords, causing burns on the tongue and
lips. Pieces of equipment commonly used in a veterinary hospital, such as clippers, heating pads, and heating lamps, are
capable of burning patients. Always use these tools with the
proper caution.
Burns are classified as partial thickness or full thickness. In
partial-thickness burns, damage is limited to the superficial
layers of skin. Full-thickness burns involve all layers of the
skin, as well as the underlying tissues. Table 5 compares
the clinical features of the two types of injuries.
Lesson 4
261
Table 5
CLINICAL COMPARISON OF BURN TYPES
Partial Thickness
Full Thickness
Very painful
Not painful
Bleeding
No bleeding
Red, edematous
Dry, brittle, leathery
Hair doesnt pull out easily
Hair pulls out easily
Initial management of burns involves application of cold

compresses. The hair should be clipped away from the area.
The affected area should be cleaned before application of an
antibacterial ointment.
Partial-thickness burns are very painful. The animal will
often require analgesics (pain-relieving drugs) or sedation for
initial wound care. When caring for burn patients, remember
that theyll often have problems other than the obvious skin
lesions. Animals burnt by direct flames should be evaluated
for evidence of damage to their airway and lungs caused by
smoke inhalation.
Puppies and kittens that have bitten electric cords are at risk
for developing fluid in their lungs secondary to the electric
shock. In addition to treatment of their oral wounds, these
animals should be monitored carefully for 12 to 24 hours for
evidence of any breathing difficulty.
When an animal has a full-thickness burn, its completely
lost the normal protective function provided by the skin.
Theyre extremely prone to infection, but theres another
complication you may not have thought of. With no skin to
hold moisture in the body, an animal will rapidly lose a
large amount of water and protein. These materials must be
replaced immediately if the animal is to survive a full-thickness burn.
262
Venomous Bites and Stings

Many members of the animal kingdom produce toxins that
are used offensively to obtain food and to protect themselves.
Venomous animals exist in essentially all parts of North
America, although theres much variation in the venomous
species that occur in specific regions of the country. You
should become familiar with the poisonous species of snakes
and spiders in your area.
Snakes
There are only a few species of poisonous snakes in the
United States. Rattlesnakes, copperheads, water moccasins,
and coral snakes are responsible for the majority of poisonous
snakebites in animals, with rattlesnake bites accounting for
80% of all animal deaths from snakebites.
Animals rapidly develop paralysis following a coral snake
bite. The clinical signs following a bite from any other major
species of snake are local necrosis and effects on red blood
cells and blood clotting. A snakebite is often suspected by the
typical appearance of the bite wound. Most snakebites occur
around the head, neck, or extremities. There will be marked
local swelling, bruising, and pain associated with the wound.
The appearance of the wound cant be used to reliably distinguish between a poisonous and nonpoisonous bite.
Animals bitten by a poisonous snake (other than a coral snake)
may show both a local reaction and a systemic reaction to the
bite. The local reaction consists of pain, swelling, and bruising
around the area that was bitten. Systemic reactions include
shock and abnormal bleeding. When a snake bites, its venom
is released from the fangs into the area of the wound.
Enzymes in the venom are designed to destroy tissue in the
bite area, so the affected tissue will often become necrotic
(dead). If toxic amounts of venom are in the area of the bite
and spread through the body, there will be a generalized or
systemic reaction.
The first goal in treatment of a patient thats been bitten is to
prevent spread of the venom. This can best be accomplished by
keeping the animal quiet. Physical activity increases the uptake
Lesson 4
263
of venom into the circulation. Owners shouldnt attempt to

suck the venom from the wound. If the animal appears to be
having a systemic reaction, antivenom (sometimes called
antivenin) should be given to neutralize the venom.
Supportive therapy with intravenous fluids will be needed if
the animal shows signs of shock. Antibiotics should be given
to prevent infection at the site of the bite wound. Bites from
nonpoisonous snakes should be treated in the same manner
as puncture wounds.
Spiders and Scorpions

