An article identifies how we as humans have forgotten how to think. Intrigued, I read further. It explained how some airline accidents occurred because of too much reliance on the autopilot, and in an emergency, the pilots reacted, incorrectly, instead of responding to the situation, resulting in dozens of deaths.
I was educated as a veterinary technician by a seasoned group of veterinarians, not other technicians as some quick private schools tend to use. We learned the real-world way to nurse animals as well as the new technologies. As an example, I will use the anesthesia and fluids drip scenarios to explain.
In some veterinary practices, there are rigid protocols for starting animals under anesthesia or a certain amount of fluids to be given while under anesthesia. These figures are always based on weight and species of animal. However, a thinking person should not need the "basic" protocol to begin with. Every patient should be treated uniquely and separately based on a number of variables including age, blood chemistry, type of operation, circumstances surrounding the operation, weight, and of course, species.
For instance, a pet undergoing anesthesia for a heart valve repair doesn't need the same level as one getting a dental cleaning. Female cats need inhalant anesthesia for sterilization, males do not. Older pets must be monitored for additional factors that younger pets do not need. Same with giving fluids intravenously while under inhalant anesthesia. A dehydrated pet in an emergency situation needs an entirely different protocol than a 6 month old spaniel going for a spay.
I want to point out why I decided to leave a well known chain veterinary practice for exactly these reasons, and to remind folks to ask questions about procedures to their veterinarians, which keep doctors and technicians on their toes and accountable to clients.
My first example was regarding pre-anesthetic fluids to a dog about to undergo a spay, a straightforward operation but not exactly a simple one. The doctor asked me to set up the dog at a certain rate before she was going to go to surgery s the dog would get a certain amount of fluids in her body to offset any blood loss or low volume induced shock. A great, precautionary measure I endorsed. The facility had two fluid machines, a stand with a hook and a box that would pinch the tube until the appropriate amount of flow was obtained in relation to how much you wanted to give over a period of time. One machine was for the pre-op and treatment room, the other was in the operating room. The machine in the treatment room was, for whatever reason, not functioning, so instead of going into the clean operating room to get the other machine, I set up a manual drip. This involves calculating the need of the pet, the time period to deliver, the drip rate per ml and then by per drops in a ml, then looking at your watch's second hand and setting the dial that comes on the tube. This is what the dial is for (manual setting).
The doctor came by and was upset that I hadn't used the machine from the operating room. Did she think I couldn't do simple math? Did she think that I would perhaps not contaminate the clean machine when it was returned to the operating room? Did she think I would over or under dose the pet or that I couldn't count drops per second? I wasn't sure about her reasoning, and not feeling comfortable to ask, I left my system in place knowing I was perfectly capable of doing this task. I bit my tongue over the sanitation issue of the operating room.
Another instance came along later when setting up for a surgery of a small dog, a straightforward castration of a dog which would take less than 20 minutes. The dog was small, and the smaller they are, the more attention they need; their body systems fail quicker for the simple reason of volume - a tablespoon of blood means more to a chihuahua than it does to a saint Bernard. In my head I was able to quickly calculate the fluid dose, which came to about 99 drips per hour, or something of that nature (20 pound dog). I set the machine to 100, and the doctor has a bit of a hissy fit that I had not set it at 99. I reset her glorious machine at 99 and we continued on. I resisted telling her she was nuts to be doing my job instead of her own.
Extra fluids on a small dog that amount to perhaps 0.5 of a ml of fluids over a 20 minute procedure. This is even a difficult amount to measure, about 1/10th of a teaspoon. They don't even make measuring spoons that small. In my educated opinion, and the fact that there is more than that amount simply in the tube that delivers the fluids, over 20 minutes, even if there had been complications to cause an hour of surgery, the dog would have benefited from this extra half a milliliter rather than it cause detriment, simply because he was a small dog, all of which can benefit from 6-7 extra drops.
The reliance on this machine was absurd. However, the corporate office, in its attempt to create a Big Mac button its cash register, dumbed down the ability of a good technician to calculate and think and set up. What if I'd needed to suddenly increase fluids? Instead of simply lifting the bag or squeezing it, I would have had to touch the pad and re-enter data to reset it, then unset it a few moments later down the road, simply to be able to accurately count how many mls of fluid the dog was being pushed, not necessarily what is received, because of the difference in the tube anyway! There are markings on the bag that tell you how much fluid has been dispensed, there is no urgent need for the machine to do it.
I will continue on this vein (pun intended) in another post using anesthesia induction as an example of idiocy when it is always the same, for every pet, no matter what, and the trouble this causes for the pet (and the technician who follows blind protocols without thinking). In an effort to make things run smoothly, I didn't want to insult the veterinarian's intelligence by stating the obvious, but these things seemed obvious to me, and I kept wondering why they didn't jump out and shout at the doctor.
Lastly, about fluids, I was trained in a theater of veterinarians, well known and accomplished, published veterinarians, and machines were the last thing we relied upon. We didn't use drip machines, and we never stepped away from our patient while it was under anesthesia. We didn't record everything in a computer, or let a machine read all our blood smears. Perhaps thinking isn't what this company I worked for wanted. In that case, a robot could have been doing the work. What have humans evolved for if not to think?
No comments:
Post a Comment