Very few spiders are capable of harming a pet through a bite.
However, severe reactions are limited to two genera: the
species Lactrodectus (black widow and the red widow) and
Loxosceles (brown recluse and common brown spider).
The venom of the black widow and red widow spiders contains a
neurotoxin thats destructive to nerve tissue. The bite of the
black widow is highly poisonous. These bites are painful, and
within a short time the toxin spreads to the entire body,
causing muscle spasms, excessive salivation, convulsions,
and paralysis. An effective antivenom is available if the
animal can be treated quickly after the bite.
The venom of the brown recluse and common brown spiders
contains proteins that cause necrosis of the skin. These
spiders dont bite unless theyre provoked, such as when a
pet wants to hunt or play with the spider. The bite isnt
painful, but it produces a severe local skin reaction with
complete necrosis and sloughing of the skin. Brown recluse
spider bites heal slowly, requiring at least eight weeks for a
full recovery.
Although the infamous tarantula is capable of a poisonous
bite, reports of bites to domestic animals from this species
are very rare. The hair of the tarantula may cause a mild
itching reaction, but this is also rarely seen in animals.
Scorpions normally inhabit climates such as those found in
places like Mexico and India. Like spiders, scorpions prefer
hiding to stinging, but if a pet tries to play with a scorpion,
it may be stung. The last segment of the scorpions tail con-
264
tains the stinging apparatus through which the venom is

injected. Severe, immediate pain is produced at the sting site.
Cold packs will help slow the progression of the poison.
Flying Insects
Dogs and cats may have adverse reactions to stings from
bees, yellow jackets, wasps, and hornets. The animals dense
fur helps to protect pets from most stings. Theyre most
often stung on the exposed areas of the head and paws. Pets
usually wont be presented for emergency for the insect bite
itself, but rather for the allergic reaction to it. The local
reaction to an insect bitetransient redness, swelling, and
painwill usually resolve without treatment. An ice pack or
topical analgesics may help to relieve some of the discomfort.
A systemic allergic reaction to the bite will cause a diffuse
swelling of the face or of a limb. The swelling will often be
pruritic (itchy). The allergic reaction is treated with antihistamines
and steroids. Any pet with facial swelling should be seen by
the veterinarian, as the throat may begin to close. Animals
can also have anaphylactic reasons. The animal may vomit
and collapse, or go into a coma. These require immediate veterinary care, or the animal will die
Large Animal Emergencies

Most emergencies are the same in large animals as in small
animals, with some variations in treatment. Fractures,
wounds, dystocia (difficulty with birth), toxin injection, and
exposure are all emergencies seen in both large and small
animals. Variances in treatment occur based on the size of
the animal and the specifics of the situation, but the initial
triage is the same as outlined earlier. The power of observation in large animals is very important! Correct restraint is a
close second. Again, it is not possible to cover every emergency that youll see, but a few of the common large animal
emergencies are covered here.
Lesson 4
265
Bloat in Cattle and Sheep

Bloat is a common gastrointestinal disorder seen in ruminants.
It occurs due to either gas or foam accumulating in portions of
the stomach, causing distention. Bloat is also called ruminal
tympany and is either primary (due to foam accumulation) or
secondary (due to gas accumulation). Ruminants normally have
an active population of microorganisms in the rumen portion of
the stomach. The microorganisms are necessary to help digest
fibrous feed such as grasses and legumes. Normal digestion
causes the microorganisms to produce large quantities of gas,
and this is expelled by eructation (belching).
Bloat occurs when the animal is not able to eructate normally,
or the rate of gas production exceeds the animals eructation
ability. This is commonly seen when a cow has access to a large
quantity of clover or alfalfa, which are palatable but become
sticky when theyre digested, which mixes with gas to create
foam. Cows receiving a cheap grain diet with a high degree of
protein also develop bloat more frequently than cows with more
variety in their diets. Primary bloat is frequently associated with
a change in the animals diet. Problems with eating (uneven feed
intervals, inappetence due to illness), changes in the weather,
changes in salt or water intake, or even a stressful event can
lead to secondary bloat.
Clinical signs of bloat include abnormal distention of the
abdomen, especially along the left flank. There may be some
respiratory effort or open-mouthed breathing, and the tongue
may protrude. The animal may grunt and extend the neck. If
bloat is left untreated, the distention will prevent the animals
organs from receiving an adequate blood supply. Without oxygen
from the blood, organs become hypoxic and the animal will die.
In fact, the most common cause of finding a cow or sheep dead
in pasture is hypoxia due to bloat.
Signs of bloat may occur within an hour of the change in diet,
but more commonly it is not seen for two to three days. This
time delay is caused by the amount of foam or gas buildup
required to cause symptoms.
Diagnosis is based on clinical signs, physical examination, and
a rectal examination. Analysis of rumen fluid can be performed.
The response to treatment is also helpful in diagnosis. Treatment
266
involves either passing a stomach tube to help remove foam/gas,

or rumenotomy, in which an incision through the skin and muscles into the rumen allows foam/gas to escape. In chronic cases,
a rumenostomy, or a permanent hole in the rumen, may be performed to allow gas to escape as it builds up.
Choke in Horses, Camelids, and Ruminants

The general term for esophageal obstruction is choke. Choke
occurs when food or a foreign body is lodged in the esophagus.
Choking animals present with coughing fits, heavy drooling, and
obvious respiratory distress. This is not considered a life-threatening emergency if the animal is still able to breathe, but it can
be very distressing for the owner to watch. Treatment consists of
trying to move the food bolus or foreign body into the stomach
using a stomach tube. The foreign body rarely needs to be
moved beyond the stomach, as its often digested or passed
without incident.
Respiratory Distress in Large Animals

There are many causes of respiratory distress, both acute and
chronic. Respiratory distress occurs when the animal cant get
enough oxygen either into the lungs, or from the lungs into the
bloodstream. Any animal may suffer from an obstruction in the
esophagus or an infection such as pneumonia. Other causes of
respiratory distress include trauma, pneumothorax, and chronic
obstructive pulmonary disease (COPD). In some cases, severe
pain, even pain not related to the respiratory system, can cause
breathing problems. Diagnosing the cause of respiratory distress
involves a thorough physical examination including listening to
the trachea and lungs, a chest ultrasound, radiographs, thoracocentesis/thorocentesis, and/or a transtracheal wash.
Treatment for respiratory distress depends on the cause. If the
animals distress is coming from pain not related to the respiratory system, administering pain medication and fixing the
underlying problem will return respiration to normal. Diseases
with infection require antibiotics. Whatever the cause, if the animal is in distress, supplemental oxygen should be given until
the animal can breathe normally.
Lesson 4
267
Reproductive Emergencies
Dystocia refers to any difficult birth. Its not common in the
horse but is fairly common in cattle, sheep, and goats. Dystocia
requires quick diagnosis and treatment to save the mother and
the offspring. In some instances, the offspring cant be saved
and may be cut into pieces so it can be removed without the
need for surgery.
Dystocia can occur due to uterine torsion or malpositioning of
the fetus. A Caesarean section can be performed to remove the
fetus, but the veterinarian must determine if this poses excessive risk to the mother. The veterinary technician normally helps
with the removal of the fetus. If surgery is performed, the technician will also be required to assist. Reproductive emergencies
can be particularly emotional, so its important to take your time
becoming comfortable with the procedures. If youre confident
that youre performing your job to the best of your ability, youll
be better able to manage the stress of these types of situations.
Uterine prolapse generally occurs in association with pregnancy.
The uterus can fold out of the body through the cervix, leading
to tears. If the uterine artery is torn, the animal may bleed to
death. Most uterine prolapses start off mildly, meaning the
uterus is not entirely outside the body. These prolapses can
usually be managed medically. Some cases, as with an artery
tear, require surgery to prevent death. Most animals whove
experienced uterine prolapse once wont be used for breeding a
second time.
Most other emergencies found in large animals are treated similarly to those found in small animals. Open wounds, fractures,
and muscle trauma are the more common emergencies seen in
large animals.
Youve now covered some of the basic emergencies you might
encounter as a veterinary technician. Our discussion in no way
covered all emergency situations, and not every veterinarian
treats emergencies the same way, but you should now have
enough information to be able to participate in emergency
animal care.
268
Congratulations! Youve now completed Lesson 4. Now, review

the material youve learned in this study guide as well as all
of the assigned pages in your textbook for Assignments
1215. Once you feel you understand the material, complete
Self-Check 15. Then check your answers with those provided
at the end of this study guide. If youve missed any answers,
or you feel unsure of the material, review the assigned pages
in your textbook and this study guide. When you feel totally
confident that you completely understand the information
presented in Assignments 12 through 15, complete your
Lesson 4
269
Self-Check 15
1. List four potential causes of shock.
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
2. Describe what happens to the mucous membranes during shock.
__________________________________________________________
__________________________________________________________
3. What is the initial therapy for congestive heart failure?
a. Radiographs
b. Diuretics and fluid therapy
c. Oxygen and diuretics

d. Oxygen and radiographs
4. Define saddle thrombus.
__________________________________________________________
__________________________________________________________
5. What are the three parts to a seizure (in order of occurrence)?
a. Aura, postictus, ictus
b. Ictus, postictus, aura
c. Postictus, ictus, aura

d. Aura, ictus, postictus
270
Self-Check 1
1. c
3. Grooming and bathing help prevent skin disease.

4. (urine) scalding
5. Decubital sores develop over bony prominences as the
result of continuous pressure and damage to overlying
skin.
6. Padded rings or donut bandages, foam padding or other
thick bedding material, frequent turning of the animal,
keeping the animal clean and dry, use of slings and carts
7. c
8. b
9. a
Self-Check 2
1. d
2. b
3. c
4. a
5. b
6. aspiration pneumonia
Answers
2. Data collection, interpretation, implementation of a plan,

evaluation of a plan
271
Self-Check 3
1. Genetic background, nutrition, internal disorders,
environmental factors
2. From birth to 1 year of age
3. 1 year of age and until approximately 6 to 8 years
4. 6 to 8 years and older
5. Chlamydia, feline leukemia virus (FLV), rabies, feline
infectious peritonitis (FIP), and FVRCP (feline viral
rhinotracheitis, feline calicivirus infection, and feline
panleukopenia)
Self-Check 4
1. Altered walking, lameness, traumatic tearing (easier to
get caught if long), ingrown nail, abscess formation
2. b
3. c
4. False
5. four, eight oclock
6. c
Self-Check 5
1. Liquid, tablet, capsule
2. b
3. Through the lymph and blood system
4. The injection site is located by placing the fingers on the
wings of the ileum and allowing the thumb to fall naturally. The injection goes at the point where the thumb
lands.
5. c
272
Self-Check Answers
Self-Check 6
1. medication administration, blood sampling
2. c
3. tourniquet
4. c
5. b
6. c
Self-Check 7
1. b
2. The chemical solutions can irritate the animals mucous
membranes, and the solutions may inhibit bacterial
growth when urine is collected for culture.
3. True
4. False
5. True
6. Catheterization, bladder expression, free catch,
cystocentesis
7. b
8. c
Self-Check Answers
273
Self-Check 8
1. d
2. a
3. Subcutaneous, oral, intraperitoneal, intraosseous,
intravenous
4. Abscess and peritonitis
5. c
6. An instrument for ascertaining the pressure of liquids or
gases
7. c
8. 12 ml/kg/hr
9. The blood pressure in the vein and right side of the heart
10. c
Self-Check 9
1. root, crown
2. enamel, dentin, pulp
3. d
4. c
5. b
Self-Check 10
1. c
2. d
3. b
4. a
5. d
6. b
7. c
8. simple, sectioned, surgical
274
Self-Check Answers
Self-Check 11
1. By the person performing the dental, or by dictating the
information to a second person
2. Calculus index, missing teeth, malformed and malpositioned teeth, supernumerary teeth, traumatized teeth,
gingival index, stomatitis and kissing ulcers, tooth
mobility, gingival recession and hyperplasia, probing
depth, furcation, periodontal index
3. False
4. False
Self-Check 12
1. Abrasions, avulsions, incisions, lacerations, punctures
2. Inflammatory phase, proliferative phase, maturation
phase
3. False
4. a
5. a
6. Primary (contact), secondary (padded conforming),
tertiary (holding and protective)
7. Primary
Self-Check 13
1. Protect wounds, support the leg
2. a
3. To help hold the bandage in place
4. Elizabethan collar
5. Proud flesh/Exuberant granulation tissue
6. a
7. b
8. d
Self-Check Answers
275
9. e
10. b
11. c
12. a
13. d
Self-Check 14
1. c
2. Loss of consciousness, trauma, open fractures, excessive
bleeding, penetrating wounds to the thorax or abdomen
(gunshots, arrows), labored breathing, seizures, straining
to urinate, poisoning or snakebite, prolapse of organs,
profuse diarrhea or vomiting, eye injuries
3. Respiratory, cardiovascular, urogenital, and CNS
4. b
5. Over the heart
6. False
Self-Check 15
1. Trauma, blood loss, severe infections, and heart disease
2. In the very early stages of shock, the heart rate increases
and the mucous membranes become bright pink, with a
shortened capillary refill time. As shock becomes more
severe, mucous membranes become pale, with a prolonged
capillary refill time.
3. c
4. A clot in the terminal aorta
5. d
276
Self-Check Answers

Medical Nursing

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Study Guide

About the Author

Copyright 2015 by Penn Foster, Inc.

LESSON 1: ANIMAL NURSING CARE AND

LESSON 2: SAMPLE COLLECTION AND

LESSON 3: DENTAL PROPHYLAXIS

LESSON 4: WOUNDS, BANDAGES, CASTS,

Since veterinary technicians perform most of the routine

Explain the routine care, feeding, medication, and

Identify and describe the requirements, routes,

Identify and describe the most common procedures used

Explain the principles and procedures of dog and cat

Describe wound care and how bandages play a part in

Describe types and parts of bandages and specify the

Identify and describe the function of specialty bandages

Welcome to Medical Nursing for the Veterinary Technician! This

Explain the proper way to maintain, change, and remove

Identify emergency and critical patients via the telephone

Recognize the signs of common emergency problems and

Describe the general approach to the poisoned patient

Explain the steps involved to perform basic cardiopulmonary resuscitation

A lesson assignments page that lists the schedule of

Explanatory material on each assignment

Self-checks and answers that allow you to measure

2. Your course textbook, Clinical Textbook for Veterinary

8. When youre confident that you understand all the

Remember to regularly check your student portal. Your instructor may

Lesson 2: Sample Collection and Fluid Administration

Lesson 1: Animal Nursing Care and

Lesson 3: Dental Prophylaxis

Lesson 4: Wounds, Bandages, Casts,

ASSIGNMENT 1YOUR ROLE

Animal Nursing Care and

A clinical problem is anything that interferes with the animals

Medical Nursing for Veterinary Technicians

may resist to the point that the intended benefit is lost.

An environment as clean, comfortable, and stress-free

Food and water at all times, unless restricted for medical

Adequate exercise and grooming care, unless restricted

Prompt and humane pain relief

Humane treatment of every animal at all times

Individual cleaning to keep every animal dry and free of

Routine Care and Observation

Routine animal care requires the following equipment and

Bathing and grooming areas for both small and large

Grooming and bathing equipment and supplies such as

Clean water and food in accessible containers

Daily medication orders for all hospitalized and

Adequate-sized kennels and exercise areas for small

Adequate-sized pens or stalls and exercise areas for large

Adequate supply of bandages, tape, and ointments for

FIGURE 1Grooming and

Medical Nursing for Veterinary Technicians

Cleanliness and Animal Care

Medical Nursing for Veterinary Technicians

residual activity and just anesthetize the fleas. If the fleas

Basic Grooming Protocols

Medical Nursing for Veterinary Technicians

require a variety of foods (picky eaters), its important to

AnyCity Animal Hospital

444 Main Street

N Birth Date: ____________

Hit by car 4/17/2004 10 A.M.

Diagnosed with Osteoarthritis

Date: Patient: __ Case #: